All Articles

Genevieve Ataa Fordjour*, Albert P. C. Chan

Department of Building and Real Estate, The Hong Kong Polytechnic University, China

This study aims to explore the need for occupational psychological health interventions in the construction industry by identifying occupational psychological health conditions among construction employees. To achieve this aim, 300 questionnaires were equally distributed to purposively selected construction professionals and construction trade workers in Ghana. Four main constructs namely: individual lifestyle, psychosocial symptoms, physiological conditions, and work attitudes, were assessed to identify occupational psychological health conditions among the two construction working groups. These four main constructs were further divided into 20 occupational psychological health indicators. Quantitative analysis of the data was done, and a comparison made between the scores obtained from the two construction groups. Using the measures of individual lifestyle and work attitudes, the construction trade workers were found to be more prevalent in adverse occupational psychological health conditions than the construction professionals. The measures of psychosocial symptoms and physiological conditions, however, revealed no much statistically significant differences between the mean scores obtained from the two construction groups. Each of the two-construction group had their participants experiencing some form of adverse occupational psychological health conditions. Differences between the two groups in terms of factors such as task levels, role demands and income levels, are likely to influence their different level of vulnerability to psychological disorders. This study recommends some psychological health interventions to enhance the well-being of all construction employees. The findings from this study form the basic step in designing a preventive occupational psychological health model, with the aim to promote a psychologically safe and healthy construction workplace.

Madeline O. Jansen, K. Brendan Butler, David A. Jansen*

Tulane University School of Medicine, New Orleans, Louisiana, USA

Animation Deformity (AD) is a common and serious complication in breast cancer patients undergoing reconstructive surgery involving subpectoral breast implant placement. AD is associated with an increased risk of poor mental health outcomes, including diminished quality of life, depression, suicidality, body image dissatisfaction, and body dysmorphic disorder. Breast cancer survivors, especially those who elect to undergo reconstructive surgery, are known to be a vulnerable population for the development of mental health disorders. Because effective management of AD can be beneficial to a patient’s psychological wellbeing, this represents an important area of consideration for the surgical community. There are several methods for treating AD, which can involve repositioning the implant or inhibiting pectoralis muscle contraction. Such methods include manual muscle transection, neuromodulation, and selective nerve ablation. Research efforts have yet to examine which techniques produce more satisfactory improvements in psychosocial health. Thus, this may be an important area of focus for future research. This review examines contemporary research findings in order to broaden understandings of the relationship between AD and mental health, as well to highlight the importance of managing this complication.

Krishna A. Kumar*

Kerala Institute of Medical Sciences (KIMS), India

Welfare programs for the disabled individuals have been carried out in many countries, in accordance with UNCRPD, through legislative measures. The social and political developments in India enabled legislation for such measures in India. To avail benefits under such welfare schemes, the degree of their psychosocial disability needs to be assessed quantitatively through valid, reliable and workable instruments. Though Chronic Mentally ill persons were included as a beneficiary group, under the Persons With Disabilities Act 1995 in India, lack of a quantified scale for psychiatric disabilities, deprived the benefits to the mentally ill , available to other category of disabled persons. This prompted the IPS in 2001, to develop a Scale for Psychiatric Disability as a time – bound one year prime project. The IDEAS Scale, thus developed, could get approval from Government of India, as the official Scale for Psychiatric Disability in India, soon after its release by IPS, through effective liaison with Administrators in Government. The internal consistency, face validity, content validity, reliability, comparability with WHO Scale, and utility and utilization for Disability Assistance Programs have all been established through studies since 2005 .The stigma on the mentally ill persons, though not totally eliminated, also got attenuated through inclusion in the spectrum of disabled individuals, covered by welfare and rehablititation programmes. The Rights of Persons with Disabilities Act 2016 (RPWD 2016) and the Mental Health Care Act 2017 (MHC Act 2017) are new legislative measures, implemented in India for the welfare of mentally ill persons. In the wake of these legislations there has been renewed interest, and concerted efforts in IPS to evolve guidelines for effective use of IDEAS and standardization of Disability Certification procedures. The time bound commitment of IPS in 2001, to develop IDEAS and getting its official acceptance by Government of India, through effective liaison, and the renewed interest and present concerted efforts to utilize it for helping large number of disabled chronic mentally ill, form sequential precious contributions for Community Mental Health in India. It seems an inspiring imitable model for professional Mental Health Organizations in other countries, probably with relevance in other health-care disciplines as well.

Abbreviations

IPS : Indian Psychiatric Society

IDEAS : Indian Disability Evaluation and Assessment Scale

UNCRPD : United Nations Convention for Rights of Persons with Disabilities

WHODAS 2.0: World Health Organization Disability Assessment Schedule- 2.0

RPWDA 2016: Rights of Persons With Disabilities Act 2016

MHC Act2017: Mental Health Care Act 2017

Richard Thompson*

36, Dealtry Road, London, SW15 6NL, UK

Exposure to green plants, green space and gardening is now recognised as a valuable type of social prescribing for problems of mental and physical health, and the evidence behind their beneficial effects is strong.

Ignacio Garcia-Cabeza¹*, Ferreira Victor¹, Epifanio Maria M², Enrique de Portugal¹

¹Service of Psychiatry, Gregorio Maranon University Hospital, Complutense University of Madrid, Spain

²Martin de Vargas Health Center, Spain

The authors review the complex relationship between insight, adherence and symptoms with the functioning of the patient with diagnose of psychosis, either directly or as intermediary factors of each other.

Insight has been proposed to act through symptoms or psychodynamic factors. But in turn, adherence and insight are related in a bidirectional way and the first is one of the best predictors of outcomes in psychosis. Similarly symptoms, especially negative ones, are associated with a worse evolution of the disease.

The authors suggest that insight plays a role in the functioning of the patient, producing both a direct effect and also as a mediator by the improvement of adherence.

It is proposed that insight becomes a key therapeutic target in combined programs in order to favor better outcomes in the evolution of psychosis.

Christi A. Patten¹*, James A. Levine², Pamela S. Sinicrope¹, Ioannis T. Pavlidis³

¹Department of Psychology and Psychiatry, Mayo Clinic, Rochester, Minnesota, USA

²Foundation Ipsen, Paris, France; and Case Western Reserve University, Ohio, USA

³Department of Computer Science, University of Houston, Houston, Texas, USA

Smokers have an increased risk of depressive symptoms and depressive disorders. Smokers reporting higher levels of depressive symptoms prior to cessation treatment have greater difficulty quitting smoking. However, few interventions have targeted depressed smokers, a tobacco use disparity group. There is preliminary evidence to support the use of supervised, vigorous intensity exercise interventions to help smokers with depression quit. This Mini-Review addresses the potential role of exercise interventions for this population. We cover: (1) tobacco cessation treatments that have targeted depressed smokers, (2) efficacy of supervised exercise interventions for depression and smoking cessation, (3) results from a pilot study of supervised, vigorous intensity exercise for depressed women delivered in a community setting, and (4) future directions including technologies to scale up delivery of exercise interventions and exercise maintenance strategies. Future studies are needed that broaden the characteristics of participants in trials to include racially diverse men and women with a range of depressive symptoms. Positioning exercise delivery within community settings enhances the possible reach of interventions to a more diverse population of smokers. Delivery of exercise coaching through robotic and other digital technologies could also increase intervention scalability and open new avenues to explore methods and strategies to promote exercise adherence/maintenance.

E. Ahnemark^1*, M. Di Schiena², A.-C. Fredman^2,8, E. Medin^3,4, J. K. Söderling⁵, Y. Ginsberg^6,7

¹Shire, Vasagatan 7, SE-111 20 Stockholm, Sweden

²Prima Child and Adult Psychiatry AB, Stockholm, Sweden

³PAREXEL International, Stockholm, Sweden

⁴Department of Learning, Informatics, Management and Ethics, Karolinska Institute, Stockholm, Sweden

⁵Bell Analytics, Stockholm, Sweden

⁶Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden

⁷Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institute, Stockholm, Sweden

⁸Psychiatry Centre, Stockholm County Council, Södertälje, Sweden

Priyanka Patil, Thomas L. Schwartz*

Dept of Psychiatry, SUNY Upstate Medical University, Syracuse, New York

Background: The standard of care for schizophrenia treatment is the class of medications called the second generation antipsychotics (SGA). However, response rates of schizophrenia to SGA are far from ideal, and approximately one third of patients are likely to need high dosing, polypharmacy or switching of antipsychotics. To do this safely, clinicians’ knowledge of SGA pharmacodynamics, pharmacokinetics, therapeutic drug monitoring (TDM) levels, as well as, dose equivalency is imperative.

Aims:

• To review standard dosing, pharmacokinetic, and pharmacodynamic properties of the SGA.

• To further review the use of high, or “super-dosing”, of SGA.

• To investigate the clinical importance of monitoring drug levels for SGA.

• To describe possible SGA dose equivalency.

Materials and Methods: A Medline, PubMed (including observational studies, randomized controlled trials, meta-analyses, and systematic reviews) and textbook review was conducted without any date or language restriction. Each SGA (risperidone, paliperidone, lurasidone, ziprasidone, iloperidone, olanzapine, quetiapine, asenapine, aripiprazole, brexpiprazole and cariprazine) was searched and cross referenced with higher dosing, TDM, pharmacodynamics and pharmacokinetics. All possible studies were included. This paper focused on schizophrenia and use of SGA by oral route. Clozapine was excluded. Although it is an SGA, its properties and efficacy are different enough from other SGA and were felt beyond the scope of this current paper.

Discussion: A discussion of the concepts of pharmacokinetic failure, pharmacodynamic failure, Therapeutic Drug Monitoring, SGA dosing equivalencies and super dosing of SGA monotherapies is presented. SGA have pharmacodynamic and pharmacokinetic profiles which are distinctive and lead to unique side-effect profiles, drug-drug interactions, and clinical effects. For example, a SGA such as olanzapine, quetiapine and ziprasidone have evidence that high dosing is of value. Also, TDM drug monitoring is more clinically relevant in certain SGA like olanzapine, quetiapine, and risperidone. These differences are critically delineated.

Summary: This review article allows for a formal, evidence-based discussion regarding several advanced psychopharmacologic concepts which should allow the individual prescriber to elevate their prescribing practices.

Rebecca Grzadzinski^1,2*, Catherine Lord³

¹University of North Carolina at Chapel Hill (UNC), Chapel Hill, NC, USA

²Carolina Institute for Developmental Disabilities, Carrboro, NC, USA

³University of California at Los Angeles (UCLA), Los Angeles, CA, USA

Apostolos P. Georgopoulos^1,2,3,4,5*, Lisa M. James^1,2,3,4, Peka Christova^1,2,3, Brian E. Engdahl^1,2,3,6

¹ Brain Sciences Center, Department of Veterans Affairs Health Care System, Minneapolis, Minnesota, USA

² Department of Neuroscience, University of Minnesota Medical School, Minneapolis, Minnesota, USA

³ Center for Cognitive Sciences, University of Minnesota, Minneapolis, Minnesota, USA

⁴ Department of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota, USA

⁵ Department of Neurology, University of Minnesota Medical School, Minneapolis, Minnesota, USA

⁶ Department of Psychology, University of Minnesota Medical School, Minneapolis, Minnesota, USA

Posttraumatic stress disorder (PTSD) is a debilitating disorder that can develop following exposure to a traumatic event. Although the cause of PTSD is known, the brain mechanisms of its development remain unknown, especially why it arises in some people but not in others. Most of the research on PTSD has dealt with psychological and brain mechanisms underlying its symptomatology, including intrusive memories, fear and avoidance (see ref.1 for a broad coverage of PTSD research)¹. Here we focus, instead, on the origin of PTSD, namely on the neural mechanisms underlying its development. Specifically, we propose a two-hit model for PTSD development, with the following components. (a) The 1st hit is a neuroimmune challenge, as a preexisting condition, and the 2nd hit is intense glutamatergic neurotransmission, induced by the traumatic event; (b) the key molecule that mediates the effects of these two hits is intercellular adhesion molecule 5 (ICAM-5) which was found to be differentially expressed in PTSD². ICAM-5 is activated by neuroimmune challenge^3,4 and glutamatergic neurotransmission^5,6, it further enhances glutamatergic transmission⁶, and exerts a potent effect on synapse formation and neural plasticity, in addition to immunoregulatory functions^3,4,7; and (c) with respect to the neural network(s) involved, the brain areas most involved are medial temporal cortical areas, and interconnected cortical and subcortical areas^8-10. We hypothesize that the net result of intense glutamatergic transmission in those areas induced by a traumatic event in the presence of ongoing neuroimmune challenge leads to increased levels of ICAM-5 which further enhances glutamatergic transmission and thus leads to a state of a neural network with highly correlated neural interactions, as has been observed in functional neuroimaging studies^8-10. We assume that such a “locked-in” network underlies the intrusive re-experiencing in PTSD and maintains associated symptomatology, such as fear and avoidance.

Eugenio Fazio*

Department of Fundamental and Applied Sciences for Engineering, Sapienza Università di Roma via A. Scarpa 16, 00161 Roma Italy

Many technologies we use are inspired by nature. This happens in different domains, ranging from mechanics to optics to computer sciences. Nature has incredible potentialities that man still does not know or that he striving to learn through experience. These potentialities concern the ability to solve complex problems through approaches of various types of distributed intelligence. In fact, there are forms of intelligence in nature that differ from that of man, but are nevertheless exceedingly efficient. Man has often used as a model those forms of distributed intelligence that allow colonies of animals to develop places of housing or collective behaviors of extreme complexity. Recently, M. Alonzo et alii (Sci.Rep. 8, 5716 (2018)) published a hardware implementation to solve complex routing problems in modern information networks by exploiting the immense possibilities offered by light. This article presents an addressable photonic circuit based on the decision-making processes of ant colonies looking for food. When ants search for food, they modify their surroundings by leaving traces of pheromone, which may be reinforced and function as a type of path marker for when food has been found. This process is based on stigmergy, or the modification of the environment to implement distributed decision-making processes. The photonic hardware implementation that this work proposes is a photonic X-junction that simulates this stigmergic procedure. The experimental implementation is based on the use of non-linear substrates, i.e. materials that can be modified by light, simulating the modification induced by the ants on the surrounding environment when they leave the pheromone traces. Here, two laser beams generate two crossing channels in which the index of refraction is increased with respect to the whole substrate. These channels act as integrated waveguides (almost self-written optical fibers) within which optical information can be propagated (as happens for the ants that follow traces of pheromone already “written”). The proposed device is a X-junction with two crossing waveguides, whose refractive index contrast is defined by the intensities of the writing light beams. The higher the writing intensity, the greater the induced index variation, as if it were an increasingly intense pheromone trace. The information will follow the most contrasted harm of the junction, which is driven and eventually switched by the writing light intensity. Any optical information that will be sent to the device will follow the most intense trace, i.e. the most contrasted waveguide. The paper demonstrates a device that can be wholly operated using the light and that can be the basis of complex hardware configurations that might reproduce the stigmergic distributed intelligence. This is a highly significant innovation in the field of electronic and photonic technologies, within which artificial cognition and decision processes are implemented into a hardware circuit and not in a software code.

M. Fernández Rodríguez^1,2*, M. Menéndez Granda³, Villaverde González⁴

¹Mental Health Center I “La Magdalena” University Hospital San Agustín de Avilés. Health Area III, Asturias, Spain

²Gender Identity Treatment Unit of Principality of Asturias (UTIGPA), Spain

³Master of General Health Psychology, University of Oviedo, Asturias, Spain

⁴Intern Resident Psychologist, University Hospital San Agustín Avilés. Health Area III Asturias, Spain

The aim of this article is to highlight the historical path of transsexualism diagnosis since its inclusion to its elimination from the catalogue of mental disorders. We analyse the terminological changes that may account for this phenomenon in order to depathologise and just as the controversies raised by its location in the new Manual of International Statistical Classification of Diseases and Related Health Problems ICD-11.

ICD-11 drives out the term "Transsexualism" and replaces it with the term "Gender Incongruence" (GI). This new terminology will no longer be part of the chapter on mental disorders (Chapter 6) but a new chapter (Chapter 17) entitled "Conditions relating to sexual health" is created. These changes of ICD-11 represent a breakthrough and a great sense of freedom for trans people, since WHO has included the different variants of gender in normality by not being considered a mental disorder.

The aim of this paper is to highlight the historical development of the diagnosis of transsexualism from its inclusion to the elimination of the chapter of mental disorders. Terminological changes that can best reflect this phenomenon to depathologize and the controversies raised by its location in the new manual of ICD-11 are analyzed.

Celia Andreu-Sánchez^1*, Miguel Ángel Martín-Pascual^{1, 2}, Agnès Gruart³, José María Delgado-García³

¹Neuro-Com Research Group, Department of Audiovisual Communication and Advertising, Universitat Autònoma de Barcelona, Barcelona, Spain

²Instituto Radio Televisión Española, RTVE, Barcelona, Spain

³División de Neurociencias, Universidad Pablo de Olavide, Sevilla, Spain

Hamilton Fairfax*

Department of Clinical Psychology, Church Lane, Exeter, Devon, EX2 5DY, UK

This article reviews the current research regarding the use of Mindfulness as treatment in Obsessive Compulsive Disorder which been an area of increasing interest for more than decade. Research investigation the application of specific models Mindfulness and integrative treatments incorporating Mindfulness is reviewed together with a consideration of how descriptive components of Mindfulness may contribute to understanding its contribution to OCD treatment. This is briefly examined by considering the main mechanism of change proposed by the Mindfulness literature and followed by a discussion of the criticism of applying Mindfulness to OCD. The convulsion suggests that whilst there is good evidence to support Mindfulness in the treatment of OCD, particularly for those who have not benefited from traditional innervations, there is not enough evidence for it to be considered a stand alone treatment. The current literature suggests that Mindfulness may be best considered as adjunctive treatment within an existing treatment framework but further research is required to further investigate it is effect and clarify its contribution to change.

Jitender Aneja*

Department of Psychiatry, All India Institute of Medical Sciences, India

Background: The response to risperidone in patients with schizophrenia is influenced by many factors including the genetic ones. The innovations in biotechnology have provided essential tools for conduction of pharmaco-genetic research and subsequently a number of pharmaco-dynamic and pharmaco-kinetic studies delineating the response of anti-psychotics in schizophrenia have been conducted till date. So, we may prevision that pharmaco-genetic knowledge can provide us with the tools to personalize treatment in routine psychiatric clinical practice.

Purview of this article: This article is a narrative review of existing pharmaco-genetic research that has elicited relationship of various gene polymorphisms and response to risperidone monotherapy in patients with schizophrenia. The association of response to risperidone treatment and the genetic markers across the dopaminergic, serotonergic, and the metabolizing enzymes have been reported here. However, the pharmaco-kinetic aspects of the metabolizing enzymes and other genes are not reviewed in this paper.

Conclusions: Some of the genes coding for dopaminergic and serotonergic receptors and their mutations have been shown to predict risperidone response. Certain promising observations have been made for the association of DRD2 receptor genes (Ser311Cys, -141C Ins/Del), DRD3 (Ser9Gly), 5-HTR2A genes (102T>C), and COMT genes. Although, some positive association with some other genes have also been found, but the evidence is minimal. Despite the availability of such evidence, it is limited for clinical utilization in its present form. However, efforts shall be made at further exploration of genetic underpinnings of schizophrenia, refinement of study methods, and discovery of newer biomarkers to attain utilization of pharmaco-genetics in clinical practice.

Jacqueline Pei^1,2, Katherine Flannigans^1*, Sarah Keller², Michelle Stewart^1,2, Alexandra Johnson³

¹Canada Fetal Alcohol Spectrum Disorder Research Network, PO Box 11364 Wessex PO, Vancouver, BC, Canada, V5R 0A4

²Department of Educational Psychology, University of Alberta, 6-102 Education North, Edmonton, AB, Canada, T6G 2G5

³Department of Justice Studies, University of Regina, 3737 Wascana Parkway, Regina, SK, Canada, S4S 0A2

Fetal Alcohol Spectrum Disorder (FASD) is a neurodevelopmental disability that occurs as a result of fetal exposure to alcohol. Such exposure can impact physical, cognitive, social-emotional, and behavioural development, which renders individuals with FASD vulnerable to a range of adverse life outcomes when adequate supports and services are not available. One of the common adverse outcomes associated with FASD is criminal justice system (CJS) involvement, and individuals with FASD are believed to be over-represented in forensic and correctional settings. The FASD population is an exceptionally heterogeneous and complex group, with varying life experiences, clinical profiles, and levels of functional ability. These factors likely impact how an individual with FASD might engage with the CJS, function within the system, and respond to justice-related supports and intervention initiatives. In this mini review, we provide a synopsis of the current state of the literature regarding the intersections between FASD and the CJS, including research on prevalence and screening, as well as profiles and perspectives of individuals with FASD who are justice-involved. Further, recommendations are put forward to guide our work with justice-involved individuals with FASD, keeping in mind that no two individuals will present in the same way.

Hassan Mahmood Jindal¹, Shamala Devi Sekaran^2*

¹Department of Medical Microbiology, University of Malaya, Kuala Lumpur, 50603, Malaysia

²Department of Microbiology, Faculty of Medicine, MAHSA University, 42610 Jenjarom, Selangor, Malaysia

Despite the effort and decades of research, S. pneumoniae remains a primary cause of infectious morbidity and mortality worldwide. Although Antibiotics are lifesaving medications that offer tremendous benefits to patients with infectious diseases. Yet, several reports have revealed that the overuse and misuse of these agents had led to antibiotic resistance. Our study utilized whole genome sequencing (WGS) to reveal the pattern of antibiotic-resistance among ten pneumococcal isolates with various degree of susceptibility to antibacterial drugs. The main purpose of our study was to explore genetic variations related to drug-resistance in those ten strains. The results indicated that pneumococcal strains with resistant profile were associated with greater number of SNPs compared to susceptible ones. Out of all the SNPs identified, 31 were unique and had not been reported before. Our data propose that these SNPs could possess an important role in modifying the degree of sensitivity to different antibacterial drugs. In this article we comment on the methodology and results of our study which previously published in Journal of Biomedical Science.

Pablo Levín*

Faculty of Economics, University of Buenos Aires (FCE/UBA), Argentina

Both this mini-review and the reviewed article were composed by this author (an economist), to probe into the ample but as yet hardly explored interface between two disciplines (Psychiatry and Political Economy) that have mostly grown heretofore with their backs turned to each other. In facing such a very large and complex almost newfound interdisciplinary field –itself a decisive step towards the integration of an all-encompassing philosophy of culture; a full systematic discussion is neither to be announced nor expected. At some point however our statements may appear apodictic in form and emphatic in tone; but please bear in mind that these excesses are just meant to make our point. Our purpose is to call for further discussion, with a serious caveat as to the danger entailed in interdisciplinary conversation, of begetting still another syncretic contraption.

We hopefully feel instead, that this abridged version comes closer than the earlier article; to the desideratum of a synthetic concept; potentially impinging upon: i.e., constituting; the vast area where these two disciplines overlap; by developing the concept of a "triple culture aporia (TCA)" -as a theoretical archetype for Ideology.

The TCA concept has to saddle over upon the interdisciplinary boundaries we’re here concerned with; shedding new light on the absolute originality of today’s human condition. To make this clearer, we should bring forth the concept of historical heteronomy, to wit, contemporary human’s self-inflicted incapacity for becoming our own full- fledged contemporaries. In a nutshell: chronologic contemporariness is given to us as a matter of fact; but prevailing institutionalized education falls short from –or indeed systematically precludes; preparing us to raise ourselves up to present historical contemporaneity; to confront its exigencies, to reap its high rewards; the latter being the utmost specifically human aspiration!

It is our deep conviction, that a (the?) main source of our individual distresses and sufferings –included those that bring us as patients to the psychiatrist’s office; are to be sought among our failures in our quest for Bildung; not constrained into its xviii enlightenment still incipient notion; but open to its urgently needed updated concept…which is what this review is about.

Megan Chernosky*

University in Louisville, Kentucky, USA

This paper will discuss the correlation between participation in a mental health peer-support training and adolescents’ self-reported feelings of preparedness to deal with mental health crises. The paper will focus on lesbian, gay, bisexual, transgender, queer, intersex, asexual, and other non-heterosexual, non-cisgender youth (LGBTQIA+) between the ages of 13 and 21 years old. The study used a quantitative, written survey with eighteen questions before the intervention, and another with five questions after the intervention. The study originally involved eleven participants, but the number of participants decreased to seven dues to attrition. The intervention was administered to every participant. The data were analyzed to find the averages and standard deviations for each category. The results found that the average preparedness increased after the intervention. Due to lack of a control group, the researcher was not able to determine causation, but they were able to determine correlation. The researcher concluded that there was a short-term increase in feelings of preparedness to deal with crises in correlation with receiving the mental health training.

Per Bergsholm*

Department of Psychiatry, District General Hospital of Førde, Box 1000, 6807, Førde, Norway

The category diagnosis of functional psychoses builds on views of influential professionals. Until the second half of the 1800s, the conceptions of mania and melancholia from the Greek antiquity included largely all functional psychoses. Disturbed mood and energy were central symptoms, and the idea of unitary psychosis prevailed. From the 1900s this was followed by a dichotomy between schizophrenia and affective psychoses and broadening of the schizophrenia concept. Affective symptoms were strongly downgraded. Many psychoses with mixed features were described, and there have now long been four main categories of functional psychoses – affective, schizophrenic, schizoaffective/cycloid/reactive/polymorphic, and delusional/paranoid psychoses. The last three are included in “psychotic disorders”. The boundaries between categories have varied with time, place and professionals’ views. DSM-5 is updated with separate chapters for catatonia and psychotic symptoms, both unspecific, and removal of the subtypes of schizophrenia. However, time may be running out for categorical psychosis diagnoses, which may be replaced by continuum, spectrum, dimensional and research domain criteria. Affective symptoms are often difficult to acknowledge, diagnosis is often done on the basis of preconceptions, and patients’ affect characterized accordingly. Chronic mood disorders may appear as schizophrenic or paranoid psychosis, end-stages like heart failure in heart diseases. This underscores the importance of early and optimal treatment of mood disorders, which may be the most important cause of schizophrenia and other functional psychoses.

Wolfgang Wölwer^1*, Gerhard Buchkremer², Heinz Häfner³, Joachim Klosterkötter⁴, Wolfgang Maier⁵, Hans-Jürgen Möller⁶, Wolfgang Gaebel¹

¹Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Düsseldorf, LVR Klinikum Düsseldorf, Germany

²Department of Psychiatry and Psychotherapy, University Tübingen, Germany

³Research Group Schizophrenia Research, Central Institute of Mental Health Mannheim, Germany

⁴Department of Psychiatry and Psychotherapy, University Cologne, Germany

⁵Department of Psychiatry and Psychotherapy, University Bonn, Germany

⁶Department of Psychiatry and Psychotherapy, University Munich, Germany

Background: The German Research Network on Schizophrenia (GRNS) was funded by the Federal Ministry of Education and Research (BMBF) from 1999 to 2011. The aim was to obtain a better horizontal and vertical networking of German research and care facilities on schizophrenia, in order to investigate open research questions, to transfer the results into clinical practice and after all to improve care and quality of life in patients with schizophrenia.

Objectives / Methods: This paper describes the concept and functioning of the GRNS as well as its results on the basis of selected research projects.

Results: The GRNS comprised about 25 clinical trials of high practical relevance, which were closely interrelated regarding content, methodology and organization. The trials primarily served the development and evaluation of new and established diagnostic and therapeutic approaches, the assessment of the status quo of clinical care as well as its improvement, together with the investigation of basic scientific questions. Many substantial results to highly relevant issues could be obtained, which led or will lead to an improvement in mental health care.

Conclusions: Quantitative and qualitative evaluation parameters such as scientific publications and raising of additional grants, as well as promotion of young scientists, public relations activities, congress activities and foundation of the European Scientific Association on Schizophrenia and other Psychoses (ESAS) prove the successful work of the network. The successful grant raising will allow continuing cooperative schizophrenia research in Germany as initiated by the GRNS.

Laleh Jamshidi^1*, Lies Declercq¹, John M. Ferron², Mariola Moeyaert³, S. Natasha Beretvas⁴, and Wim Van den Noortgate¹

¹Faculty of Psychology and Educational Sciences & imec-Itec, KU Leuven (University of Leuven), Belgium

²University of South Florida, Tampa, Florida, USA

³University at Albany – State University of New York, New York, USA

⁴University of Texas at Austin, Texas, USA

Single-case experimental design (SCED) studies are becoming more prevalent in a variety of different fields and are increasingly included in meta-analyses (MAs) and systematic reviews (SRs). As MA/SR’s conclusions are used as an evidence base for making decisions in practice and policy, the methodological quality and reporting standards of SRs/MAs are of uttermost importance. One way to improve the reliability and validity of SCED MAs and therefore to provide more confidence in MA/SR findings to practitioners and clinicians to decide on a particular intervention is the use of high-quality standards when conducting and reporting MAs/SRs. In the current study, some existing tools for assessing the quality of SRs/MAs that might also be helpful for SCED MAs will be reviewed briefly. These tools and guidelines can help meta-analysts, reviewers, and users to organize and evaluate the quality and reliability of the findings.

Verletta Saxon^1*, Dhrubodhi Mukherjee², Deborah Thomas³

¹Department of Children and Family Services, State of Illinois, Chicago, IL, United States

²Associate Professor, Department of Social Work, University of North Texas, Denton, TX, United States

³Crisis Manager, Centerstone of Illinois, Carterville, IL, United States

Shifting resources and funding from institutionalized care for those with mental illness to community-based care has shown promise for behavioral health parity in health crisis circumstances and yet, it has been underfunded. One of the unfortunate trends of deinstitutionalization of behavioral health services in general has been a persistent gap in emergency crisis services. This gap in services leaves those in a behavioral health crisis to receive treatment in the Hospital Emergency Departments culminating in an astounding increase in overall healthcare expenditures. Providing behavioral health crisis assessment and treatment in busy emergency departments that produce long waits for care can be a challenging environment for those in need of immediate treatment for psychological needs. Crisis Stabilization Centers are effective at providing suicide prevention services, addressing behavioral health treatment, diverting individuals from entering a higher level of care and addressing the distress experienced by individuals in a behavioral health crisis. Studies also show that the cost of Crisis Stabilization Centers is significantly less than psychiatric inpatient units and satisfaction among clients is greater. Expanding the options for Behavioral Health Crisis Care from community-based behavioral health out-patient care and inpatient care to various community alternatives, benefits individuals in crisis as well as the community. This article provides an overview of community alternatives to psychiatric hospitalization, financial barriers to care and future research.

Rüdiger Hardeland*

University of Goettingen, Johann Friedrich Blumenbach Institute of Zoology and Anthropology, Goettingen, Germany

In the traditional view of mood disorders, the circadian system has been insufficiently considered. However, polymorphisms of circadian oscillator genes in bipolar disorder, seasonal affective disorder, and subforms of major depressive disorder as well as demonstrable deviations in overt circadian rhythms indicate a role of the circadian system in these pathologies. Circadian malfunction affects sleep, and sleep deprivation can initiate proinflammatory responses. Being parts of the circadian system, melatonin and sirtuin 1 deserve particular attention. Either of them displays neuroprotective, anti-inflammatory, and circadian amplitude-enhancing properties, which are of relevance to neurodegeneration that is observed in a number of depressive patients. Notably, both circulating melatonin levels as well as sirtuin 1 expression decline by age. In the gerontological context, melatonin upregulates sirtuin 1, which mediates some of melatonin’s actions. Correction of a deviating circadian system seems to be of value regarding causes that contribute to depressive symptoms.

Gadi Lissak*

Meuhedet Health Services, Jerusalem, Israel