[Religion and suicide - part 2: confessions, religiousness, secularisation and national suicide rates]. / Religion und Selbsttötung - teil 2 Konfessionen, Säkularisierung, Religiosität und die Nationalen Suizidraten.

OBJECTIVE: National suicide rates differ remarkably. The influence of religion on the frequency of suicides was already stressed by Durkheim, however, character and dimension of this influence are still unclear. Our study claims to assess the association between (a) the distribution of believers of different religions, (b) the secularization, (c) the religiousness and the national suicide rates by gender. METHOD: Data of the distribution of religious confessions and of the religiousness of the inhabitants of the single countries were correlated with the national suicide rates and illustrated by means of Scatter/Dot-Plots. RESULTS: Independent of gender, low suicide rates were found in Islamic countries. Buddhist countries showed high suicide rates in women, and countries with a high percentage of inhabitants without confession high suicide rates in men. Only catholic countries showed an association between secularisation and suicide rates. In countries with a high proportion of religious inhabitants we found low suicide rates. CONCLUSIONS: Although none of the World religions support the human right of suicide, the mosaic religions of resurrection refuse suicide more strictly than the Eastern religions of reincarnation. All in all our study supports the hypothesis that religiousness can be seen as a protective factor against suicide.

[Etiological illness concepts in patients suffering from schizophrenia from Austria and Pakistan with special consideration of the gender aspect]. / Krankheitsmodelle bei PatientInnen mit Schizophrenie in Pakistan und in Österreich unter besonderer Berücksichtigung von Genderaspekten.

OBJECTIVE: Etiological illness concepts of patients with schizophrenia are an important factor for the drug compliance as well as for a successful psychotherapeutic approach. These cognitive representations are influenced by issues like the illness, culture, gender, and age. The aim of this study was the elaboration of the interaction of these factors with special consideration of the gender aspect. METHOD: The notions about the reasons of illness were explored by means of a 41-item standardized self-rating instrument in 240 patients suffering from schizophrenia from Pakistan and Austria. RESULTS: Only in the scale "conflicts" the mean values for Austrian women were statistically significant higher than for their male counterparts. In Pakistani patients we found no significant differences, patients with an early age at onset of illness more frequently reported a magic-religious explanatory model in both cultures. Austrian patients with a longer duration of illness believed more often that the outbreak of the illness was caused by negligent behaviour. CONCLUSION: While gender has important effects on course and outcome of schizophrenia, the influence on etiological illness concepts is rather weak. Two reasons can be postulated: (a) The acquirement of knowledge about the development of mental disorders is culture-specific, but not gender-specific, (b) psychotic disorders are even out originally existing gender differences.

[Mental health beliefs between culture and subjective illness experience]. / Subjektive Krankheitsmodelle zwischen spezifischer Krankheitserfahrung und Kultur.

OBJECTIVE: Subjective health beliefs are representations about pathogenesis, course and treatment options of psychic as well as somatic illnesses. They are important for a psychotherapeutic interaction as well as for a stable drug adherence. However, it remains unclear whether these representations are primarily affected by the cultural background or by an individual's specific illness experiences, a question of increasing importance in our era of globalized migration. METHOD: The study sample consisted of 203 Austrians (125 with schizophrenia, 78 with obsessivecompulsive disorder) and 190 Pakistanis (120 with schizophrenia, 70 with obsessive-compulsive disorder). All patients completed the "Causal Explanations of Mental Disorders" (CEMD), a 41-item self-rating questionnaire. RESULTS: Pakistani patients reported magic-religious oriented mental health beliefs more frequently. In contrast, Austrians' beliefs are more often in line with the bio-psychosocial explanations of Western medicine. Concerning mental health beliefs the cultural background seems to be more important than the subjective experience with a distinctive mental disorder. CONCLUSIONS: Although the subjective experience is of importance for the shape of illnessspecific cognitions, mental health beliefs are primarily caused by the patients' socio-cultural origin. It is a challenge for psychiatry to improve the co-operation with culture-anthropology and other social sciences.

Diencephalic serotonin transporter availability predicts both transporter occupancy and treatment response to sertraline in obsessive-compulsive checkers.

BACKGROUND: To our knowledge, no studies have investigated the predictive value of central serotonin transporter (SERT) availability for treatment response to serotonin reuptake inhibitors (SSRIs) in patients with obsessive-compulsive disorder (OCD). This study used brain imaging to examine the relationship between pretreatment SERT availability and transporter occupancy as well as treatment response by sertraline in patients displaying prominent behavioral checking compulsions (OC checkers). METHODS: Single photon emission computed tomography (SPECT) was used to measure thalamic-hypothalamic SERT availability with [(123)I]-2beta-carbomethoxy-3beta-(4-iodophenyl)-tropane in 28 nondepressed OC checkers at baseline and after 14 weeks of treatment with sertraline (175 mg daily). SERT availability was correlated with OC severity and treatment response as assessed with the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). Associations between individual transporter occupancies and clinical parameters were investigated. RESULTS: 1) Correlation analyses between thalamic-hypothalamic SERT availability and OC severity showed significant negative associations at baseline and after treatment with sertraline. 2) Pretreatment SERT availability correlated significantly with both transporter occupancy and treatment response; in addition, a positive association was found between transporter occupancy and treatment response directly. 3) Using multivariate statistical models, the data demonstrated that higher pretreatment SERT availability significantly predicted higher occupancy rates as well as better treatment response 14 weeks later. CONCLUSIONS: Higher pretreatment thalamic-hypothalamic SERT availability may predict both higher occupancy rates and better treatment response to sertraline. The data suggest a strong connection between transporter occupancy and treatment response.

Changes in thalamus-hypothalamus serotonin transporter availability during clomipramine administration in patients with obsessive-compulsive disorder.

To the authors' knowledge there is as of yet no study demonstrating in vivo alterations in human serotonin transporters (SERT) during clomipramine treatment in patients with obsessive-compulsive disorder. The only study in which SERT binding has been investigated in obsessive-compulsive disorder (OCD) patients before and after treatment is a small pilot study by Stengler-Wenzke et al (2006), who treated five OCD patients with citalopram. In the study at hand, we measured transporter availability in the thalamus-hypothalamus with [(123)I] beta-CIT single photon emission computed tomography (SPECT) in 24 patients with DSM-IV OCD. All patients displayed prominent behavioral checking compulsions (OC-checkers). At baseline and upon medication after 12 weeks of treatment with clomipramine (150 mg daily) 24 non-depressed OC-checkers underwent a SPECT measurement of brain SERT availability using [(123)I]-2beta-carbomethoxy-3beta-(4-iodophenyl)tropane. For quantification of brain serotonin transporter availability, a ratio of specific to non-displaceable [(123)I] beta-CIT brain binding was used (BP(ND)=(thalamus and hypothalamus-cerebellum)/cerebellum). The SERT availability was compared between baseline and after treatment and correlated with severity of OC symptomatology and treatment response as assessed with the Yale-Brown Obsessive Compulsive Scale (Y-BOCS). After treatment with clomipramine patients showed a 48% reduced brain serotonin transporter availability in the thalamus-hypothalamus, as compared with values at baseline (0.72+/-0.12 vs 1.39+/-0.18, p<0.001). Correlations between brain SERT availability and OC symptomatology (Y-BOCS scores) revealed significantly negative associations both at baseline and after treatment (r=-0.46; p<0.05 and r=-0.53; p<0.01 respectively). These data suggest that the SERT availability values could be considered a biological indicator of disease severity. Moreover, in search of predictors we found that higher pretreatment SERT availability significantly predicted better treatment response 12 weeks later (B=14.145+/-4.514; t=3.133; p=0.005). These results provide further support for an important role of alterations in serotonergic neurons in the pathophysiology of OCD.

[123I]-beta-CIT SPECT imaging shows reduced thalamus-hypothalamus serotonin transporter availability in 24 drug-free obsessive-compulsive checkers.

Numerous findings indicate alterations in brain serotonin systems in obsessive-compulsive disorder (OCD). We investigated the in vivo availability of thalamus-hypothalamus serotonin transporters (SERT) in patients with DSM-IV OCD who displayed prominent behavioral checking compulsions (OC-checkers). Four hours after injection of [(123)I]-2beta-carbomethoxy-3beta-(4-iodophenyl)tropane ([(123)I]-beta-CIT), single photon emission computed tomography (SPECT) scans were performed in 24 medication-free non-depressed OC-checkers and 24 age- and gender-matched healthy controls. For quantification of brain serotonin transporter availability, a ratio of specific to non-displaceable [(123)I]-beta-CIT brain binding was used (V''(3)=(thalamus and hypothalamus-cerebellum)/cerebellum). Drug-free non-depressed OC-checkers showed an 18% reduced brain serotonin transporter availability in the thalamus and hypothalamus, as compared with healthy control subjects (1.38+/-0.19 vs 1.69+/-0.21; p<0.001). There was a strong negative correlation between severity of OC symptomatology (Y-BOCS scores) and SERT availability (r=-0.80; p<0.001). Moreover, we found a significant positive correlation between illness duration and serotonin transporter availability (r=0.43; p<0.05). This first report of significantly reduced [(123)I]-beta-CIT binding in the thalamus-hypothalamus region in OC-checkers suggests reduced brain serotonin transporter availability, which is more pronounced with increased severity of OC symptomatology and short duration of illness. The results provide direct evidence for an involvement of the serotonergic system in the pathophysiology of OCD.

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.

Magnetic resonance imaging in patients with obsessive-compulsive disorder with good versus poor insight.

The DSM-IV provides two subtypes of obsessive-compulsive disorder (OCD), labelled as OCD with insight and OCD with poor insight. For the latter, patients generally fail to recognize that the obsessions or compulsions are excessive or unreasonable. Several studies have shown significant brain abnormalities in OCD patients. However, at present, it remains unclear whether a specific pattern of structural brain abnormalities is related to poor insight in OCD. In the present study, magnetic resonance imaging (MRI) findings were compared in OCD patients with insight versus those with poor insight. Outpatients with diagnoses of OCD according to DSM-IV (300.30) and ICD-10 (F42) (n = 84; mean age 38+/-13; 35 females, 49 males) were dichotomized into the two subtypes. All subjects underwent an MRI examination. MRI findings were rated as "MRI abnormality" and "normal MRI." In our sample, 48% of the patients had MRI abnormalities. There was a highly significant difference between the two groups according to frequencies of MRI abnormalities, with 83% of the patients with poor insight showing MRI abnormalities compared with only 21% of the patients with insight. The specifier "poor insight" helps to identify a subgroup of OCD with a higher frequency of brain abnormalities of various types. This distinction should be taken into account in future studies concerning the course and therapeutic outcome of OCD.

Gender differences: does alcohol affect females more than males?

Human substance use is complex, being influenced by many psychopathological and sociological factors as well as the substance's pharmacological effects. Dependence development is not attributable directly to the consumed substance, but takes also all the other issues into regard. One of all these issues might be that gender represents an influencing factor and impacts on tolerance of a substance, on abuse patterns and finally on development of dependence as well as on addiction related disorders. Therapeutic programs' needs might be different too. In general, more men than women are alcohol dependent or have alcohol problems, but women are at greater risk for adverse effects and alcohol related diseases. Death rates among female alcoholics are 50 to 100 percent higher than those of men. Major impairments, diagnosis, medical and psychosocial consequences and their implication on treatment will be outlined.

Anxiety and hostility in the manifest dreams of schizophrenic patients.

Aside from delusions, hallucinations, and thought disorders, affective disturbances belong to the most prominent symptoms of the schizophrenic process. However, nearly no empirical work has been done on the systematic investigation of the dream affects of patients with schizophrenia. We compared 96 dreams of 19 patients with schizophrenia and an equal number of dreams of 19 healthy controls collected over an 8-week period by means of the Gottschalk-Gleser Analysis Scales. Additionally, central psychopathological syndromes were measured by means of the AMDP-scales each day a patient reported a dream. Although cluster analyses showed general similarities in the organization of dream affects in the two groups, we found differences between patient and control groups in the frequency and intensity of anxious and hostile affects. As in delusions of persecution, patients experience themselves in their dreams more frequently as victims of hostility from outside, which corresponds well with a significantly higher intensity of threat anxieties (death, mutilation). On the other hand, value anxieties (guilt and separation) are found less frequently in the dreams of patients with schizophrenia pointing, together with a less differentiated organization of the dream affects, to the typical affective flattening of residual syndromes.