Studies on internet gaming disorders indicate that especially online role-playing games have a high addictive potential in particular in male adolescents. These games enable the parallel gaming of multiple users in online virtual worlds with or against each other via their graphical agent (avatar). Recent findings suggest online role-playing addicts to have a deficient self-concept. The latter's potential compensation by means of a higher identification with the own avatar might be an etiological factor in the development of an online role-playing game addiction. On a neurobiological level, especially the left Angular Gyrus (AG) seems to be associated with identification and empathy processes. An according fMRI-based study on long-term gamers of online role-playing games indicated increased brain activations in the left AG during the rating of personality traits referring to the avatar relative to self-referencing and the referencing of close others (Ganesh et al., 2011). However, the extent to which these results represent specific neurobiological mechanisms that are associated with self-concept deficits or a stronger identification with the own avatar in the development of online role-playing game addiction remains unknown to date.

N=16 addicted and n=17 regular gamers of online role-playing games (mean age=28 and 26 years, respectively) underwent functional Magnetic Resonance Imaging (fMRI) while 1) completing a Giessen-Test (GT)-derived paradigm assessing participants’ concepts of self, ideal and avatar and 2) while viewing and evaluating images of the own person, the own avatar as well as unknown persons. Additionally, a questionnaire referring to the own body image and a Visual Analogue Scale (VAS) for the evaluation of the own as well as avatar's attractiveness, sympathy and gender identity were applied.

Addicts of online role-playing games rated their body image, gender identity and social response (i.e. social popularity) significantly lower. Neurobiologically, they showed increased left AG activations during the reflection about their avatar (relative to their ideal and/or their self) compared to non-addicted gamers. Furthermore, within-group differences revealed left AG response during the perception of images showing their avatar (relative to images of themselves). In addition, addicted gamers had hypoactivations in the bilateral AG during the perception of images of their own person compared to the perception of unknown persons. The left-lateral AG hypoactivation positively correlated with the degree of the gender identity.

In line with previous findings, our results indicate self-concept deficits in online role-playing game addicts and a stronger identification with the own avatar, which might neurobiologically be reflected in AG activations. The results could point towards problems in the formation of an own identity as a cause for online role-playing game addiction development. Longitudinal studies may shed light on these potentially causal relations.

The early and correct identification and treatment of memory disorders is crucial for the well-being and prognosis of persons with dementia and their families. Family physicians are in the key position, but previous surveys showed, that their competency regarding this task is too low, although they regard dementia diagnosis as part of their job.

After a pilot study with personal interviews we designed a web-based survey. It presented case vignettes, case 1 with mild cognitive impairment in a male or female version, case 2 describing a moderate dementia syndrome in a female multimorbid person. Three alternatives described a typical course of vascular dementia, Alzheimer dementia and Lewy Body dementia. One version of case 1 and case 2 each were randomized to the participants. The questionnaire consisted of open questions and those with given answer categories.

From 7‘603 invitations and additional reminders, we received 709 full answers (9.3%). The physicians were family physicians (50.7%), specialists for internal medicine (23.2%), psychiatrists (21.9%) and neurologists (3.5%). The respondents were representative regarding age and sex distribution for swiss physicians.

Regarding diagnosis, a vascular concept of memory disorders is still strong. Alzheimer dementia is still considered by a low number of physicians. For the investigations neuropsychological screening tests were cited frequently, neuroimaging less often. Antidementia drugs were considered in about 60% of case 1 and less frequently in case 2. Non-drug approaches covered a wide range of activities and were mentioned by two thirds of the physicians.

Compared to previous surveys using other methods we detect some improvement in guideline adherence. However there still remains much to do to improve medical outpatient care.

We thank the Swiss Alzheimer Associaton for funding this study.

A variety of interventions are available to supportthe caregivers of dementia patients. For the purpose of service planning, we developed aninstrument to assess the needs of dementia caregivers and whether these needsare met. Another aim was to investigate aspects of reliability and validity ofthis new instrument.

Thedevelopment of this instrument ('Carers’ Needs Assessment for Dementia” =CNA-D) wasbased on in-depth interviews and a focus group. The combined inter-rater and test-retest reliabilitywas investigated among 45 dementia caregivers. For analyzing concurrent validity correlations of the CNA-D with the ”ZaritBurden Inventory' were used. Content validity wasinvestigated by performing a separate survey among 40 caregivers and 40 professionals.

The CNA-D is asemi-structured research interview including 18 problem areas. For each ofthese problem areas, the CNA-D offers several possible interventions. Therelevance of the problem areas and the interventions (contentvalidity) wasconfirmed by the majority of the study participants. Significant positiveassociations were found between the total score of the 'Zarit Burden Inventory'on the one hand, and the number of problems and the number of unmet needsaccording to the CNA-D on the other hand. The agreement between the interviewerswas 'excellent” (i.e. kappa above 0.75) in 73.7% of the problem areas and in69.9% of the interventions.

These results suggest that the CNA-D is both validand reliable. The CNA-D seems to be able to comprehensively assess the needs ofdementia caregivers

Electroconvulsivetherapy (ECT) is the most acutely effective treatment for severe depression butis limited by cognitive side-effects, to which older adult may be morevulnerable. The most common form of ECTworldwide uses bitemporal (BT) electrode placement which is more powerful thanright unilateral (RUL) placement but is associated with more cognitivedeficits. However, RUL-ECT at higherelectrical doses may be as effective as BT-ECT but with less cognitiveside-effects. The aim of this trial is to compare the effectiveness and cognitiveside-effects of high-dose RUL-ECT with standard BT-ECT.

Wecarried out a pragmatic, two-group, parallel-design, randomised, non-inferiority trial (ISRCTN23577151) of twice-weekly BT-ECT at 1.5 timesseizure threshold versus high-dose RUL-ECT at 6 times seizure threshold forpatients with a major depressive episode. 138 patients (69 per group) were randomised to ensure adequate power toassess non-inferiority of high-dose RUL ECT. The primary outcome was the Hamilton Rating Scale for Depression (HRSD-24) score at end-of-treatment and the pre-specifiednon-inferiority margin was 4•0 points. Secondary outcomes included response, remission and relapse rates plus cognitive performance during and after theallocated ECT course with a six-month follow-up.

Recruitment wasfrom May 2008 until November 2012. Overall, high-dose RUL ECT was non-inferior toBT ECT with respect to the HDRS-24 at the end of ECT course(mean difference 1.2 points in favour of RUL ECT (95% CI, −1.510 to 3.995). Analyses of the effects of age on recovery of orientation after individualtreatments and cognitive performance soon after completion of the ECT courseand during the six-month follow-up will be presented and discussed.

Depression and cognitive decline are highly prevalent in elderly as is comorbidity between the two. Depressed patients are at high risk to develop dementia. To date, knowledge has been limited on course and outcome in severe geriatric depression.

The association between depression and dementia remains unclear. Both white matter hyperintensities (WMH) and medial temporal lobe atrophy (MTA) are associated with depression, mild cognitive impairment and dementia, which possibly explains a common underlying mechanism of these diseases. The objective of this study was to identify associations between WMH, MTA, dementia and mortality in patients with severe geriatric depression formerly treated with ECT.

Data of 92.1% of the former patients was obtained. A total of 51.3 % (39 out of 76) of former patients participated in the follow-up study. Cognitive decline was identified in patients seven to 12 years after ECT, using the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). WMH and MTA scores were available from the initial study.

56.6% of the patients were deceased and 35.5% of the patients were alive during FU. 61.5% (24 out of 39) of the included patients showed cognitive decline and 17.9% (7 out of 39) of the included patients were diagnosed with dementia. Depression with psychotic symptoms was significantly associated with no cognitive decline at follow-up (p=0.007). WMH and mortality were significantly associated (p=0.047).

Depression with psychotic symptoms is associated with cognitive decline at follow-up and WMH before ECT– not MTA or dementia – increases mortality after ECT.

Despite the highly beneficial effects of ECT in the elderly, the close relationship between brain structure and LLD and the possible predictive value of structural changes on ECT response in LLD, no study has addressed the effects of ECT on gray matter volume (GMV) in the elderly so far.

In this presentation we review recent studies elucidating neural effects of ECT in non-elderly cohorts and present a longitudinal structural neuroimaging study in a cohort of 28 elderly subjects to compare GMV before and after ECT. Given the different cortical and subcortical areas implicated in LLD and the absence of previous studies revealing specific regions of interest, we applied a whole brain approach (voxel-based morphometry (VMB)) to explore structural changes. We also investigated the correlation between structural changes and changes in mood, cognition and psychomotor function (given their clinical relevance in LLD).

We observed significant right-hemispheric GMV increase in the caudate nucleus, medial temporal lobe (including hippocampus and amygdala), insula and posterior superior temporal cortex. Furthermore, a correlation was found between the increase of GMV in the caudate nucleus region and the change in psychomotor function scores indicating interesting and potentially specific clinical associations. Potential neurobiological mechanisms underlying these GMV increases will be discussed.

Negative symptoms have been associated with functional outcome of patients with schizophrenia by a large body of literature. However, in previous studies negative symptoms were regarded as a unitary construct, while recent literature data suggest that they include at least two factors, ‘Avolition” and ‘Poor Emotional Expression” (EE), that might show different relationships to functional outcome; moreover, the inter-relationships of negative symptoms, neurocognition, social cognition and real-life functioning are poorly understood.

A large multicenter study was carried out by the Italian Network for Research on Psychoses to model relationship between the negative symptom domains and real-life functioning, taking into account the role of other psychopathological dimensions including depression, neurocognition, functional capacity and social cognition.

A structural equation model was used to investigate direct and indirect effects of the 2 negative symptoms domains, other psychopathological dimensions, including depression, and neurocognition on real-life functioning. Social cognition and functional capacity were modeled as mediators.

In 921 patients with schizophrenia we found that the considered variables explained about 50% of real-life functioning variance. Avolition and functional capacity were the strongest independent predictors, followed by positive and disorganization dimensions, neurocognition and social cognition. EE had only a modest indirect effect on functioning. Neurocognition strongly predicted functional capacity and social cognition, which mediated its effects on functioning.

Our results support the heterogeneity of the two negative symptom domains. Only avolition is a strong predictor of functioning in real-life of patients with schizophrenia independent of social cognition, neurocognition and functional capacity.

The study was carried out within the project ‘Multicenter study on factors influencing real-life social functioning of people with a diagnosis of schizophrenia” of the Italian Network for Research on Psychoses.

Negative symptoms show a modest association with dysfunctions in cognition and decision-making. Recently, a consensus has emerged that negative symptoms can be divided into the dimensions apathy and diminished expression, but there is still limited evidence for a differential association of these dimensions with cognition and decision-making.

We conducted two studies to investigate whether apathy and diminished expression are differentially associated with cognitive and motivational processes in patients with schizophrenia.

Apathy and diminished expression were assessed with the Brief Negative Symptom Scale. In study 1 50 patients completed a cognitive test battery. In study 2 31 patients performed an effort-based decision making task assessing the willingness to work for a reward. They also performed an option generation task assessing the ability to generate options for actions in ill-structured situations.

In study 1 no significant association of either negative symptom association with a composite cognitive score was observed. A strong negative association was found between diminished expression and verbal learning. In study 2 apathy was strongly and specifically associated with increased effort discounting, i.e. apathetic patients were less willing to work for a reward. Patients also showed a reduction in the quantity of options for action generated in ill-structured decision situations.

We provide evidence for a differential association of cognitive and motivational processes with dimensions of negative symptoms. Diminished expression is associated with cognitive dysfunction, specifically verbal memory performance. In contrast, apathy is associated with specific motivational and cognitive processes underlying decision-making in patients with schizophrenia.