Bt te Wildt

Maladaptive connectivity of Broca’s area in schizophrenia during audiovisual speech perception: An fMRI study

Speech comprehension relies on auditory as well as visual information, and is enhanced in healthy subjects, when audiovisual (AV) information is present. Patients with schizophrenia have been reported to have problems regarding this AV integration process, but little is known about which underlying neural processes are altered. Functional magnetic resonance imaging was performed in 15 schizophrenia patients (SP) and 15 healthy controls (HC) to study functional connectivity of Brocas area by means of a beta series correlation method during perception of audiovisually presented bisyllabic German nouns, in which audio and video either matched or did not match. Brocas area of SP showed stronger connectivity with supplementary motor cortex for incongruent trials whereas HC connectivity was stronger for congruent trials. The right posterior superior temporal sulcus (RpSTS) area showed differences in connectivity for congruent and incongruent trials in HC in contrast to SP where the connectivity was similar for both conditions. These smaller differences in connectivity in SP suggest a less adaptive processing of audiovisually congruent and incongruent speech. The findings imply that AV integration problems in schizophrenia are associated with maladaptive connectivity of Brocas and RpSTS area in particular when confronted with incongruent stimuli. Results are discussed in light of recent AV speech perception models.

Internet- und Computerspielsucht

Das Kapitel gibt einen umfassenden Uberblick zum Konzept der Internet- und Computerspielsucht. Zunachst werden diagnostische Kriterien und Screening-Instrumente zur Diagnose in ihrer Entstehungsgeschichte vom Konzept der Internet Addiction nach Kimberley Young bis hin zur Aufnahme der Internet Gaming Disorder unter den „conditions for further study“ im DSM-5 vergleichend dargestellt. Es schliest sich ein Uberblick zur Epidemiologie von Internet- und Computerspielsucht an. Dieser zeigt, dass sich bislang die Pravalenzschatzungen zwischen 3 und 15 % bewegen und demnach eine hohe Bandbreite aufweisen. Abschliesend werden Befunde zur Komorbiditat und zu Risikokorrelaten einer Internet- und Computerspielsucht dargestellt. Zusammengefasst bleibt fur Internet- oder Computerspielabhangige neben einem hohen Leidensdruck auch eine hohe psychische Belastung festzustellen, welche sich auch in einem erhohten Auftreten komorbider Storungen im klinischen Kontext zeigt.

1986 – Depression, anxiety and the risk of permanent disability and mortality in the working population in germany: a cohort study

Background Absenteeism from work and inpatient treatment are well defined events in the course of any illness and may be indicators for the need of an intervention. The aim of this study was to estimate of the influence of these events on later permanent disability and death in a working population when caused by anxiety and/or depression. Methods Data of 128,001 members of a health insurance with a observation period of 6.4 years were used. Excess risks were calculated for patients suffering from anxiety, depression or both using Coxs proportional hazard models adjusted for age, gender, education and job classification. Results Patients who received outpatient treatment had higher rates of permanent disability (hazard ratio (HR) 1.48 (Confidence interval 1.30, 1.69) for depression, 1.25 (1.07, 1.45) for anxiety) but lower premature mortality (HR 0.80(0.62, 1.03), 0.53(0.38, 0.73)) than controls. Inpatient treatment and co-morbidity were associated with further raised rates of permanent disability. Depressed inpatients also had higher premature mortality (HR 2.50(1.80, 3.48)). Conclusions The study shows a dose-responsive relationship between depression, anxiety, comorbidity and need for hospital treatment. It was was unexpected that some exposures seem to reduce mortality risk. Life style may partly explain this effect. However, these patients are subject to many other exposures, into which more research is needed to get a better understanding of the phenomenon.

S30-03 - The nosological role of comorbidity in patients with internet and video-game addiction

Background and Objectives With the Cyberspaces exponential growth of influence questions arise about its mental impacts. The presented study examines the question whether the dependent use of the Internet can be understood as an impulse control disorder, an addiction or as a symptom of other psychiatric conditions. Methods Internet dependent patients seeking for psychiatric assistance and fulfilling the criteria for pathological Internet use (PIU) were examined with the Structured Clinical Interview according to DSM-IV (SCID), and a variety of questionnaires including the Barratt Impulsiveness Scale (BIS), the Beck Depression Inventory (BDI) and the Dissociative Experience Scale (DES). The patient group was compared to a matched group of healthy controls. Results The adult patient-group consisted of 25 subjects, 76% male, with a mean age of 29.36 years. Average time spent in Cyberspace was 6.47 h/d, mostly in online-role-playing games. According to SCID I and BDI, 19 patients (76%) suffered from a depressive syndrome, with 10 cases of major depressive disorder (40%) and 8 cases of adjustment disorder with depression (32%). Six patients (24%) suffered from a comorbid anxiety disorder. Compared to controls, the patient group presented significantly higher levels of depression (BDI), impulsivity (BIS) and dissociation (DES). Conclusions PIU shares common psychopathological features and comorbidities with substance related disorders. Therefore, it might be seen as a diagnostic entity in itself within a spectrum of behavioral and substance dependencies. Especially Internet role play may contain an addictive potential for adolescents and adults with subclinical psychopathology.

FC20-03 - Motives for khat use and abstinence in yemen - a gender perspective

Background Khat consumption is widespread in Yemeni society and causes problems both in economic development and public health. The gender-specific motives for khat use and abstinence were studied to create a toe-hold for more specific interventions. Methods In a sample with equal numbers of males, females, abstainers and consumers, 320 subjects were interviewed on their specific opinions about khat and its impact on subjective and public health, and on social and community functioning. Strata were compared in their acceptance and denial of opinions. Notions that could predict abstinence status or gender were identified with multivariate logistic regression analysis. Results Male khat users had a strong identification with khat use, while females were more ambivalent. The notion that khat consumption is a bad habit (odds ratio (OR) 3.4) and consumers are malnuorished (OR 2.2) were associated with female gender among khat users. Among the females worries about health impact (OR 3.2) and loss of esteem in the family (OR 3.1) when using khat predicted abstinence. Male abstainers opposed khat users in the belief that khat is the cause of social problems (OR 5.1). Conclusions Distinct beliefs allow a differentiation between males, females, khat users and abstainers when targeting preventive measures. In accordance to their specific values female khat users are most ambivalent towards their habit. Positive opinions scored lower than expected in the consumers. Public opinion towards khat may have become slightl more negative in recent years. This finding creates a strong toe-hold for gender-specific public health interventions.

FC25-03 - Detrimental effects of anxiety disorders on ability to work associated with a protective effect on mortality in the middle decades of life

Aims Most available data about psychiatric mortality and invalidity concerns inpatients, although the majority of patients are treated as outpatients only. It was the aim of this study to estimate the effect of anxiety disorders on early retirement and premature death in the working population with special emphasis on outpatients. Methods 125.019 workes between age 16 and 58 were followed for an average of 6.4 years. Excess risks of death and permanent disability were calculated with multivariate Cox regression models. Results Outpatient and inpatient treatment for anxiety disorders (OR 1.40 resp. OR 2.10) were associated with higher risks of early retirement. Males generally were more often affected by this bad outcome than females. Further analysis showed decreased risks of premature death for outpatients with an anxiety disorder (OR 0.33). The effect tended to be most prominent during the middle decades of life and got smaller with older age, at which all-cause mortality approximated that of the control group. No significant effect on mortality could be shown for inpatients. Conclusions Patients with outpatient treatment for anxiety disorders have an elevated risk of permanent disability early in life, while all-cause mortality is lower. This beneficial effect can only be partly explained by different risk-taking behaviors. Different causes of death early in life and their connections with these disorders need to be discussed, too. Treatment should have a strong focus on preserving ability to work.