Transcranial direct current stimulation (tDCS) is currently investigated for the treatmentof various neuropsychiatric disorders. Neuroplastic effects may be achieved by prolonged neuronal depolarization/hyperpolarization.

Schizophrenia studies revealed a neuroplasticity deficit of cortical areas. Promising results of anodal/cathodal tDCS for acute and chronic symptoms were shown in one randomized clinical trial and several case reports.

To improve negative symptoms, anodal tDCS over the left dorsolateral prefrontal cortex (DLPFC) and cathodal tDCS above the supraorbital region was used. Clinical scores were assessed with Positive and Negative Symptoms Scale (PANSS) and Scale for the Assessment of Negative Symptoms (SANS).

20 patients with predominant negative symptoms and stable medication (>3 weeks) were randomized to active or sham group. Anode was placed over the left DLPFC, cathode over right orbit. 2 mA tDCS was delivered 10 times within weeks 1 and 2. Concomitant medication was continued. Functional connectivity MRI (fcMRI) was performed before and after tDCS.

Post-hoc test (least significant difference, factor ‘group’) showed significant PANSS amelioration in the active group (p = 0.014) for the follow-up, two weeks after the end of stimulation. SANS revealed significant improvement in the active group in week 1 (p = 0.047), week 2 (p = 0.005), and follow-up (p = 0.011). In the active group, fcMRI showed a significant deactivated cluster (corrected p< 0.05) in the anatomical regions of ncl. accumbens, subgenual cortex and striatum.

tDCS is a promising tool to improve various schizophrenic symptoms that are otherwise often difficult to treat.

Apathy is defined as lack of motivation that occurs in various neuropsychological disorders. Apathy frequently co-occurs in patients with late-life depression, and previous studies have shown that apathy is associated with frontal cognitive impairment that constitutes the distinct depressive syndrome in late-life depression. Here we tested elderly patients with mild to moderate depression on behavioral tasks requiring executive and non-executive functions.

The aim of this study was to examine that apathy, not depression, is associated with executive function in patients with late-life depression.

We enrolled 83 patients (67.9 ± 6.4 years of age; 51 women) with major depressive disorder from the geriatric psychiatric clinic of the Chang Gung Memorial Hospital. The inclusion criteria included a diagnosis of non-demented major depressive disorder. Patients with a history of any psychiatric disorders other than major depression, or major medical illness including neurological disorders such as Parkinson's disease, were also excluded. All participants were administered the 17-item Hamilton Depression Scale. The apathy-related items of the Ham-D are diminished work/interest, anergy, lack of insight, and psychomotor retardation.

We employed pairs of behavioral task to assess whether apathy has a distinct effect on executive control functions. Each test pair consisted of an executive and a non-executive task.

We showed that the extent of apathy significantly accounted for variances in performance in the frontal executive but not non-executive cognitive tasks.

These results extend previous studies by relating apathy to deficits in executive function in patients with late-life depression and suggest the importance of assessing the ‘apathetic syndrome’ in the clinical evaluation of patients with late-life depression

Over the last years, the bavarian population, which was relatively homogeneous, has become increasingly culturally diverse. Many migrants to Bavaria have been exposed to extreme stress before, during, and after migration, with potential effects on their physical and mental health. Health problems and suicide rates are of great public health concern. This study compares descriptively frequencies of attempted suicide among native germans and immigrants in Bavaria.

We investigated official data on completed suicide in Bavaria in relation to nationality (german/non-german), age, gender and administrative district. Data were extracted from the Bavarian Police Mortality Database (2009–2010) and were analysed using multilevel models to investigate individual and regional factors and the relevance of nonspecific regional heterogeneity.

After adjustments for age, sex and year, nationality (German vs. non-German) was significant associated with completed suicide in most models considered. We could not find significant regional heterogeneity.

Further research is needed regarding the influence of nationality and migration status on suicidal behaviour using multilevel models.

Transcranial direct current stimulation (tDCS) is currently discussed as a therapeutic intervention in various psychiatric disorders. Based on the report about the effectiveness of tDCS in a patient with catatonic schizophrenia, we applied bilateral prefrontal tDCS in a patient with corpus callosum aplasia (CCA) and severe catatonia instead of maintenance electroconvulsive therapy (ECT).

To investigate whether tDCS can replace ECT in a largely treatment-resistant patient.

The 41 year-old male patient showed severe catatonic symptoms since adolescence and was treated by weekly ECT for almost 6 years. Due to cardiac complications and increasing cognitive deficits caused by long-term ECT and weekly anesthesia, tDCS was suggested. The anode was positioned over the left dorsolateral prefrontal cortex (DLPFC), the cathode over the right DLPFC. 2mA tDCS was delivered for 2x 20 minutes (90 minutes break in between), three times a week for the first two weeks, thereafter once to twice weekly. Concomitant medication (clozapine 600 mg/d, aripiprazole 10 mg/d, pirenzepine 50 mg/d, lorazepam 3 mg/d) was continued.

So far, more than 20 double sessions of tDCS were applied. ECT was needed once after a period of hospitalisation for 10 days due to pneumonia. Since then the patient has solely received tDCS for more than 13 weeks. Catatonic symptoms resolved further under tDCS compared to ECT (Bush-Francis Catatonia Rating Scale: 27/69 points during ECT, 5/69 during tDCS).

tDCS in combination with neuroleptic treatment could be an alternative to ECT in organic catatonia. Further studies are needed to support our hypothesis.

Asperger's Syndrome is a neuro-developmental disorder characterised by social impairment and restricted interests, similar to those found in autism, but with cognitive and linguistic skills preserved. As DSM-5 has eliminated Asperger's Syndrome, will the patients be included in ASD (Autistic Spectrum Disorders)?

The objective of this study is the revaluation of the diagnosis according to the DSM-5 criteria, in a sample of subjects affected by ASD-Asperger's Syndrome.

The secondary aim is to evaluate adaptive skills in order to estimate the probability of the individual's autonomy.

We performed an observational study. Twelve subjects with ASD-Asperger's Syndrome diagnosis with an IQ≥75 were included. An interview to evaluate the existence of ASD, according to the DSM-5 criteria and Vineland adaptive behaviour scales (VABS) to evaluate the adaptive skills, were administered during the sample.

The ASD diagnosis according to DSM-5 is confirmed only in 16.6% of the included subjects. 83.4% were excluded as they did not meet the social communication criteria and the required age for the onset of this specific symptomatology; the VABS subscales of daily skills and socialization are impaired for the entire sample.

Our research shows how the DSM-5 criteria, despite being more specific than DSM-IV, might exclude the subjects affected by Asperger's Syndrome from the Autistic spectrum. Their exclusion would involve the loss of access to specialistic interventions and clinical trials aimed at psychopathological and pharmacological depth

Patients with Major Depression (MD) experience increased negative affect, associated with dysfunction in the regulation of emotions, cognitive control and processing of self-referential information, suggesting prefrontal involvement. Gamma band activity is known to play a role in integrating cognitive processes whereas late positive potentials (LPP) are crucial for emotion regulation. Here, we investigate neural correlates during elaboration of attachment-relevant personalized stimuli in MD.

Identifying neural correlates of MD during exposure to attachment-relevant stimuli with EEG.

To find out whether an increase in the gamma band and LPP may be related to the elaboration of attachment-relevant personalized stimuli in MD.

20 depressed (DSM-IV) unmedicated outpatients and healthy controls (N = 20) were presented with a validated set of seven standardised attachment-related scenes. Each picture stimulus was accompanied by three neutral sentences and three personal attachment relevant keysentences derived form a previously conducted attachment interview.

EEG recording was performed with 32 electrodes. Evoked gamma activity was characterized by a Morlet wavelet transformation using the software Brain Vision Analyzer 2.0. We computed LPP for the time slot 500–1000 ms.

Patients showed higher levels of gamma activity and late positive potentials than control participants in fronto-central electrode sites that have been previously associated with emotion regulation and cognitive functions.

The present study offers evidence that EEG gamma activity reflects important indicators of processing personal affective stimuli in MD compared to healthy individuals. The involvement of the medial prefrontal cortex may also relate to the self-focused functioning that characterizes depressed individuals.

Preclinical studies have suggested that continuous, long-term opiate exposure may be neurotoxic. There is accumulating evidence for neural and neuropsychological abnormalities in diverse human drug addiction populations. However, the structural and behavioural correlates of human opiate dependency have been less studied than other drugs.

We investigated brain structure and neuropsychological functioning in opiate dependent, treatment-seeking patients receiving Methadone Maintenance Treatment, to test hypotheses of regional grey matter reductions correlating with methadone exposure and neuropsychological measures.

Cambridge Gambling Task (CGT) data were acquired from 47 patients receiving MMT and 51 controls. T1 weighted Magnetic Resonance Images were acquired from a representative subset of these volunteers.

MMT patients exhibited grey matter reductions in the orbito-medial prefrontal cortex and basal ganglia. Additionally, patients exhibited significant abnormalities on CGT behavioural measures; risk adjustment, risk taking and impulsivity. Both the initial titration dose of methadone at the commencement of MMT following protocolised tolerance testing, and methadone dose at the time of scanning, correlated with grey matter reductions in the globus pallidus. Abnormal risk adjustment behaviour correlated with reductions in globus pallidus grey matter, increased risk taking with orbitofrontal grey matter reductions, and increased impulsivity with cingulate cortex reductions.

These findings support an interpretation of heightened risk taking and impulsivity in patients receiving MMT. However, the anatomically restricted correlates with indices of methadone exposure suggest that most structural brain abnormalities are not opiate linked, with the possible exception of the globus pallidus.

Preclinical studies have suggested that continuous, long-term opiate exposure may be neurotoxic. There is accumulating evidence for neural and neuropsychological abnormalities in diverse human drug addiction populations. However, the structural and behavioural correlates of human opiate dependency have been less studied than other drugs.

We investigated brain structure and neuropsychological functioning in opiate dependent, treatment-seeking patients receiving Methadone Maintenance Treatment, to test hypotheses of regional grey matter reductions correlating with methadone exposure and neuropsychological measures.

Cambridge Gambling Task (CGT) data were acquired from 47 patients receiving MMT and 51 controls. T1 weighted Magnetic Resonance Images were acquired from a representative subset of these volunteers.

MMT patients exhibited grey matter reductions in the orbito-medial prefrontal cortex and basal ganglia. Additionally, patients exhibited significant abnormalities on CGT behavioural measures; risk adjustment, risk taking and impulsivity. Both the initial titration dose of methadone at the commencement of MMT following protocolised tolerance testing, and methadone dose at the time of scanning, correlated with grey matter reductions in the globus pallidus. Abnormal risk adjustment behaviour correlated with reductions in globus pallidus grey matter, increased risk taking with orbitofrontal grey matter reductions, and increased impulsivity with cingulate cortex reductions.

These findings support an interpretation of heightened risk taking and impulsivity in patients receiving MMT. However, the anatomically restricted correlates with indices of methadone exposure suggest that most structural brain abnormalities are not opiate linked, with the possible exception of the globus pallidus.

Several brain circuits are relevant in the neurobiology of addiction. Here we want to highlight symptoms related to the domains of mood, anhedonia and anxiety that may precede drug abuse and represent a specific risk factor for addiction. The mood regulation circuit that contributes to regulation of stress reactivity and the interoception circuit that contributes to awareness of drug craving and mood also participate in addiction but their involvement in the human brain has been much less investigated.

Here we aim to investigate mood and anxiety in opiate dependent, treatment-seeking patients receiving Methadone Maintenance Treatment, to test hypothesis of regional grey matter reduction correlating with mood and anxiety.

Cambridge Gambling Task (CGT) data were acquired from 30 patients receiving MMT and 23 controls. T1 weighted Magnetic Resonance Images were acquired from a representative subset of these volunteers.

MMT patients exhibited grey matter reductions in the orbito-medial prefrontal cortex and basal ganglia. Additionally, patients exhibited significant abnormalities in the clinical rating scales BDI, Anhedonia, HAD-Anxiety, IDS and Snaith Hamilton. Increased BDI, HAD-Anxiety and IDS correlated with grey matter reductions in the hippocampus, amygdala, bed nucleus of stria terminalis and insula. Increased Snaith Hamilton correlated with grey matter reductions in periaqueductal gray, ventral tegmental area and nucleus caudate.

These findings support an interpretation of a neurobiological underpinning of mood and addiction. However, the anatomically restricted correlates with mood and anxiety suggest that a rationale for adopting a mood addiction model should be further investigated.

Familial liability to both severe and common mental disorder predicts psychotic disorder, psychotic symptoms and psychotic-like experiences (PLe). However, the relation between familial liability and psychosis outcome may be associated with genetic variation. We investigated the influence of familial liability on PLe in a nonpsychotic, general population based group, and the potential moderating effect of the BDNFVal 66Met polymorphism.

PLe and familial liability were assessed in 313 individuals (mean age 38.6±13.3; gender: 43% males). Familial liability was obtained using the questions from Family Interview for Genetic Studies and dichotomized to none or at least one mental disorder in the first degree relatives (parents and siblings). PLe (visual and auditory hallucinations) were assessed through relevant questions in CIDI 2.1 G section on psychotic disorders. The sample undergone clinical reinterviews with the Structured Clinical Interview for DSMIV. BDNF val66met (rs6265) was genotyped using standardized procedures.

Familial liability was associated with PLe (OR= 1.8; CI: 1.1–3.0; p: 0.012). The association between familial liability and PLe was significant in individuals with Val/Val allele (OR= 2.2; CI: 1.2-4.1; p: 0.009) whereas there was no evidence for an association between familial liability and PLe in Met carrier individuals.

Individuals with a familial liability for mental disorders are more likely to report PLe. Val/Val genotype reported more PLe when exposed to familial liability than did individuals carrying Met allele. Therefore, the observed gene-environment interaction effect may be partially responsible for individual variation in response to familial liability.

Illness management group programmes providing information and coping strategies for clients and their relatives have gained importance in Europe.

At the Department for Psychiatry and Psychotherapy LMU Munich three cognitive-psychoeducational treatment programmes in schizophrenia, bipolar disorder and major depression were implemented and evaluated. Randomised controlled trials with two year follow-up were to evaluate programmes in schizophrenia and in major depression.

196 clients with schizophrenia were randomised to Coping-Oriented Cognitive Therapy (COP) or Supportive Therapy (SUP). Psychopathological Symptoms (BPRS-E), Psychosocial Functioing (GAF), Knowledge about Psychosis and its treatment, Illnesss concepts, and Cognitive Functioning were assessed.

Participants in COP showed higher gains in knowledge compared to SUP from pre- to post-treatment. At two year follow-up there were no significant differerences between the groups in relapse rates, however compared to other studies the rates were promising.

Cognitive therapy gains importance in treating inpatients with depression, however, there are only few controlled studies available.

119 inpatients with major depression were assigned to cognitive-psychoeducational therapy (CPT) or supportive therapy (SUP).

A comprehensive battery for cognitive, psychopathological and psychosocial variables was asessed

Clients in CPT had a significant lower relapse rate compared to SUP.

Recently contolled studies (e.g. Schramm et al. 2007) showed the superiority of combining pharmacotherapy and psychotherapy in major depression. The high drop-out rate in our sample has to be acknowledged and to be discussed.

Recent studies suggest that depression is associated with somatic pain. Despite growing research interest in the topic, the effects of depression-related somatic pain remain unclear. The present study sought to investigate the relationships between depression-related somatic pain, treatment satisfaction, and functions of daily living, and to compare them with the relationships between these factors and mental health measures.

We administered an Internet-based survey to 663 patients with depression in Japan, including questions about pain symptoms, mental health, functions of daily living, and dissatisfaction with depression treatment. The SF-8 questionnaire was used to assess functions of daily living. We conducted a multiple linear regression analysis to examine the associations between depression-related somatic pain, functions of daily living and treatment satisfaction, and between mental health measures, somatic pain and functions of daily living.

An increase per unit in the number of pain symptoms was associated with a 1.04-unit decrease in physical functioning score (P < 0.001), a 0.67-unit decrease in the role functioning-physical score (P < 0.001), and a 0.53-unit decrease in role functioning-emotional score (P = 0.0010). Meanwhile, we found no significant association between the number of pain symptoms and patients’ satisfaction with treatment, and no significant association between the number of pain symptoms and social functioning.

These results suggest that even when patients report satisfaction with their treatment, they may be suffering from reduced physical functioning and role functioning. These impairments may escape clinical recognition when clinicians or patients fail to discuss pain symptoms.

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1. - To measure the insight of a clinical population of schizophrenics.

2. - To specify factors correlated with a great insight.

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1. - A cross-sectional study on 30 schizophrenic male followed in the Department of Psychiatry B, Hedi Cheker hospital in Sfax, Tunisia.

2. - For each patient:

We collected the demographic and clinical data and we used the following scales:

1. * The Insight Scale (IS) for the measurement of ‘insight.

2. * Positive and negative syndrome scale (PANSS) to assess the severity of symptoms.

3. * The Drug Attitude Inventory (DAI-10) to assess the assumption relating to drugs.

4. * The Calgary Depression Scale for Schizophrenia (CDSS) to assess depression.

5. * The Satisfaction With Life Scale (SWLS) to determine the degree of life satisfaction.

The average age of the group was 40,08 years. Fifteen patients had a primary school and 68% were unemployed. Socioeconomic level was low in 80% of cases. Paranoid schizophrenia was the predominant type (56%). The average duration of hospitalization was 7.28 weeks. Twenty patients consulted regularly after their first hospitalization. The insight was poor in half of cases. Twenty-six patients had a positive subjective response to treatment. The majority of subjects had no depression (84%). Eleven subjects were satisfied with their life.

The great insight was correlated with positive subjective response to treatment (p = 0.023).

The great insight was associated with better drug compliance, with a limited number of relapses and a favorable disease progression. However, it was also associated with poor life satisfaction.

Ear acupuncture based on the NADA-Protocol combines the use of five standardized ear points in an open group setting. The NADA-Protocol has shown some positive effects in patients with different psychiatric diseases. To assess the practicality and effectiveness of NADA ear acupuncture we conducted a prospective observational trial on a psychosomatic ward.

During the 6 months investigation period the CGI, SCL-90R, SF-36 and ‘Cohen’s Perceived Stress Scale’ (PSS) were applied at baseline, every six weeks before and every four weeks after introduction of the NADA-Protocoll. The current level of ‘stress’, ‘sensation of pain’, ‘agitation’ and ‘fatigue’ were assessed using visual analog scales (VAS). We applied regression models with NADA group intervention and time or their interaction as factors.

We included a total of 31 patients, (22 females (71%); mean age 42,6 years), mainly diagnosed with a Major Depressive Episode. We found an increase in SF-36 total scores in linear regression (p = 0.04, t = 2.17). The VAS scores for’stress’ (before 4,1 (SD 3,2); after 2,5 (SD 2,3); linear regression p < 0.0001), and’agitation’ (before 4,6 (SD 3,2); after 3,0 (SD 2,5); linear regression p < 0.0001) dropped significantly. In all models the intervention, the time and their interaction were significant factors.

The NADA-Protocol seemed to have some impact on increase in overall health-related quality of life and ‘stress’ and ‘agitation’ levels. As for now the NADA-Protocol appears to be a useful additional treatment option in the context of patients on a psychosomatic ward.

The aim of the study was level of anxiety, depression and alexithymia in patients with rheumatoid arthritis (RA).

Alexithymia is defined as the difficulty in verbal expression of feelings. Alexithymia is more common seen in patients with chronic and temporary health problems.

One hundred forty eight patients with rheumatoid arthritis and a hundred healthy subject were included into the study. The level of alexithymia was assessed with Toronto Alexithymia Scale- 20 (TAS-20). Depression and anxiety disorders severity and quality of life (QoL) were assessed Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), World Health Organization Quality of Life Assessment- Brief (WHOQoL-BREF), respectively.

TAS-20 scores in patients group was higher than control group. The patients with rheumatoid arthritis had significantly poorer scores in all domains of WHOQoL-BREF (p<0.001). BDI and BAI scores were greater than control group. There was no significant difference between patients with or without alexithymia in terms of sociodemographic features, treatment and scales scores.

The results of this study suggest that alexithymia is more common in patients with RA. Treatment of alexithymia may improve QoL, depressive and anxiety symptoms.