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Introduction The mismatch negativity (MMN) represents one of the major paradigms in cognitive neurophysiology. The attenuation of this subtraction wave of auditory event-related potentials (being a marker of discrimination of rare deviant stimuli among a series of standard stimuli) is well established in schizophrenia research. Moreover, first MMN results in patients with alcohol dependence mostly indicated an enhanced MMN though heterogeneously. In contrast to this “traditional” oddball MMN an optimized MMN including a higher number of deviants but within the same time interval was deficient in schizophrenia patients as shown by our group. Interestingly, the two clinical entities (schizophrenia, alcohol dependence) are in a close connection to glutamate neurotransmitter system underlying the generation of MMN. Methods 25 inpatients with alcohol dependence received a multichannel EEG with auditory MMN in i) oddball (20% deviants) as well as optimized MMN (50% standards, five deviants with 10% each). 25 healthy subjects without harmful use of alcohol served as controls. Results Following alcohol withdrawal patients showed decreased MMN amplitudes in the fronto-central region and increased latencies as compared to controls. Especially when taking the optimized MMN, the amplitudes of the cortico-central region significantly correlated positively (deviants: duration, intensity, localization: 0.001 > p ’s) with length of time of alcohol abstinence. Conclusion Attenuation of optimized MMN might indicate down-regulation of glutamatergic systems after withdrawal. Further, this study confirms the alteration of latencies representing delay of early auditory information processing in alcohol patients. Efficient neurospychobiological monitoring could improve diagnostic evaluation and potentially prediction of effects of psychotropic agents in patients with substance dependence. [ABSTRACT FROM AUTHOR]

As opposed to suicide that is officially registered risk factors for suicide attempts are more difficult to establish. Therefore, a large data set of inpatients in a university hospital was transformed and analyzed for accompanying risk factors at admission of suicidal patients. Apart from standard hospital data additional items were also derived from medical records and follow-up entries. The initial data file consisted of 16,895 data sets (i.e., hospitalizations) from year 1985 until 2005 that was transformed into a final file with 5,146 consistent data sets covering 233 variables. The analysis is based on a main group classification into suicide attempts 'positive” and suicide attempts 'negative”. Statistical analysis was done with Mann-Whitney-U-Tests, CHI2, correlation coefficients (r and ϕCOLE) and logistic regression. Patients with suicide attempts were significantly younger and were at higher risk for personality disorder (RR=1.69, p<0.001), affective disorder (RR=1.49, p<0.001) and neurotic disorder (RR=1.37, p<0.001). Male individuals and those with repeated suicide attempts used the more severe methods. Further risk factors included suicidality at admission, childhood trauma or abuse, and suicide of related parties (RR's between 1.39 and 3.07). Patients with suicide attempts showed higher numbers of hospitalizations though shorter duration of their inpatient treatment than patients without suicide attempts. By means of a large and elaborated data file of inpatients a profile of risk factors for attempted suicide was identified providing a basis for more close intervention during inpatient treatment and thereafter. [ABSTRACT FROM AUTHOR]

Introduction: Comorbid depression in somatic illness is highly prevalent. However, most depression questionnaires show violation of unidimensionality and hypersensitivity of items. Objectives: The Depression Screening (DESC) is a new self-rating scale for the measurement of depression severity that we developed from a calibrated Rasch-homogeneous item bank (N=367) to improve short depression assessment in patients beyond psychiatric settings. Aim: To present data for both parallel forms (10 questions each) of the DESC, and to examine its Rasch model qualities in different patient groups and a representative German general population sample. Methods: Patient groups with depression, heart disease, neurological or otolaryngological disease (N=333) were investigated with the DESC accompanied by diagnostic interviews and established depression scales. The demographic sample (N=2509) was interviewed face to face, too. Adherence to Rasch model assumptions was determined with analysis of model fit, and further measures. Norm values were calculated. Results: Both DESC versions feature different but highly correlated item sets. Cut-off scores with good sensitivity (0.82, 0.81) and specificity (0.78, 0.77) for the diagnosis of an affective disorder were developed with ROC analyses. No serious Differential Item Functioning in Rasch analyses for both scales was found. In the German validation sample the Rasch dimension “depression” explained 68.5% and 69.3% respectively of the variance. Validity was determined through sufficient intercorrelations with other scales (e.g. BDI, HADS). Conclusions: Our studies support the good psychometric RASCH qualities of both DESC forms and offer important advancements in depression screening being of use for time-limited clinical and research applications. [ABSTRACT FROM AUTHOR]

Objectives: Depressive syndromes in chronic heart failure (CHF) are highly prevalent with 20-40% and are associated with various aspects of increased cardiac mortality and impact on health system. Likewise, CHF may increase the risk of developing depression or vice-versa via bidirectional interactions of possible shared pathophysiology. Methods: While at current only a minority of comorbid patients with CHF receives adequate diagnosis and treatment, identification, treatment, and prevention by optimizing cardiological and psychiatric strategies appears essential. - An introductory overview on the occurrence, atypical presentation of symptoms, and risk factors of depression and CHF will be given (Norra et al. 2008) with main regard on the recent work. Results: Concerning depression profiles, conventional cut-off-scores of rating instruments were analysed and have to be newly discussed in cardiologic patients (Forkmann et al. 2009). Further, depressed inpatients versus cardiologic inpatients with depression (Norra et al. in prep) showed differences on the cognitive-emotional aspects of depression (e.g. self-accusation, crying, social withdrawal) as opposed to great similarities (e.g. anergy, sleep disturbances). Here, sleep-related breathing disorders may also contribute to the depressive phenotype in CHF (Skobel, Norra et al. 2005). Interestingly, poor subjective sleep quality significantly predicts increased depressive symptoms in cardiac disease (Norra et al. in prep). Conclusions: Only early screening, diagnosis and treatment of subclinical/modified depression in CHF may prevent further deteriorating effects of this comorbid disease on the heart and brain. A multicenter trial ‘MyHeart’ (EU 6th framework, IST 507816) is ongoing with a special focus on potential cardiac markers and depressive symptoms. [Copyright &y& Elsevier]

Although various instruments for the assessment of depression are available, substantial psychometric problems like multidimensionality or dependence on sample characteristics have been demonstrated. Here, modern test theories, e.g. Rasch Analysis, offer new directions of assessments. So far, Rasch analysis has been applied to the evaluation of diagnostic tools for depression, though neither a concise rating instrument is available consequently using Rasch methodology nor an integration with Structural Equation Modelling (SEM). Therefore, two parallel 10 item depression questionnaires of Depression Screening Version (DESC) were developed by combining Rasch analysis and SEM. Both scales were based on previously established Rasch homogeneous item bank for depression (N=367) and proved one-dimensionality according to Rasch and SEM analyses, justifying total score interpretation of the DESC. The new data of 333 patients suffering from psychic disorder including depression as well as different somatic disorder were included for a first psychometric evaluation. Both DESC versions feature different but highly correlated item sets. Cut-off scores with good sensitivity (0.82, 0.81) and specificity (0.78, 0.77) for the diagnosis of an depressive syndrome were developed with ROC analyses. Sensitivity was even superior to the Beck Depression Inventory (BDI). No serious Differential Item Functioning in Rasch analyses for both scales was found. The DESC represents a short screening instrument for depressive symptoms in two parallel versions with highly sufficient psychometric quality. Particularly clinicians, who aim at screening diverse samples of patients within a limited time frame or repeatedly during the course of their diseases, will benefit from this new screening instrument. [Copyright &y& Elsevier]

Standardization in psychiatry is a developmental process which, following on from psychopathology and nosology is now increasingly affecting the field of treatment. The development of guidelines for the treatment of psychiatric diseases has now become well accepted, although the impact on routine practice is still limited. Treatment pathways bring recommendations from guidelines into a clear and practice-oriented algorithm. The prerequisite for this is the inclusion of all aspects and elements of the treatment as well as all professions involved in the treatment and a valid electronic data processing foundation. Such an approach is presented here with the example of the development and implementation of a clinical pathway for inpatients with schizophrenia. Initial results revealed that patients who received multi-professional treatment within such a clinical pathway, improved better than patients of the control group, as measured by CGI, PANSS and PSP. This shows that introduction of a clinical pathway leads to an improvement of treatment quality. Standardization of psychiatric treatment processes could be highly relevant in respect to the new remuneration system for psychiatry in Germany. [ABSTRACT FROM AUTHOR]

Hintergrund: Schlafbezogene Atmungsstörungen gehen neben einer erheblichen Störung der Befindlichkeit auch mit dem Risiko für ernsthafte Gesundheitsfolgen, einschließlich psychischer Erkrankungen einher. Zustätzlich liegen bei Menschen mit psychischen Erkrankungen vermehrte Risikofaktoren für das Auftreten schlafbezogener Atmungsstörungen vor. Ziel der Untersuchung war es, nun erstmals für Deutschland die Prävalenz der obstruktiven Schlafapnoe (OSAS) als häufigster Form der schlafbezogenen Atmungsstörungen bei Patienten mit psychiatrischen Krankheitsbildern zu erheben.Methodik: An 10 Kliniken im Bundesgebiet und einer Einrichtung in der Schweiz wurde bei insgesamt 249 Probanden, die sich als stationäre Patienten in den jeweiligen psychiatrischen Kliniken befanden, ein Schlafapnoescreening durchgeführt.Ergebnisse: Mit einem auffälligen Screeningergebnis bei 23,7 % der Probanden war eine hohe Prävalenz hinsichtlich des Vorliegens schlafbezogener Atmungsstörungen zu verzeichnen. Männliches Geschlecht, höheres Alter und hoher BMI erwiesen sich als wesentliche Risikofaktoren für die Detektion eines OSAS.Diskussion: Obwohl das Schlafapnoesyndrom zu ausgeprägten Störungen der Befindlichkeit führen kann und unbehandelt mit ernsthaften somatischen Gesundheitsfolgen einhergeht, gehört eine diesbezügliche schlafmedizinische Diagnostik gegenwärtig nicht zur diagnostischen Routine an psychiatrischen Krankenhäusern, sodass schlafbezogene Atmungsstörungen bei dieser Patientengruppe vermutlich häufig nicht diagnostiziert werden. Mit Blick auf die Ergebnisse dieser und vorhergehender Studien sollte dieser Themenkomplex Gegenstand weiterer Forschung sein. [ABSTRACT FROM AUTHOR]

Background: Despite of the undisputed impact of education quality on becoming a specialist in psychiatry and psychotherapist, systematic studies in this field do not exist in Germany, apart from the evaluation of practical education by the medical councils. Materials and Methods: The Akademie-OWL, an education union of psychiatric clinics in the East Westphalia region of Germany, has provided 12-item questionnaire-based routine evaluations of theoretical education seminars since 2009. Seminars are held by consultants of psychiatry and psychotherapy within six separate weeks over a period of four years. All lecturers receive feedback from the evaluation. The results of this ongoing evaluation are presented using a typical example and in an aggregated format as a time series on the basis of one global item. Results: The data show that (1) the full range of a five-point Likert scale is used by the candidates, (2) psychiatric competences of the lecturers are more positively evaluated than their didactic competences, (3) neither within the four-years period of psychiatric education nor between different generations of candidates are systematic changes of evaluation results observed, and (4) minor to moderate differences of evaluation were observed between the different thematic fields of psychiatry and psychotherapy. Discussion: These results indicate the need of more systematic education research on establishing valid and reliable specific instruments as well as the need of systematic training of didactic competences of teaching consultants. [ABSTRACT FROM AUTHOR]

Introduction: Adjunctive treatment with supraphysiological doses of levothyroxine (L-T4 ) in bipolar depression shows promise, but the neurobiological mechanisms underlying clinical improvement are unknown. It has been postulated from animal studies that exogenous thyroid hormones may exert their modulatory effects in patients with affective disorders via an increase in serotonergic neurotransmission. Therefore, we investigated the loudness dependence of auditory evoked potentials (LDAEP) as a measure of central serotonergic activity and response to L-T4. Methods: This 6-week, double-blind, randomized, placebo-controlled study assessed the effi cacy of L-T4 adjunctive to continuing treatment with mood stabilizer and/or antidepressant medication in 20 patients with bipolar depression. LDAEP was assessed before and after treatment with L-T4. Results: Scores of the Hamilton Depression Rating Scale and Montgomery Asberg Depression Rating Scale decreased significantly during the study. There was no difference in pre- and posttreatment LDAEP between the groups, and no correlation between LDAEP and psychometric measures in the course of the study. Discussion: The hypothesis of a relationship between response of augmentation therapy with levothyroxine in bipolar depression and serotonergic activity could not be confirmed. [ABSTRACT FROM AUTHOR]

The article provides information on a study that demonstrated alterations of physiological parameters relevant for depression over a continuous and complete monitoring period of six weeks. Variations of circadian activity profiles and sleep patterns were altered in various somatic and neuropsychiatric disorders. It evaluates the course of a depressive episode in a group of in-patients during their treatment in hospital. It reveals the results of the study.

Background: The study aimed at presenting normative data for both parallel forms of the "Rasch-based Depression Screening (DESC)", to examine its Rasch model conformity and convergent and divergent validity based on a representative sample of the German general population.Methods: The sample was selected with the assistance of a demographic consulting company applying a face to face interview (N = 2509; mean age = 49.4, SD = 18.2; 55.8% women). Adherence to Rasch model assumptions was determined with analysis of Rasch model fit (infit and outfit), unidimensionality, local independence (principal component factor analysis of the residuals, PCFAR) and differential item functioning (DIF) with regard to participants' age and gender. Norm values were calculated. Convergent and divergent validity was determined through intercorrelations with the depression and anxiety subscales of the Hospital Anxiety and Depression Scale (HADS-D and HADS-A).Results: Fit statistics were below critical values (< 1.3). There were no signs of DIF. The PCFAR revealed that the Rasch dimension "depression" explained 68.5% (DESC-I) and 69.3% (DESC-II) of the variance, respectively which suggests unidimensionality and local independence of the DESC. Correlations with HADS-D were rDESC-I = .61 and rDESC-II = .60, whereas correlations with HADS-A were rDESC-I = .62 and rDESC-II = .60.Conclusions: This study provided further support for the psychometric quality of the DESC. Both forms of the DESC adhered to Rasch model assumptions and showed intercorrelations with HADS subscales that are in line with the literature. The presented normative data offer important advancements for the interpretation of the questionnaire scores and enhance its usefulness for clinical and research applications. [ABSTRACT FROM AUTHOR]