Cannabis use can both increase and reduce anxiety in humans. The neurophysiological substrates of these effects are unknown.

Fifteen healthy English-native right-handed men were studied on three separate occasions using an event-related fMRI paradigm while viewing faces that implicitly elicited different levels of anxiety. Each scanning session was preceded by the ingestion of either 10mg of D-9-THC, 600mg of CBD, or a placebo, in a double-blind, randomised, placebo controlled design. Electrodermal activity (Skin Conductance Response, SCR) and objective and subjective ratings of anxiety were recorded durign the scanning.

D-9THC increased anxiety, as well as levels of intoxication, sedation and psychotic symptoms, whereas there was a trend for a reduction in anxiety following administration of CBD. The number of SCR fluctuations during the processing of intensely fearful faces increased following administration of D-9THC but decreased following administration of CBD. CBD attenuated the BOLD signal in the amygdala and the anterior and posterior cingulate cortex while subjects were processing intensely fearful faces, and its suppression of the amygdalar and posterior cingulate responses was correlated with the concurrent reduction in SCR fluctuations. D-9-THC mainly modulated activation in frontal and parietal areas.

D-9-THC and CBD had clearly distinct effects on the neural, eclectrodermal and symptomatic response to fearful faces. The effects of CBD on activation in limbic and paralimbic regions may contribute to its ability to reduce autonomic arousal and subjective anxiety, whereas the anxiogenic effects of D-9-THC may be related to effects in other brain regions.

In contrast to delta-9-tetrahydrocannabinol, the phytocannabinoid cannabidiol does not exert psychotomimetic effects. Cannabidiol was suggested a re-uptake inhibitor of anandamide and potential antipsychotic properties have been hypothesized for it. We therefore performed a clinical trial to investigate thesis hypothesis and to clarify the underlying link to the neurobiology of schizophrenia.

We performed an explorative, 4-week, double-blind, controlled clinical trial on the effects of purified cannabidiol in acute schizophrenia compared to the antipsychotic amisulpride. The antipsychotic properties of both drugs were the primary target of the study. Furthermore, side-effects and anxiolytic capabilities of both treatments were investigated.

42 patients fulfilling DSM-IV criteria of acute paranoid schizophrenia participated in the study. Both treatments were associated with a significant decrease of psychotic symptoms after 2 and 4 weeks as assessed by BPRS and PANSS. However, there was no statistical difference between both treatment groups. In contrast, cannabidiol induced significantly less side effects (EPS, increase in prolactin, weight gain) when compared to amisulpride.

Cannabidiol revealed substantial antipsychotic properties in acute schizophrenia. This is in line with our suggestion of an adaptive role of the endocannabinoid system in paranoid schizophrenia, and raises further evidence that this adaptive mechanism may represent a valuable target for antipsychotic treatment strategies.

The Stanley Medical Research Institute (00-093 to FML) and the Koeln Fortune Program (107/2000 + 101/2001 to FML) funded this study.

This study examined the effect of Delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) on brain activation during a motor inhibition task.

Functional magnetic resonance imaging and behavioural measures were recorded while 15 healthy volunteers performed a Go/No-Go task following administration of either THC or CBD or placebo in a double-blind, pseudo-randomized, placebo-controlled repeated measures within-subject design.

Relative to placebo, THC attenuated activation in the right inferior frontal and the anterior cingulate gyrus. In contrast, CBD deactivated the left temporal cortex and insula. These effects were not related to changes in anxiety, intoxication, sedation, and psychotic symptoms.

These data suggest that THC attenuates the engagement of brain regions that mediate response inhibition. CBD modulated function in regions not usually implicated in response inhibition.

The purpose of this study was to investigate disability among patients suffering from schizophrenia and to identify predictors of disability.

101 patients from different types of psychiatric services in Vienna and diagnosed with schizophrenia according to ICD-10 were included. They were investigates by means of 36-Item self-administered version of the WHO Disability Assessment Schedule II (WHO-DAS-II) and the PANSS-scale. Patients’ mothers and fathers were asked to fill in the Family Problem Questionnaire.

The mean total score of the WHO-DAS-II was 74.1 (SD 21.9). When using weighted sub-scores the highest disability scores were found for social contacts, participation in society and household (means 2.58, 2.57 and 2.51 respectively). Using logistic regression, overall disability was positively associated with patient's age, overall severity of symptoms (PANSS) and number of previous hospital admissions. Overall disability was not associated with duration of illness and or patient's gender. The subjective burden experienced by patients’ fathers and mothers were increased by reduced social contacts and impaired participation in society, while we could not find an association with other domains of patient's disability (understanding, mobility, self-care, household).

This study shows that schizophrenia results in disability in several domains. Family caregivers’ burden was predominantly increased by social consequences of schizophrenia.

The International Classification of Functioning, Disability and Health, ICF, discriminates between functions, activities/capacities, context factors and participation. There is only limited information on disorders of capacity in neurotic disorders.

213 inpatients of a department of behavioral and psychosomatic medicine (70% women, median age 45 years) were rated with the “Mini-ICF-Rating for Pychological Disorders, Mini-ICF-P”. This instrument assesses thirteen dimensions of capacity, derived fom the ICF, which can be impaired by mental disorders. Rating varies between 0 (no problem) to 4 (can not fullfill respective requirements at all).

61% of patients suffered from disorders from section F4 (neurotic, adjustment and somatoform disorders) of the ICD-10 (WHO, 1991), 29% from F3 (affective disorders) and 10% from F6 (personality disorders).

41% were on sick leave before admission. The average global score of the Mini-ICF-P was 0,84 (SD = 0,56), corresponding to “mild disability”. Highest disability was found for “flexibility” (M = 1,64, SD = 0,94), and lowest for “self maintenance” (M = 0,19, SD = 0,44) and “mobility” (M = 0,43, SD = 0,85). The Mini-ICF-P-score and profile was correlated with rate and duration of sick leave, but also type of disorder (e.g. depression vs. phobias), and course of treatment.

Comparatively minor disorders of capacity are associated with high rates of sick leave, i.e. disorders of participation. Not only restoration of functons but also of capacities should be targets of treatment.

Repeatedly, it has been demonstrated that depression increases the risk of developing cardiovascular disorders; vice versa, in subjects with pre-existing heart disease, comorbid depression was found to predict an unfavourable cardiovascular prognosis. However, several studies failed to observe that treatment of depression positively influences cardiac risk. Therefore, focus of research has shifted to identification of subjects, who would benefit from antidepressant therapy that is tailored to their individual needs.

Search of literature databases, focusing latest goals and advances in diagnosis and therapy of depression in subjects with cardiovascular disease.

Screening cardiac patients for depression seems to result in a different population of depressed patients, as compared with most trials testing antidepressant agents. This different inclusion process obviously favoured oversampling of subjects with minor or reversible depressive syndromes such as adjustment disorders. It is known that in these conditions placebo treatment is powerful, sometimes equalling verum condition in effectiveness.

This hypothesis is supported by re-analysis of former studies revealing selective serotonin reuptake inhibitors (SSRI) to be more effective in subjects with severe or recurrent depression or in patients, in whom depression had begun prior to the onset of cardiovascular disease (e.g., myocardial infarction). Surprisingly, some data support the notion that treatment with SSRIs ameliorates cardiac prognosis irrespective of their antidepressant action. Ongoing studies deal with treatment of depression in patients with heart failure or stroke, and with psychotherapy aimed at reducing cardiac risk factors.

Psychiatric comorbidity of general hospitals inpatients leads to complicated courses of illness and to increased health car costs as compared to patients that suffer from somatic illnesses alone. Such patients are cared for by psychiatric Consultation-Liaison (CL) services. When analyze guidelines that deal with the organization of psychiatric CL-services in USA and the UK, as well with a guideline developed for psychosomatic CL-services in Germany, and an Dutch guideline released in 2008

Literature search and review of guidelines.

Existing guidelines in CL-psychiatry are in part controversial with regard to recommendation for treatments, preferences as to concentrate on clinical, or on organizational issues, and differ even in the grade of evidence given to single topics, such as effectiveness of CL-interventions.

To improve the efficiency of CL-psychiatry, guidelines might be important, as well for the treatment of psychiatric diseases in general, but even more so for diseases that are frequent in general hospitals such as delirium. However, reliability of guidelines in CL-psychiatry differing among countries should be improved.

It is widely recognized the importance of Consultation Liaison (C-L) training for general psychiatry residents. The present International and European panorama is diverse among countries which reflect different cultural, historical and political backgrounds.

To present the postgraduate training in C-L Psychiatry during Psychiatry Residency in Portugal and discuss it in a trans-european perspective.

Review of the literature. MEDLINE and PubMed databases searches, using combinations of the Medline Subject Heading terms consultation-liaison psychiatry and training, residency, internship.

In Portugal, during postgraduate training, rotation to a C-L psychiatry service is mandatory, with a minimal duration of three months. It is possible to prolong the duration of the stage for several months as an optional rotation training. National psychiatric directives define generally the core competencies and skills to acquire during the C-L Psychiatry training. There are no specific national guidelines for C-L Psychiatry training. There is no C-L Psychiatry speciality or sub-speciality. Liaison Psychiatry is practised in general hospitals where there is a psychiatric unit.

Portuguese psychiatry residents are exposed to C-L work as part of their clinical experience in general psychiatry as the national psychiatry residency training program include three months minimum of compulsory training in C-L Psychiatry in a general hospital. It is crucial to reflect on training issues in C-L Psychiatry in Portugal and Europe, since it is a step to a common path of higher quality and homogeneity of training across european countries.

In two recent studies the SNP rs2230912 (Gln460Arg) located in exon 13 of P2RX7-gene (chromosome 12q24) provided the strongest evidence of association with bipolar disorder (BP) (Barden et al,2006; McQuillin et al, 2008) and in one study with the unipolar major depression (Mdd-UP) ( Lucae et al, 2006).

In the present study we investigated the involvement of the SNP rs2230912 in BPI in four European samples from Germany, Poland, Romania and Russia and in the combined sample (N=1445) in comparison with a combined sample of 2006 normal controls. Additionally, a Mdd-UP sample (N=640) from Germany was studied.

All patients were diagnosed according to DSM-IV-R. The BPI sample consisted of 802 females (55.5%) and 643 males (44.5%); the mean AO was 26.9 (SD=10.6); the mean age-at-interview was 42.7 (SD=12.5). The control sample had a mean age of 39.74 (SD=11.22) [1113 females (55.5%); 893 males (44.5%)]. Genotyping of all national samples was performed at Bonn University using the Mass ARRAY system on a Sequenom Compact MALDI-TOF-device. The single marker analysis was performed with FAMHAP software.

There was no allelic association between the G-allele of the SNP rs2230912 and either BPI or Mdd-UP both in the national samples and in the combined sample. The genotypic analysis also indicated no significant results. Our samples of patients and controls had genotypic distributions similar to those of the previously published studies and even in these studies there were no significant differences in genotype frequencies between BPI patients and controls.

The purpose of this study was to examine whether vulnerability to stress is associated with physical and mental illness. We have two main goals:

1. 1. Studying the importance of vulnerability to stress in the state of health of the individual;

2. 2. Examining the effects of interactions between the life events, vulnerability to stress and social support in physical and mental symptoms.

Multivariate analyses were used in a sample of 255 subjects of general population, evaluated in four different moments, spaced of three months. Regression analysis was used to identify the factors explaining the state of health, at every moment.

The results suggest that vulnerability to stress emerge as the larger predictor of changes in health status of individuals in each moment of assessment. Its role is strongest regarding mental health. The longitudinal study suggest two interactions:

1. 1. The interaction between life events and factor 1 of vulnerability to stress (perfectionism and low tolerance to frustration), which might explain the changes that occur in mental health.

2. 2. The interaction between life events, the factor 7 of vulnerability to stress (deprivation of affection and rejection) and social support explains the changes that occur in physical health, along the study.

Findings suggest the importance of vulnerability to stress in physical and mental health.

Primary dystonia (PDy) is an idiopathic neurological disorder causing involuntary muscle contraction. Its pathophysiology is believed to involve basal-ganglia (BG) dysfunction. A possible association with Obsessive-compulsive symptoms (OCS) is regarded as further evidence of BG involvement but remains controversial due to contradictory research data. We proposed to answer three questions:

1. 1. Do PDy patients have high OCS scores?

2. 2. Are OCS in PDy reactive?

3. 3. Does botulinum toxin treatment (BT) influence PDy psycopathology?

45 patients with blepharospasm, spasmodic torticollis, writer's cramp; 43 patients with hemifacial spasm, cervical spondilarthropathy, peripheral hand neuropathy; 27 healthy volunteers.

Assessment: non-structured DSM-IV based psychiatric interview; Symptom Checklist 90 Revised (SCL-90R); Yale-Brown Obsessive-Compulsive Scale (YBOCS); Unified Dystonia Rating Scale (UDRS).

PDy patients scored significantly higher than controls and healthy controls on the YBOCS (11.1 ± 7.24; 5.98 ± 4.33; 2.07 ± 0.92, both p< 0.001). Controls’ mean score was also significantly higher than healthy subjects’. Controls scored higher than PDy and healthy subjects on the SCL-90R somatization scale. BT treated PDy patients had significantly lower anxiety and somatization but higher UDRS and similar YBOCS ratings compared to untreated patients.

Higher ratings of OCS but not of depression, anxiety or somatization in PDy patients suggests a neurophysiological origin for OCS in PDy. However, diseased controls also scored higher than healthy subjects, suggesting that OCS may nevertheless be partly reactive in PDy. BT may decrease anxiety/depressive symptoms but not OCS, lending further strength to a possible neurophysiological aetiology for OCS in PDy.