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Introduction: Memory deficiency has been shown in schizophrenia patients, but results on the role of sleep parameters in overnight consolidation of associative verbal memory are still missing. Therefore, the aim of our study was to elucidate underlying processes of impaired sleep-related consolidation of associative word pairs in schizophrenia including standard sleep parameters as well as sleep spindle counts and spectral analysis. Methods: Eighteen stably medicated schizophrenia patients and 24 healthy age-matched controls performed an associative declarative memory task before and after polysomnographic recordings. Part of the participants expected verbal associative memory testing in the morning, while the others did not. Furthermore, participants filled in self-rating questionnaires of schizophrenia-typical experiences (Eppendorf Schizophrenia Inventory [ESI] and Psychotic Symptom Rating Scale). Results: Schizophrenia patients performed worse in verbal declarative memory in the evening as well as in overnight consolidation (morning compared to evening performance). While duration of slow-wave sleep was nearly comparable between groups, schizophrenia patients showed lower sleep spindle count, reduced delta power during slow-wave sleep, and reduced spindle power during the slow oscillation (SO) up-state. In healthy but not in schizophrenia patients, a linear relationship between overnight memory consolidation and slow-wave sleep duration as well as delta power was evident. No significant effect with respect to the expectation of memory retrieval was evident in our data. Additionally, we observed a negative linear relationship between total number of sleep spindles and ESI score in healthy participants. Discussion/Conclusion: As expected, schizophrenia patients showed deficient overnight verbal declarative memory consolidation as compared to healthy controls. Reduced sleep spindles, delta power, and spindle power during the SO up-state may link sleep and memory deficiency in schizophrenia. Additionally, the absence of a linear relationship between sleep-related memory consolidation and slow-wave sleep as well as delta power suggests further functional impairments in schizophrenia. Note that this conclusion is based on observational data. Future studies should investigate if stimulation of delta waves during sleep could improve memory performance and thereby quality of life in schizophrenia.

BACKGROUND AND PURPOSE Many drugs can worsen myasthenia symptoms. The clinician usually relies on cautionary lists compiled according to case reports. We intended to provide a quantitative basis for a risk comparison within the groups of antiepileptic, antidepressant, neuroleptic, and sedative drugs. METHODS We extracted adverse drug reaction (ADR) counts (total and myasthenia related) for drugs from these groups and calculated the reporting odds ratio (ROR) within the drug groups from the World Health Organization pharmacovigilance database. For a given drug, the ROR was increased above 1 if the proportion of myasthenia-related ADRs for this drug was larger than the same proportion for the rest of drugs in that same group. If the 95% confidence interval of ROR was >1, this was taken as a signal for a higher risk of the given drug as compared to the average of the respective group. RESULTS Gabapentin, sertraline, citalopram, lithium, and amisulpride had a signal for the ROR to be increased above 1 within their respective groups. Bupropion, desvenlafaxine, duloxetine, escitalopram, and paroxetine had ROR values

Aversive autobiographical memories play a key role in the development and maintenance of many mental disorders. Imagery rescripting is a well-established psychotherapeutic intervention aiming to create a more adaptive version of an aversive memory by modifying its interpretation. Sleep has been shown to support reconsolidation of updated neutral memories. Here, we investigated in healthy participants whether a 90-min nap compared to wake supports the adaptive reconsolidation of autobiographical memories. Forty-four university students received a single 50-min imagery rescripting session. Thereafter, half of the participants took a 90-min nap, whereas the other half stayed awake. Subjective (arousal ratings, reports of emotions and dysfunctional cognitions) and heart rate (HR) responses to individual memory scripts were measured before the intervention (pre), after the 90-min retention interval (post 1) and 7 days later (post 2). Results demonstrate a significant decrease in distress of aversive memories pre to post imagery rescripting. The nap group showed less distressing dysfunctional cognitions along with a lower HR in response to the negative memory script as compared to the wake group at post 1. These differences were no longer evident 1 week later (post 2). Central sleep spindle density during the nap was correlated with the reduction in HR in response to the negative memory script from pre to post 1. Our results provide first evidence for sleep benefitting adaptive reconsolidation of aversive autobiographical memories. Future research should expand this approach to clinical populations and investigate precise conditions under which sleep may benefit psychotherapeutic interventions utilizing reconsolidation mechanisms.

Zusammenfassung. Hintergrund: Viele Patienten, die im Rahmen einer Entwöhnungstherapie von Wochenend-Heimfahrten zurückkehren, verschweigen ihre Rückfälle. Hier sollte überprüft werden, ob die Therapeuten der Patienten heimliche Rückfälle gut entdecken können. Methodik: In dieser explorativen Studie wurden die Rückfälle von Patienten einer Entwöhnungstherapie anhand von Patientenangaben und Atemalkoholwerten bei Rückkehr in die Therapie und anhand von post hoc ausgewerteten Ethylglukuronid-Bestimmungen im Urin mit den Therapeuteneinschätzungen verglichen. Ergebnisse: Nach der Therapeuteneinschätzung hatte in 1190 von 1501 (79,3 %) erfassten Heimfahrten wahrscheinlich kein Rückfall stattgefunden. In 231 Fällen (15,4 %) hatten die Therapeuten die Rückfallwahrscheinlichkeit mit 40–60 % angegeben. In 80 Fällen (5,3 %) nahmen sie einen Rückfall auf der Heimfahrt als sehr wahrscheinlich (70–100 %) an. Der Vergleich der Therapeuteneinschätzungen mit den EtG-Bestimmungen zeigte keine Übereinstimmung (Kappa .077), d. h. viele Rückfälle waren von den Therapeuten nicht erkannt worden. Schlussfolgerungen: Die Ergebnisse zeigen, dass die Therapeuten die Rückfallhäufigkeit von Patienten während der Heimfahrten am Wochenende während einer Langzeittherapie deutlich unterschätzten. Um Rückfälle konstruktiv in der Therapie aufarbeiten zu können, sollten diese deshalb mit laborchemischen Methoden wie der EtG-Bestimmung gesichert werden.

Zusammenfassung Hintergrund Multimorbidität stellt eine große Herausforderung in der Altersmedizin dar. Methodik Darstellung explorativer Daten aus der Gerontopsychiatrie Studie Berlin (Gepsy-B), in der über einen Zeitraum von 3 Jahren Daten von 941 älteren stationären Patienten erfasst wurden. Ergebnisse 94,2 % der Patienten litten an zumindest einer chronischen somatischen Erkrankung, im Mittel an 2,70 + 1,39, wobei die Anzahl mit dem Alter stieg (r = 0,257, p Schlussfolgerung Ältere psychiatrisch erkrankte Patienten haben oft zugleich eine ausgeprägte somatische Multimorbidität, die den Behandlungserfolg wesentlich mit beeinflussen dürfte.

ZusammenfassungEine Alkoholintoxikation ist der häufigste Grund für eine psychiatrische Konsultation in Notfallambulanzen von Krankenhäusern. Viele der betroffenen Patienten verweigern eine adäquate Überwachung und Behandlung. In diesen Fällen muss dann der Dienstarzt entscheiden, ob eine Entlassung medizinisch vertretbar ist. Dabei muss insbesondere die Frage der Einwilligungsfähigkeit des Patienten geklärt werden. Das Risiko einer erheblichen unmittelbaren Eigengefährdung durch Unfälle, komplizierten Alkoholentzug oder Suizid und das Risiko der unmittelbaren Fremdgefährdung durch aggressives Verhalten gegenüber Dritten muss in der Entscheidung angemessen berücksichtigt werden. In dem Artikel werden die wesentlichen Punkte beim Notfall-Management von Alkoholintoxikierten erörtert und in Checklisten zusammengefasst.

Autism spectrum disorder (ASD) is characterized by difficulties in social communication and interaction, which have been related to atypical neural processing of rewards, especially in the social domain. Since intranasal oxytocin has been shown to modulate activation of the brain’s reward circuit, oxytocin could be a useful tool to ameliorate the processing of social rewards in ASD and thus improve social difficulties. In this randomized, double-blind, placebo-controlled, crossover fMRI study, we examined effects of a 24 IU dose of intranasal oxytocin on reward-related brain function in 37 men with an ASD diagnosis and 37 age- and IQ-matched control participants. Participants performed an incentive delay task that allows the investigation of neural activity associated with the anticipation and receipt of monetary and social rewards. Apart from a specific interaction effect in a single voxel within the left amygdala during the receipt of rewards, oxytocin did not influence neural processes related to the anticipation or consumption of social or monetary rewards in either group. Exploratory analyses suggested that oxytocin may increase ventral striatum sensitivity to monetary, but not social rewards, in individuals with high levels of self-reported anxiety, depression, alexithymia, and autistic traits irrespective of an ASD diagnosis. There were no significant differences in reward-related brain function between the two groups under placebo. Overall, our results do not support the hypothesis that intranasal oxytocin generally enhances activation of reward-related neural circuits in men with and without ASD without intellectual impairment. How and if oxytocin can be beneficial in the treatment of social difficulties in ASD needs to be addressed by examining moderating influences of individual differences and context on reward-related oxytocin effects.

Sleep disorders increase in prevalence and intensity with aging and often become chronic. Cognitive Behavioral Therapy of Insomnia (CBT-I) and the 3 P model of insomnia allows to differentiate between predisposing, precipitating and perpetuating factors influencing insomnia and to attenuate their effects. This treatment usually is the better alternative to long-term prescription of hypnotic medication. Its principles are outlined here.Schlafstörungen treten im Verlauf des Alterns vermehrt auf und neigen zur Chronifizierung. Mithilfe der Kognitiven Verhaltenstherapie der Insomnie (CBT-I) lassen sich nichtorganische Schlafstörungen in ihrer Entstehung und Aufrechterhaltung besser verstehen und mit gezielten Interventionen mildern oder beseitigen. Es ist oft die bessere Alternative zur langzeitigen Verschreibung von Schlafmitteln.

Introduction Major depressive disorder (MDD) and obesity are both common disorders associated with significant burden of disease worldwide. Importantly, MDD and obesity often co-occur, with each disorder increasing the risk for developing the other by about 50%–60%. Statins are among the most prescribed medications with well-established safety and efficacy. Statins are recommended in primary prevention of cardiovascular disease, which has been linked to both MDD and obesity. Moreover, statins are promising candidates to treat MDD because a meta-analysis of pilot randomised controlled trials has found antidepressive effects of statins as adjunct therapy to antidepressants. However, no study so far has tested the antidepressive potential of statins in patients with MDD and comorbid obesity. Importantly, this is a difficult-to-treat population that often exhibits a chronic course of MDD and is more likely to be treatment resistant. Thus, in this confirmatory randomised controlled trial, we will determine whether add-on simvastatin to standard antidepressant medication with escitalopram is more efficacious than add-on placebo over 12 weeks in 160 patients with MDD and comorbid obesity.Methods and analysis This is a protocol for a randomised, placebo-controlled, double-blind multicentre trial with parallel-group design (phase II). One hundred and sixty patients with MDD and comorbid obesity will be randomised 1:1 to simvastatin or placebo as add-on to standard antidepressant medication with escitalopram. The primary outcome is change in the Montgomery-Åsberg Depression Rating Scale (MADRS) score from baseline to week 12. Secondary outcomes include MADRS response (defined as 50% MADRS score reduction from baseline), MADRS remission (defined as MADRS score

Multimorbiditat stellt eine grose Herausforderung in der Altersmedizin dar; unter anderem stellt sich die Frage, wo eine adaquate Behandlung stattfinden soll. Methodik: Explorative Datenauswertung der Gerontopsychiatrie Studie Berlin (Gepsy-B), in deren Rahmen die Daten von 1266 binnen 3 Jahren stationar psychiatrisch aufgenommenen alteren Patienten (>65 Jahre) eines Versorgungskrankenhauses in Berlin ausgewertet wurden. Ergebnisse: Bei 17,4 % der in die Psychiatrie aufgenommenen Falle war eine Verlegung in eine somatische Klinik erforderlich. Sie betraf besonders Patienten mit Multimorbiditat (Anzahl der somatischen Diagnosen: 11,7 + 3,7 vs. 9,9 + 3,8, U‑test p

Zusammenfassung Hintergrund Das Delir ist eine häufige Komplikation nach Herzoperationen und mit negativen Folgen wie erhöhter Mortalität und Morbidität verbunden. Daher ist die Kenntnis von Risikofaktoren für präventive Maßnahmen erforderlich. Fragestellung Welches sind prädisponierende Risikofaktoren des Delirs? Methodik Prospektive Longitudinalstudie an 241 elektiven herzchirurgischen Patienten mit präoperativer Erhebung potenzieller Risikofaktoren und zweifach täglicher Delirmessung über die ersten 5 postoperativen Tage. Ergebnisse 13 % der Patienten erlitten ein Delir. Verminderte kognitive Leistungsfähigkeit (OR: 3,80; 95 %-KI: 1,66 – 8,66), höhere Komorbidität (OR: 1,36; 95 %-KI: 1,07 – 1,73) und höheres Alter (OR: 1,08; 95 %-KI: 1,02 – 1,13) konnten als Risikofaktoren für ein Delir ermittelt werden. Schlussfolgerung Ein Delir nach Herzoperation ist häufig. Insbesondere kognitiv eingeschränkte, kränkere, ältere Patienten sind betroffen.

Delirium tremens is one of the most common complications of alcohol withdrawal. It is potentially lethal and therefore should be detected as early as possible and be monitored and treated intensively. The assessment of risk factors with the Luebeck Alcohol-Withdrawal Risk Scale short form (LARS-11) can help to predict the risk of severe withdrawal adequately. As delirium cannot be differentiated from Wernicke-Encephalopathy with sufficient certainty high parenteral doses of Vitamin B1 and Magnesium orally should be given in case of any severe withdrawal symptoms. According to guidelines delirium tremens should be treated with benzodiazepines besides adequate electrolyte and fluid substitution. Haloperidol is often additionally given to better control hallucinations. Delirium tremens usually subsides within 10 days of treatment.The article gives an overview of alcohol withdrawal with its different facets, its differential diagnoses, and the treatment options.

Multimorbidity in older psychiatric patients.Multimorbidity represents a great challenge in the medical care of older people.This exploratory study was part of the Gerontopsychiatry study Berlin (Gepsy-B), an analysis of data on all 941 older inpatients (65 years) admitted to a psychiatric hospital within a period of 3 years.Nearly all patients (94,2 %) suffered from a chronic somatic disorder. The mean number of chronic somatic disorders was 2.70 + 1.39 and showed age dependency (r = 0.257, p.001). The most prevalent disorders were cerebrovascular disorders (56.5 %), hypertension (54.8 %), chronic ischemic heart diseases or arrhythmias (52.2 %) and diabetes mellitus type II (37.5 %). Furthermore, many of the patients suffered from disabilities such as movement disorders (26.2 %), severe hearing loss (16.5 %), incontinence (15.1 %) or severely reduced vision (7.4 %). Organic brain disorders were more often associated with chronic somatic disorders or disabilities.Older patients treated for psychiatric disorders very often show somatic multimorbidity that probably limit treatment outcome.Multimorbidität stellt eine große Herausforderung in der Altersmedizin dar.Darstellung explorativer Daten aus der Gerontopsychiatrie Studie Berlin (Gepsy-B), in der über einen Zeitraum von 3 Jahren Daten von 941 älteren stationären Patienten erfasst wurden.94,2 % der Patienten litten an zumindest einer chronischen somatischen Erkrankung, im Mittel an 2,70 + 1,39, wobei die Anzahl mit dem Alter stieg (r = 0,257, p,001). Die häufigsten waren zerebrovaskuläre (56,5 %) und Herzerkrankungen (52,2 %) sowie Hypertonus (54.8 %) und Diabetes mellitus Typ II (37,5 %). Zusätzlich litten viele Patienten an schweren körperlichen Beeinträchtigungen wie Bewegungsstörungen (26,2 %), schwerer Hypakusis (16,5 %), Inkontinenz (15,1 %) und ausgeprägter Sehminderung (7,4 %). Organische Hirnschädigungen waren dabei besonders häufig mit chronischen somatischen Erkrankungen oder Beeinträchtigungen assoziiert.Ältere psychiatrisch erkrankte Patienten haben oft zugleich eine ausgeprägte somatische Multimorbidität, die den Behandlungserfolg wesentlich mit beeinflussen dürfte.

Alcohol intoxication is the most common psychiatric cause of admission to German emergency rooms. Many of these patients refuse inpatient observation or treatment. Therefore, the physician in charge will have to decide on how to proceed. The capacity to consent has to be clarified, especially if the patient insists on being discharged. In this context, the risks of injuries, complicated alcohol withdrawal, and aggressive or suicidal behaviour have to be evaluated. In this article, the juridical aspects and the necessary mental and physical assessments, especially in case of discharge of the patient against medical advice, are presented. Essential aspects are summarized in checklists.Eine Alkoholintoxikation ist der häufigste Grund für eine psychiatrische Konsultation in Notfallambulanzen von Krankenhäusern. Viele der betroffenen Patienten verweigern eine adäquate Überwachung und Behandlung. In diesen Fällen muss dann der Dienstarzt entscheiden, ob eine Entlassung medizinisch vertretbar ist. Dabei muss insbesondere die Frage der Einwilligungsfähigkeit des Patienten geklärt werden. Das Risiko einer erheblichen unmittelbaren Eigengefährdung durch Unfälle, komplizierten Alkoholentzug oder Suizid und das Risiko der unmittelbaren Fremdgefährdung durch aggressives Verhalten gegenüber Dritten muss in der Entscheidung angemessen berücksichtigt werden. In dem Artikel werden die wesentlichen Punkte beim Notfall-Management von Alkoholintoxikierten erörtert und in Checklisten zusammengefasst.

Delirium tremens is one of the most common complications of alcohol withdrawal. It is potentially lethal and therefore should be detected as early as possible and be monitored and treated intensively. The assessment of risk factors with the Luebeck Alcohol-Withdrawal Risk Scale short form (LARS-11) can help to predict the risk of severe withdrawal adequately. As delirium cannot be differentiated from Wernicke-Encephalopathy with sufficient certainty high parenteral doses of Vitamin B1 and Magnesium orally should be given in case of any severe withdrawal symptoms. According to guidelines delirium tremens should be treated with benzodiazepines besides adequate electrolyte and fluid substitution. Haloperidol is often additionally given to better control hallucinations. Delirium tremens usually subsides within 10 days of treatment. The article gives an overview of alcohol withdrawal with its different facets, its differential diagnoses, and the treatment options.

Hintergrund Schlaf ist wichtig fur die Gedachtniskonsolidierung. Ein chronischer Konsum von 0,4 g Alkohol/kg Korpergewicht (KG) beeintrachtigt die kognitiven Fahigkeiten. Eine kunstliche Erhohung von Cortisol in der ersten Nachthalfte beeintrachtigt die deklarative Gedachtniskonsolidierung und Alkohol kann die Cortisolsekretion stimulieren.

Hintergrund: Beim malignen neuroleptischen Syndrom (MNS) handelt es sich um ein potenziell lebensbedrohliches medikamenteninduziertes Krankheitsbild. Die Kernsymptomatik besteht aus Hyperthermie ohne Infektnachweis, Diaphorese (Schwitzen), Rigor der Skelettmuskulatur, wechselnder Bewusstseinsstorung und Erhohung der Kreatinkinase im Blut. Ferner besteht eine vegetative Dysfunktion mit Herzfrequenz- und Blutdruckschwankungen. Ziel dieser Ubersichtsarbeit ist es, die aktuelle Studienlage zusammenzufassen und die Diagnosestellung des MNS bzw. die Abgrenzung von anderen Syndromen zu erleichtern. Daruber hinaus werden die therapeutischen Optionen, die beim MNS zu Verfugung stehen, erortert. Methode: Es wurde eine systematische Literaturrecherche durchgefuhrt. Es wurden Bucher, Fallberichte und Leitlinien eingeschlossen. Ergebnisse: In dieser Ubersichtsarbeit werden die aktuell gangigen diagnostischen Kriterien, die Differenzialdiagnose, die vermutete Atiopathogenese und mogliche therapeutische Interventionen dargestellt. Schlussfolgerung: Das fruhe klinische Erscheinungsbild ist heterogen und macht die Diagnostik nicht leicht. Dabei ist eine fruhe Behandlung wichtig fur eine gute Prognose und rasche Ruckbildung. Die Therapieoptionen richten sich nach der bisherigen klinischen Erfahrung auf der Basis von Einzelfallberichten und Expertenmeinungen. Bei der Diagnosestellung sollten die Kernsymptome beachtet werden: Einnahme von Dopamin-Antagonisten, Hyperthermie, Diaphorese, Rigor, Bewusstseinsstorungen, CK-Erhohung und vegetative Dysregulation.

Objectives Deficits in declarative memory performance are among the most severe neuropsychological impairments in schizophrenia and contribute to poor clinical outcomes. The importance of sleep for brain plasticity and memory consolidation is widely accepted, and sleep spindles seem to play an important role in these processes. The aim of this study was to test the associations of sleep spindles and picture memory consolidation in patients with schizophrenia and healthy controls. Methods We studied 16 patients with schizophrenia on stable antipsychotic medication (mean age ± standard deviation, 29.4 ± 6.4 years) and 16 healthy controls matched for age and educational level. Sleep was recorded and scored according to American Academy of Sleep Medicine (AASM) standard criteria. We performed a picture recognition paradigm and compared recognition performance for neutral and emotional pictures in sleep and wake conditions. Results Recognition accuracy was better in healthy controls than in patients with schizophrenia in the sleep and wake conditions. However, the memory-promoting effect of sleep was significantly lower in schizophrenia patients than in controls. Sleep spindle activity was reduced in patients, and sleep spindle density was correlated with sleep-associated facilitation of recognition accuracy for neutral pictures. Conclusion Reduced sleep spindles seem to play an important role as a possible mechanism or biomarker for impaired sleep-related memory consolidation in patients with schizophrenia, and are a new target for treatment to improve memory functions and clinical outcomes in these patients.

Alpha/theta neurofeedback training is supposed to enhance cognitive performance as well as alleviate psychiatric disorders. Sleep during this training is regarded a confounding factor, although it is usually not controlled. Here, the amount of sleep, the impact of sleep on frequency results and the validity of subjective judgments of having fallen asleep were investigated. 40 healthy young subjects participated in 31 training units of real or mock feedback. It turned out that stage 2 sleep occurred in 10-14 % of training time, in 95 % of the subjects and in 1/3 of all training units. Sleep significantly influenced the theta/alpha ratio and theta but not alpha amplitudes. Only about 2/3 of the subjective judgements were correct and no more than 13 % of the participants could reliably identify sleep. These data demonstrate that sleep can easily occur during alpha/theta neurofeedback training and should be controlled by objective means.

Multimorbidity is an increasing challenge in geriatric medicine, also in psychiatric patients. The question arises where an adequate treatment should be carried out.This exploratory study was part of the Gerontopsychiatry study Berlin (Gepsy-B), an investigation of all admissions of older inpatients (65 years) to a psychiatric hospital within 3 years. A total of 1266 admissions to a hospital in Berlin could be analyzed.Of the patients primarily admitted to the psychiatric department, 17.4% had to be transferred to a somatic department with a preponderance of patients with higher multimorbidity (11.7 ± 3.7 vs. 9.9 ± 3.8 somatic diagnoses, U‑test p 0.001). Of the patients 19.7% were transferred from somatic departments to the psychiatric department mainly due to delirium. They were also often multimorbid (mean number of somatic diagnoses: 11.7 + 3.7 vs. 10.3 + 3.8, U‑test p 0.001).Multimorbidity results in more frequent transfer of older patients in hospital.

Objective This study was conducted to evaluate the effectiveness of a cognitive behavioral self-help program (SHP) in combination with pharmacotherapy in patients with primary insomnia in general practice. Participants Patients were recruited from 31 general practitioners (GPs) in the Hamburg area, who were randomly assigned to the two different study conditions. Eighty patients completed the study. They had suffered from insomnia for several years and showed a high impairment according to the Pittsburgh Sleep Quality Index. Intervention According to assignment of their GP the patients either received a progressively reduced 4-week pharmacotherapy or a combination of pharmacotherapy and a SHP consisting of six chapters on progressive muscle relaxation, cognitive relaxation, modified stimulus control, thought stopping, and cognitive restructuring. Measures and results After study enrollment patients had short weekly consultations with their GPs during treatment to receive sleep medication and questionnaires. They completed questionnaires measuring general sleep quality and sleep-disruptive beliefs and also sleep diaries before treatment, during treatment, immediately following treatment, and at a 6-week and 6-month follow-up time point. For collection of changes in mood the Beck Depression Inventory was used. The whole sample showed reductions of sleep onset latency and time awake after sleep onset. Total sleep time increased and mood improved. Patients additionally working with the SHP showed significantly more improvements in sleep quality and negative sleep-related cognitions like ruminating and focusing on sleep. Treatment effects were significant at the end of therapy and remained stable at the six-week and six-month follow-up. Conclusion This study supports the use of a cognitive-behavioral SHP on primary insomnia in the setting of a general practice and should be investigated in more detail. Also, regular appointments and the utilization of sleep logs seem to have a positive influence on sleep disorders.

Alcohol dependence (AD) is the most serious form of alcohol-use disorder. AD is associated with intense mental, physical, and functional impairment; high societal costs; and long-term suffering by both the dependent individual and the individual’s family members (e.g., Caetano, Nelson, & Cunradi, 2001). However, AD is also fairly widespread, with a 12-month prevalence rate of nearly 4% in the general population (Hasin, Stinson, Ogburn, & Grant, 2007). Despite the development and implementation of several empirically supported treatments, only about 25% of clients have been found to remain abstinent during the first year following treatment termination (Miller, Walters, & Bennett, 2001). Thus, there is a strong and pressing need to improve the efficacy of treatment for AD. According to the relapse prevention model proposed by Marlatt and colleagues (Marlatt & Witkiewitz, 2005), relapse is likely to occur when at-risk individuals are confronted with high-risk situations and lack the coping skills necessary to deal with such situations effectively. Consistent with this model, a number of studies have focused on identifying specific high-risk situations. Extensive evidence from these studies has shown that negative affect is one of the most prominent factors associated with relapse to maladaptive drinking. First, AD is highly associated with affect-related disorders, such as anxiety, depression, and borderline personality disorder (Gregory et al., 2008; Hasin et al., 2007), and individuals with co-occurring symptoms of these disorders display significantly higher rates of relapse after treatment (Bradizza, Stasiewicz, & Paas, 2006). Second, the majority of clients retrospectively attribute relapse to negative affective states (Lowman, Allen, & Stout, 1996; Zywiak, Connors, Maisto, & Westerberg, 1996). Third, negative affect -- such as stress/nervousness, anxiety, anger, dysphoric/depressed mood, feelings of loneliness/uselessness/boredom -- predicts subsequent desire to drink/drinking-level in epidemiological studies and relapse in treatment-outcome studies (Falk, Yi & Hilton, 2008; Gamble et al., 2010; Hodgins, el-Guebaly, & Armstrong, 1995; Swendsen et al., 2000; Willinger et al., 2002). Fourth, in laboratory paradigms, the induction of negative affect was shown to predict increased urges to drink and increased expectancies of relief after drinking (Cooney, Litt, Morse, Bauer & Gaupp, 1997; Birch et al., 2004; Sinha et al., 2009). Fifth, interventions focusing on the reduction of depressed mood or anxiety symptoms have been shown to decrease relapse and severity of alcohol use disorders (Brown, Evans, Miller, Burgess, & Mueller, 1997; Watt, Stewart, Birch, & Bernier, 2006), and interventions with a strong focus on emotion-regulation skills, such as dialectical behavioral therapy (Linehan, 1993a) have been shown to reduce substance use (including alcohol) in clients suffering from borderline personality disorder (Harned et al., 2008; Linehan et al., 2002). Finally, evidence suggests that although alcohol may initially reduce negative affect to some extent (Armeli et al., 2003; Kushner et al., 1996; Swendsen et al., 2000), maladaptive use eventually leads to the continuation and potential increase of such affect, thereby generating a vicious cycle contributing to the chronic and escalating nature of AD (Heinz et al., 1998; Koob & Le Moal, 2001; Witkiewitz & Villarroel, 2009). In line with these findings, a number of theories contend that affect regulation is a primary motive for alcohol use; such models include the affective processing model (Baker, Piper, McCarthy, Majeskie, & Fiore, 2004), the motivational model of alcohol use (Cox & Klinger, 1988; Cooper, Frone, Russel, & Mudar, 1995), the stress and negative affect model (Colder & Chassin, 1993), the self-medication model (Khantzian, 1997), the stress response dampening theory (Levenson, Sher, Grossman, Newman, & Newlin, 1980), and the tension reduction hypothesis (Conger, 1956). The implication of these models is that emotion-regulation skills (i.e., skills relevant for “monitoring, evaluating, and modifying emotional reactions, especially their intensive and temporal features, to accomplish one’s goals”; Thompson, 1994, pp. 27-28), should be important -- if not essential -- for preventing relapse in AD. This hypothesis received preliminary support from studies demonstrating that trait emotional intelligence (defined as the ability to be aware of emotions, identify emotions correctly and modify emotions effectively) was negatively associated with alcohol-related problems (Riley & Schutte, 2003) and that emotional intelligence moderated the association between negative emotions and craving for alcohol in AD patients (Cordovil de Sousa Uva et al., 2010). Additional research has shown that abstinent alcoholics report more difficulty effectively regulating their emotions than do social drinkers (Fox, Hong, & Sinha, 2008). However, research has yet to investigate the predictive effects of emotion-regulation skills on alcohol use during and after treatment. To facilitate the utilization of the emotion-regulation framework for clinical purposes, Berking (2010) has synthesized and expanded upon previous theories (e.g., Gross, 1998; Larsen, 2000; Saarni, 1999; Greenberg, 2002) and proposed a skill-based model of emotion regulation. According to the Adaptive Coping with Emotions (ACE) Model (Berking, 2010), effective emotion regulation can be conceptualized as the situation-adapted interplay of the abilities to (a) be aware of emotions, (b) identify and label emotions, (c) correctly interpret emotion-related body sensations, (d) understand the prompts of emotions, (e) actively modify negative emotions to feel better, (f) accept negative emotions when necessary, (g) tolerate negative emotions when they cannot be changed, (h) confront (vs. avoid) distressing situations in order to attain important goals, and (i) compassionately support (encourage, self-soothe) oneself in emotionally distressing situations (in order to counterbalance potential short-term negative effects that engagement in the other skills may have on one’s emotions). Empirical studies have shown that all skills included in the ACE model are significantly associated with various indicators of mental health in clinical and at-risk populations (Berking et al., 2010; Berking, Meier, & Wupperman, 2010; Berking, Orth, Wupperman, Meier, & Caspar, 2008; Berking, Wupperman, et al. 2008; Berking & Znoj, 2008). However, research has not yet investigated whether these skills are associated with AD and whether they facilitate abstinence during or after treatment for AD. In addition, as deficient emotion-regulation skills are likely to be associated with other potential predictors of relapse, such as symptom severity (Langenbucher, Sulesund, Chung, & Morgenstern, 1996), degree of comorbidity (Tate, Brown, Unrod, & Ramo, 2004), cognitive abilities (Blume, Schmaling, & Marlatt, 2005), and negative mood (Hodgins et al., 1995), it is important to investigate whether emotion-regulation skills predict alcohol use beyond these additional factors. Moreover, there is a lack of research comparing the emotion-regulation skills of populations with alcohol-use disorders with those of other clinical populations. Although some evidence exists for the transdiagnostic nature of emotion-regulation skills (Aldao, Nolen-Hoeksema, & Schweizer, 2010), deficits in these skills may be more integral to some disorders than to others. For example, in the emotional disorders (i.e. depression and anxiety) the inability to effectively regulate dysfunctional emotions can be conceptualized as the core of these disorders (Moses & Barlow, 2006); whereas in disorders such as AD, deficits in these skills might be seen as one relevant factor among many that contribute to the onset and maintenance of the disorder (Marlatt & Donovan, 2005). Finally, few studies have assessed a broad range of emotion-regulation skills in order to identify the skills most strongly associated with (changes in) psychopathological symptoms (e.g. Berking, Wupperman, et al., 2008) -- and thus the skills that should be considered important targets in treatment. At this point, no such study is available for AD. Therefore, the major aim of the present study was to test the primary hypotheses that (1) more effective pretreatment emotion-regulation skills would negatively predict alcohol use during treatment and (2) more effective posttreatment emotion-regulation skills would negatively predict alcohol use during the three months following termination of treatment; even when controlling for other predictors potentially related to emotion regulation. Additionally, we investigated whether, (a) more effective pretreatment emotion-regulation skills would be associated with lower pretreatment AD symptom severity, (b) AD patients would report less successful emotion-regulation than did non-clinical controls, but more successful emotion-regulation than did patients meeting criteria for major depressive disorder (MDD), and (c) specific emotion-regulation skills could be identified as particularly important in negatively predicting alcohol use during and after treatment for AD.

Die Befundlage, dass appetitregulierenden Hormonen wie Leptin, Ghrelin, Resistin, Adiponektin und Insulin im Rahmen der Alkoholabhangigkeit neben Veranderungen der HPA-Achse und Modulation der dopaminergen, serotonergen, noradrenergen, GABAergen etc. Neurotransmission-Bedeutung zukommt, hat sich in den letzten Jahren zunehmend verdichtet. Nachdem diese Hormone wahrscheinlich bei Alkoholabhangigkeit und Essstorungen gemeinsamen Mechanismen unterliegen, ist auch eine Verbindung zu craving vorstellbar. Daruber hinaus wird die Bedeutung von Pro- Opiomelanocortin (POMC) als integrierendem Faktor diskutiert.

Background. The importance of sleep for memory consolidation has become a major focus of research. While it is known that abstaining alcohol-dependent patients often have sleep disorders and that there is some cognitive impairment during early abstention a possible interaction of disturbed sleep with overnight memory consolidation has not been addressed in a study as yet. Methods. Twenty-four alcohol-dependent patients with a short abstention period (mean 21.9 ± 7.6 days) were compared with 12 patients with an abstention period of several months (115.7 ± 43.8 days). Groups did not differ with respect to daily alcohol consumption before treatment, duration of alcohol dependence, and age. Before sleep all patients learned a list of semantically associated word pairs and a face name association task to a fixed criterion (at least 60% of correct recall) and they performed a mirror tracing task. After a polysomnographically registered night the patients were tested for retention of the learned declarative material by cued recall and had to perform the mirror tracing task again. Results. The groups did not differ with respect to sleep parameters or sleep-associated memory consolidation. Across both groups the duration of alcohol dependence correlated negatively with the amount of non-REM sleep and recall in the face name association task correlated negatively with daily alcohol consumption before abstention. Among the longer-term abstainers the duration of abstention correlated with the amount of slow wave sleep. Conclusions. Our data support the hypothesis that chronic and high alcohol consumption negatively affects sleep and declarative memory consolidation during the first months of abstention. Between an abstention period of a few weeks and of several months no change in sleep parameters and nightly memory consolidation could be demonstrated, however.

Background: Ghrelin is a 28-amino acid gut-brain peptide, mainly secreted by the gastric mucosa. Its effects are linked to energy homeostasis and particularly seem to increase hunger and food intake. In recent years, studies suggested that appetite-regulating peptides, such as ghrelin play a relevant role in alcoholism. Since data published to date on the potential role of ghrelin as state and/or trait marker in alcoholism and the association with craving are controversial, we aimed at further elucidating these aspects. Patients and Methods: One-hundred nine alcohol-dependent abstinent patients after withdrawal (27 f, 82 m), (ICD 10 F 10.25) and 45 healthy volunteers (12 f, 33 m) were included. Laboratory testing (Ghrelin RIA 90, Mediagnost Inc., Germany) was performed and several craving scales [Obsessive Compulsive Drinking Scale, Alcohol Urge Questionnaire and Visual Analogue Scale (VAS)] were applied at the beginning and at the end of the 3-week rehabilitation program. Results: (1) Ghrelin levels are significantly higher in female alcohol-dependent patients as compared to controls, not, however, in men alcoholics. (2) In several statistical subanalyses, an association of craving and ghrelin was found. The results, however, remain heterogeneous. Conclusion: The data suggest gender-dependent ghrelin levels in alcohol-dependent patients. We therefore conclude, that it might be useful to perform statistical analyses gender-specific. With regard to a potential correlation of ghrelin and craving the results seem to depend on gender, duration of the abstinence period and the instrument used.

Evidence is growing that appetite regulating peptides such as leptin and ghrelin, but also other hormones including prolactin are altered in alcoholism. The brain pro-opiomelanocortin (POMC) system which has important mediating roles in alcohol intake also has important functions in prolactin regulation and energy homeostasis. Furthermore, it has been demonstrated to be functionally integrated with leptin regulation. The satiety factor leptin seems to be counteracted by the gut-derived peptide ghrelin which increases hunger and food intake. Consequently, the POMC system may have a role in integrating regulation of alcohol effects and these seemingly disparate regulatory systems. The goal of this mini-review is to discuss the results of some recent investigations of the potential interactions of these systems with acute and chronic alcohol responses.

Hypothalamo-pituitary-adrenocorticoid (HPA)-axis reactivity to psychosocial or pharmacological stimulants is diminished in alcohol-dependent patients during early abstinence but recovers after several months of abstention. In order to assess the physiological reactivity in the morning we used the cortisol awakening response (CAR) in saliva to compare 24 early abstainers (mean 21.9+/-7.6, range 10-36 days) with 12 alcohol-dependent patients with longer abstention periods (mean 116.8+/-45.7, range 59-230 days) and looked for an association with sleep, especially rapid eye movement (REM) sleep of the preceding night. Both groups did not differ with respect to age, duration of alcohol dependence, daily drinking dosage before detoxification, body mass index, depressivity, level of anxiety, daily cigarette consumption or sleep quality during the preceding 14 days. Sleep in the night before cortisol assessment did not differ with respect to total sleep time (412.4+/-35.9 vs. 407.0+/-38.7 min). Immediately upon awakening and 15, 30, 45 and 60 min later, specimens of salivary cortisol were collected. While starting from equal levels upon awakening longer abstaining patients with alcohol dependence showed a stronger CAR (ANOVA with repeated measurement, time x group effect: F=4.33, p0.01) with distinctly higher cortisol levels 45 and 60 min after awakening (T=3.79, p0.001 and T=3.06, p0.005, respectively). Across both groups the time spent in REM-sleep only correlated with cortisol levels upon awakening (r=0.33, p0.05). Our data indicate that CAR is a useful tool for investigating alterations in the HPA-axis regulation in abstaining alcohol-dependent patients.

A central cognitive function of sleep is to consolidate newly acquired memories for long-term storage. Here, we investigated whether the overnight consolidation of declarative memory in patients with chronic sleep disturbances is impaired, owing to less slow wave sleep (SWS) and an increased cortisol release.Polysomnographic recordings, serum cortisol concentrations, and overnight memory consolidation in 16 patients with primary insomnia were compared with those of 13 healthy control subjects.Patients displayed distinctly less overnight consolidation of declarative memory (p.05), which was significantly correlated with SWS in the control subjects (r = .69) but with rapid eye movement (REM) sleep in the patients (r = .56), who had a diminished amount of SWS (p.05). Increased cortisol levels in the middle of the night were associated with impaired retrieval of declarative memory after sleep for both control subjects (r = -.52) and patients (r = -.46).Primary insomnia is associated with a diminished sleep-related consolidation of declarative memory. Efficient overnight consolidation of declarative memory is associated with high amounts of SWS and low serum cortisol levels during the early part of the night. Where SWS is decreased, REM sleep might play a partly compensatory role in the consolidation of declarative memory.

Background and purpose To investigate the impact of a short daytime nap on procedural and declarative memory consolidation. Patients and methods Following a normal night's sleep, 34 young healthy subjects were randomly assigned to a nap or wake condition of about 45 min in the early afternoon after learning procedural and declarative memory tasks. Subjects were controlled for alertness and cortisol secretion. Results The afternoon naps were dominated by sleep stage 2 but contained some slow wave sleep (SWS) and rapid eye movement (REM) sleep as well. Naps significantly improved procedural, but not declarative, memory. Females showed more improvement than males in the declarative memory tasks irrespective of nap or wake. There was no difference between groups with respect to cortisol secretion or alertness. Conclusions A short nap is favorable for consolidation of procedural memory. The possibly confounding effect of gender should always be considered in research on sleep and memory.

In obsessive-compulsive disorder (OCD), a dysfunction of neuronal circuits involving prefrontal areas and the basal ganglia is discussed that implies specific oculomotor deficits. Performance during reflexive and predictive saccades, antisaccades and predictive smooth pursuit was compared between patients with OCD (n=22), patients with schizophrenia (n=21) and healthy subjects (n=24). Eye movements were recorded by infrared reflection oculography. In both patient groups, higher frequencies of anticipatory saccades with reduced amplitudes in the predictive saccade task were observed. Additionally, reduced smooth pursuit eye velocity and increased frequencies of saccadic intrusions during smooth pursuit as well as increased error rates in the antisaccade task were demonstrated for patients suffering from schizophrenia. Patients with OCD and schizophrenia revealed different patterns of oculomotor impairment: whereas increased anticipation of predictive saccades provides evidence for a dysfunction of the circuit between the frontal eye field and the basal ganglia in both groups, results from the antisaccade task imply additional deficits involving the dorsolateral prefrontal cortex in schizophrenic patients. Furthermore, the cortical network for smooth pursuit (especially the frontal eye field) is also assumed to be disturbed in schizophrenia.

ResumenSe interrogó a 30 pacientes hospitalizados varones dependientes de alcohol sin trastorno depresivo concurrente, 13 de ellos con antecedentes familiares positivos de dependencia de alcohol en un familiar en primer grado (AFP), sobre su deseo y hábitos de consumo con respecto a cigarrillos, café y dulces mientras estaban en un tratamiento hospitalario de tres semanas después de la deshabituación de alcohol. Seis semanas después del alta del hospital, se evaluó de nuevo a los pacientes en cuanto a la recaída. Once pacientes (36,6%) habían recaído en el seguimiento. Los que recayeron eran más jóvenes que los que se abstuvieron. Los días hasta la recaída correlacionaban negativamente con la intensidad del deseo de beber alcohol, el deseo de fumar cigarrillos y con un consumo más alto de cigarrillos. Los pacientes con AFP no recaían antes pero tenían un deseo más fuerte de beber café y comer dulces y tenían un consumo más alto de café.

Chronic alcohol consumption is associated with an increased risk for upper aerodigestive tract cancer and hepatocellular carcinoma. Increased acetaldehyde production via alcohol dehydrogenase (ADH) has been implicated in the pathogenesis. The allele ADH1C*1 of ADH1C encodes for an enzyme with a high capacity to generate acetaldehyde. So far, the association between the ADH1C*1 allele and alcohol-related cancers among heavy drinkers is controversial. ADH1C genotypes were determined by polymerase chain reaction and restriction fragment length polymorphism in a total of 818 patients with alcohol-associated esophageal (n=123), head and neck (n=84) and hepatocellular cancer (n=86) as well as in patients with alcoholic pancreatitis (n=117), alcoholic liver cirrhosis (n=217), combined liver cirrhosis and pancreatitis (n=17) and in alcoholics without gastrointestinal organ damage (n=174). The ADH1C*1 allele and genotype ADH1C*1/1 were significantly more frequent in patients with alcohol-related cancers than that in individuals with nonmalignant alcohol-related organ damage. Using multivariate analysis, ADH1C*1 allele frequency and rate of homozygosity were significantly associated with an increased risk for alcohol-related cancers (p

Thirty male alcohol dependent inpatients without concurrent depressive disorder, 13 of them with a positive family history of alcohol dependence in a first degree relative (PFH), were questioned about their desire and consumption habits with respect to cigarettes, coffee, and sweets while on a three-week inpatient treatment after detoxification from alcohol. Six weeks after discharge from hospital, the patients were reassessed for relapse. Eleven patients (36.6%) had relapsed at follow-up. Relapsers were younger than abstainers. The days until relapse correlated negatively with intensity of desire to drink alcohol, desire to smoke cigarettes, and with a higher consumption of cigarettes. PFH patients did not relapse earlier but they had a stronger desire to drink coffee and eat sweets and had a higher coffee consumption.

This article presents the proceedings of a symposium held at the meeting of the International Society for Biomedical Research on Alcoholism (ISBRA) in Mannheim, Germany, in October 2004. This symposium explored the potential role of hypothalamic-pituitary-adrenal (HPA) axis dysregulation upon relapse. HPA axis stimulation induces the release of the glucocorticoid cortisol, a compound with profound effects upon behavior and emotion. Altered stress-responses of the HPA axis in abstinent alcohol-dependent subjects, therefore, may influence their affective and behavioral regulation, thus impacting their potential for relapse. Bryon Adinoff began the symposium with a review of HPA axis dysfunction in alcohol-dependent subjects, including recent studies from his lab demonstrating an attenuated glucocorticoid response to both endogenous and exogenous stimulation in one-month abstinent men. Klaus Junghanns presented his work demonstrating that a blunted ACTH or cortisol response to subjective stressors (social stressor or alcohol exposure) is predictive of a return to early drinking. The final two presenters examined the interaction between naltrexone and HPA responsiveness in alcohol-dependent or at-risk subjects, as naltrexone induces an increase in ACTH and cortisol. Falk Kiefer discussed the relationship between basal HPA axis responsivity and clinical outcome following treatment with naltrexone or acamprosate. Plasma ACTH significantly decreased over the course of the study in the medication groups, but not the placebo group. Lower basal concentrations of ACTH and cortisol were associated with quicker relapse in the placebo group only. Suchitra Krishnan-Sarin described her preliminary work, in which family-history positive (FH+) and family history negative (FH-) subjects were administered naltrexone, followed by an assessment of alcohol-induced craving. The cortisol response to alcohol was significantly and inversely related to craving in the FH+, but not the FH-, subjects. Alterations in HPA axis responsivity may therefore have a negative impact upon clinical outcome in alcohol-dependent subjects, and disinhibition of the axis with medication may have therapeutic potential.

Background: Alcohol abuse is associated with several gastrointestinal diseases, such as esophageal carcinoma, chronic alcoholic pancreatitis, and liver cirrhosis. Increased mean corpuscular volume (MCV) has been recognized as a biomarker for alcohol abuse and heavy drinkers. Recent studies from Japan revealed that macrocytosis is related to ALDH-2/2 genotype, leading to increased acetaldehyde accumulation. It has also demonstrated that increased MCV values could also be an independent biomarker for esophageal cancer in Asians. Therefore, the aim of the current study was to investigate possible associations of MCV value with polymorphisms of ADH1C in white patients with alcohol-associated esophageal carcinoma, chronic alcoholic pancreatitis, and alcoholic cirrhosis as well as in heavy drinkers without organ damage. Methods: In this study, a total of 510 alcoholic patients were enrolled with esophageal cancer (n= 98), chronic pancreatitis (n= 98), alcoholic liver cirrhosis (n= 151), and alcohol abuse without gastrointestinal disease (n= 163). ADH1C genotyping was performed by PCR-based restriction fragment length polymorphism (PCR-RFLP) analysis from whole blood. The relation between MCV and ADH1C gene polymorphisms (ADH1C*1 and 1C*2) controlled for the amount of drinking, smoking, and age were investigated using both univariate and multivariate analysis. Results: In univariate analysis, higher alcohol consumption was associated with increased MCV. Other variables were not associated with macrocytosis. In multiple linear regression analysis, after adjustment for age and smoking, higher alcohol consumption and female sex were independently associated with higher MCV values. No other variables, including which alcohol-associated disease the patient had, had an independent effect. Adding ADH genotype rendered no independent significant effect on MCV value. Conclusions: In a white population, MCV values were not associated with genotype polymorphisms of ADH1C. In contrast to findings in Asians, macrocytosis does not seem to be an independent biomarker for esophageal cancer. The role of ADH1C polymorphism in increasing MCV and the potential use of MCV as a marker for esophageal carcinoma are still pending.

Aims: To test whether the risk of relapse in alcohol dependence is predicted by the subjective experience of cue exposure (CE) and/or cortisol reactivity to alcohol cues. Methods: Salivary cortisol and self-ratings of 'tension' and 'desire to drink' were measured in 32 detoxified alcohol-dependent inpatients during CE sessions conducted in the first and third week of motivation enhancement therapy. Subjects completed the Toronto Alexithymia Scale (TAS-20) and the Abbreviated Alcohol Expectancy Questionnaire (B-AEQ) towards the end of the inpatient treatment to measure emotional self-awareness and the expected positive effects of alcohol. Results: Six weeks after the end of the inpatient treatment, 15 patients were abstinent. Relapse was verified or was presumed for 17 patients. Those who had relapsed had shown an attenuated response to CE in the third week as an inpatient but did not differ from abstainers in terms of subjective reaction to cues. Subjective ratings of CE were not related to salivary cortisol or relapse but showed several associations with factors one and two of the TAS-20. The expectancy of enhanced social contacts by using alcohol (factor 1 of the B-AEQ) correlated negatively with the decline in salivary cortisol during the CE session in the third week of treatment. Subjective ratings of CE correlated with Alexithymiascores. Conclusions: Alcoholic patients who use alcohol to enhance their social contacts typically lack hypothalamo-hypophyscal-pituitary-adrenocortical (HPA) reactivity in the early period of abstention. They are at an increased risk of early relapse and perhaps use alcohol to increase cortisol secretion again.

Morning and evening salivary cortisol levels were correlated with sleep parameters in 14 patients with primary insomnia and 15 healthy controls. Salivary cortisol was sampled immediately after awakening (T1), 15 min later (T2), and immediately before going to bed (T3) for 1 week at home. In parallel with this, subjects estimated parameters of sleep in a daily sleep log. Patients and controls were all non-smokers who did not differ regarding morning awakening time or bedtime. Cortisol after awakening was significantly decreased in primary insomnia. Salivary cortisol at the time of awakening correlated negatively with the subjective estimation of sleep quality, i.e. a low salivary cortisol level directly after awakening correlated with a higher frequency of nightly awakenings (r = -0.50), a diminished sleep quality (r = -0.34) and a decreased feeling of recovery after awakening (r = -0.35; all p < 0.05). Furthermore, awakening cortisol was negatively correlated with the Pittsburgh Sleep Quality Index (r = -0.43) and with a questionnaire on sleep-related cognitions with the subscales rumination in bed (r = -0.56 ) and focusing on sleep-related thoughts (r = -0.46; all p < 0.05).

Background After dementia the group of depressive disorders is considered to be the second most common psychiatric disorder in the elderly. There is dispute regarding whether depression in the elderly differs from depression in the younger age groups by a longer duration of inpatient treatment, a more frequent occurrence of delusions, more cognitive impairment or by a more frequent co-occurrence of physical disease. This study aimed to compare younger with older inpatients with respect to these aspects. Methods Retrospective chart review of all admissions to the psychiatric department of a General University Hospital (n=9400) and review of the documentation of 15 348 psychiatric consultations in the years 1990–1998. The clinical diagnoses were made according to the ICD-10 criteria. Results 15.5% of the psychiatric inpatients in this period suffered from depressive episodes (ICD-10 F31.3–31.5,32,33). The proportion of depressive episodes increased with age, making up 5.4% in the age group below 30 years and 37.4% in the age group of 70–79 years. On the basis of the ICD-10 criteria for the severity of depressive episodes no significant differences could be demonstrated between the younger (