W an der Heiden

Universität Heidelberg, Heidelberg, Baden-Wuerttemberg, Germany

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Publications (66)160.97 Total impact

  • H Häfner, K Maurer, W An der Heiden
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    ABSTRACT: BACKGROUND: The ABC schizophrenia study conducted by the same team over 25 years initially aimed at illuminating the onset, prodromal stage and sex differences in age at first hospitalization in schizophrenia. New hypotheses were systematically generated from the results achieved. METHODS: A population-based sample of 276 first admission cases (232 first episodes, age 12-59 years), including a subsample of 130 first admissions (115 first episodes), were assessed to study prodromal stage, first illness episode, medium and long-term course and symptom dimensions in schizophrenia. The samples were compared with age and sex-matched healthy controls and with patients first admitted for unipolar depression. A total of 1,109 consecutive first admissions for schizophrenia spectrum disorders independent from the other study samples were assessed to study changes in symptomatology across the age range. RESULTS: Before the onset of psychotic symptoms the prodromal stages of schizophrenia and severe and moderately severe depression are difficult to distinguish. The most frequent symptom in the course of schizophrenia, depressed mood, also represents the most frequent initial symptom in both disorders. Prodromal depression is a predictor of more depressive and positive symptoms in the first episode but not in the further course of the illness. Psychosis incidence for men, diagnosed according to ICD 9 (295, 297, 298.3/4), shows a pronounced peak at age 15-24 years, for women a lower peak at age 15-29 years and a second, still lower peak at the menopausal age of 45-49 years. The explanation, confirmed in animal experiments, lies in a protective effect of estrogen due to reduced D2 receptor sensitivity. The effect is antagonized by an elevated genetic risk. Functional and social impairment emerge even at the prodromal stage and the severity depends on sex and social status. Young men with schizophrenia show a less favorable social course because of the earlier age of onset and socially adverse illness behavior. Late onset is associated with a milder, primarily paranoid symptomatology and less severe social impairment. Schizophrenia is a disorder of all ages showing roughly equal life time incidence rates for men and women but considerable difference in certain periods of age. The symptom dimensions show a plateau-like course 2-5 years after the first episode. Hidden behind this picture are irregular symptom exacerbations which vary in duration. Schizophrenia conveys the picture of recurrent vulnerability to crisis and not of a stable residual state of disordered brain development or of a progressive neurodegenerative process.
    Der Nervenarzt 05/2013; DOI:10.1007/s00115-013-3788-6 · 0.86 Impact Factor
  • Heinz Häfner, Kurt Maurer, Wolfram an der Heiden
    Der Nervenarzt 05/2013; DOI:10.1007/s00115-013-3788-6/Mai · 0.86 Impact Factor
  • H Häfner, K Maurer, W An der Heiden
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    ABSTRACT: PURPOSE: The ABC Schizophrenia study, led by a single research team, investigated a schizophrenia sample systematically over quarter of a century. This paper summarises results from 1996 onwards. The initial goals were to explain the considerably higher age at first admission in women, and to obtain precise information on the onset and early course of schizophrenia as a prerequisite for early intervention. METHOD: The study was hypothesis-driven. People with schizophrenia were compared in the prodrome and at first admission to those with unipolar depression and to healthy controls. We analysed the medium-term (5-year) and the long-term (12-year) course of schizophrenia, its symptom dimensions, social parameters and predictors. Samples: (1) 276 population-based first admissions (232 first episodes) of schizophrenia (age range 12-59 years); (2) a subsample of 130 first admissions for schizophrenia; (3) 130 first admissions for unipolar depression; (4) 130 healthy population controls and (5) 1,109 consecutive first admissions for schizophrenia spectrum disorder without an age limit. RESULTS: The prodromal stages of schizophrenia and depression were very similar until positive symptoms appeared. The most frequent symptom in schizophrenia was depressed mood. The course of psychosis from prodrome to 12 years following first admission was very variable. From 5 to 12 years after first admission the course was characterised by irregular exacerbations of the main symptom dimensions, with no overall deterioration or improvement. CONCLUSIONS: Schizophrenic psychosis and severe affective disorder, rather than representing discrete illnesses, probably mark different stages in the manifestation of psychopathology produced by various degrees of brain dysfunction.
    Social Psychiatry 05/2013; 48(7). DOI:10.1007/s00127-013-0700-4 · 2.58 Impact Factor
  • Source
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    ABSTRACT: Es werden zwei neuartige ambulante kinder- und jugendpsychiatrische Versorgungsangebote, die im Rahmen des Landesprogramms zur Weiterentwicklung der außerstationären psychiatrischen Versorgung Baden-Württemberg gefordert werden, beschrieben. Hierbei steht der Vergleich mit zwei Erziehungsberatungsstellen im Vordergrund. Es wurde festgestellt, daß vorwiegend ein Klientel, das nicht aufgrund eigener Initiative kommt, durch die neuen Einrichtungen erreicht wird. Des weiteren zeigt sich, daß der Anteil an Zuweisungen aus dem ärztlichen Bereich bei den neuartigen kinder- und jugendpsychiatrischen Angeboten höher ist als bei beiden Erziehungsberatungsstellen. (DIPF/Orig.)
  • Heinz Häfner, Wolfram an der Heiden
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    ABSTRACT: Affective symptoms, depression in particular, show high rates in schizophrenia. When occurring in combination with subclinical psychotic symptoms they are precursors of psychosis risk. Their increase over time is associated with an increase in psychosis risk and their decrease with a fall therein. The prodromal stage of severe depression and the prepsychotic prodromal stage of schizophrenia show, in the mean, more or less identical symptoms, but are diagnostically distinguishable from each other only after the onset of psychotic symptoms. In the course of full-blown schizophrenia depressive mood is the most frequent symptom, even more frequent than the positive symptoms specific to schizophrenia. In psychotic relapse episodes depressive symptoms, too, increase and to some extent also decrease when the psychosis remits. 15–20% of the relapse episodes are characterised by affective symptoms without psychotic symptoms. Attempts to identify a depressive prodrome in psychotic relapses have not yielded consistent results. The Kraepelinian model of two discrete illness groups does not provide an adequate description of the functional association between affective and psychotic symptoms observable throughout the illness course. A model of schizophrenia based on symptom dimensions, which are in part functionally related and differ in their shares in individual illness, seems to be closer to reality. Since the currently available antipsychotic and antidepressant medications and specific psychotherapeutic techniques act on symptom dimensions rather than the Kraepelinian disease concepts, a dimensional model of schizophrenia seems more useful in therapeutic respect as well. KeywordsPsychosis-Schizophrenia-Depression in schizophrenia-Subclinical symptoms-Prodromal stage-Long-term course-Symptom dimensions in schizophrenia
    04/2011: pages 389-402;
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    Dirk van Kampen, Kurt Maurer, Wolfram an der Heiden, Heinz Häfner
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    ABSTRACT: Validation of Van Kampen's Schizotypic Syndrome Questionnaire (SSQ) model of schizophrenic prodromal unfolding. The SSQ model comprises 12 negative, asocial and psychotic-like symptoms that are hypothesized to determine each other in terms of cause and effect. Use was made of the Interview for the Retrospective Assessment of the Onset of Schizophrenia (IRAOS)-dependent retrospective data assembled in the Mannheim Age-Beginning-Course Study sample of first-episode schizophrenic patients to measure the SSQ symptoms. Both the mean positions of the IRAOS-assessed symptoms on a continuum representing the proportion of total time of pre-psychotic disturbance and the outcome of a series of LISREL analyses conducted on the IRAOS-dependent data were addressed. Both kinds of data supported the validity of the SSQ model; however, this was after introducing some (relatively minor or demonstrable ineffective) changes in the model as the 'translation' of the SSQ symptoms by means of the IRAOS was not always easy, or proved even impossible in the case of one symptom. The conclusion seems warranted that the present investigation supports the validity of the SSQ model as a model of pre-psychotic and prodromal unfolding in patients diagnosed as suffering from schizophrenia. From a theoretical perspective, arguments are presented to interpret the SSQ model as a model of the core or principal symptoms of schizophrenia, including their temporal unfolding.
    Early Intervention in Psychiatry 05/2009; 3(2):137-50. DOI:10.1111/j.1751-7893.2009.00120.x · 1.74 Impact Factor
  • Heinz Häfner, Wolfram an der Heiden, Kurt Maurer
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    ABSTRACT: We tested Kraepelin's dichotomy model by studying the separability of schizophrenia and depression on the basis of symptoms and illness course. Matched untreated patients with schizophrenia and depression (n = 130 each) and 130 "healthy" controls were assessed from onset to first admission. In a second study the same variables were studied in 107 patients with schizophrenia over a homogenised follow-up of 134 months (11.2 years). The symptom most frequently marking the onset of both schizophrenia and depression was depressive mood. Both disorders exhibited the same prodromal core syndrome. It was not until the emergence of positive symptoms that the disorders became separable by the international classification systems. Depression remained the most frequent syndrome over the entire course of schizophrenia. Depression does not represent comorbidity, but an integral part of psychosis. A dimensional disease model based on successively emerging hierarchical symptom patterns, not unknown to the later Kraepelin, is offered as an explanation.
    European Archives of Psychiatry and Clinical Neuroscience 07/2008; 258 Suppl 2:85-96. · 3.36 Impact Factor
  • Heinz Häfner, Wolfram an der Heiden, Kurt Maurer
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    ABSTRACT: ObjectiveWe tested Kraepelin’s dichotomy model by studying the separability of schizophrenia and depression on the basis of symptoms and illness course. Materials and methodsMatched untreated patients with schizophrenia and depression (n=130 each) and 130 “healthy” controls were assessed from onset to first admission. In a second study the same variables were studied in 107 patients with schizophrenia over a homogenised follow-up of 134months (11.2years). ResultsThe symptom most frequently marking the onset of both schizophrenia and depression was depressive mood. Both disorders exhibited the same prodromal core syndrome. It was not until the emergence of positive symptoms that the disorders became separable by the international classification systems. Depression remained the most frequent syndrome over the entire course of schizophrenia. ConclusionDepression does not represent comorbidity, but an integral part of psychosis. A dimensional disease model based on successively emerging hierarchical symptom patterns, not unknown to the later Kraepelin, is offered as an explanation.
    European Archives of Psychiatry and Clinical Neuroscience 06/2008; 258:85-96. DOI:10.1007/s00406-008-2011-4 · 3.36 Impact Factor
  • H. Häfner, W. an der Heiden
    Schizophrenia, Second Edition, 10/2007: pages 101 - 141; , ISBN: 9780470987353
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    ABSTRACT: 35 children 12-42 years of age of patients with schizophrenia (ABC-Cohort-12-year-follow-up) were interviewed for studying objective and subjective effects of growing up with a schizophrenic parent. Social development and childhood experiences were assessed and quantitatively and qualitatively evaluated. The majority of probands had to take on early responsibilities in their family. Experienced deficits in parental care and problems with poor communication within the family were also mentioned. Compared with controls they showed only light disadvantages in the level of education and vocational training. Even if early independence could be a positive resource for children with a schizophrenic parent the restrictions in the child's life and development should not be overlooked. Information on the illness and support in dealing with stressful situations are frequently needed.
    Psychiatrische Praxis 10/2006; 33(6):269-76. · 1.64 Impact Factor
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    ABSTRACT: Comparison of symptom-related and social role development between patients with schizophrenia, major depression and healthy controls provided insights into the untreated early course of the two disorders. Symptoms, functional impairment and social disability were assessed and compared using the IRAOS and several other cross-sectional instruments in three samples. At the early illness stages there was considerable overlap in the symptom patterns and impairments presented by persons with schizophrenia and severe depression. The two disorders did not diverge until later in the early illness course with the onset of psychotic symptoms. Depressive symptoms showed a maximum in the first psychotic episode and relapse episodes and decreased with the remitting episode. Due to differences in cognitive appraisal depressed patients reported more functional impairment and social disability than patients with schizophrenia did. The early course of symptoms and social impairment in schizophrenia and depression seems to offer an opportunity to distinguish these disorders from variants of normal development fairly early. However, early diagnostic distinction and prediction of psychosis versus depression risk at the pre-psychotic prodromal stage do not seem promising due to the broad overlap in symptoms and impairment.
    Der Nervenarzt 08/2006; 77(7):809-22. DOI:10.1007/s00115-005-1920-y · 0.86 Impact Factor
  • Psychiatrische Praxis 06/2006; 33(6):269-276. DOI:10.1055/s-2005-866948 · 1.64 Impact Factor
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    ABSTRACT: We studied descriptive and causal associations between schizophrenia, depressive symptoms and episodes of depression. Untreated psychotic, depressive and negative symptoms were assessed retrospectively from onset until first admission using the IRAOS in a population-based sample of 232 first episodes of schizophrenia. A representative subsample of 130 patients, studied retrospectively until onset and followed up prospectively over 6 months after first admission, were compared with 130 age- and sex-matched healthy population controls and with 130 equally matched first admissions for unipolar depressive episodes. The lifetime prevalence of depressive mood (>or=2 weeks) at first admission for schizophrenia was 83%. The most frequent initial symptom of schizophrenia was depressive mood, appearing more than 4 years before first admission and followed by negative symptoms and functional impairment. Showing considerable overlap in symptoms and functional impairment at their initial stages, schizophrenia and unipolar depression became clearly distinguishable with the emergence of psychotic symptoms. In the first psychotic episode 71% presented clinically relevant depressive symptoms, 23% fulfilled the ICD-10 criteria for a depressive episode. With remitting psychosis the prevalence of depression, too, decreased. The high frequency of depressive symptoms at the prepsychotic prodromal stage and their increase and decrease with the psychotic episode suggests that depression in schizophrenia might be expression of an early, mild stage of the same neurobiological process that causes psychosis. The high prevalence of depression in the population and the diversity of its causes prompted us to speculate about a hierarchical model of preformed dimensional patterns of psychopathology.
    Schizophrenia Research 10/2005; 77(1):11-24. DOI:10.1016/j.schres.2005.01.004 · 4.43 Impact Factor
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    ABSTRACT: Depressive symptoms are quantitatively and qualitatively among the most important characteristics of schizophrenia. The following contribution reports on the prevalence of depression in 107 patients of the ABC schizophrenia study over 12 years after first hospital admission, looks into a preponderance of depression at certain stages of the illness and the predictive value of depressive symptoms for course and outcome. All but one of the 107 patients experienced one to 10 episodes of depressed mood between index assessment and long-term follow-up. In any month of the observation period about 30-35% of the patients presented at least one symptom of the depressive core syndrome (depressive mood, loss of pleasure, loss of interests, loss of self-confidence, feelings of guilt, suicidal thoughts/suicide attempt). Depressive symptoms are particularly frequent during a psychotic episode at a rate of approximately 50%. There were moderate but statistically significant correlations between the amount of depressive symptoms during a psychotic episode and the frequency of relapses, defined by hospital admissions as well as the total length of inpatient treatment. Depression occurring in the interval was not associated with an increased need for inpatient treatment.
    European Archives of Psychiatry and Clinical Neuroscience 07/2005; 255(3):174-84. DOI:10.1007/s00406-005-0585-7 · 3.36 Impact Factor
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    ABSTRACT: Risk factors, emergence and accumulation of symptoms in the untreated early course were studied as a basis for understanding the relationship between schizophrenia and depression. 130 representative first admissions for schizophrenia were compared retrospectively with 130 individually matched first admissions for depressive episodes and with 130 healthy controls. Onsets of schizophrenia and severe depression were marked by depressive symptoms, followed by negative symptoms and functional impairment. This prodromal core syndrome became more prevalent as the disorders progressed, and it reappeared in psychotic relapses. Psychotic symptoms emerged late, indicating a different and more severe "disease pattern". The prevalence of depressive symptoms in the general population and at the prodromal stage of numerous mental disorders precipitated by various psychological and biological factors suggests that depression might be an expression of an inborn mild reaction pattern of the human brain. With progressing brain dysfunction more severe patterns like psychosis are expressed.
    European Archives of Psychiatry and Clinical Neuroscience 07/2005; 255(3):167-73. DOI:10.1007/s00406-005-0584-8 · 3.36 Impact Factor
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    ABSTRACT: Using the Interview for the Retrospective Assessment of the Onset of Schizophrenia (IRAOS), we assessed 170 first illness episodes with a nonpsychotic prodromal stage (73% of the population-based Age, Beginning, Course [ABC] study sample of 232 first illness episodes of schizophrenia from a German population of about 1.5 million). Conrad's (1958) and Docherty et al.'s (1978) stage models of the early course presume unidirectional and compelling patterns of symptom manifestation. Using structural equation modeling, we tested the explanatory power of the stages as latent variables and to what extent these models tally with each other and with data on symptom onset. The models neither converged nor were they confirmed. The reasons for and possible implications of this result will be discussed. We also tested, using various techniques, a causal model of the determinants of social course. The only significant predictors of 5-year social outcome turned out to be social development at psychosis onset and the socially adverse illness behavior of young men. The influence of the traditional predictors, age and gender, type of onset (chronic, acute), and symptomatology, was mediated by these two variables assessed at the end of the prodromal stage.
    Schizophrenia Bulletin 02/2003; 29(2):325-40. · 8.61 Impact Factor
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    ABSTRACT: Onset and lifetime prevalence of substance abuse were assessed retrospectively using the IRAOS interview in a population-based, controlled sample of 232 first episodes of schizophrenia (ABC sample). Subjects with schizophrenia were twice as likely as controls to have a lifetime history of substance abuse at the age of first admission (alcohol abuse: 23.7 versus 12.3%; drug abuse: 14.2 versus 7.0%). 88% of the patients with drug abuse took cannabis. The sequence of substance abuse and schizophrenia was studied on the timing of abuse onset and illness onset, the latter as based on various definitions: first sign of the disorder, first psychotic symptom and first admission. 62% of the patients with drug abuse and 51% of those with alcohol abuse began the habit before illness onset (=first sign of the disorder). Abuse onset and illness onset occurred highly significantly within the same month (drug abuse in 34.6%, alcohol abuse in 18.2%). Unexpectedly, no temporal correlation was found between abuse onset and the onset of the first psychotic episode. We concluded that a small proportion of schizophrenias might have been precipitated by substance--mainly cannabis--abuse. Long-term effects of early substance abuse were studied prospectively at six cross-sections over five years from first admission on in a subsample of 115 first episodes of schizophrenia. Abusers showed significantly more positive symptoms and a decrease in affective flattening compared with controls. Five-year outcome as based on treatment compliance, utilization of rehabilitative measures and rate of employment was also poorer for patients with than without early substance abuse.
    Schizophrenia Research 05/2002; 54(3):243-51. DOI:10.1016/S0920-9964(01)00249-3 · 4.43 Impact Factor
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    ABSTRACT: Poorly defined cohorts and weak study designs have hampered cross-cultural comparisons of course and outcome in schizophrenia. To describe long-term outcome in 18 diverse treated incidence and prevalence cohorts. To compare mortality, 15- and 25-year illness trajectory and the predictive strength of selected baseline and short-term course variables. Historic prospective study. Standardised assessments of course and outcome. About 75% traced. About 50% of surviving cases had favourable outcomes, but there was marked heterogeneity across geographic centres. In regression models, early (2-year) course patterns were the strongest predictor of 15-year outcome, but recovery varied by location; 16% of early unremitting cases achieved late-phase recovery. A significant proportion of treated incident cases of schizophrenia achieve favourable long-term outcome. Sociocultural conditions appear to modify long-term course. Early intervention programmes focused on social as well as pharmacological treatments may realise longer-term gains.
    The British Journal of Psychiatry 07/2001; 178:506-17. DOI:10.1192/bjp.178.6.506 · 7.34 Impact Factor
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    ABSTRACT: This paper focuses on the long-term course of social disability in schizophrenia assessed at first onset, and after 1, 2 and 15 years in incidence cohorts in six European centres in Bulgaria, Germany, Ireland, The Netherlands, the Czech Republic and the United Kingdom. The study population comprises 349 patients comprising 75% of the original cohorts. Social disability was assessed in a standardized way with the WHO Disability Assessment Schedule. Social disability in schizophrenia appears to be a persistent phenomenon. Its severity decreased overall in the period of follow-up, but this was not so in a small group traced to hospital or sheltered accommodation. Only 17% of subjects had no disability and 24% still suffered from severe disability. The great majority lived with their family, a partner, or alone. A deteriorating course was more frequent than late improvement. Gender, age, onset, duration of untreated psychosis or type of remission during the first 2 years did not predict the long-term outcome of disability. Severity of disability at the first three assessments of the illness contributed significantly to the explanation of its variance at 15 years. Disability generally ameliorates, but less than expected or hoped. It needs continuing attention and care in this era of de-institutionalization.
    Psychological Medicine 10/2000; 30(5):1155-67. DOI:10.1016/S0920-9964(00)90721-7 · 5.43 Impact Factor
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    ABSTRACT: Women fall ill with schizophrenia 3 to 4 years later than men. The neurobiological mechanism, explaining the delay of onset in women until menopause, is presumably due to a sensitivity reducing effect of oestrogen on central d(2) receptors, as we have previously shown in animal experiments and in a controlled clinical study. The gender difference in age at onset seems to disappear in familial cases with schizophrenia, but it increases to highly significant values of 5 years or more in isolated cases according to a recent study by Albus and Maier (Schizophrenia Research 18:51-57, 1995). We tried to replicate these findings and to test the hypothesis of a functional antagonism between genetic predisposition to illness and the protective effect of oestrogen in a population-based sample of 232 first illness episodes of schizophrenia. In women with at least one first-degree relative suffering from schizophrenia, age at onset defined by first psychotic symptom was significantly reduced by several years and the difference with men disappeared. In sporadic female cases (no mental disorder in first-degree relatives) the age at onset was slightly increased compared with the total sample, which was in accordance with our hypothesis. In men with familial schizophrenia, but without a protective agent like oestrogen, the age at onset was only slightly and non-significantly reduced compared with the total group and with sporadic cases. This was in line with Albus and Maier and with our hypothesis that only the protective effect of oestrogen could be antagonized by a strong genetic disposition. The second main risk factor for schizophrenia is pre- and peri-natal complications. We compared men and women from our sample of first illness episodes with a history of pre- and peri-natal complications with those without a history of obstetric complications. In women the age at first psychotic symptom was markedly reduced, but due to small case numbers not significantly, compared with women without the risk factor and with the total group. Again, schizophrenic men with a history of pre- and peri-natal complications showed only a small, non-significant reduction of age at onset compared with the total and the group without the risk factor. Therefore, we concluded that the degree of genetically determined vulnerability and, presumably to a slightly lesser extent, the degree of pre- and peri-natal brain injury antagonizes the onset delaying effect of oestrogen in schizophrenia.
    Schizophrenia Research 08/2000; 44(1):81-93. DOI:10.1016/S0920-9964(99)00139-5 · 4.43 Impact Factor

Publication Stats

2k Citations
160.97 Total Impact Points

Institutions

  • 1989–2013
    • Universität Heidelberg
      • Central Institute of Mental Health
      Heidelberg, Baden-Wuerttemberg, Germany
  • 1983–2013
    • Central Institute of Mental Health
      • Klinik für Abhängiges Verhalten und Suchtmedizin
      Mannheim, Baden-Württemberg, Germany
  • 2007
    • National Institute of Mental Health (NIMH)
      베서스다, Maryland, United States