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Purpose: Living in disadvantaged urban areas is associated with poor mental health. The purpose of this study was to assess which social characteristics were associated with psychological distress within a disadvantaged, multi-ethnic neighbourhood of Berlin. Methods: The study was conducted in an area of Berlin with the highest rates of unemployment and highest density of migrants. A total of 143 participants aged 18–57 years were included from a random sample. The social characteristics educational level, employment status, marital status, living alone, per-capita income and background of migration were collected. Psychological distress was assessed using the General Health Questionnaire GHQ-28; scores ≥ 5 indicated psychological distress corresponding to psychiatric caseness. Results: Psychological distress was found in 40.6% ( n = 58) of the sample. Psychological distress was associated with younger age (OR = 0.95, 95% CI = 0.92–0.98, p = .004), female gender (OR = 3.51, 95% CI = 1.55–7.92, p = .003) and living alone (OR = 3.88, 95% CI = 1.58–9.52, p = .003), but not with background of migration, low educational level or with unemployment. Conclusions: Young age and female gender may predispose for psychological distress in disadvantaged areas. Living alone could be a social indicator of poor mental health within disadvantaged urban areas. The directionality of the association is unclear. Background of migration, low income and educational level do not seem to be associated with poor mental health within those areas.

The aim of the study was to assess the response to random sampling for a mental health survey in a deprived multi-ethnic area of Berlin, Germany, with a large Turkish-speaking population. A random list from the registration office with 1,000 persons stratified by age and gender was retrieved from the population registry and these persons were contacted using a three-stage design including written information, telephone calls and personal contact at home. A female bilingual interviewer contacted persons with Turkish names. Of the persons on the list, 202 were not living in the area, one was deceased, 502 did not respond. Of the 295 responders, 152 explicitly refused (51.5%) to participate. We retained a sample of 143 participants (48.5%) representing the rate of multi-ethnicity in the area (52.1% migrants in the sample vs. 53.5% in the population). Turkish migrants were over-represented (28.9% in the sample vs. 18.6% in the population). Polish migrants (2.1 vs. 5.3% in the population) and persons from the former Yugoslavia (1.4 vs. 4.8% in the population) were under-represented. Bilingual contact procedures can improve the response rates of the most common migrant populations to random sampling if migrants of the same origin gate the contact. High non-contact and non-response rates for migrant and non-migrant populations in deprived urban areas remain a challenge for obtaining representative random samples.

The present work critically examines two assumptions frequently stated by supporters of cognitive neuroenhancement. The first, explicitly methodological, assumption is the supposition of effective and side effect-free neuroenhancers. However, there is an evidence-based concern that the most promising drugs currently used for cognitive enhancement can be addictive. Furthermore, this work describes why the neuronal correlates of key cognitive concepts, such as learning and memory, are so deeply connected with mechanisms implicated in the development and maintenance of addictive behaviour so that modification of these systems may inevitably run the risk of addiction to the enhancing drugs. Such a potential risk of addiction could only be falsified by in-depth empirical research. The second, implicit, assumption is that research on neuroenhancement does not pose a serious moral problem. However, the potential for addiction, along with arguments related to research ethics and the potential social impact of neuroenhancement, could invalidate this assumption. It is suggested that ethical evaluation needs to consider the empirical data as well as the question of whether and how such empirical knowledge can be obtained.

Ziel der vorgelegten Studie ist der Vergleich von Qualitat und Quantitat psychischer Symptommuster sowie Art und Haufigkeit von Suchtverhalten zwischen Personen mit und ohne Migrationshintergrund innerhalb eines sozial schwachen Stadtteils von Berlin. Es wurde eine Zufallsstichprobe aus dem Einwohnermelderegister gezogen, stratifiziert fur Alter (18 bis 57 Jahre) und Geschlecht. In die Studie wurden 143 Personen aufgenommen. Die Teilnahmequote der erfolgreich kontaktierten Personen betrug 48,5%. Seelische Belastung wurde mithilfe des General Health Questionnaire-28 (GHQ-28) mit den 4 Subskalen fur korperliche Beschwerden, Angst und Schlafstorungen, soziale Dysfunktion und schwere Depression erfasst. Trinkverhalten wurde mit dem Alcohol Use Identification Disorder Test (AUDIT) quantifiziert. Nikotinabhangigkeit wurde mit dem Fagestrom Test for Nicotine Dependence (FTND) gemessen. Von den teilnehmenden Personen hatten 51,7% einen Migrationshintergrund. Personen mit Migrationshintergrund wiesen ein niedrigeres Bildungsniveau und eine geringere Teilhabe am Erwerbsleben auf. Personen mit und ohne Migrationshintergrund zeigten identische Verteilungsmuster bezuglich der mittleren Symptomlast in den Bereichen korperliche Beschwerden, Angst und Schlafstorungen, soziale Dysfunktion und schwere Depression. Bei Personen ohne Migrationshintergrund fand sich riskanteres Verhalten bezuglich des Alkoholkonsums. Die vorgestellte Untersuchung gibt keinen Anhalt dafur, dass Personen mit Migrationshintergrund ein unterschiedliches Symptommuster bezuglich Angst, Depression oder Somatisierung zeigen, wenn sie innerhalb einer niedrigen Sozialschicht untersucht werden. Personen mit Migrationshintergrund gleichen moglicherweise hohere soziale Risikoprofile durch weniger riskanten Alkoholkonsum aus. Grosere Stichproben mussen Aufschluss uber einzelne Subgruppen von Migranten sowie Unterschiede bezuglich des Rauchverhaltens und anderer stoffgebundener Suchte geben.

ObjectiveTo determine the prevalence of depression in migrants aged 50 years or older in comparison to residents without a history of migration in 11 European countries.Methods and subjectsThe Survey of Health, Ageing and Retirement in Europe (SHARE), a cross-national, multidisciplinary, household-based panel survey using nationally representative probability samples (n= 28,517) of 11 European countries of the non-institutionalized population aged 50 years and older. Depression was measured using the EURO-D scale, and odds ratios (OR) were estimated for migration status. Effects of sociodemographic variables, somatic comorbidities, functional impairment, cognitive function, geographic region, and time lived in current country of residence were assessed in multivariate logistic regression analysis.ResultsAdjusting for confounds, the OR for depression in migrants was 1.42 (95% CI, 1.28–1.59). The influence of migration status on the prevalence of depression was significantly greater in Northern (OR, 1.85; 95% CI, 1.39–2.46) and Western Europe (OR, 1.38; 95% CI, 1.22–1.57), compared to Southern Europe (OR, 1.16; 95% CI, 0.79–1.70) (p< 0.05 for the interaction).ConclusionWe found a higher prevalence of depression in first-generation migrants aged 50 years or older, together with relevant geographical variation. This difference was not due to other known predictors of depression in older age.

Purpose Pharmacological treatment is used in patients with somatoform disorders (SD) although the empirical evidence is scarce. We evaluated the current pharmacological treatment strategies used for psychiatric in-patients diagnosed with SD in Central Europe. Methods Cross-sectional data of the pharmacological treatment, age, gender, and the primary psychiatric diagnosis of 70 566 in-patients were collected on 2 days in April and October of the years 1994–2006 in 57 psychiatric hospitals and departments. Results Three hundred fifty nine patients corresponding to 0.51% of the psychiatric in-patient population were hospitalized for SD. 94.7% of the SD patients received psychopharmacological treatment including antidepressants (78.2%), neuroleptics (43.3%), tranquilizers (22.6%), hypnotics (15.6%), and anticonvulsants (12.3%). 61.3% were treated with psychotropic combinations, most commonly antidepressant and neuroleptic (36.2%). In addition, 63.7% received one or multiple somatic medications. Discussion As compared to general medical and neurological in-patient populations, SD patients represent a small proportion of the psychiatric in-patient population. They commonly receive multiple psychotropic and somatic medications. The psychotropics used have predominantly sedating characteristics. Conclusion SD patients are at risk of polypharmacy in psychiatry. Copyright © 2010 John Wiley & Sons, Ltd.

Objectives: The present study in hypomanic and manic patients explored how amygdala responses to affective stimuli depend on the valence of the stimuli presented. Methods: We compared 10 patients with 10 matched healthy control subjects. We measured blood oxygen level-dependent (BOLD) responses in the amygdala while subjects passively viewed photographs taken from the International Affective Picture System. After the fMRI session, subjects saw the pictures again and subjectively rated the emotional valence and intensity of each picture. Results: Compared to healthy individuals, hypomanic or manic patients showed higher valence ratings in positive pictures and associated larger BOLD responses in the left amygdala during positive versus neutral picture viewing. This enhanced amygdala activation was correlated with Young Mania Rating Scale scores and with euphoric as opposed to irritable symptom presentation. Conclusions: Increased valence ratings and amygdala responses to positive affective stimuli may reflect a positive processing bias contributing to elevated mood states characteristic for euphoric mania.

Migrants tend not to use the public health system for addictive disorders. Frequently quoted reasons for the limited access are language barriers and fear of loosing the right of residence. We examined explanatory models for addictive disorders among ethnic German migrants from the former Soviet Union, migrants from Turkey and native Germans with semi-structured interviews and with methods for the assessment of semantic structures such as free listings, pile sorts and multidimensional clustering. The results confirmed differences in explanatory models of addictive behavior, which may contribute to misunderstandings in communication with professionals. Turkish youth and ethnic Germans from the former Soviet Union tended to overestimate their abilities to control drugs of abuse, a feeling that may contribute to delayed contact with the professional health care system. Migrants from the former Soviet Union were particularly concerned that contact with psychiatric or psychotherapeutic institutions may cause stigmatization and social exclusion. Furthermore, we observed culturally different expectations regarding adequate and effective treatment options. These findings suggest that in order to avoid misunderstandings, professionals who work with migrants should explore and discuss cultural differences in explanatory models of the development and maintenance of addictive behavior.

Objectives: Optimal pharmacotherapy of the alcohol withdrawal syndrome (AWS) in outpatient settings is still a matter of discussion. The aim of this evaluation was to examine the efficacy and tolerability of a combination of levetiracetam and tiapride for outpatient alcohol detoxification. Methods: This was an open-label evaluation. After screening eligibility for outpatient detoxification, 9 alcohol-dependent patients received levetiracetam and tiapride in a flexible dosage regimen up to 2500 and 300 mg/d, respectively, for a maximum of 7 days. Severity of alcohol withdrawal was assessed daily using the Alcohol Withdrawal Syndrome Scale (AWSS). Results: All patients completed the treatment successfully. The mean initial doses of levetiracetam and tiapride were 2166.7 and 300 mg/d, respectively. AWS as indicated by the AWSS score decreased clearly over 5 days. The combination of levetiracetam and tiapride was well tolerated. Neither treatment discontinuations because of side effects of the medication nor serious medical complications were observed during the detoxification. Conclusions: The results of this evaluation provide first evidence that the combination of levetiracetam and tiapride might be an effective and safe treatment option for mild to moderate AWS in outpatient settings. Further randomized controlled trials are warranted to confirm these preliminary results.

Pharmacological treatment is used in patients with somatoform disorders (SD) although the empirical evidence is scarce. We evaluated the current pharmacological treatment strategies used for psychiatric in-patients diagnosed with SD in Central Europe.Cross-sectional data of the pharmacological treatment, age, gender, and the primary psychiatric diagnosis of 70,566 in-patients were collected on 2 days in April and October of the years 1994-2006 in 57 psychiatric hospitals and departments.Three hundred fifty nine patients corresponding to 0.51% of the psychiatric in-patient population were hospitalized for SD. 94.7% of the SD patients received psychopharmacological treatment including antidepressants (78.2%), neuroleptics (43.3%), tranquilizers (22.6%), hypnotics (15.6%), and anticonvulsants (12.3%). 61.3% were treated with psychotropic combinations, most commonly antidepressant and neuroleptic (36.2%). In addition, 63.7% received one or multiple somatic medications.As compared to general medical and neurological in-patient populations, SD patients represent a small proportion of the psychiatric in-patient population. They commonly receive multiple psychotropic and somatic medications. The psychotropics used have predominantly sedating characteristics.SD patients are at risk of polypharmacy in psychiatry.

INTRODUCTION: Anticonvulsant drugs are increasingly being used for alcohol detoxification in in- and outpatient settings. The aim of this study was to examine the efficacy, medical safety and mid-term outcome of levetiracetam, a drug with no marked liver toxicity, for outpatient alcohol detoxification. METHODS: This was an open-label observational study. After screening eligibility for outpatient alcohol detoxification, patients were seen daily for 5 days and received levetiracetam in a flexible dosage regime between 500 and 4 000 mg/d for a maximum of 7 days. Diazepam was used as a rescue medication. The severity of alcohol withdrawal was evaluated daily using the ALCOHOL WITHDRAWAL SYNDROME SCALE (AWSS). Mid-term treatment outcome was assessed at a 6-month follow-up. RESULTS: A total number of 131 consecutively admitted alcohol-dependent patients received an outpatient detoxification treatment, 122 (93.1%) completed the programme successfully. The mean initial dose of levetiracetam was 1 850 mg/d. Alcohol withdrawal syndrome as indicated by the AWSS score decreased clearly over 5 days. Overall, the medication was well tolerated. There was no treatment discontinuations due to side effects of levetiracetam. No serious medical complications, especially seizures or deliria, were observed during the detoxification. At the 6-month follow-up, 57 patients (43.5%) were still abstinent. Patients with previous detoxifications had a significant higher risk for relapse (HR=1.88; p=0.016; CI 95%: 1.12-3.14) than patients without previous treatments. DISCUSSION: The findings of this study provide some evidence that levetiracetam is an efficacious and safe treatment option for outpatient alcohol detoxification. Further randomised, controlled trials including mid- and long-term follow-ups are needed to confirm these findings.

In Germany, the public system of addiction treatment is used less by migrants with addictive disorders than by their non-migrant counterparts. To date, the literature has focused primarily on language, sociocultural factors, and residence status when discussing access barriers to this part of the health care system. However, little attention has been paid to cultural differences in explanatory models of addictive behaviour. This is surprising when we consider the important role played by popular knowledge in a population's perceptions of and responses to illnesses, including their causes, symptoms, and treatment.In the present study, we examined explanatory models of addictive behaviour and of mental disorders in 124 native German und Russian-German youth and compared these models to those observed in an earlier study of 144 German and Turkish youth. We employed the free listing technique German and to compile the terms that participating subjects used to describe addictive behaviour. Subsequently, we examined how a subset of our study population assigned these terms to the respective disorders by means of the pile sort method.Although the explanatory models used by the German and Russian-German youth in our study were surprisingly similar, those employed by Turkish youth did not make any fundamental distinction between illegal and legal drugs (e.g. alcohol and nicotine). German and Russian-German youth regarded eating disorders as “embarrassing” or “disgraceful”, but Turkish youth did not. Unlike our German and Russian-German subjects, the Turkish youth did not classify eating disorders as being addictive in nature. Moreover, medical concepts crucial to a proper understanding of dependence disorders (e.g. the term “physical dependence”) were characterised by almost half of our Turkish subjects as useless in describing addictions.These findings show that it is impossible to translate medical or everyday concepts of disease and treatment properly into a different language without considering the connotations and implications of each term as it relates to the respective culture. Terms that are central to Western medical models of disease may otherwise be misunderstood, misinterpreted, or simply rejected.

Einleitung Abhängigkeitserkrankungen sind psychische Erkrankungen, die für die Betroffenen weitreichende Konsequenzen haben. Das Ziel der Erforschung möglicher genetischer Faktoren für die Entwicklung einer Sucht ist es, Erkenntnisse über die Ätiologie dieser Erkrankungen zu gewinnen und zielgenauere Therapieformen zu entwickeln. Zur Untersuchung der Rolle genetischer Faktoren stehen verschiedene Strategien zur Verfügung, welche in diesem Artikel vorgestellt werden.