Guilt and Shame in Patients with Obsessive-Compulsive Disorders

INTRODUCTION

Obsessive-compulsive disorder (OCD) is a tremendous psychiatric illness with a variety of severe symptoms. Feelings of shame and guilt are universal social emotions that fundamentally shape the way people interact with each other. Mental illness is therefore often related to pronounced feelings of shame and guilt in a maladaptive form.

METHODS

A total of 62 participants (38 women and 24 men) were clinically and psychometrically investigated.

RESULTS

The OCD patients (n = 31) showed a maladaptive guilt and shame profile, characterized by increased interpersonal feelings of guilt accompanied by a stronger tendency to self-criticism and increased punitive sense of guilt with a simultaneous prevailing tendency to perfectionism, as well as an increased concern for the suffering of others. The proneness to profuse shame in OCD patients seems to be in the context of the violation of inner values and a negative self-image with persistent self-criticism.

CONCLUSION

Although there are limitations with a small sample size in this monocentric approach, our study underlines the importance of an individual consideration of the leading obsessive-compulsive symptomatology, especially in the context of very personal feelings of guilt and shame. Further multidimensional studies on guilt and shame could contribute to their implementation more strongly in individualized psychotherapy.

[Virtual reality in teaching using mentally ill patient avatars]

BACKGROUND

Medical interaction and exploration techniques are the most important tools that medical students have to acquire in the subject of psychiatry and psychotherapy. The new digital technologies currently available, such as virtual reality (VR), as important supplements can contribute to a significant improvement in the teaching of psychiatric-psychopathological learning content as well as, in particular, the technique of ascertaining the psychiatric history and diagnosis.

OBJECTIVE

Evaluation of the Bochum Avatar Exploration Project (AVEX) as part of the curricular course in medical studies at the Ruhr University Bochum for its possibilities to convey learning content and techniques of anamnesis and diagnosis in the subject of psychiatry and psychotherapy.

METHODS

In AVEX, a total of 87 medical students in the clinical study section have so far been able to enter into a dialogue with "mentally ill" avatars and gain experience with VR technology as a learning and teaching method in the subject of psychiatry and psychotherapy.

RESULTS

Despite the limited possibilities for interaction with the digital avatars, it is possible to achieve a substantial transfer of learning content in psychiatry; however, the students must be well supported by the lecturers.

CONCLUSION

The AVEX project already shows promising possibilities for supplementing the teaching of medical students, even if the fit of questions and replies in dialogue with the virtual avatars still needs to be improved. As advances in the linguistic communication of emotions and the visual effects of the avatar representation can be predicted, the significance of this technology will continue to increase.

Emotional Context Effects on the Rating of Ambiguous Facial Expressions in Depression and Schizophrenia Spectrum Disorders

ObjectiveTo investigate the influence of visual contextual information on emotion recognition of ambiguous facial expressions in depression and schizophrenia spectrum disorders. Method: Ambiguous facial expressions and emotional contexts representing anger, disgust, fear, joy, sadness and surprise were validated in a pre-test with healthy independent raters. Afterwards, 20 healthy participants (8 women, 12 men; mean age 24.35 ± 2.85 years), 20 participants with schizophrenia spectrum disorders (9 women, 11 men; mean age 40.25 ± 11.68 years) and 19 participants with depression (11 women, 8 men; mean age 43.74 ± 12.65 years) rated the emotional content of nine different faces in seven different emotion-suggesting contexts. The proportions of context-congruent answers and differences between emotion ratings in each context were analysed using non-parametric Kruskal-Wallis and explorative, paired Wilcoxon tests. Correlational analyses explored the influence of clinical symptoms assessed by clinician-administered scales. Results: The overall proportion of context-congruent answers did not differ between participants with depression and schizophrenia spectrum disorders compared to healthy participants. Participants with schizophrenia spectrum disorders were more susceptible to anger-suggesting contexts and participants with depression were more susceptible to fear-suggesting contexts. Differences in emotion recognition were associated with the severity of depressive, but not psychotic, symptoms. Conclusion: Despite increased susceptibility to anger-suggesting cues in schizophrenia and to fear-suggesting cues in depression, visual contextual influence remains largely consistent with healthy participants. Preserved emotional responsiveness suggests an efficacy of emotion training but emphasizes the need for additional research focusing on other factors contributing to social interaction deficits.

Death Anxiety in Obsessive-Compulsive Disorders

Objective: Death anxiety has long been attributed a role as a psychopathologically decisive factor in the development of mental illnesses such as obsessive-compulsive disorder (OCD). For example, patients with washing compulsions associate their behavior with a fear of life-threatening diseases or patients with control compulsions report that the constant checking is driven by the fear of fatal or deadly consequences for the occupants.Method: The Bochum Questionnaire to Assess Death Anxiety and Attitudes Towards Death (BOFRETTA) was administered to 31 patients with OCD and 31 healthy volunteers within a semi-structured interview using broad psychometry.Results: OCD patients showed increased death anxiety and negative attitute to death in comparison to healthy volunteers. A significant correlation was found between BOFRETTA-anxiety and the currently present religious obsessive thoughts.Conclusions: Our investigation provides further findings on the role of death anxiety and the problematic attitude towards death in OCD patients.

Death Anxiety in the Context of Religion, Personality and Life Meanings

Previous studies on the context between death anxiety and religion do not provide any clear evidence regarding "anxiety buffer" function. In this explorative study, death anxiety and attitude to death were determined in the context of mood, personality and meaning of life among groups of Muslims (n = 60) and Christian Protestants (n = 60). Death anxiety and attitude to death were assessed using the Bochum questionnaire for recording death anxiety and attitudes to death. Death anxiety was mild to moderate in our healthy Participants of Muslim and Christian faith. Attitude towards death was therefore much more pronounced among Muslim members than Christians. The influence of religious beliefs on the fear of death does not appear to be direct and linear. Sources that provide meaning in life and emotional stability can contribute to a reduction in death anxiety and a less problematic attitude towards death.

[Perioperative anxiety and fear of death]

An important field of anesthesiology but also of psychiatry and psychotherapy, is perioperative anxiety and especially the fear of death. In this review article the most important types of anxiety in the individual phases before, during and after surgery are presented and diagnostic aspects as well as risk factors are discussed. Benzodiazepines can classically be used therapeutically here, but in recent years the preoperative anxiety-reducing effects of e.g., supporting talks, acupuncture, aroma therapy, and relaxation methods have come more into focus, because benzodiazepines promote postoperative delirium, which significantly increases morbidity and mortality. Perioperative fear of death should, however, be given greater clinical and scientific attention in order not only to have a better understanding and preoperative care of patients, but also to reduce adverse consequences during surgery and afterwards.

Embitterment and metacognition in obsessive-compulsive disorder

OBJECTIVE

Embitterment is a persistent emotion that is known to everybody in reaction to injustice and being let down, associated with feelings of helplessness and hopelessness. People with psychiatric disorders can develop bitterness, which is to be understood as a form of reactive embitterment to the illness. The aim of this explorative study was to investigate the occurrence of embitterment in obsessive-compulsive patients compared to healthy volunteers and in the context of their metacognitions and other biographical and clinical characteristics.

METHOD

Following a semi-structured diagnostic interview, a number of measures were administered to 31 patients with obsessive-compulsive disorder (OCD) [ICD-10 F42.X: mean age 35.2 (SD = 10.7) years] and 31 healthy volunteers [mean age 39.1 (SD = 15.0) years]. These measures included the Post-Traumatic Embitterment Disorder questionaire (PTEDq) for measuring embitterment, the Yale-Brown Obsessive-Compulsive Scale, the Metacognition Questionnaire and other psychometric questionnaires such as the Beck Depression Inventory and the State-Trait Anxiety Inventory.

RESULTS

Patients with OCD scored more than three times higher (mean = 2.0, SD = 1.1) than the healthy participants in the PTEDq (mean = 0.6, SD = 0.8; p < 0.001), but the cut-off of < 2.5 for a clinically relevant embitterment disorder was not reached. Dysfunctionally distorted metacognition (MCQ-30), which is a consistent finding in OCD, as well as a generally high degree of clinical impairment were significantly cor related to the degree of embitterment.

CONCLUSION

Our findings suggest that embitterment as measured by PTEDq is important in patients with OCD, who are characterized by metacognitive distortions with an injustice of fate as well as a mortification of their self-image. In future, it would be necessary to screen patients with OCD not only for depressive symptoms but also specifically for feelings of embitterment in order to be able to initiate appropriate psychotherapeutic measures at an early stage.

Narcissism and central serotonergic neurotransmission in depression

OBJECTIVES

Based on previous research, it has been proposed that the development of depressive disorders is related to altered functioning of the serotonergic systems as well as the personality style, including narcissism. However, it is unclear to date how personality style, especially narcissism, depressive disorders and serotonergic activity are related.

METHODS

We included 74 patients with a depressive disorder (DP) and 74 healthy controls (HC) in the study. All participants completed the Personality Style and Disorder Inventory (PSDI) and the Beck Depression Inventory (BDI II). Moreover, we conducted EEG recordings for analysis of serotonergic neurotransmission by using the so-called intensity or loudness dependence of the auditory evoked potentials (LDAEP).

RESULTS

Significantly higher LDAEP results emerged for the DP group compared to the HC group, which indicated lower serotonergic activity in the patient's group. In addition, the positive correlation between ambitious-narcissistic personality and LDAEP reached significance in depressive patients.

LIMITATIONS

There was only a monocentric cross-sectional study with only one scale having differences between the two groups due to age and education.

CONCLUSIONS

Our data supports the theory of lower serotonergic activity in patients with depressive disorders and further suggests that high narcissistic personality traits are related to lower serotonergic neurotransmission in patients.

Relationships between fear of flying, loudness dependence of auditory evoked potentials and frontal alpha asymmetry

Previous research has suggested that fear of flying, which is defined as a situational, specific phobia, could overlap with depressive and anxiety disorders. Whether the neuronal dysfunctions including altered serotonergic activity in the brain and altered neural oscillations observed for depressive and anxiety disorders also overlap with alterations in fear of flying is unclear. Here, thirty-six participants with self-reported fear of flying (FF) and forty-one unaffected participants (NFF) were recruited. The participants completed the Beck Depression Inventory (BDI-II), the State-trait Anxiety Inventory (STAI) and the Fear of Flying Scale (FFS). EEG-recording was conducted during resting-state and during presentation of auditory stimuli with varying loudness levels for analysis of the Loudness Dependence of Auditory Evoked Potentials (LDAEP), which is suggested to be inversely related to central serotonergic activity. Participants with fear of flying did not differ from the control group with regard to BDI-II and STAI data. The LDAEP was higher over F4 electrode in the FF group compared to controls, whereas exploratory analysis suggest that differences between groups were conveyed by female participants. Moreover, the FF group showed relatively higher right frontal alpha activity compared to the control group, whereas no difference in frequency power (alpha, beta and theta) was observed. Thus, this study brought the first hint for reduced serotonergic activity in individuals with fear of flying and relatively higher right frontal activity. Thus, based on the preliminary findings, future research should aim to examine the boundaries with anxiety and depressive disorders and to clarify the distinct neural mechanisms.

[Obsessive Doubting as a Philosophical-Psychopathological Phenomenon]

Obsessive doubting (OD) is a rather forgotten and underestimated psychopathological phenomenon, although clinically it seems to exist in many patients with e. g. obsessive-compulsive disorder. The few primary psychoanalytic and cognitive-scientific studies in the literature concerning OD do not explain the phenomenon completely, nor do they offer treatment perspectives. Here, another way is proposed. Doubting whether one's perception of objects, other people and one's own self is correct, which is part of human nature, can reach pathological dimensions as in OD. Doubting is regarded as an existential problem of human beings, and is one of the major questions of philosophy from very early times, but is especially central to scepticism. If grounds against such doubting can be found, mental solution strategies within the framework of theoretical depth psychotherapy including cognitive training approaches can be established for treatment of patients with OD.

[Paranormal Experience and Mental Disorders]

Paranormal experiences such as superstition, perception of the supernatural and magical thinking have accompanied human history into the so-called modern world and play a major role in developmental psychology. Yet this area has remained unclear in its terminology, in its phenomenal scope, but also in its relation to reality in literature and everyday practice. The attempt is here undertaken clarify the significance of paranormal experience on a theoretical level in the sense of a "unsure experience of reality", but also to present its importance for diagnostics and therapy of psychiatric conditions in the context of e. g., psychotic, dissociative or OCD-related symptomatology.

Computer-based mother-infant interaction analysis and mental functioning in postpartum depression

BACKGROUND

Among mothers suffering from postpartum depression (PD), 10-13% additionally experience a mother-infant interaction disturbance that causes a severe mental health risk for the infant. Besides depressive symptomology, the underlying factors promoting dysfunctional maternal interaction behavior have not yet been sufficiently investigated. Therefore, we examined potential relationships between computer-based mother-infant interaction among postpartum depressed dyads and maternal mental functioning.

METHODS

Mother-infant interaction was video-recorded and evaluated via a computer-based micro-interaction analysis program (INTERACT). We included only 25 hospitalized mother-infant dyads that fulfilled the diagnostic criteria of PD and tested mothers on their mental functioning (empathy, theory of mind, meta-cognition and alexithymia).

RESULTS

Behavioral interaction analyses indicated that mothers with PD were prone to inactive maternal behavior, less positive maternal behavior along with more rejective behavior and also disengaged affect towards the infant. Distortions in mothers' mental functioning may have had an influence on the dysfunctional patterns of mother-infant dyads.

CONCLUSIONS

Cognitive and social functioning could be an influencing factor on dysfunctional maternal interaction behavior. Early detection of distortions of mental processing in expectant mothers might help to inhibit the clinical manifestation of dysfunctional mother-infant bonding and negative child outcome in PD.

Impairments of Social Interaction in Depressive Disorder

OBJECTIVE

Despite the numerous findings on the altered emotion recognition and dysfunctional social interaction behavior of depressive patients, a lot of the relationships are not clearly clarified.

METHODS

In this pilot study, 20 depressive patients (mean±SD, 38.4±14.2) and 20 healthy subjects (mean±SD, 38.9±15.3) (each in dyads) were videographed. We then analyzed their social interaction behavior and emotion processing in terms of emotion recognition, their own emotional experience, and the expression of emotions under the conditions of a semi-structured experimental paradigm.

RESULTS

Patients showed more significant impairment regarding the dimensions of social interaction behavior (i.e., attention, interest, and activity) and their interaction behavior was characterized by neutral affectivity, silence, and avoidance of direct eye contact. This interactive behavioral style was statistically related to depressive psychopathology. There were no differences concerning emotion recognition.

CONCLUSION

Impairments of non-verbal and verbal social interaction behavior of depressive patients seem to be less associated with disturbances of basic skills of emotion recognition.

Capacities for meta-cognition, social cognition, and alexithymia in postpartum depression

Postpartum depression (PPD), a female-specific disorder, is the most common medical complication associated with childbirth (10-20%). The pathological relevance of emotion processing, meta-cognition, alexithymia, and social cognition to PPD is unclear. We tested 25 mothers with PPD (mean age: 30.72 ± 5.76 years) and 25 healthy mothers (mean age: 32.03 ± 3.54 years) for alexithymia (Toronto Alexithymia Scale) and evaluated cognitive empathy (Faux Pas Test), affective empathy (Interpersonal Reactivity Index), meta-cognition (Meta-Cognitions Questionnaire), sociodemographic and clinical-psychometric characteristics and personality dimensions. Mothers with PPD showed higher levels of neuroticism and more anxiety-depressive characteristics. Their metacognitive abilities were significantly altered and they more often had alexithymia. Significant correlations between alexithymia and meta-cognition, trait anxiety, and neuroticism were found. Alexithymia, neurotic personality traits, and dysfunctional meta-cognition appear more frequently in PPD women than healthy women. Social cognition abilities were not significantly altered. Alexithymia and metacognitive distortions play important roles in the pathogenesis of PPD. Dysfunctional meta-cognition, neuroticism, and alexithymia may be risk factors that should be detected early in expectant mothers to prevent the development of PPD.

[Psychopathology and Theory of Perceptual Disturbances]

Current classification systems for psychiatric disorders are primarly based on categorial typologies and describe these as distinct nosological entities. A dimensional perspective allows descriptions of a gradual transition between pathologies as well as between normality and pathologies of psychiatric symptoms. Using acoustic hallucinations as most common form of perception disturbances as example, psychiatric-psychopathological and theoretical pros and cons for a dimensional classification of psychiatric symptomatology are sketched in this article. Although doubts concerning the similarity of real perceptions and acoustic hallucinations which underlie such mental events are controversially discussed, many hints could be found for a continuum of hallucinatoric symptoms from the mentally healthy population up to the group of patients with schizophrenia. Studies which investigate the neurophysiological mechanisms of acoustic hallucinations such as hearing voices in healthy persons in comparison to those in patients with schizophrenia could contribute to further differentiation.

Time experience in patients with schizophrenia and affective disorders

Background

The experience of time, or the temporal order of external and internal events, is essential for humans. In psychiatric disorders such as depression and schizophrenia, impairment of time processing has been discussed for a long time.

Aims

In this explorative pilot study, therefore, the subjective time feeling as well as objective time perception were determined in patients with depression and schizophrenia, along with possible neurobiological correlates.

Methods

Depressed (n = 34; 32.4 ± 9.8 years; 21 men) and schizophrenic patients (n = 31; 35.1 ± 10.7 years; 22 men) and healthy subjects (n = 33; 32.8 ± 14.3 years; 16 men) were tested using time feeling questionnaires, time perception tasks and critical flicker-fusion frequency (CFF) and loudness dependence of auditory evoked potentials (LDAEP) to determine serotonergic neurotransmission.

Results

There were significant differences between the three groups regarding time feeling and also in time perception tasks (estimation of given time duration) and CFF (the “DOWN” condition). Regarding the LDAEP, patients with schizophrenia showed a significant negative correlation to time experience in terms of a pathologically increased serotonergic neurotransmission with disturbed time feeling.

Conclusions

Impairment of time experience seems to play an important role in depression and schizophrenia, both subjectively and objectively, and novel neurobiological correlates have been uncovered. It is suggested, therefore, that alteration of experience of time should be increasingly included in the current psychopathological findings.

P300 and delay-discounting in obsessive-compulsive disorder

Previous research showed that dysfunctions of fronto-striatal neural networks are implicated in the pathophysiology of obsessive-compulsive disorder (OCD). Accordingly, patients with OCD showed altered performances during decision-making tasks. As P300, evoked by oddball paradigms, is suggested to be related to attentional and cognitive processes and generated in the medial temporal lobe and orbitofrontal and cingulate cortices, it is of special interest in OCD research. Therefore, this study aimed to investigate P300 in OCD and its associations with brain activity during decision-making: P300, evoked by an auditory oddball paradigm, was analysed in 19 OCD patients and 19 healthy controls regarding peak latency, amplitude and source density power in parietal cortex areas by sLORETA. Afterwards, using a fMRI paradigm, Blood-oxygen-level-dependent (BOLD) contrast imaging was conducted during a delay-discounting paradigm. We hypothesised differences between groups regarding P300 characteristics and associations with frontal activity during delay-discounting. The P300 did not differ between groups, however, the P300 latency over the P4 electrode correlated negatively with the NEO-FFI score openness to experience in patients with OCD. In healthy controls, P300 source density power correlated with activity in frontal regions when processing rewards, a finding which was absent in OCD patients. To conclude, associations of P300 with frontal brain activation during delay-discounting were found, suggesting a contribution of attentional or context updating processes. Since this association was absent in patients with OCD, the findings could be interpreted as being indeed related to dysfunctions of fronto-striatal neural networks in patients with OCD.

Relationship between Psychopathology and Sources of Meaning in Psychotherapeutically Treated Patients: A Naturalistic Cross-Sectional Analysis

INTRODUCTION

The experience of meaning seems to be crucial for psychic well-being. In the literature, there are reports of relationships between personality, illness, and life meanings. The objective of this study was to investigate types of experiences of meaning (meaningfulness, crisis of meaning, existential indifference) and their associations with some psychopathological categories in a clinical population.

METHODS

In a naturalistic and cross-sectional design, 56 German patients in outpatient psychotherapy (29 women, 27 men; mean age = 42.8 years, standard deviation = 13.8) were assessed by the Sources of Meaning and Meaning in Life Questionnaire (SoMe) Questionnaire (meaning of life, hedonism, eudaemonia). Psychopathology (Beck Depression Inventory (BDI), Clinical Global Impression scale, Symptom Checklist (SCL)-90), self-esteem (Rosenberg scale), neuroticism (NEO-Five-Factor Inventory), and suicidality (Suicide Behaviors Questionnaire Revised (SBQ-R)).

RESULTS

Three distinct groups concerning the experience of meaning emerged: meaningfulness (33.9%), crisis of meaning (21.4%), and, as the largest group, existential indifference (42.9%). Eudaemonia as well as the hedonistic SoMe variables of fun and wellness were shown to be inversely related to psychopathology such as suicide risk (SBQ-R), general symptom distress (SCL-90), and depressive symptomatology (BDI-II).

CONCLUSION

This study highlights the importance of a differential consideration of existential factors, sources of meaning and life orientations for psychopathology in mental health, which should be more considered in standard psychotherapeutic situations.

Epistemological reflections on chances and borders of "biological psychiatry"

OBJECTIVES

After decades of intensive research in the field of biological psychiatry and its partly modest and non-specific results, the self-critical question arises as to whether basic predispositions in epistemology and philosophy of science prevent bigger successes.

METHODS/RESULTS

Central here are the arguments that the brain is unable to recognise itself completely and that the psychological mental level cannot be connected with the physiological neurobiological level in a causal way.

CONCLUSION

In conclusion, for biological psychiatry it might be well advised to reflect on the research, diagnostics and treatment realistically achievable according to the theoretical framework, so that the impression of valid knowledge progress, although limited, remains motivating for our younger generation.

[Traumatization and Schizophrenic Disorders - A Multidimensional View]

Prevalence of traumatizing of patients with schizophrenia is higher as in the normal community. Meta analyses show significant relationships between traumatic experiences in childhood and psychotic disorders. Patients with schizophrenia as well as those with posttraumatic stress disorder (PTSD) are characterized by brain morphological changes (mygdala und Hippocampus). In these two patient groups, neuroendocrinological disturbances (cortisol und α-amylase) as well as a worse clinical outcome could be additionally found. In the psychodynamic theoretical discussion, there are only few approaches concerning trauma and psychosis. Specifically here, the name of Frieda Fromm-Reichmann should be noted, who already pointed out the great meaning of child traumatization (especially physical and sexual abuse) for the later manifestation of schizophrenia. She also developed first principles of analytic psychosis therapy with the working on the deep life anxiety caused by the trauma in the here and now of the transference situation. It is assumed that schizophrenic disorders and PTSD have to be understood as trauma consequence diseases, which occur in comorbidty in a so far unknown extent.

Death Anxiety and Attitudes towards Death in Patients with Multiple Sclerosis: An Exploratory Study

Background: Death and the anxiety of it becomes more apparent when confronted with a chronic disease. Even though multiple sclerosis (MS) is a treatable condition today, it is still accompanied by a multitude of impairments, which in turn may intensify of death anxiety. Objective: The aim of this study is to explore the relationship between depression, anxiety and death anxiety in individuals with MS. Methods: Fifty-six MS patients were recruited at the Department of Neurology of the University Clinic in Basel. Death anxiety was assessed using the Bochumer Questionnaire on attitude to death and death anxiety 2.0 (BOFRETTA 2.0). Results: Scores of death anxiety towards it in MS patients were low. Only disability (EDSS) was moderately correlated with death anxiety. Depression in MS was significantly correlated with fatigue and disability, but not with the BOFRETTA 2.0. Conclusion: Scores of death anxiety and the attitude towards death are low in this MS cohort. It was shown that both psychopathological and neurological deficits impact the subject of death with respect to multiple sclerosis.

Differences in interactional behaviour in postpartum depression with and without pre-existing mental disorder

BACKGROUND

Mothers with postpartum depression (PPD) show impaired affects and behaviour patterns in the mother-child interaction, which affects an infant's emotional and cognitive development and the maternal course of disease. However, impairment of the mother-child relationship does not occur in every case of PPD.

AIM

The aim of this exploratory-descriptive video-based study was to investigate the possible associations between mother-child interactions and aspects of maternal biography and clinical history, with a focus on pre-existing mental disorder.

METHODS

Sixty-two mother-child dyads (31 mothers with PPD and pre-existing mental disorders and 31 mothers with PPD but no further mental disorder) hospitalized at the mother and baby unit (MBU) of the LWL-Hospital Herten were included in this study. The Marcé Clinical Checklist and the "Mannheimer Beurteilungsskala zur Erfassung der Mutter-Kind-Interaktion im Säuglingsalter" (MBS-MKI-S) were used to explore sociodemographic and clinical parameters, and video-based interaction behaviour was examined.

RESULTS

Mother-infant interaction behaviour showed a significant group difference on the MBS-MKI-S-Vm subscale (variability in maternal behaviour) before psychiatric treatment (exact Mann-Whitney U test: U = 555, p = 0.023), with higher scores in mothers with a pre-existing mental disorder. Furthermore, significant differences were shown on the MBS-MKI-S-RSm (maternal reactivity/sensitivity) (U = 259, p = 0.019) and MBS-MKI-S-Rc (child's reactivity) subscales at discharge (U = 251, p = 0.021). Among mothers with a pre-existing diagnosis, the MBS-MKI-S-Tm (maternal tenderness) and MBS-MKI-S-Rc (child's reactivity) subscales were significantly correlated after treatment.

CONCLUSIONS

Mothers with PPD and a pre-existing mental disorder displayed significantly more behavioural variability than mothers with only PPD. Maternal behaviour seems to influence the child's responsive behaviour; thus, mothers and their children can benefit from inpatient treatment at an MBU. Further investigations with larger samples should be conducted.

[Disturbances of time experience in mental disorders]

Experience of time is a field of only little research in psychiatry which is and was often induced by philosophers interested in the human existence in time. This review article underlines the importance to differentiate between several forms of time experience. With respect to current knowledge, there are disturbances of time experience in the sense of knowledge about basal temporal relations only in organic brain disorders, while objective time perception was found to be changed in patients with schizophrenia, but less in those with depression. In contrast, the subjective time feeling seems to be disturbed in several psychiatric diseases. Up to now, however, it is still unclear how especially the subjective time feeling as a psychopathological alteration could be best scientifically investigated, without focusing only on the phenomenological single case level. Therefore, time experience should be studied at different levels of time perception and time feeling in mental disorders combined also with modern neurobiological methods, such as EEG and fMRI, in order to clarify in which specific way changed time experience is present in mentally ill patients and how this could be relevant for the pathophysiology of these illnesses.

Pareidolias and Creativity in Patients with Mental Disorders

OBJECTIVE

Pareidolias are ilusionary misjudgments and are seen as the result of deliberately or unconsciously caused misinterpretations by the human brain, which tends to complete diffuse and apparently incomplete perceptual images. The psychopathological value of pareidolia in the context of neuropsychiatric diseases has, however, been little researched so far.

METHODS

In this pilot study, a total of 25 patients (mean age 43.3 years, SD 16.2) with an affective disorder or schizophrenic disease (ICD-10: F3.X or F2.X) and 25 healthy volunteers (mean age 46.1 years, SD 15.4) were compared for sociodemographic factors and psychometric findings, as well as pareidolias and creativity.

RESULTS

We found that the patients identified significantly fewer pareidolias than healthy controls (p = 0.002) and that patients with schizophrenia, in particular, had a significantly lower hit rate (p = 0.005). Across the whole group, there were clear positive correlations between pareidolia and high creativity, as well as personality traits such as impulsiveness/spontaneity, extraversion, and conscientiousness.

CONCLUSIONS

Unexpectedly, having less nosology-specific features than individual specific properties such as creativity and extraversion, and especially openness and verbal intelligence, in patients with affective disorder or schizophrenia promotes the recognition of pareidolia as a specific form of illusionary misperception.

[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.