ABSTRACTS - World Psychiatric Association

model requires a conceptual shift from current assessment and treatment
planning strategies. It is based on repeated assessments, individualized
plans and attention to subclinical symptoms.
RS23.2.
THE COGNITIVE BEHAVIORAL ANALYSIS SYSTEM
OF PSYCHOTHERAPY AS A NEW PSYCHOLOGICAL
TREATMENT STRATEGY FOR CHRONIC
DEPRESSION
E. Schramm
Department of Psychiatry and Psychotherapy, University
of Freiburg, Germany
Chronic depression accounts for roughly a third of all mood disorders.
It is a particularly disabling disorder, which is associated with
greater comorbidity and suicidality, more significant impairments in
functioning, and increased health care utilization than acute major
depressive episodes. In the past, chronic depression was often considered
treatment resistant. Relatively few psychotherapy studies
have focused on chronic forms of depression. In chronic major
depression, a specific form of psychotherapy, the cognitive behavioral
analysis system of psychotherapy (CBASP), proved to be as effective
as medication. The combination of CBASP and medication revealed
significant superiority over both monotherapies. CBASP integrates
behavioral, cognitive, and interpersonal strategies. It focuses on problems
resulting from an inhibition of maturation in early childhood by
using the therapeutic relationship in a personal, disciplined way. In
addition, other interpersonal strategies are used to overcome preoperational
thinking. By means of a specific behavioral technique, the
situation analysis, patients learn to focus on the consequences of
their behaviour and to use efficient social problem-solving.
RS23.3.
CHILDHOOD TRAUMA AS A RISK FACTOR
FOR CHRONICITY OF DEPRESSION
J. Wiersma
Department of Psychiatry and Institute for Research
in Extramural Medicine, VU University, Amsterdam,
The Netherlands
Childhood trauma is linked to adult depression and might lead to a
more chronic course of depression. In this study (n=1230) data from
the Netherlands Study of Depression and Anxiety (NESDA) have
been used to investigate the relationship between childhood trauma
(emotional neglect, psychological abuse, physical abuse and sexual
abuse), early life events (parental loss, divorce of parents, separation
and regularly run away from home), and chronicity of depression.
Results show that chronicity of depression was associated with a significantly
higher prevalence of emotional neglect, psychological
abuse, physical abuse, and sexual abuse. No associations were found
between early life events and chronicity of depression. The strongest
association was found for those who experienced a great number of
severe childhood traumas and chronic depression. After controlling
for comorbid anxiety, severity of depression and age of onset, the
association still existed. These results suggest that number and severity
of childhood traumas play an important role as a risk factor for a
chronic course of depression. For the treatment of depressed patients,
it is therefore important to detect the presence of childhood trauma,
since it may indicate a more chronic course.
RS23.4.
THE SPECIFIC PSYCHOPATHOLOGY OF CHRONIC
DEPRESSION
E.-L. Brakemeier
Department of Psychiatry and Psychotherapy, Charité-
Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin,
Germany
By conceptualizing cognitive behavioral analysis system of psychotherapy
(CBASP), McCullough proposed that chronically depressed
patients have a primitive representational worldview, not addressed
adequately in most contemporary therapy programs. Thus, psychotherapists
are likely to overestimate the capabilities for change of their
chronically depressed patients. McCullough pointed out that the essential
problem of the disorder involves an age-inappropriate cognitiveemotional
approach to reality that prevents the patient from recognizing
his connection with environment. CBASP is based on two hypotheses
concerning the specific psychopathology of chronic depression: a)
patients are unaware that their primitive verbal thoughts/behaviour
patterns keeps them perceptually disconnected from the environment;
b) chronic depression is a developmental disorder leading patients to
“preoperational thinking”. This means that: a) they think in a prelogical
and precausal manner; b) their behaviors are not influenced by logical
reasoning or reality-based feedback; c) they are characterized by
pervasive egocentricity; d) they use language in a monologue fashion;
e) they are unable to generate true empathy; f) they show emotional
deregulation under stress. Regarding the first hypothesis, a theoretical
learning model and videotapes from therapy sessions try to demonstrate
the proposed perceptional disconnection of chronically
depressed patients. Concerning the second hypothesis, recent trials
with different approaches to operationalize the six dimensions of the
“preoperational thinking” are presented.
RS24.
IS CYCLOTHYMIA THE MOST COMMON AFFECTIVE
PHENOTYPE
RS24.1.
THE EPIDEMIOLOGY OF CYCLOTHYMIC
TEMPERAMENT IN THE GENERAL POPULATION:
RELATIONSHIP WITH SUICIDALITY
E.G. Karam, M.M. Salamoun, Z. Mneimneh, J. Fayyad,
A.N. Karam, J. Yeretzian
Department of Psychiatry and Clinical Psychology, Faculty
of Medicine, Balamand University, Beirut, Lebanon
Temperament is the theoretical mediation between environment and
mental health disorders. The Temperament Evaluation of Memphis,
Pisa, Paris and San Diego Autoquestionnaire (TEMPS-A) has been
translated and validated in several languages, and used in different
subgroups (e.g., clinical, students, company, employees and people
with different educational levels). Lebanon is the only country that
has validated the TEMPS-A in a national cohort, as part of the
Lebanese Evaluation of the Burden of Ailments and Needs Of the
Nation (LEBANON). A total of 1334 respondents (47% of the total
national sample) were selected from the specific study for the assessment
of temperament, namely the LEBANON-TEMP; of these, nine
respondents refused to take the TEMPS-A and five had incomplete
questionnaires, reducing the sample to 1320. In our sample, 6.2% of
the respondents had z-scores above +2 standard deviations on the irritable
temperament, 4.6% on the anxious, 4.4% on the cyclothymic,
54 World Psychiatry 8:S1 - February 2009