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Butovskaya M, Burkova V, Apalkova Y, Dronova D, Rostovtseva V, Karelin D, Mkrtchyan R, Negasheva M, Batsevich V. Sex, population origin, age and average digit length as predictors of digit ratio in three large world populations. Sci Rep 2021; 11:8157. [PMID: 33854119 PMCID: PMC8046776 DOI: 10.1038/s41598-021-87394-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 03/25/2021] [Indexed: 02/06/2023] Open
Abstract
Recently, a number of authors have claimed that sexual dimorphism in the second-to-fourth digit ratio (2D:4D) is simply dependent on digit length and is an artifact of allometry. The goal of our study is to verify the validity of these assumptions. The study sample comprised 7,582 individuals (3,802 men and 3,780 women) from three large world populations: Europeans (n = 3043), East Africans (n = 2844), and Central Asians (n = 1695). The lengths of the second and fourth digits on both hands were measured. Digit ratios were computed according to standard procedures. Analyses were conducted separately for each hand for the whole sample and in succession for the three large populations. Additionally, we separately tested four age cohorts (≤ 13, 14-18, 19-30, and 31 ≥ years) to test the effect of developmental allometry. The second and fourth digits showed strong positive linear relationships on both hands, and demonstrated an increase with age; digit length in women from the youngest age cohort was longer or equal to that of men, and shorter than men in older age cohorts. However, the 2D:4D magnitude and its sexual dimorphism remained stable throughout the ontogeny. To test for an allometric effect on 2D:4D, the average digit lengths were calculated. Both sex and population origin were permanent reliable predictors of 2D:4D, whereas average digit length was not. Height was applied as another measure of allometric effect on the limited sample (≤ 30 years) from the European population, along with sex and age. No allometric effect was observed in this case. We conclude that sex differences in 2D:4D are not an artifact of allometry.
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Affiliation(s)
- Marina Butovskaya
- Institute of Ethnology and Anthropology, Russian Academy of Sciences, Leninsky pr., 32a, Moscow, Russia, 119991.
- National Research University Higher School of Economics, Moscow, Russia.
- Russian State University for the Humanities, Moscow, Russia.
| | - Valentina Burkova
- Institute of Ethnology and Anthropology, Russian Academy of Sciences, Leninsky pr., 32a, Moscow, Russia, 119991
- National Research University Higher School of Economics, Moscow, Russia
| | - Yulia Apalkova
- Institute of Ethnology and Anthropology, Russian Academy of Sciences, Leninsky pr., 32a, Moscow, Russia, 119991
| | - Daria Dronova
- Institute of Ethnology and Anthropology, Russian Academy of Sciences, Leninsky pr., 32a, Moscow, Russia, 119991
| | - Victoria Rostovtseva
- Institute of Ethnology and Anthropology, Russian Academy of Sciences, Leninsky pr., 32a, Moscow, Russia, 119991
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Association patterns between 2D:4D ratio and age at menarche: the impact of methodology. ANTHROPOLOGICAL REVIEW 2020. [DOI: 10.2478/anre-2020-0026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
The ratio of index finger to ring finger length (2D:4D) is a sexually dimorphic feature and widely used as an indicator of prenatal androgen-estrogen exposure. Several studies have investigated the relationship between the 2D:4D ratio and the onset of the first menstrual period (menarche) in women.
The present study tested the association patterns between 2D:4D ratio and age at menarche. Furthermore, the impact of methods of measuring finger lengths was considered.
Two samples were used to conduct the study. One sample consisted of 110 women who self-measured their finger lengths. The finger length measurements in the second sample (88 women) were taken from one trained observer using the caliper-based technique. Age at menarche was determined using a retrospective method.
Women from the first sample reported an average age for the onset of the first menstrual bleeding at 12.9 (SD = 1.4) years of age. There was no significant association between the left and right 2D:4D ratio and the age at menarche. The second sample showed a mean age at menarche at 12.8 (SD = 1.3) years of age. Here, the right hand 2D:4D ratio and age at menarche were significantly correlated (p<0.001).
A more feminine 2D:4D ratio was significantly associated with an earlier menarcheal age only in the sample with direct finger length measurements by a trained investigator. The sample using self-measurements yielded no significant associations between menarcheal age and 2D:4D. The use of a reliable and well-founded methodology is essential for obtaining meaningful results.
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Effects of hand preference on digit lengths and digit ratios among children and adults. Early Hum Dev 2020; 151:105204. [PMID: 33059164 DOI: 10.1016/j.earlhumdev.2020.105204] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 09/28/2020] [Accepted: 09/29/2020] [Indexed: 01/21/2023]
Abstract
BACKGROUND Prenatal sex hormones may not exclusively determine effects of hand preference on digit ratios. Genetic determination is an alternative possibility. AIM To study the likelihood of similar effects of hand preference on digit lengths and digit ratios. METHODS We selected similar numbers of left-handers and right-handers in samples of kindergarten children (N = 101, age range: 3.5-7 years) and adults (N = 189, age range: 17-28 years) and measured digit lengths (excluding the thumb) directly on the palmar hand. RESULTS Compared to right-handers, left-handers had longer digits and lower third-to-fourth (3D:4D) digit ratios among children, whereas an opposite pattern of handedness differences occurred among adults. CONCLUSIONS Effects of hand preference on digit lengths and ratios might be genetically/ontogenetically determined. Also discussed are implications of this set of findings for digit ratio research.
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Lofeu L, Brandt R, Kohlsdorf T. Digit identity matters: origin and evolution of sexual dimorphism in the digit lengths of tropidurid lizards. Biol J Linn Soc Lond 2020. [DOI: 10.1093/biolinnean/blaa088] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Sexual dimorphism in digit lengths reflects phenotypic evolution mediated by developmental steroids. Differences in the identity of the sexually-dimorphic digit may evolve if the concentrations of sex-steroid receptors in the digit are easily modified and the initial changes have low impact on fitness. Accordingly, sexual dimorphism in digit lengths might initially originate under neutral selective regimes, being subsequently co-opted by embryonic hormonal effects on sensitive traits that are more likely to be targeted by selection. Correlated variation among sexually-dimorphic traits might therefore reflect pleiotropic hormonal modulation during development. Moreover, the identity and trend of the sexually-dimorphic digit might be evolutionarily labile even among closely-related species. We evaluated this model by assessing the identity of sexually-dimorphic digits among 11 Tropiduridae lizard species and inferring evolutionary patterns of sexual dimorphism. Assuming that digit lengths can be used as a proxy for hormonal modulation of steroid-sensitive traits during development, we tested for evolutionary associations among sexual dimorphism of digit lengths, body size and other traits that may be direct targets of sexual selection in the Tropiduridae. Sexual dimorphism in digit lengths is evolutionarily labile in the Tropiduridae, and diversity, instead of conservatism, seems to rule developmental mechanisms underlying the evolution of sexual dimorphism in digit ratios.
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Affiliation(s)
- Leandro Lofeu
- Department of Biology, FFCLRP, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Renata Brandt
- Department of Biology, FFCLRP, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
- Science North, Sudbury, ON, Canada
| | - Tiana Kohlsdorf
- Department of Biology, FFCLRP, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
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Butovskaya M, Rostovtseva V, Butovskaya P, Burkova V, Dronova D, Filatova V, Sukhodolskaya E, Vasiliev V, Mesa T, Rosa A, Lazebny O. Oxytocin receptor gene polymorphism (rs53576) and digit ratio associates with aggression: comparison in seven ethnic groups. J Physiol Anthropol 2020; 39:20. [PMID: 32795360 PMCID: PMC7427763 DOI: 10.1186/s40101-020-00232-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 08/03/2020] [Indexed: 11/10/2022] Open
Abstract
Background The specific role of the oxytocin receptor (OXTR) gene polymorphisms in emotional support seeking, related to social norms and culturally normative behavior, has been discussed in several studies. Evidence on the association between aggression and OXTR polymorphisms has also been reported. The goal of the current study was to analyze the effect of the OXTR rs53576 polymorphism, prenatal testosterone effect (second-to-fourth digit ratio, or 2D:4D), and culture on aggression assessed with the Buss-Perry Aggression Questionnaire (BPAQ). Methods The data were collected in Russia and Tanzania and included seven ethnic groups of European, Asian, and African origin. The total sample included 1705 adults (837 males, 868 females). All the subjects were evaluated with the BPAQ. As a measure of prenatal androgenization, the second and fourth digits were measured directly from hand, and the digit ratios were calculated. All the participants provided buccal samples, from which genomic DNA was extracted, and the OXTR gene rs53576 polymorphism was genotyped. Statistical analysis was performed using SPSS version 23.0; the alpha level for all analyses was set at 0.05. Results The ethnic group factor was the most significant predictor of ratings on BPAQ (medium effect size for physical aggression, anger and hostility scales, and low for verbal aggression). To study the effect of sex, the OXTR polymorphism, and prenatal androgenization, we conducted the z-score transformation for BPAQ scales and 2D:4D for each ethnic group and pooled these data into new z-score variables. According to the GLM analysis after leveling the effects of culture (z-transformation), all four scales of BPAQ demonstrated association with sex (main effects), with men scoring higher on physical and verbal aggression and women scoring higher on anger and hostility. Anger and hostility scales were also associated with OXTR polymorphism and 2D:4D of the right hand. The lowest levels of anger and hostility were observed in individuals with the AA genotype, especially in men. Conclusions Our data suggest that both oxytocin (OXTR gene polymorphism) and fetal testosterone (2D:4D) may significantly affect emotional (anger) and cognitive (hostility) aggression in humans, given the leveling the role of culture.
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Affiliation(s)
- Marina Butovskaya
- Institute of Ethnology and Anthropology, Russian Academy of Sciences, Leninsky Prospect 32a, 119991, Moscow, Russia. .,National Research University Higher School of Economics, Moscow, Russia.
| | - Victoria Rostovtseva
- Institute of Ethnology and Anthropology, Russian Academy of Sciences, Leninsky Prospect 32a, 119991, Moscow, Russia
| | | | - Valentina Burkova
- Institute of Ethnology and Anthropology, Russian Academy of Sciences, Leninsky Prospect 32a, 119991, Moscow, Russia.,National Research University Higher School of Economics, Moscow, Russia
| | - Daria Dronova
- Institute of Ethnology and Anthropology, Russian Academy of Sciences, Leninsky Prospect 32a, 119991, Moscow, Russia
| | - Vasilisa Filatova
- Institute of Ethnology and Anthropology, Russian Academy of Sciences, Leninsky Prospect 32a, 119991, Moscow, Russia
| | - Eugenia Sukhodolskaya
- Federal Budget Institution of Science "Central Research Institute of Epidemiology" of The Federal Service on Customers' Rights Protection and Human Well-being Surveillance, Moscow, Russia
| | - Vasiliy Vasiliev
- Institute of Gene Biology, Russian Academy of Sciences, Moscow, Russia
| | - Tania Mesa
- Secció de Zoologia i Antropologia Biològica, Departament de Biologia Evolutiva, Ecologia i Ciències Ambientals, Facultat de Biologia, Universitat de Barcelona (UB), Barcelona, Spain
| | - Araceli Rosa
- Secció de Zoologia i Antropologia Biològica, Departament de Biologia Evolutiva, Ecologia i Ciències Ambientals, Facultat de Biologia, Universitat de Barcelona (UB), Barcelona, Spain.,Institut de Biomedicina de la Universitat de Barcelona (IBUB), Barcelona, Spain.,Centre for Biomedical Research Network on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Barcelona, Spain
| | - Oleg Lazebny
- Koltzov Institute of Developmental Biology, Russian Academy of Sciences, Moscow, Russia
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Tabachnik M, Sheiner E, Wainstock T. The association between second to fourth digit ratio, reproductive and general health among women: findings from an Israeli pregnancy cohort. Sci Rep 2020; 10:6341. [PMID: 32286380 PMCID: PMC7156723 DOI: 10.1038/s41598-020-62599-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 03/15/2020] [Indexed: 12/17/2022] Open
Abstract
The ratio between the length of second and fourth digits (2D:4D) is a putative biomarker for prenatal testosterone and estrogen exposure. The aim of the study was to examine the association between 2D:4D and women’s general and reproductive health. This analysis was conducted within a prospective pregnancy cohort study. The study population included 187 women. 2D:4D was measured directly in both hands using a digital caliper. Multivariable linear and logistic models were used to study the associations between digit ratio and the studied health characteristics. Mean age of the participants was 30.7 ± 4.9 years. The mean age at menarche was 12.9 ± 1.4 years. Right hand 2D:4D mean ± SD was 0.965 ± 0.03. Left hand 2D:4D mean ± SD was 0.956 ± 0.03. An association was found between right 2D:4D and age at menarche, with older age in women with 2D:4D ≥ mean versus 2D:4D < mean (13.2 ± 1.5 and 12.8 ± 1.3 respectively, b = 0.48, 95%CI:0.06–0.91) while controlling for ethnicity. Higher 2D:4D was also associated with heavier menses bleeding and dysmenorrhea. There is an association between 2D:4D and sub optimal reproductive characteristics, including later age at menarche, heavier menses bleeding and dysmenorrhea. These findings support the association between the intrauterine period and reproductive characteristics. Further studies are required to support our findings.
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Affiliation(s)
- Maya Tabachnik
- The Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, POB 653, Beer-Sheva, 84105, Israel.
| | - Eyal Sheiner
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, POB 151, Beer-Sheva, 84101, Israel
| | - Tamar Wainstock
- The Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, POB 653, Beer-Sheva, 84105, Israel
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Kasielska-Trojan A, Danilewicz M, Sitek A, Antoszewski B. Body size measurements, digit ratio (2D:4D) and oestrogen and progesterone receptors' expressions in juvenile gigantomastia. J Pediatr Endocrinol Metab 2020; 33:403-408. [PMID: 32084005 DOI: 10.1515/jpem-2019-0534] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 01/16/2020] [Indexed: 02/06/2023]
Abstract
Background Juvenile breast hypertrophy is characterised by massive enlargement of the breast in the peri-pubertal period. We aimed to analyse body size measurements (body mass index [BMI], waist-to-hip circumference ratio [WHR]), digit ratio (ratio of II and IV digits' length [2D:4D]) and oestrogen receptor (ER) alpha (ERα) and progesterone receptors (PRs) in the breast gland in women with juvenile gigantomastia. Methods The study involved 30 women (mean age 25.7 years) (mean age of onset - 14.8 years). ERα and PR expressions were detected immunohistochemically in breast gland samples. For comparison, 100 controls (50 women and 50 men) were included. Results BMI and WHR in women with gigantomastia were higher than in control women and the former had a higher WHR than expected for their BMI. 2D:4D in the examined women did not differ from that in control women. However, left 2D:4D was negatively related to the age of gigantomastia onset. There were no correlations between ER and PR expressions and the analysed body and digit ratios. Conclusions The lack of a relationship between 2D:4D and juvenile breast hypertrophy may suggest that foetal exposure to sex hormones may not be crucial in its aetiology. However, the link between high left 2D:4D and early development of gigantomastia suggests that prenatal sex hormones have a role in its development timing. High WHR, and particularly high WHR relative to BMI, may indicate that these women had at some stage of development higher circulating androgens, which may have been converted to oestrogens in breasts due to local aromatase activity. Verification of this hypothesis could allow consideration of the role of aromatase inhibitors in juvenile breast hypertrophy.
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Affiliation(s)
- Anna Kasielska-Trojan
- Plastic, Reconstructive and Aesthetic Surgery Clinic, Institute of Surgery, Medical University of Lodz, Lodz, Poland
| | | | - Aneta Sitek
- Department of Anthropology, Faculty of Biology and Environmental Protection, University of Lodz, Lodz, Poland
| | - Boguslaw Antoszewski
- Plastic, Reconstructive and Aesthetic Surgery Clinic, Institute of Surgery, Medical University of Lodz, Lodz, Poland
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Li T, Meng Y, Yao R, Han H, Wu L, Zhou Y, Li Z, Zhang Y, Fu L. The associations between left-hand digit ratio (2D:4D) and puberty characteristics among Chinese girls. Early Hum Dev 2019; 130:22-26. [PMID: 30660014 DOI: 10.1016/j.earlhumdev.2019.01.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 01/09/2019] [Accepted: 01/09/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND The aim of this study was to analyse the associations of left-hand digit ratio (2D:4D), digit length and puberty characteristics to show the role of prenatal hormones in development among Chinese girls. METHOD A total of 318 Chinese girls aged 8-15 years were recruited using a stratified cluster sampling method. The index finger (2D), ring finger (4D) of the left hand, oestradiol and testosterone were measured, and age at menarche (AAM), breast (high and low) and pubic hair (high and low) development were recorded. RESULTS Girls who had experienced menarche had longer left digits (2D and 4D) and higher oestradiol, testosterone than those who had not. The high breast group had longer digits (2D and 4D), and higher oestradiol than the low breast group. With regard to pubic hair development, the high group had high 2D:4D, longer 2D and higher oestradiol, testosterone than the low group. After adjusting for oestradiol and testosterone, 4D length was positively related to occurrence of menarche. In addition, 2D and 2D:4D were significantly correlated with pubic hair development after adjusting for oestradiol, respectively. CONCLUSION Prenatal hormone level may be related to the development of puberty characteristics among Chinese girls.
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Affiliation(s)
- Ting Li
- Department of Child and Adolescent Health, School of Public Health, Bengbu Medical College, Bengbu, China
| | - Yanqiu Meng
- Department of Child and Adolescent Health, School of Public Health, Bengbu Medical College, Bengbu, China
| | - Rongying Yao
- Department of Child and Adolescent Health, School of Public Health, Bengbu Medical College, Bengbu, China
| | - Hui Han
- Department of Child and Adolescent Health, School of Public Health, Bengbu Medical College, Bengbu, China
| | - Lu Wu
- Department of Child and Adolescent Health, School of Public Health, Bengbu Medical College, Bengbu, China
| | - Yanni Zhou
- Department of Child and Adolescent Health, School of Public Health, Bengbu Medical College, Bengbu, China
| | - Zhiqiang Li
- Department of Child and Adolescent Health, School of Public Health, Bengbu Medical College, Bengbu, China
| | - Yifei Zhang
- Department of Child and Adolescent Health, School of Public Health, Bengbu Medical College, Bengbu, China
| | - Lianguo Fu
- Department of Child and Adolescent Health, School of Public Health, Bengbu Medical College, Bengbu, China.
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Eichler A, Heinrich H, Moll GH, Beckmann MW, Goecke TW, Fasching PA, Muschler MR, Bouna-Pyrrou P, Lenz B, Kornhuber J. Digit ratio (2D:4D) and behavioral symptoms in primary-school aged boys. Early Hum Dev 2018; 119:1-7. [PMID: 29486372 DOI: 10.1016/j.earlhumdev.2018.02.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 02/12/2018] [Accepted: 02/14/2018] [Indexed: 10/18/2022]
Abstract
The second-to-forth digit length ratio (2D:4D) is considered to be a biomarker for intrauterine androgen levels. It is associated with adult and child mental health problems, primarily with behavioral symptoms and predominantly in males. Using a cross-sectional design, we examined whether 2D:4D was associated with conduct disorder (CD) symptoms in 138 primary-school aged children (54% boys, Mage = 7.70 years) and considered child sex as a moderating factor. Children's digit lengths were measured from hand scans and mothers rated the behavioral/emotional symptoms of their child. The regression analyses revealed that 2D:4D ratios were associated with behavioral symptoms in boys (β = -0.260, p = 0.026), but not in girls (β = -0.040, p = 0.762). Child emotional symptoms, analyzed as a control, were not significantly correlated with 2D:4D. In conclusion, prenatal brain hyperandrogenization - operationalized by the 2D:4D biomarker - could result in behavioral symptoms in boys at early school age, reflecting one predictor for early onset CD. Our data support the use of 2D:4D as a marker of prenatal androgen exposure.
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Affiliation(s)
- Anna Eichler
- Department of Child and Adolescent Mental Health, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Schwabachanlage 6+10, 91054 Erlangen, Germany.
| | - Hartmut Heinrich
- Department of Child and Adolescent Mental Health, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Schwabachanlage 6+10, 91054 Erlangen, Germany; kbo-Heckscher-Klinikum, Deisenhofener Str. 28, 81539 München, Germany
| | - Gunther H Moll
- Department of Child and Adolescent Mental Health, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Schwabachanlage 6+10, 91054 Erlangen, Germany
| | - Matthias W Beckmann
- Department of Obstetrics and Gynecology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Universitätsstraße 21-23, 91054 Erlangen, Germany
| | - Tamme W Goecke
- Department of Obstetrics and Gynecology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Universitätsstraße 21-23, 91054 Erlangen, Germany; Department of Perinatal Medicine and Obstetrics, RoMed Hospital Rosenheim, Pettenkoferstraße 10, 83022 Rosenheim, Germany
| | - Peter A Fasching
- Department of Obstetrics and Gynecology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Universitätsstraße 21-23, 91054 Erlangen, Germany
| | - Marcel-René Muschler
- Department of Psychiatry and Psychotherapy, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054 Erlangen, Germany
| | - Polyxeni Bouna-Pyrrou
- Department of Psychiatry and Psychotherapy, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054 Erlangen, Germany
| | - Bernd Lenz
- Department of Psychiatry and Psychotherapy, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054 Erlangen, Germany
| | - Johannes Kornhuber
- Department of Psychiatry and Psychotherapy, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054 Erlangen, Germany
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