[Differential diagnosis of bipolar disorder: historical and clinical implications and perspectives]. / Differenzialdiagnostik der Bipolaren Störung: historische und klinische Implikationen und Perspektiven.

In DSM-5, bipolar disorder (BS) is no longer conceptualised as a pure mood disorder together with unipolar depression, but as a bridge between schizophrenia and depressive disorders. This nosological classification is founded on the historical context of the 19th century. In addition to unipolar depression and schizophrenia, schizoaffective disorder, borderline personality disorder and attention-deficit hyperactivity disorder (ADHD) overlap with BS symptomatology. Overlap also exists with somatic diseases such as multiple sclerosis, Cushing's syndrome and syphilis as well as iatrogenic affective syndromes.

[Nutrition and dietary supplements in neurological diseases]. / Ernährung und Nahrungsergänzungsmittel bei neurologischen Erkrankungen.

"Healthy" diets and supplements are widely used for prevention and disease modification in vascular, inflammatory and degenerative neurological diseases. Apart from a large number of cross-sectional and prospective cohort studies, there are only few interventional studies on individual dietary measures. A recent study confirmed the stroke preventive effect of a Mediterranean diet rich in olive oil and nuts; a ketogenic diet reduces seizure frequency in epilepsy. Supplementation of riboflavin, magnesium and coenzyme Q10 are probably effective in migraine prophylaxis. Creatine can improve muscle strength in muscular dystrophy and myositis. There is insufficient evidence to recommend any of the many dietary supplements, such as vitamins, omega-3 fatty acids and other substances for the prevention or improvement of all other neurological diseases. This review critically evaluates the present data on the role of nutrition and dietary supplements in neurological diseases.

[Nutrition and dietary supplements in psychiatric diseases]. / Ernährung und Nahrungsergänzungsmittel bei psychiatrischen Erkrankungen.

Nutrition and specific nutritional supplements can have prophylactic or therapeutic properties with respect to certain psychiatric disorders. A traditional Mediterranean diet, for example, seems to have prophylactic benefits against depression and dementia, whereas overeating and obesity increase the risk for both.Although evidence for nutritional supplements in the treatment of psychiatric disorders is not sufficient for general recommendations, data from observational studies and randomized controlled trials (RCT) seem to point to their use for specific indications. Folate, S-adenosylmethionine (SAM) and eicosapentaenoic acid (EPA), for instance, seem to have antidepressant properties, zinc may be beneficial in attention deficit hyperactivity disorder (ADHD), vitamin B6 (pyridoxine) could reduce extrapyramidal side effects of antipsychotics and N-acetylcysteine (NAC) seems to be effective against negative symptoms, abnormal movements and akathisia in schizophrenia.Psychiatric disorders, in turn, may lead to deficiency of mineral nutrients and vitamins. For instance, vitamin B1 (thiamine) deficiency is common in alcohol-dependent patients and should therefore be considered during withdrawal treatment. Although vitamin malnutrition is uncommon in developed countries, vitamin deficiency syndromes, such as pernicious anemia or Wernicke's encephalopathy are still relevant differential diagnoses.Some psychopharmacological drugs may additionally change the nutritional habits of the patients in an unfavorable way leading to weight gain and obesity and the risk for further psychiatric problems.

[Predictive factors of depression and its therapy]. / Prädiktive Faktoren der Depression und ihrer Therapie.

Predictive factors of for the occurrence of depressive episodes include psychosocial and biological risk factors. These factors reflect the heterogeneity and complexity of the disease. They can identify groups that would benefit from preventive measures and provide indications for suitable preventive strategies. In recent decades considerable scientific effort, for example in the field of psychiatric genetics, has been undertaken to identify predictive factors for individual antidepressant therapy response and as an aid for individual treatment decisions. However, no clinically usable conclusions could yet be drawn from the respective findings. In practice clinical factors, such as symptom cluster of the depressive disorder and specific properties of the antidepressant, individual factors and contextual factors, such as the type of treatment facility, decision support and economic aspects, are factors influencing the choice of a specific antidepressant. Early clinical improvement under antidepressant medication in the first 2 weeks of treatment is one of the best predictors for the long-term treatment outcome in patients with major depressive disorder.

[Research on Depression in the GDR - Historical Lines of Development and Therapeutic Approaches]. / Depressionsforschung in der DDR - historische Entwicklungslinien und Therapieansätze.

BACKGROUND: Historical research has raised the issue of whether GDR psychiatry was isolated from Western influences to such an extent that an autonomous East German psychiatry developed. Taking a chronological approach and being based on a clearly defined range of topics, the objective of this paper is to identify specific contributions made by GDR psychiatry to academic research as well as the degree of its international orientation by focusing on the treatment and research on depression. METHODS: We have performed a systematic review of the East German psychiatric journal "Psychiatrie, Neurologie und medizinische Psychologie" and a screening of all psychiatric textbooks that appeared in the GDR. RESULTS: Although East German psychiatry was oriented towards Soviet as well as Western developments, some internationally used therapeutic or conceptual innovations reached East German clinics only with some delay. Yet, East German psychiatrists have also contributed their own, independent nosological and therapeutic concepts to research on depression. Pivotal figures included, among others, R. Lemke (Jena), D. Müller-Hegemann (Leipzig) or K. Leonhard (Berlin). CONCLUSION: With regard to research on depression one cannot truly speak of an autonomous East German psychiatry. Developments in East and West were largely running in parallel.

[The discussion about the application and impact of music on depressive diseases throughout history and at present]. / Die Diskussion um die Anwendung und die Wirksamkeit von Musik bei depressiven Störungen in Geschichte und Gegenwart.

Music therapy is the customised application of music for therapeutic use. For the treatment of depression it is mostly applied within a multimodal therapeutic approach. Since music was already used in prehistoric societies to cure diseases, it can be considered as a traditional therapy. As early as the antiquity physicians discussed the kind of music, the duration and frequency of its application. In the 19th century the pioneers of modern scientific psychiatry began to follow these questions with empirical experimental research. Since the 20th century, research has been investigating the influence of music on biological and psychological parameters. Current studies show that music therapy appears to improve symptoms of depression, especially in combination with antidepressants. Due to the limited number of randomised studies, the validity of its efficiency is limited. Further research is necessary to provide evidence-based recommendations regarding music therapy for the treatment of depression.

[Obesity and depression: an overview on the complex interactions of two diseases]. / Adipositas und Depression: eine Übersicht über die vielschichtigen Zusammenhänge zweier Volkserkrankungen.

Both obesity and depression are diseases of civilization with a high clinical and scientific relevance. Correlations between both diseases usually turn out to be very complex and are not always applicable to all affected patients to the same extent. Especially, dysregulations of neuroimmunological parameters and physiological regulatory processes play an important role in the development and maintenance of both obesity and mood disorders. Due to the complexity of the underlying mechanisms it is difficult to apply standardized interventions for patients in clinical practice. Therapeutic measures should always be applied in the context of current research and adapted to the individual situation of the patient.

[Metabolic disorders under antipsychotic treatment]. / Stoffwechselstörungen unter antipsychotischer Therapie.

Patients with severe mental illness, such as schizophrenia, depression or bipolar disorder, are more likely to be overweight and to suffer from dyslipidaemia, diabetes or cardiovascular disease. Unhealthy lifestyles, including poor diet and sedentary behaviour, but also pharmacotherapy contribute to the adverse risk profile. This article reviews the epidemiology and pharmacodynamics of metabolic abnormalities in psychiatric patients treated with antipsychotics, focusing on substance-specific differences.

[Schizophrenic disorders. The development of immunological concepts and therapy in psychiatry]. / Schizophrene Störungen. Die Entwicklung immunologischer Krankheits- und Therapiekonzepte.

Immunological changes reported in patients with schizophrenia may play an aetiological role in these disorders. Further, immunomodulatory medications can influence the symptoms of psychiatric disorders. Antipsychotic agents such as clozapine may act therapeutically through the modulation of the immune system and also lead to side effects in that domain.Both the understanding and factual foundations of immunological concepts and immunological therapies of schizophrenic disorders have changed throughout the history of medicine. These are important considerations in psychiatry where diagnostic, nosological and therapeutic complexity is the norm. The article exemplarily presents publications of the psychiatrists such as Julius Wagner von Jauregg, Lewis Campbell Bruce and Friedrich Ostmann as well as neuropathologist Hermann Lehmann-Facius and haematologist William Dameshek.

[Christa Kohler's "communicative psychotherapy" as an integrated psychotherapeutic concept and its biographical, scientific and historical context]. / Christa Kohlers "Kommunikative Psychotherapie"--ein integratives Psychotherapiekonzept im biografischen, wissenschaftlichen und historischen Kontext.

"Communicative psychotherapy" was developed in the 1960s by the East German psychotherapist and psychiatrist Christa Kohler (1928-2004) for the treatment of "neuroses". Similar to established present-day psychotherapeutic methods, such as cognitive behaviour therapy, it combined diverse therapeutic approaches into an integrated treatment programme. This included individual and group therapy, exercise, work and occupational therapy. In contrast to modern psychotherapeutic practice, communicative psychotherapy was based on a firm system of values, namely socialist ideals. According to this system, psychological breakdown was viewed and treated ideologically. In addition, any lack of conformity with the East German system was likewise regarded as a psychopathological deviation, which should be subjected to psychological treatment. The latter concept requires a critical analysis from a current-day perspective. For the first time, this paper concentrates on Kohler's work on neuroses and the theory and practice of her communicative psychotherapy, albeit without neglecting Kohler's other scientific works, her biographical information and her Stasi documents.

Body dysmorphic disorder, muscle dysmorphia, weight and shape dissatisfaction and the use of appearance-enhancing drugs in the military: a systematic review.

BACKGROUND: Body dysmorphic disorder (BDD) and muscle dysmorphia (MD) are common but often underdiagnosed disorders. These disorders have rarely been explored in the context of military personnel by mental health researchers despite the emphasis on physical fitness in military populations. We conducted a comprehensive systematic literature review on scientific studies of BDD and MD and the accompanying symptoms within the military. METHODS: We used the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines and used PubMed, Web of Science and PsycINFO as databases with "body dysmorphic disorder," "muscle dysmorphia," "body image," "performance and image enhancing drugs," "anabolic steroid," military personnel," "soldiers," "navy," "air force," "army" and "armed forces" as search terms. RESULTS: A total of 20 eligible articles reporting data of 42 952 study participants were used. According to the identified literature, prevalence rates of BDD in the military are ~10% in men and ~20% in women, whereas ~15% of men and ~5% of women may suffer from MD. Further identified related problems in military populations were excessive bodybuilding, the use of anabolic drugs, the intake of stimulants, weight and shape concerns, and weight-control behaviours. CONCLUSIONS: BDD, MD, as well as the use of anabolic and stimulating drugs, are highly prevalent in military personnel. Despite the importance of these problems in the military, there are no military-specific treatment studies available. A pre-existing focus on physical appearance and fitness might contribute to the decision to pursue a professional military career. The military environment might be a maintaining factor of BDD or MD, but not the ultimate cause of the disorder in an affected individual.

Gene-PUFA interactions and obesity risk.

Although there are indications for modulatory effects of PUFA on associations between SNP and obesity risk, scientific evidence in human subjects is still scarce. The present analyses investigated interaction effects between SNP in candidate genes for obesity and PUFA in erythrocyte membranes on obesity risk. Within the second Bavarian Food Consumption Survey (cross-sectional, population-based), 568 adults provided blood samples. Fatty acid composition of erythrocyte membranes was analysed by means of GC. Genotyping was performed for twenty-one genes, including cytokines, adipokines, neurotransmitters and transcription factors. In addition, plasma IL-6 concentrations were analysed. For the statistical analysis, a logistic regression model assuming additive genetic effects was chosen. About 20 % of the study participants were classified as obese (BMI ≥ 30 kg/m(2)). Several significant gene-PUFA interactions were found, indicating regulatory effects of PUFA by gene variants of IL-2, IL-6, IL-18, TNF receptor family member 1B and 21, leptin receptor and adiponectin on obesity risk. After stratification by genotype, the strongest effects were found for rs2069779 (IL-2) and all tested PUFA as well as for rs1800795 (IL-6) and linoleic or arachidonic acid. The obesity risk of minor allele carriers significantly decreased with increasing fatty acid content. The genetic PUFA-IL-6 interaction was also reflected in plasma IL-6 concentrations. If replicated in a prospective study with sufficient statistical power, the results would indicate a beneficial effect of high PUFA supply for a substantial proportion of the population with respect to obesity risk.

[Hormone-based classification and therapy concepts in psychiatry]. / Hormonelle Krankheits- und Therapiekonzepte in der Psychiatrie.

This study retells key aspects of the history of the idea of hormone-based classification and therapy concepts in psychiatry. Different contributions to the history are not only represented from a historical, but also from a current medico-scientific perspective. One of the oldest, yet ethically most problematic, indications concerning hormonal methods to modify undesirable behaviour and sexuality was castration, which was widely used in the 20th century to "cure" homosexuality. Felix Platter, whose concept was humoral-pathological in nature, documented the first postpartum psychosis in the German-speaking countries, the pathogenesis of which according to present-day expertise is brought about by changes in female hormones. The concept of an "endocrine psychiatry" was developed at the beginning of the 20th century. Some protagonists for neuroendocrinology are highlighted, such as Paul Julius Möbius around 1900 or, in the 1950s, Manfred Bleuler, the nestor of this new discipline. Only the discovery of the hormones as such and the development of technologies like radioimmunassay to measure and quantify these hormone changes in mental illnesses allowed investigating these conditions properly. Ever since hormone-based therapeutic and classification concepts have played an important role, above all, in sexual, affective and eating disorders as well as alcohol dependence.

[Antihistaminergic antipsychotics cause weight gain]. / Antihistaminerge Antipsychotika verursachen Gewichtszunahme.

In recent years, weight gain has increasingly gained attention as a side effect of antipsychotic therapy due to its metabolic and cardiovascular health risks and its negative effect on therapy compliance. The various antipsychotics show clear differences concerning their influence on body weight. These differences seem to be mainly due to the affinity of these substances to the histaminergic H1 receptors and due to serotonergic mechanisms. In the hypothalamus, the antihistaminergic effect of those antipsychotics which are associated with a high amount of weight gain leads to an increase of the activity of the adenosine monophosphate-activated protein kinase (AMPK). Hypothalamic AMPK activity has an integrative function regarding orexigenic and anorexigenic signals.

[The relevance of the TNF-alpha system in psychiatric disorders]. / Die Bedeutung des TNF-alpha-Systems für Erkrankungen des Gehirns.

Changes regarding the immune system and specifically the cytokine system, of which tumor necrosis factor-alpha (TNF-alpha) is a part, have been shown to be involved in the development of neurological and psychiatric disorders such as multiple sclerosis, Parkinson's and Alzheimer's disease, depression, schizophrenia or narcolepsy. Besides, there is evidence that the risk of stroke correlates with the serum concentrations of different cytokines. Additionally, body weight, age and neuroendocrinological mechanism have a strong influence upon plasma levels of TNF-alpha and its soluble receptors (sTNF-Rs). TNF-alpha might contribute to the pathogenesis of these diseases by an activation of the hypothalamo-pituitary-adrenocortical (HPA) axis, an activation of neuronal serotonin transporters, the stimulation of the indoleamine 2,3-dioxygenase which leads to tryptophan depletion, by immunologically mediated destruction of neurons, or neurotoxic release of glutamate. Psychotropic drugs influence the TNF-alpha system, too. During psychopharmacological treatment of schizophrenia, some antipsychotics might act on neurotransmitter metabolism via inducing the proinflammatory cytokine system. Hopefully, these hypotheses may lead to new therapeutical strategies for psychiatric patients in the near future.

Depression, comorbidities and the TNF-alpha system.

Depression has frequently been reported to be associated with other physical diseases and changes in the cytokine system. We aimed to investigate associations between a medical history of depression, its comorbidities and cytokine plasma levels in the Bavarian Nutrition Survey II (BVS II) study sample and in patients suffering from an acute depressive episode. The BVS II is a representative study of the Bavarian population aged 13-80years. The disease history of its 1050 participants was assessed through face-to-face interviews. A sub-sample of 568 subjects and 62 additional acutely depressed inpatients of the Max Planck Institute of Psychiatry participated in anthropometric measurements and blood sampling. Tumor necrosis factor-alpha (TNF-alpha) and soluble TNF receptor (sTNF-R) p55 and sTNF-R p75 plasma levels were measured using enzyme-linked immunosorbent assays. A history of depression was associated with a higher incidence of high blood pressure, peptic ulcer, dyslipoproteinemia, osteoporosis, allergic skin rash, atopic eczema and thyroid disease. Within the BVS II sample, participants with a history of depression differed from subjects who had never had depression with regard to sTNF-R p55 and sTNF-R p75 levels even when controlling for age, BMI and smoking status. Acutely depressed inpatients showed even higher levels of sTNF-R p55 and sTNF-R p75 than subjects in the normal population. TNF-alpha levels were also significantly elevated in acutely depressed patients. These results confirm earlier studies regarding the comorbidities of depression and support the hypothesis that activation of the TNF-alpha system may contribute to the development of a depressive disorder.

[Advances in the treatment of multiple sclerosis?]. / Patient mit multipler Sklerose: Was können Sie in der Hausarztpraxis für ihn tun?

The natural course of multiple sclerosis (MS) is probably more favourable than previously assumed years ago. Since the introduction of interferons in Germany, the establishment and further development of new diagnostic criteria (McDonald criteria), the causal and symptomatic treatment possibilities and initiation of therapy early in the course of the disease have led to a considerable change in the treatment of MS. MS attacks are usually treated with the intravenous administration of high-dosed steroids. When the attack symptoms do not sufficiently subside, plasmapheresis can be considered. For long-term treatment of MS, beta interferon, glatirameracetate and natalizumab are available as basic causal therapy and natalizumab and mitoxantrone are available for escalation therapy. Frequently occurring spasticity, chronic fatigue syndrome, depression, cognitive disturbances, incontinence, pain, ataxia and sexual disorders must be treated symptomatically. Overall, the outpatient treatment of MS is complex and should be carried out with close cooperation between the family doctor, neurological practices and outpatient departments specialized in treating MS.

Are sleep duration, midpoint of sleep and sleep quality associated with dietary intake among Bavarian adults?

BACKGROUND/OBJECTIVES: Only few epidemiologic studies examined sleep characteristics in relation to dietary behaviour. Our aim was to analyse associations of sleep duration, midpoint of sleep and sleep quality with dietary intake among the Bavarian population. SUBJECTS/METHODS: Within the cross-sectional Bavarian Food Consumption Survey II, 1050 subjects aged 13-81 years were recruited. Dietary intake was assessed with three 24-h dietary recalls by telephone (EPIC-Soft). In our study, 814 participants aged 18 years or older, who completed at least two 24-h dietary recalls and who had complete and plausible information on sleep characteristics were analysed. Dietary intake was described by the consumption of main food groups, energy-proving nutrients and energy intake. Sleep was measured by the Pittsburgh Sleep Quality Index Questionnaire, from which categories of self-reported usual sleep duration in half-h-steps per night, midpoint of sleep and overall sleep quality were derived. RESULTS: Sleep duration was associated with intake of non-alcoholic beverages (P<0.01), carbonated beverages (P=0.04), water (P=0.04) and coffee/black tea (P=0.01) with higher intake among short duration sleepers. No association was found between the consumption of other main food groups, energy-proving nutrients or total daily energy intake and sleep duration. Midpoint of sleep was associated with intake of carbonated beverages (P=0.02, highest intake among subjects with early midpoint of sleep). No association between sleep quality and dietary intake was detected. CONCLUSIONS: Our findings demonstrate only specific associations between sleep characteristics and dietary intake, and mainly sleep duration was associated with beverage intake.

[Affective disorders and diabetes]. / Affektive Störungen bei Diabetes: Bessern Antidepressiva die Blutzuckereinstellung?

Affective disorders increase the risk for the occurrence of type 2 diabetes, and the presence of type 1 or type 2 diabetes may contribute to the development of an affective disorder. Certain antidepressants and behavioral therapy seem to improve blood sugar levels in patients suffering from depression and type 2 diabetes, although these antidepressants may lead to weight gain. However, some antipsychotics unfavorably affect weight development and carbohydrate metabolism. In diabetic patients, the physician should be particularly alert to affective symptoms, and in mentally ill patients, he should look out for metabolic changes that may be caused by diabetogenic psychopharmacological medication.