Obsessive-compulsive disorder--A question of conscience? An fMRI study of behavioural and neurofunctional correlates of shame and guilt.

Shame and guilt can be described as 'self-conscious emotions' and are an essential part of the psychopathology in obsessive-compulsive disorder (OCD). Our primary aim was to explore whether individuals with OCD are processing shame and guilt differently from healthy individuals (N = 20 in both groups; 50% female; age: 20-40 years) on the behavioural and neurobiological level. For the experimental task, participants were scanned with functional magnetic resonance tomography (functional magnetic resonance imaging, 3 T) while imagining neutral, shame inducing and guilt inducing scenarios. In addition to clinical questionnaires, participants were asked to complete questionnaires measuring shame and guilt. The functional data indicate an increased activity in OCD patients in the shame condition in the limbic, temporal and sub-lobar (hypothalamus) areas, in the guilt condition inter alia in frontal, limbic and temporal areas. In summary we found activity in OCD patients in neural networks which are responsible for stimulus filtering, emotion regulation, impulse control and memory. The results from our study may contribute to a better understanding of the origins and maintenance of OCD in association with the pathological processing of shame and guilt on different functional levels.

[Evaluation of an online discussion forum for depressive patients and their relatives--an examination focussing motives and effects of participation]. / Evaluation eines Online-Diskussionsforums für an Depression Erkrankte und Angehörige--eine Untersuchung zu Motiven und Auswirkungen der Teilnahme.

OBJECTIVE: The profile of psychiatric patients, who write within the online discussion forum of the German Research Network on Depression and Suicidality, is described. The question of which diagnoses are predominant among the forum members and the question of their treatment status shall be answered. Furthermore, the effects of participation in the forum on individual handling of the illness are examined. METHODS: 55 active users were interviewed by telephone using a computer-assisted version of a fully structured psychiatric interview (DIA-X) and online with the Beck Depression Inventory (BDI). Moreover, their treatment status and their motivation to use the online forum were asked for. RESULTS: 52 study participants (94.5%) received the diagnosis depression. Currently, 36.5% of the respondents suffer from a depressive episode. Frequent comorbid disorders are phobic disorders and somatoform disorders. 90.2% received outpatient treatment before, 64.7% inpatient treatment. In the year before this study started, 78.2% of participants were treated by a psychiatrist / neurologist and 63.6% by a psychological psychotherapist. By participating in the online discussion forum, the respondents expect to receive information about the disorder, support in coping with depressive symptoms as well as an exchange with other affected persons and their relatives. The respondents stated that their trust in medical treatment was raised (63.3%) and that they were encouraged to seek professional help (61.2%). Furthermore, 32.7% of the interviewed participants rated their attitudes towards the treatment with medication more positive than before being a member in the discussion forum. CONCLUSIONS: The forum reaches its targets and the users do not see it as an alternative, but rather as a supplement to professional and psychological care. By participating in the forum, aspects of self-help, especially a strengthened sense of community and acceptance of and coping with the own illness-related situation can be accomplished.