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Previous studies have associated mental distress and disorders with increased health care utilization and costs. However, most studies have selected subjects from treatment facilities or have applied retrospective designs. N = 3,300 subjects from the baseline cohort of the Study of Health in Pomerania were followed up 5 years later. Mental distress was assessed with the SF-12 Health Survey and the Composite Diagnostic Screener for mental disorders. Two-part econometric models were applied adjusting for medical confounders and baseline services use. At 5-year follow-up somatization at baseline predicted an increase of inpatient (+39.9%) and outpatient costs (+11.9%). Depression predicted an increase of inpatient (+24.1%) and outpatient costs (+8.9%). Comorbidity of somatization and depression and somatization and anxiety predicted an increase in overall health care costs of ≥50%. Simple and time-efficient screening procedures for mental disorders may help to identify subjects at risk for increased future health care utilization. Standardized therapeutic interventions should be evaluated in subjects at risk in primary care.

Background Cortical inhibition deficits have been demonstrated in several disorders with deficits in impulsive control (e.g., attention-deficit/hyperactivity disorder [ADHD], tic disorder, Tourette syndrome) by using transcranial magnetic stimulation (TMS). With borderline personality disorder (BPD), we investigated another disorder associated with high impulsivity by TMS. We hypothesized that BPD patients display decreased cortical inhibition and/or increased cortical excitation as assessed with TMS. Methods Different inhibitory and excitatory TMS parameters were investigated in 19 unmedicated female BPD patients and 19 healthy control subjects matched for sex, age, handedness, and body height. Additionally, the results were controlled for ADHD symptomatology. Results A reduced cortical silent period (CSP) duration was found in BPD patients compared with healthy control subjects in the right cortex. Even after controlling for ADHD symptoms, this result remained significant. Conclusions These findings support an association between BPD and cortical inhibition deficits as indexed through TMS. The results are discussed considering basic neurobiological mechanisms that may explain our findings of decreased intracortical inhibition in BPD patients.

Background: Dissociation is often related to previous trauma and also occurs frequently in schizophrenia. Dissociation and psychosis may reflect a posttraumatic syndrome in some patients with schizophrenia. Sampling and Methods: In total, 80 patients diagnosed with schizophrenia were investigated by means of the Childhood Trauma Questionnaire (CTQ), the Dissociative Experience Scale and the Symptom Check List 90-R. CTQ subscales and groups reporting high and low dissociation were compared using MANOVA. Results: Childhood traumatic experiences were frequent [mean CTQ total score = 45.4 ± 17.5 (SD)]. Physical neglect was clearly associated with high dissociation, whereas abuse was not. Furthermore, there was a significant association of physical neglect with psychopathological distress not fully accounted for by dissociation. Conclusions: Dissociation may be specifically linked to childhood physical neglect in patients diagnosed with schizophrenia. Dissociation alone may not explain the effects of childhood maltreatment on adult psychopathology in schizophrenia; however, conclusions from the present study are limited due to its cross-sectional design.

The multiaxial system of operational psychodynamic diagnosis (OPD) is based on five axes covering illness experience and prerequisites for treatment, interpersonal relations, conflict, structure and symptomatology following ICD-10, Chapter V (F). The new version, OPD-2, has developed from a purely diagnostic system into one including a set of tools and procedures for treatment planning and for measuring change, as well as for determining the appropriate main focuses of treatment and developing appropriate treatment strategies. Focusing on axis I of the system, the concept and content of OPD are introduced and data concerning aspects of reliability and validity are discussed.

Little is known about psycholeptic and psychoanaleptic medicine (PM) use in the general population. This study presents prevalence data about PM use. The sample included 4310 individuals aged 20–79 from a general population health examination in a northern German area (participation proportion: 68.8%; Study of Health in Pomerania, SHIP). Medicines taken during the past seven days were assessed from the medicine packages or self-reports and classified according to the Anatomical Therapeutic Chemical (ATC) classification developed by the World Health Organization. In total, 6.3% of the sample reported PM intake, 8.7% of the women and 4.7% of the men. During the past 12 months prior to the health examination, 49.2% of the individuals with PM use consulted a general practitioner but not a neurologist or a psychiatrist. Among the study participants with PM use, 88.8% had one or more mental disorders during lifetime according to a screening questionnaire. It is concluded that considerable proportions of individuals with current PM use exist although lower than may be expected on the basis of the number of individuals with mental disorder in the general population. Copyright © 2008 John Wiley & Sons, Ltd.

OBJECTIVE The aim of the study was to determine the quality of life and the sense of coherence in a sample of former German child soldiers of World War II. METHODS 103 participants were recruited by the press, then administered a Short-Form-Health-Survey (SF-12), a sense-of-coherence scale (SOC) and 2 qualitative questions on possible resources in the combat situation. RESULTS The quality of life was not lowered compared to a comparison group of the same age. The sense of coherence was significantly higher than that of the comparison group. CONCLUSIONS The participants belonged to a comparably unobtrusive group of veterans. A possible protective variable might be the high sense of coherence.

INTRODUCTION Because of the presence of pronounced impulsiveness and affective dysregulation in subjects with Borderline Personality Disorder (BPD) executive dysfunctions have been suspected. Previous studies in this area revealed inconsistent results. However, most of these studies did not control for comorbidity (e. g. impulsiveness, depression) and current medication of participants. The aim of this study was, therefore, to investigate executive (dys)functions in patients with BPD and healthy controls controlling for impulsivity. Furthermore, a second control group with depression was included to test the specificity of the results. METHOD 24 unmedicated, female BPD patients as well as 24 healthy controls were matched for age, sex, and intelligence. Additionally, 22 female subjects with a life-time diagnosis of depression were included. All subjects completed a neuropsychological test battery assessing executive functions. RESULTS No significant differences in executive functioning were found between the three groups. BPD patients showed, however, a decreased ability to delay a gratification compared with controls. CONCLUSION These results implicate that BPD patients have deficits in motivational areas while other executive functions are not or only marginally involved.

Recently there is a growing psychotraumatological interest in late life effects in former German warchildren. The following article focusses on kind and amount of trauma and psychopathology (Symptom Check List 90-R; SCL-90-R) in elderly people, who have grown up during World War II. By means of psychometric self-reports we assessed their current interpersonal problems (Inventory of Interpersonal Problems; IIP), the quality of life (SF-36 Health Survey) and their sense of coherence (Antonovsky's Sense of coherence-Scale; SOC). Compared to norms from the general population and from "healthy controls", respectively, former German warchildren showed a higher psychopathological distress. They showed an interpersonal pattern of lower expressive/dominant in favour of enlarged passive and caring behaviour. The psychosocial dimension of quality of life was reduced, in contrast to the somatic scales. The former warchildren showed an increased sense of coherence, especially in the dimension of "meaningfulness". We discuss our findings in the light of the current scientifical knowledge and highlight possible future prospects to develop the warchildhood debate from the clinical and scientifical point of view.

Introduction This study investigates the role of harm avoidance (HA) as a possible risk factor in the familiality of obsessive-compulsive disorder (OCD). HA is considered to be a genetically influenced personality trait with an increasingly understood neuroanatomical basis. Method 75 subjects with OCD from hospital sites and a community sample and their 152 first degree relatives and 75 age and sex matched controls with their 143 first degree relatives were evaluated with structured clinical interviews (DSM-IV). HA was assessed with Cloninger's Tridimensional Personality Questionnaire (TPQ). Results Subjects with OCD had higher scores of HA than controls (p ≤ 0.001). First degree relatives of OCD cases also showed higher HA than relatives of control subjects (p = 0.001).These results remained stable when comparing only OCD subjects versus controls (p ≤ 0.001) and relatives of OCD cases versus relatives of controls (p = 0.005) without current comorbid disorders. Limitations The investigation of HA alone does not allow to disentangle the transmission of biological versus psychological factors related to an elevated level of anxiety in families of OCD cases. Conclusion This is the first study to extent previous findings of elevated HA in OCD cases to their first degree relatives. Thus, HA may partially mediate the familial risk for OCD.

Research in social psychiatry has partly neglected the problem of comparatively disturbed persons, who are characterized by a shift from the regular social psychiatric care system into homelessness, closed psychiatric treatment or other desintegrated areas. Against this background in Mecklenburg-Vorpommern, an evaluation of all clinical and complementary institutions engaged in psychiatry was realized. 83.5 % of the institutions took part in the study and 137 (5.21 %) persons were identified as critical. 59.4 % of the institutions, especially therapeutic living groups, remarked that they had treated critical persons during the last year. Sociodemographically, the critical persons could be characterized by comparatively limited interpersonal relationships und a high unemployed status. A factor analysis has resulted in 4 factors characterizing the problematical behaviour: (i) aggression, low social adjustment and impulsivity; (ii) suicidal behaviour; (iii) delinquency and substance use; (iv) manipulative behaviour and pestering. Defining a comparatively high of disturbed behaviour, 51 persons could be identified.

Given the great epidemiological, social, and psychological importance of sexual offences, and their deleterious consequences for victims, it seems vital to focus on potential risk factors for becoming a sexual offender. Our study aims to contribute to a better understanding of specific risk factors for sexual offenders by including a number of potentially important variables: biographical, clinical, and forensic. The sample consisted of 51 male inpatients at two maximum security forensic hospitals in Germany. The 19 sexual offenders were compared to the 32 non-sexual offenders. Personality disorder diagnoses and childhood maltreatment were assessed by experts; current psychopathology and interpersonal problems were measured using self-report questionnaires. Narcissistic personality disorders were significantly more frequent in sexual offenders than in the comparison group. Moreover, sexual offenders had been sexually abused as children significantly more often than the non-sexual offenders. Our f...

Zusammenfassung {! Fragestellungen:} Welchen Langsschnittverlauf zeigen Posttraumatische Belastungsstorungen bei Holocaust-Uberlebenden? Wird dieser Verlauf durch salutogene Faktoren beeinflusst? {! Methodik:} Auf der Basis der Befunde von 600 durch auslandische arztliche Untersucher erstellte Entschadigungsgutachten werden die bei den Uberlebenden fassbaren einzelnen Anteile der Posttraumatischen Belastungsstorung aufgelistet und verschiedenartige salutogene Faktoren identifiziert. {! Ergebnisse:} Die haufigsten Symptome der Posttraumatischen Belastungsstorungen, die bei uber der Halfte der Uberlebenden nicht progredient verliefen, waren Intrusionen und Hyperarousal sowie depressive und Angststorungen. Die salutogenen Faktoren betrafen den Staat Israel, differenzierte Kommunikationen innerhalb der ehelichen Beziehungen von Uberlebenden, die Geburt von Kindern und spezielle Holocaust-Thematisierungen. {! Diskussion:} Die Korrelationen der Symptome und Verlaufe der Posttraumatischen Belastungsstorungen ein...

Hinter der diagnostischen Kategorie der dissoziativen Storungen verbergen sich klinisch sehr heterogene Bilder. Die dissoziativen Bewusstseinsstorungen sind durch Beeintrachtigungen in den psychischen Funktionen des Bewusstseins, des Identitatsempfindens, des autobiografischen Gedachtnisses und des Selbst- und Welterlebens charakterisiert. Die Konversionsstorungen zeichnen sich durch Funktionsausfalle im Bereich der Willkurmotorik, der Sensibilitat und der Sensorik aus. Die phanomenologische Heterogenitat spiegelt sich in sehr unterschiedlichen Pravalenzen wider, die von auserst selten (z. B. die Fugue) bis zu 30% in klinischen Populationen schwankt. Realtraumatisierungen kommt eine wichtige Rolle in der Atiopathogenese zu. Hohe Komorbiditatsraten mit anderen psychischen Storungen, eine Neigung zur Chronifizierung sowie ein somatisches Krankheitskonzept bei Patienten mit Konversionsstorungen erschweren die psychotherapeutische Behandlung. Diese kann in Abhangigkeit der Therapieziele sowohl psychodynamisch als auch kognitiv-behavioral gestaltet werden.

OBJECTIVE While there are numerous studies on the mental sequelae of political imprisonment in the former German Democratic Republic (GDR), there is little knowledge about the prevalence of mental disorders in victims of other forms of political persecution. METHODS 74 individuals, who were subject to non-criminal repressions in the GDR, were investigated by means of a standardized psychiatric interview. RESULTS They had been exposed to a variety of reprisals such as observations, purposeful indiscretions, arranged professional failure and other forms of social marginalization. At least one mental disorder was found in 60 % of the participants. Affective disorders were the most common ones with a lifetime prevalence of 38 %, followed by anxiety (23 %) and somatoform disorders (28 %). CONCLUSIONS The frequency of mental disorders in our sample of politically persecuted people was higher than in the general population and similar to that of political prisoners, who only show higher rates of anxiety and posttraumatic stress disorders.

BACKGROUND Aim of this study was to examine effects of an outpatient intervention program for obese children. METHOD 45 obese children were treated with a cognitive-behavioural intervention program (IG) and were compared with 21 children of a waiting list (WG). Weight, self esteem, emotional and behaviour problems were measured at the beginning (T0) and the end (of T1) of the intervention. Additionally, predictors of therapy success were examined. RESULTS The intervention program lead to a moderate reduction of weight, whereas there was no weight reduction in the waiting group. Furthermore, self esteem increased and emotional problems decreased in the IG. Neither a positive family history of obesity nor the weight at T0 did predict treatment outcome. CONCLUSION Obese children profited from the cognitive-behavioral intervention program, weight reduction was, however, only moderate. Therefore, specific predictors for therapy success should be evaluated in further studies.

Background: Both reduced postsynaptic dopamine D2 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. Methods: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. Results: 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 × 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. Conclusions:Our findings support a role for a gene-personality interaction of DRD2 exon 8 × SDD in alcohol consumption in males.

Zusammenfassung. In der vorliegenden Arbeit wird die Frage empirisch untersucht, inwieweit dissoziative Symptomatik mit somatoformen Störungen assoziiert ist. Hierzu wurden n = 497 Patienten mit affektiven Störungen (F3), Angststörungen und Anpassungsstörungen (F4), dissoziativen Störungen (F44) sowie somatoformen Störungen (F45) mit der Symptom-Check-Liste (SCL-90-R) und dem Fragebogen zu Dissoziativen Symptomen (FDS) untersucht. Es zeigte sich bei Patienten mit somatoformen Störungen eine hohe Ausprägung dissoziativer Psychopathologie und pseudoneurologischer Symptome, die sogar auf dem Niveau der Dissoziation bei Patienten mit dissoziativen Störungen lag. Unabhängig von Alter, Geschlecht und Diagnosengruppen bestanden zwischen Dissoziation und klassischen pseudoneurologischen Symptomen wie Taubheitsgefühlen, Kloßgefühl und Schweregefühlen in Armen und Beinen, aber auch zu Kopfschmerzen, signifikante Assoziationen. Die mögliche therapeutische und klassifikatorische Implikation dieser Ergebnisse wird diskutiert.

Zusammenfassung. Theoretischer Hintergrund: Positive Alkoholwirkungserwartungen stellen ein bedeutsames Risiko für problematischen Alkoholkonsum dar. Ziel dieser Studie war die Identifikation der Korrelate positiver Alkoholwirkungserwartungen (AE) im Jugendalter. Methode: 311 Jugendliche (Alter 12-18 Jahre) einer Allgemeinbevölkerungsstichprobe wurden bezüglich der Familiengeschichte einer Alkoholstörung (FHalk), Verhaltensproblemen, Zugehörigkeit zu einer substanzkonsumierenden Peergoup und Ausmaß an positiven AE untersucht. Ergebnisse: Kinder aus Familien mit Alkoholstörungen wiesen dann ausgeprägte positive AE (oberstes Terzil) auf, wenn sie zusätzlich ein hohes Ausmaß an Verhaltensproblemen hatten (Odds Ratio (OR): 6.5; 95% Konfidenzintervall (KI): 1.3-32.6). Jugendliche mit aggressiven und delinquenten Verhaltensproblemen zeigten positivere AE im Vergleich zu Jugendlichen ohne Verhaltensprobleme vor allem bezüglich Spannungsreduktion (OR: 2.0; KI: 1.1-3.6) und sozialer Kompetenz (OR: 2.3; KI: 1.3-4.3), während die Zugehörigkeit in einer substanzkonsumierenden Peergroup mit hohen Erwartungen an soziales Wohlbefinden (OR: 2.3; KI: 1.4-3.7) und Kompetenz (OR: 2.0; KI: 1.1-3.6) assoziiert war. Schlussfolgerungen: Präventions- und Interventionsprogramme zur Veränderung von Einstellungen zu Alkohol sollten speziell auf Jugendliche aus Hochrisikogruppen zugeschnitten werden, wobei sowohl individuelle Merkmale als auch Aspekte der familiären und nicht familiären Umwelt berücksichtigt werden müssen.

Zusammenfassung: Zahlreiche epidemiologische Studien der letzten Jahre haben weltweit eine Lebenszeitprävalenz der Zwangsstörung von 1-3 % ermittelt. Es findet sich in der Allgemeinbevölkerung eine leicht erhöhte Erkrankungsrate bei Frauen. Aktuelle kontrollierte Familienstudien zeigen eindeutig eine familiäre Transmission der Zwangsstörung auf. Diese Befunde deuten, zusammen mit einigen allerdings methodisch schwächeren Zwillingsstudien, auf eine genetische Erkrankungsdisposition hin. Zahlreiche genetische Assoziationsstudien sind bislang bei der Zwangsstörung mit zumeist inkonsistenten Befunden durchgeführt worden. Gerade Kandidatengene des serotonergen und dopaminergen Systems zeigten keine konsistenten Assoziationen. In methodisch optimierten aktuellen Studien zeigten sich viel versprechende Assoziationen zu Polymorphismen des Glutamat-Transportergens (SLC1A1) und des OLIG2-Gens (Oligodendrocyte lineage transcription factor 2). Methodische Implikationen für zukünftige genetische Untersuchungen bei der als ätiopathogenetisch heterogen imponierenden Zwangsstörung werden diskutiert.

Objective: Although obsessive–compulsive disorder (OCD) is usually conceptualized as an anxiety disorder some studies suggested it to be a deficit of impulse control. The purpose of this study was to assess impulsiveness in OCD families and compare it to control families. Method: Seventy cases and their 139 relatives were compared with 70 controls and their 134 relatives from a German family study on OCD (German Epidemiologic Network for OCD Studies). All subjects were interviewed and diagnosed according DSM-IV criteria and were administered the Barratt Impulsiveness Scale (BIS) and PADUA-Inventory to assess obsessive-compulsive symptoms. Results: OCD subjects had significantly higher scores of cognitive impulsiveness. However, first-degree relatives of OCD cases and of controls had comparable BIS-11 scores. Significant associations of aggressive obsessions and checking with cognitive impulsiveness were found. Conclusion: OCD is a severe mental disorder that is characterized by a lack of cognitive inhibition. However, impulsiveness does not represent a familial trait in families of OCD subjects.

This study examined correlations of borderline personality disorder (BPD) symptoms with scales from Cloninger’s psychobiological model taking gender and psychiatric comorbidity into consideration. Inpatients with BPD (n = 202) were compared to several control groups including psychiatrically healthy persons (n = 327), subjects with affective disorders (n = 46), alcohol use disorders (n = 47), cluster C personality disorders (n = 23) and antisocial personality disorder (n = 25). The results indicate that only males with BPD presented an ‘explosive’ temperament suggested by Cloninger, with simultaneously high levels of novelty seeking and harm avoidance. In contrast, women with BPD were characterized by high levels of harm avoidance, but not novelty seeking. Regarding temperament and character dimensions our analyses suggest that patients with BPD could be characterized, in particular, by a combination of high harm avoidance and very low self-directedness. The specific temperament configuration of BPD postulated by Cloninger’s psychobiological model could only partially be supported. The results provide support for the importance of controlling for gender effects when investigating the applicability of dimensional models with respect to personality disorders.

Severe mental disorders like psychotic disorders including schizophrenia and schizoaffective disorders have a 12-month-prevalence of 2.6, bipolar disorders of 1.5 % in Germany. The relapse risk is high; so many patients need intensive monitoring and lifelong treatment. A high medication adherence is essential for a successful treatment. But in practice, medication adherence is low and decreases over time. Telemedical care concepts might improve treatment and bridge gaps between in- and outpatient treatment. A telemedical care concept based on regular telephone calls and short text messages was developed. The primary objective is to assess whether regular telephone calls and text messages can improve the medication adherence of patients. Secondary objectives are the reduction of rehospitalization rates, the improvement of quality of life and of the severity of symptoms. The Tecla study (Post stationary telemedical care of patients with severe psychiatric disorders) is a two-armed prospective randomized controlled trial. The participants in the intervention group receive in addition to usual care regular telephone calls every 2 weeks and weekly text messages on patient-individual topics during a 6 months period. Patients in the control group receive only regular care. Inclusion criteria are a physician-diagnosed bipolar disorder, schizoaffective disorder or schizophrenia and a signed informed consent. Exclusion criteria are planned inpatient treatments within the next 6 months and being non-reachable by phone. After 3 and 6 months both groups receive follow up assessments. The primary objective of this study is the medication adherence that is measured with the Medication Adherence Report Scale, German version (MARS-D). The MARS-D is a self-report with five items. Adherent behaviour is mostly overestimated using self-reports. The strength of the MARS-D is to detect non-adherent behaviour. The original Medication Adherence Report Scale in English language (MARS-5) was developed to encourage the patient to answer truthfully to the questions that are asked in a non-threatening and non-judgmental way to minimize social desirability bias in admitting non-adherent behaviour. This study is registered at 2015\05\21at the German Clinical Trials Register DRKS00008548 .

The currently dominating research paradigm in evidence-based medicine is expounded and discussed regarding the problems deduced from so-called empirically supported treatments (EST) in psychology and psychotherapy. Prevalent political and economic as well as ideological backgrounds influence the present dominance of the medical model in psychotherapy by implementing the randomized-controlled research design as the standard in the field. It has been demonstrated that randomized controlled trials (RCTs) are inadequate in psychotherapy research, not the least because of the high complexity of the psychotherapy and the relatively weak role of the treatment concept in the change process itself. All major meta-analyses show that the Dodo bird verdict is still alive, thereby demonstrating that the medical model in psychotherapy with its RCT paradigm cannot explain the equivalence paradox. The medical model is inappropriate, so that the contextual model is proposed as an alternative. Extensive process-outcome research is suggested as the only viable and reasonable way to identify highly complex interactions between the many factors regularly involved in change processes in psychotherapy.

For the purpose of retrospective assessment and characterization of childhood trauma in adults, the factorial validity of the short form of the Childhood Trauma Questionnaire (CTQ–SF) in Germany was evaluated by conducting confirmatory factor analyses for three samples including 1,524 adult psychiatric patients, 224 inmates, and 295 university students. In addition, sex-specific confirmatory factor analyses were performed within each sample. Because several authors have suggested a different factor structure than that originally proposed in the manual, two competing models focusing on the Physical neglect subscale were examined. In psychiatric patients and inmates, the fit indices were reasonable to good. Among the students, factor loadings were markedly lower, and fit indices were poor. Sex-specific analyses did not indicate sex differences. Comparing the original and the alternative models revealed better fit indices of the original factor structure. The present findings indicate that the German version of the CTQ–SF has factorial validity in psychiatric patients and inmates, but not in students.

Background:Sexual violence and wartime rapes are prevalent crimes in violent conflicts all over the world. Processes of reconciliation are growing challenges in post-conflict settings. Despite this, so far few studies have examined the psychological consequences and their mediating factors. Our study aimed at investigating the degree of longtime readiness to reconcile and its associations with post-traumatic distress within a sample of German women who experienced wartime rapes in 1945.Methods:A total of 23 wartime rape survivors were compared to age- and gender-matched controls with WWII-related non-sexual traumatic experiences. Readiness to reconcile was assessed with the Readiness to Reconcile Inventory (RRI-13). The German version of the Post-traumatic Diagnostic Scale (PDS) was used to assess post-traumatic stress disorder (PTSD) symptomatology.Results:Readiness to reconcile in wartime rape survivors was higher in those women who reported less post-traumatic distress, whereas the subscale “openness to interaction” showed the strongest association with post-traumatic symptomatology. Moreover, wartime rape survivors reported fewer feelings of revenge than women who experienced other traumatization in WWII.Conclusions:Our results are in line with previous research, indicating that readiness to reconcile impacts healing processes in the context of conflict-related traumatic experiences. Based on the long-lasting post-traumatic symptomatology we observed that our findings highlight the need for psychological treatment of wartime rape survivors worldwide, whereas future research should continue focusing on reconciliation within the therapeutic process.

We analyzed the putative association between abdominal obesity (measured in waist circumference) and gray matter volume (Study of Health in Pomerania: SHIP-2, N=758) adjusted for age and gender by applying volumetric analysis and voxel-based morphometry (VBM) with VBM8 to brain magnetic resonance (MR) imaging. We sought replication in a second, independent population sample (SHIP-TREND, N=1586). In a combined analysis (SHIP-2 and SHIP-TREND) we investigated the impact of hypertension, type II diabetes and blood lipids on the association between waist circumference and gray matter. Volumetric analysis revealed a significant inverse association between waist circumference and gray matter volume. VBM in SHIP-2 indicated distinct inverse associations in the following structures for both hemispheres: frontal lobe, temporal lobes, pre- and postcentral gyrus, supplementary motor area, supramarginal gyrus, insula, cingulate gyrus, caudate nucleus, olfactory sulcus, para-/hippocampus, gyrus rectus, amygdala, globus pallidus, putamen, cerebellum, fusiform and lingual gyrus, (pre-) cuneus and thalamus. These areas were replicated in SHIP-TREND. More than 76% of the voxels with significant gray matter volume reduction in SHIP-2 were also distinct in TREND. These brain areas are involved in cognition, attention to interoceptive signals as satiety or reward and control food intake. Due to our cross-sectional design we cannot clarify the causal direction of the association. However, previous studies described an association between subjects with higher waist circumference and future cognitive decline suggesting a progressive brain alteration in obese subjects. Pathomechanisms may involve chronic inflammation, increased oxidative stress or cellular autophagy associated with obesity.

This longitudinal study investigated the scope and course of attention problems over a period of time from preteen (ages 7–12 years) to early teen years (ages 13–17 years). We compared symptoms in subjects with and without a family history (FH) of alcohol abuse or dependence from among families without evidence of antisocial personality disorder. Evaluations of attention problems for the offspring were based on the Child Behavior Checklist and a validated semistructured interview carried out with the mother. The findings indicate no higher risk for attention problems and attention-deficit hyperactivity disorder (ADHD)-like symptoms in the children of families with an alcohol use disorder. Regarding the course of problems, the ADHD symptom count tended to decrease over time, especially for children without a FH of alcohol abuse or dependence. Further research will be needed to determine whether results can be replicated with families from different social strata and including subjects with the antisocial personality disorder.

The classification of personality disorders (PD) according to ICD-10 and DSM-IV has been critisized for several reasons. For example, those who have attempted to validate the presence of a non-arbitrary distinction between normal and abnormal personality functioning have suggested that no such distinction exists. Furthermore, PDs frequently co-occur with a number of Axis-I conditions and other Axis-II disorders leading to multiple diagnoses. Therefore, many have suggested classifying PDs dimensionally, rather than categorically. However, there are only a few studies that have investigated the applicability of these models with respect to PDs, and most of these studies used the Big Five. In this study we investigated the applicability of the Seven-Factor model of temperament and character for the classification of PDs. Our results show that the Seven-Factor model discriminates well between PDs and healthy controls, as well as between PDs and Axis-I disorders. We discuss our findings and present a modified scheme to diagnose PDs.

The relationship between Kernberg's psychodynamic model of personality organization (PO) and dissociation has not yet been explored. Seventy-two nonclinical subjects and 222 psychiatric patients completed the Dissociative Experiences Scale and the Inventory of Personality Organization. Its Reality Testing subscale emerged as the most important predictor for all facets of dissociation. Discussing our results in the framework of Fonagy and coworkers' model of mentalization, we suggest that dissociation may reflect the preoedipal "pretend" mode of psychic functioning while impaired reality testing and psychotic experiences might be indicative of the "psychic equivalent" mode.

Although pathological dissociation (PD) has received increasing scientific attention in Anglo-American countries, European research on the frequency, clinical and demographic correlates of this discontinuous construct are lacking. An 8-item subscale of the Dissociative Experiences Scale, called the DES-Taxon, was administered to five samples comprising a non-clinical population, students, unselected psychiatric inpatients, eating-disordered inpatients and psychosomatic outpatients with a total of 1,759 adult participants. In the two non-clinical samples, the frequency of PD ranged between 0.3 and 1.8%. Its prevalence was highest in the psychiatric inpatients (5.4%) followed by the eating disorders (4.8%) and the psychosomatic outpatients (2.2%). PD was seen in all diagnostic groups and it was associated with more psychopathological distress and younger age. PD is frequently found in clinical populations in European countries, too. However, methodological problems relating to its empirical determination might obscure the clinical and scientific value of the construct.

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.

Background: To investigate the relationship between dissociative experiences, psychopathological distress, a history of trauma and posttraumatic symptoms in adult schizophrenia. Methods: Eighty-seven schizophrenic inpatients returned self-questionnaires [Dissociative Experience Scale (DES); Symptom Checklist (SCL-90-R); PTSD Symptom Scale (PDS)]. Based upon this self-rating, 14 of the participants fulfilled the cut-off definition of PTSD according to DSM-IV criteria, 43 had a history of trauma without a self-rated diagnosis of PTSD. DES scores were also compared to a convenience sample of 297 non-clinical controls. Results: We found no significant impact of trauma alone but a significant influence of posttraumatic symptomatology on the level of current psychopathological distress (GSI) and the DES subscale absorption. However, in logistic regression, posttraumatic symptomatology was associated with GSI but not with DES. Schizophrenic patients even without trauma or posttraumatic symptoms had significantly higher scores in all three DES subscales than non-clinical controls. Conclusion: Pronounced posttraumatic symptoms in schizophrenia are associated with severe additional psychopathological distress whereas the increase in dissociation (absorption) in this group of patients may be secondary to the increase in symptom load. However, schizophrenia itself seems to be associated independently from trauma and pathological posttraumatic conditions with a broad range of dissociative symptoms.

Background: Previous studies have suggested an association between alexithymia and obsessive-compulsive disorder (OCD). However, it is unclear to which extent alexithymic traits in OCD patients reflect familial deficits in cognitively processing and communicating feelings that are also present in their first-degree relatives. This study investigates the hypotheses of an elevated level of alexithymia in subjects with OCD and their first-degree relatives compared to controls and their first-degree relatives. Methods: 82 cases with OCD and 169 first-degree relatives were compared to 76 controls and 144 first-degree relatives from a German family study on OCD (GENOS). All subjects completed the 20-item Toronto Alexithymia Scale (TAS-20). Direct or family informant interviews were carried out with the German version of the Schedule for Affective Disorders and Schizophrenia – lifetime version for anxiety disorders (DSM-IV). Results: OCD was associated with significantly higher scores of alexithymia. However, first-degree relatives of OCD cases and of controls did not differ in TAS-20 scores. In linear regression analyses, the TAS-20 total score showed significant intrafamilial associations within the families of control subjects but not within families of OCD cases. Conclusion: OCD is a severe mental disorder that is associated independently from other current comorbid axis I disorders with deficits in identifying and expressing feelings. However, alexithymia does not represent a familial risk factor for OCD.

Zusammenfassung: Die von internationalen und nationalen psychiatrischen Fachgesellschaften publizierten Leitlinien beziehen sich in erster Linie auf umschriebene spezifische psychische Störungen und in zweiter Linie auf Behandlungsstrategien. Diagnostische Leitlinien sind bisher lediglich als Teil dieser störungsbezogenen Veröffentlichungen vorgelegt worden. Trotzdem enthalten die operationalisierten Klassifikationssysteme Prinzipien, die sich im Sinne von Leitlinien verstehen lassen, wie das Komorbiditätsprinzip und der multiaxiale diagnostische Ansatz. Darüber hinaus müssen umfassende diagnostische Ansätze eine dimensionale Sichtweise zur Beschreibung von Verlaufsprozessen und Veränderung beinhalten. Einige Ansätze zur Qualitätssicherung werden vorgestellt und diskutiert.

Schizophrenia may be related to immunity as is suggested by many findings of altered immune parameters in schizophrenic patients. How immune alterations might be involved in the emergence of psychosis is still unclear. Clearly, however, the dopamine hypothesis has been confirmed in recent studies, which implies a crucial role for dopamine and the dopamine D2 receptor (D2R) within the pathogenesis of schizophrenia. The Dopamine D3 receptor (D3R) is considered to have autoreceptor properties modulating the synthesis and release of dopamine, thereby possibly antagonizing the dopamine D2-receptor-mediated effects of dopamine and has been found reduced in schizophrenic patients during acute psychosis and increasing in the advent of negative schizophrenic symptoms. Immune parameters apparently influence the expression of dopamine receptors by means of their capability to induce regulatory factors involved in the expression of dopamine receptor subtypes, such as the neurotrophins, associations of which with psychosis have been reported repeatedly. Here, we propose a hypothesis of immune alterations that influence the production of distinct neurotrophins such as BDNF and NGF that, as animal studies suggest, influence the expression of dopamine receptor subtypes. This mechanism could result in a decrease of D3R and a consecutive relative preponderance of D2R and thereby connect immune alterations and schizophrenia.

Objective: Previous results indicated a facilitated transcallosal inhibition via the corpus callosum (CC) in alexithymic male students. This study investigates transcallosal inhibition in alexithymic and nonalexithymic psychiatric inpatients. Method: Transcallosal inhibition was elicited by means of transcranial magnetic stimulation (TMS) of the primary motor cortex. Seven right-handed male and 12 female psychiatric patients with Toronto Alexithymia Scale (TAS-20) scores of ≧61 and 12 patients with TAS-20 scores of Results: There was a significant effect of alexithymia on TCT (Wilks λ = 0.76; F = 4.1; d.f. = 2, 26; p = 0.027) indicating that alexithymic patients had shorter bidirectional TCTs than nonalexithymic patients. The in-between models showed a significant impact of alexithymia on both right to left TCT (F = 4.8; d.f. = 1; p = 0.038) and left to right TCT (F = 5.0; d.f. = 1; p = 0.033). Neither gender nor scores of depression (Montgomery-Asberg Depression Rating Scale) had any significant effects on TCT. Conclusion: Our results confirm and extend the previous findings of a facilitated, bidirectional transcallosal inhibition in alexithymia to male and female psychiatric inpatients. Facilitated transcallosal inhibition should be considered as a neurobiological correlate of alexithymia.

BACKGROUND: Studies in forensic psychiatry indicate that persons in prison and psychologically disturbed sexual offenders have a high degree of traumatic experiences. But less is known about other specific risk factors. The aim of this study was to investigate the extent to which the diagnoses and traumata of sexual offenders differ from those of non-sexual offenders. METHOD: 51-male, German, forensic psychiatric patients were examined. Various self-evaluation questionnaires served to ascertain dissociative and general psychopathology and interpersonal problems. RESULTS: No significant correlations were found between sexual offences and forensic or socio-demographic variables. Nor was it possible to identify any differences in dissociative and psychopathological factors between sexual offenders and non-sexual offenders. However, the comparison between these groups showed that the former more frequently reported sexual abuse in their biographies and the diagnosis more frequently indicated a narcissistic personality disorder. But the logistic regression analysis coupled with age pointed to only sexual abuse in childhood as a significant factor. CONCLUSION: Our data support the idea that one's own traumatic experiences are reproduced later. That indicates the significance of dealing with traumatic experiences in childhood for this group of offenders. Language: de

Objective Alexithymia and posttraumatic stress disorder (PTSD) might share a neuroendocrine pattern characterized by increased urinary norepinephrine (N) and decreased cortisol (C) levels, resulting in a high N/C ratio, at least among male alcoholics. We aimed to explore if this association can also be found in other populations. Methods Twenty-four-hour urine samples were obtained from 12 major depressive disorder (MDD) patients and 23 healthy controls (HC) and tested for N and free C. Participants completed the 20-item Toronto Alexithymia Scale (TAS) and the Symptom Check List (SCL). Results Controlling for depression, the neuroendocrine parameters did not differ between the MDD and HC participants nor between women and men. The TAS was not associated with N, C or the N/C ratio in the MDD and HC participants nor in females alone. However, in men, the N/C ratio correlated significantly with the TAS (r=.80). Conclusions Our preliminary findings indicate that alexithymia is associated with an increased noradrenergic activity and a decreased basal activity of the hypothalamic–pituitary–adrenal (HPA) axis among men. This gender difference may reflect divergent underlying neurobiological processes of alexithymia in men and women.

High comorbidity, suicidal ideation, difficult temperament, and character are key symptoms of persons with borderline personality disorder (BPD). We investigated 478 persons, 40 of whom had a BPD according SCID-II, self-rating. Participants were examined with a semistructured interview and several self-rating questionnaires in their households. Taking the high comorbidity of persons with BPD into account, we compared the BPD group with four control groups with different axis 1 or personality disorders and one nonclinical group. Persons with BPD showed high comorbidity with affective, anxiety, and alcohol use disorders. With respect to suicidality, 75% reported that they wish to be dead at least sometimes, and about one-third said that they had already attempted suicide. Regarding temperament and character dimensions, our analyses revealed higher novelty seeking for persons with BPD compared to participants without BPD, although this difference was primarily attributable to males with BPD. Additionally, participants with BPD reported higher harm avoidance compared to control groups, while this was more distinctive for females. Finally, we found that persons with BPD had very low levels of self-directedness. This effect was independent from gender and was found in all group comparisons. Therapy of BPD should take into account high comorbidity and suicidality of patients. Moreover, our results show that low self-directedness seems to be specific for persons with BPD. Therefore, therapy must address those deficits by focusing on skills training as well as on aspects of maturation.

Hintergrund: Traumata finden sich besonders haufig bei Patienten mit Borderline-Personlichkeitsstorung (BPS). Es wurde daher vermutet, dass diese Patienten auch die Kriterien fur eine komplexe post

The authors investigated the hypothesis that dissociation may represent a functional dysconnectivity syndrome using a transcranial magnetic stimulation (TMS) approach. Transcranial magnetic stimulation investigations that included motor thresholds and the transcallosal conduction time (TCT) reflecting the interhemispheric transfer were performed in 74 right-handed students. All subjects completed the Dissociative Experience Scale. The high dissociators had a significantly lower left hemispheric excitability than right hemispheric excitability. They also had a significantly shorter TCT from the left to the right hemisphere than did the low dissociators. These results suggest that the neural basis of dissociation may involve a cortical asymmetry with a left hemispheric superiority or, alternatively, a lack of right hemispheric integration.

Given the clinical and scientific relevance of dissociative experiences our study aimed to assess the psychometric properties of a short version of the German Dissociative Experience Scale (called FDS-20) as well as its ability to measure changes in dissociation. In a large sample (N = 1289) the FDS- 20 showed good internal consistency. A factor analysis indicated that the scale measures one single factor reflecting the general degree of dissociative psychopathology. Between-group-comparisons suggested a good discriminant validity between high and low dissociators; however, due to high standard deviations the FDS-20 is not well suited for an individual diagnosis and therefore, it should be used as a screening device. Low effect sizes (d < 0,3) between scores at the beginning and the end of inpatient treatment as well as low micro -indices pointed to a temporal stable construct and a trait scale, respectively. Alternatively to group comparisons, individual parameters of treatment success (statistical and clinical significance) were calculated. They proved to be more appropriate in measuring changes in dissociation.

Objective To investigate the prognostic relevance of the axis "structure" of operationalized psychodynamic diagnostics (OPD) with respect to the symptom-related and interpersonal outcome of inpatient psychotherapy by applying group comparisons as well as individual criteria. Methods The structural level of 102 psychiatric inpatients was related to the general and dissociative psychopathology (SCL-90; FDS-20) as well as interpersonal problems (IIP) at the beginning and at the end of inpatient treatment. Results There was a tendency toward an association between the structural level and psychopathological improvement. However, we did not find any clear relationship between structure and interpersonal difficulties either at the beginning or during the course of the treatment. The structural dimensions did not correlate with the reduction of psychopathology or interpersonal problems. From the patients perspective, however, overall personality structure, defence and object perception were important predictors for therapy success. Conclusions In correspondence with other studies our findings suggest that consistent predictions on therapy outcome in regards to psychopathology and interpersonal problems are not possible on the basis of the axis "structure". The possible implications for a differential therapy indication are discussed.

The primary purpose of the study was to test a hypothetical model for aggressive and delinquent conduct problems in adolescence. A total of 168 adolescents from 121 families were studied using several questionnaires and a semi-structured interview. The following factors were considered: obstetric complications temperament (novelty-seeking), self-esteem, family influences (perceived parenting, alcohol abuse/dependence of parents, antisocial personality disorder of the father) and peer-group characteristics (peer rejection and membership in a deviant peer group). The evaluation methods applied included correlation analyses and testing of two hypothetical models using structural equation modeling. The correlation analyses revealed significant relationships between adolescent aggressive and delinquent behavioral problems and parental antisocial behavior; perceived parental rejection and low emotional warmth; adolescent novelty-seeking, self-esteem, peer rejection and peer deviance. The two empirical models, separately for aggressive and delinquent behavior problems, revealed direct relationships between paternal antisocial behavior, parental rejection, adolescent novelty seeking, peer deviance, peer rejection, and offspring aggression and delinquency. There were, however, two differences with respect to the relationships between peer rejection, peer deviance, aggression and delinquency. First, peer rejection was more strongly associated with aggressive behavior and only moderately linked to delinquency. Second, deviance in the peer-group was found to be closely related with delinquency but only moderately with aggression. Our findings suggest that several pathways for aggressive and delinquent conduct problems are comparable while others were not. Regarding the findings of the empirical models, we conclude that only intervention measures that include parents, peers and individual adolescents may help decrease the incidence of aggressive and delinquent conduct problems.

Previous studies found an elevation of the dopamine D3 receptor (DRD3) mRNA as determined in peripheral lymphocytes in schizophrenic patients. The aim of this study was to test the hypothesis of elevated DRD3 mRNA in schizophrenia compared to bipolar disorder. Twenty-four patients, 13 schizophrenic and 11 bipolar, were included according to DSM-IV criteria. Psychometric measures were conducted using the Scale for the Assessment of Positive Symptoms, Scale for the Assessment of Negative Symptoms, Brief Psychiatric Rating Scale, Montgomery-Åsberg Depression Rating Scale and Young Mania Rating Scale. mRNA was isolated from lymphocytes of venous blood samples and DRD3 mRNA was quantified using real-time reverse transcription PCR. We found a decrease in DRD3 mRNA in 13 schizophrenic (p = 0.009) and 11 bipolar (p = 0.023) patients as compared to controls. Medication history and severity of positive symptoms did not significantly influence DRD3 expression. Higher levels of DRD3 mRNA were correlated with negative schizophrenic symptoms. Interestingly, after treatment of patients with antipsychotics, DRD3 mRNA levels increased to similar levels as those of healthy controls. Bipolar patients, however, showed a slower increase in DRD3 mRNA levels after 3 weeks of therapy. Our findings suggest that the expression of DRD3 mRNA is reduced in schizophrenia and bipolar disorder, supporting the hypothesis of distorted homeostasis of dopamine receptor subtypes in psychotic disorder. The observed diminution was not specific for schizophrenia but also for bipolar disorder requiring further analysis of the regulatory factors involved in dopamine receptor subtype expression.

Zusammenfassung. Während die Sozialpsychiatrie an den Universitäten auf dem Rückzug zu sein scheint, hat sich die Patientenversorgung in der Psychiatrie in den letzten Jahrzehnten stark sozialpsychiatrisch verändert. Im Gegensatz zu diesem akademischen Trend gibt das vorliegende Themenheft einen Überblick über innovative sozialpsychiatrische Forschungsvorhaben, die sich nicht nur der Versorgungsfoschung, sondern auch der sozialpsychiatrischen Grundlagenforschung widmen. Wir diskutieren, inwieweit die akademische Zukunft der Psychiatrie auf dem Gebiet der Sozialpsychiatrie liegen wird.