A 2-year longitudinal study of neuropsychological functioning, psychosocial adjustment and rehospitalisation in schizophrenia and major depression.

Neuropsychological functioning turns out to be a rate-limiting factor in psychiatry. However, little is known when comparing neuropsychological and psychosocial functioning in inpatients with schizophrenia or severe depression in their treatment pathways including add-on psychoeducation or the latter combined with cognitive behavioral therapy up to 2-year follow-up. To evaluate this question, we investigated these variables in two randomised controlled trials including 196 patients with DSM-IV schizophrenia and 177 patients with major depression. Outcome measures were assessed in the hospital at pre- and posttreatment and following discharge until 2-year follow-up. We focused on neuropsychological and psychosocial functioning regarding its differences and changes over time in data of two pooled trials. There were significant time effects indicating gains in knowledge about the illness, short and medium-term memory (VLMT) and psychosocial functioning (GAF), however, the latter was the only variable showing a time x study/diagnosis interaction effect at 2-year follow-up, showing significant better outcome in depression compared to schizophrenia. Moderator analysis showed no changes in psychosocial and neuropsychological functioning in schizophrenia and in affective disorders due to age, duration of illness or sex. Looking at the rehospitalisation rates there were no significant differences between both disorders. Both groups treated with psychoeducation or a combination of psychoeducation and CBT improved in neuropsychological and psychosocial functioning as well as knowledge about the illness at 2-year follow-up, however, patients with major depression showed greater gains in psychosocial functioning compared to patients with schizophrenia. Possible implications of these findings were discussed.

Sixth Kraepelin Symposium-Understanding and Treating Cognitive Impairment and Depression in Schizophrenia and Affective Disorders.

The Sixth Kraepelin Symposium was held at the Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich in October 2018, covering reports from 12 working groups (Keith H. Nuechterlein, Ph.D., University of California, Los Angeles; Kim T. Mueser, Ph.D., Center for Psychiatric Rehabilitation, Boston University, U.S.A.; Dominic Dwyer, Ph.D, Hospital LMU, Munich; David Fowler, Ph.D. University of Sussex, Brighton, U.K.; Martin Hautzinger, Ph.D., University of Tübingen; Nikolaos Koutsouleris, M.D., Hospital LMU, Munich; Stephan Leucht, M.D., Technical University Munich, Munich; David Miklowitz, Ph.D., UCLA School of Medicine, Los Angeles. U.S.A.; Cornelius Schüle, M.D., Hospital LMU, Munich; Florian Seemüller. M.D., kbo-Lech-Mangfall Clinics for Psychiatry and Psychotherapy, Garmisch Partenkirchen; Carla Torrent, Ph.D., Institute of Neuroscience, University of Barcelona, Barcelona, Spain.) from the United States and Europe on understanding and treating cognitive impairment and depression in schizophrenia and affective disorders. Current psychological interventions to improve outcome in schizophrenia and affective disorder such as cognitive remediation, illness management, psychoeducational and cognitive therapy were focused on, as were evidence-based psychological and pharmacological treatment options, guidelines for treating cognitive deficits and depression in schizophrenia, Cochrane-meta-analysis of acute therapies, relapse prevention as well as supported withdrawal from medication. Prevention of cognitive dysfunction and symptom exacerbation was approached in terms of machine learning methods to revisit Kraepelin's illness distinctions, application of new strategies in order to increase the rate of social recovery in patients with first-episode psychosis as well as in terms of state of the art psychosocial interventions for bipolar disorder in adolescents. Finally, the dissemination of information to consumers and the contribution to the reduction of stereotypes in psychiatry was also part of the symposiums aims.

Forty years of structural brain imaging in mental disorders: is it clinically useful or not?

Structural brain imaging was introduced into routine clinical practice more than 40 years ago with the hope that it would support the diagnosis and treatment of mental disorders. It is now widely used to exclude organic brain disease (eg, brain tumors, cardiovascular, and inflammatory processes) in mental disorders. However, questions have been raised about whether structural brain imaging is still needed today and whether it could also be clinically useful to apply new biostatistical methods, such as machine learning. Therefore, the current paper not only reviews structural findings in Alzheimer disease, depression, bipolar disorder, and schizophrenia but also discusses the role of structural imaging in supporting diagnostic, prognostic, and therapeutic processes in mental disorders. Thus, it attempts to answer the questions whether, after four decades of use, structural brain imaging is clinically useful in mental disorders or whether it will become so in the future.

Las imágenes estructurales del cerebro se introdujeron en la práctica clínica de rutina hace más de 40 años con la esperanza que respaldarían el diagnóstico y el tratamiento de los trastornos mentales. En la actualidad se emplean ampliamente para excluir enfermedades cerebrales orgánicas (como tumores cerebrales, alteraciones cardiovasculares y procesos inflamatorios) en los trastornos mentales. Sin embargo, hoy en día han surgido dudas de si aún se requieren imágenes cerebrales estructurales y también de si podría ser útil clínicamente la aplicación de nuevos métodos bioestadísticos, como el aprendizaje de máquinas. Por lo tanto, en este artículo no solo se revisan los hallazgos estructurales en la Enfermedad de Alzheimer, la depresión, el trastorno bipolar y la esquizofrenia, sino que también se analiza el papel de las imágenes estructurales en el apoyo a los procesos diagnóstico, pronóstico y terapéutico en los trastornos mentales. Por consiguiente, se intenta responder a las preguntas sobre si, después de cuatro décadas de empleo, las imágenes cerebrales estructurales son clínicamente útiles en los trastornos mentales o si lo serán en el futuro.

L'imagerie cérébrale structurelle a été introduite en pratique clinique de routine il y a plus de 40 ans avec l'espoir qu'elle aiderait au diagnostic et au traitement des troubles mentaux. Aujourd'hui elle est largement utilisée pour exclure une maladie cérébrale organique (par exemple, des tumeurs cérébrales, des processus cardiovasculaires et inflammatoires) dans les maladies mentales. Cependant, les questions suivantes se posent: l'imagerie cérébrale structurelle est-elle encore utile aujourd'hui? De nouvelles méthodes biostatistiques comme l'apprentissage automatique ne seraient-elles pas cliniquement utiles? Par conséquent, cet article ne s'attache pas seulement à analyser les résultats structuraux dans la maladie d'Alzheimer, la dépression, les troubles bipolaires et la schizophrénie mais discute aussi du rôle de l'imagerie structurelle dans l'aide au diagnostic, au pronostic et aux processus thérapeutiques dans les troubles mentaux. Il tente donc de répondre aux questions de l'utilité clinique de l'imagerie cérébrale structurelle dans les troubles mentaux après 40 ans d'utilisation et de son devenir.