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Introduction: Mental disorders play a major role in today's society. The study presented relates to people with depressive disorders. Resilience trainings offers an opportunity to cope well with stress. The study focuses on the evaluation of the LOOVANZ program conducted for patients with depressive experiences and behavior in acute psychiatric care. 50 inpatients took part in the training in a psychiatric clinic. Methods: A pre-post design based on three fully standardized questionnaires was used to evaluate the training effects: Beck Depression Inventory Revision, DGPG resilience scale 32 and the scale of general self-efficacy (SWE). Results: Lower values for the level of depression and higher values for resilience and SWE were found. A negative correlation between the depressive symptoms and the resilience factors and also between the depressive symptoms and the SWE could be identified before and after the training. There is a positive correlation between resilience factors and SWE at both times of survey. Results: Effects should not be considered individually due to a multimodal therapy approach. However, the intervention study enabled an initial evaluation with promising results, which provide a basis for further studies and highlight further research needs and practical relevance. [ABSTRACT FROM AUTHOR]

Relatives of patients with depression represent a care group that have been largely neglected. Evidence has shown that they experience high levels of stress, whilst being at an increased risk of developing depression themselves. Psychoeducational support services for relatives can reduce stress. This article highlights the current situation that relatives experience, and provides opportunities to convey quick help to target persons. [ABSTRACT FROM AUTHOR]

Abstract: Background: This study investigated the extent to which the cognitive impairment of alcohol-dependent patients improves relative to abstinence and depression. Methods: We examined alcohol-dependent patients with (n = 22) and without depression (n = 58) neuropsychologically and regarding depressivity three times (after withdrawal, 6 weeks later, and 6 months later). Additionally, we examined 33 healthy control subjects. Results: Alcohol-dependent patients showed decreased reasoning compared to healthy control subjects. In the further course, abstinent patients tended to perform better than relapsed patients, and depressivity was associated with weaker performance. Discussion: Alcohol-dependent patients suffer from cognitive deficits, some of which seem to improve in the further course of treatment, especially with abstinence. [ABSTRACT FROM AUTHOR]

Background: The supply of online therapy options for mild to moderate depressive disorders has substantially risen both nationally and internationally in the past years. While the efficacy and efficiency of specific online-based therapeutic services were indicated within the framework of scientific evaluations, little is known about the acceptance of these new therapy options. Methods: In a nationwide online survey of online-based therapy options for mild to moderate depressive disorders, the attitude and stance as well as the use intention and the subjectively perceived knowledge of 657 medical practitioners and therapists, active in psychotherapeutic and psychiatric treatment were collated. The impact of the potential predictors on the use intention of online-based therapies, based on the unified theory of acceptance and use of technology, was analyzed by means of a binary logistic regression model. Results: Besides the perceived performance and expense expectations, the supportive framework conditions, the influence of the cooperative environment, the individual technical affinity as well as the evaluation of the prospective significance of online-based therapy proved to be significantly influential predictors on the user intention. Special predictability for a positive user intention was shown related to the perceived potential of online therapy. Conclusion: The results underline the relevance of further evidence-basing of online therapy for mild to moderate depressive disorders. A user-oriented, participatory technology development proves to be just as relevant as a comprehensive sensitization, elucidation and education of potential users for a successful implementation. [ABSTRACT FROM AUTHOR]

The psychological and cognitive impairments from multiple sclerosis (MS) have been in the focus of both patients and physicians for several years now. However, existing functional and compensatory treatment approaches have yielded only modest benefits. It has been hypothesized that patients might benefit from cognitive behavioral therapy approaches. The Metacognitive and Allday life-relevant Training in MS patients (MaTiMS) was developed with a focus toward addressing the specific cognitive and psychological difficulties found in MS as well as underlying cognitive biases through a metacognitive approach. To date, no comparable therapeutic developments exist for MS patients. This review provides an overview of typical cognitive biases in MS and their treatment. [ABSTRACT FROM AUTHOR]

The relationship between cognitive deficits and sleep disturbances in depression has to date been rarely investigated. In this study, depressive inpatients completed questionnaires regarding depressive symptomatology and sleep quality (Pittsburgh Sleep Quality Inventory, PSQI), followed by neuropsychological assessments of attentional-executive functions (Trail Making Test: TMT-A, TMT-B) on day 1 (evening) and day 2 (morning). Patients with severe sleep disturbances (PSQI > 10, n = 8) performed poorer on both TMT-A and TMT-B than patients with at most moderate sleep disturbances (PSQI = 10, n = 8). Significant positive relationships between PSQI global score and completion time of TMT-B remained stable after controlling for confounders. These findings highlight the close relationship between cognitive dysfunction and sleep disturbances in depressive patients. Possible therapeutic implications are discussed. [ABSTRACT FROM AUTHOR]

Background: Depressive disorders are common and lead to both individual suffering and high socioeconomic costs. Despite the fact that several effective therapies are available, remission is often not achieved. Electroconvulsive therapy (ECT) can be a therapeutic option in these cases. Objectives: This review outlines the current evidence for the efficacy, safety and tolerability of ECT for depressive disorders. Material and methods: A selective literature search was carried out with particular consideration of meta-analyses, systematic reviews, and recommendations of national and international therapy guidelines. Results: For the majority of patients ECT is an effective, safe and well-tolerated therapy for the treatment of depressive disorders. There are relatively high remission rates even in patients with pharmacoresistant depression. There is evidence for a particularly high responsiveness in specific populations. In contrast to the proven effectiveness in the acute treatment of depressive disorders, there is a relative lack of data concerning maintenance therapy. Side effects including cognitive deficits are mostly transient. Modifications in the ECT technique have an impact on effectiveness and tolerability. Conclusion: When administered correctly ECT is a highly effective therapy for the treatment of depressive disorders. In the light of the abundance of depressive disorders and lack of remission despite adequate pharmacological treatment, a broader availability and application of ECT would be desirable. The same is true for a more intensive research into the mechanisms of action and response predictors of ECT. [ABSTRACT FROM AUTHOR]

Background: The assessment of health-related quality of life (hrQoL) is an important tool in therapy studies and in the treatment of patients with Huntington's disease (HD). In the absence of causal interventions, HD therapy targets the alleviation of symptoms aiming to improve impaired hrQoL. The aim of this study was to determine the impact of disease characteristics on hrQoL in HD. Methods: A total of 80 genetically confirmed HD patients underwent an assessment using the Unified Huntington's Disease Rating Scale, the Beck Depression Inventory, the Hamilton Rating Scale and the SF-36, a scale for the assessment of physical and mental QoL. Results: Multiple regression analysis revealed that health-related physical and mental QoL was considerably influenced by the functional capacity. The mental QoL also correlated with the degree of depressive symptoms, age and the number of CAG repeats. However, there was no statistical relation between QoL and motor and cognitive abilities. Discussion: This study underlines the relationship between function capacity and depressive symptoms with mental and physical QoL. This is the first time that hrQoL has been investigated in a German speaking cohort. The results are in accordance with previous studies of hrQoL in HD. [ABSTRACT FROM AUTHOR]

Background: Due to the demographic development depressive disorders in old age are becoming a central and urgent healthcare challenge. Objectives: The article reviews effective approaches towards treatment of depression in the elderly. Methods: A literature review of complex interventions improving depression care was carried out. Results: Robust evidence exists for the use of collaborative care models which incorporate collaboration between mental health and medical providers in the primary care setting (e.g. general practitioners and specialists), regular monitoring, case management, and evidence-based treatment. Staged treatment approaches seem to be appropriate by which initially use treatment strategies of low intensity. For patients with limited mobility, home-based approaches have proven to be particularly practical and effective. Conclusion: Multidisciplinary and multimodal treatment approaches represent an effective and efficient way of healthcare provision for late life depression. In Germany, only few initiatives inspired by successful international models have so far been identified. [ABSTRACT FROM AUTHOR]

The treatment of depressive episodes is characterized by a delay in response of antidepressant medications and high rates of therapeutic failure. In recent years several open and five controlled trials have demonstrated the antidepressant efficacy of ketamine for major depression. In addition a recent study established the utility of nasal ketamine which may render the necessity of intravenous administration obsolete. The current state of evidence is reviewed and discussed. [ABSTRACT FROM AUTHOR]

Several studies in clinical neuroscience have focused on the analysis of expression of emotions, identification of emotions and experience of emotions. These empirical studies produced certain insights into emotional competency in different mental diseases, most of them in schizophrenia. The current article gives a description of the scientific data about alterations in emotional competency in several mental diseases (e.g. schizophrenia, depression, bipolar and borderline diseases) and links the data, if possible, with clinical relevance with a special focus on emotional competency in prodromal schizophrenia. [ABSTRACT FROM AUTHOR]

Background: Patients with depression are treated for a relatively long period as inpatients in Germany. A new treatment model with symptom-orientated release management, post-hospitalization treatment and standardized referral to outpatient therapists could be suitable to specifically shorten the hospital stay of patients who have already profited sufficiently from treatment. Materials and methods: The aim of the present study was to investigate the effects of a new treatment method (intervention group) with hospitalized depressive patients in comparison to a standard protocol (treatment-as-usual control group) on the length of stay as part of a pragmatic randomized, controlled multicentre study. The evaluation was made using covariance analysis. Results: Of the 202 randomized patients 184 could be included in the analysis. The estimated marginal mean of the length of stay (n = 83) was 57.3 days (range 1-305 days, SE = 3.8) in the intervention group and (n = 101) 57.6 days (range: 6-196 days, SE = 3.5) in the control group. There were no significant statistical differences between the groups (p = 0.966). Conclusions: An effect of the new treatment model on the inpatient length of hospital stay in depressive patients could not be demonstrated. [ABSTRACT FROM AUTHOR]

The prevalence of a major depressive disorder in patients after myocardial infarction is 20%. Depression is a risk factor for incident coronary heart disease and poor prognosis after myocardial infarction. Poor lifestyle habits and adherence to cardiac therapy as well as metabolic and pathophysiologic changes may partially explain this link. The threatening experience of an acute coronary event and immune and inflammatory changes may be unique features contributing to incident depression after myocardial infarction. While psychotherapy, antidepressants, and physical exercise may alleviate depressive symptoms in patients with coronary heart disease, cardiac rehabilitation additionally reduces mortality risk. Attempts are being undertaken to identify the cardiotoxic characteristics of depression to develop even more effective therapies in the future. [ABSTRACT FROM AUTHOR]

Background: The ABC schizophrenia study conducted by the same team over 25 years initially aimed at illuminating the onset, prodromal stage and sex differences in age at first hospitalization in schizophrenia. New hypotheses were systematically generated from the results achieved. Methods: A population-based sample of 276 first admission cases (232 first episodes, age 12-59 years), including a subsample of 130 first admissions (115 first episodes), were assessed to study prodromal stage, first illness episode, medium and long-term course and symptom dimensions in schizophrenia. The samples were compared with age and sex-matched healthy controls and with patients first admitted for unipolar depression. A total of 1,109 consecutive first admissions for schizophrenia spectrum disorders independent from the other study samples were assessed to study changes in symptomatology across the age range. Results: Before the onset of psychotic symptoms the prodromal stages of schizophrenia and severe and moderately severe depression are difficult to distinguish. The most frequent symptom in the course of schizophrenia, depressed mood, also represents the most frequent initial symptom in both disorders. Prodromal depression is a predictor of more depressive and positive symptoms in the first episode but not in the further course of the illness. Psychosis incidence for men, diagnosed according to ICD 9 (295, 297, 298.3/4), shows a pronounced peak at age 15-24 years, for women a lower peak at age 15-29 years and a second, still lower peak at the menopausal age of 45-49 years. The explanation, confirmed in animal experiments, lies in a protective effect of estrogen due to reduced D2 receptor sensitivity. The effect is antagonized by an elevated genetic risk. Functional and social impairment emerge even at the prodromal stage and the severity depends on sex and social status. Young men with schizophrenia show a less favorable social course because of the earlier age of onset and socially adverse illness behavior. Late onset is associated with a milder, primarily paranoid symptomatology and less severe social impairment. Schizophrenia is a disorder of all ages showing roughly equal life time incidence rates for men and women but considerable difference in certain periods of age. The symptom dimensions show a plateau-like course 2-5 years after the first episode. Hidden behind this picture are irregular symptom exacerbations which vary in duration. Schizophrenia conveys the picture of recurrent vulnerability to crisis and not of a stable residual state of disordered brain development or of a progressive neurodegenerative process. [ABSTRACT FROM AUTHOR]

Background: Currently there is much debate about the concept of burnout and its use as a diagnostic entity. The aim of the present survey was to present the view of mental health professionals towards the concept of burnout. Methods: A total of 300 mental health professionals were surveyed using a structured questionnaire. Results: The majority of participants see burnout as a state of exhaustion which constitutes a risk factor for later developing a mental disorder. Participants reported that from their point of view typical triggers for burnout exist while symptoms overlap to a great extent with depression. Psychotherapy as well as interventions at the workplace are regarded as promising interventions; however, in the clinical routine only a minority of participants actually contacted the patients' workplace. In the participants workplace settings most Burnout-Patients suffered from a diagnosis defined in ICD 10 but judged themselves to be suffering from burnout. Discussion: Burnout-Patients in mental health settings differ from the picture currently drawn in the media, probably because Burnout-Patients reach the mental health sector only after already having developed a manifest psychiatric disorder. [ABSTRACT FROM AUTHOR]

The phenomenon of anhedonia, the inability to experience pleasure, is one of the essential elements for the diagnosis of depressive disorders. According to the criteria of both the ICD-10 and the DSM-IV, the presence of this symptom is crucial for the diagnosis of depressive disorders. In recent years scientific approaches using animal studies and projects of functional imaging have allowed the development of a new concept of the pathophysiology of anhedonia. The hypothesis that functional changes within the mesolimbic reward system could represent the neural correlate of anhedonia has contributed to a new concept of depressive disorders and allows testing of new therapeutic options for patients suffering from very resistant forms of depression. By using the method of deep brain stimulation present clinical studies try to ascertain whether the symptom of anhedonia can be alleviated by influencing the neural activity of the reward system. This article will give a critical overview about the background for new therapeutic approaches and illuminates the results of these studies. [ABSTRACT FROM AUTHOR]

The survey "Datenerhebung zur Depression in der Allgemeinbevölkerung" was conducted from fall 2010 to spring 2011 on several online platforms. The results show that there is a considerable timespan between the appearance of initial symptoms of depression and the first diagnosis of a patient. Intervention at early stages of the disease can reduce a potentially long time of suffering and can lead to the successful treatment of depression. General practitioners play an important role as the link between patient and psychiatrist. [ABSTRACT FROM AUTHOR]

Depression and diabetes mellitus type 2 are frequently comorbid conditions. Both disorders may increase the incidence of the other disorder and impair the prognosis. Thus, it is important for psychiatrists to consider depressed patients as high-risk diabetes subjects to screen for metabolic risks and to consider metabolic risks of antidepressant treatment. [ABSTRACT FROM AUTHOR]

In many neurological diseases a depressive syndrome is a characteristic sign of the primary disease or is an important comorbidity. Post-stroke depression, for example, is a common and relevant complication following ischemic brain infarction. Approximately 4 out of every 10 stroke patients develop depressive disorders in the course of the disease which have a disadvantageous effect on the course and the prognosis. On the other hand depression is also a risk factor for certain neurological diseases as was recently demonstrated in a meta-analysis of prospective cohort studies which revealed a much higher stroke risk for depressive patients. Furthermore, depression plays an important role in other neurological diseases with respect to the course and quality of life, such as Parkinson's disease, multiple sclerosis and epilepsy. This article gives a review of the most important epidemiological, pathophysiological and therapeutic aspects of depressive disorders as a comorbidity of neurological diseases and as a risk factor for neurological diseases. [ABSTRACT FROM AUTHOR]

Major depression is an independent risk factor for the development of cardiovascular disease. In patients with existing cardiovascular disease, major depression has a large impact on the quality of life and is associated with a poor course and prognosis. Potential mechanisms responsible for this association can be categorized as biological and behavioural variables that do not exclude each other but interact. Biological factors include alterations of the autonomous nervous system, the hypothalamic-pituitary-adrenal axis, the immune system and the vascular system. Major depression also raises the risk for further diseases, such as diabetes mellitus or obesity, which themselves are associated with higher cardiovascular risks. On a behavioural level, depression is often associated with an unhealthy life style such as smoking and physical inactivity. Additionally, depressed patients have more difficulties to implement recommended behavioural changes and to adhere to medication. Furthermore, some classes of antidepressants may also increase cardiovascular risk. All these factors play an important role in the association between depression and cardiovascular disease. [ABSTRACT FROM AUTHOR]

Depression in old age is common and has severe consequences. The paper reviews the most recent results of population-based and primary care-based studies reporting the prevalence, course and risk factors for depression in old age. Consequences of late life depression for the individual and for the society in terms of costs of illness are outlined. Studies of health service utilization and costs showed homogeneously that healthcare costs for depressive elderly individuals are one third higher compared to non-depressive individuals even though most do not receive depression-specific treatment. Late life depression is underrecognized and undertreated and data from Germany are rare. Improvement strategies, such as collaborative care models are discussed; however, adaptation and implementation to the German context are still pending. Future demographic changes will facilitate mental health service research into late life depression. [ABSTRACT FROM AUTHOR]

An analysis of the current literature provided irrefutable evidence that patients with hepatitis C not only suffer from the medical effects of this disease, but after virostatic therapy has been initiated including interferon-α and ribavirin also experience depressions in particular and develop other forms of psychological abnormalities which do not routinely abate after cessation of antiviral treatment. Neuropsychiatric disorders persist in about one third of the affected patients manifesting the cardinal symptoms of lethargy, depression and also cognitive impairments. Migration of the hepatitis C virus into the brain during the viremic phase and neurotropism of the virus have been implicated as the causes for this development. Moreover there are indications that the virostatic agents act on the neurotransmitter system. These findings should have consequences for managing the treatment of hepatitis C patients. [ABSTRACT FROM AUTHOR]

The term epigenetics describes mechanisms that can change the function of genes in the absence of an alteration of the actual DNA sequence. Among others, histone protein modifications (methylation, acetylation and phosphorylation) and DNA methylation constitute epigenetic mechanisms. Histone methylation and histone deacetylation in promoter regions of neurotrophic factors that have been associated with depression lead to their reduced expression. The methylation of DNA in promoter regions of genes coding for receptors and neurotrophic factors also results in their reduced expression, as was revealed for depressive disorders. Preclinical studies have shown that maternal care has a crucial influence on the reactivity of the hypothalamic-pituitary-adrenocortical axis of the offspring due to epigenetic mechanisms. These are acquired modifications that can be partially reversed by drug treatment (antidepressants). [ABSTRACT FROM AUTHOR]

The general efficacy of psychotherapeutic approaches in the treatment of mental disorders has been demonstrated by meta-analyses. Disorder-specific methods are increasingly dominating the field. In the field of depression psychological interventions have proven to be as equally effective as pharmacotherapy in mild and moderate depressives but with longer lasting effects after termination of treatment. The combination of both methods is particularly relevant for the therapy of severe and chronic depression. The indications should be differentiated beyond the severity and course of the disorder, e.g. according to previous traumatization, comorbidity, patient difficulty and the empirical evidence of the different approaches. [ABSTRACT FROM AUTHOR]

Based on epidemiological data on the risk for dementia conveyed by depression, we report recent findings on the effects of depressive disorders on cognition in later life and its relationship to incipient Alzheimer's disease. We review the current literature on possible mechanisms underlying the depression-dementia association. The findings summarized in this review underline the central importance of depressive disorders for the diagnosis and treatment of psychiatric disorders in later life. [ABSTRACT FROM AUTHOR]

Background: Previous research about the aetiology of depression has analysed how depression-associated personality traits influence familial transmission. Using the community-based sample of the Greifswald Family Study, we investigated longitudinally to which extent the temperament factor harm avoidance influences the correlation between parent's depression and the depression of their offspring (with regard to possible sex differences). Methods: To test this familial transmission a structural equation model was conducted with the data of 193 children (mean age 19.5, SD=2.41) and their biological parents. Depression was assessed with structured clinical interviews, and harm avoidance with Cloninger's Temperament and Character Inventory (TCI, JTCI). Results: The harm avoidance scores of the mothers were significantly correlated with the harm avoidance scores of their children, but the correlation of the father's and children's scores did not reach significance. The extent of harm avoidance at the first assessment of the 14-year-old children predicted depression 5 years later. Conclusion: These results indicate the importance of personality as a vulnerability marker for developing affective disorders. The results are discussed with respect to prevention programmes for children and parents with depression, especially if they exhibit strongly avoidant or anxious behaviour. [ABSTRACT FROM AUTHOR]

Depression is considered an independent risk factor for coronary artery disease (CAD) and other vascular conditions. Moreover, comorbid depressive disorder in CAD patients carries an increased risk of cardiac events and mortality. Among survivors of acute myocardial infarction, up to 20% meet diagnostic criteria for major depression, the presence of which carries a fivefold increased risk of cardiac death within 6 months. Heart patients with depressive comorbidity require particular care for both adequate treatment of their affective disorder and reduction of their cardiac risk. Antidepressant treatment must follow established guidelines; special care is needed to avoid cardiac side effects. In this review, we discuss the pathophysiological and prognostic significance of comorbid depression in CAD and weigh risks and benefits of available treatment options - particularly different drug classes and psychotherapy - in light of recent study results. [ABSTRACT FROM AUTHOR]

International studies have indicated a high prevalence of depression and a lack of coping with stress in medical students. Freshman and advanced medical students were investigated using a specific questionnaire and the Beck Depression Inventory (BDI) with a response rate of 100%. Of the subjects studied 81.1% did not have any depression, 13.1% slight and 5.8% clinically relevant symptoms of depression. The severity of symptoms was highly associated with subjective appraisal of stressors. Coping skills of first year students significantly influenced the depression symptoms calling for preventative measures even in freshman medical students. [ABSTRACT FROM AUTHOR]

in the past, future depression research will be oriented to the genetics and pharmacology of antidepressants as well as molecular and clinical biomarkers. Using new technologies patient populations with practically equal disease mechanisms will be identified which can be specifically treated with new drugs or a combination of presently available drugs. This signifies the integration of neuroscientific knowledge into the diagnostics of depression. The application of a personalized depression therapy supported by genetic testing and biomarkers raises the possibility of early recognition of the risk of disease and a targeted intervention before the symptoms of disease emerge. [ABSTRACT FROM AUTHOR]

The National Health Care guidelines on unipolar depression play a leading role regarding the multitude of players providing general care services, regarding scientific research and, last but not least, regarding common etiologic and therapeutic concepts as perceived by affected people and their relatives. In terms of health care, depression as a universal disorder comprises qualitative and quantitative aspects. For practicing neurologists/psychiatrists the guidelines provides many suggestions for different forms of treatment of the many kinds of depressive patients. When using a comprehensive approach, the criteria of evidence-based medicine are particularly important for practicing psychiatrists regarding the knowledge based on medical experience and patients preferences. It is important to point out that the hitherto fervently debated treatment dichotomy of psychotherapy versus pharmacotherapy is beginning to diminish. This is also reflected by the holistic perception of diseases and treatment approaches prevailing among established psychiatrists and the apparent development of health care quality towards individualized medicine. [ABSTRACT FROM AUTHOR]

Unipolar depressive disorders are among the most frequent reasons for utilizing the health care system. Although efficacious treatments are available and further advances have recently been made there is still a need for improving diagnostic and therapeutic procedures. Alignment of treatment on evidence-based treatment guidelines establishes an essential mainstay. The new S3 and National Health Care guidelines on unipolar depression, the compilation of which was coordinated by the German Society of Psychiatry, Psychotherapy and Neurology (DGPPN) and which were approved by 29 scientific and professional associations, is the ambitious effort to present state of the art evidence and clinical consensus for the treatment of depression. For pharmacotherapy of depression differentiated recommendations can be given, also separate from and in addition to psychotherapy. [ABSTRACT FROM AUTHOR]

Depression is a cross-cultural disorder, which displays cultural differences in symptom presentation and prevalence. The guidelines for the assessment of cultural influencing factors for the medical history and therapy and the consideration of stressors associated with the immigration process can help to better understand the socio-cultural background of patients with an immigration background and facilitate the differential diagnosis. Using these strategies, psychiatry and psychotherapy are better prepared to deal with this large heterogeneous population given the fact that one fifth of Germany’s population has an immigration background. The transcultural aspects of depression are illustrated with a case report. [ABSTRACT FROM AUTHOR]

Nicotine, by its impact on several neurotransmitter systems, influences sleep. Sleep disturbance is a common symptom in different psychiatric disorders and there is a high prevalence of smoking in psychiatric patients. Systematic literature search. Symptoms of insomnia are observed during nicotine consumption and its withdrawal. The effects of therapeutic nicotine substitution after smoking cessation on sleep are often masked by withdrawal symptoms. Depressive non-smokers experience an improvement of mood under nicotine administration and in turn, depressive symptoms and sleep impairment during nicotine withdrawal have a negative impact on abstinence rates. Sleep disturbance is a comorbid risk factor influencing abstinence during smoking cessation. In depressive patients the complex relationship between affect, sleep, nicotine consumption and its withdrawal should be carefully monitored. In such subgroups of smokers willing to quit this has to be taken care of in therapeutic interventions. [ABSTRACT FROM AUTHOR]

Rationale: Diagnosis of a malignant disease can cause serious psychological problems in patients as well as their intimate partners. Aim: This study investigated anxiety, depression, posttraumatic symptoms and feelings of guilt in patients and their partners segregated by sex. Method: In a clinical representative sample 248 cancer patients and 154 of their partners were assessed using standard questionnaires shortly after diagnosis and again six and twelve months thereafter. Results:Cancer patients' female partners most frequently indicated psychopathology that required treatment (29% anxiety, 33% depression, 17% posttraumatic symptoms). Conclusion: Cancer patients' female partners are at high risk of developing psychopathology. Hence they routinely should be included in patient exploration and, if need be, referred to psychooncological treatment. [ABSTRACT FROM AUTHOR]

Patients with bipolar disorder often present initially with a major depressive episode. The correct diagnosis at the first presentation could help to find an effective medication regimen, to prevent antidepressant-induced rapid cycling and to reduce antidepressant-induced manic episodes, e.g. though combination therapy with a mood stabilizer. Consistent predictors for an underlying bipolar illness are an early age of onset, a highly recurrent illness course with more than five episodes, the presentation of atypical features, psychotic symptoms, the presence of psychiatric comorbidities like anxiety disorders, history of suicide attempts (especially at an early age), positive family anamnesis for bipolar disorder, and a rapid evolvement of the depressive episode. So far there are no pathognomonic markers for bipolar disorder. Therefore we propose to assess the risk of each patient for having bipolar disorder individually. Patients who are at a high risk should at least be informed and should be closely monitored for the development of manic episodes. [ABSTRACT FROM AUTHOR]

Background: Only few studies investigated the effectiveness of psychotherapy in post-stroke depression (PSD). The aim of this feasibility study was to compare interpersonal psychotherapy, pharmacotherapy, and their combination regarding depression and rehabilitation outcome. Patients and methods: Post-stroke depression was found in 35% of 485 stroke patients examined. Seventy-four PSD patients were randomised to one of three treatment conditions. Severity of depression was measured by the Hamilton Depression Rating Scale and the Hospital Anxiety and Depression Scale. The Barthel Index and a questionnaire for health-related quality of life were used as measurements of rehabilitation outcome. Results: There were no significant differences between the three groups in patient mood or rehabilitation outcome. Concerning the severity of depression, quality of life, and social support, all patients showed benefits from antidepressive treatment. In addition a correlation was found between rehabilitation outcome and depression. Conclusion: In this feasibility study all antidepressive treatments were successfully implemented in the rehabilitation of post-stroke depressed patients. Combination therapy (interpersonal psychotherapy plus medication) was as effective as one of those elements alone. Because of the small sample size however, further randomized trials are required. [ABSTRACT FROM AUTHOR]

Stroke is the third leading cause of death, just after heart disease and cancer. Its incidence will probably increase dramatically in the coming decades. For prevention it is urgently necessary to gain fundamental knowledge about the risk factors and pathophysiological mechanisms. It is now widely accepted that depression and stroke are correlated with each other. There is little knowledge, however, about the links that might connect both diseases. This review discusses different mechanisms that lead to an increased stroke risk and can be influenced by depression as well thus possibly linking depression and stroke. [ABSTRACT FROM AUTHOR]

Deep brain stimulation is a novel and reversible surgical intervention in the treatment of psychiatric disorders. Recent studies in small samples of patients with depression and obsessive-compulsive disorder have come up with promising results. Neurosurgical interventions in psychiatric patients raise ethical questions in the context of historical experiences with traditional and irreversible psychosurgical procedures that need to be discussed. [ABSTRACT FROM AUTHOR]

The term 'raptus melancholicus' is rarely used in clinical or scientific discussions. There is a lack of data on frequency and attribution to psychiatric disorders. It is found more often in the older literature where authors write of detailed personal experiences with this malicious phenomenon, but the published information is isolated as well. Clinicians and forensic psychiatrists judge raptus melancholicus to represent a risk for suicidal attempts as it appears suddenly and unexpectedly, arising from a state of delayed and inhibited psychomotor motility. This enigma, which sounds quite paradoxical, requires a psychopathological explanation as offered here. The inclusion of forensic aspects suggests that raptus melancholicus is not such a rare entity. [ABSTRACT FROM AUTHOR]

The wide spectrum of comorbid mental disorders in epilepsy includes anxiety, affective, and personality disorders and psychosis. While the prevalence of mental disorders in the general epileptic population is listed at 6%, this rate is considerably higher in focal epilepsies, especially temporal lobe epilepsy, and the numbers given in the literature range from 20% to 70%, of which anxiety and depression are the most prominent. According to the Diathesis Stress Model, the effects of previously existing vulnerability and neurobiologic, iatrogenic, and psychosocial stress factors vary in the development of mental disorders in epilepsy. Roles are also played by learned reactions in responce to psychosocial stress as well as structural and functional disturbances in the limbic neuronal networks regulating affective, emotional, and social behaviors. Therapeutic measures may also contribute to the development of mental health problems. Several antiepileptic drugs have proven valuable in psychiatric treatment of mental disorders but also may have psychiatric side effects. Although established as a successful treatment option for focal epilepsies, surgery is also reported to influence mental health. [ABSTRACT FROM AUTHOR]

Introduction: A discrepancy is often observed between the presence of botulinum toxin antibodies (Btx-Ab) and successful therapy. We studied whether depression and an ongoing pension application explain this contradiction. Method: Sixty-five patients treated with Btx were questioned for subjective therapy failure (TF). The extensor digitorum brevis test (EDB test) indicated the presence of Btx-Ab. The Beck Depression Inventory and an exploration investigated for a depressive disturbance as well as an ongoing application for pension. We correlated the EDB test and the TF with a depressive disturbance and the wish for a pension. Results: Forty-three patients had TF, from which 22 Btx-Ab were positive. A depressive disturbance was found in 25 patients, and an ongoing application for pension in 21. The EDB test and TF did not however correlate TF with a depressive disturbance (P=0.003) and a pension desire (P=0.021). The TF mostly appeared at the beginning of treatment. Discussion: A depressive disturbance and an ongoing application for a pension influence the therapeutic success more strongly initially than the development of Btx-Ab. Conclusion: Besides Btx-Ab a depressive disturbance and an ongoing application for pension influences the therapeutic success. [ABSTRACT FROM AUTHOR]