[Help-seeking behavior and pathways to care for patients with obsessive-compulsive disorders]. / Hilfesuchverhalten und Behandlungswege von Patienten mit Zwangsstörungen.

BACKGROUND: Obsessive-compulsive disorder (OCD) is a chronic and debilitating disorder that is relatively common and is associated with a wide range of functional impairments. This is partly associated with delayed help-seeking behavior of OCD patients, which shows a lag of up to 10 years after onset of the obsessive-compulsive symptoms to the first attempt at seeking professional treatment. The reasons for the delay in initial help-seeking behavior by OCD patients are manifold but still not clear. Early detection and early treatment might, however, have beneficial effects on the treatment-seeking behavior. AIM: The aim of the study was to examine the help-seeking behavior and the pathways to care of patients with OCD using a modified version of the structured pathways to care questionnaire initially designed for research into schizophrenia. RESULTS: For the 40 outpatients with OCD who completed the interview retrospectively, the latent period between symptom onset and first seeking professional contact was on average 6.5 years, while the median delay to a third attempt at seeking treatment was nearly 15 years. Although the majority of participants consulted a professional neurological and psychotherapeutic practice even at the first attempt and 90% complained of specific OCD symptoms, only 20% received the standard treatment consisting of cognitive behavioral therapy and medication with a selective serotonin reuptake inhibitor (SSRI). The most common reason for delaying seeking treatment was that the patient was not convinced of having a mental illness such as OCD and of the necessity for treatment. Even so, approximately 40% of the participants reported fear of stigmatization and discrimination as a major reason for the delay in the first attempt at seeking help. CONCLUSION: Psychoeducation and broad utilization of evidence-based treatment still appears necessary and can contribute to improvement in the help-seeking behavior of OCD patients.

Dopamine-modulated aversive emotion processing fails in alcohol-dependent patients.

Negative mood states after alcohol detoxification may enhance the relapse risk. As recently shown in healthy volunteers, dopamine storage capacity (V d) in the left amygdala was positively correlated with functional activation in the left amygdala and anterior cingulate cortex (ACC) during an emotional task; high functional connectivity between the amygdala and the ACC, a region important for emotion regulation, was associated with low trait anxiety. Based on these findings, we now tested whether detoxified alcohol-dependent patients have a disrupted modulation of the anterior cingulate cortex activation in response to aversive stimuli by amygdala dopamine. Furthermore, we asked whether disrupted functional coupling between amygdala and ACC during aversive processing is related to trait anxiety.We used combined 6-[18F]-fluoro-l-DOPA positron emission tomography (PET), functional magnetic resonance imaging (fMRI) and Spielberger's state-trait anxiety questionnaire (STAI) in 11 male detoxified alcohol-dependent patients compared to 13 matched healthy controls.Unlike healthy controls, patients showed no significant correlation between our PET metric for dopamine storage capacity (FDOPA V d), in left amygdala and activation in left ACC. Moreover, the functional connectivity between amygdala and ACC during processing of aversive emotional stimuli was reduced in patients. Voxel-based morphometry did not reveal any discernible group differences in amygdala volume.These results suggest that dopamine-modulated corticolimbic circuit function is important for responding to emotional information such that apparent functional deficits in this neuromodulatory circuitry may contribute to trait anxiety in alcohol-dependent patients.

Development and factorial validation of a short version of the narcissism inventory (NI-20).

BACKGROUND: Narcissism is seen as a normal but heterogeneously formed personality variable, ranging from 'grandiosity-exhibitionism' to 'vulnerability-sensitivity'. This article reports the development and factorial validation of a short version of a narcissism inventory. SAMPLING AND METHODS: The sample includes data of 4,509 consecutive psychosomatic inpatients. The overall sample was divided in 2 equally sized randomized subsamples. One sample (n = 2,262) was used for exploratory factor analysis (principal component analysis). The other sample (n = 2,265) was used for confirmatory tests of the model fit of the newly built NI-20 version, and to analyze the model fit separately for men and women using structural equation modeling with AMOS software. RESULTS: The short version (NI-20) consists of 20 items, with items representing almost all of the original 18 subscales and 4 second-order dimensions. The NI-20 possesses properties similar to the NI-90, with a considerable gain in test economy. The 4-factor structure of the NI-20 was confirmed, and reaches good fit indices. CONCLUSIONS: The NI-20 is an economical instrument with acceptable psychometric characteristics that reflects the heterogeneous aspects of narcissism. A methodological limitation is that the interactions between sociodemographic variables were not included as potential predictors.

[Neuroimaging diagnosis of alcohol dependence]. / Bildgebung in der Diagnostik der Alkoholabhängigkeit.

Neuroimaging provides insight into the main biological mechanisms underlying alcohol dependence. This article discusses results from brain imaging studies on neurobiological correlates of alcohol dependence. Cardinal symptoms of alcohol dependence are the development of tolerance, withdrawal symptoms, drug craving, loss of control on alcohol intake, and harmful consequences of alcohol consumption. Brain imaging studies support the hypothesis that tolerance can be understood as a neuroadaptive mechanism to ensure homeostasis during chronic alcohol intake. When alcohol consumption is suddenly interrupted during detoxification, the loss of homeostasis typically manifests as withdrawal syndrome. While tolerance reduces the effects of chronic alcohol intake, sensitization is a neuroadaptive process that increases the effects of alcohol and raises incentive salience. Brain imaging studies indicate that sensitization and drug craving are associated with neuroadaptive processes in the brain reward system. Harmful consequences of alcohol intake also include neurotoxic effects on the central nervous system characterized by local and global atrophy. These findings can be best diagnosed with neuroimaging.

[Evidence-based psychotherapy: addiction and personality disorders as comorbidities]. / Evidenzbasierte Psychotherapie: Sucht und Persönlichkeitsstörung als Komorbidität.

A large number of studies have shown that various psychotherapeutic methods have a positive effect on the course of addiction and personality disorders when they are treated separately. Co-morbid occurrence of both disorders is common but a chronologically separated treatment often leads to renewed occurrence of the symptoms of the initially treated disorder. Failures of abstinence motivation, severe drug craving and the activation of dysfunctional behavior patterns frequently lead to renewed consumption of addictive substances and thus endanger the further course of treatment. So far, evidence of effectiveness exists only for dialectic behavior therapy and dual focus schema therapy. This article summarizes the current state of knowledge and introduces both methods by highlighting the core therapeutic strategies.

[Aggressive and impulsive behavior: neurobiological models explain how affectregulation might work and social skills develop]. / Impulsives Verhalten, Aggressivität und Sucht: Umwelt oder Gene--wo liegt die Ursache?

A person's impulsive actions are characterized by a lack of sufficient planning or an assessment of possibly harmful consequences. An impulse control disorder can be diagnosed if such actions occur frequently, even in low-stress situations. In psychiatry there are a number of syndromes that are associated with an impulse control disorder. Neurobiological findings point to a reduced turnover of serotonin in the brain of persons with an impulse control disorder and aggressive behaviour. However, a reduced turnover of serotonin is also found in persons who can consume immoderate amounts of alcohol but who experience no such unpleasant effects and thus have a high risk of becoming dependent. The serotonin turnover of an individual is controlled by environmental influences in interaction with genetic factors. In this article, impulse control disorders will be discussed with regard to their origin and social effects.

Hippocampal glutamate concentration predicts cerebral theta oscillations during cognitive processing.

RATIONALE: Brain waves reflect collective behavior of neurons and provide insight into distributed network processing. Frontal and hippocampal theta oscillations (4-7 Hz) were linked to cognitive tasks and animal studies have suggested an involvement of glutamatergic neurotransmission in integrative frontal-hippocampal processing. Human evidence for such relationships is lacking. METHODS: Here, we studied the associations between glutamate concentrations in the hippocampal region, measured by a 3-T proton magnetic resonance spectroscopy (1H-MRS), and EEG theta activity during an auditory target detection paradigm. RESULTS: A robust relationship between hippocampal glutamate and frontal theta activity during stimulus processing was found. Moreover, frontal theta oscillations were related to response speed. CONCLUSION: The results suggest a functional coupling between the frontal cortex and hippocampal region during stimulus processing and support the idea of the hippocampus as a neural rhythm generator driven by glutamatergic neurotransmission. These preliminary data show, for the first time, a relationship between in vivo measured glutamate and basic cerebral information processing in humans.

Mental health care in Berlin.

AIM: To provide information on the mental health care system in Berlin, Germany. METHOD: Using available data we report on the spectrum of mental health care services provided in Berlin, the number of professionals working in these sectors, funding arrangements, pathways into care, and user/carer involvement. RESULTS: The health care system in Berlin consists of a network of inpatient, outpatient, ancillary, and rehabilitative facilities, all of which are meant to work in a synergistic fashion. However, although the individual treatment options are generally well-planned, there is still a lack of co-ordination between them. Currently, the entire network is threatened by cuts in state funding for ancillary and rehabilitative services, by further reductions in the number of hospital beds, and by insurance company cuts in prescription drug budgets, such as those used for atypical antipsychotics in outpatient care. DISCUSSION: Despite many similarities with the situation in other European capitals, the system of mental health care in Berlin suffers from a variety of problems related to co-ordination and costs that are unique to the German capital.

[Neurobiology of substance-related addiction: findings of neuroimaging]. / Neurobiologie stoffgebundener Abhängigkeitserkrankungen - Befunde bildgebender Verfahren.

Neuroimaging provides insight into the main biological mechanisms underlying drug and alcohol dependence. Cardinal symptoms of drug dependence are the development of tolerance against drug effects, withdrawal symptoms, drug craving, reduced control over drug intake and harmful consequences of drug consumption. Brain imaging studies support the hypothesis that tolerance development can be understood as a neuroadaptive mechanism to ensure homeostasis during chronic drug intake. When drug consumption is suddenly interrupted during detoxification, the loss of homeostasis can manifest as a withdrawal syndrome. While tolerance development reduces the effects of chronic drug intake, sensitization is a neuroadaptive process that increases the effects of a drug dose. Brain imaging studies indicate that sensitisation and drug craving are associated with neuroadaptive processes in the brain reward system. Harmful consequences of drug intake include neurotoxic effects on the central nervous system. Besides discussing brain imaging studies on the neurobiological correlates of drug dependence, this review also presents studies on vulnerability factors that predispose individuals to excessive drug intake.

Association between cerebral glutamate and human behaviour: the sensation seeking personality trait.

INTRODUCTION: Brain imaging studies have linked the anterior cingulate cortex (ACC) to motivation, drive, and personality traits like novelty and sensation seeking. Animal studies have shown glutamatergic neurotransmission to be important in ACC function as well as motivated behaviour. However, the role of glutamate in related personality traits like sensation seeking has not been investigated in humans. METHODS: The associations between sensation seeking personality scores and absolute glutamate concentrations in the ACC and the hippocampal region measured by 3-Tesla proton magnetic resonance spectroscopy (1H-MRS) were investigated. RESULTS: ACC glutamate concentration was negatively correlated with the sensation seeking sum score and the experience seeking subscore. A weak negative correlation was also observed between the hippocampal glutamate and the sensation seeking sum score. The reexamination of the glutamate concentration after 4 weeks revealed a similar relationship with sensation seeking. DISCUSSION: Although preliminary, the results are in line with the key role of the ACC for motivation and executive control and with the impact of glutamate on novelty related behaviour observed in animal experiments. The role of the hippocampus for novelty processing is discussed. Glutamate measurement with 1H-MRS may facilitate the understanding of biological underpinnings of personality traits and psychiatric diseases associated with dysfunctions in motivation and drive.

Dopamine and the diseased brain.

Dysfunction of central dopaminergic neurotransmission has been implicated in a series of neuropsychiatric disorders, including Tourette's syndrome, schizophrenia, and drug and alcohol dependence. The behavioral and psychopathological manifestations of central dopaminergic dysfunction differ depending on the site of their neurobiological correlate. These sites may be found in the dorsal or ventral striatum, but also in cortical regions such as the limbic and prefrontal cortex, among other locations. A low basic dopamine turnover and an increase in the availability of dopamine D2 receptors in the caudate body have been associated with the severity of motor tics in Tourette's syndrome. In the ventral striatum and particularly in the nucleus accumbens, different drugs of abuse stimulate dopamine release and thus reinforce drug consumption. The downregulation of dopamine D2 receptors in this area of the brain has been associated with alcohol craving and an increase in the processing of alcohol-related stimuli in the medial prefrontal cortex. Brain imaging studies in which intrasynaptic dopamine release is manipulated in vivo have shown that increased subcortical dopamine release is associated with the pathogenesis of positive symptoms in schizophrenia. This review discusses a broad range of brain imaging and neuroendocrinological studies on dopaminergic dysfunction in neuropsychiatric disorders, including relevant findings on the basis of primate studies. In addition, the hypothesis is examined that phasic dopamine release is associated with salience attribution to external stimuli, insofar as it mediates reward anticipation in the ventral striatum and limbic cortex, habit formation in the dorsal striatum, and working memory function in the prefrontal cortex.