Jeder dritte Mensch erkrankt im Laufe seines Lebens an einer psychischen Störung. Welche Faktoren im Laufe eines Lebens von der frühkindlichen Entwicklung über die Pubertät bis hin zum Arbeitsleben für die mentale Gesundheit eine Rolle spielen, erörtern renommierte Experten aus aller Welt bei der Herrenhäuser Konferenz „Mental Health throughout Life“ vom 3. bis 5. April 2013 in Hannover. Das Abschlusspanel moderiert nature-Chefredakteur Philip Campbell. Medienvertreter(innen) sind herzlich eingeladen. Gern unterstützen wir auch Ihre Vorberichterstattung.
Im Fokus der hochkarätig besetzten Herrenhäuser Konferenz stehen drei Phasen im Leben eines jeden Menschen, in denen das Risiko besonders hoch ist, psychisch zu erkranken:
(Bitte beachten Sie auch die Abstracts der Vorträge!).
• „Early Brain Development“: In der ersten Session präsentieren die Wissenschaftler(innen) neueste Erkenntnisse aus der Hirnforschung über die Zusammenhänge zwischen frühkindlichen Erfahrungen, der Entwicklung des Gehirns und einer daraus resultierenden Prädisposition, als Jugendlicher oder Erwachsener psychisch zu erkranken.
• „Adolescence“: Teenager sind für psychische Erkrankungen wie Angstzustände, Psychosen oder Essstörungen besonders anfällig. Welche Rolle das familiäre Umfeld, soziale Kontakte zu Gleichaltrigen, aber auch ein möglicher Drogenkonsum als Jugendlicher auf die mentale Gesundheit haben können, erörtern die Experten in dieser Session.
• „Adulthood“: Wie können Stress und Burnout am Arbeitsplatz vermieden werden? Und wie lassen sich psychisch kranke Mitarbeiter ins Unternehmen reintegrieren? Antworten auf diese Fragen geben Fachleute in der dritten Session.
Die vierte Session „Promoting Mental Health and Intervention“ befasst sich mit derzeitigen und möglichen zukünftigen Therapieformen. Auf diesen Erkenntnissen aufbauend werden im Abschlusspanel der Konferenz mit Philip Campbell (Chefredakteur „nature“) neue Ansätze zur Verbesserung der mentalen Gesundheit und zur Therapie von psychischen Erkrankungen aufgezeigt
Die VolkswagenStiftung lädt Medienvertreter ein zur Herrenhäuser Konferenz
„Mental Health throughout Life“
3. bis 5. April 2013,
Schloss Herrenhausen, Auditorium, Hannover.
Akkreditierung wird erbeten unter presse(at)volkswagenstiftung.de.
Mehr Informationen und das Tagungsprogramm zum Download unter: http://www.contoo.de/c/mentalhealth.
Bitte beachten Sie auch die Abstracts der Vorträge!
Abstracts zur Herrenhäuser Konferenz „Mental Health throughout Life“
Mental Health and Labour: Jobs for People with Mental Illness, and Mental Ill-health in the Workplace – Two Sides of One Coin?
University of Ulm
Interventions aiming at labour market integration follow the principles of ‘first train then place’ (gradual) or ‘first place then train’ (direct job placement). There is strong evidence that in both the US and Europe ‘first place then train’ or supported employment (SE) interventions are superior in terms of job integration to ‘treatment as usual’ or traditional vocational rehabilitation. Recent work suggests that SE is effective also in improving clinical and service use outcomes, and that positive effects on psychopathology and service utilisation may be consecutive to job placement (Kilian et al 2012). Results are influenced by socioeconomic context and characteristics of the social security system.
There is a high level of interest in workplace mental health (and in effective mental health promotion interventions), and there is evidence of high levels of mental distress in the workforce in modern market economies. In a German study, a stress management intervention in the workplace was effective in lowering perceived stress reactivity and sympathetic nervous system activation in lower and middle management employees (Limm et al 2011). Rothermund et al (2012) presented a mixed methods implementation study of a new model of care, bridging the gap between company-supported mental health care and consultation-liaison psychosomatic care.
The dual task of identifying and implementing effective interventions for job integration among people with mental disorders and of securing mental health in the general workforce is a key challenge to the field of mental health services research.
Current Progress in Psychotherapy: The Example of Depression Treatment
University Hospital Freiburg
In contrast to the area of psychopharmacological treatment, which is presently characterized by stagnation, the field of psychotherapy for psychiatric disorders has experienced significant progress and innovation over the past few decades. This development is largely due to the fact that traditional gaps and obstacles in the field of psychotherapy have been overcome.
The advent and development of specific disorder-tailored psychotherapeutic techniques helped to bridge the gap between competing schools of psychotherapy, i.e. especially behaviour therapy and psychoanalysis. Recent evidence-based developments of psychotherapeutic strategies to treat acute and chronic depressive patients (IPT, CBASP) encompass elements from different therapeutic schools, tailoring them to pathopsychology and individual treatment. In the meantime, disorder-specific psychotherapies are considered first line-treatment options for several psychiatric disorders, with a large evidence base from randomized controlled trials.
Another important development concerns the relationship between neuroscience and psychotherapy. The tremendous progress in brain imaging methods revealed that mental disorders (e.g. depression) are linked to dysfunctional brain circuits and that successful psychotherapy not only improves subjective well-being but is accompanied by a normalization of these dysfunctional brain circuits. A new discipline called “Neuropsychotherapy” focuses on the new bi-directional interactions between cognition, emotions and behaviour on the one hand and neurobiological dysfunctions on the other hand. These bi-directional interactions argue for a stronger integration of psycho-physiological approaches like neuro-biofeedback into current research avenues. It can be hypothesized that by influencing neuronal circuit dysfunctions through biofeedback an improvement of psychopathology may occur. A similarly exciting strategy could aim at improving the effectiveness of psychotherapeutic methods by add-on application of hormones like Oxytocin (the so-called trust hormone) or drugs like D-Cycloserin, a memory enhancer. These strategies supposedly enhance psychotherapeutic approaches by either increasing interpersonal confidence or enhancing processes of memory consolidation. The treatment of depression is seen as a stimulating field to subject these current developments to rigorous empirical test.
Mental Health Equity: A Global Perspective
Pamela Y. Collins
National Institute of Mental Health, Bethesda
Neuropsychiatric disorders account for a significant proportion of the burden of noncommunicable disease in high, middle, and low-income countries. Yet, marked inequities in financing of health services and supply of human resources for mental health care are evident between countries and within countries. Global mental health research requires that investigators address questions of equity while acknowledging the global economic, political, and cultural interconnections that shape the experience of mental illness and the lives of people with mental illness. Consequently, researchers engage with populations affected by poverty, displacement, and migration; they recognize the social consequences of global events on local communities. Within countries, mental health inequities must be examined through the complex relationships of socioeconomic status, culture, sex, gender, genetics, race and ethnicity. A global research perspective can facilitate exploration of the underlying mechanisms that produce difference and disparity in diverse populations. The presentation will discuss these issues.
The Teen Brain: Insights from Neuroimaging
Jay N. Giedd
National Institute of Mental Health, Bethesda
The adolescent brain has been forged by evolution to have different features than those of a child or an adult, but it is not broken or defective. Phenomenal ability to adapt to environmental demands (i.e. plasticity), dynamic changes in the brain’s reward circuitry, and dramatic alterations in how the different components of the brain interact with each other make adolescence a time of great opportunity but also a time of vulnerability. Adolescence is the most common time for the emergence of many psychiatric conditions, including anxiety and mood disorders, eating disorders, psychosis, and substance abuse. Neurobiological maturation drives behavioural changes of increased risk taking, heightened sensation seeking, and a move away from parent to peer affiliation. These behaviours are not inherently bad but may contribute to an increased likelihood for addiction, unwanted teen pregnancy, sexually transmitted diseases, motor vehicle accidents, or violent criminal activity. Neuroimaging investigations are beginning to map trajectories of brain development in health and illness, discern the influences - for good or ill - on these trajectories, and explore how the biological changes interact with the behavioural changes and social context to affect the lives of teens and their families. Dr. Giedd will summarize results from his 21 year ongoing longitudinal brain imaging study encompassing over 9,000 scans from 3,000 youths; discuss the impact of the digital revolution on the way teens learn, play, and interact; and speculate on future directions of adolescent neuroscience research.
The Urban Risk is Real, but Still Mysterious
VU University Amsterdam
Being raised in the city has been associated with increased risk for mental disorders. For example, research has consistently shown that around one third of all schizophrenia incidences may be related to environmental factors operating in the urban environment (Krabbendam & van Os, 2005). These impact on developing children and adolescents to increase the later expression of psychosis-like at-risk mental states and overt psychotic disorders.
Neuroimaging and neuropsychological studies have begun to elucidate the neural mechanisms underlying the urban effect. A recent functional imaging study suggested that urban upbringing and current city living both have effects on the neural correlates of social stress processing (Lederbogen et al., 2010). In addition, several studies have suggested that experimental exposure to natural settings has positive effects on stress-sensitivity, self-control and other-regarding behaviour. These studies show that it is possible to further investigate epidemiological findings using neuroimaging and neuropsychological methods. Yet, there are many factors in the urban environment that may potentially play a role in association with mental health outcomes. This means that the next step for research is to investigate much more fine-grained aspects of city living, some of which may convey negative effects on wellbeing, while other factors may have positive effects. Given that the percentage of the world population living in cities will only increase, it becomes crucially important to understand the effects of city living on mental health.
Beyond Single Magic Bullets: True Healthcare Innovation for Serious Neuropsychiatric Disorders
Husseini K. Manji
Janssen Research & Development
A host of cutting-edge approaches – from genomics to data mining, proteomics to biomarkers, pathway modelling to protein engineering, neuroimaging to optogenetics – is revolutionizing the development of novel neuroscience treatments. Nevertheless, although many believe we are in a golden age of neuroscience, scientific breakthroughs have not yet resulted in commensurate therapeutic advances.
Severe neuropsychiatric disorders are characterized by dysfunction in diverse biological systems, including the intricate network of limbic, striatal, and fronto-cortical circuits that mediate mood state, cognition, self-awareness, and insight. Compelling evidence suggests that impaired signalling pathways play a role in the pathophysiology of these disorders, and that mood stabilizers significantly affect signalling pathways regulating neural and synaptic plasticity. It is likely that abnormalities in cellular plasticity cascades also underscore the impaired structural plasticity seen in morphometric studies. These changes in structural plasticity appear to regulate both resilience and the long-term course of illness. In the search for improved therapeutics to treat these illnesses, several promising synaptic plasticity and neurotrophic strategies are being investigated.
Equally important to these scientific advances, however, is the paradigm shift that must accompany future research. The move from a ‘diagnose and treat’ approach to a ‘predict and pre-empt’ model will become increasingly crucial. In this respect, R&D organizations will need to develop novel solutions that encompass meaningful and measurable patient outcomes. These will undoubtedly involve holistic solutions of which medication is one component, but many other modalities and services are brought together to optimize outcome.
The Contribution of Epigenetics to our Understanding of the Developmental Origins of Vulnerability for Psychopathology
McGill University, Montreal
The quality of the early family environment shapes phenotypic variation and influences vulnerability for a wide range of mental disorders. Our studies attempt to define the mechanisms by which variations in parent – child interactions influence the expression of genes in brain regions associated with mental health outcomes. We focus on epigenetic mechanisms, notably DNA methylation and histone modifications that regulate gene transcription. Studies in rodents show that maternal care directly alters the epigenetic state of genes, such as the glucocorticoid receptor gene in the offspring, providing a basis for stable individual differences in stress reactivity. Translational studies using human tissue show that a history of childhood maltreatment also associates with epigenetic modifications that influence glucocorticoid receptor expression and differences in stress reactivity. More recent studies reveal widespread effects of maternal care on the rodent ‘epigenome’ to such an extent that effects appear to occur across the genome. Studies in humans using genome-wide approaches support this conclusion and suggest that epigenetic states at specific genomic regions emerge as a function of gene – environment interdependency. A major issue in the emerging field of ‘translational epigenetics’ is that of its application as a potential ‘marker’ of vulnerable states associated with childhood experience.
Drugs, the Adolescent Brain and Mental Health
Robin M. Murray
King’s College, London
Adolescence is a time of exploration, including for many exploring the effect of drugs; especially cigarettes, alcohol, and cannabis. While cigarette smoking has generally declined in the developed world, and drinking has not changed dramatically, the use of cannabis became steadily more common in the last quarter of the 20th century. In the last decade, the use of cannabis slightly declined in Europe but the starting agefell. It is relatively safe; but as it is so commonly used, any small risk of adverse effects can be important. Since 2002, nine cohort studies have shown that regular use of cannabis carries a small but significantly increased risk of developing psychotic illnesses like schizophrenia. The risk of psychosis appears to be higher in those with a family history of the disorder, in those with a psychosis-prone personality, and in those who start using cannabis in early adolescence. In accord with the latter, animal studies suggest that the impact on the brain may be greater and more prolonged in juvenile animals. The risk increases with the frequency of use and with the potency of the cannabis used. In this respect, it is interesting that high potency cannabis such as the “skunk” widely available in UK contains about 14-18% tetrahydrocannabinol (THC) as opposed to about 4-5% in resin (hash); it also contains much less cannabidiol (CBD) than resin. We and others have carried out experimental studies showing that intravenous injection of THC can produce an acute psychotic state; this can be partially prevented by pre-treatment with CBD. Imaging studies also have shown that CBD appears to produce opposite effects to THC. There is also some evidence that some individuals are more susceptible to cannabis-related psychoses than others; current research focuses on the genes COMT and AKT1. There is less evidence concerning the effect of cannabis on other mental illnesses; but one recent follow-up study has suggested that heavy use of cannabis in adolescence may cause permanent loss of up to 8 points of IQ.
Neurobiological Consequences of Child Abuse
Charles B. Nemeroff
University of Miami
Genetic, brain imaging and neurotransmitter studies have revealed the long-term consequences of child abuse and neglect and examined how these changes increase vulnerability to mood disorders in adulthood. Exposure to trauma during childhood increases the risk of certain psychiatric disorders beyond the risk associated with adult violence exposure. We have demonstrated a number of long-term neurobiological consequences of child abuse and neglect, including structural and functional brain imaging changes, neuroendocrine and immune alterations. In particular, alterations in the hypothalamic-pituitary-adrenal (HPA) axis, a major mediator of the stress response, contribute to the long-term effects of early life trauma. However, not all exposed individuals demonstrate altered HPA axis physiology, suggesting that genetic variations influence the psychiatric consequences of trauma exposure. Variants in the gene encoding the CRR1 receptor, FKBP5 and others interact with adverse early environmental factors to predict risk for stress-related psychiatric disorders. Studies of the CRF system thus suggest molecular targets for new drug development, biological risk factors, and predictors of treatment response. In addition, the effect of abuse may extend beyond the immediate victim into subsequent generations as a consequence of epigenetic effects transmitted directly to offspring and/or behavioural changes in affected individuals. Recognition of the biological consequences and transgenerational impact of trauma has critical importance for both treatment and research as well as public health policy.
How Your Friends Affect You: Social Networks and Mental Health in Adolescence
Mark A. Pachucki
Massachusetts General Hospital, Boston
The roles that our peers play in shaping mental health during adolescence matter a great deal. Peers inform hundreds of daily decisions about health behaviours in the moment – among them eating and exercise patterns, drinking, drug use, and unsafe sexual behaviour. Through peer reinforcement these choices can be transformed over time into lifelong habits. Identifying peers on the basis of patterns of daily interactions between adolescents can help parents, teachers, and health professionals to target more effective health interventions. I discuss new research on social network dynamics and chart the recent shift toward computational social science for understanding mental health and informing prevention strategies.
Psychosocial Influences on Early Brain Development
University College London
Four main topics are considered. First, does ‘experience-expectant’ biological programming, as shown for the visual cortex, apply to other brain systems? How does ‘experience-adaptive’ programming differ? How do both differ from the changes in brain structure and function that derive from later experiences that do not involve a sensitive period? Do these reflect brain plasticity changes? Second, how do the effects of ‘pure’ psychosocial deprivation on brain growth differ from the effects of subnutrition, and what are the processes involved at the neural level? Third, what is involved in the biological embedding of experiences – such as through epigenetic effects or effects on the HPA axis. Do these account for psychological and psychopathological effects, and do they differentiate between sensitizing and steeling effects? Fourth, gene-environment interactions (GxE) involve chronic early adversity more than later experienced acute stressors. The implication is that the biological causal pathways involved in G and in E effects are close together, and that they extend over a long time frame. What are the biological pathways and how do they operate? Findings on the four topics will be used to consider the challenges for the determination of clinical implications.
Rewiring Faulty Circuits – The Promise of Deep Brain Stimulation for Psychiatry
Thomas E. Schlaepfer
University Hospital Bonn
The introduction of Deep Brain Stimulation for treatment resistant disorders might very well lead to the most significant development in clinical psychiatry of the last forty years – possibly offering a rise of hope for patients to whom medicine had hitherto little to offer. Furthermore, translational research on neuromodulation will allow us to glean something about the underlying cause of patient's illnesses before figuring out a treatment that addresses the source of the problem. Major depression offers perhaps the best example of the rapid progress being made in understanding the biology of mental illness. Studies on the underlying neurobiology of major depression have typically focused on the description of biological differences between patients and healthy subjects such as alterations of monoaminergic or endocrine systems. Psychotropic drugs work by altering neurochemistry to a large extent in widespread regions of the brain, many of which may be unrelated to depression. We believe that more focused, targeted treatment approaches that modulate specific networks in the brain will prove a more effective approach to help treatment-resistant patients. In other words, whereas existing depression treatments approach this disease as a general brain dysfunction, a more complete and appropriate treatment will arise from thinking of depression as a dysfunction of specific brain networks that mediate mood and reward signals. A better understanding of defined dysfunctions in these networks will invariably lead to a better understanding of patients afflicted with depression and perhaps contribute to a de-stigmatization of psychiatric patients and the medical specialty treating them.
Neuroeconomics – Investigating the Biological Foundation of Human Capital Development and Wellbeing
University of Bonn
Personality traits, economic preferences and cognitive abilities are very important determinants of economic and social success. In recent years it has been shown that these cognitive and non-cognitive skills do have predictive value for important economic outcomes. On the other hand, there is growing knowledge about inter-individual variability in the underlying neurophysiological processes related to these skills. These biomarkers allow us to acquire complementary information on inter-individual heterogeneity. While recent research suggests that, e.g., the use of functional imaging methods does provide additional information for surveying measures on the prediction of behaviour changes, larger studies that investigate the actual value of biomarkers for providing additional predictive values for a broader range of economic outcomes and their use in mental disorders are completely missing.
Within this talk, the neurobiological basis of economically relevant will be discussed. The aims will be two-fold: i) to show important biological influences on relevant determinants of economic and social success and ii) to discuss their predictive value above and beyond classical measures from social science. Only with such a combined approach will it be possible to investigate the value of biomarkers as predictors for social and economic outcomes and mental wellbeing.
The Risk of Mental Disorders throughout the Lifespan: Symptom Progression, Critical Trajectories and Consequences for Prevention and Early Targeted Intervention
Technical University Dresden
Epidemiological studies over the past 3 decades have revealed three major results: (1) every year, about 1/3 of the population is affected by mental disorders – some for just a few weeks or months, some persistently. (2) Projections of the lifetime risk reveal that up to age 65 every second person in the general population is affected by a mental disorder at some point in their life. (3) The majority of people affected have an onset of their condition in childhood or adolescence. For many, these data on the size and associated burden of mental disorders are puzzling at first sight. However, one might ask, why should we expect that our brain as the most complex organ of the body is less frequently affected by disease and dysfunction? These results have considerably changed our concepts and models of mental health and mental disorders. The talk presents a developmental perspective of mental health, presents novel symptom-progression and trajectory models, and discusses the value of novel approaches of prevention and early targeted intervention
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