Personalized therapy for affective disorders
Affective disorders such as major depression and bipolar disorder have a high lifetime prevalence and are among the diseases with the highest rates of disability. They are also often associated with somatic disorders, such as cardiovascular or neurological diseases. However, our current treatment strategies remain insufficiently effective. One possible reason for this is the lack of understanding regarding the biological causes of mental disorders. Additionally, the association with concomitant internal diseases has not been thoroughly investigated. A main issue is the lack of an individualized treatment of affective disorders, taking into account the individual’s life history. Currently, treatment type depends on the individual medical doctor, who determines whether and how a patient is treated with psychotherapy and/or psychopharmacology.
Due to a favorable probability of success using antidepressant treatment, but an incomplete response in some of the patients, individualized therapeutic approaches are additionally required. We implement these in our department as follows:
1. individualized psychotherapy
After initial psychoeducation on affective disorders, each patient receives counseling on the criteria for psychotherapeutic treatment. Cognitive behavioral therapy and interpersonal therapy are primarily used, but also individualized Schema-therapy approaches, CBASP or trauma-specific therapy methods (Dr. Sell, Dr. Gajewska, Prof. Dr. Unterecker).
2. individualized pharmacotherapy
Psychopharmacotherapy is of great importance, especially in cases of moderate to severe depression and bipolar disorder. Appropriate information is provided by psychoeducation and in medical visits. Pharmacogenetic analyses for determination of drug metabolism (CYP2D6, CYP2C19) and therapeutic drug monitoring are used to enable an effective individualized psychopharmacological treatment (Dr. Scherf-Clavel, Dr. PD Weber, Prof. Dr. Unterecker).
3. individualized combination therapies with non-invasive stimulation methods
In case of insufficient effectiveness of pharmacotherapy and psychotherapy, augmentative non-invasive stimulation procedures such as sleep deprivation, light therapy, rTMS and ECT may be considered. Selection of the respective non-invasive stimulation method for the individual patient relies on aspects such as somatic concomitant diseases, previous response to a certain therapy method, severity of therapy resistance, age, previous course of the disease and severity of the affective disorder (Prof. Herrmann, PD Dr. Polak, Dr. Weidner).
4. individualized phenotyping and intervention
Mental disorders must always be assessed in their social context and treated accordingly. For this purpose, the inclusion of smartphone-based surveys and interventions is helpful. The use of corresponding smartphone applications enables a close recording of mental symptoms and provides the basis for interventions in the immediate everyday life of the patient (Prof. Hein).
5. individualized approaches to comorbidities: consultation/liaison.
Due to a high comorbidity between mental and physical diseases, interdisciplinary treatment approaches and consultation cooperation between somatic treatment disciplines are often required. This is ensured at Würzburg University Hospital by a dedicated consultation-liaison service (Dr. Warrings, Prof. Dr. Unterecker).
6. Prevention: Primary, Secondary, Tertiary
Due to the high lifetime prevalence of mental disorders in the general population, preventive approaches play an important role. A distinction must be made between primary, secondary and tertiary prevention.
Primary prevention in childhood, adolescence and young adulthood is aimed at preventing or delaying the onset of a disease; in the case of affective disorders, particular importance is placed on the effective treatment of anxiety disorders and attention deficit hyperactivity disorder. Secondary prevention aims to detect the disease at an early stage, thus opening up the possibility of timely treatment to prevent a secondary disease. Tertiary prevention (rehabilitation) is aimed at preventing the disease from becoming chronic, the development of secondary disease and relapse. It is also important to maintain and, as far as possible, improve social integration. All preventive approaches are supported by information events, which are regularly held by medical and psychological staff from the Center for Mental Health. For example, lectures are given several times a year on the prevention and treatment of the most common mental disorders are offered in the ‘Greisinghäuser’ in Würzburg, the medical and psychological staff support the ‘Abendsprechstunde’ of the ‘Mainpost’, and lectures are held in the Main-Franconian region via the ‘Unibund’. In addition, we provide multidisciplinary care via outpatient treatment in our hospital. If necessary, we also offer early more intensive therapy by means of day-care or inpatient treatment. A close exchange with outpatient practitioners, also within the framework of regular further training events at the Center for Mental Health, as well as close contact with psychological psychotherapists and the local psychotherapy training institutes facilitates individualized therapeutic approaches in the treatment of patients with mental disorders. Rehabilitative approaches are developed and implemented in cooperation with rehabilitation clinics, with a special focus on increasing the capacity to work (Prof. Kittel-Schneider, Prof. Erhardt-Lehmann, Prof. Heiner Vogel).
Prof. Dr. med. Dipl.-Psych. Stefan Unterecker
Phone: +49 931 201 77545
- Prof. Dr. med. Angelika Erhardt-Lehmann
- Dipl.-Psych. Dr. rer. nat. Agnieszka Gajewska
- Prof. Dr. rer. nat. Grit Hein
- Prof. Dr. med. Sarah Kittel-Schneider
- PD Dr. med. Dipl chem. Thomas Polak
- Dr. rer. nat. Maike Scherf-Clavel
- Dr. phil. Roxane Sell
- Prof. Dr. phil. Heiner Vogel
- Dr. med. Bodo Warrings
- PD Dr. biol. hum. Heike Weber
- Dr. med. Anne Weidner