Psychische Erkrankungen in der Lebensspanne ... - DGPPN

Topic 25 G Weitere Themen // Other topics
offered and there was no sign of a decline in treatments in recent
years. 159 (72 %) of the 222 therapists who had provided such treatment
considered that a service should be available for people who
want to change their sexual orientation.
004
Scientific and ethical evaluation of interventions aimed at changing
sexual orientation
Christof Wagner (Karlsruhe)
Introduction: The American Medical Association and the American
Psychiatric Association oppose the use of “repara tive” or
“conversion” therapy that is based upon the assumption that homosexuality
per se is a mental disorder or based upon the a priori assumption
that the patient should change his / her homosexual orientation.
In spite of that, several religious and political organizations
opposing full civil rights for gays and lesbians offer conversion therapies.
In a recent survey of mental health professionals in Britain,
four percent of therapists reported that they would attempt to
change a client‘s sexual orientation if asked for such therapy.
Method: Methods: A systematic review of the research base of interventions
aimed at changing sexual orientation was performed.
Discussion / Results: Twelve randomized controlled trials published
between 1969 and 1981 were identified. Their methodological
quality was poor. All compared electrical aversive therapy with
another treatment (e. g. apomorphine aversion therapy, covert sensitization,
or desensitization) or a waiting-list control group (one
trial). There was no evidence that any intervention caused a persistent
change of sexual orientation. Between 1982 and 2009 no randomized
controlled trial investigating currently practiced conversion
therapies was published. The most cited study by Robert Spitzer
(2003) is a telephone survey based on retrospective self-report data
of participants of different types of conversion therapies. This study
does not allow any conclusions about the efficacy of a specific intervention.
In further retrospective interview studies and testimonies
of former patients evidence for harmful effects of conversion therapies
was found. Among the harmful effects perceived were depressive
symptoms, increased feelings of guilt, decreased self-esteem,
substance abuse and suicidality. Most participants of conversion
therapies were motivated by social pressure, religious conflicts, or
internalized negative attitudes towards homosexuality. The practice
of conversion therapies often collides with established medical ethical
principles such as the avoidance of harm and discrimination
and the abstention from deceptive statements.
Donnerstag, 26. 11. 2009, 08.30 – 10.00 Uhr, Salon 19
S-052 Symposium
The Biomarker Paradigm in Psychiatry
Vorsitz: C. Luckhaus (Düsseldorf), J. Wiltfang (Essen)
001
Potential applications and limitations of biomarkers in psychiatry
Jürgen Zielasek (Heinrich-Heine Universität, Psychiatrie und Psychotherapie,
Düsseldorf)
Introduction: Biomarkers provide fascinating new approaches in
biological psychiatry, but their use as diagnostic tools must be subjected
to rigorous scientific criteria.
Method: This review will deal with the issues of context sensitivity
of biomarkers, how the biomarker approach relates to the endophenotype
approach, and how national guidelines may include biomarkers.
Discussion / Results: When considering biomarkers for mental
disorders, the clinical context of any assesment of biological parameters
needs to be taken into account. Also, biomarkers need to
pass the classical tests of sufficient sensitivity, specificity, positive
and negative predictive value, and feasibility before they can be
introduced to routine care. National guidelines are under development
to define the necessary prerequisites for biomarker applications
in psychiatry. Given the complexity of mental disorders,
biomarkers have not yet become substitutes for clinical diagnosis in
psychiatry, but may become essential elements of the diagnostic
process in some disorders.
002
Status quo und perspectives of neurochemical dementia diagnostics
Jens Wiltfang (Universität Duisburg-Essen, Psychiatrie und Psychotherapie)
In numerous independent, multi-centric studies in thousands of
patients, the diagnosis of Alzheimer‘s Disease (AD) was supported
by disease specific increases of tau and its phosphorylated forms
(p-tau) as well as decreased Aβ1-42 concentrations in the cerebrospinal
fluid (CSF), whereat test accuracies of 80 % – 90 % were
reached. Accordingly, the diagnosis of AD can be done in compliance
with currently revised guidelines by a combination of a clinical
examination, a neuropsychological test as well as the biomarker
tau, p-tau and Aβ42 in the CSF by means of typical findings. Thereby
the diagnostic significance of biomarker p-tau and Aβ42 for AD
in the CSF as sole criteria seems to be at least just as estimable in a
study controlled after an autopsy as the combination of clinical evaluation
according to diagnostic guidelines and cranial imaging via
MRT. Especially the disease specific changes of the biomarker p-tau
and Aβ42 in patients in the prodromal state of Mild Cognitive Impairment
(MCI) offers the possibility to predict the development of
incipient AD 4 – 6 years prior to its clinical manifestation. Thus it is
possible to identify patients with MCI, who carry a particularly
high risk to develop AD. In the meanwhile, several studies show a
superior diagnostic performance of the Aβ peptide ratio 42/40 in
the identification of Aβ42 as compared to the sole determination of
Aβ42. These results underline that a multiparametric approach
significantly supports the diagnostic accuracy in neurochemical
dementia diagnostics. In addition meanwhile promising results indicate
novel biomarkers for Lewy-Body-Dementia and Frontotemporal
Dementia. Moreover, a blood-based neurochemical diagnosis
of AD seems feasible in the near future.
003
Validity of biomarkers and aspects of their benefit assessment
Stefan Lange (IQWiG, Köln)
Introduction: Biomarkers are used in clinical research and development
with respect to different objectives, i. e. as surrogates for
patient-relevant outcomes in clinical trials, as factors that provide
information about prognosis (natural course without treatment), or
as factors that predict outcomes depending on treatment (decision
making). The validity of the biomarkers and the methods of their
benefit assessment depend on these objectives.
Method: The study designs that are required to assess the validity
and benefit of biomarkers will be described and illustrated.
Discussion / Results: For the validation of surrogates, meta-analyses
of randomized controlled trials are required in which both the
biomarkers and the patient-relevant outcomes have been ascertained.
Observational cohort studies are the preferred study design to
establish the prognostic value of a biomarker. In this context, it has
to be ensured that the natural course is not biased by specific interventions
that were applied in dependence of the biomarker result.
To assess the benefit of a biomarker for (treatment-related) decision
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