European Psychiatry (EUR PSYCHIAT)

Publications in this journal

• Article: Dimensional anxiety scales for DSM-5: Sensitivity to clinical severity.

  S Knappe, J Klotsche, A Strobel, R T Lebeau, M G Craske, H-U Wittchen, K Beesdo-Baum
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  ABSTRACT: PURPOSE: Psychometric properties and clinical sensitivity of brief self-rated dimensional scales to supplement categorical diagnoses of anxiety disorders in the DSM-5 were recently demonstrated in a German treatment seeking sample of adults. The present study aims to demonstrate sensitivity of these scales to clinical severity levels. METHODS: The dimensional scales were administered to 102 adults at a university outpatient clinic for psychotherapy. Diagnostic status was assessed using the Munich-Composite International Diagnostic Interview. To establish a wide range of clinical severity, we considered subthreshold (n=83) and threshold anxiety disorders (n=49, including Social Phobia, Specific Phobia, Agoraphobia, Panic Disorder, and Generalized Anxiety Disorder). RESULTS: Individuals with either subthreshold or threshold anxiety disorder scored higher on all dimensional scales relative to individuals without anxiety. In addition, individuals with a threshold anxiety disorder scored higher on the dimensional scales than individuals with a subthreshold anxiety disorder (except for specific phobia). Disorder-related impairment ratings, global functioning assessments and number of panic attacks were associated with higher scores on dimensional scales. Findings were largely unaffected by the number of anxiety disorders and comorbid depressive disorders. CONCLUSION: The self-rated dimensional anxiety scales demonstrated sensitivity to clinical severity, and a cut-off based on additional assessment of impairment and distress may assist in the discrimination between subthreshold and threshold anxiety disorders. Findings suggest further research in various populations to test the utility of the scales for use in DSM-5.
  European Psychiatry 03/2013;
• Article: Do psychosis prodrome onset negative symptoms predict first presentation negative symptoms?

  J Lyne, L Renwick, K Madigan, B O'Donoghue, M Bonar, T Grant, A Kinsella, K Malone, N Turner, E O'Callaghan, M Clarke
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  ABSTRACT: BACKGROUND: Negative symptoms have been previously reported during the psychosis prodrome, however our understanding of their relationship with treatment-phase negative symptoms remains unclear. OBJECTIVES: We report the prevalence of psychosis prodrome onset negative symptoms (PONS) and ascertain whether these predict negative symptoms at first presentation for treatment. METHODS: Presence of expressivity or experiential negative symptom domains was established at first presentation for treatment using the Scale for Assessment of Negative Symptoms (SANS) in 373 individuals with a first episode psychosis. PONS were established using the Beiser Scale. The relationship between PONS and negative symptoms at first presentation was ascertained and regression analyses determined the relationship independent of confounding. RESULTS: PONS prevalence was 50.3% in the schizophrenia spectrum group (n=155) and 31.2% in the non-schizophrenia spectrum group (n=218). In the schizophrenia spectrum group, PONS had a significant unadjusted (χ(2)=10.41, P<0.001) and adjusted (OR=2.40, 95% CI=1.11-5.22, P=0.027) association with first presentation experiential symptoms, however this relationship was not evident in the non-schizophrenia spectrum group. PONS did not predict expressivity symptoms in either diagnostic group. CONCLUSION: PONS are common in schizophrenia spectrum diagnoses, and predict experiential symptoms at first presentation. Further prospective research is needed to examine whether negative symptoms commence during the psychosis prodrome.
  European Psychiatry 03/2013;
• Article: Is it worth assessing progress as early as week 2 to adapt antidepressive treatment strategy? Results from a study on agomelatine and a global meta-analysis.

  P Gorwood, F Bayle, G Vaiva, P Courtet, E Corruble, P-M Llorca
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  ABSTRACT: CONTEXT: A delay of 4-8weeks before modifying the prescribed antidepressant treatment is usually proposed when incomplete treatment response is observed. A number of studies nevertheless proposed that the lack of early improvement (usually 20% decrease of severity at week 2) is predictive of the absence of subsequent treatment response, potentially saving weeks of inadequate treatment, but with no information for non-interventional studies devoted to outpatients. METHOD: Two thousand nine hundred and thirty-eight outpatients with major depressive disorder were included in a multicentre, non-interventional study, assessing at inclusion, week 2 and week 6, mood (QIDS-C, CGI, PGI and VAS) sleep (LSEQ) and functionality (SDS). All metrics at week 2 were tested for their capacity to predict response (and then remission) at week 6, all patients being treated by agomelatine. A meta-analysis of all studies (n=12) assessing the predictive role of improvement at week 2 was also performed, assessing specific effect size of published studies and the weight of the different parameters they used. RESULTS: The QIDS-C and the CGI-I were the only instruments with an area under the curve over 0.7, with different cut-offs for treatment response and remission. A decrease of more than five points at the QIDS-C had the highest positive predictive value for treatment response, and a CGI-I over three had the highest negative predictive value, which would favour relying on the clinicians for warning (too high CGI-I), and on instruments for confidence (favourable decrease of the QIDS-C). The meta-analysis of all studies also detected a large effect size of early improvement, stressing how rating week 2 severity could be beneficial in clinical practice. CONCLUSIONS: Previous reports stressing the interest of an assessment at week 2 were reinforced by the present results, which also defined more accurately what could be the most appropriate cut-offs, and how combining these early results could be more effective.
  European Psychiatry 02/2013;
• Article: Age of onset group characteristics in forensic patients with schizophrenia.

  D Vinokur, S Z Levine, D Roe, A Krivoy, T Fischel
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  ABSTRACT: This study aims to empirically identify age of onset groups and their clinical and background characteristics in forensic patients with schizophrenia. Hospital charts were reviewed of all 138 forensic patients with schizophrenia admitted to Geha Psychiatric Hospital that serves a catchment area of approximately 500,000 people, from 2000 to 2009 inclusive. Admixture analysis empirically identified early- (M=19.99, SD=3.31) and late-onset groups (M=36.13, SD=9.25). Early-onset was associated with more suicide attempts, violence before the age of 15, and early conduct problems, whereas late-onset was associated with a greater likelihood of violence after the age of 18 and marriage (P<0.01). The current findings provide clinicians with a unique direction for risk assessment and indicate differences in violence between early- and late-onset schizophrenia, particularly co-occurrence of harmful behavioral phenotypes.
  European Psychiatry 02/2013;
• Article: Factors associated with borderline personality disorder in major depressive patients and their relationship to bipolarity.

  J M Azorin, A Kaladjian, M Adida, E Fakra, R Belzeaux, E Hantouche, S Lancrenon
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  ABSTRACT: OBJECTIVE: To analyze the interface between borderline personality disorder (BPD) and bipolarity in depressed patients comorbid with BPD. METHODS: As part of National Multi-site Study of 493 consecutive DSM-IV major depressive patients evaluated in at least two semi-structured interviews 1month apart, 19 (3.9%) had comorbid BPD (BPD+), whereas 474 (96.1%) did not manifest this comorbidity (BPD-). RESULTS: Compared to BPD (-), BPD (+) patients displayed higher rates of bipolar (BP) disorders and temperaments, an earlier age at onset with a family history of affective illness, more comorbidity, more stressors before the first episode which was more often depressive or mixed, as well as a greater number and severity of affective episodes. CONCLUSIONS: The hypothesis which fitted at best our findings was to consider BPD as a contributory factor in the development of BP disorder, which could have favoured the progression from unipolar major depression to BP disorder. We could not however exclude that some features of BP disorder may have contributed to the development of BPD.
  European Psychiatry 02/2013;
• Article: Prediction of psychosis in clinical high-risk patients by the Schizotypal Personality Questionnaire. Results of the EPOS project.

  R K R Salokangas, P Dingemans, M Heinimaa, T Svirskis, S Luutonen, J Hietala, S Ruhrmann, G Juckel, H Graf von Reventlow, D Linszen, M Birchwood, P Patterson, F Schultze-Lutter, J Klosterkötter
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  ABSTRACT: OBJECTIVE: Schizotypal features indicate proneness to psychosis in the general population. It is also possible that they increase transition to psychosis (TTP) among clinical high-risk patients (CHR). Our aim was to investigate whether schizotypal features predict TTP in CHR patients. METHODS: In the EPOS (European Prediction of Psychosis Study) project, 245 young help-seeking CHR patients were prospectively followed for 18 months and their TTP was identified. At baseline, subjects were assessed with the Schizotypal Personality Questionnaire (SPQ). Associations between SPQ items and its subscales with the TTP were analysed in Cox regression analysis. RESULTS: The SPQ subscales and items describing ideas of reference and lack of close interpersonal relationships were found to correlate significantly with TTP. The co-occurrence of these features doubled the risk of TTP. CONCLUSIONS: Presence of ideas of reference and lack of close interpersonal relations increase the risk of full-blown psychosis among CHR patients. This co-occurrence makes the risk of psychosis very high.
  European Psychiatry 02/2013;
• Article: Gender differences in first-episode psychosis at 5-year follow-up - two different courses of disease? Results from the OPUS study at 5-year follow-up.

  A Thorup, N Albert, M Bertelsen, L Petersen, P Jeppesen, P Le Quack, G Krarup, P Jørgensen, M Nordentoft
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  ABSTRACT: OBJECTIVE: Gender differences in psychosis have been investigated, and the results have contributed to a better understanding of the disease, but many questions are unanswered. In clinical terms, women and men with psychosis differ in terms of access to social support, tendency of substance abuse, level of functioning and symptom patterns. We aimed to investigate how gender differences at onset of psychosis develop during the first 5years of treatment. METHOD: A total of 578 patients with a first-episode psychosis in the schizophrenia spectrum were included in the Danish OPUS trial - a randomized clinical trial comparing 2years of intensive early-intervention programme with standard treatment. All patients were assessed with validated instruments at inclusion, and after 2 and 5years. Data were analysed for significant gender differences. RESULTS: Males have significantly higher levels of negative symptoms at all times, and are more likely to live alone and suffer from substance abuse. Females reach higher levels of social functioning at follow-up, and show a greater tendency to be employed or in education than males. Markedly more women than men live with children. More women than men reach a state of recovery and are more compliant with medication. CONCLUSION: There are significant gender differences at 2- and 5-year follow-up in this large cohort of first-episode psychotic patients. Males and females show different symptomatology and different levels of social functioning.
  European Psychiatry 02/2013;
• Article: Safety of phosphatidylserine containing omega3 fatty acids in ADHD children: A double-blind placebo-controlled trial followed by an open-label extension.

  I Manor, A Magen, D Keidar, S Rosen, H Tasker, T Cohen, Y Richter, D Zaaroor-Regev, Y Manor, A Weizman
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  ABSTRACT: OBJECTIVE: To evaluate the safety of phosphatidylserine (PS) enriched with omega3 fatty acids, mainly eicosapentaenoic (PS-Omega3) in children with attention-deficit hyperactivity disorder (ADHD). METHODS: Two hundred children diagnosed with ADHD were randomised to receive either PS-Omega3 (300mg PS-Omega3/day) or placebo for 15 weeks. One hundred and fifty children continued into an open-label extension for an additional 15 weeks in which they all consumed PS-Omega3 (150mg PS-Omega3/day). Standard blood biochemical and haematological safety parameters, blood pressure, heart rate, weight and height were evaluated. Adverse events and the Side Effect Rating Scale were also assessed. RESULTS: One hundred and sixty-two participants completed the double-blind phase. No significant differences were noted between the two study groups in any of the safety parameters evaluated. One hundred and forty participants completed the open-label phase. At the end of this phase, no significant changes from baseline were observed in any of the studied parameters among participants who consumed PS-Omega3 for 30 weeks. CONCLUSIONS: Study results demonstrate that consumption of PS-Omega3 by children with ADHD, as indicated in a 30-week evaluation period, is safe and well tolerated, without any negative effect on body weight or growth.
  European Psychiatry 01/2013;
• Article: P-611-Differences in emotional states of anxiety, depression and stress between patients with diabetes mellitus and psychiatric outpatients to the general population in Greece

  G Lyrakos, E Hatziagelaki, I Spyropoulos, A Goundella, M Karachalios, B Spinaris
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  ABSTRACT: Abstract Introduction Managing diabetes is an overwhelming task, particularly for the newly diagnosed patient. Many diabetics struggle to cope with the requirements of the disease and the complications that it causes. As a result, many diabetics suffer from depression which is the most common psychiatric disorder witnessed in the diabetic population. Objectives To compare the levels the emotional states of anxiety, depression and stress in patients with diabetes mellitus (DM) to the general population and chronic patients with psychological problems. Aims To reveille the significant differences between those patients. Methods We conducted a survey in a random sample of 279 patients with diabetes Mellitus (DM), 109 psychiatric outpatients (PO) and 383 healthy adults (C), using the Depression Anxiety Stress scale (DASSI-42). Statistical analysis was conducted with SPSS 16 for windows. ANOVA test was used to reveille the statistical significance between the groups in anxiety, stress, depression and total Scale. Results Patients with DM had a significant difference to the PO patients and C in anxiety (MDPO=−12.251 p<.001), (MDC=1.303 p<.001). They also had a significant difference from the PO in stress (MDPO=−11.465 p<.001), depression (MDPO=−15.751 p<.001), and total DASS (MDPO=−39.566 p<.001). Patients with DM had no significant difference to the control group in the above domains. Conclusions Analysis shows that patient with DM who are under medical treatment experience anxiety in a greater level than the general population, but in terms of stress and depression they are in the same level to the general population.
  European Psychiatry 12/2012; 27:1.
• Article: Psychoeducation and cognitive-behavioral therapy for patients with refractory bipolar disorder: A 5-year controlled clinical trial.

  A González Isasi, E Echeburúa, J M Limiñana, A González-Pinto
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  ABSTRACT: OBJECTIVE: The aim of this research, which represents an additional and longer follow-up to a previous trial, was to evaluate a 5-year follow-up study of a combined treatment (pharmacological+psychoeducational and cognitive-behavioral therapy) as compared with a standard pharmacological treatment in patients with refractory bipolar disorder. METHOD: Forty patients were randomly assigned to either an Experimental group-under combined treatment - or a Control group - under pharmacological treatment. Data were analyzed by analysis of variance (ANOVA), with repeated measures at different evaluation time points. RESULTS: Between-group differences were significant at all evaluation time points after treatment. Experimental group had less hospitalization events than Control group in the 12-month evaluation (P=0.015). The Experimental group showed lower depression and anxiety in the 6-month (P=0.006; P=0.019), 12-month (P=0.001; P<0.001) and 5-year (P<0.001, P<0.001) evaluation time points. Significant differences emerged in mania and misadjustment already in the post-treatment evaluation (P=0.009; P<0.001) and were sustained throughout the study (6-month: P=0.006, P<0.001; 12-month: P<0.001, P<0.001; 5-year: P=0.004, P<0.001). After 5-year follow-up, 88.9% of patients in the Control group and 20% of patients in the Experimental group showed persistent affective symptoms and/or difficulties in social-occupational functioning. CONCLUSIONS: A combined therapy is long-term effective for patients with refractory bipolar disorder. Suggestions for future research are commented.
  European Psychiatry 12/2012;
• Article: The Autonomic Nervous System Questionnaire and the Brief Patient Health Questionnaire as screening instruments for panic disorder in Finnish primary care.

  V Tilli, K Suominen, H Karlsson
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  ABSTRACT: PURPOSE: As panic disorder often remains unrecognized in the health care system, some screening methods have been developed to enhance its recognition. The aim of this study was to test and compare the Autonomic Nervous System Questionnaire (ANS) and the Brief Patient Health Questionnaire (BPHQ) in primary care. SUBJECTS AND METHODS: A total sample of 211 primary care outpatients was studied. The Structured Clinical Interview for DSM-IV was the criterion standard for the presence of panic disorder. Indices of diagnostic utility for both screening methods were calculated and compared. RESULTS: The AUC (area under the ROC curve) was 0.885 for the ANS and 0.877 for the BPHQ. At the optimal cut-off level, the ANS had the sensitivity of 0.88 and specificity of 0.77; the BPHQ had the sensitivity of 0.79 and the specificity of 0.87. There was not any statistically significant difference between the screens. CONCLUSIONS: Both screening methods can be recommended both for clinical practice and research use. In busy primary care practice, the BPHQ may be more useful, as it can be used together with the depression module of the BPHQ.
  European Psychiatry 12/2012;
• Article: Interactions between transcranial direct current stimulation (tDCS) and pharmacological interventions in the Major Depressive Episode: Findings from a naturalistic study.

  A R Brunoni, R Ferrucci, M Bortolomasi, E Scelzo, P S Boggio, F Fregni, B Dell'osso, M Giacopuzzi, A C Altamura, A Priori
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  ABSTRACT: BACKGROUND: Transcranial direct current stimulation (tDCS) is a non-invasive, neuromodulatory technique with an emerging role for treating major depression. OBJECTIVE: To investigate the interactions between tDCS and drug therapy in unipolar and bipolar depressed patients who were refractory for at least one pharmacological treatment. METHODS: This was a naturalistic study using data from 54 female and 28 male patients (mean age of 54 years) that consecutively visited our psychiatric unit. They received active tDCS (five consecutive days, 2mA, anodal stimulation over the left and cathodal over the right dorsolateral prefrontal cortex, twice a day, 20minutes). The outcome variable (mood) was evaluated using the Beck Depression Inventory (BDI) and the Hamilton Depression Rating Scale (HDRS). Predictor variables were age, gender, disorder and pharmacological treatment (seven dummy variables). We performed univariate and multivariate analyses as to identify predictors associated to the outcome. RESULTS: After 5 days of treatment, BDI and HDRS scores decreased significantly (29%±36%, 18%±9%, respectively, P<0.01 for both). Benzodiazepine use was independently associated with a worse outcome in both univariate (β=4.92, P<0.01) and multivariate (β=5.8, P<0.01) analyses; whereas use of dual-reuptake inhibitors positively changed tDCS effects in the multivariate model (β=-4.7, P=0.02). A similar trend was observed for tricyclics (β=-4, P=0.06) but not for antipsychotics, non-benzodiazepine anticonvulsants and other drugs. CONCLUSION: tDCS over the DLPFC acutely improved depressive symptoms. Besides the inherent limitations of our naturalistic design, our results suggest that tDCS effects might vary according to prior pharmacological treatment, notably benzodiazepines and some antidepressant classes. This issue should be further explored in controlled studies.
  European Psychiatry 11/2012;
• Article: Killing in combat and suicide risk.

  T R Rice, L Sher
  European Psychiatry 11/2012;
• Article: Moderating effect of schizotypy on the relationship between smoking and neurocognition.

  H Hori, J Matsuo, T Teraishi, D Sasayama, Y Kawamoto, Y Kinoshita, M Ota, K Hattori, H Kunugi
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  ABSTRACT: PURPOSE: Smoking rates in schizotypic individuals are shown to be elevated, as in patients with schizophrenia, although findings on the association of smoking with different symptomatology of schizotypy have been mixed. Moreover, possible moderating effects of schizotypy on the relationship between smoking and cognition have not been well documented. SUBJECTS AND METHODS: The Schizotypal Personality Questionnaire (SPQ) and the full version of the Wechsler Memory Scale-Revised (WMS-R) were administered to 501 healthy adults. Subjects were divided into smokers (n=85) and non-smokers (n=416) based on the presence/absence of current smoking. RESULTS: The analysis of covariance (ANCOVA) on the three factor scores as well as the total score of the SPQ, controlling for age and gender, revealed that cognitive-perceptual factor was significantly associated with an increased rate of smoking (P=0.048). The ANCOVA on the WMS-R indices, with smoking group as a fixed factor and age, gender and total SPQ score as covariates, revealed that the schizotypy-by-smoking interaction was significant for attention/working memory (P=0.029). DISCUSSION AND CONCLUSION: Positive schizotypy may be associated with more smoking. Schizotypy and smoking could interact with each other to negatively affect attention/working memory.
  European Psychiatry 11/2012;
• Article: Outreach and support in South London (OASIS), 2001-2011: Ten years of early diagnosis and treatment for young individuals at high clinical risk for psychosis.

  P Fusar-Poli, M Byrne, S Badger, L R Valmaggia, P K McGuire
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  ABSTRACT: INTRODUCTION: Prevention of psychosis has become a major objective of modern clinical psychiatry. An increasing number of new services have been established in Europe and in the world. The OASIS team has become an established model where clinical practice and research are fully integrated in the field of preventative interventions in psychosis. METHOD: Comprehensive analysis of different clinical and service measures describing the 2001-2011 implementation of the OASIS team. RESULTS: Over the last decade, the OASIS team has received a total of 1102 referrals, mostly young males from ethnic minorities. After the assessment, 35% were diagnosed with an At Risk Mental State (ARMS) while 32% were already psychotic. Within the ARMS, 70% met the inclusion criteria for the attenuated psychotic symptoms subgroup, 1% met the inclusion criteria for the genetic deterioration syndrome, 9% met inclusion criteria for a brief and self-limited intermittent psychotic episode and the others met inclusion criteria for more than one subgroup. Most of them had at least one comorbid diagnosis, mainly relating to anxiety and depressive domains. The majority of the OASIS clients received cognitive behavioural therapy alone or in combination with antidepressants/antipsychotics. Over the 2-year follow-up time, 44 subjects (15.2%) developed a frank psychotic episode. CONCLUSIONS: The OASIS service represents one of the largest and most established prodromal services in the world. The burden of research evidence and the translational impact produced on the clinical practice support the OASIS as a model for the development of similar services.
  European Psychiatry 11/2012;
• Article: Driving performance in adults with ADHD: Results from a randomized, waiting list controlled trial with atomoxetine.

  E Sobanski, D Sabljic, B Alm, R W Dittmann, P M Wehmeier, G Skopp, P Strohbeck-Kühner
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  ABSTRACT: PURPOSE: To investigate effects of a 12-week treatment with atomoxetine (ATX) on driving performance in real traffic, driving-related neuropsychological performance tests and self-evaluation of driving in adult patients with ADHD compared to an untreated control group with ADHD. METHODS: Parallel group design with an ATX and a waiting list group. At baseline and endpoint patients were evaluated with a standardized on-road driving test (SDBO), a driving-related neuropsychological test battery (Act and React Test System [ART2020]), and subjective measures of driving performance (one-week driving diary, Driver Coping Questionnaire). RESULTS: Forty-three of the 64 included patients completed the study (n=22 ATX, n=21 controls). Mean intervention period was 11.9±3.0 weeks, mean daily ATX dosage was 71.6±14.9mg. At endpoint, 60.1% of patients treated with ATX and 0% of waiting list group had reduced ADHD symptoms by greater or equal to 30%. In SDBO, ATX group reduced driving errors in three of four driving performance categories (attention, P<0.05; risk-related self-control, P<0.005; driver skills, P<0.001), number of driving errors remained stable in control group. At endpoint, 47.6% of control group and 18.2% of ATX group (P<0.05) did not fulfil the driving fitness criteria according to German Guidelines (percentile rank less or equal to 16 in one or more subtests in ART2020). Total number of self-reported critical traffic situations decreased from 12.0 to 6.8 per week in ATX group (P<0.05) and remained stable in controls by 9.3 and 9.9 at baseline and endpoint (ns). Coping strategies with stressful traffic situations did not change within both groups. CONCLUSION: Our study provides first evidence that treatment with ATX improves driving performance in real traffic in adults with ADHD.
  European Psychiatry 10/2012;