Psychische Erkrankungen in der Lebensspanne ... - DGPPN

Topic 4 G Affektive Störungen, F3 // Affective disorders, F3
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Psychoanalytische Behandlung der chronischen Depression und
ihre neuronalen Korrelate: Eine Verlaufstudie mit der fMRT
Henrik Kessler (Universitätsklinik Ulm, Klinik für Psychosomatik)
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Treatment-resistant depression (TRD): current pharmacological
treatment options
Mazda Adli (Charité Campus Mitte, Psychiatrie und Psychotherapie,
Berlin)
Although the neurobiological basis of depression is far from being
sufficiently understood thorough considerable progress has been
achieved in the recent years to understand important mechanisms
on genetic, endocrinological and cellular levels which open up potential
novel and more specific treatment approaches. However,
today strategies for the treatment of depression comprise a confusing
variety of options. About 30 antidepressants are currently on
the market which mainly differ with regard to their side effect profiles.
All biological treatment strategies (except for sleep deprivation)
show a latency of onset of several weeks and a non-response
rate of about 30 to 50 %. Therefore, in daily routine it has been
shown useful to follow a stepwise sequence of therapeutic strategies
and to perform a standardized evaluation of response at critical decision
points to avoid or to overcome TRD. Innovative pharmacological
and personalized treatment approaches carry the promise of
shortening treatment duration and increasing response rates in the
near future. As of today, depressive disorders show a good prognosis
if the treatment options cover all available strategies and the response
to a particular treatment is evaluated based on systematic
treatment algorithms.
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Deep Brain Stimulation as a putative treatment for treatment-
resistant depression
Thomas Schläpfer (Universitätsklinikum Bonn, Psychiatrie und Psychotherapie)
Introduction: A substantial number of patients suffering from severe
neuropsychiatric disorders do not respond to conventional
therapeutic approaches. Results from functional neuroimaging research
and the development of neuromodulatory treatments lead to
novel putative strategies.
Method: Recently, one of those methods, deep brain stimulation
(DBS) has been applied in selected patient with major depression
and obsessive-compulsive disorder and major depression.
Discussion / Results: Different targets have been chosen in a hypothesis-guided
way and first results have demonstrated that DBS
might be able to modulate dysfunctional neural networks in both
major depression and OCD. Although DBS is a unique and promising
method for otherwise treatment resistant psychiatric patients,
mandatory treatment standards have to be applied for patient and
target selection.
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Donnerstag, 26. 11. 2009, 08.30 – 10.00 Uhr, Saal 7
S-037 Symposium
Genetic predisposition and stressors – who will become depressed?
(Referat Neurobiologie und Genetik)
Vorsitz: H. Grabe (Stralsund), M. Rietschel (Mannheim)
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Depression and Genetic Findings in Genome-wide Analyses
Susanne Lucae (MPI für Psychiatrie, München)
Einleitung: Die Heritabilität der unipolaren Depression wird auf
35 – 40 % geschätzt, allerdings blieb die Suche nach den ursächlich
beteiligten Genen mit Hilfe von Kandidatengen-Analysen bisher
weitgehend erfolglos. Seit wenigen Jahren sind nun genomweite
Analysen technisch möglich.
Methode: Am Max-Planck-Institut für Psychiatrie führten wir eine
genomweite Assoziationsstudie zur unipolaren Depression mit
zwei anschließenden Replikationsstudien durch. In funktionellen
Analysen (mRNA-Expression, Mausmodell) konnte ein interessantes
Kandidatengen weiter untersucht und validiert werden.
Diskussion / Ergebnisse: Es wurden bereits einige wenige genomweite
Studien zur unipolaren Depression publiziert, andere sind in
Vorbereitung. Es wird die genomweite Analyse zur unipolaren Depression
vorgestellt, die am Max-Planck-Institut für Psychiatrie
durchgeführt wurde. Außerdem werden bereits publizierte genomweiten
Studien zusammengefasst und diskutiert.
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Corticosteroid Receptor Gene Variants and Experimental Stress
Reactivity: Implications for the Development of Depressive Disorders
Stefan Wüst (ZI Mannheim, Genetische Epidemiologie)
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Genetic Findings in Personality as Risk Factors for Affective Disorders
Andreas Reif (Universität Würzburg, Psychiatrische Klinik)
T. Nguyen, A. Strobel, C. Jacob, K.-P. Lesch
Introduction: Neuroticism and related personality dimensions are
etiologically heterogeneous traits with complex genetics. Definition
of clinical phenotypes are not rooted in their neurobiology and respective
animal models have considerable limitations. Even more
so, depression is a complex behavior with equally diverse underlying
neurobiological underpinnings not readily explained by simplistic
models. Formal genetic studies however have consistently
argued for the notion that high levels of Neuroticism as well as
Cluster C personality disorders are risk factors for later-life depression,
especially in the presence of adverse life events.
Discussion / Results: Although research on the neurobiology of
those behaviors is still in its infancy, several milestones have already
been reached: Variation in gene expression were confirmed to play
a predominant role in individual differences in complex traits including
personality and behavior; gene x environment interaction
were established in humans and the nonhuman primate model;
gene-phenotype correlations were substantiated by func tional neuroimaging;
as well as the notion that both genes and environmental
factor impact on brain development and thus set the stage for the
susceptibility to depression is increasingly appreciated. Investigation
of subtle alterations in the expression of genes of the serotonergic
pathway, such as the serotonin transporter (5HTT), of correlations
between 5HTT genotype and brain activity, and of environmental
variables interacting with 5HTT variants currently strengthen re-