45 years German Society of Biological Psychiatry (DGBP).

The foundation of a German Society of Biological Psychiatry (DGBP) was initiated at the Second World Congress of Biological Psychiatry of the WFSBP in Barcelona in 1978. Its mission was and is to promote interdisciplinary research on the biology of mental disorders and to translate results of biological research into clinical practice. During the presidency of Peter Falkai, its tasks were defined to improve the quality and support of biologically oriented research in Germany by the DFG (Deutsche Forschungsgemeinschaft; German Research Foundation), BMBF (Bundesministerium für Bildung und Forschung) and EU (European Union), to promote young researchers doing biologically oriented research, to improve on the diagnosis and therapy of mental disorders and to advise policy makers by taking part in legal processes. The DGBP has been a corporate member of the WFSBP from its beginning, became a cooperative member of the DGPPN (Deutsche Gesellschaft für Psychiatrie und Psychotherapie, Psychosomatik und Nervenheilkunde), later of the German Brain Council, and fostered relationships with other scientific societies. Over the past 45 years, more than twenty congresses were held in Germany and neighboring countries. Emerging from the pandemic, the DGBP is ready to continue its mission to promote interdisciplinary research on the biology of mental disorders with a focus on the development of young scientists and to translate results of biological research into clinical practice, with regard to pharmacotherapy in close cooperation with the Arbeitsgemeinschaft Neuropsychopharmakologie und Pharmakopsychiatrie (AGNP). In this sense, this article also aims to stimulate the cooperation of the society with other national and international partners and to foster new relationships with young scientists and professionals interested in the aims and goals of the DGBP.

Assessment of Psychosocial Functioning in a Large Cohort of Patients with Schizophrenia.

BACKGROUND: This study addresses the question of whether psychosocial functioning measured by the Personal and Social Performance (PSP) Scale is related to various psychopathological measures in a cohort of patients with schizophrenia. METHODS: The 'Neuroleptic Strategy Study' (NeSSy) performed at 14 German hospitals between 2010 and 2013 compared two treatment strategies instead of individual drugs. Secondary end-points were the two PSP scales as well as measures of quality of life (SF-36) and the Positive and Negative Syndrome Scale (PANSS). RESULTS: 149 patients were randomised. There was no difference between the two treatment strategies (first-generation versus second-generation antipsychotics) with regard to the PSP. There were differences in doctors' assessments regarding psychosocial functioning compared with patients' own assessments. Furthermore, there were relationships between the PSP and quality of life, level of skills (ICF), and severity of disease (PANSS), level of sexual activities and poor well-being under antipsychotic medication but not with cognitive changes. CONCLUSIONS: The findings on psychosocial functioning of patients with schizophrenia related to severity and skill level could be confirmed. Further findings were the correlation between psychosocial functioning and quality of life, well-being under treatment, and sexuality what emphasizes the substantial importance of a reduced psychosocial functioning.

Cognitive and emotional empathy in individuals at clinical high risk of psychosis.

BACKGROUND: Impairments of social cognition are considered core features of schizophrenia and are established predictors of social functioning. However, affective aspects of social cognition including empathy have far less been studied than its cognitive dimensions. The role of empathy in the development of schizophrenia remains largely elusive. METHODS: Emotional and cognitive empathy were investigated in large sample of 120 individuals at Clinical High Risk of Psychosis (CHR-P) and compared with 50 patients with schizophrenia and 50 healthy controls. A behavioral empathy assessment, the Multifaceted Empathy Test, was implemented, and associations of empathy with cognition, social functioning, and symptoms were determined. RESULTS: Our findings demonstrated significant reductions of emotional empathy in individuals at CHR-P, while cognitive empathy appeared intact. Only individuals with schizophrenia showed significantly reduced scores of cognitive empathy compared to healthy controls and individuals at CHR-P. Individuals at CHR-P were characterized by significantly lower scores of emotional empathy and unspecific arousal for both positive and negative affective valences compared to matched healthy controls and patients with schizophrenia. Results also indicated a correlation of lower scores of emotional empathy and arousal with higher scores of prodromal symptoms. CONCLUSION: Findings suggest that the tendency to 'feel with' an interaction partner is reduced in individuals at CHR-P. Altered emotional reactivity may represent an additional, early vulnerability marker, even if cognitive mentalizing is grossly unimpaired in the prodromal stage. Different mechanisms might contribute to reductions of cognitive and emotional empathy in different stages of non-affective psychotic disorders and should be further explored.

[Oxytocin in schizophrenia : Evidence for an etiological and therapeutic relevance of the social neuromodulator]. / Oxytocin bei Schizophrenie : Evidenz für eine ätiologische und therapeutische Relevanz des sozialen Neuromodulators.

Neurobiological results from animal models as well as biochemical and genetic findings in patients indicate that the oxytocin (OT) system may be dysfunctional in schizophrenia. On this pathogenetic basis transnasally administered OT (tnOT) could be an innovative treatment option for schizophrenia. Experimental data from animal studies are also suggestive of a particular effectiveness in treatment-resistant schizophrenia. To date, clinical data on tnOT treatment of schizophrenia patients does not unequivocally support a general therapeutic effect on the psychopathology but suggests positive effects on higher integrated social cognitive performance, such as empathy and mentalization. In particular, tnOT augmentation of a social cognitive skills training resulted in a marked and lasting treatment effect; however, numerous person- and context-dependent variables can potentially moderate individual effects of OT and may even reverse effects in certain constellations. Most clinical studies so far have not systematically accounted and controlled for these factors with the probable result of larger variance of recorded treatment effects and lower likelihood of ascertaining positive effectiveness. Furthermore, there is still a gap of knowledge on dose response relations and central nervous system (CNS) permeation in man following tnOT administration. This review aims to give a concise overview on the evidence for the etiological relevance of the neurohormone OT and its treatment potential in schizophrenia.

Requirements for the implementation of open door policies in acute psychiatry from a mental health professionals' and patients' view: a qualitative interview study.

BACKGROUND: Treating legally committed patients on open, instead of locked wards is controversially discussed and the affected stakeholders (patients, mental health professionals) have ambiguous views on the benefits and disadvantages. The study aims to assess the opinions and values of relevant stakeholders with regard to the requirements for implementing open wards in psychiatric hospitals. METHODS: Semi-structured interviews were conducted with 15 psychiatrists, 15 psychiatric nurses and 15 patients, and were analyzed using qualitative content analysis. RESULTS: The interviewees identified conceptual, personnel and spatial requirements necessary for an open door policy. Observation and door watch concepts are judged to be essential for open wards, and patients appreciate the therapeutic value they hold. However, nurses find the door watch problematic. All groups suggest seclusion or small locked divisions as a possible way of handling agitated patients. All stakeholders agree that such concepts can only succeed if sufficient, qualified staff is available. They also agree that freedom of movement is a key element in the management of acutely ill patients, which can be achieved with an open door policy. Finally, the interviewees suggested removing the door from direct view to prevent absconding. CONCLUSIONS: For psychiatric institutions seeking to implement (partially) open wards, the present results may have high practical relevance. The stakeholders' suggestions also illustrate that fundamental clinical changes depend on resource investments which - at least at a certain point - might not be feasible for individual psychiatric institutions but presumably require initiatives on the level of mental health care providers or policy makers.

[The Indian Ayurveda medicine-a meaningful supplement to psychiatric treatment?] / Indische Ayurveda-Medizin ­ eine sinnvolle Ergänzung psychiatrischer Behandlung?

Ayurveda is a traditional Indian system of medicine that is more than 3000 years old, consisting mostly of a specific diet, oily infusions mainly in the area of the head, enemas, medicinal plants and yoga. It is based on a naturopathic and anthropological belief in association with the hinduistic religion. Ayurveda has been practiced very successfully in India but so far it has only been insufficiently appreciated by western medicine, especially psychiatry. An exception is Scharfetter from Zürich who wrote a review article on this topic in 1976. Nevertheless, it is probable that particularly the immunological mechanisms of psychotic and affective disorders can be influenced by the application of ayurvedic methods; however, the empirical data source, particularly with respect to randomized controlled trials and meta-analyses regarding psychiatric disorder symptoms is limited. Even if Ayurveda is applied in a highly individualized manner, this should be rapidly improved for further evidential assessment. First positive experiences in the neuropsychiatric field in Germany are already available.

[Homeopathy for psychiatric patients-for and against]. / Homöopathie bei psychiatrischen Patienten ­ Für und Wider.

The application of homeopathic treatment quickly becomes a matter of ideological confrontation; however, homeopathy is steadily gaining in sympathy in the population. Although the possible effectiveness and the modes of action are currently not scientifically elucidated and the study situation regarding homeopathic treatment in psychiatry is still manageable, there is a whole series of positive evidence for the effects of homeopathic remedies for mental disorders, such as depression, anxiety disorders and addiction. The most important studies are presented and the most important arguments are weighed up with respect to the pros and cons. It is clear that homoeopathic remedies can only be used as an add-on and not alone. These remedies belong in the hands of physicians experienced in homeopathic and psychiatric psychopharmacology. It would be advisable to at least try out homeopathy for the well-being of the patient not only in the case of very mild disorders but also in severe chronic cases, since due to the generally good tolerability, no avoidable disadvantage should result.

[Psychotherapy for people with bipolar disorders : An overview of evidence-based procedures and new developments]. / Psychotherapie für Menschen mit bipolaren Störungen : Übersicht über evidenzbasierte Verfahren und neuere Entwicklungen.

Many individual studies and meta-analyses have shown that psychotherapeutic interventions for people with bipolar disorders can positively influence the course of the disease. This article gives an overview of the development of psychotherapy for people with bipolar disorders. According to the current guidelines the evidence-based procedures with their mechanisms of action are presented and new developments in psychotherapy research in this field are outlined.

Preventing involuntary admissions: special needs for distinct patient groups.

BACKGROUND: Coercive measures in psychiatry are a controversial topic and raise ethical, legal and clinical issues. Involuntary admission of patients is a long-lasting problem and indicates a problematic pathway to care situations within the community, largely because personal freedom is fundamentally covered by the UN declaration of human rights and the German constitution. METHODS: In this study, a survey on a large and comprehensive population of psychiatric in-patients in the eastern part of North Rhine-Westphalia, Germany, was carried out for the years 2004-2009, including 230.678 treatment cases. The data were collected from the dataset transferred to health insurance automatically, which, since 2004 is available in an electronic form. In addition, a wide variety of information on treatment, sociodemographic and illness-related factors were collected and analysed. Data were collected retrospectively and analyses were calculated using statistical software (IBM SPSS Statistics 19.0®). Quantitative data are presented as mean and standard deviation. Due to the unequal group sizes, group differences were calculated by means of Chi-square tests or independent sample t tests. A Bonferroni correction was applied to control for multiple comparisons. RESULTS: We found an over-representation of involuntary admissions in young men (<21 years) suffering from schizophrenia and in female patients aged over 60 with a diagnosis of dementia. Most of our results are concordant with the previous literature. Also admission in hours out of regular out-patient services elevated the risk. CONCLUSION: The main conclusion from these findings is a need for a fortification of ambulatory treatment offers, e.g. sociopsychiatric services or ward round at home for early diagnosis and intervention. Further prospective studyies are needed.

[Dermatological diseases and their importance for psychiatry]. / Dermatologische Erkrankungen und ihre Bedeutung für die Psychiatrie.

The relationship between skin and psychiatric disorders is not an uncommon occurrence in the clinical practice; however, there are only a few systematic studies and in addition knowledge about the neurobiological and immunological mechanisms is lacking. Impairments and disorders of the skin are often an (early) sign of a psychiatric disorder. In the sense of true psychosomatics, psychiatrists should also be aware of this relationship as far as possible. This review article focuses on the most important dermatological diagnoses in relation to the respective psychiatric comorbidities and presents the most important aspects of epidemiology, symptomatology, pathophysiology and treatment options.

[Establishing ward-independent, intensive treatment concept in a psychiatric hospital : A model project within the new German remuneration system]. / Implementierung stationsungebundener Leistungen in der Psychiatrie : Modellvorhaben zum neuen Entgeltsystem.

Model projects according to § 64b of the Social Code V in the context of the new remuneration system in psychiatry and psychosomatics, offer great possibilities to improve the treatment of people with mental illnesses. This article presents the model project of the University Hospital Bochum, which is essentially characterized by improved transition through the internal hospital sections so that patients can be quickly transferred from inpatient and daycare sections to high frequency outpatient sections with ward-independent therapies (SUL), including outreach home treatment. The SUL is also intended to facilitate preadmission crises, to significantly reduce duration of inpatient treatment and to maximize post-inpatient continuity of treatment.

[Social psychiatry and neurobiology : A long overdue convergence exemplified by schizophrenia]. / Sozialpsychiatrie und Neurobiologie : Eine längst fällige Annäherung am Beispiel der Schizophrenie.

BACKGROUND: The proliferation of biological psychiatry has greatly increased over the last two decades. With the possibility to carry out brain research using modern technical methods, it seemed that social influencing factors would lose importance in the development of mental diseases; however, in actual fact this does not seem to be justified. It is necessary to overcome this separation, in that social factors are incorporated into a conceptual framework in the development of mental diseases, which simultaneously also takes the results of current neurobiological research into consideration. OBJECTIVES AND METHODS: The aims of this review article are to summarize the current state of sociopsychiatric research and to emphasize the perspectives of the biological principles and their validity with respect to the social dimensions of psychiatry, as exemplified by schizophrenic disorders. The article presents the options for a biosocial approach in social psychiatry and gives an overview of the currently available literature. RESULTS AND CONCLUSION: There is an abundance of neurobiological research approaches, which are closely associated with sociopsychiatric topics, such as social cognition. Social psychiatry and biological psychiatry should no longer be considered as diametrically opposed subdisciplines. On the contrary, the options which could emerge from a synthesis must be used in research and clinical practice.

[Stigma of mental illness among students]. / Stigmatisierung psychischer Erkrankung unter Schülern.

BACKGROUND: Social stigma connected to mental illness is a societal problem for which we lack data, especially among children and teenagers. OBJECTIVES: The purpose of this study was to assess how adolescents stigmatize mental illness in peers and to investigate if stigmatizing attitudes differed as a function of other variables (e. g. age, gender, level of education). MATERIALS AND METHODS: A German translation of the Revised Attribution Questionnaire (r-AQ), a nine-item survey, was administered to 246 pupils between 14 and 16 years of age, who were recruited from seven German schools. RESULTS: The pupils investigated in the study scored in the non-stigmatizing range of the questionnaire. Demographic factors did not have a significant effect on their stigmatizing attitude. CONCLUSIONS: The low stigmatizing tendencies can be explained by existing contact with the mentally ill or by possible effects of recruitment. Future research should take knowledge about mental illness as a possible factor influencing stigmatizing attitudes into account.

Evaluation of the 'Jumping to conclusions' bias in different subgroups of the at-risk mental state: from cognitive basic symptoms to UHR criteria.

BACKGROUND: Patients with psychosis display the so-called 'Jumping to Conclusions' bias (JTC) - a tendency for hasty decision-making in probabilistic reasoning tasks. So far, only a few studies have evaluated the JTC bias in 'at-risk mental state' (ARMS) patients, specifically in ARMS samples fulfilling 'ultra-high risk' (UHR) criteria, thus not allowing for comparisons between different ARMS subgroups. METHOD: In the framework of the PREVENT (secondary prevention of schizophrenia) study, a JTC task was applied to 188 patients either fulfilling UHR criteria or presenting with cognitive basic symptoms (BS). Similar data were available for 30 healthy control participants matched for age, gender, education and premorbid verbal intelligence. ARMS patients were identified by the Structured Interview for Prodromal Symptoms (SIPS) and the Schizophrenia Proneness Instrument - Adult Version (SPI-A). RESULTS: The mean number of draws to decision (DTD) significantly differed between ARM -subgroups: UHR patients made significantly less draws to make a decision than ARMS patients with only cognitive BS. Furthermore, UHR patients tended to fulfil behavioural criteria for JTC more often than BS patients. In a secondary analysis, ARMS patients were much hastier in their decision-making than controls. In patients, DTD was moderately associated with positive and negative symptoms as well as disorganization and excitement. CONCLUSIONS: Our data indicate an enhanced JTC bias in the UHR group compared to ARMS patients with only cognitive BS. This underscores the importance of reasoning deficits within cognitive theories of the developing psychosis. Interactions with the liability to psychotic transitions and therapeutic interventions should be unravelled in longitudinal studies.

Editorial to Child and Adolescence Psychopharmacology.

The editors of Pharmacopsychiatry have decided in 2016 to prepare special issues regularly in order provide our readers volumes of the journal with a thematic focus 1. The first such special issue is dedicated to the field of child and adolescent psychopharmacology. Many young patients are treated with psychotherapeutic, but also pharmacotherapeutic, methods worldwide. Most of our psychopharmacological agents are not approved by the federal institutions for persons under 18 years old. However, severe mental illnesses like schizophrenia, depression, anxiety, ADHD, and bipolar disorder frequently require pharmacological treatments in children and adolescents. We also see a wide range of rather unspecific emotional and behavioral disturbances up to excitation crises or suicidal acts in this young population, so that we see the necessity for standardized and valid psychopharmacological treatment regimens based on meta-analyses, randomized controlled trials, and guidelines 2. Child and adolescent psychiatry is unfortunately far away from this; industry-supported research is rare in this area, but also not all child and adolescent psychiatrists see the importance of psychopharmacological treatment and trust specific psychotherapy, psychoeducation, and educational strategies. These are all extremely important treatments, but one can/should think that psychopharmacotherapy is an important addition and often a cornerstone for the other treatments.

[Skin Diseases in Primary Psychiatric Disorders]. / Erkrankungen der Haut bei primär psychischen Störungen.

Somatic diseases in psychiatric disorders are frequently seen in clinical practice. Several international studies have shown that patients with a primary psychiatric disorder are at increased risk for developing severe somatic comorbidities in comparison to the normal population. Whereas there has been accumulation of knowledge on cardiovascular comorbidities, the relationship between skin and psychiatric disorders is less understood. There are only a few systematic studies on this subject and, in addition, there is lack of knowledge about underlying neurobiological and immunological mechanisms. Impairments and disorders of the skin are often an (early) sign of a psychiatric disorder. Somatic treatment of skin diseases should be initiated as early as possible in patients with psychiatric disorders. This review article focuses on dermatological diagnoses that are related to primary psychiatric disorders such as psychotic and affective disorders as well as addiction disorders, and presents the most important aspects of epidemiology, symptomatology and possible pathophysiology.

Does lithium reduce acute suicidal ideation and behavior? A protocol for a randomized, placebo-controlled multicenter trial of lithium plus Treatment As Usual (TAU) in patients with suicidal major depressive episode.

BACKGROUND: Lithium has proven suicide preventing effects in the long-term treatment of patients with affective disorders. Clinical evidence from case reports indicate that this effect may occur early on at the beginning of lithium treatment. The impact of lithium treatment on acute suicidal thoughts and/or behavior has not been systematically studied in a controlled trial. The primary objective of this confirmatory study is to determine the association between lithium therapy and acute suicidal ideation and/or suicidal behavior in inpatients with a major depressive episode (MDE, unipolar and bipolar disorder according to DSM IV criteria). The specific aim is to test the hypothesis that lithium plus treatment as usual (TAU), compared to placebo plus TAU, results in a significantly greater decrease in suicidal ideation and/or behavior over 5 weeks in inpatients with MDE. METHODS/DESIGN: We initiated a randomized, placebo-controlled multicenter trial. Patients with the diagnosis of a moderate to severe depressive episode and suicidal thoughts and/or suicidal behavior measured with the Sheehan-Suicidality-Tracking Scale (S-STS) will be randomly allocated to add lithium or placebo to their treatment as usual. Change in the clinician administered S-STS from the initial to the final visit will be the primary outcome. DISCUSSION: There is an urgent need to identify treatments that will acutely decrease suicidal ideation and/or suicidal behavior. The results of this study will demonstrate whether lithium reduces suicidal ideation and behavior within the first 5 weeks of treatment. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT02039479.

[Acute agitation conditions]. / Erregungszustände.

Acute agitation psychiatric emergencies as frequently occur in psychiatric as well as in non-psychiatric settings, such as general hospitals, specialized clinics, emergency services and private practices. Psychiatric emergencies can be life-threatening and necessitate immediate treatment. This article presents the core symptomatology, differential diagnoses and treatment options of acute agitation emergencies. Case control studies and reliable data regarding prevalence and treatment of acute agitation in psychiatric and general hospitals or private practices are sparse. Existing evidence suggests that optimization of diagnosis and therapy of psychiatric emergencies, such as acute agitation is warranted. Treatment of acute agitation, psychological distress and other psychiatric emergencies are highly demanding regarding psychiatric expertise and concerning the personality and behavior of the therapist. The basis of therapy comprises the ability to form a stable and trustworthy relationship with the patient as well as to patiently calm down agitated patients. Unambiguous and rapid decision-making that takes effective pharmacological treatment options into account usually leads to swift amelioration of the acute symptomatology.

[Computer-assisted treatment pathway for schizophrenia. Development and initial experiences]. / EDV-gestützter Behandlungspfad für Schizophrenie. Pfadentwicklung und erste Erfahrungen.

Standardization in psychiatry is a developmental process which, following on from psychopathology and nosology is now increasingly affecting the field of treatment. The development of guidelines for the treatment of psychiatric diseases has now become well accepted, although the impact on routine practice is still limited. Treatment pathways bring recommendations from guidelines into a clear and practice-oriented algorithm. The prerequisite for this is the inclusion of all aspects and elements of the treatment as well as all professions involved in the treatment and a valid electronic data processing foundation. Such an approach is presented here with the example of the development and implementation of a clinical pathway for inpatients with schizophrenia. Initial results revealed that patients who received multi-professional treatment within such a clinical pathway, improved better than patients of the control group, as measured by CGI, PANSS and PSP. This shows that introduction of a clinical pathway leads to an improvement of treatment quality. Standardization of psychiatric treatment processes could be highly relevant in respect to the new remuneration system for psychiatry in Germany.