EU-GEI Newsletter 1 (August 2011)


OUR RESEARCH: Assessing environmental exposure - rural vs urban settings

PUBLICATIONS: City living and urban upbringing affect neural social stress processing in humans

YOUNG RESEARCHERS IN EU-GEI: Eva Velthorst, being thrown at the deep end .. and loving it!


A DAY IN THE LIFE OF …. Wendy Beuken, project assistant EU-GEI (MUMC)

EU-GEI MEETINGS: Closing in on the envirome in mental health

EU-GEI PARTNERS and affiliated partners




Dear readers,

Welcome to the EU-GEI project and to our first Newsletter!

The EU-GEI project started in May 2010 with a consortium of 26 partners in 11 European countries, China and Australia, and is funded under the theme Health of the Seventh Framework Programme for Research and Technological Development of the EU.

The aim of the EU-GEI is to indentify the interactive genetic, clinical and environmental determinants, involved in the development, severity and outcome of schizophrenia.

EU-GEI is alive and kicking!

With enthusiasm and dedication we have laid the foundations of the EU-GEI project in the first project year. All sites have started patient recruitment, bureaucratic hiccups have been sorted, instruments have been aligned (well…with the exception of the late discovery of  non-parallel versions of AVLT in one workpackage), more and more centres are approaching us asking if they can join – even without budget (which they can, most of the time) and the first EU-GEI papers have been published in Nature (WP4; see elsewhere in this issue) and Archives of General Psychiatry (WP7 – cannabis genetic sensitivity analysis).

Things going as they are, we should see results of the first preliminary analyses early in 2012, when molecular genetic data will accumulate in Cardiff for analysis. In addition, exciting add-ons have been set up, particularly in the area of epigenetics and immunology. Many centers have added neuroimaging and momentary assessment phenotypes to the data collection, greatly enriching the potential of EU-GEI.

In the meantime, published findings suggest that the GxE approach indeed may be instrumental in explaining variation in disease (severity) so all we need to do is stay on track!

With the Newsletter we plan to keep you updated on the progress of the EU-GEI research programme, share plans and issues and eventually research results. Feel free to contact us if you want to make a contribution to this newsletter! Your input (partners, stakeholders, general audience) for future issues of this Newsletter is much appreciated!

Jim van Os



OUR RESEARCH: Assessing environmental exposure - rural vs urban settings

by Craig Morgan
Institute of Psychiatry - King's College London (WP2)

There has long been evidence that mental health problems are more common in cities than in the countryside. In particular, serious mental disorders (psychoses) such as schizophrenia are around 2 times more common in urban areas.  However, we don’t know why this is.

One aim of the EU-GEI programme, therefore, is to investigate what may explain the high rates of schizophrenia and other psychotic disorders in cities.

We will do this in two stages.

First, over a three-year period we will count the number of individuals experiencing schizophrenia or another psychotic disorder for a first time in 12 carefully defined areas across 5 European countries (the UK, the Netherlands, France, Spain and Italy).  Within each country we have included in the study at least one urban and one rural site.  This means we can then compare the ‘incidence’ (number of individuals with a first episode of psychosis) between urban (i.e., densely populated) and rural (i.e., less densely populated) areas. No study has done this on such a scale before.

Second, in each area we will collect detailed information on exposure to potential risk factors for psychosis (including: characteristics of neighbourhoods; childhood and adult trauma and social adversity; substance use; and genes) from individuals with a first episode of psychosis (‘cases’), from siblings of those with a disorder, and from a representative sample of the general population (‘controls’).  This will allow us to compare the impact and prevalence of such risk factors in urban and rural areas.

What we predict is that individuals with a genetic vulnerability for psychosis who live in cities will more often develop a psychotic disorder because they are more frequently exposed to risk factors that are common in cities (such as social stressors and substance use).
This is an ambitious project and there are a number of challenges.  We have to ensure, for example, that we identify all individuals with a first episode of psychosis in all areas – a task that requires constant checking with all mental health services in each site.  We also have to ensure information about risk factors is collected in the same way across all sites.  The first steps to ensuring this have been careful translation of all assessments into relevant languages and the creation of an innovative web based training programme for the teams of researchers collecting data across Europe.

But the challenges are worth it!  For the first time in human history, more people now live in cities than live in the countryside.  It is essential that we understand what it is about living in cities that can contribute to the onset of serious mental disorders.  Only then will we be able to intervene to reduce the risks!



PUBLICATIONS: City living and urban upbringing affect neural social stress processing in humans

Published In      : Nature, Volume 474, 23 June 2011
EU-GEI authors  : Professor Andreas Meyer- Lindenberg 
                          P4 – Central Institute of Mental Health, Mannheim - Germany

Multiple lines of evidence strongly connect schizophrenia to city life. In particular, schizophrenia is about 200-300% more common in people born in cities than in those from less heavily populated districts. This is important since by 2050, two-thirds of the world's population will be living in cities. It has been estimated that if everyone were born in country surroundings, the number of patients with schizophrenia would be reduced by 30%. In addition to these striking effects on schizophrenia risk, currently living in cities increases the rates of depression and anxiety disorders. It has been suggested that social stress plays a part in these effects, but the mechanisms involved were unknown.

Now, in a EU-GEI funded study of healthy German volunteers that appeared in Nature in 2001, Andreas Meyer-Lindenberg, Florian Lederbogen, Leila Haddad, Peter Kirsch und their colleagues from the Central Institute of Mental health in Mannheim, Germany, provided the first direct evidence for a central role of social stress processing in the link between cities and mental illness. Using functional magnetic resonance imaging, a key brain structure for negative emotion (the amygdala) was found to be more active during stress in city dwellers, and a regulatory brain area (the cingulate cortex) more active in people born in cities. Since this area of the cingulate has been implicated in schizophrenia before, the findings suggest that this structure might be especially vulnerable to early-life effects of urban life, leading to a dysfunction contributing to schizophrenia risk in adolescents and adults. These results identify potential mechanisms linking a key environmental risk factor to the social environment and mental illness, and might contribute to planning healthier urban surroundings.

To view the full article in Nature, click HERE

Photo: Professor Andreas Meyer-Lindenberg



YOUNG RESEARCHERS IN EU-GEI: Eva Velthorst, being thrown at the deep end .. and loving it!

When Lieuwe de Haan asked me to help him coordinating one of the work packages in a promising large-scale study to schizophrenia, I had no idea what to expect; even more so when I laid my eyes on the elaborate and sophisticated protocol. What on earth did I say yes to…? Two years, loads of emails on website arrangements, genetic sampling, MRI scans, and the adaptation of instruments later, I can honestly tell I have no regrets on my decision to be thrown at the deep end whatsoever!

What started out as an internship and side job as research assistant in 2006 has grown into a steady long-term relationship with the Early Psychosis department of the AMC in Amsterdam; not least because of my current position for EU-GEI. At the moment, our academic centre, which encompasses a diagnostic centre, clinical care unit, outreaching team and research department, is involved in the incidence and prodromal work packages and responsible for the training in EU-GEI.

The coordination of these three tasks in our centre is sometimes hectic, but brings about a lot of variation. The combination of incidental clinical diagnostic interviews, emailing (lots), the recruitment of patients, recording of role plays, training and writing makes each day different. It is nice to see that things do
pay off in the end, and that most parts of the project start to run smoothly now.

From the end of 2009, we have been trying to establish a web-based training area in collaboration with the web designers of Mediamens. It seems that more and more researchers find their way to this closed web area to search for instruments or follow the online training. With this online training we hope to establish good inter-rater reliability among all researchers participating in EU-GEI. Challenging of course, but we believe an important target in such a large scale study.
Besides this web based training, we sometimes assist with training on site. I find this latter aspect – in particular training in new and unknown settings- amazing. Honoured to meet all these great researchers in other centres, trips to England and Turkey and the visit of Serbian researchers in our centre have taught me that the world is larger than our dear familiar Early Psychosis department. During these field trainings, it is surprising to notice that, irrespective of the widely varying settings, everyone shares the same amount of enthusiasm, commitment and eagerness to make this project a wide success.

Dear EU-GEI researchers, thanks a lot for a warm welcome in the world of science! You have convinced me that researchers are not as ‘musty’ as I feared they would be, and I hope that we are just at the beginning of years of fruitful collaboration.

Photo: Group picture of onsite training at Ankara University
          Eva is standing 2nd from the left (in second row)




SERMES was created as a Special Employment Centre (center to provide employment opportunities to disabled workers) in 1997, with a group of seven members of staff whose experience in data processing and storing spans over ten years. Initially SERMES activities targeted a limited group of clients in different sectors including banking and large department stores, offering data entry, processing and checking.

Due to the staff efforts and drive, the raise in competition and the need for companies to comply with a law in Spain regarding disabled workers (LISMI law and subsequent regulation), SERMES CEO decided to develop a new strategy in order to become more competitive in this market. Such strategy led to a diversification of SERMES activities within the clinical research sector giving rise to a new brand, image and unit called SERMES CRO, a specialized business unit.

In 2001, SERMES created its Clinical Research Unit, SERMES CRO, as a specialized business unit, which is now the main part of the business in Spain and Portugal. SERMES CRO today offers clinical development services to biotechnology, pharmaceutical companies and independent institutions acting as sponsors of clinical studies.

Additionally, SERMES is founder of PSN, a full-service global Contract Research Organization supporting clinical studies, with over 250 employees in 12 offices across Northern America (US & Canada) and Europe (Germany, Austria & Switzerland, Denmark, Sweden & Norway, Netherlands & Belgium, Italy, France, United Kingdom & Ireland and, Spain & Portugal).

SERMES has more than 150 employees, and its main offices are located in Madrid and Barcelona.

With regard to the EU-GEI Project, SERMES is responsible of the data entry in a central European project database of all the clinical information obtained from the patients enrolled in the 5 Spanish Hospitals which are participating in work packages 2 and 6.

SERMAS is one of five SME's participating in the EU-GEI project



A DAY IN THE LIFE OF …. Wendy Beuken, project assistant EU-GEI (MUMC)

Monday morning, 6:30 AM time to get up. Since I am piloting a PsyMate protocol, I start with completing the morning questionnaire: “Did you sleep well?”. Yes I did, so I fill in option 7: very well. After breakfast and taking my son to school, it’s time to go to work.

9 AM. Busy day ahead, first I have to get our Serbian temp started with implementing the Serbian scales in 4D. Most of the scales have been translated, so if everything goes ok, our affiliated partner in Serbia should be able to start within a few weeks. 

9:30 AM. Rushing to a meeting with Catherine van Zelst regarding the D-STIGMI study.  We need to adjust the PsyMate protocol. Some items have been changed or replaced, so all the jumps in the scales need to be checked. We decide to pilot the PsyMate 1 more day and then it should be ready for the clients.

11:00 AM. Just received a phone call from Eva. We need to add an extra item to the General info- list, which means all translations have to be adjusted and also the database needs to be updated. This is not the first time – and it will not be the last time either - that scales need to be adjusted. I have another beep to fill in on the PsyMate, “Do you feel hungry?”. Breakfast has been a while and I do feel quite hungry, so it’s a score 5.

12:30 PM.  Time for a quick lunch behind the desk, also time to catch up with Karin and Kirsten on the weekend

12:45 PM.  Over the weekend the 4D database has been updated. As a consequence all  passwords have been  reset, and I have received a lot of emails of people who aren’t able to log in. This means new passwords! Some problems are solved easily…

14:30 PM.  A teleconference with a client in Spain. They need help starting 4D and programming the PsyMate.  I never used a Spanish version of 4D, and since my Spanish is not that great I am glad they have an English speaking professor available to help with the translation. After 45 minutes they are up and running.

15:15 PM.  Kirsten and I have a meeting regarding the SCID. The SCID is used in WP5 and different versions are used by the partners. We need to compare the items and make a version in 4D which can be used for data entry. During the meeting my PsyMate starts beeping, asking me ”Has this beep disturbed you?”. I don’t have to think twice: option 7, very much!

16:30 PM. Dubravka, our Serbian temp is finished and I can send the finalized documents to Eva for the website.  We will now start the preparations for the training of our Serbian partners.
The PsyMate is beeping again: “What have you used since the last beep?”. I had some coffee, so my answer is: caffeine.

17:30 PM.  Time to go home and have dinner. The PsyMate will probably beep two or three more times and then of course there is the end-of-the-day questionnaire that I need to complete before going to bed. It is all part of the job …

Photo: Wendy (left) and Kirsten (right) completing a PsyMate beep



EU-GEI MEETINGS: Closing in on the envirome in mental health

Closing in on the envirome in mental health

A joint conference of the European Psychiatric Association (section Epidemiology) and the EU-GEI project on the envirome and mental health in June 2012

The relationship between mental ill health and the environment is extremely topical. With the novel concept of “extended mind” – the notion that the mind is not “in” the brain but rather is a reflection of the causal interaction between cerebral representations and the environment – epidemiology urgently needs to devise novel ways to study onset of ill health from the environmental mind perspective. In addition, even though molecular genetic studies of psychiatric phenotypes have remained remarkably inconclusive, much of the genetic contribution to mental ill health and resilience may exert powerful effects through the environment. Furthermore, the effects of the environment on psychological mechanisms, the epigenome and brain structure and function can now be studies and brought together by interested epidemiologists. The challenge of combining all these perspectives for the purpose of research and treatment will be addressed during the conference. Top researchers and students together will endeavour to create clarity and bring the field forward.

Special attention will be given to work by PhD students, for whom reduced admission fees will apply and multiple prizes will be made available.
Although the topic is about the envirome and mental health, the conference welcomes any PhD contribution in the broadly defined area of psychiatric epidemiology, health services research, and culture and psychiatry.

EPA Maastricht 2012: 13th – 16th June, 2012
Maastricht School of Management, Maastricht – the Netherlands
for more information:




EU-GEI PARTNERS and affiliated partners

Universiteit Maastricht

King’s College London - Institute of Psychiatry
Cardiff University
Central Institute of Mental Health
Ankara Universitesi
Servicio Madrileño de Salud
Academisch Medisch Centrum – Universiteit van Amsterdam
Institut National de la Santé et de la Recherche Medicale (INSERM), University Paris XII
Katholieke Universiteit Leuven
University Mental Health Research Institute
Medizinische Universität Wien
Universität Basel
Universität zu Köln – Universitätsklinikum
SERMES Planificacion
Wingz b.v.
E.C.S. International BV
Omega Pro Proje Arastirma Gelistirme ve Danismanlik Ltd Þti
Mediamens B.V.
The University of Hong Kong
Universidad del Pais Vasco
The Chancellor, Masters and Scholars of the University of Cambridge
Royal College of Surgeons in Ireland
Ludwig-Maximilians-Universität München
Alma Mater Studiorum – Universita di Bologna
Universita Degli Studi di Palermo
University of Melbourne

For contact details see HERE

Affiliated partners
EU-GEI's affiliated partners are external parties participating in the project.
As conditions of participation, affiliated partners have agreed to meet the EU-GEI standards with respect to the identification, recruitment and assessment of subjects.
All related costs will be met by the new affiliated centres (with no funding being available from EU-GEI).

Fundação Faculdade de Medicina da Unversidade de São Paulo (Brazil)
University of Verona - Section of Psychiatry and Clinical Psychology (Italy)
University of Copenhagen (Denmark)
Kortenberg/Leuven UPC (K.U. Leuven) (Belgium)
University of Pavia (Italy)
INSERM - Université Paris Descartes (France)
University of Belgrade - Clinic for Psychiatry (Serbia)




Project Management

Karin Quanten
Maastricht University Medical Centre
Department of Psychiatry and Neuropsychology
Location Vijverdal
Vijverdalseweg 1 | 6226 NB | Maastricht – The Netherlands
PO Box 616 (VIJV-SN2) | 6200 MD | Maastricht - The Netherlands
T +31 43 3688622 | F +31 43 3688689

Wendy Beuken
Maastricht University Medical Centre
Department of Psychiatry and Neuropsychology
Location Vijverdal
Vijverdalseweg 1 | 6226 NB | Maastricht – The Netherlands
PO Box 616 (VIJV-SN2) | 6200 MD | Maastricht - The Netherlands
T +31 43 3688640 | F +31 43 3688689

This newsletter was produced as part of EU-GEI dissemination activities.
Contact: Karin Quanten

Design by Mediamens B.V.

EU-GEI: European Network of National Schizophrenia Networks studying Gene-Environment Interactions