Hannah Heimann

A preliminary study of increased amygdala activation to positive affective stimuli in mania

OBJECTIVES The present study in hypomanic and manic patients explored how amygdala responses to affective stimuli depend on the valence of the stimuli presented. METHODS We compared 10 patients with 10 matched healthy control subjects. We measured blood oxygen level-dependent (BOLD) responses in the amygdala while subjects passively viewed photographs taken from the International Affective Picture System. After the fMRI session, subjects saw the pictures again and subjectively rated the emotional valence and intensity of each picture. RESULTS Compared to healthy individuals, hypomanic or manic patients showed higher valence ratings in positive pictures and associated larger BOLD responses in the left amygdala during positive versus neutral picture viewing. This enhanced amygdala activation was correlated with Young Mania Rating Scale scores and with euphoric as opposed to irritable symptom presentation. CONCLUSIONS Increased valence ratings and amygdala responses to positive affective stimuli may reflect a positive processing bias contributing to elevated mood states characteristic for euphoric mania.

Cognitive neuroenhancement: false assumptions in the ethical debate.

The present work critically examines two assumptions frequently stated by supporters of cognitive neuroenhancement. The first, explicitly methodological, assumption is the supposition of effective and side effect-free neuroenhancers. However, there is an evidence-based concern that the most promising drugs currently used for cognitive enhancement can be addictive. Furthermore, this work describes why the neuronal correlates of key cognitive concepts, such as learning and memory, are so deeply connected with mechanisms implicated in the development and maintenance of addictive behaviour so that modification of these systems may inevitably run the risk of addiction to the enhancing drugs. Such a potential risk of addiction could only be falsified by in-depth empirical research. The second, implicit, assumption is that research on neuroenhancement does not pose a serious moral problem. However, the potential for addiction, along with arguments related to research ethics and the potential social impact of neuroenhancement, could invalidate this assumption. It is suggested that ethical evaluation needs to consider the empirical data as well as the question of whether and how such empirical knowledge can be obtained.

Efficacy and safety of levetiracetam for outpatient alcohol detoxification.

INTRODUCTION Anticonvulsant drugs are increasingly being used for alcohol detoxification in in- and outpatient settings. The aim of this study was to examine the efficacy, medical safety and mid-term outcome of levetiracetam, a drug with no marked liver toxicity, for outpatient alcohol detoxification. METHODS This was an open-label observational study. After screening eligibility for outpatient alcohol detoxification, patients were seen daily for 5 days and received levetiracetam in a flexible dosage regime between 500 and 4 000 mg/d for a maximum of 7 days. Diazepam was used as a rescue medication. The severity of alcohol withdrawal was evaluated daily using the ALCOHOL WITHDRAWAL SYNDROME SCALE (AWSS). Mid-term treatment outcome was assessed at a 6-month follow-up. RESULTS A total number of 131 consecutively admitted alcohol-dependent patients received an outpatient detoxification treatment, 122 (93.1%) completed the programme successfully. The mean initial dose of levetiracetam was 1 850 mg/d. Alcohol withdrawal syndrome as indicated by the AWSS score decreased clearly over 5 days. Overall, the medication was well tolerated. There was no treatment discontinuations due to side effects of levetiracetam. No serious medical complications, especially seizures or deliria, were observed during the detoxification. At the 6-month follow-up, 57 patients (43.5%) were still abstinent. Patients with previous detoxifications had a significant higher risk for relapse (HR=1.88; p=0.016; CI 95%: 1.12-3.14) than patients without previous treatments. DISCUSSION The findings of this study provide some evidence that levetiracetam is an efficacious and safe treatment option for outpatient alcohol detoxification. Further randomised, controlled trials including mid- and long-term follow-ups are needed to confirm these findings.

Social characteristics of psychological distress in disadvantaged areas of Berlin

Purpose: Living in disadvantaged urban areas is associated with poor mental health. The purpose of this study was to assess which social characteristics were associated with psychological distress within a disadvantaged, multi-ethnic neighbourhood of Berlin. Methods: The study was conducted in an area of Berlin with the highest rates of unemployment and highest density of migrants. A total of 143 participants aged 18–57 years were included from a random sample. The social characteristics educational level, employment status, marital status, living alone, per-capita income and background of migration were collected. Psychological distress was assessed using the General Health Questionnaire GHQ-28; scores ≥ 5 indicated psychological distress corresponding to psychiatric caseness. Results: Psychological distress was found in 40.6% (n = 58) of the sample. Psychological distress was associated with younger age (OR = 0.95, 95% CI = 0.92–0.98, p = .004), female gender (OR = 3.51, 95% CI = 1.55–7.92, p = .003) and living alone (OR = 3.88, 95% CI = 1.58–9.52, p = .003), but not with background of migration, low educational level or with unemployment. Conclusions: Young age and female gender may predispose for psychological distress in disadvantaged areas. Living alone could be a social indicator of poor mental health within disadvantaged urban areas. The directionality of the association is unclear. Background of migration, low income and educational level do not seem to be associated with poor mental health within those areas.

Random Sampling for a Mental Health Survey in a Deprived Multi-Ethnic Area of Berlin

The aim of the study was to assess the response to random sampling for a mental health survey in a deprived multi-ethnic area of Berlin, Germany, with a large Turkish-speaking population. A random list from the registration office with 1,000 persons stratified by age and gender was retrieved from the population registry and these persons were contacted using a three-stage design including written information, telephone calls and personal contact at home. A female bilingual interviewer contacted persons with Turkish names. Of the persons on the list, 202 were not living in the area, one was deceased, 502 did not respond. Of the 295 responders, 152 explicitly refused (51.5%) to participate. We retained a sample of 143 participants (48.5%) representing the rate of multi-ethnicity in the area (52.1% migrants in the sample vs. 53.5% in the population). Turkish migrants were over-represented (28.9% in the sample vs. 18.6% in the population). Polish migrants (2.1 vs. 5.3% in the population) and persons from the former Yugoslavia (1.4 vs. 4.8% in the population) were under-represented. Bilingual contact procedures can improve the response rates of the most common migrant populations to random sampling if migrants of the same origin gate the contact. High non-contact and non-response rates for migrant and non-migrant populations in deprived urban areas remain a challenge for obtaining representative random samples.

A combination of levetiracetam and tiapride for outpatient alcohol detoxification: a case series.

Objectives:Optimal pharmacotherapy of the alcohol withdrawal syndrome (AWS) in outpatient settings is still a matter of discussion. The aim of this evaluation was to examine the efficacy and tolerability of a combination of levetiracetam and tiapride for outpatient alcohol detoxification. Methods:This was an open-label evaluation. After screening eligibility for outpatient detoxification, 9 alcohol-dependent patients received levetiracetam and tiapride in a flexible dosage regimen up to 2500 and 300 mg/d, respectively, for a maximum of 7 days. Severity of alcohol withdrawal was assessed daily using the Alcohol Withdrawal Syndrome Scale (AWSS). Results:All patients completed the treatment successfully. The mean initial doses of levetiracetam and tiapride were 2166.7 and 300 mg/d, respectively. AWS as indicated by the AWSS score decreased clearly over 5 days. The combination of levetiracetam and tiapride was well tolerated. Neither treatment discontinuations because of side effects of the medication nor serious medical complications were observed during the detoxification. Conclusions:The results of this evaluation provide first evidence that the combination of levetiracetam and tiapride might be an effective and safe treatment option for mild to moderate AWS in outpatient settings. Further randomized controlled trials are warranted to confirm these preliminary results.

Pharmacoepidemiology of patients hospitalized for somatoform disorders in psychiatric hospitals and departments.

Pharmacological treatment is used in patients with somatoform disorders (SD) although the empirical evidence is scarce. We evaluated the current pharmacological treatment strategies used for psychiatric in‐patients diagnosed with SD in Central Europe.