Fronto-temporal connections have long been thought to be involved in schizophrenia. Two fronto-temporal connections of interest are uncinate fasciculus (UF) and cingulum bundle (CB), which recently have been investigating using Diffusion Tensor Imaging (DTI), a new technique that affords an opportunity to evaluate white matter fiber integrity in vivo. Using this technique, we previously reported abnormalities in UF and CB in chronic patients. Additionally, we noted that schizotypal personality disordered subjects showed UF but not CB abnormalities.

Here, we sought to determine whether or not UF and CB white matter integrity are altered at initial onset of illness, and are specific to schizophrenia. We evaluated twelve first-episode schizophrenia, 12 first-episode affective psychosis and 12 controls using DTI on a 1.5T magnet. Fractional anisotropy (FA) and mean diffusivity (Dm) were used to quantify water diffusion, and cross-sectional area was defined with a directional threshold method.

Findings showed bilateral reduction of UF FA, but not Dm, in first-episode schizophrenia compared with controls and first-episode affective psychotic patients. For CB, there were no statistically significant group differences for either FA or Dm.

These findings suggested that UF white matter integrity, but not CB white matter integrity, is altered at initial onset of schizophrenia and may be specific to schizophrenia. In contrast, CB abnormalities are not present at first episode of schizophrenia and may reflect progressive changes that occur over the course of the illness. The latter will need to be investigated using a longitudinal design.

Diffusion tensor MRI was used to assess white matter integrity in patients with bipolar I disorder (BD) (n=42), schizophrenia (n=28) and healthy controls (n=38). Clinically stable patients with one other close family member with the same diagnosis were selected. In a second study, we examined white matter associations with Neuregulin I in a sample of healthy controls. Fractional anisotropy (FA) was compared between the groups using voxel-based morphometry, automated region of interest analysis and probabilistic tractography. Results : Patients with BD and those with schizophrenia showed reduced FA in the anterior limb of the internal capsule, anterior thalamic radiation and uncinate fasciculus compared with controls. Results from the second study showed reductions in those carrying a Neuregulin 1 variant previously associated with psychotic symptoms.

Reduced white matter density and integrity is common to both schizophrenia and BD. It is likely that this shared white matter disruption is determined in part by shared genetic risk factors.

Routine outcome measurement is mandated in public mental health services in Australia, but uptake and compliance is variable. This may be because of uncertainties and resistances among clinicians. The objective of this study was to survey attitudes and experiences to routine outcome measurement among staff in adult area mental health services and to understand their correlates.

As part of a larger study, a specifically designed questionnaire was distributed to all staff.

The questionnaire return rate was high. A wide range of opinion was found, ranging from very positive to very negative, with the majority being somewhat positive. Staff who had attended training reported the measures as easier to use than those who had not. Staff who had recently seen feedback of their outcome measures rated outcome measures as more valuable but less easy to use than those who had not seen feedback. Compared to other disciplines, medical staff and psychologists tended to rate outcome measures as less useful. Administrative staff rated outcome measures as more valuable than did clinical staff.

The results have implications for the implementation and sustainability of routine outcome measurement. It is helpful to distinguish between clinicians' views as to the general value of outcome measurement, which is often positive, and their experience of ease of use, which may be much less positive. The results highlight the need for staff to receive targeted training and usable reports, and to have access to resources to extract value from outcome measures.

Outcome management has been suggested as a promising strategy to improve quality of mental health care. However, there is a lack of evidence on the efficacy of feedback of treatment outcome to people with severe mental disorder and their clinicians. Thus, the study "Outcome monitoring and outcome management in inpatient psychiatric care" (EMM) aims to to ascertain the short- and mid-term effect of outcome management in inpatient psychiatric care.

This cluster-randmised trial started in June 2005. 294 participants who gave informed consent have been recruited among patients admitted to a large psychiatric hospital in rural Bavaria. These were asked to provide information on treatment outcome on the Outcome Questionnaire 45 via weekly computerised assessments. Patients and clinicians in the intervention group received continuous feedback of outcome.

Patients were willing and able to provide outcome data on a regular basis. Patients highly valued feedback of outcome while clinician acceptance was moderate. At discharge, there were no differences between the feedback and no-feedback groups on patient-rated outcome. However, as compared to the no-feedback group, length of stay of patients with good outcome who received feedback was shorter while it was longer for those with unfavorable outcome. Further findings on the mid-term effect of feedback at follow-up and on the cost-effectiveness of the intervention will be reported.

Implications of these results for further improving the effectiveness of outcome management in mental health services and thus contributing to an adaptive allocation of treatment resources will be discussed.

There have been concerns about the risk benefit ratio of treatment with antidepressants and antipsychotics in the light of recent evidence pointing to a risk of suicide induction during the course of treatment with antidepressants. These concerns have led to a series of recent studies exploring national rates of suicide and correlating these with data on antidepressant consumption, which apparently showed reductions in suicides since the advent of the SSRIs.

The data from controlled trials on antidepressants and antipsychotics however point to increased suicide and suicide attempt rates. Against this background we have looked at suicide rates in schizophrenia in North Wales from the pre- and post-antipsychotic eras and have compared suicide rates in the Nordic countries with autopsy and ill-defined death rates, and antidepressant sales, during the period 1961 through to 2003.

There has been a 10-fold rise in suicide rates in schizophrenia since the introduction of the antipsychotics. In the Nordic countries, there is no relationship between antidepressant consumption and suicide rates but a close correlation between suicide rates and both autopsy and ill-defined death rates, which appear to need further clarification.

Combined these datasets suggest efforts to reduce suicide rates, in particular efforts that rely on psychotropic drug use may be quixotic.

Major mood disorders are quite prevalent, but frequently underreferred, underdiagnosed and undertreated illnesses. The early recognition and appropriate treatment of unipolar and bipolar mood disorders is particularly important, since untreated mood disorders carry extremely high risk of both attempted and committed suicide. Recent studies clearly show that suicidal behaviour in patients with major mood disorders is state and severity dependent and this means that suicidality markedly decreases or vanishes after clinical recovery from major depressive episode or from dysphoric mania. However, since the majority of mood disorder patients never committ and more than half of them never attempt suicide, special clinical characteristics of the illness as well as some familial and psycho-social factors should also play a contributory role in this self-destructive behavuour.

Considering the clinically explorable suicide risk factors in patients with mood disorders (family and/or personal history of suicidal behaviour, early onset of the disorder, severe depressive episode/hopelessness, agitated/mixed depression, bipolar II diagnosis, comorbid Axis I and Axis II disorders, adverse life situations, lack of social and medical support), in the majority of the cases, suicidal behaviour is predictable with a good chance. There are also several evidences that (succesfull) long-term treatment of unipolar depressives (with antidepressants and/or lithium) and bipolar patients (with mood stabilizers and with antidepressants/antipsychotics) substantially reduces the risk of attempted and completed suicide, even in this high-risk population. Most recent studies also show that supplementary psycho-social interventions (psychoeducation, and targeted psychotherapies) further improve the results.

International suicide rate in developed countries averages 13.3 x 100.000 population, a rate increased from 1955 to 2001 by 3.3% which has decreased from 1990 to 2001 by 11.7%. This decline may be associated with an improved health care, including medical interventions, with the most relevant role is attributed to treatments with antidepressants. Most of the studies showing an inverse correlation between increased usage of antidepressants and decreased suicide rates are based on ecological designs which do not provide information on the individual level.

In order to prevent suicidal behavior it is fundamental to know that: [a] 90% of all suicides are associated with a psychiatric disorder, especially mood disorders that account for more than a half of all completed suicides; [b] the ratio of attempts to suicide in the general population is about 20:1, whereas the same ratio is about 5:1 in Bipolar Disorder (BPD) patients, showing higher lethality of suicide attempts. Indeed, the Standardized Mortality Ratio reaches the highest value (20; normal value = 1) in mood disorder patients among all psychiatric disorders, with little differences between BPD I and II, and Major Depressive Disorder.

Early interventions are important since suicide occurs in patients with BPD in the first years after illness onset. From a medical point of view, the use of antidepressants has not been associated with reduction of suicidal behavior. In BPD, the only treatment showing a consistent reduction of suicidal behavior is the maintenance therapy with lithium salts.

To analyse GxE interactions assess non-shared environmental (E) risk factors for the development of AN specific for sisters discordant for an ED, polymorphisms in the serotonin transporter (G),.

We interviewed 128 sister pairs discordant for an eating disorder using the Oxford-RFI as part of the European "Healthy Eating" multicenter study at 3 university centres (Vienna, London, Barcelona) (AN-R: 58; AN-BP: 70; 128 sisters without ED). To examine association between AN, G and E, and G x E-interaction, conditional logistic regression was used with a Cox proportional hazards regression model using the exact method.

Genotype (GT) distributions did not differ between the sister groups. Significant main effects were found for disruptive events, interpersonal problems and family dieting behaviour. The risk for AN increased with higher levels in these variables independently of the genotype. Significant interactions were found for G x parental problems and G x burden by parental psychiatric disorder. The increase of risk for AN with increasing number of problems with parents is larger for the S/S genotype than for L/L. However, a higher burden by parental psychiatric illness (subjective E according to Turkheimer 2000) increased the risk for AN-this was larger for the L/L than for the S/S GT.

This study suggests that there is an interaction between stress (problems with parents) and the ss GT which increases the risk of developing AN.

The research on the aetiology of eating disorders (EDs) has implicated many apparently disparate risk factors, which include: biochemical, genetic, familial and psychological factors. In the environmental domain, the presence of particular traits such as perfectionism, comorbidity in the family, eating patterns during childhood and exposures to adverse events have been revealed to be implicated in the aetiology of EDs. Whereas, from a biological point of view some recent new findings have suggested the important role of genetic factors, in combination with share and non-share environmental factors, developmental factors seems to have also a crucial role in the development of EDs later in life.

In order to replicate these findings in a larger sample, we performed several combined population (case-control) and family-based studies of eight independently recruited samples from several European countries participating in the European Community Framework V “Factors in Healthy Eating” project. We analyzed as well genetic as environmental factors, but also developmental factors that might be implicated.

The findings of our studies agree with the growing body of research indicating that a variety of environmental and social factors are associated with unhealthy individual and family eating patterns during childhood and early adolescence, and which if not detected early could result in the development of a subsequent eating disorder.

Anorexia nervosa (AN) patients show remarkably rigid control over eating and exhibit persistent and obsessive temperament traits. Neuropsychological studies have shown minor impairments in cognitive flexibility in AN patients. The aim of the present study was to investigate alterations of the functional neuroanatomy in AN patients performing a cognitive flexibility task.

Thirteen female subjects aged 18 to 26 years with chronic AN (8 with the purging subtype) and 15 age-matched healthy female controls (HC) underwent functional magnetic resonance imaging while performing a reactive flexibility task. In an event related paradigm, participants had to respond with a different button press to infrequent target stimuli embedded in the prepotent presentation of standard stimuli. The performance to the task was quantified as reaction time and number of correct trials.

On behavioral level, AN patients and the HC group showed a similar performance (reaction times, number of correct trials) in the reactive flexibility task. During correct behavioral shifts, the AN patients compared to the HC group showed decreased activation of the bilateral thalamus, ventral anterior cingulate gyrus (ACC), ventral insula, dorsolateral prefrontal (DLPFC), premotor cortex, visual stream and cerebellum (p uncorr. < .001).

AN patients show an impaired activation in thalamo-(striato)-cortical loops involved in response selection and behavioral shift. These findings support from a neurobiological perspective a more generalized cognitive rigidity in AN, that is not restricted to food, weight and shape.

Complex psychiatric disorders develop from interactions between genetic and environmental factors. Offspring of women with a history of an eating disorder (ED) are a high risk group due to a combination of both genetic vulnerability and rearing/environmental factors.

The aim of this study is to examine the clinical features and also the experiences of mother-daughter dyads where both mother and daughter have had an eating disorder in order to explore factors that may impact on risk for and outcome in eating disorders.

Mother-daughter ED dyads participated in a study that used a combination of quantitative and qualitative methodologies.

the quantitative assessment found marked differences distinguishing ED mothers from control mothers (with no ED history), particularly in areas such as caregiving, eating attitudes and personality traits. The qualitative assessment identified an important phenomenological interaction between the mothers’ and daughters’ experiences of an eating disorder.

These results shed light on the significant role and impact of a mother's eating disorder when her offspring develops the same illness. The study's findings highlight the need to take these possible transmission factors and the impact of maternal ED into account in clinical practice.

To describe the characteristics of psychiatric research and their changes within one decade by analysing the publications in three high impact general psychiatric journals.

All articles published in the “American Journal of Psychiatry“, “British Journal of Psychiatry” and “Archives of General Psychiatry” in 1994 and 2004 were considered for analysis. The publications were classified as “research” or “non-research” articles and further categorised according to a range of variables including “methodology”, “research area”, “subject matter”; “number of participants” and “statement on funding”. Data were analysed descriptively.

In 2004 the overall percentage of non-research articles was 6,8% higher than in 1994. The use of different research methods remained fairly stable, with the exception of case-control studies, which accounted for a slightly higher percentage of all publications in 2004 compared to 1994. Further relevant developments included the tremendous increase in published studies involving neuro imaging techniques from 1994 to 2004. An increase in publications was also found for genetic and cross-cultural studies, while the number publications in most other research areas remained relatively stable. Moreover, the percentage of papers reporting funding also increased significantly from 1994 to 2004.

The systematic analysis of journal content can be used to assess the state of psychiatric knowledge and practice. Highlighting advancements and changes over time it may reflect research trends and policies.

Qualitative research has been met with growing interest in recent years. Several trends in medical and psychiatric practice, including patient orientation, the recovery movement and the search for evidence-based psychotherapeutic interventions, have propelled scientific inquiry into subjective perspectives on experiencing mental health problems, their consequences, and psychiatric services. While initially largely criticised as lacking scientific rigour, the value of qualitative research has increasingly been recognised, following a certain disenchantment with genetic research, the acknowledgement of methodological limitations in measuring subjective constructs such as needs, quality of life or stigma with standardised tools, and the definition of clear quality criteria for qualitative studies.

Multiple databases (Ovid Medline, PsycINFO, PsychLit, Cochrane Reviews) were scanned for relevant publications in the period from 1990 to 2007.

A proliferation of qualitative literature could be noted, especially from 2000 onward. Published research focuses on patients’ and caregivers’ experiences of mental health problems (subjective illness models, stigma, help-seeking motivations) and of using mental health services (expectations, empowerment, service evaluation). Among mental health professionals, experiences of service provision (service development, job motivation, stress & burnout) were studied.

Qualitative methods are becoming an integral part of the methodological canon of psychiatric research. This presentation gives an overview of publication trends regarding topics covered, journals featuring qualitative papers, and methodological quality criteria. It further focuses on fields of application for qualitative vs. quantitative methods and discusses specific requirements on scientific writing in publishing qualitative data.