G. Sachs

Cognitive and emotion recognition deficits in obsessive-compulsive disorder

Previous investigations have demonstrated impaired recognition of facial affect and cognitive dysfunction in several psychiatric disorders. The specificity of these deficits is still debated. The aim of this study was to investigate the deficits in emotion recognition and cognition in obsessive-compulsive disorder (OCD). Forty patients with OCD (DSM-IV, 16 women, 34.7+/-10.4 years) and 40 healthy volunteers (16 women, 34.7+/-8.7 years) were compared. All participants underwent a computerized neuropsychological test battery (Gur, R.C., Erwin, R.J., Gur, R.E., Zwil, A.S., Heimberg, C., Kraemer, H.C., 1992. Facial emotion discrimination II. Behavioral findings in depression. Psychiatry Research 42, 241-251; Gur, R.C., Ragland, J.D., Moberg, P.J., Turner, T.H., Bilker, W.B., Kohler, C., Siegel, S.J., Gur, R.E., 2001. Computerized neurocognitive scanning: I. Methodology and validation in healthy people. Neuropsychopharmacology 25, 766-776). A German version of the Penn Facial Emotion Acuity Test, the Facial Emotion Intensity Differentiation, including happy, sad and neutral faces, and the Facial Memory Test were administered. Executive functions were assessed by a computerized version of the Wisconsin Card Sorting Test and attention was evaluated using the Continuous Performance Test. OCD patients performed more poorly than healthy controls in facial memory tests (especially delayed), as well as in attention and executive functions. The only significant difference between the groups in emotion processing was poorer recognition of sad female faces in patients, who misperceived neutral faces as sad. The results point to memory and executive deficits in addition to a negative bias in emotion recognition in OCD patients.

EEG mapping in patients with social phobia

Recent studies have suggested an information-processing bias in social phobia (SP). Little is known about the electrophysiological correlates of anxiety in SP. The aim of the present study was to investigate the quantitative electroencephalogram (EEG) in 25 drug-free patients with SP as compared with age- and sex-matched normal controls and to correlate anxiety and depressive symptoms with EEG data. EEG was recorded under vigilance-controlled and resting conditions. The Spielberger State and Trait Anxiety Scale (STAI) and the Beck Depression Inventory (BDI) were administered to assess anxiety and depression levels. Multivariate analysis of variance revealed significant differences between patients and controls, specifically frontopolarly and right centrally. Statistical analysis demonstrated a decrease in absolute and relative delta, theta power, alpha-adjacent slow-beta and fast beta power and an increase in absolute and relative intermediate beta power, as well as an acceleration of the total centroid and a slowing in beta centroid and its variability. Trait anxiety and depression scores correlated positively with the dominant alpha frequency and the alpha centroid, and negatively with absolute theta and slow alpha power as well as with the centroid of the delta/theta frequency band. In conclusion, EEG mapping in patients with SP revealed significant differences from normal controls suggesting a hyperarousal as a pathogenetic factor of anxiety.

P300 event-related potentials and cognitive function in social phobia

The aim of the study was to investigate abnormalities of event-related potentials (ERPs) in social phobia patients indicating deficits in speed and amount of perceptual and cognitive resources as well as relationships between ERPs and cognitive functioning. ERPs were recorded from 19 EEG leads in a two-tone oddball paradigm in medication-free patients with DSM-IV social phobia (n=25) and in age- and sex-matched healthy controls (HC). Neuropsychological test performance was administered. Compared with the HC group, patients with social phobia showed reductions in N1 at temporal leads, N2 and P300 amplitudes, predominantly centroparietally, and longer P300 latencies. The observed P300 latency prolongation was associated with reduced Non-Verbal Learning Test (NVLT) but not the Wisconsin Card Sorting Test (WCST) scores. The reduction in N1 amplitude indicates an impairment in perceptual processing. The reduced P300 amplitudes may reflect reduced cognitive resources for the evaluation of relevant information. The increased P300 latency, indicating longer stimulus evaluation time, was correlated to deficits in learning processes as measured by the Non-Verbal Learning Test but not to executive function as measured by the Wisconsin Card Sorting Test. It may therefore be concluded that social phobia patients show deficits in cognitive information processing as reflected by ERPs.

No amygdala attenuation in schizophrenic patients treated with atypical antipsychotics.

Functional magnetic resonance (fMRI) imaging was used to measure amygdala activation in an emotional valence discrimination task in clinically stable patients with schizophrenia treated with atypical antipsychotics and healthy controls. No difference was detected between patients with schizophrenia and controls.

Obsessive Compulsive and Related Disorders: From the Biological Basis to a Rational Pharmacological Treatment

59 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com Commentary Obsessive Compulsive and Related Disorders: From the Biological Basis to a Rational Pharmacological Treatment

Older and Newer Strategies for the Pharmacological Management of Agitation in Patients with Bipolar Disorder or Schizophrenia

BACKGROUNDnThe management of acute agitation in patients with bipolar disorder or schizophrenia is a multifaceted and dynamic task, which presents unique and complex challenges to healthcare providers.nnnOBJECTIVEnTo ascertain and describe which medications are best to use in patients with agitation, affected by bipolar disorder or schizophrenia.nnnMETHODnSelective review of current literature and guidelines referred to the treatment of agitation in individuals affected with bipolar disorder or schizophrenia Results: When possible, the pharmacologic management of agitation should be preceded by a in-depth evaluation of the possible causes of the agitation. The use for of first and second-generation antipsychotic medications, of benzodiazepines and of the newer inhaled antipsychotic loxapine, is reviewed and commented.nnnCONCLUSIONnThe mainstay of medication treatment of acute agitation should be based on a thotough assessment cause. If agitation is due to delirium or to another physial condition, an attempt to address the underlying causes should be always considered. When agitation is primarily due to schizophrenia or bipolar disorder, antipsychotics and/or benzodiazepines are usually the mainstay of treatment. Newer inhaled formulation of loxapine has shown ability to rapidly reduce the agitation in mild to moderate patients with schizophrenia or bipolar disorder, with a decrease in agitation that was evident since the first assessment, 10 minutes after the first dose.

Gruppenpsychotherapie bei Panikstörung

Seit die Panikstorung im Diagnosticai and Statistical Manual of Mental Disorders (DSM-III) des Amerikanischen Psychiaterverbandes (APA 1980) definiert wurde, ist eine grose Zahl von pharmakotherapeutischen Studien erschienen. Dabei haben sich die alten trizyklischen und die neuen selektiv serotonergen Antidepressiva wie auch die Monoaminooxidase-Hemmkorper bei Anwendung uber 8 bis 12 Wochen als wirksam erwiesen; es kommt durch diese Medikamente zu einer deutlichen Reduktion der Panikattacken und der agoraphoben Symptomatik sowie der damit einhergehenden Behinderungen (Katschnig 1996). Auch aus dem psychotherapeutischen Bereich kamen nach und nach Studien, in denen belegt werden konnte, das bei Panikattacken zumindest kognitive Therapie auserst wirksam ist (Margraf et al. 1993). Bis heute gibt es nur wenige randomisierte Vergleichsstudien, die Pharmakotherapie und Psychotherapie miteinander vergleichen. In einer der am besten geplanten Untersuchungen, der von Clark und Mitarbeitern (1994), zeigte sich, das sowohl medikamentose als auch kognitive Therapie wirksam ist, nach Ende der Therapie kognitive Therapie jedoch einen persistierenderen Effekt als eine abgesetzte Pharmakotherapie aufweist.

Addiction: the Burden of Cyclothymic Temperament

Disorders of the bipolar spectrum (e.g. cyclothymic disorder) and subthreshold manifestations of mood disorders (such as temperamental traits) have been suggested to influence the course of psychiatric diseases. Cyclothymic temperament (as described by Kraepelin and as measured by Akiskals temperament scale, the TEMPS) has been suggested to be the most morbid and prodromal element in the pathogenic chain of personal disposition to behavioural and emotional problems. We studied the effects of affective temperaments on psychoactive substance use, on alcohol dependence and opioid dependence. In particular, we wanted to test the hypothesis whether cyclothymic temperament mediates a deleterious effect. 1380 inhabitants of residential student homes in Austria, 116 alcohol dependent patients at the Medical University of Vienna and 101 opioid dependent patients at the Oum El Nour rehabilitation center in Lebanon were investigated. Temperament was assessed using the briefTEMPS-M auto-questionnaire. In opioid dependence, subtypes were assessed according to the LAT interview (www.lat-online.at). In the college student group, cyclothymic (and irritable) temperament serves as predictor of self-reported nicotine dependence, alcohol abuse and cannabis use. In alcohol dependent patients, cyclothymic temperament influenced the age of onset of alcohol abuse and the age of onset of alcohol dependence. In the opioid dependence group, patients exhibiting symptoms of severe negative childhood development according to the LAT interview (e.g. prenatal trauma, cerebral trauma before the age of 14) showed the highest percentage of cyclothymic temperament. Our data show that cyclothymic temperament as measured by the briefTEMPS-M is an important negative pathoplastic factor for substance-related addictive disorders.

EPA-1288 - Training of affect recognition in schizophrenia

Social cognitive deficits are an important target in the treatment of patients with schizophrenia (1). The objectives of long-term treatment are not only to prevent relapse and reach remission but also to improve psychosocial functioning and working performance. Atypical antipsychotic agents have been linked to a certain positive effect on cognition. We used functional magnetic resonance imaging (fMRI) to evaluate the effects of psychotropic drugs on social cognition. The findings indicated a similar activation pattern in patients with schizophrenia and healthy controls (3). In addition to treatment with psychopharmacological agents, neuropsychological rehabilitation programmes can further improve cognitive function and functional outcome. In a randomised study, we investigated the effects of atypical antipsychotic agents in combination with computer-based training on social recognition. Methods Schizophrenic patients (n=20) receiving treatment with new antipsychotics in combination with a six-week training on affect recognition (TAR) were compared with a randomized control group (n=18) receiving pharmacological treatment with new antipsychotics in combination with occupational therapy (TAU). Effects on social cognition were tested with the Vienna Emotion Recognition Task (VERT-K). In addition, we investigated neurocognitive performance using the Wisconsin Card Sorting Test (WCST), TAP Alertness, Vigilance and working memory, negative symptoms using PANNS, depression using Beck‘s Depression Scale (BDI) and Quality of Life (WHOQOL-Bref). Results In comparison to the TAU group, the TAR group achieved significant improvements in affect recognition in general as well as in recognizing sad faces. While the TAR group showed improved Quality of Life and Negative Symptoms, both groups were able to enhance some aspects of neurocognitive performance. Discussion A six-week training on affect recognition (TAR) contributes to improvements in some aspects of cognitive and emotional performance with additional positive effects on functional outcome. The training group achieved improvements in social relationships, an important domain of quality of life (2).

P02-332 - Neurocognitive predictors of functional outcome in patients with bipolar disorder

Introduction Neurocognitive deficits are known as a core feature in bipolar disorder (BPD). Persisting neurocognitive impairment is associated with low self-reported quality of life and low psychosocial functioning. Current findings indicate the importance of adjunctive psychosocial interventions in the treatment of BPD patients to enhance symptomatic and functional outcome. Objectives To assess whether functional outcome in patients with BPD is affected by cognitive psychoeducational therapy, clinical parameters and cognitive impairment. Aims To identify potential predictors of functional outcome, global clinical impression and early recurrence in patients with BPD. Methods Using a neurocognitive test battery 43 patients with BPD in euthymic state were compared to 40 healthy controls. Patients were assigned to two treatment Conditions cognitive psychoeducational therapy over 14 weeks (nxa0=xa019, 12 female, age) and treatment-as-usual (nxa0=xa024, 14 female). Predictors for functional disability, global clinical impression and early recurrence including clinical and cognitive variables as well as treatment conditions were examined using logistic regression. Results Compared to healthy controls patients with BPD showed lower performance in executive function (pxa0 Conclusions Patients with BPD seem to benefit from cognitive psychoeducational training mainly in areas of working life. The extent of cognitive impairment appears to impact clinical outcome and recurrence rate.