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The influence of baseline severity on the efficacy of Silexan, a proprietary essential oil from Lavandula angustifolia, in anxiety disorders has not been investigated in a pooled dataset. We report on an individual patient data analysis of all five double-blind, randomized, placebocontrolled trials with Silexan in anxiety disorders. Eligible participants received Silexan 80 mg/d or placebo for 10 weeks. Analyses were based on the Hamilton Anxiety Rating Scale (HAMA), its psychic and somatic anxiety subscores, and the Clinical Global Impressions (CGI) scale. To correlate baseline severity with outcome, patients were segregated into mild, moderate, and severe cases. Altogether 1,172 patients (Silexan, n = 587; placebo, n = 585) were analyzed. For the HAMA total score, we found a significant association between the score at baseline and the treatment effect of Silexan versus placebo at week 10 (p < 0.001). HAMA items from the somatic domain scored lower at baseline and showed less improvement than items from the psychic domain, particularly in patients with mild or moderate baseline symptoms. For CGI item 2 (global improvement), significant efficacy favoring Silexan were observed in mild, moderate, and severe baseline symptom severity. Although significant improvements were found for all subsets, the more severe the initial symptoms, the greater the treatment effects documented by the HAMA. Overall this analysis confirms that Silexan is an effective treatment option in early or mild stages of anxiety disorder. Given its favorable safety profile, Silexan can thus fill a therapeutic gap in the treatment of (subsyndromal) anxiety disorders. [ABSTRACT FROM AUTHOR]

Hanns Hippius (1925–2021) can be seen as a stimulating pioneer of Psychopharmacology and of Neuroscience. He was very influential in this area not only in Germany, but also on an international level. With reference to clinical psychopharmacology especially his activities for the development of Clozapine are of greatest importance. When he became Chairman of the Psychiatric Department of the Ludwig-Maximilians-University Munich (1971–1994), he established all necessary facilities for research in Psychopharmacology and Neuroscience, which was at that time a great progress in psychiatry. This was the base to establish a Munich school of clinical psychopharmacology and neuroscience. A majority of his co-workers did research in psychopharmacology and neuroscience and made their academic careers in this area and several achieved university chair positions in Germany, on which they could procreate the standards and knowledge of the Munich school of psychopharmacology and neuroscience. His engagement for psychopharmacology can be seen in addition in the fact that he was co-founder and one of the first presidents of CINP (1972–1974), the International College of Psychopharmacology. The recollections presented in this article describe the objective data as well as some personal experiences of the author. [ABSTRACT FROM AUTHOR]

Phenomenon: This study aimed to investigate how students can develop their understanding of trauma biomechanics by means of technology-enhanced learning—an interactive visualization tool developed to enhance understanding of the biomechanics underlying an injury via dynamic imaging sequences. Approach: Students were invited to explore the content as a learning resource during an interprofessional clinical placement on an orthopedic ward. Thirty volunteer medical, nursing, and physiotherapy/occupational therapy students participated in 10 interprofessional groups of three participants. They were video recorded while interacting with learning software that was divided into five sections: Work Up, General Information, Biomechanical Case Study, Biomechanical Risk Assessment, and Treatment. Investigators probed students' learning experiences via four focus group discussions. A sociomaterial perspective was adopted, directing the analytical focus to how students' made use of talk, gestures, bodies, and material objects to understand the visualized phenomena. Findings: When connecting the visualization to a patient case, certain features of the technology stood out as important for promoting engagement and understanding trauma mechanisms. Decreased tempo, showing the directions and dynamics of trauma biomechanics in slow-motion, and color coding of the strain on the affected structures were especially important for evoking the emotional responses. The visualization tool also supported students' explorations of causal relationships between external forces and their biomedical effects. These features emphasize the sociomaterial relation between the design of the technology and the student activities. Insights: Dynamic visualization of biomechanical events has the potential to improve the understanding of injury mechanisms and specifically to identify anatomical structures at high risk of injury. Dynamic visualizations for educational purposes seem to promote possibilities for learners to contextualize visual representations relative to one's own body. Educational methods and practice need explicit attention and development in order to use the full potential of the visualization technology for learning for the health care professions. [ABSTRACT FROM AUTHOR]

Interestingly, Moncrieff et al. do not cite studies that prove the efficacy of antidepressants; as far as the serotonergic antidepressants are concerned, such studies could well be discussed as providing ex juvantibus support for the serotonin theory. The umbrella review by Moncrieff et al. summarizes the results of all systematic reviews and meta-analyses on the serotonin hypothesis of depression and subdivides the hypothesis into six areas: serotonin and the 5-hydroxyindoleacetic acid (HIAA) level in body fluids, serotonin receptor activity, serotonin transporter activity, results of tryptophan depletion studies, serotonin transporter gene levels, and the interaction between the serotonin transporter gene and stress. Is the serotonin hypothesis/theory of depression still relevant?. [Extracted from the article]

Purpose To compare health-related quality of life and radiographic outcomes in patients treated with either anterior or posterior fusion surgery for Lenke 5C type idiopathic scoliosis. Methods We used data from the Swedish spine registry and identified 59 patients with idiopathic scoliosis treated with fusion for Lenke 5C type curves; 27 patients underwent anterior surgery and 32 underwent posterior surgery. All patients had pre- and postoperative radiographic data and postoperative clinical data at a minimum of two years after surgery. Patient-reported outcomes measures included the Scoliosis Research Society (SRS)-22r, EuroQoL 5 dimensions 3 levels (EQ-5D-3L), EQ-visual analogue scale (VAS) and VAS for back pain. Radiographic assessment included measurement of the angle of the major curve, disc angulation below the lowest instrumented vertebra, curve flexibility, rate of curve correction, differences in sagittal parameters, number of fused vertebrae and length of fusion. Results The mean age at surgery was 16 years in both groups. The mean follow-up time was 3.8 years. There were no significant differences in the SRS-22r score and EQ-5D-3L index at follow-up (all p ≥ 0.2). Postoperatively, both the anterior and posterior fusion group demonstrated a significant correction of the major curve (p ≤ 0.001) with no significant difference of the correction rate between the groups (p = 0.4). The posterior fusion group had shorter operative time (p < 0.001) and higher perioperative blood loss (p = 0.004) while the anterior group had lower number of fused vertebrae (p< 0.001). Conclusion The type of surgical approach for Lenke 5C curves is not associated with differences in health-related quality of life, despite the lower number of fused vertebrae after anterior surgery. [ABSTRACT FROM AUTHOR]

Anxiolytic drugs often have sedative effects that impair the ability to drive. Our double-blind, randomized crossover trial investigated the effect of Silexan, a non-sedating, anxiolytic herbal medicinal product, on driving performance in healthy volunteers. Part 1 aimed at demonstrating equivalence between 80 mg/d Silexan and placebo. Part 2 was performed to demonstrate superiority of 160 and 320 mg Silexan over 1 mg lorazepam and included a placebo arm for assay sensitivity. Driving performance was assessed in a validated, alcohol-calibrated simulator test. The primary outcome was the standard deviation of the lane position (SDLP). Secondary outcomes included driving errors and sleepiness. Fifty and 25 subjects were randomized in Parts 1 and 2, respectively. In Part 1, Silexan 80 mg was confirmed to be equivalent to placebo after single administration (equivalence range: δ = ±2 cm). The 95% confidence interval (CI) for the SDLP marginal mean value difference Silexan–placebo for single administration was −1.43; +1.38 and thus similar to the 95% CI of −1.45; +0.79 cm for 7 days' multiple dosing. In Part 2, 95% CIs for SDLP marginal mean value differences to lorazepam were −8.58; −5.42 cm for Silexan 160 mg and −8.65; −5.45 cm for 320 mg (p < 0.001). Confirmatory results were supported by secondary outcomes, where results for Silexan were comparable to placebo and more favorable than for lorazepam. The study demonstrates that single doses of up to 320 mg Silexan and multiple doses of 80 mg/d have no adverse effect on driving performance. [ABSTRACT FROM AUTHOR]

Interest in the topic of termination of life has been growing for 2 decades. After legalisation of active euthanasia and assisted suicide (EAS) in the Netherlands in 2002, movements to implement similar laws started in other European countries. However, many people objected to legalisation on the basis of the experiences in the Netherlands and as a matter of principal. This selected and focussed review presents the theoretical discussions about EAS and describes the respective parliamentary discussions in Germany and the data and experiences in the Netherlands. It also considers people with mental disorders in the context of termination-of-life services. So far, only a few European countries have introduced legislation on EAS. Legalisation of EAS in the Netherlands resulted in an unexpectedly large increase in cases. The number of people with mental disorders who terminate their lives on request remains low. Experience from the Netherlands shows that widening criteria for EAS has problematic consequences. Termination of life on request, which a subgroup of people support, is a matter of ongoing debate. Because of several problematic aspects, including ethical considerations, only a few countries in the world allow active euthanasia or assisted suicide. Even if euthanasia is well regulated, legalising it can have problematic consequences that are difficult to control, such as an unwanted excessive increase in euthanasia cases. The well-documented experiences with the euthanasia law in the Netherlands serve as an example of what is to be expected when euthanasia is legalised. We need to pay close attention to the relationship between suicide and suicide prevention on the one hand and euthanasia acts and promotion of euthanasia on the other. Further ethical, psychological and legal research is needed. In particular, the role of palliative medicine in societies' approach to end-of-life care must be explored in much more detail. [ABSTRACT FROM AUTHOR]

Objectives: Predictors for unfavorable treatment outcome in major depressive disorder (MDD) applicable for treatment selection are still lacking. The database of a longitudinal multicenter study on 1079 acutely depressed patients, performed by the German research network on depression (GRND), allows supervised and unsupervised learning to further elucidate the interplay of clinical and psycho‐sociodemographic variables and their predictive impact on treatment outcome phenotypes. Experimental Procedures: Treatment response was defined by a change of HAM‐D 17‐item baseline score ≥50% and remission by the established threshold of ≤7, respectively, after up to eight weeks of inpatient treatment. After hierarchical symptom clustering and stratification by treatment subtypes (serotonin reuptake inhibitors, tricyclic antidepressants, antipsychotic, and lithium augmentation), prediction models for different outcome phenotypes were computed with random forest in a cross‐center validation design. In total, 88 predictors were implemented. Results: Clustering revealed four distinct HAM‐D subscores related to emotional, anxious, sleep, and appetite symptoms, respectively. After feature selection, classification models reached moderate to high accuracies up to 0.85. Highest accuracies were observed for the SSRI and TCA subgroups and for sleep and appetite symptoms, while anxious symptoms showed poor predictability. Conclusion: Our results support a decisive role for machine learning in the management of antidepressant treatment. Treatment‐ and symptom‐specific algorithms may increase accuracies by reducing heterogeneity. Especially, predictors related to duration of illness, baseline depression severity, anxiety and somatic symptoms, and personality traits moderate treatment success. However, prospectives application of machine learning models will be necessary to prove their value for the clinic. [ABSTRACT FROM AUTHOR]

Subthreshold psychiatric disorders do not fully meet the diagnostic criteria of syndromal disorders but may be associated with comparable disability. To investigate the anxiolytic effect of Silexan, an active substance from lavender oil for oral administration, in patients with subthreshold anxiety, a meta-analysis that included all published trials with Silexan in this indication was performed. Three randomised, placebo-controlled trials in subthreshold anxiety disorders (anxiety disorder not otherwise specified, restlessness and agitation, mixed anxiety and depressive disorder) were included. Eligible participants with a baseline Hamilton Anxiety Rating Scale (HAMA) total score ≥ 18 points received 1 × 80 mg/day Silexan or placebo for 10 weeks. Outcomes included the HAMA, the Pittsburgh Sleep Quality Index, the Zung Self-rating Anxiety Scale, the Clinical Global Impressions questionnaire and the SF-36 health status inventory. Data were analysed using meta-analysis based on pooled raw data of individual patients (random effects models). A total of 697 patients were assessed for efficacy. Silexan was superior to placebo in reducing the HAMA total score during 10 weeks' treatment [mean value difference, 95% confidence interval: 3.83 (1.28; 6.37) points]. Superiority was comparably pronounced for psychic and somatic anxiety as well as for observer- and self-rated anxiety. Silexan had a beneficial effect on sleep (secondary to the anxiolytic effect) without causing sedation and improved the patients' health-related quality of life. Adverse event incidence in both treatment groups was comparable [risk ratio: 1.06 (0.85; 1.33)]. Silexan has a significant and clinically meaningful anxiolytic effect in subthreshold anxiety. The results cannot be generalised to other lavender oil products. [ABSTRACT FROM AUTHOR]

Presents a study which measured the hole minority carrier diffusion length and the edge surface-recombination velocity as a function of distance from p-n junction in gallium arsenide p/n concentrator solar cells. Measurements of the edge surface-recombination velocity and the hole minority carrier diffusion length as a function of x; Results and discussion.

According to ICD-10 criteria, mixed anxiety and depressive disorder (MADD) is characterized by co-occurring, subsyndromal symptoms of anxiety and depression, severe enough to justify a psychiatric diagnosis, but neither of which are clearly predominant. MADD appears to be very common, particularly in primary care, although prevalence estimates vary, often depending on the diagnostic criteria applied. It has been associated with similarly pronounced distress, impairment of daily living skills, and reduced health-related quality of life as fully syndromal depression and anxiety. Although about half of the patients affected remit within a year, non-remitting patients are at a high risk of transition to a fully syndromal psychiatric disorder. The validity and clinical usefulness of MADD as a diagnostic category are under debate. It has not been included in the recently released DSM-5 since the proposed diagnostic criteria turned out to be not sufficiently reliable. Moreover, reviewers have disputed the justification of MADD based on divergent results regarding its prevalence and course, diagnostic stability over time, and nosological inconsistencies between subthreshold and threshold presentations of anxiety and depressive disorders. We review the evidence in favor and against MADD and argue that it should be included into classification systems as a diagnostic category because it may enable patients to gain access to appropriate treatment early. This may help to reduce patients' distress, prevent exacerbation to a more serious psychiatric disorder, and ultimately reduce the societal costs of this very common condition. [ABSTRACT FROM AUTHOR]

Significant changes of schizophrenia patients during inpatient treatment were evalutaed and compared to established outcome criteria. The concept of reliable and clinically significant change methods was applied to three hundred and ninety-six patients suffering from a schizophrenia spectrum disorder. First, information on whether or not the change of the patient's condition is sufficient in order to declare that it is beyond a measurement error or random effect (= reliable change) was evaluated and in a second step it was observed if the reliable change was clinically meaningful (= clinically significant change). Different Positive and Negative Syndrome Scale for Schizophrenia (PANSS) thresholds were applied to define the clinically significant change (40, 45 and 50 points). These changes were then compared to established outcome criteria such as response and remission. Seventy-nine of the 396 patients (20%) showed a reliable improvement of symptoms, whereas 70% improved without achieving a reliable change of their condition. Of the 79 patients achieving a reliable change during treatment 8-15% concurrently showed a clinically significant change depending on the respective PANSS threshold. In contrast, 56% of the patients achieved response and 60% were in remission at discharge when applying established outcome criteria. Our results showed that a rather small number of schizophrenia patients were found to reliably change during inpatient treatment, with even less patients achieving a clinically significant change. The concept of reliable and clinically significant changes revealed to be a lot more stringent than today's established outcome criteria and should be critically evaluated regarding its use in schizophrenia patients. Copyright © 2015 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Given a finite set of points $\mathbb {X}\subset \mathbb {R}^{n}$, one may ask for polynomials p which belong to a subspace V and which attain given values at the points of $\mathbb {X}$. We focus on subspaces V of $ \mathbb {R}[x_{1},\ldots ,x_{n}]$, generated by low order monomials. Such V were computed by the BM-algorithm, which is essentially based on an LU-decomposition. In this paper we present a new algorithm based on the numerical more stable QR-decomposition. If $\mathbb {X}$ contains only points perturbed by measurement or rounding errors, the homogeneous interpolation problem is replaced by the problem of finding (normalized) polynomials minimizing ${\sum }_{u\in \mathbb {X}} p(u)^{2}$. We show that such polynomials can be found easily as byproduct in the QR-decomposition and present an error bound showing the quality of the approximation. [ABSTRACT FROM AUTHOR]

In a 15-year follow-up study, we used a comparative approach to assess course and outcome for all functional psychoses. The presented results focus on negative symptoms and refer to a sample of 76 patients with schizophrenia, 38 patients with a schizoaffective disorder and 32 patients with an affective disorder according to ICD-9. These patients were assessed at their first psychiatric hospitalization and 15 years later. In summary, the findings indicate that the course and outcome of schizophrenia is less favorable than that of affective and schizoaffective disorders. Negative symptoms occurred in all functional psychoses, but were more frequent and prominent in the schizophrenic group than in the other two diagnostic groups at any time of assessment. Narrower concepts of negative symptoms, conceptualized as the deficit syndrome, seem to be specific for schizophrenia and appear quite rarely in patients with affective psychoses. Overall, our study supports Kraepelin''s original hypothesis that bifurcated the psychoses into the affective psychoses and schizophrenia, whereby the latter have a more deleterious long-term course and outcome. [Copyright &y& Elsevier]

Objectives. To evaluate the neuronal nicotinic channel modulator TC-5214 (dexmecamylamine) as adjunct therapy in patients with major depressive disorder (MDD) and inadequate response to prior antidepressant treatment. Methods. Study 004 (D4130C00004) and Study 005 (D4130C00005) comprised an 8-week open-label antidepressant (SSRI/SNRI) treatment period followed by an 8-week randomised, active treatment with twice-daily TC-5214 (0.5, 2 or 4 mg in Study 004; 0.1, 1 or 4 mg in Study 005) or placebo, adjunct to ongoing SSRI/SNRI. Primary efficacy endpoint was change in MADRS total score from randomisation (Week 8) to treatment end (Week 16). Secondary endpoints included MADRS response and remission, and changes in SDS and HAM-D-17-item scores. Safety and tolerability were monitored throughout. Results. Studies 004 and 005 randomised 640 and 696 patients, respectively, to TC-5214 or placebo. No statistically significant improvements in MADRS total score or any secondary endpoints were seen with TC-5214 versus placebo in either study at treatment end. The most commonly reported adverse events (> 10%) with TC-5214 were constipation, dizziness and dry mouth. Conclusions. TC-5214 adjunct to antidepressant was generally well tolerated. However, the studies were not supportive of an antidepressant effect for TC-5214 in patients with MDD and inadequate response to prior antidepressant therapy. [ABSTRACT FROM AUTHOR]

Effective treatment of negative symptoms is one of the most important unmet needs in schizophrenic disorders. Because the evidence on current psychopharmacological treatments is unclear, the authors reviewed the findings published to date by searching PubMed with the keywords negative symptoms, antipsychotics, antidepressants, glutamatergic compounds, monotherapy and add-on therapy and identifying additional articles in the reference lists of the resulting publications. The findings presented here predominantly focus on results of meta-analyses. Evidence for efficacy of current psychopharmacological medications is difficult to assess because of methodological problems and inconsistent results. In general, the second-generation antipsychotics (SGAs) do not appear to have good efficacy in negative symptoms, although some show better efficacy than first-generation antipsychotics, some of which also demonstrated efficacy in negative symptoms. Specific trials on predominant persistent negative symptoms are rare and have been performed with only a few SGAs. More often, trials on somewhat persistent negative symptoms evaluate add-on strategies to ongoing antipsychotic treatment. Such trials, mostly on modern antidepressants, have demonstrated some efficacy. Several trials with small samples have evaluated add-on treatment with glutamatergic compounds, such as the naturally occurring amino acids glycine and d-serine and new pharmacological compounds. The results are highly inconsistent, although overall efficacy results appear to be positive. The unsatisfactory and inconsistent results can be partially explained by methodological problems. These problems need to be solved in the future, and the authors propose some possible solutions. Further research is required to identify effective treatment for the negative symptoms of schizophrenia. [ABSTRACT FROM AUTHOR]

Part 1 of this paper discussed several more general aspects of Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and offered a detailed, paradigmatic analysis of changes made to the chapter on depressive disorders. This second part focusses on several other disorders, including bipolar and schizophrenia spectrum disorders. The respective changes and their possible consequences are discussed under consideration of traditional psychiatric classification, particularly from the perspective of European traditions and on the basis of a PubMed search and review papers. The general conclusion is that even seemingly small changes such as the introduction of the mixed feature specifier can have far-reaching consequences. Contrary to the original plans, DSM-5 has not radically changed to become a primarily dimensional diagnostic system but has preserved the categorical system for most disorders. The ambivalence of the respective decision-making becomes apparent from the last minute decision to change the classification of personality disorders from dimensional back to categorical. The advantages and disadvantages of the different approaches are discussed in this context. In DSM-5, only the chapter on addictive disorders has a somewhat dimensional structure. Also in contrast to the original intentions, DSM-5 has not used a more neurobiological approach to disorders by including biological markers to increase the objectivity of psychiatric diagnoses. Even in the most advanced field in terms of biomarkers, the neurocognitive disorders, the primarily symptom-based, descriptive approach has been preserved and the well-known amyloid-related and other biomarkers are not included. This is because, even after so many years of biomarker research, the results are still not considered to be robust enough to use in clinical practice. [ABSTRACT FROM AUTHOR]

DSM-5 was published in 2013 after about 10 years of preparation. Part 1 of this paper discusses several more general aspects of DSM-5 and offers a detailed, paradigmatic analysis of changes made to the chapter on depressive disorders. The background for the changes is analysed on the basis of a PubMed search and review papers on the classification of mental disorders in general and on empirical knowledge about individual disorders. Contrary to the original plans, DSM-5 has not introduced a primarily dimensional diagnostic system but has widely preserved the categorical system of disorders. Also, it has not adopted a more neurobiological approach to disorders by including biological markers to increase the objectivity of psychiatric diagnoses but has maintained the primarily symptom-based, descriptive approach. The criteria for some disorders have been changed, including affective, schizophrenic and addiction disorders, and a few new disorders have been added. A minimal version of the dimensional approach was realised through the introduction of several transnosological specifiers and the option to make symptom- or syndrome-related severity and dimensional assessments. These specifiers and assessments might allow a more individualised description of a patient's psychopathological state and more personalised treatment. However, most of the symptom- and syndrome-related assessments are not mandatory and therefore may not be used in clinical practice. [ABSTRACT FROM AUTHOR]

Objective: Psychiatric symptoms are common and bothersome in individuals with post-COVID-19 syndrome. Because they are often mixed and subthreshold, established treatment regimens cannot be applied. There is an urgent need to identify therapeutics for affected patients. Silexan, a proprietary essential oil from Lavandula angustifolia, has demonstrated efficacy against anxiety, comorbid symptoms, and subthreshold and mixed syndromes. The aim of the current narrative review is to examine the therapeutic potential of Silexan for psychiatric manifestations in patients with post-COVID-19 syndrome. Methods: We reviewed clinical evidence regarding the efficacy of Silexan and first clinical experience in patients with psychiatric symptoms attributable to the post-COVID-19 syndrome. Furthermore, we discussed potential modes of action based on nonclinical data. Results: Silexan has demonstrated therapeutic efficacy for the treatment of generalised anxiety disorder; subsyndromal anxiety disorders; comorbid depressive, somatic, and sleep disturbance symptoms; and mixed anxiety and depression. Emerging clinical experience also suggests the effectiveness and tolerability of Silexan for patients with post-COVID-19 syndrome. This can be explained by the fact that the therapeutic profile of Silexan overlaps with the spectrum of psychiatric symptoms in such patients. Conclusion: Preliminary findings indicate a promising potential of Silexan for the treatment of psychiatric manifestations in patients with post-COVID-19 syndrome. Anxiety and mixed neuropsychiatric manifestations are commonly observed in patients with post-COVID-19 syndrome. Silexan has anxiolytic properties and can alleviate comorbid depressive, somatic, and sleep impairment symptoms. Silexan exhibits several biological mechanisms, such as neurotrophic and anti-inflammatory properties, which have the potential to positively impact post-COVID-19 disease. Silexan has a favourable safety profile and high acceptance among patients. Emerging data suggest that Silexan can alleviate neuropsychiatric symptoms in patients with post-COVID-19 syndrome. Silexan should be considered as a therapeutic in patients with psychiatric manifestations of post-COVID-19 syndrome. [ABSTRACT FROM AUTHOR]

Objective. After 10 years of preparation, DSM-5 was published in 2013. This paper will examine the possible effects of DSM-5 on psychiatric diagnosis and psychopharmacotherapy. Methods. DSM-5 was compared with DSM-IV to identify the important changes in psychiatric diagnosis and possible consequences for psychopharmacotherapy. Results. Contrary to the original plans, DSM-5 did not make radical changes and move towards dimensional diagnosis but preserved the previous categorical system of disorders and a primarily symptom-based descriptive approach. The dimensional approach was only adopted through the introduction of several transnosological specifiers and the option to make symptom- or syndrome-related assessments. The criteria for some disorders were changed, including affective, dependence and schizophrenic disorders, and a few new disorders were added. Conclusion. The DSM-IV diagnostic system was largely preserved, although some changes were made, primarily in the field of affective disorder and in several criteria sets. The new transnosological specifiers, severity assessments and cross-cutting dimensional assessments may help to individualise treatment. [ABSTRACT FROM AUTHOR]

Background: Idiopathic scoliosis is a three-dimensional structural deformity of the spine that occurs in children and adolescents. Recent reviews on bracing and exercise treatment have provided some evidence for effect of these interventions. The purpose of this study is to improve the evidence base regarding the effectiveness of conservative treatments for preventing curve progression in idiopathic scoliosis. Methods/design: Patients: Previously untreated girls and boys with idiopathic scoliosis, 9 to 17 years of age with at least one year of remaining growth and a curve Cobb angle of 25-40 degrees will be included. A total of 135 participants will be randomly allocated in groups of 45 patients each to receive one of the three interventions. Interventions: All three groups will receive a physical activity prescription according to the World Health Organisation recommendations. One group will additionally wear a hyper-corrective night-time brace. One group will additionally perform postural scoliosis-specific exercises. Outcome: Participation in the study will last until the curve has progressed, or until cessation of skeletal growth. Outcome variables will be measured every 6 months. The primary outcome variable, failure of treatment, is defined as progression of the Cobb angle more than 6 degrees, compared to the primary x-ray, seen on two consecutive spinal standing x-rays taken with 6 months interval. Secondary outcome measures include the SRS-22r and EQ5D-Y quality of life questionnaires, the International Physical Activity Questionnaire (IPAQ) short form, and Cobb angle at end of the study. Discussion: This trial will evaluate which of the tested conservative treatment approaches that is the most effective for patients with adolescent idiopathic scoliosis. [ABSTRACT FROM AUTHOR]

Given the importance of the term 'evidence' in evidence-based medicine (EBM), the meaning of this term is evaluated, going back to the philosophical tradition and current meaning of the terms 'evidence' and 'truth'. Based on this, current problems in the definition of evidence and in the grading of evidence in EBM are described, taking examples from the field of psychiatry and especially pharmacopsychiatry. These problems underline that the use of the term evidence in EBM is inconsistent and inconclusive. This should be fairly stated in all EBM-related publications, especially in EBM-based guidelines, to avoid severe misunderstandings in and outside the field of psychiatry. Although EBM might have increased empirically driven rational decision-making in psychiatry/medicine, the current limitations should be carefully considered. [ABSTRACT FROM AUTHOR]

In a recent paper, Horder and colleagues (Horder et al., 2010, J Psychopharmacol 25: 1277–1288) have suggested that the mainproblem in the Kirsch analysis is methodological. We argue that the results are similar irrespective of the method used. In our opinion the data suggest that placebo and drug effects are non-additive: antidepressants act independently of depression severity, while the placebo effect is present only in milder cases. While the response in the placebo group is due to unstable ‘noise’ and ‘artefacts’, the medication effect is reliable, valid and stable. [ABSTRACT FROM PUBLISHER]

Abstract: Background: Most predictor analyses search for single predictors or rely on data from randomized controlled trials. We aimed at detecting a set of clinical baseline variables for prediction of response and remission in 1014 naturalistically treated inpatients with major depressive episode treated for 53.62±47.5days. Methods: A three-staged procedure was implemented. First, univariate tests were used for finding associations with baseline variables. Second, logistic regression and third-CART analyses were used to determine predictors of response to inpatient treatment. Results: Presence of suicidality, a higher initial HAMD-21 total score, an episode length<24months, fewer previous hospitalizations, and absence of any ICD-10F4 comorbidity predicted response in 2 different statistical models. Remission was predicted by lower HAMD-21 baseline score, episode length<24months and fewer previous hospitalizations in both models. Limitation: Results were assessed by a post-hoc analysis, based on prospectively collected data. No controlled study design. Conclusion: Contrary to current beliefs, baseline suicidality might be associated with higher chances for response. In addition, baseline severity might impact outcome depending on which criterion (remission or response) used. [Copyright &y& Elsevier]

Kraepelin's system of mental diseases has contributed substantially to the foundation of modern psychiatric diagnosis in the DSM-IV and ICD-10. Considering Kraepelin's influence in the creation of these diagnostic tools, the question arises as to how Kraepelin's contemporaries and successors reacted to his nosology. Historical libraries and archives in Munich, Berlin and Paris were searched for European and American psychiatric literature using the keywords 'Kraepelin', 'dichotomy' and 'manic-depressive disorder'. Literature from 1900 to 1960 was examined and compared to the current literature regarding Kraepelin's impact on modern classification systems. The sixth edition of Kraepelin's 'Lehrbuch' (1899) presented the dichotomy in its entirety and led to three different periods of critical comment on dichotomy and methodology between 1900 and 1960. But on the whole, Kraepelin's system was quickly and completely adopted in clinical diagnosis. The publications appearing on and following Kraepelin's centenary in 1956 represent his work as generally being the foundation of modern psychiatry. The neo-Kraepelinian movement, beginning in the late 1960s, developed more differentiated views of Kraepelin's scientific background and methodology. Notwithstanding all the criticism of Kraepelin's dichotomy, it remains more than ever the basis of psychiatric diagnosis. The criticism today shows parallels to the statements made during Kraepelin's era, mainly concerning the issue of diagnostic overlapping of the two disease entities, manic-depressive disorder and schizophrenia, and includes the question of syndromatology. [ABSTRACT FROM AUTHOR]

Schizophrenia is a disorder with a poor long-term outcome. Second generation antipsychotics (SGAs) offer some better treatment options for patients suffering from schizophrenia in terms of a broader efficacy profile and reduced risks of extrapyramidal side effects (EPS). However, in the long-term treatment conditions the problem of a high non-adherence rate has not been resolved sufficiently. The introduction of depot formulations of SGAs might serve as an option to further improve the situation. The respective data of long-acting injectable risperidone are reviewed. Future perspectives of a broader indication of this approach are discussed. [ABSTRACT FROM AUTHOR]

Abstract: Remission and response were suggested as the most relevant outcome criteria for the treatment of depression. There is still marked uncertainty as to what cut-offs should be used on current depression rating scales. The goal of the present study was to compare the validity of different HAMD, MADRS and BDI cut-offs for response and remission. The naturalistic prospective study was performed in 12 psychiatric hospitals in Germany. All evaluable patients (n =846) were hospitalized and had to meet DSM-IV criteria for major depressive disorder. Biweekly ratings were assessed using HAMD-21, MADRS and BDI. A CGI-S score of 1 and a CGI-I score of at least 2 was used as the primary comparative measure of remission and response, respectively. A HAMD-21 cut-off≤7 (AUC: 0.92), HAMD-17 cut-of≤6 (AUC: 0.90), MADRS cut-off≤7 (AUC: 0.94) and BDI cut-off≤12 (AUC: 0.83) were associated with a maximum of specificity and sensitivity for defining remission. A minimum decrease of 47% of the HAMD-21 (AUC: 0.90), ≤57% for HAMD-17 (AUC: 0.89), ≤ 46% for MADRS (0.91) and a decrease of 47% for the BDI baseline score (AUC: 0.78) best corresponded CGI response criteria. Our data largely confirmed currently used remission and response criteria in naturalistically treated patients. [ABSTRACT FROM AUTHOR]

Given the limited explanatory power of the available neurobiological findings, results of long-term follow-up studies should still be considered as one criterion among others in the development of psychiatric classification systems regarding schizophrenia and affective disorders. A total of 323 first hospitalized inpatients of the Psychiatric Department of the University Munich were recruited at index time and followed up after 15 years. The full follow-up evaluation including several standardized assessment procedures (AMDP, PANSS, SANS, DAS, GAS) could be performed in 197 patients. The patients originally diagnosed according to ICD-9 were re-diagnosed according to ICD-10 and DSM-IV, using SCID among others. Schizophrenic patients had a much poorer outcome than affective or schizoaffective patients in terms of negative syndrome, deficit syndrome, psychosocial impairments and GAS results, and a higher prevalence of a chronic course. The logistic regression analyses performed to find optimized predictor combinations for the prognosis of a chronic course found, for example, the total Strauss–Carpenter Scale score, male gender and several other psychopathological syndromes to be relevant predictors. The findings reflect some long-term related validity for the differentiation between schizophrenia and affective disorders. The Strauss–Carpenter Scale, male gender as well as several psychopathological syndromes are the most relevant predictors for chronicity. [ABSTRACT FROM AUTHOR]

Abstract: A comparison between different types of ground-based sensors has been carried out to derive macroscopic cloud data such as cloud cover and cloud-base heights. The instruments compared in the campaign at the Meteorological Observatory Lindenberg in the period May to September 2006 include an infrared (IR) sky scanner called Nubiscope, a Daylight VIS/NIR Whole Sky Imager (WSI), a ceilometer LD-40 measuring in the near infrared region (NIR) and a Ka band cloud radar measuring in the micro wave band (extremely high frequency or EHF) region. In addition, our data analysis included regular hourly cloud observations by weather observers, and vertical profiles of temperature, humidity and winds taken from six-hourly radio soundings at the site. The comparison has been focused on performance and features of the Nubiscope as a prototype instrument for automatic cloud observations. Cloud cover (CC) derived from the Nubiscope cloud algorithm compares quite well with CC derived from both WSI and from observations. CC differences are within ±2Okta in 67% of cases between Nubiscope and observations, and in 90% of cases between Nubiscope and WSI. The cloud detection capability as derived from the zenith signals of Nubiscope and WSI shows coincidence in about 90% of cases. For cloud-base heights (CBHs) from Nubiscope data and ceilometer as well as from radar reflectivity, the comparison showed a general good correspondence in the lower and middle troposphere up to heights of about 6km with some systematic difference due to the different detection methods. For the upper troposphere above 6km the differences become widespread and more random. Cloud detection capabilities of the instruments are also illustrated by a case study of moving clouds with patterns similar to contrails that were erroneously classified as such by the weather observer mainly due to lack of height information that the ceilometer did not provide. By combined information from WSI, radio sonde humidity and radar, they were shown not to be contrails, but most likely low-level water clouds either of natural origin or built from aircraft at their ascent or descent flight close to the airport. [Copyright &y& Elsevier]

The objective of the European Post-marketing Observational Serdolect® (EPOS) Study was to compare the safety of treatment with Serdolect (sertindole) with that of usual treatment in patients with schizophrenia, in normal European clinical practice. The EPOS was a multicentre, multinational, referenced, cohort study. Patients were enrolled at 226 centres in ten European countries. The study was prematurely terminated in 1998 as a result of the temporary market suspension of sertindole. Termination of the study reduced the number of patients recruited from the planned 12,000 to 2,321. While the power of the study was weakened, it did provide useful mortality information, which may be useful for future long-term studies. Crude mortality in the sertindole and non-sertindole groups was 1.45 (95% confidence interval, CI 0.53–3.16) and 1.50 (CI 0.72–2.76) deaths/100 patient-years exposed, respectively. There were no more cardiac deaths in the sertindole group than in the non-sertindole group. QT interval prolongation did not translate into an increased risk of death. Sertindole was well tolerated and caused few extrapyramidal symptoms. Although CIs remained large, this post-marketing study does not provide any evidence against the use of sertindole under normal conditions. Sertindole was well tolerated and posed no significant safety problems. [ABSTRACT FROM AUTHOR]

Proof of efficacy of a psychotropic medicinal product is the key point of clinical psychopharmacology. This especially concerns the licensing of a new compound, but apart from this special case, lots of efficacy questions need to be answered in clinical psychopharmacology, such as, e.g. the question of the efficacy of a combination therapy. The methodology of the scientific proof of efficacy has already had a long tradition and has been developed further in the recent past under different aspects. Especially the double-blind randomised parallel group comparison has been developed as a design of highest methodological standard. However, often designs have their place and justification under certain conditions and in relation to certain questions. Although in the recent past, with the over-emphasis of so-called effectiveness studies, the inherent methodological limitations of these studies have not been addressed properly (Möller in Eur Arch Psychiatry Clin Neurosci 258:257–270, ), which in consequence devaluated the scientific merits of the classical double-blind randomised control group study designs in the view of those colleagues, who are not that experienced in study design issues. Therefore, it seems to be timely and necessary to review the principle standards and problems concerning the proof of efficacy in clinical psychopharmacology. [ABSTRACT FROM AUTHOR]

Psychopharmacotherapy should now be regulated in the sense of evidence-based medicine, as is the case in other areas of clinical treatment in medicine. In general this is a meaningful development, which principally will have a positive impact on routine health care in psychiatry. But several related problems should not be ignored. So far consensus on an internationally accepted evidence graduation could not be reached due to several difficulties related to this. For example, focussing on the results of meta-analyses instead of considering relevant single studies results in a decision-making logic which is in conflict with the rationale applied by drug authorities in the licensing process. Another example is the relevance of placebo-controlled trials: if randomized placebo-controlled phase-III studies are prioritized in the evidence grading, the evidence possibly deviates too far from the conditions of routine clinical care due to the special selection of patients in those studies. However, a grading primarily based on active comparator trials could lead to wrong conclusions about efficacy. This concerns especially the so-called “effectiveness” studies and other forms of phase-IV studies with their less restrictive methodological rigidity. Attempts to regulate psychopharmacotherapy in the sense of evidence-based medicine come closer to their limits the more complex the clinical situation and the respective decision-making logic are. Even in times of evidence-based medicine a large part of complex clinical decision-making in psychopharmacotherapy still relies more on clinical experience and a consensus on clinical experience, traditions and belief systems than on results of efficacy oriented phase-III and effectiveness-oriented phase-IV clinical studies. [ABSTRACT FROM AUTHOR]

Evidence-based medicine (EBM) is becoming the guiding principle for clinical treatment decisions. But evidence remains a loosely defined term. Multiple criteria for evidence criteria have been proposed. Most influential evidence criteria give priority to meta-analyses because they promise an objective procedure to combine the outcomes of all informative, putatively conflicting studies on the same issue in an overall score. However, we claim that meta-analyses are of limited informative value for the following six reasons: (1) meta-analyses are often “overpowered” with clinically irrelevant results that might emerge as highly significant; (2) there is serious concern of publication biases with “negative” studies not being published; (3) meta-analyses consider the variation in the results of the empirical studies included to be random noise, however, the variability of results across studies can be informative; (4) the result of a meta-analysis depends on the strategy used to identify the included empirical studies; (5) the quality of conclusions from meta-analyses depends on the statistical tests used to combine the results of the separate studies; (6) the qualitative conclusions drawn from the meta-analytical combination of individual studies may depend on specific design aspects of the individual studies. Thus, meta-analyses are primarily a method to generate hypotheses through an a posteriori analysis of treatment effects. [ABSTRACT FROM AUTHOR]

The existence and importance of an accelerated adjacent segment disc degeneration (ASD) after lumbar fusion have previously not been demonstrated by RCTs. The objectives of this study were, to determine whether lumbar fusion in the long term accelerates degenerative changes in the adjacent disc and whether this affects the outcome, by using a prospective randomised design. A total of 111 patients, aged 18–55, with isthmic spondylolisthesis were randomised to exercise (EX, n = 34) or posterolateral fusion (PLF, n = 77), with ( n = 37) or without pedicle screw instrumentation ( n = 40). The minimum 10 years FU rate was 72%, with a mean FU time of 12.6 years (range 10–17 years). Three radiographic methods of ASD quantification were used, i.e. two digital radiographic measurement methods and the semi quantitative UCLA grading scale. One digital measurement method showed a mean disc height reduction by 2% in the EX group and by 15% in the PLF group ( p = 0.0016), and the other showed 0.5 mm more disc height reduction in the PLF compared to the Ex group (ns). The UCLA grading scale showed normal discs in 100% of patients in the EX group, compared to 62% in the PLF group ( p = 0.026). There were no significant differences between instrumented and non-instrumented patients. In patients with laminectomy we found a significantly higher incidence of ASD compared to non laminectomised patients (22/47 vs. 2/16 respectively, p = 0.015). In the longitudinal analysis, the posterior and anterior disc heights were significantly reduced in the PLF group, whereas in the EX group only the posterior disc height was significantly reduced. Except for global outcome, which was significantly better for patients without ASD, the clinical outcome was not statistically different in patients with and without ASD. In conclusion, the long-term RCT shows that fusion accelerates degenerative changes at the adjacent level compared with natural history. The study suggests that not only fusion, but also laminectomy may be of pathogenetic importance. The clinical importance of ASD seems limited, with only the more severe forms affecting the outcome. [ABSTRACT FROM AUTHOR]

Psychopharmacotherapy should now be regulated in the sense of evidence-based medicine (EBM), as is the case in other areas of clinical treatment in medicine. In general this is a meaningful development, which will principally have a positive impact on routine health care in psychiatry. But several related problems should not be ignored. So far consensus on an internationally accepted evidence graduation could not be reached, due to several difficulties related to this. A principle question is also whether it is sufficient to base EBM primarily on the results of phase III trials with their high internal validity. Restrictions to generalise findings of phase III trials suggest the need for additional sources of evidence, amongst others “effectiveness” studies and other kinds of phase IV studies with their less restrictive methodological standards. Attempts to regulate psychopharmacotherapy in the sense of evidence-based medicine come closer to their limits the more complex the clinical situation and the respective decision-making logic are. Even in times of evidence-based medicine we are faced with the situation that a large part of complex clinical decision-making in psychopharmacotherapy still relies more on personal clinical experience and a group consensus about clinical experience, traditions and belief systems than on results of efficacy oriented phase III and effectiveness-oriented phase IV clinical studies. [ABSTRACT FROM AUTHOR]

A reason for the necessity to revise ICD-10 and DSM-IV is the increase of knowledge in the past 20 years, especially neurobiological knowledge. But is this increase of knowledge, for example in the field of neurogenetics, of such magnitude that a revision of the psychiatric classification is necessary and promises to be fruitful? The current plans for DSM-V or ICD-11, respectively, focus on different improvements. In this context also the introduction of a purely syndromatic/dimensional approach without including etiopathogenetic hypotheses, is discussed. A switch to such a dimensional approach, which was discussed among others in the DSM-V task force Deconstructing Psychosis, would be the most radical development. It could avoid many theoretical pre-assumptions about causal hypotheses, which are still associated with ICD-10 and DSM-IV. This would indeed increase the validity of psychiatric classification, but it would also reduce the information as compared to traditional diagnostic categories with all the current implications concerning etiopathogenesis, therapy and prognosis. Such a dimensional approach would also mean that the syndromes would have to be assessed in a standardized way for each person seeking help from the psychiatric service system or for each person undergoing psychiatric research. This would have to be a multi-dimensional assessment covering all syndromes existing within different psychiatric disorders. Based on the different aspects that must be considered in this context, a careful revision seems more advisable than a radical change of classification. [ABSTRACT FROM AUTHOR]

The paper will highlight and discuss some of the important issues and controversies of current depression treatment like the efficacy of antidepressants, their effect on suicidality, their place in a complex psychiatric treatment strategy including psychotherapy and other psychosocial activities. The efficacy of antidepressants is clinically significant, but often monotherapy with one drug has to be followed by others or by comedication/augmentation therapy approaches. Psychosocial therapy, predominantly focused on psychotherapeutic strategies, can also contribute in a relevant way to the therapeutic success. Generally, antidepressants reduce suicidality, but under special conditions like young age or personality disorder, they can also be harmful in this respect. However, under the conditions of good clinical practice, the risk-benefit relationship of treatment with antidepressants can be judged as favourable. In addition, the paper tries to analyse the question about how to reach individualised, evidence and value oriented decision making in the complex treatment of depressive patients. The capacity of psychiatrists to individualise treatment decisions in terms of “the right drug/treatment for the right patient” is still restricted since there are currently not enough powerful clinical or biological predictors, which help to achieve this goal. There is hope that in future pharmacogenetics will contribute significantly to a personalised treatment. The ideal that all steps of classical decision making can be based on the strict rule of evidence-based medicine is far away from reality. Individualised decision making is so complex that the rigorous expectations of evidence-based medicine can hardly be fulfilled. Finally, it should be considered that clinical decision making is not only evidence but also value oriented. [ABSTRACT FROM AUTHOR]

The article presents a study which investigates the predictive factors for the outcome of patients with adult isthmic spondylolisthesis who were operated on with posterolateral lumbar fusion and posterior lumbar interbody fusion. Questionnaires on clinical history and a pain drawing are administered to the patients. The multivariate regression analysis reveals that work status is a significant determinant of outcome. It concludes that patients who work before surgery have more favorable outcome.

Standardized rating scales are an important tool to improve the assessment of psychopathological symptoms in terms of validity and reliability. Especially observer-rated scales are of primary importance in this respect. Self-rating scales can give a meaningful complementary view to the findings of observer-rated scales. Besides scales covering more or less the whole spectrum of psychopathological symptoms, specialised scales focussing only on symptoms of disorders like schizophrenia or depression were developed. They are widely used, specifically for pragmatic reasons. [ABSTRACT FROM AUTHOR]

The metaanalysis of Kirsch (PLoS Med 5:e45, 2008) has (unfortunately!) attracted too much attention in the specialized press and especially in the lay press. Therefore, intensive critical commenting is necessary to not further alarm experts and health authorities as well as patients and family members. The specified commenting on these metaanalyses shall be prefaced with a short and critical commentary regarding the general significance of metaanalyses. The results of metaanalyses should not too naively be interpreted as the ‘truth’ as regards to the evidence based psychopharmacotherapy, but should be qualified in their significance due to principal methodological reasons Maier (Nervenarzt 78:1028–1036, 2007; Möller (Nervenarzt 78:1014–1027, 2007). Especially from these derived effect sizes should be interpreted carefully. [ABSTRACT FROM AUTHOR]

Europe has a rich tradition in psychopathology and psychiatric classification. This could be helpful developing new classification systems like ICD-11 and DSM-V. Some examples of this are described and further discussed, such as the categorical vs. the syndromatological approach, the relevance of hierarchical rules for the delineation of nosological entities, the antagonistic tradition of unitarian vs. splitting approaches and the relevance of a differentiated psychopathological description. Finally, the conclusion is that a too radical change of the classificatory system, e.g. in the direction of a purely symptomatical/dimensional systematic, or a totally new classification based on modern new biological findings, might be problematic and premature. [ABSTRACT FROM AUTHOR]

In the past few years several papers have reported critically on the risk of suicidal thoughts and behaviour associated with antidepressants, primarily SSRIs. The risk-benefit ratio of antidepressant (AD) treatment has been questioned especially in children and adolescents. The critical publications led to warnings being issued by regulatory authorities such as the FDA, MHRA and EMEA and stimulated new research activity in this field. However, potential harmful effects of antidepressants on suicidality are difficult to investigate in empirical studies because these have several methodological limitations. Randomised controlled trials (RCTs) are the most reliable way to test the hypothesis that AD have such side effects. In addition to meta-analyses of RCTs, complementary research methods should be applied to obtain the most comprehensive information. We undertook a comprehensive review of publications related to the topics ADs, suicide, suicidality, suicidal behaviour and aggression. Based on this comprehensive review we conclude that ADs, including SSRIs, carry a small risk of inducing suicidal thoughts and suicide attempts, in age groups below 25 years, the risk reducing further at the age of about 30–40 years. This risk has to be balanced against the well-known beneficial effects of ADs on depressive and other symptoms (anxiety, panic, obsessive-compulsive symptoms), including suicidality and suicidal behaviour. According to the principles of good clinical practice, decision making should consider carefully the beneficial effects of AD treatment as well as potentially harmful effects and attempt to keep the potential risks of AD treatment to a minimum. It is the major problem facing efforts to identify the possible ‘suicidal effects’ of antidepressants. [ABSTRACT FROM AUTHOR]

In recent years, so-called “effectiveness studies” have gained increasing importance in the context of evidence-based medicine. These studies supposedly follow less restrictive methodological standards than phase III studies in terms of patient selection, co-medication and other design issues, and their results should therefore be better generalisable than those of phase III studies. Effectiveness studies, like other types of phase IV studies, can therefore contribute to the knowledge about antipsychotics or other psychopharmaceuticals and supply relevant information in addition to that gained from phase III trials. However, the less restrictive design and inherent methodological problems of phase IV studies mean that their results cannot falsify the results of phase III studies. The greater complexity of phase IV studies, for example the greater variance caused by the different kinds of confounders, means that their results have to be interpreted with great care and especially with a high degree of awareness of problematic design issues, such as insensitive primary outcome criteria, biased randomisation, unblinded treatment conditions, inclusion of chronic refractory patients, etc. Some recently published effectiveness studies on antipsychotic treatment of schizophrenia will be discussed under these methodological aspects. The main conclusions of these trials will be questioned on the basis of their severe methodological pitfalls. [ABSTRACT FROM AUTHOR]

This paper describes basic principles of systematics for psychiatric disorders such as the categorical and dimensional approach. It summarises validity aspects of the traditional psychiatric nosology and syndromatology. The importance and limitations of the dichotomy of schizophrenia and affective disorders, first suggested by Kraepelin, is reviewed in the light of results from modern research in the field of classification, follow-up and neurobiological studies, especially neurochemical, neurogenetic and neuroimaging studies. Current developments towards DSM-V and ICD-11 are critically reflected. The conclusion is reached that there might be insufficient data to establish a new systematics of psychoses. Therefore it might be premature to leave the Kraepelinian dichotomy totally although it has to be modified in the light of new research. [ABSTRACT FROM AUTHOR]

It is increasingly recognised that major depressive disorder can be a chronic condition with many patients experiencing recurrent episodes. Remission from a depressive episode implies the absence or near absence of depressive symptoms. However, for many patients the periods between depressive episodes are not symptom free. Residual symptoms are predictors of relapse or recurrence, and may be associated with residual psychosocial impairment. In clinical studies, remission is commonly defined using a cut-off score on a rating scale for depressive symptoms, such as a score of ≤7 on the 17-item Hamilton scale. However, there is debate about which scales and cut-offs are optimal and full-length rating scales are not widely used in clinical practice. In spite of such issues, it seems clear that a therapy should aim at the most complete remission possible. Unfortunately, recent studies have highlighted that in clinical practice usually only a low rate of remission is achieved. Although long-term treatment with antidepressants can reduce the risk of relapse or recurrence only a minority of patients in clinical practice achieve this as treatment is often prematurely stopped due to long-term side effects such as sleep disturbance, sexual dysfunctioning and weight gain. Therefore, it represents an unmet need to come up with antidepressant drugs of greater efficacy and improved tolerability as such treatments could lead to more complete remission in more patients. [ABSTRACT FROM AUTHOR]

The author discusses whether there is a need for a new psychiatric classification at the current state of knowledge. He claims that the reason for the increase of knowledge in the past 20 years, especially neurobiological knowledge is due to revise International Classification of Diseases (ICD-10) and Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). He cites psychopharmacological decision-making and psychiatric classification.

The article compares the outcome of posterolateral fusion (PLF) and posterior lumbar interbody fusion (PLIF) in adult isthmic spondylolisthesis. There were 88 patients with an age range between 18 and 55 were operated on with PLIF, while 77 patients operated on with PLF. Based on the results, the authors concluded that the type of fusion does not affect the two-year outcome of surgical treatment of adult with isthmic spondylolisthesis.

Abstract: The florid positive symptoms of schizophrenia (hallucinations, delusions, grossly disordered thinking) are often obvious. By comparison, negative symptoms (flattened affect, impoverished speech, apathy, avolition, anhedonia) are subtler and more difficult to recognize and diagnose. However, there is increasing recognition of the importance of negative symptoms in patients with schizophrenia. Secondary negative symptoms attributable to such factors as unrelieved positive symptoms, the adverse effects of antipsychotic pharmacotherapy, or social isolation may subside with resolution of such factors. In contrast, primary negative symptoms are an intrinsic aspect of schizophrenia; they are persistent and have been associated with poorer clinical outcomes. Although the lack of a reliably effective treatment for negative symptoms is a serious unmet need in this patient population, accurate diagnosis is still important. Assessment of suspected negative symptoms, using validated rating scales, can help to rule out comorbid affective or cognitive disorders that may mimic negative symptoms and to distinguish primary negative symptoms from potentially reversible secondary negative symptoms. This article reviews the definitions and classification of negative symptoms, compares the tools available for their assessment, and offers practical clinical algorithms for sorting through the differential diagnosis. [Copyright &y& Elsevier]

Schizophrenia remains a severe disorder that is associated with a poor outcome in a large subgroup of patients. Major efforts should be made to improve treatment for all patients who have this debilitating disease. Second-generation antipsychotics were a major step forward in this respect; however, important unmet needs remain, such as a better solution for frequent noncompliance problems. Depot formulations are known to have advantages in this respect. However, for a long time, only depot formulations of conventional antipsychotics were available, with their high risk of extrapyramidal adverse effects. Therefore, there has been only very restricted use of depot antipsychotics, which mainly focused on patients with chronic disease who were difficult to treat and had a high risk of noncompliance. The situation may change with the advent of a depot formulation of an atypical antipsychotic. The first depot formulation of an atypical antipsychotic to be introduced to the market is long-acting injectable risperidone. On the basis of the pharmacokinetic properties of the depot formulation, a 2-week interval between administrations is recommended. The antipsychotic efficacy of long-acting risperidone was demonstrated in two 12-week, double-blind, randomised, phase III studies, one versus placebo and the other versus oral risperidone. These two studies, together with one open-label, long-term study over 12 months, belong to the core group of trials that were relevant for the licensing of long-acting risperidone. A relapse-prevention, control group study comparing the long-acting formulation versus oral risperidone was not performed because of the known principal methodological problems of such a comparison. Instead, as much clinical data as possible was collected from observational studies that investigated questions relevant for clinical practice, such as efficacy, safety and tolerability in different subgroups, and transition from pre-treatment with different kinds of antipsychotics to long-acting risperidone. On the basis of these data, it can be stated that the efficacy of the long-term formulation of risperidone is proven, and that the safety and tolerability are more or less comparable to those of oral risperidone. The local tolerability at the injection site is good. Because it is well known that noncompliance is a frequent feature of the treatment of schizophrenia, and considering the advantages of atypical antipsychotics, consideration of whether long-acting atypical antipsychotics should have a broader indication than is the case with the depot formulations of the classical antipsychotics is warranted. [ABSTRACT FROM AUTHOR]