Action Plan B3 of the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA) focuses on the integrated care of chronic diseases. Area 5 (Care Pathways) was initiated using chronic respiratory diseases as a model. The chronic respiratory disease action plan includes (1) AIRWAYS integrated care pathways (ICPs), (2) the joint initiative between the Reference site MACVIA-LR (Contre les MAladies Chroniques pour un VIeillissement Actif) and ARIA (Allergic Rhinitis and its Impact on Asthma), (3) Commitments for Action to the European Innovation Partnership on Active and Healthy Ageing and the AIRWAYS ICPs network. It is deployed in collaboration with the World Health Organization Global Alliance against Chronic Respiratory Diseases (GARD). The European Innovation Partnership on Active and Healthy Ageing has proposed a 5-step framework for developing an individual scaling up strategy: (1) what to scale up: (1-a) databases of good practices, (1-b) assessment of viability of the scaling up of good practices, (1-c) classification of good practices for local replication and (2) how to scale up: (2-a) facilitating partnerships for scaling up, (2-b) implementation of key success factors and lessons learnt, including emerging technologies for individualised and predictive medicine. This strategy has already been applied to the chronic respiratory disease action plan of the European Innovation Partnership on Active and Healthy Ageing.

Attention-deficit/hyperactivity disorder (ADHD) is a common, highly heritable neurodevelopmental disorder. Genetic loci have not yet been identified by genome-wide association studies. Rare copy number variations (CNVs), such as chromosomal deletions or duplications, have been implicated in ADHD and other neurodevelopmental disorders. To identify rare (frequency ≤1%) CNVs that increase the risk of ADHD, we performed a whole-genome CNV analysis based on 489 young ADHD patients and 1285 adult population-based controls and identified one significantly associated CNV region. In tests for a global burden of large (>500 kb) rare CNVs, we observed a nonsignificant (P=0.271) 1.126-fold enriched rate of subjects carrying at least one such CNV in the group of ADHD cases. Locus-specific tests of association were used to assess if there were more rare CNVs in cases compared with controls. Detected CNVs, which were significantly enriched in the ADHD group, were validated by quantitative (q)PCR. Findings were replicated in an independent sample of 386 young patients with ADHD and 781 young population-based healthy controls. We identified rare CNVs within the parkinson protein 2 gene (PARK2) with a significantly higher prevalence in ADHD patients than in controls \((P=2.8 × 10^{-4})\) after empirical correction for genome-wide testing). In total, the PARK2 locus (chr 6: 162 659 756-162 767 019) harboured three deletions and nine duplications in the ADHD patients and two deletions and two duplications in the controls. By qPCR analysis, we validated 11 of the 12 CNVs in ADHD patients \((P=1.2 × 10^{-3})\) after empirical correction for genome-wide testing). In the replication sample, CNVs at the PARK2 locus were found in four additional ADHD patients and one additional control \((P=4.3 × 10^{-2})\). Our results suggest that copy number variants at the PARK2 locus contribute to the genetic susceptibility of ADHD. Mutations and CNVs in PARK2 are known to be associated with Parkinson disease.

This paper describes the influence of neuroleptic therapy on facial action in drug-naive schizophrenics. In a comparative study of medicated and unmedicated schizophrenic patients, the coordinates of 12 small light-reflecting points, attached to subjects' faces, were computer-recorded and analyzed automatically during a semistandardized clinical interview. In addition, facial activity in videotaped interviews was coded using the Facial Action Coding System (FACS). Each sample group comprised of eight patients with the DSMIII- R diagnostic criteria "schizophrenia" or "schizophreniform disorder". Subjects were studied on two occasions, one shortly after admission to the hospital, the other three weeks later. Group I was unmedicated during the first session, whereas group2 was medicated throughout the study. Three weeks after the start of medication, at the second interview, both recording methods showed a reduction in facial activity and facial expression across all subjects in group 1. The facial action of patients in group2, however, remained unchanged.

Introduction Although symptomatic therapy is available for Parkinson's disease, patients and relatives are faced with continuous severe psychological problems. These psychological problems include: 1. lack of emotional expression, 2. bradephrenia, 3. depression, 4. lack of motivation,S. social anxiety, 6. stress induced increase of symptoms. The first four of these may be at least in part due to the dopamine deficiency. However, even as part of the primary symptoms they have social and communicative impact for patients and relatives. Social anxiety and stress induced increase of symptoms on the other hand clearly result from an interaction of somatic and psychological factors. Social anxiety mainly develops in Parkinson I s disease as an indirect consequence of the motor symptoms. Patients are afraid of being negatively evaluated in the public, of receiving negative comments etc. Thus r social withdrawal increases and the improvement of neurological symptoms following drug treatment may not be fully exploited on the psychosocial level. Stress induced increase of motor symptoms is a commonly observed phenomenon in Parkinson's disease. Even minor stressors, mainly social in nature, can have extreme effects and may elicit or increase tremor or rigidity. A patient can be well in one moment, but unable to move in the next when being aware that he has to leave the house in an hour. Given this situation, patients and relatives have to develop strategies fo~ an emotional balance in the presence of a continuous confrontation with the direct and indirect consequences of the disease. A precondition for developing new psychologically based strategies is an optimwn medical treatment. The integrated approach for neurological and psychological support has the following goals: 1. improving medical treatment for the individual patient, 2. improving psychological coping and psychosocial adaptation for patients and relatives, and 3. evaluating and improving medical and psychological therapy. CONCLUSION Psychological intervention can provide considerable help for a substantial part of Parkinson patients. The main target is coping with stressful social situations. Relaxation and cognitive restructuring together with situational behavioral analysis and training of social skills specifically adapted to the disease are" the main strategies. Various problems remain open at the moment, like the maintenance of motivation which is especially critical for Parkinson patients. Parkins on 's disease is a neurological disease with a known pathological substrate and a therapy which is effective at least for several years on a symptomatic level. The symptoms are tightly connected with psychological emotional and cognitive processes. Moreover, patients and relatives have to cope with symptoms which strongly influence social interaction. And they have to cope together with this situation over a period of ten or twenty years. Thus not only for the patient but also for the health of the relatives, psychological aid is urgently needed. We suggest to integrate psychological approach into the neurological diagnosis and treatment.