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Substance use is a significant factor associated with new arrests, detentions and compulsory admissions for patients in forensic assertive community teams (FACT). To enhance community tenure for forensic patients and facilitate their sustainable integration into society, a treatment that offers a community-based alternative to admission following substance use was developed. In this paper, the development of the project, FENIX + is described along with the reporting of a pilot study of all included patients during 12 months (N = 24). Recidivism risk and community integration were assessed utilizing the Short-Term Risk Assessment and Treatability (START) as well as the Measurements in Addiction for Triage and Evaluation (MATE) scales. The included patients avoided 60% of admissions, exhibited positive changes in their desire for assistance, and successfully reduced their risk of recidivism. By accessing the community-based alternative, they were able to delay admissions effectively. These promising results suggest that a community-based treatment could benefit patients at risk of reoffending following substance use. [ABSTRACT FROM AUTHOR]

Background: Depression is generally perceived from the perspective of the common‐cause disease model. However, the network perspective assumes mutual influence of individual symptoms and stresses the importance of investigating symptom dynamics. Gaining a better understanding of symptom dynamics within individuals might contribute to more effective treatments. Methods: Current exploratory longitudinal research studied the associations and directionality between 43 symptoms from the generic questionnaire Symptom Questionnaire‐48 (SQ‐48) using dynamic time warp (DTW) analyses, in which trajectories with similar time‐dependent patterns can be identified. Data from individuals were analysed first, yielding distance matrices for all symptom trajectories, after which the data were aggregated. Results: The 148 included patients were all admitted for the treatment of their clinical depression. Undirected DTW analyses of three patients with longer time series but otherwise randomly chosen showed large variability among individuals. Group‐level undirected DTW analyses showed numerous significant edges between symptoms, largely clustering symptoms according to the eight pre‐existing subscales of the SQ‐48. Group‐level directed DTW analyses showed five symptoms with significant outstrength: 'hopeless', 'restless', 'down/depressed', 'feeling tense' and 'no enjoyment', meaning that change in these key symptoms preceded change in other symptoms. Limitations: The 43 included symptoms of the SQ‐48 primarily focus on internalizing problems in severely depressed inpatients, potentially limiting generalizability. Conclusions: DTW networks provided us with five key symptoms based on the dynamics of symptom scores. Future studies could explore whether process‐based therapy targeted at symptoms with high outstrength might result in more effectivity as part of personalized treatment. [ABSTRACT FROM AUTHOR]

Psychomotor slowing has consistently been observed in schizophrenia, however research on motor learning in schizophrenia is limited. Additionally, motor learning in schizophrenia has never been compared with the waning of motor learning abilities in the elderly. Therefore, in an extensive study, 30 individuals with schizophrenia, 30 healthy age-matched controls and 30 elderly participants were compared on sensorimotor learning tasks including sequence learning and adaptation (both explicit and implicit), as well as tracking and aiming. This paper presents new findings on an explicit motor sequence learning task, an explicit verbal learning task and a simple aiming task and summarizes all previously published findings of this large investigation. Individuals with schizophrenia and elderly had slower Movement Time (MT)s compared with controls in all tasks, however both groups improved over time. Elderly participants learned slower on tracking and explicit sequence learning while individuals with schizophrenia adapted slower and to a lesser extent to movement perturbations in adaptation tasks and performed less well on cognitive tests including the verbal learning task. Results suggest that motor slowing is present in schizophrenia and the elderly, however both groups show significant but different motor skill learning. Cognitive deficits seem to interfere with motor learning and performance in schizophrenia while task complexity and decreased movement precision interferes with motor learning in the elderly, reflecting different underlying patterns of decline in these conditions. In addition, evidence for motor slowing together with impaired implicit adaptation supports the influence of cerebellum and the cerebello-thalamo-cortical-cerebellar (CTCC) circuits in schizophrenia, important for further understanding the pathophysiology of the disorder. [ABSTRACT FROM AUTHOR]

Background: The Cultural Formulation Interview (CFI) is designed to improve understanding of patients’ mental health care needs. The lack of empirical evidence on the impact and effectiveness of CFI use in clarifying people’s perspectives, experiences, context, and identity, and in preventing cultural misunderstandings between migrant patients and clinicians, inspired this study. The objective is to examine the effect of the CFI on the strength of therapeutic working alliances, and the potential mediating or moderating role of perceived empathy. Materials and methods: A multicenter randomized controlled trial will be conducted, involving migrant patients, their confidants, and clinicians. The CFI will be administered in the intervention group, but not in the control group. Validated questionnaires will be used to assess therapeutic working alliances and perceived empathy. T-tests and linear regression analyses will be conducted to investigate between-group differences and possible mediating or moderating effects. Results: This study will indicate whether or not the CFI strengthens the therapeutic working alliance between patients and clinicians, as moderated and/or mediated by perceived empathy. Discussion: Research on the effect and impact of using the CFI in mental health care for migrant patients is important to clarify whether its use strengthens the therapeutic working alliance with clinicians. This can lead to a reduction in cultural misunderstandings and improve mental health care for migrant patients. The results may also be important for the implementation of the CFI as a standard of care. Ethics and dissemination: This research protocol was tailored to the needs of patients in collaboration with experts by experience. It was approved by the Ethical Review Board of the Tilburg Law School and registered in the Clinical Trials Register under number NCT05788315. Positive results may stimulate further implementation of the CFI in clinical practice, and contribute to improving the impact of the CFI on the therapeutic working alliances. [ABSTRACT FROM AUTHOR]

Non-adherence to medication significantly affects bipolar disorder outcomes. Long-Acting Injectable antipsychotics show promise by ensuring adherence and averting relapses. This narrative review sought to evaluate the efficacy of second-generation injectable antipsychotics in bipolar disorder through searches in Embase, MEDLINE, and PsycInfo for randomized controlled trials and mirror-image studies. Risperidone and aripiprazole Long-Acting Injectables demonstrated effectiveness in preventing mood recurrences compared to placebos in adults with bipolar disorder. They showed superiority in preventing mania/hypomania relapses over placebos but did not appear to significantly outperform active oral controls. Notably, active controls seem to be more effective in preventing depression relapses than Long-Acting Injectables. Mirror-Image studies point toward the reduction of hospitalization rates following LAI initiation. The available evidence points thus toward the efficacy of LAIs, especially in managing manic episodes and reducing hospitalizations, The current evidence does not however immediately support prioritizing LAIs over oral medications in bipolar disorder treatment. More high-quality studies, especially comparing LAIs directly with active controls, are crucial to gain a comprehensive understanding of their efficacy. These findings highlight the need for further research to guide clinicians in optimizing treatment strategies for bipolar disorder. [ABSTRACT FROM AUTHOR]

Major depressive disorder remains a major challenge due to its biopsychosocial burden with increased morbidity and mortality. Despite successful treatment options for the acute episode, recurrence rates are high, on average four times in a life span. Both pharmacological as non-pharmacological evidence-based therapeutic options to prevent and treat recurrent depression are discussed. Although some risk factors for recurrence are well known, better evidence is needed. Antidepressant medication should be continued after acute treatment at its full therapeutic dose for longer periods, at least 1 year. There are no clear differences between classes of antidepressant medication when treatment is focused on preventing relapse. Bupropion is the only antidepressant with a proven efficacy to prevent recurrence in seasonal affective disorder. Recent findings conclude maintenance subanesthetic ketamine and esketamine treatment can be effective in sustaining antidepressant effect following remission. Furthermore, the pharmacological approach must be integrated with lifestyle interventions, especially aerobic exercise. Finally, combining pharma- and psychotherapy seems to improve outcome. Network and complexity sciences will help to decrease the high recurrence rates of MDD by developing more integrative and personalized approaches. [ABSTRACT FROM AUTHOR]

Background: Despite a high prevalence of mental disorders among asylum seekers, many barriers to mental healthcare exist. Cultural and contextual factors strongly influence the experience and expression of psychological distress, putting asylum seekers at greater risk of misdiagnosis and inappropriate treatment. The Cultural Formulation Interview (CFI) is a useful tool to map out cultural and contextual factors of mental disorders; however, to the best of our knowledge, it has not yet been investigated in asylum seekers specifically. The primary aim of this study is to evaluate the value of the CFI in the psychiatric assessment of asylum seekers. Second, we will describe the themes relevant to psychiatric distress in asylum seekers that are identified by the CFI. In addition, asylum seekers' experience of the CFI will be evaluated. Methods and analysis: This cross-sectional, mixed-method clinical study aims to recruit a group of 60-80 asylum seekers (age 15-29) with mental health symptoms. Data will be collected using structured (MINI, PCL-5, HDRS-17, WHOQoL-BREF & BSI) and semi-structured (CFI & CFI-debriefing) questionnaires to assess cultural background, contextual factors, and illness severity. Multidisciplinary case discussions will be held after the completion of interviews, following a methodological stepped approach. Combining qualitative and quantitative research techniques, this study aims to generate reliable knowledge on working with the CFI in asylum seekers. Based on the findings, recommendations for clinicians will be developed. Discussion: This study addresses the knowledge gap on using the CFI in asylum seekers. Compared to prior studies, it will provide new insights into the use of the CFI in the specific context of working with asylum seekers. Ethics and dissemination: Prior research on the CFI in asylum seekers is limited, partly because of their high vulnerability and low access to care. The study protocol has been tailored in close collaboration with several stakeholders and validated after piloting. Ethical approval has already been obtained. Together with the stakeholders, the results will be translated into guidelines and training materials. Recommendations to policymakers will also be provided. [ABSTRACT FROM AUTHOR]

While attention has been given to maladaptive personality traits in the sexual offending literature, little is known about how individuals who engage in child sexual abuse (CSOs) score on general personality traits, and how subgroups of CSOs vary in these traits. This study investigated general personality traits of (subgroups of) CSOs (n=57) as compared to those who engage in nonsexual offending (n=33) and nonoffending controls (n=36) by using the HEXACO model and the Reinforcement Sensitivity Theory. Results revealed that the personality features of the CSOs are more similar to those of the nonoffending subgroup than to those of the nonsexual offending subgroup. Whereas the nonsexual offending subgroup showed personality traits that may affect their self-regulatory abilities, the CSOs showed traits that may impair their socio-affective functioning. However, the subgroup of CSOs that showed an enduring pattern of offending did display a constellation of personality traits typically found in antisocial individuals. These findings can inform treatment strategies for CSOs. Practice impact statement This article assists clinicians in designing tailored treatment strategies for individuals who perpetrate sexual offences against children (CSOs) by identifying how CSOs score on general personality traits. In contrast to nonsexual offenders who showed personality traits that may affect their self-regulatory abilities, CSOs showed personality traits that may affect their socio-affective functioning. This highlights the importance of addressing problems in the socio-affective domain such as intimacy deficits and emotional regulation difficulties in treatment programmes for CSOs. The present research also revealed personality differences within CSOs and showed how these differences should be taken into account when designing treatment strategies for CSOs. [ABSTRACT FROM AUTHOR]

Self-regulation problems are critically involved in the onset and the maintenance of sexual offending behavior against children. Studying the neuropsychological underpinnings of these problems could help deepen our understanding of this contributing factor and, thus, of sexual offending behavior. Whereas most studies have examined executive functioning in relation to self-regulation problems in individuals convicted of sexual offenses against children (ISOCs), this review aimed to provide an overview of what is known about another process that is involved in self-regulation, that is reinforcement learning. The results of this review suggested that ISOCs are impaired in their ability to acquire and reverse stimulus-reward and stimulus-punishment associations relative to nonoffender controls, but similar to a control group of individuals convicted of nonsexual violent offenses. These reinforcement learning impairments were found to be more pronounced in nonpedophilic ISOCs than in pedophilic ISOCs. By paving the way towards a deeper understanding of the self-regulation problems seen in ISOCs, this review can help guide treatment strategies for ISOCs. [ABSTRACT FROM AUTHOR]

Introduction: Chronic low-grade inflammation is suggested to play a pathophysiological role in bipolar disorder (BD) and its related cognitive dysfunctions. Although kynurenine (KYN) pathway metabolites are key inflammatory mediators, studies investigating the association between KYN metabolism and cognition in BD are scarce. We aimed to explore the relationship between KYN metabolism and cognitive functioning across different mood states in BD. Methods: Sixty-seven patients with BD (35 depressed and 32 [hypo] manic) and 29 healthy controls were included. Cognitive functioning was assessed at 3 time intervals (baseline, 4, and 8 months) assessing processing speed, sustained attention, verbal memory, working memory, and response inhibition. Plasma samples for quantification of 3-hydroxykynurenine, quinolinic acid, and kynurenic acid (KYNA) were concurrently provided. Linear mixed models were used for statistical analysis. Results: The manic group showed deficits in all assessed cognitive domains with the exception of verbal memory at all test moments. The bipolar depression group showed deficits in the processing speed at all test moments. Throughout the whole follow-up period, KYNA was significantly lower in both patient groups than in controls. Only in the bipolar depression group, low KYNA was associated with worse global cognitive functioning (B = 0.114, p = 0.02) and slower processing speed in particular (B = 0.139, p = 0.03). Conclusion: Only in the bipolar depression group, lower KYNA was associated with worse cognitive functioning. Future large-scale longitudinal studies are warranted to confirm the role of KYN metabolites in cognitive impairment in patients with BD and the possible therapeutic implications of this relationship. [ABSTRACT FROM AUTHOR]

Background: The "cognitive dysmetria hypothesis" of schizophrenia proposes a disrupted communication between the cerebellum and cerebral cortex, resulting in sensorimotor and cognitive symptoms. Sensorimotor adaptation relies strongly on the function of the cerebellum. Objectives: This study investigated whether sensorimotor adaptation is reduced in schizophrenia compared with age-matched and elderly healthy controls. Methods: Twenty-nine stably treated patients with schizophrenia, 30 age-matched, and 30 elderly controls were tested in three motor adaptation tasks in which visual movement feedback was unexpectedly altered. In the "rotation adaptation task" the perturbation consisted of a rotation (30° clockwise), in the "gain adaptation task" the extent of the movement feedback was reduced (by a factor of 0.7) and in the "vertical reversal task," up- and downward pen movements were reversed by 180°. Results: Patients with schizophrenia adapted to the perturbations, but their movement times and errors were substantially larger than controls. Unexpectedly, the magnitude of adaptation was significantly smaller in schizophrenia than elderly participants. The impairment already occurred during the first adaptation trials, pointing to a decline in explicit strategy use. Additionally, post-adaptation aftereffects provided strong evidence for impaired implicit adaptation learning. Both negative and positive schizophrenia symptom severities were correlated with indices of the amount of adaptation and its aftereffects. Conclusions: Both explicit and implicit components of sensorimotor adaptation learning were reduced in patients with schizophrenia, adding to the evidence for a role of the cerebellum in the pathophysiology of schizophrenia. Elderly individuals outperformed schizophrenia patients in the adaptation learning tasks. [ABSTRACT FROM AUTHOR]

Introduction: Currently cancer-related cognitive impairment (CRCI) is mainly assessed by means of questionnaires, which is very laborious for the patients and the supervising physician. We evaluated a new online cognitive assessment tool, the MyCognition Quotient (MyCQ, Cambridge) in breast cancer survivors with CRCI, and compared the results with a psychometric test measuring cognitive complaints, depression, and anxiety. Materials and methods: In this prospective study, 46 adult patients between 18 and 70 years old with a diagnosis of BC were studied, all complaining of disturbing cognitive impairment. They participated in a physical cognitive rehabilitation program. The patients had an online cognitive assessment (MyCQ Med by MyCognition) every 4 weeks on their home computer. In addition patients were assessed in the outpatient clinic by the principal investigator at baseline, after 3 and 6 months using the following validated neuro-psychological surveys: the Hospital Anxiety and Depression Scale (HADS), Beck Cognitive Insight Scale (BCIS), and Cognitive Failure Questionnaire (CFQ). MyCQ scores were correlated with the results of these surveys. Results: Only weak correlations could be found between overall MyCQ or the MyCQ subtests with the psychometric tests (between − 0.43 and 0.458) at baseline and when combining data at time point 0, 3, and 6 months. Linear mixed models showed there was a significant association between Latency Choice Reaction Time and CFQ (continuous; p = 0.026). An AUC of 0.640 and a cut-off of 481.5 ms in Latency Choice Reaction Time were found to distinguish patients with CFQ below 44 to patients with CFQ above 44 (sensitivity 0.63 and specificity 0.73). In Latency Coding an AUC of 0.788 and a cut-off of 1316 ms were found to distinguish non-depressive patients from patients likely to present with depressive symptoms (sensitivity 0.75 and specificity 0.76). Conclusion: MyCQ cannot replace the various psychometric tests. However, abnormal Latency in cognitive tests, Choice Reaction Time and Coding, seems promising to be used as a screening tool to detect specific aspects of abnormal cognitive functioning in patients with cognitive complaints and depressive symptoms. [ABSTRACT FROM AUTHOR]

Introduction: The neurobiological mechanisms underlying the acute cognitive effects of electroconvulsive therapy (ECT) remain poorly understood. Prior research has shown that proinflammatory cytokines such as IL-6, TNF-α, IL1-β, and IL-10 may interfere with cognitive functioning. Interestingly, immunomodulation is one of the proposed modes of action of ECT. This study investigates whether changes of peripheral levels of IL-6, TNF-α, IL1-β, and IL-10 are related to changes in cognitive functioning following ECT. Methods: In the week before and 1 week after an acute course of ECT, 62 patients suffering from depression underwent a neuropsychological evaluation to assess their processing speed using the Symbol Digit Substitution Test (SDST), verbal episodic memory using the Hopkins Verbal Learning Test-Revised (HVLT-R), and their retrospective autobiographic memory using the Autobiographical Memory Interview (AMI) with the peripheral inflammatory markers being measured at the same 2 time points. Results: Patients improved drastically following ECT, while their main performance on both the HVLT-R and AMI declined and their SDST scores remained stable. The levels of IL-6 and IL1-β had both decreased, where the decrease in IL-6 was related to the decrease in HVLT-R scores. Higher baseline IL-10 levels were associated with a more limited decrease of the HVLT-R scores. Conclusion: Our findings tentatively suggest that the effects of ECT on verbal episodic memory may be related to the treatment's immunomodulatory properties, most notably due to decreased IL-6 levels. Moreover, baseline IL-10 appears to be a potential biomarker to predict the effects of ECT on verbal episodic memory. Whilst compelling, the results of this study should be interpreted with caution as, due to its exploratory nature, no correction for multiple comparisons was made. Further, a replication in larger cohorts is warranted. [ABSTRACT FROM AUTHOR]

• Awareness of illness is positively associated with suicidality. • Demoralization fully mediated between awareness of illness and suicidality. • Recognition and treatment of demoralization in schizophrenia is important. The lifetime risk of suicide is significantly higher in patients with schizophrenia than in the general population. It has been suggested that insight is an important risk factor for suicidality in schizophrenia, but only in the presence of feelings of hopelessness and demoralization more generally. This study set out to investigate these assumptions in a sample of patients diagnosed with schizophrenia (n = 81) with the Structured Clinical Interview for DSM-IV Axis I. We hypothesized that there would be a positive association between insight in schizophrenia, measured by the Insight Scale for Psychosis, and suicidality among these patients, measured by the Beck Scale for Suicide Ideation. Furthermore, we expected demoralization, measured by the Demoralization Scale, to mediate the association between insight and suicidality. With regard to the association between insight and suicidality, only the dimension awareness of illness was significantly positively associated with suicidality (r =.34, p ≤.01**). Demoralization fully mediated the relationship between awareness of illness and suicidality (Sobel test z = 1.93, p <.05). This was a cross-sectional study in a relatively small sample, based on self-report questionnaires only. This study emphasizes the importance of recognizing and treating demoralization features in schizophrenia. [ABSTRACT FROM AUTHOR]

Prior studies suggest that persons with a sexual offense against a child (PSOCs) present with an impairment in learning from reinforcement, which may contribute to the behavioral dysregulation often seen in PSOCs. Therefore, gaining more insight into the nature of this impairment seems essential to better understand child sexual (re)offending. Using a passive avoidance task, we found that PSOCs (n = 57) have difficulties with selecting behaviors that are associated with reward and suppressing behaviors that are associated with punishment relative to nonoffending men (n = 33), but not compared with persons with a nonsexual offense history (n = 31). The latter ability was particularly compromised in nonpedophilic PSOCs. By unraveling a source of pathology in the mechanisms that are involved in behavioral control, this study helps setting a step toward new, more tailored, therapeutic approaches. [ABSTRACT FROM AUTHOR]

Background: Although differences in symptom profiles and outcome between depressive patients with an underlying major depressive disorder (MDD) and bipolar depression (BD) have been reported, studies with sequential short-interval assessments in a real-life inpatient setting are scarce. Objectives: To examine potential differences in symptom profile and course of depressive symptomatology in depressive inpatients with underlying MDD and BD. Methods: A cohort of 276 consecutive inpatients with MDD (n = 224) or BD (n = 52) was followed during their hospitalization using routine outcome monitoring (ROM), which included a structured diagnostic interview at baseline (Mini-International Neuropsychiatric Interview Plus [MINI-Plus]) and repeated 17-item Hamilton Depression Rating Scale every 2 weeks. MDD and BD were compared regarding their symptom profiles and time to response and remission. Furthermore, the concordance between the MINI-Plus and clinical diagnosis was analyzed. Results: Patients were on average 52 and 47 years old in the MDD and BD group, respectively, and 66 versus 64% were female. Compared to patients with BD, patients with MDD scored higher on weight loss (p = 0.02), whereas the BD group showed a higher long-term likelihood of response (hazard ratio = 1.93, 95% confidence interval 1.16–3.20, p for interaction with time = 0.04). Although the same association was seen for remission, the interaction with time was not significant (p = 0.48). Efficiency between the MINI-Plus and clinical diagnosis of BD was high (0.90), suggesting that the MINI-Plus is an adequate ROM diagnostic tool. Conclusions: In routine clinical inpatient care, minor differences in the symptom profile and the course of depressive symptomatology may be helpful in distinguishing MDD and BD, particularly when using sequential ROM assessments. [ABSTRACT FROM AUTHOR]

Since the introduction of DSM-III anhedonia has become a core depressive criterion and is defined as the loss of interest or pleasure. Although the origin of the word goes back to the end of the 19th century and numerous anhedonic symptoms are described in classic texts on depression, this centrality in the diagnosis of depression is only recent. Anhedonia is best described as a symptom complex with unclear boundaries cutting across the tripartite model of the mind (affect, volition, and cognition). Popular concepts of anhedonia pertain to the pleasure cycle and positive affectivity. These concepts partially overlap and are often mixed up, but clearly stem from different theoretical backgrounds: the affective science of reward processing versus more general, dimensional modelling of affect. The former concept seems more suitable to understand anhedonic emotions, the latter more suitable to understand anhedonic mood or trait. This narrative review covers the history of "anhedonia," the different anhedonic phenomena, and psychopathological concepts. An attempt is made to go beyond a merely descriptive psychopathology. Neurobiological and psychological insights shed a light on how symptoms are made and interconnected; these insights possibly call for a new psychopathological language. [ABSTRACT FROM AUTHOR]

Objective: To examine the relationship between childhood trauma and the response to group cognitive-behavioural therapy (GCBT) for chronic fatigue syndrome (CFS). Methods: A single cohort study conducted in an outpatient university referral center for CFS including a well-documented sample of adult patients meeting the CDC criteria for CFS and having received 9 to 12 months of GCBT. A mixed effect model was adopted to examine the impact of childhood trauma on the treatment response in general and over time. The main outcome measures were changes in fatigue, as assessed with the Checklist Individual Strength (total score), and physical functioning, as gauged with the Short Form 36 Health Survey subscale, with the scales being completed at baseline, immediately after treatment completion and after 1 year. Results: We included 105 patients with CFS. Childhood trauma was not significantly associated with the response to GCBT over time on level of fatigue or physical functioning. Conclusion: Childhood trauma does not seem to have an effect on the treatment response to dedicated GCBT for CFS sufferers over time. Therefore, in the allocation of patients to this kind of treatment, a history of childhood trauma should not be seen as prohibitive. [ABSTRACT FROM AUTHOR]

Children with complex needs require coordinated care and collaboration between the different sectors in child mental health care. These needs and service issues are individually defined and therefore challenging for the mental health system to respond effectively. Different barriers at the organizational and policy level to initiate and maintain collaborative relationships are reported. This research explores the reality of working with a protocol for collaboration (Client Network Consultation (CNC)) by questioning the experiences of adolescents, parents, and practitioners. A qualitative design with semistructured individual interviews is used, guided by the questions from the Wraparound Fidelity Index. Useful and practical insights on effective collaboration result from the in-depth analysis of the interviews. A neutral chairperson, the presence of specialist practitioners, visualization, participation of adolescents, and parents are among the effective elements reported. Some challenges remain; the principle of equality, monitoring the action points resulting from the collaboration and effective crisis management seem very difficult to fully achieve in practice. These results present experiences from adolescents, parents, and practitioners to support an effective collaborative process for working together with children and families with complex needs. [ABSTRACT FROM AUTHOR]

Introduction: Electroconvulsive therapy (ECT) influences the concentration of peripheral inflammatory markers, such as interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α). In which way this immune effect contributes to the impact of ECT on the central nervous system in depression remains unknown. Objective: The aim of this study was to examine whether the hippocampal volumetric increase in depressed patients treated with ECT is related to changes in peripheral IL-6 and TNF-α levels. Methods: IL-6 and TNF-α plasma levels were measured in 62 patients 1 week before and after an acute course of ECT. Hippocampal volumes were analyzed in a magnetic resonance imaging (MRI) subsample of 13 patients at the same time points. Results: A significant decrease in IL-6 levels was observed in the total sample and a significant increase in hippocampal volume in the MRI subsample. The reduction of peripheral IL-6 correlated with an increase in total hippocampal volume. A more limited decrease of TNF-α correlated with a more limited increase of both the total and left hippocampus volumes. Conclusion: This pilot study is the first to highlight the link between peripheral immune changes and hippocampal volume increase following ECT. Further research is required to conclude whether ECT indeed exerts its central effect on the brain via changes of peripheral inflammatory markers. [ABSTRACT FROM AUTHOR]

Objective: In DSM-5, Section III, the Level of Personality Functioning (LPF) was proposed as a severity index of personality disorders (PDs), but as it reflects both trait-like (availability) and state-like (accessibility) features, of which, moreover, the relationship with the experience of patients is unclear, we critically examined LPF in patients with general psychopathology. Method: This study compared the validity of the direct Inventory of Personality Organization (IPO), and the indirect Differentiation-Relatedness Scale (DRS) LPF-measure, in relation to measures of intrapersonal and interpersonal functioning. The sample consisted of 70 inpatients with general psychopathology and no primary PDs. Associations of both measures with DSM-PDs were examined, with and without controlling for clinical distress. Results: The IPO was significantly related to age and clinical distress. When controlling for clinical distress, the IPO was still associated with cluster A (odd) and B (erratic) PD features, high levels of self-criticism, conflict in relationships and low levels of adaptive coping strategies. The DRS was only related to the schizotypical PD. Conclusions: In patients with general psychopathology, both the IPO and the DRS, appear to have limitations in measuring LPF. The IPO seems to be prone to state effects, although correlations with PDs remained significant when controlling for clinical distress. The DRS seemed to be more independent from clinical distress but was unexpectedly unrelated to features of personality pathology. DRS reflects availability, while IPO also reflects different degrees of accessibility of LPF in PDs. [ABSTRACT FROM AUTHOR]

Objectives: Cytokines are thought to contribute to the pathogenesis of psychiatric symptoms by kynurenine pathway activation. Kynurenine metabolites affect neurotransmission and can cause neurotoxicity. We measured inflammatory markers in patients with bipolar disorder (BD) and studied their relation to kynurenine metabolites and mood. Methods: Patients with BD suffering from an acute mood episode were assigned to the depressive (n = 35) or (hypo)manic (n = 32) subgroup. Plasma levels of inflammatory markers [cytokines, C‐reactive protein] and kynurenine metabolites [tryptophan (TRP), kynurenine (KYN), 3‐hydroxykynurenine (3‐HK), quinolinic acid (QA), kynurenic acid (KYNA)] were measured on 6 time points during 8 months follow‐up. Biological marker levels in patients were compared to controls (n = 35) and correlated to scores on mood scales. Spearman correlations and linear mixed models were used for statistical analysis. Results: Twenty patients of the manic subgroup, 29 of the depressive subgroup, and 30 controls completed the study. The manic subgroup had a rapid remission of mood symptoms, but in the depressive subgroup subsyndromal symptoms persisted. No differences in inflammation were found between groups. A strong correlation between tumor necrosis factor‐α and KYN, KYN/TRP, 3‐HK and QA (ρ > 0.60) was specific for the manic group, but only at baseline (during mania). The depressive subgroup had a lower neuroprotective ratio (KYNA/3‐HK, P =.0004) and a strong association between interferon‐y and kynurenine pathway activation (P <.0001). KYNA was low in both patient groups versus controls throughout the whole follow‐up (P =.0008). Conclusions: Mania and chronic depressive symptoms in BD are accompanied by a strong interaction between inflammation and a potentially neurotoxic kynurenine metabolism. [ABSTRACT FROM AUTHOR]

Objective: Different patterns of immune system upregulation are present in the acute vs. post-treatment states of psychotic illness. We explored the existence of state and trait markers in the peripheral immune system and two immune-associated neuroendocrine pathways (IDO and GTP-CH1 pathway) in a longitudinal sample of psychosis patients. We also evaluated the association of these markers with neuropsychiatric symptomatology. Method: Plasma concentrations of peripheral blood markers were measured in a transdiagnostic group of 49 inpatients with acute psychosis and 52 matched healthy control subjects. Samples were obtained in patients within 48 h after hospital admission for an acute psychotic episode (before initiation of antipsychotics), after 1–2 weeks and again after 8 weeks of treatment. Kynurenine, kynurenic acid (KA), 3-hydroxykynurenine (3-HK), quinolinic acid (QA), phenylalanine, tyrosine, nitrite, and neopterin were measured using HPLC and LC-MS/MS analysis. Concentrations of CRP, CCL2 (MCP1) and cytokines were determined with multiplex immunoassay. PANSS interviews and cognitive tests were performed at baseline and follow-up. Mixed model analyses were used to identify trait and state markers. Results: Patients had significantly higher plasma concentrations of CRP, CCL2, IL1RA, and lower concentrations of KA and KA/Kyn at all time points (F7.5–17.5, all p < 0.001). Increased concentrations of IL6, IL8, IL1RA, TNFα, and CCL2 and decreased QA and 3-HK (F8.7–21.0, all p < 0.005) were found in the acute psychotic state and normalized after treatment. Low nitrite concentrations at admission rose sharply after initiation of antipsychotic medication (F42.4, p < 0.001). PANSS positive scale scores during the acute episode correlated with pro-inflammatory immune markers (r ≥ |0.5|), while negative scale scores correlated inversely with IDO pathway markers (r ≥ |0.4|). Normalization of KA and 3-HK levels between admission and follow-up corresponded to a larger improvement of negative symptoms (r = 0.5, p < 0.030) A reverse association was found between relative improvement of SDST scores and decreasing KA levels (r = 0.5, p < 0.010). Conclusion: The acute psychotic state is marked by state-specific increases of immune markers and decreases in peripheral IDO pathway markers. Increased CRP, CCL2, and IL1RA, and decreased KA and KA/Kyn are trait markers of psychotic illness. [ABSTRACT FROM AUTHOR]

Background: To examine the association between childhood trauma and work functioning, and to elucidate to what extent this association can be accounted for by depression and/or anxiety. Methods: Data of 1,649 working participants were derived from the Netherlands Study of Depression and Anxiety (NESDA, n = 2,981). Childhood trauma (emotional neglect, psychological, physical, and sexual abuse before age 16) was assessed with a structured interview and work functioning, in terms of absenteeism and presenteeism, with the Health and Labor Questionnaire Short Form (SF-HLQ) and the World Health Organization Disability Assessment Schedule II (WHODAS-II), respectively. Depressive and/or anxiety disorders were assessed with the Composite Interview Diagnostic Instrument (CIDI). Mediation analyses were conducted. Results: At baseline, 44.8% reported to have experienced childhood trauma. Workers with the highest childhood trauma level showed significantly (p < 0.001) more absenteeism as well as more presenteeism. Mediation analyses revealed that indirect effects between the childhood trauma index and both work indices were significantly mediated by current depressive disorder (p = 0.023 and p < 0.001, respectively) and current comorbid depression-anxiety (p = 0.020 and p < 0.001, respectively), with the latter accounting for the largest effects (PM = 0.23 and PM = 0.29, respectively). No significant mediating role in this relationship was found for current anxiety disorder and remitted depressive and/or anxiety disorder. Conclusions: Persons with childhood trauma have significantly reduced work functioning in terms of absenteeism and presenteeism. This seems to be largely accounted for by current depressive disorders and current comorbid depression-anxiety. [ABSTRACT FROM AUTHOR]

Confronted with any kind of critical event, people tend to develop an urgent need for answers that provide a useful interpretation of what they experience as a painfully intruding disaster. This urge results from the often-unbearable suffering and the disruption of everyday life, routines, and relations. Moreover, dreams and aspirations one had for the future, the realization of which they perceived as important in leading a meaningful life, may be lost or have to be reconsidered. Accompanying feelings of disappointment, demoralization, or even desperation are often treated as symptoms of depression. This approach is called into question by the concept of demoralization, which points to the presence of healthy modes of functioning in a state of lucid awareness of one's condition. In this article, we focus on the case of schizophrenia, as we suppose that having to deal with recurring psychotic episodes constitutes such a pervasive experience, possibly leading to meaning deficiency. We propose then a treatment perspective that integrates care for the processes of mourning and of meaning making. This view, described here in the case of schizophrenic psychosis, is offered as a paradigm that can serve the approach to other serious conditions requiring prolonged care. [ABSTRACT FROM AUTHOR]

Background: Child molesters form a heterogeneous group, but one generally shared characteristic is maladaptive, rigid behaviour. Impairments in reinforcement learning may explain these maladaptive tendencies, but this has not been systematically investigated. Further, it is not known if such impairments vary with subtype of child molesters.Aims: To investigate the presence of impairments in reinforcement learning among child molesters and to test for differences in patterns of impairment with subtype.Methods: A group of 59 child molesters was recruited from several prisons in a two-stage screening process, the first using records and the second interview; a comparison group of 33 offenders who had never committed a sex offence and who denied paedophile ideation was similarly recruited; 36 nonoffender comparison men were recruited by social media and word of mouth. Each was asked to perform a probabilistic reversal learning task, in which stimulus-outcome contingencies had to be learned.Results: Child molesters, as a group, made significantly more errors on the probabilistic reversal learning task than the nonoffenders; the comparison offenders and the nonoffenders gained similar scores, although findings may have been confounded by older age in the child molester group. Nonpaedophilic child molesters had significantly worse scores than paedophilic child molesters.Conclusions: Child molesters, especially those not diagnosed with paedophilia, have deficits during both the acquisition and reversal of contingencies, suggesting reinforcement learning deficits that may undermine their capacity to benefit maximally from therapy without preliminary work to repair those deficits, possibly in conjunction with extending the offender programmes. Testing before programme entry would enable accurate targeting of scarce resources in this respect. [ABSTRACT FROM AUTHOR]

Objective: To investigate the potential role of the Maudsley Staging Method (MSM) in the prediction of electroconvulsive therapy (ECT) outcome in severely depressed adults. Method: Between August 2015 and August 2017, 73 consecutive patients with a major depressive episode (DSM‐IV‐TR) scheduled for ECT were recruited. Prior to their first ECT session, the MSM was completed to assess the level of therapy resistance. To determine the reduction in depression severity and response and remission rates, symptom severity was assessed at baseline and within one week after the last ECT session using the 17‐item Hamilton Depression Rating Scale (HDRS17). Results: The percentage of symptom reduction following ECT was best predicted by the MSM episode duration and depression severity factors (R2 completer sample 0.24). Episode duration alone was the best predictor of remission (area under the ROC curve for completers: 0.72). Adding age to the models increased their predictive capacity. Conclusion: An adapted version of the MSM gauging shorter episode duration, more severe depressive symptoms and older age is significantly associated with ECT effectiveness in adults with severe recurrent depression and is thus highly suitable for use in clinical practice, promoting the shared treatment decision‐making process. [ABSTRACT FROM AUTHOR]

Objective: To explore the correlations between observer ratings and instrumental parameters across domains of psychomotor functioning in depression. Method: In total, 73 patients with major depressive disorder underwent extensive psychomotor and clinical testing. Psychomotor functioning was assessed with (i) an observer-rated scale (the CORE measure) and also objectively with (ii) 24-h actigraphy, and (iii) a fine motor drawing task. Results: Observer ratings of retardation correlated with instrumental assessments of fine and gross motor functioning. In contrast, observer ratings of agitation did not correlate with observer ratings of retardation or with the instrumental measures. These associations were partly influenced by age and, to a lesser extent, by depression severity. Conclusion: Psychomotor disturbance is a complex concept with different manifestations in depressed patients. Although observer ratings of retardation correspond well with instrumental measures of the motor domains, objective measurement of agitation and other aspects of psychomotor disturbance require further research. [ABSTRACT FROM AUTHOR]

Heterogeneity in borderline personality disorder (BPD) drives the search for BPD subtypes to optimize the assessment and treatment of these patients. Therefore, the aims of the present study were (1) to replicate previously identified BPD subtypes based on reactive and regulative temperament; (2) to compare them on symptomatology and coping; and (3) to investigate whether these subtypes show different treatment responses after 3 months of inpatient dialectical behaviour therapy (DBT). A total of 145 BPD inpatients were assessed by means of measures of temperament, symptomatology and coping. Through model‐based clustering on the Behavioural Inhibition and Behavioural Activation Scales (BISBAS) and Effortful Control Scale (ECS), we identified three BPD subtypes: an Emotional/Disinhibited subtype (15%, high BAS and low ECS); a Low Anxiety subtype (41%, low BIS) and an Inhibited subtype (44%, low BAS). After 3 months of DBT, 75 patients completed the measures for a second time. Repeated measure ANOVAs demonstrated a general improvement on all symptoms and coping strategies. In addition, the BPD subtypes showed trajectory differences in clinical and borderline specific symptomatology and dissociation. These findings indicate that BPD subtypes based on temperament demonstrate different treatment responses, which can contribute to the search of more BPD subtype tailored treatment interventions. © 2018 John Wiley & Sons, Ltd. Highlights: Three BPD subtypes were identified based on reactive and regulative temperament: the Emotional/Disinhibited, Inhibited and Low Anxiety subtype.All BPD patients improved in symptomatology and coping after 3 months of DBT.The three BPD subtypes differed in symptom trajectory after 3 months of DBT.In contrast to the other two subtypes, the Low Anxiety subtype did not show a significant decrease in symptomatology. [ABSTRACT FROM AUTHOR]

Background: Childhood trauma subtypes sexual abuse, physical abuse, emotional maltreatment, and neglect may have differential effects on the brain that persist into adulthood. A systematic review of neuroimaging findings supporting these differential effects is as yet lacking. Objectives: The present systematic review aims to summarize the findings of controlled neuroimaging trials regarding long-term differential effects of trauma subtypes on the human brain. Methods: A systematic literature search was performed using the PubMed and PsycINFO databases from January 2017 up to and including January 2018. Additional papers were identified by a manual search in the reference lists of selected papers and of relevant review articles retrieved by the initial database search. Studies were then assessed for eligibility by the first author. Only original human studies directly comparing neuroimaging findings of exposed and unexposed individuals to well-defined emotional, physical or sexual childhood maltreatment while controlling for the effects of other subtypes were included. A visual summary of extracted data was made for neuroimaging modalities for which comparison between trauma subtypes was feasible, taking the studies' numbers and sample sizes into account. Results: The systematic literature search yielded 25 publications. Sexual abuse was associated with structural deficits in the reward circuit and genitosensory cortex and amygdalar hyperreactivity during sad autobiographic memory recall. Emotional maltreatment correlated with abnormalities in fronto-limbic socioemotional networks. In neglected individuals, white matter integrity and connectivity were disturbed in several brain networks involved in a variety of functions. Other abnormalities, such as reduced frontal cortical volume, were common to all maltreatment types. Conclusions: There is some evidence for long-term differential effects of trauma subtypes on the human brain. The observed alterations may result from both protective adaptation of and damage to the brain following exposure to threatening life events. Though promising, the current evidence is incomplete, with few brain regions and neuroimaging modalities having been investigated in all subtypes. The comparability of the available evidence is further limited by the heterogeneity of study populations regarding gender, age and comorbid psychopathology. Future neuroimaging studies should take this potentially differential role of childhood trauma subtypes into account. [ABSTRACT FROM AUTHOR]

Background: Retardation and agitation are symptoms of major depressive disorder (MDD), and their presence could play a role in determining clinically meaningful depressive subtypes such as nonmelancholic depression (NMD) and melancholic depression (MD). In this project, we explored whether three depression subgroups (NMD, MD with psychotic symptoms, and MD without psychotic symptoms) could be distinguished based on objective measures of psychomotor functioning. Methods: Sixty-nine patients with MDD underwent extensive clinical and psychomotor testing prior to treatment with electroconvulsive therapy. Psychomotor functioning was assessed subjectively using the Core Assessment of Psychomotor Change (CORE) and objectively by means of both 24-h actigraphy and performance on a fine motor drawing task. Results: The daytime activity levels measured by actigraphy were significantly lower (F = 7.1, p = 0.0004) in MD patients both with and without psychotic symptoms than in those with NMD. No objective psychomotor variable was able to distinguish between melancholic patients with and those without psychotic symptoms. Conclusions: The depression subtypes NMD, MD with psychotic symptoms, and MD without psychotic symptoms are not marked by increasing psychomotor retardation, possibly because psychomotor disturbance in MD with psychotic symptoms often consists of agitation rather than retardation, or a mixture of the two. However, psychomotor functioning as measured by actigraphy can be used to distinguish between NMD patients and MD patients. [ABSTRACT FROM AUTHOR]

Objectives: According to a recent study, ratings on the Psychotic Depression Assessment Scale (PDAS) obtained via a dedicated semi-structured interview are valid measures of the severity of psychotic depression. This study aimed to further test the validity, scalability and responsiveness of the PDAS in older adults using independent ratings on the Clinical Global Impression Scale – Severity (CGI-S) and the Montgomery-Asberg Depression Rating Scale (MADRS) as references. Methods: Ratings were performed at admission and discharge at two old age psychiatric wards in Flanders, Belgium. In total, 62 older adults (mean age: 74.3 years) with psychotic depression were included. The PDAS was rated by trained nurses using the semi-structured PDAS interview. Senior psychiatrists scored the participants on the CGI-S. Psychologists or experienced nurses rated participants on the MADRS. Clinical validity was assessed by correlating the PDAS total scores with CGI-S ratings and MADRS total scores. Mokken analysis was performed to assess the scalability of the PDAS. Responsiveness was assessed by comparing the proportion of participants in remission (PDAS total score <8 at study baseline and endpoint). Results: The Spearman correlation coefficients were 0.76 and 0.79 for the PDAS versus CGI-S and PDAS versus MADRS, respectively. The Mokken analysis yielded a Loevinger coefficient of 0.46, which is indicative of scalability. At admission, no participants met the PDAS remission criterion. At discharge, 54% (95% confidence interval: 47%–60%) of the patients met this criterion. Conclusion: The PDAS appears to be a clinically valid, scalable and responsive measure of the severity of psychotic depression in older adults. [ABSTRACT FROM AUTHOR]

Background: A mild pro-inflammatory status accompanies bipolar disorder (BD). Inflammation can cause a shift in monoamine metabolism, thereby activating more cytotoxic pathways. The extent to which low-grade inflammation in BD interacts with monoamine metabolism and how this accords to aging and clinical course is unknown. Objectives: We evaluated the presence of alterations in inflammation and monoamine metabolism in BD throughout different mood states and the role of aging therein. Methods: Sixty-seven patients with BD were included during an acute mood episode, either depressive (n = 29), (hypo)manic (n = 29), or mixed (n = 9). Plasma levels of inflammatory markers [tumor necrosis factor alpha (TNF-α), interferon gamma (IFN-y), interleukin-6 (IL-6), and C-reactive protein (CRP)] and markers of monoamine metabolism (neopterin, tryptophan, kynurenine, phenylalanine, and tyrosine) were measured repeatedly during a follow-up of 8 months. Levels in patients were compared to controls (n = 35) and correlated to HDRS-17 and YMRS scores. Spearman correlations and linear mixed model analysis were used for statistical analysis. Results: Forty-nine patients and 30 controls (age range: 22–62 years) completed the study. No significant differences in inflammatory markers were found between patients and controls overall. Tryptophan, tyrosine, and phenylalanine levels were lower in patients. In both patients and controls, markers of inflammation correlated only weakly with markers of monoamine metabolism, but correlations representative for activity of cytotoxic pathways in monoamine metabolism were more pronounced in patients. In patients, but not in controls, older age was associated with increases in inflammatory markers (IL-6, CRP, neopterin) and the kynurenine/tryptophan ratio. None of the biological markers correlated significantly with mood symptom severity. Conclusion: Our data suggest an increased susceptibility of patients with BD to develop a pro-inflammatory state and to shift monoamine metabolism toward more cytotoxic pathways. These findings are in support of the theory of neuroprogression and accelerated aging in BD. Since associations between biological markers and clinical characteristics are limited, it remains to be determined if alterations in biological markers are due to a disease effect or rather are a consequence of confounding factors. [ABSTRACT FROM AUTHOR]

Background: Electroconvulsive therapy (ECT) is considered to be the most effective treatment in severe major depression. The identification of reliable predictors of ECT response could contribute to a more targeted patient selection and consequently increased ECT response rates. Aims To investigate the predictive value of age, depression severity, psychotic and melancholic features for ECT response and remission in major depression.Method: A meta-analysis was conducted according to the PRISMA statement. A literature search identified recent studies that reported on at least one of the potential predictors.Results: Of the 2193 articles screened, 34 have been included for meta-analysis. Presence of psychotic features is a predictor of ECT remission (odds ratio (OR) = 1.47, P = 0.001) and response (OR = 1.69, P < 0.001), as is older age (standardised mean difference (SMD) = 0.26 for remission and 0.35 for response (P < 0.001)). The severity of depression predicts response (SMD = 0.19, P = 0.001), but not remission. Data on melancholic symptoms were inconclusive.Conclusions: ECT is particularly effective in patients with depression with psychotic features and in elderly people with depression. More research on both biological and clinical predictors is needed to further evaluate the position of ECT in treatment protocols for major depression. Declaration of interest None. [ABSTRACT FROM AUTHOR]

Non-forensic or regular assertive community treatment (ACT) has positive effects on non-forensic outcomes but has poor effects on forensic outcome measures. In this study, we examined non-forensic and forensic outcome measures of a forensic adaptation of ACT (ForACT) within a continuum of care for internees. Data were collected retrospectively from files of 70 participants in the ForACT group who had been released from a forensic hospital. The control group comprised internees who had left prison and entered community-based care (n = 56). The ForACT group demonstrated significantly better outcomes on forensic measures, such as arrests and incarcerations, and had better community tenure. However, this group showed high hospitalization rates. The findings indicate that this type of community-based care can be beneficial for such internees; however, internees continue to experience difficulties reintegrating into society. [ABSTRACT FROM AUTHOR]

Interagency collaboration has many advantages, but seems hard to realise in practice. In Belgium, the need for collaboration between the practitioners in the field of child welfare and child psychiatry, especially for children and adolescents with complex health care needs, was identified. Children with complex health care needs require coordinated care and collaboration between the different sectors in child mental health care (child welfare, child psychiatry, disability care). The authors have developed a standardised protocol based on the wraparound principles, which support interagency collaboration with family participation, named Client Network Consultation (CNC). Focus groups evaluated the CNC by eliciting practitioners’ views on the structure, content and impact of collaborative interagency protocols with family involvement. Thematic analysis revealed four core themes: (1) Empowering the child and the family; (2) Utilising the strength of the collective; (3) Being considerate versus constructive a dilemma for participants in CNC; and (4) The structure of a protocol offers opportunities and challenges. Results of the study offer implications for daily practice. Several challenges for interprofessional (IP) practice in the complex field of child and adolescent mental health care are described. The value of the CNC protocol to engage families in a clinical process is also discussed. [ABSTRACT FROM PUBLISHER]

Background/Aims: Major depressive disorder (MDD) is highly recurrent. This may be due to increased stress sensitivity after remission. Both inflammatory and psychosocial stressors are implicated in the pathogenesis of MDD, but the additive or differential effect is unclear. Methods: We conducted a single-blind placebo-controlled study to investigate the effects of inflammatory stress (i.e., typhoid vaccination), psychosocial stress (i.e., Trier Social Stress Test [TSST]), or a combination of both in women (25-45 years old) with (partially) remitted recurrent MDD (n = 21) and healthy female controls (n = 18). We evaluated the effect on mood measured by the Profile of Mood States, markers of the hypothalamic-pituitary- adrenal (HPA) axis activity, and inflammatory system activation. The study was performed during 2 testing days, separated by a washout of 7-14 days. In a crossover design, subjects received one of the interventions on one day and placebo on the other. Results: A lowering of mood was seen in patients (β [95% CI] = -4.79 [-6.82 to -2.75], p < 0.001) only after vaccination, but not after the TSST or the combination; this effect was not observed in controls. Controls experienced a significantly different response on adrenocorticotropic hormone (ACTH) after vaccination, with a general rise in ACTH not observed in patients. In both groups, the TSST activated the HPA axis and suppressed the inflammatory parameters. Conclusions: There is a differential effect of inflammatory and psychosocial stress on mood and HPA axis activation in patients with remitted recurrent MDD. This may be an interesting treatment target in MDD. [ABSTRACT FROM AUTHOR]

Although there still is conflicting evidence whether schizophrenia is a neurodegenerative disease, cognitive changes in schizophrenia resemble those observed during normal aging. In contrast to extensively demonstrated deficits in explicit learning, it remains unclear whether implicit sequence learning is impaired in schizophrenia and normal aging. Implicit sequence learning was investigated using a computerized drawing task, the 'implicit pattern learning task (IPLT)' in 30 stable patients with schizophrenia, 30 age-matched controls and 30 elderly subjects on two consecutive days and after 1 week (sessions 1, 2 and 3). Fixed sequence trials were intermixed with random trials, and sequence learning was assessed by subtraction of the response time in fixed sequence trials from random trials. Separate analyses of response times and movement accuracy (i.e., directional errors) were performed. Explicit sequence knowledge was assessed using three different awareness tasks. All groups learned equally during sessions 1 and 2. In session 3, control subjects showed significantly larger learning scores than patients with schizophrenia ( p = .012) and elderly subjects ( p = .021). This group difference is mainly expressed in movement time and directional errors. Patients with schizophrenia demonstrated less subjective sequence awareness, and both patients with schizophrenia and elderly subjects had less explicit sequence recall. Explicit recall was positively correlated with task performance in all groups. After a short 24 h interval, all subjects showed similar improvements in implicit sequence learning. However, no benefit of prior task exposure 1 week later was observed in patients with schizophrenia and elderly subjects compared to controls. As patients with schizophrenia and elderly both display less explicit sequence recall, the control group superiority after 1 week could be explained by an explicit learning component. The few patients with schizophrenia and elderly subjects who had some sequence recall could possibly utilize this explicit knowledge to improve their task performance but did this by distinct mechanisms. [ABSTRACT FROM AUTHOR]

An extensive body of literature provides evidence supporting the effectiveness of assertive community treatment (ACT) with regard to non-forensic outcome measures, such as number of hospital admissions and length of stay. However, research findings on the effectiveness of ACT for forensic outcome measures, such as rearrests or detentions, is much less clear. The present review, therefore, focuses on the application of ACT in forensic populations, combining key elements of ACT with elements of forensic rehabilitation models. Specifically, a review of the literature was conducted using a systematic methodology in an attempt to combine evidence-based elements of 40 years of research on regular ACT with elements of forensic rehabilitation models. Results reveal limited yet promising evidence in support of the effectiveness of forensic ACT for forensic outcome measures. Implications for future research and clinical practice are discussed. [ABSTRACT FROM AUTHOR]

Introduction: Cognitive control impairments have been suggested to be a critical component in the overall cognitive deficits observed in patients diagnosed with schizophrenia. Here, we zoom in on a specific function of cognitive control,conflict adaptation. Abnormal neural activity patterns have been observed for patients diagnosed with schizophrenia in core conflict adaptation areas such as anterior cingulate cortex and prefrontal cortex. On the one hand, this strongly indicates that conflict adaptation is affected. On the other hand, however, outcomes at the behavioural level are needed to create a window into a precise interpretation of this abnormal neural activity.Methods.We present a narrative review of behavioural work within the context of conflict adaptation in schizophrenia, focusing on various major conflict adaptation markers: congruency sequence effects, proportion congruency effects, and post-error and post-conflict slowing. The review emphasises both methodological and theoretical aspects that are relevant to the understanding of conflict adaptation in schizophrenia.Results. Based on the currently available set of behavioural studies on conflict adaptation, no clear-cut answer can be provided as to the precise conflict adaptation processes that are impaired (and to what extent) in schizophrenia populations.Conclusions. Future work is needed in state-of-the-art designs in order to reach better insight into the specifics of conflict adaptation impairments associated with schizophrenia. [ABSTRACT FROM PUBLISHER]

Studies on the impact of childhood trauma on postpartum depression show inconsistencies and methodological limitations. The present study examines the effect of childhood trauma on depression 12 and 24 weeks after childbirth, while controlling for history of depression, depression symptoms during pregnancy and type D personality. During the third trimester of pregnancy, 210 women completed self-report questionnaires assessing depression (current and/or past episodes), childhood trauma and type D personality, of whom 187 participated in the postpartum follow-up, with depression symptoms being reassessed at 12 and 24 weeks after delivery with three depression outcome measures. Eventually, 183 participants were retained for analysis. Results indicated no predictive value of childhood trauma on postpartum depression in the univariate analyses, nor after controlling for previous depression, depression symptoms during pregnancy and type D personality. However, past depression and depression symptoms during pregnancy did independently and convincingly predict postpartum depression, especially at 12 weeks and to a lesser extent at 24 weeks following childbirth. Overall, we found no significant association between childhood trauma and postpartum depression. Past depression and depression symptoms during pregnancy are more relevant factors to assess before childbirth. [ABSTRACT FROM AUTHOR]