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Bleier A, Seethaler M, Bermpohl F, Majić T, Mick I. Psychiatric and non-psychiatric patients during the midst of Covid-19: Pandemic distress, psychosis and the belief in conspiracy theories. J Psychiatr Res 2024; 171:332-339. [PMID: 38350310 DOI: 10.1016/j.jpsychires.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 01/29/2024] [Accepted: 02/01/2024] [Indexed: 02/15/2024]
Abstract
BACKGROUND The COVID-19 pandemic was associated with increased levels of psychological distress in the general population, at the same time providing a perfect breeding ground for conspiracy beliefs. Psychiatric patients are considered as a population with an increased vulnerability for stressful events, and conspiracy beliefs show overlaps with paranoid ideations. The aim of the present study was to investigate if psychiatric patients experienced higher levels of pandemic distress than non-psychiatric patients, if they were more prone to conspiracy beliefs and if pandemic distress as well as other mental health variables were associated with believing in conspiracy theories. METHODS Indicators for mental health (pandemic distress, depressive symptoms, general anxiety symptoms, perceived stress) and indicators for believing in conspiracy theories were assessed within psychiatric (n = 73) and non-psychiatric patients (n = 29) during the midst of the pandemic. RESULTS Psychiatric patients reported higher levels of pandemic distress than non-psychiatric patients. Conspiracy measurements correlated positively with pandemic distress, but not with anxiety and depression. No differences were found between psychiatric patients with or without psychotic disorder and non-psychiatric patients in regard to conspiracy measurements. CONCLUSION Our findings suggest a higher susceptibility of psychiatric patients to pandemic distress, but not an increased level of believing in conspiracy theories. The common notion that people suffering from psychosis are more likely to believe in conspiracy theories was not supported. Furthermore, distress caused by a specific event and not anxiety per se seems to be related to the degree of conspiracy beliefs.
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Affiliation(s)
- Angelika Bleier
- Department of Psychiatry and Neurosciences, Charité - Universitätsmedizin Berlin, Campus Mitte (CCM) and Psychiatrische Universitätsklinik der Charité im St. Hedwig-Krankenhaus, Große Hamburger Str. 5-11, 10115, Berlin, Germany.
| | - Magdalena Seethaler
- Department of Psychiatry and Neurosciences, Charité - Universitätsmedizin Berlin, Campus Mitte (CCM) and Psychiatrische Universitätsklinik der Charité im St. Hedwig-Krankenhaus, Große Hamburger Str. 5-11, 10115, Berlin, Germany.
| | - Felix Bermpohl
- Department of Psychiatry and Neurosciences, Charité - Universitätsmedizin Berlin, Campus Mitte (CCM) and Psychiatrische Universitätsklinik der Charité im St. Hedwig-Krankenhaus, Große Hamburger Str. 5-11, 10115, Berlin, Germany; Faculty of Philosophy, Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Unter den Linden 6, 10099, Berlin, Germany; Einstein Center for Neurosciences, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Tomislav Majić
- Department of Psychiatry and Neurosciences, Charité - Universitätsmedizin Berlin, Campus Mitte (CCM) and Psychiatrische Universitätsklinik der Charité im St. Hedwig-Krankenhaus, Große Hamburger Str. 5-11, 10115, Berlin, Germany.
| | - Inge Mick
- Department of Psychiatry and Neurosciences, Charité - Universitätsmedizin Berlin, Campus Mitte (CCM) and Psychiatrische Universitätsklinik der Charité im St. Hedwig-Krankenhaus, Große Hamburger Str. 5-11, 10115, Berlin, Germany.
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Meyer K, Schoofs N, Hildebrandt A, Bermpohl F, Priebe K. What to think or how to think - is symptom reduction in posttraumatic symptomatology associated with change in posttraumatic cognitions or perseverative thinking? A latent change score model approach. Psychother Res 2024:1-16. [PMID: 38412334 DOI: 10.1080/10503307.2024.2316009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 02/01/2024] [Indexed: 02/29/2024] Open
Abstract
OBJECTIVE Patients with posttraumatic stress disorder (PTSD) report changes in what they think of the world and themselves, referred to as posttraumatic cognitions, and changes in how they think, reflected in increased perseverative thinking. We investigated whether pre-post therapy changes in the two aspects of thinking were associated with pre-post therapy changes in posttraumatic symptom severity. METHOD 219 d clinic patients with posttraumatic stress symptoms received trauma-focused psychotherapy with cognitive behavioral and metacognitive elements. The posttraumatic cognitions inventory (PTCI), the perseverative thinking questionnaire (PTQ), and the Davidson trauma scale (DTS) were applied at two occasions, pre- and post-therapy. Using latent change score models, we investigated whether change in PTCI and change in PTQ were associated with change in DTS and its subscales. We then compared the predictive value of PTQ and PTCI in joint models. RESULTS When jointly modeled, change in overall DTS score was associated with change in both PTCI and PTQ. Concerning DTS subscales, reexperiencing and avoidance were significantly associated with change in PTCI, but not in PTQ. CONCLUSION Results indicate that both aspects of cognition may be valuable targets of psychotherapy. A focus on posttraumatic cognitions might be called for in patients with severe reexperiencing and avoidance.
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Affiliation(s)
- Kristina Meyer
- Department of Psychiatry and Neurosciences, Psychiatric University Clinic of the Charité at St. Hedwig-Hospital, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Nikola Schoofs
- Department of Psychiatry and Neurosciences, Psychiatric University Clinic of the Charité at St. Hedwig-Hospital, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Andrea Hildebrandt
- Department of Psychology, Psychological Methods and Statistics, Carl von Ossietzky Universität Oldenburg, Berlin, Germany
| | - Felix Bermpohl
- Department of Psychiatry and Neurosciences, Psychiatric University Clinic of the Charité at St. Hedwig-Hospital, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Kathlen Priebe
- Department of Psychiatry and Neurosciences, Psychiatric University Clinic of the Charité at St. Hedwig-Hospital, Charité Universitätsmedizin Berlin, Berlin, Germany
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von Peter S, Stuetzle S, Brieger A, Ponew A, Lust C, Bermpohl F, Bechdolf A, Hardt O, Schomerus G, Speerforck S. Leaving the stigma to the patients? Frequency of crisis experiences among mental health professionals in Berlin and Brandenburg and how they cope with it. J Ment Health 2024; 33:66-74. [PMID: 36880330 DOI: 10.1080/09638237.2023.2182415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 11/16/2022] [Indexed: 03/08/2023]
Abstract
BACKGROUND Although mental health professionals' mental health problems are gaining increased attention, there is little systematic research on this topic. AIMS This study investigated the frequency of crisis experiences among mental health professionals and examined how they approach these experiences in terms of their personal and social identities. METHODS An online survey was conducted among mental health professionals in 18 psychiatric hospital departments in the German federal states of Berlin and Brandenburg (N = 215), containing questions about personal crisis experiences, help sought, service use, meaningfulness of lived experiences, causal beliefs of mental illness and psychotherapeutic orientation. Social identification was assessed via semantic differential scales derived from preliminary interview studies. To investigate relationships between the variables, explorative correlation analyses were calculated. RESULTS Results showed a high frequency rate of crisis experiences, substantial rates of suicidal ideation and incapacity to work and high service use. Most participants regarded their experiences as meaningful for their personal identity. Meaningfulness was positively related to a psychosocial causation model of mental illness, to psychodynamic psychotherapeutic orientation and to a high degree of disidentification with users and crisis experienced colleagues. CONCLUSION The (paradoxical) disintegration of personal and social identity of may be understood as a strategy to avoid stigmatization. A more challenging coping style among professionals is discussed.
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Affiliation(s)
| | - Stefan Stuetzle
- Medical University Brandenburg Theodor Fontane, Neuruppin, Germany
| | - Anna Brieger
- Medical University Brandenburg Theodor Fontane, Neuruppin, Germany
| | - Angel Ponew
- Medical University Brandenburg Theodor Fontane, Neuruppin, Germany
| | - Christian Lust
- Medical University Brandenburg Theodor Fontane, Neuruppin, Germany
| | - Felix Bermpohl
- Department of Psychiatry and Psychotherapy, Psychiatric University Clinic at St. Hedwig Hospital, Berlin, Germany
| | - Andreas Bechdolf
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine with Early Intervention and Recognition Center (FRITZ), Vivantes Klinikum Am Urban, Berlin, Germany
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | - Olaf Hardt
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Vivantes Klinikum Neukölln, Berlin, Germany
| | - Georg Schomerus
- Department of Psychiatry and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany
| | - Sven Speerforck
- Department of Psychiatry and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany
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Morgenroth CL, Kleymann P, Ripke S, Awasthi S, Wagner E, Oviedo-Salcedo T, Okhuijsen-Pfeifer C, Luykx JJ, van der Horst MZ, Hasan A, Bermpohl F, Gutwinski S, Schreiter S. Polygenetic risk scores and phenotypic constellations of obsessive-compulsive disorder in clozapine-treated schizophrenia. Eur Arch Psychiatry Clin Neurosci 2024; 274:181-193. [PMID: 37020043 PMCID: PMC10786740 DOI: 10.1007/s00406-023-01593-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 03/14/2023] [Indexed: 04/07/2023]
Abstract
Obsessive-compulsive symptoms (OCS) are frequently observed in individuals with schizophrenia (SCZ) treated with clozapine (CLZ). This study aimed to analyze prevalence of OCS and obsessive-compulsive disorder (OCD) in this subgroup and find possible correlations with different phenotypes. Additionally, this is the first study to examine polygenetic risk scores (PRS) in individuals with SCZ and OCS. A multicenter cohort of 91 individuals with SCZ who were treated with CLZ was recruited and clinically and genetically assessed. Symptom severity was examined using the Positive and Negative Symptom Scale (PANSS), Clinical Global Impression Scale (CGI), the Calgary Depression Scale for Schizophrenia (CDSS), Global Assessment of Functioning Scale (GAF) and Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). Participants were divided into subgroups based on phenotypic OCS or OCD using Y-BOCS scores. Genomic-wide data were generated, and PRS analyses were performed to evaluate the association between either phenotypic OCD or OCS severity and genotype-predicted predisposition for OCD, SCZ, cross-disorder, and CLZ/norclozapine (NorCLZ) ratio, CLZ metabolism and NorCLZ metabolism. OCS and OCD were frequent comorbidities in our sample of CLZ-treated SCZ individuals, with a prevalence of 39.6% and 27.5%, respectively. Furthermore, the Y-BOCS total score correlated positively with the duration of CLZ treatment in years (r = 0.28; p = 0.008) and the PANSS general psychopathology subscale score (r = 0.23; p = 0.028). A significant correlation was found between OCD occurrence and PRS for CLZ metabolism. We found no correlation between OCS severity and PRS for CLZ metabolism. We found no correlation for either OCD or OCS and PRS for OCD, cross-disorder, SCZ, CLZ/NorCLZ ratio or NorCLZ metabolism. Our study was able to replicate previous findings on clinical characteristics of CLZ-treated SCZ individuals. OCS is a frequent comorbidity in this cohort and is correlated with CLZ treatment duration in years and PANSS general psychopathology subscale score. We found a correlation between OCD and PRS for CLZ metabolism, which should be interpreted as incidental for now. Future research is necessary to replicate significant findings and to assess possible genetic predisposition of CLZ-treated individuals with SCZ to OCS/OCD. Limitations attributed to the small sample size or the inclusion of subjects on co-medication must be considered. If the association between OCD and PRS for CLZ metabolism can be replicated, it should be further evaluated if CYP1A2 alteration, respectively lower CLZ plasma level, is relevant for OCD development.
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Affiliation(s)
- Carla Lou Morgenroth
- Department of Psychiatry and Neurosciences, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany.
| | - Philipp Kleymann
- Department of Psychiatry and Neurosciences, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
| | - Stephan Ripke
- Department of Psychiatry and Neurosciences, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
| | - Swapnil Awasthi
- Department of Psychiatry and Neurosciences, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
| | - Elias Wagner
- Department of Psychiatry and Psychotherapy, University Hospital-LMU Munich, Munich, Germany
| | - Tatiana Oviedo-Salcedo
- Department of Psychiatry and Psychotherapy, University Hospital-LMU Munich, Munich, Germany
| | - Cynthia Okhuijsen-Pfeifer
- Department of Psychiatry, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Jurjen J Luykx
- Department of Psychiatry, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Brain Center Rudolf Magnus, Department of Translational Neuroscience, University Medical Center Utrecht, Utrecht, The Netherlands
- GGNet Mental Health, Warnsveld, The Netherlands
| | - Marte Z van der Horst
- Department of Psychiatry, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- GGNet Mental Health, Warnsveld, The Netherlands
| | - Alkomiet Hasan
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, University of Augsburg, Bezirkskrankenhaus Augsburg, Augsburg, Germany
| | - Felix Bermpohl
- Department of Psychiatry and Neurosciences, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
| | - Stefan Gutwinski
- Department of Psychiatry and Neurosciences, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
- Department of Psychiatry, St. Hedwig-Krankenhaus, Charité-Universitätsmedizin, Berlin, Germany
| | - Stefanie Schreiter
- Department of Psychiatry and Neurosciences, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
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Martini J, Bröckel KL, Leopold K, Berndt C, Sauer C, Maicher B, Juckel G, Krüger-Özgürdal S, Fallgatter AJ, Lambert M, Bechdolf A, Reif A, Matura S, Biere S, Kittel-Schneider S, Stamm T, Bermpohl F, Kircher T, Falkenberg I, Jansen A, Dannlowski U, Correll CU, Fusar-Poli P, Hempel LM, Mikolas P, Ritter P, Bauer M, Pfennig A. Young people at risk for developing bipolar disorder: Two-year findings from the multicenter prospective, naturalistic Early-BipoLife study. Eur Neuropsychopharmacol 2024; 78:43-53. [PMID: 37913697 DOI: 10.1016/j.euroneuro.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 09/18/2023] [Accepted: 10/09/2023] [Indexed: 11/03/2023]
Abstract
Early identification and intervention of individuals with an increased risk for bipolar disorder (BD) may improve the course of illness and prevent long‑term consequences. Early-BipoLife, a multicenter, prospective, naturalistic study, examined risk factors of BD beyond family history in participants aged 15-35 years. At baseline, positively screened help-seeking participants (screenBD at-risk) were recruited at Early Detection Centers and in- and outpatient depression and attention-deficit/hyperactivity disorder (ADHD) settings, references (Ref) drawn from a representative cohort. Participants reported sociodemographics and medical history and were repeatedly examined regarding psychopathology and the course of risk factors. N = 1,083 screenBD at-risk and n = 172 Ref were eligible for baseline assessment. Within the first two years, n = 31 screenBD at-risk (2.9 %) and none of Ref developed a manifest BD. The cumulative transition risk was 0.0028 at the end of multistep assessment, 0.0169 at 12 and 0.0317 at 24 months (p = 0.021). The transition rate with a BD family history was 6.0 %, 4.7 % in the Early Phase Inventory for bipolar disorders (EPIbipolar), 6.6 % in the Bipolar Prodrome Interview and Symptom Scale-Prospective (BPSS-FP) and 3.2 % with extended Bipolar At-Risk - BARS criteria). In comparison to help-seeking young patients from psychosis detection services, transition rates in screenBD at-risk participants were lower. The findings of Early-BipoLife underscore the importance of considering risk factors beyond family history in order to improved early detection and interventions to prevent/ameliorate related impairment in the course of BD. Large long-term cohort studies are crucial to understand the developmental pathways and long-term course of BD, especially in people at- risk.
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Affiliation(s)
- Julia Martini
- Department of Psychiatry and Psychotherapy, University Hospital, TUD Dresden University of Technology, Dresden, Germany
| | - Kyra Luisa Bröckel
- Department of Psychiatry and Psychotherapy, University Hospital, TUD Dresden University of Technology, Dresden, Germany
| | - Karolina Leopold
- Department of Psychiatry and Psychotherapy, University Hospital, TUD Dresden University of Technology, Dresden, Germany; Department of Psychiatry, Psychotherapy and Psychosomatics, Vivantes Hospital at Urban and Vivantes Hospital at Friedrichshain, Berlin, Germany
| | - Christina Berndt
- Department of Psychiatry and Psychotherapy, University Hospital, TUD Dresden University of Technology, Dresden, Germany
| | - Cathrin Sauer
- Department of Psychiatry and Psychotherapy, University Hospital, TUD Dresden University of Technology, Dresden, Germany
| | - Birgit Maicher
- Department of Psychiatry and Psychotherapy, University Hospital, TUD Dresden University of Technology, Dresden, Germany
| | - Georg Juckel
- Department of Psychiatry and Psychotherapy, LWL-University Hospital Bochum, Ruhr-University Bochum, Bochum, Germany
| | - Seza Krüger-Özgürdal
- Department of Psychiatry and Psychotherapy, LWL-University Hospital Bochum, Ruhr-University Bochum, Bochum, Germany
| | - Andreas J Fallgatter
- Tübingen Center for Mental Health (TüCMH), Department of General Psychiatry and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Martin Lambert
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Andreas Bechdolf
- Department of Psychiatry, Psychotherapy and Psychosomatics, Vivantes Hospital at Urban and Vivantes Hospital at Friedrichshain, Berlin, Germany; Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Andreas Reif
- Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital Frankfurt am Main, Frankfurt am Main, Germany
| | - Silke Matura
- Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital Frankfurt am Main, Frankfurt am Main, Germany
| | - Silvia Biere
- Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital Frankfurt am Main, Frankfurt am Main, Germany
| | - Sarah Kittel-Schneider
- Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital Frankfurt am Main, Frankfurt am Main, Germany; Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital Würzburg, Würzburg, Germany
| | - Thomas Stamm
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité Universitätsmedizin Berlin, Berlin, Germany; Department of Psychiatry, Psychotherapy and Psychosomatic, Hospitals of Ruppin - Medical School Brandenburg Theodor Fontane, Neuruppin, Germany
| | - Felix Bermpohl
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Tilo Kircher
- Department for Psychiatry and Psychotherapy, University Hospital Marburg, Marburg, Germany
| | - Irina Falkenberg
- Department for Psychiatry and Psychotherapy, University Hospital Marburg, Marburg, Germany
| | - Andreas Jansen
- Department for Psychiatry and Psychotherapy, University Hospital Marburg, Marburg, Germany
| | - Udo Dannlowski
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Christoph U Correll
- Department of Child- and Adolescent Psychiatry, Charité Universitätsmedizin Berlin, Berlin, Germany; Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA; Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Paolo Fusar-Poli
- EPIC Lab, Department of Psychosis Studies, King's College London, London, UK; Department of Brain and Behavioral Health Sciences, University of Pavia, Pavia, Italy
| | - Lisa Marie Hempel
- Department of Psychiatry and Psychotherapy, University Hospital, TUD Dresden University of Technology, Dresden, Germany
| | - Pavol Mikolas
- Department of Psychiatry and Psychotherapy, University Hospital, TUD Dresden University of Technology, Dresden, Germany
| | - Philipp Ritter
- Department of Psychiatry and Psychotherapy, University Hospital, TUD Dresden University of Technology, Dresden, Germany
| | - Michael Bauer
- Department of Psychiatry and Psychotherapy, University Hospital, TUD Dresden University of Technology, Dresden, Germany
| | - Andrea Pfennig
- Department of Psychiatry and Psychotherapy, University Hospital, TUD Dresden University of Technology, Dresden, Germany.
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Mikolas P, Marxen M, Riedel P, Bröckel K, Martini J, Huth F, Berndt C, Vogelbacher C, Jansen A, Kircher T, Falkenberg I, Lambert M, Kraft V, Leicht G, Mulert C, Fallgatter AJ, Ethofer T, Rau A, Leopold K, Bechdolf A, Reif A, Matura S, Bermpohl F, Fiebig J, Stamm T, Correll CU, Juckel G, Flasbeck V, Ritter P, Bauer M, Pfennig A. Prediction of estimated risk for bipolar disorder using machine learning and structural MRI features. Psychol Med 2024; 54:278-288. [PMID: 37212052 DOI: 10.1017/s0033291723001319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
BACKGROUND Individuals with bipolar disorder are commonly correctly diagnosed a decade after symptom onset. Machine learning techniques may aid in early recognition and reduce the disease burden. As both individuals at risk and those with a manifest disease display structural brain markers, structural magnetic resonance imaging may provide relevant classification features. METHODS Following a pre-registered protocol, we trained linear support vector machine (SVM) to classify individuals according to their estimated risk for bipolar disorder using regional cortical thickness of help-seeking individuals from seven study sites (N = 276). We estimated the risk using three state-of-the-art assessment instruments (BPSS-P, BARS, EPIbipolar). RESULTS For BPSS-P, SVM achieved a fair performance of Cohen's κ of 0.235 (95% CI 0.11-0.361) and a balanced accuracy of 63.1% (95% CI 55.9-70.3) in the 10-fold cross-validation. In the leave-one-site-out cross-validation, the model performed with a Cohen's κ of 0.128 (95% CI -0.069 to 0.325) and a balanced accuracy of 56.2% (95% CI 44.6-67.8). BARS and EPIbipolar could not be predicted. In post hoc analyses, regional surface area, subcortical volumes as well as hyperparameter optimization did not improve the performance. CONCLUSIONS Individuals at risk for bipolar disorder, as assessed by BPSS-P, display brain structural alterations that can be detected using machine learning. The achieved performance is comparable to previous studies which attempted to classify patients with manifest disease and healthy controls. Unlike previous studies of bipolar risk, our multicenter design permitted a leave-one-site-out cross-validation. Whole-brain cortical thickness seems to be superior to other structural brain features.
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Affiliation(s)
- Pavol Mikolas
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Michael Marxen
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Philipp Riedel
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Kyra Bröckel
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Julia Martini
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Fabian Huth
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Christina Berndt
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Christoph Vogelbacher
- Core-Facility Brainimaging, Faculty of Medicine, University of Marburg, Marburg, Germany
- Department of Psychiatry, University of Marburg, Marburg, Germany
- Center for Mind, Brain and Behavior (CMBB), University of Marburg and Justus Liebig University Giessen, Germany
| | - Andreas Jansen
- Core-Facility Brainimaging, Faculty of Medicine, University of Marburg, Marburg, Germany
- Department of Psychiatry, University of Marburg, Marburg, Germany
- Center for Mind, Brain and Behavior (CMBB), University of Marburg and Justus Liebig University Giessen, Germany
| | - Tilo Kircher
- Core-Facility Brainimaging, Faculty of Medicine, University of Marburg, Marburg, Germany
- Department of Psychiatry, University of Marburg, Marburg, Germany
- Center for Mind, Brain and Behavior (CMBB), University of Marburg and Justus Liebig University Giessen, Germany
| | - Irina Falkenberg
- Core-Facility Brainimaging, Faculty of Medicine, University of Marburg, Marburg, Germany
- Department of Psychiatry, University of Marburg, Marburg, Germany
- Center for Mind, Brain and Behavior (CMBB), University of Marburg and Justus Liebig University Giessen, Germany
| | - Martin Lambert
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Vivien Kraft
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gregor Leicht
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph Mulert
- Center for Mind, Brain and Behavior (CMBB), University of Marburg and Justus Liebig University Giessen, Germany
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Centre for Psychiatry, Justus-Liebig University Giessen, Giessen, Germany
| | - Andreas J Fallgatter
- Department of Psychiatry, Tuebingen Center for Mental Health, University of Tuebingen, Tuebingen, Germany
| | - Thomas Ethofer
- Department of Psychiatry, Tuebingen Center for Mental Health, University of Tuebingen, Tuebingen, Germany
| | - Anne Rau
- Department of Psychiatry, Tuebingen Center for Mental Health, University of Tuebingen, Tuebingen, Germany
| | - Karolina Leopold
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Vivantes Hospital Am Urban and Vivantes Hospital Im Friedrichshain, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Andreas Bechdolf
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Vivantes Hospital Am Urban and Vivantes Hospital Im Friedrichshain, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Andreas Reif
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt - Goethe University, Frankfurt am Main, Germany
| | - Silke Matura
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt - Goethe University, Frankfurt am Main, Germany
| | - Felix Bermpohl
- Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Charité University Medicine, Berlin, Germany
| | - Jana Fiebig
- Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Charité University Medicine, Berlin, Germany
| | - Thomas Stamm
- Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Charité University Medicine, Berlin, Germany
- Department of Clinical Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Christoph U Correll
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin Berlin, Berlin, Germany
- Department of Psychiatry, Northwell Health, The Zucker Hillside Hospital, Glen Oaks, NY, USA
- Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Georg Juckel
- Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL University Hospital, Ruhr-University, Bochum, Germany
| | - Vera Flasbeck
- Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL University Hospital, Ruhr-University, Bochum, Germany
| | - Philipp Ritter
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Michael Bauer
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Andrea Pfennig
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
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7
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Bathe-Peters R, Priebe K, Schulte S, Meyer K, Schulte-Herbrüggen O, Ülsmann D, Bermpohl F, Schoofs N. The Affect Intolerance Scale (AIS), German version: A validation study in a student and clinical sample of patients with trauma-related disorders. J Behav Ther Exp Psychiatry 2023; 81:101841. [PMID: 36827946 DOI: 10.1016/j.jbtep.2023.101841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 11/24/2022] [Accepted: 02/10/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND AND OBJECTIVES The Affect Intolerance Scale (AIS) assesses two core concepts of emotion regulation: appraisals of negative emotions as threatening and proneness to emotional avoidance. Maladaptive emotion regulation is associated with various psychopathologies. We translated and validated the AIS in a German student and clinical sample of patients with trauma-related disorders. METHODS 340 patients, 161 with post-traumatic stress disorder and 179 with adjustment disorder, and 322 students were enrolled. We employed exploratory and confirmatory factor analyses in a cross-validation design to investigate construct validity, convergent and discriminant validity, and reliability. RESULTS We replicated the originally described two-factor structure in both samples. Cronbach's α was 0.947 in the student and 0.950 in the clinical sample. AIS subscales showed moderate to high correlations with convergent and low correlations with discriminant measures. AIS total scores were significantly larger in the clinical sample, controlled for gender and age. LIMITATIONS This study provides a unified cross-validation model in a clinical and a student sample at the cost of reduced sample sizes. CONCLUSIONS The AIS is a valid measure of affect intolerance with the discriminative ability to distinguish between patients with trauma-related disorders and students. Test redundancy within both sub-constructs of the AIS might lead to biased estimates but allows for increased test precision, rendering the AIS a tool suitable for individual treatment monitoring.
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Affiliation(s)
- Rouven Bathe-Peters
- Charité Universitätsmedizin Berlin, Department of Psychiatry and Neurosciences, CCM, Charitéplatz 1, 10117, Berlin, Germany.
| | - Kathlen Priebe
- Charité Universitätsmedizin Berlin, Department of Psychiatry and Neurosciences, CCM, Berlin, Germany
| | - Sarah Schulte
- Friedrich von Bodelschwingh Clinic for Psychiatry, Psychotherapy and Psychosomatic Medicine, Berlin, Germany
| | - Kristina Meyer
- Charité Universitätsmedizin Berlin, Department of Psychiatry and Neurosciences, CCM, Berlin, Germany
| | - Olaf Schulte-Herbrüggen
- Friedrich von Bodelschwingh Clinic for Psychiatry, Psychotherapy and Psychosomatic Medicine, Berlin, Germany
| | - Dominik Ülsmann
- Friedrich von Bodelschwingh Clinic for Psychiatry, Psychotherapy and Psychosomatic Medicine, Berlin, Germany
| | - Felix Bermpohl
- Charité Universitätsmedizin Berlin, Department of Psychiatry and Neurosciences, CCM, Berlin, Germany
| | - Nikola Schoofs
- Charité Universitätsmedizin Berlin, Department of Psychiatry and Neurosciences, CCM, Berlin, Germany
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8
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Amare AT, Thalamuthu A, Schubert KO, Fullerton JM, Ahmed M, Hartmann S, Papiol S, Heilbronner U, Degenhardt F, Tekola-Ayele F, Hou L, Hsu YH, Shekhtman T, Adli M, Akula N, Akiyama K, Ardau R, Arias B, Aubry JM, Hasler R, Richard-Lepouriel H, Perroud N, Backlund L, Bhattacharjee AK, Bellivier F, Benabarre A, Bengesser S, Biernacka JM, Birner A, Marie-Claire C, Cervantes P, Chen HC, Chillotti C, Cichon S, Cruceanu C, Czerski PM, Dalkner N, Del Zompo M, DePaulo JR, Étain B, Jamain S, Falkai P, Forstner AJ, Frisen L, Frye MA, Gard S, Garnham JS, Goes FS, Grigoroiu-Serbanescu M, Fallgatter AJ, Stegmaier S, Ethofer T, Biere S, Petrova K, Schuster C, Adorjan K, Budde M, Heilbronner M, Kalman JL, Kohshour MO, Reich-Erkelenz D, Schaupp SK, Schulte EC, Senner F, Vogl T, Anghelescu IG, Arolt V, Dannlowski U, Dietrich D, Figge C, Jäger M, Lang FU, Juckel G, Konrad C, Reimer J, Schmauß M, Schmitt A, Spitzer C, von Hagen M, Wiltfang J, Zimmermann J, Andlauer TFM, Fischer A, Bermpohl F, Ritter P, Matura S, Gryaznova A, Falkenberg I, Yildiz C, Kircher T, Schmidt J, Koch M, Gade K, Trost S, Haussleiter IS, Lambert M, Rohenkohl AC, Kraft V, Grof P, Hashimoto R, Hauser J, Herms S, Hoffmann P, Jiménez E, Kahn JP, Kassem L, Kuo PH, Kato T, Kelsoe J, Kittel-Schneider S, Ferensztajn-Rochowiak E, König B, Kusumi I, Laje G, Landén M, Lavebratt C, Leboyer M, Leckband SG, Tortorella A, Manchia M, Martinsson L, McCarthy MJ, McElroy S, Colom F, Millischer V, Mitjans M, Mondimore FM, Monteleone P, Nievergelt CM, Nöthen MM, Novák T, O'Donovan C, Ozaki N, Pfennig A, Pisanu C, Potash JB, Reif A, Reininghaus E, Rouleau GA, Rybakowski JK, Schalling M, Schofield PR, Schweizer BW, Severino G, Shilling PD, Shimoda K, Simhandl C, Slaney CM, Squassina A, Stamm T, Stopkova P, Maj M, Turecki G, Vieta E, Veeh J, Witt SH, Wright A, Zandi PP, Mitchell PB, Bauer M, Alda M, Rietschel M, McMahon FJ, Schulze TG, Clark SR, Baune BT. Association of polygenic score and the involvement of cholinergic and glutamatergic pathways with lithium treatment response in patients with bipolar disorder. Mol Psychiatry 2023; 28:5251-5261. [PMID: 37433967 DOI: 10.1038/s41380-023-02149-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 05/31/2023] [Accepted: 06/16/2023] [Indexed: 07/13/2023]
Abstract
Lithium is regarded as the first-line treatment for bipolar disorder (BD), a severe and disabling mental health disorder that affects about 1% of the population worldwide. Nevertheless, lithium is not consistently effective, with only 30% of patients showing a favorable response to treatment. To provide personalized treatment options for bipolar patients, it is essential to identify prediction biomarkers such as polygenic scores. In this study, we developed a polygenic score for lithium treatment response (Li+PGS) in patients with BD. To gain further insights into lithium's possible molecular mechanism of action, we performed a genome-wide gene-based analysis. Using polygenic score modeling, via methods incorporating Bayesian regression and continuous shrinkage priors, Li+PGS was developed in the International Consortium of Lithium Genetics cohort (ConLi+Gen: N = 2367) and replicated in the combined PsyCourse (N = 89) and BipoLife (N = 102) studies. The associations of Li+PGS and lithium treatment response - defined in a continuous ALDA scale and a categorical outcome (good response vs. poor response) were tested using regression models, each adjusted for the covariates: age, sex, and the first four genetic principal components. Statistical significance was determined at P < 0.05. Li+PGS was positively associated with lithium treatment response in the ConLi+Gen cohort, in both the categorical (P = 9.8 × 10-12, R2 = 1.9%) and continuous (P = 6.4 × 10-9, R2 = 2.6%) outcomes. Compared to bipolar patients in the 1st decile of the risk distribution, individuals in the 10th decile had 3.47-fold (95%CI: 2.22-5.47) higher odds of responding favorably to lithium. The results were replicated in the independent cohorts for the categorical treatment outcome (P = 3.9 × 10-4, R2 = 0.9%), but not for the continuous outcome (P = 0.13). Gene-based analyses revealed 36 candidate genes that are enriched in biological pathways controlled by glutamate and acetylcholine. Li+PGS may be useful in the development of pharmacogenomic testing strategies by enabling a classification of bipolar patients according to their response to treatment.
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Affiliation(s)
- Azmeraw T Amare
- Discipline of Psychiatry, School of Medicine, University of Adelaide, Adelaide, SA, Australia.
| | - Anbupalam Thalamuthu
- Centre for Healthy Brain Ageing (CHeBA), Discipline of Psychiatry and Mental Health, UNSW Medicine & Health, University of New South Wales, Sydney, Australia
| | - Klaus Oliver Schubert
- Discipline of Psychiatry, School of Medicine, University of Adelaide, Adelaide, SA, Australia
- Northern Adelaide Local Health Network, Mental Health Services, Adelaide, SA, Australia
| | - Janice M Fullerton
- Neuroscience Research Australia, Sydney, NSW, Australia
- School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
| | - Muktar Ahmed
- Discipline of Psychiatry, School of Medicine, University of Adelaide, Adelaide, SA, Australia
| | - Simon Hartmann
- Discipline of Psychiatry, School of Medicine, University of Adelaide, Adelaide, SA, Australia
| | - Sergi Papiol
- Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU Munich, Munich, Germany
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilian-University Munich, Munich, Germany
| | - Urs Heilbronner
- Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU Munich, Munich, Germany
| | - Franziska Degenhardt
- Institute of Human Genetics, University of Bonn, School of Medicine & University Hospital Bonn, Bonn, Germany
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, LVR Klinikum Essen, University of Duisburg-Essen, Rheinische Kliniken, Essen, Germany
| | - Fasil Tekola-Ayele
- Epidemiology Branch, Division of Population Health Research, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Liping Hou
- Intramural Research Program, National Institute of Mental Health, National Institutes of Health, US Department of Health & Human Services, Bethesda, MD, USA
| | - Yi-Hsiang Hsu
- HSL Institute for Aging Research, Harvard Medical School, Boston, MA, USA
- Program for Quantitative Genomics, Harvard School of Public Health, Boston, MA, USA
| | - Tatyana Shekhtman
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Mazda Adli
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Campus Charité Mitte, Berlin, Germany
| | - Nirmala Akula
- Intramural Research Program, National Institute of Mental Health, National Institutes of Health, US Department of Health & Human Services, Bethesda, MD, USA
| | - Kazufumi Akiyama
- Department of Biological Psychiatry and Neuroscience, Dokkyo Medical University School of Medicine, Mibu, Tochigi, Japan
| | - Raffaella Ardau
- Unit of Clinical Pharmacology, Hospital University Agency of Cagliari, Cagliari, Italy
| | - Bárbara Arias
- Unitat de Zoologia i Antropologia Biològica (Dpt. Biologia Evolutiva, Ecologia i Ciències Ambientals), Facultat de Biologia and Institut de Biomedicina (IBUB), University of Barcelona, CIBERSAM, Barcelona, Spain
| | - Jean-Michel Aubry
- Department of Psychiatry, Mood Disorders Unit, HUG - Geneva University Hospitals, Geneva, Switzerland
| | - Roland Hasler
- Department of Psychiatry, Mood Disorders Unit, HUG - Geneva University Hospitals, Geneva, Switzerland
| | - Hélène Richard-Lepouriel
- Department of Psychiatry, Mood Disorders Unit, HUG - Geneva University Hospitals, Geneva, Switzerland
| | - Nader Perroud
- Department of Psychiatry, Mood Disorders Unit, HUG - Geneva University Hospitals, Geneva, Switzerland
| | - Lena Backlund
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
- Center for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
| | | | - Frank Bellivier
- INSERM UMR-S 1144, Université Paris Cité, Département de Psychiatrie et de Médecine Addictologique, AP-HP, Groupe Hospitalier Saint-Louis-Lariboisière-F.Widal, Paris, France
| | - Antonio Benabarre
- Bipolar and Depressive Disorders Program,, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Susanne Bengesser
- Department of Psychiatry and Psychotherapeutic Medicine, Research Unit for bipolar affective disorder, Medical University of Graz, Graz, Austria
| | - Joanna M Biernacka
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Armin Birner
- Department of Psychiatry and Psychotherapeutic Medicine, Research Unit for bipolar affective disorder, Medical University of Graz, Graz, Austria
| | - Cynthia Marie-Claire
- INSERM UMR-S 1144, Université Paris Cité, Département de Psychiatrie et de Médecine Addictologique, AP-HP, Groupe Hospitalier Saint-Louis-Lariboisière-F.Widal, Paris, France
- Université Paris Cité, Inserm, Optimisation Thérapeutique en Neuropsychopharmacologie, F-75006, Paris, France
| | - Pablo Cervantes
- The Neuromodulation Unit, McGill University Health Centre, Montreal, Canada
| | - Hsi-Chung Chen
- Department of Psychiatry & Center of Sleep Disorders, National Taiwan University Hospital, Taipei, Taiwan
| | - Caterina Chillotti
- Unit of Clinical Pharmacology, Hospital University Agency of Cagliari, Cagliari, Italy
| | - Sven Cichon
- Institute of Human Genetics, University of Bonn, School of Medicine & University Hospital Bonn, Bonn, Germany
- Department of Biomedicine, University Hospital Basel, Basel, Switzerland
- Institute of Neuroscience and Medicine (INM-1), Research Center Jülich, Jülich, Germany
| | - Cristiana Cruceanu
- Douglas Mental Health University Institute, McGill University, Montreal, Canada
| | - Piotr M Czerski
- Psychiatric Genetic Unit, Poznan University of Medical Sciences, Poznan, Poland
| | - Nina Dalkner
- Department of Psychiatry and Psychotherapeutic Medicine, Research Unit for bipolar affective disorder, Medical University of Graz, Graz, Austria
| | - Maria Del Zompo
- Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy
| | - J Raymond DePaulo
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Bruno Étain
- INSERM UMR-S 1144, Université Paris Cité, Département de Psychiatrie et de Médecine Addictologique, AP-HP, Groupe Hospitalier Saint-Louis-Lariboisière-F.Widal, Paris, France
| | - Stephane Jamain
- Inserm U955, Translational Psychiatry laboratory, Fondation FondaMental, Créteil, France
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilian-University Munich, Munich, Germany
- Max Planck Institute of Psychiatry, Munich, Germany
| | - Andreas J Forstner
- Institute of Human Genetics, University of Bonn, School of Medicine & University Hospital Bonn, Bonn, Germany
- Institute of Neuroscience and Medicine (INM-1), Research Center Jülich, Jülich, Germany
| | - Louise Frisen
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
- Center for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Mark A Frye
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Sébastien Gard
- Pôle de Psychiatrie Générale Universitaire, Hôpital Charles Perrens, Bordeaux, France
| | - Julie S Garnham
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Fernando S Goes
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Maria Grigoroiu-Serbanescu
- Biometric Psychiatric Genetics Research Unit, Alexandru Obregia Clinical Psychiatric Hospital, Bucharest, Romania
| | - Andreas J Fallgatter
- University Department of Psychiatry and Psychotherapy Tuebingen, University of Tübingen, Tuebingen, Germany
| | - Sophia Stegmaier
- Department of General Psychiatry, University of Tuebingen, Tuebingen, Germany
| | - Thomas Ethofer
- Department of General Psychiatry, University of Tuebingen, Tuebingen, Germany
- Department of Biomedical Resonance, University of Tuebingen, Tuebingen, Germany
| | - Silvia Biere
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Frankfurt, Goethe University, Frankfurt, Germany
| | - Kristiyana Petrova
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Frankfurt, Goethe University, Frankfurt, Germany
| | - Ceylan Schuster
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Frankfurt, Goethe University, Frankfurt, Germany
| | - Kristina Adorjan
- Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU Munich, Munich, Germany
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilian-University Munich, Munich, Germany
| | - Monika Budde
- Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU Munich, Munich, Germany
| | - Maria Heilbronner
- Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU Munich, Munich, Germany
| | - Janos L Kalman
- Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU Munich, Munich, Germany
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilian-University Munich, Munich, Germany
| | - Mojtaba Oraki Kohshour
- Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU Munich, Munich, Germany
- Department of Immunology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Daniela Reich-Erkelenz
- Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU Munich, Munich, Germany
| | - Sabrina K Schaupp
- Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU Munich, Munich, Germany
| | - Eva C Schulte
- Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU Munich, Munich, Germany
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilian-University Munich, Munich, Germany
| | - Fanny Senner
- Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU Munich, Munich, Germany
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilian-University Munich, Munich, Germany
| | - Thomas Vogl
- Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU Munich, Munich, Germany
| | - Ion-George Anghelescu
- Department of Psychiatry and Psychotherapy, Mental Health Institute Berlin, Berlin, Germany
| | - Volker Arolt
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Udo Dannlowski
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Detlef Dietrich
- AMEOS Clinical Center Hildesheim, Hildesheim, Germany
- Center for Systems Neuroscience (ZSN), Hannover, Germany
| | - Christian Figge
- Karl-Jaspers Clinic, European Medical School Oldenburg-Groningen, Oldenburg, 26160, Germany
| | - Markus Jäger
- Department of Psychiatry II, Ulm University, Bezirkskrankenhaus Günzburg, Günzburg, Germany
| | - Fabian U Lang
- Department of Psychiatry II, Ulm University, Bezirkskrankenhaus Günzburg, Günzburg, Germany
| | - Georg Juckel
- Department of Psychiatry, Ruhr University Bochum, LWL University Hospital, Bochum, Germany
| | - Carsten Konrad
- Department of Psychiatry and Psychotherapy, Agaplesion Diakonieklinikum, Rotenburg, Germany
| | - Jens Reimer
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Psychiatry, Health North Hospital Group, Bremen, Germany
| | - Max Schmauß
- Department of Psychiatry and Psychotherapy, Bezirkskrankenhaus Augsburg, Augsburg, Germany
| | - Andrea Schmitt
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilian-University Munich, Munich, Germany
- Laboratory of Neuroscience (LIM27), Institute of Psychiatry, University of Sao Paulo, São Paulo, Brazil
| | - Carsten Spitzer
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Rostock, Rostock, Germany
| | - Martin von Hagen
- Clinic for Psychiatry and Psychotherapy, Clinical Center Werra-Meißner, Eschwege, Germany
| | - Jens Wiltfang
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Göttingen, Germany
- German Center for Neurodegenerative Diseases (DZNE), Göttingen, Germany
| | - Jörg Zimmermann
- Psychiatrieverbund Oldenburger Land gGmbH, Karl-Jaspers-Klinik, Bad Zwischenahn, Germany
| | - Till F M Andlauer
- Department of Neurology, University Hospital rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Andre Fischer
- German Center for Neurodegenerative Diseases (DZNE), Göttingen, Germany
| | - Felix Bermpohl
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Campus Charité Mitte, Berlin, Germany
| | - Philipp Ritter
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Medical Faculty, Technische Universität Dresden, Dresden, Germany
| | - Silke Matura
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Frankfurt, Goethe University, Frankfurt, Germany
| | - Anna Gryaznova
- Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU Munich, Munich, Germany
| | - Irina Falkenberg
- Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany
| | - Cüneyt Yildiz
- Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany
| | - Tilo Kircher
- Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany
| | - Julia Schmidt
- Institute for Medical Informatics, University Medical Center Göttingen, Göttingen, Germany
| | - Marius Koch
- Institute for Medical Informatics, University Medical Center Göttingen, Göttingen, Germany
| | - Kathrin Gade
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Göttingen, Germany
| | - Sarah Trost
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Göttingen, Germany
| | - Ida S Haussleiter
- Department of Psychiatry, Ruhr University Bochum, LWL University Hospital, Bochum, Germany
| | - Martin Lambert
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anja C Rohenkohl
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Vivien Kraft
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Paul Grof
- Mood Disorders Center of Ottawa, Ontario, Canada
| | - Ryota Hashimoto
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi, Kodaira, Tokyo, 187-8553, Japan
| | - Joanna Hauser
- Psychiatric Genetic Unit, Poznan University of Medical Sciences, Poznan, Poland
| | - Stefan Herms
- Institute of Human Genetics, University of Bonn, School of Medicine & University Hospital Bonn, Bonn, Germany
- Department of Biomedicine, University Hospital Basel, Basel, Switzerland
| | - Per Hoffmann
- Institute of Human Genetics, University of Bonn, School of Medicine & University Hospital Bonn, Bonn, Germany
- Department of Biomedicine, University Hospital Basel, Basel, Switzerland
| | - Esther Jiménez
- Bipolar and Depressive Disorders Program,, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Jean-Pierre Kahn
- Service de Psychiatrie et Psychologie Clinique, Centre Psychothérapique de Nancy - Université de Lorraine, Nancy, France
| | - Layla Kassem
- Intramural Research Program, National Institute of Mental Health, National Institutes of Health, US Department of Health & Human Services, Bethesda, MD, USA
| | - Po-Hsiu Kuo
- Department of Public Health & Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Tadafumi Kato
- Laboratory for Molecular Dynamics of Mental Disorders, RIKEN Brain Science Institute, Saitama, Japan
| | - John Kelsoe
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Sarah Kittel-Schneider
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Frankfurt, Germany
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, University Hospital of Würzburg, Wurzburg, Germany
| | | | - Barbara König
- Department of Psychiatry and Psychotherapeutic Medicine, Landesklinikum Neunkirchen, Neunkirchen, Austria
| | - Ichiro Kusumi
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Gonzalo Laje
- Intramural Research Program, National Institute of Mental Health, National Institutes of Health, US Department of Health & Human Services, Bethesda, MD, USA
| | - Mikael Landén
- Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the Gothenburg University, Gothenburg, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Catharina Lavebratt
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
- Center for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Marion Leboyer
- Inserm U955, Translational Psychiatry laboratory, Université Paris-Est-Créteil, Department of Psychiatry and Addictology of Mondor University Hospital, AP-HP, Fondation FondaMental, Créteil, France
| | - Susan G Leckband
- Office of Mental Health, VA San Diego Healthcare System, San Diego, CA, USA
| | | | - Mirko Manchia
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
- Department of Pharmacology, Dalhousie University, Halifax, NS, Canada
| | - Lina Martinsson
- Department of Clinical Neurosciences, Karolinska Institutet, Stockholm, Sweden
| | - Michael J McCarthy
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
- Department of Psychiatry, VA San Diego Healthcare System, San Diego, CA, USA
| | - Susan McElroy
- Department of Psychiatry, Lindner Center of Hope / University of Cincinnati, Mason, OH, USA
| | - Francesc Colom
- Mental Health Research Group, IMIM-Hospital del Mar, Barcelona, Catalonia, Spain
- Department of Genetics, Microbiology and Statistics, Faculty of Biology, University of Barcelona, Barcelona, Spain
| | - Vincent Millischer
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
- Center for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Marina Mitjans
- Department of Genetics, Microbiology and Statistics, Faculty of Biology, University of Barcelona, Barcelona, Spain
- Institut de Biomedicina de la Universitat de Barcelona (IBUB), Barcelona, Spain
- Centro de Investigación Biomédica en Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | - Francis M Mondimore
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Palmiero Monteleone
- Neurosciences Section, Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Salerno, Italy
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | | | - Markus M Nöthen
- Institute of Human Genetics, University of Bonn, School of Medicine & University Hospital Bonn, Bonn, Germany
| | - Tomas Novák
- National Institute of Mental Health, Klecany, Czech Republic
| | - Claire O'Donovan
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Norio Ozaki
- Department of Psychiatry & Department of Child and Adolescent Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Andrea Pfennig
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Medical Faculty, Technische Universität Dresden, Dresden, Germany
| | - Claudia Pisanu
- Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy
| | - James B Potash
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Andreas Reif
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Frankfurt, Germany
| | - Eva Reininghaus
- Department of Psychiatry and Psychotherapeutic Medicine, Research Unit for bipolar affective disorder, Medical University of Graz, Graz, Austria
| | - Guy A Rouleau
- Montreal Neurological Institute and Hospital, McGill University, Montreal, Canada
| | - Janusz K Rybakowski
- Department of Adult Psychiatry, Poznan University of Medical Sciences, Poznan, Poland
| | - Martin Schalling
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
- Center for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Peter R Schofield
- Neuroscience Research Australia, Sydney, NSW, Australia
- School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
| | - Barbara W Schweizer
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Giovanni Severino
- Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy
| | - Paul D Shilling
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Katzutaka Shimoda
- Department of Psychiatry, Dokkyo Medical University School of Medicine, Mibu, Tochigi, Japan
| | - Christian Simhandl
- Bipolar Center Wiener Neustadt, Sigmund Freud University, Medical Faculty, Vienna, Austria
| | - Claire M Slaney
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Alessio Squassina
- Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy
| | - Thomas Stamm
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Campus Charité Mitte, Berlin, Germany
- Department of Clinical Psychiatry and Psychotherapy, Brandenburg Medical School, Brandenburg, Germany
| | - Pavla Stopkova
- National Institute of Mental Health, Klecany, Czech Republic
| | - Mario Maj
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Gustavo Turecki
- Douglas Mental Health University Institute, McGill University, Montreal, Canada
| | - Eduard Vieta
- Bipolar and Depressive Disorders Program,, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Julia Veeh
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Frankfurt, Germany
| | - Stephanie H Witt
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Adam Wright
- School of Psychiatry, University of New South Wales, and Black Dog Institute, Sydney, Australia
| | - Peter P Zandi
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Philip B Mitchell
- School of Psychiatry, University of New South Wales, and Black Dog Institute, Sydney, Australia
| | - Michael Bauer
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Medical Faculty, Technische Universität Dresden, Dresden, Germany
| | - Martin Alda
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
- National Institute of Mental Health, Klecany, Czech Republic
| | - Marcella Rietschel
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Francis J McMahon
- Intramural Research Program, National Institute of Mental Health, National Institutes of Health, US Department of Health & Human Services, Bethesda, MD, USA
| | - Thomas G Schulze
- Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU Munich, Munich, Germany
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD, USA
- Department of Psychiatry and Behavioral Sciences, SUNY Upstate Medical University, Norton College of Medicine, Syracuse, NY, USA
| | - Scott R Clark
- Discipline of Psychiatry, School of Medicine, University of Adelaide, Adelaide, SA, Australia
| | - Bernhard T Baune
- Department of Psychiatry and Psychotherapy, University of Münster, Münster, Germany
- Department of Psychiatry, Melbourne Medical School, University of Melbourne, Parkville, VIC, Australia
- The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia
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Lütt A, Tsamitros N, Wolbers T, Rosenthal A, Bröcker AL, Schöneck R, Bermpohl F, Heinz A, Beck A, Gutwinski S. An explorative single-arm clinical study to assess craving in patients with alcohol use disorder using Virtual Reality exposure (CRAVE)-study protocol. BMC Psychiatry 2023; 23:839. [PMID: 37964300 PMCID: PMC10647047 DOI: 10.1186/s12888-023-05346-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 11/03/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND Alcohol use disorder (AUD) belongs to the most burdensome clinical disorders worldwide. Current treatment approaches yield unsatisfactory long-term effects with relapse rates up to 85%. Craving for alcohol is a major predictor for relapse and can be intentionally induced via cue exposure in real life as well as in Virtual Reality (VR). The induction and habituation of craving via conditioned cues as well as extinction learning is used in Cue Exposure Therapy (CET), a long-known but rarely used strategy in Cognitive Behavioral Therapy (CBT) of AUD. VR scenarios with alcohol related cues offer several advantages over real life scenarios and are within the focus of current efforts to develop new treatment options. As a first step, we aim to analyze if the VR scenarios elicit a transient change in craving levels and if this is measurable via subjective and psychophysiological parameters. METHODS A single-arm clinical study will be conducted including n = 60 patients with AUD. Data on severity of AUD and craving, comorbidities, demographics, side effects and the feeling of presence in VR will be assessed. Patients will use a head-mounted display (HMD) to immerse themselves into three different scenarios (neutral vs. two target situations: a living room and a bar) while heart rate, heart rate variability, pupillometry and electrodermal activity will be measured continuously. Subjective craving levels will be assessed before, during and after the VR session. DISCUSSION Results of this study will yield insight into the induction of alcohol craving in VR cue exposure paradigms and its measurement via subjective and psychophysiological parameters. This might be an important step in the development of innovative therapeutic approaches in the treatment of patients with AUD. TRIAL REGISTRATION This study was approved by the Charité-Universitätsmedizin Berlin Institutional Review Board (EA1/190/22, 23.05.2023). It was registered on ClinicalTrials.gov (NCT05861843).
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Affiliation(s)
- A Lütt
- Psychiatric University Hospital Charité at St. Hedwig Hospital, 10115, Berlin, Germany.
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Campus Charité Mitte, 10117, Berlin, Germany.
- Berlin Institute of Health at Charité, Universitätsmedizin Berlin, 10117, Berlin, Germany.
- German Center for Mental Health (DZPG), partner site Berlin, Berlin, Germany.
| | - N Tsamitros
- Psychiatric University Hospital Charité at St. Hedwig Hospital, 10115, Berlin, Germany
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Campus Charité Mitte, 10117, Berlin, Germany
- Berlin Institute of Health at Charité, Universitätsmedizin Berlin, 10117, Berlin, Germany
| | - T Wolbers
- German Center for Neurodegenerative Diseases (DZNE), 39120, Magdeburg, Germany
| | - A Rosenthal
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Campus Charité Mitte, 10117, Berlin, Germany
| | - A L Bröcker
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Campus Charité Mitte, 10117, Berlin, Germany
| | - R Schöneck
- Salus Clinic Lindow, 16835, Lindow, Germany
| | - F Bermpohl
- Psychiatric University Hospital Charité at St. Hedwig Hospital, 10115, Berlin, Germany
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Campus Charité Mitte, 10117, Berlin, Germany
| | - A Heinz
- Psychiatric University Hospital Charité at St. Hedwig Hospital, 10115, Berlin, Germany
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Campus Charité Mitte, 10117, Berlin, Germany
- German Center for Mental Health (DZPG), partner site Berlin, Berlin, Germany
| | - A Beck
- Faculty of Health, Health and Medical University, 14471, Potsdam, Germany
| | - S Gutwinski
- Psychiatric University Hospital Charité at St. Hedwig Hospital, 10115, Berlin, Germany
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Campus Charité Mitte, 10117, Berlin, Germany
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10
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Bittner N, Funk CSM, Schmidt A, Bermpohl F, Brandl EJ, Algharably EEA, Kreutz R, Riemer TG. Psychiatric Adverse Events of Acetylcholinesterase Inhibitors in Alzheimer's Disease and Parkinson's Dementia: Systematic Review and Meta-Analysis. Drugs Aging 2023; 40:953-964. [PMID: 37682445 PMCID: PMC10600312 DOI: 10.1007/s40266-023-01065-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND The acetylcholinesterase inhibitors (AChEIs) donepezil, galantamine, and rivastigmine are commonly used in the management of various forms of dementia. OBJECTIVES While these drugs are known to induce classic cholinergic adverse events such as diarrhea, their potential to cause psychiatric adverse events has yet to be thoroughly examined. METHODS We sought to determine the risk of psychiatric adverse events associated with the use of AChEIs through a systematic review and meta-analysis of double-blind randomized controlled trials involving patients with Alzheimer's dementia and Parkinson's dementia. RESULTS A total of 48 trials encompassing 22,845 patients were included in our analysis. Anorexia was the most commonly reported psychiatric adverse event, followed by agitation, insomnia, and depression. Individuals exposed to AChEIs had a greater risk of experiencing appetite disorders, insomnia, or depression compared with those who received placebo (anorexia: odds ratio [OR] 2.93, 95% confidence interval [CI] 2.29-3.75; p < 0.00001; decreased appetite: OR 1.93, 95% CI 1.33-2.82; p = 0.0006; insomnia: OR 1.55, 95% CI 1.25-1.93; p < 0.0001; and depression: OR 1.59, 95% CI 1.23-2.06, p = 0.0004). Appetite disorders were also more frequent with high-dose versus low-dose therapy. A subgroup analysis revealed that the risk of insomnia was higher for donepezil than for galantamine. CONCLUSIONS Our findings suggest that AChEI therapy may negatively impact psychological health, and careful monitoring of new psychiatric symptoms is warranted. Lowering the dose may resolve some psychiatric adverse events, as may switching to galantamine in the case of insomnia. CLINICAL TRIAL REGISTRATION The study was pre-registered on PROSPERO (CRD42021258376).
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Affiliation(s)
- Nadine Bittner
- Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany
| | - Cleo S. M. Funk
- Institute of Clinical Pharmacology and Toxicology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10115 Berlin, Germany
| | - Alexander Schmidt
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Felix Bermpohl
- Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany
| | - Eva J. Brandl
- Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany
| | - Engi E. A. Algharably
- Institute of Clinical Pharmacology and Toxicology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10115 Berlin, Germany
| | - Reinhold Kreutz
- Institute of Clinical Pharmacology and Toxicology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10115 Berlin, Germany
| | - Thomas G. Riemer
- Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany
- Institute of Clinical Pharmacology and Toxicology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10115 Berlin, Germany
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11
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Wuebken K, Bermpohl F, Boedeker K, Hindi Attar C, Kluczniok D, Schoofs N, Fuchs A, Neukel C, Herpertz SC, Brunner R, Winter SM, Kaess M, Jaite C, Dittrich K. The mediating role of attachment and anger: exploring the impact of maternal early-life maltreatment on child abuse potential. Front Psychiatry 2023; 14:1267038. [PMID: 37965361 PMCID: PMC10641504 DOI: 10.3389/fpsyt.2023.1267038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 10/02/2023] [Indexed: 11/16/2023] Open
Abstract
Background Maternal early-life maltreatment (ELM) increases the risk of subsequent child maltreatment, but the underlying mechanisms of these intergenerational effects remain largely unknown. Identifying these mechanisms is crucial for developing preventive interventions that can break the cycle of abuse. Notably, previous research has shown that ELM often results in attachment insecurity and altered anger characteristics. Therefore, this study determines whether these characteristics mediate the relationship between maternal history of ELM and child abuse potential. Methods The study sample included 254 mothers, of whom 149 had experienced ELM to at least a moderate degree. Maternal ELM was assessed using the Childhood Experience of Care and Abuse (CECA) interview. Attachment insecurity, trait anger and anger expression, and maternal abuse potential were assessed using the Vulnerable Attachment Questionnaire (VASQ), State-Trait Anger Expression Inventory (STAXI), and Child Abuse Potential Inventory (CAPI), respectively. Results The severity of maternal ELM predicted higher child abuse potential, with attachment insecurity and anger suppression mediating this effect. Specifically, higher levels of maternal ELM were associated with greater attachment insecurity and increased anger suppression, resulting in a higher child abuse potential. Although higher levels of trait anger were directly associated with higher child abuse potential, this parameter did not mediate the relationship with ELM. In addition, no significant associations were observed between outwardly expressed anger and ELM or child abuse potential. All analyses were adjusted for maternal mental disorders, years of education, and relationship status. Discussion Attachment insecurity and anger suppression may serve as pathways linking the maternal history of ELM to the risk of child abuse, even when considering maternal psychopathology. Overall, our findings indicate that interventions aimed at strengthening attachment and improving anger suppression may be beneficial for all mothers with ELM history and high child abuse potential, not just those who suffer from mental illness.
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Affiliation(s)
- Karolina Wuebken
- Department of Psychiatry and Psychotherapy, Charité—Universitätsmedizin Berlin, Charité Campus Mitte, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany
| | - Felix Bermpohl
- Department of Psychiatry and Psychotherapy, Charité—Universitätsmedizin Berlin, Charité Campus Mitte, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany
| | - Katja Boedeker
- Adolescent Psychiatry, Psychosomatics and Psychotherapy, Charité—Universitätsmedizin Berlin, Charité Campus Virchow, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany
| | - Catherine Hindi Attar
- Department of Psychiatry and Psychotherapy, Charité—Universitätsmedizin Berlin, Charité Campus Mitte, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany
| | - Dorothea Kluczniok
- Department of Psychiatry and Psychotherapy, Charité—Universitätsmedizin Berlin, Charité Campus Mitte, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany
| | - Nikola Schoofs
- Department of Psychiatry and Psychotherapy, Charité—Universitätsmedizin Berlin, Charité Campus Mitte, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany
| | - Anna Fuchs
- Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Corinne Neukel
- Department of General Psychiatry, Center for Psychosocial Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Sabine C. Herpertz
- Department of General Psychiatry, Center for Psychosocial Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Romuald Brunner
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Sibylle Maria Winter
- Adolescent Psychiatry, Psychosomatics and Psychotherapy, Charité—Universitätsmedizin Berlin, Charité Campus Virchow, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany
| | - Michael Kaess
- Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, Heidelberg University Hospital, Heidelberg, Germany
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Charlotte Jaite
- Adolescent Psychiatry, Psychosomatics and Psychotherapy, Charité—Universitätsmedizin Berlin, Charité Campus Virchow, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany
- Department of Clinical Psychology and Psychotherapy in Childhood and Adolescence, University of Hildesheim, Hildesheim, Germany
| | - Katja Dittrich
- Adolescent Psychiatry, Psychosomatics and Psychotherapy, Charité—Universitätsmedizin Berlin, Charité Campus Virchow, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany
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12
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Nöhles VB, Bermpohl F, Falkai P, Reif-Leonhard C, Jessen F, Adli M, Otte C, Meyer-Lindenberg A, Bauer M, Rubarth K, Anghelescu IG, Rujescu D, Correll CU. Patient characteristics, validity of clinical diagnoses and Outcomes Associated with Suicidality in Inpatients with Symptoms of Depression (OASIS-D): design, procedures and outcomes. BMC Psychiatry 2023; 23:744. [PMID: 37828493 PMCID: PMC10571442 DOI: 10.1186/s12888-023-05230-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 09/28/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Suicidality, ranging from passive suicidal thoughts to suicide attempt, is common in major depressive disorder (MDD). However, relatively little is known about patient, illness and treatment characteristics in those with co-occurring MDD and suicidality, including the timing of and factors associated with the offset, continuation or reemergence of suicidality. Here, we present the background, rationale, design and hypotheses of the Patient Characteristics, Validity of Clinical Diagnoses and Outcomes Associated with Suicidality in Inpatients with Symptoms of Depression (OASIS-D) study, an investigator-initiated, observational study, funded by Janssen-Cilag GmbH. METHODS/RESULTS OASIS-D is an eight-site, six-month, cohort study of patients aged 18-75 hospitalized with MDD. Divided into three sub-studies and patient populations (PPs), OASIS-D will (i) systematically characterize approximately 4500 consecutively hospitalized patients with any form of unipolar depressive episode (PP1), (ii) evaluate the validity of the clinical diagnosis of moderate or severe unipolar depressive episode with the Mini-International Neuropsychiatric Interview (M.I.N.I.) and present suicidality (at least passive suicidal thoughts) present ≥ 48 h after admission with the Sheehan-Suicide Tracking Scale (S-STS), assessing also predictors of the diagnostic concordance/discordance of MDD in around 500 inpatients (PP2), and (iii) characterize and prospectively follow for 6 months 315 inpatients with a research-verified moderate or severe unipolar depressive episode and at least passive suicidal thoughts ≥ 48 h after admission, evaluating treatment and illness/response patterns at baseline, hospital discharge, 3 and 6 months. Exploratory objectives will describe the association between the number of days with suicidality and utilization of outpatient and inpatient care services, and structured assessments of factors influencing the risk of self-injurious behavior without suicidal intent, and of continuous, intermittent or remitted suicidality during the 6-month observation period. CONCLUSION Despite their frequency and clinical relevance, relatively little is known about patient and treatment characteristics of individuals with MDD and suicidality, including factors moderating and mediating the outcome of both MDD and suicidality. Results of the OASIS-D study are hoped to improve the understanding of the frequency, correlates and 6-month naturalistic treatment and outcome trajectories of different levels of suicidality in hospitalized adults with MDD and suicidality. TRIAL REGISTRATION NCT04404309 [ClinicalTrials.gov].
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Affiliation(s)
- Viktor B Nöhles
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin - Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Felix Bermpohl
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin - Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Campus St. Hedwig Hospital, Berlin, Germany
| | - Peter Falkai
- Clinic for Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Christine Reif-Leonhard
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Frank Jessen
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
| | - Mazda Adli
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin - Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Campus Mitte, Berlin, Germany
- Center for Psychiatry, Psychotherapy and Psychosomatic Medicine, Fliedner Klinik Berlin, Berlin, Germany
| | - Christian Otte
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin - Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Andreas Meyer-Lindenberg
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Mannheim, Germany
| | - Michael Bauer
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Kerstin Rubarth
- Institute of Medical Informatics, Charité Universitätsmedizin - Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Institute of Biometry and Clinical Epidemiology, Charité Universitätsmedizin - Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Ion-George Anghelescu
- Clinic for Psychiatry, Psychosomatics and Psychotherapy, Mental Health Institute Berlin, Berlin, Germany
| | - Dan Rujescu
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Christoph U Correll
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin - Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
- Psychiatry Research, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA.
- Department of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
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13
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Adam M, Moran JK, Kippe YD, Schouler-Ocak M, Bermpohl F, Gutwinski S, Goldschmidt T. Increase in presentations with new-onset psychiatric disorders in a psychiatric emergency department in Berlin, Germany during the second wave of the COVID-19 pandemic - a retrospective cross-sectional study. Front Psychiatry 2023; 14:1240703. [PMID: 37904853 PMCID: PMC10613500 DOI: 10.3389/fpsyt.2023.1240703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 09/25/2023] [Indexed: 11/01/2023] Open
Abstract
Introduction While numerous studies have identified an increase in symptoms of depression as well as anxiety and distress due to the COVID-19 pandemic, relatively few studies have investigated the new-onset of psychiatric diseases during the pandemic. Methods This study focuses on the number of psychiatric new-onset diagnoses in a psychiatric emergency department (pED) in Berlin, Germany during the second wave of the pandemic (i.e. from 09/15/2020 to 03/01/2021 = COVID-19-period) compared to pre-pandemic times (09/15/2019 to 03/01/2020 = control period). We focused on diagnostic subgroups and performed logistic regression analysis to investigate potential risk groups based on covariables such as age, gender, homelessness, attending in police custody and familial relationship. Results Overall, there was a 59.7% increase in new-onset psychiatric diagnoses during the COVID-19-period. Increases in the following diagnoses were observed: new-onset of substance-related and addictive disorders (+192.5%), depressive disorders (+115.8%), schizophrenia spectrum and psychotic disorders (+113.3%) and anxiety disorders (+63.6%). These diagnostic subgroups, together with attending in police custody, were found to predict pED presentations with new-onset during the COVID-19-period. Interestingly, in the group of new-onset psychiatric diseases in the COVID-19-period, higher amounts of job loss and living alone as well as a relative decrease in familial relationships were observed. Discussion COVID-19 infections and post-COVID-19 syndrome are unlikely to have played a substantial role in the increase of new-onset diseases in this study. Conclusion: Our findings underline the role of indirect factors in new-onset of psychiatric diseases during the pandemic and should be a caveat for future pandemic control policies.
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14
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Wullschleger A, Vandamme A, Mielau J, Heinz A, Bermpohl F, Mahler L, Montag C. Relationship between perceived coercion and perceived justification of coercive measures - secondary analysis of a randomized-controlled trial. BMC Psychiatry 2023; 23:712. [PMID: 37784077 PMCID: PMC10546675 DOI: 10.1186/s12888-023-05192-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 09/14/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND Subjective perception of coercion has gained attention as an important outcome. However, little is known about its relation to patients' appraisal of the justification of coercive measures. The present study aims to analyze the relationship between patients' appraisal of the justification of coercive measures and their level of perceived coercion. METHODS This study presents a secondary analysis of the results of a multi-center RCT conducted to evaluate the effects of post-coercion review. Patients who experienced at least one coercive measure during their hospital stay were included in the trial. Participants' appraisal of the justification of coercive measures was categorized into patient-related and staff-related justifications. Subjective coercion was assessed using the Coercion Experience Scale (CES) and used as dependent variable in a multivariate regression model. RESULTS 97 participants who completed the CES were included in the analysis. CES scores were significantly associated with the perception of the coercive measure as justified by staff-related factors (B = 0,540, p < 0,001), as well as with higher level of negative symptoms (B = 0,265, p = 0,011), and with mechanical restraint compared to seclusion (B=-0,343, p = 0,017). CONCLUSIONS Patients' perceptions of coercive measures as justified by staff-related factors such as arbitrariness or incompetence of staff are related to higher levels of perceived coercion. Multiprofessional efforts must be made to restrict the use of coercive measures and to ensure a transparent and sustainable decision-making process, particularly with patients showing high levels of negative symptoms. Such key elements should be part of all coercion reduction programs.
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Affiliation(s)
- Alexandre Wullschleger
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt- Universität Zu Berlin, Campus Charité Mitte, Berlin, Germany.
- Division of Adult Psychiatry, Department of Psychiatry, Geneva University Hospitals, Ch. Du Petit-Bel-Air 2, Thônex, 1226, Switzerland.
| | - Angelika Vandamme
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt- Universität Zu Berlin, Campus Charité Mitte, Berlin, Germany
| | - Juliane Mielau
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt- Universität Zu Berlin, Campus Charité Mitte, Berlin, Germany
| | - Andreas Heinz
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt- Universität Zu Berlin, Campus Charité Mitte, Berlin, Germany
| | - Felix Bermpohl
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt- Universität Zu Berlin, Campus Charité Mitte, Berlin, Germany
| | - Lieselotte Mahler
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt- Universität Zu Berlin, Campus Charité Mitte, Berlin, Germany
- Department of Psychiatry, Clinics in the Theodor-Wenzel-Werk, Berlin, Germany
| | - Christiane Montag
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt- Universität Zu Berlin, Campus Charité Mitte, Berlin, Germany
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Watrin-Avino LM, Forbes FJ, Buchwald MC, Dittrich K, Correll CU, Bermpohl F, Bödeker K. Affect Recognition, Theory of Mind, and Empathy in Preschool Children with Externalizing Behavior Problems-A Group Comparison and Developmental Psychological Consideration. Children (Basel) 2023; 10:1455. [PMID: 37761416 PMCID: PMC10529822 DOI: 10.3390/children10091455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/19/2023] [Accepted: 08/24/2023] [Indexed: 09/29/2023]
Abstract
Preschool mental disorders are often associated with significant interpersonal problems, related to impaired affect recognition, theory of mind (ToM), and empathy. To date, these skills have not been studied together in preschoolers with externalizing behavior problems (EBPs). The aim of the present study was to investigate whether and to what extent preschool children with EBPs show impairments in affect recognition, ToM, and empathy. Preschoolers with EBPs, defined by current psychiatric treatment and T-scores ≥ 60 on the externalizing problem scale of the Child Behavior Checklist (CBCL/1½-5 or 6-18R) were compared to non-clinical controls (HCs), defined by no past and no current psychiatric treatment and T-scores < 60 on all CBCL broad-band scales. Groups were compared on affect recognition (NEuroPSYchological Assessment-II), affective ToM (Test of Emotion Comprehension), cognitive ToM (Extended Theory-of-Mind Scale), parent-reported emotional contagion, attention to others' feelings, and prosocial action (Empathy Questionnaire), IQ and language (Wechsler Preschool and Primary Scale of Intelligence-III Matrices, Active and Passive Vocabulary test), controlling for age, sex, and language abilities. Compared to 28 HCs, 22 preschoolers with EBPs (total sample meanage = 5.5 years +/- 0.8 years, range= 4.2-6.9 years, males 66%) had significantly greater impairments in cognitive ToM (p = 0.0012, η2 = 0.266), attention to others' feelings (p = 0.0049, η2 = 0.222), and prosocial action (p = 0.0070, η2 = 0.210), each representing strong effect sizes. EBPs were significantly related to cognitive domains, like prosocial action (r = -0.501), cognitive ToM (r = -0.425), and attention to others' feelings (r = -0.332), but not to affective domains of social cognition. Social cognitive development may be impaired as early as preschool age and should be promoted before the child starts school.
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Affiliation(s)
- Laura M. Watrin-Avino
- Department of Child and Adolescent Psychiatry, Charité Campus Virchow, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany; (F.J.F.); (M.C.B.); (K.D.); (C.U.C.); (K.B.)
| | - Franziska J. Forbes
- Department of Child and Adolescent Psychiatry, Charité Campus Virchow, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany; (F.J.F.); (M.C.B.); (K.D.); (C.U.C.); (K.B.)
| | - Martin C. Buchwald
- Department of Child and Adolescent Psychiatry, Charité Campus Virchow, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany; (F.J.F.); (M.C.B.); (K.D.); (C.U.C.); (K.B.)
| | - Katja Dittrich
- Department of Child and Adolescent Psychiatry, Charité Campus Virchow, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany; (F.J.F.); (M.C.B.); (K.D.); (C.U.C.); (K.B.)
| | - Christoph U. Correll
- Department of Child and Adolescent Psychiatry, Charité Campus Virchow, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany; (F.J.F.); (M.C.B.); (K.D.); (C.U.C.); (K.B.)
- The Zucker Hillside Hospital, Department of Psychiatry, Northwell Health, Glen Oaks, NY 11004, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Department of Psychiatry and Molecular Medicine, Hofstra University, Hempstead, NY 11549, USA
- The Feinstein Institutes for Medical Research, Center for Psychiatric Neuroscience, Northwell Health, New Hyde Park, NY 11030, USA
- DZPG, German Center for Mental Health, Partner Site Berlin, 10785 Berlin, Germany
| | - Felix Bermpohl
- Department of Psychiatry and Neuroscience, Charité Campus Mitte, Charité—University Medicine Berlin, 10117 Berlin, Germany;
| | - Katja Bödeker
- Department of Child and Adolescent Psychiatry, Charité Campus Virchow, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany; (F.J.F.); (M.C.B.); (K.D.); (C.U.C.); (K.B.)
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16
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Just SA, Bröcker AL, Ryazanskaya G, Nenchev I, Schneider M, Bermpohl F, Heinz A, Montag C. Validation of natural language processing methods capturing semantic incoherence in the speech of patients with non-affective psychosis. Front Psychiatry 2023; 14:1208856. [PMID: 37564246 PMCID: PMC10411549 DOI: 10.3389/fpsyt.2023.1208856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 07/07/2023] [Indexed: 08/12/2023] Open
Abstract
Background Impairments in speech production are a core symptom of non-affective psychosis (NAP). While traditional clinical ratings of patients' speech involve a subjective human factor, modern methods of natural language processing (NLP) promise an automatic and objective way of analyzing patients' speech. This study aimed to validate NLP methods for analyzing speech production in NAP patients. Methods Speech samples from patients with a diagnosis of schizophrenia or schizoaffective disorder were obtained at two measurement points, 6 months apart. Out of N = 71 patients at T1, speech samples were also available for N = 54 patients at T2. Global and local models of semantic coherence as well as different word embeddings (word2vec vs. GloVe) were applied to the transcribed speech samples. They were tested and compared regarding their correlation with clinical ratings and external criteria from cross-sectional and longitudinal measurements. Results Results did not show differences for global vs. local coherence models and found more significant correlations between word2vec models and clinically relevant outcome variables than for GloVe models. Exploratory analysis of longitudinal data did not yield significant correlation with coherence scores. Conclusion These results indicate that natural language processing methods need to be critically validated in more studies and carefully selected before clinical application.
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Affiliation(s)
- Sandra Anna Just
- Department of Psychiatry and Neurosciences, Campus Charité Mitte, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - Anna-Lena Bröcker
- Department of Psychiatry and Neurosciences, Campus Charité Mitte, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | | | - Ivan Nenchev
- Department of Psychiatry and Neurosciences, Campus Charité Mitte, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - Maria Schneider
- IPB Institut für Integrative Psychotherapieausbildung Berlin, MSB Medical School Berlin, GmbH, Berlin, Germany
| | - Felix Bermpohl
- Department of Psychiatry and Neurosciences, Campus Charité Mitte, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - Andreas Heinz
- Department of Psychiatry and Neurosciences, Campus Charité Mitte, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - Christiane Montag
- Department of Psychiatry and Neurosciences, Campus Charité Mitte, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
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Jäckel D, Willert A, Brose A, Leopold K, Nischk D, Senner S, Pogarell O, Sachenbacher S, Lambert M, Rohenkohl A, Kling-Lourenco P, Rüsch N, Bermpohl F, Schouler-Ocak M, Disselhof V, Skorupa U, Bechdolf A. Correction: Enhancing educational and vocational recovery in adolescents and young adults with early psychosis through Supported Employment and Education (SEEearly): study protocol for a multicenter randomized controlled trial. Trials 2023; 24:476. [PMID: 37491354 PMCID: PMC10369747 DOI: 10.1186/s13063-023-07524-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023] Open
Affiliation(s)
- D Jäckel
- Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Charité UniversitätsmedizinBerlin, Berlin, Germany
- Department of Psychiatry, Psychotherapy and Psychosomatics, Vivantes Klinikum Am Urban and Vivantes Klinikum Im Friedrichshain, Berlin, Germany
| | - A Willert
- Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Charité UniversitätsmedizinBerlin, Berlin, Germany.
- Department of Psychiatry, Psychotherapy and Psychosomatics, Vivantes Klinikum Am Urban and Vivantes Klinikum Im Friedrichshain, Berlin, Germany.
| | - A Brose
- Department of Psychiatry, Psychotherapy and Psychosomatics, Vivantes Klinikum Am Urban and Vivantes Klinikum Im Friedrichshain, Berlin, Germany
| | - K Leopold
- Department of Psychiatry, Psychotherapy and Psychosomatics, Vivantes Klinikum Am Urban and Vivantes Klinikum Im Friedrichshain, Berlin, Germany
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - D Nischk
- Department of Social Psychiatry, Zentrum Für Psychiatrie, Reichenau, Germany
| | - S Senner
- Department of Social Psychiatry, Zentrum Für Psychiatrie, Reichenau, Germany
| | - O Pogarell
- Department of Psychiatry and Psychother- Apy, University Hospital, LMU Munich, Munich, Germany
| | - S Sachenbacher
- Department of Psychiatry and Psychother- Apy, University Hospital, LMU Munich, Munich, Germany
| | - M Lambert
- Department of Psy- Chiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - A Rohenkohl
- Department of Psy- Chiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - P Kling-Lourenco
- Department of Psychiatry II, University of Ulm and BKH Günzburg, Ulm, Germany
| | - N Rüsch
- Department of Psychiatry II, University of Ulm and BKH Günzburg, Ulm, Germany
| | - F Bermpohl
- Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Charité UniversitätsmedizinBerlin, Berlin, Germany
- Psychiatric University Clinic of Charité at St. Hedwig Hospital, Berlin, Germany
| | - M Schouler-Ocak
- Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Charité UniversitätsmedizinBerlin, Berlin, Germany
- Psychiatric University Clinic of Charité at St. Hedwig Hospital, Berlin, Germany
| | - V Disselhof
- Department of Psychiatry, Psychotherapy and Psychosomatics, Vivantes Klinikum Am Urban and Vivantes Klinikum Im Friedrichshain, Berlin, Germany
| | - U Skorupa
- Department of Psychiatry, Psychotherapy and Psychosomatics, Vivantes Klinikum Am Urban and Vivantes Klinikum Im Friedrichshain, Berlin, Germany
| | - A Bechdolf
- Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Charité UniversitätsmedizinBerlin, Berlin, Germany
- Department of Psychiatry, Psychotherapy and Psychosomatics, Vivantes Klinikum Am Urban and Vivantes Klinikum Im Friedrichshain, Berlin, Germany
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18
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Jäckel D, Willert A, Brose A, Leopold K, Nischk D, Senner S, Pogarell O, Sachenbacher S, Lambert M, Rohenkohl A, Kling-Lourenco P, Rüsch N, Bermpohl F, Schouler-Ocak M, Disselhoff V, Skorupa U, Bechdolf A. Enhancing educational and vocational recovery in adolescents and young adults with early psychosis through Supported Employment and Education (SEEearly): study protocol for a multicenter randomized controlled trial. Trials 2023; 24:440. [PMID: 37400899 PMCID: PMC10316586 DOI: 10.1186/s13063-023-07462-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 06/13/2023] [Indexed: 07/05/2023] Open
Abstract
BACKGROUND Psychotic disorders often develop a chronic course with devastating consequences for individuals, families, and societies. Early intervention programs for people in the first 5 years after the initial psychotic episode (early psychosis) can significantly improve the outcome and are therefore strongly recommended in national and international guidelines. However, most early intervention programs still focus on improving symptoms and relapse prevention, rather than targeting educational and vocational recovery. The aim of the present study is to explore the effects of Supported Employment and Education (SEE) following the Individual Placement and Support (IPS) model in people with early psychosis. METHODS The SEEearly trial compares treatment as usual (TAU) plus SEE to TAU alone in outpatient psychiatric settings. The study is a six-site, two-arm, single-blinded, superiority randomized controlled trial (RCT). Participants are randomly assigned (1:1) to the intervention or control group. Aiming to recruit 184 participants, with an assumed drop-out rate of 22%, we will be able to detect a 24% difference in the main outcome of employment/education with 90% power. We make assessments at baseline and at 6- and 12-month follow-ups. Outcome data on employment/education, medication, and current psychiatric treatment is obtained monthly through phone based short assessments. The primary outcome is steady participation for at least 50% of the 12-month follow-up in competitive employment and/or mainstream education. Secondary employment outcomes capture length of employment/education, time to first employment/education, monthly wages/educational attainment, and social return on investment (SROI). Secondary non-employment outcomes include subjective quality of life, psychopathology, substance use, relapse, hospitalization, and functional impairment. To be eligible, participants must be between 16 and 35 years, fulfill diagnostic criteria for early psychosis, and be interested in competitive employment and/or mainstream education. DISCUSSION In SEEearly, we hypothesize that participants with psychosis, who receive TAU plus SEE, present with better primary and secondary outcomes than participants, who receive TAU alone. Positive results of this study will justify SEE as an evidence-based strategy for clinical routine treatment in people with early psychosis. TRIAL REGISTRATION SEEearly was registered nationally and internationally in the German Clinical Trials Register (DRKS; identifier: DRKS00029660) on October 14, 2022.
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Affiliation(s)
- D Jäckel
- Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Charité Universitätsmedizin Berlin, Berlin, Germany
- Department of Psychiatry, Psychotherapy and Psychosomatics, Vivantes Klinikum am Urban and Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | - A Willert
- Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Charité Universitätsmedizin Berlin, Berlin, Germany.
- Department of Psychiatry, Psychotherapy and Psychosomatics, Vivantes Klinikum am Urban and Vivantes Klinikum im Friedrichshain, Berlin, Germany.
| | - A Brose
- Department of Psychiatry, Psychotherapy and Psychosomatics, Vivantes Klinikum am Urban and Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | - K Leopold
- Department of Psychiatry, Psychotherapy and Psychosomatics, Vivantes Klinikum am Urban and Vivantes Klinikum im Friedrichshain, Berlin, Germany
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - D Nischk
- Department of Social Psychiatry, Zentrum für Psychiatrie, Reichenau, Germany
| | - S Senner
- Department of Social Psychiatry, Zentrum für Psychiatrie, Reichenau, Germany
| | - O Pogarell
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - S Sachenbacher
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - M Lambert
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - A Rohenkohl
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - P Kling-Lourenco
- Department of Psychiatry II, University of Ulm and BKH Günzburg, Ulm, Germany
| | - N Rüsch
- Department of Psychiatry II, University of Ulm and BKH Günzburg, Ulm, Germany
| | - F Bermpohl
- Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Charité Universitätsmedizin Berlin, Berlin, Germany
- Psychiatric University Clinic of Charité at St. Hedwig Hospital, Berlin, Germany
| | - M Schouler-Ocak
- Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Charité Universitätsmedizin Berlin, Berlin, Germany
- Psychiatric University Clinic of Charité at St. Hedwig Hospital, Berlin, Germany
| | - V Disselhoff
- Department of Psychiatry, Psychotherapy and Psychosomatics, Vivantes Klinikum am Urban and Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | - U Skorupa
- Department of Psychiatry, Psychotherapy and Psychosomatics, Vivantes Klinikum am Urban and Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | - A Bechdolf
- Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Charité Universitätsmedizin Berlin, Berlin, Germany
- Department of Psychiatry, Psychotherapy and Psychosomatics, Vivantes Klinikum am Urban and Vivantes Klinikum im Friedrichshain, Berlin, Germany
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Meyer K, Hindi Attar C, Fiebig J, Stamm T, Bassett TR, Bauer M, Dannlowski U, Ethofer T, Falkenberg I, Jansen A, Juckel G, Kircher T, Mulert C, Leicht G, Rau A, Rauh J, Ritter D, Ritter P, Trost S, Vogelbacher C, Walter H, Wolter S, Hautzinger M, Bermpohl F. Daring to Feel: Emotion-Focused Psychotherapy Increases Amygdala Activation and Connectivity in Euthymic Bipolar Disorder-A Randomized Controlled Trial. Biol Psychiatry Cogn Neurosci Neuroimaging 2023; 8:750-759. [PMID: 36898634 DOI: 10.1016/j.bpsc.2023.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 02/18/2023] [Accepted: 02/24/2023] [Indexed: 03/10/2023]
Abstract
BACKGROUND In bipolar disorder (BD), the alternation of extreme mood states indicates deficits in emotion processing, accompanied by aberrant neural function of the emotion network. The present study investigated the effects of an emotion-centered psychotherapeutic intervention on amygdala responsivity and connectivity during emotional face processing in BD. METHODS In a randomized controlled trial within the multicentric BipoLife project, euthymic patients with BD received one of two interventions over 6 months: an unstructured, emotion-focused intervention (FEST), where patients were guided to adequately perceive and label their emotions (n = 28), or a specific, structured, cognitive behavioral intervention (SEKT) (n = 31). Before and after interventions, functional magnetic resonance imaging was conducted while patients completed an emotional face-matching paradigm (final functional magnetic resonance imaging sample of patients completing both measurements: SEKT, n = 17; FEST, n = 17). Healthy control subjects (n = 32) were scanned twice after the same interval without receiving any intervention. Given the focus of FEST on emotion processing, we expected FEST to strengthen amygdala activation and connectivity. RESULTS Clinically, both interventions stabilized patients' euthymic states in terms of affective symptoms. At the neural level, FEST versus SEKT increased amygdala activation and amygdala-insula connectivity at postintervention relative to preintervention time point. In FEST, the increase in amygdala activation was associated with fewer depressive symptoms (r = 0.72) 6 months after intervention. CONCLUSIONS Enhanced activation and functional connectivity of the amygdala after FEST versus SEKT may represent a neural marker of improved emotion processing, supporting the FEST intervention as an effective tool in relapse prevention in patients with BD.
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Affiliation(s)
- Kristina Meyer
- Department of Psychiatry and Neurosciences, Charité Campus Mitte, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
| | - Catherine Hindi Attar
- Department of Psychiatry and Neurosciences, Charité Campus Mitte, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Jana Fiebig
- Department of Psychiatry and Neurosciences, Charité Campus Mitte, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Thomas Stamm
- Department of Psychiatry and Neurosciences, Charité Campus Mitte, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Department of Clinical Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Tyler R Bassett
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany
| | - Michael Bauer
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany
| | - Udo Dannlowski
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Thomas Ethofer
- University Clinic for Psychiatry and Psychotherapy, Tübingen, Germany; Department of Biomedical Magnetic Resonance, University Clinic for Radiology Tübingen, Tübingen, Germany
| | - Irina Falkenberg
- Department of Psychiatry and Psychotherapy, University of Marburg, Germany
| | - Andreas Jansen
- Department of Psychiatry and Psychotherapy, University of Marburg, Germany; Core-Facility Brainimaging, Faculty of Medicine, University of Marburg, Marburg, Germany
| | - Georg Juckel
- Department of Psychiatry, Ruhr University Bochum, LWL University Hospital, Bochum, Germany
| | - Tilo Kircher
- Department of Psychiatry and Psychotherapy, University of Marburg, Germany
| | - Christoph Mulert
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Center for Psychiatry, Justus Liebig University, Giessen, Germany
| | - Gregor Leicht
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anne Rau
- University Clinic for Psychiatry and Psychotherapy, Tübingen, Germany
| | - Jonas Rauh
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Dirk Ritter
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany
| | - Philipp Ritter
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany
| | - Sarah Trost
- Department of Psychiatry and Psychotherapy, Georg-August-University Göttingen, Göttingen, Germany; Department of Geriatric Psychiatry, Universitäre Altersmedizin FELIX PLATTER, Basel, Switzerland
| | - Christoph Vogelbacher
- Translational Clinical Psychology, Department of Psychology, Philipps-University Marburg, Marburg, Germany
| | - Henrik Walter
- Department of Psychiatry and Neurosciences, Charité Campus Mitte, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Sarah Wolter
- Department of Psychiatry and Psychotherapy, Georg-August-University Göttingen, Göttingen, Germany; Department of Psychiatry and Psychotherapy, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Martin Hautzinger
- Department of Psychology, Clinical Psychology and Psychotherapy, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Felix Bermpohl
- Department of Psychiatry and Neurosciences, Charité Campus Mitte, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
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Cole C, Klotz E, Junghanss J, Oster A, Vandamme A, Bermpohl F, Mahler L. Coercive measures in psychiatry - When do they occur and who is at risk? J Psychiatr Res 2023; 164:315-321. [PMID: 37393796 DOI: 10.1016/j.jpsychires.2023.06.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 05/26/2023] [Accepted: 06/21/2023] [Indexed: 07/04/2023]
Abstract
Coercive measures (CM) in psychiatry adversely affect patients and efforts to minimize CM are steadily increasing. One area that has not been a strong focus of preventative efforts to date is the time of use of CM during hospitalization although previous research indicates that the admission situation and early hospitalization are times of increased risk for CM. This study therefore aims to contribute to the body of research in this field by analyzing in detail the times of use of CM and identifying patient characteristics serving as predictors for CM during early hospitalization. Using a large sample (N = 1556) of all cases admitted in 2019 via the emergency room at the Charité Department of Psychiatry at St. Hedwig Hospital in Berlin, this study supports previous research showing that the risk of CM is highest within the first 24 h h of hospitalization. Of 261 cases who experienced CM, 71.6% (n = 187) experienced a CM within the first 24 h of hospitalization and 54.4% (n = 142) of cases only experienced CM within the first 24 h of hospitalization and did not receive any CM after. Furthermore, this study identified significant predictors for the early use of CM during hospitalization including acute intoxication (p < .01), aggression (p < .01), male gender (p < .001) and limited communication ability (p < .001). The results highlight the importance of directing preventative efforts to minimize the use of CM not only to psychiatric units but also to mental health crisis response and to develop interventions specifically tailored to this time and patient groups at highest risk.
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Affiliation(s)
- Celline Cole
- Charité Universiätsmedizin Berlin, Department of Psychiatry and Psychotherapy at St. Hedwig Hospital, Grosse Hamburger Str. 5-11, 10115, Berlin, Germany.
| | - Eva Klotz
- Charité Universiätsmedizin Berlin, Department of Psychiatry and Psychotherapy at St. Hedwig Hospital, Grosse Hamburger Str. 5-11, 10115, Berlin, Germany
| | - Julia Junghanss
- Charité Universiätsmedizin Berlin, Department of Psychiatry and Psychotherapy at St. Hedwig Hospital, Grosse Hamburger Str. 5-11, 10115, Berlin, Germany
| | - Anna Oster
- Charité Universiätsmedizin Berlin, Department of Psychiatry and Psychotherapy at St. Hedwig Hospital, Grosse Hamburger Str. 5-11, 10115, Berlin, Germany; Department of Psychiatry and Psychotherapy, Clinics in the Theodor-Wenzel-Werk, Berlin, Germany
| | - Angelika Vandamme
- Charité Universiätsmedizin Berlin, Department of Psychiatry and Psychotherapy at St. Hedwig Hospital, Grosse Hamburger Str. 5-11, 10115, Berlin, Germany
| | - Felix Bermpohl
- Charité Universiätsmedizin Berlin, Department of Psychiatry and Psychotherapy at St. Hedwig Hospital, Grosse Hamburger Str. 5-11, 10115, Berlin, Germany
| | - Lieselotte Mahler
- Charité Universiätsmedizin Berlin, Department of Psychiatry and Psychotherapy at St. Hedwig Hospital, Grosse Hamburger Str. 5-11, 10115, Berlin, Germany; Department of Psychiatry and Psychotherapy, Clinics in the Theodor-Wenzel-Werk, Berlin, Germany
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21
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Huth F, Tozzi L, Marxen M, Riedel P, Bröckel K, Martini J, Berndt C, Sauer C, Vogelbacher C, Jansen A, Kircher T, Falkenberg I, Thomas-Odenthal F, Lambert M, Kraft V, Leicht G, Mulert C, Fallgatter AJ, Ethofer T, Rau A, Leopold K, Bechdolf A, Reif A, Matura S, Biere S, Bermpohl F, Fiebig J, Stamm T, Correll CU, Juckel G, Flasbeck V, Ritter P, Bauer M, Pfennig A, Mikolas P. Machine Learning Prediction of Estimated Risk for Bipolar Disorders Using Hippocampal Subfield and Amygdala Nuclei Volumes. Brain Sci 2023; 13:870. [PMID: 37371350 DOI: 10.3390/brainsci13060870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 05/23/2023] [Accepted: 05/25/2023] [Indexed: 06/29/2023] Open
Abstract
The pathophysiology of bipolar disorder (BD) remains mostly unclear. Yet, a valid biomarker is necessary to improve upon the early detection of this serious disorder. Patients with manifest BD display reduced volumes of the hippocampal subfields and amygdala nuclei. In this pre-registered analysis, we used structural MRI (n = 271, 7 sites) to compare volumes of hippocampus, amygdala and their subfields/nuclei between help-seeking subjects divided into risk groups for BD as estimated by BPSS-P, BARS and EPIbipolar. We performed between-group comparisons using linear mixed effects models for all three risk assessment tools. Additionally, we aimed to differentiate the risk groups using a linear support vector machine. We found no significant volume differences between the risk groups for all limbic structures during the main analysis. However, the SVM could still classify subjects at risk according to BPSS-P criteria with a balanced accuracy of 66.90% (95% CI 59.2-74.6) for 10-fold cross-validation and 61.9% (95% CI 52.0-71.9) for leave-one-site-out. Structural alterations of the hippocampus and amygdala may not be as pronounced in young people at risk; nonetheless, machine learning can predict the estimated risk for BD above chance. This suggests that neural changes may not merely be a consequence of BD and may have prognostic clinical value.
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Affiliation(s)
- Fabian Huth
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, 01062 Dresden, Germany
| | - Leonardo Tozzi
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Michael Marxen
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, 01062 Dresden, Germany
| | - Philipp Riedel
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, 01062 Dresden, Germany
| | - Kyra Bröckel
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, 01062 Dresden, Germany
| | - Julia Martini
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, 01062 Dresden, Germany
| | - Christina Berndt
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, 01062 Dresden, Germany
| | - Cathrin Sauer
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, 01062 Dresden, Germany
| | - Christoph Vogelbacher
- Core-Facility Brainimaging, Faculty of Medicine, University of Marburg, 35037 Marburg, Germany
- Translational Clinical Psychology, Philipps-University Marburg, 35037 Marburg, Germany
- Center for Mind, Brain and Behavior (CMBB), University of Marburg and University Giessen, 35039 Marburg, Germany
| | - Andreas Jansen
- Core-Facility Brainimaging, Faculty of Medicine, University of Marburg, 35037 Marburg, Germany
- Center for Mind, Brain and Behavior (CMBB), University of Marburg and University Giessen, 35039 Marburg, Germany
- Department of Psychiatry and Psychotherapy, University of Marburg, 35037 Marburg, Germany
| | - Tilo Kircher
- Center for Mind, Brain and Behavior (CMBB), University of Marburg and University Giessen, 35039 Marburg, Germany
- Department of Psychiatry and Psychotherapy, University of Marburg, 35037 Marburg, Germany
| | - Irina Falkenberg
- Center for Mind, Brain and Behavior (CMBB), University of Marburg and University Giessen, 35039 Marburg, Germany
- Department of Psychiatry and Psychotherapy, University of Marburg, 35037 Marburg, Germany
| | - Florian Thomas-Odenthal
- Center for Mind, Brain and Behavior (CMBB), University of Marburg and University Giessen, 35039 Marburg, Germany
- Department of Psychiatry and Psychotherapy, University of Marburg, 35037 Marburg, Germany
| | - Martin Lambert
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Vivien Kraft
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Gregor Leicht
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Christoph Mulert
- Center for Mind, Brain and Behavior (CMBB), University of Marburg and University Giessen, 35039 Marburg, Germany
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
- Centre for Psychiatry, Justus-Liebig University Giessen, 35390 Gießen, Germany
| | - Andreas J Fallgatter
- Department of Psychiatry, Tuebingen Center for Mental Health, University of Tuebingen, 72074 Tuebingen, Germany
| | - Thomas Ethofer
- Department of Psychiatry, Tuebingen Center for Mental Health, University of Tuebingen, 72074 Tuebingen, Germany
| | - Anne Rau
- Department of Psychiatry, Tuebingen Center for Mental Health, University of Tuebingen, 72074 Tuebingen, Germany
| | - Karolina Leopold
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Vivantes Hospital Am Urban and Vivantes Hospital Im Friedrichshain, Charité-Universitätsmedizin, 10117 Berlin, Germany
| | - Andreas Bechdolf
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Vivantes Hospital Am Urban and Vivantes Hospital Im Friedrichshain, Charité-Universitätsmedizin, 10117 Berlin, Germany
| | - Andreas Reif
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe University Frankfurt, University Hospital, 60323 Frankfurt, Germany
| | - Silke Matura
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe University Frankfurt, University Hospital, 60323 Frankfurt, Germany
| | - Silvia Biere
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe University Frankfurt, University Hospital, 60323 Frankfurt, Germany
| | - Felix Bermpohl
- Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Charité University Medicine, 10117 Berlin, Germany
| | - Jana Fiebig
- Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Charité University Medicine, 10117 Berlin, Germany
| | - Thomas Stamm
- Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Charité University Medicine, 10117 Berlin, Germany
- Department of Clinical Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, 16816 Neuruppin, Germany
| | - Christoph U Correll
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin Berlin, 10117 Berlin, Germany
- Department of Psychiatry, Northwell Health, The Zucker Hillside Hospital, Glen Oaks, New York, NY 11004, USA
- Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY 11549, USA
| | - Georg Juckel
- Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL University Hospital, Ruhr-University, 44791 Bochum, Germany
| | - Vera Flasbeck
- Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL University Hospital, Ruhr-University, 44791 Bochum, Germany
| | - Philipp Ritter
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, 01062 Dresden, Germany
| | - Michael Bauer
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, 01062 Dresden, Germany
| | - Andrea Pfennig
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, 01062 Dresden, Germany
| | - Pavol Mikolas
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, 01062 Dresden, Germany
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22
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Just SA, Seethaler M, Sarpeah R, Waßmuth N, Bermpohl F, Brandl EJ. Correction to: Loneliness in Elderly Inpatients. Psychiatr Q 2023:10.1007/s11126-023-10021-2. [PMID: 37130965 DOI: 10.1007/s11126-023-10021-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Affiliation(s)
- Sandra Anna Just
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte (Psychiatric University Hospital of Charité at St. Hedwig Hospital), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt- Universität zu Berlin, Berlin Institute of Health, Große Hamburger Str. 5-11, 10115, Berlin, Germany.
| | - Magdalena Seethaler
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte (Psychiatric University Hospital of Charité at St. Hedwig Hospital), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt- Universität zu Berlin, Berlin Institute of Health, Große Hamburger Str. 5-11, 10115, Berlin, Germany
| | - Rosana Sarpeah
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte (Psychiatric University Hospital of Charité at St. Hedwig Hospital), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt- Universität zu Berlin, Berlin Institute of Health, Große Hamburger Str. 5-11, 10115, Berlin, Germany
| | - Nathalie Waßmuth
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte (Psychiatric University Hospital of Charité at St. Hedwig Hospital), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt- Universität zu Berlin, Berlin Institute of Health, Große Hamburger Str. 5-11, 10115, Berlin, Germany
| | - Felix Bermpohl
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte (Psychiatric University Hospital of Charité at St. Hedwig Hospital), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt- Universität zu Berlin, Berlin Institute of Health, Große Hamburger Str. 5-11, 10115, Berlin, Germany
| | - Eva Janina Brandl
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte (Psychiatric University Hospital of Charité at St. Hedwig Hospital), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt- Universität zu Berlin, Berlin Institute of Health, Große Hamburger Str. 5-11, 10115, Berlin, Germany
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23
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Meyer K, Hindi Attar C, Fiebig J, Stamm T, Bassett TR, Bauer M, Dannlowski U, Ethofer T, Falkenberg I, Jansen A, Juckel G, Kircher T, Mulert C, Leicht G, Rau A, Ritter D, Ritter P, Trost S, Vogelbacher C, Walter H, Wolter S, Hautzinger M, Bermpohl F. Boosting the Theory of Mind Network: Specific Psychotherapy Increases Neural Correlates of Affective Theory of Mind in Euthymic Bipolar Disorder. Biol Psychiatry Cogn Neurosci Neuroimaging 2023; 8:572-580. [PMID: 36087699 DOI: 10.1016/j.bpsc.2022.08.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 08/16/2022] [Accepted: 08/16/2022] [Indexed: 05/09/2023]
Abstract
BACKGROUND In bipolar disorder, impaired affective theory of mind (aToM) performance and aberrant neural activation in the ToM brain network partly explain social functioning impairments. However, it is not yet known whether psychotherapy of bipolar disorder influences neuroimaging markers of aToM. METHODS In this study, conducted within the multicentric randomized controlled trial of the BipoLife consortium, patients with euthymic bipolar disorder underwent 2 group interventions over 6 months (mean = 28.45 weeks): 1) a specific, cognitive behavioral intervention (specific psychotherapeutic intervention [SEKT]) (n = 31) targeting impulse regulation, ToM, and social skills and 2) an emotion-focused intervention (FEST) (n = 28). To compare the effect of SEKT and FEST on neural correlates of aToM, patients performed an aToM task during functional magnetic resonance imaging before and after interventions (final functional magnetic resonance imaging sample of pre- and postcompleters, SEKT: n = 16; FEST: n = 17). Healthy control subjects (n = 32) were scanned twice with the same time interval. Because ToM was trained in SEKT, we expected an increased ToM network activation in SEKT relative to FEST postintervention. RESULTS Both treatments effectively stabilized patients' euthymic state in terms of affective symptoms, life satisfaction, and global functioning. Confirming our expectations, SEKT patients showed increased neural activation within regions of the ToM network, bilateral temporoparietal junction, posterior cingulate cortex, and precuneus, whereas FEST patients did not. CONCLUSIONS The stabilizing effect of SEKT on clinical outcomes went along with increased neural activation of the ToM network, while FEST possibly exerted its positive effect by other, yet unexplored routes.
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Affiliation(s)
- Kristina Meyer
- Department of Psychiatry and Neurosciences, CCM, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
| | - Catherine Hindi Attar
- Department of Psychiatry and Neurosciences, CCM, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Jana Fiebig
- Department of Psychiatry and Neurosciences, CCM, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Thomas Stamm
- Department of Psychiatry and Neurosciences, CCM, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Department of Clinical Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Tyler R Bassett
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Michael Bauer
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Udo Dannlowski
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Thomas Ethofer
- Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health, University of Tübingen, Tübingen, Germany
| | - Irina Falkenberg
- Department of Psychiatry, University of Marburg, Marburg, Germany
| | - Andreas Jansen
- Department of Psychiatry, University of Marburg, Marburg, Germany; Core-Facility Brain Imaging, Faculty of Medicine, University of Marburg, Marburg, Germany
| | - Georg Juckel
- Department of Psychiatry, Ruhr University Bochum, LWL, University Hospital, Bochum, Germany
| | - Tilo Kircher
- Department of Psychiatry, University of Marburg, Marburg, Germany
| | - Christoph Mulert
- Center for Psychiatry, Justus Liebig University, Giessen, Germany; Center for Psychiatry, Justus Liebig University, Giessen, Germany
| | - Gregor Leicht
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anne Rau
- Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health, University of Tübingen, Tübingen, Germany
| | - Dirk Ritter
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Philipp Ritter
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Sarah Trost
- Department of Psychiatry and Psychotherapy, Georg-August-University Göttingen, Göttingen, Germany; Universitäre Altersmedizin FELIX PLATTER, Basel, Switzerland
| | | | - Henrik Walter
- Department of Psychiatry and Neurosciences, CCM, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Sarah Wolter
- Department of Psychiatry and Psychotherapy, Georg-August-University Göttingen, Göttingen, Germany; Department of Psychiatry and Psychotherapy, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Martin Hautzinger
- Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health, University of Tübingen, Tübingen, Germany
| | - Felix Bermpohl
- Department of Psychiatry and Neurosciences, CCM, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
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24
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Brandt L, Ritter K, Schneider-Thoma J, Siafis S, Montag C, Ayrilmaz H, Bermpohl F, Hasan A, Heinz A, Leucht S, Gutwinski S, Stuke H. Predicting psychotic relapse following randomised discontinuation of paliperidone in individuals with schizophrenia or schizoaffective disorder: an individual participant data analysis. Lancet Psychiatry 2023; 10:184-196. [PMID: 36804071 DOI: 10.1016/s2215-0366(23)00008-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 12/09/2022] [Accepted: 12/20/2022] [Indexed: 02/17/2023]
Abstract
BACKGROUND Predicting relapse for individuals with psychotic disorders is not well established, especially after discontinuation of antipsychotic treatment. We aimed to identify general prognostic factors of relapse for all participants (irrespective of treatment continuation or discontinuation) and specific predictors of relapse for treatment discontinuation, using machine learning. METHODS For this individual participant data analysis, we searched the Yale University Open Data Access Project's database for placebo-controlled, randomised antipsychotic discontinuation trials with participants with schizophrenia or schizoaffective disorder (aged ≥18 years). We included studies in which participants were treated with any antipsychotic study drug and randomly assigned to continue the same antipsychotic drug or to discontinue it and receive placebo. We assessed 36 prespecified baseline variables at randomisation to predict time to relapse, using univariate and multivariate proportional hazard regression models (including multivariate treatment group by variable interactions) with machine learning to categorise the variables as general prognostic factors of relapse, specific predictors of relapse, or both. FINDINGS We identified 414 trials, of which five trials with 700 participants (304 [43%] women and 396 [57%] men) were eligible for the continuation group and 692 participants (292 [42%] women and 400 [58%] men) were eligible for the discontinuation group (median age 37 [IQR 28-47] years for continuation group and 38 [28-47] years for discontinuation group). Out of the 36 baseline variables, general prognostic factors of increased risk of relapse for all participants were drug-positive urine; paranoid, disorganised, and undifferentiated types of schizophrenia (lower risk for schizoaffective disorder); psychiatric and neurological adverse events; higher severity of akathisia (ie, difficulty or inability to sit still); antipsychotic discontinuation; lower social performance; younger age; lower glomerular filtration rate; benzodiazepine comedication (lower risk for anti-epileptic comedication). Out of the 36 baseline variables, predictors of increased risk specifically after antipsychotic discontinuation were increased prolactin concentration, higher number of hospitalisations, and smoking. Both prognostic factors and predictors with increased risk after discontinuation were oral antipsychotic treatment (lower risk for long-acting injectables), higher last dosage of the antipsychotic study drug, shorter duration of antipsychotic treatment, and higher score on the Clinical Global Impression (CGI) severity scale The predictive performance (concordance index) for participants who were not used to train the model was 0·707 (chance level is 0·5). INTERPRETATION Routinely available general prognostic factors of psychotic relapse and predictors specific for treatment discontinuation could be used to support personalised treatment. Abrupt discontinuation of higher dosages of oral antipsychotics, especially for individuals with recurring hospitalisations, higher scores on the CGI severity scale, and increased prolactin concentrations, should be avoided to reduce the risk of relapse. FUNDING German Research Foundation and Berlin Institute of Health.
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Affiliation(s)
- Lasse Brandt
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Charité Campus Mitte, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
| | - Kerstin Ritter
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Charité Campus Mitte, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Bernstein Center of Computational Neuroscience Berlin, Berlin, Germany
| | - Johannes Schneider-Thoma
- Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany
| | - Spyridon Siafis
- Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany
| | - Christiane Montag
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Charité Campus Mitte, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Hakan Ayrilmaz
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Charité Campus Mitte, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Felix Bermpohl
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Charité Campus Mitte, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Berlin School of Mind and Brain, Berlin, Germany
| | - Alkomiet Hasan
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Augsburg, Medical Faculty, Bezirkskrankenhaus Augsburg, Augsburg, Germany
| | - Andreas Heinz
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Charité Campus Mitte, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Bernstein Center of Computational Neuroscience Berlin, Berlin, Germany; Berlin School of Mind and Brain, Berlin, Germany
| | - Stefan Leucht
- Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany
| | - Stefan Gutwinski
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Charité Campus Mitte, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Heiner Stuke
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Charité Campus Mitte, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Berlin Institute of Health, Berlin, Germany
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Amare A, Thalamuthu A, Schubert KO, Fullerton J, Ahmed M, Hartmann S, Papiol S, Heilbronner U, Degenhardt F, Tekola-Ayele F, Hou L, Hsu YH, Shekhtman T, Adli M, Akula N, Akiyama K, Ardau R, Arias B, Aubry JM, Backlund L, Bhattacharjee AK, Bellivier F, Benabarre A, Bengesser S, Biernacka J, Birner A, Marie-Claire C, Cervantes P, Chen HC, Chillotti C, Cichon S, Cruceanu C, Czerski P, Dalkner N, Del Zompo M, DePaulo JR, Etain B, Jamain S, Falkai P, Forstner AJ, Frisén L, Frye M, Gard S, Garnham J, Goes F, Grigoroiu-Serbanescu M, Fallgatter A, Stegmaier S, Ethofer T, Biere S, Petrova K, Schuster C, Adorjan K, Budde M, Heilbronner M, Kalman J, Oraki Kohshour M, Reich-Erkelenz D, Schaupp S, Schulte E, Senner F, Vogl T, Anghelescu IG, Arolt V, Dannlowski U, Dietrich DE, Figge C, Jäger M, Lang F, Juckel G, Spitzer C, Reimer J, Schmauß M, Schmitt A, Konrad C, von Hagen M, Wiltfang J, Zimmermann J, Andlauer T, Fischer A, Bermpohl F, Kraft V, Matura S, Gryaznova A, Falkenberg I, Yildiz C, Kircher T, Schmidt J, Koch M, Gade K, Trost S, Haußleiter I, Lambert M, Rohenkohl AC, Kraft V, Grof P, Hashimoto R, Hauser J, Herms S, Hoffmann P, Jiménez E, Kahn JP, Kassem L, Kuo PH, Kato T, Kelsoe J, Kittel-Schneider S, Ferensztajn-Rochowiak E, König B, Kusumi I, Laje G, Landén M, Lavebratt C, Leboyer M, Leckband SG, Tortorella A, Manchia M, Martinsson L, McCarthy M, McElroy SL, Colom F, Mitjans M, Mondimore F, Monteleone P, Nievergelt C, Nöthen M, Novak T, O'Donovan C, Ozaki N, Pfennig A, Pisanu C, Potash J, Reif A, Reininghaus E, Rouleau G, Rybakowski JK, Schalling M, Schofield P, Schweizer BW, Severino G, Shilling PD, Shimoda K, Simhandl C, Slaney C, Squassina A, Stamm T, Stopkova P, Maj M, Turecki G, Vieta E, Veeh J, Witt S, Wright A, Zandi P, Mitchell P, Bauer M, Alda M, Rietschel M, McMahon F, Schulze TG, Millischer V, Clark S, Baune B. Association of Polygenic Score and the involvement of Cholinergic and Glutamatergic Pathways with Lithium Treatment Response in Patients with Bipolar Disorder. Res Sq 2023:rs.3.rs-2580252. [PMID: 36824922 PMCID: PMC9949170 DOI: 10.21203/rs.3.rs-2580252/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Lithium is regarded as the first-line treatment for bipolar disorder (BD), a severe and disabling mental disorder that affects about 1% of the population worldwide. Nevertheless, lithium is not consistently effective, with only 30% of patients showing a favorable response to treatment. To provide personalized treatment options for bipolar patients, it is essential to identify prediction biomarkers such as polygenic scores. In this study, we developed a polygenic score for lithium treatment response (Li+PGS) in patients with BD. To gain further insights into lithium's possible molecular mechanism of action, we performed a genome-wide gene-based analysis. Using polygenic score modeling, via methods incorporating Bayesian regression and continuous shrinkage priors, Li+PGS was developed in the International Consortium of Lithium Genetics cohort (ConLi+Gen: N=2,367) and replicated in the combined PsyCourse (N=89) and BipoLife (N=102) studies. The associations of Li+PGS and lithium treatment response - defined in a continuous ALDA scale and a categorical outcome (good response vs. poor response) were tested using regression models, each adjusted for the covariates: age, sex, and the first four genetic principal components. Statistical significance was determined at P<����������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Mazda Adli
- Charité - Universitätsmedizin Berlin, Campus Charité Mitte
| | | | | | | | - Bárbara Arias
- Facultat de Biologia and Institut de Biomedicina (IBUB), Universitat de Barcelona, CIBERSAM
| | | | | | | | - Frank Bellivier
- Pôle de Psychiatrie, AP-HP, Groupe Hospitalier Lariboisière-F. Widal
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Louise Frisén
- Karolinska Institutet and Center for Molecular Medicine, Karolinska University Hospital
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Till Andlauer
- Technical University of Munich, Klinikum rechts der Isar
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Esther Jiménez
- College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Jean-Pierre Kahn
- College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Layla Kassem
- College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Po-Hsiu Kuo
- College of Public Health, National Taiwan University, Taipei, Taiwan
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Marina Mitjans
- Max Planck Institute of Experimental Medicine, Göttingen, Germany
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Thomas Stamm
- Charité - Universitätsmedizin Berlin, Campus Charité Mitte
| | | | - Mario Maj
- University of Campania "Luigi Vanvitelli", Naples
| | | | | | | | | | | | - Peter Zandi
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine
| | | | | | | | | | - Francis McMahon
- National Institute of Mental Health Intramural Research Program; National Institutes of Health
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Brandl EJ, Reiche S, Hullmeine L, Mick I, Hadzibegovic J, Zerbe LK, Bermpohl F, Schouler-Ocak M. [Utilization of a Specialized Outpatient Service for Parents with Mental Disorders]. Psychother Psychosom Med Psychol 2023. [PMID: 36720231 DOI: 10.1055/a-2003-9630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Patients with mental disorders have a high need for support during the peripartum period. Only few outpatient services have specialized on parents with mental disorders. This study assesses a newly established outpatient unit. METHODS We analyzed the population utilizing the outpatient service for parents with psychiatric disorders (N=279) at the psychiatric university hospital of Charité at St. Hedwig-hospital in Berlin, Germany, from June 2017 until December 2021. RESULTS The service was mainly utilized by individuals with affective disorders, a higher education and good compliance. Patients with migration background started psychotherapy less often. DISCUSSION The data indicate a good acceptance of a specialized outpatient unit for parents with psychiatric disorders; however, it was mainly utilized by individuals with a higher socioeconomic status and less commonly by individuals with severe mental illness. More specialized treatment units for parents would be desirable.
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Affiliation(s)
- Eva Janina Brandl
- Department for Psychiatry and Psychotherapy, Psychiatric University Clinic of Charité at St. Hedwig Hospital, Berlin, Germany
| | - Susanne Reiche
- Geriatrics, Alexianer St. Hedwig-Krankenhaus, Berlin, Germany
| | - Lisa Hullmeine
- Department for Psychiatry and Psychotherapy, Psychiatric University Clinic of Charité at St. Hedwig Hospital, Berlin, Germany
| | - Inge Mick
- Department for Psychiatry and Psychotherapy, Psychiatric University Clinic of Charité at St. Hedwig Hospital, Berlin, Germany
| | - Jasmina Hadzibegovic
- Department for Psychiatry and Psychotherapy, Psychiatric University Clinic of Charité at St. Hedwig Hospital, Berlin, Germany
| | - Lena-Karoline Zerbe
- Department for Psychiatry and Psychotherapy, Psychiatric University Clinic of Charité at St. Hedwig Hospital, Berlin, Germany
| | - Felix Bermpohl
- Department for Psychiatry and Psychotherapy, Psychiatric University Clinic of Charité at St. Hedwig Hospital, Berlin, Germany
| | - Meryam Schouler-Ocak
- Psychiatry and Psychotherapy, Psychiatric University Clinic of the Charité at St. Hedwigs Hospital Berlin, Berlin, Germany
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Goldschmidt T, Kippe Y, Finck A, Adam M, Hamadoun H, Winkler JG, Bermpohl F, Schouler-Ocak M, Gutwinski S. Psychiatric presentations and admissions during the first wave of Covid-19 compared to 2019 in a psychiatric emergency department in Berlin, Germany: a retrospective chart review. BMC Psychiatry 2023; 23:38. [PMID: 36639626 PMCID: PMC9839445 DOI: 10.1186/s12888-023-04537-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 01/09/2023] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Most studies agree that the Covid-19 pandemic and the subsequent lockdown had a negative impact on mental health. On the other hand, international studies have shown that psychiatric emergency departments (pED) experienced a decrease in presentations and admissions. METHODS Retrospective chart review of all pED presentations and admissions during the first wave of Covid-19 pandemic in Germany (Covid-19 period: 3/2/20 to 05/24/20) in a psychiatric hospital in Berlin compared to 1 year earlier (pre-Covid-19 period). Descriptive statistics and logistic regression were performed. RESULTS We observed no statistical significant changes in overall pED presentations and overall hospital admissions during the Covid-19 period compared to the pre-Covid-19 period (813 vs. 894, - 9.1%, p = 0.064 and (363 vs. 437, - 16.9%, p = 0.080 respectively). In the subgroup analysis, less patients with depressive disorders (p = 0.035) and with personality disorders (p = 0.002) presented to the pED, a larger number of presentations with schizophrenia was observed (p = 0.020). In the Covid-19 period, less patients with substance use disorder and paranoid schizophrenia were admitted to the hospital via the pED than in the pre-Covid-19 period (p = 0.035 and p = 0.006, respectively). Bed capacity was reduced in the Covid-19 period by - 32.8% (p < 0.001). Presentations in police custody were 13.7% (p = 0.029) higher during the Covid-19 compared to pre-Covid-19 period, with higher rates in female presentations (p = 0.008) and suicide attempts (p = 0.012) and less hospital admissions (p = 0.048). Logistic regression analyses revealed that positive predictors for pED presentation during Covid-19 period were police custody (p < 0.001), being redirected from another hospital (p < 0.001), suicide attempt (p = 0.038), suicidal thoughts (p = 0.004), presentation with paranoid schizophrenia (p = 0.001) and bipolar and manic disorders (p = 0.004), negative predictors were hospital admission (p < 0.001), depressive disorders (p = 0.021) and personality disorders (p < 0.001). CONCLUSIONS A larger number of presentations in police custody during the Covid-19 period may represent untreated medical needs. This was seen predominantly in female patients, suggesting this subgroup might have suffered particularly under lockdown measures. Patients with paranoid schizophrenia were the only subgroup, which increased in absolute numbers, also suggesting a particular lockdown effect. Reduced bed capacity due to infection curbing measures is suggestive to have played an important role in augmenting the threshold for hospital admissions.
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Affiliation(s)
- T Goldschmidt
- Psychiatrische Universitätsklinik der Charité im St. Hedwig Krankenhaus, Große Hamburger Str. 5-11, 10115, Berlin, Germany.
| | - Y Kippe
- Psychiatrische Universitätsklinik der Charité im St. Hedwig Krankenhaus, Große Hamburger Str. 5-11, 10115, Berlin, Germany
| | - A Finck
- Psychiatrische Universitätsklinik der Charité im St. Hedwig Krankenhaus, Große Hamburger Str. 5-11, 10115, Berlin, Germany
| | - M Adam
- Psychiatrische Universitätsklinik der Charité im St. Hedwig Krankenhaus, Große Hamburger Str. 5-11, 10115, Berlin, Germany
| | - H Hamadoun
- Psychiatrische Universitätsklinik der Charité im St. Hedwig Krankenhaus, Große Hamburger Str. 5-11, 10115, Berlin, Germany
| | - J G Winkler
- Psychiatrische Universitätsklinik der Charité im St. Hedwig Krankenhaus, Große Hamburger Str. 5-11, 10115, Berlin, Germany
| | - F Bermpohl
- Psychiatrische Universitätsklinik der Charité im St. Hedwig Krankenhaus, Große Hamburger Str. 5-11, 10115, Berlin, Germany
| | - M Schouler-Ocak
- Psychiatrische Universitätsklinik der Charité im St. Hedwig Krankenhaus, Große Hamburger Str. 5-11, 10115, Berlin, Germany
| | - S Gutwinski
- Psychiatrische Universitätsklinik der Charité im St. Hedwig Krankenhaus, Große Hamburger Str. 5-11, 10115, Berlin, Germany
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Badouin J, Bechdolf A, Bermpohl F, Baumgardt J, Weinmann S. Preventing, reducing, and attenuating restraint: A prospective controlled trial of the implementation of peer support in acute psychiatry. Front Psychiatry 2023; 14:1089484. [PMID: 36824670 PMCID: PMC9941159 DOI: 10.3389/fpsyt.2023.1089484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 01/20/2023] [Indexed: 02/10/2023] Open
Abstract
INTRODUCTION The use of restraint as a means of managing patients is considered a critical factor that interferes with recovery. Strategies to create a less restrictive environment within psychiatric facilities are therefore eagerly sought. Peer support workers (PSWs) are increasingly employed in mental health settings. The prevailing theory is that PSWs have the potential to contribute to conflict and restraint prevention efforts in acute psychiatric wards. However, to date, research in support of this claim remains limited. OBJECTIVE The present study aimed at assessing the effectiveness of employing peer support workers with regard to reducing the use of restraint. METHODS This prospective controlled pre-post study sought to evaluate the implementation of peer support in one locked ward compared to treatment as usual (TAU) with no implementation of peer support in a second locked ward of a psychiatry department in Berlin, Germany. The pre-post comparison was planned to consist of two assessment periods of 3 months each, taking place directly before and after peer support implementation or TAU. Both assessments were extended to a period of 6 months, before and after the initially planned 12-month implementation process, in order to balance the effects of disruptions and of the COVID-19 pandemic. Using routine data, the proportion, frequency, and duration of mechanical restraint, forced medication as well as mechanical restraint in combination with forced medication, were evaluated. RESULTS In the control group, an increase in the proportion of patients subjected to measures of restraint was found between pre- and post-assessment, which was accompanied by a further increase in the mean number of events of restraint per patient within this group. In the intervention group, no significant change in the application of restraint was observed during the study period. DISCUSSION There is some indication that peer support may be protective with regard to restraint in acute wards. However, our study faced major challenges during the implementation process and the post-assessment period, such as COVID-19 and staff reorganization. This may have led to peer support not reaching its full potential. The relationship between the implementation of peer support and the use of restraint therefore merits further investigation.
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Affiliation(s)
- Julia Badouin
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Vivantes Hospital Am Urban, Vivantes Hospital im Friedrichshain, Academic Hospital, Charité-University Medicine Berlin, Berlin, Germany.,Department of Psychiatry and Neuroscience, Charité Campus Mitte Charité-University Medicine Berlin, Berlin, Germany
| | - Andreas Bechdolf
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Vivantes Hospital Am Urban, Vivantes Hospital im Friedrichshain, Academic Hospital, Charité-University Medicine Berlin, Berlin, Germany.,ORYGEN, National Centre of Excellence in Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Felix Bermpohl
- Department of Psychiatry and Neuroscience, Charité Campus Mitte Charité-University Medicine Berlin, Berlin, Germany
| | - Johanna Baumgardt
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Vivantes Hospital Am Urban, Vivantes Hospital im Friedrichshain, Academic Hospital, Charité-University Medicine Berlin, Berlin, Germany.,Wissenschaftliches Institut der AOK (WIdO), Berlin, Germany
| | - Stefan Weinmann
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Vivantes Hospital Am Urban, Vivantes Hospital im Friedrichshain, Academic Hospital, Charité-University Medicine Berlin, Berlin, Germany.,Psychiatric Hospital, Theodor-Wenzel-Werk, Berlin, Germany.,University Psychiatric Clinic (UPK), University Basel, Basel, Switzerland
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Tsamitros N, Beck A, Sebold M, Schouler-Ocak M, Bermpohl F, Gutwinski S. [The application of virtual reality in the treatment of mental disorders]. Nervenarzt 2023; 94:27-33. [PMID: 36053303 PMCID: PMC9859917 DOI: 10.1007/s00115-022-01378-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 07/18/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Virtual reality (VR) enables immersion in an interactive digital world with realistic experiences, that can be applied for controlled and personalized interventions. This review summarizes the current research on VR in the treatment of mental disorders. METHODS Selective literature search in PubMed and Google Scholar. RESULTS An increasing number of publications report the therapeutic application of VR for the treatment of mental disorders. Most VR applications are based on established therapy approaches, such as exposure therapy. According to meta-analytic data, virtual exposure therapy (VRET) for specific phobia and agoraphobia with panic disorder is as effective as traditional in vivo exposure therapy. VRET for the treatment of social phobia is significantly more effective than waitlist and placebo control groups with, however, currently inconsistent metanalytic results when compared to in vivo exposure therapy. VRET for the treatment of posttraumatic stress disorder (PTSD) is similar in effectiveness compared to active psychotherapy. For psychosis, positive results have been reported for the VR-based treatment of auditory verbal hallucinations. For patients with a substance use disorder, VR can induce craving, with still unverified diagnostic and therapeutic relevance. CONCLUSIONS VRET can broaden the psychotherapy options for anxiety disorders. Encouraging results of VR-based treatments for psychosis and PTSD indicate the need for further research concerning its effectiveness and safety. In the field of substance use disorders, evaluation of clinical-orientated VR applications is needed.
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Affiliation(s)
- N. Tsamitros
- Psychiatrische Universitätsklinik der Charité – Universitätsmedizin Berlin im St. Hedwig-Krankenhaus/Institutsambulanz, Müllerstr. 56–58, 13349 Berlin, Deutschland ,Klinik für Psychiatrie und Psychotherapie, Campus Charité Mitte, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Deutschland ,Klinik für Psychiatrie und Psychotherapie, Campus Benjamin Franklin, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Deutschland
| | - A. Beck
- Klinik für Psychiatrie und Psychotherapie, Campus Charité Mitte, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Deutschland ,Fakultät Gesundheit, Health and Medical University, Campus Potsdam, Potsdam, Deutschland
| | - M. Sebold
- Klinik für Psychiatrie und Psychotherapie, Campus Charité Mitte, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Deutschland
| | - M. Schouler-Ocak
- Psychiatrische Universitätsklinik der Charité – Universitätsmedizin Berlin im St. Hedwig-Krankenhaus/Institutsambulanz, Müllerstr. 56–58, 13349 Berlin, Deutschland ,Klinik für Psychiatrie und Psychotherapie, Campus Charité Mitte, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Deutschland
| | - F. Bermpohl
- Psychiatrische Universitätsklinik der Charité – Universitätsmedizin Berlin im St. Hedwig-Krankenhaus/Institutsambulanz, Müllerstr. 56–58, 13349 Berlin, Deutschland ,Klinik für Psychiatrie und Psychotherapie, Campus Charité Mitte, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Deutschland
| | - S. Gutwinski
- Psychiatrische Universitätsklinik der Charité – Universitätsmedizin Berlin im St. Hedwig-Krankenhaus/Institutsambulanz, Müllerstr. 56–58, 13349 Berlin, Deutschland ,Klinik für Psychiatrie und Psychotherapie, Campus Charité Mitte, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Deutschland
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Roth M, Kluczniok D, Roepke S, Heim C, Herpertz SC, Hindi Attar C, Dittrich K, Boedeker K, Winter SM, Ridder NS, Poppinga SK, Bermpohl F. Relationship between Borderline Personality Disorder, Emotional Availability, and Cortisol Output in Mother-Child Dyads. Psychopathology 2023; 56:90-101. [PMID: 35073545 DOI: 10.1159/000521519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 12/09/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Mothers with borderline personality disorder (BPD) often show altered emotional availability toward their own child and heightened stress vulnerability. The aims of the present study were (1) to examine total cortisol output in saliva during mother-child interaction in mothers with BPD and their children and (2) to test whether maternal nonhostility as a subscale of emotional availability mediates the relationship between maternal BPD and child total cortisol output. METHODS We investigated 16 mothers with BPD and 30 healthy control mothers (HC) and 29 children of mothers with BPD and 33 children of HC mothers. Children were between 5 and 12 years old. Salivary cortisol was collected prior to and twice after an episode of a 21-min standardized play situation between mother and child. Nonhostility was rated using the emotional availability scales. Analyses of covariance were computed to test for group differences in total cortisol output (measured with area under the curve with respect to ground). Pearson's correlation was calculated to test the association between maternal and child total cortisol output. To test the second question, a mediation analysis according to Preacher and Hayes was conducted. RESULTS Mothers with BPD and their children had lower total cortisol output. Maternal and child total cortisol output was significantly correlated. Contrary to our hypothesis, maternal nonhostility did not mediate the relationship between BPD and child total cortisol output. CONCLUSION Results imply that the hormonal stress activity of mothers with BPD and their children is altered, which may reflect modified stress regulation and stress vulnerability in mother and child and may impact on mother-child interaction. The finding of a positive association between mother's and child total cortisol output could indicate an intergenerational transmission of these alterations.
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Affiliation(s)
- Maria Roth
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Mitte, Berlin, Germany
| | - Dorothea Kluczniok
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Mitte, Berlin, Germany
| | - Stefan Roepke
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Benjamin Franklin, Berlin, Germany
| | - Christine Heim
- Department of Medical Psychology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Mitte, Berlin, Germany
| | - Sabine C Herpertz
- Department for General Psychiatry, Center of Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Catherine Hindi Attar
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Mitte, Berlin, Germany
| | - Katja Dittrich
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Virchow, Berlin, Germany
| | - Katja Boedeker
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Virchow, Berlin, Germany
| | - Sibylle M Winter
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Virchow, Berlin, Germany
| | - Neele S Ridder
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Mitte, Berlin, Germany
| | - Sina K Poppinga
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Mitte, Berlin, Germany
| | - Felix Bermpohl
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Mitte, Berlin, Germany
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Plank IS, Christiansen LN, Kunas SL, Dziobek I, Bermpohl F. Mothers need more information to recognise associated emotions in child facial expressions. Cogn Emot 2022; 36:1299-1312. [PMID: 35930357 DOI: 10.1080/02699931.2022.2105819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Parenting requires mothers to read social cues and understand their children. It is particularly important that they recognise their child's emotions to react appropriately, for example, with compassion to sadness or compersion to happiness. Despite this importance, it is unclear how motherhood affects women's ability to recognise emotions associated with facial expressions in children. Using videos of an emotionally neutral face continually and gradually taking on a facial expression associated with an emotion, we quantified the amount of information needed to match the emotion with the facial expression. Mothers needed more information than non-mothers to match the emotions with the facial expressions. Both mothers and non-mothers performed equally on a control task identifying animals instead of emotions, and both groups needed less information when recognising the emotions associated with facial expressions in adolescents than pre-schoolers. These results indicate that mothers need more information for to correctly recognise typically associated emotions in child facial expressions but not for similar tasks not involving emotions. A possible explanation is that child facial expressions associated with emotions may have a greater emotional impact on mothers than non-mothers leading to task interference but possibly also to increased compassion and compersion.
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Affiliation(s)
- Irene S Plank
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany.,Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany.,Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Einstein Center for Neurosciences, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Lina-Nel Christiansen
- Center for Chronically Sick Children, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Stefanie L Kunas
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Isabel Dziobek
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany.,Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany.,Einstein Center for Neurosciences, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Felix Bermpohl
- Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany.,Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Einstein Center for Neurosciences, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
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Kippe YD, Adam M, Finck A, Moran JK, Schouler-Ocak M, Bermpohl F, Gutwinski S, Goldschmidt T. Suicidality in psychiatric emergency department situations during the first and the second wave of COVID-19 pandemic. Eur Arch Psychiatry Clin Neurosci 2022; 273:311-323. [PMID: 36071277 PMCID: PMC9451117 DOI: 10.1007/s00406-022-01486-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 08/29/2022] [Indexed: 11/26/2022]
Abstract
Psychiatric patients are prone to mental health deterioration during the Covid-19 pandemic. Little is known about suicidality in psychiatric patients during the Covid-19 pandemic. This study is a retrospective chart review of psychiatric emergency department (pED) presentations with present or absent suicidality (5634 pED attendances, 4110 patients) in an academic pED in Berlin, Germany. Poisson regression analysis was performed on the effect of Covid-19 period on suicidality (suicidal ideation (SI), suicide plans (SP) or suicide attempt (SA)) during the first (3/2/2020-5/24/2020 "first-wave") and second (9/15/2020-3/1/2021 "second-wave") wave of the Covid-19 pandemic compared to the same periods one year earlier. During the first-wave the number of pED visits per person with SI, SP and SA was higher compared to one year earlier (SI RR = 1.614; p = 0.016; SP RR = 2.900; p = 0.004; SA RR = 9.862; p = 0.003). SI and SP were predicted by interaction between substance use disorder (SUD) and second-wave (SI RR = 1.305, p = 0.043; SP RR = 1.645, p = 0.018), SA was predicted by interaction between borderline personality disorder (BPD) and second-wave (RR = 7.128; p = 0.012). Suicidality increased during the first-wave of Covid-19 pandemic in our sample. In the second-wave this was found in patients with SUD and BPD. These patients may be at particular risk of suicidality during the Covid-19 pandemic.
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Affiliation(s)
- Yann David Kippe
- Psychiatrische Universitätsklinik der Charité Im St. Hedwig Krankenhaus, Große Hamburger Str. 5-11, 10115 Berlin, Germany
| | - Maia Adam
- Psychiatrische Universitätsklinik der Charité Im St. Hedwig Krankenhaus, Große Hamburger Str. 5-11, 10115 Berlin, Germany
| | - Anna Finck
- Psychiatrische Universitätsklinik der Charité Im St. Hedwig Krankenhaus, Große Hamburger Str. 5-11, 10115 Berlin, Germany
| | - James Kenneth Moran
- Psychiatrische Universitätsklinik der Charité Im St. Hedwig Krankenhaus, Große Hamburger Str. 5-11, 10115 Berlin, Germany
| | - Meryam Schouler-Ocak
- Psychiatrische Universitätsklinik der Charité Im St. Hedwig Krankenhaus, Große Hamburger Str. 5-11, 10115 Berlin, Germany
| | - Felix Bermpohl
- Psychiatrische Universitätsklinik der Charité Im St. Hedwig Krankenhaus, Große Hamburger Str. 5-11, 10115 Berlin, Germany
| | - Stefan Gutwinski
- Psychiatrische Universitätsklinik der Charité Im St. Hedwig Krankenhaus, Große Hamburger Str. 5-11, 10115 Berlin, Germany
| | - Thomas Goldschmidt
- Psychiatrische Universitätsklinik der Charité Im St. Hedwig Krankenhaus, Große Hamburger Str. 5-11, 10115, Berlin, Germany.
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Cole C, Klotz E, Junghanss J, Oster A, Bermpohl F, Vandamme A, Mahler L. Patient communication ability as predictor of involuntary admission and coercive measures in psychiatric inpatient treatment. J Psychiatr Res 2022; 153:11-17. [PMID: 35792341 DOI: 10.1016/j.jpsychires.2022.06.048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 05/30/2022] [Accepted: 06/24/2022] [Indexed: 10/17/2022]
Abstract
Coercive measures (CM) and involuntary admission to psychiatric treatment can have detrimental consequences for patients. Past research shows that certain clinical, treatment and admission-related characteristics put patients at a higher risk of experiencing CM and involuntary admission. Although of high societal importance, the association between patients' communication ability and CM and involuntary admission has not been subject of past research. To explicitly examine this association the authors conducted a retrospective study using data from patients admitted to psychiatric inpatient treatment via the emergency room at Charité St. Hedwig Hospital, Berlin in 2019. As independent variable, communication ability at admission was recorded (perfect; limited due to language or other reasons; impossible due to language or other reasons) along with possibly confounding variables including demographic, clinical and admission-related details. As dependent variables, involuntary admission and CM were recorded. Multivariate logistic regression analyses were conducted examining the association between communication ability and involuntary admission and CM. In a sample of N = 1556, controlling for potential confounders, limited (OR = 3.08; p = .004) or no communication ability (OR = 4.02; p = .003) due to language barrier or limited (OR = 3.10; p < .001) or no communication ability (OR = 13.71; p < .001) due to other factors were significant predictors for involuntary admission. Limited communication ability due to language barrier (OR = 4.53; p < .001) and limited (OR = 1.58; p = .034) and no communication ability (OR = 3.55; p < .001) due to other factors were significant predictors for CM. These findings show that patients impaired in their communication ability are at higher risk of involuntary admission and CM and highlight the urgency of implementing appropriate interventions facilitating communication during admission and treatment.
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Affiliation(s)
- Celline Cole
- Charité University Medicine Berlin, Department of Psychiatry at St. Hedwig Hospital (PUK Charité im SHK), Grosse Hamburger Str. 5-11, 10115, Berlin, Germany.
| | - Eva Klotz
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
| | - Julia Junghanss
- Charité University Medicine Berlin, Department of Psychiatry at St. Hedwig Hospital (PUK Charité im SHK), Grosse Hamburger Str. 5-11, 10115, Berlin, Germany
| | - Anna Oster
- Department of Psychiatry and Psychotherapy, Clinics in the Theodor-Wenzel-Werk, Potsdamer Chaussee 69, 14129, Berlin, Germany
| | - Felix Bermpohl
- Charité University Medicine Berlin, Department of Psychiatry at St. Hedwig Hospital (PUK Charité im SHK), Grosse Hamburger Str. 5-11, 10115, Berlin, Germany
| | - Angelika Vandamme
- Charité University Medicine Berlin, Department of Psychiatry at St. Hedwig Hospital (PUK Charité im SHK), Grosse Hamburger Str. 5-11, 10115, Berlin, Germany
| | - Lieselotte Mahler
- Charité University Medicine Berlin, Department of Psychiatry at St. Hedwig Hospital (PUK Charité im SHK), Grosse Hamburger Str. 5-11, 10115, Berlin, Germany; Department of Psychiatry and Psychotherapy, Clinics in the Theodor-Wenzel-Werk, Potsdamer Chaussee 69, 14129, Berlin, Germany
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Plank IS, Hindi Attar C, Kunas SL, Dziobek I, Bermpohl F. Motherhood and theory of mind: increased activation in the posterior cingulate cortex and insulae. Soc Cogn Affect Neurosci 2022; 17:470-481. [PMID: 34592763 PMCID: PMC9071419 DOI: 10.1093/scan/nsab109] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 08/24/2021] [Accepted: 09/30/2021] [Indexed: 01/27/2023] Open
Abstract
Despite growing evidence on effects of parenthood on social understanding, little is known about the influence of parenthood on theory of mind (ToM), the capacity to infer mental and affective states of others. It is also unclear whether any possible effects of parenthood on ToM would generalise to inferring states of adults or are specific to children. We investigated neural activation in mothers and women without children while they predicted action intentions from child and adult faces. Region-of-interest analyses showed stronger activation in mothers in the bilateral posterior cingulate cortex, precuneus (ToM-related areas) and insulae (emotion-related areas). Whole-brain analyses revealed that mothers compared to non-mothers more strongly activated areas including the left angular gyrus and the ventral prefrontal cortex but less strongly activated the right supramarginal gyrus and the dorsal prefrontal cortex. These differences were not specific to child stimuli but occurred in response to both adult and child stimuli and might indicate that mothers and non-mothers employ different strategies to infer action intentions from affective faces. Whether these general differences in affective ToM between mothers and non-mothers are due to biological or experience-related changes should be subject of further investigation.
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Affiliation(s)
- Irene Sophia Plank
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin 10099, Germany
- Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin 10099, Germany
- Department of Psychiatry and Neurosciences | CCM, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin 10117, Germany
- Einstein Center for Neurosciences, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin 10117, Germany
| | - Catherine Hindi Attar
- Department of Psychiatry and Neurosciences | CCM, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin 10117, Germany
| | - Stefanie Lydia Kunas
- Department of Psychiatry and Neurosciences | CCM, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin 10117, Germany
| | - Isabel Dziobek
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin 10099, Germany
- Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin 10099, Germany
- Einstein Center for Neurosciences, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin 10117, Germany
| | - Felix Bermpohl
- Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin 10099, Germany
- Department of Psychiatry and Neurosciences | CCM, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin 10117, Germany
- Einstein Center for Neurosciences, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin 10117, Germany
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Plank IS, Hindi Attar C, Kunas SL, Bermpohl F, Dziobek I. Increased child‐evoked activation in the precuneus during facial affect recognition in mothers. Hum Brain Mapp 2022; 43:2911-2922. [PMID: 35278010 PMCID: PMC9120561 DOI: 10.1002/hbm.25825] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 01/21/2022] [Accepted: 02/18/2022] [Indexed: 01/13/2023] Open
Abstract
Successful parenting requires constant inferring of affective states. Especially vital is the correct identification of facial affect. Previous studies have shown that infant faces are processed preferentially compared to adult faces both on the behavioural and the neural level. This study specifically investigates the child‐evoked neural responses to affective faces and their modulation by motherhood and attention to affect. To do so, we used a paradigm to measure neural responses during both explicit and implicit facial affect recognition (FAR) in mothers and non‐mothers using child and adult faces. Increased activation to child compared to adult faces was found for mothers and non‐mothers in face processing areas (bilateral fusiform gyri) and areas associated with social understanding (bilateral insulae and medial superior frontal gyrus) when pooling implicit and explicit affect recognition. Furthermore, this child‐evoked activation was modulated by motherhood with an increase in mothers compared to non‐mothers in the left precuneus. Additionally, explicitly recognising the affect increased child‐evoked activation in the medial superior frontal gyrus in both mothers and non‐mothers. These results suggest preferential treatment of affective child over adult faces, modulated by motherhood and attention to affect.
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Affiliation(s)
- Irene Sophia Plank
- Department of Psychology, Faculty of Life Sciences Humboldt‐Universität zu Berlin Berlin Germany
- Faculty of Philosophy, Berlin School of Mind and Brain Humboldt‐Universität zu Berlin Berlin Germany
- Department of Psychiatry and Neurosciences CCM Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt‐Universität zu Berlin Berlin Germany
- Einstein Center for Neurosciences Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt‐Universität zu Berlin Berlin Germany
| | - Catherine Hindi Attar
- Department of Psychiatry and Neurosciences CCM Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt‐Universität zu Berlin Berlin Germany
| | - Stefanie Lydia Kunas
- Department of Psychiatry and Neurosciences CCM Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt‐Universität zu Berlin Berlin Germany
| | - Felix Bermpohl
- Faculty of Philosophy, Berlin School of Mind and Brain Humboldt‐Universität zu Berlin Berlin Germany
- Department of Psychiatry and Neurosciences CCM Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt‐Universität zu Berlin Berlin Germany
- Einstein Center for Neurosciences Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt‐Universität zu Berlin Berlin Germany
| | - Isabel Dziobek
- Department of Psychology, Faculty of Life Sciences Humboldt‐Universität zu Berlin Berlin Germany
- Faculty of Philosophy, Berlin School of Mind and Brain Humboldt‐Universität zu Berlin Berlin Germany
- Einstein Center for Neurosciences Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt‐Universität zu Berlin Berlin Germany
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Calderaro M, Baethge C, Bermpohl F, Gutwinski S, Schouler-Ocak M, Henssler J. Offspring's risk for suicidal behaviour in relation to parental death by suicide: systematic review and meta-analysis and a model for familial transmission of suicide. Br J Psychiatry 2022; 220:121-129. [PMID: 35049479 DOI: 10.1192/bjp.2021.158] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Exposure to parental suicide has been associated with increased risk for suicide and suicide attempts, although the strength of this association is unclear as evidence remains inconsistent. AIMS To quantify this risk using meta-analysis and identify potential effect modifiers. METHOD A systematic search in PubMed, PsycInfo and Embase databases to 2020 netted 3614 articles. Inclusion criteria were: observation of history of parental death by suicide, comparison with non-exposed populations and definition of suicide and suicide attempt according to standardised criteria. We focused on population-based studies. The primary outcome was the pooled relative risk (RR) for incidence of suicide attempt and suicide in offspring of a parent who died by suicide compared with offspring of two living parents. Additionally, we compared the RR for attempted and completed suicide after parental suicide with the RR for attempted and completed suicide after parental death by other causes. RESULTS Twenty studies met our inclusion criteria. Offspring exposed to parental suicide were more likely to die by suicide (RR = 2.97, 95% CI 2.50-3.53) and attempt suicide (RR = 1.76, 95% CI 1.58-1.96) than offspring of two living parents. Furthermore, their risk of dying by or attempting suicide was significantly higher compared with offspring bereaved by other causes of death. CONCLUSIONS The experience of losing a parent to suicide is a strong and independent risk factor for suicidal behaviour in offspring. Our findings highlight the need for prevention strategies, outreach programmes and support interventions that target suicide-related outcomes in the exposed population.
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Affiliation(s)
- Mara Calderaro
- Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Charité Universitätsmedizin Berlin,Germany; and Institute for Medical Information Processing, Biometry and Epidemiology, LMU Munich, Germany; and Pettenkofer School of Public Health, Munich, Germany
| | - Christopher Baethge
- Department of Psychiatry and Psychotherapy, University of Cologne Medical School, Germany
| | - Felix Bermpohl
- Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Charité Universitätsmedizin Berlin,Germany
| | - Stefan Gutwinski
- Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Charité Universitätsmedizin Berlin,Germany
| | - Meryam Schouler-Ocak
- Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Charité Universitätsmedizin Berlin,Germany
| | - Jonathan Henssler
- Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Charité Universitätsmedizin Berlin,Germany; and Department of Psychiatry and Psychotherapy, University of Cologne Medical School, Germany
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Brandt L, Schneider-Thoma J, Siafis S, Efthimiou O, Bermpohl F, Loncar L, Neumann K, Hasan A, Heinz A, Leucht S, Gutwinski S. Adverse events after antipsychotic discontinuation: an individual participant data meta-analysis. Lancet Psychiatry 2022; 9:232-242. [PMID: 35183280 DOI: 10.1016/s2215-0366(22)00014-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 12/05/2021] [Accepted: 12/20/2021] [Indexed: 01/20/2023]
Abstract
BACKGROUND Adverse events can occur after antipsychotic discontinuation but evidence from antipsychotic drug trials is scarce. We aimed to estimate the occurrence of adverse events after discontinuing antipsychotics. METHODS For this two-stage individual participant data meta-analysis, we searched the Yale University Open Data Access Project's database for randomised controlled trials of antipsychotics from database inception until May 6, 2021. We included placebo-controlled antipsychotic randomised controlled trials with individual participant data of participants (aged ≥ 18 years, of any sex and ethnicity) with schizophrenia, schizoaffective disorder, or bipolar disorder. Studies were excluded if treatment with antidepressants, lithium, or antiepileptic drugs was initiated as additive therapy at the start of the placebo phase. Starting from the screening or washout phase, we divided participants who were randomised to placebo into two groups: the discontinuation group (participants who discontinued prestudy antipsychotics at the start of the screening or washout phase) and control group (participants who did not take prestudy antipsychotics for at least 4 weeks before the start of the screening or washout phase). Participants were excluded from the discontinuation and control groups if they discontinued prestudy treatment with antidepressants, lithium, or antiepileptic drugs up to 4 weeks before baseline, received an antipsychotic as a tolerability test, or received a long-acting injection of an antipsychotic within 12 weeks before baseline. In the discontinuation group, individuals were excluded if they discontinued prestudy antipsychotic treatment more than 3 days before, or any day after, the start of screening or washout phase. The prespecified primary outcome was occurrence of at least one new somatic adverse event with an onset within 4 weeks after the start of the screening or washout phase. We implemented a generalised linear model that accounted for potential confounders, to estimate the effect of antipsychotic discontinuation. This study is registered with PROSPERO (CRD42021224350). FINDINGS We identified 409 records of which 18 were eligible and included in the analysis. From these 18 studies, 692 individuals (242 [35·0%] women and 450 [65·0%] men) were eligible for the discontinuation group and 935 individuals (339 [36·3%] women and 596 [63·7%] men) were eligible for the control group (median age in both groups: 39 years [IQR 30-47]). New somatic adverse events occurred in 295 (43%) individuals in the discontinuation group and 293 (31%) individuals in the control group (OR 1·74; 95% CI 1·27-2·39; τ2=0·15; moderate strength of evidence). New psychiatric adverse events were also more frequent in the discontinuation group than the control group (OR 2·01; 95% CI 1·38-2·94). Longer duration of treatment before discontinuation (OR for doubling the duration of treatment: 1·08; 95% CI 1·01-1·14) was associated with a higher probability of new somatic adverse events after antipsychotic discontinuation, and tapered discontinuation (compared with abrupt discontinuation: 0·54; 0·32-0·91) and no history of somatic illness (compared with history of somatic illness: 0·63; 0·43-0·91) were associated with lower probabilities of new somatic adverse events after antipsychotic discontinuation. The risk of bias was moderate in 13 (72·2%) studies and serious in five (27·8%) studies. INTERPRETATION We detected moderate evidence of emerging somatic adverse events after discontinuation of first-generation and second-generation antipsychotics, particularly after discontinuation of longer durations of treatment. Tapered discontinuation can mitigate the risk of emerging somatic adverse events after antipsychotic discontinuation. These findings have implications for the safety of treatment discontinuation and could be used for tailored treatment planning. FUNDING German Research Foundation.
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Affiliation(s)
- Lasse Brandt
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Berlin, Germany; Charité Campus Mitte, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
| | - Johannes Schneider-Thoma
- Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Spyridon Siafis
- Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Orestis Efthimiou
- Department of Psychiatry, University of Oxford, Oxford, UK; Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Felix Bermpohl
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Berlin, Germany; Charité Campus Mitte, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Luka Loncar
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Berlin, Germany; Charité Campus Mitte, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Konrad Neumann
- Institute of Biometry and Clinical Epidemiology, Berlin Institute of Health, Berlin, Germany; Charité Campus Mitte, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Alkomiet Hasan
- Department of Psychiatry, Psychotherapy and Psychosomatics of the University Augsburg, Bezirkskrankenhaus Augsburg, University of Augsburg, Medical Faculty, Augsburg, Germany
| | - Andreas Heinz
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Berlin, Germany; Charité Campus Mitte, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Berlin School of Mind and Brain, Berlin, Germany; Bernstein Center of Computational Neuroscience Berlin, Berlin, Germany
| | - Stefan Leucht
- Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Stefan Gutwinski
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Berlin, Germany; Charité Campus Mitte, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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Kunas SL, Stuke H, Heinz A, Ströhle A, Bermpohl F. Evidence for a hijacked brain reward system but no desensitized threat system in quitting-motivated smokers: An fMRI study. Addiction 2022; 117:701-712. [PMID: 34312937 DOI: 10.1111/add.15651] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 07/14/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND AIMS Several aspects of how quitting-motivated tobacco use disorder (TUD) subjects and never-smokers differ in terms of reward and threat processing remain unresolved. We aimed to examine aberrant reward and threat processes in TUD and the association with smoking characteristics. DESIGN A between- and within-subjects functional magnetic resonance imaging (fMRI) experiment with a 2 (groups) × 4 (stimulus type) factorial design. The experimental paradigm had four conditions: pictures of (1) cigarettes served as drug-related-positive cues, (2) food as alternative reward cues, (3) long-term consequences of smoking as drug-related-negative cues and (4) neutral pictures as control. SETTING/PARTICIPANTS Adult participants (n = 38 TUD subjects and n = 42 never-smokers) were recruited in Berlin, Germany. MEASUREMENTS As contrasts of primary interest, the interactions of group × stimulus-type were assessed. Significance threshold correction for multiple testing was carried out with the family-wise error method. Correlation analyses were used to test the association with smoking characteristics. FINDINGS The 2 × 2 interaction of smoking status and stimulus type revealed activations in the brain reward system to drug-related-positive cues in TUD subjects (between-subjects effect: P-values ≤ 0.036). As a response to drug-related-negative cues, TUD subjects showed no reduced activation of the aversive brain network. Within the TUD group, a significant negative association was found between response of the aversive brain system to drug-related-negative cues (within-subjects effect: P-values ≤ 0.021) and the number of cigarettes smoked per day (right insula r = -0.386, P = 0.024; left insula r = -0.351, P = 0.042; right ACC r = -0.359, P = 0.037). CONCLUSIONS Moderate smokers with tobacco use disorder appear to have altered brain reward processing of drug-related-positive (but not negative) cues compared with never smokers.
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Affiliation(s)
- Stefanie L Kunas
- Campus Charité Mitte, Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Heiner Stuke
- Campus Charité Mitte, Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Andreas Heinz
- Campus Charité Mitte, Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Andreas Ströhle
- Campus Charité Mitte, Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Felix Bermpohl
- Campus Charité Mitte, Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Kunas SL, Stuke H, Plank IS, Laing EM, Bermpohl F, Ströhle A. Neurofunctional alterations of cognitive down-regulation of craving in quitting motivated smokers. Psychol Addict Behav 2022; 36:1012-1022. [PMID: 35175067 DOI: 10.1037/adb0000820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Cognitive down-regulation of craving involves a neural network within the prefrontal cortex. Tobacco use disorder (TUD) and trait impulsivity have been associated with prefrontal cortex impairments and down-regulation deficits. However, general deficits in down-regulation of craving (regarding non-drug-related cues) compared to never-smokers (NS), differential alterations between drug-related and non-drug-related cues, as well as its links to subject characteristics (smoking severity, trait impulsivity) have so far sparsely been investigated in TUD. METHOD In this study, 78 subjects (37 TUD & 42 NS) underwent functional magnetic resonance imaging while performing a down-regulation of craving task. Two reward cue-types were presented (drug cues and alternative rewards). Subjects applied down-regulation of craving during a LATER condition and up-regulated their craving during a NOW condition. Subjective craving ratings were assessed after each trial. To evaluate down-regulation of craving, we investigated the LATER versus NOW condition. RESULTS TUD subjects showed no differences in down-regulation on a behavioral level, neither compared to NS nor between the two reward cue-types. On a neurofunctional level, we found a stronger BOLD response in the middle temporal gyrus in TUD subjects compared to NS in the alternative reward condition. No differences between the two reward cue-types were found within TUD subjects. During down-regulation across both reward cue-types, we identified significant negative associations between activation of control areas and smoking severity. CONCLUSIONS Results neither indicate evidence for the expected general alterations in down-regulation of craving in TUD, compared to NS, nor specific alterations between drug-related and alternative reward cues on a neurofunctional level. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Seeger FR, Neukel C, Williams K, Wenigmann M, Fleck L, Georg AK, Bermpohl F, Taubner S, Kaess M, Herpertz SC. Parental Mental Illness, Borderline Personality Disorder, and Parenting Behavior: The Moderating Role of Social Support. Curr Psychiatry Rep 2022; 24:591-601. [PMID: 36282473 PMCID: PMC9592879 DOI: 10.1007/s11920-022-01367-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/19/2022] [Indexed: 01/29/2023]
Abstract
PURPOSE OF REVIEW Parental mental disorders, particularly borderline personality disorder (BPD), impair parenting behavior. Consequently, the children exhibit an elevated risk for psychopathology across their lifespan. Social support for parents is thought to moderate the relationship between parental mental illness and parenting behavior. It may dampen negative effects and serve as starting point for preventive interventions. This paper provides a literature overview regarding the impact of social support on the sequelae of parental mental illness and BPD for parenting behavior. RECENT FINDINGS Current literature highlights the increased burden of families with a mentally ill parent and associated changes in parenting behavior like increased hostility and affective dysregulation, especially in the context of parental BPD. Literature further demonstrates the powerful impact of social support in buffering such negative outcomes. The effect of social support seems to be moderated itself by further factors like socioeconomic status, gender, or characteristics of the social network. Social support facilitates positive parenting in mentally ill parents and may be particularly important in parents with BPD. However, social support is embedded within a framework of influencing factors, which need consideration when interpreting scientific results.
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Affiliation(s)
- Fabian R Seeger
- Department of General Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Voßstraße 4, D - 69115, Heidelberg, Germany
| | - Corinne Neukel
- Department of General Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Voßstraße 4, D - 69115, Heidelberg, Germany
| | - Katharina Williams
- Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Marc Wenigmann
- Department of General Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Voßstraße 4, D - 69115, Heidelberg, Germany
| | - Leonie Fleck
- Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Anna K Georg
- Department of Psychosocial Prevention, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Felix Bermpohl
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Svenja Taubner
- Department of Psychosocial Prevention, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Michael Kaess
- Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Sabine C Herpertz
- Department of General Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Voßstraße 4, D - 69115, Heidelberg, Germany.
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41
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Kunas SL, Bermpohl F, Plank IS, Ströhle A, Stuke H. Aversive drug cues reduce cigarette craving and increase prefrontal cortex activation during processing of cigarette cues in quitting motivated smokers. Addict Biol 2022; 27:e13091. [PMID: 34427358 DOI: 10.1111/adb.13091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 05/30/2021] [Accepted: 07/29/2021] [Indexed: 11/29/2022]
Abstract
Aversive drug cues can be used to support smoking cessation and create awareness of negative health consequences of smoking. Better understanding of the effects of aversive drug cues on craving and the processing of appetitive drug cues in abstinence motivated smokers is important to further improve their use in cessation therapy and smoking-related public health measures. In this study, 38 quitting motivated smokers underwent functional magnetic resonance imaging (fMRI) scanning while performing a novel extended cue-reactivity paradigm. Pictures of cigarettes served as appetitive drug cues, which were preceded by either aversive drug cues (e.g., smokers' leg) or other cues (neutral or alternative reward cues). Participants were instructed to rate their craving for cigarettes after presentation of drug cues. When aversive drug cues preceded the presentation of appetitive drug cues, behavioural craving was reduced and activations in prefrontal (dorsolateral prefrontal cortex) and paralimbic (dorsal anterior cingulate cortex [dACC] and anterior insulae) areas were enhanced. A positive association between behavioural craving reduction and neurofunctional activation changes was shown for the right dACC. Our results suggest that aversive drug cues have an impact on the processing of appetitive drug cues, both on a neurofunctional and a behavioural level. A proposed model states that aversive drug-related cues activate control-associated brain areas (e.g., dACC), leading to increased inhibitory control on reward-associated brain areas (e.g., putamen) and a reduction in subjective cravings.
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Affiliation(s)
- Stefanie L. Kunas
- Department of Psychiatry and Neuroscience Campus Charité Mitte, Charité‐Universitätsmedizin Berlin Berlin Germany
| | - Felix Bermpohl
- Department of Psychiatry and Neuroscience Campus Charité Mitte, Charité‐Universitätsmedizin Berlin Berlin Germany
| | - Irene S. Plank
- Department of Psychiatry and Neuroscience Campus Charité Mitte, Charité‐Universitätsmedizin Berlin Berlin Germany
- Einstein Center for Neurosciences Charité Campus Mitte, Universitätsmedizin Berlin Berlin Germany
- Berlin School of Mind and Brain, Institute of Psychology Humboldt‐Universität zu Berlin Berlin Germany
| | - Andreas Ströhle
- Department of Psychiatry and Neuroscience Campus Charité Mitte, Charité‐Universitätsmedizin Berlin Berlin Germany
| | - Heiner Stuke
- Department of Psychiatry and Neuroscience Campus Charité Mitte, Charité‐Universitätsmedizin Berlin Berlin Germany
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Wullschleger A, Vandamme A, Mielau J, Stoll L, Heinz A, Bermpohl F, Bechdolf A, Stelzig M, Hardt O, Hauth I, Holthoff-Detto V, Mahler L, Montag C. Effect of standardized post-coercion review on subjective coercion: Results of a randomized-controlled trial. Eur Psychiatry 2021; 64:e78. [PMID: 34872630 PMCID: PMC8715283 DOI: 10.1192/j.eurpsy.2021.2256] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Post-coercion review has been increasingly regarded as a useful intervention in
psychiatric inpatient setting. However, little is known about its effect on perceived
coercion. Methods A multicenter, two-armed, randomized controlled trial was conducted, aiming at
analyzing the effect of post-coercion review on perceived coercion. People with severe
mental disorders, who experienced at least one coercive measure during inpatient
treatment, were randomized using Zelen’s design to an intervention group receiving
standardized post-coercion review, or a control group treated as usual. The MacArthur
admission experience scale (AES) and the coercion ladder (CL) were used to assess
perceived coercion during inpatient treatment. The coercion experience scale (CES)
measured experienced coercion during the coercive intervention. Analyses of covariance
were performed to determine group differences. Results Of 422 randomized participants, n = 109 consented to participate in
the trial. A restricted intention-to-treat analysis of all individuals who consented
revealed no significant effect of the intervention on perceived coercion. A significant
interaction effect between the factors gender and intervention on the AES scores was
found. Sensitivity analysis revealed significant effects of the intervention on both AES
and CL scores and an interaction effect between intervention and gender, indicating a
higher efficacy in women. No effect of the intervention on CES scores was found. Conclusions Standardized post-coercion review sessions did not alleviate the subjective perception
of coercion in the total sample. However, post hoc analysis revealed a significant
effect of the intervention in women. Results indicate the need to further address
gender-specific issues related to coercion.
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Affiliation(s)
- A Wullschleger
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,Division of Adult Psychiatry, Department of Psychiatry, Geneva University Hospitals, Thônex, Switzerland
| | - A Vandamme
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - J Mielau
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - L Stoll
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - A Heinz
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - F Bermpohl
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - A Bechdolf
- Department of Psychiatry, Psychotherapy and Psychosomatics, Vivantes Hospital Am Urban and Vivantes Hospital im Friedrichshain/Charité Medicine Berlin, Berlin, Germany.,Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
| | - M Stelzig
- Department of Psychiatry, Psychotherapy and Psychosomatics, Vivantes Wenckebach Clinic, Berlin, Germany
| | - O Hardt
- Department of Psychiatry, Psychotherapy and Psychosomatics, Vivantes Clinic Neukölln, Berlin, Germany
| | - I Hauth
- Department of Psychiatry, Psychotherapy and Psychosomatics, St. Joseph Hospital Berlin-Weissensee, Berlin, Germany
| | - V Holthoff-Detto
- Department of Psychiatry, Psychotherapy and Psychosomatics, Alexianer Hospital Hedwigshöhe, St. Hedwig Kliniken Berlin, Berlin, Germany.,Medical Faculty, University of Technology, Dresden, Germany
| | - L Mahler
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,Department of Psychiatry, Clinics in the Theodor-Wenzel-Werk, Berlin, Germany
| | - C Montag
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
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Abstract
The study was designed to investigate the impact of the Coronavirus Disease 2019 (COVID-19) pandemic on mental health and perceived psychosocial support for elderly psychiatric patients in a longitudinal design. n = 32 patients with affective or anxiety disorders aged ≥60 years were included. Telephone interviews were conducted in April/May 2020 (T1) and August 2020 (T2). The psychosocial impact (PSI) of the pandemic and psychopathology were measured. Changes between T1 and T2 were examined. Patients' psychosocial support system six months before the pandemic and at T1/T2 was assessed. We found a significant positive correlation between general PSI and depression as well as severity of illness. General PSI differed significantly depending on social contact. Neither general PSI nor psychopathology changed significantly between T1 and T2. At T1, patients' psychosocial support systems were reduced as compared to six months before. Patients reported an increase in psychosocial support between T1 and T2 and high demand for additional support (sports, arts/occupational therapy, physiotherapy, psychotherapy). Elderly psychiatric patients show a negative PSI of the pandemic. They are likely to suffer from an impaired psychosocial situation, emphasizing the importance of developing concepts for sufficient psychosocial support during a pandemic.
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Affiliation(s)
- Magdalena Seethaler
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte (Psychiatric University Clinic at St. Hedwig Hospital), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
| | - Sandra Just
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte (Psychiatric University Clinic at St. Hedwig Hospital), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Philip Stötzner
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte (Psychiatric University Clinic at St. Hedwig Hospital), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Felix Bermpohl
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte (Psychiatric University Clinic at St. Hedwig Hospital), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Eva Janina Brandl
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte (Psychiatric University Clinic at St. Hedwig Hospital), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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Plank IS, Hindi Attar C, Kunas SL, Dziobek I, Bermpohl F. Increased activation in the bilateral anterior insulae in response to others in pain in mothers compared to non-mothers. Sci Rep 2021; 11:22757. [PMID: 34815443 PMCID: PMC8610985 DOI: 10.1038/s41598-021-02162-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 11/10/2021] [Indexed: 12/21/2022] Open
Abstract
Empathy allows us to share emotions and encourages us to help others. It is especially important in the context of parenting where children's wellbeing is dependent on their parents' understanding and fulfilment of their needs. To date, little is known about differences in empathy responses of parents and non-parents. Using stimuli depicting adults and children in pain, this study focuses on the interaction of motherhood and neural responses in areas associated with empathy. Mothers showed higher activation to both adults and children in pain in the bilateral anterior insulae, key regions of empathy for pain. Additionally, mothers more strongly activated the inferior frontal, superior temporal and the medial superior frontal gyrus. Differences between adult and child stimuli were only found in occipital areas in both mothers and non-mothers. Our results suggest a stronger neural response to others in pain in mothers than non-mothers regardless of whether the person is a child or an adult. This could indicate a possible influence of motherhood on overall neural responses to others in pain rather than motherhood specifically shaping child-related responses. Alternatively, stronger responses to others in pain could increase the likelihood for women to be in a relationship and subsequently to have a child.
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Affiliation(s)
- Irene Sophia Plank
- Department of Psychology, Institute of Life Sciences, Humboldt-Universität Zu Berlin, Berlin, Germany.
- Berlin School of Mind and Brain, Humboldt-Universität Zu Berlin, Berlin, Germany.
- Department of Psychiatry and Neurosciences | CCM, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany.
- Einstein Center for Neurosciences, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany.
| | - Catherine Hindi Attar
- Department of Psychiatry and Neurosciences | CCM, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
| | - Stefanie L Kunas
- Department of Psychiatry and Neurosciences | CCM, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
| | - Isabel Dziobek
- Department of Psychology, Institute of Life Sciences, Humboldt-Universität Zu Berlin, Berlin, Germany
- Berlin School of Mind and Brain, Humboldt-Universität Zu Berlin, Berlin, Germany
- Einstein Center for Neurosciences, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
| | - Felix Bermpohl
- Berlin School of Mind and Brain, Humboldt-Universität Zu Berlin, Berlin, Germany
- Department of Psychiatry and Neurosciences | CCM, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
- Einstein Center for Neurosciences, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
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Vogelbacher C, Sommer J, Schuster V, Bopp MHA, Falkenberg I, Ritter PS, Bermpohl F, Hindi Attar C, Rauer L, Einenkel KE, Treutlein J, Gruber O, Juckel G, Flasbeck V, Mulert C, Hautzinger M, Pfennig A, Matura S, Reif A, Grotegerd D, Dannlowski U, Kircher T, Bauer M, Jansen A. The German research consortium for the study of bipolar disorder (BipoLife): a magnetic resonance imaging study protocol. Int J Bipolar Disord 2021; 9:37. [PMID: 34786613 PMCID: PMC8595454 DOI: 10.1186/s40345-021-00240-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 10/05/2021] [Indexed: 11/21/2022] Open
Abstract
Background Bipolar disorder is one of the most severe mental disorders. Its chronic course is associated with high rates of morbidity and mortality, a high risk of suicide and poor social and occupational outcomes. Despite the great advances over the last decades in understanding mental disorders, the mechanisms underlying bipolar disorder at the neural network level still remain elusive. This has severe consequences for clinical practice, for instance by inadequate diagnoses or delayed treatments. The German research consortium BipoLife aims to shed light on the mechanisms underlying bipolar disorders. It was established in 2015 and incorporates ten university hospitals across Germany. Its research projects focus in particular on individuals at high risk of bipolar disorder, young patients in the early stages of the disease and patients with an unstable highly relapsing course and/or with acute suicidal ideation. Methods Functional and structural magnetic resonance imaging (MRI) data was acquired across nine sites within three different studies. Obtaining neuroimaging data in a multicenter setting requires among others the harmonization of the acquisition protocol, the standardization of paradigms and the implementation of regular quality control procedures. The present article outlines the MRI imaging protocols, the acquisition parameters, the imaging paradigms, the neuroimaging quality assessment procedures and the number of recruited subjects. Discussion The careful implementation of a MRI study protocol as well as the adherence to well-defined quality assessment procedures is one key benchmark in the evaluation of the overall quality of large-scale multicenter imaging studies. This article contributes to the BipoLife project by outlining the rationale and the design of the MRI study protocol. It helps to set the necessary standards for follow-up analyses and provides the technical details for an in-depth understanding of follow-up publications. Supplementary Information The online version contains supplementary material available at 10.1186/s40345-021-00240-6.
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Affiliation(s)
- Christoph Vogelbacher
- Department of Psychiatry and Psychotherapy, University of Marburg, Rudolf-Bultmann-Straße 8, 35039, Marburg, Germany. .,Center for Mind, Brain, and Behavior (CMBB), Universities of Marburg and Gießen, Marburg, Germany.
| | - Jens Sommer
- Center for Mind, Brain, and Behavior (CMBB), Universities of Marburg and Gießen, Marburg, Germany.,Core-Facility Brainimaging, Faculty of Medicine, University Marburg, Marburg, Germany
| | - Verena Schuster
- Department of Psychiatry and Psychotherapy, University of Marburg, Rudolf-Bultmann-Straße 8, 35039, Marburg, Germany.,Center for Mind, Brain, and Behavior (CMBB), Universities of Marburg and Gießen, Marburg, Germany
| | - Miriam H A Bopp
- Department of Psychiatry and Psychotherapy, University of Marburg, Rudolf-Bultmann-Straße 8, 35039, Marburg, Germany.,Center for Mind, Brain, and Behavior (CMBB), Universities of Marburg and Gießen, Marburg, Germany.,Department of Neurosurgery, University Marburg, Marburg, Germany
| | - Irina Falkenberg
- Department of Psychiatry and Psychotherapy, University of Marburg, Rudolf-Bultmann-Straße 8, 35039, Marburg, Germany.,Center for Mind, Brain, and Behavior (CMBB), Universities of Marburg and Gießen, Marburg, Germany
| | - Philipp S Ritter
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Felix Bermpohl
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Psychiatry and Psychotherapy, Charité at St. Hedwig-Krankenhaus, Berlin, Germany
| | - Catherine Hindi Attar
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Psychiatry and Psychotherapy, Charité at St. Hedwig-Krankenhaus, Berlin, Germany
| | - Lisa Rauer
- Section for Experimental Psychopathology and Neuroimaging, Department of General Psychiatry, Heidelberg University, Heidelberg, Germany
| | - Karolin E Einenkel
- Section for Experimental Psychopathology and Neuroimaging, Department of General Psychiatry, Heidelberg University, Heidelberg, Germany
| | - Jens Treutlein
- Section for Experimental Psychopathology and Neuroimaging, Department of General Psychiatry, Heidelberg University, Heidelberg, Germany
| | - Oliver Gruber
- Section for Experimental Psychopathology and Neuroimaging, Department of General Psychiatry, Heidelberg University, Heidelberg, Germany
| | - Georg Juckel
- Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Vera Flasbeck
- Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Christoph Mulert
- Center for Mind, Brain, and Behavior (CMBB), Universities of Marburg and Gießen, Marburg, Germany.,Center of Psychiatry, Justus-Liebig University, Giessen, Germany.,Giessen Graduate School for Life Sciences, Justus-Liebig University, Giessen, Germany
| | - Martin Hautzinger
- Department of Psychology Clinical Psychology and Psychotherapy, Eberhard Karls University, Tübingen, Germany
| | - Andrea Pfennig
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Silke Matura
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Frankfurt, Germany
| | - Andreas Reif
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Frankfurt, Germany
| | | | - Udo Dannlowski
- Department of Psychiatry, University of Münster, Münster, Germany
| | - Tilo Kircher
- Department of Psychiatry and Psychotherapy, University of Marburg, Rudolf-Bultmann-Straße 8, 35039, Marburg, Germany.,Center for Mind, Brain, and Behavior (CMBB), Universities of Marburg and Gießen, Marburg, Germany
| | - Michael Bauer
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Andreas Jansen
- Department of Psychiatry and Psychotherapy, University of Marburg, Rudolf-Bultmann-Straße 8, 35039, Marburg, Germany.,Center for Mind, Brain, and Behavior (CMBB), Universities of Marburg and Gießen, Marburg, Germany.,Core-Facility Brainimaging, Faculty of Medicine, University Marburg, Marburg, Germany
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Neukel C, Bermpohl F, Kaess M, Taubner S, Boedeker K, Williams K, Dempfle A, Herpertz SC. Understanding and breaking the intergenerational cycle of abuse in families enrolled in routine mental health services: study protocol for a randomized controlled trial and two non-interventional trials investigating mechanisms of change within the UBICA II consortium. Trials 2021; 22:749. [PMID: 34711261 PMCID: PMC8555002 DOI: 10.1186/s13063-021-05653-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 09/24/2021] [Indexed: 11/10/2022] Open
Abstract
Background Parents’ mental illness (MI) and parental history of early life maltreatment (ELM) are known to be significant risk factors for poor parenting while poor parenting is a crucial mediator of the intergenerational continuity of child maltreatment. Hence, maltreatment prevention programs for families with an MI parent, which pay particular attention to experiences of ELM in the parent, are urgently needed. Parental mentalizing was previously found to mediate successful parenting. Interventions aimed at improving the parental mentalizing capacity reduced maltreatment risk in parents. The aim of the present study is to investigate the effectiveness of a mentalization-based parenting-counseling in acutely mentally ill parents currently treated at a psychiatric hospital. Methods Mentalization-based parenting-counseling (MB-PC) vs. enhanced standard clinical care (SCC+) will be administered in a cluster-randomized-controlled trial (RCT). Patients treated at psychiatric hospitals with children between 1.5 and 15 years will be included in the trial. MB-PC will be administered as a 12-h combined individual and group program enriched by social counseling (over a course of 5 weeks) as add-on to standard clinical care, while the control condition will be standard clinical care plus a 90-min psychoeducation workshop on positive parenting. Primary efficacy endpoint is self-reported parenting practices at follow-up. Embedded within the RCT will be two sub-studies investigating social cognition and dyadic synchrony as biobehavioral mechanisms of change. Discussion The main goal of the present study is to investigate ways to break the intergenerational continuity of maltreatment by assessing the benefits of a prevention program which aims at improving parenting in vulnerable mothers and fathers. MB-PC is a short, low-cost intervention which can be delivered by nurses and social workers and is applicable to MI patients with children with a broad range of diagnoses. If it is shown to be effective, it can be directly implemented into standard psychiatric hospital care thereby providing help to prevent child maltreatment. Trial registration German Clinical Trials Register DRKS00017398. Registered on 5 July 2019
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Affiliation(s)
- C Neukel
- Department of General Psychiatry, Center for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany.
| | - F Bermpohl
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Campus Charité Mitte, Berlin, Germany, Berlin, Germany
| | - M Kaess
- Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany.,University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - S Taubner
- Department of Psychosocial Prevention, University Hospital of Heidelberg, Heidelberg, Germany
| | - K Boedeker
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Campus Virchow-Klinikum, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Berlin, Germany
| | - K Williams
- Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany
| | - A Dempfle
- Institute of Medical Informatics and Statistics, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - S C Herpertz
- Department of General Psychiatry, Center for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany
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47
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Brandt L, Montag C, Bermpohl F, Finck A, Wieacker E, Heinz A, Gutwinski S. The effect of second-generation antipsychotic withdrawal on the occurrence of vacuous chewing movements in animal models: A review. Behav Brain Res 2021; 418:113637. [PMID: 34687829 DOI: 10.1016/j.bbr.2021.113637] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 10/01/2021] [Accepted: 10/18/2021] [Indexed: 11/02/2022]
Abstract
INTRODUCTION Abrupt discontinuation of antipsychotics is associated with an increased risk of adverse events such as extrapyramidal symptoms in humans. In animal models, vacuous chewing movements may occur after antipsychotic discontinuation. We aim to assess vacuous chewing movements after the discontinuation of second-generation antipsychotics in animal models. METHODS PubMed, EMBASE, and Web of Science databases were searched for studies since inception until January 2, 2021. In addition, we manually searched references from included and relevant studies. Studies were included if a behavioral assessment of vacuous chewing movements (VCMs) in animal models was performed after discontinuation of a second-generation antipsychotic (SGA). Findings will be reviewed qualitatively and discussed with regard to clinical implications. RESULTS 5607 studies were screened and five studies were considered eligible for the qualitative analysis. The five studies reported results of behavioral assessments of VCMs after discontinuation of clozapine, olanzapine, and risperidone. VCMs were not reported to be increased after discontinuation of clozapine and olanzapine. However, VCMs were reported to be increased after discontinuation of higher but not lower dosages of risperidone. DISCUSSION These findings, based on a limited series of studies, suggest differences in the occurrence of extrapyramidal symptoms between second-generation antipsychotics. More research is needed to determine the magnitude of differences between antipsychotics and implications for clinical practice in humans.
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Affiliation(s)
- Lasse Brandt
- Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Psychiatric University Clinic at Hospital St. Hedwig, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
| | - Christiane Montag
- Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Psychiatric University Clinic at Hospital St. Hedwig, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
| | - Felix Bermpohl
- Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Psychiatric University Clinic at Hospital St. Hedwig, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Berlin School of Mind and Brain, Germany.
| | - Anna Finck
- Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Psychiatric University Clinic at Hospital St. Hedwig, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
| | - Esma Wieacker
- Department of Psychology and Psychotherapy, Witten/Herdecke University, Witten/Herdecke, Germany.
| | - Andreas Heinz
- Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Psychiatric University Clinic at Hospital St. Hedwig, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Berlin School of Mind and Brain, Germany; Bernstein Center of Computational Neuroscience Berlin, Germany.
| | - Stefan Gutwinski
- Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Psychiatric University Clinic at Hospital St. Hedwig, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
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48
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Dittrich K, Boedeker K, Kluczniok D, Hindi Attar C, Winter SM, Roepke S, Heim C, Herpertz SC, Bermpohl F. Elevated inflammatory markers in women with remitted major depressive disorder and the role of early life maltreatment. Brain Behav Immun 2021; 97:219-225. [PMID: 34339804 DOI: 10.1016/j.bbi.2021.07.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 07/07/2021] [Accepted: 07/28/2021] [Indexed: 12/17/2022] Open
Abstract
Major depressive disorder (MDD) has been linked to elevated inflammation markers. It remains unclear whether the elevation of C-reactive protein (CRP) and interleukin-6 (IL-6) levels are not only observable in acute MDD but also in patients after remission. MDD is a common sequela of early life maltreatment (ELM), which has also been associated with elevated inflammation markers. While the majority of studies investigated (acute) MDD and ELM as isolated predictors of inflammation, a few studies found inflammation levels to be more pronounced in patients with MDD that were exposed to ELM. This investigation included both ELM and MDD in one study and aimed at distinguishing between the effects of MDD in remission (rMDD) and ELM and investigating potential accumulative effects on the inflammatory markers CRP and IL-6 in a population of N = 126 women (n = 122 for CRP and n = 66 for IL-6). We further investigated how disorder characteristics (course and severity) and specific types of ELM affect levels of CRP and IL-6. We found that rMDD predicted levels of CRP and IL-6 and physical abuse predicted levels of CRP when considering both predictors simultaneously, while other types of ELM did not. A later onset of MDD and a shorter time interval since the last episode were associated with higher levels of IL-6. Our findings contribute to the existing literature on the association between MDD and inflammation, suggesting that elevated levels of inflammation markers may persist even after remission of MDD. Our findings on physical abuse as a specific predictor of CRP in the presence of rMDD suggest that different types of ELM could result in distinct inflammation profiles.
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Affiliation(s)
- Katja Dittrich
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Campus Virchow-Klinikum, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Berlin, Germany.
| | - Katja Boedeker
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Campus Virchow-Klinikum, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Berlin, Germany
| | - Dorothea Kluczniok
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Campus Charité Mitte, Department of Psychiatry and Neurosciences, Berlin, Germany
| | - Catherine Hindi Attar
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Campus Charité Mitte, Department of Psychiatry and Neurosciences, Berlin, Germany
| | - Sibylle M Winter
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Campus Virchow-Klinikum, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Berlin, Germany
| | - Stefan Roepke
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Campus Benjamin Franklin, Department of Psychiatry and Neurosciences, Berlin, Germany
| | - Christine Heim
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Psychology, Berlin, Germany; Pennsylvania State University, College of Health and Human Development, Department of Biobehavioral Health, PA, USA
| | - Sabine C Herpertz
- University Hospital Heidelberg, Centre for Psychosocial Medicine, General Psychiatry, Heidelberg, Germany
| | - Felix Bermpohl
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Campus Charité Mitte, Department of Psychiatry and Neurosciences, Berlin, Germany
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49
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Mikolas P, Bröckel K, Vogelbacher C, Müller DK, Marxen M, Berndt C, Sauer C, Jung S, Fröhner JH, Fallgatter AJ, Ethofer T, Rau A, Kircher T, Falkenberg I, Lambert M, Kraft V, Leopold K, Bechdolf A, Reif A, Matura S, Stamm T, Bermpohl F, Fiebig J, Juckel G, Flasbeck V, Correll CU, Ritter P, Bauer M, Jansen A, Pfennig A. Individuals at increased risk for development of bipolar disorder display structural alterations similar to people with manifest disease. Transl Psychiatry 2021; 11:485. [PMID: 34545071 PMCID: PMC8452775 DOI: 10.1038/s41398-021-01598-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/06/2021] [Accepted: 08/25/2021] [Indexed: 02/08/2023] Open
Abstract
In psychiatry, there has been a growing focus on identifying at-risk populations. For schizophrenia, these efforts have led to the development of early recognition and intervention measures. Despite a similar disease burden, the populations at risk of bipolar disorder have not been sufficiently characterized. Within the BipoLife consortium, we used magnetic resonance imaging (MRI) data from a multicenter study to assess structural gray matter alterations in N = 263 help-seeking individuals from seven study sites. We defined the risk using the EPIbipolar assessment tool as no-risk, low-risk, and high-risk and used a region-of-interest approach (ROI) based on the results of two large-scale multicenter studies of bipolar disorder by the ENIGMA working group. We detected significant differences in the thickness of the left pars opercularis (Cohen's d = 0.47, p = 0.024) between groups. The cortex was significantly thinner in high-risk individuals compared to those in the no-risk group (p = 0.011). We detected no differences in the hippocampal volume. Exploratory analyses revealed no significant differences in other cortical or subcortical regions. The thinner cortex in help-seeking individuals at risk of bipolar disorder is in line with previous findings in patients with the established disorder and corresponds to the region of the highest effect size in the ENIGMA study of cortical alterations. Structural alterations in prefrontal cortex might be a trait marker of bipolar risk. This is the largest structural MRI study of help-seeking individuals at increased risk of bipolar disorder.
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Affiliation(s)
- Pavol Mikolas
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany.
| | - Kyra Bröckel
- grid.412282.f0000 0001 1091 2917Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Christoph Vogelbacher
- grid.10253.350000 0004 1936 9756Core-Facility Brainimaging, Faculty of Medicine, University of Marburg, Marburg, Germany ,grid.10253.350000 0004 1936 9756Department of Psychiatry, University of Marburg, Marburg, Germany ,grid.8664.c0000 0001 2165 8627Center for Mind, Brain and Behavior (CMBB), University of Marburg and Justus Liebig University Giessen, Marburg, Germany
| | - Dirk K. Müller
- grid.412282.f0000 0001 1091 2917Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany ,grid.4488.00000 0001 2111 7257Neuroimaging Center, Technische Universität Dresden, Dresden, Germany ,grid.4488.00000 0001 2111 7257Institute for Medical Informatics and Biometry, Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Michael Marxen
- grid.412282.f0000 0001 1091 2917Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany ,grid.4488.00000 0001 2111 7257Neuroimaging Center, Technische Universität Dresden, Dresden, Germany
| | - Christina Berndt
- grid.412282.f0000 0001 1091 2917Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Cathrin Sauer
- grid.412282.f0000 0001 1091 2917Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Stine Jung
- grid.412282.f0000 0001 1091 2917Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Juliane Hilde Fröhner
- grid.412282.f0000 0001 1091 2917Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany ,grid.4488.00000 0001 2111 7257Neuroimaging Center, Technische Universität Dresden, Dresden, Germany
| | - Andreas J. Fallgatter
- grid.10392.390000 0001 2190 1447Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health, University of Tübingen, Tübingen, Germany
| | - Thomas Ethofer
- grid.10392.390000 0001 2190 1447Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health, University of Tübingen, Tübingen, Germany ,grid.10392.390000 0001 2190 1447Department for Biomedical Resonance, University of Tübingen, Tübingen, Germany
| | - Anne Rau
- grid.10392.390000 0001 2190 1447Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health, University of Tübingen, Tübingen, Germany
| | - Tilo Kircher
- grid.10253.350000 0004 1936 9756Core-Facility Brainimaging, Faculty of Medicine, University of Marburg, Marburg, Germany ,grid.10253.350000 0004 1936 9756Department of Psychiatry, University of Marburg, Marburg, Germany ,grid.8664.c0000 0001 2165 8627Center for Mind, Brain and Behavior (CMBB), University of Marburg and Justus Liebig University Giessen, Marburg, Germany
| | - Irina Falkenberg
- grid.10253.350000 0004 1936 9756Core-Facility Brainimaging, Faculty of Medicine, University of Marburg, Marburg, Germany ,grid.10253.350000 0004 1936 9756Department of Psychiatry, University of Marburg, Marburg, Germany ,grid.8664.c0000 0001 2165 8627Center for Mind, Brain and Behavior (CMBB), University of Marburg and Justus Liebig University Giessen, Marburg, Germany
| | - Martin Lambert
- grid.13648.380000 0001 2180 3484Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Vivien Kraft
- grid.13648.380000 0001 2180 3484Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Karolina Leopold
- grid.6363.00000 0001 2218 4662Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Vivantes Hospital Am Urban and Vivantes Hospital Im Friedrichshain, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Andreas Bechdolf
- grid.6363.00000 0001 2218 4662Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Vivantes Hospital Am Urban and Vivantes Hospital Im Friedrichshain, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Andreas Reif
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital, Goethe University, Frankfurt, Germany
| | - Silke Matura
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital, Goethe University, Frankfurt, Germany
| | - Thomas Stamm
- grid.6363.00000 0001 2218 4662Department of Psychiatry and Neurosciences, Charité Campus Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany ,grid.473452.3Department of Clinical Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Felix Bermpohl
- grid.6363.00000 0001 2218 4662Department of Psychiatry and Neurosciences, Charité Campus Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Jana Fiebig
- grid.6363.00000 0001 2218 4662Department of Psychiatry and Neurosciences, Charité Campus Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Georg Juckel
- grid.5570.70000 0004 0490 981XDepartment of Psychiatry, Psychotherapy and Preventive Medicine, LWL University Hospital, Ruhr-University, Bochum, Germany
| | - Vera Flasbeck
- grid.5570.70000 0004 0490 981XDepartment of Psychiatry, Psychotherapy and Preventive Medicine, LWL University Hospital, Ruhr-University, Bochum, Germany
| | - Christoph U. Correll
- grid.6363.00000 0001 2218 4662Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin Berlin, Berlin, Germany ,grid.440243.50000 0004 0453 5950Department of Psychiatry, Northwell Health, The Zucker Hillside Hospital, Glen Oaks, NY USA ,grid.512756.20000 0004 0370 4759Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY USA
| | - Philipp Ritter
- grid.412282.f0000 0001 1091 2917Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Michael Bauer
- grid.412282.f0000 0001 1091 2917Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Andreas Jansen
- grid.10253.350000 0004 1936 9756Core-Facility Brainimaging, Faculty of Medicine, University of Marburg, Marburg, Germany ,grid.10253.350000 0004 1936 9756Department of Psychiatry, University of Marburg, Marburg, Germany ,grid.8664.c0000 0001 2165 8627Center for Mind, Brain and Behavior (CMBB), University of Marburg and Justus Liebig University Giessen, Marburg, Germany
| | - Andrea Pfennig
- grid.412282.f0000 0001 1091 2917Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
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50
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Johanßen H, Schoofs N, Kliegl R, Bermpohl F, Ülsmann D, Schulte-Herbrüggen O, Priebe K. Negative Posttraumatic Cognitions Color the Pathway from Event Centrality to Posttraumatic Stress Disorder Symptoms. Cogn Ther Res 2021. [DOI: 10.1007/s10608-021-10266-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Abstract
Background
The centrality of an event indicates the extent to which it becomes a core part of identity and life story. Event centrality (EC) has been shown to have a strong relationship with PTSD symptoms, which seems to be indirectly influenced by negative posttraumatic cognitions (PTC). However, research on this potential mediation and its causal links particularly with clinical samples is limited and essential to derive treatment implications.
Methods
Pre- and posttreatment data of 103 day-unit patients with PTSD was examined using mediation analyses and structural equation modeling.
Results
Negative PTC mediated the relationship between EC and PTSD symptoms, partially pre- and completely posttreatment. Within extended longitudinal analyses causal directions of the mediation pathways were not adequately interpretable due to unexpected suppression effects.
Conclusions
The results suggest that EC may only have an indirect effect on PTSD symptoms through negative PTC. Thus, decreasing negative PTC which are connected to centralized events might be a key element for PTSD treatment. Thereby, transforming the cognitions’ valence to more positive and constructive forms could be crucial rather than mere decentralization. Although suppression effects limited causal inferences, they do not contradict the mediation and further indicate potential interactional terms and a transformation of EC.
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