Psychische Erkrankungen in der Lebensspanne ... - DGPPN

Topic 4 G Affektive Störungen, F3 // Affective disorders, F3
lationsprotokollen abhängen und psychopharmakologisch moduliert
werden können. Für den PFC fanden sich in EEG-Untersuchungen
(Grossheinrich et al. Biological Psychiatry 2009; Keeser et
al. submitted 2009) nach Theta Burst rTMS und nach tDCS über bis
zu einer Stunde anhaltende Post-Stimulationseffekte. Nach präfrontaler
tDCS zeigten Gesunde und depressive Patienten z.T. divergente
Veränderungen sowohl hinsichtlich des EEG-Spektrums als
auch ihrer Lokalisation (sLORETA). Zu länger anhaltenden neuroplastischen
Prozessen nach rTMS und tDCS liegen nur vereinzelt
Studien vor, systematische Untersu-chungen zur Entwicklung dieser
Veränderungen über die Zeit fehlen bislang. Die Entstehung
und Dynamik neuroplastischer Prozesse nach rTMS und tDCS ist
bislang nur in Ansätzen verstanden, besitzt aber vermutlich eine
große Bedeutung für die therapeutische Anwendung beider Verfahren
bei Depressionen. Insbesondere die Interaktion zwischen
rTMS- und tDCS-induzierter Neuroplastizität und spezifischen
Veränderungen von Hirnstruktur und Neuroplastizit bei Depressionen
sollte Gegenstand weiterer Forschung sein.
Mittwoch, 25. 11. 2009, 15.30 - 17.00 Uhr, Salon 11/12
S-031 Symposium
Remitted depression: neurobiological and neuropsychological
factors
Vorsitz: D. E. Dietrich (Hannover), M. Rothermundt (Münster)
001
HPA system activity and remission of depression
Michael Deuschle (ZI für Seelische Gesundheit, Mannheim)
Introduction: Depending on the antidepressant and remission,
HPA system activity usually declines during the course of antidepressant
treatment. HPA system activiy as assessed by the combined
Dex /CRH test has been shown to be related to the risk for relapse.
However, HPA system activity has rarely been measured in the
long-term course of treatment.
Method: We measured nighttime urine excretion of cortisol for
6 months in a group of depressed patients after discharge from inpatient
treatment. Moreover, we assessed stress response in patients
in long-term remission.
Discussion / Results: In the aftermath of inpatient treatment, we
found cortisol excretion still to decline, both in patients with favorable
and unfavorable course. Also, patients in long-term remission
had low baseline HPA system activity, when compared to healthy
controls. It may be concluded that HPA system activity ameloriates
in the aftermath of an acute episode.
002
Serum markers as indicators of remission
Matthias Rothermundt (Universitätsklinikum Münster, Psychiatrie
und Psychotherapie)
Introduction: Depression is associated with a volume reduction in
various brain regions positively correlated with increasing duration
of depression. This volume loss is caused by a decrease of glia cell
amount and reduction of neuronal cell size, but not by a decline of
neuronal cell numbers. Glial and neuronal markers might be useful
to indicate cellular changes in a clinical setting.
Method: BDNF as neuronal and S100B as glial cell marker are evaluated
regarding their potential contribution to evaluate the stage of
disease in major depression.
Discussion / Results: BDNF is decreased in unmedicated pa tients
with major depression and normalizes after successful antidepressi-
ve treatment. S100B concentration is elevated in acute major depression
especially in patients with the melancholic subtype of depression.
The S100B concentration at onset predicts the therapeutic
outcome. Discussion: Serum markers indicating neuronal and glial
function can contribute to the assessment of the stage of major depression.
They might even be helpful as prognostic markers. However,
more studies are needed to finally evaluate the chances and
limitations of these markers.
003
Neurophysiological changes of cognitive function and S100B in
remitted depression
Detlef E. Dietrich (Medizin. Hochschule Hannover, Klinik für Psychiatrie)
Y. Zhang, M. Rothermundt
Introduction: Memory and attentional processes have been shown
to be impaired in depressed patients and may partly even persist in
the remitted state. Part of this variability might be explained by biological
factors: S100B is an astroglial calcium-binding protein with
neuroplastic properties and has been shown to be increased in a
subgroup of depressive patients. Its pathophysiologic role in depression,
however, is not yet sufficiently understood. Electrophysiological
techniques, e.g. event-related potentials (ERPs), may be
used to substantiate a possible influence of S100B on cognitive processes.
Method: In the presented investigations, ERPs recorded in a visual
continuous word recognition paradigm and a target evaluation /
response inhibition experiment were therefore investigated in patients
with remitted major depression in relation to serum levels of
S100B.
Discussion / Results: Patients with increased S100B serum levels
showed a normal old / new effect in the recognition memory paradigm
and a normal N2- and P3-amplitude in the target evaluation
experiment in contrast to a reduced old / new effect and a re duced
N2- and P3-amplitude in the patients with lower S100B levels compared
to aged matched control groups. The findings provide evidence
of a correlation between S100B levels and cognitive processing
in patients with recurrent depression and further substantiate
S100B’s role as a marker in the course of affective disorders.
004
The impact of fate and the neuropsychology of depression
Hinderk M. Emrich (Medizin. Hochschule Hannover, Psychiatrie und
Psychotherapie)
Mittwoch, 25. 11. 2009, 15.30 – 17.00 Uhr, Salon 13/14
S-032 Symposium
Treatment-resistant depression: Neural modes of action of
up- to-date treatment strategies from psychotherapy to neuromodu
l ati on
Vorsitz: K. Schnell (Bonn), T. Schläpfer (Bonn)
001
Neuronale Plastizität im Verlauf kognitiv-behavioraler Psychotherapieverfahren
bei chronischer Depression
Henrik Walter (Zentrum für Nervenheilkunde, Klinik für Psychiatrie
Medizinische Psychologie, Bonn)
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