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In the healthy brain, homeostatic balance between excitation and inhibition maintains neural stability. Reduced inhibition may explain shared symptoms observed in autism and psychosis. Here we review evidence suggesting that altered levels of gamma-aminobutyric acid (GABA) may underlie both disorders, providing a potential cross-diagnostic therapeutic target.
Tobacco smoking remains one of the leading causes of preventable illness and death and is heritable with complex underpinnings. Converging evidence suggests a contribution of the polygenic risk for smoking to the use of tobacco and other substances. Yet, the underlying brain mechanisms between the genetic risk and tobacco smoking remain poorly understood.
Genomic, neuroimaging, and self-report data were acquired from a large cohort of adolescents from the IMAGEN study (a European multicenter study). Polygenic risk scores (PGRS) for smoking were calculated based on a genome-wide association study meta-analysis conducted by the Tobacco and Genetics Consortium. We examined the interrelationships among the genetic risk for smoking initiation, brain structure, and the number of occasions of tobacco use.
A higher smoking PGRS was significantly associated with both an increased number of occasions of tobacco use and smaller cortical volume of the right orbitofrontal cortex (OFC). Furthermore, reduced cortical volume within this cluster correlated with greater tobacco use. A subsequent path analysis suggested that the cortical volume within this cluster partially mediated the association between the genetic risk for smoking and the number of occasions of tobacco use.
Our data provide the first evidence for the involvement of the OFC in the relationship between smoking PGRS and tobacco use. Future studies of the molecular mechanisms underlying tobacco smoking should consider the mediation effect of the related neural structure.
Compulsory admission procedures of patients with mental disorders vary between countries in Europe. The Ethics Committee of the European Psychiatric Association (EPA) launched a survey on involuntary admission procedures of patients with mental disorders in 40 countries to gather information from all National Psychiatric Associations that are members of the EPA to develop recommendations for improving involuntary admission processes and promote voluntary care.
The survey focused on legislation of involuntary admissions and key actors involved in the admission procedure as well as most common reasons for involuntary admissions.
We analyzed the survey categorical data in themes, which highlight that both medical and legal actors are involved in involuntary admission procedures.
We conclude that legal reasons for compulsory admission should be reworded in order to remove stigmatization of the patient, that raising awareness about involuntary admission procedures and patient rights with both patients and family advocacy groups is paramount, that communication about procedures should be widely available in lay-language for the general population, and that training sessions and guidance should be available for legal and medical practitioners. Finally, people working in the field need to be constantly aware about the ethical challenges surrounding compulsory admissions.
In 1990, Latin American countries committed to psychiatric reforms including psychiatric bed removals. Aim of the study was to quantify changes in psychiatric bed numbers and prison population rates after the initiation of psychiatric reforms in Latin America.
We searched primary sources to collect numbers of psychiatric beds and prison population rates across Latin America between the years 1991 and 2017. Changes of psychiatric bed numbers were compared against trends of incarceration rates and tested for associations using fixed-effects regression of panel data. Economic variables were used as covariates. Reliable data were obtained from 17 Latin American countries: Argentina, Bolivia, Brazil, Chile, Colombia, Costa Rica, Ecuador, Honduras, Guatemala, Mexico, Nicaragua, Panama, Paraguay, Peru, El Salvador, Uruguay and Venezuela.
The number of psychiatric beds decreased in 15 out of 17 Latin American countries (median −35%) since 1991. Our findings indicate the total removal of 69 415 psychiatric beds. The prison population increased in all countries (median +181%). Panel data regression analyses showed a significant inverse relationship −2.70 (95% CI −4.28 to −1.11; p = 0.002) indicating that prison populations increased more when and where more psychiatric beds were removed. This relationship held up when introducing per capita income and income inequality as covariates −2.37 (95% CI −3.95 to −0.8; p = 0.006).
Important numbers of psychiatric beds have been removed in Latin America. Removals of psychiatric beds were related to increasing incarceration rates. Minimum numbers of psychiatric beds need to be defined and addressed in national policies.
Armed reprisals are the limited use of military force in response to unlawful actions perpetrated against states. Historically, reprisals provided a military remedy for states that had been wronged (often violently) by another state without having to resort to all-out war in order to counter or deter such wrongful actions. While reprisals are broadly believed to have been outlawed by the UN Charter, states continue to routinely undertake such self-help measures. As part of the roundtable, “The Ethics of Limited Strikes,” this essay examines the doctrine of armed reprisals in light of recent instances of states using force “short of war” in this manner. We argue that the ban on reprisals has been largely ignored by states, and that recent attempts to apply the laws of armed conflict to the cyber domain (such as the Tallinn Manual) are further weakening this prohibition. We conclude that this is a potentially dangerous development that lowers the bar for resorting to military force, risking escalation and thereby further destabilizing the international system.
CVD is the most common chronic condition and the highest cause of mortality in the USA. The aim of the present work was to investigate diet and sedentary behaviour in relation to mortality in US CVD survivors. The National Health and Nutrition Examination Surveys conducted between 1999 and 2014 linked to the US mortality registry updated to 2015 were investigated. Multivariate adjusted Cox regression was used to derive mortality hazards in relation to sedentary behaviour and nutrient intake. A multiplicative and additive interaction analysis was conducted to evaluate how sedentariness and diet influence mortality in US CVD survivors. A sample of 2473 participants followed for a median period of 5·6 years resulted in 761 deaths, and 199 deaths were due to CVD. A monotone increasing relationship between time spent in sedentary activities and mortality risk was observed for all-cause and CVD mortality (hazard ratio (HR) = 1·20, 95 % CI 1·09, 1·31 and HR = 1·19, 95 % CI 1·00, 1·67, respectively). Inverse mortality risks in the range of 22–34 % were observed when comparing the highest with the lowest tertile of dietary fibre, vitamin A, carotene, riboflavin and vitamin C. Sedentariness below 360 min/d and dietary fibre and vitamin intake above the median interact on an additive scale influencing positively all-cause and CVD mortality risk. Reduced sedentariness in combination with a varied diet rich in dietary fibre and vitamins appears to be a useful strategy to reduce all-cause and CVD mortality in US CVD survivors.
Even though recent research indicates that sexual symptoms are highly prevalent in post-traumatic stress disorder following childhood sexual abuse and cause severe distress, current treatments neither address them nor are they effective in reducing them. This might be due to a lack of understanding of sexual symptoms' specific role in the often complex and comorbid psychopathology of post-traumatic stress disorder following childhood abuse.
Post-traumatic, dissociative, depressive, and sexual symptoms were assessed in 445 inpatients with post-traumatic stress disorder following childhood sexual abuse. Comorbidity structure was analyzed using a partial correlation network with regularization.
A total of 360 patients (81%) reported difficulties engaging in sexual activities and 102 patients (23%) reported to suffer from their sexual preferences. Difficulties engaging in sexual activities were linked to depressive and hyperarousal symptoms, whereas sexual preferences causing distress were linked to anger and dissociation. Dissociative amnesia, visual intrusions, and physical reactions to trauma reminders were of central importance for the network. Dissociative amnesia, depressed mood, lack of energy, and difficulties engaging in sexual activities were identified as bridge symptoms. Local clustering analysis indicated the non-redundancy of sexual symptoms.
Sexual symptoms are highly prevalent in survivors of childhood sexual abuse with post-traumatic stress disorder. Further research is needed regarding the link of difficulties engaging in sexual activities, depression, and post-traumatic stress disorder, as well as regarding the association of dissociation and sexual preferences causing distress. Sexual symptoms require consideration in the treatment of post-traumatic stress disorder following childhood sexual abuse.
This chapter discusses the diverse terminology used to describe contact situations between two or more cultures by focusing on Welsch’s discussions of multi-, inter- and transculturality. The anthropological and psychological dimensions of cultural concepts are shown to arise from the need of human beings as pattern-building and storytelling animals to position themselves by defining identities and alterities in a diverse environment which makes essentialist ontological self-definitions impossible. Using topical and historical examples, the chapter argues that conceptualization of the world as increasingly hybrid and transcultural has very concrete material, social and political consequences. The chapter then explores the connections between notions of cosmopolitanism and different conceptualizations of difference, particularism and universalism. Finally, the ethical dimensions of different ways of categorizing cultures and their implications for developing inter- and transcultural competence as the basis for constructing a peaceful and dialogic future of togetherness in difference are discussed.
The legal system undergoes again a deep process of transformation that may be attributed to the emergence of the “society of networks”. The earlier transformations that took place in the “society of organisations” were centred around the organisation as a kind of “big individual” that was and still is able to aggregate and manage long chains of actions as opposed to the individual subject whose action was rule oriented and followed established patterns of experience. The “society of organisations” was characterised by the rise of all kinds of social norms (standards), organised generation of knowledge, and practices of “balancing” that the multiplication of long chains of action have made necessary. The “society of networks” leads to more complex processes of knowledge generation and tends to create new “quasi-subjects” that follow mobile project-like patterns of co-operation. They are focused on “high knowledge” that is involved in permanent processes of self-transformation. The emergence of “data driven technologies” that do not follow stable trajectories is paradigmatic. It is a challenge for the legal system if what the new loosely aggregated quasi-subjects of the “society of networks” do is “surfing fluid reality” (Bahrami and Evans). This evolution finds its repercussion in new challenges for the regulatory state and also for contracting practices in private law. “Serial law” might be a new paradigm of law that “reads” processes of change in real time and experiments with forms of co-ordination that refer to learning processes.
Neurotransmitter systems such as dopamine and glutamate play a major role in encoding prediction errors and in learning of cue-triggered and goal-directed behaviour. Dysfunction of these neurotransmitter systems affect prefrontal-limbic neurocircuits and thus contribute to the formation of delusions, and to motivational and affective deficits. For example, reduced activation of the ventral striatum during reward anticipation has been associated with craving for drugs of abuse and with motivational deficits such as apathy, a so-called negative symptom in schizophrenia. Dopamine-dependent learning dysfunctions in alcohol dependence impairs learning of alternative, non substance-associated behaviour. On the other hand, aberrant activation during feedback of negative outcomes correlated with delusion formation in schizophrenic psychoses. Multimodal imaging studies implied glutamatergic and dopaminergic dysfunction to be associated with altered functional brain activation. Human genetic and imaging studies revealed that candidate genes, which affect monoamine metabolism, interact with neurotransmission and task-relevant activation in these brain areas; furthermore, first and second-generation neuroleptics differentially interact with functional brain activation in these neurocircuits. Together, these findings suggest that the combination of genetic and imaging studies may help to elucidate the neurobiologcial correlates of dysfunctional learning processes in psychosis and addiction and to identify new targets for behavioural and pharmacological interventions.
Alcohol dependence is one of the most fatal mental diseases amongst men in western industrialized nations and is the major risk factor for the development of more than 60 chronic illnesses. With no further intervention, relapse rates in detoxified alcoholics are high and usually exceed 85% of all detoxified patients. It has been suggested that stress and exposure to priming doses of alcohol and to alcohol-associated stimuli (cues) contribute to the relapse risk after detoxification.
In the last decades there has been substantial progress in scientific research of the neurobiological principles of alcohol-related disorders. Recent studies using multi modal imaging techniques like functional magnetic resonance imaging (fMRI) and positron emission tomography (PET) observed dysfunctions of the mesolimbic dopaminergic brain reward system (ventral striatum including the nucleus accumbens): Functional brain activation is increased during the processing of alcohol-associated cues and decreased during the confrontation with other non-alcoholic reward-indicating stimuli. This alcohol-associated “hijacking” of the reward system is associated with craving and the prospective relapse risk.
Moreover, the reward-associated learning seems to be disturbed in alcohol-dependent patients, so that addicted persons have problems to integrate informations about positive and negative consequences of their actions and to adapt their behavior accordingly. Personality traits like impulsiveness seem to be relevant in this context as well.
These findings about the different neurobiological mechanisms of addiction and relapse raise hope for new psychotherapeutic and pharmacological treatment approaches of alcohol dependence that is adapted to individual relapse mechanisms and needs.
Migration-related factors could be additional risk factors for the development of depression and suicidal behaviour in migrant populations. In particular, the success or failure of migration will impact on migrants’ mental well-being. The premigration experiences, the act of migration itself, the motive for migration, postmigration experiences and the structural prerequisites in the host country play a central role. On the basis of the results of a population based study on the factors associated with mental distress in female Turkish migrants in two German cities (Berlin, Hamburg) the impact of migration-specific factors on the expression of mental distress will be discussed. Factors which will be examined among others are, reasons for migration, residence status, perceived ethnic discrimination and acculturation strategies, socio-economic status and traumatic experiences (pre- and post-migration).
The process of migration can be a risk factor for suicidal behaviour. Factors such as circumstances of the migration and individual characteristics like age, education, and his offspring play an important role. The empiric evidence of today's suicide prevention therapy strategies - following a suicidal crisis or a suicide attempt - in order to prevent prospective crises are limited. There are not enough protective therapy recommendations. Psychotherapeutic interventions and antidepressants are not proven to be better than a standard treatment. An appropriate treatment of depression (antidepressant, psychotherapy, psychoeducation, self-help) seems to be preventive. In this contribution the current state of epidemiology, ethiopathogenesis, models of suicidal behaviour and suicide prevention will be discussed.
We have compared oxcarbazepine (OXC) with acamprosate (ACP) in relapse prevention in recently withdrawn alcohol dependent patients. Oxcarbazepine blocks voltage-sensitive sodium channels. Its metabolite reduces high-voltage-activated calcium currents in striatal and cortical neurons, thus reducing glutamatergic transmission at corticostriatal synapses. This reduction is of interest in the treatment of alcohol dependence, since acamprosate modulates NMDA receptors, resulting in an inhibition of glutamatergic transmission. Furthermore, OXC has revealed a mood-stabilizing effect in bipolar affective disorders.
In a randomized open label pilot study 30 detoxified alcohol dependent patients were followed up for six months to assess treatment outcome in pharmacological relapse prevention. 15 alcoholics were treated with OXC and 15 with ACP. We asked for the time until first and heavy relapse and for drinks on drinking days. We assessed craving (OCDS), the severity of depression (ADS) and the degree of state anxiety (STAI).
After withdrawal, time to severe relapse and time to first consumption of any ethanol by OXC patients was not longer than for ACP patients. Abstinent patients in both study groups showed significantly lower OCDS-G than relapsed patients. No undesired effects occurred when OXC patients consumed alcohol.
While the current sample size clearly limits further conclusions from this pilot study, it is noteworthy that OXC is well tolerated. Thus, in medication-based relapse prevention, OXC could have the potential of a promising alternative for alcoholic patients unable to benefit from ACP or naltrexone or who suffer from affective lability. OXC certainly merits a larger placebo controlled trial.
Alcohol stimulates dopamine release and chronic intake is associated with neuroadaptation in the brain reward system. Previous studies described
1) increased brain activation following the presentation of alcohol-associated stimuli, which was directly correlated with dopamine D2 receptor reductions in the ventral striatum, and
2) a decreased response to stimuli that predict non-alcohol (e.g. monetary) rewards.
This alteration of brain responses to alcohol-associated versus non-alcohol cues may result from altered reward-associated learning in alcoholism. Indeed, alcohol-dependent patients displayed a decreased learning rate and performeance in a probabilistic reversal task. A brain imaging study revealed that the decreased learning rate was associated with impaired prefrontal-striatal connectivity during reward-dependent reversal learning. These results point to deficits in reward-associated learning, which contribute to alcohol craving. Since such reward-associated learning deficits can interfere with learning of new, non-alcohol associated behavior, cognitive behavior therapy may profit from taking such learning speed impairments into account.
Studies demonstrate that suicidality in female Turkish immigrants in some European countries is higher compared to native-born women of the same age. This indicates a demand for a better understanding of suicide in this group of the society, and, based on such knowledge, specific concepts for prevention. Embedded in the development of a suicide prevention campaign for women of Turkish origin in Berlin, Germany, we assessed explanatory models of suicidal behavior using a qualitative approach. Specifically, we employed focus group discussions with Turkish experts as well as focus group discussions with Turkish women from the community. Groups were stratified by age (age range 18-34, 35-49, and 50+) in order to account for age effects and effects of migration generation. Results show differential conceptions of suicidal crises, the patterns of distress, the perceived causes, and the preferences for help-seeking and treatment as a function of age group and expertise. Based upon these results, we provide a framework for explanatory models of suicidal crisis behavior that are specific for women with a Turkish migratory background in Germany.
Treatment of alcohol addiction remains challenging, since only half of all patients achieve long-term abstinence by currently available therapies.
In the last 2 years, there have been promising reports on deep brain stimulation (DBS) of NAc in addiction (animal models, one case report of a patient with severe anxiety disorder and secondary addiction). Our group treated 5 patients with treatment resistant alcohol addiction with DBS so far. Our initial data of the first 3 patients has just been published. However, these very positive results arise from a continuous open stimulation and have not been placebo controlled.
To assess the impact of discontinuation of bilateral DBS of the NAc on craving for alcohol in patients whose addiction remitted after initiation of DBS.
Crossover, double-blinded phase of 2 × 4 weeks with sham-stimulation in one and stimulation in the other 4 weeks.
Until now, one patient finished the 8 weeks of study (remaining patients will finish experiment in December 2009). In this patient, stimulation was continued in the first and stopped in the latter 4 weeks. While he experienced no changes or side effects in the first part, he showed a massive craving for alcohol one day after discontinuation, which again remitted when the experiment was stopped and the stimulator was turned on again after 3 days.
DBS of NAc seems to selectively alleviate craving for alcohol thus enabling patients to remain abstinent. These results justify clinical studies in larger samples of patients with treatment resistant alcohol addiction.
The aim of the main study is to examine the influence of risk factors and protecting factors that help elicit or alleviate mental health issues. An epidemiological cross-sectional data collection approach will be employed for this purpose, and the main outcome variable will be mental health as assessed with the General Health Questionnaire. We will recruit 340 German women and 340 Turkish migrant women. Constructs such as general self-efficacy, social support and extraversion depict protective factors and constructs such as social strain and neuroticism are considered as risk factors in this regard. Furthermore, the coherence between various acculturation patterns will be explored in order to be able to examine the presence of psychiatric symptoms more precisely.
We will present the first results of the pilot study by 50 Turkish migrant women to review the reliability and validity of the used instruments and to evaluate the hypotheses and experimental design.