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Background and aims Existing evidence suggests that text message interventions can help people to reduce their alcohol consumption. However, studies with alcohol-dependent patients are lacking. In this study a 1-year automatic mobile phone-based short messaging service (SMS) intervention on alcohol consumption in patients after alcohol detoxification in hospital was compared with treatment as usual. Design Multi-center, randomized, controlled, two parallel-group, observer-blinded trial. Setting and participants Primary and secondary care: four hospitals and community (1 million residents, 7600 km2 area in Germany). A total of 462 patients with alcohol dependence (ICD-10) were included during inpatient detoxification treatment. Patients were randomly assigned (1 : 1) to an SMS intervention and treatment as usual (SMS + TAU; n = 230; mean age: 45.4 years; 22.6% women) or TAU alone (n = 232 mean age: 44.5 years; 22.8% women). Planned, automated messages were sent to patients over 1 year to record assistance needs. A 'yes' or missing response triggered a telephone call from a hospital therapist. Outcome was assessed by an independent survey center. Measurements The primary end-point was a three-category alcohol consumption measure covering months 10-12 after discharge: abstinence, non-heavy drinking, heavy drinking [men > 60 g/day; women > 40 g/day equal to World Health Organization (WHO) criteria: high risk and very high risk, mean consumption]. Secondary end-points were number of abstinent days over 12 months and frequency of abstinence. Results The arms differed primarily in the heavy drinking category (intervention group 22.2%, TAU-only group 32.3%) in months 9-12. This is reflected by an odds ratio (OR) = 1.68, 95% confidence interval (CI) = 1.11-2.54, P = 0.015 for heavy drinking versus non-heavy drinking/abstinence. No difference between treatments was found with respect to any drinking versus abstinence (OR = 1.13). These results were confirmed by models adjusting for randomization strata. Conclusions In Germany, a 12-month mobile phone short messaging service-based intervention enhanced the reduction in heavy drinking for 1 year in routine care among adults with alcohol dependence discharged from inpatient alcohol detoxification.

Introduction Colorectal cancer (CRC) is the third most common cancer in the U.S. Early detection of CRC can substantially increase survival rates. Test compliance may be improved by offering a blood-based test option. Methods Endoscopy II trial specimens were tested for AFP, CA19-9, CEA, hs-CRP, CyFra 21-1, Ferritin, Galectin-3, and TIMP-1 levels. These biomarkers, as well as patient demographic information (e.g., age, gender), were included in algorithm development. Six statistical methods were utilized to develop algorithms that would discriminate cancer vs. noncancers. Statistical methods included logistic regression, adaptive index modeling, partial least-squares discriminant analysis, feature vector (weighted and unweighted), and random forest. The performance of these algorithms was compared against benchmark criteria established for stool-based tests. Results Using several statistical methods, the presence of CRC and high-risk adenomas was detected with an AUCs of at least 0.65–0.76, with a few of models approaching the stool-based tests benchmark performance. Further, common markers were utilized across the different statistical techniques, with model complexities ranging from 3 to 9 markers. Conclusions Predictive models identified subjects with CRC and high-risk adenomas with the similar levels of statistical accuracy. Clinical performance differences were minimal across the statistical techniques, although the intuitive interpretations, model complexity, clinical adoption and implementation varied.

Background: A pre-post pilot study was conducted to test the feasibility, acceptability, and potential effectiveness of a fully automatized computer-based intervention targeting hazardous drinking and depressiveness in proactively recruited health care patients (HCPs). To address the importance of the sample selection when testing interventions, HCPs were compared to media recruited volunteers (MVs). Method: In a multicenter screening program 2,773 HCPs were screened for hazardous drinking and depressive symptoms. MVs were recruited via media solicitation. Over a period of 6 months, study participants received 6 individualized counseling letters and weekly short messages. Pre-post data were analyzed for 30 participants (15 HCPs, 15 MVs). Intervention acceptability was assessed in post-intervention interviews conducted with 32 study participants. Results: MVs showed higher problem severity and motivation to change than HCPs. Over the course of the intervention both subsamples reduced regular binge drinking (HCPs: p = 0.016; MVs: p = 0.031) and depressiveness (HCPs: p = 0.020; MVs: p < 0.001). MVs further reduced average daily alcohol consumption (p = 0.034). The intervention received positive ratings from both subsamples, the alcohol module was rated more favorably by MVs than by HCPs (p = 0.012). Subsamples further differed in terms of intervention usage (p = 0.013). Conclusion: The intervention was technically and logistically feasible, well accepted, and may have the potential to reduce hazardous drinking and depressive symptoms in different populations. Subsamples differed in terms of problem severity, motivation to change, intervention usage, pre-post changes, and attitudes toward the intervention, showing that intervention development should involve the intended target populations to avoid biased conclusions on intervention effectiveness and acceptability.

Individuals with pathological gambling have an increased risk for suicidal events. Additionally, the prevalence of comorbid psychiatric disorders is high among pathological gamblers. This study analyzes whether the type of gambling is associated with suicidal events in pathological gamblers independently from comorbidity. Participants were recruited in 4 different ways: via random telephone sample from the general population, via individual invitation for study participation in gambling locations, through various media and the distribution of a leaflet in various settings, and via inpatient treatment facilities for pathological gambling. The final sample included 442 participants with a lifetime diagnosis of pathological gambling. A standardized clinical interview was conducted. High financial losses were associated with suicidal events (odds ratio [OR] = 1.94, 95% 95% confidence interval [CI], [1.11, 3.37]), as were mood disorders (OR = 7.70, 95% CI, [4.44, 13.37]) and female gender (OR = 2.52, 95% CI, [1.20, 5.28]). Gambling on electronic gambling machines in gambling halls or bars was associated with increased odds of suicidal events (OR = 2.94, 95% CI, [1.38, 6.24]). Other types of gambling, such as casino games or betting on sports, or the number of DSM-IV criteria for pathological gambling were not associated independently with suicidal events. Our findings suggest that gambling on electronic gambling machines in gambling halls or bars is associated with suicidal events in pathological gamblers independently of comorbidity. This result shows that the type of gambling needs to be considered as a relevant factor in gambling research. (PsycINFO Database Record Language: en

Aims: To test the feasibility, acceptability and initial effectiveness of a text message-based aftercare treatment programme among alcohol outpatients. Methods: Clients treated for alcohol use disorders from three Swiss outpatient alcohol treatment centres were invited by their counsellors to participate in a study testing an interactive aftercare programme employing the use of text messages and personal phone calls. Fifty study participants were randomly assigned to either the 6-month aftercare programme ( n = 25) or treatment as usual ( n = 25). The intervention consisted of (a) monitoring of self-selected drinking goals at regular intervals, (b) motivational text messages to stick to self-selected drinking goals and (c) proactive telephone calls from counsellors when participants neglected to stick to their drinking goals or expressed a need for support. Follow-up interviews were conducted 6 months after randomization. Results: Throughout the programme, participants received a total of 421 text message prompts. Out of these, participants provided valid replies to 371 (88.1%) within 48 h. Out of the 25 participants in the intervention group, 11 (44.0%) sent at least one call-for-help reply. Based on complete case data, at risk alcohol use at follow-up was 41.7% in the control group and 28.6% in the intervention group (OR = 0.56, 95% CI = 0.16–1.95, P = 0.36). Conclusions: The interactive low-intensive aftercare programme was well accepted by the participants. Testing its efficacy within an adequately powered randomized controlled trial might be reasonable.

BACKGROUND: In public health settings, short message service (SMS) appears to be a promising low-cost modality for reducing alcohol consumption. Here, we test a simple interactive SMS-based helpline with detoxified alcohol-dependent patients to extend findings to curative settings. METHODS: This controlled, prospective, 2-group before-after block-assignment, open pilot study tested the feasibility and efficacy of an 8-week outpatient interactive mobile phone SMS intervention (n = 42) against treatment as usual (TAU; n = 38) after inpatient detoxification. Patients were asked whether they needed any help via an automatically generated text message twice a week. A therapist called the individual back when notified. Alcohol consumption was assessed using the telephone version of Form-90 4 and 8 weeks after discharge from inpatient detoxification. The primary end point was defined as attaining low-risk consumption (males ≤30 g or 3.75 units per drinking day (DDD); females ≤20 g or 2.5 units per DDD) 8 weeks after discharge. Missing data were replaced by multiple imputation. RESULTS: Among all messages sent, 20.5% were followed by a phone call. Feasibility and acceptability were good, as indicated by successful implementation of the SMS procedure and the rapid inclusion of patients. Adherence was satisfactory with 57.14% of the participants replying to at least 50% of the prompts. Patients reported a typical preadmission DDD of 281.25 ± 244.61 g. In the SMS group, 55.7% of 42 patients, and 40% of 38 patients in the TAU group, achieved low-risk consumption (risk diff: 0.16; 95% CI -0.06 to 0.37; p = 0.122). CONCLUSIONS: In detoxified alcohol-dependent patients, relapse prevention based on SMS was well received and implemented efficiently and rapidly. An adequately powered multicenter study is currently being conducted to test the nonsignificant but encouraging findings of this exploratory study with more rigorous trial methods (ISRCTN78350716).

Background/aims: The application of intranasal oxytocin enhances facial emotion recognition in normal subjects and in subjects with autism spectrum disorders (ASD). In addition, various features of social cognition have been associated with variants of the oxytocin receptor gene (OXTR). Therefore, we tested for associations between mind-reading, a measure for social recognition and OXTR polymorphisms. Methods: 76 healthy adolescents and young adults were tested for associations between OXTR rs53576, rs2254298, rs2228485 and mind-reading using the “Reading the Mind in the Eyes Test” (RMET). Results: After Bonferroni correction for multiple comparisons, rs2228485 was associated with the number of incorrect answers when subjects evaluated male faces (P =0.000639). There were also associations between OXTR rs53576, rs2254298 and rs2228485 and other RMET dimensions according to P

Background Public stigma and self-stigma are two facets of mental illness stigma. Self-stigma denotes the internalization of negative public perceptions by persons with mental illness and has been shown to decrease general self-efficacy. To date, self-stigma has not been examined in people suffering from alcohol dependence, a particularly severely stigmatized mental disorder. Methods By adopting the Self-Stigma in Mental Illness Scale (SSMI), we developed the Self-Stigma in Alcohol Dependence Scale (SSAD). The scale is based on a focus-group derived list of 16 negative stereotypes about alcohol dependent persons. It consists of four 16-item subscales measuring four hypothetical stages of self-stigma, stereotype awareness (aware), stereotype agreement (agree), self-concurrence (apply), and self-esteem decrement (harm). We employed the SSAD in a cross-sectional study of 153 patients hospitalized for alcohol detoxification to examine its reliability and validity. Results The four stages of self-stigma could be reliably measured with the SSAD (Cronbach's alpha, 0.86–0.93). Each step in the process of self-stigmatization was most closely associated with its preceding step. Other significantly related independent variables in multiple regression analyses included desire for social distance (associated with agree), duration of drinking problems (associated with apply) and depressive symptoms (associated with apply and harm). Both apply and harm were significantly related to reduced drinking-refusal self-efficacy in analyses controlling for depressive symptoms and variables related to duration and severity of the drinking problem. Discussion The SSAD showed good validity and reliability measuring the stages of self-stigma in this group. Self-stigma appears to be associated with lower drinking-refusal self-efficacy.

Dysregulations of the hypothalamic-pituitary-adrenal (HPA) axis have been implicated in the pathogenesis of depressive disorders and the corticotropin-releasing hormone (CRH) was found to modulate emotional memory consolidation. Recently, two studies have reported an interaction between childhood abuse and the TAT-haplotype of the CRH-Receptor Gene (CRHR1) connecting childhood adversities and genetic susceptibility to adult depression. We tested the hypothesis of an interaction of childhood maltreatment with single nucleotide polymorphisms (SNPs) and haplotypes of the CRHR1 gene not previously investigated. Caucasian subjects (n = 1,638) from the German general population (Study of Health in Pomerania, SHIP) were analyzed. As in the previous studies, childhood abuse and neglect were assessed with the Childhood Trauma Questionnaire (CTQ) and depression with the Beck Depression Inventory (BDI-2). The CRHR1-SNPs were genotyped on the Affymetrix Genome-Wide Human SNP Array 6.0 platform. We identified an interaction between the TAT-haplotype and childhood physical neglect. The interaction with physical neglect showed significant (P < 0.05) results in 23 of the 28 SNPs, with rs17689882 (P = 0.0013) reaching "gene-wide" significance. Although we did not replicate the specific interaction of abuse and the TAT-haplotype of the CRHR1 gene we confirmed the relevance of an interplay between variants within the CRHR1 gene and childhood adversities in the modulation of depression in adults. The largest effect was found for rs17689882, a SNP previously not analyzed. Relevant sample differences between this and prior studies like lower BDI-2 scores, less childhood maltreatment and higher psychosocial functioning may account for the differences in gene-environment interaction findings. © 2010 Wiley-Liss, Inc.

There has been debate whether polymorphisms within the serotonin transporter-linked polymorphic region (5-HTTLPR) moderate susceptibility to posttraumatic stress disorder (PTSD). The authors investigated 5-HTTLPR genotypes and their interaction with the number of traumatic events in the prediction of PTSD in a general population sample.Analyses were based on data from 3,045 subjects who participated in the Study of Health in Pomerania. All participants were assessed with the PTSD module of the Structured Clinical Interview for DSM-IV. The short (S)/long (L) polymorphism of 5-HTTLPR (rs4795541) and the A-G polymorphism (rs25531) were genotyped.Among the participants, 1,663 had been exposed to at least one traumatic event, and 67 (4.0%) developed PTSD. Among those who had experienced less than three traumatic events, the lifetime prevalence of PTSD was 2.6%, 3.5%, and 4.3% for those with zero, one, and two L(A) alleles, respectively, but the lifetime prevalence was 0%, 7.3%, and 19.6%, respectively, among those with three or more traumatic experiences. This finding suggests that there is an additive excess risk for frequent trauma in the L(A)/L(A) genotype, which was confirmed by the relative excess risk due to interaction (RERI). In allelic analysis, RERI was 3.3. Thus, the odds ratio for PTSD in L(A) allele carriers exposed to three or more traumas was 3.3 times higher as a result of the interaction between PTSD and the L(A) allele.An additive gene-environment interaction with the high expression L(A) allele of 5-HTTLPR and frequent trauma in PTSD was found. The attributable proportion indicated that more than 60% of all L(A) allele carriers who were exposed to three or more traumas developed PTSD as a result of an interaction between genotype and exposure.

Schizophrenia has a considerable genetic background. Epidemiological studies suggest an inverse clinical association between schizophrenia and migraine. However, it is unclear to what extent this inverse comorbidity can be explained by genetic mechanisms or by schizophrenia-related behavioral factors. For both disorders hypotheses of glutamate N-methyl-D-aspartate (NMDA) receptor dysfunction have been developed in the past. We hypothesized that both conditions share common genetic factors with inverse effects, primary in the glutamatergic system and genes involved in NMDA activation. Data from the population based Study of Health in Pomerania (N=3973) were used. Based on the results from the recent genome-wide association study for schizophrenia, we calculated polygenic scores (PRS) for subsets of SNPs with different p-value cutoffs and for biological sub-entities. These scores were tested for an association of distinct biological pathways with migraine. The PRS for schizophrenia was inversely associated with migraine in our sample. This association was exclusively based on the genome-wide hits and on single nucleotide polymorphisms near or within genes encoding proteins involved in glutamatergic neurotransmission. This association could be attributed to a single intronic variant rs4523957 in SRR encoding serine-racemase. Additional expression quantitative trait loci analyses of functional variants in SRR and gene-by-gene interaction analyses further supported the validity of this finding. SRR represents the rate limiting enzyme for the synthesis of D-serine, an important co-agonist of the NMDA receptor. According to our results, a decreased versus increased activation of NMDA receptors may play a role in the etiology of schizophrenia, as well as in migraine.

Twin studies suggest a genetic influence upon perceived parenting. The D2 dopaminergic receptor is involved in the modulation of social behaviors, and might influence parenting and its perception. A polymorphism (E8) in exon 8 of the D2 receptor gene (DRD2) has been previously associated with alcoholism-related phenotypes. Similarly, the Pro385Ser variant of GABRA6, the polymorphic gene for GABA(A) receptor α6 subunit, has been associated with alcohol- and depression-related traits; and rat pups maintained a more immature GABAR phenotype after brief separation distress. The relationships among DRD2 (E8) and GABRA6 (Pro385Ser) polymorphisms, and perceived parenting were studied here. The association of DRD2 (E8) and GABRA6 (Pro385Ser) genotypes and perceived parental rearing behavior (short-EMBU; questionnaire concerning own memories concerning upbringing) were determined in 207 unrelated adults using multivariate analysis of variance. Temperaments (Temperament and Character Inventory; TCI) were included as covariates. Probands with DRD2 (E8) A/A genotype showed higher scores for father rejection (P = 0.011), parents overprotection (P = 0.021), and father overprotection (P = 0.016) in the total group. An interaction between DRD2 and GABRA6 genotypes on father rejection (P = 0.010) and parents rejection (P = 0.030) was also observed. Further analyses showed that these associations were restricted to the female subgroup only; however, secondary gender-specific analyses were not corrected for multiple testing. Our findings support a role for DRD2 (E8) and GABRA6 (Pro385Ser) in perceived parenting. © 2006 Wiley-Liss, Inc.

Barban N, Jansen R, de Vlaming R, Vaez A, Mandemakers JJ, Tropf FC, Shen X, Wilson JF, Chasman DI, Nolte IM, Tragante V, van der Laan SW, Perry JR, Kong A; BIOS Consortium, Ahluwalia TS, Albrecht E, Yerges-Armstrong L, Atzmon G, Auro K, Ayers K, Bakshi A, Ben-Avraham D, Berger K, Bergman A, Bertram L, Bielak LF, Bjornsdottir G, Bonder MJ, Broer L, Bui M, Barbieri C, Cavadino A, Chavarro JE, Turman C, Concas MP, Cordell HJ, Davies G, Eibich P, Eriksson N, Esko T, Eriksson J, Falahi F, Felix JF, Fontana MA, Franke L, Gandin I, Gaskins AJ, Gieger C, Gunderson EP, Guo X, Hayward C, He C, Hofer E, Huang H, Joshi PK, Kanoni S, Karlsson R, Kiechl S, Kifley A, Kluttig A, Kraft P, Lagou V, Lecoeur C, Lahti J, Li-Gao R, Lind PA, Liu T, Makalic E, Mamasoula C, Matteson L, Mbarek H, McArdle PF, McMahon G, Meddens SF, Mihailov E, Miller M, Missmer SA, Monnereau C, van der Most PJ, Myhre R, Nalls MA, Nutile T, Kalafati IP, Porcu E, Prokopenko I, Rajan KB, Rich-Edwards J, Rietveld CA, Robino A, Rose LM, Rueedi R, Ryan KA, Saba Y, Schmidt D, Smith JA, Stolk L, Streeten E, Tönjes A, Thorleifsson G, Ulivi S, Wedenoja J, Wellmann J, Willeit P, Yao J, Yengo L, Zhao JH, Zhao W, Zhernakova DV, Amin N, Andrews H, Balkau B, Barzilai N, Bergmann S, Biino G, Bisgaard H, Bønnelykke K, Boomsma DI, Buring JE, Campbell H, Cappellani S, Ciullo M, Cox SR, Cucca F, Toniolo D, Davey-Smith G, Deary IJ, Dedoussis G, Deloukas P, van Duijn CM, de Geus EJ, Eriksson JG, Evans DA, Faul JD, Sala CF, Froguel P, Gasparini P, Girotto G, Grabe HJ, Greiser KH, Groenen PJ, de Haan HG, Haerting J, Harris TB, Heath AC, Heikkilä K, Hofman A, Homuth G, Holliday EG, Hopper J, Hyppönen E, Jacobsson B, Jaddoe VW, Johannesson M, Jugessur A, Kähönen M, Kajantie E, Kardia SL, Keavney B, Kolcic I, Koponen P, Kovacs P, Kronenberg F, Kutalik Z, La Bianca M, Lachance G, Iacono WG, Lai S, Lehtimäki T, Liewald DC; LifeLines Cohort Study, Lindgren CM, Liu Y, Luben R, Lucht M, Luoto R, Magnus P, Magnusson PK, Martin NG, McGue M, McQuillan R, Medland SE, Meisinger C, Mellström D, Metspalu A, Traglia M, Milani L, Mitchell P, Montgomery GW, Mook-Kanamori D, de Mutsert R, Nohr EA, Ohlsson C, Olsen J, Ong KK, Paternoster L, Pattie A, Penninx BW, Perola M, Peyser PA, Pirastu M, Polasek O, Power C, Kaprio J, Raffel LJ, Räikkönen K, Raitakari O, Ridker PM, Ring SM, Roll K, Rudan I, Ruggiero D, Rujescu D, Salomaa V, Schlessinger D, Schmidt H, Schmidt R, Schupf N, Smit J, Sorice R, Spector TD, Starr JM, Stöckl D, Strauch K, Stumvoll M, Swertz MA, Thorsteinsdottir U, Thurik AR, Timpson NJ, Tung JY, Uitterlinden AG, Vaccargiu S, Viikari J, Vitart V, Völzke H, Vollenweider P, Vuckovic D, Waage J, Wagner GG, Wang JJ, Wareham NJ, Weir DR, Willemsen G, Willeit J, Wright AF, Zondervan KT, Stefansson K, Krueger RF, Lee JJ, Benjamin DJ, Cesarini D, Koellinger PD, den Hoed M, Snieder H, Mills MC.

Background: Behavioral problems in adolescence have been shown to be associated with the presence of a positive family history of alcoholism (FH+), obstetric complications (OCs), and negative parenting practices. Method: This study tested the relation of these factors to aggression/delinquency and attention problems in an untreated population sample of 154 adolescents in Pomerania. Furthermore, we evaluated the predictive strength of a FH+, OCs and negative parenting styles in a prospective subsample of 127 adolescents using a hierarchical regression analysis. Results: Group comparisons between offspring with higher vs. lower values on aggression/delinquency revealed that only rejection by the parents was significantly more often reported by teenagers with higher measures on these behavioral problems. Offspring with higher values on attention problems had more OCs reported by the mother and also had more feelings of parental rejection compared to controls. The results of the hierarchical regression analysis showed that parental rejection was the only significant predictor for both aggression/delinquency, and attention problems measured 1 year after the initial assessment. Conclusion: We conclude that parental rejection is a major risk factor for both aggression/delinquency and attention problems. Reflecting the fact that these behavioral problems have been reported to be strongly associated with later substance misuse, the improvement of parenting practices should be considered in prevention and intervention programs.

Background: Several studies from different epidemiological backgrounds have shown that unipolar depression is more prevalent in females than in males. This study examines gender differences in depression in a sample of 4075 probands recruited representatively from the general population in the northern German epidemiological catchment area of Lubeck. Methods: Probands were interviewed with M-CIDI by lay interviewers. Results: Being married only seems to increase the female depression risk when having children, while higher education reduced female excess; both male and female risk for depression raised sharply in separated, divorced and widowed probands. Not being employed was associated with an increased risk in male depression whereas in females risk was nearly unchanged. The gender ratio increased with the minimum number of depressive symptoms. Female excess was not reduced by a higher degree of subjective impairment or melancholic features. Females also predominated in longer episode durations. Female excess in the total group emerged beginning from adolescence with a tendency for a male excess in the prepubescent ages. No birth cohort effect was observed. Limitations: The cross-sectional design of this study precluded causal analysis of reported associations and some retrospective assessments are error-prone because of recall bias. Conclusions: We support previous findings of variations in gender differences in depression, however observed social parameter influences underline the need for a more detailed analysis of subgroups and underlying psychological mechanisms.

We tested the use of some subscales of the psychiatric symptom checklist SCL-90-R in predicting relapse within a 1-year follow-up period after a combined detoxification- and abstinence-focused day patient psychotherapy program in 20 men and 13 women with alcohol dependence. Scores of the SCL-90-R subscales interpersonal sensitivity (p = 0.008), anxiety (p = 0.022), phobic anxiety (p = 0.019) and Global Severity Index (GSI; p = 0.040) on admission were higher in the subgroup with relapse within the first year after therapy. A decrease in depression (p = 0.004), anxiety (p = 0.006) and GSI (p = 0.006) scores during therapy was associated with a longer abstinence duration (shorter vs. longer than 24 weeks). Therefore we propose to further investigate the capacity of the SCL-90-R to identify subgroups at higher risk for relapse after detoxification and abstinence therapy in patients with alcohol dependence.

The risk for suicidal ideation and suicide attempts among pathological gamblers is high compared to the general population. Little is known about the interplay of Axis I and Axis II disorders, severity of gambling disorder, and suicidal ideation and suicide attempts. The study aims to address this linkage. The sampling design of the study "Pathological Gambling and Epidemiology" (PAGE) included four recruitment channels: general population, gambling locations, project telephone hotline, and in-patient treatment for pathological gambling. A total of 442 study participants with lifetime pathological gambling received a clinical interview. The multivariate analysis showed mood disorders (Relative Risk Ratio, RRR=5.14, 95%-Confidence Interval, CI=2.91-9.07), substance use disorders (RRR=1.73, CI=1.02-2.94), and early onset of gambling disorder (RRR=0.96, CI=0.93-0.99) to be associated with suicidal ideation. Suicidal attempts were associated with female sex (RRR=3.58, CI=1.56-8.19), mood disorders (RRR=11.92, CI=4.70-30.26), and Cluster B personality disorders (RRR=2.40, CI=1.13-5.10). Among study participants with suicide attempts, more had a Cluster B personality disorder than among participants with ideation solely (RRR=3.08, CI=1.48-6.40). Among this large mixed sample of pathological gamblers, high proportions of individuals with suicidal events, multi-morbidity on Axis I, and a strong linkage to Cluster B personality disorders were found.

a b s t r a c t Background: Alcohol dependence is a severely stigmatized disorder. Perceived stigma may deter help- seeking and is associated with higher co-morbidity and self-stigma in persons with alcohol dependence. We assess changes in the perception of alcohol-related stigma over 21 years in the general population. Methods: Two representative population surveys using identical methodology were conducted in Germany in 1990 and 2011 (n = 1022 and n = 967), eliciting the perceived discrimination and devalu- ation of someone with a history of alcohol problems as measured with an adoption of Link's Perceived Discrimination and Devaluation Scale (aPDDS), and perceived negative stereotypes of an "alcoholic." Results: Both on item level and using factor scores, attitudes changed significantly between 1990 and 2011. Perceived discrimination and devaluation of someone with a history of alcohol dependence decreased considerably by 0.44 standard deviations (SD). Perceived negative stereotypes related to unpredictabil- ity of an "alcoholic" increased slightly by 0.15 SD, while perceived stereotypes related to strangeness decreased (−0.23 SD). Conclusions: Our findings suggest that particularly the image of someone who has received treatment for alcohol dependence has improved in Germany. This parallels increasing acceptance of professional treatment for alcohol dependence among the general population over the last twenty years, and contrasts with overall unchanged negative attitudes toward persons who actually suffer from alcohol problems. © 2014 Elsevier Ireland Ltd. All rights reserved.

Partial sleep deprivation (PSD) results in a pronounced decrease of depressive symptoms in the majority of patients with major depressive disorder. Generally this acute antidepressant effect is not stable, relapse usually occurs after one night of recovery sleep. We therefore studied whether light therapy, beginning in the morning after PSD, is able to prevent the relapse after sleep deprivation, using a controlled, balanced, parallel design. All patients received an antidepressant medication, which was kept constant before and during the study period. Fourteen of 20 patients (70%) showed a reduction of at least 40% in the Hamilton Depression Rating Scale (HDRS) in the morning after PSD and were classified as PSD responders. Responders as well as nonresponders were randomly assigned to receive either bright light (BL/3000 lux) or dim light (DL/100 lux) therapy during the following 6 days after PSD. In the responder group BL therapy prevented significantly (p = 0.005) the relapse after the next night of sleep and prolonged significantly (p = 0.011) the antidepressant effects of PSD up to 7 days. In contrast, patients in the DL condition relapsed after the recovery night and showed no further improvement of the depressive syndrome after 1 week of DL therapy. PSD nonresponders did not benefit from light treatment. These findings indicate that BL therapy might be efficacious to prevent relapse after PSD.

D(2) receptor function can be assessed by growth hormone (GH) response to apomorphine. Several association studies between dopamine receptor polymorphisms and results of the apomorphine challenge test with normal and alcohol-dependent subjects yielded inconsistent results. In this pilot study, we tested polymorphisms from the DRD2 region for GH response to apomorphine challenge in more detail.Apomorphine challenge tests measuring GH responses on 5 time points were performed on day 1 of alcohol detoxification in 43 patients with alcohol dependence; patients were genotyped for 11 polymorphisms including DRD2, ANKK1, NCAM1 and TTC12.Associations (p0.05) were found for ANKK1 (rs11604671, rs1800497) and DRD2 (rs6276, rs1076560), which are located on adjacent chromosomal positions. Consistent with PET studies suggesting a reduced D(2) receptor availability in patients carrying the ANKK1 rs1800497 T polymorphism (formerly known as DRD2 TaqI A1) we found a reduced GH response to apomorphine in those subjects.This has been the first study showing significant associations between apomorphine-induced GH response and SNPs in DRD2 and ANKK1 in alcohol-dependent patients. In this respect, our preliminary results are in line with other reports which suggested that DRD2 and ANKK1 polymorphisms influence D(2) receptor availability and signal transduction in the dopaminergic pathways. Small sample size in our study limits the generalizability of our results.

A new questionnaire to assess body dissatisfaction and shame, body boundary and body expression is presented. Scales BOUNDARY AND BODY PSYCHOTICISM, BODY EXPRESSION and BODY DISSATISFACTION AND SHAME were developed deductively. The first version was given to a sample of 134 nurse students and 512 psychotherapeutic inpatients. An item and factor analysis was conducted in the total sample. A 3-factor solution was found in a confirmatory factorial analysis (39% variance explained). The final version of the questionnaire consists of 46 items. The scales showed a satisfactory or good reliability and validity. To test criterion validity SCL-90-R and the body image questionnaire (FKB-20) were used. All SCL-90-R subscales were highly correlated with body dissatisfaction and shame (KUS) (r0.5). BODY BOUNDARY AND PSYCHOTICISM scale (AKP) was correlated with SCL-90-R scales psychoticism (r=0.56), interpersonal sensitivity (r=.55) and anxiety (r=0.51). BODY DISSATISFACTION AND SHAME scale (KUS) was also correlated (r=0.77) with scale REJECTION OF THE BODY of FKB-20. First results of the Questionnaire of physical aspects of boundary, shame and expression (FK-ASA) suggest that the scales describe the postulated aspects of body image.

Associations of oxytocin receptor gene (OXTR) variants and autism spectrum disorders (ASD) have been reported in earlier studies; in one of the studies associations with IQ and daily living skills were found additionally. Variations of the oxytocin receptor gene might also regulate affect, attachment and separation beyond the diagnostic borders of autism. We tested hypotheses of associations between positive and negative affects and social and emotional loneliness (285 adults), IQ (117 adolescents) and polymorphisms of the oxytocin receptor gene (OXTR rs53576, rs2254298 and rs2228485) in normal subjects. Individuals with the oxytocin OXTR rs53576 A/A genotype showed lower positive affect scores (F=5.532, df=1; p=0.019). This effect was restricted to males (F=13.098, df=1; p=0.00047). Haplotypes constructed with the three markers were associated with positive affect (p=0.0012), negative affect (p

Both reduced postsynaptic dopamine D(2) receptor function and the character variable self-directedness (SDD) are related to the level of alcohol consumption. We examined for interactions between DRD2 exon 8(rs6276), a polymorphism which has been associated with various alcohol-related phenotypes, SDD and alcohol consumption.A total of 144 male and 186 female probands with alcohol dependence or abuse diagnoses and without were included in the study. All subjects were assessed with the alcohol section of the Semi-Structured Assessment for the Genetics of Alcoholism and the Temperament and Character Inventory.Male probands with A/A genotype reported significantly higher alcohol consumption in a typical week (ANOVA; p = 0.024); those with A/A genotype and low SDD showed particularly high consumption levels (interaction DRD2 x SDD: p = 0.019). Alcohol dependence/abuse (DSM-IV) but not nicotine dependence was also relevant for higher alcohol consumption (trend: p = 0.052). In the female group, only alcohol disorders predicted alcohol consumption.Our findings support a role for a gene-personality interaction of DRD2 exon 8 x SDD in alcohol consumption in males.

Previous studies have yielded conflicting results as to the putative role of the functional polymorphism of the promoter region of the serotonin transporter gene (SLC6A4) in the etiology of anxiety-related traits and depressive disorders. Recently, a significant gene-environment interaction was found between life stressors, the short allele of the SLC6A4 polymorphism and depression. The aim of the present study was to investigate if such a gene-environment interaction could be replicated within a different population with a different risk structure. A total of 1005 subjects from a general population sample (Study of Health in Pomerania) were genotyped. Mental and physical distress were assessed on 38 items of the modified complaint scale (BL-38). The interaction between the SLC6A4 genotype, social stressors and chronic diseases with regard to the BL-38 score was evaluated by ANOVA. There was no independent association of genotype with mental and physical distress. However, significant interactions between genotype, unemployment and chronic diseases (F = 6.6; df = 3, 671; P0.001) were found in females but not in males. The genotype explained 2% of the total variance of the BL-38 score and 9.1% of the explained variance. The results partly confirm previous findings of a significant gene-environment interaction of the short allele, indicating a higher mental vulnerability to social stressors and chronic diseases. The relevance of this finding is sustained by the fact that the sample characteristics and the risk structure were highly different from previous studies.

Objective There is an ongoing debate on whether the wish to die in old age is a normal phenomenon and should be accepted as opposed to similar wishes in younger ages. The authors asked to what extent the age of a patient influences treatment decisions of physicians and nurses. Methods Real-life case vignettes of three persons ages 70 and over, with subthreshold depression and a wish to die, were presented to 19 physicians and 83 nurses, with the question of whether they would initiate psychopharmacological treatment or psychotherapy. For half of the participants, the real age of these persons was reduced by 20 years. Neither the participants nor the facilitators were aware of the focus of the study. Results The patient's age had a major influence on treatment decisions by physicians and nurses. The question of whether patients who expressed the wish to die should receive treatment, be it psychotherapy or intensive care, was answered with "yes" by both physicians and nurses significantly less frequently when the real age of the patient was known, whereas when a lower patient age (–20 years) was given, they more often saw the need for psychotherapy or other medical interventions. Conclusions Age stereotypes have an influence on medical decision-making. Physicians and nurses must be trained in this respect in order to avoid maltreatment of elderly patients.

Aims: To investigate (1) whether aggressive and delinquent behaviour problems predict subsequent adolescent drinking behaviour; and (2) to what extent this association is mediated by alcohol expectancies and/or peer delinquency/substance use. Methods: 147 adolescents (approximately 15 years old) were interviewed with regard to their drinking behaviour. In addition, several self-rating questionnaires were given to gather information regarding the peers of these children. Results: As proposed by the Acquired Preparedness Model (APM), we found that behavioural problems were related to quantity and frequency of alcohol consumed, and that this relationship was mediated by alcohol expectancies. Regarding peer relations, we found positive correlations between drinking behaviour and peer delinquency/substance use, aggression/delinquency and alcohol expectancies. Furthermore, the association between behavioural problems and drinking decreased dramatically if peer delinquency/substance use was accounted for. A hierarchical regression analysis revealed that both alcohol expectancies and peer delinquency/substance use predicted alcohol consumption of adolescents at the 1-year follow-up above and beyond the effects of age, sex, family history of alcoholism and aggression/delinquency of respondents. Conclusions: Alcohol expectancies and peer delinquency/substance use are both crucial to the amount and frequency of adolescent alcohol use. They should be considered in designing prevention and intervention strategies in this age group.

Considering that epidemiological research on dissociative disorders has suggested a 9 to 1 predominance of female cases, this study investigated the relationship between gender and dissociation using a dimensional approach. A total of 2,153 participants from different diagnostic groups completed the Dissociative Experience Scale. In order to control for the confounding effect of current psychopathology a subgroup 790 subjects additionally completed the SCL-90. We did not find any differences in the general or pathological dissociation scores. Hypothetical gender differences in dissociative psychopathology were not a function of diagnostic categories. There were no significant sex differences in the distribution of high dissociators. Our findings suggest that men and women do not generally differ in dissociative psychopathology. The implications for future investigations on the epidemiology, etiology, and psychobiology of dissociative symptoms are discussed.

— Aims and Methods: Alcohol withdrawal treatment efficacy of tiapride/carbamazepine (A) vs clomethiazole (B) vs diazepam (C) in non-intoxicated patients and vs tiapride/carbamazepine in intoxicated patients (D; breath alcohol concentration ≥ 1 g/l) was tested ( n = 127) in a controlled randomized open-label study. Results: Efficacy and safety were not different between groups (total group: delirium, 3.9%; seizure, 0.8%), except for a lack of efficacy in 18% of intoxicated tiapride/carbamazepine patients. A change of medication in this group was necessary only when primarily intoxicated patients had reached the non-intoxicated range. Conclusions: Treatment with tiapride/carbamazepine in alcohol-intoxicated patients proved to be safe.

Background: This study evaluated the severity of depressive symptomatology as it relates to: (a) sociodemographic factors and (b) the occurrence and type of acute and chronic psychosocial triggers or life events before admission. Methods: In total, 718 psychiatric inpatients were assessed with the AMDP-system by the treating psychiatrist within the first 2 days after admission. Results: In the females, sociodemographic factors (being married, children in the household, higher education and the quality of interactions) but not psychosocial stressors or life events were found to be related to severity of depression on admission. Females showed more severe depressive syndromes than males, however, depression severity in males was independent of sociodemographic factors, life events or psychosocial triggers. Limitations: Clinical assessment was based on retrospective history taking. The sample consisted of inpatients only, the results require replication using larger and more diverse samples. Conclusion: Gender differences and life conditions such as familial distress are related to severity of depression. The present criteria for the differentiation between depressive disorders and adjustment disorders are not independent and should be substituted by a multiaxial assessment.

The purpose of this study was to test a hypothetical model of alcohol problems in German adolescents. Among 180 offspring, family history of alcoholism, parenting styles, behavioral and emotional problems, peer-group characteristics, feelings of self-esteem, behavioral problems and psychiatric comorbidity of the parents were examined.Data were generated from the Study of Health in Pomerania (SHIP), in which families were randomly selected if 12-18 year old biological offspring were members of the household; a smaller group of subjects was selected from local outpatient treatment centers. Members of 133 families, including 180 (50.6% male) offspring who were appropriate for the current analyses, received personal semistructured diagnostic interviews and several self-rating questionnaires. Analyses compared offspring with alcohol problems (AP; n = 40) and with no alcohol problems (NAP; n = 140), and used structural equation modeling to test a hypothetical model.The comparisons revealed that the AP group had significantly more behavioral problems (e.g., aggression/delinquency), more perceived parental rejection and less emotional warmth, a higher amount of alcohol consumption, were more likely to associate with substance-using peers and more often received a diagnosis of conduct disorder or antisocial personality disorder. Whereas the family history of alcoholism did not differ significantly between groups, parents of offspring with an alcohol use disorder had significantly more additional diagnoses on DSM-IV Axis I. The evaluation of the model supported the importance of aggression/delinquency and association with substance-using peers for alcohol problems in people. An additional diagnosis in the parents was directly and indirectly (through aggression/delinquency) related to alcohol problems of the adolescents.The data indicate that alcohol problems in the offspring are associated with several domains of influence in their environment. Prospective studies measuring both biological and environmental factors using sufficient sample sizes will be needed for optimal understanding of the development of alcohol problems in youth.

We tested the hypothesis that allelic variants of the human dopamine D2 receptor E8 genotype are associated with (i) dopamine D2 antagonist tiapride dose in treatment of alcohol withdrawal (n = 50) and (ii) with anxiety and depression in patients during alcoholism detoxification therapy (admission n = 87; discharge n = 50). DRD2 E8 A/A genotype was associated with increased dose of tiapride during a 9-day detoxification therapy and with increased anxiety and depression scores on admission and 2 weeks later. The findings suggest a pharmacogenetic influence of DRD2 E8 genotype on tiapride efficacy in alcohol withdrawal. In an earlier report, DRD2 E8 A/A genotype was associated with reduced responsiveness to the dopamine D2 agonist apomorphine; however, it is not clear whether both findings share the same biological basis. Earlier findings concerning association of DRD2 E8 A/A with increased anxiety and depression are replicated for the first time.

The results of this study provide evidence for the importance of psychosocial risks in childhood for aggressive behavior in adolescence. This study demonstrated that aggressive adolescents differed from a nonaggressive control group in an increased exposure to prior psychotraumatic events, such as sexual abuse (tendency), physical abuse, and broken homes. However, in predicting later aggressive behavior, long-term and chronically effective negative living conditions seem of greater importance. Parenting behavior which includes harsh punishment and emotional rejection as well as separation of the parents early in life are particularly important factors. Whereas aggressive girls do not differ from the nonaggressive control group in terms of self-reported mental health, the aggressive boys reported more attention deficits, depression, anxiety, delinquency, and social problems.