Research on pathogenesis and treatment has long been concentrated on the problems involving abnormalities in the reward and motivational system. However, current research also looks at decision making, including both error detection and behavioral inhibition. It is assumed that compulsive use and relapse in patients with a substance use disorder or with pathological gambling are the result not only of excessive salience of drug related stimuli but also of impaired error detection and behavioral disinhibition.

In this presentation an overview will be given of the research on decision making in alcoholics, drug addicts and pathological gamblers. The data show that patients with both chemical and non-chemical addictions have serious problems with error detection and behavioral inhibition independent of the presence of antisocial or borderline personality disorders. Recent data also show that ex-addicts have fewer problems with behavioral inhibition, indicating either pre-existing normality or improvement after abstinence. The fact that patients with low levels of behavioral inhibition relapse more frequently supports the first explanation. It, therefore, seems important to improve decision making in patients with addictive behaviors, using pharmacological interventions (cognitive enhancers), neurophysiological techniques (biofeedback)or psychotherapeutic treatments(training).

In alcoholism, central serotonergic dysfunction may contribute to negative affect and impulsive aggression. In animal experiments and human studies, serotonin transporters and receptors interact with central processing of affectively negative stimuli. Monoamine effects on central processing of emotionally salient stimuli are genetically influenced, and besides single gene effect, gene-gene interactions have been postulated. Gene-gene effects are often assumed but difficult to test in behavioral genetics due to the small explained behavioral variance. Processing of unpleasant stimuli in the amygdala has been associated with a functional polymorphism (val158-met)in the catechol-O-methyltransferase (COMT) gene and independently with a functional polymorphism in the regulatory region of the serotonin transporter (5-HTT) gene. 5-HTT function may also be affected by a recently detected A/G exchange in the long allele (insertion)of the 5-HTT regulatory region. In individuals with more COMT met158 alleles and with more s or lG alleles of the 5-HTT regulatory region, aversive stimuli elicited greater neuronal activity in the bilateral amygdalae and hippocampi. These genotype effects were additional to amygdala and hippocampus activation by aversive versus neutral stimuli, indicating that COMT val158-met and 5-HTT genotype were additionally associated with increased processing of aversive stimuli in the amygdalae. Functional brain imaging may be used to assess the interaction of multiple genotypes with anxiety and impulsive aggressiveness in alcohol-dependent patients.

Decision making research continues to generate new approaches to understanding addiction, in relation to developing interconnected concepts of myopia, hypersensitivity to reward and hyposensitivity to punishment. Despite high levels of inter-subject variance in former studies, little progress has been made in describing how individuals differ in terms of their decision-making strategies and behaviours within these decision-making tasks. A study was undertaken to develop methods for analysing and describing adapting response behaviours within a decision-making task. In addition, the effect of task manipulations such as feedback, penalties and practice were examined. Substitute medication maintained adult males were recruited for this study.

Interesting behavioural traits appear to reflect the performance differences between individuals, perhaps offering an additional approach to understanding the idiosyncratic nature of response behaviour during these tasks. Some insight was also gained in how task design may relate to decision-making strategies / response behaviours.

Impulse-control disorders are characterized by the presence of irresistible urges or impulses. With regard to phenomenology and pathogenesis of these disorders two yet unsolved questions attracted researchers: do Impulse-Control Disorders represent disorders of impulses (are the urges so penetrating that the individuum is no longer able to control them) or are they primary disorders to control ubiquitary impulses, or both of them. An answer to these questions is essential for pharmacological and psychotherapeutic treatment planning. In ICD-10 and DSM-IV, however, these questions remain untouched. There, the diagnosis impulse (control) disorders should be used for kinds of persistently repeated maladaptive behaviour that are not secondary to a recognized psychiatric syndrome, and in which it appears that there is repeated failure to resist impulses to carry out the behaviour and the patients report a prodromal period of tension with a feeling of release at the time of the act. Pathological gambling, pyromania, kleptomania, and trichotillomania must be attributed to the rest-category named “Impulse Control Disorders” in DSM-IV or named “Habit and Impulse Disorders” in ICD-10. As we know from clinical praxis, patients suffering from pathological gambling show a much more complex psychopathology quite similar to substance-related disorders. Therefore we propose for DSM-V that pathological gambling should be attributed as gambling addiction (or gambling dependence syndrome) together with other substance-related and non-substance related addictions (e.g. internet addiction, buying addiction, working addiction) to a new group of dependence disorders.

Antipsychotic treatment is frequently associated with unspecific EEG abnormalities; however, in a minority of subjects under antipsychotics severe alterations of brain electric activity including epileptiform activity might occur. Consequently, the risk of seizures is increased under psychopharmacology; however, differences between classes of antipsychotics (e.g. first or second generation drugs) have not been studied extensively and risk profiles regarding changes in brain electric activity remain to be established yet. We investigated psychiatric patients under antipsychotic medication using routine clinical neurophysiological assessments and compared first and second generation drugs. Aim of the study was to estimate the risk of EEG abnormalities under either class of medication by using both visual (standard) and quantified electroencephalography (qEEG) and to analyse the clinical relevance of such findings. In addition the association of brain electric activity under antipsychotics as assessed by novel electromagnetic imaging techniques with clinical parameters such as symptomatology or drug response was investigated.

There were significant differences in the prevalence of EEG abnormalities between first and second generation antipsychotics, with severe abnormalities being more pronounced under some of the second generation drugs. The use of either class was safe in general, but the differences might be of relevance in subjects with a history of seizures. The use of qEEG techniques in the clinical setting in terms of characterising the patients and the respective responses to medication will further be discussed.

QEEG almost consistently reports an abnormal excess of delta/theta activity, reduced alpha activity and posterior excess of beta activities in schizophrenics. LORETA allows more precise localization of these findings (excess of delta in bilateral anterior cingulate, increase of beta in parietal gyrus).All antipsychotic drugs induce significant changes in QEEG reflecting differential effects on inhibitory and excitatory activities. Two QEEG profiles of first-generation antipsychotics may be differentiated: a)chlorpromazine-type profile, characterized by an increase in delta/theta and a decrease in alpha and beta power spectra, and b)haloperidol-type profile, which exhibits no significant change in delta/theta frequency band but increase of alpha and alfa adjacent beta activity. The second generation antipsychotics have different QEEG and LORETA profiles probably reflecting their different mechanism of action. Clozapine produces an increase of delta, theta and alpha1 and decrease of alpha2 and fast beta activities. Comparing to antipsychotic-naïve schizophrenics, clozapine-treated patients showed an excess of delta and theta activities in anterior cingulate and medial frontal cortex. QEEG profile of olanzapine is similar to clozapine, whereas tomography show slightly different pattern (decrease of alpha1-beta activities in the occipital cortex and posterior limbic structures and decrease of beta3 sources in the fronto-temporal cortex and anterior cingulum). Risperidone increased current density in frontal regions for delta, theta and alpha1 in healthy subjects, whereas we found no changes in LORETA between risperidone-treated and antipsychotic-naïve patients. According to‘key–lock principle'the pharmaco-EEG topography and tomography could be helpful in the optimization of antipsychotic therapy.

Supported by the projects IGA MZCR NR9330-3/2007 and MSMTCR1M0517.

Our standpoint for characterization of any drugs on sleep is based on three issues: 1) Assessment of drug induced effects on sleep in healthy young volunteers leads to unbiased conclusions about the pharmacological effects of a compound per se. 2) Working hypothesis underlying the scenario states that electrophysiological changes are directly related to the biochemical changes each compound induces in the brain. 3) Only changes on sleep macrostructure do not provide enough information for documenting pharmacological effects on sleep EEG. From a pharmacological perspective, second generation antipsychotic, as a class, may be defined in part as agents with simultaneously serotonin 2A and dopamine 2 antagonist properties. However, no two agents have exactly identical properties, including multiple pharmacologic actions at serotonin and dopamine receptor subtypes and multiple pharmacologic actions at other neurotransmitter receptors. Current knowledge about the parts played by the different transmitters on the control of the sleep-wake continuum, although important, is far for being clearly established. Availability of EEG sleep data on the effects of antipsychotic drugs is more than sparse. No attempts have been made to determine short-term, intermediate-term, or long-term effects. Questions of rebound following withdrawal or of tolerance have not been addressed. Up to date the most robust finding dealing with sleep EEG changes and second generation of antipsychotics is the increase of slow wave sleep (SWS) after drugs, as olanzapine, which show potent 5HT2A/2C antagonism activity. Further adequately designed, justified and analysed studies are certainly needed to advance in the field.

The World Psychiatric Asociation has rcently launched its institutional program "Psychiatry for the Person", with the aim to indroduce a more subjectivistic and individ centred approach in diagnosing, treating and monitoring psychiatric disorders as human conditions.

Suicide prevention "for the person" seems here to be one of the most important fields in applying these principles. The suicididal person is influenced by his/her genetic predisposition and personality traits, his/her specific psychiatric disorder or dysfunction in biological and social framework, his/her individual psychosocial and existential general and acute life circumstances and exists in a concrete lifethreatening situation.

This together with different grades of competenc or incompetency, decompensation or functional break downs influences the individuals capacity to cope with the suicidal situation and has to be encounterersd with in an individual and even cultural sensitive suicide preventive ad-hoc approach.

Concrete examples will be given outgoing from a description of depressive and psychotic persons in aspecific suicidal situation and strategies will be described.

France is among European Countries with alarmingly high rates of suicide (around

11 000 deaths/year) and suicide attempts (≈ 160 000 /year). Suicide stands particulary high in certain regions and among young people.

In October 2000, the French Federation of Psychiatric Societies (“Fédération Française de Psychiatrie) and the National Health Agency (“Haute Autorité de Santé”) organized a Consensus Conference entitled : “How to detect and manage suicidal crisis”, which was the starting point for lounching a national training Program aimed at physicians and caregivers. Several academics (psychiatrists and psychologists) were trained for each of the French “regions” who, in turn, had to teach and train “first line” caregivers locally, throughout the country.

The aims of the National Program were to 1) increase awareness of the “first line” resource persons and caregivers 2) provide simple pragmatic and immediately usable technical skills to caregivers and 3) use interactive sessions based on role-playing and case-work on real cases.

The Program, as it was developed and organized in Lorraine will be presented

Whereas in Germany clomethiazol has been the standard treatment for alcohol withdrawal, in the U.S. benzodiazepine treatment is used as the standard treatment. Recently there has been some discussion if the standard treatment in Germany should be reconsidered. Up to now there is no study giving a valid argument for this change, but there are clinical observations favouring benzodiazepines. In a retrospective study we are evaluating around 800 inpatient alcohol withdrawals in the last two years in order to give better evidence on which medication to choose and to establish a therapeutic regimen apart from the "intuitive" medication.. About 80% of the patients received clomethiazol as a withdrawal medication, while the rest received either diazepam or oxazepam, usually in case of a contraindication for clomethiazol (e.g. pulmonary disorders). Preliminary results show that benzodiazepines have equal effectiveness and tolerability, despite the negative selection of the subsample.

Decision making tasks such as the Iowa Gambling Task and Rogers' Decision Making Task have been used to consistently identify decision making problems in addict samples. The role of the Ventromedial Prefrontal Cortex (VmPFC) and Orbital Frontal Cortex (OFC) have been linked to impaired decision making through fMRI studies and comparison studies with patients who have suffered bilateral damage to the VmPFC. These regions have been associated to traits, in addicts, such as dysfunctional inhibitory control, hypersensitivity to reward, difficulties in reverse learning (or strategy shifting) and insensitivity to future consequences. Research suggests that the reported poor performance of addicts is a possible artefact of decision making tasks which encourage poor decisions initially, paired with an impaired ability to switch task strategies as experience and knowledge is gained.

Prevalence: Substance use in young women (16-24 years old) has increased in the last decade. Twenty-four per cent of young women aged 16-24 are 'heavy drinkers' (defined as more 6 units in a day on at least one day in the previous week). Several studies conducted in the UK in the 1990s on different populations of pregnant women demonstrated nicotine use in about a third of pregnant women, cannabis use in about 11%, opiate use in less than 2% and cocaine use is about 1%. Other studies confirmed that 10.6-15.6% of antenatal women will be using substances other than tobacco in the first trimester and when objective measures on women in labour were reported about 3.5% had evidence of substances other than tobacco. Consequences: It is estimated that at least a quarter of a million children are growing up in homes where one or both parents have drug problems which may expose them to social and environmental hazards in the UK. The National Confidential Enquiry into Maternal Deaths found that the overall leading cause of pregnancy related death is psychiatric disorder, and 8% of all mothers who died were substance users especially young disadvantaged women who were up to 20 times more likely to die than those from advantaged groups. Impact on the fetus: Studies on the impact of substance misuse on the fetal growth remains relatively under-researched. Smoking in pregnancy is associated with low birth weight, shorter length and increased perinatal mortality. Apart from fetal alcohol syndrome, a major cause of preventable learning disability. Some studies report that cannabis using mothers are some likely to have preterm delivery, minor physical abnormalities, reduced birth length and weight; cocaine use is associated with placental abruption while heroin use is associated with reduced birth weight. There is very little recent research on this topic in the UK. Screening and assessment tools: The variation in reported prevalence is related to different methods of assessment from self report to meconium analysis. Few studies have used objective measures or structured interviews. Studies were also undertaken at different gestational stages in different settings. Substance use in women is underdetected in maternity units and recent robust information on prevalence is not available. In light of the above, this presentation will present a prevalence survey undertaken to establish the nature and extent of substance misuse in pregnant women presenting for scans at 20 weeks gestation.

Haemophilia is a life threatening, life long condition caused by absence of or defective coagulation factors. People with haemophilia tend to bleed internally into joints and muscles, which can lead to pain. Pain is a distressing symptom that can affect people with haemophilia in a number of ways. A bleed into a joint can cause acute, severe pain whereas the long-term effects of recurrent bleeds can lead to chronic and disabling symptoms. People with haemophilia use different types of analgesics for pain relief. On the other hand, patients with haemophilia need to manage psychological pain, too. A high percentage of hemophiliac patients suffer from different psychological problems, most common anxiety, depression and somatization disorders. Physical and psychological pain need to be differentiated and assessed correctly in order to be managed properly. According to our clinical experiences, several patients with haemophilia were abusing analgesics to reduce and control co-morbid anxiety or depression. Aim of our study is to evaluate the use of analgesics in patients with haemophilia. We will evaluate the medical records of 180 patients with haemophilia from Slovenian Haemophilia society and search for type of analgesics, indications for their prescription and potential complications: physical and psychiatric side effects (overdoses, analgetic abuse or misuse according to the ICD - 10 criteria?). The pattern of the analgetic use will be compared to the results of the quality of life questionnaire and functional parameters of the large joints.

In spite of results of previous studies which shows significantly higher rate of sexual dysfunction in veterans with PTSD in all domains (desire, arousal, orgasm, activity and satisfaction) these problems were not enought examined. Erectile disorder and premature ejaculation were most frequently reported problems.

Aim of the study were to examine full range of sexual functioning (sexual activity, erectile disorder, sexual desire, orgazmic disorder, dyspareunia and premature ejaculation) in veterans with PTSD. In that purpose two groups were formed: experimental group of veterans with PTSD (N=70) and control group of healty examinees (N=60).

Results show reduced satisfaction and reduced frequency of sexual activity, hypoactive sexual desire and erectile disorder in veterans with PTSD. Our results confirm results of previous studies about sexual dysfunction in veterans with PTSD.

Mentioned sexual dysfunction could be explained as results of posttraumatic stress disorder as well as comorbid diagnosis, and interpersonal relationship disturbances, problems with closeness, intimacy and partners relationship disturbance.

Results of this study show that both erectile disorder and hypoactive sexual desire disorder in veterans with PTSD, cause loss of self-confidence, reduced frequency of sexual activities as well as unsatisfaction with sexual aspects of life.