To assess in a naturalistic setting the effectiveness of olanzapine within 12-month follow-up, in schizophrenic and bipolar outpatients.In this abstract, baseline patient characteristics are provided and compared between the olanzapine coated (OC) and orally disintegrating (OD) formulations to investigate prescribing patterns.

ZEN is a 1-year prospective, observational study, carried out in France, Germany and Greece from April’07 to May’09. Baseline patient characteristics were compared using Students-t, Chi2 or Fisher's-exact tests. Patients who started olanzapine prior to 60 days before the study or for whom the olanzapine formulations could not be determined were excluded from the analysis.

903 of the 927 enrolled patients were analyzed (45.2% paranoid schizophrenia, 32.2% bipolar disorder). 410 patients received the OC form and 493 the OD form. Distribution of gender was comparable across groups (55.1% male).OC patients were older than OD patients (43.1 vs 39.1 years, p< 0.001) and had a longer mean duration of illness (14.4 vs 11.2 years; p< 0.001). OD patients were more severely ill irrespective of diagnosis (p< 0.006, mean CGI schizophrenia=4.2 vs 3.8, CGI bipolar disorder=4.1 vs 3.7). At initiation, daily dose in OD patients was higher (15.0 vs 10.6 mg, p< 0.0001). Based on the 6-level SUMD scale, more OC patients were clearly aware of having a mental disorder (44.7% vs 32.9%; p< 0.001). OC patients were more compliant at baseline (mean MARS score 6.6 vs 5.5, p< 0.001).

Baseline characteristics show that the utilization of each oral form of olanzapine in outpatient setting is associated with different patient profiles.

Albumin is a protein which serves as a transporter for a variety of metabolites and as a storage for a lot of substances. Although albumin cannot pass the blood-brain-barrier and thus influence the CNS directly, a negative relation between cognitive impairment and serum albumin level has been observed in studies of normal and pathological aging.

The aim of the present study was to investigate the association between albumin and social cognition in ADHD.

20 adult patients with ADHD and 20 healthy controls participated in a double-blind within subjects crossover study. Participants completed the Moral-Judgment-Test, Tuebingen Affect Battery, the Movie for the Assessment of Social Cognition (MASC) and Cambridge Behaviour Scale (EQ). In addition, ADHD symptoms were assessed by the Wender Utah Rating Scale (WURS-K) and ADHD Self Rating Scale. Serum albumin levels were determined after blood withdrawal.

In the patient group serum albumin levels were negatively associated with ADHD pathology measured by WURS-K. In addition, a low level of albumin was related with poorer performance in theory of mind, moral judgment competence and affective prosody tasks.

The results suggest that albumin is related to social cognition in younger patients with ADHD. This is, to the knowledge of the authors, the first investigation, in which the association between albumin and cognition has been investigated in ADHD. Thus the findings of the present study need replication and the neural mechanisms have to be explored in future studies. Further studies are needed to exclude a possible medication effect.

Attention deficit disorder (ADHD) is a psychiatric disorder, which is characterized by deficits of executive functions (EF) and impulsivity. Whereas a variety of studies on the involvement of the dopaminergic system in ADHD exists, the impact of the serotonergic system to EF in ADHD in adults is underinvestigated.

To ascertain the effects of rapid tryptophan depletion (RTD) and the resultant reduction of the central nervous levels of serotonin on the EF of male adult patients with ADHD.

20 ADHD patients and 20 healthy controls completed the RTD test on one day and a placebo on another day in a double-blind within subject crossover design.- In addition, the subtest alertness of the TAP and a modified Version of the Continuous performance test (AX-CPT) with three stimulus conditions (AX, AY, BX) were administered.

Statistical analysis revealed significant shorter reaction times, more errors and more omission errors in the ADHD group in the AX-CPT. The omissions error rate increased in both groups in the RTD condition but not in the placebo condition. Statistical analyses did not yield any significant differences between groups in the subtest alertness and no significant interaction of group and effect of the RTD condition could be observed.

In addition to higher impulsivity of patients with ADHD as reflected by shorter reaction times and higher error rates, the results of the present study imply an involvement of the serotonergic system as reflected by RTD in sustained and selective attention.

Numerous results from investigations including children with ADHD show associations between a diminished serotonin synthesis and memory impairments as well as higher aggression scores. The aim of the present study was the investigation of the association between a diminished serotonin synthesis, logical memory and impulsive aggression in male adult patients with ADHD.

Twenty male adult patients with ADHD and twenty healthy controls were recruited for this double-blind within subjects crossover study. Subjects completed the Rapid Tryptophan Depletion (RTD) Test or a placebo condition (balanced amino acid load) on either one of two examination days. Clinical variables and general intellectual functioning were assessed. The neuropsychological test battery included the subtest logical memory from the Wechsler Memory Scale (WMS-R), self-assessment of aggression as well as the Point Subtraction Aggression Game (PSAG).

Statistical analysis revealed significant memory impairments of ADHD patients, which were associated with severity of symptoms in early childhood as well as subjective aggression scores. Effects of the tryptophan depletion were not found, neither for the logical memory subtest nor performance in the PSAG.

In contrast to previous studies, these findings suggest that the serotonergic system as reflected by the RTD Test has no effect on memory performance or impulsive aggression. However, these results may be due to possible interactions of other catecholamine systems with the serotonergic system that were not controlled in this study. Therefore an additional study is needed to further explore the catecholamine systems and their effects on memory and impulsive aggression.

The German version of the Conners Adult ADHD Rating Scales (CAARS) has proven to show very high model fit in confirmative factor analyses with the established factors inattention/memory problems, hyperactivity/restlessness, impulsivity/emotional lability, and problems with self-concept in both large healthy control and ADHD patient samples. This study now presents data on the psychometric properties of the German CAARS-self-report (CAARS-S) and observer-report (CAARS-O) questionnaires.

CAARS-S/O and questions on sociodemographic variables were filled out by 466 patients with ADHD, 847 healthy control subjects that already participated in two prior studies, and a total of 896 observer data sets were available. Cronbach's-alpha was calculated to obtain internal reliability coefficients. Pearson correlations were performed to assess test-retest reliability, and concurrent, criterion, and discriminant validity. Receiver Operating Characteristics (ROC-analyses) were used to establish sensitivity and specificity for all subscales.

Coefficient alphas ranged from .74 to .95, and test-retest reliability from .85 to .92 for the CAARS-S, and from .65 to .85 for the CAARS-O. All CAARS subscales, except problems with self-concept correlated significantly with the Barrett Impulsiveness Scale (BIS), but not with the Wender Utah Rating Scale (WURS). Criterion validity was established with ADHD subtype and diagnosis based on DSM-IV criteria. Sensitivity and specificity were high for all four subscales.

The reported results confirm our previous study and show that the German CAARS-S/O do indeed represent a reliable and cross-culturally valid measure of current ADHD symptoms in adults.

One aim of personalized medicine is to determine which treatment is to be preferred for an individual patient, given all patient information available. Particularly in mental health, however, there is a lack of a single objective, reliable measure of outcome that is sensitive to crucial individual differences among patients.

We examined the feasibility of quantifying the total clinical value provided by a treatment (measured by both harms and benefits) in a single metric. An expert panel was asked to compare 100 pairs of patients, one from each treatment group, who had participated in a randomized clinical trial (RCT) involving interpersonal psychotherapy (IPT) and escitalopram, selecting the patient with the preferred outcome considering both benefits and harms.

From these results, an integrated preference score (IPS) was derived, such that the differences between any two patients' IPSs would predict the clinicians' preferences. This IPS was then computed for all patients in the RCT. A second set of 100 pairs was rated by the panel. Their preferences were highly correlated with the IPS differences (r=0.84). Finally, the IPS was used as the outcome measure comparing IPT and escitalopram. The 95% confidence interval (CI) for the effect size comparing treatments indicated clinical equivalence of the treatments.

A metric that combines benefits and harms of treatments could increase the value of RCTs by making clearer which treatments are preferable and, ultimately, for whom. Such methods result in more precise estimation of effect sizes, without increasing the required sample size.