The impact of age on load-related dorsolateral prefrontal cortex activation

Healthy aging is accompanied by working memory-related functional cerebral changes. Depending on performance accuracy and the level of working memory demands, older adults show task-related patterns of either increased or decreased activation compared to younger adults. Controversies remain concerning the interpretation of these changes and whether they already manifest in earlier decades of life. To address these issues, functional magnetic resonance imaging (fMRI) was used to examine brain activation during spatial working memory retrieval in 45 healthy individuals between 20 and 68 years of age. Participants performed a modified version of the Corsi Block-Tapping test (CBT). The CBT requires the storage and subsequent reproduction of spatial target sequences and allows modulating working memory load by a variation of sequence length. Results revealed that activation intensity at the lowest CBT load level increased with increasing age and positively correlated with the number of errors. At higher CBT load levels, activation intensity decreased with increasing age together with a disproportional accuracy decline on the behavioral level. Moreover, results suggests that younger individuals showed higher activation intensity at high CBT load than at low CBT load switching to the opposite pattern at an age of about 40 years. Consistent with the assumptions of the Compensation-Related Utilization of Neural Circuits Hypothesis (CRUNCH), the present results reveal specific age-related alterations in left dorsolateral prefrontal cortex activation in response to increasing task load. Specifically, the results point toward increasing neural inefficiency with age at low task load and a progressive limitation of resources with age at higher task load. The present findings argue for an increasing functional cerebral dysfunction over a time span of 50 years that may partly be compensated on the behavioral level until a resource ceiling is approached.

The impact of self-reported childhood trauma on emotion regulation in borderline personality disorder and major depression

Early life stress is said to play a critical role in the development of borderline personality disorder (BPD) and major depressive disorder (MDD), but the underlying mediating factors remain uncertain. This study aimed to investigate self-reported childhood trauma, emotion regulation difficulties, and their associations in a sample of BPD (n = 49) and MDD (n = 48) patients and healthy control participants (n = 63). Multiple regressions were used to evaluate the impact of the quality and severity of self-reported childhood trauma on self-reported emotion regulation. The results supported an association between self-reported maltreatment experiences, especially emotional abuse and neglect, and emotion regulation difficulties. Additional analyses showed that emotion regulation difficulties influence the association between self-reported emotional abuse and acute symptomatology in the BPD subgroup. Emotion regulation difficulties may be 1 pathway through which early life stress, particularly emotional abuse, increases the risk for developing BPD symptomatology.

Mesiotemporal volume loss associated with disorder severity: a VBM study in borderline personality disorder

Results of MRI volumetry in Borderline Personality Disorder (BPD) are inconsistent. Some, but not all, studies reported decreased hippocampus, amygdala, and/or prefrontal volumes. In the current study, we used rater-independent voxel-based morphometry (VBM) in 33 female BPD patients and 33 healthy women. We measured gray matter (GM) volumes of the whole brain and of three volumes of interest (VOI), i.e., the hippocampus/parahippocampal gyrus, the amygdala and the anterior cingulate gyrus (ACC). Analyses were conducted using lifetime diagnoses of posttraumatic stress disorder (PTSD) and major depression (MD) as covariates. We used adversive childhood experiences and the numbers of BPD criteria (as an indicator of disorder severity) to investigate associations with GM volumes. We did not find volume differences between BPD patients and healthy subject, neither of the whole brain nor of the three VOIs, independent of presence or absence of comorbid PTSD and MD. We also did not find a relationship between childhood maltreatment and the patients’ brain volumes. However, within the patient group, the number of BPD criteria fulfilled was inversely correlated with left hippocampal/parahippocampal volume (x=-32, y=-23, z=-18, k=496, t=5.08, p=.007). Consequently, mesiotemporal GM volumes do not seem to differentiate patients from healthy subjects, but might be associated with symptom severity within the BPD group.

Increased attempts to suppress negative and positive emotions in Borderline Personality Disorder

Patients with Borderline Personality Disorder (BPD) show evidence of disturbed emotion regulation. In particular, patients may try to suppress their emotions with possibly negative effects on mental health. We investigated the suppression of both negative and positive emotions in BPD patients and healthy participants. Thirty BPD patients and 30 matched healthy controls were assessed for emotion suppression using the Emotion Acceptance Questionnaire (EAQ). In addition, we administered additional questionnaires to validate emotion suppression findings. BPD patients reported increased attempts to suppress both negative and positive emotions. These findings indicate that BPD patients are not simply acting out negative emotions. Therapeutic approaches that focus on emotion acceptance of emotions are supported by our study data. Apart from negative emotions, treatment programs should consider positive emotions as well.

Acute glucocorticoid effects on response inhibition in borderline personality disorder

INTRODUCTION

Growing evidence suggests inhibition dysfunctions in borderline personality disorder (BPD). Moreover, abnormalities in hypothalamic-pituitary-adrenal (HPA) axis functioning have also been found in BPD patients. In healthy individuals, response inhibition has been sensitive to acute stress, and previous research indicates that effects mediated by the HPA axis become particularly apparent when emotional stimuli are processed. This study aimed to explore the influence of acute hydrocortisone administration on response inhibition of emotional stimuli in BPD patients compared to healthy control participants.

METHODS

After a single administration of 10mg hydrocortisone or placebo, 32 female BPD patients and 32 healthy female participants performed an adapted emotional go/no-go paradigm to assess response inhibition for emotional face stimuli in a cross-over study.

RESULTS

Acute cortisol elevations decreased the reaction times to target stimuli in both BPD patients and healthy controls. Patients and controls did not differ in task performance; however, BPD patients with comorbid posttraumatic stress disorder (PTSD) displayed longer reaction times than patients without PTSD. In contrast, the occurrence of comorbid eating disorder had no significant impact on go/no-go performance. No significant interaction effect between the treatment condition and the emotional valence of the face stimuli was found.

CONCLUSIONS

Acute hydrocortisone administration enhances response inhibition of face stimuli in BPD patients and healthy controls, regardless of their emotional valence. Our results agree with the suggestion that moderate cortisol enhancement increases the inhibition of task-irrelevant distracters.

Effects of acute cortisol administration on response inhibition in patients with major depression and healthy controls

Glucocorticoids (GCs) have repeatedly been shown to impair hippocampus-mediated, declarative memory retrieval and prefrontal cortex-based working memory in healthy subjects. However, recent experimental studies indicated that patients with major depressive disorder (MDD) lack these impairing effects. These missing effects have been suggested to result from dysfunctional brain GC receptors. The purpose of the present study was to investigate whether response inhibition, an executive function relying on the integrity of the prefrontal cortex, would be impaired after cortisol administration in patients with MDD. In a placebo-controlled, double blind crossover study, 50 inpatients with MDD and 54 healthy control participants conducted an emotional go/no-go task consisting of human face stimuli (fearful, happy, and neutral) after receiving a dose of 10 mg hydrocortisone and after placebo. GC administration had an enhancing effect on inhibitory performance in healthy control participants, indicated by faster responses, while no GC effect was revealed for the patients group. Moreover, patients showed an overall worse performance than healthy participants. In conclusion, this study further supports the hypothesis of impaired central glucocorticoid receptor function in MDD patients. Regarding the importance of inhibitory functioning for daily living, further studies are needed to examine the impact of glucocorticoids on response inhibition.

Effects of cortisol on memory in women with borderline personality disorder: role of co-morbid post-traumatic stress disorder and major depression

BACKGROUND

Stress and cortisol administration are known to have impairing effects on memory retrieval in healthy humans. These effects are reported to be altered in patients with major depressive disorder (MDD) and post-traumatic stress disorder (PTSD) but they have not yet been investigated in borderline personality disorder (BPD).

METHOD

In a placebo-controlled cross-over study, 71 women with BPD and 40 healthy controls received either placebo or 10 mg of hydrocortisone orally before undertaking a declarative memory retrieval task (word list learning) and an autobiographical memory test (AMT). A working memory test was also applied.

RESULTS

Overall, opposing effects of cortisol on memory were observed when comparing patients with controls. In controls, cortisol had impairing effects on memory retrieval whereas in BPD patients cortisol had enhancing effects on memory retrieval of words, autobiographical memory and working memory. These effects were most pronounced for specificity of autobiographical memory retrieval. Patients with BPD alone and those with co-morbid PTSD showed this effect. We also found that co-morbid MDD influenced the cortisol effects: in this subgroup (BPD + MDD) the effects of cortisol on memory were absent.

CONCLUSIONS

The present results demonstrate beneficial effects of acute cortisol elevations on hippocampal-mediated memory processes in BPD. The absence of these effects in patients with co-morbid MDD suggests that these patients differ from other BPD patients in terms of their sensitivity to glucocorticoids (GCs).

Increased suppression of negative and positive emotions in major depression

BACKGROUND

Patients with major depression (MDD) show increased suppression of negative emotions. Emotion suppression is related to depressive symptoms such as depressive mood and anhedonia. It is not clear whether MDD patients also suppress positive emotions. In the present study we aim to investigate suppression of both negative and positive emotions in MDD patients as well as the relation between emotion suppression and depressive symptoms. In addition, we suggest that emotion suppression might be associated with fear of emotions.

METHODS

39 MDD patients and 41 matched healthy control subjects were investigated for emotion suppression and fear of emotions with the Emotion Acceptance Questionnaire (EAQ). In addition, we applied additional questionnaires to validate emotion suppression findings and to assess depressive symptoms.

RESULTS

MDD patients reported increased suppression of both negative and positive emotions. Suppression of negative and positive emotions was related to depressive symptoms. Patients also reported more fear of emotions than healthy subjects and this fear was related to emotion suppression in both study samples.

LIMITATIONS

Due to the cross-sectional and correlational study design, causal directions between the variables tested cannot be stated.

CONCLUSIONS

Fear of emotion might be one reason why MDD patients suppress emotions. With regard to positive emotions, our results strongly suggest that therapeutic approaches should not only encourage patients to participate in potentially enjoyable situations but that patients may also benefit from practicing the allowance of pleasant emotions.

Patients with borderline personality disorder and major depressive disorder are not distinguishable by their neuropsychological performance: a case-control study

OBJECTIVE

Patients with borderline personality disorder (BPD) and patients with major depressive disorder (MDD) exhibit a broad range of neuropsychological deficits. Studies in both groups of patients point to differences but also similarities. However, studies that compare both patient groups are missing from the literature. The present study aimed to compare neuropsychological functioning in BPD and MDD patients.

METHOD

Eighteen patients with BPD, 27 patients with MDD, 17 patients with BPD and MDD, and 76 healthy control subjects were included in the case-control study. Patients were treated for their disorders as inpatients of the Clinic of Psychiatry and Psychotherapy Bethel, Ev. Hospital Bielefeld (Bielefeld, Germany). All patients met DSM-IV diagnoses as assessed by trained psychotherapists within the first week of their admission. In addition to a comprehensive neuropsychological test battery, the inhibitory control of emotional stimuli was assessed. Data were collected between June 2004 and June 2007.

RESULTS

Patients showed only a few impairments and no increased distractibility toward emotionally negative stimuli. Patients with BPD and patients with MDD were not distinguishable by the neuropsychological test results.

CONCLUSIONS

These data did not support the notion of specific neuropsychological profiles in BPD and MDD. Future research needs to clarify the overlap of symptoms between both disorders.

Effect of direct eye contact in PTSD related to interpersonal trauma: an fMRI study of activation of an innate alarm system

In healthy individuals, direct eye contact initially leads to activation of a fast subcortical pathway, which then modulates a cortical route eliciting social cognitive processes. The aim of this study was to gain insight into the neurobiological effects of direct eye-to-eye contact using a virtual reality paradigm in individuals with posttraumatic stress disorder (PTSD) related to prolonged childhood abuse. We examined 16 healthy comparison subjects and 16 patients with a primary diagnosis of PTSD using a virtual reality functional magnetic resonance imaging paradigm involving direct vs averted gaze (happy, sad, neutral) as developed by Schrammel et al. in 2009. Irrespective of the displayed emotion, controls exhibited an increased blood oxygenation level-dependent response during direct vs averted gaze within the dorsomedial prefrontal cortex, left temporoparietal junction and right temporal pole. Under the same conditions, individuals with PTSD showed increased activation within the superior colliculus (SC)/periaqueductal gray (PAG) and locus coeruleus. Our findings suggest that healthy controls react to the exposure of direct gaze with an activation of a cortical route that enhances evaluative 'top-down' processes underlying social interactions. In individuals with PTSD, however, direct gaze leads to sustained activation of a subcortical route of eye-contact processing, an innate alarm system involving the SC and the underlying circuits of the PAG.

Protecting self-esteem from stigma: a test of different strategies for coping with the stigma of mental illness

BACKGROUND

To date, there has been little research into effective strategies for preventing the detrimental effects of stigma on the well-being of people with mental illness.

AIM

The present research set out to identify adaptive strategies for dealing with the stigma of mental illness.

METHODS

On the basis of the responses of 355 people with mental illness (PWMI) a standardized questionnaire assessing 10 identity management strategies was developed. Participants also reported their personal experiences with stigma, depression and self-esteem.

RESULTS

Hierarchical regression analyses showed that after controlling for depression and stigmatizing experiences, the strategies of community involvement, humour and positive ingroup stereotyping were related to higher self-esteem. Secrecy, selective disclosure and attempts at overcompensation or disproving stereotypes were related to lower self-esteem. The following strategies were unrelated to self-esteem: comparing the present social position of PWMI with that in the past, normalization of the illness within a medical model, information seeking and selective withdrawal.

CONCLUSIONS

PWMI should be encouraged to seek support within their community and to develop a positive image of their ingroup.

Effects of acute hydrocortisone administration on declarative memory in patients with major depressive disorder: a placebo-controlled, double-blind crossover study

OBJECTIVE

Major depressive disorder (MDD) has been associated with hypercortisolism, reduced glucocorticoid feedback sensitivity, and impaired memory function. In healthy subjects, administration of hydrocortisone impairs declarative memory. The aim of this study was to examine the effects of acute hydrocortisone administration on memory retrieval in MDD patients and healthy controls. We further tested whether the enhancing or impairing effects of hydrocortisone would prevail when it was given after encoding and when delayed retrieval was tested at a time point when glucocorticoid levels were still elevated.

METHOD

In a placebo-controlled, double-blind crossover study, 44 patients with DSM-IV MDD and 51 healthy control participants received either placebo or 10 mg of hydrocortisone orally before memory testing. A word list paradigm and the Logical Memory Test from the Wechsler Memory Scale were applied. The study was conducted from April 2008 until April 2010 at sites in Bielefeld and Hamburg, Germany.

RESULTS

In both memory tests, patients with MDD performed worse than controls. Healthy controls showed impaired memory performance after hydrocortisone administration compared to placebo. In contrast, hydrocortisone had no effects on memory in MDD patients. Furthermore, in healthy controls we found that administration of hydrocortisone immediately after learning did not lead to an enhanced free recall during increased cortisol levels.

CONCLUSIONS

It appears that the impairing effects of hydrocortisone on memory performance are missing in patients with MDD. This might be interpreted in the context of reduced central glucocorticoid receptor functioning.

Hydrocortisone impairs working memory in healthy humans, but not in patients with major depressive disorder

OBJECTIVE

Several studies have shown that stress or the administration of glucocorticoids can impair hippocampus-based declarative memory retrieval and prefrontal dependent working memory performance in healthy subjects. Major Depressive Disorder (MDD) is often characterized by memory impairment and increased cortisol secretion. Studies indicate that the impairing effects of glucocorticoids on declarative memory performance are missing in patients with MDD. The purpose of our study was to investigate whether the finding of missing effects of acute cortisol administration on memory performance in MDD is also seen when examining prefrontal-based working memory.

METHODS

In a placebo-controlled study, 57 patients with MDD and 56 sex- and age-matched healthy control subjects received either placebo or 10 mg of hydrocortisone orally before memory testing. To test the verbal modality of working memory, the Word Suppression Test was applied with one negative and one neutral test part.

RESULTS

After hydrocortisone intake, healthy subjects showed a significantly poorer working memory performance compared to placebo treatment when negative interference words were administered. In contrast, memory performance of MDD patients was not affected by hydrocortisone treatment.

CONCLUSIONS

The missing effects of glucocorticoid administration on working memory in MDD might be interpreted in the context of reduced central glucocorticoid receptor function.

Psychometrische Analyse eines neuen Fragebogens zur Erfassung der Akzeptanz von unangenehmen und angenehmen Gefühlen (FrAGe)

Zusammenfassung. Die Akzeptanz von Gefühlen ist eine zentrale, der psychischen Gesundheit dienliche Emotionsregulationsstrategie. Das Ziel dieser Untersuchung besteht in einer ersten Überprüfung der testtheoretischen Kennwerte eines neu entwickelten Fragebogens zur Akzeptanz von unangenehmen und angenehmen Gefühlen. In zwei Studien mit 171 und 207 nicht klinischen Probanden wurden die testtheoretischen Kennwerte des ‹Fragebogens zur Akzeptanz von Gefühlen (FrAGe)› bestimmt. Der FrAGe enthält Items aus den Bereichen Akzeptanz angenehmer Gefühle, Akzeptanz unangenehmer Gefühle, Unterdrückung angenehmer Gefühle und Unterdrückung unangenehmer Gefühle. Zur ersten Validierung wurden die ‹Difficulties in Emotion Regulation Scale (DERS)› und eine Kurzversion der ‹Symptomcheckliste (SCL-K-9)› eingesetzt. Die ursprüngliche Fragebogenversion mit 40 Items wurde in der ersten Studie auf Basis von Itemanalysen überarbeitet und auf 32 Items gekürzt. Die zweite Studie zeigte gute bis zufriedenstellende Itemkennwerte sowie eine entsprechende Reliabilität und Validität des FrAGe. Einige Items im Bereich angenehmer Gefühle zeigten bei den nicht klinischen Probanden erwartungsgemäß extremere Itemmittelwerte. Insgesamt sprechen die Ergebnisse für gute psychometrische Eigenschaften des FrAGe. Bei nicht klinischen Personen ist insbesondere die Erfassung von Emotionsakzeptanz unangenehmer Gefühle empfehlenswert.

Die deutsche Version des „Early Trauma Inventory” (ETI)

Zusammenfassung. Für den deutschsprachigen Raum stehen derzeit kaum evaluierte Instrumente zur Erfassung traumatischer Ereignisse in der Kindheit und Jugend zur Verfügung. Während das strukturierte klinische Interview für DSM-IV das Vorliegen einer Traumatisierung in der Kindheit und Jugend mittels eines binären Items erfasst, wird mit dem „Early Trauma Inventory” (ETI; Bremner, Vermetten & Mazure, 2000 ) ein breites Spektrum traumatischer Ereignisse erhoben. Beim ETI handelt es sich um ein halbstandardisiertes klinisches Interview mit den Skalen „Emotionale Erfahrungen”, „Erzieherische/Körperliche Bestrafung”, „Sexuelle Erlebnisse” und „Generelle Traumata”. An einer Stichprobe von 230 Probanden wurden die Reliabilität und Validität der deutschen Übersetzung überprüft. Es konnten gute Reliabilitätskoeffizienten gefunden werden sowie hohe bis moderate Korrelationen zwischen dem ETI und einem Fragebogen zur Erfassung traumatischer Erfahrungen in der Kindheit (CTQ). Niedrigere Korrelationskoeffizienten fanden sich zwischen dem ETI und entfernt assoziierten Konstrukten, wie z.B. Depressivität. Insgesamt sprechen die Ergebnisse für eine zufriedenstellende psychometrische Qualität des ETI.

[Adherence and cognitive performance in schizophrenia]

BACKGROUND

It is known that many patients with schizophrenia show non-adherence with regard to antipsychotic medication. Furthermore, many studies indicate cognitive deficits in schizophrenic patients. In this review, we compare the results of studies examining the relationship of non-adherence and cognitive performance.

METHOD

Based on a systematic literature review, the impact of cognitive performance on the adherence behaviour of patients with schizophrenia was examined.

RESULTS

We found 18 studies analysing the impact of cognitive performance on adherence behaviour. Most studies indicated that patients with stronger cognitive impairments show lower adherence behaviour. Possible causal mechanisms are discussed.

A New Approach in Clinical Neuropsychology to the Assessment of Spatial Working Memory: The Block Suppression Test

The Block Suppression Paradigm developed by Beblo, Klaver, Grubich, Wachowius, and Herrmann (1999) is based on the Corsi Block tapping test and requires that a subject reproduces every 2nd block in a given sequence. Results from two studies of a standardized version, the Block Suppression Test (BST), are presented here. In Study 1 the BST was administered to 48 healthy subjects along with a battery of comprehensive neuropsychological tests. The reliability of the BST proved satisfactory under psychometric analysis, while Principal Component Analysis (PCA) confirmed its validity. In Study 2 the BST was administered to a clinical sample of 31 brain-damaged patients to demonstrate its clinical practicability.

The impact of neutral and emotionally negative distraction on memory performance and its relation to memory complaints in major depression

Patients with major depression (MDD) often report relevant cognitive problems in everyday life while performance in standardised neuropsychological tests is not severely disturbed. This discrepancy may partly be due to the differences between the demands of everyday life with the presence of emotionally relevant distractors and standardised neuropsychological settings without those distractors. In the present study, we hypothesise that patients with major depression (MDD) show an increased distractibility towards emotionally negative stimuli and that this distractibility is related to complaints of cognitive functioning in everyday life. Thirty MDD patients and 48 healthy participants performed our recently developed learning paradigm with neutrally and negatively valenced distraction as well as without distraction. Both groups also performed a neuropsychological test battery as well as self- and observer ratings of impairments in memory and attention in every day life. In the MDD sample, cognitive impairments were reported by the patients and their relatives but were not found in the neuropsychological tests. We found a trend towards a poorer memory performance with negatively valenced distraction in the MDD sample when compared to the performance of healthy subjects. However, this impairment was not related to the self- and observer ratings. This result may be due to the fact that the distractors were not personally relevant to the subjects whereas everyday life implies such distractors. Further research is needed to explore everyday cognitive functioning of patients with MDD.

Effects of acute cortisol administration on autobiographical memory in patients with major depression and healthy controls

OBJECTIVE

Overgeneral autobiographical memory has become a well established phenomenon within major depressive disorder (MDD). Neuroendocrinologically, MDD is often characterized by a dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, i.e. hypercortisolemia and reduced feedback sensitivity. In healthy participants cortisol administration has been found to impair autobiographical memory retrieval. The purpose of this study was to compare the effects of acute cortisol administration on autobiographical memory in MDD patients with the effects observed in healthy controls. We hypothesized that in contrast to healthy control subjects acute cortisol administration would not affect autobiographical memory performance in MDD due to reduced central glucocorticoid sensitivity.

METHODS

In a placebo-controlled, double-blind crossover study, 16 patients with MDD and 16 healthy control subjects received a placebo or 10mg of hydrocortisone orally before autobiographical memory testing (AMT).

RESULTS

In the placebo condition depressed patients performed poorer than controls. After hydrocortisone intake, healthy subjects reported significantly fewer specific memories on the AMT compared to placebo treatment. In contrast, memory specificity of MDD patients was not affected by hydrocortisone treatment.

CONCLUSIONS

The present findings replicate previous findings of impaired autobiographical memory retrieval after hydrocortisone treatment in healthy subjects and of impaired AMT performance in depressed patients. We speculate that the missing acute impairing effect of hydrocortisone on autobiographical memory in depressed patients might reflect reduced central glucocorticoid sensitivity. However alternative explanations cannot be ruled out.

[Regarding the search for a specific neuropsychological profile in depression: limits and perspectives]

It has long been known that patients with depression show neuropsychological symptoms. A great number of studies aimed at an exact characterization of these symptoms. Scientifically, the knowledge about such a profile was thought to provide information about neurobiological dysfunctions. Clinically, this knowledge would be useful to differentiate depression from other psychiatric or neurological diseases. However, the neuropsychological profile of depression is still not well established. We discuss four perspectives that provide possible explanations for the current state of knowledge and may help to further develop our knowledge about neuropsychological dysfunctions in depression: first, because there is great variation in the aetiology and phenomenology of depression and even in different subtypes of affective disorders, unitary neuropsychological profiles can not be expected. Further research should focus on relevant factors that influence cognitive functioning of depressed patients. Second, neuropsychological tests administered should be specific for certain cognitive functions and, third, should provide emotionally relevant stimuli as well. Finally, future studies should systematically consider psychiatric control groups in addition to healthy participants. With the consideration of these factors, neuropsychological research in depression significantly contributes to our understanding and conceptualization of mental disorders.

Entwicklung eines Fragebogens zur subjektiven Einschätzung der geistigen Leistungsfähigkeit (FLei) bei Patienten mit psychischen Störungen

Das Ziel dieser Untersuchung besteht in einer ersten Überprüfung der testtheoretischen Kennwerte des neu entwickelten «Fragebogens zur geistigen Leistungsfähigkeit (FLei)» bei Patienten mit psychischen Störungen. An der Untersuchung nahmen insgesamt 259 Personen teil, 68 Schizophreniepatienten, 94 depressive Patienten und 97 Kontrollpersonen. Die ursprüngliche Version des Fragebogens umfasste 88 Items der Bereiche Aufmerksamkeit, Gedächtnis und Exekutivfunktionen sowie Fragen zum visuellen Neglekt. Der Fragebogen konnte auf 35 Items reduziert werden. Items verschiedener Funktionsbereiche waren hoch miteinander korreliert. Itemkennwerte, interne Konsistenz und Split-Half Reliabilität sind durchgängig als gut zu bezeichnen. Depressive Patienten berichteten die deutlichsten Defizite. Eine funktionsspezifische Auswertung ist aufgrund der hohen Interkorrelationen zwischen den Funktionsbereichen nur bedingt zu empfehlen. In weiteren Untersuchungen sollten die Ergebnisse an einer unabhängigen Stichprobe bestätigt werden.

Relationship between coping with negative life-events and psychopathology: major depression and borderline personality disorder

Ninety psychiatric in-patients and 73 controls have been asked about their coping styles to negative life-events. Patients reported more emotion-oriented coping than controls. Emotion-oriented coping style was positively correlated with psychopathology, while task-oriented coping was negatively correlated with psychopathology in events which the participants had difficulties dealing with.

Emotion-induced memory dysfunction in borderline personality disorder

INTRODUCTION

Although emotional dysregulation is a core problem in borderline personality disorder (BPD), few neuropsychological studies have evaluated the impact of emotion. The present study aimed at the comprehensive investigation of verbal memory functions with and without emotionally relevant interference in BPD. BPD patients were expected to perform as well as healthy subjects in standard memory tasks but to show fewer capacities to control for emotionally negative interference.

METHODS

47 patients with BPD and 70 healthy control subjects participated. An experimental task assessed verbal memory with respect to standard and emotionally relevant and neutral interference learning conditions. Applied standard tests covered working memory, delayed memory, and word fluency.

RESULTS

Memory performances of BPD patients were impaired when negatively valenced interference was conducted but normal in all other conditions. These results remained stable after controlling for comorbid major depression and posttraumatic stress disorder.

DISCUSSION

The present findings suggest no general impairment of verbal memory functions in BPD but control and inhibition of interference by emotionally significant material seem to be disturbed.

Neural correlates of the individual emotional Stroop in borderline personality disorder

OBJECTIVE

Emotional dysregulation is a key feature of borderline personality disorder (BPD) with altered inhibitory functions having suggested as being crucial. The anterior cingulate cortex and further prefrontal brain regions are crucial for response inhibition. The regulation of emotions is ensured via inhibitory control over the amygdala. The present study aimed to investigate neural correlates of response inhibition in BPD by using an emotional Stroop paradigm extending the task to word stimuli which were related to stressful life events.

METHODS

Twenty BPD patients and 20 healthy controls underwent functional magnetic resonance imaging (fMRI) while performing the individual emotional Stroop task. A block design was used with the following word type conditions: neutral words, general negative words, and individual negative words. The individual negative words were recruited from a prior interview conducted with each participant.

RESULTS

While BPD patients had overall slower reaction times in the Stroop task compared to healthy controls, there was no increased slowing with emotional interference. Controls exhibited significant fMRI blood oxygenation level-dependent signal increases in the anterior cingulate cortex as well as in frontal cortex contrasting generally negative vs. neutral and individual negative vs. neutral conditions, respectively. BPD patients did not show equivalent signal changes.

CONCLUSIONS

These results provide further evidence for a dysfunctional network of brain areas in BPD, including the ACC and frontal brain regions. These areas are crucial for the regulation of stress and emotions, the core problems of BPD patients.

Attentional bias to personally relevant words in borderline personality disorder is strongly related to comorbid posttraumatic stress disorder

Current research indicates altered inhibitory functioning in borderline personality disorder (BPD). The emotional stroop task is a widely used method for investigating inhibition of interference. In the present study we used an individualized version of the emotional stroop task to investigate inhibitory functioning in BPD with respect not only to valence but also to personal relevance of the stimuli. Thirty-one BPD patients and 49 healthy controls performed the individual emotional stroop task that consisted of (1) words related to personal negative life events that were currently relevant (2) words related to personal negative life events that were not currently relevant, (3) negative words that were not personally relevant, and (4) neutral words. BPD patients showed greater interference only for words related to personal negative life events with current relevance. A comparison between BPD patients with and without posttraumatic stress disorder (PTSD) revealed reduced inhibitory functioning only in BPD patients with PTSD. Inhibition of interference in BPD patients seems not to be altered in general but is exclusively disturbed in those with comorbid PTSD when highly relevant personal factors are the focus of attention.

One-year functional magnetic resonance imaging follow-up study of neural activation during the recall of unresolved negative life events in borderline personality disorder

BACKGROUND

Recall of adverse life events under brain imaging conditions has been shown to coincide with activation of limbic and prefrontal brain areas in borderline personality disorder (BPD). We investigate changes of functional magnetic resonance imaging (fMRI) activation patterns during the recall of unresolved adverse life events (ULE) over 1 year.

METHOD

Thirteen female BPD patients participated in the study. During fMRI measurement subjects recalled ULE and negative but resolved life events (RLE) after individual cue words to stimulate autobiographical memory retrieval. Subjective intensity of emotional and sensoric experiences during recall was assessed as well as standardized measures of psychopathology.

RESULTS

A 2x2 factorial analysis of fMRI data (Deltat1/t2xDeltaULE/RLE) revealed major right more than left differences of activation (i.e. t1>t2) of the posterior more than anterior cingulate, superior temporal lobes, insula, and right middle and superior frontal lobes (second-level analysis, t=3.0, puncorrected=0.003). The opposite contrast (Deltat2/t1xDeltaULE/RLE) did not reveal any differences. We did not find changes of emotional or sensoric qualities during recall (ULE versus RLE) or of psychopathology measures over the 1-year period.

CONCLUSIONS

Although subjective and clinical data did not change within 1 year, we observed a substantial decrease of temporo-frontal activation during the recall of ULE from t1 to t2. If future research confirms these findings, the question arises whether the decrease of neural activation precedes clinical improvement in BPD.

Neural correlates of episodic and semantic memory retrieval in borderline personality disorder: an fMRI study

Verbal memory impairment in borderline personality disorder (BPD) is still a matter of debate. In this study we combine investigations of both, memory retrieval as well as underlying neural circuits in BPD. Functional magnetic resonance imaging (fMRI) was used to study regional brain activation in 18 right-handed female patients with BPD and 18 matched controls during the retrieval of an episodic memory retrieval (EMR) task (free recall of a word list) and a semantic memory retrieval (SMR) task (verbal fluency). Despite unaffected performance in EMR and SMR, patients with BPD showed task-specific increased activation compared with controls. During EMR, the increased activation encompassed the posterior cingulate cortex bilaterally, the left middle and superior temporal gyrus, the right inferior frontal gyrus, and the right angular gyrus. SMR was associated with increased activation of the posterior cingulate cortex, of the right fusiform gyrus, of the left anterior cingulate cortex, and of the left postcentral gyrus. Our findings suggest that BPD patients may need to engage larger brain areas to reach a level of performance in episodic and semantic retrieval tasks that is comparable to that of healthy controls.

Early detection of Alzheimer's disease: a new working memory paradigm

OBJECTIVES

Early detection of Alzheimer's disease (AD) offers the chance to decelerate the patients' cognitive decline and to prolong a self-determined, independent life. Neuropsychological testing is one key approach to establish an early diagnosis. Whereas more global cognitive abilities can be preserved until further progression of the disease, specific executive abilities such as dual-task or active inhibition processes decline very early. Our recently developed working memory paradigm, the Block Suppression Test (BST), requires an active inhibition of irrelevant stimuli and thus should differentiate between Alzheimer patients and controls in early disease stages more accurately than classical screening instruments.

METHODS

In a pilot study we applied the BST, the MMSE, the clock drawing test, a digit-word transformation task as well as verbal and spatial memory span tasks to a group of 13 patients with Alzheimer's disease and 13 elderly controls and compared the instruments' capability to differentiate between patients and controls.

RESULTS

The BST showed the highest sensitivity among all applied tests with a perfect differentiation of healthy subjects and patients. The patients' backward spans were significantly reduced, in the inhibition condition they showed disproportionally worse performances.

CONCLUSIONS

Our results reveal a specific inhibition deficit in mild AD rather than a global working memory breakdown. The BST thus was superior for early diagnosis. However, these findings must be replicated in a larger sample to prove the BST's applicability for the early diagnostic assessment of AD and other dementias.

fMRI of alcohol craving after individual cues: a follow-up case report

Alcohol addiction is typically associated with intense alcohol craving triggered by internal or environmental cues linked with past alcohol use. We used functional magnetic resonance imaging (fMRI) to record cerebral correlates of craving in an alcoholic patient. Craving was evoked by highly individual cues associated with past alcohol use and was assessed before (T1) and after an 8-month period of psychotherapy (T2). To control for effects of life event memories related to non alcoholic cravings, the patient provided two events from periods of his life when he experienced caffeine craving. We detected activation of the superior temporal lobe during recall of a highly alcohol craving situation (T1 minus T2), whereas we did not observe any activation during coffee craving recall when pre und post activations were compared. These results indicate that the superior temporal lobe may be involved when alcohol craving is initiated by individual verbal cues. Further studies using individual cues are needed to explore the neural correlates of alcohol craving.

Stability of the dexamethasone suppression test in borderline personality disorder with and without comorbid PTSD: a one-year follow-up study

Alterations in hypothalamic-pituitary-adrenal axis feedback regulation have been repeatedly reported in patients with borderline personality disorder (BPD). Due to the cross-sectional design of these studies, little is known about the longitudinal course of HPA axis functioning. In a sample of 13 patients with BPD, the dexamethasone suppression test (DST) has been used in a one-year follow-up study. There were no changes of cortisol concentrations before or after dexamethasone intake between baseline and follow-up examination. Patients with comorbid posttraumatic stress disorder (PTSD) showed more pronounced cortisol suppression compared to those without PTSD. The DST seems to be a stable marker of alterations in HPA axis feedback regulation in BPD, which is also reflected by substantial correlations between percentage of cortisol suppression at baseline and follow-up examination.

Cognitive performance and subjective complaints before and after remission of major depression

INTRODUCTION

Patients with major depression report on severe cognitive deficits but objective neuropsychological test results indicate rather mild problems. In the present study we aimed at investigating neuropsychological performance, subjective complaints, and observer ratings of cognitive abilities in everyday life.

METHODS

Fifteen patients with major depression were studied in the acute state of illness and after remission. Fifteen healthy control subjects were investigated, too. A comprehensive neuropsychological battery, questionnaires for self and observer rating of cognitive abilities, and clinical questionnaires were administered.

RESULTS

As expected problems reported in self and observer ratings exceeded neuropsychological deficits in tests. Neuropsychological test results tended to be improved at the second test session, with patients showing a more pronounced improvement in flexibility.

CONCLUSIONS

The data support the hypothesis that cognitive problems in everyday life indeed exceed results in standardised tests. However, it seems also likely from our data that results are additionally influenced by patients negative self perception.

Habituieren oder sensitivieren Patienten mit Alkoholabhängigkeit an suchtassoziierte Stimuli?

Zusammenfassung: Der emotionale Stroop Test ist ein in der Forschung häufig eingesetztes Verfahren, um Interferenzeffekte durch emotionale oder krankheitsrelevante Stimuli zu untersuchen. So konnte gezeigt werden, dass Patienten mit Alkoholabhängigkeit verlangsamte Reaktionszeiten auf alkoholspezifische Reize aufweisen. Inwieweit dieser Effekt bei Wiederholungsmessungen stabil ist, wurde bisher weniger intensiv untersucht. Dies ist insofern erstaunlich, als dass sowohl Theorien existieren, die eine Normalisierung der Reaktionszeiten nahe legen (Habituation), als auch Konzepte, die gleich bleibende oder zunehmend verlangsamte Reaktionszeiten erwarten lassen (Sensitivierung), möglicherweise assoziiert mit verstärktem oder neu entstehendem Craving. In dieser Studie wurden 20 Patienten mit Alkoholabhängigkeit nach abgeschlossenem Alkoholentzug mit einem Stroop Test untersucht, in dem u. a. individuell bedeutsame alkoholbezogene Wörter präsentiert wurden. Zunächst konnten frühere Befunde einer verstärkten Interferenz durch alkoholassoziierte Wörter repliziert werden. Weiterhin konnte gezeigt werden, dass Patienten mit einer Alkoholerkrankung an diese Stimuli habituieren. In weiteren Studien sollte untersucht werden, inwieweit dieser Habituationseffekt auch auf physiologischer Ebene nachweisbar ist.

Deficits in visual functions and neuropsychological inconsistency in Borderline Personality Disorder

For Borderline Personality Disorder (BPD) cognitive and perceptual impairments were reported in some but not all studies. The aim of the present study was to analyze the neuropsychological performance of BPD patients in different domains. Predominant impairments of visual functions and an increased intra-individual variation of test performances within neuropsychological domains were expected. We investigated 22 patients with BPD and a matched sample of 22 healthy control subjects. A comprehensive clinical and neuropsychological test battery was administered. Effect sizes indicate primarily deficits of visual functions such as visual memory (Wechsler Memory Scale-Revised, WMS-R: Visual pair associates and visual reproduction, Complex Figure Test: Recall) and visuo-spatial abilities (Leistungspruefsystem, LPS 9 and 10: Spatial imagination and embedded figures), but also of executive functions (Tower of Hanoi, Trail Making Test-B, semantic and figural fluency, LPS 4: Reasoning). In addition, the intra-individual ranges of neuropsychological test results in BPD patients were increased compared to those of healthy subjects. This finding might be due to a high degree of temporary stress that interferes with effective cognitive processing. Further research is needed to confirm the present results and to control for stress during the test procedure.

Functional MRI correlates of the recall of unresolved life events in borderline personality disorder

BACKGROUND

Patients with borderline personality disorder (BPD) frequently report unresolved life events but it is still poorly understood, how these experiences are represented in the brain. Using functional magnetic resonance imaging (fMRI), the present study aimed at investigating the neural correlates of the recall of unresolved life events in patients with BPD and healthy controls.

METHOD

Twenty female BPD patients and 21 healthy control subjects underwent fMRI. During measurement subjects recalled unresolved and resolved negative life events. Individual cue words were used to stimulate autobiographical memory. After scanning, subjects rated their emotional states during the recall of both types of memories.

RESULTS

When contrasting unresolved and resolved life events, patients showed significant bilateral activation of frontotemporal areas including the insula, amygdala, and the anterior cingulate cortex, the left posterior cingulate cortex, right occipital cortex, the bilateral cerebellum and the midbrain. In healthy subjects, no differential brain activation was related to these conditions. The 2 x 2 factorial analysis (DeltaBPD - Deltacontrols) revealed similar results with bilateral activation of the frontal cortex including parts of the insula and of the orbitofrontal cortex, temporal activation including the amygdala, activation of the right occipital cortex, and parts of the cerebellum. Patients but not controls reported higher levels of anxiety and helplessness during the unresolved versus resolved memory condition.

CONCLUSIONS

The activation of both, the amygdala and prefrontal areas, might reflect an increased effortful but insufficient attempt to control intensive emotions during the recall of unresolved life events in patients with BPD.

Assessing Learning With and Without Interference

Abstract. Whereas learning in every day life requires the inhibition of irrelevant information, standardized memory tests usually do not contain interfering stimuli. The present study aims at an initial evaluation of a new verbal learning paradigm that considers learning with emotionally neutral or negative interference, and learning without interference. In three learning trials, 82 healthy subjects learned three 15-item word lists derived from the Auditory Verbal Learning Test. Word recall in both conditions with interference was decreased, especially in the first learning trial and regardless of emotional valence. Working memory, therefore, might be more affected by interference than learning. These first promising results indicate the usability of the new verbal paradigm for clinical purposes.

Dexamethasone suppression test in borderline personality disorder--effects of posttraumatic stress disorder

BACKGROUND

Divergent findings of hypothalamic-pituitary-adrenal (HPA) axis functioning in borderline personality disorder (BPD) may be caused by a different degree of comorbid posttraumatic stress disorder (PTSD), in which alterations of the HPA axis are well known. Here we investigate alterations of the HPA axis in BPD patients with and without comorbid PTSD compared to healthy controls. Considering previous findings current major depression (MDD) was taken into account as a confounding variable.

METHODS

Apart from clinical assessment the 0.5 mg dexamethasone suppression test (DST) was performed in 21 female borderline patients and 23 healthy controls.

RESULTS

Twelve BPD patients suffered from comorbid PTSD. Relative suppression (%) did not differ between healthy controls and the total BPD group, but BPD patients with comorbid PTSD showed increased suppression compared to those without. Comorbid MDD was not associated with suppression.

CONCLUSIONS

Our results do not indicate a dysfunction of the HPA axis in BPD. However, comorbid PTSD seems to be associated with a relative hypersuppression in the 0.5 mg DST.

Diagnostik depressiver Störungen im Alter

Zusammenfassung: Depressive Störungen bleiben häufig unentdeckt, obwohl sie zu den häufigsten psychischen Störungen gehören und bekannt ist, dass sich eine fehlende Behandlung negativ auf den Erkrankungsverlauf und die Entwicklung körperlicher Krankheiten auswirken kann. Aufgrund eines veränderten Symptomprofils und zusätzlicher differenzialdiagnostischer Fragestellungen, z. B. in der Abgrenzung zu demenziellen Erkrankungen, ergeben sich gerade bei älteren Patienten schwierige diagnostische Fragestellungen. Eine angemessene Diagnostik setzt zum einen den Einsatz kategorialer Untersuchungsverfahren voraus, die an den Klassifikationssystemen ICD-10 oder DSM-IV orientiert sind. Zur Einschätzung des Depressionsschweregrades und der Beurteilung von Krankheitsverläufen müssen zusätzlich Ratingskalen eingesetzt werden. Selbst- und Fremdratingverfahren ermöglichen dabei einen unterschiedlichen Zugang zur depressiven Symptomatik, weshalb beide Verfahrenstypen verwendet werden sollten. Da die meisten bekannten Verfahren nicht für die Diagnosestellung im höheren Lebensalter konstruiert wurden, erfordert der diagnostische Prozess einen feinfühligen, die Besonderheiten depressiver Störungen im Alter berücksichtigenden Umgang mit diesen Verfahren.