Bromundt V.,Psychiatric Hospital |
Koster M.,Psychiatric Hospital |
Georgiev-Kill A.,Psychiatric Hospital |
Wirz-Justice A.,Psychiatric Hospital |
And 2 more authors.
British Journal of Psychiatry | Year: 2011
Background: Irregular sleep-wake cycles and cognitive impairment are frequently observed in schizophrenia, however, how they interact remains unclear. Aims: To investigate the repercussions of circadian rhythm characteristics on cognitive performance and psychopathology in individuals with schizophrenia. Method: Fourteen middle-aged individuals diagnosed with schizophrenia underwent continuous wrist actimetry monitoring in real-life settings for 3 weeks, and collected saliva samples to determine the onset of endogenous melatonin secretion as a circadian phase marker. Moreover, participants underwent multiple neuropsychological testing and clinical assessments throughout the study period. Results: Sleep-wake cycles in individuals with schizophrenia ranged from well entrained to highly disturbed rhythms with fragmented sleep epochs, together with delayed melatonin onsets and higher levels of daytime sleepiness. Participants with a normal rest-activity cycle (objectively determined by high relative amplitude of day/night activity) performed significantly better in frontal lobe function tasks. Stepwise regression analysis revealed that relative amplitude and age represented the best predictors for cognitive performance (Stroop colour-word interference task, Trail Making Test A and B, semantic verbal fluency task), whereas psychopathology (Positive and Negative Syndrome Scale) did not significantly correlate with either cognitive performance levels or the quality of sleep-wake cycles. Conclusions: Consolidated circadian rhythms and sleep may be a prerequisite for adequate cognitive functioning in individuals with schizophrenia. © 2011 The Royal College of Psychiatrists.
Simmons M.,Ida Darwin Hospital |
Barrett E.,Our Ladys Hospital |
Wilkinson P.,University of Cambridge |
Pacherova L.,Psychiatric Hospital
European Child and Adolescent Psychiatry | Year: 2012
The objective of this study was to investigate trainee experiences of Child and Adolescent Psychiatry (CAP) training across Europe in the following domains: (A) structure and organisation of training; (B) training quality and content; and (C) working conditions and recruitment. CAP trainee representatives were contacted via email across 34 countries in Europe using the European Federation of Psychiatric Trainees (EFPT) email list to complete a survey on CAP training in 2010-2011. The European Union of Medical Specialties CAP group and trainees at the 2011 EFPT forum validated the survey data. Full surveys were submitted by 28 of the 34 countries who have national CAP training schemes. These 28 countries are subject to the following further analysis. 7/28 countries (25 %) have a core common trunk in general psychiatry before trainees specialise in CAP. All countries bar one have national training standards for CAP. Training standards are implemented in practice to a variable extent. There is a CAP-specific theoretical education programme and national CAP conference in 25/28 countries (89 %). Supervision occurs at least weekly in 19/28 countries (68 %); emergency duty supervision is available in 18/28 (64 %) countries; educational supervision is available in 13/28 countries (46 %). Psychotherapy training is obligatory in 19/28 countries (68 %). Research training is obligatory in 8/28 countries (29 %). Sub-specialty experience is extremely variable. Recruitment into CAP is a problem in 19/28 countries (68 %). Training experiences in CAP varies widely across European countries. © 2012 Springer-Verlag.
Silic A.,Psychiatric Hospital |
Karlovic D.,University of Zagreb |
Serretti A.,University of Bologna
Journal of Affective Disorders | Year: 2012
Background: Recent studies suggest comorbidity between major depressive disorder (MDD) and metabolic syndrome. For both disorders, impaired serotoninergic neurotransmission and inflammatory factors have been suggested. The objective of this study was to investigate the concentration of platelet serotonin, interleukin-6 (IL-6) and C-reactive protein (CRP) in MDD patients with and without metabolic syndrome. The second goal was to investigate the association of the concentrations of platelet serotonin, IL-6 and CRP with individual components of metabolic syndrome in MDD patients. Methods: A total of 145 MDD patients were included in the study (diagnosed according DSM IV TR criteria). The metabolic syndrome was defined according to the criteria of the American National Cholesterol Education Program-Treatment Panel III (ATP III). Inflammation factors (IL-6 and CRP) and platelet serotonin concentration were assessed by the enzyme-linked immunosorbent assay (ELISA). Results: MDD patients with metabolic syndrome showed lower platelet serotonin and higher IL-6 and CRP concentrations when compared to MDD patients without metabolic syndrome. An inverse correlation was found between platelet serotonin and waist circumference and serum glucose levels. A positive correlation was found between IL-6 and glucose or triglyceride concentrations, while the correlation with HDL cholesterol was negative. Limitations: Data on dietary habits or physical activity prior to hospitalisation were not collected. Also, the study was a cross-sectional without a prospective design. Conclusion: Metabolic syndrome in patients with MDD may be associated with reduced concentrations of platelet serotonin and increased concentrations of IL-6 and CRP. © 2012 Elsevier B.V.
Ribeiro-Santos R.,Federal University of Minas Gerais |
Teixeira A.L.,Federal University of Minas Gerais |
Salgado J.V.,Federal University of Minas Gerais |
Salgado J.V.,Psychiatric Hospital
Current Neuropharmacology | Year: 2014
Objective: Recent evidence has associated immune and inflammatory changes to cognitive performance in many diseases, including schizophrenia. Since this is a new research field where concepts are not yet solid and new questions and hypothesis are still arising, the present study aimed at summarizing the available clinical data associating schizophrenia, cognition and inflammation/immune function. Methods: A systematic review of the literature was made by searching the following terms in Medline: “schizophrenia or psychosis or psychotic” AND “inflamm* or immun* or cytokine or IL-* or TNF-* or kynureni* or KYNA”, AND “cognit* or attention or memory or executive function”. Results: Seventy five papers were identified using the selected terms, and seven papers were included in the review. Papers excluded focused mainly on basic research or other neuropsychiatric disorders. Conclusions: Recent findings link inflammatory markers to cognition in schizophrenia, suggesting that inflammation is associated with worst cognitive performance. Microglial activation, monoaminergic imbalance, brain abnormalities and the kynurenine pathway are possible mechanisms underlying cognitive impairment in schizophrenia. Clinical trials with addition of immunomodulatory drugs have shown promising results, opening new windows to tackle cognition in schizophrenia. © 2014 Bentham Science Publishers.
Thimm J.C.,Psychiatric Hospital |
Thimm J.C.,Norwegian University of Science and Technology
Clinical Psychology and Psychotherapy | Year: 2010
In schema therapy, early maladaptive schemas (EMS) are hypothesized to be the result of adverse relational experiences in childhood that hinder the resolution of important psychological developmental tasks. The purpose of the present study was to examine the relationships between EMS and the resolution of the developmental tasks that are described in Erikson's scheme of personality development. One hundred and forty-fi ve adult psychiatric outpatients completed measures of EMS and resolution of psychosocial development tasks at two occasions. Results from correlational and regression analyses showed that EMS are generally associated with unsuccessful psychosocial task resolution. Furthermore, schema change predicted changes in the resolution of developmental tasks. These fi ndings give support to Young's theory of schema development. © 2009 John Wiley & Sons, Ltd.
Traber R.,Psychiatric Hospital |
Schnyder U.,University of Zürich
Journal of Psychopharmacology | Year: 2013
Psychiatrists and psychotherapists in the US (1970s to 1985) and Switzerland (1988-1993) used MDMA legally as a prescription drug, to enhance the effectiveness of psychotherapy. Early reports suggest that it is useful in treating trauma-related disorders. Recently, the first completed pilot study of MDMA-assisted psychotherapy for PTSD yielded encouraging results. Designed to test the safety and efficacy of MDMA-assisted psychotherapy in patients with treatment-resistant PTSD; our randomized, double-blind, active-placebo controlled trial enrolled 12 patients for treatment with either low-dose (25 mg, plus 12.5 mg supplemental dose) or full-dose MDMA (125 mg, plus 62.5 mg supplemental dose). MDMA was administered during three experimental sessions, interspersed with weekly non-drug-based psychotherapy sessions. Outcome measures used were the Clinician-Administered PTSD Scale (CAPS) and the Posttraumatic Diagnostic Scale (PDS). Patients were assessed at baseline, three weeks after the second and third MDMA session (end of treatment), and at the 2-month and 1-year follow-ups.We found that MDMA-assisted psychotherapy can be safely administered in a clinical setting. No drug-related serious adverse events occurred. We did not see statistically significant reductions in CAPS scores (p = 0.066), although there was clinically and statistically significant self-reported (PDS) improvement (p = 0.014). CAPS scores improved further at the 1-year follow-up. In addition, three MDMA sessions were more effective than two (p = 0.016). © The Author(s) 2013.
News Article | February 21, 2017
A pastor spits out prayers as his subject falls to the ground, writhing and contorting after a 30-day fast. Ministers form a circle around the emaciated man and douse him in anointing oil and holy water. When the prayer tsunami ends, a hovering calm ensues. A hologram glides through the man’s atrophied body as he springs to his feet, professing his salvation. So goes the standard script for a deliverance session or exorcism in Nigerian film. Bree, whose name has been changed to protect her identity, said her first deliverance session in 2004 had none of this Nollywood drama. “The pastor acted like it was pretty normal and routine. It was a quick 15 minutes, and nothing changed,” she says, stifling a laugh. “I felt like he didn’t realise it was a big spiritual issue, and he didn’t treat it with the weight it deserved.” Bree, who identifies as lesbian and Christian, has been grappling with reconciling her faith and sexuality for most of her life. Growing up in a conservative community where the two identities were considered mutually exclusive, her sense of God’s disapproval and abandonment had taken its toll. Her meandering from unstable to abusive relationships only confirmed her belief that her sexuality was wrong and something that would continually punish her. In 2009, while attending a Pentecostal church service with her girlfriend at the time, the pastor asked women who wanted to be delivered from the spirit of lesbianism to approach the altar. “I was so tired of feeling rejected by God. I just wanted peace,” she says of her decision to step forward. “I was so conflicted. You go to church and keep hearing about how lesbians and gay people are an abomination, how they are going to hell, and you don’t understand why God is rejecting you before you even had a chance to say, ‘I don’t want this’.” This time around, the pastor laid hands on Bree and her girlfriend. Believing they were entranced in spirit, the women rolled on the ground and were surrounded by ministers. “It was intense, and I was hopeful this was it, maybe we had been cured. I needed to not be gay anymore,” Bree says. After a tearful breakup from her partner following the deliverance session, they got back together a week later, both exhausted from acting “healed.” “I finally had a conversation with God saying that if this is who I am, ‘you made me, then you fix me’,” Bree says. Bree believes one of the burdens religious exorcism places on sexual minorities is the need to “perform” - pretend to be straight. She reminds herself to switch feminine pronouns to masculine ones when discussing past relationships with work colleagues and when writing on her blog. Once, when a colleague gave her a suspicious look for staring admiringly at a woman, Bree invented a quick fib about having previously met the person. Olumide Makanjuola, executive director of The Initiative for Equal Rights (TIERS), an organisation based in Lagos that works on LGBTQI rights and sexual health, says that “performing” is mentally straining. “In a space like Nigeria, people perform sexuality quite well. We don’t care what performance does to people mentally, as we are focused on how people see us and how they imagine us,” Makanjuola says. Through his work, Makanjuola has encountered many people in the local lesbian, gay, bisexual, transgender, queer and intersex (LGBTQI) community dealing with acute anxiety and depression as a result of performing straightness brought on by deliverance attempts and conversion therapy. “Exorcism reduces people. They feel so incomplete and powerless,” he says. “We run a religious system that is full of condemnation as opposed to understanding, which is very problematic.” Makanjuola emphasises the need to deconstruct social norms society places on people, whether gay or straight, and warns about the mental health strain that can arise from this constant need to perform. Bree says her deep-seated distrust of Nigeria’s mental health system prevented her from seeking professional help when coming to terms with her faith and sexuality. “I wouldn’t talk to a professional about it, because I’m not going to have someone validate negative feelings,” she says. “The people who we talk to will fall back on culture or religion.” Makanjuola says Nigeria’s LGBTQI community often faces stigmatised responses from healthcare providers because of institutionalised homophobia and prejudice, making it difficult for them to seek help. Addressing this lack of trust and presumed discrimination, psychiatrist Gbonju Abiri from the Federal Neuro-Psychiatric Hospital in Lagos says: “Nigeria is deeply ingrained in culture and religious beliefs, and we are not able to deal with diversity just yet as we should. Our practice encourages that we should put health above all first.” She adds that many LGBTQI patients ask doctors about their views on sexuality prior to consultations, using the doctors’ responses to determine whether or not to go forward with the appointment. Acceptance of homosexuality is difficult in a country which outlaws gay marriage. Nigeria’s Same Sex Marriage Prohibition Act, which stipulates up to 14 years in prison for divergent sexual orientation and gender identity expressions, was signed into law by President Goodluck Jonathan in 2014. Makanjuola believes the law validates existing social prejudices. “As a health service receiver, you are dealing with two monsters: a doctor who is prejudiced towards you, and a service provider who is also using the law to validate their own sense of what is right. If you win with the law, are you going to win with the angle of their personal belief system?” he asks. In 2012, exhausted from feeling depressed and condemned, Bree decided to study more about the intersection between her faith and her sexuality. She looked through the works of theologians, unlearning most of what she had been taught and reading stories of people who had taken their own lives when faced with similar battles. “You can’t blame people, because there is a culture that has been handed down, but I will not accept that anybody is an abomination because of whom they love,” she says. After hours spent counselling a young woman on the verge of suicide who was unable to find an existence between her faith and her sexuality, Bree is now working towards earning a professional counselling qualification to help others who were once in her shoes. Now that she has found acceptance inside herself, she hopes to help others do the same. From 20-25 February the Guardian Global Development Professionals Network is highlighting the work of the LGBT rights activists throughout the world with our LGBT change series. Nominate LGBT heroes here, join the conversation at #LGBTChange and email email@example.com to pitch an idea. Join our community of development professionals and humanitarians. Follow @GuardianGDP on Twitter.
Krogh J.,Copenhagen University |
Videbech P.,Psychiatric Hospital |
Thomsen C.,Copenhagen University |
Gluud C.,Copenhagen University |
Nordentoft M.,Copenhagen University
PLoS ONE | Year: 2012
Background: The effect of referring patients from a clinical setting to a pragmatic exercise intervention for depressive symptoms, cognitive function, and metabolic variables has yet to be determined. Methods: Outpatients with major depression (DSM-IV) were allocated to supervised aerobic or stretching exercise groups during a three months period. The primary outcome was the Hamilton depression score (HAM-D17). Secondary outcomes were cognitive function, cardiovascular risk markers, and employment related outcomes. Results: 56 participants were allocated to the aerobic exercise intervention versus 59 participants to the stretching exercise group. Post intervention the mean difference between groups was -0.78 points on the HAM-D17 (95% CI -3.2 to 1.6; P =. 52). At follow-up, the participants in the aerobic exercise group had higher maximal oxygen uptake (mean difference 4.4 l/kg/min; 95% CI 1.7 to 7.0; P =. 001) and visuospatial memory on Rey's Complex Figure Test (mean difference 3.2 points; 95% CI 0.9 to 5.5; P =. 007) and lower blood glucose levels (mean difference 0.2 mmol/l; 95% CI 0.0 to 0.5; P =. 04) and waist circumference (mean difference 2.2 cm; 95% CI 0.3 to 4.1; P =. 02) compared with the stretching exercise group. Conclusions: The results of this trial does not support any antidepressant effect of referring patients with major depression to a three months aerobic exercise program. Due to lower recruitment than anticipated, the trial was terminated prior to reaching the pre-defined sample size of 212 participants; therefore the results should be interpreted in that context. However, the DEMO-II trial does suggest that an exercise program for patients with depression offer positive short-term effects on maximal oxygen uptake, visuospatial memory, fasting glucose levels, and waist circumference. Trial Registration: ClinicalTrials.gov NCT00695552. © 2012 Krogh et al.
Lietaer G.,Catholic University of Leuven |
Dierick P.,Psychiatric Hospital
Person-Centered and Experiential Psychotherapies | Year: 2015
As part of the Leuven Group Psychotherapy Process Study, a questionnaire to assess group participants’ perceptions of hindering factors in group sessions was administered to 489 members of 78 psychotherapy and experiential learning groups of client-centered/experiential, psychoanalytic, behavioral, Gestalt, drama- and body-oriented orientations. In this article we focus on the specific meaning and impact of these hindering factors. Within this inquiry the following questions are empirically investigated: To what degree do group members experience these hindering factors and to what degree do they experience them as harmful? How do these hindering factors relate to therapeutic factors and to intermediate outcome ratings? Are they experienced differently as a function of severity of group members’ problems and as a function of therapeutic orientation? The central finding of the study points to the ambiguous character of hindering factors and their potential to become converted into corrective therapeutic experiences. © 2015, © 2015 World Association for Person-Centered & Experiential Psychotherapy & Counseling.
Hatzinger M.,Psychiatric Hospital |
Brand S.,University of Basel |
Herzig N.,University of Basel |
Holsboer-Trachsler E.,University of Basel
Journal of Psychiatric Research | Year: 2011
Background: Hypothalamic-pituitary-adrenocortical axis reactivity (HPA AR) is the key indicator of the psychophysiological response to stress. The HPA AR may vary with age and gender. To investigate these factors concurrently, the aims of the present study were to observe HPA AR (plasma ACTH and plasma cortisol) in response to a pharmacological challenge (dexamethasone/corticotropin releasing hormone test: DEX/CRH-test) and as a function of age and gender. Method: 19 young (10 females and 9 males; mean age = 24.05 years) and 23 elderly (11 females and 12 males; mean age = 71.61 years) healthy volunteers took part in the study. To assess HPA AR, participants underwent the combined DEX/CRH test applied with the following DEX doses: 0.75, 1.5, and 3.0 mg, respectively. Results: A dose-dependent response was observed in young adult participants, but not in elderly participants. With increasing DEX doses, ACTH and cortisol values decreased in young adult participants, while the decrease was blunted among elderly compared to young adult participants. No differences were observed for gender. Conclusions: Results point to diminished HPA axis sensitivity as an effect of normal aging, irrespective of gender. Therefore, altered HPA regulation in old age should be taken into account for developing new therapeutic approaches acting on the HPA axis and its receptor mechanisms. © 2011 Elsevier Ltd.