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Zepf FD, König L, Kaiser A, Ligges C, Ligges M, Roessner V, Banaschewski T, Holtmann M. [Beyond NICE: Updated Systematic Review on the Current Evidence of Using Puberty Blocking Pharmacological Agents and Cross-Sex-Hormones in Minors with Gender Dysphoria]. Z Kinder Jugendpsychiatr Psychother 2024. [PMID: 38410090 DOI: 10.1024/1422-4917/a000972] [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] [Indexed: 02/28/2024]
Abstract
Beyond NICE: Updated Systematic Review on the Current Evidence of Using Puberty Blocking Pharmacological Agents and Cross-Sex-Hormones in Minors with Gender Dysphoria Abstract: Objective: The suppression of physiological puberty using puberty-blocking pharmacological agents (PB) and prescribing cross-sex hormones (CSH) to minors with gender dysphoria (GD) is a current matter of discussion, and in some cases, PB and CSH are used in clinical practice for this particular population. Two systematic reviews (one on PB, one on CSH treatment) by the British National Institute for Clinical Excellence (NICE) from 2020 indicated no clear clinical benefit of such treatments regarding critical outcome variables. In particular, these two systematic NICE reviews on the use of PB and CSH in minors with GD detected no clear improvements of GD symptoms. Moreover, the overall scientific quality of the available evidence, as discussed within the above-mentioned two NICE reviews, was classified as "very low certainty" regarding modified GRADE criteria. Method: The present systematic review presents an updated literature search on this particular topic (use of PB and CSH in minors with GD) following NICE principles and PICO criteria for all relevant new original research studies published since the release of the two above-mentioned NICE reviews (updated literature search period was July 2020-August 2023). Results: The newly conducted literature search revealed no newly published original studies targeting NICE-defined critical and important outcomes and the related use of PB in minors with GD following PICO criteria. For CSH treatment, we found two new studies that met PICO criteria, but these particular two studies had low participant numbers, yielded no significant additional clear evidence for specific and clearly beneficial effects of CSH in minors with GD, and could be classified as "low certainty" tfollowing modified GRADE criteria. Conclusions: The currently available studies on the use of PB and CSH in minors with GD have significant conceptual and methodological flaws. The available evidence on the use of PB and CSH in minors with GD is very limited and based on only a few studies with small numbers, and these studies have problematic methodology and quality. There also is a lack of adequate and meaningful long-term studies. Current evidence doesn't suggest that GD symptoms and mental health significantly improve when PB or CSH are used in minors with GD. Psychotherapeutic interventions to address and reduce the experienced burden can become relevant in children and adolescents with GD. If the decision to use PB and/or CSH is made on an individual case-by-case basis and after a complete and thorough mental health assessment, potential treatment of possibly co-occurring mental health problems as well as after a thoroughly conducted and carefully executed individual risk-benefit evaluation, doing so as part of clinical studies or research projects, as currently done in England, can be of value in terms of generation of new research data. The electronic supplement (ESM) 1 is an adapted and abreviated English version of this work.
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Affiliation(s)
- Florian D Zepf
- Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany
- German Center for Mental Health (DZPG), Site Jena-Magdeburg-Halle, Jena, Germany
| | - Laura König
- Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany
- German Center for Mental Health (DZPG), Site Jena-Magdeburg-Halle, Jena, Germany
| | - Anna Kaiser
- Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Carolin Ligges
- Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany
- German Center for Mental Health (DZPG), Site Jena-Magdeburg-Halle, Jena, Germany
| | - Marc Ligges
- Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany
- German Center for Mental Health (DZPG), Site Jena-Magdeburg-Halle, Jena, Germany
| | - Veit Roessner
- Department of Child and Adolescent Psychiatry, TU Dresden, Dresden, Germany
- German Center for Child and Adolescent Health (DZJK), partner site Leipzig-Dresden, Germany
| | - Tobias Banaschewski
- Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
- German Center for Mental Health (DZPG), partner site Mannheim-Heidelberg-Ulm, Germany
| | - Martin Holtmann
- LWL-Universitätsklinik Hamm der Ruhr-Universität Bochum, Hamm, Germany
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2
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Jecke L, Zepf FD. Delivering transgender-specific knowledge and skills into health and allied health studies and training: a systematic review. Eur Child Adolesc Psychiatry 2023:10.1007/s00787-023-02195-8. [PMID: 37115277 DOI: 10.1007/s00787-023-02195-8] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 03/11/2023] [Indexed: 04/29/2023]
Abstract
Many transgender individuals face inequities, discrimination, and sometimes even a lack of transgender-specific knowledge in health care settings. Educational curricula can address such disparities and help future health professionals to become more knowledgeable, confident, and well-prepared for addressing the needs of transgender individuals. This systematic review aims to summarize current training interventions about care of transgender individuals for health and allied health students, and to analyse the effects of the respective intervention. A total of six databases (Pubmed, MEDLINE, Scopus, Web of Science, Embase and SciSearch) were screened for original articles published between 2017 and June 2021. Search terms and eligibility criteria were pre-specified, and after a structured selection process 21 studies were included into further analysis. Extracted data contained information on general study properties, population, design, program format and outcomes of interest. A narrative synthesis was used to summarize detected results. Study quality was assessed for each individual study. A self-developed 18-item checklist combining criteria of two prior published tools was used to assess overall quality of quantitative studies. For qualitative studies a 10-item checklist by Kmet et al. [HTA Initiat, 2004] was applied. Eligible studies were designed for multiple health or allied health profession students, and varied widely regarding program format, duration, content, and assessed outcomes. Almost all (N = 19) interventions indicated improvements in knowledge, attitude, confidence and comfort levels or practical skills concerning care for transgender clients. Major limitations included the lack of long-term data, validated assessment tools, control groups and comparative studies. Training interventions contribute to prepare future health professionals to deliver competent and sensitive care and which may improve the prospective experienced health care reality of transgender individuals. However, currently there is no common consensus about best practice of education. Additionally, little is known about whether detected effects of training interventions translate into noticeable improvements for transgender clients. Further studies are warranted to assess the direct impact of specific interventions in the light of the respective target populations.
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Affiliation(s)
- L Jecke
- Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany
| | - F D Zepf
- Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany.
- German Center for Mental Health (DZPG), Site Jena-Magdeburg-Halle, Jena, Germany.
- Center for Intervention and Research on Adaptive and Maladaptive Brain Circuits Underlying Mental Health (C-I-R-C), Jena-Magdeburg-Halle, Jena, Germany.
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Morandini HAE, Rao P, Hood SD, Zepf FD, Silk TJ, Griffiths KR. Age-related resting-state functional connectivity of the Vigilant Attention network in children and adolescents. Brain Cogn 2021; 154:105791. [PMID: 34509772 DOI: 10.1016/j.bandc.2021.105791] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 08/27/2021] [Accepted: 08/29/2021] [Indexed: 11/25/2022]
Abstract
The development of Vigilant Attention (VA), the ability to focus and maintain our attention to repetitive and cognitively unchallenging tasks over time, has been investigated for more than a decade. The development of this critical executive function across the lifespan has been characterised by a rapid improvement in VA performance throughout childhood and adolescence, a steady improvement in adulthood and a slow decline in older adulthood. However, the development of the neural correlates of VA in children and adolescents remains poorly understood. Using a cross-sectional design, the present study used a meta-analytically defined VA network in children and adolescents to explore the developmental trend of the resting-state functional connectivity (rsFC) within the VA network across two independent cohorts. The results showed a linear and non-linear decrease of rsFC between the left and right VA brain regions across age. However, the results could not be reproduced in the replication cohort, potentially due to a smaller sample size. Based on previous findings from behavioural studies, the present findings suggest that changes in rsFC may underlie a developmental shift in cognitive strategies in neurotypical children and adolescents.
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Affiliation(s)
- Hugo A E Morandini
- Centre & Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia; Division of Psychiatry, UWA Medical School, Faculty of Health & Medical Sciences, The University of Western Australia, Australia.
| | - Pradeep Rao
- Centre & Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia; Telethon Kids Institute, Perth, Western Australia, Australia; Child and Adolescent Mental Health Service, Child and Adolescent Health Service, Perth, Australia
| | - Sean D Hood
- Division of Psychiatry, UWA Medical School, Faculty of Health & Medical Sciences, The University of Western Australia, Australia
| | - Florian D Zepf
- Centre & Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia; Telethon Kids Institute, Perth, Western Australia, Australia; Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Jena University Hospital, Friedrich Schiller University, Jena, Germany
| | - Timothy J Silk
- School of Psychology, Deakin University, Geelong, Australia; Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Kristi R Griffiths
- The Brain Dynamics Centre, Westmead Institute for Medical Research, The University of Sydney, Westmead, NSW, Australia
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Morandini HAE, Rao P, Hood SD, Griffiths K, Silk TJ, Zepf FD. Effects of dietary omega-3 intake on vigilant attention and resting-state functional connectivity in neurotypical children and adolescents. Nutr Neurosci 2021; 25:2269-2278. [PMID: 34369315 DOI: 10.1080/1028415x.2021.1955434] [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: 10/20/2022]
Abstract
BACKGROUND Vigilant Attention (VA) is a critical cognitive function allowing to maintain our attention, particularly in redundant or intellectually unchallenging situations. Evidence has shown that, as the brain develops, VA abilities rapidly improve throughout childhood and adolescence. Dietary omega-3 polyunsaturated fats (PUFA), playing a critical role for proper brain development and maturation of cortical regions, may contribute to variations in VA abilities. OBJECTIVE The present study investigated the effect of dietary omega-3 PUFA intake (docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA)) on resting-state functional connectivity (rsFC) of a meta-analytically defined VA network in 24 neurotypical children and adolescents (7.3-17.2 years) from the Healthy Brain Network databank. METHODS Functional MRI and phenotypical information were collected from the Healthy Brain Network databank. Intake of omega-3 DHA and EPA was assessed using a food frequency questionnaire and was adjusted for total calorie intake. Out of scanner VA-related performance was assessed using the VA condition of the Adaptive Cognitive Evaluation tool. RESULTS Overall, reported intake of omega-3 PUFA was not significantly associated with VA-related performance. Furthermore, energy-adjusted omega-3 intake was not significantly correlated with rsFC within the VA network. A complementary whole-brain analysis revealed that energy-adjusted omega-3 intake was correlated with decreased rsFC between parieto-occipital brain regions. CONCLUSION The present study was not able to detect a relationship between dietary omega-3 and rsFC or VA performance.
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Affiliation(s)
- Hugo A E Morandini
- Centre & Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Australia.,Division of Psychiatry, UWA Medical School, Faculty of Health & Medical Sciences, The University of Western Australia, Perth, Australia
| | - Pradeep Rao
- Centre & Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Australia.,Telethon Kids Institute, Perth, Australia.,Child and Adolescent Mental Health Service, Child and Adolescent Health Service, Perth, Australia
| | - Sean D Hood
- Division of Psychiatry, UWA Medical School, Faculty of Health & Medical Sciences, The University of Western Australia, Perth, Australia
| | - Kristi Griffiths
- The Brain Dynamics Centre, Westmead Institute for Medical Research, The University of Sydney, Westmead, Australia
| | - Timothy J Silk
- School of Psychology, Deakin University, Geelong, Australia.,Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Florian D Zepf
- Centre & Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Australia.,Telethon Kids Institute, Perth, Australia.,Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Jena University Hospital, Friedrich Schiller University, Jena, Germany
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5
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Morandini HA, Silk TJ, Griffiths K, Rao P, Hood SD, Zepf FD. Meta-analysis of the neural correlates of vigilant attention in children and adolescents. Cortex 2020; 132:374-385. [DOI: 10.1016/j.cortex.2020.08.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 07/10/2020] [Accepted: 08/18/2020] [Indexed: 01/02/2023]
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Moore JK, Thomas CS, van Hall HW, Strauss P, Saunders LA, Harry M, Mahfouda S, Lawrence SJ, Zepf FD, Lin A. The Perth Gender Picture (PGP): Young people's feedback about acceptability and usefulness of a new pictorial and narrative approach to gender identity assessment and exploration. Int J Transgend Health 2020; 22:337-348. [PMID: 34240076 PMCID: PMC8118236 DOI: 10.1080/26895269.2020.1795960] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
BACKGROUND A number of psychological assessment tools have been developed to describe various dimensions of gender. Some of these tools are restricted to a binary gender concept and are inflexible in reflecting how a young person's gender may change and develop over time. Most are text questionnaires which require a good level of literacy. AIMS This study aimed to evaluate a newly developed pictorial tool that facilitates a conversation about gender between a child or adolescent (aged 11-18) and their clinician, enabling a diverse understanding and expression of gender identity. METHODS The Perth Gender Picture (PGP) was co-created between clinicians and young clients between 2016 and 2018. In 2018, the measure was evaluated through a pilot study at the Gender Diversity Service at Perth Children's Hospital in Western Australia. After use of the PGP during a clinical consultation, clients were invited to fill in a feedback questionnaire about their experience of its use. Clinicians participated in unstructured interviews to give their feedback. RESULTS Most participants rated the PGP as easy to understand, acceptable and useful, and many stated that they found gender easier to describe with the picture rather than words. The results show positive uptake from clients, demonstrating feasible implementation with gender diverse young people. DISCUSSION This evaluation positions the PGP as a useful tool to facilitate conversations about gender identity between gender diverse children and adolescents and their clinicians, in a nonjudgmental and playful manner. It is well-suited to young people who may have limited literacy or difficulty with complex language. The PGP has potential for use in other age groups and non-clinical contexts.
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Affiliation(s)
- Julia K. Moore
- The Gender Diversity Service, Child and Adolescent Health Service – Mental Health, Perth Children's Hospital, Perth, Australia
- Centre and Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Division of Psychiatry and Division of Paediatrics and Child Health, School of Medicine, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Australia
| | - Cati S. Thomas
- The Gender Diversity Service, Child and Adolescent Health Service – Mental Health, Perth Children's Hospital, Perth, Australia
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - Hans-willem van Hall
- The Gender Diversity Service, Child and Adolescent Health Service – Mental Health, Perth Children's Hospital, Perth, Australia
| | - Penelope Strauss
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
- School of Population and Global Health, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Australia
| | - Liz A. Saunders
- The Gender Diversity Service, Child and Adolescent Health Service – Mental Health, Perth Children's Hospital, Perth, Australia
- The School of Human Sciences (Exercise and Sports Science), The University of Western Australia, Perth, Australia
| | - Melanie Harry
- The Gender Diversity Service, Child and Adolescent Health Service – Mental Health, Perth Children's Hospital, Perth, Australia
| | - Simone Mahfouda
- Centre and Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Division of Psychiatry and Division of Paediatrics and Child Health, School of Medicine, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Australia
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
- School of Psychological Science, Faculty of Science, The University of Western Australia, Perth, Australia
| | - Sahra J. Lawrence
- The Gender Diversity Service, Child and Adolescent Health Service – Mental Health, Perth Children's Hospital, Perth, Australia
| | - Florian D. Zepf
- Centre and Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Division of Psychiatry and Division of Paediatrics and Child Health, School of Medicine, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Australia
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
- Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Jena University Hospital, Friedrich Schiller University, Jena, Germany
| | - Ashleigh Lin
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
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Stewart RM, Wong JWY, Mahfouda S, Morandini HAE, Rao P, Runions KC, Zepf FD. Acute Tryptophan Depletion Moja-De: A Method to Study Central Nervous Serotonin Function in Children and Adolescents. Front Psychiatry 2020; 10:1007. [PMID: 32210845 PMCID: PMC7067742 DOI: 10.3389/fpsyt.2019.01007] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Accepted: 12/20/2019] [Indexed: 11/13/2022] Open
Abstract
Serotonin (5-HT) is widely implicated as a key neurotransmitter relevant to a range of psychiatric disorders and psychological processes. The role of central nervous 5-HT function underlying these processes can be examined through serotonergic challenge methodologies. Acute tryptophan depletion (ATD) is a key challenge method whereby a diminished dietary intake of tryptophan-the amino acid precursor to brain 5-HT synthesis-results in temporary diminished central nervous 5-HT synthesis. While this particular methodology has been used in adult populations, it was only recently that modifications were made to enable the use of ATD in child and adolescent populations. Additionally, the Moja-De modification of the ATD challenge methodology has demonstrated benefits over other ATD techniques used previously. The aim of this protocol paper is to describe the ATD Moja-De methodology in detail, its benefits, as well as studies that have been conducted to validate the procedure in child and adolescent samples. The ATD Moja-De protocol provides a potential methodology for investigating the role of central nervous 5-HT via manipulation of brain tryptophan availability in human psychopathology from a developmental viewpoint.
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Affiliation(s)
- Richard M. Stewart
- Centre & Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, WA, Australia
| | - Janice W. Y. Wong
- Centre & Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, WA, Australia
- Brain and Behaviour, Telethon Kids Institute, Perth, WA, Australia
- Specialised Child and Adolescent Mental Health Services, Department of Health, Perth, WA, Australia
| | - Simone Mahfouda
- Centre & Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, WA, Australia
- Brain and Behaviour, Telethon Kids Institute, Perth, WA, Australia
- School of Psychological Sciences, Faculty of Science, The University of Western Australia, Perth, WA, Australia
| | - Hugo A. E. Morandini
- Centre & Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, WA, Australia
| | - Pradeep Rao
- Centre & Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, WA, Australia
- Community Child and Adolescent Mental Health Services, Department of Health, Perth, WA, Australia
| | - Kevin C. Runions
- Centre & Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, WA, Australia
- Brain and Behaviour, Telethon Kids Institute, Perth, WA, Australia
- Community Child and Adolescent Mental Health Services, Department of Health, Perth, WA, Australia
| | - Florian D. Zepf
- Centre & Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, WA, Australia
- Brain and Behaviour, Telethon Kids Institute, Perth, WA, Australia
- Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Jena University Hospital, Friedrich Schiller University, Jena, Germany
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Königschulte W, Civai C, Hildebrand P, Gaber TJ, Fink GR, Zepf FD. Effects of serotonin depletion and dopamine depletion on bimodal divided attention. World J Biol Psychiatry 2020; 21:183-194. [PMID: 30295116 DOI: 10.1080/15622975.2018.1532110] [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] [Indexed: 10/28/2022]
Abstract
Objectives: This study aimed to explore the effects of acute phenylalanine tyrosine depletion (APTD) and acute tryptophan depletion (ATD) on bimodal divided attention. A balanced amino acid mixture (BAL) served as control condition.Methods: Fifty-three healthy adults (final analyzed sample was N = 49, age: M = 23.8 years) were randomly assigned to APTD, ATD or BAL in a double-blind, between-subject approach. Divided attention was assessed after 4 h. Blood samples were taken before and 6 h after challenge intake.Results: Amino acid concentrations following challenge intake significantly decreased (all P ≤ 0.01). There was a significant difference in the mean reaction time (RT) towards auditory stimuli, but not towards visual stimuli between the groups. Post-hoc comparison of mean RTs (auditory stimuli) showed a significant difference between ATD (RT = 604.0 ms, SD = 56.9 ms) and APTD (RT = 556.4 ms, SD = 54.2 ms; P = 0.037), but no RT difference between ATD and BAL or APTD and BAL (RT = 573.6 ms, SD = 45.7 ms).Conclusions: The results indicate a possible dissociation between the effects of a diminished brain 5-HT and DA synthesis on the performance in a bimodal divided attention task. The difference was exclusively observed within the RT towards auditory signals.
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Affiliation(s)
- W Königschulte
- Clinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, RWTH Aachen University, Aachen, Germany.,JARA Translational Brain Medicine, Aachen & Jülich, Germany
| | - C Civai
- School of Psychology, University of Kent, Canterbury, UK
| | - P Hildebrand
- Clinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, RWTH Aachen University, Aachen, Germany.,JARA Translational Brain Medicine, Aachen & Jülich, Germany
| | - T J Gaber
- Clinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, RWTH Aachen University, Aachen, Germany.,JARA Translational Brain Medicine, Aachen & Jülich, Germany
| | - G R Fink
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Jülich, Germany.,Department of Neurology, University of Cologne, Cologne, Germany
| | - F D Zepf
- Clinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, RWTH Aachen University, Aachen, Germany.,JARA Translational Brain Medicine, Aachen & Jülich, Germany.,Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Jena University Hospital, Friedrich Schiller University Jena, Germany.,Centre and Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, School of Medicine, Division of Psychiatry and Clinical Neurosciences & Division of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, The University of Western Australia, Perth, Australia.,Telethon Kids Institute, Perth, Australia
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9
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Wang B, Eastwood PR, Becker A, Isensee C, Wong JWY, Huang RC, Runions KC, Stewart RM, Meyer T, Brüni LG, Rothenberger A, Zepf FD. Concurrent developmental course of sleep problems and emotional/behavioral problems in childhood and adolescence as reflected by the dysregulation profile. Sleep 2020; 42:5231982. [PMID: 30521022 DOI: 10.1093/sleep/zsy243] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [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: 07/19/2018] [Revised: 10/04/2018] [Accepted: 12/03/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Longitudinal data on the course and relationship of concurrent psychopathology in youth are scarce but are of need for better practical patient care and prevention. This study explores the course of (and relationships over time) between sleep problems and concurrent dimensional difficulties relating to anxiety/depression, attention deficiency, and aggressive behaviors in childhood and adolescence. The latter three may jointly form a broad syndrome, the dysregulation profile. METHODS Young people from the Raine Study, a large community cohort sample (N = 1625) were followed from age 5 to 17 years. Developmental courses of sleep problems and its concurrent regulatory difficulties were estimated separately and jointly. RESULTS The majority of adolescents reported low levels of problems and which appeared to be stable over time, while a small group (rates between 7.8% and 10.1%) reported enduring problematic developmental courses. Sleep problems and regulatory difficulties shared a strong association in their development over time (individual's probabilities of having the same courses, i.e. low-low and high-high, were between 89.8% and 92.3%). Furthermore, having persistent sleep problems over time was associated with an increased risk of having regulatory difficulties by approximately 10 times, and vice versa. CONCLUSION Findings from this study provide empirical evidence for a strong mutual association in the development of sleep problems and difficulties of dysregulation with emotion, cognition, and aggression. It may be suggested that a positive screening of one such psychopathological dimension should lead to a careful assessment, not only to reduce the problem in question but also to prevent the youth from further problems.
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Affiliation(s)
- Biyao Wang
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center of Goettingen, Goettingen, Germany
| | - Peter R Eastwood
- Centre for Sleep Science, School of Human Sciences, University of Western Australia, Perth, WA, Australia
| | - Andreas Becker
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center of Goettingen, Goettingen, Germany
| | - Corinna Isensee
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center of Goettingen, Goettingen, Germany
| | - Janice W Y Wong
- Centre and Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Western Australia, Perth, WA, Australia.,Telethon Kids Institute, Perth, WA, Australia.,Specialised Child and Adolescent Mental Health Services, Department of Health in Western Australia, Perth, WA, Australia
| | | | - Kevin C Runions
- Centre and Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Western Australia, Perth, WA, Australia.,Telethon Kids Institute, Perth, WA, Australia
| | - Richard M Stewart
- Centre and Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Western Australia, Perth, WA, Australia
| | - Thomas Meyer
- Department of Psychosomatic Medicine and Psychotherapy, German Centre for Cardiovascular Research, University of Goettingen, Goettingen, Germany
| | - L G Brüni
- Child and Adolescent Psychiatry, Psychiatry Services Thurgau, Weinfelden, Switzerland
| | - Aribert Rothenberger
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center of Goettingen, Goettingen, Germany
| | - Florian D Zepf
- Centre and Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Western Australia, Perth, WA, Australia.,Telethon Kids Institute, Perth, WA, Australia.,Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Jena University Hospital, Friedrich Schiller University Jena, Germany
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10
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Rao P, Caunt JN, Wong JWY, Moore JK, Zepf FD. Child and adolescent psychiatry training in Australia and New Zealand. Eur Child Adolesc Psychiatry 2020; 29:95-103. [PMID: 31641901 DOI: 10.1007/s00787-019-01422-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 06/19/2019] [Accepted: 10/10/2019] [Indexed: 10/25/2022]
Abstract
The specialty of Child and Adolescent Psychiatry was formally recognised in the 1930s. The Faculty of Child and Adolescent Psychiatry was established in 1964 in Australia, as a subspecialty in The Royal Australian and New Zealand College of Psychiatrists (RANZCP). The aim of the current article is first to provide a brief summary and overview of the current status of Child and Adolescent Psychiatry (CAP), followed by an outline of the requirements of the Training Program for CAP in Australia and New Zealand. The training required to become a fully qualified child and adolescent psychiatrist in Australia and New Zealand consists of different stages and takes the form of competency-based training. Information relating to assessment types, supervision and research requirements is also described. Accreditation procedures for the training program are stipulated by RANZCP to monitor standards and to ensure consistency within the programs delivered across Australia and New Zealand. Employment opportunities for trainees upon completion of the program are discussed. In summary, this article highlights the requirements of the training programs for CAP in Australia and New Zealand.
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Affiliation(s)
- P Rao
- Centre and Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Division of Psychiatry and Clinical Neurosciences and Division of Paediatrics and Child Health, School of Medicine, Faculty of Health and Medical Sciences, The University of Western Australia, 35 Stirling Highway, Crawley, Perth, WA, 6009, Australia. .,Child and Adolescent Mental Health Service, Child and Adolescent Health Service, 52-54 Monash Avenue, Nedlands, Perth, WA, 6008, Australia. .,Telethon Kids Institute, 15 Hospital Avenue, Nedlands, Perth, WA, 6008, Australia.
| | - J N Caunt
- Child and Adolescent Mental Health Service, Child and Adolescent Health Service, 52-54 Monash Avenue, Nedlands, Perth, WA, 6008, Australia
| | - J W Y Wong
- Centre and Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Division of Psychiatry and Clinical Neurosciences and Division of Paediatrics and Child Health, School of Medicine, Faculty of Health and Medical Sciences, The University of Western Australia, 35 Stirling Highway, Crawley, Perth, WA, 6009, Australia.,Child and Adolescent Mental Health Service, Child and Adolescent Health Service, 52-54 Monash Avenue, Nedlands, Perth, WA, 6008, Australia.,Telethon Kids Institute, 15 Hospital Avenue, Nedlands, Perth, WA, 6008, Australia
| | - J K Moore
- Centre and Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Division of Psychiatry and Clinical Neurosciences and Division of Paediatrics and Child Health, School of Medicine, Faculty of Health and Medical Sciences, The University of Western Australia, 35 Stirling Highway, Crawley, Perth, WA, 6009, Australia.,Child and Adolescent Mental Health Service, Child and Adolescent Health Service, 52-54 Monash Avenue, Nedlands, Perth, WA, 6008, Australia
| | - F D Zepf
- Centre and Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Division of Psychiatry and Clinical Neurosciences and Division of Paediatrics and Child Health, School of Medicine, Faculty of Health and Medical Sciences, The University of Western Australia, 35 Stirling Highway, Crawley, Perth, WA, 6009, Australia.,Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Jena University Hospital, Friedrich Schiller University, Am Steiger 6, 07743, Jena, Germany.,Telethon Kids Institute, 15 Hospital Avenue, Nedlands, Perth, WA, 6008, Australia
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11
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Bär KJ, Köhler S, Cruz FDL, Schumann A, Zepf FD, Wagner G. Functional consequences of acute tryptophan depletion on raphe nuclei connectivity and network organization in healthy women. Neuroimage 2019; 207:116362. [PMID: 31743788 DOI: 10.1016/j.neuroimage.2019.116362] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 11/09/2019] [Accepted: 11/13/2019] [Indexed: 01/01/2023] Open
Abstract
Previous research on central nervous serotonin (5-HT) function provided evidence for a substantial involvement of 5-HT in the regulation of brain circuitries associated with cognitive and affective processing. The underlying neural networks comprise core subcortical/cortical regions such as amygdala and medial prefrontal cortex, which are assumed to be modulated amongst others by 5-HT. Beside the use of antidepressants, acute tryptophan depletion (ATD) is a widely accepted technique to manipulate of 5-HT synthesis and its respective metabolites in humans by means of a dietary and non-pharmacological tool. We used a double-blind, randomized, cross-over design with two experimental challenge conditions, i.e. ATD and tryptophan (TRP) supplementation (TRYP+) serving as a control. The aim was to perturb 5-HT synthesis and to detect its impact on brain functional connectivity (FC) of the upper serotonergic raphe nuclei, the amygdala and the ventromedial prefrontal cortex as well as on network organization using resting state fMRI. 30 healthy adult female participants (age: M = 24.5 ± 4.4 yrs) were included in the final analysis. ATD resulted in a 90% decrease of TRP in the serum relative to baseline. Compared to TRYP + for the ATD condition a significantly lower FC of the raphe nucleus to the frontopolar cortex was detected, as well as greater functional coupling between the right amygdala and the ventromedial prefrontal cortex. FC of the raphe nucleus correlated significantly with the magnitude of TRP changes for both challenge conditions (ATD & TRYP+). Network-based statistical analysis using time series from 260 independent anatomical ROIs revealed significantly greater FC after ATD compared to TRYP+ in several brain regions being part of the default-mode (DMN) and the executive-control networks (ECN), but also of salience or visual networks. Finally, we observed an impact of ATD on the rich-club organization in terms of decreased rich-club coefficients compared to TRYP+. In summary we could confirm previous findings that the putative decrease in brain 5-HT synthesis via ATD significantly alters FC of the raphe nuclei as well as of specific subcortical/cortical regions involved in affective, but also in cognitive processes. Moreover, an ATD-effect on the so-called rich-club organization of some nodes with the high degree was demonstrated. This may indicate effects of brain 5-HT on the integration of information flow from several brain networks.
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Affiliation(s)
- Karl-Jürgen Bär
- Psychiatric Brain and Body Research Group, Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany.
| | - Stefanie Köhler
- Psychiatric Brain and Body Research Group, Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany
| | - Feliberto de la Cruz
- Psychiatric Brain and Body Research Group, Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany
| | - Andy Schumann
- Psychiatric Brain and Body Research Group, Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany
| | - Florian D Zepf
- Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Jena University Hospital, Friedrich Schiller University, 07743, Jena, Germany
| | - Gerd Wagner
- Psychiatric Brain and Body Research Group, Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany.
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12
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Mahfouda S, Panos C, Whitehouse AJ, Thomas CS, Maybery M, Strauss P, Zepf FD, O’Donovan A, van Hall HW, Saunders LA, Moore JK, Lin A. Mental Health Correlates of Autism Spectrum Disorder in Gender Diverse Young People: Evidence from a Specialised Child and Adolescent Gender Clinic in Australia. J Clin Med 2019; 8:E1503. [PMID: 31547002 PMCID: PMC6832530 DOI: 10.3390/jcm8101503] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 09/07/2019] [Accepted: 09/16/2019] [Indexed: 12/30/2022] Open
Abstract
Research suggests an overrepresentation of autism spectrum diagnoses (ASD) or autistic traits in gender diverse samples, particularly in children and adolescents. Using data from the GENTLE (GENder identiTy Longitudinal Experience) Cohort at the Gender Diversity Service at the Perth Children's Hospital, the primary objective of the current retrospective chart review was to explore psychopathology and quality of life in gender diverse children with co-occurring ASD relative to gender diverse children and adolescents without ASD. The Social Responsiveness Scale (Second Edition) generates a Diagnostic and Statistical Manual of Mental Disorders (DSM-5) score indicating a likely clinical ASD diagnosis, which was used to partition participants into two groups (indicated ASD, n = 19) (no ASD indicated, n = 60). Indicated ASD was far higher than would be expected compared to general population estimates. Indicated ASD on the Social Responsiveness Scale 2 (SRS 2) was also a significant predictor of Internalising behaviours (Anxious/Depressed, Withdrawn/Depressed, Somatic Complaints, Thought Problems subscales) on the Youth Self Report. Indicated ASD was also a significant predictor of scores on all subscales of the Paediatric Quality of Life Inventory. The current findings indicate that gender diverse children and adolescents with indicated ASD comprise an especially vulnerable group that are at marked risk of mental health difficulties, particularly internalising disorders, and poor quality of life outcomes. Services working with gender diverse young people should screen for ASD, and also provide pathways to appropriate care for the commonly associated mental health difficulties.
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Affiliation(s)
- Simone Mahfouda
- Telethon Kids Institute, The University of Western Australia, Perth 6008, Australia (C.S.T.); (P.S.); (F.D.Z.); (A.L.)
- School of Psychological Science, Faculty of Science, The University of Western Australia, Perth 6008, Australia;
- Centre and Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Division of Psychiatry and Clinical Neurosciences and Division of Paediatrics and Child Health, School of Medicine, Faculty of Health and Medical Sciences, The University of Western Australia, Perth 6008, Australia;
| | - Christina Panos
- Discipline of Psychology, College of Science, Health, Engineering and Education, Murdoch University, Perth 6150, Australia; (C.P.); (A.O.)
| | - Andrew J.O. Whitehouse
- Telethon Kids Institute, The University of Western Australia, Perth 6008, Australia (C.S.T.); (P.S.); (F.D.Z.); (A.L.)
| | - Cati S. Thomas
- Telethon Kids Institute, The University of Western Australia, Perth 6008, Australia (C.S.T.); (P.S.); (F.D.Z.); (A.L.)
- The Gender Diversity Service, Child and Adolescent Mental Health Service, Child and Adolescent Health Service, Perth Children’s Hospital, Nedlands 6009, Australia; (H.-W.v.H.); (L.A.S.)
| | - Murray Maybery
- School of Psychological Science, Faculty of Science, The University of Western Australia, Perth 6008, Australia;
| | - Penelope Strauss
- Telethon Kids Institute, The University of Western Australia, Perth 6008, Australia (C.S.T.); (P.S.); (F.D.Z.); (A.L.)
- School of Population and Global Health, Faculty of Health and Medical Sciences, The University of Western Australia, Perth 6008, Australia
| | - Florian D. Zepf
- Telethon Kids Institute, The University of Western Australia, Perth 6008, Australia (C.S.T.); (P.S.); (F.D.Z.); (A.L.)
- Centre and Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Division of Psychiatry and Clinical Neurosciences and Division of Paediatrics and Child Health, School of Medicine, Faculty of Health and Medical Sciences, The University of Western Australia, Perth 6008, Australia;
- Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Jena University Hospital, Friedrich Schiller University, 07743 Jena, Germany
| | - Amanda O’Donovan
- Discipline of Psychology, College of Science, Health, Engineering and Education, Murdoch University, Perth 6150, Australia; (C.P.); (A.O.)
| | - Hans-Willem van Hall
- The Gender Diversity Service, Child and Adolescent Mental Health Service, Child and Adolescent Health Service, Perth Children’s Hospital, Nedlands 6009, Australia; (H.-W.v.H.); (L.A.S.)
| | - Liz A. Saunders
- The Gender Diversity Service, Child and Adolescent Mental Health Service, Child and Adolescent Health Service, Perth Children’s Hospital, Nedlands 6009, Australia; (H.-W.v.H.); (L.A.S.)
- The School of Human Sciences (Exercise and Sports Science), The University of Western Australia, Perth 6008, Australia
| | - Julia K. Moore
- Centre and Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Division of Psychiatry and Clinical Neurosciences and Division of Paediatrics and Child Health, School of Medicine, Faculty of Health and Medical Sciences, The University of Western Australia, Perth 6008, Australia;
- The Gender Diversity Service, Child and Adolescent Mental Health Service, Child and Adolescent Health Service, Perth Children’s Hospital, Nedlands 6009, Australia; (H.-W.v.H.); (L.A.S.)
| | - Ashleigh Lin
- Telethon Kids Institute, The University of Western Australia, Perth 6008, Australia (C.S.T.); (P.S.); (F.D.Z.); (A.L.)
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13
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Hildebrandt CS, Helmbold K, Linden M, Langen KJ, Filss CP, Runions KC, Stewart RM, Rao P, Moore JK, Mahfouda S, Morandini HAE, Wong JWY, Rink L, Zepf FD. No detectable effects of acute tryptophan depletion on short-term immune system cytokine levels in healthy adults. World J Biol Psychiatry 2019; 20:416-423. [PMID: 29353534 DOI: 10.1080/15622975.2018.1428357] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 10/18/2022]
Abstract
Objectives: Recent research suggested an influence of diminished central nervous serotonin (5-HT) synthesis on the leptin axis via immunological mechanisms in healthy adult females. However, studies assessing immunological parameters in combination with dietary challenge techniques that impact brain 5-HT synthesis in humans are lacking. Methods: In the present trial, a pilot analysis was conducted on data obtained in healthy adult humans receiving either different dietary acute tryptophan depletion (ATD) challenge or tryptophan (TRP)-balanced control conditions (BAL) to study the effects of reduced central nervous 5-HT synthesis on serum tumor necrosis factor α (TNF-α), interleukin-1β (IL-1β) and IL-6 concentrations. The data of N = 35 healthy adults were analysed who were randomly subjected to one of the following two dietary conditions in a double-blind between-subject approach: (1) The Moja-De ATD challenge (ATD), or (2) TRP-balanced control condition for ATD Moja-De (BAL). Serum concentrations for the assessment of relevant parameters (TNF-α, IL-1β and IL-6) and relevant TRP-related characteristics after the respective challenge procedures were assessed at baseline (T0) and in hourly intervals after administration over a period of 6 h (T1-T6). Results: The ATD condition did not result in significant changes to cytokine concentrations for the entire study sample, or in male and female subgroups. Depletion of CNS 5-HT via dietary TRP depletion appears to have no statistically significant short-term impact on cytokine concentrations in healthy adults. Conclusions: Future research on immunological stressors in combination with challenge techniques will be of value in order to further disentangle the complex interplay between brain 5-HT synthesis and immunological pathways.
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Affiliation(s)
- Caroline S Hildebrandt
- a Jülich Aachen Research Alliance, JARA Translational Brain Medicine , Aachen , Germany.,b Clinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy , RWTH Aachen University , Aachen , Germany.,c Clinics of the City Cologne GmbH , Child and Adolescent Psychiatry and Psychotherapy , Cologne , Germany
| | - Katrin Helmbold
- a Jülich Aachen Research Alliance, JARA Translational Brain Medicine , Aachen , Germany.,b Clinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy , RWTH Aachen University , Aachen , Germany
| | - Maike Linden
- a Jülich Aachen Research Alliance, JARA Translational Brain Medicine , Aachen , Germany.,b Clinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy , RWTH Aachen University , Aachen , Germany
| | - Karl-Josef Langen
- d Institute of Neuroscience and Medicine (INM-4) Research Centre Jülich , Jülich , Germany.,e Section JARA-Brain , Jülich-Aachen Research Alliance (JARA) , Jülich , Germany.,f Department of Nuclear Medicine , RWTH Aachen University Hospital , Aachen , Germany
| | - C P Filss
- e Section JARA-Brain , Jülich-Aachen Research Alliance (JARA) , Jülich , Germany.,f Department of Nuclear Medicine , RWTH Aachen University Hospital , Aachen , Germany
| | - Kevin C Runions
- g Centre & Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; School of Medicine, Division of Psychiatry and Clinical Neurosciences and Division of Paediatrics and Child Health , The University of Western Australia , Perth , Australia.,h Telethon Kids Institute , Perth , Australia
| | - Richard M Stewart
- g Centre & Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; School of Medicine, Division of Psychiatry and Clinical Neurosciences and Division of Paediatrics and Child Health , The University of Western Australia , Perth , Australia
| | - Pradeep Rao
- g Centre & Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; School of Medicine, Division of Psychiatry and Clinical Neurosciences and Division of Paediatrics and Child Health , The University of Western Australia , Perth , Australia.,i Department of Health , Community Child and Adolescent Mental Health Services (CAMHS) , Perth , Western Australia , Australia
| | - Julie K Moore
- g Centre & Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; School of Medicine, Division of Psychiatry and Clinical Neurosciences and Division of Paediatrics and Child Health , The University of Western Australia , Perth , Australia.,j Princess Margaret Hospital, Department of Health , Pediatric Consultation Liason Program, Acute Child and Adolescent Mental Health Services (CAMHS) , Perth , Western Australia , Australia
| | - Simone Mahfouda
- g Centre & Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; School of Medicine, Division of Psychiatry and Clinical Neurosciences and Division of Paediatrics and Child Health , The University of Western Australia , Perth , Australia.,h Telethon Kids Institute , Perth , Australia
| | - Hugo A E Morandini
- g Centre & Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; School of Medicine, Division of Psychiatry and Clinical Neurosciences and Division of Paediatrics and Child Health , The University of Western Australia , Perth , Australia
| | - Janice W Y Wong
- g Centre & Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; School of Medicine, Division of Psychiatry and Clinical Neurosciences and Division of Paediatrics and Child Health , The University of Western Australia , Perth , Australia.,h Telethon Kids Institute , Perth , Australia.,k Department of Health , Specialised Child and Adolescent Mental Health Services (CAMHS) , Perth , Western Australia , Australia
| | - Lothar Rink
- l Department of Immunology , RWTH Aachen University Hospital , Aachen , Germany
| | - Florian D Zepf
- a Jülich Aachen Research Alliance, JARA Translational Brain Medicine , Aachen , Germany.,b Clinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy , RWTH Aachen University , Aachen , Germany.,g Centre & Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; School of Medicine, Division of Psychiatry and Clinical Neurosciences and Division of Paediatrics and Child Health , The University of Western Australia , Perth , Australia.,h Telethon Kids Institute , Perth , Australia.,k Department of Health , Specialised Child and Adolescent Mental Health Services (CAMHS) , Perth , Western Australia , Australia
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14
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Klasen M, Wolf D, Eisner PD, Eggermann T, Zerres K, Zepf FD, Weber R, Mathiak K. Serotonergic Contributions to Human Brain Aggression Networks. Front Neurosci 2019; 13:42. [PMID: 30853880 PMCID: PMC6395384 DOI: 10.3389/fnins.2019.00042] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 10/30/2018] [Accepted: 01/16/2019] [Indexed: 12/28/2022] Open
Abstract
Aggressive behavior is associated with dysfunctional frontolimbic emotion regulation circuits. Recent findings suggest serotonin as a primary transmitter for prefrontal amygdala control. However, the association between serotonin levels, amygdala regulation, and aggression is still a matter of debate. Neurobehavioral models furthermore suggest a possible mediating influence of the monoamine oxidase A gene (MAOA) on this brain-behavior relationship, with carriers of low expressing allele varieties being a risk group for aggression. In the present study, we investigated the influence of brain serotonin modulation and MAOA genotype on functional amygdala connectivity during aggressive behavior. Modulation of serotonergic neurotransmission with acute tryptophan depletion (ATD) and placebo were administered in a double-blind, cross-over design in 38 healthy male participants. Aggressive behavior was modeled in a violent video game during simultaneous assessment of brain activation with functional magnetic resonance imaging (fMRI). Trait aggression was measured with the Buss-Perry Aggression Questionnaire (BP-AQ), and MAOA genotypes were assessed from blood samples. Voxel-wise functional connectivity with anatomically defined amygdala was calculated from the functional data. Tryptophan depletion with ATD reduced aggression-specific amygdala connectivity with bilateral supramarginal gyrus. Moreover, ATD impact was associated with trait aggression and MAOA genotype in prefrontal cortex regions. In summary, serotonergic corticolimbic projections contribute to aggressive behavior. Genotype-specific vulnerability of frontolimbic projections may underlie the elevated risk in low expressing allele carriers.
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Affiliation(s)
- Martin Klasen
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, RWTH Aachen, Aachen, Germany
- JARA – Translational Brain Medicine, Aachen, Germany
| | - Dhana Wolf
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, RWTH Aachen, Aachen, Germany
- JARA – Translational Brain Medicine, Aachen, Germany
| | - Patrick D. Eisner
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, RWTH Aachen, Aachen, Germany
- JARA – Translational Brain Medicine, Aachen, Germany
| | - Thomas Eggermann
- Institute of Human Genetics, Medical School, RWTH Aachen University, Aachen, Germany
| | - Klaus Zerres
- Institute of Human Genetics, Medical School, RWTH Aachen University, Aachen, Germany
| | - Florian D. Zepf
- Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Jena University Hospital, Friedrich Schiller University, Jena, Germany
- Centre and Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Division of Psychiatry and Clinical Neurosciences and Division of Paediatrics and Child Health, School of Medicine, Faculty of Health and Medical Sciences, University of Western Australia, Perth, WA, Australia
- Telethon Kids Institute, Perth, WA, Australia
| | - René Weber
- Media Neuroscience Lab, Department of Communication, University of California, Santa Barbara, Santa Barbara, CA, United States
| | - Klaus Mathiak
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, RWTH Aachen, Aachen, Germany
- JARA – Translational Brain Medicine, Aachen, Germany
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15
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Runions KC, Morandini HAE, Rao P, Wong JWY, Kolla NJ, Pace G, Mahfouda S, Hildebrandt CS, Stewart R, Zepf FD. Serotonin and aggressive behaviour in children and adolescents: a systematic review. Acta Psychiatr Scand 2019; 139:117-144. [PMID: 30446991 DOI: 10.1111/acps.12986] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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] [Accepted: 11/12/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The role of serotonin (5-HT) in human aggression has been the subject of a large number of studies, mostly with adults. Meta-analyses indicate a small but significant inverse relationship between central nervous 5-HT availability and aggression, but genetically informed studies suggest two pathways: one to reactive aggression and the other to proactive aggression. METHOD We conducted a systemic review on central nervous 5-HT function in children and adolescents, with attention to the function of aggression. RESULTS In total, 675 articles were screened for relevance, with 45 reviewed. These included blood assays (e.g. plasma, 5-HIAA; platelet 5-HTR2A ), epigenetic studies, retrospective PET studies and 5-HT challenge paradigms (e.g. tryptophan depletion). Overall, findings were mixed, with support both for negative and for positive associations of central nervous 5-HT function with aggression in children and adolescents. CONCLUSION We propose factors that may be blurring the picture, including problems in the conceptualization and measurement of aggression in young people, the lack of prospective designs and the bias towards clinical samples of boys. Research needs to account for variance in the both motivation for and implementation of aggression, and look to the behavioural economics literature to consider the roles of reward, vengeance and self-control more clearly.
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Affiliation(s)
- K C Runions
- Department of Health, Child and Adolescent Mental Health Services, Bentley, WA, Australia.,Telethon Kids Institute, University of Western Australia, Perth, WA, Australia.,Division of Psychiatry and Clinical Neurosciences and Division of Paediatrics and Child Health, Centre & Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, School of Medicine, University of Western Australia, Perth, WA, Australia
| | - H A E Morandini
- Division of Psychiatry and Clinical Neurosciences and Division of Paediatrics and Child Health, Centre & Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, School of Medicine, University of Western Australia, Perth, WA, Australia
| | - P Rao
- Department of Health, Child and Adolescent Mental Health Services, Bentley, WA, Australia.,Division of Psychiatry and Clinical Neurosciences and Division of Paediatrics and Child Health, Centre & Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, School of Medicine, University of Western Australia, Perth, WA, Australia
| | - J W Y Wong
- Department of Health, Child and Adolescent Mental Health Services, Bentley, WA, Australia.,Telethon Kids Institute, University of Western Australia, Perth, WA, Australia.,Division of Psychiatry and Clinical Neurosciences and Division of Paediatrics and Child Health, Centre & Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, School of Medicine, University of Western Australia, Perth, WA, Australia
| | - N J Kolla
- Centre for Addictions and Mental Health, University of Toronto, Toronto, ON, Canada
| | - G Pace
- Department of Health, Child and Adolescent Mental Health Services, Bentley, WA, Australia
| | - S Mahfouda
- Telethon Kids Institute, University of Western Australia, Perth, WA, Australia.,School of Psychological Sciences, Faculty of Sciences, University of Western Australia, Perth, WA, Australia
| | - C S Hildebrandt
- Jülich Aachen Research Alliance, JARA Translational Brain Medicine, Aachen, Germany.,Child and Adolescent Psychiatry and Psychotherapy, Clinics of the City Cologne GmbH, Cologne, Germany
| | - R Stewart
- Division of Psychiatry and Clinical Neurosciences and Division of Paediatrics and Child Health, Centre & Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, School of Medicine, University of Western Australia, Perth, WA, Australia
| | - F D Zepf
- Division of Psychiatry and Clinical Neurosciences and Division of Paediatrics and Child Health, Centre & Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, School of Medicine, University of Western Australia, Perth, WA, Australia.,Clinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Clinics of the Friedrich Schiller University, Jena, Germany
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16
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Wolf D, Klasen M, Eisner P, Zepf FD, Zvyagintsev M, Palomero-Gallagher N, Weber R, Eisert A, Mathiak K. Central serotonin modulates neural responses to virtual violent actions in emotion regulation networks. Brain Struct Funct 2018; 223:3327-3345. [PMID: 29948188 PMCID: PMC6698268 DOI: 10.1007/s00429-018-1693-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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: 11/06/2017] [Accepted: 06/03/2018] [Indexed: 12/31/2022]
Abstract
Disruptions in the cortico-limbic emotion regulation networks have been linked to depression, anxiety, impulsivity, and aggression. Altered transmission of the central nervous serotonin (5-HT) contributes to dysfunctions in the cognitive control of emotions. To date, studies relating to pharmaco-fMRI challenging of the 5-HT system have focused on emotion processing for facial expressions. We investigated effects of a single-dose selective 5-HT reuptake inhibitor (escitalopram) on emotion regulation during virtual violence. For this purpose, 38 male participants played a violent video game during fMRI scanning. The SSRI reduced neural responses to violent actions in right-hemispheric inferior frontal gyrus and medial prefrontal cortex encompassing the anterior cingulate cortex (ACC), but not to non-violent actions. Within the ACC, the drug effect differentiated areas with high inhibitory 5-HT1A receptor density (subgenual s25) from those with a lower density (pregenual p32, p24). This finding links functional responses during virtual violent actions with 5-HT neurotransmission in emotion regulation networks, underpinning the ecological validity of the 5-HT model in aggressive behavior. Available 5-HT receptor density data suggest that this SSRI effect is only observable when inhibitory and excitatory 5-HT receptors are balanced. The observed early functional changes may impact patient groups receiving SSRI treatment.
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Affiliation(s)
- Dhana Wolf
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Medical Faculty, RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany.
| | - Martin Klasen
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Medical Faculty, RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Patrick Eisner
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Medical Faculty, RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Florian D Zepf
- Centre and Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Division of Psychiatry and Clinical Neurosciences and Division of Paediatrics and Child Health, School of Medicine, The University of Western Australia, Perth, Australia
- Specialised Child and Adolescent Mental Health Services, Department of Health in Western Australia, Perth, Australia
| | - Mikhail Zvyagintsev
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Medical Faculty, RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Nicola Palomero-Gallagher
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Medical Faculty, RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
- Institute of Neuroscience and Medicine (INM-1), Research Centre Jülich, Jülich, Germany
| | - René Weber
- Media Neuroscience Lab, Department of Communication, University of California Santa Barbara, Santa Barbara, CA, USA
| | - Albrecht Eisert
- Department of Pharmacy, RWTH Aachen, Aachen, Germany
- Department of Pharmacology and Toxicology, RWTH Aachen, Aachen, Germany
| | - Klaus Mathiak
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Medical Faculty, RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
- JARA-Translational Brain Medicine, Aachen, Germany
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17
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Stewart RM, Hood SD, Rao P, Moore JK, Runions KC, Murphy SE, Wong JWY, Zepf FD. Using acute tryptophan depletion to investigate predictors of treatment response in adolescents with major depressive disorder: study protocol for a randomised controlled trial. Trials 2018; 19:434. [PMID: 30097056 PMCID: PMC6086023 DOI: 10.1186/s13063-018-2791-4] [Citation(s) in RCA: 4] [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: 06/27/2017] [Accepted: 07/06/2018] [Indexed: 11/21/2022] Open
Abstract
Background Selective serotonin reuptake inhibitors (SSRIs) are amongst the most prescribed antidepressants for adolescents with depressive symptoms and major depressive disorder. However, SSRIs have significant shortcomings as a first-line treatment considering that not all patients respond to these antidepressants. Amongst paediatric populations, meta-analyses indicate that up to approximately 40% of patients do not respond, and for those who do show benefit, there is substantial heterogeneity in response onset. The neurotransmitter serotonin (5-HT) plays a role in the clinical effectiveness and mechanisms of action of SSRIs. However, the exact and complete mechanism of action and reasons for the low response rate to SSRIs in some adolescent populations remains unknown. Methods To examine SSRI response and the role of 5-HT, this study will employ a randomised double-blind within subject, repeated measures design, recruiting adolescent patients with major depressive disorder. Participants will be subjected to acute tryptophan depletion (ATD) and the balanced control condition on two separate study days within a first study phase (Phase A), and the order in which these conditions (ATD/balanced control condition) occur will be random. This phase will be followed by Phase B, where participants will receive open label pharmacological treatment as usual with the SSRI fluoxetine and followed-up over a 12-week period. Discussion ATD is a neurodietary method typically used to investigate the impact of lowered brain 5-HT synthesis on mood and behaviour. The major hypothesis of this study is that ATD will be negatively associated with mood and cognitive functioning, therefore reflecting individual serotonergic sensitivity and related depressive symptoms. Additionally, we expect the aforementioned effects of ATD administration on mood to predict clinical improvement with regard to overall depressive symptomatology 12 weeks into SSRI treatment. Trial registration Australian and New Zealand Clinical Trials Registry (ANZCTR) ACTRN12616001561471. Registered on 11 November 2016. Electronic supplementary material The online version of this article (10.1186/s13063-018-2791-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Richard M Stewart
- Centre & Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Divisions of Paediatrics and Psychiatry, UWA Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, 35 Stirling Highway (M561), Crawley WA, Perth, 6009, Australia
| | - Sean D Hood
- Division of Psychiatry, UWA Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Australia
| | - Pradeep Rao
- Centre & Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Divisions of Paediatrics and Psychiatry, UWA Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, 35 Stirling Highway (M561), Crawley WA, Perth, 6009, Australia.,Community Child and Adolescent Mental Health Services (CAMHS), Department of Health in Western Australia, Perth, Australia
| | - Julia K Moore
- Centre & Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Divisions of Paediatrics and Psychiatry, UWA Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, 35 Stirling Highway (M561), Crawley WA, Perth, 6009, Australia.,Paediatric Consult-Liaison, Acute Child and Adolescent Mental Health Services (CAMHS), Department of Health, Perth, Western Australia, Australia
| | - Kevin C Runions
- Centre & Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Divisions of Paediatrics and Psychiatry, UWA Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, 35 Stirling Highway (M561), Crawley WA, Perth, 6009, Australia.,Community Child and Adolescent Mental Health Services (CAMHS), Department of Health in Western Australia, Perth, Australia.,Telethon Kids Institute, Perth, Australia
| | - Susannah E Murphy
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Janice W Y Wong
- Centre & Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Divisions of Paediatrics and Psychiatry, UWA Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, 35 Stirling Highway (M561), Crawley WA, Perth, 6009, Australia.,Telethon Kids Institute, Perth, Australia.,Specialised Child and Adolescent Mental Health Services (CAMHS), Department of Health in Western Australia, Perth, Australia
| | - Florian D Zepf
- Centre & Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Divisions of Paediatrics and Psychiatry, UWA Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, 35 Stirling Highway (M561), Crawley WA, Perth, 6009, Australia. .,Telethon Kids Institute, Perth, Australia. .,Specialised Child and Adolescent Mental Health Services (CAMHS), Department of Health in Western Australia, Perth, Australia.
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18
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Wong JWY, Morandini HAE, Dingerkus VLS, Gaber TJ, Runions KC, Rao P, Mahfouda S, Helmbold K, Bubenzer-Busch S, Koenemann R, Stewart RM, Zepf FD. Effects of Dietary Acute Tryptophan Depletion (ATD) on NPY Serum Levels in Healthy Adult Humans Whilst Controlling for Methionine Supply-A Pilot Study. Nutrients 2018; 10:E594. [PMID: 29751614 PMCID: PMC5986474 DOI: 10.3390/nu10050594] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 04/28/2018] [Accepted: 05/01/2018] [Indexed: 11/19/2022] Open
Abstract
Central nervous serotonin (5-HT) can influence behaviour and neuropsychiatric disorders. Evidence from animal models suggest that lowered levels of neuropeptide Y (NPY) may have similar effects, although it is currently unknown whether decreased central nervous 5-HT impact NPY concentrations. Given that the production of NPY is dependent on the essential amino acid methionine (MET), it is imperative to account for the presence of MET in such investigations. Hence, this study sought to examine the effects of acute tryptophan depletion (ATD; a dietary procedure that temporarily lowers central nervous 5-HT synthesis) on serum concentrations of NPY, whilst using the potential renal acid load indicator (PRAL) to control for levels of MET. In a double-blind repeated measures design, 24 adult humans randomly received an AA-load lacking in TRP (ATD) on one occasion, and a balanced control mixture with TRP (BAL) on a second occasion, both with a PRAL of nearly 47.3 mEq of MET. Blood samples were obtained at 90, 180, and 240 min after each of the AA challenges. ATD, and therefore, diminished substrate availability for brain 5-HT synthesis did not lead to significant changes in serum NPY concentrations over time, compared to BAL, under an acute acidotic stimulus.
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Affiliation(s)
- Janice W Y Wong
- Centre & Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, School of Medicine, Division of Psychiatry and Clinical Neurosciences and Division of Paediatrics and Child Health, The University of Western Australia, 6009 Perth, Australia.
- Specialised Child and Adolescent Mental Health Services (CAMHS), Department of Health, 6009 Perth, Australia.
- Telethon Kids Institute, 6009 Perth, Australia.
| | - Hugo A E Morandini
- Centre & Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, School of Medicine, Division of Psychiatry and Clinical Neurosciences and Division of Paediatrics and Child Health, The University of Western Australia, 6009 Perth, Australia.
| | - Vita L S Dingerkus
- Acute Child and Adolescent Mental Health Services (CAMHS), Department of Health, 6009 Perth, Australia.
- Clinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, RWTH Aachen University Hospital, 52074 Aachen, Germany.
- Department of Ophthalmology, Triemli Hospital Zürich, CH-8063 Zürich, Switzerland.
| | - Tilman J Gaber
- Clinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, RWTH Aachen University Hospital, 52074 Aachen, Germany.
| | - Kevin C Runions
- Centre & Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, School of Medicine, Division of Psychiatry and Clinical Neurosciences and Division of Paediatrics and Child Health, The University of Western Australia, 6009 Perth, Australia.
- Telethon Kids Institute, 6009 Perth, Australia.
- Community Child and Adolescent Mental Health Services (CAMHS), Department of Health, 6009 Perth, Australia.
| | - Pradeep Rao
- Centre & Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, School of Medicine, Division of Psychiatry and Clinical Neurosciences and Division of Paediatrics and Child Health, The University of Western Australia, 6009 Perth, Australia.
- Department of Ophthalmology, Triemli Hospital Zürich, CH-8063 Zürich, Switzerland.
| | - Simone Mahfouda
- Centre & Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, School of Medicine, Division of Psychiatry and Clinical Neurosciences and Division of Paediatrics and Child Health, The University of Western Australia, 6009 Perth, Australia.
- Telethon Kids Institute, 6009 Perth, Australia.
- School of Psychological Sciences, Faculty of Science, The University of Western Australia, 6009 Perth, Australia.
| | - Katrin Helmbold
- Clinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, RWTH Aachen University Hospital, 52074 Aachen, Germany.
| | - Sarah Bubenzer-Busch
- Clinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, RWTH Aachen University Hospital, 52074 Aachen, Germany.
| | - Rebecca Koenemann
- Clinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, RWTH Aachen University Hospital, 52074 Aachen, Germany.
| | - Richard M Stewart
- Centre & Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, School of Medicine, Division of Psychiatry and Clinical Neurosciences and Division of Paediatrics and Child Health, The University of Western Australia, 6009 Perth, Australia.
| | - Florian D Zepf
- Centre & Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, School of Medicine, Division of Psychiatry and Clinical Neurosciences and Division of Paediatrics and Child Health, The University of Western Australia, 6009 Perth, Australia.
- Specialised Child and Adolescent Mental Health Services (CAMHS), Department of Health, 6009 Perth, Australia.
- Telethon Kids Institute, 6009 Perth, Australia.
- Clinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, RWTH Aachen University Hospital, 52074 Aachen, Germany.
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19
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Affiliation(s)
- Siegfried Zepf
- University of Saarland, Narzissenstrasse 5, Saarbrucken, D – 66119, Germany –
| | - Florian D. Zepf
- University of Saarland, Narzissenstrasse 5, Saarbrucken, D – 66119, Germany –
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20
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Zepf FD, Bubenzer-Busch S, Runions KC, Rao P, Wong JWY, Mahfouda S, Morandini HAE, Stewart RM, Moore JK, Biskup CS, Eickhoff SB, Fink GR, Langner R. Functional connectivity of the vigilant-attention network in children and adolescents with attention-deficit/hyperactivity disorder. Brain Cogn 2017; 131:56-65. [PMID: 29150311 PMCID: PMC6432906 DOI: 10.1016/j.bandc.2017.10.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 10/31/2017] [Accepted: 10/31/2017] [Indexed: 01/31/2023]
Abstract
ADHD affects functional connectivity in a brain network for vigilant attention (VA). First evidence showing the VA network is intrinsically coupled in older children. ADHD patients showed less consistent network connectivity, forming 2 subnetworks. Lower network integrity in ADHD is due to both weaker and stronger connections. Aberrant connectivity between several regions is linked to ADHD symptomatology.
The ability to maintain attention to simple tasks (i.e., vigilant attention, VA) is often impaired in attention-deficit/hyperactivity disorder (ADHD), but the underlying pathophysiological mechanisms at the brain network level are not clear yet. We therefore investigated ADHD-related differences in resting-state functional connectivity within a meta-analytically defined brain network of 14 distinct regions subserving VA (comprising 91 connections in total), as well as the association of connectivity with markers of behavioural dysfunction in 17 children (age range: 9–14 years) with a diagnosis of ADHD and 21 age-matched neurotypical controls. Our analyses revealed selective, rather than global, differences in the intrinsic coupling between nodes of the VA-related brain network in children with ADHD, relative to controls. In particular, ADHD patients showed substantially diminished intrinsic coupling for 7 connections and increased coupling for 4 connections, with many differences involving connectivity with the anterior insula. Moreover, connectivity strength of several aberrant connections was found to be associated with core aspects of ADHD symptomatology, such as poor attention, difficulties with social functioning, and impaired cognitive control, attesting to the behavioural relevance of specific connectivity differences observed in the resting state.
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Affiliation(s)
- Florian D Zepf
- Centre & Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, School of Medicine, Division of Psychiatry and Clinical Neurosciences & Division of Pediatrics and Child Health, The University of Western Australia, Perth, Australia; Specialised Child and Adolescent Mental Health Services (CAMHS), Department of Health in Western Australia, Perth, Australia; Clinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, RWTH Aachen University, Aachen, Germany.
| | - Sarah Bubenzer-Busch
- Clinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, RWTH Aachen University, Aachen, Germany
| | - Kevin C Runions
- Community Child and Adolescent Mental Health Services (CAMHS), Department of Health in Western Australia, Perth, Australia; Telethon Kids Institute, Perth, Australia
| | - Pradeep Rao
- Centre & Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, School of Medicine, Division of Psychiatry and Clinical Neurosciences & Division of Pediatrics and Child Health, The University of Western Australia, Perth, Australia; Community Child and Adolescent Mental Health Services (CAMHS), Department of Health in Western Australia, Perth, Australia
| | - Janice W Y Wong
- Centre & Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, School of Medicine, Division of Psychiatry and Clinical Neurosciences & Division of Pediatrics and Child Health, The University of Western Australia, Perth, Australia; Specialised Child and Adolescent Mental Health Services (CAMHS), Department of Health in Western Australia, Perth, Australia; Telethon Kids Institute, Perth, Australia
| | - Simone Mahfouda
- Centre & Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, School of Medicine, Division of Psychiatry and Clinical Neurosciences & Division of Pediatrics and Child Health, The University of Western Australia, Perth, Australia; Telethon Kids Institute, Perth, Australia
| | - Hugo A E Morandini
- Centre & Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, School of Medicine, Division of Psychiatry and Clinical Neurosciences & Division of Pediatrics and Child Health, The University of Western Australia, Perth, Australia
| | - Richard M Stewart
- Centre & Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, School of Medicine, Division of Psychiatry and Clinical Neurosciences & Division of Pediatrics and Child Health, The University of Western Australia, Perth, Australia
| | - Julia K Moore
- Centre & Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, School of Medicine, Division of Psychiatry and Clinical Neurosciences & Division of Pediatrics and Child Health, The University of Western Australia, Perth, Australia; Paediatric Consultation-Liaison Program, Child and Adolescent Mental Health Services, Department of Health in Western Australia, Perth, Australia
| | - Caroline S Biskup
- Clinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, RWTH Aachen University, Aachen, Germany
| | - Simon B Eickhoff
- Institute of Neuroscience and Medicine (INM-1, INM-7), Research Centre Jülich, Jülich, Germany; Institute of Clinical Neuroscience & Medical Psychology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany; Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Gereon R Fink
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Jülich, Germany; Department of Neurology, University of Cologne, Cologne, Germany
| | - Robert Langner
- Institute of Neuroscience and Medicine (INM-1, INM-7), Research Centre Jülich, Jülich, Germany; Institute of Clinical Neuroscience & Medical Psychology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany; Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
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21
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Klasen M, Wolf D, Eisner PD, Habel U, Repple J, Vernaleken I, Schlüter T, Eggermann T, Zerres K, Zepf FD, Mathiak K. Neural networks underlying trait aggression depend on MAOA gene alleles. Brain Struct Funct 2017; 223:873-881. [PMID: 29019036 DOI: 10.1007/s00429-017-1528-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [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: 11/14/2016] [Accepted: 09/20/2017] [Indexed: 12/29/2022]
Abstract
Low expressing alleles of the MAOA gene (MAOA-L) have been associated with an increased risk for developing an aggressive personality. This suggests an MAOA-L-specific neurobiological vulnerability associated with trait aggression. The neural networks underlying this vulnerability are unknown. The present study investigated genotype-specific associations between resting state brain networks and trait aggression (Buss-Perry Aggression Questionnaire) in 82 healthy Caucasian males. Genotype influences on aggression-related networks were studied for intrinsic and seed-based brain connectivity. Intrinsic connectivity was higher in the ventromedial prefrontal cortex (VMPFC) of MAOA-L compared to high expressing allele (MAOA-H) carriers. Seed-based connectivity analyses revealed genotype differences in the functional involvement of this region. MAOA genotype modulated the relationship between trait aggression and VMPFC connectivity with supramarginal gyrus (SMG) and areas of the default mode network (DMN). Separate analyses for the two groups were performed to better understand how the genotype modulated the relationship between aggression and brain networks. They revealed a positive correlation between VMPFC connectivity and aggression in right angular gyrus (AG) and a negative correlation in right SMG in the MAOA-L group. No such effect emerged in the MAOA-H carriers. The results indicate a particular relevance of VMPFC for aggression in MAOA-L carriers; in specific, a detachment from the DMN along with a strengthened coupling to the AG seems to go along with lower trait aggression. MAOA-L carriers may thus depend on a synchronization of emotion regulation systems (VMPFC) with core areas of empathy (SMG) to prevent aggression.
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Affiliation(s)
- Martin Klasen
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Medical School, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany.
- JARA-Translational Brain Medicine, RWTH Aachen University, 52074, Aachen, Germany.
| | - Dhana Wolf
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Medical School, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany
- JARA-Translational Brain Medicine, RWTH Aachen University, 52074, Aachen, Germany
| | - Patrick D Eisner
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Medical School, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany
- JARA-Translational Brain Medicine, RWTH Aachen University, 52074, Aachen, Germany
| | - Ute Habel
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Medical School, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany
- JARA-Translational Brain Medicine, RWTH Aachen University, 52074, Aachen, Germany
| | - Jonathan Repple
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Medical School, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany
- JARA-Translational Brain Medicine, RWTH Aachen University, 52074, Aachen, Germany
- Department of Psychiatry and Psychotherapy, University of Muenster, 48149, Münster, Germany
| | - Ingo Vernaleken
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Medical School, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany
- JARA-Translational Brain Medicine, RWTH Aachen University, 52074, Aachen, Germany
| | - Thorben Schlüter
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Medical School, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany
- JARA-Translational Brain Medicine, RWTH Aachen University, 52074, Aachen, Germany
| | - Thomas Eggermann
- Institute of Human Genetics, Medical School, RWTH Aachen University, 52074, Aachen, Germany
| | - Klaus Zerres
- Institute of Human Genetics, Medical School, RWTH Aachen University, 52074, Aachen, Germany
| | - Florian D Zepf
- JARA-Translational Brain Medicine, RWTH Aachen University, 52074, Aachen, Germany
- Centre & Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; School of Medicine, Division of Paediatrics and Child Health & Division of Psychiatry and Clinical Neurosciences, The University of Western Australia, Perth, Australia
- Specialised Child and Adolescent Mental Health Services, Department of Health in Western Australia, Perth, Australia
| | - Klaus Mathiak
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Medical School, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany
- JARA-Translational Brain Medicine, RWTH Aachen University, 52074, Aachen, Germany
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22
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Mahfouda S, Moore JK, Siafarikas A, Zepf FD, Lin A. Puberty suppression in transgender children and adolescents. Lancet Diabetes Endocrinol 2017; 5:816-826. [PMID: 28546095 DOI: 10.1016/s2213-8587(17)30099-2] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 03/14/2017] [Accepted: 03/14/2017] [Indexed: 12/22/2022]
Abstract
The World Professional Association for Transgender Health's standards of care recommend suspending puberty, preferably with the use of gonadotropin-releasing hormone agonists, in certain gender non-conforming minors (aged under 18 years) who have undergone a psychiatric assessment and have reached at least Tanner stage II of puberty. This approach seeks to lessen the discordance between assigned natal sex and gender identity by temporarily halting the development of secondary sexual characteristics, essentially widening the temporal window for gender clarification. Despite promising preliminary evidence on the clinical utility of this approach, there is a dearth of research to inform evidence-based practice. In view of these challenges, we review the available empirical evidence on the cognitive, physical, and surgical implications of puberty suppression in gender-incongruent children and adolescents. We also explore the historical underpinnings and clinical impetus for suspending puberty in this population, and propose key research priorities.
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Affiliation(s)
- Simone Mahfouda
- Centre and Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Division of Psychiatry and Clinical Neurosciences and Division of Paediatrics and Child Health, School of Medicine, Faculty of Health and Medical Sciences, University of Western Australia, Perth, WA, Australia; Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
| | - Julia K Moore
- Centre and Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Division of Psychiatry and Clinical Neurosciences and Division of Paediatrics and Child Health, School of Medicine, Faculty of Health and Medical Sciences, University of Western Australia, Perth, WA, Australia; Gender Diversity Service, Acute Child and Adolescent Mental Health Service, Child and Adolescent Health Service, Perth, WA, Australia
| | - Aris Siafarikas
- Telethon Kids Institute, University of Western Australia, Perth, WA, Australia; Department of Endocrinology and Diabetes, Princess Margaret Hospital, Perth, WA, Australia; Division of Paediatrics and Child Health, School of Medicine, Faculty of Health and Medical Sciences, University of Western Australia, Perth, WA, Australia; Institute for Health Research, University of Notre Dame, Fremantle, WA, Australia
| | - Florian D Zepf
- Centre and Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Division of Psychiatry and Clinical Neurosciences and Division of Paediatrics and Child Health, School of Medicine, Faculty of Health and Medical Sciences, University of Western Australia, Perth, WA, Australia; Telethon Kids Institute, University of Western Australia, Perth, WA, Australia; Specialised Child and Adolescent Mental Health Services, Department of Health in Western Australia, Perth, WA, Australia.
| | - Ashleigh Lin
- Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
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23
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Affiliation(s)
- K Runions
- Centre & Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Medicine, Dentistry and Health Sciences, School of Medicine, Division of Psychiatry and Clinical Neurosciences & Division of Paediatrics and Child Health, The University of Western Australia, Perth, WA, Australia.,Telethon Kids Institute, Perth, WA, Australia
| | - P Rao
- Centre & Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Medicine, Dentistry and Health Sciences, School of Medicine, Division of Psychiatry and Clinical Neurosciences & Division of Paediatrics and Child Health, The University of Western Australia, Perth, WA, Australia.,Department of Health in Western Australia, Community Child & Adolescent Mental Health Services, Perth, WA, Australia
| | - J W Y Wong
- Centre & Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Medicine, Dentistry and Health Sciences, School of Medicine, Division of Psychiatry and Clinical Neurosciences & Division of Paediatrics and Child Health, The University of Western Australia, Perth, WA, Australia.,Telethon Kids Institute, Perth, WA, Australia.,Department of Health in Western Australia, Specialised Child and Adolescent Mental Health Services (CAMHS), Perth, WA, Australia
| | - F D Zepf
- Centre & Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Medicine, Dentistry and Health Sciences, School of Medicine, Division of Psychiatry and Clinical Neurosciences & Division of Paediatrics and Child Health, The University of Western Australia, Perth, WA, Australia.,Telethon Kids Institute, Perth, WA, Australia.,Department of Health in Western Australia, Specialised Child and Adolescent Mental Health Services (CAMHS), Perth, WA, Australia
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24
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Zepf FD, Rao P, Runions K, Stewart RM, Moore JK, Wong JW, Linden M, Sungurtekin I, Glass F, Gut L, Peetz D, Hintereder G, Schaab M, Poustka F, Wöckel L. Differences in serum zinc levels in acutely ill and remitted adolescents and young adults with bulimia nervosa in comparison with healthy controls - a cross-sectional pilot study. Neuropsychiatr Dis Treat 2017; 13:2621-2630. [PMID: 29089768 PMCID: PMC5655160 DOI: 10.2147/ndt.s137549] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 11/23/2022] Open
Abstract
BACKGROUND Research has implicated that changes in zinc (Zn) metabolism may be associated with the biological underpinnings of eating disorders, in particular anorexia nervosa. However, to date research on the role of Zn in patients with bulimia nervosa (BN) is scarce. OBJECTIVE We aimed to explore serum Zn concentrations in young patients with BN, with a focus on the stage of the disorder, comparing acutely ill and recovered patients with BN with healthy controls. METHODS Serum Zn concentrations were obtained from healthy controls and from acutely ill and remitted young patients with BN. Mean duration of remission was 4.0±3.5 years. RESULTS Remitted patients showed elevated serum Zn concentrations when compared to controls (Cohen's d=2.022), but concentrations were still in the normal range. Acutely ill patients also had higher serum Zn levels when compared to controls (all values still being within the reference range, Cohen's d=0.882). There was no difference between acutely ill and remitted patients with BN in serum Zn concentrations. Of note, remitted patients had a significantly higher body weight when compared to the other two groups. Overall, there were no significant differences in dietary preferences with regard to Zn containing foods between the groups. CONCLUSION The present study provides preliminary evidence that the underlying factors for changes in Zn serum concentrations in young patients with BN do not vary with regard to the stage of illness (acute versus remitted BN). Further prospective research is needed in order to disentangle the possible interplay between serum Zn status and bulimic eating behaviors.
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Affiliation(s)
- Florian D Zepf
- Centre and Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Western Australia.,Specialised Child and Adolescent Mental Health Services (CAMHS), Department of Health in Western Australia
| | - Pradeep Rao
- Centre and Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Western Australia.,Community Child and Adolescent Mental Health Services, Department of Health in Western Australia
| | - Kevin Runions
- Community Child and Adolescent Mental Health Services, Department of Health in Western Australia.,Telethon Kids Institute, University of Western Australia
| | - Richard M Stewart
- Centre and Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Western Australia
| | - Julia K Moore
- Centre and Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Western Australia.,Paediatric Consultation-Liaison Program, Child and Adolescent Mental Health Services, Department of Health in Western Australia, Perth, WA, Australia
| | - Janice Wy Wong
- Centre and Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Western Australia.,Telethon Kids Institute, University of Western Australia
| | - Maike Linden
- Centre and Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Western Australia.,Specialised Child and Adolescent Mental Health Services (CAMHS), Department of Health in Western Australia.,Clinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, RWTH Aachen University, Aachen
| | - Idil Sungurtekin
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Mannheim
| | - Franziska Glass
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Goethe University, Frankfurt am Main
| | - Linda Gut
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Goethe University, Frankfurt am Main
| | - Dirk Peetz
- Institute of Laboratory Medicine, HELIOS Klinikum Berlin-Buch, Berlin.,Department of Clinical Chemistry and Laboratory Medicine, University Center of the Johannes Gutenberg University Mainz, Mainz
| | - Gudrun Hintereder
- Department of Laboratory Medicine, Goethe University, Frankfurt am Main
| | - Michael Schaab
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University of Leipzig, Leipzig, Germany
| | - Fritz Poustka
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Goethe University, Frankfurt am Main
| | - Lars Wöckel
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Goethe University, Frankfurt am Main.,Center of Child and Adolescent Psychiatry and Psychotherapy, Clienia Littenheid AG, Littenheid, Switzerland
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25
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Albrecht JS, Bubenzer-Busch S, Gallien A, Knospe EL, Gaber TJ, Zepf FD. Effects of a structured 20-session slow-cortical-potential-based neurofeedback program on attentional performance in children and adolescents with attention-deficit hyperactivity disorder: retrospective analysis of an open-label pilot-approach and 6-month follow-up. Neuropsychiatr Dis Treat 2017; 13:667-683. [PMID: 28293109 PMCID: PMC5342612 DOI: 10.2147/ndt.s119694] [Citation(s) in RCA: 7] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The aim of this approach was to conduct a structured electroencephalography-based neurofeedback training program for children and adolescents with attention-deficit hyperactivity disorder (ADHD) using slow cortical potentials with an intensive first (almost daily sessions) and second phase of training (two sessions per week) and to assess aspects of attentional performance. PATIENTS AND METHODS A total of 24 young patients with ADHD participated in the 20-session training program. During phase I of training (2 weeks, 10 sessions), participants were trained on weekdays. During phase II, neurofeedback training occurred twice per week (5 weeks). The patients' inattention problems were measured at three assessment time points before (pre, T0) and after (post, T1) the training and at a 6-month follow-up (T2); the assessments included neuropsychological tests (Alertness and Divided Attention subtests of the Test for Attentional Performance; Sustained Attention Dots and Shifting Attentional Set subtests of the Amsterdam Neuropsychological Test) and questionnaire data (inattention subscales of the so-called Fremdbeurteilungsbogen für Hyperkinetische Störungen and Child Behavior Checklist/4-18 [CBCL/4-18]). All data were analyzed retrospectively. RESULTS The mean auditive reaction time in a Divided Attention task decreased significantly from T0 to T1 (medium effect), which was persistent over time and also found for a T0-T2 comparison (larger effects). In the Sustained Attention Dots task, the mean reaction time was reduced from T0-T1 and T1-T2 (small effects), whereas in the Shifting Attentional Set task, patients were able to increase the number of trials from T1-T2 and significantly diminished the number of errors (T1-T2 & T0-T2, large effects). CONCLUSION First positive but very small effects and preliminary results regarding different parameters of attentional performance were detected in young individuals with ADHD. The limitations of the obtained preliminary data are the rather small sample size, the lack of a control group/a placebo condition and the open-label approach because of the clinical setting and retrospective analysis. The value of the current approach lies in providing pilot data for future studies involving larger samples.
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Affiliation(s)
- Johanna S Albrecht
- Clinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, RWTH Aachen University, Aachen; JARA Translational Brain Medicine, Aachen & Jülich; Center for Pediatrics and Adolescent Medicine Elisabeth Hospital Rheydt, Mönchengladbach
| | - Sarah Bubenzer-Busch
- Clinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, RWTH Aachen University, Aachen; JARA Translational Brain Medicine, Aachen & Jülich
| | - Anne Gallien
- Clinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, RWTH Aachen University, Aachen; Clinic for Neurology, Medical Center City Region Aachen, Würselen
| | - Eva Lotte Knospe
- Clinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, RWTH Aachen University, Aachen; JARA Translational Brain Medicine, Aachen & Jülich
| | - Tilman J Gaber
- Clinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, RWTH Aachen University, Aachen; JARA Translational Brain Medicine, Aachen & Jülich; NeuroCare Group, Munich, Germany
| | - Florian D Zepf
- Clinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, RWTH Aachen University, Aachen; JARA Translational Brain Medicine, Aachen & Jülich; Centre and Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, School of Paediatrics and Child Health & School of Psychiatry and Clinical Neurosciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Western Australia; Department of Health in Western Australia, Specialised Child and Adolescent Mental Health Services, Perth, WA, Australia
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26
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Borgs GP, Runions K, Biskup CS, Königschulte W, Rao P, Wong J, Moore J, Stewart RM, Zepf FD. Reactive aggression in young patients with ADHD-a critical role for small provocations. Acta Psychiatr Scand 2016; 134:566-568. [PMID: 27869991 DOI: 10.1111/acps.12661] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- G P Borgs
- Clinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, RWTH Aachen University, Aachen, Germany
| | - K Runions
- Centre & Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Medicine, Dentistry and Health Sciences, School of Psychiatry and Clinical Neurosciences & School of Paediatrics and Child Health, The University of Western Australia, Perth, WA, Australia.,Telethon Kids Institute, Perth, WA, Australia
| | - C S Biskup
- Clinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, RWTH Aachen University, Aachen, Germany
| | - W Königschulte
- Clinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, RWTH Aachen University, Aachen, Germany
| | - P Rao
- Centre & Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Medicine, Dentistry and Health Sciences, School of Psychiatry and Clinical Neurosciences & School of Paediatrics and Child Health, The University of Western Australia, Perth, WA, Australia.,Department of Health in Western Australia, Community Child & Adolescent Mental Health Services, Perth, WA, Australia
| | - J Wong
- Centre & Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Medicine, Dentistry and Health Sciences, School of Psychiatry and Clinical Neurosciences & School of Paediatrics and Child Health, The University of Western Australia, Perth, WA, Australia
| | - J Moore
- Centre & Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Medicine, Dentistry and Health Sciences, School of Psychiatry and Clinical Neurosciences & School of Paediatrics and Child Health, The University of Western Australia, Perth, WA, Australia.,Department of Health in Western Australia, Paediatric Consultation Liaison Program, Perth, WA, Australia
| | - R M Stewart
- Centre & Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Medicine, Dentistry and Health Sciences, School of Psychiatry and Clinical Neurosciences & School of Paediatrics and Child Health, The University of Western Australia, Perth, WA, Australia
| | - F D Zepf
- Centre & Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Medicine, Dentistry and Health Sciences, School of Psychiatry and Clinical Neurosciences & School of Paediatrics and Child Health, The University of Western Australia, Perth, WA, Australia.,Telethon Kids Institute, Perth, WA, Australia.,Department of Health in Western Australia, Specialised Child and Adolescent Mental Health Services (CAMHS), Perth, WA, Australia
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27
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Wang B, Isensee C, Becker A, Wong J, Eastwood PR, Huang RC, Runions KC, Stewart RM, Meyer T, Brüni LG, Zepf FD, Rothenberger A. Developmental Trajectories of Sleep Problems from Childhood to Adolescence Both Predict and Are Predicted by Emotional and Behavioral Problems. Front Psychol 2016; 7:1874. [PMID: 27990129 PMCID: PMC5131000 DOI: 10.3389/fpsyg.2016.01874] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [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: 09/03/2016] [Accepted: 11/14/2016] [Indexed: 12/02/2022] Open
Abstract
Although the prevalence rates of sleep disorders at different stages of childhood and adolescence have been well established, little is known about the developmental course of general sleep problems. This also holds true for the bidirectional relationship between sleep problems and emotional as well as behavioral difficulties. This longitudinal study investigated the general pattern and the latent trajectory classes of general sleep problems from a large community sample aged 5–14 years. In addition, this study examined the predictive value of emotional/behavioral difficulties (i.e., anxiety/depression, attention problems, and aggressive behavior) on sleep problems latent trajectory classes, and vice-versa. Participants (N = 1993) were drawn from a birth cohort of Western Australian children born between 1989 and 1991 who were followed until 14 years of age. Sleep problems were assessed at ages 5, 8, 10, and 14, respectively, whereas anxiety/depression, attention problems, and aggressive behavior were assessed at ages 5 and 17 years. Latent growth curve modeling revealed a decline in an overall pattern of sleep problems during the observed 10-year period. Anxiety/depression was the only baseline factor that predicted the longitudinal course of sleep problems from ages 5 to 14 years, with anxious and depressed participants showing faster decreasing patterns of sleep problems over time than those without anxiety or depression. Growth mixture modeling identified two classes of sleep problem trajectories: Normal Sleepers (89.4%) and Troubled Sleepers (10.6%). Gender was randomly distributed between these groups. Childhood attention problems, aggressive behavior, and the interaction between gender and anxiety/depression were significantly predictive of membership in the group of Troubled Sleepers. Group membership in Troubled Sleepers was associated with higher probability of having attention problems and aggressive behavior in mid-adolescence. Boys and girls with behavioral difficulties, and girls with emotional difficulties were at increased risk of having sleep problems during later childhood and adolescence. Developmental trajectories of sleep problems were also predictive of behavioral difficulties in later life. Findings from this study provide empirical evidence for the heterogeneity of sleep problems and their development, and emphasize the importance of understanding sleep problems and their relationship to children and adolescents’ mental health.
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Affiliation(s)
- Biyao Wang
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center of Goettingen Goettingen, Germany
| | - Corinna Isensee
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center of Goettingen Goettingen, Germany
| | - Andreas Becker
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center of Goettingen Goettingen, Germany
| | - Janice Wong
- Centre and Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, The University of Western Australia, Perth WA, Australia
| | - Peter R Eastwood
- Centre for Sleep Science, School of Anatomy, Physiology and Human Biology, The University of Western Australia, Perth WA, Australia
| | | | - Kevin C Runions
- Centre and Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, The University of Western Australia, Perth WA, Australia
| | - Richard M Stewart
- Centre and Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, The University of Western Australia, Perth WA, Australia
| | - Thomas Meyer
- Department of Psychosomatic Medicine and Psychotherapy, German Centre for Cardiovascular Research, University of Goettingen Goettingen, Germany
| | - L G Brüni
- Child and Adolescent Psychiatry, Psychiatry Services Thurgau Frauenfeld, Switzerland
| | - Florian D Zepf
- Centre and Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, The University of Western Australia, PerthWA, Australia; Specialised Child and Adolescent Mental Health Services, Department of Health, PerthWA, Australia
| | - Aribert Rothenberger
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center of Goettingen Goettingen, Germany
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28
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Rao P, Moore JK, Stewart R, Runions K, Bear N, Wong JWY, Holtmann M, Zepf FD. Bipolar disorder in children and adolescents: diagnostic inpatient rates from 2000 to 2013 in Germany. Int J Bipolar Disord 2016; 4:23. [PMID: 27837521 PMCID: PMC5106426 DOI: 10.1186/s40345-016-0064-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 08/13/2016] [Accepted: 10/23/2016] [Indexed: 11/14/2022] Open
Abstract
Background Despite growing consensus on nosology and epidemiology of bipolar disorder (BD) in minors, differences remain. We contribute to this discussion by measuring long-term trends in the inpatient discharge rates of BD in minors. Methods Nationwide German inpatient discharge diagnoses of BD and other related psychiatric disorders were mapped between 2008 and 2013 using registry data from the German Federal Health Monitoring System. This was compared with previously published data, 2000–2007, to assess long-term trends in diagnosis of BD at discharge. Long-term trends (2000–2013) were also computed. Results Discharge diagnosis of BD increased by 18% (2.02–2.46 per 100,000) in minors. There was a significant increase of 24.1% in adolescents 15–19 years old (6.56–8.14 per 100,000). BD, at discharge, as a proportion of all psychiatric disorders, increased from 0.26% in 2008 to 0.27% in 2013. When analysing long-term trends (2000–2013), the rates for BD increased significantly as did trends for all mental disorders, except for psychotic disorders, which fell by almost 14%. Between 2000 and 2013, the rate for depression in minors increased by 730%. Limitations The dataset consisted of cross-sectional administrative data points with diagnoses based on clinical criteria. Conclusions The rate of BD as a discharge diagnosis in German minors has increased significantly, consistently exceeding the general trend for a rise in rates for mental disorders. Overall, the rate of discharge diagnosis of BD from inpatient units in Germany remains a small proportion of all psychiatric diagnoses.
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Affiliation(s)
- Pradeep Rao
- Centre & Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; School of Psychiatry and Clinical Neurosciences & School of Paediatrics and Child Health; Faculty of Medicine, Dentistry and Health Sciences, The University of Western Australia, Perth, Australia. .,Department of Health, Western Australia, Community Child and Adolescent Mental Health Services, Perth, WA, Australia.
| | - Julie K Moore
- Centre & Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; School of Psychiatry and Clinical Neurosciences & School of Paediatrics and Child Health; Faculty of Medicine, Dentistry and Health Sciences, The University of Western Australia, Perth, Australia.,Paediatric Consultation-Liaison Program, Department of Health, Western Australia, Child and Adolescent Mental Health Services, Perth, WA, Australia
| | - Richard Stewart
- Centre & Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; School of Psychiatry and Clinical Neurosciences & School of Paediatrics and Child Health; Faculty of Medicine, Dentistry and Health Sciences, The University of Western Australia, Perth, Australia
| | - Kevin Runions
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - Natasha Bear
- Telethon Kids Institute, The University of Western Australia, Perth, Australia.,Department of Clinical Research and Education, Child and Adolescent Health Service, Department of Health, Western Australia, Perth, WA, Australia
| | - Janice W Y Wong
- Centre & Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; School of Psychiatry and Clinical Neurosciences & School of Paediatrics and Child Health; Faculty of Medicine, Dentistry and Health Sciences, The University of Western Australia, Perth, Australia.,Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - Martin Holtmann
- Hospital for Child and Adolescent Psychiatry, LWL University Hospital of the Ruhr University Bochum, Hamm, Germany
| | - Florian D Zepf
- Centre & Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; School of Psychiatry and Clinical Neurosciences & School of Paediatrics and Child Health; Faculty of Medicine, Dentistry and Health Sciences, The University of Western Australia, Perth, Australia.,Telethon Kids Institute, The University of Western Australia, Perth, Australia.,Department of Health in Western Australia, Specialised Child and Adolescent Mental Health Services (CAMHS), Perth, Australia
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29
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Biskup CS, Helmbold K, Baurmann D, Klasen M, Gaber TJ, Bubenzer-Busch S, Königschulte W, Fink GR, Zepf FD. Resting state default mode network connectivity in children and adolescents with ADHD after acute tryptophan depletion. Acta Psychiatr Scand 2016; 134:161-71. [PMID: 27145324 DOI: 10.1111/acps.12573] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [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] [Accepted: 02/25/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Alterations of the default mode network (DMN) have been described in patients with neuropsychiatric disorders, including attention deficit hyperactivity disorder (ADHD), and the neurotransmitter serotonin (5-HT) is known to modulate DMN activity. This study aimed to explore the role of 5-HT on the DMN and its functional connectivity (FC) in young patients with ADHD. METHODS Young male patients with ADHD (n = 12) and healthy controls (n = 10) (both aged 12-17 years) were subjected to acute tryptophan depletion (ATD) and subsequently diminished brain 5-HT synthesis. Three hours after challenge intake (ATD or a balanced control condition, BAL), resting state fMRI scans were obtained. RESULTS In patients, ATD led to attenuated FC of the right superior premotor cortex (BA 6) with the DMN, comparable to the extent found in controls after BAL administration. ATD lowered FC of the left somatosensory cortex (BA 3) with the DMN, independently of the factor group, but with stronger effects in controls. CONCLUSIONS Data reveal a serotonergic modulation of FC between BA 6 and 3, known to be relevant for motor planning and sensory perception, and the DMN, thereby possibly pointing toward ATD acting beneficially on neural planning of motor activity in patients with ADHD.
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Affiliation(s)
- C S Biskup
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, RWTH Aachen University, Aachen, Germany.,JARA Translational Brain Medicine, Aachen & Jülich, Germany.,Cognitive Neuroscience, Institute for Neuroscience and Medicine (INM3), Research Centre Jülich, Jülich, Germany
| | - K Helmbold
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, RWTH Aachen University, Aachen, Germany.,JARA Translational Brain Medicine, Aachen & Jülich, Germany
| | - D Baurmann
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, RWTH Aachen University, Aachen, Germany.,JARA Translational Brain Medicine, Aachen & Jülich, Germany.,Cognitive Neuroscience, Institute for Neuroscience and Medicine (INM3), Research Centre Jülich, Jülich, Germany
| | - M Klasen
- Department of Psychiatry, Psychosomatics and Psychotherapy, RWTH Aachen University, Aachen, Germany
| | - T J Gaber
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, RWTH Aachen University, Aachen, Germany.,JARA Translational Brain Medicine, Aachen & Jülich, Germany
| | - S Bubenzer-Busch
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, RWTH Aachen University, Aachen, Germany.,JARA Translational Brain Medicine, Aachen & Jülich, Germany.,Cognitive Neuroscience, Institute for Neuroscience and Medicine (INM3), Research Centre Jülich, Jülich, Germany
| | - W Königschulte
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, RWTH Aachen University, Aachen, Germany.,JARA Translational Brain Medicine, Aachen & Jülich, Germany.,Cognitive Neuroscience, Institute for Neuroscience and Medicine (INM3), Research Centre Jülich, Jülich, Germany
| | - G R Fink
- Cognitive Neuroscience, Institute for Neuroscience and Medicine (INM3), Research Centre Jülich, Jülich, Germany.,Department of Neurology, University of Cologne, Cologne, Germany
| | - F D Zepf
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, RWTH Aachen University, Aachen, Germany.,JARA Translational Brain Medicine, Aachen & Jülich, Germany.,Cognitive Neuroscience, Institute for Neuroscience and Medicine (INM3), Research Centre Jülich, Jülich, Germany.,Centre & Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; School of Psychiatry and Clinical Neurosciences & School of Paediatrics and Child Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Western Australia, Perth, WA, Australia.,Specialised Child and Adolescent Mental Health Services (CAMHS), Department of Health in Western Australia, Perth, WA, Australia
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30
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Bubenzer-Busch S, Herpertz-Dahlmann B, Kuzmanovic B, Gaber TJ, Helmbold K, Ullisch MG, Baurmann D, Eickhoff SB, Fink GR, Zepf FD. Neural correlates of reactive aggression in children with attention-deficit/hyperactivity disorder and comorbid disruptive behaviour disorders. Acta Psychiatr Scand 2016; 133:310-23. [PMID: 26292852 DOI: 10.1111/acps.12475] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [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] [Accepted: 07/09/2015] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Attention deficit hyperactivity disorder (ADHD) is often linked with impulsive and aggressive behaviour, indexed by high comorbidity rates between ADHD and disruptive behaviour disorders (DBD). The present study aimed to investigate underlying neural activity of reactive aggression in children with ADHD and comorbid DBD using functional neuroimaging techniques (fMRI). METHOD Eighteen boys with ADHD (age 9-14 years, 10 subjects with comorbid DBD) and 18 healthy controls were administered a modified fMRI-based version of the 'Point Subtraction Aggression Game' to elicit reactive aggressive behaviour. Trials consisted of an 'aggression phase' (punishment for a fictitious opponent) and an 'outcome phase' (presentation of the trial outcome). RESULTS During the aggression phase, higher aggressive responses of control children were accompanied by higher activation of the ventral anterior cingulate cortex and the temporoparietal junction. Patients displayed inverted results. During the outcome phase, comparison between groups and conditions showed differential activation in the dorsal striatum and bilateral insular when subjects gained points. Losing points was accompanied by differential activation of regions belonging to the insula and the middle temporal sulcus. CONCLUSION Data support the hypothesis that deficient inhibitory control mechanisms are related to increased impulsive aggressive behaviour in young people with ADHD and comorbid DBD.
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Affiliation(s)
- S Bubenzer-Busch
- Clinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, RWTH Aachen University, Aachen, Germany.,Institute of Neuroscience and Medicine (INM-3), Cognitive Neuroscience, Jülich Research Centre, Jülich, Germany.,JARA Translational Brain Medicine, Aachen, Jülich, Germany
| | - B Herpertz-Dahlmann
- Clinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, RWTH Aachen University, Aachen, Germany.,JARA Translational Brain Medicine, Aachen, Jülich, Germany
| | - B Kuzmanovic
- Institute of Neuroscience and Medicine (INM-8), Ethics in the Neurosciences, Jülich Research Centre, Jülich, Germany.,Department of Psychiatry and Psychotherapy, Neuroimaging Lab, University Hospital Cologne, Cologne, Germany
| | - T J Gaber
- Clinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, RWTH Aachen University, Aachen, Germany.,JARA Translational Brain Medicine, Aachen, Jülich, Germany
| | - K Helmbold
- Clinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, RWTH Aachen University, Aachen, Germany.,JARA Translational Brain Medicine, Aachen, Jülich, Germany
| | - M G Ullisch
- Institute of Neuroscience and Medicine (INM-4), Medical Imaging Physics, Jülich Research Centre, Jülich, Germany.,Interdisciplinary Nanoscience Center, iNANO, University of Aarhus, Aarhus, Denmark
| | - D Baurmann
- Clinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, RWTH Aachen University, Aachen, Germany.,Institute of Neuroscience and Medicine (INM-3), Cognitive Neuroscience, Jülich Research Centre, Jülich, Germany.,JARA Translational Brain Medicine, Aachen, Jülich, Germany
| | - S B Eickhoff
- Institute of Clinical Neuroscience and Medical Psychology, Heinrich-Heine University, Düsseldorf, Germany.,Institute of Neuroscience and Medicine (INM-1), Institute of Clinical Neuroscience and Medical Psychology - Brain Network Modeling Group, Jülich Research Centre, Jülich, Germany
| | - G R Fink
- Institute of Neuroscience and Medicine (INM-3), Cognitive Neuroscience, Jülich Research Centre, Jülich, Germany.,Department of Neurology, University of Cologne, Cologne, Germany
| | - F D Zepf
- Clinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, RWTH Aachen University, Aachen, Germany.,Institute of Neuroscience and Medicine (INM-3), Cognitive Neuroscience, Jülich Research Centre, Jülich, Germany.,JARA Translational Brain Medicine, Aachen, Jülich, Germany.,Department of Child and Adolescent Psychiatry, Faculty of Medicine, Dentistry and Health Sciences, School of Psychiatry and Clinical Neurosciences & School of Pediatrics and Child Health, The University of Western Australia, Perth, WA, Australia.,Specialised Child and Adolescent Mental Health Services (CAMHS), Department of Health in Western Australia, Perth, WA, Australia
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Zepf FD, Stewart RM. Inflammation, immunity and suicidality: a potential role for autoantibodies against neurotransmitters and antiphospholipid syndrome? Acta Psychiatr Scand 2016; 133:249-50. [PMID: 26456155 DOI: 10.1111/acps.12508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- F D Zepf
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Dentistry and Health Sciences, School of Psychiatry and Clinical Neurosciences & School of Paediatrics and Child Health, The University of Western Australia, Perth, WA, Australia. .,Department of Health in Western Australia, Specialised Child and Adolescent Mental Health Services (CAMHS), Perth, WA, Australia.
| | - R M Stewart
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Dentistry and Health Sciences, School of Psychiatry and Clinical Neurosciences & School of Paediatrics and Child Health, The University of Western Australia, Perth, WA, Australia
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Runions KC, Stewart RM, Moore J, Martinez Ladino Y, Rao P, Zepf FD. Disruptive mood dysregulation disorder in ICD-11: a new disorder or ODD with a specifier for chronic irritability? Eur Child Adolesc Psychiatry 2016; 25:331-2. [PMID: 26578258 DOI: 10.1007/s00787-015-0789-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 10/22/2015] [Indexed: 10/22/2022]
Affiliation(s)
| | - R M Stewart
- Department of Child and Adolescent Psychiatry, The University of Western Australia, 35 Stirling Highway (M561), Crawley, Perth, WA, 6840, Australia
| | - J Moore
- Department of Child and Adolescent Psychiatry, The University of Western Australia, 35 Stirling Highway (M561), Crawley, Perth, WA, 6840, Australia
| | - Y Martinez Ladino
- Department of Child and Adolescent Psychiatry, The University of Western Australia, 35 Stirling Highway (M561), Crawley, Perth, WA, 6840, Australia
| | - P Rao
- Department of Child and Adolescent Psychiatry, The University of Western Australia, 35 Stirling Highway (M561), Crawley, Perth, WA, 6840, Australia
| | - F D Zepf
- Department of Child and Adolescent Psychiatry, The University of Western Australia, 35 Stirling Highway (M561), Crawley, Perth, WA, 6840, Australia. .,Specialised Child and Adolescent Mental Health Services (CAMHS), Department of Health in Western Australia, Perth, WA, Australia.
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Zepf FD, Stewart RM, Hood S, Guillemin GJ. Great expectations: Nutritional medicine as a mainstream in clinical psychiatry and weighing opportunities against risks. Med Hypotheses 2016; 88:68-9. [PMID: 26880642 DOI: 10.1016/j.mehy.2016.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 01/19/2016] [Indexed: 11/19/2022]
Affiliation(s)
- F D Zepf
- Department of Child and Adolescent Psychiatry, School of Psychiatry and Clinical Neurosciences & School of Paediatrics and Child Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Western Australia, Perth, WA, Australia; Specialised Child and Adolescent Mental Health Services (CAMHS), Department of Health in Western Australia, Perth, WA, Australia.
| | - R M Stewart
- Department of Child and Adolescent Psychiatry, School of Psychiatry and Clinical Neurosciences & School of Paediatrics and Child Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Western Australia, Perth, WA, Australia
| | - S Hood
- School of Psychiatry and Clinical Neurosciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Western Australia, Perth, WA, Australia
| | - G J Guillemin
- Neuropharmacology Group, MND and Neurodegenerative Diseases Research Centre, Macquarie University, Sydney, NSW, Australia
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Rao P, Moore JK, Stewart R, Hood SD, Runions K, Zepf FD. Diagnostic inexactitude - Reframing and relabelling Disruptive Mood Dysregulation Disorder for ICD-11 does not solve the problem. Med Hypotheses 2015; 85:1035-6. [PMID: 26545314 DOI: 10.1016/j.mehy.2015.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 09/18/2015] [Accepted: 10/11/2015] [Indexed: 11/26/2022]
Affiliation(s)
- P Rao
- Department of Child and Adolescent Psychiatry, School of Psychiatry and Clinical Neurosciences & School of Paediatrics and Child Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Western Australia (M561), Perth, WA 6009, Australia; Community Child and Adolescent Mental Health Services, Department of Health in Western Australia, Perth, WA, Australia
| | - J K Moore
- Department of Child and Adolescent Psychiatry, School of Psychiatry and Clinical Neurosciences & School of Paediatrics and Child Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Western Australia (M561), Perth, WA 6009, Australia; Paediatric Consultation-Liaison Program, Child and Adolescent Mental Health Services, Department of Health in Western Australia, Perth, WA, Australia
| | - R Stewart
- Department of Child and Adolescent Psychiatry, School of Psychiatry and Clinical Neurosciences & School of Paediatrics and Child Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Western Australia (M561), Perth, WA 6009, Australia
| | - S D Hood
- School of Psychiatry and Clinical Neurosciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Western Australia, GPO Box D184, Perth, WA 6840, Australia
| | - K Runions
- Telethon Kids Institute, Perth, WA, Australia
| | - F D Zepf
- Department of Child and Adolescent Psychiatry, School of Psychiatry and Clinical Neurosciences & School of Paediatrics and Child Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Western Australia (M561), Perth, WA 6009, Australia; Specialised Child and Adolescent Mental Health Services (CAMHS), Department of Health in Western Australia, Perth, WA, Australia.
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35
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Sánchez CL, Van Swearingen AED, Arrant AE, Biskup CS, Kuhn CM, Zepf FD. Simplified dietary acute tryptophan depletion: effects of a novel amino acid mixture on the neurochemistry of C57BL/6J mice. Food Nutr Res 2015; 59:27424. [PMID: 26278978 PMCID: PMC4538305 DOI: 10.3402/fnr.v59.27424] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [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: 01/28/2015] [Revised: 06/24/2015] [Accepted: 06/24/2015] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Diet and nutrition can impact on the biological processes underpinning neuropsychiatric disorders. Amino acid (AA) mixtures lacking a specific neurotransmitter precursor can change the levels of brain serotonin (5-HT) or dopamine (DA) in the central nervous system. The availability of these substances within the brain is determined by the blood-brain barrier (BBB) that restricts the access of peripheral AA into the brain. AA mixtures lacking tryptophan (TRP) compete with endogenous TRP for uptake into the brain across the BBB, which in turn leads to a decrease in central nervous 5-HT synthesis. OBJECTIVE The present study compared the effects of a simplified acute tryptophan depletion (SATD) mixture in mice on blood and brain serotonergic and dopaminergic metabolites to those of a commonly used acute tryptophan depletion mixture (ATD Moja-De) and its TRP-balanced control (BAL). DESIGN The SATD formula is composed of only three large neutral AAs: phenylalanine (PHE), leucine (LEU), and isoleucine (ILE). BAL, ATD Moja-De, or SATD formulas were delivered to adult male C57BL/6J mice by gavage. TRP, monoamines, and their metabolites were quantified in blood and brain regions (hippocampus, frontal cortex, amygdala, caudate putamen, and nucleus accumbens). RESULTS Both ATD Moja-De and SATD significantly decreased levels of serum and brain TRP, as well as brain 5-HIAA and 5-HT compared with BAL. SATD reduced HVA levels in caudate but did not alter total DA levels or DOPAC. SATD decreased TRP and serotonergic metabolites comparably to ATD Moja-De administration. CONCLUSION A simplified and more palatable combination of AAs can manipulate serotonergic function and might be useful to reveal underlying monoamine-related mechanisms contributing to different neuropsychiatric disorders.
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Affiliation(s)
- Cristina L Sánchez
- Clinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, JARA Brain, RWTH Aachen University, Aachen, Germany.,Department of Pharmacology and Cancer Biology, Duke University Medical Center, Durham, NC, USA
| | | | - Andrew E Arrant
- Department of Pharmacology and Cancer Biology, Duke University Medical Center, Durham, NC, USA
| | - Caroline S Biskup
- Clinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, JARA Brain, RWTH Aachen University, Aachen, Germany
| | - Cynthia M Kuhn
- Department of Pharmacology and Cancer Biology, Duke University Medical Center, Durham, NC, USA
| | - Florian D Zepf
- Clinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, JARA Brain, RWTH Aachen University, Aachen, Germany.,Department of Child and Adolescent Psychiatry, School of Paediatrics and Child Health & School of Psychiatry and Clinical Neurosciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Western Australia, Perth, WA, Australia.,Specialised Child and Adolescent Mental Health Services (CAHMS), Department of Health, Perth, WA, Australia;
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36
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Gaber TJ, Dingerkus VLS, Crockett MJ, Bubenzer-Busch S, Helmbold K, Sánchez CL, Dahmen B, Herpertz-Dahlmann B, Zepf FD. Studying the effects of dietary body weight-adjusted acute tryptophan depletion on punishment-related behavioral inhibition. Food Nutr Res 2015; 59:28443. [PMID: 26268708 PMCID: PMC4534625 DOI: 10.3402/fnr.v59.28443] [Citation(s) in RCA: 9] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 06/22/2015] [Accepted: 06/23/2015] [Indexed: 12/15/2022] Open
Abstract
Background Alterations in serotonergic (5-HT) neurotransmission are thought to play a decisive role in affective disorders and impulse control. Objective This study aims to reproduce and extend previous findings on the effects of acute tryptophan depletion (ATD) and subsequently diminished central 5-HT synthesis in a reinforced categorization task using a refined body weight–adjusted depletion protocol. Design Twenty-four young healthy adults (12 females, mean age [SD]=25.3 [2.1] years) were subjected to a double-blind within-subject crossover design. Each subject was administered both an ATD challenge and a balanced amino acid load (BAL) in two separate sessions in randomized order. Punishment-related behavioral inhibition was assessed using a forced choice go/no-go task that incorporated a variable payoff schedule. Results Administration of ATD resulted in significant reductions in TRP measured in peripheral blood samples, indicating reductions of TRP influx across the blood–brain barrier and related brain 5-HT synthesis. Overall accuracy and response time performance were improved after ATD administration. The ability to adjust behavioral responses to aversive outcome magnitudes and behavioral adjustments following error contingent punishment remained intact after decreased brain 5-HT synthesis. A previously observed dissociation effect of ATD on punishment-induced inhibition was not observed. Conclusions Our results suggest that neurodietary challenges with ATD Moja–De have no detrimental effects on task performance and punishment-related inhibition in healthy adults.
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Affiliation(s)
- Tilman J Gaber
- Clinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, RWTH Aachen University, Aachen, Germany.,JARA Translational Brain Medicine, Aachen & Jülich, Germany
| | - Vita L S Dingerkus
- Clinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, RWTH Aachen University, Aachen, Germany
| | - Molly J Crockett
- Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom
| | - Sarah Bubenzer-Busch
- Clinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, RWTH Aachen University, Aachen, Germany.,JARA Translational Brain Medicine, Aachen & Jülich, Germany
| | - Katrin Helmbold
- Clinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, RWTH Aachen University, Aachen, Germany.,JARA Translational Brain Medicine, Aachen & Jülich, Germany
| | - Cristina L Sánchez
- Clinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, RWTH Aachen University, Aachen, Germany.,JARA Translational Brain Medicine, Aachen & Jülich, Germany
| | - Brigitte Dahmen
- Clinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, RWTH Aachen University, Aachen, Germany.,JARA Translational Brain Medicine, Aachen & Jülich, Germany
| | - Beate Herpertz-Dahlmann
- Clinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, RWTH Aachen University, Aachen, Germany.,JARA Translational Brain Medicine, Aachen & Jülich, Germany
| | - Florian D Zepf
- Clinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, RWTH Aachen University, Aachen, Germany.,JARA Translational Brain Medicine, Aachen & Jülich, Germany.,Institute for Neuroscience and Medicine, Jülich Research Centre, Jülich, Germany.,Department of Child and Adolescent Psychiatry, School of Psychiatry and Clinical Neurosciences & School of Paediatrics and Child Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Western Australia, Perth, Australia.,Specialised Child and Adolescent Mental Health Services (CAMHS), Department of Health in Western Australia, Perth, WA, Australia;
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37
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Cordes JS, Mathiak KA, Dyck M, Alawi EM, Gaber TJ, Zepf FD, Klasen M, Zvyagintsev M, Gur RC, Mathiak K. Cognitive and neural strategies during control of the anterior cingulate cortex by fMRI neurofeedback in patients with schizophrenia. Front Behav Neurosci 2015; 9:169. [PMID: 26161073 PMCID: PMC4480149 DOI: 10.3389/fnbeh.2015.00169] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [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: 11/15/2014] [Accepted: 06/15/2015] [Indexed: 11/13/2022] Open
Abstract
Cognitive functioning is impaired in patients with schizophrenia, leading to significant disabilities in everyday functioning. Its improvement is an important treatment target. Neurofeedback (NF) seems a promising method to address the neural dysfunctions underlying those cognitive impairments. The anterior cingulate cortex (ACC), a central hub for cognitive processing, is one of the brain regions known to be dysfunctional in schizophrenia. Here we conducted NF training based on real-time functional magnetic resonance imaging (fMRI) in patients with schizophrenia to enable them to control their ACC activity. Training was performed over 3 days in a group of 11 patients with schizophrenia and 11 healthy controls. Social feedback was provided in accordance with the evoked activity in the selected region of interest (ROI). Neural and cognitive strategies were examined off-line. Both groups learned to control the activity of their ACC but used different neural strategies: patients activated the dorsal and healthy controls the rostral subdivision. Patients mainly used imagination of music to elicit activity and the control group imagination of sports. In a stepwise regression analysis, the difference in neural control did not result from the differences in cognitive strategies but from diagnosis alone. Based on social reinforcers, patients with schizophrenia can learn to regulate localized brain activity. However, cognitive strategies and neural network location differ from healthy controls. These data emphasize that for therapeutic interventions in patients with schizophrenia compensatory strategies may emerge. Specific cognitive skills or specific dysfunctional networks should be addressed to train impaired skills. Social NF based on fMRI may be one method to accomplish precise learning targets.
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Affiliation(s)
- Julia S Cordes
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Medical School, RWTH Aachen University Aachen, Germany ; JARA-Translational Brain Medicine, RWTH Aachen University Aachen, Germany
| | - Krystyna A Mathiak
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Medical School, RWTH Aachen University Aachen, Germany ; JARA-Translational Brain Medicine, RWTH Aachen University Aachen, Germany ; Clinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, RWTH Aachen University Aachen, Germany
| | - Miriam Dyck
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Medical School, RWTH Aachen University Aachen, Germany ; JARA-Translational Brain Medicine, RWTH Aachen University Aachen, Germany
| | - Eliza M Alawi
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Medical School, RWTH Aachen University Aachen, Germany ; JARA-Translational Brain Medicine, RWTH Aachen University Aachen, Germany
| | - Tilman J Gaber
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Medical School, RWTH Aachen University Aachen, Germany ; Clinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, RWTH Aachen University Aachen, Germany
| | - Florian D Zepf
- JARA-Translational Brain Medicine, RWTH Aachen University Aachen, Germany ; Clinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, RWTH Aachen University Aachen, Germany ; Department of Child and Adolescent Psychiatry, School of Psychiatry and Clinical Neurosciences and School of Paediatrics and Child Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Western Australia (M561) Perth, WA, Australia ; Specialised Child and Adolescent Mental Health Services (CAMHS), Department of Health in Western Australia Perth, WA, Australia
| | - Martin Klasen
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Medical School, RWTH Aachen University Aachen, Germany ; JARA-Translational Brain Medicine, RWTH Aachen University Aachen, Germany
| | - Mikhail Zvyagintsev
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Medical School, RWTH Aachen University Aachen, Germany ; JARA-Translational Brain Medicine, RWTH Aachen University Aachen, Germany
| | - Ruben C Gur
- Department of Psychiatry, University of Pennsylvania Philadelphia, PA, USA
| | - Klaus Mathiak
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Medical School, RWTH Aachen University Aachen, Germany ; JARA-Translational Brain Medicine, RWTH Aachen University Aachen, Germany ; Institute of Psychiatry, Psychology and Neuroscience, King's College London London, UK
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Mathiak KA, Alawi EM, Koush Y, Dyck M, Cordes JS, Gaber TJ, Zepf FD, Palomero-Gallagher N, Sarkheil P, Bergert S, Zvyagintsev M, Mathiak K. Social reward improves the voluntary control over localized brain activity in fMRI-based neurofeedback training. Front Behav Neurosci 2015; 9:136. [PMID: 26089782 PMCID: PMC4452886 DOI: 10.3389/fnbeh.2015.00136] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [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: 11/14/2014] [Accepted: 05/11/2015] [Indexed: 11/17/2022] Open
Abstract
Neurofeedback (NF) based on real-time functional magnetic resonance imaging (rt-fMRI) allows voluntary regulation of the activity in a selected brain region. For the training of this regulation, a well-designed feedback system is required. Social reward may serve as an effective incentive in NF paradigms, but its efficiency has not yet been tested. Therefore, we developed a social reward NF paradigm and assessed it in comparison with a typical visual NF paradigm (moving bar). We trained twenty-four healthy participants, on three consecutive days, to control activation in dorsal anterior cingulate cortex (ACC) with fMRI-based NF. In the social feedback group, an avatar gradually smiled when ACC activity increased, whereas in the standard feedback group, a moving bar indicated the activation level. In order to assess a transfer of the NF training both groups were asked to up-regulate their brain activity without receiving feedback immediately before and after the NF training (pre- and post-test). Finally, the effect of the acquired NF training on ACC function was evaluated in a cognitive interference task (Simon task) during the pre- and post-test. Social reward led to stronger activity in the ACC and reward-related areas during the NF training when compared to standard feedback. After the training, both groups were able to regulate ACC without receiving feedback, with a trend for stronger responses in the social feedback group. Moreover, despite a lack of behavioral differences, significant higher ACC activations emerged in the cognitive interference task, reflecting a stronger generalization of the NF training on cognitive interference processing after social feedback. Social reward can increase self-regulation in fMRI-based NF and strengthen its effects on neural processing in related tasks, such as cognitive interference. A particular advantage of social feedback is that a direct external reward is provided as in natural social interactions, opening perspectives for implicit learning paradigms.
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Affiliation(s)
- Krystyna A Mathiak
- Department of Psychiatry, Psychotherapy and Psychosomatics, Behavioral Psychobiology, RWTH Aachen University Aachen, Germany ; Translational Brain Medicine, Jülich-Aachen Research Alliance Jülich, Aachen, Germany ; Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University Aachen, Germany
| | - Eliza M Alawi
- Department of Psychiatry, Psychotherapy and Psychosomatics, Behavioral Psychobiology, RWTH Aachen University Aachen, Germany ; Translational Brain Medicine, Jülich-Aachen Research Alliance Jülich, Aachen, Germany
| | - Yury Koush
- Department of Psychiatry, Psychotherapy and Psychosomatics, Behavioral Psychobiology, RWTH Aachen University Aachen, Germany ; Translational Brain Medicine, Jülich-Aachen Research Alliance Jülich, Aachen, Germany ; Department of Radiology and Medical Informatics, University of Geneva Geneva, Switzerland ; Institute of Bioengineering, Ecole Polytechnique Fédérale de Lausanne Lausanne, Switzerland
| | - Miriam Dyck
- Department of Psychiatry, Psychotherapy and Psychosomatics, Behavioral Psychobiology, RWTH Aachen University Aachen, Germany ; Translational Brain Medicine, Jülich-Aachen Research Alliance Jülich, Aachen, Germany
| | - Julia S Cordes
- Department of Psychiatry, Psychotherapy and Psychosomatics, Behavioral Psychobiology, RWTH Aachen University Aachen, Germany ; Translational Brain Medicine, Jülich-Aachen Research Alliance Jülich, Aachen, Germany
| | - Tilman J Gaber
- Translational Brain Medicine, Jülich-Aachen Research Alliance Jülich, Aachen, Germany ; Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University Aachen, Germany
| | - Florian D Zepf
- Department of Child and Adolescent Psychiatry, School of Psychiatry and Clinical Neurosciences and School of Paediatrics and Child Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Western Australia (M561) Perth, WA, Australia ; Specialised Child and Adolescent Mental Health Services, Department of Health in Western Australia Perth, WA, Australia
| | | | - Pegah Sarkheil
- Department of Psychiatry, Psychotherapy and Psychosomatics, Behavioral Psychobiology, RWTH Aachen University Aachen, Germany ; Translational Brain Medicine, Jülich-Aachen Research Alliance Jülich, Aachen, Germany
| | - Susanne Bergert
- Department of Psychiatry, Psychotherapy and Psychosomatics, Behavioral Psychobiology, RWTH Aachen University Aachen, Germany ; Translational Brain Medicine, Jülich-Aachen Research Alliance Jülich, Aachen, Germany
| | - Mikhail Zvyagintsev
- Department of Psychiatry, Psychotherapy and Psychosomatics, Behavioral Psychobiology, RWTH Aachen University Aachen, Germany ; Translational Brain Medicine, Jülich-Aachen Research Alliance Jülich, Aachen, Germany
| | - Klaus Mathiak
- Department of Psychiatry, Psychotherapy and Psychosomatics, Behavioral Psychobiology, RWTH Aachen University Aachen, Germany ; Translational Brain Medicine, Jülich-Aachen Research Alliance Jülich, Aachen, Germany
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39
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Helmbold K, Zvyagintsev M, Dahmen B, Bubenzer-Busch S, Gaber TJ, Crockett MJ, Klasen M, Sánchez CL, Eisert A, Konrad K, Habel U, Herpertz-Dahlmann B, Zepf FD. Effects of serotonin depletion on punishment processing in the orbitofrontal and anterior cingulate cortices of healthy women. Eur Neuropsychopharmacol 2015; 25:846-56. [PMID: 25869157 DOI: 10.1016/j.euroneuro.2015.02.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [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: 02/12/2014] [Revised: 01/27/2015] [Accepted: 02/21/2015] [Indexed: 11/30/2022]
Abstract
Diminished synthesis of the neurotransmitter serotonin (5-HT) has been linked to disrupted impulse control in aversive contexts. However, the neural correlates underlying a serotonergic modulation of female impulsivity remain unclear. The present study investigated punishment-induced inhibition in healthy young women. Eighteen healthy female subjects (aged 20-31) participated in a double-blinded, counterbalanced, placebo-controlled, within subjects, repeated measures study. They were assessed on two randomly assigned occasions that were controlled for menstrual cycle phase. In a randomized order, one day, acute tryptophan depletion (ATD) was used to reduce 5-HT synthesis in the brain. On the other day, participants received a tryptophan-balanced amino acid load (BAL) as a control condition. Three hours after administration of ATD/BAL, neural activity was recorded during a modified Go/No-Go task implementing reward or punishment processes using functional magnetic resonance imaging (fMRI). Neural activation during No-Go trials in punishment conditions after BAL versus ATD administration correlated positively with the magnitude of central 5-HT depletion in the ventral and subgenual anterior cingulate cortices (ACC). Furthermore, neural activation in the medial orbitofrontal cortex (mOFC) and the dorsal ACC correlated positively with trait impulsivity. The results indicate reduced neural sensitivity to punishment after short-term depletion of 5-HT in brain areas related to emotion regulation (subgenual ACC) increasing with depletion magnitude and in brain areas related to appraisal and expression of emotions (mOFC and dorsal ACC), increasing with trait impulsivity. This suggests a serotonergic modulation of neural circuits related to emotion regulation, impulsive behavior, and punishment processing in females.
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Affiliation(s)
- K Helmbold
- RWTH Aachen University, Clinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Germany; Jülich Aachen Research Alliance, JARA Translational Brain Medicine, Germany
| | - M Zvyagintsev
- Jülich Aachen Research Alliance, JARA Translational Brain Medicine, Germany; RWTH Aachen University, Department of Psychiatry, Psychotherapy and Psychosomatics, Germany
| | - B Dahmen
- RWTH Aachen University, Clinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Germany
| | - S Bubenzer-Busch
- RWTH Aachen University, Clinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Germany; Jülich Aachen Research Alliance, JARA Translational Brain Medicine, Germany
| | - T J Gaber
- RWTH Aachen University, Clinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Germany; Jülich Aachen Research Alliance, JARA Translational Brain Medicine, Germany
| | - M J Crockett
- Wellcome Trust Centre for Neuroimaging, University College London, United Kingdom
| | - M Klasen
- Jülich Aachen Research Alliance, JARA Translational Brain Medicine, Germany; RWTH Aachen University, Department of Psychiatry, Psychotherapy and Psychosomatics, Germany
| | - C L Sánchez
- RWTH Aachen University, Clinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Germany; Jülich Aachen Research Alliance, JARA Translational Brain Medicine, Germany
| | - A Eisert
- Department of Pharmacy, RWTH Aachen University, Aachen, Germany
| | - K Konrad
- RWTH Aachen University, Clinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Germany; Jülich Aachen Research Alliance, JARA Translational Brain Medicine, Germany; Institute for Neuroscience and Medicine, Jülich Research Centre, Germany
| | - U Habel
- Jülich Aachen Research Alliance, JARA Translational Brain Medicine, Germany; RWTH Aachen University, Department of Psychiatry, Psychotherapy and Psychosomatics, Germany
| | - B Herpertz-Dahlmann
- RWTH Aachen University, Clinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Germany; Jülich Aachen Research Alliance, JARA Translational Brain Medicine, Germany
| | - F D Zepf
- Department of Health in Western Australia, Specialised Child and Adolescent Mental Health Services (CAMHS), Perth, WA, Australia; Department of Child and Adolescent Psychiatry, School of Psychiatry & Clinical Neurosciences and School of Paediatrics & Child Health, The University of Western Australia, Perth, WA, Australia.
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Sanchez CL, Biskup CS, Herpertz S, Gaber TJ, Kuhn CM, Hood SH, Zepf FD. The Role of Serotonin (5-HT) in Behavioral Control: Findings from Animal Research and Clinical Implications. Int J Neuropsychopharmacol 2015; 18:pyv050. [PMID: 25991656 PMCID: PMC4648158 DOI: 10.1093/ijnp/pyv050] [Citation(s) in RCA: 9] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 04/29/2015] [Indexed: 11/13/2022] Open
Abstract
The neurotransmitters serotonin and dopamine both have a critical role in the underlying neurobiology of different behaviors. With focus on the interplay between dopamine and serotonin, it has been proposed that dopamine biases behavior towards habitual responding, and with serotonin offsetting this phenomenon and directing the balance toward more flexible, goal-directed responding. The present focus paper stands in close relationship to the publication by Worbe et al. (2015), which deals with the effects of acute tryptophan depletion, a neurodietary physiological method to decrease central nervous serotonin synthesis in humans for a short period of time, on the balance between hypothetical goal-directed and habitual systems. In that research, acute tryptophan depletion challenge administration and a following short-term reduction in central nervous serotonin synthesis were associated with a shift of behavioral performance towards habitual responding, providing further evidence that central nervous serotonin function modulates the balance between goal-directed and stimulus-response habitual systems of behavioral control. In the present focus paper, we discuss the findings by Worbe and colleagues in light of animal experiments as well as clinical implications and discuss potential future avenues for related research.
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Affiliation(s)
- C L Sanchez
- Clinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, RWTH Aachen University, Aachen, Germany (Drs Sanchez, Biskup, and Mr Gaber); Jülich Aachen Research Alliance, JARA Translational Brain Medicine, Aachen & Jülich, Germany (Drs Sanchez, Biskup, and Mr Gaber); Department of Pharmacology and Cancer Biology, Duke University, Durham, NC (Drs Sanchez and Kuhn); Department of Psychiatry, Psychotherapy and Psychosomatics, University of Heidelberg, Heidelberg, Germany (Dr Herpertz); School of Psychiatry and Clinical Neurosciences (Dr Hood), and Department of Child and Adolescent Psychiatry, School of Psychiatry and Clinical Neurosciences & School of Paediatrics and Child Health (Dr ZEPF), Faculty of Medicine, Dentistry and Health Sciences, The University of Western Australia, Perth, WA, Australia; Specialised Child and Adolescent Mental Health Services, Department of Health in Western Australia, Perth, WA, Australia (Dr ZEPF)
| | - C S Biskup
- Clinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, RWTH Aachen University, Aachen, Germany (Drs Sanchez, Biskup, and Mr Gaber); Jülich Aachen Research Alliance, JARA Translational Brain Medicine, Aachen & Jülich, Germany (Drs Sanchez, Biskup, and Mr Gaber); Department of Pharmacology and Cancer Biology, Duke University, Durham, NC (Drs Sanchez and Kuhn); Department of Psychiatry, Psychotherapy and Psychosomatics, University of Heidelberg, Heidelberg, Germany (Dr Herpertz); School of Psychiatry and Clinical Neurosciences (Dr Hood), and Department of Child and Adolescent Psychiatry, School of Psychiatry and Clinical Neurosciences & School of Paediatrics and Child Health (Dr ZEPF), Faculty of Medicine, Dentistry and Health Sciences, The University of Western Australia, Perth, WA, Australia; Specialised Child and Adolescent Mental Health Services, Department of Health in Western Australia, Perth, WA, Australia (Dr ZEPF)
| | - S Herpertz
- Clinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, RWTH Aachen University, Aachen, Germany (Drs Sanchez, Biskup, and Mr Gaber); Jülich Aachen Research Alliance, JARA Translational Brain Medicine, Aachen & Jülich, Germany (Drs Sanchez, Biskup, and Mr Gaber); Department of Pharmacology and Cancer Biology, Duke University, Durham, NC (Drs Sanchez and Kuhn); Department of Psychiatry, Psychotherapy and Psychosomatics, University of Heidelberg, Heidelberg, Germany (Dr Herpertz); School of Psychiatry and Clinical Neurosciences (Dr Hood), and Department of Child and Adolescent Psychiatry, School of Psychiatry and Clinical Neurosciences & School of Paediatrics and Child Health (Dr ZEPF), Faculty of Medicine, Dentistry and Health Sciences, The University of Western Australia, Perth, WA, Australia; Specialised Child and Adolescent Mental Health Services, Department of Health in Western Australia, Perth, WA, Australia (Dr ZEPF)
| | - T J Gaber
- Clinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, RWTH Aachen University, Aachen, Germany (Drs Sanchez, Biskup, and Mr Gaber); Jülich Aachen Research Alliance, JARA Translational Brain Medicine, Aachen & Jülich, Germany (Drs Sanchez, Biskup, and Mr Gaber); Department of Pharmacology and Cancer Biology, Duke University, Durham, NC (Drs Sanchez and Kuhn); Department of Psychiatry, Psychotherapy and Psychosomatics, University of Heidelberg, Heidelberg, Germany (Dr Herpertz); School of Psychiatry and Clinical Neurosciences (Dr Hood), and Department of Child and Adolescent Psychiatry, School of Psychiatry and Clinical Neurosciences & School of Paediatrics and Child Health (Dr ZEPF), Faculty of Medicine, Dentistry and Health Sciences, The University of Western Australia, Perth, WA, Australia; Specialised Child and Adolescent Mental Health Services, Department of Health in Western Australia, Perth, WA, Australia (Dr ZEPF)
| | - C M Kuhn
- Clinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, RWTH Aachen University, Aachen, Germany (Drs Sanchez, Biskup, and Mr Gaber); Jülich Aachen Research Alliance, JARA Translational Brain Medicine, Aachen & Jülich, Germany (Drs Sanchez, Biskup, and Mr Gaber); Department of Pharmacology and Cancer Biology, Duke University, Durham, NC (Drs Sanchez and Kuhn); Department of Psychiatry, Psychotherapy and Psychosomatics, University of Heidelberg, Heidelberg, Germany (Dr Herpertz); School of Psychiatry and Clinical Neurosciences (Dr Hood), and Department of Child and Adolescent Psychiatry, School of Psychiatry and Clinical Neurosciences & School of Paediatrics and Child Health (Dr ZEPF), Faculty of Medicine, Dentistry and Health Sciences, The University of Western Australia, Perth, WA, Australia; Specialised Child and Adolescent Mental Health Services, Department of Health in Western Australia, Perth, WA, Australia (Dr ZEPF)
| | - S H Hood
- Clinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, RWTH Aachen University, Aachen, Germany (Drs Sanchez, Biskup, and Mr Gaber); Jülich Aachen Research Alliance, JARA Translational Brain Medicine, Aachen & Jülich, Germany (Drs Sanchez, Biskup, and Mr Gaber); Department of Pharmacology and Cancer Biology, Duke University, Durham, NC (Drs Sanchez and Kuhn); Department of Psychiatry, Psychotherapy and Psychosomatics, University of Heidelberg, Heidelberg, Germany (Dr Herpertz); School of Psychiatry and Clinical Neurosciences (Dr Hood), and Department of Child and Adolescent Psychiatry, School of Psychiatry and Clinical Neurosciences & School of Paediatrics and Child Health (Dr ZEPF), Faculty of Medicine, Dentistry and Health Sciences, The University of Western Australia, Perth, WA, Australia; Specialised Child and Adolescent Mental Health Services, Department of Health in Western Australia, Perth, WA, Australia (Dr ZEPF)
| | - F D Zepf
- Clinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, RWTH Aachen University, Aachen, Germany (Drs Sanchez, Biskup, and Mr Gaber); Jülich Aachen Research Alliance, JARA Translational Brain Medicine, Aachen & Jülich, Germany (Drs Sanchez, Biskup, and Mr Gaber); Department of Pharmacology and Cancer Biology, Duke University, Durham, NC (Drs Sanchez and Kuhn); Department of Psychiatry, Psychotherapy and Psychosomatics, University of Heidelberg, Heidelberg, Germany (Dr Herpertz); School of Psychiatry and Clinical Neurosciences (Dr Hood), and Department of Child and Adolescent Psychiatry, School of Psychiatry and Clinical Neurosciences & School of Paediatrics and Child Health (Dr ZEPF), Faculty of Medicine, Dentistry and Health Sciences, The University of Western Australia, Perth, WA, Australia; Specialised Child and Adolescent Mental Health Services, Department of Health in Western Australia, Perth, WA, Australia (Dr ZEPF)
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Schneider I, Regenbogen C, Kohn N, Zepf FD, Bubenzer-Busch S, Schneider F, Gur RC, Habel U. Reduced Responsiveness to Social Provocation in Autism Spectrum Disorder. Autism Res 2015; 8:297-306. [PMID: 25603913 DOI: 10.1002/aur.1446] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [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: 11/15/2013] [Accepted: 11/25/2014] [Indexed: 11/09/2022]
Abstract
Deficits in emotion processing and social interaction are prominent symptoms of autism spectrum disorder (ASD). ASD has also been associated with aggressive tendencies towards self and others. The prevalence of aggressive behavior in this disorder, its etiology and its impact on social life are still unclear. This study investigated behavioral and physiological effects of social provocation in patients with ASD and healthy controls. We used a modified Taylor Aggression Paradigm in 24 high-functioning patients with ASD and 24 healthy controls. Participants were instructed to play against a fictitious human opponent. Money withdrawals toward the participant represented provocation and money deduction by the participant denoted aggressive behavior. Throughout the measurement, electrodermal activity (EDA) was recorded. Healthy controls showed higher aggressive responses to high provocation compared to low provocation, which demonstrated the effectiveness of the used procedure in eliciting aggression. Patients' responses were not influenced by the level of social provocation, although in both groups aggression was higher after lost compared to won trials. Physiologically, controls showed fewer but higher EDA amplitudes when responding aggressively, whereas patients displayed the opposite pattern of more but lower EDA amplitudes. The modified Taylor Aggression Paradigm successfully elicited aggression and revealed different behavioral and neurophysiological responses in patients and healthy controls. Patients' aggressive behavior as well as their physiological responses were less modulated by level of provocation compared to controls. Therapeutic attempts for patients might concentrate on improving empathic abilities and the understanding of social situations, including provocation and aggressive behavior.
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Affiliation(s)
- Isabella Schneider
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical School, RWTH Aachen University, Aachen, Germany.,JARA Translational Brain Medicine, Forschungszentrum Jülich, Jülich, Germany
| | - Christina Regenbogen
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical School, RWTH Aachen University, Aachen, Germany.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Nils Kohn
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical School, RWTH Aachen University, Aachen, Germany.,JARA Translational Brain Medicine, Forschungszentrum Jülich, Jülich, Germany
| | - Florian D Zepf
- JARA Translational Brain Medicine, Forschungszentrum Jülich, Jülich, Germany.,Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Medical School, RWTH Aachen University, Aachen, Germany.,Department of Child and Adolescent Psychiatry, School of Paediatrics and Child Health & School of Psychiatry and Clinical Neurosciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Western Australia, Perth, Australia.,Specialised Child and Adolescent Mental Health Services (CAMHS), Department of Health in Western Australia, Perth, WA, Australia
| | - Sarah Bubenzer-Busch
- JARA Translational Brain Medicine, Forschungszentrum Jülich, Jülich, Germany.,Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Medical School, RWTH Aachen University, Aachen, Germany
| | - Frank Schneider
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical School, RWTH Aachen University, Aachen, Germany.,JARA Translational Brain Medicine, Forschungszentrum Jülich, Jülich, Germany.,Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ruben C Gur
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ute Habel
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical School, RWTH Aachen University, Aachen, Germany.,JARA Translational Brain Medicine, Forschungszentrum Jülich, Jülich, Germany
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Zepf FD, Sánchez CL, Biskup CS, Kötting WF, Bubenzer S, Helmbold K, Eisert A, Gaber TJ, Landgraf M, Dahmen B, Poustka F, Wöckel L, Stadler C, Grabemann M, Mette C, Heinrich V, Uekermann J, Abdel-Hamid M, Kis B, Zimmermann M, Wiltfang J, Kuhn CM. Acute tryptophan depletion - converging evidence for decreasing central nervous serotonin synthesis in rodents and humans. Acta Psychiatr Scand 2014; 129:157-9. [PMID: 24237607 DOI: 10.1111/acps.12215] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- F D Zepf
- Clinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, RWTH Aachen University, Aachen, Germany; JARA Translational Brain Medicine, Aachen, Jülich, Germany; Institute for Neuroscience and Medicine, Jülich Research Centre, Jülich, Germany.
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von Polier GG, Zepf FD. Physiosomatic complaints, immune-inflammatory pathways, and serotonin-related mood symptoms: relevance for tryptophan-related challenge procedures and clinical considerations with respect to the DSM-V. Acta Psychiatr Scand 2014; 129:98-9. [PMID: 24117193 DOI: 10.1111/acps.12197] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- G G von Polier
- Clinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, RWTH Aachen University, Aachen, Germany
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Maier A, Ernst JP, Müller S, Gross D, Zepf FD, Herpertz-Dahlmann B, Hagenah U. Self-perceived stigmatization in female patients with anorexia nervosa--results from an explorative retrospective pilot study of adolescents. Psychopathology 2014; 47:127-32. [PMID: 24008842 DOI: 10.1159/000350505] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [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: 12/12/2012] [Accepted: 03/06/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND The stigma of mental illness has been identified as an important barrier to treatment and recovery. Previous research reported the stigmatization of individuals with eating disorders by both health professionals and the general public. The aim of this pilot study was to empirically assess the previous stigmatization and discrimination experiences of young female patients with anorexia nervosa (AN) using a retrospective explorative approach. METHODS An in-house questionnaire that was developed to survey experiences of stigmatization was mailed to 75 former adolescent patients with AN. The mean time of assessment after discharge was 5.6 ± 1.2 years. The patients were asked to respond anonymously. The response rate was approximately 48% (n = 36). RESULTS Feelings that society held negative stereotypes of individuals with AN, concrete experiences of stigmatization and discrimination, and rejection by peers were reported. A remarkable degree of self-stigmatization, as indexed by high rates of agreement to stigmatizing statements, was detected. Approximately one third of the participants reported delayed initiation of treatment due to fear of stigmatization and discrimination. CONCLUSION Stigmatization plays a decisive role in young patients with AN and impacts their motivation to seek professional help and engage in treatment. Clinicians should be aware of the stigmatization related to eating disorders and its burden for affected patients.
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Affiliation(s)
- A Maier
- Institute of History, Theory and Ethics in Medicine, RWTH Aachen University, Aachen, Germany
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Holtmann M, Poustka L, Zepf FD, Banaschewski T, Priller J, Bölte S, Legenbauer T. Severe Affective and Behavioral Dysregulation in Youths Is Associated with a Proinflammatory State 1MH and LP contributed equally to the paper. Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie 2013; 41:393-9. [DOI: 10.1024/1422-4917/a000255] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Objective: A heritable behavioral phenotype, the so-called Dysregulation Profile (DP), characterized by extreme scores on the syndrome scales Anxious/Depressed (A/D), Attention Problems (AP), and Aggressive Behavior (AGG), has been identified on the Child Behavior Checklist (CBCL). It characterizes children with severe affective and behavioral dysregulation. The present study examined possible alterations of the inflammatory system in CBCL-DP using a clinical sample of n = 133 children and adolescents. Method: Participants with the CBCL-DP scoring ≥ 2.5 SDs above average constituted the CBCL-DP subgroup (n = 51). Those with CBCL-DP scores of 1 SD or less above average were regarded as controls (n = 82). Groups were compared in terms of serum levels of C-reactive protein (CRP) and albumin. Results: Participants showing the CBCL-DP exhibited increased CRP and decreased albumin levels compared to controls. CRP was correlated with AGG, AP, and the CBCL-DP total score. A negative correlation was observed between albumin and AGG, AP, the CBCL-DP score, and A/D. These associations could not be attributed to differences in age, sex, weight, socioeconomic status, global functioning, or duration of illness. Conclusions: This is the first study to demonstrate associations between the CBCL-DP and a proinflammatory state. Limitations include the lack of a healthy control group, the use of a single measurement of inflammatory markers, and the lack of follow-up data. Future research should address whether inflammatory diathesis in these children confers increased susceptibility to later development of cardiovascular disease and other medical morbidities.
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Affiliation(s)
- Martin Holtmann
- Ruhr-University Bochum, LWL-University Hospital for Child and Adolescent Psychiatry, Hamm, Germany
- Department of Child and Adolescent Psychiatry and Psychotherapy, Goethe-University, Frankfurt/Main, Germany
| | - Luise Poustka
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Mannheim, Germany
| | - Florian D. Zepf
- Department of Child and Adolescent Psychiatry and Psychotherapy, Goethe-University, Frankfurt/Main, Germany
- Department of Child & Adolescent Psychiatry & Psychotherapy, RWTH Aachen University, Germany
- JARA Translational Brain Medicine, Aachen, Germany
| | - Tobias Banaschewski
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Mannheim, Germany
| | - Josef Priller
- Division of Experimental and Molecular Psychiatry, Department of Psychiatry and Psychotherapy; Charité University Medicine, Berlin
| | - Sven Bölte
- Department of Child and Adolescent Psychiatry and Psychotherapy, Goethe-University, Frankfurt/Main, Germany
- Center of Neurodevelopmental Disorders (KIND), Karolinska Institutet, Stockholm, Sweden
| | - Tanja Legenbauer
- Ruhr-University Bochum, LWL-University Hospital for Child and Adolescent Psychiatry, Hamm, Germany
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Kötting WF, Bubenzer S, Helmbold K, Eisert A, Gaber TJ, Zepf FD. Effects of tryptophan depletion on reactive aggression and aggressive decision-making in young people with ADHD. Acta Psychiatr Scand 2013; 128:114-23. [PMID: 22913430 DOI: 10.1111/acps.12001] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [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: 01/01/2023]
Abstract
OBJECTIVE The neurotransmitter serotonin (5-HT) has been linked to the underlying biological processes related to aggressive behaviour. However, only a few studies on this subject involving young people have been published so far. METHOD We aimed to investigate the effects of acute tryptophan depletion (ATD) on reactive aggression and decision-time for aggressive responses in a sample of young people with Attention deficit hyperactivity disorder (n = 20), a population at risk for aggressive behaviour. The study design was a double-blind within-subject crossover design. Aggression was assessed using a Point subtraction aggression game (PSAG) with high (HP) and low provocation (LP) trials 2.5 h after the intake of ATD and a tryptophan-balanced control condition. RESULTS A chi-square comparison was used to identify the effect of ATD on increased aggression after LP. Boys were more likely to respond with an increased aggressive response after HP under ATD as represented by an increased relative risk and odds ratios. Girls had a higher relative risk than boys of an increased point subtraction under ATD after LP. No significant gender differences in decision-time were detected. CONCLUSION An effect of ATD on increased aggression was found in the whole sample after LP. Research involving larger samples is needed to confirm the present preliminary findings.
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Affiliation(s)
- W F Kötting
- Clinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, RWTH Aachen University, Aachen, Germany
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Zepf FD, Landgraf M, Biskup CS, Dahmen B, Poustka F, Wöckel L, Stadler C. No effect of acute tryptophan depletion on verbal declarative memory in young persons with ADHD. Acta Psychiatr Scand 2013; 128:133-41. [PMID: 23418985 DOI: 10.1111/acps.12089] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [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] [Accepted: 01/03/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Animal experiments and studies in adults have shown that the neurotransmitter serotonin (5-HT) plays an important role in learning and memory processes. However, data on this relationship in young persons are scarce, and neurodietary research in this age group is limited compared with the extensive literature on adults. Here, we aimed to explore the effects of a diminished central nervous 5-HT synthesis, which is achieved by acute tryptophan depletion (ATD) Moja-De , on memory function in young males with attention deficit hyperactivity disorder (ADHD). METHOD Twenty-two male patients with ADHD (ages 9-15 years, mean 10.95 ± 1.17 years) received ATD, thus diminishing central nervous 5-HT synthesis, and a tryptophan-balanced amino acid load (BAL) in a randomized, double-blind, within-subject, crossover design study. Approximately 1.7 h after administration of ATD/BAL, verbal declarative memory was assessed using the 'Auditory Verbal-Learning-Test' (AVLT). RESULTS There were no significant effects of ATD administration on verbal declarative memory function. CONCLUSION In this study, changes in 5-HT neurotransmission were not associated with specific aspects of verbal declarative memory in young persons with ADHD. Future studies with healthy control groups that address effects of covarying attentional processes are warranted.
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Affiliation(s)
- F D Zepf
- Clinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, RWTH Aachen University, Aachen, Germany.
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49
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Grabemann M, Mette C, Zimmermann M, Heinrich V, Uekermann J, Wiltfang J, Abdel-Hamid M, Zepf FD, Kis B. No clear effects of acute tryptophan depletion on processing affective prosody in male adults with ADHD. Acta Psychiatr Scand 2013; 128:142-8. [PMID: 23581825 DOI: 10.1111/acps.12130] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [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] [Accepted: 02/26/2013] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Adults with attention deficit hyperactivity disorder (ADHD) have difficulties processing affective prosody, and research evidence demonstrates the importance of brain serotonin (5-HT) in the neurobiology of ADHD. This study aimed to investigate whether diminished brain 5-HT synthesis, as achieved by acute tryptophan depletion (ATD), can impair the processing of affective prosody in adults with ADHD. METHOD Twenty male patients with ADHD and twenty male healthy controls received ATD and a tryptophan-balanced control condition on separate days in a double-blind within-subject repeated measures crossover design. In both conditions, the Tübingen Affect Battery was administered in which subjects had to name the affective prosody of sentences with neutral, congruent, or incongruent semantic content. RESULTS Participants in the group of patients with ADHD perceived affective prosody less accurately than controls. Participants with ADHD showed compromised processing of sentences, committing more errors than healthy controls when identifying affect in instances of incongruent semantic content (P = 0.031). ATD did not contribute to this effect (all P > 0.5). CONCLUSION The difficulties male adults with ADHD have in accurately processing affective prosody may result from impairments in their ability to inhibit unwanted stimuli and impulses. No clear evidence implicates 5-HT as a cause of these impairments.
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Affiliation(s)
- M Grabemann
- Department of Psychiatry and Psychotherapy, University of Duisburg-Essen, LVR Clinics Essen, Essen, Germany.
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50
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Mette C, Zimmermann M, Grabemann M, Abdel-Hamid M, Uekermann J, Biskup CS, Wiltfang J, Zepf FD, Kis B. The impact of acute tryptophan depletion on attentional performance in adult patients with ADHD. Acta Psychiatr Scand 2013; 128:124-32. [PMID: 23419004 DOI: 10.1111/acps.12090] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [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] [Accepted: 01/03/2013] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To date, the impact of the neurotransmitter serotonin (5-HT) on different neuropsychological functions in adults with attention deficit hyperactivity disorder (ADHD) is underinvestigated. We aimed to examine the effects of acute tryptophan depletion (ATD) and the resulting reduction in central nervous 5-HT synthesis on target/non-target discrimination ability and sustained attention in adults with ADHD using an AX-Continuous Performance Test (AX-CPT). METHOD Twenty male patients with ADHD (age: M = 30.25 SD = 9.37) and twenty male healthy controls (age: M = 27.90 SD = 6.01) received ATD on one day and a tryptophan-balanced control condition (BAL) on another day in a double-blind within-subject crossover design. A continuous performance test (AX-CPT) with three conditions (AX, AY, and BX) was administered on both days under depleted and sham-depleted conditions. RESULTS In patients omissions increased after ATD when compared with BAL. Patient's reaction time decreased after ATD when compared with BAL, which was contrasted by opposite effects in controls. Patients showed fewer correct responses (AX condition) and showed a higher rate of errors (condition AXE ) independent of ATD or BAL intake. CONCLUSION The present preliminary results are indicative of the contribution of serotonergic neurotransmission to attentional processes in adults with ADHD.
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Affiliation(s)
- C Mette
- Department of Psychiatry and Psychotherapy, LVR Clinics Essen, University of Duisburg-Essen, Essen, Germany.
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