Falkai, P.

Möller, H.-J.

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P. Falkai

H.-J. Möller

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Emotional status: diagnosis and treatment for severe psychiatric disorders

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European Archives of Psychiatry and Clinical Neuroscience

EDITORIAL
Emotional status: diagnosis and treatment for severe
psychiatric disorders
P. Falkai • H.-J. Mo¨ller
Published online: 28 December 2011
 The Author(s) 2011. This article is published with open access at Springerlink.com
This edition focuses on the emotional status that is affected
in a variety of psychiatric disorders, ranging from affective
disorders to schizophrenia and patients with drug abuse.
In patients with major depressive disorders, hypomania
is a common cluster of symptoms that is derived from
diagnostic DSM-IV criteria. To assess the clinical validity
of these criteria in an international sample, Angst et al. [1]
analyzed clinical data including family history, course, and
clinical characteristics in 5,635 patients with major
depressive episodes. Items for hypomania, irritability,
elevated mood, and increased activity could be shown to be
valid and confirm symptom threshold in DSM-IV. How-
ever, brief hypomanic episodes over only a few days were
also valid for which reason DSM-IV durational require-
ments should be altered. Additionally, exclusion criteria
like hypomania due to antidepressant treatment should be
revised in the face of the exclusion of patients with bipolar
disorder. During the last years, the usage of antidepressants
in treating acute depression and its efficacy were under
debate. In a review of randomized clinical trials and meta-
analyses, Baghai et al. [2] summarize methodological
issues of these studies and confirm efficacy and clinical
effectiveness of antidepressants in the treatment of
depressive disorder. Additionally, they allocate individu-
alized antidepressant treatment to be safe and well tolerated
in most patients and assert that it should be combined with
psychotherapy.
In patients with affective disorders and schizophrenia,
improved diagnostic criteria are needed and might be
developed by neuroimaging tools. A glutamate hypothesis
has been linked to both syndromes, and the application of
modern magnetic resonance spectroscopy (MRS) may elu-
cidate the relationship between risk genes and the glutamate
system as a first step in the development of a more person-
alized medicine. Gruber et al. [3] investigated brain-derived
neurotrophic factor (BDNF) polymorphisms and MRS in a
sample of 103 patients with schizophrenia, bipolar disorder,
and healthy controls. Independently of diagnosis, in the left
hippocampus, they found homozygous met-allele carriers
exhibiting lower NAA/Cre and (Glu ? Gln)/Cre metabolic
ratios compared with val/val homozygotes. Alterations in
BDNF have been hypothesized to be related to disturbed
synaptic plasticity in psychiatric diseases, and this study is
the first of its kind to show associations with the glutamate
system. A MRS study by Wang et al. [4] revealed the rela-
tionship between higher Glu/Cr ratio and post-stroke
depression in the frontal lobe, thus according to the
hypothesis of increased glutamate activity in depression.
Suicide is the most severe complication in psychiatric
diseases. During the last years, the internet verifiably has
served as a platform for suicide attempters. Hagihara et al.
[5] found an association between internet suicide-related
searches and the incidence of suicide in Japan during a
period of 77 months. Correspondingly, the authors claim a
stricter regulation of internet suicide websites.
Emotional responses are not only altered in patients with
affective disorders, but also in cannabis users with a negative
emotional state. Somaini et al. [6] compared fourteen active
marijuana smokers and fourteen marijuana-dependent
patients abstinent for a period of 6 months with healthy
controls. In a self-assessment, active cannabis users had
higher scores of pleasant emotions and lower arousal levels
P. Falkai (&)
Department of Psychiatry and 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-Maximililans-University Munich,
Nussbaumstr. 7, 80336 Munich, Germany
123
Eur Arch Psychiatry Clin Neurosci (2012) 262:1–2
DOI 10.1007/s00406-011-0284-5
along with hyperactivity of the HPA axis with an impaired
hormonal reaction to negative emotions. The study shows a
reduced sensitivity to negative emotions and HPA axis
dysfunction in active cannabis users. In contrast, in patients
with paranoid schizophrenia, Haralanova et al. [7] found
higher subjective emotional arousal evoked by neutral social
stimuli, contributing to the paranoid symptom complex of
schizophrenia. This maybe represents a clinical phenotype
linked to underlying neurobiological disturbances.
The molecular basis of repetitive transcranial magnetic
stimulation (rTMS), which is a novel technique for brain
stimulation and a novel therapeutic tool in psychiatric
diseases, has been investigated by Hellmann et al. [8]. The
group detected increased cyclic adenosine monophosphate
(cAMP) levels and phosphorylation of the transcription
factor cAMP response element-binding protein (CREB) in
human-derived neuroblastoma cell culture in response to
rTMS. Interestingly, pretreatment with ketamine potenti-
ated the response, thus confirming the role of ketamine on
electroconvulsive therapy in clinical studies. From animal
studies, it is well known that cAMP signaling within neu-
rons plays an important role in depression and antide-
pressant treatment. In the hippocampus, CREB-regulated
gene transcription promotes dendritic sprouting and neu-
rogenesis. There is a need of investigations on the molec-
ular basis of modern treatment approaches in psychiatric
diseases aiming at the development of regenerative treat-
ment strategies in favor of improving their outcome.
Open Access This article is distributed under the terms of the
Creative Commons Attribution Noncommercial License which per-
mits any noncommercial use, distribution, and reproduction in any
medium, provided the original author(s) and source are credited.
References
1. Angst J, Gamma A, Bowden CL, Azorin JM, Perugi G, Vieta E,
Young AH (2011) Diagnostic criteria for bipolarity based on an
international sample of 5,635 patients with DSM-IV major
depressive episodes. Eur Arch Psychiatry Clin Neurosci. doi:
10.1007/s00406-011-0228-0
2. Baghai TC, Blier P, Baldwin DS, Bauer M, Goodwin GM,
Fountoulakis KN, Kasper S, Leonard BE, Malt UF, Stein DJ,
Versiani M, Mo¨ller H-J (2011) Executive summary of the report
by the WPA section on pharmacopsychiatry on general and
comparative efficacy and effectiveness of antidepressants in the
acute treatment of depressive disorders. Eur Arch Psychiatry Clin
Neurosci. doi:10.1007/s00406-011-0274-7
3. Gruber O, Hasan A, Scherk H, Wobrock T, Schneider-Axmann T,
Ekawardhani S, Schmitt A, Backens M, Reith W, Meyer J, Falkai
P (2011) Association of the brain-derived neurotrophic factor
val66met polymorphism with magnetic resonance spectroscopic
markers in the human hippocampus: in vivo evidence for effects
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10.1007/s00406-011-0214-6
4. Wang X, Li Y-H, J Lu, M-H Li, Zhao J-G, Sun X-J, Zhang B, Ye
J-L (2011) Glutamate level detection by magnetic resonance
spectroscopy in patients with post-stroke depression. Eur Arch
Psychiatry Clin Neurosci. doi:10.1007/s00406-011-0209-3
5. Hagihara A, Miyazaki S, Abe T (2011) Internet suicide searches
and the incidence of suicide in young people in Japan. Eur Arch
Psychiatry Clin Neurosci. doi:10.1007/s00406-011-0212-8
6. Somaini L, Manfredini M, Amore M, Zaimovic A, Raggi MA,
Leonardi C,Gerra ML, Donnini C, Gerra G (2011) Psychobi-
ological responses to unpleasant emotions in cannabis users.
Eur Arch Psychiatry Clin Neurosci. doi:10.1007/s00406-011-
0223-5
7. Haralanova E, Haralanov S, Beraldi A, Mo¨ller H-J, Hennig-Fast K
(2011) Subjective emotional over-arousal to neutral social scenes
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10.1007/s00406-011-0227-1
8. Hellmann J, Ju¨ttner R, Roth C, Bajbouj M, Kirste I, Heuser I,
Gertz K, Endres M, Kronenberg G (2011) Repetitive magnetic
stimulation of human-derived neuron-like cells activates cAMP-
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2 Eur Arch Psychiatry Clin Neurosci (2012) 262:1–2
123


2 Eur Arch Psychiatry Clin Neurosci

Association of the brain-derived neurotrophic factor val66met polymorphism with magnetic resonance spectroscopic markers in the human hippocampus: in vivo evidence for effects on the glutamate system. Eur Arch Psychiatry Clin Neurosci.

Diagnostic criteria for bipolarity based on an international sample of 5,635 patients with DSM-IV major depressive episodes. Eur Arch Psychiatry Clin Neurosci.

Glutamate level detection by magnetic resonance spectroscopy in patients with post-stroke depression. Eur Arch Psychiatry Clin Neurosci.

Internet suicide searches and the incidence of suicide in young people in Japan. Eur Arch Psychiatry Clin Neurosci.

Mo ¨ller H-J (2011) Executive summary of the report by the WPA section on pharmacopsychiatry on general and comparative efﬁcacy and effectiveness of antidepressants in the acute treatment of depressive disorders. Eur Arch Psychiatry Clin Neurosci.

Psychobiological responses to unpleasant emotions in cannabis users. Eur Arch Psychiatry Clin Neurosci.

Repetitive magnetic stimulation of human-derived neuron-like cells activates cAMPCREB pathway. Eur Arch Psychiatry Clin Neurosci.

Subjective emotional over-arousal to neutral social scenes in paranoid schizophrenia. Eur Arch Psychiatry Clin Neurosci.

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Emotional status: diagnosis and treatment for severe psychiatric disorders

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