There is a clear consensus that psychotherapy works. Simultaneously, there is considerable disagreement as to what makes psychotherapy work: specific techniques or common factors. However, this dichotomy of specific techniques and common factors is not justified. Conceptual considerations and empirical data rather suggest an integrative view.

The present study empirically analyses the relationships between specific techniques, common factors and the outcome of psychotherapy.

After each psychotherapy session the patients of a psychiatric outpatient clinic completed a questionnaire, which evaluated the implementation of common factors. Likewise, the therapists rated the techniques they had applied during the session on a technique questionnaire at the end of each session. In addition, measurements of patient characteristics as well as pre- and post-treatment assessments of their psychopathology, social functioning, resources, coping style and quality of life were accomplished. Hierarchical regression analyses (mixed models) were then performed to analyze the associations between techniques, common factors and outcome variables.

Results indicate that patterns of specific techniques are associated with the implementation of different common factors. In addition, specific associations of therapy techniques and common factors are related to distinct outcome variables.

The identification of the active therapeutic ingredients and work mechanisms facilitates the development of integrated personalized psychotherapeutic interventions, which are tailored to the particular problems, needs and resources of the individual patient. This would allow for moving away from delivering standardized treatment packages with different untested elements and, thereby, might enhance the effectiveness and efficient implementation of evidence-based psychotherapy approaches.

it is well established that adversities and GRIN2B genetic variants (encoding NMDAR GluN2B subunit) are independently associated with behavioral and cognitive impairments in childhood. However, a high proportion of children exposed to risk have good, long-term outcomes.

for the first time, we explored how environmental adversities and GRIN2B genetic variants influence children's cognitive abilities and behavioral problems.

we adopted a gene-by-environment interaction (GxE) approach, to identify children with an unfavorable developmental outcome with the potential of better informing the understanding of susceptibility to developmental disorders.

6 SNPs of GRIN2B were genotyped in 625 children aged 6-11 years from an Italian community-based sample. The interactive effect of GRIN2B variants with 4 measures of adversities (low socioeconomic status - SES, preterm delivery, maternal smoking, absence of breastfeeding) was investigated upon cognitive abilities (vocabulary, block design, forward/backward digit spans of Wechsler's Intelligence Scale, and Rey Figure test) and parents-rated behavioral problems (Child Behavior Checklist/6-18).

rs5796555 x gestational age interaction (p= .00145) influenced cognition, with lower IQ memory among children in the ‘A/A genotype and ≤ 36 gestational age’ group, compared to all other groups. Rs2268119 x SES interaction (p= .00008) influenced behavior, with more attention problems among children in the ‘either A/T or T/T genotype and low SES’ group, compared to all other groups.

GRIN2B targets children with the worst outcome in memory and attention functioning among children exposed to environmental adversities. Identification of children with the highest risk may prompt cost-effective preventive/treatment strategies.

Ostracism (social exclusion) has been found to be a remarkable stress factor to mentally ill people with difficulties in situations of social interaction. In an earlier study it was found that patients with borderline personality disorder (BPD) showed differences in oxytocin dysregulation by having lower oxytocin plasma levels during a social exclusion paradigm (Jobst et al., 2013, submitted). To our knowledge, this is the first study investigating neuroendocrinological changes of social exclusion in chronically depressed patients. Chronic depression (CD) is associated with poor social functioning and behavioral interpersonal problems which are considered to be based on the non-responsiveness of CD patients to environmental consequences.

To manipulate a situation of social exclusion we used the Cyberball Paradigm, a virtual ball tossing game which has been well validated and applied in numerous previous studies on the effects of social exclusion. 19 CD patients (according to DSM-IV) and 19 healthy controls matched for gender, age and education underwent repeated neuroendocrine measurements in a standardized laboratory setting during the Cyberball Paradigm. Assessments of psychological variables as well as measurements of oxytocin plasma levels were performed at baseline, 5 min, 15 min and 40 min after Cyberball.

As an association of interpersonal problems in BPD with oxytocin dysregulation has been found, we suggest differences in changes of oxytocin levels in a social exclusion situation in CD patients versus healthy subjects. The data will be presented and discussed in relation to specific interpersonal problems of patients suffering from CD.

Higher sustainability in outpatient mental health care is frequently demanded but hardly analyzed. Cooperation, burn out and job satisfaction do account as indicators for sustainability in health care systems. Knowing their status' and influencing factors among central players provides toeholds for more sustainability in outpatient mental health care.

1. 1. Evaluating the status quo of job satisfaction, burn out and cooperation among registered psychiatrist in Switzerland.

2. 2. Analyzing interactions between the three indicators.

A postal survey was conducted among all registered psychiatrists in the German speaking part of Switzerland (n=1.485) via the Swiss Medical Association containing standardized questionnaires concerning work satisfaction, burn out and cooperation in outpatient mental health care.

The response rate was 23.3%; 347 cases were included in further analyzes. A great range of quality and quantity of cooperation was found; respectively depending on the different stakeholders of outpatient mental health care. Overall, quality of cooperation was predominantly high while quantity of cooperation was comparatively low. Overall job satisfaction with was rather high, while burn out rates were rather low. High quality of cooperation proved to be the strongest and most significant factor for an increase of job satisfaction and a decrease of burn out risk. Further analyzes are in progress.

Concerning the role of psychiatrist, present data suggest a rather high sustainability of the Swiss outpatient health care system. Since high quality of cooperation seems to be a reinforcing factor, it should be a central target in developing sustainable mental health care concepts.

Internalized or self-stigma is known to affect engagement with treatment and long term outcomes in people with chronic mental illness. Little data exists regarding the incidence of internalized stigma in young people experiencing first-episode psychosis and there are no clearly proven interventions with which to address it in this age group.

To identify the extent of internalized stigma in young people with first-episode psychosis.

52 young people (mean age 21 years) attending an early intervention service in Wellington, New Zealand completed Internalized Stigma of Mental Illness (ISMI) scales at the start of a randomized controlled trial of a new narrative-based psychotherapeutic intervention. Mean total and subscale ISMI scores were compared with a previously studied older cohort of people with chronic mental illness.

Statistically significant differences in total and most subscale ISMI scores were identified between young people with first-episode psychosis and the older cohort of people with chronic mental illness.

Internalized stigma exists, but is less severe in young people with first-episode psychosis than older people with chronic mental illness. Potential reasons and implications will be discussed.

The aim of this presentation is to summarize the results of the published systematic reviews / meta-analyses of the randomized controlled trials that have investigated the effectiveness of medications for the treatment of obsessive compulsive disorder (OCD) in children/adolescents and adults and to present preliminary results from a new review study using network meta-analytical techniques

Medline, Cochrane database, and the register of controlled trials maintained by the Cochrane Collaboration Depression, Anxiety & Neurosis Group (CCDAN) were searched for relevant trials, systematic reviews and/or meta-analyses.

Regarding the new review study we were able to extract 103 pharmacological arms (preliminary results: 9 for Fluoxetine, 16 for Fluvoxamine, 11 for Paroxetine, 10 for Sertraline, 16 for Clomipramine, 7 for Citalopram / escitalopram, 2 for Venlafaxine, and 32 for Placebo) with a total number of 6572 patients randomized. The previous meta-analyses have confirmed the efficacy for all SSRIs and Clomipramine in all age groups while for other drugs further evidence is required. In the context of this presentation preliminary results of the relative efficacy of each drug, using network meta-analysis techniques will also be reported.

Several antidepressants have established their efficacy and acceptability for the management of non-resistant OCD. The major weakness of the literature so far is that head to head comparisons between antidepressants are few and therefore it is difficult to establish a clear hierarchy of the efficacy and acceptability of the various agents. This gap in the present literature will be filled by the present review.

Besides affective instability and identity diffusion, disturbances in social interactions are a core symptom of borderline personality disorder (BPD). Interpersonal problems in BPD have been suggested to be associated with oxytocin dysregulation. To directly address this hypothesis, we investigated oxytocin plasma levels during a social exclusion (ostracism) paradigm in female BPD patients.

Twenty-two female BPD patients (diagnosed according to DSM-IV) and twenty-one healthy controls matched for gender, age, and education underwent repeated neuroendocrine measurements in a standardized laboratory setting during the Cyberball paradigm, a virtual balltossing game that evokes a social exclusion situation. Emotional reactions were assessed and oxytocin and cortisol levels measured at baseline and 5, 15, and 40 min after Cyberball.

After social exclusion, oxytocin plasma levels were lower in BPD patients than in healthy controls, whereas cortisol levels did not differ between groups. BPD patients showed distinct differences in emotion regulation compared to healthy participants and reacted to social exclusion with an increase of other-focused negative emotions, particularly anger and contempt.

Our pilot study suggests that the oxytocin system shows a differential response to social exclusion in BPD patients compared to healthy controls. This difference may be related to the high rejection sensitivity of BPD patients and their difficulties in resolving social conflict.

The aim of this case study is to illustrate what role factors such as culture and migration history play for the course of mental illnesses. Methods We present a report on a male patient from Iraq, age 48, suffering from depression and chronicle pain syndrome. Stressful experiences such as the loss of his wife and daughter were the trigger for depressive episodes.

There are three main challenges with regard to treating patients with different that recently immigrated: (1) the language barrier, (2) cultural differences that complicate communication, and (3) the use of stereotypes. In order to optimize treatment it is necessary to consider the specific background of migration as well as the details of the migration history itself.

There are specific difficulties that hamper the treatment of migrants, namely cultural differences and communication barriers. Support from complementary health care is necessary to prevent further social isolation.

In the last decades the unethiological approach in clinical medicine is very frequent (the ‘medicine of consequences’, N. Ilankovic). Because the syndromological diagnoses and (relative) effective symptomatic therapy in clinical psychiatry, in most cases the therapeutic targets are only the phenomenology of behavioral disorders and the neurochemical, imunological and morphological consequences, without precise etiopathogenetic approach.

Researchers have found that both medical and psychiatric comorbidity is common in patients with psychiatric disorders, particularly in children, adolescents and in old age.

To schow how many psychotic disorders have real and detectable etiology, very frequently extracerebral origin.

Clinical and etiological analysis of data of all clinical laboratory and neuroimaging investigationes by 100 patients with psychotic disorders with schizophrenic and schizophreniform clinical pictures.

In most of patient (29%) the cause of psychotic episode was the substance abuse, in 25% extracerebral focal and systemic infection (inflammation), in 16% endocrin-metabolic disorders (extracerebral origin), in 11% brain damage, in 7% cerebrovascular disorders, and in 7% neurodevelopmental disorders.

In about 70% of our patients with schizophrenic and schizophreniform psychotic disorders the primary causes of illness were extracerabral. The real etiological approach and diagnosis in clinical psychiatry open the door to most targeted etiological therapy of psychotic and other mental disorders.

Attachment and companionship are fundamental basic needs of human beings and contribute the feeling of security and social affiliation. It is assumed that dysfunctional attachment behaviour in people with Borderline Personality Disorder leads to difficulties in the interpersonal contact. Unsecure and especially disorganized manners of attachment seem to be frequently represented by mentally ill people. In this study the release of oxytocin according to attachment relevant situations was investigated and attachment representations of people with BPD have been analysed.

In order to determine attachment representations of healthy people and of people with BPD we used the validated ‘Adult Attachment Projective’/ ‘AAP’ by George, West and Pettem (1999). The projective contains eight contour drawings of attachment relevant situations. The participant should make up a story of each picture, which was evaluated by its coherence, its content and the used defence mechanisms. Attachment representations of 30 patients with BPD were surveyed. Furthermore we measured the release of oxytocin evoked by an activation of the attachment system via the ‘AAP’ in 10 healthy people. Therefor blood drawings were performed at four different points of time.

Here, we present pilot data on oxytocin measures induced via the ‘AAP’. We could detect a decrease of oxytocin in healthy people caused by an activation of the attachment system. Moreover attachment representations of patients with BPD will be presented and discussed. These preliminary data could lead to further studies on a possible dysregulation of the attachment- and the oxytocin system of people with BPD.

To investigate serotonin (SERT) and dopamine (DAT) transporter availabilities in depressed patients under treatment with the selective serotonin reuptake inhibitor (SSRI) escitalopram.

27 patients (10m, 42±16y) underwent [123I]β-CIT SPECT to assess SERT and DAT availabilities at baseline and after four weeks of treatment with escitalopram. Hamilton Rating Scale for Depression (HAMD) and Beck Depression Inventory (BDI) were used for clinical ratings. Parametric maps with specific to nonspecific ratios (BPND) were calculated for each voxel using cerebellum as reference region. VOI-based BPND were calculated in striatum (DAT) and midbrain/pons (SERT).

At baseline, mean DAT-BPND was 6.06±0.81 in striatum and SERT-BPND 1.94±0.18 in thalamus. There were negative correlations with age of DAT in striatum (R=-0.60; p<0.01) and SERT in thalamus (R=-0.45; p<0.05). Under treatment there was a 20% occupancy of SERT in thalamus (p < 0.0001), whereas DAT availability increased by 17% in striatum (p<0.001), notably in the younger patients; higher SERT occupancy was associated with lesser DAT increase (R=0.55, p<0.05). There was a negative correlation of baseline HAM-D and DAT availability in putamen (R=- 0.45, p<0.05).

DAT and SERT availabilities decreased age-dependently comparable to studies in healthy volunteers. The SSRI-induced increase in DAT was less pronounced in elderly patients, even though occupancy of SERT was higher. These findings might have implications on dosage and side effect profile of SSRI medication in older patients.

At baseline, mean DAT-was 6.06±0.81 in striatum and SERT-1.94±0.18 in thalamus. There were negative correlations with age of DAT in striatum (R=-0.60; p<0.01) and SERT in thalamus (R=-0.45; p<0.05). Under treatment there was a 20% occupancy of SERT in thalamus (p < 0.0001), whereas DAT availability increased by 17% in striatum (p<0.001), notably in the younger patients; higher SERT occupancy was associated with lesser DAT increase (R=0.55, p<0.05). There was a negative correlation of baseline HAM-D and DAT availability in putamen (R=- 0.45, p<0.05).

27 patients (10m, 42±16y) underwent [123I]β-CIT SPECT to assess SERT and DAT availabilities at baseline and after four weeks of treatment with escitalopram. Hamilton Rating Scale for Depression (HAMD) and Beck Depression Inventory (BDI) were used for clinical ratings. Parametric maps with specific to nonspecific ratios (BPND) were calculated for each voxel using cerebellum as reference region. VOI-based BPND were calculated in striatum (DAT) and midbrain/pons (SERT). Results At baseline, mean DAT-was 6.06±0.81 in striatum and SERT-1.94±0.18 in thalamus. There were negative correlations with age of DAT in striatum (R=-0.60; p<0.01) and SERT in thalamus (R=-0.45; p<0.05). Under treatment there was a 20% occupancy of SERT in thalamus (p < 0.0001), whereas DAT availability increased by 17% in striatum (p<0.001), notably in the younger patients; higher SERT occupancy was associated with lesser DAT increase (R=0.55, p<0.05). There was a negative correlation of baseline HAM-D and DAT availability in putamen (R=-0.45, p<0.05).

Previous studies have shown that structural brain changes are among the best-studied candidate markers for schizophrenia (SZ) along with global functional connectivity (FC) alterations of resting-state (RS) networks. Only few studies tried to combine these data domains to outperform unimodal pattern classification approaches. We aimed at distinguishing SZ patients from healthy controls (HC) at the single-subject level by applying multivariate pattern recognition analysis to both gray matter (GM) volume and FC measures.

The RS functional and structural MRI data from 74 HC and 71 patients with SZ were obtained from the publicly available COBRE database. The machine learning pipeline wrapped into repeated nested cross-validation was used to train a multi-modal diagnostic system and evaluate its generalization capacity in new subjects.

Both functional and structural classifiers were able to distinguish between HC and SZ patients with similar accuracies. The RS classifier was showing a slightly higher accuracy (75%) comparing to GM volume classifier (74.4%). Ensemble-based data fusion outperformed pattern classification based on single MRI modalities by reaching 76.6% accuracy, as determined by cross-validation. Further analysis showed that RS classification was less sensitive to age-related effects across the life span than GM volume.

Our findings suggest that age plays an important role in discriminating SZ patients from HC, but that RS is more robust towards age-differences compared to GM volume. Single neuroimaging modalities provide useful insight into brain function or structure, while multimodal fusion emphasizes the strength of each and provides higher accuracy in discriminating SZ patients from HC.

Asylum Seekers experience different kinds of trauma, such as tortures, threats and loss of family members in the countries of origin, but also desperate journeys and legal concerns in the accepting countries. Our aim is to investigate mental health disorders among AS and to study the importance of torture in the development of their symptoms.

We recruited 45 AS (males, age 29±6), guests of a reception center in Borgo Mezzanone (Foggia, Italy). The following instruments were administered: MINI, SCL-90-R and Davidson Trauma Scale (DTS). Pre-migration, migration, and post-migration stressors were assessed using a self-administered scale.

75,6% of our patients reported a Major Depressive Episode currently, while 20% in the past. 35,6% suffered from PTSD, 13,3% agoraphobia. and 88,9% GAD. 2,3% reported psychotic symptoms and 13,3% alcohol or drugs abuse in the last year. Torture showed a correlation with PTSD (p<0,01), while physical injuries correlated with alcohol abuse (p<0,02), but not with other psychiatric disorders. Tortured ones had greater scores in pre-migration stressors scale (p<0,001) and greater DTS avoidance (p=0,03), DTS global gravity (p=0,003) and DTS total score (p=0,04). Both torture and PTSD did not correlate with SCL-90-R scales.

most of AS showed depressive and anxious symptoms and one-third had PTSD. All of them experienced different kinds of traumas, but only torture seems to play a major role in developing PTSD, while all kinds of trauma are equally important as to the perceived symptomatology, since both torture and PTSD did not correlate with higher SCL-90-R scores.