1. PD Dr. Stieglitz, Freiburg: "Clinic, epidemiology, and rating of therapeutical effects"
2. PD Dr. Volz, Jena: "Clinical studies on therapeutical effects in somatoform disorders"

3. PD Dr. Soyka, Munich: "Depressive and somatic symptoms and therapy in prolonged ethanol withdrawal syndrome"

4. Prof. Dr. W.E.Müller, Frankfurt: "Pharmacotherapeutical effects of Opipramol and extracts of St. John´s wort"

- Dr. Stoll, Nuremberg

- Prof. Dr. Schulz, Berlin

- Prof. Dr. Linden, Berlin

- Dr. Dr. Boerner, Munich

Somatoform disorders were first operationalized internationally in ICD-10. There, a number of different disorders with primarily physical/somatic symptoms are subsumed under somatoform disorders.

Whereas these disorders are rather rare in in-patient psychiatry, they are frequent for out-patients. Because diagnostic and therapeutical interventions are often unnecessary and because somatic disorders frequently result in temporary or permanent disablement, they are of great economic importance.

- Better understanding of the clinical symptoms

- Evaluation of the severity of symptoms

- Discussion of the data from controlled clinical trials

- Discussion of related areas with somatic symptoms

- possible pharmacological mechanisms of psychopharmacological drugs in somatoform disorders

PD Dr. Stieglitz will discuss diagnostic procedures based on ICD-10. He will especially emphasize disorders of somatization as a core group of Somatoform Disorders. Because of the above-mentioned high economic importance of this group of disorders and because of the severe suffering of the patients it is essential to identify the illness early and correctly. On the one hand, possibilities of diagnostic classifying will be discussed. On the other hand, the focus will be on methods of syndrome diagnostics, both on general methods, like lists of complaint, and on special methods with close reference to the individual group of disorders concerned.

PD Dr. Volz will deal with the current state of trials showing the effectiveness of psychopharmacological drugs in Somatoform Disorders. It is remarkable that so far only a very limited number of controlled clinical trials have adequately been carried out. A clinical study comparing opipramol and placebo will be presented as a paradigmatic trial. In an outlook Dr. Volz will shortly discuss which substances might be promising for new trials for psychopharmacological effectiveness.

PD Dr. Soyka will talk about the importance of somatic symptoms in prolonged ethanol withdrawal. He will focus on parallels to and differences from the somatizing disorders in the proper sense of the word and on the problem of specific parmacological therapy of this disorder.

Finally, Prof. Dr. Müller will discuss pharmacological mechanisms of substances with a potential effect on somatoform disorders. He will focus on opipramol and extracts of St. John´s wort. Both the pharmacological mechanisms they have in common and the ones that are different will be discussed. For example, opipramol operates, among other things, as a sigma-ligand, which seems to be of high importance for part of its operating mechanism.

Contributions will be short (10-12 min. max.). Thus, there should be sufficient time for discussion, which promises to be especially interesting because of the panel members invited (Dr. Stoll, Nuremberg, Prof. Dr. Schulz, Berlin, Prof. Dr. Linden , Berlin, Dr. Dr. Boerner, Munich).

1. Dr. Auer, Munich: "Influence of hallucinogenes and psychostimulatory substances on brain metabolism"

2. PD Dr. Gouzoulis-Mayfrank, Aachen: "Influence of hallucinogenes and psychostimulatory substances on brain metabolism"

3. PD Dr. Schröder, Heidelberg: "Upregulation of D2 dopamin receptor and therapeutical effects through neuroleptic therapy in neuroleptics-naive schizophrenic patients"

4. Dr. Gründer, Mainz: "Effects of neuroleptic therapy on the dopamin metabolism of schizophrenics"

5. Dr. Meisenzahl, Munich: "Dopamin-receptor binding of Risperidon and Olanzapin in schizophrenic patients through SPECT"

6. Dr. Tauscher, Vienna: "In vivo determination of the serotonin transporter in psychiatric patients through ß-CIT"

Functional neuroimaging methods allowing to visualize brain function in vivo have gained increasing importance in psychiatric research since the introduction of Positron-Emission Tomography (PET) and of Single Photon Emission Tomography (SPECT), especially through the new methods of magnetic resonance tomography, like functional magnetic resonance tomography (fMRT) and magnetic resonance spectroscopy (MRS). These techniques permit measuring of activities in individual brain areas, e.g. by measuring the glucose or oxygen consumption, as well as determining the density of receptors or the activities of individual cerebral enzymes.

Thus it is evident that this method can be used to examine fundamental effects of psychopharmacological drugs. It is the aim of the symposium to give a survey of these effects.

New possibilities for intra-cerebral ph-registration through MRT, still at an experimental stage at the moment, will be presented (Dr. Auer. Munich). Classical SPECT and PET methods (Dr. Meisenzahl, PD Dr. Gouzoulis-Mayfrank) and SPECT and PET methods for showing enzyme activities (Dr. Tauscher, Dr. Gründer) will be explained.

In the following, as an example of how neuroimaging methods can be applied to show psychopharmacological effects, PD Dr. Schröder´s study will be dealt with in detail:

Experiments with animal models and pathoanatomical studies indicated that during therapy with conventional neuroleptics the number and/or the density of D2 dopamin receptors increased in the basal ganglia ("receptor upregulation"). This result was confirmed in 15 patients with schizophrenic psychosis. It was examined for success of therapy, for possible side-effects, and for neurological soft signs (NSS). All patients were drug-naive and were treated with neuroleptics for the first time in the course of this study. Using single photon emission computed tomography (SPECT) and IBZM as tracers, the D2 dopamin receptor system was examined at the moment of admission to the hospital, e.g. in a drug-naive state, and after standardized therapy with benperidol (12-16mg/d for 25 d). The psychopathological symptoms were recorded on the brief psychiatric rating scale (BPRS), and the possible extrapyramidal side-effects and the NSS were recorded on the rating scale for extrapyramidal side-effects (RSESE) or the Heidelberg NSS scale.SPECT was recorded 2h after intravenous administration of 185 Mbq ¹²³I-IBZM. The data were analyzed by dividing the values of activity in the basal ganglia and the frontal cortex (BG/FC quotient). The patient sample was dichotomized in patients with a positive therapeutical effect and those with a negative therapeutical effect. During neuroleptic therapy patients with a negative therapeutical effect showed an increase of the BG/FC quotient, whereas in patients with a positive therapeutical effect the quotient decreased (df=1, F=4.1, p=0.06). The alteration in the BG/FC quotients correlated significantly with the extrapyramidal side-effects, but not with the NSS. According to these results, the upregulation of the D2 dopamin receptors can be demonstrated clinically, too. It is associated with a dissatisfactory reaction to conventional neuroleptics and with a an increase of extrapyramidal side-effects.

We hope that we will be able to provide the participants with an up-to-date survey of methods and experiments with sufficient opportunity for discussion.