Falkai, P.

Möller, H.-J.

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P. Falkai

H.-J. Möller

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European Archives of Psychiatry and Clinical Neuroscience

Affective disorders: the role of the duration of untreated illness, suicidality and pharmacogenetics

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EDITORIAL
Affective disorders: the role of the duration of untreated illness,
suicidality and pharmacogenetics
P. Falkai • H.-J. Mo¨ller
 The Author(s) 2010. This article is published with open access at Springerlink.com
Dear colleagues,
This issue of the European Archives of Psychiatry and
Clinical Neurosciences is mainly dealing with topics
around affective disorders.
A large-scale 15 year-follow-up of 323 first hospitalized
patients documents the substantial differences in outcome
between schizophrenia and affective disorders [1]. This
difference was most pronounced in the Strauss-Carpenter-
Scale, male sex and several psychopathological syndromes.
During a large-scale follow-up of 320 patients with bipolar
disorder [2] duration of untreated illness (DUI) was cor-
related with worse outcome, mainly increased suicidality
and suicide attempts. In this respect, another interesting
paper [3] supports the association of seasonality of suicide
attempts and gender. Interestingly female gender is asso-
ciated with a reduction of suicide attempts in spring by
10%.
In a large-scale four-level community-based interven-
tion program conducted in Nu¨rnberg (Nu¨rnberg alliance
against depression (NAD)), it was shown that the number
of suicide acts (main outcome completed and attempted
suicide) dropped significantly (-21.7%) comparing the
baseline year and the control region. Interestingly
sustainable effects on suicidality could be maintained one
year after the main intervention [4].
One of the hot topics of treatment prediction is phar-
macogenetics. In a review article on the pharmacogenetics
of antidepression treatment evaluating the current literature
[5], it was found that there is currently a focus on new
candidate single nucleotide polymorphisms—particularly
in the 5HT2A-receptor gene and the gene coding for the
cochaperone FKBP5. However, the article concluded that
the ‘‘pharamacogenetics of therapeutic effects and off side
effects of antidepressants are unable to guide decisions on
the selection of the most beneficial drug for an individual
patient’’.
Finally two articles on interesting innovative neurobio-
logical aspects of psychiatric disorders should be men-
tioned. The article by Koch et al. [6] found increased
fractional anisotrophy (FA) in cortico pontine-cerebellar
circuits in schizophrenia compared to control subjects
suggesting some neuroplastic changes in these networks.
This finding is in contrast to a solid literature suggesting
reduced fractional anisotrophy in extended cortical and
subcortical white matter fractions in schizophrenia. The
second article points in a similar direction [7] combining
ERP and fMRI in subjects with ADHD compared to con-
trols using a go/no go-task. Reduced medial/lateral frontal
activity was demonstrated supporting the involvement of
this neural network in different psychiatric disorders
including ADHD.
We hope you will enjoy reading the articles of the
August issue during this hot summer.
Open Access This article is distributed under the terms of the
Creative Commons Attribution Noncommercial License which
permits any noncommercial use, distribution, and reproduction in
any medium, provided the original author(s) and source are
credited.
P. Falkai (&)
Department of Psychiatry und Psychotherapy,
University of Go¨ttingen, von-Siebold-Str. 5,
37075 Go¨ttingen, Germany
e-mail: pfalkai@gwdg.de
H.-J. Mo¨ller
Psychiatry Hospital, Ludwigs-Maximilians-University Munich,
Nussbaumstr. 7, 80336 Mu¨nchen, Germany
123
Eur Arch Psychiatry Clin Neurosci (2010) 260:365–366
DOI 10.1007/s00406-010-0128-8
References
1. Mo¨ller HJ, Ja¨ger M, Riedel M, Obermeier M, Strauss A,
Bottlender R (2010) The Munich 15-year follow-up study
(MUFUSSAD) on first-hospitalized patients with schizophrenic
or affective disorders: comparison of psychopathological and
psychosocial course and outcome and prediction of chronicity. Eur
Arch Psychiatry Clin Neurosci. doi:10.1007/s00406-010-0117-y
2. Altamura AC, Dell’osso B, Berlin HA, Buoli M, Bassetti R,
Mundo E (2009) Duration of untreated illness and suicide in
bipolar disorder: a naturalistic study. Eur Arch Psychiatry Clin
Neurosci. doi:10.1007/s00406-009-0085-2
3. Mergl R, Havers I, Althaus D, Rihmer Z, Schmidtke A, Lehfeld H,
Niklewski G, Hegerl U (2009) Seasonality of suicide attempts:
association with gender. Eur Arch Psychiatry Clin Neurosci. doi:
10.1007/s00406-009-0086-1
4. Hegerl U, Mergl R, Havers I, Schmidtke A, Lehfeld H, Niklewski
G, Althaus D (2009) Sustainable effects on suicidality were found
for the Nuremberg alliance against depression. Eur Arch Psychi-
atry Clin Neurosci. doi:10.1007/s00406-009-0088-z
5. Zobel A, Maier W (2010) Pharmacogenetics of antidepressive
treatment. Eur Arch Psychiatry Clin Neurosci. doi:10.1007/
s00406-009-0091-4
6. Koch K, Wagner G, Dahnke R et al (2009) Disrupted white matter
integrity of corticopontinecerebellar circuitry in schizophrenia. Eur
Arch Psychiatry Clin Neurosci. doi:10.1007/s00406-009-0087-0
7. Karch S, Thalmeier T, Lutz J et al (2009) Neural correlates (ERP/
fMRI) of voluntary selection in adult ADHD patients. Eur Arch
Psychiatry Clin Neurosci. doi:10.1007/s00406-009-0089-y
366 Eur Arch Psychiatry Clin Neurosci (2010) 260:365–366
123


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Affective disorders: the role of the duration of untreated illness, suicidality and pharmacogenetics

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