1
|
Abstract
The reliability of inhibitory control task performance as well as the existence of an underlying unitary inhibitory construct have been questioned. The present study is the first to use a trait and state decomposition approach to formally quantify the reliability of inhibitory control and to examine its hierarchical structure. N = 150 participants carried out antisaccade, Eriksen flanker, go/nogo, Simon, stop-signal, and Stroop tasks on three occasions. By applying latent state-trait modeling and latent growth-curve modeling, reliability was estimated and divided into the amount of variance explained by trait effects and trait changes (consistency) and the amount of variance explained by situational effects and effects of Situation × Person interaction (occasion specificity). Mean reaction times for all tasks revealed excellent reliabilities (.89-.99). Importantly, on average, 82% of variance was accounted for by consistency while specificity was rather small. Although primary inhibitory variables revealed lower reliabilities (.51-.85), the majority of explained variance was again trait determined. Trait changes were observed for most variables and were strongest when comparing the first occasion to later ones. In addition, in some variables, those improvements were particularly high in initially underperforming subjects. An analysis of the construct of inhibition on trait level showed that communality between tasks was low. We conclude that most variables in inhibitory control tasks are mainly affected by stable trait effects, but there is only little evidence of a common, underlying inhibitory control construct at trait level. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
Collapse
|
2
|
Polner B, Faiola E, Urquijo MF, Meyhöfer I, Steffens M, Rónai L, Koutsouleris N, Ettinger U. The network structure of schizotypy in the general population. Eur Arch Psychiatry Clin Neurosci 2021; 271:635-645. [PMID: 31646383 PMCID: PMC8119252 DOI: 10.1007/s00406-019-01078-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 10/03/2019] [Indexed: 12/13/2022]
Abstract
Schizotypal personality traits show similarity with schizophrenia at various levels of analysis. It is generally agreed that schizotypal personality is multidimensional; however, it is still debated whether impulsive nonconformity should be incorporated into theories and measurement of schizotypy. In addition, relatively little is known about the network structure of the four-dimensional model of schizotypal personality. To estimate the network structure of schizotypy, we used data from participants recruited from the community (N = 11,807) who completed the short version of the Oxford-Liverpool Inventory of Feelings and Experiences, a widespread self-report instrument that assesses the positive, negative, disorganised and impulsive domains of schizotypy. We performed community detection, then examined differences between communities in terms of centralities and compared the strength of edges within and between communities. We found communities that almost perfectly corresponded to the a priori-defined subscales (93% overlap, normalised mutual information = 0.74). Items in the disorganisation community had higher closeness centrality relative to items in the other communities (Cliff's Δs ranged from 0.55 to 0.83) and weights of edges within the disorganisation community were stronger as compared to the negative schizotypy and impulsive nonconformity communities (Cliff's Δs = 0.33). Our findings imply that the inclusion of impulsive nonconformity items does not dilute the classical three-factor structure of positive, negative and disorganised schizotypy. The high closeness centrality of disorganisation concurs with theories positing that cognitive slippage and associative loosening are core features of the schizophrenic phenotype.
Collapse
Affiliation(s)
- Bertalan Polner
- Department of Cognitive Science, Budapest University of Technology and Economics, Egry József utca 1., T épület, V. emelet 506, Budapest, 1111, Hungary.
| | - Eliana Faiola
- Department of Psychology, University of Bonn, Kaiser-Karl-Ring 9, 53111, Bonn, Germany
| | - Maria F Urquijo
- Department of Psychiatry and Psychotherapy, University of Munich, Nussbaumstr. 7, 80336, Munich, Germany
| | - Inga Meyhöfer
- Department of Psychiatry and Psychotherapy, Münster University Hospital, Westfälische Wilhelms-University, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Maria Steffens
- Department of Psychology, University of Bonn, Kaiser-Karl-Ring 9, 53111, Bonn, Germany
| | - Levente Rónai
- Department of Cognitive Science, Budapest University of Technology and Economics, Egry József utca 1., T épület, V. emelet 506, Budapest, 1111, Hungary
- Institute of Psychology, University of Szeged, Egyetem u. 2, Szeged, 6722, Hungary
| | - Nikolaos Koutsouleris
- Department of Psychiatry and Psychotherapy, University of Munich, Nussbaumstr. 7, 80336, Munich, Germany
| | - Ulrich Ettinger
- Department of Psychology, University of Bonn, Kaiser-Karl-Ring 9, 53111, Bonn, Germany
| |
Collapse
|
3
|
Schröder R, Kasparbauer AM, Meyhöfer I, Steffens M, Trautner P, Ettinger U. Functional connectivity during smooth pursuit eye movements. J Neurophysiol 2020; 124:1839-1856. [PMID: 32997563 DOI: 10.1152/jn.00317.2020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 11/22/2022] Open
Abstract
Smooth pursuit eye movements (SPEM) hold the image of a slowly moving stimulus on the fovea. The neural system underlying SPEM primarily includes visual, parietal, and frontal areas. In the present study, we investigated how these areas are functionally coupled and how these couplings are influenced by target motion frequency. To this end, healthy participants (n = 57) were instructed to follow a sinusoidal target stimulus moving horizontally at two different frequencies (0.2 Hz, 0.4 Hz). Eye movements and blood oxygen level-dependent (BOLD) activity were recorded simultaneously. Functional connectivity of the key areas of the SPEM network was investigated with a psychophysiological interaction (PPI) approach. How activity in five eye movement-related seed regions (lateral geniculate nucleus, V1, V5, posterior parietal cortex, frontal eye fields) relates to activity in other parts of the brain during SPEM was analyzed. The behavioral results showed clear deterioration of SPEM performance at higher target frequency. BOLD activity during SPEM versus fixation occurred in a geniculo-occipito-parieto-frontal network, replicating previous findings. PPI analysis yielded widespread, partially overlapping networks. In particular, frontal eye fields and posterior parietal cortex showed task-dependent connectivity to large parts of the entire cortex, whereas other seed regions demonstrated more regionally focused connectivity. Higher target frequency was associated with stronger activations in visual areas but had no effect on functional connectivity. In summary, the results confirm and extend previous knowledge regarding the neural mechanisms underlying SPEM and provide a valuable basis for further investigations such as in patients with SPEM impairments and known alterations in brain connectivity.NEW & NOTEWORTHY This study provides a comprehensive investigation of blood oxygen level-dependent (BOLD) functional connectivity during smooth pursuit eye movements. Results from a large sample of healthy participants suggest that key oculomotor regions interact closely with each other but also with regions not primarily associated with eye movements. Understanding functional connectivity during smooth pursuit is important, given its potential role as an endophenotype of psychoses.
Collapse
Affiliation(s)
| | | | - Inga Meyhöfer
- Department of Psychology, University of Bonn, Bonn, Germany
| | - Maria Steffens
- Department of Psychology, University of Bonn, Bonn, Germany
| | - Peter Trautner
- Institute for Experimental Epileptology and Cognition Research, University of Bonn, Bonn, Germany.,Core Facility MRI, Bonn Technology Campus, University of Bonn, Bonn, Germany
| | | |
Collapse
|
4
|
Brakemeier S, Sprenger A, Meyhöfer I, McDowell JE, Rubin LH, Hill SK, Keshavan MS, Pearlson GD, Tamminga CA, Gershon ES, Keedy SS, Sweeney JA, Clementz BA, Lencer R. Smooth pursuit eye movement deficits as a biomarker for psychotic features in bipolar disorder-Findings from the PARDIP study. Bipolar Disord 2020; 22:602-611. [PMID: 31721386 DOI: 10.1111/bdi.12865] [Citation(s) in RCA: 9] [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] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Smooth pursuit eye movement deficits are an established psychosis biomarker across schizophrenia, schizoaffective and psychotic bipolar disorder (BPwP). Whether smooth pursuit deficits are also seen in bipolar disorder without psychosis (BPwoP) is unclear. Here we present data from the Psychosis and Affective Research Domains and Intermediate Phenotypes (PARDIP) study comparing bipolar patients with and without psychotic features. METHODS Probands with BPwP (N = 49) and BPwoP (N = 36), and healthy controls (HC, N = 71) performed eye tracking tasks designed to evaluate specific sensorimotor components relevant for pursuit initiation and pursuit maintenance. RESULTS While BPwoP did not differ from either BPwP or HC on initial eye acceleration, they performed significantly better than BPwP on early (P < .01) and predictive (P = .02) pursuit maintenance measures, both without differing from HC. BPwP were impaired compared to HC on initial eye acceleration, and on early and predictive pursuit maintenance (all P < .01). In contrast to the three pursuit measures, BPwP and BPwoP were both impaired on general neurocognitive assessments in relation to HC (both P < .001), without a significant difference between the two bipolar patient groups. CONCLUSIONS Our findings support the model that impairments of sensorimotor and cognitive processing as required for early and later predictive smooth pursuit maintenance are relatively specific to those bipolar patients with a history of psychosis. This suggests that the neural circuitry for developing feed-forward predictive models for accurate pursuit maintenance is associated with the occurrence of psychotic features in bipolar patients. In contrast, generalized neuropsychological impairments did not differentiate the two bipolar patient groups.
Collapse
Affiliation(s)
- Svenja Brakemeier
- Department of Psychiatry and Psychotherapy, University of Muenster, Muenster, Germany
| | - Andreas Sprenger
- Department of Neurology, University of Luebeck, Luebeck, Germany
| | - Inga Meyhöfer
- Department of Psychiatry and Psychotherapy, University of Muenster, Muenster, Germany.,Otto Creutzfeldt Center for Cognitive and Behavioral Neuroscience, University of Muenster, Muenster, Germany
| | - Jennifer E McDowell
- Departments of Psychology and Neuroscience, Bio-Imaging Research Center, University of Georgia, Athens, GA, USA
| | - Leah H Rubin
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - S Kristian Hill
- Department of Psychology, Rosalind Franklin University of Medicine and Science, Chicago, IL, USA
| | - Matcheri S Keshavan
- Department of Psychiatry, Harvard Medical School, Beth Israel Deacones Medical Center, Boston, MA, USA
| | - Godfrey D Pearlson
- Departments of Psychiatry and Neuroscience, Yale School of Medicine, and Olin Research Center, Institute of Living/Hartford Hospital, Hartford, CT, USA
| | - Carol A Tamminga
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Elliot S Gershon
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, USA
| | - Sarah S Keedy
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, USA
| | - John A Sweeney
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, OH, USA
| | - Brett A Clementz
- Departments of Psychology and Neuroscience, Bio-Imaging Research Center, University of Georgia, Athens, GA, USA
| | - Rebekka Lencer
- Department of Psychiatry and Psychotherapy, University of Muenster, Muenster, Germany.,Otto Creutzfeldt Center for Cognitive and Behavioral Neuroscience, University of Muenster, Muenster, Germany
| |
Collapse
|
5
|
Agtzidis I, Meyhöfer I, Dorr M, Lencer R. Following Forrest Gump: Smooth pursuit related brain activation during free movie viewing. Neuroimage 2020; 216:116491. [DOI: 10.1016/j.neuroimage.2019.116491] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 12/13/2019] [Accepted: 12/22/2019] [Indexed: 10/25/2022] Open
|
6
|
Meyhöfer I, Kasparbauer AM, Steffens M, Ettinger U. Effects of nicotine on smooth pursuit eye movements in healthy non-smokers. Psychopharmacology (Berl) 2019; 236:2259-2271. [PMID: 30874860 DOI: 10.1007/s00213-019-05223-1] [Citation(s) in RCA: 7] [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] [Received: 09/26/2018] [Accepted: 03/06/2019] [Indexed: 12/12/2022]
Abstract
RATIONALE The non-selective nicotinic acetylcholine receptor (nAChR) agonist nicotine has been argued to improve attention via enhanced filtering of irrelevant stimuli. Here, we tested this hypothesis in the context of smooth pursuit eye movements (SPEMs), an oculomotor function previously shown to improve with nicotine in some but not all studies. OBJECTIVES In order to test whether nicotine improves performance particularly when the inhibition of distracting stimuli is required, SPEM was elicited in conditions with or without peripheral distractors. Additionally, different target frequencies were employed in order to parametrically vary general processing demands on the SPEM system. METHODS Healthy adult non-smokers (N = 18 females, N = 13 males) completed a horizontal sinusoidal SPEM task at different target frequencies (0.2 Hz, 0.4 Hz, 0.6 Hz) in the presence or absence of peripheral distractors in a double-blind, placebo-controlled, cross-over design using a 2 mg nicotine gum. RESULTS Nicotine increased peak pursuit gain relative to placebo (p < .001), but an interaction with distractor condition (p = .001) indicated that this effect was most pronounced in the presence of distractors. Catch-up saccade frequency was reduced by nicotine (p = .01), particularly at higher target frequencies (two-way interaction, p = .04). However, a three-way interaction (p = .006) indicated that the reduction with nicotine was strongest at the highest target frequency (0.6 Hz) only without distractors, whereas in the presence of distractors, it was strongest at 0.4-Hz target frequency. There were no effects of nicotine on subjective state measures. CONCLUSIONS Together, these findings support a role of both distractor inhibition and general processing load in the effects of nicotine on smooth pursuit.
Collapse
Affiliation(s)
- Inga Meyhöfer
- Department of Psychology, University of Bonn, Kaiser-Karl-Ring 9, 53111, Bonn, Germany.,Department of Psychiatry and Psychotherapy, Otto Creutzfeldt Center for Cognitive and Behavioral Neuroscience, University of Muenster, Muenster, Germany
| | | | - Maria Steffens
- Department of Psychology, University of Bonn, Kaiser-Karl-Ring 9, 53111, Bonn, Germany
| | - Ulrich Ettinger
- Department of Psychology, University of Bonn, Kaiser-Karl-Ring 9, 53111, Bonn, Germany.
| |
Collapse
|
7
|
Meyhöfer I, Ettinger U, Faiola E, Petrovsky N, Kumari V. The effects of positive schizotypy and sleep deprivation on prepulse inhibition. Schizophr Res 2019; 209:284-285. [PMID: 31104915 DOI: 10.1016/j.schres.2019.05.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 09/19/2018] [Revised: 04/04/2019] [Accepted: 05/06/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Inga Meyhöfer
- Department of Psychology, University of Bonn, Bonn, Germany; Department of Psychiatry and Psychotherapy, Otto Creutzfeldt Center for Cognitive and Behavioral Neuroscience, University of Muenster, Muenster, Germany
| | - Ulrich Ettinger
- Department of Psychology, University of Bonn, Bonn, Germany.
| | - Eliana Faiola
- Department of Psychology, University of Bonn, Bonn, Germany
| | | | - Veena Kumari
- Centre for Cognitive Neuroscience, College of Health and Life Sciences, Brunel University London, Uxbridge, UK
| |
Collapse
|
8
|
Bey K, Meyhöfer I, Lennertz L, Grützmann R, Heinzel S, Kaufmann C, Klawohn J, Riesel A, Ettinger U, Kathmann N, Wagner M. Schizotypy and smooth pursuit eye movements as potential endophenotypes of obsessive-compulsive disorder. Eur Arch Psychiatry Clin Neurosci 2019; 269:235-243. [PMID: 29721727 DOI: 10.1007/s00406-018-0899-x] [Citation(s) in RCA: 6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 04/24/2018] [Indexed: 12/27/2022]
Abstract
Patients with obsessive-compulsive disorder (OCD) show dysfunctions of the fronto-striatal circuitry, which imply corresponding oculomotor deficits including smooth pursuit eye movements (SPEM). However, evidence for a deficit in SPEM is inconclusive, with some studies reporting reduced velocity gain while others did not find any SPEM dysfunctions in OCD patients. Interestingly, psychosis-like traits have repeatedly been linked to both OCD and impaired SPEM. Here, we examined a large sample of n = 168 patients with OCD, n = 93 unaffected first-degree relatives and n = 171 healthy control subjects to investigate whether elevated levels of schizotypy and SPEM deficits represent potential endophenotypes of OCD. We applied a SPEM task with high demands on predictive pursuit that is more sensitive to assess executive dysfunctions than a standard task with continuous visual feedback, as episodes of target blanking put increased demands on basal ganglia and prefrontal involvement. Additionally, we examined the relation between schizotypy and SPEM performance in OCD patients and their relatives. Results indicate that OCD patients and unaffected relatives do not show deficient performance in either standard or predictive SPEM. Yet, both patients and relatives exhibited elevated levels of schizotypy, and schizotypy was significantly correlated with velocity gain during standard trials in unmedicated and depression-free OCD patients. These findings highlight the role of schizotypy as a candidate endophenotype of OCD and add to the growing evidence for predisposing personality traits in OCD. Furthermore, intact gain may represent a key characteristic that distinguishes the OCD and schizophrenia patient populations.
Collapse
Affiliation(s)
- Katharina Bey
- Department of Psychiatry and Psychotherapy, University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany. .,German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany.
| | - Inga Meyhöfer
- Department of Psychology, University of Bonn, Bonn, Germany.,Department of Psychiatry and Psychotherapy, University of Münster, Münster, Germany
| | - Leonhard Lennertz
- Department of Psychiatry and Psychotherapy, University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - Rosa Grützmann
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Stephan Heinzel
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany.,Clinical Psychology and Psychotherapy, Freie Universität Berlin, Berlin, Germany
| | - Christian Kaufmann
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Julia Klawohn
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany.,Biomedical Sciences and Psychology, Florida State University, Tallahassee, FL, USA
| | - Anja Riesel
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | | | - Norbert Kathmann
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Michael Wagner
- Department of Psychiatry and Psychotherapy, University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany.,German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany.,Department for Neurodegenerative Diseases and Geriatric Psychiatry, University Hospital Bonn, Bonn, Germany
| |
Collapse
|
9
|
Faiola E, Meyhöfer I, Steffens M, Kasparbauer AM, Kumari V, Ettinger U. Combining trait and state model systems of psychosis: The effect of sleep deprivation on cognitive functions in schizotypal individuals. Psychiatry Res 2018; 270:639-648. [PMID: 30384284 DOI: 10.1016/j.psychres.2018.10.033] [Citation(s) in RCA: 2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 09/11/2018] [Accepted: 10/10/2018] [Indexed: 12/29/2022]
Abstract
Model systems of psychosis play an important role in pathophysiology and drug development research. Schizotypal individuals display similar cognitive impairments as schizophrenia patients in several domains. Therefore, schizotypy may be interpreted as a trait model system of psychosis. In addition, experimentally controlled sleep deprivation is a putative state psychosis model that evokes subclinical psychosis-like states. We aimed to further validate these model systems by examining them in relation to central cognitive biomarkers of schizophrenia. Most of all, we were interested in investigating, for the first time, effects of their combination on cognitive function. Healthy subjects with high (N = 17) or low (N = 19) levels of schizotypy performed a cognitive task battery after one night of normal sleep and after 24 h of sleep deprivation. Sleep deprivation impaired performance in the go/nogo and n-back tasks relative to the normal sleep control condition. No differences between groups or interactions of group with sleep condition were found. The role of sleep deprivation as a model of psychosis is thus supported to some extent by impairments in inhibitory control. However, classical measures of cognition may be less able to detect deficits in schizotypy, in line with evidence of more basic information processing dysfunctions in schizotypy.
Collapse
Affiliation(s)
- Eliana Faiola
- Department of Psychology, University of Bonn, Kaiser-Karl-Ring 9, Bonn 53111, Germany.
| | - Inga Meyhöfer
- Department of Psychology, University of Bonn, Kaiser-Karl-Ring 9, Bonn 53111, Germany.
| | - Maria Steffens
- Department of Psychology, University of Bonn, Kaiser-Karl-Ring 9, Bonn 53111, Germany.
| | | | - Veena Kumari
- Centre for Cognitive Neuroscience, Department of Life Sciences, Brunel University London, Kingston Lane, Uxbridge UB8 3PH, UK.
| | - Ulrich Ettinger
- Department of Psychology, University of Bonn, Kaiser-Karl-Ring 9, Bonn 53111, Germany.
| |
Collapse
|
10
|
Abstract
Schizotypy is defined as a time-stable multidimensional personality trait consisting of positive, negative, and disorganized facets. Schizotypy is considered as a model system of psychosis, as there is considerable overlap between the 2 constructs. High schizotypy is associated with subtle but fairly widespread cognitive alterations, which include poorer performance in tasks measuring cognitive control. Similar but more pronounced impairments in cognitive control have been described extensively in psychosis. We here sought to provide a quantitative estimation of the effect size of impairments in schizotypy in the updating, shifting, and inhibition dimensions of cognitive control. We included studies of healthy adults from both general population and college samples, which used either categorical or correlative designs. Negative schizotypy was associated with significantly poorer performance on shifting (g = 0.32) and updating (g = 0.11). Positive schizotypy was associated with significantly poorer performance on shifting (g = 0.18). There were no significant associations between schizotypy and inhibition. The divergence in results for positive, negative, and disorganized schizotypy emphasizes the importance of examining relationships between cognition and the facets of schizotypy rather than using the overall score. Our findings also underline the importance of more detailed research to further understand and define this complex personality construct, which will also be of importance when applying schizotypy as a model system for psychosis.
Collapse
Affiliation(s)
- Maria Steffens
- Department of Psychology, University of Bonn, Kaiser-Karl-Ring, Bonn, Germany
| | - Inga Meyhöfer
- Department of Psychology, University of Bonn, Kaiser-Karl-Ring, Bonn, Germany
| | - Kaja Fassbender
- Department of Psychology, University of Bonn, Kaiser-Karl-Ring, Bonn, Germany
| | - Ulrich Ettinger
- Department of Psychology, University of Bonn, Kaiser-Karl-Ring, Bonn, Germany,To whom correspondence should be addressed; tel: +49-228-734208, e-mail:
| | - Joseph Kambeitz
- Department of Psychiatry and Psychotherapy, University of Munich, Munich, Germany
| |
Collapse
|
11
|
Ettinger U, Meyhöfer I, Mehta MA, Kumari V, Corr PJ, Williams SC, Perkins AM. Effects of lorazepam on saccadic eye movements: the role of sex, task characteristics and baseline traits. J Psychopharmacol 2018; 32:678-690. [PMID: 29783905 DOI: 10.1177/0269881118772450] [Citation(s) in RCA: 10] [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] [Indexed: 11/17/2022]
Abstract
BACKGROUND Saccadic eye movements are controlled by a network of parietal, frontal, striatal, cerebellar and brainstem regions. The saccadic peak velocity is an established biomarker of benzodiazepine effects, with benzodiazepines reliably reducing the peak velocity. AIMS In this study, we aimed to replicate the effects of benzodiazepines on peak velocity and we investigated effects on previously less studied measures of saccades. We also explored the roles of sex, task characteristics and the baseline variables age, intelligence and trait anxiety in these effects. METHOD Healthy adults ( N = 34) performed a horizontal step prosaccade task under 1 mg lorazepam, 2 mg lorazepam and placebo in a double-blind, within-subjects design. RESULTS We replicated the dose-dependent reduction in peak velocity with lorazepam and showed that this effect is stronger for saccades to targets at smaller eccentricities. We also demonstrated that this effect is independent of sex and other baseline variables. Lorazepam effects were widespread, however, occurring on mean and variability measures of most saccadic variables. Additionally, there were sex-dependent lorazepam effects on spatial consistency of saccades, indicating more adverse effects in females. CONCLUSIONS We conclude that saccadic peak velocity is a sensitive and robust biomarker of benzodiazepine effects. However, lorazepam has pronounced effects also on other parameters of horizontal saccades. Sex-dependent drug effects on spatial consistency may reflect cerebellar mechanisms, given the role of the cerebellum in saccadic spatial accuracy.
Collapse
Affiliation(s)
| | - Inga Meyhöfer
- 1 Department of Psychology, University of Bonn, Germany
| | - Mitul A Mehta
- 2 Department of Neuroimaging, King's College London, UK
| | - Veena Kumari
- 3 Centre for Cognitive Neuroscience, Brunel University London, Uxbridge, UK
| | - Philip J Corr
- 4 Department of Psychology, City University of London, UK
| | | | - Adam M Perkins
- 5 Department of Psychological Medicine, King's College London, UK
| |
Collapse
|
12
|
Steffens M, Becker B, Neumann C, Kasparbauer AM, Meyhöfer I, Weber B, Mehta MA, Hurlemann R, Ettinger U. Effects of ketamine on brain function during smooth pursuit eye movements. Hum Brain Mapp 2018; 37:4047-4060. [PMID: 27342447 DOI: 10.1002/hbm.23294] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [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: 03/09/2016] [Revised: 05/18/2016] [Accepted: 06/13/2016] [Indexed: 11/07/2022] Open
Abstract
The uncompetitive NMDA receptor antagonist ketamine has been proposed to model symptoms of psychosis. Smooth pursuit eye movements (SPEM) are an established biomarker of schizophrenia. SPEM performance has been shown to be impaired in the schizophrenia spectrum and during ketamine administration in healthy volunteers. However, the neural mechanisms mediating SPEM impairments during ketamine administration are unknown. In a counter-balanced, placebo-controlled, double-blind, within-subjects design, 27 healthy participants received intravenous racemic ketamine (100 ng/mL target plasma concentration) on one of two assessment days and placebo (intravenous saline) on the other. Participants performed a block-design SPEM task during functional magnetic resonance imaging (fMRI) at 3 Tesla field strength. Self-ratings of psychosis-like experiences were obtained using the Psychotomimetic States Inventory (PSI). Ketamine administration induced psychosis-like symptoms, during ketamine infusion, participants showed increased ratings on the PSI dimensions cognitive disorganization, delusional thinking, perceptual distortion and mania. Ketamine led to robust deficits in SPEM performance, which were accompanied by reduced blood oxygen level dependent (BOLD) signal in the SPEM network including primary visual cortex, area V5 and the right frontal eye field (FEF), compared to placebo. A measure of connectivity with V5 and FEF as seed regions, however, was not significantly affected by ketamine. These results are similar to the deviations found in schizophrenia patients. Our findings support the role of glutamate dysfunction in impaired smooth pursuit performance and the use of ketamine as a pharmacological model of psychosis, especially when combined with oculomotor biomarkers. Hum Brain Mapp 37:4047-4060, 2016. © 2016 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- M Steffens
- Department of Psychology, University of Bonn, Bonn, Germany
| | - B Becker
- Department of Psychiatry and Division of Medical Psychology, University of Bonn, Bonn, Germany
| | - C Neumann
- Department of Anesthesiology, University of Bonn, Bonn, Germany
| | | | - I Meyhöfer
- Department of Psychology, University of Bonn, Bonn, Germany
| | - B Weber
- Center for Economics and Neuroscience, University of Bonn, Bonn, Germany.,Department of Epileptology, University Hospital Bonn, Bonn, Germany.,Department of NeuroCognition/Imaging, Life&Brain Research Center, Bonn, Germany
| | - M A Mehta
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - R Hurlemann
- Department of Psychiatry and Division of Medical Psychology, University of Bonn, Bonn, Germany
| | - U Ettinger
- Department of Psychology, University of Bonn, Bonn, Germany.
| |
Collapse
|
13
|
Bey K, Lennertz L, Grützmann R, Heinzel S, Kaufmann C, Klawohn J, Riesel A, Meyhöfer I, Ettinger U, Kathmann N, Wagner M. Impaired Antisaccades in Obsessive-Compulsive Disorder: Evidence From Meta-Analysis and a Large Empirical Study. Front Psychiatry 2018; 9:284. [PMID: 30008679 PMCID: PMC6033994 DOI: 10.3389/fpsyt.2018.00284] [Citation(s) in RCA: 7] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 06/11/2018] [Indexed: 01/23/2023] Open
Abstract
Increasing evidence indicates that patients with obsessive-compulsive disorder (OCD) exhibit alterations in fronto-striatal circuitry. Performance deficits in the antisaccade task would support this model, but results from previous small-scale studies have been inconclusive as either increased error rates, prolonged antisaccade latencies, both or neither have been reported in OCD patients. In order to address this issue, we investigated antisaccade performance in a large sample of OCD patients (n = 169) and matched control subjects (n = 183). As impaired antisaccade performance constitutes a potential endophenotype of OCD, unaffected first-degree relatives of OCD patients (n = 100) were assessed, as well. Furthermore, we conducted a quantitative meta-analysis to integrate our data with previous findings. In the empirical study, OCD patients exhibited significantly increased antisaccade latencies, intra-subject variability (ISV) of antisaccade latencies, and antisaccade error rates. The latter effect was driven by errors with express latency (80-130 ms), as patients did not differ significantly from controls with regards to regular errors (>130 ms). Notably, unaffected relatives of OCD patients showed elevated antisaccade express error rates and increased ISV of antisaccade latencies, as well. Antisaccade performance was not associated with state anxiety within groups. Among relatives, however, we observed a significant correlation between antisaccade error rate and harm avoidance. Medication status of OCD patients, symptom severity, depressive comorbidity, comorbid anxiety disorders and OCD symptom dimensions did not significantly affect antisaccade performance. Meta-analysis of 10 previous and the present empirical study yielded a medium-sized effect (SMD = 0.48, p < 0.001) for higher error rates in OCD patients, while the effect for latencies did not reach significance owing to strong heterogeneity (SMD = 0.51, p = 0.069). Our results support the assumption of impaired antisaccade performance in OCD, although effects sizes were only moderately large. Furthermore, we provide the first evidence that increased antisaccade express error rates and ISV of antisaccade latencies may constitute endophenotypes of OCD. Findings regarding these more detailed antisaccade parameters point to potentially underlying mechanisms, such as early pre-stimulus inhibition of the superior colliculus.
Collapse
Affiliation(s)
- Katharina Bey
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany.,German Center for Neurodegenerative Diseases, Bonn, Germany
| | - Leonhard Lennertz
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany
| | - Rosa Grützmann
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Stephan Heinzel
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany.,Clinical Psychology and Psychotherapy, Freie Universität Berlin, Berlin, Germany
| | - Christian Kaufmann
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Julia Klawohn
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany.,Biomedical Sciences and Psychology, Florida State University, Tallahassee, FL, United States
| | - Anja Riesel
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Inga Meyhöfer
- Department of Psychology, University of Bonn, Bonn, Germany
| | | | - Norbert Kathmann
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Michael Wagner
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany.,German Center for Neurodegenerative Diseases, Bonn, Germany.,Department for Neurodegenerative Diseases and Geriatric Psychiatry, University Hospital Bonn, Bonn, Germany
| |
Collapse
|
14
|
Meyhöfer I, Steffens M, Faiola E, Kasparbauer AM, Kumari V, Ettinger U. Combining two model systems of psychosis: The effects of schizotypy and sleep deprivation on oculomotor control and psychotomimetic states. Psychophysiology 2017; 54:1755-1769. [PMID: 28714081 DOI: 10.1111/psyp.12917] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 05/31/2017] [Accepted: 06/07/2017] [Indexed: 11/26/2022]
Abstract
Model systems of psychosis, such as schizotypy or sleep deprivation, are valuable in informing our understanding of the etiology of the disorder and aiding the development of new treatments. Schizophrenia patients, high schizotypes, and sleep-deprived subjects are known to share deficits in oculomotor biomarkers. Here, we aimed to further validate the schizotypy and sleep deprivation models and investigated, for the first time, their interactive effects on smooth pursuit eye movements (SPEM), prosaccades, antisaccades, predictive saccades, and measures of psychotomimetic states, anxiety, depression, and stress. To do so, n = 19 controls and n = 17 high positive schizotypes were examined after both a normal sleep night and 24 h of sleep deprivation. Schizotypes displayed higher SPEM global position error, catch-up saccade amplitude, and increased psychotomimetic states. Sleep deprivation impaired SPEM, prosaccade, antisaccade, and predictive saccade performance and increased levels of psychotomimetic experiences. Additionally, sleep deprivation reduced SPEM gain in schizotypes but not controls. We conclude that oculomotor impairments are observed in relation to schizotypy and following sleep deprivation, supporting their utility as biomarkers in model systems of psychosis. The combination of these models with oculomotor biomarkers may be particularly fruitful in assisting the development of new antipsychotic or pro-cognitive drugs.
Collapse
Affiliation(s)
- Inga Meyhöfer
- Department of Psychology, University of Bonn, Bonn, Germany
| | - Maria Steffens
- Department of Psychology, University of Bonn, Bonn, Germany
| | - Eliana Faiola
- Department of Psychology, University of Bonn, Bonn, Germany
| | | | - Veena Kumari
- Research & Development, Sovereign Health, San Clemente, California
| | | |
Collapse
|
15
|
Bey K, Kloft L, Lennertz L, Grützmann R, Heinzel S, Kaufmann C, Klawohn J, Riesel A, Meyhöfer I, Kathmann N, Wagner M. Volitional saccade performance in a large sample of patients with obsessive-compulsive disorder and unaffected first-degree relatives. Psychophysiology 2017; 54:1284-1294. [PMID: 28481032 DOI: 10.1111/psyp.12884] [Citation(s) in RCA: 2] [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: 09/23/2016] [Revised: 03/31/2017] [Accepted: 03/31/2017] [Indexed: 01/16/2023]
Abstract
Recent evidence indicates that patients with obsessive-compulsive disorder (OCD) as well as their unaffected first-degree relatives show deficits in the volitional control of saccades, suggesting that volitional saccade performance may constitute an endophenotype of OCD. Here, we aimed to replicate and extend these findings in a large, independent sample. One hundred and fifteen patients with OCD, 103 healthy comparison subjects without a family history of OCD, and 31 unaffected first-degree relatives of OCD patients were examined using structured clinical interviews and performed a volitional saccade task as well as a prosaccade task. In contrast to previous reports, neither patients nor relatives showed impairments in the performance of volitional saccades compared to healthy controls. Notably, medicated patients did not differ from nonmedicated patients, and there was no effect of depressive comorbidity. Additional analyses investigating correlations between saccade performance and OCD symptom dimensions yielded no significant associations. In conclusion, the present results do not support the notion that volitional saccade execution constitutes an endophenotype of OCD. Possible explanations for inconsistencies with previous studies are discussed.
Collapse
Affiliation(s)
- Katharina Bey
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany.,German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Lisa Kloft
- Department of Psychology, Humboldt University of Berlin, Berlin, Germany
| | - Leonhard Lennertz
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany
| | - Rosa Grützmann
- Department of Psychology, Humboldt University of Berlin, Berlin, Germany
| | - Stephan Heinzel
- Department of Psychology, Humboldt University of Berlin, Berlin, Germany.,Clinical Psychology and Psychotherapy, Freie Universität Berlin, Berlin, Germany
| | - Christian Kaufmann
- Department of Psychology, Humboldt University of Berlin, Berlin, Germany
| | - Julia Klawohn
- Department of Psychology, Humboldt University of Berlin, Berlin, Germany
| | - Anja Riesel
- Department of Psychology, Humboldt University of Berlin, Berlin, Germany
| | - Inga Meyhöfer
- Department of Psychology, University of Bonn, Bonn, Germany
| | - Norbert Kathmann
- Department of Psychology, Humboldt University of Berlin, Berlin, Germany
| | - Michael Wagner
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany.,German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| |
Collapse
|
16
|
Meyhöfer I, Kumari V, Hill A, Petrovsky N, Ettinger U. Sleep deprivation as an experimental model system for psychosis: Effects on smooth pursuit, prosaccades, and antisaccades. J Psychopharmacol 2017; 31:418-433. [PMID: 28347256 DOI: 10.1177/0269881116675511] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [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: 12/19/2022]
Abstract
Current antipsychotic medications fail to satisfactorily reduce negative and cognitive symptoms and produce many unwanted side effects, necessitating the development of new compounds. Cross-species, experimental behavioural model systems can be valuable to inform the development of such drugs. The aim of the current study was to further test the hypothesis that controlled sleep deprivation is a safe and effective model system for psychosis when combined with oculomotor biomarkers of schizophrenia. Using a randomized counterbalanced within-subjects design, we investigated the effects of 1 night of total sleep deprivation in 32 healthy participants on smooth pursuit eye movements (SPEM), prosaccades (PS), antisaccades (AS), and self-ratings of psychosis-like states. Compared with a normal sleep control night, sleep deprivation was associated with reduced SPEM velocity gain, higher saccadic frequency at 0.2 Hz, elevated PS spatial error, and an increase in AS direction errors. Sleep deprivation also increased intra-individual variability of SPEM, PS, and AS measures. In addition, sleep deprivation induced psychosis-like experiences mimicking hallucinations, cognitive disorganization, and negative symptoms, which in turn had moderate associations with AS direction errors. Taken together, sleep deprivation resulted in psychosis-like impairments in SPEM and AS performance. However, diverging somewhat from the schizophrenia literature, sleep deprivation additionally disrupted PS control. Sleep deprivation thus represents a promising but possibly unspecific experimental model that may be helpful to further improve our understanding of the underlying mechanisms in the pathophysiology of psychosis and aid the development of antipsychotic and pro-cognitive drugs.
Collapse
Affiliation(s)
- Inga Meyhöfer
- 1 Department of Psychology, University of Bonn, Bonn, Germany
| | - Veena Kumari
- 2 Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,3 NIHR Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation Trust, London, UK
| | - Antje Hill
- 1 Department of Psychology, University of Bonn, Bonn, Germany.,4 Institute of Sport and Exercise Sciences, University of Münster, Münster, Germany
| | | | - Ulrich Ettinger
- 1 Department of Psychology, University of Bonn, Bonn, Germany
| |
Collapse
|
17
|
Meyhöfer I, Bertsch K, Esser M, Ettinger U. Variance in saccadic eye movements reflects stable traits. Psychophysiology 2015; 53:566-78. [DOI: 10.1111/psyp.12592] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 10/09/2015] [Accepted: 11/03/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Inga Meyhöfer
- Department of Psychology; University of Bonn; Bonn Germany
| | - Katja Bertsch
- Department of General Psychiatry; Center for Psychosocial Medicine, Heidelberg University Hospital; Heidelberg Germany
| | - Moritz Esser
- Department of Psychology; University of Bonn; Bonn Germany
| | | |
Collapse
|
18
|
Meyhöfer I, Steffens M, Kasparbauer A, Grant P, Weber B, Ettinger U. Neural mechanisms of smooth pursuit eye movements in schizotypy. Hum Brain Mapp 2014; 36:340-53. [PMID: 25197013 DOI: 10.1002/hbm.22632] [Citation(s) in RCA: 20] [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] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 08/29/2014] [Accepted: 08/29/2014] [Indexed: 11/11/2022] Open
Abstract
Patients with schizophrenia as well as individuals with high levels of schizotypy are known to have deficits in smooth pursuit eye movements (SPEM). Here, we investigated, for the first time, the neural mechanisms underlying SPEM performance in high schizotypy. Thirty-one healthy participants [N = 19 low schizotypes, N = 12 high schizotypes (HS)] underwent functional magnetic resonance imaging at 3T with concurrent oculographic recording while performing a SPEM task with sinusoidal stimuli at two velocities (0.2 and 0.4 Hz). Behaviorally, a significant interaction between schizotypy group and velocity was found for frequency of saccades during SPEM, indicating impairments in HS in the slow but not the fast condition. On the neural level, HS demonstrated lower brain activation in different regions of the occipital lobe known to be associated with early sensory and attentional processing and motion perception (V3A, middle occipital gyrus, and fusiform gyrus). This group difference in neural activation was independent of target velocity. Together, these findings replicate the observation of altered pursuit performance in highly schizotypal individuals and, for the first time, identify brain activation patterns accompanying these performance changes. These posterior activation differences are compatible with evidence of motion processing deficits from the schizophrenia literature and, therefore, suggest overlap between schizotypy and schizophrenia both on cognitive-perceptual and neurophysiological levels. However, deficits in frontal motor areas observed during pursuit in schizophrenia were not seen here, suggesting the operation of additional genetic and/or illness-related influences in the clinical disorder.
Collapse
Affiliation(s)
- Inga Meyhöfer
- Department of Psychology, University of Bonn, Bonn, Germany
| | | | | | | | | | | |
Collapse
|
19
|
Ettinger U, Meyhöfer I, Steffens M, Wagner M, Koutsouleris N. Genetics, cognition, and neurobiology of schizotypal personality: a review of the overlap with schizophrenia. Front Psychiatry 2014; 5:18. [PMID: 24600411 PMCID: PMC3931123 DOI: 10.3389/fpsyt.2014.00018] [Citation(s) in RCA: 184] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Accepted: 02/06/2014] [Indexed: 01/22/2023] Open
Abstract
Schizotypy refers to a set of temporally stable traits that are observed in the general population and that resemble the signs and symptoms of schizophrenia. Here, we review evidence from studies on genetics, cognition, perception, motor and oculomotor control, brain structure, brain function, and psychopharmacology in schizotypy. We specifically focused on identifying areas of overlap between schizotypy and schizophrenia. Evidence was corroborated that significant overlap exists between the two, covering the behavioral brain structural and functional as well molecular levels. In particular, several studies showed that individuals with high levels of schizotypal traits exhibit alterations in neurocognitive task performance and underlying brain function similar to the deficits seen in patients with schizophrenia. Studies of brain structure have shown both volume reductions and increase in schizotypy, pointing to schizophrenia-like deficits as well as possible protective or compensatory mechanisms. Experimental pharmacological studies have shown that high levels of schizotypy are associated with (i) enhanced dopaminergic response in striatum following administration of amphetamine and (ii) improvement of cognitive performance following administration of antipsychotic compounds. Together, this body of work suggests that schizotypy shows overlap with schizophrenia across multiple behavioral and neurobiological domains, suggesting that the study of schizotypal traits may be useful in improving our understanding of the etiology of schizophrenia.
Collapse
Affiliation(s)
- Ulrich Ettinger
- Department of Psychology, University of Bonn , Bonn , Germany
| | - Inga Meyhöfer
- Department of Psychology, University of Bonn , Bonn , Germany
| | - Maria Steffens
- Department of Psychology, University of Bonn , Bonn , Germany
| | - Michael Wagner
- Department of Psychiatry and Psychotherapy, University of Bonn , Bonn , Germany
| | | |
Collapse
|