Computerized positive mental imagery training versus cognitive control training versus treatment as usual in inpatient mental health settings: study protocol for a randomized controlled feasibility trial.

BACKGROUND: Enhancing the capacity to experience positive affect could help improve recovery across a range of areas of mental health. Experimental psychopathology research indicates that a computerized cognitive training paradigm involving generation of positive mental imagery can increase state positive affect, and more recent clinical studies have suggested that this training could be used as an adjunct treatment module to target symptoms related to positive affect deficits, specifically anhedonia. The current study investigates the feasibility of adding a positive mental imagery computerized training module to treatment for patients in inpatient mental health settings, with a focus on increasing positive affect and reducing anhedonia. The positive mental imagery training (PMIT) is added to treatment as usual (TAU) in the inpatient setting, and compared to TAU alone, or TAU plus an alternative cognitive training module not hypothesized to increase positive affect, cognitive control training (CCT). METHODS: The study is a feasibility randomized controlled trial with three parallel arms. Up to 90 patients admitted to inpatient mental health treatment clinics in Germany will be randomized to PMIT + TAU, CCT + TAU, or TAU on a 1:1:1 ratio. PMIT or CCT consist of an introductory session followed by up to 8 full training sessions over 2 weeks. All three arms (including TAU) include regular completion of mood measures over the 2-week period. Outcome measures are completed pre and post this 2-week training/monitoring period, and at 2-week follow-up. Data will be presented in the form of both raw means and standardized effect sizes, with 95% confidence intervals, for both intention-to-treat and per-protocol samples. DISCUSSION: The study will inform feasibility of conducting a fully powered randomized controlled trial investigating the addition of the positive mental imagery training as a treatment adjunct to inpatient treatments for mental health, including potential refinement of study procedures, inclusion/exclusion criteria, and preliminary indications of the likely range of effect sizes. TRIAL REGISTRATION: clinicaltrials.gov, NCT02958228 (date registered: 4 November 2016).

Criminal behaviour and violent crimes in former inpatients with affective disorder.

BACKGROUND: Several studies have reported criminal and violent behaviour in people with schizophrenia but few have investigated the association between affective disorders and violent behaviour. METHODS: We reviewed the national crime register for records of criminal offences committed by 1561 patients with affective disorders treated between 1990 and 1995 in the Psychiatric Hospital of the University of Munich. The sample was divided into patients with bipolar I disorder, manic disorder and major depressive disorder. Sociodemographic and other risk factors for non-violent and violent criminal behaviour were analysed. RESULTS: Sixty-five (4.16%) patients had been convicted in the 7 to 12 years after discharge (307 cases). The rate of criminal behaviour and violent crimes was highest in the manic disorder group: 15.7% (14 of 89) were listed in the national crime register and 5.6% (5 of 89) were convicted of physical injury offences. Violence and criminality were comparatively rare in patients with major depressive disorder: only 1.42% (10 of 702) committed violent crimes. Male gender was a substantial risk factor for non-violent and especially violent behaviour: the rate of violent crimes was six times higher than in females. Marital status appeared to influence the prevalence of later delinquency: separated, divorced and widowed patients committed offences more frequently. A history of substance use problems before clinical treatment was reported by 21.2% (329 of 1561) of the sample. A wide range of different crimes were committed, with defalcation, theft and fraud being the most frequent. Twenty-one cases of physical assault and one case of later homicide were recorded. In contrast to other forensic studies, we did not find a significant effect of substance abuse on the risk of later delinquent behaviour. CONCLUSION: The frequency of criminal behaviour and violent crimes in individuals with affective disorder depends on much more than just the diagnosis. This study may stimulate further research to identify psychopathological predictors for future violent and criminal behaviour.

Influence of trait anxiety on inhibitory control in alcohol-dependent patients: simultaneous acquisition of ERPs and BOLD responses.

Alcohol-dependence is often associated with comorbid psychiatric symptoms. However, the results concerning the influence of these symptoms on cognitive functioning in alcoholism are still inconsistent. The aim of this study was to determine performance monitoring in healthy volunteers and alcohol-dependent patients, and to assess the influence of trait anxiety on these processes. Sixteen healthy volunteers and 16 detoxified alcohol-dependent patients completed an auditory go/nogo paradigm. Functional magnetic resonance imaging, event-related potentials and behavioral data were acquired simultaneously. The patients were classified by median split based on level of self-rated trait anxiety (state-trait anxiety inventory; STAI). The results showed no significant differences regarding inhibition-associated electrophysiological and behavioral responses between alcohol-dependent patients with high-trait anxiety scores and alcohol-addicts with low-STAI scores. However, the functional MRI data revealed elevated activations during the response inhibition task especially in the middle frontal gyrus (BA 6/9), the superior frontal gyrus (BA 6/8/9) and the right inferior frontal gyrus, as well as temporo-parietal brain regions in patients with high-trait anxiety compared to non-anxious alcohol-addicts. Patients and healthy controls showed comparable results with regard to neural and behavioral responses. These results suggest that inhibitory control capacities of alcohol-dependent patients are not consistent: alcohol-addicts with high-trait anxiety ratings showed elevated neural responses compared to patients without any comorbid psychiatric symptoms. This may indicate that comorbid psychiatric symptoms need to be considered when assessing brain responses in alcohol-dependent patients.

Influence of anxiety on electrophysiological correlates of response inhibition capacities in alcoholism.

Anxiety disorders are highly prevalent in patients with alcohol use disorder. The purpose of the present study was to examine the neural correlates of behavioral inhibition in alcohol-dependent patients (ICD-10: F 10.2), and in healthy controls and to determine the influence of anxiety on these processes. Therefore, behavioral responses (reaction times; error rates) and event-related potentials of 16 patients with alcohol dependence syndrome and 16 age-and gender-matched healthy controls were recorded while the participants performed an auditory go/no-go task. The patient group was stratified according to their self-rated trait anxiety (STAI) with scores above and below median. We hypothesized that patients suffering from alcohol dependence would show reduced no-go P3 amplitudes involved in response inhibition compared to healthy subjects. In patients with alcoholism and high trait anxiety the decline of no-go P3 amplitudes was expected to be less distinct. The estimation of effect size based on the reaction times of patients with high and low anxiety ratings revealed a cohen's d of 0.61 indicating a small effect. High trait anxiety ratings were also associated with slightly enhanced no-go P3 amplitudes in central brain regions (Mean no-go P3 amplitude at Cz: 10.43 microV) compared to patients with low anxiety scores (Mean 8.98 microV). The effect size (cohen's d) revealed a small effect. Using the Mann-Whitney-U-test for independent samples of the comparison of high- and low-anxious patients, however, did not reveal any significant differences concerning no-go P3 amplitudes. Patients with alcohol use disorder and healthy controls did not differ significantly with regard to reaction time, error rate and no-go P3 amplitudes. This study suggests that no-go P3 amplitudes in patients with alcohol use disorder might be affected to some degree by habitual anxiety. The results emphasize the importance of monitoring trait anxiety in studies regarding cognitive functions in subjects with alcohol use disorder.

Clinical correlates of later violence and criminal offences in schizophrenia.

BACKGROUND: Violence and criminality in patients with schizophrenia has been described in several studies but prediction of later criminal behavior is difficult. METHODS: We reviewed the national crime register for records of criminal offences committed by 1662 patients with schizophrenia treated between 1990 and 1995 in the Psychiatric Hospital of the University of Munich. Analyses were performed to determine predictors of later criminal behavior, and the psychopathological syndrome scales in the Association for Methodology and Documentation in Psychiatry (AMDP) system were used to establish possible psychopathological characteristics for such behavior. RESULTS: One hundred and sixty nine (10.2%) of the 1662 patients had been convicted in the 7-12 years after discharge, whereby male patients (117 of 685, 17.1%) outnumbered female patients ( 52 of 977, 5.3%) by more than 3 to 1. The rate of violent crimes was especially high: 62 (3.7%) patients were convicted for physical injury offences. Five cases of manslaughter or murder were recorded. AMDP syndrome scales were found to be predictive for later criminal offences. Significantly higher rates of criminal conviction and recidivism were found for patients with lack of insight at discharge. Analyses also showed a significantly higher risk of non-violent and violent crimes in patients with a hostility syndrome at admission and discharge. There was a significantly lower incidence of criminal behavior in subjects with a depressive syndrome. CONCLUSION: Data indicate a significant rate of minor and serious physical injury offences in former inpatients with schizophrenia. Moreover, results identify risk factors for future non-violent and violent criminal behavior in patients with schizophrenia.

[Psychiatric emergencies on ICU]. / Psychiatrische Erkrankungen auf der Intensivstation--Teil II--Psychiatrische Notfälle.

Psychiatric emergencies are catatonia, stupor, central serotonine syndrome, malignant neuroleptic syndrome, suicide risk and agitation. In this article some clinical features of the aforementioned and its therapy are summarized.