Co-Planar Stereotaxic Atlas of the Human Brain—3-Dimensional Proportional System: An Approach to Cerebral Imaging, J. Talairach, P. Tournoux. Georg Thieme Verlag, New York (1988), 122 pp., 130 figs. DM 268

中枢神経系疾患の治療は正常細胞（ニューロン）の機能維持を目的とするが，脳血管障害のように機能障害の原因が細胞の死滅に基づくことは多い．一方，脳腫瘍の治療においては薬物療法や放射線療法といった腫瘍細胞の死滅を目標とするものが大きな位置を占める．いずれの場合にも，細胞死の機序を理解することは各種病態や治療法の理解のうえで重要である．現在のところ最も研究の進んでいる細胞死の型はアポトーシスである．そのなかで重要な位置を占めるミトコンドリアにおける反応および抗アポトーシス因子について概要を紹介する．

Neuroscience 細胞死：最近の知見

The dopamine hypothesis of schizophrenia has been one of the most enduring ideas in psychiatry. Initially, the emphasis was on a role of hyperdopaminergia in the etiology of schizophrenia (version I), but it was subsequently reconceptualized to specify subcortical hyperdopaminergia with prefrontal hypodopaminergia (version II). However, these hypotheses focused too narrowly on dopamine itself, conflated psychosis and schizophrenia, and predated advances in the genetics, molecular biology, and imaging research in schizophrenia. Since version II, there have been over 6700 articles about dopamine and schizophrenia. We selectively review these data to provide an overview of the 5 critical streams of new evidence: neurochemical imaging studies, genetic evidence, findings on environmental risk factors, research into the extended phenotype, and animal studies. We synthesize this evidence into a new dopamine hypothesis of schizophrenia-version III: the final common pathway. This hypothesis seeks to be comprehensive in providing a framework that links risk factors, including pregnancy and obstetric complications, stress and trauma, drug use, and genes, to increased presynaptic striatal dopaminergic function. It explains how a complex array of pathological, positron emission tomography, magnetic resonance imaging, and other findings, such as frontotemporal structural and functional abnormalities and cognitive impairments, may converge neurochemically to cause psychosis through aberrant salience and lead to a diagnosis of schizophrenia. The hypothesis has one major implication for treatment approaches. Current treatments are acting downstream of the critical neurotransmitter abnormality. Future drug development and research into etiopathogenesis should focus on identifying and manipulating the upstream factors that converge on the dopaminergic funnel point.

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The Dopamine Hypothesis of Schizophrenia: Version III—The Final Common Pathway

Purpose of reviewThe aim of this article is to review recent epidemiological research on age-of-onset of mental disorders, focusing on the WHO World Mental Health surveys.Recent findingsMedian and inter-quartile range (IQR; 25th–75th percentiles) of age-of-onset is much earlier for phobias (7–14, IQ

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Age of onset of mental disorders: a review of recent literature

A rating scale for drug-induced akathisia has been derived that incorporates diagnostic criteria for pseudoakathisia, and mild, moderate, and severe akathisia. It comprises items for rating the observable, restless movements which characterise the condition, the subjective awareness of restlessness, and any distress associated with the akathisia. In addition, there is an item for rating global severity. A standard examination procedure is recommended. The inter-rater reliability for the scale items (Cohen's kappa) ranged from 0.738 to 0.955. Akathisia was found in eight of 42 schizophrenic in-patients, and nine had pseudoakathisia, where the typical sense of inner restlessness was not reported.

A rating scale for drug-induced akathisia

This study addresses the question of whether psychosocial functioning measured by the Personal and Social Performance (PSP) Scale is related to various psychopathological measures in a cohort of patients with schizophrenia. The ‘Neuroleptic Strategy Study’ (NeSSy) performed at 14 German hospitals between 2010 and 2013 compared two treatment strategies instead of individual drugs. Secondary end-points were the two PSP scales as well as measures of quality of life (SF-36) and the Positive and Negative Syndrome Scale (PANSS). 149 patients were randomised. There was no difference between the two treatment strategies (first-generation versus second-generation antipsychotics) with regard to the PSP. There were differences in doctors’ assessments regarding psychosocial functioning compared with patients’ own assessments. Furthermore, there were relationships between the PSP and quality of life, level of skills (ICF), and severity of disease (PANSS), level of sexual activities and poor well-being under antipsychotic medication but not with cognitive changes. The findings on psychosocial functioning of patients with schizophrenia related to severity and skill level could be confirmed. Further findings were the correlation between psychosocial functioning and quality of life, well-being under treatment, and sexuality what emphasizes the substantial importance of a reduced psychosocial functioning.

Assessment of Psychosocial Functioning in a Large Cohort of Patients with Schizophrenia

Motor impairments of psychiatric patients can be assessed with digital recordings of handwriting tasks. The investigation of patients with bipolar affective disorders differentiates intraindividual ch

https://epub.ub.uni-muenchen.de/16550/1/10_1159_000054851.pdf

Periodic Motor Impairments in a Case of 48-Hour Bipolar Ultrarapid Cycling before and under Treatment with Valproate

Die Frage nach der idealen Konzeption und konkreten Ausgestaltung der BehandlungvonMenschenmitpsychischen Erkrankungen durchzieht die Geschichte psychiatrischer Institutionen, und die Antworten darauf waren und sind stets stark von gesellschaftlichen Entwicklungen und Erwartungen beeinflusst [3]. Einigkeit dürfte heutzutage darüber bestehen, dass das Setting einer psychiatrisch-psychotherapeutischen Station und das in diesem Rahmen realisierte „therapeutische Milieu“ einen gewichtigen – förderlichen oder hinderlichen – Einfluss auf den Genesungsprozess von Menschen mit psychischen Erkrankungen haben kann [1]. Wie genau hingegen ein patientenorientiertes und an den Gegebenheiten der Versorgungsregion angepasstes baulich-räumliches, organisatorisch-konzeptionelles und personelles Behandlungsumfeld aussehen sollte, ist häufig Gegenstand kontroverser Diskussionen.

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Das Stationssetting in der Psychiatrie: Wie „offen“ kann und sollte es sein?

After decades of intensive research in the field of biological psychiatry and its partly modest and non-specific results, the self-critical question arises as to whether basic predispositions in ep...

Georg Juckel

Papers

Assessment of Psychosocial Functioning in a Large Cohort of Patients with Schizophrenia

Periodic Motor Impairments in a Case of 48-Hour Bipolar Ultrarapid Cycling before and under Treatment with Valproate

Das Stationssetting in der Psychiatrie: Wie „offen“ kann und sollte es sein?

Epistemological reflections on chances and borders of "biological psychiatry".

Religionssensible Psychotherapie und Psychiatrie