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Purpose of this study was to assess subjective well-being in schizophrenia inpatients and to find variables predictive for response and remission of subjective well-being.
The subjective well-being under neuroleptic treatment scale (SWN-K) was used in 232 schizophrenia patients within a naturalistic multicenter trial. Early response was defined as a SWN-K total score improvement of 20% and by at least 10 points within the first 2 treatment weeks, response as an improvement in SWN-K total score of at least 20% and by at least 10 points from admission to discharge and remission in subjective well-being as a total score of more or equal to 80 points at discharge. Logistic regression and CART analyses were used to determine valid predictors of subjective well-being outcome.
Twenty-nine percent of the patients were detected to be SWN-K early responders, 40% fulfilled criteria for response in subjective well-being and 66% fulfilled criteria for remission concerning subjective well-being. Among the investigated predictors, SWN-K early improvement and the educational status were significantly associated with SWN-K response. The SWN-K total score at baseline showed a significant negative predictive value for response. Baseline SWN-K total score, PANSS global subscore, and side effects as well as the educational status were found to be significantly predictive for remission.
Depressive symptoms should be radically treated and side effects closely monitored to improve the patient's subjective well-being. The important influence of subjective well-being on overall treatment outcome could be underlined.
This guidance paper from the European Psychiatric Association (EPA) aims to provide evidence-based recommendations on early intervention in clinical high risk (CHR) states of psychosis, assessed according to the EPA guidance on early detection. The recommendations were derived from a meta-analysis of current empirical evidence on the efficacy of psychological and pharmacological interventions in CHR samples. Eligible studies had to investigate conversion rate and/or functioning as a treatment outcome in CHR patients defined by the ultra-high risk and/or basic symptom criteria. Besides analyses on treatment effects on conversion rate and functional outcome, age and type of intervention were examined as potential moderators. Based on data from 15 studies (n = 1394), early intervention generally produced significantly reduced conversion rates at 6- to 48-month follow-up compared to control conditions. However, early intervention failed to achieve significantly greater functional improvements because both early intervention and control conditions produced similar positive effects. With regard to the type of intervention, both psychological and pharmacological interventions produced significant effects on conversion rates, but not on functional outcome relative to the control conditions. Early intervention in youth samples was generally less effective than in predominantly adult samples. Seven evidence-based recommendations for early intervention in CHR samples could have been formulated, although more studies are needed to investigate the specificity of treatment effects and potential age effects in order to tailor interventions to the individual treatment needs and risk status.
The aim of this guidance paper of the European Psychiatric Association is to provide evidence-based recommendations on the early detection of a clinical high risk (CHR) for psychosis in patients with mental problems. To this aim, we conducted a meta-analysis of studies reporting on conversion rates to psychosis in non-overlapping samples meeting any at least any one of the main CHR criteria: ultra-high risk (UHR) and/or basic symptoms criteria. Further, effects of potential moderators (different UHR criteria definitions, single UHR criteria and age) on conversion rates were examined. Conversion rates in the identified 42 samples with altogether more than 4000 CHR patients who had mainly been identified by UHR criteria and/or the basic symptom criterion ‘cognitive disturbances’ (COGDIS) showed considerable heterogeneity. While UHR criteria and COGDIS were related to similar conversion rates until 2-year follow-up, conversion rates of COGDIS were significantly higher thereafter. Differences in onset and frequency requirements of symptomatic UHR criteria or in their different consideration of functional decline, substance use and co-morbidity did not seem to impact on conversion rates. The ‘genetic risk and functional decline’ UHR criterion was rarely met and only showed an insignificant pooled sample effect. However, age significantly affected UHR conversion rates with lower rates in children and adolescents. Although more research into potential sources of heterogeneity in conversion rates is needed to facilitate improvement of CHR criteria, six evidence-based recommendations for an early detection of psychosis were developed as a basis for the EPA guidance on early intervention in CHR states.
To evaluate the clinical benefit of switching to quetiapine sustained release (SR) in patients with schizophrenia experiencing suboptimal efficacy/tolerability with their current antipsychotic.
This was a 12-week, multicentre, open-label study (D1444C00147). Quetiapine SR (mg/day) was initiated during a 4-day cross titration phase (300 on Day 1; 600 on Day 2; 400, 600 or 800 on Day 3; flexible-dosing [400-800] from Days 4-84). Primary objective was to demonstrate that >50% of patients would achieve clinical benefit (improved CGI-Clinical Benefit [CB] score, based on CGI-I Efficacy index and tolerability burden) at Week 12. Secondary endpoints included CGI-I and PANSS total scores. Tolerability was assessed by adverse events (AEs), SAS and BARS scores. Mean changes in rating scale scores were analysed using ANCOVA.
477 patients were switched to quetiapine SR, 370 (77.6%) completed treatment. 295 of 470 evaluable patients (62.8%) achieved a clinical benefit upon switching to quetiapine SR (95% CI 58.4, 67.1, p<0.0001). Significant improvements were observed in mean [SD] change from baseline in CGI-CB (-2.1 [3.62]) and PANSS total (-13.6 [19.23]) (both p<0.001). Mean [SD] CGI-I score at endpoint was 2.8 [1.49] (p<0.001 for mean CGI-I<4). Common AEs included somnolence (17.8%), sedation (15.1%), dizziness and dry mouth (14.0% each). The incidence of EPS was 8.0%. Mean changes (improvements) from baseline in SAS and BARS scores were -2.1 and -0.4 respectively (both p<0.001).
Switching to quetiapine SR was associated with clinical benefit and was well tolerated in patients with schizophrenia experiencing suboptimal efficacy/tolerability with their previous antipsychotic treatment.
Repetitive Transcranial Magnetic Stimulation (rTMS) research in psychiatry mostly excludes left-handed participants. We recruited left-handed people with a bulimic disorder and found that stimulation of the left prefrontal cortex may result in different effects in left- and right-handed people. This highlights the importance of handedness and cortex lateralisation for rTMS.
Aim was to examine depressive symptoms in acutely ill schizophrenia patients on a single symptom basis and to evaluate their relationship with positive, negative and general psychopathological symptoms.
Two hundred and seventy-eight patients suffering from a schizophrenia spectrum disorder were analysed within a naturalistic study by the German Research Network on Schizophrenia. Using the Calgary Depression Scale for Schizophrenia (CDSS) depressive symptoms were examined and the Positive and Negative Syndrome Scale (PANSS) was applied to assess positive, negative and general symptoms. Correlation and factor analyses were calculated to detect the underlying structure and relationship of the patient’s symptoms.
The most prevalent depressive symptoms identified were depressed mood (80%), observed depression (62%) and hopelessness (54%). Thirty-nine percent of the patients suffered from depressive symptoms when applying the recommended cut-off of a CDSS total score of > 6 points at admission. Negligible correlations were found between depressive and positive symptoms as well as most PANSS negative and global symptoms despite items on depression, guilt and social withdrawal. The factor analysis revealed that the factor loading with the PANSS negative items accounted for most of the data variance followed by a factor with positive symptoms and three depression-associated factors.
The naturalistic study design does not allow a sufficient control of study results for the effect of different pharmacological treatments possibly influencing the appearance of depressive symptoms.
Results suggest that depressive symptoms measured with the CDSS are a discrete symptom domain with only partial overlap with positive or negative symptoms.
Psychotic and psychotic-like experiences (PLEs) are frequently found in the general population when assessed with self-report questionnaires. It is not clear how these assessments can help to predict the future development of mental disorders. The degree of certainty in appraisal or the experience-related distress may add prognostic power of clinical PLE assessments. This study was designed to provide baseline data of PLEs in a representative sample, which will be monitored for the future development.
We studied the frequency of PLEs in a representative sample of 4483 participants of the German population recruited through the Mental Health Module of the German Health Interview and Examination Survey for Adults (DEGS1-MH). Participants were asked if they had had psychotic or psychosis-like experiences over their lifetime. We used the psychosis section of the Composite International Diagnostic Interview (CIDI), the Launay-Slade Hallucination Scale (LSHS) and the Peter's Delusion Inventory (PDI).
33.3% of the participants endorsed at least one item of the CIDI psychosis scale, 68.8% of the PDI and 49.0% of the LSHS. In the PDI assessments, conspiracy-related delusional experiences were most often experienced as distressing, while religious beliefs were experienced less distressing, but with high levels of conviction.
Our findings show frequent endorsement of lifetime psychotic or psychotic-like experiences in the general population in self-report questionnaires with varying degrees of distress and conviction. This provides the needed baseline assessment for follow-up studies observing the development of mental disorders with a view to determine the predictive values of these tests.
After two decades of research, prevention of psychosis becomes increasingly accepted in clinical psychiatry. However, there are still unmet scientific and clinical needs. Therefore, guidance for prediction as well as prevention is required, reflecting their current capabilities, but also their requirements and limitations.
Evaluating the current state of risk estimation and prevention.
Developing clinical recommendations for the prediction and prevention of psychosis.
42 samples, mainly defined by ultra-high risk criteria and/or the basic symptoms criterion ‘COGDIS‘, were included into meta-analyses of prevention, 15 studies into meta-analyses of prevention.
The pooled conversion rate at >4-year follow-up was 37.0% in UHR and 61.3% in COGDIS samples. The 12-month pooled risk ratio was 0.44, the NNT 10. Psychosocial functioning seemed not to improve, however results were inconclusive due to methodological issues of the trials. Both meta-analyses indicated age related differences.
Several recommendations were developed to guide prediction and prevention, emphasizing age-adapted strategies; details will be presented and discussed during the symposium.
Regarding future steps to further improve prediction and thus prevention, neurocognitive and neurobiological parameters of information processing, i.e. mismatch negativity, P300 and processing speed, as well as support vector machine based analysis of structural MRI seem to be most promising. Furthermore, with regard to current developmental models of psychotic disorders, risk should be conceptualized as dynamically modulated over time and thus presumably non-linearly related to future outcome. Therefore, studies need to consider the fluid interplay of risk and resilience factors to advance prediction significantly.
The prevalence and significance of APS and other risk symptoms in the general population, when assessed in the same way as in help-seeking persons, is still rather unclear. In two complimentary studies, we studied the prevalence of ultra-high risk and basic symptom criteria and symptoms assessed with the ‘Structured Interview for Psychosis-Risk Syndromes’ (SIPS) and the ‘Schizophrenia Proneness Instrument, Adult / Child and Youth version’ (SPI-A/SPI-CY) by trained psychologists in random community samples of age 8-17 and 16-40 years. At the time of writing, 1229 interviews with young adults and 55 with children/adolescents were completed. While only 2.8% of the young adults acknowledged the presence of any risk criterion, 9.1% of the children/adolescents did so. An even more pronounced age-related difference was found in the prevalence of lifetime risk phenomena: 25.2% of the young adults and 45.5% of the children/adolescents reported at least any one. Thereby, 'perceptual abnormalities/hallucinations” of the SIPS, mainly on APS level, were most frequent in both samples. While risk phenomena occurred, at least temporarily, in a quarter of young adults and even in nearly half of the children and adolescents, only a minority fulfilled the frequency and onset requirements of SIPS and SPI-A/SPI-CY – again with higher rates in children and adolescents. This highlights the importance of these additional requirements of the risk criteria, but also the need to further examine developmental peculiarities. These factors might play a crucial role in the differentiation between ill and non-ill persons and thus should be studied in more detail.
The basic symptom criterion 'cognitive disturbances” (COGDIS) and ultra-high risk (UHR) criteria are commonly used for the prediction of psychosis.
However, their predictive value has been assessed so far only by survival analyses using one-time baseline ratings and time-to-conversion. Thereby, potentially risk status-informative fluctuations in risk criteria ratings over time remained unaccounted for.
Therefore we studied if and how the predictive value of COGDIS and the main UHR criterion attenuated psychotic symptoms (APS) and their combination might be influenced by their presence across different assessment times.
In a naturalistic 24-month study, 146 patients at risk for 'cognitive-perceptive basic symptoms” were repeatedly examined (monthly assessments until month 6, thereafter 3-monthly) for COGDIS and APS with the Schizophrenia Proneness Instrument, Adult version, and the Structured Interview of Prodromal Syndromes. Joint latent class analysis was applied to identify different patterns of risk criteria over time and to detect the degree of their association with risk for conversion to psychosis.
The final model included 4 classes: no risk criteria, exclusively BS, exclusively APS and the combination of COGDIS and APS. Class-specific trajectories and survival functions were associated with an increased risk for the conversion to psychosis from a mild to an intense degree, demonstrating a superior performance of the combination of BS and APS.
This result reinforces earlier results of a clearly superior psychosis-predictive value of this combination at baseline and shows that its stability over time. Thus, APS and COGDIS should be repeatedly monitored.
Attachment and companionship are fundamental basic needs of human beings and contribute the feeling of security and social affiliation. It is assumed that dysfunctional attachment behaviour in people with Borderline Personality Disorder leads to difficulties in the interpersonal contact. Unsecure and especially disorganized manners of attachment seem to be frequently represented by mentally ill people. In this study the release of oxytocin according to attachment relevant situations was investigated and attachment representations of people with BPD have been analysed.
In order to determine attachment representations of healthy people and of people with BPD we used the validated ‘Adult Attachment Projective’/ ‘AAP’ by George, West and Pettem (1999). The projective contains eight contour drawings of attachment relevant situations. The participant should make up a story of each picture, which was evaluated by its coherence, its content and the used defence mechanisms. Attachment representations of 30 patients with BPD were surveyed. Furthermore we measured the release of oxytocin evoked by an activation of the attachment system via the ‘AAP’ in 10 healthy people. Therefor blood drawings were performed at four different points of time.
Here, we present pilot data on oxytocin measures induced via the ‘AAP’. We could detect a decrease of oxytocin in healthy people caused by an activation of the attachment system. Moreover attachment representations of patients with BPD will be presented and discussed. These preliminary data could lead to further studies on a possible dysregulation of the attachment- and the oxytocin system of people with BPD.
Besides affective instability and identity diffusion, disturbances in social interactions are a core symptom of borderline personality disorder (BPD). Interpersonal problems in BPD have been suggested to be associated with oxytocin dysregulation. To directly address this hypothesis, we investigated oxytocin plasma levels during a social exclusion (ostracism) paradigm in female BPD patients.
Twenty-two female BPD patients (diagnosed according to DSM-IV) and twenty-one healthy controls matched for gender, age, and education underwent repeated neuroendocrine measurements in a standardized laboratory setting during the Cyberball paradigm, a virtual balltossing game that evokes a social exclusion situation. Emotional reactions were assessed and oxytocin and cortisol levels measured at baseline and 5, 15, and 40 min after Cyberball.
After social exclusion, oxytocin plasma levels were lower in BPD patients than in healthy controls, whereas cortisol levels did not differ between groups. BPD patients showed distinct differences in emotion regulation compared to healthy participants and reacted to social exclusion with an increase of other-focused negative emotions, particularly anger and contempt.
Our pilot study suggests that the oxytocin system shows a differential response to social exclusion in BPD patients compared to healthy controls. This difference may be related to the high rejection sensitivity of BPD patients and their difficulties in resolving social conflict.
Dysfunctional coping patterns, low self-efficacy, and an excessive use of external control beliefs are assumed to be risk factors for psychosis. They are already present in patients with first-epsiode psychosis (FEP). However, it remains unclear if help-seeking patients symptomatically at-risk for psychosis (AR) show similar patterns of coping and competence/control beliefs as FEP patients.
We compared the frequency of deficits in coping, self-efficacy, and competence beliefs between AR according to the ultra-high risk and/or basic symptom criteria (n=21; mean age: 19.4±4.6) and FEP patients (n=22; mean age: 20.0±4.6). Coping strategies were assessed through the Stress-Coping-Questionnaires (SVF-120/SVF-KJ); self-efficacy and competence beliefs through the Competence and Control Beliefs Questionnaire (FKK).
Most AR and FEP patients demonstrated dysfunctional coping patterns, low self-efficicacy, and biases in control beliefs. Compared to FEP, AR patients reported even more deficits in positive coping strategies and self-efficacy than FEP. Moreover, they showed an excessive use of external fatalistic beliefs. In contrast, FEP patients demonstrated to be overly self-confident.
Dysfunctional coping and competence/control belief patterns are present before the onset of psychosis and are promising predictors of conversion to psychosis. Therefore, they appear to be important treatment targets for early intervention in psychosis. As deficit patterns of AR differ from those of FEP patients, interventions need to be tailored to the special treatment needs of both groups to prevent transition or relapse to psychosis.
An ‘Attenuated Psychosis Syndrome’ was included in Section III (Conditions for further study) of DSM-5. Although help-seeking for attenuated psychotic symptoms is not part of the final set of criteria, it had been proposed as an obligate criterion before in an attempt to avoid the suspected diagnostic creep in clinical practice. Therefore, our aim was to examine (non-)help-seeking for mental problems including attenuated psychotic symptoms and other at-risk phenomena in the general population.
1’229 persons of the general population were interviewed. Ultra-high risk criteria were assessed with the ‘Structured Interview for Psychosis-Risk Syndromes’ (SIPS), basic symptom criteria with the ‘Schizophrenia Proneness Instrument, Adult version’ (SPI-A), and help-seeking with a modified version of the WHO pathway-to-care questionnaire. Additionally, satisfaction with potential treatment outcome was assessed with the Brief Multidimensional Life Satisfaction Scale.
285 (21.9%) interviewees reported help-seeking for mental problems; 105 (8.1%) ‘help-seekers’ also reported symptoms included in the at-risk criteria for psychosis, irrespective of them fulfilling the respective time and frequency criteria (AtRisk). The group of AtRisk (29.5%) sought significantly more often help than persons not experiencing at-risk symptoms (NoRisk=19.1%; Cramer's V=0.112). Both groups mainly contacted a psychiatrist/psychologist or a general practitioner first. Main reasons for help-seeking in both groups were depressive mood (AtRisk=35.7%; NoRisk=38.5%), anxiousness (AtRisk=30.4%; NoRisk=20.9%) and family problems (AtRisk=30.4%; NoRisk=35.2%). Of the AtRisk, only two spontaneously named at-risk symptoms as a main reason for help-seeking. Interestingly, AtRisk were less satisfied with treatment success than NoRisk.
In clinical samples of specialized early detection services, ultra-high risk and basic symptom criteria are associated with a 2-year conversion rate of roughly 30%. Objectives/Aim: Their prevalence and course outside help-seeking samples is largely unknown and is therefore studied in the BEAR study. Methods/Results: At baseline, 25% of the young adults from the community (16-40 years) acknowledged the presence of any lifetime risk symptom, but only 3% met any risk criterion. After 2.5 years, those with any lifetime risk symptoms (RISK) and a control group (CONTROL) are re-interviewed. At the time of writing, 87 follow-ups were conducted: in 48 RISK (30% male, baseline age: 36±4 years) and in 39 CONTROL (46% male, baseline age: 36±2 years). Two RISK (4%), but no CONTROL reported the meanwhile development of first-episode psychosis. RISK were significantly more likely than CONTROL to report presence of any risk symptom within the follow-up period (41% vs. 5%). Thus, the relative risk to still report risk symptoms when these had already been reported before was 8.05 (95% CI: 2.0; 32.4). Altogether 18% met criteria for a non-psychotic current or within-follow-up axis-I disorder whose presence was unrelated to presence of at-risk phenomena at first or second interview (13% in both RISK and CONTROL). Conclusions: This indicates that risk symptoms might frequently be not just fleeting experiences but tend to persist. Thereby, they do not seem to increase the likelihood of developing any mental disorder but – should the result hold – might predispose to the development of psychotic symptoms.
Cognitive impairments have a high prevalence in schizophrenia, and are important determinants of functional outcome and treatment responsiveness. They are well-documented in chronic schizophrenia patients but are already apparent before the onset of the disorder and are predictive of transition to psychosis. Cognitive Remediation approaches have proved to be effective in enhancing cognitive functions and functional outcome in multi-episode schizophrenia patients. Recent studies suggest that younger people with an early course of illness are even more likely to benefit from these interventions. Therefore, Cognitive Remediation approaches may be especially appropriate for early intervention in psychosis. However, there is still a paucity of studies that evaluated Cognitive Remediation in early psychosis patients and in those symptomatically at-risk for psychosis. Moreover, several approaches are summarized under the umbrella term Cognitive Remediation. Consequently, they differ in content, setting, and practical application. Therefore, it remains rather unclear which type of therapy works best for the specific treatment needs of these patients. Against this background, this presentation will summarize and critically discuss current CRT approaches and their efficacy in early psychosis and in at-risk mental states with regard to cognitions, symptom levels, and functional outcome. Furthermore, we will present novel treatments and study designs specifically developed for early intervention in psychosis.
Childhood adversity (CA) is associated with poor mental health outcomes including psychotic symptoms.
However, the mechanisms linking CA to the development of psychosis are still poorly understood – in both their nature and the specificity of links for psychosis development. Possible links (mediators) are an excessive use of external attributions, dysfunctional coping patterns, and depressive symptoms that were associated with CA in healthy subjects but have not been studied in patients at-risk for psychosis.
Therefore, pathways models from CA to depressiveness were generated based on literature and examined separately in two samples by structural equation modeling: 137 patients at-risk for psychosis and 228 help-seeking controls.
Mediators between CA (Trauma and Distress Scale) and depressiveness (BDI II) were attribution style, self-efficacy (Competence and Control Beliefs Questionnaire) and coping strategies (Stress-Coping-Questionnaire).
Both final models showed 3 pathways running from CA to external attributions and low-self-efficacy, from these beliefs to maladaptive coping strategies and from there to depressiveness (CFI>0.9, RMSEA<0.1). In addition, the at-risk group displayed an alternative effect of CA on maladaptive coping.
Our findings suggest that CA generally increases the risk for mental health problems by the development of dysfunctional attributions and low self-efficacy that lead to maladaptive coping strategies and heightened levels of depressiveness with an additional effect of CA on maladaptive coping in at-risk patients. Thus, integrated interventions targeting these factors may enhance resilience and, thereby, prevent both the persistence of distressing symptoms and their progression to mental disorders, including psychosis.
The prevalence and psychopathological significance of current at-risk criteriain the general population when assessed in a clinical interview by trained professionals is still unknown. Therefore we started in June 2011 a study in the general population to assess (1) 3-month prevalence of at-risk criteria, (2) co-morbidity, psychosocial functioning and quality of life and (3) rate and predictors of help-seeking associated with them.
Inclusion criteria were(i) residency in the Canton Bern, (ii) age 16-40 years and (iii) telephone number available. Exclusion criteria: (i) life-time diagnosis of any psychosis and (ii) insufficient language skills. Ineligibility is defined by invalid address, unavailability during the recruitment period or deceased. Persons of suitable age are drawn randomly from the population register of the Canton Bern; corresponding telephone numbers for the delivered addresses are sought using the general phone register and internet.
356 (13.7%) of our initial sample of 2’585 persons with address plus phone number turned out as ineligible and were replaced. After replacement, altogether 622 (24.1%) did not meet the inclusion criterion of an available telephone number. The remaining 1’963 persons (inclusion sample: 76%) were contacted. Of the inclusion sample, 1’341 persons were willing to participate(participants: 68%). Of these, 108 persons (8%) met exclusion criteria, mainly by insufficient language skills. Of the 19 psychotic cases (1.4% of participants), 9 had never sought treatment and, consequently, never been diagnosed as being psychotic. 1’229 (91.7%) completed the whole interview, only 4 (0.3%) aborted the interview.
The prevalence and pathological value of attenuated psychotic symptoms (APS) and other at-risk criteria in general population the age range of highest risk of (beginning) psychosis, when assessed in the same way as in help-seeking persons, is still unclear.
In 2 complimentary studies, we studied the 3-month prevalence of ultra-high risk and basic symptom at-risk criteria assessed with the Structured Interview for Psychosis-Risk Syndromes (SIPS) and the Schizophrenia Proneness Instrument, Adult version (SPI-A) in random Swiss general population samples of 8–17 years and 16–40 years. Children and adolescents were assessed in a face-to-face, young adults in a telephone interview by trained clinical psychologists. Exclusion criteria were communication problems andl ife-time psychosis.
1’229 interviews with young adults and 55 interviews with children and adolescents were completed. While 2.8% of the young adults acknowledged the presence of any one at-risk criterion within the last 3 months, 9.1% of the children and adolescents did so. An age-related difference was also found in the prevalence of at least 1 lifetime at-risk phenomenon: 25.2% in young adults and 45.5% in children and adolescents.
While at-risk phenomena occur in a quarter of young adults of the general population and even in nearly half of the children and adolescents at least temporarily, only a minority reports sufficient recency, frequency or change in severity of these phenomena to meet present at-risk criteria according to SIPS and SPI-A. This highlights the importance of the recency, frequency or behavior-/conviction-related change-in-severity criteria included in the at-risk criteria.
Ostracism (social exclusion) has been found to be a remarkable stress factor to mentally ill people with difficulties in situations of social interaction. In an earlier study it was found that patients with borderline personality disorder (BPD) showed differences in oxytocin dysregulation by having lower oxytocin plasma levels during a social exclusion paradigm (Jobst et al., 2013, submitted). To our knowledge, this is the first study investigating neuroendocrinological changes of social exclusion in chronically depressed patients. Chronic depression (CD) is associated with poor social functioning and behavioral interpersonal problems which are considered to be based on the non-responsiveness of CD patients to environmental consequences.
To manipulate a situation of social exclusion we used the Cyberball Paradigm, a virtual ball tossing game which has been well validated and applied in numerous previous studies on the effects of social exclusion. 19 CD patients (according to DSM-IV) and 19 healthy controls matched for gender, age and education underwent repeated neuroendocrine measurements in a standardized laboratory setting during the Cyberball Paradigm. Assessments of psychological variables as well as measurements of oxytocin plasma levels were performed at baseline, 5 min, 15 min and 40 min after Cyberball.
As an association of interpersonal problems in BPD with oxytocin dysregulation has been found, we suggest differences in changes of oxytocin levels in a social exclusion situation in CD patients versus healthy subjects. The data will be presented and discussed in relation to specific interpersonal problems of patients suffering from CD.