[Concept and results of the German Research Network on Schizophrenia].

Background: The German Research Network on Schizophrenia (GRNS) was funded by the Federal Ministry of Education and Research (BMBF) from 1999 to 2011. The aim was to obtain a better horizontal and vertical networking of German research and care facilities on schizophrenia, in order to investigate open research questions, to transfer the results into clinical practice and improve care and quality of life in patients with schizophrenia.

Objectives/methods: This paper describes the concept and operations of the GRNS as well as its results on the basis of selected research projects.

Alpha-synuclein levels in blood plasma decline with healthy aging.

There is unequivocal evidence that alpha-synuclein plays a pivotal pathophysiological role in neurodegenerative diseases, and in particular in synucleinopathies. These disorders present with a variable extent of cognitive impairment and alpha-synuclein is being explored as a biomarker in CSF, blood serum and plasma. Considering key events of aging that include proteostasis, alpha-synuclein may not only be useful as a marker for differential diagnosis but also for aging per se.

[12 years of competence network schizophrenia: results and perspectives].

The German Research Network on Schizophrenia (GRNS) was funded by the Federal Ministry of Education and Research (BMBF) from 1999 to 2011. The objectives and the structure of the network with its horizontal and vertical networking of German research and care facilities served for the scientific investigation of open research questions for schizophrenia, and the transfer of the results into clinical practice. In this paper, the functioning and results of the GRNS are described on the basis of selected research projects.

Altered serum IgG levels to α-synuclein in dementia with Lewy bodies and Alzheimer's disease.

Natural self-reactive antibodies in the peripheral blood may play a considerable role in the control of potentially toxic proteins that may otherwise accumulate in the aging brain. The significance of serum antibodies reactive against α-synuclein is not well known. We explored serum IgG levels to monomeric α-synuclein in dementia with Lewy bodies (DLB) and Alzheimer's disease (AD) with a novel and validated highly sensitive ELISA assay.

Negative symptoms of schizophrenia as primary target of cognitive behavioral therapy: results of the randomized clinical TONES study.

Clinical studies on cognitive behavioral therapy (CBT) that include schizophrenia patients primarily on the basis of negative symptoms are uncommon. However, those studies are necessary to assess the efficacy of CBT on negative symptoms. This article first gives an overview of CBT on negative symptoms and discusses the methodological problems of selecting an adequate control group.

Cognitive behavioural therapy versus supportive therapy for persistent positive symptoms in psychotic disorders: the POSITIVE Study, a multicenter, prospective, single-blind, randomised controlled clinical trial.

Background: It has been demonstrated that cognitive behavioural therapy (CBT) has a moderate effect on symptom reduction and on general well being of patients suffering from psychosis. However, questions regarding the specific efficacy of CBT, the treatment safety, the cost-effectiveness, and the moderators and mediators of treatment effects are still a major issue. The major objective of this trial is to investigate whether CBT is specifically efficacious in reducing positive symptoms when compared with non-specific supportive therapy (ST) which does not implement CBT-techniques but provides comparable therapeutic attention.

Implementation of a manual-based training of humor abilities in patients with depression: a pilot study.

Humor and laughter can positively influence mood, promote optimism and lead to a change of perspective. Six patients with major depression participated in a group training program specifically designed to enhance humor abilities. After 8 weeks of training, short-term mood improvement was observed and the patients considered themselves more capable of using humor as a coping strategy.

Does the cognitive dispute of psychotic symptoms do harm to the therapeutic alliance?

We examined whether the cognitive dispute of psychotic symptoms has a negative impact on the course of the therapeutic alliance. Sixty-seven patients with persistent psychotic symptoms received either cognitive behavioral therapy (CBT) or supportive therapy. Questionnaire-based alliance ratings were repeatedly obtained throughout the course of therapy.

Quality and correlates of specific self-esteem at the beginning stabilisation phase of schizophrenia.

In view of the potential importance of self-esteem in schizophrenia, there is a considerable lack of knowledge about the characteristics of specific self-esteem. The literature suggests that the experience of the self might be particularly destabilised in the transition phase between acute and remission points of the illness. Thus, the present study aims at examining the quality and correlates of different self-concepts at the beginning stabilisation phase of schizophrenia.

Response and remission of subjective well-being in patients suffering from schizophrenia spectrum disorders.

Background: Purpose of this study was to assess subjective well-being in schizophrenia inpatients and to find variables predictive for response and remission of subjective well-being.

Method: The subjective well-being under neuroleptic treatment scale (SWN-K) was used in 232 schizophrenia patients within a naturalistic multicenter trial. Early response was defined as a SWN-K total score improvement of 20% and by at least 10 points within the first 2 treatment weeks, response as an improvement in SWN-K total score of at least 20% and by at least 10 points from admission to discharge and remission in subjective well-being as a total score of more or equal to 80 points at discharge.

Cognitive behavioural treatment of negative symptoms in schizophrenia patients: study design of the TONES study, feasibility and safety of treatment.

Currently, there are no convincing treatment strategies for negative symptoms of schizophrenia. On this background, we are conducting the treatment of negative symptoms (TONES) study which addresses the question whether cognitive behavioural therapy (CBT) is efficacious for the reduction of negative symptoms in schizophrenia. The present paper aims at presenting the design of the clinical trial of the study as well as the treatment concept.

Evaluation of a cognitive behaviourally oriented service for relapse prevention in schizophrenia.

Objective: There is little work demonstrating the effectiveness of cognitive behaviourally oriented interventions in routine service settings. This pragmatic trial is designed to test the impact of a group treatment service on relapse rates under the conditions of routine health care.

Method: A total of 169 schizophrenia patients were randomly allocated either to a comprehensive cognitive behaviourally oriented service (CBOS) or to treatment as usual (TAU).

A cluster-randomized effectiveness trial of smoking cessation modified for at-risk smoker subgroups.

A. Batra, S.E.

Defining and predicting functional outcome in schizophrenia and schizophrenia spectrum disorders.

Background: To assess criteria and to identify predictive factors for functional outcome. The criteria should cover all domains proposed by the Remission in Schizophrenia Working Group.

Method: PANSS ratings were used to evaluate the symptomatic treatment outcome of 262 inpatients with schizophrenia spectrum disorders within a naturalistic multicenter trial.

Early improvement as a predictor of remission and response in schizophrenia: Results from a naturalistic study.

Objective: To examine the predictive validity of early improvement in a naturalistic sample of inpatients and to identify the criterion that best defines early improvement.

Methods: Two hundred and forty-seven inpatients who fulfilled ICD-10 criteria for schizophrenia were assessed with the Positive And Negative Syndrome Scale (PANSS) at admission and at biweekly intervals until discharge from hospital. Remission was defined according to the recently proposed consensus criteria, response as a reduction of at least 40% in the PANNS total score from admission to discharge.

[Research into the feasibility of cognitive behavioural therapy in the treatment of psychotic disorders].

Psychotherapy in psychotic disorders is a rare condition and is confronted with much scepticism. On the background of intensive research - in particular in Great Britain, sufficient empirical evidence is available from randomised clinical trials to recommend Cognitive Behavioural Treatment for routine care. However, many research questions are open.

[Acceptance of smoke-free policy in a psychiatric department by in-patients and staff].

The high smoking prevalence among psychiatric patients and staff in psychiatric hospitals explains the difficulties in accompanying efforts for the introduction of regulations for a smoke-free environment. Prior to the establishment of regulations for a smoke-free psychiatric department at the University Hospital, Dept. of Psychiatry and Psychotherapy in Tubingen, a democratic process was initiated.

Internal capsule size associated with outcome in first-episode schizophrenia.

Subtle structural brain abnormalities are an established finding in first-episode psychosis. Nevertheless their relationship to the clinical course of schizophrenia is controversially discussed. In a multicentre study 45 first-episode schizophrenia patients (FE-SZ) underwent standardized MRI scanning and were followed up to 1 year.

[New developments in psychotherapy for schizophrenic psychoses].

There already exists sufficient evidence of the efficacy of psychotherapeutic interventions, in particular cognitive behavioral therapy, for symptom reduction and relapse prevention. Evidence-based treatment guidelines recommend this approach for routine care. An increasing number of randomized clinical trials and research on active elements of treatment characterize this field.

The influence of baseline symptoms and insight on the therapeutic alliance early in the treatment of schizophrenia.

Background: The consistent association between therapeutic alliance and outcome underlines the importance of identifying factors which predict the development of a positive alliance. However, only few studies have examined the association between pretreatment characteristics and alliance formation in patients with schizophrenia.

Objective: The study examined whether symptoms and insight would predict the therapeutic alliance in psychotherapy of schizophrenia.

Increase of visceral fat and adrenal gland volume in women with depression: preliminary results of a morphometric MRI study.

Objective: Depression is often accompanied by increased visceral adipose tissue (VAT), stress, enlarged adrenal glands, and an increased risk of cardiovascular disease. VAT turn-over is regulated by adrenal stress hormones such as cortisol. Aim of this study was to investigate the relationship between the adrenal volume as a marker for long-term stress and the volume fractions of several body fat compartments in healthy and depressive women.

Collaboration in outpatient antipsychotic drug treatment: analysis of potentially influencing factors.

Knowledge of factors relevant for medication adherence and patient collaboration is still limited. Our study aims at exploring the contribution of a variety of factors to collaboration in outpatients with schizophrenia and schizoaffective disorder. We obtained self-rated and observer-rated data from 108 outpatients during an interview 6 months after hospital discharge.

Standardized remission criteria in schizophrenia: descriptive validity and comparability with previously used outcome measures.

Introduction: Standardized consensus criteria for remission in schizophrenia were recently proposed. As yet, the validity of these criteria and their comparability with previously used outcome measures are unclear.

Methods: The symptom-severity component of the proposed remission criteria was applied to 288 inpatients who fulfilled the ICD-10 criteria for schizophrenia.