Processes that lead to normal development of the representations of self and others are also central to understanding processes of therapeutic change. These processes primarily manifest themselves through the dialectical interpersonal exchanges of gratification and frustration, of disruptions and repair that are central to the development of the self.

To evaluate the contribution of different attributes of interpersonal relationships to the development of the self and patients’ well-being during the course of psychotherapy of adolescents and young adults.

To map the different paths to positive therapeutic gains in psychotherapy.

36 adolescents and young adults were evaluated during the course of 12-month intensive psychodynamic psychotherapy. Main outcome measures were changes in the Differentiation-Relatedness scores of mother, father, significant other, self and therapist and GAF scores.

We found that changes in the level of differentiation-relatedness in patients’ self-representation were primarily associated with changes in the level of differentiation-relatedness of their description of their therapist. A best-fit model indicated that beyond change in the patient's description of the therapist and of a self-designated significant other outside the family added significantly to the explained variance predicting change in self-representation. Exploratory structural equation modeling also suggested that patients’ growing recognition of the therapeutic relationship (measured by a more matured representation of the therapist) is associated with the patients’ overall level of clinical functioning.

These results add further support to the importance of the therapeutic relationship in building more differentiated and integrated representations of self and of significant others.

Pathological Gambling (PG) is a relatively common and highly disabling impulse control disorder. A range of psychotherapeutic agents including selective serotonin reuptake inhibitors (SSRIs), antiepileptic drugs, and opioid antagonists are shown to be effective in the short-term treatment of PG. The use of a wide range pf pharmacologic treatments for PG is consistent with the observation that PG shares features of obsessive-compulsive spectrum disorders, impulse control disorders, and addictive disorders. The aim of the study is to assess the rate of relapse in treatment-responder pathological gamblers after discontinuation of the active treatment.

The 43 full -responders were then followed prospectively for an additional 9 months, which included a 3-month open-label continuation phase and a 6-month medication-free, follow-up phase. Raters were blind to the previous drug treatment.

The majority of patients did not relapse during the 6-month medication- free follow-up phase. Three out of six patients with fluvoxamine, three out of nine with topiramate, seven out of eighteen with bupropion SR, and four out of ten with naltrexone relapsed. Relapse was strictly defined as gambling behavior at any time during the 6-month medication- free follow- up period. Most of the patients did not gamble during the follow- up period, and the patients that did gamble reported a decrease in gambling losses.

This naturalistic, long-term follow-up outcome study demonstrates that among pathological gamblers who respond to a six- month trial of medication, the majority of patients appear to maintain full-response during a six-month medication- free follow-up phase.

Internet Addiction (IA) is discussed as a serious health problem. Epidemiologic investigations show prevalence rates of 3% of internet users that fulfil criteria for IA. Reported symptoms like tolerance, withdrawal, and craving resemble those of substance-related disorders. Although there is no final agreement on the classification of IA, it has often been referred to as a non-substance-related addiction fostering current issues on the next revision of DSM (Holden, 2010).

Although IA has been investigated in epidemiologic studies there is no research of its prevalence in patients in treatment because of a substance-related disorder. Regarding similarities between IA and substance-related disorders, theories suggest increased prevalence of comorbid IA in these patients.

This study focused on the identification of prevalence of comorbid IA among patients with a primary substance-related disorder in different in-patient clinics across Germany.

Sponsored by the German Federal Ministry of Health 1826 patients were screened with a diagnostic inventory for IA. For further description additional questionnaires were given assessing aspects of personality (NEO-FFI) and psychopathology (SCL-90R, BDI-II).

4.1% of the patients fulfilled criteria of IA. In these most common primary diagnoses were pathological gambling and dependency of cannabis. Concerning personality IA-subsample showed increased neuroticism and introversion. Highest symptom burden was found in depression and social insecurity.

Among patients with substance-related disorder prevalence of IA is more common than in healthy samples. Results recommend separate screening for IA in inpatient clinics for substance-related disorders to guarantee full psychological care for patients with IA.

In alcoholism, one relevant mechanism contributing to relapse is the exposure to stimuli that are associated with alcohol intake. Such conditioned cues can elicit conditioned responses like alcohol craving and consumption. In the last decade, considerable progress has been made in identifying basic neuronal mechanisms that underlie cue-induced alcohol craving.

We explored whether functional brain activation during exposure to alcohol-associated stimuli is related to the prospective relapse risk in detoxified alcohol-dependent patients.

46 alcohol-dependent and 46 healthy volunteers participated in a fMRI study using a cue reactivity paradigm, in which visual alcohol-related and control stimuli were presented. Patients were followed for 3 months. Afterwards data was analysed regarding the subsequent relapse, resulting in 16 abstainers and 30 relapsers.

Alcohol-related versus neutral stimuli activated a frontocortical-limbic network including inferior, medial and middle frontal gyrus as well as putamen in the group of patients relative to healthy controls. Moreover, abstainers showed a stronger activation in orbitofrontal cortex as well as midbrain during the presentation of alcohol-related cues whereas relapsers revealed a stronger activation of cingulate gyrus.

This study suggests that cue-induced activation of orbitofrontal cortex and dopaminergic innervated midbrain is negatively associated with the prospective relapse risk in alcohol-dependent patients. This could indicate a more pronounced and conscious processing of alcohol cues which might serve as a warning signal and a behavioural controlling function. In contrast, prospective relapsers showed a stronger activation of cingulate gyrus, a region involved in the attribution of motivational value.

. Today, the addiction is considered as biological-psychological-social disease and numerous factors are effective in tendency to narcotics abuse.about individual factors, we can suggest the relationship between personality types and narcotics abuse.

The aim of present study is the investigation of relationship between personality types (introvert-extravert) and people's tendency to narcotics addiction.

In this study, statistical population is all of male- addicts in Babolsar city. Of these, 100 persons are selected as sample of study by sample random sampling from withdrawl addiction centers and camps in Babolsar city.

The results show that: it is significant relationship between people's high scores in both groups of personality types (introvert - extravert) and people's tendency to narcotics addiction so that, however people's scores are high in both groups of personality types (Introvert - extravert), to the same extent, there is probability of tendency to narcotics addiction.

Almost, in all of the studies about addiction, personality characteristics are as factors that cause person's addiction. Also, lack of development of personality is considered as an important factor. Among personality eminent characteristics, Introversion-extraversion can be as variable and important factor in tendency to narcotics addiction.

Patients with schizophrenia are at increased risk of suicide, but data from controlled studies of how pharmacotherapy is related to suicide risk is limited.

To explore suicide risk in relation to prescription of antipsychotics and antidepressants.

Of all patients with a first clinical discharge diagnosis of schizophrenia or schizoaffective disorder in Stockholm County between 1984 and 2000 (n = 4,000), patients who died by suicide within five years from diagnosis were defined as cases (n = 84; 54% male). Individual matching was performed with schizophrenia controls from the same population. Information on prescribed medication was retrieved from psychiatric records in a blinded way. Odds ratios (OR) of the association between medication and suicide risk were calculated by conditional logistic regression.

No significant association was observed between suicide and having ever been prescribed any antidepressant (33 cases and 30 controls) or any antipsychotic (83 cases and 82 controls). A lower suicide risk was found in patients who had ever been prescribed a second generation antipsychotic (risperidone, ziprazidone, olanzapine or clozapine; 12 cases and 23 controls): OR 0.2 (95% confidence interval [CI], 0.1–0.7). When the 6 cases and 8 controls who had been prescribed clozapine were excluded, the OR was 0.1 (95% CI, 0.03–0.6).

The lower suicide risk for patients who had been prescribed second generation antipsychotics may be related to a pharmacological effect of these medications, to differences in compliance, or to differences in other characteristics associated with a lower suicide risk.

Schizophrenia has since over a hundred years been associated with autonomic dysregulation, but the prognostic importance of this phenomenon is unclear.

To explore measures in electrocardiograms (ECG) reflecting autonomic balance in early schizophrenia spectrum disorders and to examine their relation to subsequent outcome. Three aspects of routine ECG measures were investigated:

1. 1) differences between patients with first-episode schizophrenia spectrum disorders and healthy controls,

2. 2) relations to early discontinuation of first antipsychotic medication and finally

3. 3) associations to symptomatic remission status five years later.

Twelve-lead ECGs were recorded at baseline in 58 patients with first-episode schizophrenia spectrum disorders and in 47 healthy controls of similar age. Selected ECG variables included heart rate and measures of repolarization and left ventricular hypertrophy. Pharmacotherapy data were extracted from medical records. At a five-year follow-up the patients were interviewed and assessed with the Positive and Negative Syndrome Scale.

Patients had higher heart rate and a different ST-T pattern than the controls. High T-wave amplitudes in the leads aVF and V5 and ST-elevations in V5 were associated both with higher risk of an earlier discontinuation of first antipsychotic pharmacotherapy (hazard ratios 1.3–2.4) and with non-remission five years later (odds ratios 2.9–6.4).

In this longitudinal cohort study, simple ECG measures reflecting autonomic balance in the early phase of schizophrenia spectrum disorders contained prognostic information. However, as this is the first report of this association and is based on a relatively small sample, the results should be interpreted with caution.

CBT for psychosis has been developed over the past two decades and is now recommended by most clinical guidelines for schizophrenia internationally.

To provide an up-date on advances and controversies in CBT for psychosis.

Evidence from recent meta-analyses (including Lynch et al, 2010) and randomised controlled trials will be reviewed. These have generally demonstrated effectiveness in early and treatment-resistant schizophrenia of CBT, and other specific indications, e.g. co-morbid substance misuse, aggressive behaviour, command hallucinations. Treatment is based on engaging the patient in a therapeutic relationship, developing an agreed formulation and then the use of a range of techniques for hallucinations, delusions and negative symptoms.

Evidence of effectiveness in treatment-resistant psychosis remains strong but some areas for intervention remain under-researched. A series of studies are on-going which will provide more information about effective ways of working.

CBT is a very important but under-used intervention which can make clinically significant differences to patient's lives.

There is a lack of evidence-based therapy approaches designed for the increasing number of middle-aged and elderly schizophrenia patients. Only very few approaches for this population addressing social skills were published yet.

Cognitive deficits are present in most schizophrenia patients independent of age. Only few empirical data exist whether therapeutic interventions can reduce cognitive deficits in middle-aged or elderly schizophrenia patients. An exception represents the Integrated Psychological Therapy (IPT), a group-based cognitive-behavioral therapy approach combining interventions on cognition and social skills.

1. a) Do middle-aged schizophrenia patients benefit from IPT as much as do younger patients?

2. b) Do these two populations benefit equal under control conditions (unspecific group intervention and/or treatment as usual)?

3. c) Are age-specific therapy settings demanded?

A standard meta-analytic procedure was used.

Middle-aged and younger patients participating in IPT showed equal treatment effects. IPT was superior to both control conditions independent of patients’ age. Younger patients reached the level of small effects in both control conditions whereas middle-aged patients showed absolutely no effects. The therapy setting in groups with younger patients differed from that with older patients in duration of therapy and weekly therapy sessions.

Results support efficacy of IPT independently of patients’ age. Evidence-based therapy should be implemented in psychiatric rehabilitation with elderly schizophrenia patients considering their specific needs into therapy setting.

A wealth of research supports the relevance of neuro-, social cognition and negative symptoms as treatment targets in schizophrenia. However, little is known about their interdependent relationships, their relative contribution to adequate functioning and quality of life as well as their associations with subjective, process oriented variables.

Data were collected in the context of an international RCT evaluating the Integrated Neurocognitive Therapy (INT) in comparison to treatment as usual (TAU). 169 outpatients with a diagnosis of schizophrenia according to ICD-10 or DSM-IV-TR participated in the study. We chose a longitudinal design.

First, by the means of structural equation modeling (SEM) we tested social cognition and negative symptoms as mediators between neurocognition and functional outcome. Additionally, the relationships of these variables with subjective parameters (hope, psychological strain, helplessness, initiative, knowledge about the disorder, insight, self-efficacy) were assessed. Second, we analyzed the same mediators and subjective variables but used quality of life instead of the traditional functional outcome measures.

1. 1. Social cognition and negative symptoms both served as mediators between neurocognition and functional outcome. Some subjective variables (e.g. hope) were associated with negative symptoms and functional outcome.

2. 2. Cognitive functions had no significant predictive or mediating influence on quality of life. Instead subjective variables (hope, psychological strain, self-efficacy) and negative symptoms functioned as significant predictors and were strongly related to each other.

The results of the study provide further evidence for integrated treatments. Including relevant subjective variables seems promising to generalize therapy effects to quality of life.

Khat consumption is widespread in Yemeni society and causes problems both in economic development and public health. The gender-specific motives for khat use and abstinence were studied to create a toe-hold for more specific interventions.

In a sample with equal numbers of males, females, abstainers and consumers, 320 subjects were interviewed on their specific opinions about khat and its impact on subjective and public health, and on social and community functioning. Strata were compared in their acceptance and denial of opinions. Notions that could predict abstinence status or gender were identified with multivariate logistic regression analysis.

Male khat users had a strong identification with khat use, while females were more ambivalent. The notion that khat consumption is a bad habit (odds ratio (OR) 3.4) and consumers are malnuorished (OR 2.2) were associated with female gender among khat users. Among the females worries about health impact (OR 3.2) and loss of esteem in the family (OR 3.1) when using khat predicted abstinence. Male abstainers opposed khat users in the belief that khat is the cause of social problems (OR 5.1).

Distinct beliefs allow a differentiation between males, females, khat users and abstainers when targeting preventive measures. In accordance to their specific values female khat users are most ambivalent towards their habit. Positive opinions scored lower than expected in the consumers. Public opinion towards khat may have become slightl more negative in recent years. This finding creates a strong toe-hold for gender-specific public health interventions.

The Time to Change (TTC) anti-stigma campaign, launched in January 2009 in England, intends to make fundamental improvements across England in: public knowledge, attitudes and discriminatory behaviour in relation to people with mental illness. To be effective and valid the campaign must reach a wide range of diverse audiences. This study explores attitudes of people from ethnic minority communities in relation to mental health.

The study investigates:

1. 1) General attitudes and perceptions about mental illness in ethnic minority communities

2. 2) How we might increase awareness about mental wellbeing and decrease stigma in ethnic minority communities.

Ten focus groups with members of ethnic minority groups were conducted. Five groups consisted of service users and five were composed of non-service users. Two groups comprised participants from an Indian origin, two Somali origin, two Afro-Caribbean origin and the other groups were mixed.

We will present findings regarding the ways in which traditional perceptions of mental health and personal experiences of ethnic minority service users affect their perceptions of sources of support such as family, friends, medical staff and religion and how this feedback could inform ant-stigma interventions.

The study suggests that in order to maximise the impact of anti-stigma campaigns, attention should be given to sources of discrimination and traditional perceptions of mental illness which are emphasised by ethnic minority groups. When planning anti-stigma campaigns it is important to incorporate experiences and perceptions from a wide range of audiences.

Studies of cognitive behaviour therapy (CBT) for psychosis demonstrate that African-Caribbean and Black African patients have higher dropout rates and poor outcomes from treatment (Rathod et al., 2005).

The main aim of the study was to produce a culturally sensitive adaption of an existing CBT manual for therapists working with patients with psychosis from specified ethinic minority communities (African-Caribbean, Black-African/Black British, and South Asian Muslims). This will be based on gaining understanding of the way members (lay and service users) of these minority communities view psychosis, its origin, and management including their cultural influences, values and attitudes.

This qualitative study consisted of individual semi-structured interviews with patients with psychosis (n = 15); focus groups with lay members from selected ethnic communities (n = 52); focus groups or semi-structured interviews with CBT therapists (n = 22) and mental health practitioners who work with patients from the ethnic communities (n = 25). Data was analysed thematically using evolving themes and content analysis. NVivo 8 was used to manage and explore data.

Respondent groups agreed that CBT would be an acceptable treatment if culturally adapted. This would incorporate culturally-based patient health beliefs, attributions concerning psychosis, attention to help seeking pathways and technical adjustments.

While individualization of therapy is generally accepted as a principle, in practice, therapists require an understanding of patient-related factors that are culturally bound and influence the way the patient perceives or responds to therapy.

The influence of acculturation and nativity on depression in Latinos remains highly contested. One potential source of ambiguity is variation in their beliefs about the causes of their mental health ailments.

We conducted cross-sectional analyses of 450 older Latinos attending a rural mental health clinic near the U.S.-Mexico border. Primary diagnosis was grouped in one of 5 categories. The Center for Epidemiological Studies of Depression (CES-D) scale was used to measure depressive symptoms. Cultural variables included nativity and a validated acculturation scale. Patients rated their level of endorsement of 13 causes of mental health ailments A one-way ANOVA was conducted to identify cultural predictors of attribution items.

Latinos had a mean age of 70.9 (SD = 9.1). The most common primary diagnoses were depressive disorders (67.1%) and dementia (15.3%). The mean CES-D score was 15.08 (SD = 18.16), but higher for the more acculturated (p = 0.048), and patients with psychotic (M = 26.31, SD = 19.78) and bipolar (M = 26.05, SD = 19.54) disorders. Acculturation increased attribution of mental health ailments to significant others (ρ = 0.091; p = 0.054), difficulty with work (ρ = 0.162; p = 0.001), and hereditary factors (r = 0.202, 95% CI = 0.002, 0.403). Patients with psychotic disorders were most likely to attribute their symptoms to curses (p = 0.001) and supernatural factors (p = 0.024) compared to other diagnostic categories.

Acculturated Latinos attriattribute their mental health ailments to life circumstances. This may intensify depressive symptoms and partly explains the relationship between acculturation and depressive symptoms. Further, the patients’ major diagnosis must be considered when evaluating acculturative influences on depression in psychiatric populations.

Prevalence of physical illness among patients suffering from psychiatric illness is higher than in the average population. This is especially true for persons diagnosed with schizophrenia who mainly suffer from heart disease and metabolic disorders. Some of the second generation antipsychotics are likely to cause weight gain and metabolic syndrome associated with a two- to threefold increase in cardiovascular mortality and a twofold increase in all-cause mortality. The quality of the general health care in patients with severe mental illness and the lack of consensus about the prevention of somatic illness in this group of vulnerable patients need to be improved.

There is a correlation between the awareness of physical health and the physical health among patients as well as staff members.

The investigation is designed as a randomised controlled intervention study with follow-up after nine months.

The study population is from six facilities in the region of North Jutland in Denmark for severe chronically mental ill patients. All six facilities offer specialised social psychiatric treatment. The six facilities have 184 patients and approximately 200 staff members. A subsample of seven patients and seven staff members will be selected from the three interventions facilities and be invited to participate in separate focus groupsIn the intervention facilities, a detailed feedback of all index measures will be distributed to the patients and the staff. Individual health promotion and guidance will be carried out.

Socially marginalised people with mental health disorders have complex needs that require integrated care. However, mental health and social care sectors are fragmented, and inter-organisational collaboration is challenging.

A cross-national whole Network Analysis was carried out to detect and interpret patterns of relations between mental health and social care services in several European cities and assess their levels of care integration, following Leutz's levels: linkage, coordination and full integration.

Data on referrals and service routine meetings were collected in deprived areas of 14 European cities and processed within a Social Network Analysis approach. Structural indicators included degrees, components and overlapping cliques, betweenness centrality and centralisation and brokerage roles. Patterns of collaboration were compared across cities.

Few cities had full integrated services. Whole networks had relatively low densities, including denser sub-networks of similar services. The linkage across sectors remained weaker than the linkage within sectors. Services situated in broker positions were not always integrated nor commissioned for care coordination. The centrality of these services was higher when the linkage density was lower.

Although differences between structural patterns of mental health and social care networks mainly depend on national care integration policies, the study revealed structural gaps in the achievement of these patterns, whatever the policy model. This could explain why different systems are basically facing the same problems in service delivery despite these differences. These gaps constitute potential weaknesses in the quality of mental health and social care integration at the system level.