Adjustment Disorders Are Uniquely Suited for eHealth Interventions: Concept and Case Study

Background: Adjustment disorders (also known as mental distress in response to a stressor) are among the most frequently diagnosed mental disorders in psychiatry and clinical psychology worldwide. They are also commonly diagnosed in clients engaging in deliberate self-harm and in those consulting general practitioners. However, their reputation in research-oriented mental health remains weak since they are largely underresearched. This may change when the International Statistical Classification of Diseases-11 (ICD-11) by the World Health Organization is introduced, including a new conceptualization of adjustment disorders as a stress-response disorder with positively defined core symptoms. Objective: This paper provides an overview of evidence-based interventions for adjustment disorders. Methods: We reviewed the new ICD-11 concept of adjustment disorder and discuss the the rationale and case study of an unguided self-help protocol for burglary victims with adjustment disorder, and its possible implementation as an eHealth intervention. Results: Overall, the treatment with the self-help manual reduced symptoms of adjustment disorder, namely preoccupation and failure to adapt, as well as symptoms of depression, anxiety, and stress. Conclusions: E-mental health options are considered uniquely suited for offering early intervention after the experiences of stressful life events that potentially trigger adjustment disorders.

Muslimische Theologen und Philosophen im Wett- und Widerstreit um die Ratio - Ein Thesenpapier zum Diktum der 'Vernunftreligion' Islam im 11.-14. Jahrhundert

In this paper I investigate the vivid discussions among Muslim theologians and philosophers about the relationship of reason and religion from the 11th to the 14th centuries – which continue to be used as points of reference today. I argue that the idea of Islam as a religion which is in harmony with reason was one of the key postulates of the dominant thinkers of that period, regardless of their school of thought or their attitude towards literal or allegorical ways of understanding the Coran. In consequence, religion has been rationalized or even intellectualized to a high degree while philosophy in turn has been deeply coloured by religious images and concepts. Yet the understanding of religion as well as of reason and its instruments has been so heterogeneous that rationalization could bear very different, even conflicting meanings, thereby undermining the postulated harmony. In seven theses I foreground several striking similarities and differences between theologians and philosophers who diverge in their usage and understanding of reason as well as of the nature of religion.

Psychosocial outcome in patients at clinical high risk of psychosis: a prospective follow-up

Purpose In patients at clinical high risk (CHR) of psychosis, transition to psychosis has been the focus of recent studies. Their broader outcome has received less attention. We studied psychosocial state and outcome in CHR patients. Methods In the European Prediction of Psychosis Study, 244 young help-seeking CHR patients were assessed with the Strauss and Carpenter Prognostic Scale (SCPS) at baseline, and 149 (61.1 %) of them were assessed for the second time at the 18-month follow-up. The followed patients were classified into poor and good outcome groups. Results Female gender, ever-married/cohabitating relationship, and good working/studying situation were associated with good baseline SCPS scores. During follow-up, patients’ SCPS scores improved significantly. Good follow-up SCPS scores were predicted by higher level of education, good working/studying status at baseline, and white ethnicity. One-third of the followed CHR patients had poor global outcome. Poor working/studying situation and lower level of education were associated with poor global outcome. Transition to psychosis was associated with baseline, but not with follow-up SCPS scores or with global outcome. Conclusion The majority of CHR patients experience good short-term recovery, but one-third have poor psychosocial outcome. Good working situation is the major indicator of good outcome, while low level of education and non-white ethnicity seem to be associated with poor outcome. Transition to psychosis has little effect on psychosocial outcome in CHR patients. In treating CHR patients, clinicians should focus their attention on a broader outcome, and not only on preventing transition to psychosis.

Attempted suicide among immigrants in European countries: an international perspective

This study compares the frequencies of attempted suicide among immigrants and their hosts, between different immigrant groups, and between immigrants and their countries of origin.

Help-seeking pathways in early psychosis

INTRODUCTION: Understanding the help-seeking pathways of patients with a putative risk of developing psychosis helps improving development of specialised care services. This study aimed at obtaining information about: type of health professionals contacted by patients at putative risk for psychosis on their help-seeking pathways; number of contacts; type of symptoms leading to contacts with health professionals; interval between initial contact and referral to a specialised outpatient service. METHOD: The help-seeking pathways were assessed as part of a prospective study in 104 patients with suspected at-risk states for psychosis. RESULTS: The mean number of contacts prior to referral was 2.38. Patients with psychotic symptoms more often contacted mental health professionals, whereas patients with insidious and more unspecific features more frequently contacted general practitioners (GPs). CONCLUSIONS: GPs have been found to under-identify the insidious features of emerging psychosis (Simon et al. (2005) Br J Psychiatry 187:274-281). The fact that they were most often contacted by patients with exactly these features calls for focussed and specialised help for primary care physicians. Thus, delays along the help-seeking pathways may be shortened. This may be of particular relevance for patients with the deficit syndrome of schizophrenia.

Cerebral networks linked to the event-related potential P300

P300 is an event-related potential that is elicited by an oddball paradigm. In several neuropsychiatric diseases, differences in latencies and amplitude compared to healthy subjects have been reported. Because of its clinical significance, several investigations have tried to elucidate the intracranial origins of the P300 component. In the present study we could demonstrate a network of P300 generators. Investigated were 15 healthy subjects with an acoustical oddball paradigm within a fMRI block design, which enabled us to exclude attention or acoustical processing effects. The inferior and middle frontal, superior temporal, lower parietal cortex, the insula and the anterior cingulum were significantly activated symmetrical in both hemispheres.

A deviant EEG brain microstate in acute, neuroleptic-naive schizophrenics at rest

Momentary brain electric field configurations are manifestations of momentary global functional states of the brain. Field configurations tend to persist over some time in the sub-second range (“microstates”) and concentrate within few classes of configurations. Accordingly, brain field data can be reduced efficiently into sequences of re-occurring classes of brain microstates, not overlapping in time. Different configurations must have been caused by different active neural ensembles, and thus different microstates assumedly implement different functions. The question arises whether the aberrant schizophrenic mentation is associated with specific changes in the repertory of microstates. Continuous sequences of brain electric field maps (multichannel EEG resting data) from 9 neuroleptic-naive, first-episode, acute schizophrenics and from 18 matched controls were analyzed. The map series were assigned to four individual microstate classes; these were tested for differences between groups. One microstate class displayed significantly different field configurations and shorter durations in patients than controls; degree of shortening correlated with severity of paranoid symptomatology. The three other microstate classes showed no group differences related to psychopathology. Schizophrenic thinking apparently is not a continuous bias in brain functions, but consists of intermittent occurrences of inappropriate brain microstates that open access to inadequate processing strategies and context information

A Christian Identity for the Liberal State?

It seems to be impossible for the liberal state to embrace a Christian identity, because ‘liberalism’ is exactly a device for separating state and religion. Discussing the implications of a recent decision of the European Court of Human Rights, Lautsi v. Italy (2011), I argue that this is not necessarily so. If paired with a liberal commitment to pluralism, a Christian identity might even be more inclusive of minority religions than a narrowly ‘liberal’ state identity, which has been the dominant response in Western Europe to the challenge of immigrant diversity, especially that of Muslim origins.

Internet-Based Treatments - Experiences from Sweden. An Interview with Gerhard Andersson

Worldwide, Gerhard Andersson is one of the most influential researchers working on internet-based psychological treatments. Moreover, he is also one of the leading researchers in the field of psychologically oriented tinnitus research. He is full professor of clinical psychology at Linköping University and affiliated professor at the Karolinska Institute in Stockholm at the Department of Clinical Neuroscience, Section Psychiatry. Professor Andersson has been highly productive, having produced more the 300 scientific papers. During his whole career he has worked part-time with patients. Apart from his own research and clinical work, Professor Andersson has editorial responsibilities for several journals including Cognitive Behaviour Therapy, Plos One, BMC Psychiatry, and Scandinavian Journal of Psychology. The interview was conducted by Professor Thomas Berger.