1
|
Podesser F, Weninger J, Weiss EM, Marksteiner J, Canazei M. Short-term Medication Effect on Fall Risk in Multimorbid Inpatients with Dementia. Gerontology 2024:000538074. [PMID: 38626732 DOI: 10.1159/000538074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 02/25/2024] [Indexed: 04/18/2024] Open
Abstract
INTRODUCTION Dementia increases the risk of falls and fall-related injuries, which may be caused by inappropriate medication use. To date, there is little evidence on which medications are more likely to cause falls. We therefore investigated the effects of medication use and medication changes 48 hours before falls in hospitalised patients with dementia. METHODS This matched case-control study included 74 patients with a mean age of 83 years (38% women) who had been hospitalised for at least 7 days. Information on medications, diagnoses, disease severity, use of walking aids, falls, and demographics was collected from electronic medical records. The effects of number of medications and psychotropics, equivalent daily doses of antidepressants, antipsychotics and benzodiazepines, anticholinergic burden, medication initiation, dose change, medication discontinuation, as-needed medications, opioid use and the presence of fall-increasing diseases were examined separately for the periods 0h-24h and 24h-48h before the falls using binomial logistic regression analyses. RESULTS Falls increased significantly with higher daily antipsychotic doses 24 hours before the fall. In addition, the rate of falls increased with higher anticholinergic burden and prevalence of medication discontinuation 24 to 48 hours before the fall. Notably, the total number of medications and psychotropic medications had no effect on the incidence of falls. DISCUSSION/CONCLUSION With regard to the short-term effects of medication on fall risk, particular attention should be paid to the daily dose of antipsychotics, anticholinergic burden and medication discontinuation. Further studies with larger samples are needed to confirm the results of this study.
Collapse
|
2
|
Schmit A, Schurr T, Frajo-Apor B, Pardeller S, Plattner B, Tutzer F, Conca A, Fronthaler M, Haring C, Holzner B, Huber M, Marksteiner J, Miller C, Perwanger V, Pycha R, Schmidt M, Sperner-Unterweger B, Hofer A. Long-term impact of resilience and extraversion on psychological distress during the COVID-19 pandemic: a longitudinal investigation among individuals with and without mental health disorders. Front Psychiatry 2024; 15:1304491. [PMID: 38426004 PMCID: PMC10902045 DOI: 10.3389/fpsyt.2024.1304491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 01/15/2024] [Indexed: 03/02/2024] Open
Abstract
Background Over the past years, the COVID-19 pandemic has caused significant disruptions in daily routines. Although the pandemic has affected almost everyone, it has been particularly challenging for people with pre-existing mental health conditions. Therefore, this study investigated the long-term impact of resilience and extraversion on psychological distress in individuals diagnosed with mental health disorders (MHD) compared to the general population. In addition, possible gender-specific differences were investigated. Methods 123 patients with pre-existing MHD and 343 control subjects from Austria and Italy participated in three online surveys that had been conducted after the initial wave of the COVID-19 pandemic (t0), during the second lockdown in both countries (t1), and one year thereafter (t2). Participants completed standardized questionnaires on psychological distress (Brief-Symptom-Checklist), resilience (Resilience Scale), and extraversion (Big Five Inventory). A mediation model was employed to test the primary hypothesis. Possible gender-specific differences were analyzed using a moderated mediation model. Results The prevalence of psychological distress was consistently higher in patients compared to controls (t0: 37.3% vs. 13.2%, t1: 38.2% vs 11.7%, t2: 37.4% vs. 13.1%). This between-group difference in psychological distress at the first follow-up was fully mediated by baseline resilience scores (65.4% of the total effect). During the second-follow up, extraversion accounted for 18% of the total effect, whereas resilience slightly decreased to 56% of the total effect. Gender was not a significant moderator in the model. Conclusion Next to showing that people with MHD were particularly affected by the pandemic, these findings indicate that higher degrees of resilience and extraversion are related to less long-term psychological distress. Our findings stress the relevance of strengthening resilience and extraversion and to provide mental health support in times of crises, both to patients with MHD and the general population.
Collapse
Affiliation(s)
- Anna Schmit
- Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Division of Psychiatry I, Medical University Innsbruck, Innsbruck, Austria
| | - Timo Schurr
- Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Division of Psychiatry I, Medical University Innsbruck, Innsbruck, Austria
| | - Beatrice Frajo-Apor
- Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Division of Psychiatry I, Medical University Innsbruck, Innsbruck, Austria
| | - Silvia Pardeller
- Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Division of Psychiatry I, Medical University Innsbruck, Innsbruck, Austria
| | - Barbara Plattner
- Sanitary Agency of South Tyrol, Department of Psychiatry, General Hospital of Bolzano, Bolzano, Italy
| | - Franziska Tutzer
- Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Division of Psychiatry I, Medical University Innsbruck, Innsbruck, Austria
| | - Andreas Conca
- Sanitary Agency of South Tyrol, Department of Psychiatry, General Hospital of Bolzano, Bolzano, Italy
| | - Martin Fronthaler
- Sanitary Agency of South Tyrol, Therapy Center Bad Bachgart, Rodengo, Italy
| | - Christian Haring
- Department of Psychiatry and Psychotherapy B, State Hospital Hall in Tyrol, Hall in Tyrol, Austria
| | - Bernhard Holzner
- Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Division of Psychiatry I, Medical University Innsbruck, Innsbruck, Austria
| | - Markus Huber
- Sanitary Agency of South Tyrol, Department of Psychiatry, General Hospital of Brunico, Brunico, Italy
| | - Josef Marksteiner
- Department of Psychiatry and Psychotherapy A, State Hospital Hall in Tyrol, Hall in Tyrol, Austria
| | - Carl Miller
- Department of Psychiatry, County Hospital Kufstein, Kufstein, Austria
| | - Verena Perwanger
- Sanitary Agency of South Tyrol, Department of Psychiatry, General Hospital of Merano, Merano, Italy
| | - Roger Pycha
- Sanitary Agency of South Tyrol, Department of Psychiatry, General Hospital of Bressanone, Bressanone, Italy
| | - Martin Schmidt
- Department of Psychiatry, County Hospital Lienz, Lienz, Austria
| | - Barbara Sperner-Unterweger
- Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Division of Psychiatry II, Medical University Innsbruck, Innsbruck, Austria
| | - Alex Hofer
- Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Division of Psychiatry I, Medical University Innsbruck, Innsbruck, Austria
| |
Collapse
|
3
|
Tutzer F, Schurr T, Frajo-Apor B, Pardeller S, Plattner B, Schmit A, Conca A, Fronthaler M, Haring C, Holzner B, Huber M, Marksteiner J, Miller C, Perwanger V, Pycha R, Schmidt M, Sperner-Unterweger B, Hofer A. Relevance of spirituality and perceived social support to mental health of people with pre-existing mental health disorders during the COVID-19 pandemic: a longitudinal investigation. Soc Psychiatry Psychiatr Epidemiol 2023:10.1007/s00127-023-02590-1. [PMID: 38112803 DOI: 10.1007/s00127-023-02590-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 10/30/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND The COVID-19 pandemic and related measures have negatively impacted mental health worldwide. The main objective of the present longitudinal study was to investigate mental health in people living in Tyrol (Austria) and South Tyrol (Italy) during the COVID-19 pandemic and to report the prevalence of psychological distress among individuals with versus those without pre-existing mental health disorders (MHD) in the long-term (summer 2020-winter 2022). Here, we specifically focus on the relevance of spirituality and perceived social support in this regard. METHODS 161 individuals who had been diagnosed with MHD and 446 reference subjects participated in this online survey. Electronic data capture was conducted using the Computer-based Health Evaluation System and included both sociodemographic and clinical aspects as well as standardized questionnaires on psychological distress, spirituality, and the perception of social support. RESULTS The prevalence of psychological distress was significantly higher in individuals with MHD (36.6% vs. 12.3%) and remained unchanged among both groups over time. At baseline, the perception of social support was significantly higher in healthy control subjects, whereas the two groups were comparable in regards of the subjective relevance of faith. Reference subjects indicated significantly higher spiritual well-being in terms of the sense of meaning in life and peacefulness, which mediated in large part the between-group difference of psychological distress at follow-up. Notably, both faith and the perception of social support did not prove to be relevant in this context. CONCLUSIONS These findings point to a consistently high prevalence of psychological distress among people suffering from MHD and underscore the prominent role of meaning in life and peacefulness as a protective factor in times of crisis. Therapeutic strategies that specifically target spirituality may have a beneficial impact on mental health.
Collapse
Affiliation(s)
- Franziska Tutzer
- Division of Psychiatry I, Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria.
| | - Timo Schurr
- Division of Psychiatry I, Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Beatrice Frajo-Apor
- Division of Psychiatry I, Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Silvia Pardeller
- Division of Psychiatry I, Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Barbara Plattner
- Department of Psychiatry, General Hospital of Bolzano, Sanitary Agency of South Tyrol, Bolzano, Italy
| | - Anna Schmit
- Division of Psychiatry I, Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Andreas Conca
- Department of Psychiatry, General Hospital of Bolzano, Sanitary Agency of South Tyrol, Bolzano, Italy
| | - Martin Fronthaler
- Therapy Center Bad Bachgart, Sanitary Agency of South Tyrol, Rodengo, Italy
| | - Christian Haring
- Department of Psychiatry and Psychotherapy B, State Hospital Hall in Tyrol, Hall in Tyrol, Austria
| | - Bernhard Holzner
- Division of Psychiatry I, Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Markus Huber
- Department of Psychiatry, General Hospital of Brunico, Sanitary Agency of South Tyrol, Brunico, Italy
| | - Josef Marksteiner
- Department of Psychiatry and Psychotherapy A, State Hospital Hall in Tyrol, Hall in Tyrol, Austria
| | - Carl Miller
- Department of Psychiatry, County Hospital Kufstein, Kufstein, Austria
| | - Verena Perwanger
- Department of Psychiatry, General Hospital of Merano, Sanitary Agency of South Tyrol, Merano, Italy
| | - Roger Pycha
- Department of Psychiatry, General Hospital of Bressanone, Sanitary Agency of South Tyrol, Bressanone, Italy
| | - Martin Schmidt
- Department of Psychiatry, County Hospital Lienz, Lienz, Austria
| | - Barbara Sperner-Unterweger
- Division of Psychiatry II, Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Medical University Innsbruck, Innsbruck, Austria
| | - Alex Hofer
- Division of Psychiatry I, Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| |
Collapse
|
4
|
Constantini J, Bliem HR, Crepaz M, Marksteiner J. A Qualitative Literature Search and Pilot Study of Online Support Groups for Patients With Dementia and Their Carers. Gerontol Geriatr Med 2023; 9:23337214231205689. [PMID: 37881348 PMCID: PMC10594960 DOI: 10.1177/23337214231205689] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 09/15/2023] [Indexed: 10/27/2023] Open
Abstract
The ever-growing group of people living with dementia (PLWD) and their relatives face great challenges. The Covid 19 pandemic has once again placed a particular challenge on this vulnerable group. What started a decade earlier with telephone-based support groups experienced a real push during the pandemic in the form of video-based self-help services. The aim of this qualitative literature search in MEDLINE, EMBASE, CINAHL, and PsycINFO with keywords related to online, support group, caregiver, and dementia was to collect the reported experiences by the end of 2022. Peer reviewed journal papers were included when published and written in English. After the joint decision of two reviewers, it was decided to only include studies that were published in Medline. The results of the literature search are compared with experiences of the participants in a presentation group that was transformed into an online group at the time of the COVID-19 pandemic via Zoom. In search yielded a total of 129 articles. 113 articles described different types of interventions, 30 of which had a randomized design. The qualitative literature search showed on the one hand a high interest in online support groups but on the other hand that the effectiveness and efficacy in randomized trials is much less clear. In addition, we investigated the assessments and experiences of the participants in a presentation group that was transformed into an online group at the time of the COVID-19 pandemic via Zoom. This study demonstrates that PLWD and carers on virtual group meetings can express significant emotive capacity and enhanced connectivity with one another despite a diagnosis of mild to moderate dementia. Further research on entry criteria, concerns about online support services in general and necessary support for use is essential to develop the time- and location-independent possibility of video-based online self-help into an important form of support for both PLWD and their caregivers as an additional support option independent of exceptional pandemic situations.
Collapse
Affiliation(s)
| | | | - Marc Crepaz
- University of Applied Sciences Tyrol, Innsbruck, Austria
| | | |
Collapse
|
5
|
König T, Wurm R, Parvizi T, Silvaieh S, Hotzy C, Cetin H, Klotz S, Gelpi E, Bancher C, Benke T, Dal-Bianco P, Defrancesco M, Fischer P, Marksteiner J, Sutterlüty H, Ransmayr G, Schmidt R, Zimprich A, Stögmann E. C9orf72 repeat length might influence clinical sub-phenotypes in dementia patients. Neurobiol Dis 2022; 175:105927. [DOI: 10.1016/j.nbd.2022.105927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 10/27/2022] [Accepted: 11/11/2022] [Indexed: 11/15/2022] Open
|
6
|
Marksteiner J, Defrancesco M, Humpel C. Saliva tau and phospho-tau-181 measured by Lumipulse in patients with Alzheimer's disease. Front Aging Neurosci 2022; 14:1014305. [PMID: 36247998 PMCID: PMC9557075 DOI: 10.3389/fnagi.2022.1014305] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 08/08/2022] [Accepted: 09/01/2022] [Indexed: 12/04/2022] Open
Abstract
Alzheimer's disease (AD) is a severe neurodegenerative brain disorder. The determination of beta-amyloid (Aβ)-40, -42, total tau, and phospho-tau-181 (pTau181) in cerebrospinal fluid (CSF) using Lumipulse technology has been established as biomarkers for AD in recent years. As CSF collection is an invasive procedure, one aims to find biomarkers in blood or other human fluids, such as saliva. In the present study, we aim to measure these markers in human saliva. Using Salivettes, we collected saliva samples from healthy controls (n = 27), patients with AD dementia (n = 44), mild cognitive impairment (MCI) (n = 45), depression (n = 31), and 21 blinded samples, all older than 60 years. Lumipulse technology with a G600II was used to detect all four biomarkers. Our data show that the levels of total protein were highly variable and thus biomarker levels were corrected to 1 mg/ml of total protein. Saliva Aβ-40 and -42 were not detectable, because it was not recovered from the Salivettes. However, saliva total tau (577 ± 134 pg/mg, n = 22) and phospho-tau-181 (9.7 ± 1.3 pg/mg, n = 21) could be analyzed by Lumipulse technology. Saliva total tau levels were significantly decreased in patients with AD (≤ 300 pg/mg protein), while pTau181 levels (≥ 18 pg/mg protein) were significantly enhanced in patients with MCI compared to controls. Laboratory diagnosis with a cut-off of ≥ 18 pg/mg protein pTau181 (for MCI) and ≤ 300 pg/mg protein tau (for AD) for blinded samples could diagnose MCI and AD with an accuracy of 71.4%. Despite these initial promising results, the findings must be replicated in larger cohorts, and several technical problems due to saliva processing must be solved and Salivettes should not be used.
Collapse
Affiliation(s)
- Josef Marksteiner
- Department of Psychiatry and Psychotherapy A, State Hospital Hall in Tirol, Hall in Tirol, Austria
| | - Michaela Defrancesco
- Division of Psychiatry I, Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Medical University Innsbruck, Innsbruck, Austria
| | - Christian Humpel
- Laboratory of Psychiatry and Experimental Alzheimer’s Research, Medical University of Innsbruck, Innsbruck, Austria
| |
Collapse
|
7
|
Sarg B, Korde DS, Marksteiner J, Humpel C. Platelet TAU is Associated with Changes in Depression and Alzheimer's Disease. Front Biosci (Landmark Ed) 2022; 27:153. [PMID: 35638420 DOI: 10.31083/j.fbl2705153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 04/04/2022] [Accepted: 04/22/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Platelets (thrombocytes) are small anuclear cells that play an important role in blood clotting. They are activated and dysfunctional in brain disorders, such as Alzheimer's disease (AD) and depression. Platelets express the amyloid-precursor protein (APP) and release beta-amyloid40 into the blood. Recent evidence reports that platelets also express the microtubule-associated protein tau. In this study, we further characterized the molecular appearance of tau and examined its alterations in patients with neurocognitive impairment. METHODS Platelets were isolated from patients with AD, mild cognitive impairment (MCI) or depression and compared to healthy controls. Subsequently, FACS analysis was employed to characterize platelets for platelet surface P-selectin (CD62P). In order to enhance the detection levels, samples were pooled (15 samples per group) and analyzed by Lumipulse Assay, Western blots, and mass spectrometry. RESULTS Tau is expressed in human platelets and tau levels were decreased in platelets isolated from patients with AD and depression. Additionally, phospho-tau-181 was slightly increased in patients with depression. We show that tau is highly fragmented (20-40 kDa) in the platelet extracts using Western blot analysis. The mass spectrometry data did not show a clear identification of tau in the pooled platelet samples. CONCLUSIONS Our data reveal that tau is found in platelets, possibly in a highly fragmented form. Tau levels may be used as a potential diagnostic approach to differentiate AD and depression from healthy controls.
Collapse
Affiliation(s)
- Bettina Sarg
- Protein Core Facility, Institute of Medical Biochemistry, Biocenter, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Dhwani S Korde
- Laboratory of Psychiatry and Experimental Alzheimer's Research, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Josef Marksteiner
- Department of Psychiatry and Psychotherapy A, Hall State Hospital, 6060 Hall in Tirol, Austria
| | - Christian Humpel
- Laboratory of Psychiatry and Experimental Alzheimer's Research, Medical University of Innsbruck, 6020 Innsbruck, Austria
| |
Collapse
|
8
|
Bair A, Marksteiner J, Stöcklein T, Reyes del Paso GA, Duschek S. Parasympathetic cardiac control during attentional focus and worry in major depressive disorder. Int J Psychophysiol 2022; 177:1-10. [DOI: 10.1016/j.ijpsycho.2022.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 04/06/2022] [Accepted: 04/11/2022] [Indexed: 10/18/2022]
|
9
|
Hofer A, Kachel T, Plattner B, Chernova A, Conca A, Fronthaler M, Haring C, Holzner B, Huber M, Marksteiner J, Miller C, Pardeller S, Perwanger V, Pycha R, Schmidt M, Sperner-Unterweger B, Tutzer F, Frajo-Apor B. Mental health in individuals with severe mental disorders during the covid-19 pandemic: a longitudinal investigation. NPJ Schizophr 2022; 8:17. [PMID: 35260590 PMCID: PMC8903129 DOI: 10.1038/s41537-022-00225-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 12/17/2021] [Indexed: 12/14/2022]
Abstract
Research on the long-term mental health impact of the COVID-19 pandemic across mental disorders is limited, and information on the impact of public health policy measures with varying strictness is missing. This study therefore aimed at investigating psychological distress among residents of Tyrol (Austria) and South Tyrol (Italy) at the early stages of the pandemic and 5 months thereafter and examined how sociodemographic, protective, and risk factors relate to change over time. One hundred and fifteen people with severe mental illness (SMI; schizophrenia spectrum disorder, bipolar disorder, major depressive disorder with psychotic features) or major depressive disorder without psychotic features (MDD) and 481 community controls without mental disorders participated in an online survey. Next to the collection of sociodemographic and COVID-19 related variables, the Brief Symptom Checklist, the Resilience Scale, the Multidimensional Scale of Perceived Social Support, the Three-Item Loneliness Scale, and the Multidimensional State Boredom Scale-Short Form were used to assess psychological distress, resilience, perceived social support, loneliness, and boredom. Levels of psychological symptoms and the prevalence of psychological distress were significantly higher in individuals with MDD compared to the other two groups, and Italian participants were more prone to anxiety than those from Austria. Psychological distress was predicted by a lower degree of both resilience and perceived social support as well as loneliness and boredom. Notably, the prevalence of clinically relevant psychological symptoms remained unchanged among each group over time. These results underscore the relevance of tailored prevention and mitigation strategies to meet the specific needs of people both with and without mental disorders.
Collapse
Affiliation(s)
- Alex Hofer
- Division of Psychiatry I, Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Medical University Innsbruck, Innsbruck, Austria.
| | - Timo Kachel
- Division of Psychiatry I, Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Medical University Innsbruck, Innsbruck, Austria
| | - Barbara Plattner
- Department of Psychiatry, Sanitary Agency of South Tyrol, General Hospital of Bolzano, Bolzano, Italy
| | - Anna Chernova
- Division of Psychiatry I, Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Medical University Innsbruck, Innsbruck, Austria
| | - Andreas Conca
- Department of Psychiatry, Sanitary Agency of South Tyrol, General Hospital of Bolzano, Bolzano, Italy
| | - Martin Fronthaler
- Sanitary Agency of South Tyrol, Therapy center Bad Bachgart, Rodengo, Italy
| | - Christian Haring
- Department of Psychiatry and Psychotherapy B, State Hospital Hall in Tyrol, Hall in Tyrol, Austria
| | - Bernhard Holzner
- Division of Psychiatry I, Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Medical University Innsbruck, Innsbruck, Austria
| | - Markus Huber
- Department of Psychiatry, Sanitary Agency of South Tyrol, General Hospital of Brunico, Brunico, Italy
| | - Josef Marksteiner
- Department of Psychiatry and Psychotherapy A, State Hospital Hall in Tyrol, Hall in Tyrol, Austria
| | - Carl Miller
- Department of Psychiatry, County Hospital Kufstein, Kufstein, Austria
| | - Silvia Pardeller
- Division of Psychiatry I, Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Medical University Innsbruck, Innsbruck, Austria
| | - Verena Perwanger
- Department of Psychiatry, Sanitary Agency of South Tyrol, General Hospital of Merano, Merano, Italy
| | - Roger Pycha
- Department of Psychiatry, Sanitary Agency of South Tyrol, General Hospital of Bressanone, Bressanone, Italy
| | - Martin Schmidt
- Department of Psychiatry, County Hospital Lienz, Lienz, Austria
| | - Barbara Sperner-Unterweger
- Division of Psychiatry II, Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Medical University Innsbruck, Innsbruck, Austria
| | - Franziska Tutzer
- Division of Psychiatry I, Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Medical University Innsbruck, Innsbruck, Austria
| | - Beatrice Frajo-Apor
- Division of Psychiatry I, Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Medical University Innsbruck, Innsbruck, Austria
| |
Collapse
|
10
|
Weiss EM, Deisenhammer EA, Fink A, Marksteiner J, Canazei M, Papousek I. Disorder-Specific Profiles of Self-Perceived Emotional Abilities in Schizophrenia and Major Depressive Disorder. Brain Sci 2022; 12:brainsci12030356. [PMID: 35326312 PMCID: PMC8945907 DOI: 10.3390/brainsci12030356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 03/02/2022] [Accepted: 03/04/2022] [Indexed: 11/16/2022] Open
Abstract
Deficits in social cognition are a core feature of neuropsychiatric disorders. The purpose of this study was to compare profiles of self-perceived abilities across the core domains of emotional functioning between patients with schizophrenia (n = 22), major depressive disorder (n = 31) and healthy participants (n = 43) with the Self-report Emotional Ability Scale (SEAS). Profile analyses were used to explore group differences in the overall level of self-perceived effectiveness of emotional functioning and in the patterns in which the four functions of emotion perception and regulation in the intra- and inter-personal domains are arranged to each other. Both patient groups showed significantly lower overall levels of self-perceived emotional functioning compared to healthy controls. Most importantly, we found significant differences between patient groups in their profile patterns. Patients with schizophrenia indicated experiencing difficulties in all investigated domains, but the profile pattern largely matched that of healthy individuals. Instead, the profile of patients with depression was much more accentuated, showing lower perceived effectiveness of emotion perception and regulation in the intra-personal domain compared to inter-personal functions. Our results of disorder-specific emotional deficits may have profound implications for early screening and identification of at-risk populations as well as recovery-oriented interventions.
Collapse
Affiliation(s)
- Elisabeth M. Weiss
- Department of Psychology, University of Innsbruck, 6020 Innsbruck, Austria;
- Correspondence:
| | - Eberhard A. Deisenhammer
- Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Medical University of Innsbruck, 6020 Innsbruck, Austria;
| | - Andreas Fink
- Department of Psychology, University of Graz, 8010 Graz, Austria; (A.F.); (I.P.)
| | - Josef Marksteiner
- Department of Psychiatry and Psychotherapy A, Hall State Hospital, 6060 Hall in Tirol, Austria;
| | - Markus Canazei
- Department of Psychology, University of Innsbruck, 6020 Innsbruck, Austria;
| | - Ilona Papousek
- Department of Psychology, University of Graz, 8010 Graz, Austria; (A.F.); (I.P.)
| |
Collapse
|
11
|
Lommer K, Schurr T, Frajo-Apor B, Plattner B, Chernova A, Conca A, Fronthaler M, Haring C, Holzner B, Macina C, Marksteiner J, Miller C, Pardeller S, Perwanger V, Pycha R, Schmidt M, Sperner-Unterweger B, Tutzer F, Hofer A. Addiction in the time of COVID-19: Longitudinal course of substance use, psychological distress, and loneliness among a transnational Tyrolean sample with substance use disorders. Front Psychiatry 2022; 13:918465. [PMID: 35982932 PMCID: PMC9380400 DOI: 10.3389/fpsyt.2022.918465] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 07/01/2022] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Next to an increased use of alcohol, the current pandemic has been associated with increased psychological distress among the general population. Research on its effects on individuals suffering from substance use disorders (SUD) is scarce. This study aimed at expanding the existing literature on this topic with a focus on the impact of loneliness and perceived social support. METHODS Sixty-eight people diagnosed with SUD according to ICD-10 from the Austrian state of Tyrol and from the Italian Province of South Tyrol who had been treated in a psychiatric hospital in 2019 and one hundred and thirty-six matched reference subjects of the same regional background participated in an online survey. Sociodemographic variables and scores on the Brief Symptom Checklist, the Three-Item Loneliness Scale, and the Multidimensional Scale of Perceived Social Support were collected at baseline and 5 months thereafter. Baseline took place after the first wave, while follow-up largely coincided with the second wave of the pandemic. RESULTS Among both patients and the matched reference group, substance use as a means to feel better facing the pandemic rose and predicted higher levels of psychological distress. Patients were less likely to receive specific care at follow-up than at baseline and presented with a significantly higher prevalence of clinically relevant psychological distress and loneliness than the matched reference group at both assessment times. Among both groups, psychological burden remained unchanged over time. Perceived social support was generally significantly higher in the matched reference group than in patients. Loneliness and, to a lesser degree, low perceived social support predicted psychological distress. CONCLUSION These findings emphasize the need of preventive and educational measures regarding substance use behavior for both individuals suffering from SUD and those without mental health disorders.
Collapse
Affiliation(s)
- Kilian Lommer
- Division of Psychiatry I, Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Medical University Innsbruck, Innsbruck, Austria
| | - Timo Schurr
- Division of Psychiatry I, Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Medical University Innsbruck, Innsbruck, Austria
| | - Beatrice Frajo-Apor
- Division of Psychiatry I, Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Medical University Innsbruck, Innsbruck, Austria
| | - Barbara Plattner
- Department of Psychiatry, General Hospital of Bolzano, Sanitary Agency of South Tyrol, Bolzano, Italy
| | - Anna Chernova
- Division of Psychiatry I, Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Medical University Innsbruck, Innsbruck, Austria
| | - Andreas Conca
- Department of Psychiatry, General Hospital of Bolzano, Sanitary Agency of South Tyrol, Bolzano, Italy
| | - Martin Fronthaler
- Therapy Center Bad Bachgart, Sanitary Agency of South Tyrol, Rodengo, Italy
| | - Christian Haring
- Department of Psychiatry and Psychotherapy B, State Hospital Hall in Tyrol, Hall in Tyrol, Austria
| | - Bernhard Holzner
- Division of Psychiatry I, Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Medical University Innsbruck, Innsbruck, Austria
| | - Christian Macina
- Department of Psychiatry, General Hospital of Brunico, Sanitary Agency of South Tyrol, Brunico, Italy
| | - Josef Marksteiner
- Department of Psychiatry and Psychotherapy A, State Hospital Hall in Tyrol, Hall in Tyrol, Austria
| | - Carl Miller
- Department of Psychiatry, County Hospital Kufstein, Kufstein, Austria
| | - Silvia Pardeller
- Division of Psychiatry I, Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Medical University Innsbruck, Innsbruck, Austria
| | - Verena Perwanger
- Department of Psychiatry, General Hospital of Merano, Sanitary Agency of South Tyrol, Merano, Italy
| | - Roger Pycha
- Department of Psychiatry, General Hospital of Bressanone, Sanitary Agency of South Tyrol, Bressanone, Italy
| | - Martin Schmidt
- Department of Psychiatry, County Hospital Lienz, Lienz, Austria
| | - Barbara Sperner-Unterweger
- Division of Psychiatry II, Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Medical University Innsbruck, Innsbruck, Austria
| | - Franziska Tutzer
- Division of Psychiatry I, Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Medical University Innsbruck, Innsbruck, Austria
| | - Alex Hofer
- Division of Psychiatry I, Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Medical University Innsbruck, Innsbruck, Austria
| |
Collapse
|
12
|
Benke T, Marksteiner J, Ruepp B, Weiss EM, Zamarian L. Decision Making under Risk in Patients Suffering from Schizophrenia or Depression. Brain Sci 2021; 11:brainsci11091178. [PMID: 34573199 PMCID: PMC8470442 DOI: 10.3390/brainsci11091178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 08/31/2021] [Accepted: 09/05/2021] [Indexed: 11/16/2022] Open
Abstract
Studies have reported difficulties in decision making for patients with schizophrenia or depression. Here, we investigated whether there are differences between schizophrenia patients, depressed patients, and healthy individuals (HC) when decisions are to be made under risk and cognitive flexibility is required. We were also interested in the relationships between decision making, cognitive functioning, and disease severity. Thirty HC, 28 schizophrenia patients, and 28 depressed patients underwent structured clinical assessments and were assessed by the Positive and Negative Syndrome Scale or Hamilton Rating Scale. They performed the Probability-Associated Gambling (PAG) Task and a neuropsychological test battery. Both patient groups obtained lower scores than HC in memory and executive function measures. In the PAG task, relative to HC, depressed patients made slower decisions but showed a comparable number of advantageous decisions or strategy flexibility. Schizophrenia patients were slower, riskier, and less flexible compared to HC. For them, the decision making behavior correlated with the symptom severity. In both groups, decision making scores correlated with memory and executive function scores. Patients with schizophrenia or depression may have difficulties under risk when quick and flexible decisions are required. These difficulties may be more pronounced in patients who have marked cognitive deficits or severe clinical symptoms.
Collapse
Affiliation(s)
- Theresa Benke
- Department of Psychiatry and Psychotherapy A, Hall State Hospital, 6060 Hall in Tirol, Austria; (T.B.); (J.M.); (B.R.)
| | - Josef Marksteiner
- Department of Psychiatry and Psychotherapy A, Hall State Hospital, 6060 Hall in Tirol, Austria; (T.B.); (J.M.); (B.R.)
| | - Beatrix Ruepp
- Department of Psychiatry and Psychotherapy A, Hall State Hospital, 6060 Hall in Tirol, Austria; (T.B.); (J.M.); (B.R.)
| | - Elisabeth M. Weiss
- Department of Psychology, University of Innsbruck, 6020 Innsbruck, Austria;
| | - Laura Zamarian
- Department of Neurology, Medical University of Innsbruck, 6020 Innsbruck, Austria
- Correspondence:
| |
Collapse
|
13
|
Kaufmann L, Moeller K, Marksteiner J. Pain and Associated Neuropsychiatric Symptoms in Patients Suffering from Dementia: Challenges at Different Levels and Proposal of a Conceptual Framework. J Alzheimers Dis 2021; 83:1003-1009. [PMID: 34366340 PMCID: PMC8543251 DOI: 10.3233/jad-210263] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Old age is critically associated with multi-morbidity, chronic pain, and high risk for dementia. Recognizing and treating pain is very much dependent on language comprehension and production. Both may be impaired in dementia. Moreover, neuropsychiatric symptoms may interact with pain perception. The main aims of the present article were 1) to identify key areas for future research to elucidate the relation between pain and associated neuropsychiatric symptoms in dementia, and 2) to provide a conceptual framework for ameliorating the clinical process of recognizing, assessing, and managing pain in non-communicating patients with advanced dementia.
Collapse
Affiliation(s)
- Liane Kaufmann
- Depatment of Psychology, University of Innsbruck, Austria.,Department of Psychiatry and Psychotherapy A, General Hospital Hall in Tirol, Austria
| | - Korbinian Moeller
- School of Science, Centre for Mathematical Cognition, Loughborough University, United Kingdom.,Leibniz-Institut fuer Wissensmedien, Tuebingen, Germany.,LEAD Graduate School & Research Network, University of Tuebingen, Germany
| | - Josef Marksteiner
- Department of Psychiatry and Psychotherapy A, General Hospital Hall in Tirol, Austria
| |
Collapse
|
14
|
Schroeder S, Hofer SJ, Zimmermann A, Pechlaner R, Dammbrueck C, Pendl T, Marcello GM, Pogatschnigg V, Bergmann M, Müller M, Gschiel V, Ristic S, Tadic J, Iwata K, Richter G, Farzi A, Üçal M, Schäfer U, Poglitsch M, Royer P, Mekis R, Agreiter M, Tölle RC, Sótonyi P, Willeit J, Mairhofer B, Niederkofler H, Pallhuber I, Rungger G, Tilg H, Defrancesco M, Marksteiner J, Sinner F, Magnes C, Pieber TR, Holzer P, Kroemer G, Carmona-Gutierrez D, Scorrano L, Dengjel J, Madl T, Sedej S, Sigrist SJ, Rácz B, Kiechl S, Eisenberg T, Madeo F. Dietary spermidine improves cognitive function. Cell Rep 2021; 35:108985. [PMID: 33852843 DOI: 10.1016/j.celrep.2021.108985] [Citation(s) in RCA: 85] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 02/08/2021] [Accepted: 03/22/2021] [Indexed: 12/22/2022] Open
Abstract
Decreased cognitive performance is a hallmark of brain aging, but the underlying mechanisms and potential therapeutic avenues remain poorly understood. Recent studies have revealed health-protective and lifespan-extending effects of dietary spermidine, a natural autophagy-promoting polyamine. Here, we show that dietary spermidine passes the blood-brain barrier in mice and increases hippocampal eIF5A hypusination and mitochondrial function. Spermidine feeding in aged mice affects behavior in homecage environment tasks, improves spatial learning, and increases hippocampal respiratory competence. In a Drosophila aging model, spermidine boosts mitochondrial respiratory capacity, an effect that requires the autophagy regulator Atg7 and the mitophagy mediators Parkin and Pink1. Neuron-specific Pink1 knockdown abolishes spermidine-induced improvement of olfactory associative learning. This suggests that the maintenance of mitochondrial and autophagic function is essential for enhanced cognition by spermidine feeding. Finally, we show large-scale prospective data linking higher dietary spermidine intake with a reduced risk for cognitive impairment in humans.
Collapse
Affiliation(s)
- Sabrina Schroeder
- Institute of Molecular Biosciences, NAWI Graz, University of Graz, 8010 Graz, Austria; BioTechMed-Graz, 8010 Graz, Austria
| | - Sebastian J Hofer
- Institute of Molecular Biosciences, NAWI Graz, University of Graz, 8010 Graz, Austria; BioTechMed-Graz, 8010 Graz, Austria; Field of Excellence BioHealth, University of Graz, 8010 Graz, Austria
| | - Andreas Zimmermann
- Institute of Molecular Biosciences, NAWI Graz, University of Graz, 8010 Graz, Austria; Field of Excellence BioHealth, University of Graz, 8010 Graz, Austria
| | - Raimund Pechlaner
- Department of Neurology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | | | - Tobias Pendl
- Institute of Molecular Biosciences, NAWI Graz, University of Graz, 8010 Graz, Austria
| | - G Mark Marcello
- Department of Anatomy and Histology, University of Veterinary Medicine Budapest, 1078 Budapest, Hungary
| | - Viktoria Pogatschnigg
- Institute of Molecular Biosciences, NAWI Graz, University of Graz, 8010 Graz, Austria
| | - Martina Bergmann
- Institute of Molecular Biosciences, NAWI Graz, University of Graz, 8010 Graz, Austria
| | - Melanie Müller
- Institute of Molecular Biosciences, NAWI Graz, University of Graz, 8010 Graz, Austria
| | - Verena Gschiel
- Institute of Molecular Biosciences, NAWI Graz, University of Graz, 8010 Graz, Austria
| | - Selena Ristic
- Institute of Molecular Biosciences, NAWI Graz, University of Graz, 8010 Graz, Austria
| | - Jelena Tadic
- Institute of Molecular Biosciences, NAWI Graz, University of Graz, 8010 Graz, Austria; Field of Excellence BioHealth, University of Graz, 8010 Graz, Austria
| | - Keiko Iwata
- Veneto Institute of Molecular Medicine, 35129 Padova, Italy; Research Center for Child Mental Development, University of Fukui, 910-1193 Fukui, Japan; Department of Biology, University of Padova, 35121 Padova, Italy
| | - Gesa Richter
- Gottfried Schatz Research Center for Cell Signaling, Metabolism and Aging Molecular Biology and Biochemistry Medical University of Graz, 8010 Graz, Austria
| | - Aitak Farzi
- Otto Loewi Research Center (for Vascular Biology, Immunology and Inflammation), Division of Pharmacology, Medical University of Graz (MUG), 8010 Graz, Austria
| | - Muammer Üçal
- Department of Neurosurgery, RU Experimental Neurotraumatology, Medical University Graz, 8036 Graz, Austria
| | - Ute Schäfer
- Department of Neurosurgery, RU Experimental Neurotraumatology, Medical University Graz, 8036 Graz, Austria
| | - Michael Poglitsch
- Institute of Molecular Biosciences, NAWI Graz, University of Graz, 8010 Graz, Austria
| | - Philipp Royer
- Institute of Molecular Biosciences, NAWI Graz, University of Graz, 8010 Graz, Austria
| | - Ronald Mekis
- Institute of Molecular Biosciences, NAWI Graz, University of Graz, 8010 Graz, Austria
| | - Marlene Agreiter
- Institute of Molecular Biosciences, NAWI Graz, University of Graz, 8010 Graz, Austria
| | - Regine C Tölle
- Department of Biology, University of Fribourg, Chemin du Musée 10, 1700 Fribourg, Switzerland
| | - Péter Sótonyi
- Department of Anatomy and Histology, University of Veterinary Medicine Budapest, 1078 Budapest, Hungary
| | - Johann Willeit
- Department of Neurology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | | | | | | | | | - Herbert Tilg
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology and Metabolism, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Michaela Defrancesco
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Josef Marksteiner
- Department of Psychiatry and Psychotherapy A, Hall State Hospital, 6060 Hall in Tirol, Austria
| | - Frank Sinner
- HEALTH-Institute for Biomedicine and Health Sciences, Joanneum Research Forschungsgesellschaft mbH, 8010 Graz, Austria; Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria
| | - Christoph Magnes
- HEALTH-Institute for Biomedicine and Health Sciences, Joanneum Research Forschungsgesellschaft mbH, 8010 Graz, Austria
| | - Thomas R Pieber
- BioTechMed-Graz, 8010 Graz, Austria; HEALTH-Institute for Biomedicine and Health Sciences, Joanneum Research Forschungsgesellschaft mbH, 8010 Graz, Austria; Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria
| | - Peter Holzer
- Otto Loewi Research Center (for Vascular Biology, Immunology and Inflammation), Division of Pharmacology, Medical University of Graz (MUG), 8010 Graz, Austria
| | - Guido Kroemer
- Equipe Labellisée par la Ligue Contre le Cancer, Université Paris Descartes, Université Paris Diderot, Université Sorbonne Paris Cité, INSERM U1138, Centre de Recherche des Cordeliers, 75006 Paris, France; Metabolomics and Cell Biology Platforms, Institut Gustave Roussy, 94 805 Villejuif, France; Pôle de Biologie, Hôpital Européen Georges Pompidou, AP-HP, 75015 Paris, France; Suzhou Institute for Systems Biology, Chinese Academy of Sciences, 215123 Suzhou, China; Department of Women's and Children's Health, Karolinska University Hospital, 171 77 Stockholm, Sweden
| | | | - Luca Scorrano
- Veneto Institute of Molecular Medicine, 35129 Padova, Italy; Department of Biology, University of Padova, 35121 Padova, Italy
| | - Jörn Dengjel
- Department of Biology, University of Fribourg, Chemin du Musée 10, 1700 Fribourg, Switzerland
| | - Tobias Madl
- BioTechMed-Graz, 8010 Graz, Austria; Gottfried Schatz Research Center for Cell Signaling, Metabolism and Aging Molecular Biology and Biochemistry Medical University of Graz, 8010 Graz, Austria
| | - Simon Sedej
- BioTechMed-Graz, 8010 Graz, Austria; Department of Cardiology, Medical University of Graz, 8036 Graz, Austria; Faculty of Medicine, University of Maribor, 2000 Maribor, Slovenia
| | - Stephan J Sigrist
- Institute of Biology/Genetics, Freie Universität Berlin, 14195 Berlin, Germany
| | - Bence Rácz
- Department of Anatomy and Histology, University of Veterinary Medicine Budapest, 1078 Budapest, Hungary
| | - Stefan Kiechl
- Department of Neurology, Medical University of Innsbruck, 6020 Innsbruck, Austria; VASCage, Research Centre on Vascular Ageing and Stroke, 6020 Innsbruck, Austria.
| | - Tobias Eisenberg
- Institute of Molecular Biosciences, NAWI Graz, University of Graz, 8010 Graz, Austria; BioTechMed-Graz, 8010 Graz, Austria; Field of Excellence BioHealth, University of Graz, 8010 Graz, Austria.
| | - Frank Madeo
- Institute of Molecular Biosciences, NAWI Graz, University of Graz, 8010 Graz, Austria; BioTechMed-Graz, 8010 Graz, Austria; Field of Excellence BioHealth, University of Graz, 8010 Graz, Austria.
| |
Collapse
|
15
|
Defrancesco M, Bancher C, Dal-Bianco P, Hinterhuber H, Schmidt R, Struhal W, Ransmayr G, Stögmann E, Marksteiner J. [Position paper of the Austrian Alzheimer Association (Österreichische Alzheimer Gesellschaft, ÖAG) : Effects of the COVID-19 pandemic in Austria on people with dementia and their care environment-problem areas, recommendations, and strategies]. Neuropsychiatr 2021; 35:35-47. [PMID: 33123943 PMCID: PMC7594989 DOI: 10.1007/s40211-020-00363-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 10/06/2020] [Indexed: 01/10/2023]
Abstract
Older adults are particularly affected by the current COVID-19 (SARS-CoV-2) pandemic. The risk of dying from COVID-19 increases with age and is often associated with pre-existing health conditions. Globally, more than 50 million-in Austria currently approximately 140,000 people-suffer from dementia. The co-occurrence of dementia as a "pandemic of old age" together with the COVID-19 pandemic has a double impact on persons living with dementia and their caregivers. The COVID-19 pandemic poses major challenges for individuals with dementia and their caregivers: (1) People with dementia have limited access to information on COVID-19, may have difficulties with protective measures such as wearing masks and in remembering safety regulations. (2) People with dementia live alone or with their family, or are institutionalized. To reduce the chance of infection among older people in nursing homes, Austrian local authorities have banned visitors to nursing homes and long-term care facilities and implemented strict social-distancing measures. As a result, older people lost face-to-face contact with their family members, became isolated and social activities stopped. Consequently, anxiety, stress and serious concerns about infections among staff in nursing homes increased and they developed signs of exhaustion and burnout during the full lockdown of the facilities. Thus, due to the emerging COVID-19 crisis, the Austrian Alzheimer Association (Österreichische Alzheimer Gesellschaft, ÖAG) and international societies developed recommendations to support people living with dementia and their caregivers on various issues of physical and mental health.
Collapse
Affiliation(s)
- Michaela Defrancesco
- Universitätsklinik für Psychiatrie I, Department Psychiatrie, Psychotherapie und Psychosomatik, Medizinische Universität Innsbruck, Anichstraße 35, 6020, Innsbruck, Österreich.
| | - Christian Bancher
- Abteilung für Neurologie/neurologische Rehabilitation, Landesklinikum Horn-Allentsteig, Horn, Österreich
| | - Peter Dal-Bianco
- Universitätsklinik für Neurologie, Medizinische Universität Wien, Wien, Österreich
| | - Hartmann Hinterhuber
- Universitätsklinik für Psychiatrie I, Department Psychiatrie, Psychotherapie und Psychosomatik, Medizinische Universität Innsbruck, Anichstraße 35, 6020, Innsbruck, Österreich
| | - Reinhold Schmidt
- Universitätsklinik für Neurologie, Klinische Abteilung für Neurogeriatrie, Medizinische Universität Graz, Graz, Österreich
| | - Walter Struhal
- Abteilung für Neurologie, Universitätsklinikum Tulln, Karl Landsteiner Privatuniversität für Gesundheitswissenschaften, Standort Tulln, Tulln, Österreich
| | - Gerhard Ransmayr
- Abteilung für Neurologie, Kepler Universitätsklinikum, Linz, Österreich
| | - Elisabeth Stögmann
- Universitätsklinik für Neurologie, Medizinische Universität Wien, Wien, Österreich
| | - Josef Marksteiner
- Department für Psychiatrie und Psychotherapie A, Landeskrankenhaus Hall, Hall, Österreich
| |
Collapse
|
16
|
Duschek S, Bair A, Hoffmann A, Marksteiner J, Montoro CI, Reyes del Paso GA. Cardiovascular Variability and Reactivity in Major Depressive Disorder. J PSYCHOPHYSIOL 2021. [DOI: 10.1027/0269-8803/a000277] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Abstract. This study investigated cardiovascular variability and stress reactivity in major depressive disorder (MDD). While previous research has documented reduced heart rate variability, knowledge about blood pressure variability in MDD remains scarce. Regarding reactivity, a particular focus was placed on the time courses of the cardiovascular responses, which may provide insight into the autonomic mechanisms underlying the hypo-reactivity expected in MDD. In 76 MDD patients and 71 healthy controls, blood pressure was continuously recorded at rest and during mental stress induced by a 3-min serial subtraction task. Compared to controls, patients exhibited lower systolic and diastolic blood pressure, heart rate variability, and systolic and diastolic blood pressure variability. Moreover, smaller stress-related changes in heart rate, systolic and diastolic blood pressure, and sensitivity of the cardiac baroreflex arose in patients. Cardiovascular parameters did not differ between patients using antidepressants and unmedicated patients. According to time-course analysis, reduced hemodynamic modulations in MDD mainly occurred after 50 s of the stress period. Low heart rate variability in MDD reflects deficient top-down integration of the brain mechanisms allowing flexible autonomic and behavioral control; diminished blood pressure variability is indicative of poor homeostatic capacity with respect to the regulation of blood pressure and organ perfusion. Moreover, blunted cardiovascular reactivity implies poor adjustment of energetic resources to internal and environmental demands and may be a correlate of deficient motivational dynamics characterizing MDD. While cardiovascular hypo-reactivity in MDD may be mediated by baroreflex and adrenergic mechanisms, the fast-acting parasympathetic system may play a subordinate role.
Collapse
Affiliation(s)
- Stefan Duschek
- UMIT – University of Health Sciences, Medical Informatics and Technology, Institute of Psychology, Hall in Tirol, Austria
| | - Angela Bair
- UMIT – University of Health Sciences, Medical Informatics and Technology, Institute of Psychology, Hall in Tirol, Austria
| | | | | | | | | |
Collapse
|
17
|
Blasko I, Defrancesco M, Oberacher H, Loacker L, Kemmler G, Marksteiner J, Humpel C. Plasma phosphatidylcholines and vitamin B12/folate levels are possible prognostic biomarkers for progression of Alzheimer's disease. Exp Gerontol 2021; 147:111264. [PMID: 33516907 DOI: 10.1016/j.exger.2021.111264] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 12/11/2020] [Accepted: 01/24/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES In clinical practice it is important to identify patients suffering from mild cognitive impairment (MCI) who will progress to Alzheimer's disease (AD). The purpose of this study is to investigate whether lipid metabolites and vitamin B12 and folate levels are effective biomarker for an accurate prediction of MCI-to-AD conversion. METHODS During the standard diagnostic assessment at our memory clinic 48 cognitively healthy subjects and MCI patients were recruited. These participants were followed up after 7-9 years. Blood was collected, various biochemical markers (including vitamin B12 and folate) analysed and plasma lipids were measured using the AbsoluteIDQ p150 Kit. RESULTS There was no significant change in lipid levels in controls converting to MCI. However, we found significant changes in five lipids in converters from controls to AD. Interestingly, also two lipids were altered when MCI re-converted to controls. Vitamin B12 levels were not affected by conversion but folate levels significantly decreased in MCI-AD conversion. CONCLUSIONS Taken together, our study provides evidence that some plasma lipids are significantly altered in subjects converting to AD. Future studies will investigate whether the peripheral lipid changes correspond with changes in the brain during the course of the disease. Although this is a small study, there are indications that lipids may be suitable as prognostic markers.
Collapse
Affiliation(s)
- Imrich Blasko
- Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Medical University of Innsbruck, Innsbruck, Austria.
| | - Michaela Defrancesco
- Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Medical University of Innsbruck, Innsbruck, Austria
| | - Herbert Oberacher
- Institute of Legal Medicine and Core Facility Metabolomics, Medical University of Innsbruck, Innsbruck, Austria
| | - Lorin Loacker
- Central Institute of Medicinal and Chemical Laboratory Diagnostics, University Hospital, Innsbruck, Austria
| | - Georg Kemmler
- Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Christian Humpel
- Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Medical University of Innsbruck, Innsbruck, Austria
| |
Collapse
|
18
|
Tutzer F, Frajo-Apor B, Pardeller S, Plattner B, Chernova A, Haring C, Holzner B, Kemmler G, Marksteiner J, Miller C, Schmidt M, Sperner-Unterweger B, Hofer A. The Impact of Resilience and Extraversion on Psychological Distress, Loneliness, and Boredom During the COVID-19 Pandemic: A Follow-Up Study Among the General Population of Tyrol, Austria. Front Psychiatry 2021; 12:777527. [PMID: 34867560 PMCID: PMC8632804 DOI: 10.3389/fpsyt.2021.777527] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 10/19/2021] [Indexed: 11/24/2022] Open
Abstract
Background: The Covid-19 pandemic and related measures represent an enormous burden on mental health. The aim of this study was to investigate longitudinal changes in psychological distress, loneliness, boredom, and resilience over the course of the pandemic and to examine the associations between resilience and extraversion at baseline (summer 2020) and psychological distress, loneliness, and boredom at 5-month-follow-up. Methods: Residents of Tyrol (≥18a) completed an online survey on psychological distress, loneliness, boredom, resilience, and extraversion by using the Brief-Symptom-Checklist, the Three-Item Loneliness Scale, the Multidimensional State Boredom Scale-Short Form (MSBS-SF), the Resilience Scale, and the Extraversion subscale of the Big Five Inventory. Results: Of the 961 baseline participants, 384 took part in the follow-up survey. The percentage of study participants with striking psychological distress remained the same. Similarly, resilience did not change from baseline to follow-up, whereas the number of those experiencing moderate loneliness increased significantly. In contrast, at follow-up, severe loneliness was detected in significantly less people. Boredom decreased significantly over time. A moderate negative association was detected between baseline resilience and psychological distress, loneliness, and boredom at follow-up, and a weak but still significant negative association between extraversion and these outcomes. Discussion: These findings indicate that a subset of the general population consistently suffers from high levels of psychological distress and point to the protective effects of resilience and extraversion in this context. They reemphasize the importance of prevention and mitigation strategies to address these public health problems.
Collapse
Affiliation(s)
- Franziska Tutzer
- Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Medical University Innsbruck, Innsbruck, Austria
| | - Beatrice Frajo-Apor
- Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Medical University Innsbruck, Innsbruck, Austria
| | - Silvia Pardeller
- Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Medical University Innsbruck, Innsbruck, Austria
| | - Barbara Plattner
- Department of Psychiatry, General Hospital of Bolzano, Sanitary Agency of South Tyrol, Bolzano, Italy
| | - Anna Chernova
- Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Medical University Innsbruck, Innsbruck, Austria
| | - Christian Haring
- Department of Psychiatry and Psychotherapy B, State Hospital Hall in Tyrol, Hall in Tyrol, Austria
| | - Bernhard Holzner
- Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Medical University Innsbruck, Innsbruck, Austria
| | - Georg Kemmler
- Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Medical University Innsbruck, Innsbruck, Austria
| | - Josef Marksteiner
- Department of Psychiatry and Psychotherapy A, State Hospital Hall in Tyrol, Hall in Tyrol, Austria
| | - Carl Miller
- Department of Psychiatry, County Hospital Kufstein, Kufstein, Austria
| | - Martin Schmidt
- Department of Psychiatry, County Hospital Lienz, Lienz, Austria
| | - Barbara Sperner-Unterweger
- Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry II, Medical University Innsbruck, Innsbruck, Austria
| | - Alex Hofer
- Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Medical University Innsbruck, Innsbruck, Austria
| |
Collapse
|
19
|
Tutzer F, Frajo-Apor B, Pardeller S, Plattner B, Chernova A, Haring C, Holzner B, Kemmler G, Marksteiner J, Miller C, Schmidt M, Sperner-Unterweger B, Hofer A. Psychological Distress, Loneliness, and Boredom Among the General Population of Tyrol, Austria During the COVID-19 Pandemic. Front Psychiatry 2021; 12:691896. [PMID: 34177672 PMCID: PMC8222609 DOI: 10.3389/fpsyt.2021.691896] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 04/07/2021] [Accepted: 05/17/2021] [Indexed: 12/31/2022] Open
Abstract
Background: COVID-19-related mental health problems are considered a public health challenge. The aim of this study was to investigate psychological distress, loneliness, and boredom among the general population of the federal state of Tyrol, Austria. Methods: Residents of Tyrol aged ≥ 18 years were recruited via dissemination of a link through social media and other advertisements and invited to complete an online survey from June 26th to August 20th, 2020. Next to the collection of sociodemographic and COVID-19 related variables the Brief Symptom Checklist (BSCL), the Three-Item Loneliness Scale (TILS), and the Multidimensional State Boredom Scale-Short Form (MSBS-SF) were used to assess psychological distress, loneliness, and boredom. Results: 961 participants took part in the survey (68.3% woman). Of these, 14.4% were burdened from psychological distress (BSCL), 22.6% reached a TILS score ≥ 7 and were therefore classified as severely lonely, and boredom levels lay by a mean of 25.9 ± 11.0 points in the MSBS-SF (range: 7-56). Women, singles, low-income people as well as those who were unemployed were significantly more often affected by all of the selected outcomes compared to the remaining sample and they had significantly more frequently consumed alcohol or other substances since the outbreak of the pandemic in order to feel better. In addition, young and middle-aged adults were particularly burdened by loneliness and boredom. Discussion: Our findings identify vulnerable groups and factors associated with higher psychological distress, loneliness, and boredom in the context of the pandemic. In order to prevent mental health problems it will be critical to identify options of maintaining social contacts and remaining active despite pandemic-related restrictions.
Collapse
Affiliation(s)
- Franziska Tutzer
- Division of Psychiatry I, Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University Innsbruck, Innsbruck, Austria
| | - Beatrice Frajo-Apor
- Division of Psychiatry I, Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University Innsbruck, Innsbruck, Austria
| | - Silvia Pardeller
- Division of Psychiatry I, Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University Innsbruck, Innsbruck, Austria
| | - Barbara Plattner
- Department of Psychiatry, Central Hospital, Sanitary Agency of South Tyrol, Bolzano, Italy
| | - Anna Chernova
- Division of Psychiatry I, Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University Innsbruck, Innsbruck, Austria
| | - Christian Haring
- Department of Psychiatry and Psychotherapy B, State Hospital Hall in Tyrol, Hall in Tyrol, Austria
| | - Bernhard Holzner
- Division of Psychiatry I, Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University Innsbruck, Innsbruck, Austria
| | - Georg Kemmler
- Division of Psychiatry I, Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University Innsbruck, Innsbruck, Austria
| | - Josef Marksteiner
- Department of Psychiatry and Psychotherapy A, State Hospital Hall in Tyrol, Hall in Tyrol, Austria
| | - Carl Miller
- Department of Psychiatry, County Hospital Kufstein, Kufstein, Austria
| | - Martin Schmidt
- Department of Psychiatry, County Hospital Lienz, Lienz, Austria
| | - Barbara Sperner-Unterweger
- Division of Psychiatry II, Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University Innsbruck, Innsbruck, Austria
| | - Alex Hofer
- Division of Psychiatry I, Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University Innsbruck, Innsbruck, Austria
| |
Collapse
|
20
|
Chernova A, Frajo-Apor B, Pardeller S, Tutzer F, Plattner B, Haring C, Holzner B, Kemmler G, Marksteiner J, Miller C, Schmidt M, Sperner-Unterweger B, Hofer A. The Mediating Role of Resilience and Extraversion on Psychological Distress and Loneliness Among the General Population of Tyrol, Austria Between the First and the Second Wave of the COVID-19 Pandemic. Front Psychiatry 2021; 12:766261. [PMID: 34777068 PMCID: PMC8578839 DOI: 10.3389/fpsyt.2021.766261] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 09/27/2021] [Indexed: 01/16/2023] Open
Abstract
Background: During the first 3 weeks of the COVID-19 pandemic, the federal state of Tyrol, Austria had one of the strictest curfews in Austria and worldwide. The aim of the current study was to investigate the assumingly protective role of resilience and extraversion and its impact on mental health following such an uncertain and unpredictable situation. Methods: Between the first and the second wave of the pandemic, adult residents of Tyrol were invited to participate in an online survey. Next to the assessment of sociodemographic and COVID-19-related variables the Brief-Symptom-Checklist, the Three-Item Loneliness Scale, the Resilience Scaled, and the Big Five Inventory were used to assess psychological distress, loneliness, resilience, and extraversion. Mediation analysis was used to investigate the role of resilience and extraversion in the context of age-, sex-, and partnership- related differences in psychological distress and loneliness. Results: One hundred and forty-five participants took part in the survey (68.2% female). Overall, psychological distress and severe loneliness were more often detected in women and singles. They also were less resilient, while men and singles presented with a lower degree of extraversion. Study participants under the age of 30 experienced severe loneliness more frequently than older people, whereas psychological distress, resilience, and extraversion were comparable between age groups. Resilience significantly mediated the relationship between both study participants' sex and partnership situation on one hand and psychological distress and severe loneliness on the other. In addition, extraversion significantly mediated the relationship between participants' partnership situation and psychological distress. Discussion: Our findings suggest that women, singles, and young people may be particularly affected by the measures and sequelae of the COVID-19 pandemic. Interventions promoting resilience and extraversion among these groups are urgently needed to foster mental health. Ideally, they can be utilized at home in case of renewed mobility restrictions or quarantine in the future.
Collapse
Affiliation(s)
- Anna Chernova
- Division of Psychiatry I, Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University Innsbruck, Innsbruck, Austria
| | - Beatrice Frajo-Apor
- Division of Psychiatry I, Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University Innsbruck, Innsbruck, Austria
| | - Silvia Pardeller
- Division of Psychiatry I, Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University Innsbruck, Innsbruck, Austria
| | - Franziska Tutzer
- Division of Psychiatry I, Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University Innsbruck, Innsbruck, Austria
| | - Barbara Plattner
- Department of Psychiatry, Sanitary Agency of South Tyrol, General Hospital of Bolzano, Bolzano, Italy
| | - Christian Haring
- Department of Psychiatry and Psychotherapy B, State Hospital Hall in Tyrol, Hall in Tyrol, Austria
| | - Bernhard Holzner
- Division of Psychiatry I, Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University Innsbruck, Innsbruck, Austria
| | - Georg Kemmler
- Division of Psychiatry I, Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University Innsbruck, Innsbruck, Austria
| | - Josef Marksteiner
- Department of Psychiatry and Psychotherapy A, State Hospital Hall in Tyrol, Hall in Tyrol, Austria
| | - Carl Miller
- Department of Psychiatry, County Hospital Kufstein, Kufstein, Austria
| | - Martin Schmidt
- Department of Psychiatry, County Hospital Lienz, Lienz, Austria
| | - Barbara Sperner-Unterweger
- Division of Psychiatry II, Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University Innsbruck, Innsbruck, Austria
| | - Alex Hofer
- Division of Psychiatry I, Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University Innsbruck, Innsbruck, Austria
| |
Collapse
|
21
|
Rainer C, Nasrouei S, Tschofen S, Bliem HR, Wilhelm FH, Marksteiner J. Fear acquisition and extinction in elderly patients with depression. J Affect Disord 2020; 276:197-204. [PMID: 32697699 DOI: 10.1016/j.jad.2020.06.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 05/29/2020] [Accepted: 06/16/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Depression in elderly patients is common and characterized by anxiety symptoms and cognitive impairment. To our knowledge, no studies have yet investigated the process of fear extinction in these patients. We investigated fear extinction with a paradigm consisting of habituation, acquisition and extinction. METHODS We included three age matched (mean age: 75.7 years) groups: Late Life Depression (LLD, n = 33), Mild Cognitive Impairment (MCI, n = 39), healthy controls (HC, n = 39). All participants were diagnosed with a standardized procedure including clinical examination, CERAD cognitive test battery, as well as magnetic resonance imaging. Participants underwent a fear conditioning paradigm consisting of habituation, acquisition, and extinction. During acquisition, a neutral face (conditioned stimulus, CS+) was paired with an electrical unconditioned stimulus, whereas another face (safety stimulus, CS-) was unpaired. Conditioned responses were measured by US-expectancy and valence ratings. RESULTS Compared to HC, both patient groups showed a significantly lower, differential (CS+ vs. CS-) fear acquisition across all measurements. Patients with cognitive impairment showed a significantly slower extinction, which is characterized by higher US-expectancy and reduced positive valence for CS+. Fear extinction was significantly less differential (CS+ vs. CS-) in patients with LLD. LIMITATIONS Due to the cross-sectional design we cannot distinguish whether the observed differences in fear extinction are state or trait markers in the LLD patients. CONCLUSIONS In this study, we demonstrate that fear extinction is impaired in elderly patients with depression. These results can have influence on treatment strategies.
Collapse
Affiliation(s)
- Christina Rainer
- Department of Psychiatry and Psychotherapy A, State Hospital Hall, Hall, Austria; Department of Psychology, University of Innsbruck, Innsbruck, Austria.
| | - Sarah Nasrouei
- Department of Psychiatry and Psychotherapy A, State Hospital Hall, Hall, Austria; Division of Clinical Psychology, Psychotherapy, and Health Psychology, Department of Psychology, University of Salzburg, Salzburg, Austria
| | - Simon Tschofen
- Department of Psychiatry and Psychotherapy A, State Hospital Hall, Hall, Austria
| | - Harald R Bliem
- Department of Psychology, University of Innsbruck, Innsbruck, Austria
| | - Frank H Wilhelm
- Division of Clinical Psychology, Psychotherapy, and Health Psychology, Department of Psychology, University of Salzburg, Salzburg, Austria
| | - Josef Marksteiner
- Department of Psychiatry and Psychotherapy A, State Hospital Hall, Hall, Austria
| |
Collapse
|
22
|
Netzer M, Hackl WO, Schaller M, Alber L, Marksteiner J, Ammenwerth E. Evaluating Performance and Interpretability of Machine Learning Methods for Predicting Delirium in Gerontopsychiatric Patients. Stud Health Technol Inform 2020; 271:121-128. [PMID: 32578554 DOI: 10.3233/shti200087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Delirium is an acute mental disturbance that particularly occurs during hospital stay. Current clinical assessment instruments include the Delirium Observation Screening Scale (DOSS) or the Confusion Assessment Method (CAM). The aim of this work is to analyze the performance of machine learning approaches to detect delirium based on DOSS and CAM information obtained from two geropsychiatric wards in Tyrol. From a machine learning perspective, the questions of these two assessment instruments represent the features and the ICD 10 diagnoses of delirium (yes/no) is the corresponding class variable. We compare seven popular classification methods and analyze the performance and interpretability of the learning models. As our dataset is highly imbalanced, we also evaluate the effect of common sampling methods including down- and up-sampling methods as well as hybrid methods. Our results indicate a high predictive ability of advanced methods such as Random Forest that can handle even unbalanced datasets. Overall, combining a good performance of a prediction model with the ability of users to understand the prediction is challenging. However, for clinical application in fully electronic settings, a good performance seems to be more important than an easy interpretation of the prediction by the user. On the other hand, explanations of decisions are often needed to assess other criteria such as safety.
Collapse
Affiliation(s)
- Michael Netzer
- Institute of Medical Informatics, Private University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
| | - Werner O Hackl
- Institute of Medical Informatics, Private University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
| | - Michael Schaller
- Institute of Medical Informatics, Private University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
| | - Lisa Alber
- Nursing Management Board, Tyrolean Federal Hospitals, Innsbruck, Austria
| | - Josef Marksteiner
- Department of Psychiatry and Psychotherapy A, State Hospital Hall, Hall in Tirol, Austria
| | - Elske Ammenwerth
- Institute of Medical Informatics, Private University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
| |
Collapse
|
23
|
Marksteiner J, Oberacher H, Humpel C. Acyl-Alkyl-Phosphatidlycholines are Decreased in Saliva of Patients with Alzheimer's Disease as Identified by Targeted Metabolomics. J Alzheimers Dis 2020; 68:583-589. [PMID: 30814361 DOI: 10.3233/jad-181278] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Diagnosis of Alzheimer's disease (AD) is still a challenge. Salivary analysis could produce an easily accessible and inexpensive possibility to study metabolic changes in AD. In the present pilot study, we show for the first time using targeted metabolomics that acyl-alkyl phosphatidylcholines (PCae C34:1-2; PCae C36:1-2-3; PCaeC38:1c3; PCae C40:2-3) are significantly reduced in saliva of AD patients (n = 25) compared to healthy controls (n = 25). Saliva levels of PCae C36Λ1-2-3) were also decreased in patients with mild cognitive impairment (n = 25). No changes were seen for saliva diacyl-phosphatidylcholines, lyso-acyl-phosphatidylcholines, and sphinogomyelins. These data suggest specific lipid changes in the saliva of AD patients, thus salivary measures could establish new biomarkers. However, these preliminary results have to be established in larger scale studies.
Collapse
Affiliation(s)
- Josef Marksteiner
- Department of Psychiatry and Psychotherapy A, Hall State Hospital, Austria
| | - Herbert Oberacher
- Institute of Legal Medicine and Core Facility Metabolomics, Medical University of Innsbruck, Austria
| | - Christian Humpel
- Laboratory of Psychiatry and Experimental Alzheimer's Research, Medical University of Innsbruck, Austria
| |
Collapse
|
24
|
Bair A, Marksteiner J, Falch R, Ettinger U, Reyes Del Paso GA, Duschek S. Features of autonomic cardiovascular control during cognition in major depressive disorder. Psychophysiology 2020; 58:e13628. [PMID: 32621782 DOI: 10.1111/psyp.13628] [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] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 05/18/2020] [Accepted: 05/22/2020] [Indexed: 11/27/2022]
Abstract
Previous research has suggested reduced parasympathetic cardiac regulation during cognitive activity in major depressive disorder (MDD). However, little is known about possible abnormalities in sympathetic control and cardiovascular reactivity. This study aimed to provide a comprehensive analysis of autonomic cardiovascular control in the context of executive functions in MDD. Thirty six MDD patients and 39 healthy controls participated. Parameters of sympathetic (pre-ejection period, PEP) and parasympathetic control (high and low frequency heart rate variability, HF HRV, LF HRV; and baroreflex sensitivity, BRS) as well as RR interval were obtained at rest and during performance of executive function tasks (number-letter task, n-back task, continuous performance test, and Stroop task). Patients, as compared to controls, exhibited lower HF HRV and LF HRV during task execution and smaller shortenings in PEP and RR interval between baseline and tasks. They displayed longer reaction times during all conditions of the tasks and more omission errors and false alarms on the continuous performance test. In the total sample, on-task HF HRV, LF HRV and BRS, and reactivity in HF HRV, LF HRV, and PEP, were positively associated with task performance. As performance reduction arose independent of executive function load of the tasks, the behavioral results reflect impairments in attention and processing speed rather than executive dysfunctions in MDD. Abnormalities in cardiovascular control during cognition in MDD appear to involve both divisions of the autonomic nervous system. Low tonic parasympathetic control and blunted sympathetic reactivity imply reduced physiological adjustment resources and, by extension, provide suboptimal conditions for cognitive performance.
Collapse
Affiliation(s)
- Angela Bair
- Institute of Psychology, UMIT - University of Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
| | - Josef Marksteiner
- Department of Psychiatry, County Hospital of Hall in Tirol, Hall in Tirol, Austria
| | - Reingard Falch
- Department of Psychiatry, County Hospital of Hall in Tirol, Hall in Tirol, Austria
| | | | | | - Stefan Duschek
- Institute of Psychology, UMIT - University of Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
| |
Collapse
|
25
|
Foidl BM, Oberacher H, Marksteiner J, Humpel C. Platelet and Plasma Phosphatidylcholines as Biomarkers to Diagnose Cerebral Amyloid Angiopathy. Front Neurol 2020; 11:359. [PMID: 32595581 PMCID: PMC7303320 DOI: 10.3389/fneur.2020.00359] [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] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 04/14/2020] [Indexed: 01/01/2023] Open
Abstract
Alzheimer's disease is a severe neurodegenerative brain disorder and characterized by deposition of extracellular toxic β-amyloid (42) plaques and the formation of intracellular tau neurofibrillary tangles. In addition, β-amyloid peptide deposits are found in the walls of small to medium blood vessels termed cerebral amyloid angiopathy (CAA). However, the pathogenesis of CAA appears to differ from that of senile plaques in several aspects. The aim of the present study was to analyze different lipids [phosphatidylcholines (PCs) and lysoPCs] in platelets and plasma of a novel mouse model of sporadic CAA (1). Our data show that lipids are significantly altered in plasma of the CAA mice. Levels of eight diacyl PCs, two acyl-alkyl PCs, and five lysoPCs were significantly increased. In extracts of mouse blood platelets, four diacyl and two acyl-alkyl PCs (but not lysoPCs) were significantly altered. Our data show that lipids are changed in CAA with a specific pattern, and we provide for the first time evidence that selected platelet and plasma PCs may help to characterize CAA.
Collapse
Affiliation(s)
- Bettina M Foidl
- Laboratory of Psychiatry and Experimental Alzheimer's Research, Medical University of Innsbruck, Innsbruck, Austria
| | - Herbert Oberacher
- Institute of Legal Medicine and Core Facility Metabolomics, Medical University of Innsbruck, Innsbruck, Austria
| | - Josef Marksteiner
- Department of Psychiatry and Psychotherapy A, Hall State Hospital, Hall in Tirol, Austria
| | - Christian Humpel
- Laboratory of Psychiatry and Experimental Alzheimer's Research, Medical University of Innsbruck, Innsbruck, Austria
| |
Collapse
|
26
|
Defrancesco M, Marksteiner J, Kemmler G, Dal-Bianco P, Ransmayr G, Benke T, Mosbacher J, Höller Y, Schmidt R. Specific Neuropsychiatric Symptoms Are Associated with Faster Progression in Alzheimer’s Disease: Results of the Prospective Dementia Registry (PRODEM-Austria). J Alzheimers Dis 2020; 73:125-133. [DOI: 10.3233/jad-190662] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Michaela Defrancesco
- Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Medical University of Innsbruck, Innsbruck, Austria
| | - Josef Marksteiner
- Department of Psychiatry and Psychotherapy A, General Hospital, Hall, Austria
| | - Georg Kemmler
- Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Medical University of Innsbruck, Innsbruck, Austria
| | - Peter Dal-Bianco
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Gerhard Ransmayr
- Department of Neurology 2, Kepler University Hospital, Med Campus III, Linz, Austria
| | - Thomas Benke
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Jochen Mosbacher
- Department of Neurology, Division of Neurogeriatrics, Medical University of Graz, Graz, Austria
| | - Yvonne Höller
- Department of Psychology, University of Akureyri, Akureyri, Iceland
| | - Reinhold Schmidt
- Department of Neurology, Division of Neurogeriatrics, Medical University of Graz, Graz, Austria
| |
Collapse
|
27
|
Canazei M, Turiaux J, Huber SE, Marksteiner J, Papousek I, Weiss EM. Actigraphy for Assessing Light Effects on Sleep and Circadian Activity Rhythm in Alzheimer's Dementia: A Narrative Review. Curr Alzheimer Res 2020; 16:1084-1107. [DOI: 10.2174/1567205016666191010124011] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 08/10/2019] [Accepted: 09/08/2019] [Indexed: 12/18/2022]
Abstract
Background:
Alzheimer's Disease (AD) is often accompanied by severe sleep problems and
circadian rhythm disturbances which may to some extent be attributed to a dysfunction in the biological
clock. The 24-h light/dark cycle is the strongest Zeitgeber for the biological clock. People with AD,
however, often live in environments with inappropriate photic Zeitgebers. Timed bright light exposure
may help to consolidate sleep- and circadian rest/activity rhythm problems in AD, and may be a low-risk
alternative to pharmacological treatment.
Objective & Method:
In the present review, experts from several research disciplines summarized the
results of twenty-seven light intervention studies which used wrist actigraphy to measure sleep and circadian
activity in AD patients.
Results:
Taken together, the findings remain inconclusive with regard to beneficial light effects. However,
the considered studies varied substantially with respect to the utilized light intervention, study design,
and usage of actigraphy. The paper provides a comprehensive critical discussion of these issues.
Conclusion:
Fusing knowledge across complementary research disciplines has the potential to critically
advance our understanding of the biological input of light on health and may contribute to architectural
lighting designs in hospitals, as well as our homes and work environments.
Collapse
Affiliation(s)
- Markus Canazei
- Research Department, Bartenbach LichtLabor GmbH Ringgold Standard Institution, Bartenbach GmbH, Rinnerstrasse 14, Aldrans 6071, Austria
| | - Julian Turiaux
- Department of Psychology, University of Graz, Graz, Austria
| | - Stefan E. Huber
- Institute of Ion Physics and Applied Physics, University of Innsbruck, Innsbruck, Tirol, Austria
| | - Josef Marksteiner
- Department of Psychiatry and Psychotherapy A, General Hospital, Milserstrasse 10 , Hall Tirol 6060, Austria
| | - Ilona Papousek
- Department of Psychology, University of Graz, Graz, Austria
| | | |
Collapse
|
28
|
Bramboeck V, Moeller K, Marksteiner J, Kaufmann L. Loneliness and Burden Perceived by Family Caregivers of Patients With Alzheimer Disease. Am J Alzheimers Dis Other Demen 2020; 35:1533317520917788. [PMID: 32281389 PMCID: PMC10624003 DOI: 10.1177/1533317520917788] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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] [Indexed: 12/11/2022]
Abstract
BACKGROUND The present study aimed at investigating loneliness and burden experienced by family members caring for relatives diagnosed with Alzheimer disease. METHODS Participants were 40 caregivers of inpatients with Alzheimer disease. Correlation and multiple regression analyses were conducted to investigate whether caregivers' loneliness (uni- and multidimensional) and burden are associated with and predicted by (1) specific caregiver characteristics and/or (2) patients' dementia severity and neuropsychiatric symptoms. RESULTS Loneliness was significantly correlated with caregivers' sex, age, and living circumstances, while burden was significantly correlated with caregivers' education solely. Regression analyses revealed that caregivers' sex and living circumstances contributed significantly to variance explanation of loneliness (but not burden), while the additional consideration of patient variables did not improve model fit. CONCLUSIONS Loneliness reported by caregivers of relatives diagnosed with dementia is significantly modulated by caregiver (but not patient) characteristics. Notably, both uni- and multidimensional loneliness scales seem to be sensitive diagnostic tools.
Collapse
Affiliation(s)
- Verena Bramboeck
- Department of Psychiatry and Psychotherapy A, General Hospital Hall, Hall in Tirol, Austria
| | - Korbinian Moeller
- Leibniz-Institut für Wissensmedien, University of Tuebingen, Germany
| | - Josef Marksteiner
- Department of Psychiatry and Psychotherapy A, General Hospital Hall, Hall in Tirol, Austria
| | - Liane Kaufmann
- Department of Psychiatry and Psychotherapy A, General Hospital Hall, Hall in Tirol, Austria
| |
Collapse
|
29
|
Nasrouei S, Rattel JA, Liedlgruber M, Marksteiner J, Wilhelm FH. Fear acquisition and extinction deficits in amnestic mild cognitive impairment and early Alzheimer's disease. Neurobiol Aging 2019; 87:26-34. [PMID: 31843256 DOI: 10.1016/j.neurobiolaging.2019.11.003] [Citation(s) in RCA: 17] [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] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 10/16/2019] [Accepted: 11/01/2019] [Indexed: 11/30/2022]
Abstract
Impaired learning and memory functioning are prime markers for Alzheimer's disease (AD). Although initial evidence points to impaired fear acquisition in later AD, no study has investigated fear conditioning in early stages and amnestic mild cognitive impairment (aMCI), a condition often preceding AD. The present study examined if fear conditioning gradually decays from healthy elderly to patients with aMCI, to patients with AD. Patients with AD (n = 43), patients with aMCI (n = 43), and matched healthy controls (n = 40) underwent a classical fear conditioning paradigm. During acquisition, a neutral face (conditioned stimulus, CS+) was paired with an electrical stimulus, whereas another face (unconditioned stimulus, CS-) was unpaired. Conditioned responses were measured by unconditioned stimulus expectancy, valence, and skin conductance. Compared to healthy controls, both patient groups showed less differential (CS+ vs. CS-) fear acquisition across all measures. Patients further displayed slowed extinction indexed by higher unconditioned stimulus expectancy and reduced positive valence for CS+, declining from aMCI to AD. Groups did not differ in responses during a preconditioning habituation phase and in unconditioned responding. Diminished differential fear acquisition and slowed extinction could represent prognostic markers for AD onset.
Collapse
Affiliation(s)
- Sarah Nasrouei
- Division of Clinical Psychology, Psychotherapy, and Health Psychology, Department of Psychology, University of Salzburg, Salzburg, Austria; Department of Psychiatry and Psychotherapy A, State Hospital Hall, Hall, Austria.
| | - Julina A Rattel
- Division of Clinical Psychology, Psychotherapy, and Health Psychology, Department of Psychology, University of Salzburg, Salzburg, Austria
| | - Michael Liedlgruber
- Division of Clinical Psychology, Psychotherapy, and Health Psychology, Department of Psychology, University of Salzburg, Salzburg, Austria
| | - Josef Marksteiner
- Department of Psychiatry and Psychotherapy A, State Hospital Hall, Hall, Austria
| | - Frank H Wilhelm
- Division of Clinical Psychology, Psychotherapy, and Health Psychology, Department of Psychology, University of Salzburg, Salzburg, Austria
| |
Collapse
|
30
|
Huber SE, Sachse P, Mauracher A, Marksteiner J, Pohl W, Weiss EM, Canazei M. Assessment of Fractal Characteristics of Locomotor Activity of Geriatric In-Patients With Alzheimer's Dementia. Front Aging Neurosci 2019; 11:272. [PMID: 31636559 PMCID: PMC6787148 DOI: 10.3389/fnagi.2019.00272] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 09/19/2019] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Many physiological signals yield fractal characteristics, i.e., finer details at higher magnifications resemble details of the whole. Evidence has been accumulating that such fractal scaling is basically a consequence of interaction-dominant feedback mechanisms that cooperatively generate those signals. Neurodegenerative diseases provide a natural framework to evaluate this paradigm when this cooperative function declines. However, methodological issues need to be cautiously taken into account in order to be able to provide reliable as well as valid interpretations of such signal analyses. METHODS Two conceptually different fractal analyses, i.e., detrended fluctuation analysis (DFA) and analysis of cumulative distributions of durations (CDDs), are applied to actigraphy data of 36 geriatric in-patients diagnosed with dementia. The impact of the used time resolution for data acquisition on the assessed fractal outcome parameters is particularly investigated. Moreover, associations between these parameters and scores from the Mini-Mental-State-Examination and circadian activity parameters are explored. RESULTS Both analyses yield significant deviations from (mono-)fractal scaling over the entire considered time range. DFA provides robust measures for the observed break-down of fractal scaling. In contrast, analysis of CDDs results in measures which highly fluctuate with respect to the time resolution of the assessed data which affects also further derived quantities such as scaling exponents or associations with other (clinically relevant) assessed parameters. DISCUSSION To scrutinize actigraphic signal characteristics and especially their (deviations from) fractal scaling may be a useful tool for aiding diagnosis, characterization, and monitoring of dementia. However, results may, besides contextual aspects, also substantially depend on specific methodological choices. In order to arrive at both reliable and valid interpretations, these complications need to be carefully elaborated in future research.
Collapse
Affiliation(s)
- Stefan E. Huber
- Institute of Ion Physics and Applied Physics, University of Innsbruck, Innsbruck, Austria
- Department of Psychology, University of Innsbruck, Innsbruck, Austria
- Bartenbach GmbH, Aldrans, Austria
| | - Pierre Sachse
- Department of Psychology, University of Innsbruck, Innsbruck, Austria
| | - Andreas Mauracher
- Institute of Ion Physics and Applied Physics, University of Innsbruck, Innsbruck, Austria
| | - Josef Marksteiner
- Department of Psychiatry and Psychotherapy A, State Hospital Hall, Hall in Tirol, Austria
| | | | | | | |
Collapse
|
31
|
Weiss EM, Parson W, Niederstätter H, Marksteiner J, Lampe A. [Genetics of Posttraumatic Stress Disorder (PTSD)]. Psychother Psychosom Med Psychol 2018; 69:266-274. [PMID: 30025422 DOI: 10.1055/a-0634-6625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Post-traumatic stress disorder (PTSD) is a mental disorder following a severe traumatic experience and is characterized by high rates of comorbidity with related psychiatric disorders. However, even for individuals experiencing the same trauma, there is considerable inter-individual variability in the risk of PTSD, and this is largely thought to be determined by biological processes, such as genetic predisposition and epigenetic mechanism. In this review we will summarize recent research on genetics of PTSD, primarily focusing on candidate gene-association studies, targeting on functional genetic variants in the monoaminergic system and the hypothalamic-pituitary-adrenal (HPA) axis. In addition, results from recent genome-wide association studies (GWAS) will be reported and we will highlight the interplay of genetic factors with environmental factors, based on evidence from gene-environment interaction analysis and studies on the epigenetic regulation of PTSD. Finally, we will provide a brief outlook towards the potential and perspectives of pharmaco-genetic studies.
Collapse
Affiliation(s)
- Elisabeth M Weiss
- Abteilung für Biologische Psychologie, Institut für Psychologie, Graz, Österreich
| | - Walther Parson
- Institut für Gerichtliche Medizin, Medizinische Universität Innsbruck, Österreich
| | - Harald Niederstätter
- Institut für Gerichtliche Medizin, Medizinische Universität Innsbruck, Österreich
| | - Josef Marksteiner
- Abteilung für Psychiatrie und Psychotherapie A, Landeskrankenhaus Hall, Österreich
| | - Astrid Lampe
- Dept. für Psychiatrie und Psychotherapie, Medizinische Universität Innsbruck, Österreich
| |
Collapse
|
32
|
Defrancesco M, Marksteiner J, Kemmler G, Fleischhacker WW, Blasko I, Deisenhammer EA. Severity of Depression Impacts Imminent Conversion from Mild Cognitive Impairment to Alzheimer's Disease. J Alzheimers Dis 2018; 59:1439-1448. [PMID: 28731429 DOI: 10.3233/jad-161135] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Mild cognitive impairment (MCI) has been suggested to represent a prodromal stage of dementia and to confer a high risk for conversion to dementia Alzheimer's type (DAT). OBJECTIVES In this study, we examined the predictive value of depressive symptoms and neuropsychological variables on conversion of MCI to DAT. METHODS Neuropsychological and clinical follow-up data of 260 MCI patients seen at the Psychiatric Memory Clinic of the Medical University of Innsbruck between 2005 and 2015 were analyzed retrospectively. Depression was assessed using the Geriatric Depression Scale (GDS). Potential predictors of conversion from MCI to DAT were analyzed by logistic regression analyses and additional survival-analytic methods. RESULTS Of the 260 patients (mean age 71.5±7.7 years), 83 (32%) converted to DAT within a mean follow-up time of 3.2±2.2 years and estimated one-year conversion rate of 10.1%. The univariate analysis showed with few exceptions (gender, use of antidepressants, low GDS score) group differences at baseline in patients converted to DAT compared to stable MCI patients. Logistic regression analysis as well as survival analysis revealed moderate to severe depression together with higher age and specific cognitive deficits as predictors of conversion from MCI to DAT. CONCLUSION Our results support the predictive value of different neuropsychological measures on the progression of DAT. In addition, we found a strong negative influence of depression on conversion to DAT in MCI patients. These results emphasize the importance of assessing depressive symptoms in the early stages of DAT when evaluating the conversion from MCI to DAT.
Collapse
Affiliation(s)
- Michaela Defrancesco
- Department of Psychiatry and Psychosomatics, Division of Psychiatry I, Medical University of Innsbruck, Innsbruck, Austria
| | - Josef Marksteiner
- Department of Psychiatry and Psychotherapy A, Landeskrankenhaus Hall, Hall in Tirol, Austria
| | - Georg Kemmler
- Department of Psychiatry and Psychosomatics, Division of Psychiatry I, Medical University of Innsbruck, Innsbruck, Austria
| | - Walter Wolfgang Fleischhacker
- Department of Psychiatry and Psychosomatics, Division of Psychiatry I, Medical University of Innsbruck, Innsbruck, Austria
| | - Imrich Blasko
- Department of Psychiatry and Psychosomatics, Division of Psychiatry I, Medical University of Innsbruck, Innsbruck, Austria
| | - Eberhard A Deisenhammer
- Department of Psychiatry and Psychosomatics, Division of Psychiatry I, Medical University of Innsbruck, Innsbruck, Austria
| |
Collapse
|
33
|
Ransmayr G, Hermann P, Sallinger K, Benke T, Seiler S, Dal-Bianco P, Marksteiner J, Defrancesco M, Sanin G, Struhal W, Guger M, Vosko M, Hagenauer K, Lehner R, Futschik A, Schmidt R. Caregiving and Caregiver Burden in Dementia Home Care: Results from the Prospective Dementia Registry (PRODEM) of the Austrian Alzheimer Society. J Alzheimers Dis 2018; 63:103-114. [DOI: 10.3233/jad-170657] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Gerhard Ransmayr
- Department of Neurology 2, Med Campus III, Kepler University Hospital, Faculty of Medicine, Johannes Kepler University Linz, Austria
| | - Philipp Hermann
- Department of Applied Statistics, Johannes Kepler University Linz, Austria
| | | | - Thomas Benke
- Department of Neurology, Medical University Innsbruck, Austria
| | - Stephan Seiler
- Department of Neurology, Section of Neurogeriatrics, Medical University Graz, Austria
| | | | - Josef Marksteiner
- Department of Psychiatry and Psychotherapy, Regional Hospital Hall, Austria
| | - Michaela Defrancesco
- Department of Psychiatry and Psychotherapy, Medical University Innsbruck, Austria
| | - Günter Sanin
- Department of Neurology, Medical University Innsbruck, Austria
| | - Walter Struhal
- Department of Neurology 2, Med Campus III, Kepler University Hospital, Faculty of Medicine, Johannes Kepler University Linz, Austria
| | - Michael Guger
- Department of Neurology 2, Med Campus III, Kepler University Hospital, Faculty of Medicine, Johannes Kepler University Linz, Austria
| | - Milan Vosko
- Department of Neurology 2, Med Campus III, Kepler University Hospital, Faculty of Medicine, Johannes Kepler University Linz, Austria
| | - Karin Hagenauer
- Department for Clinical and Health Psychology, Med Campus III, Kepler University Hospital, Linz, Austria
| | - Riccarda Lehner
- Department of Neurology 2, Med Campus III, Kepler University Hospital, Faculty of Medicine, Johannes Kepler University Linz, Austria
| | - Andreas Futschik
- Department of Applied Statistics, Johannes Kepler University Linz, Austria
| | - Reinhold Schmidt
- Department of Neurology, Section of Neurogeriatrics, Medical University Graz, Austria
| |
Collapse
|
34
|
Marksteiner J, Blasko I, Kemmler G, Koal T, Humpel C. Bile acid quantification of 20 plasma metabolites identifies lithocholic acid as a putative biomarker in Alzheimer's disease. Metabolomics 2017; 14:1. [PMID: 29249916 PMCID: PMC5725507 DOI: 10.1007/s11306-017-1297-5] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 11/08/2017] [Indexed: 11/29/2022]
Abstract
INTRODUCTION There is still a clear need for a widely available, inexpensive and reliable method to diagnose Alzheimer's disease (AD) and monitor disease progression. Liquid chromatography-mass spectrometry (LC-MS) is a powerful analytic technique with a very high sensitivity and specificity. OBJECTIVES The aim of the present study is to measure concentrations of 20 bile acids using the novel Kit from Biocrates Life Sciences based on LC-MS technique. METHODS Twenty bile acid metabolites were quantitatively measured in plasma of 30 cognitively healthy subjects, 20 patients with mild cognitive impairment (MCI) and 30 patients suffering from AD. RESULTS Levels of lithocholic acid were significantly enhanced in plasma of AD patients (50 ± 6 nM, p = 0.004) compared to healthy controls (32 ± 3 nM). Lithocholic acid plasma levels of MCI patients (41 ± 4 nM) were not significantly different from healthy subjects or AD patients. Levels of glycochenodeoxycholic acid, glycodeoxycholic acid and glycolithocholic acid were significantly higher in AD patients compared to MCI patients (p < 0.05). All other cholic acid metabolites were not significantly different between healthy subjects, MCI patients and AD patients. ROC analysis shows an overall accuracy of about 66%. Discriminant analysis was used to classify patients and we found that 15/23 were correctly diagnosed. We further showed that LCA levels increased by about 3.2 fold when healthy subjects converted to AD patients within a 8-9 year follow up period. Pathway analysis linked these changes to a putative toxic cholesterol pathway. CONCLUSION In conclusion, 4 bile acids may be useful to diagnose AD in plasma samples despite limitations in diagnostic accuracy.
Collapse
Affiliation(s)
- Josef Marksteiner
- Department of Psychiatry and Psychotherapy A, General Hospital, Hall, Austria
| | - Imrich Blasko
- Laboratory of Psychiatry and Experimental Alzheimer's Research, Medical University of Innsbruck, Innsbruck, Austria
| | - Georg Kemmler
- Laboratory of Psychiatry and Experimental Alzheimer's Research, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Christian Humpel
- Laboratory of Psychiatry and Experimental Alzheimer's Research, Medical University of Innsbruck, Innsbruck, Austria.
- Department of Psychiatry, Psychotherapy and Psychosomatics, Anichstr. 35, 6020, Innsbruck, Austria.
| |
Collapse
|
35
|
Defrancesco M, Pechlaner R, Kiechl S, Willeit J, Deisenhammer EA, Hinterhuber H, Rungger G, Gasperi A, Marksteiner J. What Characterizes Depression in Old Age? Results from the Bruneck Study. Pharmacopsychiatry 2017; 51:153-160. [PMID: 28950394 DOI: 10.1055/s-0043-119417] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Depression in old age is associated with functional disabilities, cognitive impairment, lower self-rated quality of life, and increased mortality. The aim of the study was to reveal the prevalence of depression and to investigate the characteristics of patients treated with antidepressants. METHODS We analyzed data from the Bruneck Study 2010. All participants completed a clinical examination, cognitive screening, the 30-item Geriatric Depression Scale (GDS) (cutoff score of>8 to define relevant depressive symptoms), and the World Health Organization quality of life questionnaire (WHO-QoL). Group differences were calculated using binary logistic regression analysis. RESULTS Out of 456 participants (mean age of 73.1±8.2 years), 22.1% showed depressive symptoms, and out of these, 30% were taking antidepressants. The depressed group compared to the GDS ≤8 group showed significantly lower WHO-QoL (p<0.001) and Mini Mental State Examination (p=0.015) score. Further, 13% of the latter compared to the GDS>8 group received antidepressants, and these had a lower WHO-QoL score (p<0.033). DISCUSSION Depressive symptoms are frequent in the elderly population. Our results confirm the negative influence of depressive symptoms on cognition and quality of life. Patients with somatic comorbidities are likely to receive more antidepressant medication.
Collapse
Affiliation(s)
- Michaela Defrancesco
- Department of Psychiatry and Psychotherapy, Medical University of Innsbruck, Austria
| | | | - Stefan Kiechl
- Department of Neurology, Medical University of Innsbruck, Austria
| | - Johann Willeit
- Department of Neurology, Medical University of Innsbruck, Austria
| | | | - Hartmann Hinterhuber
- Department of Psychiatry and Psychotherapy, Medical University of Innsbruck, Austria
| | | | - Arno Gasperi
- Department of Neurology, Hospital of Bruneck, Italy
| | - Josef Marksteiner
- Department of Psychiatry and Psychotherapy A, Landeskrankenhaus Hall, Austria
| |
Collapse
|
36
|
Semino LN, Marksteiner J, Brauchle G, Danay E. Depressive Symptoms and Their Interactions With Emotions and Personality Traits Over Time: Interaction Networks in a Psychiatric Clinic. Prim Care Companion CNS Disord 2017; 19. [PMID: 28407460 DOI: 10.4088/pcc.16m02043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 12/23/2016] [Indexed: 10/19/2022] Open
Abstract
Objective Associations between depression, personality traits, and emotions are complex and reciprocal. The aim of this study is to explore these interactions in dynamical networks and in a linear way over time depending on the severity of depression. Methods Participants included 110 patients with depressive symptoms (DSM-5 criteria) who were recruited between October 2015 and February 2016 during their inpatient stay in a general psychiatric hospital in Hall in Tyrol, Austria. The patients filled out the Beck Depression Inventory-II, a German emotional competence questionnaire (Emotionale Kompetenz Fragebogen), Positive and Negative Affect Schedule, and the German versions of the Big Five Inventory-short form and State-Trait-Anxiety-Depression Inventory regarding symptoms, emotions, and personality during their inpatient stay and at a 3-month follow-up by mail. Network and regression analyses were performed to explore interactions both in a linear and a dynamical way at baseline and 3 months later. Results Regression analyses showed that emotions and personality traits gain importance for the prediction of depressive symptoms with decreasing symptomatology at follow-up (personality: baseline, adjusted R2 = 0.24, P < .001; follow-up, adjusted R2 = 0.65, P < .001). Network analyses additionally showed that the interaction network of depression, emotions, and personality traits is significantly denser and more interconnected (network comparison test: P = .03) at follow-up than at baseline, meaning that with decreased symptoms interconnections get stronger. Conclusions During depression, personality traits and emotions are walled off and not strongly interconnected with depressive symptoms in networks. With decreasing depressive symptomatology, interfusing of these areas begins and interconnections become stronger. This finding has practical implications for interventions in an acute depressive state and with decreased symptoms. The network approach offers a new perspective on interactions and is a way to make the complexity of these interactions more tangible.
Collapse
Affiliation(s)
- Laura N Semino
- Eduard-Wallnöfer-Zentrum 1, 6060 Hall in Tyrol, Austria. .,UMIT-Health and Life Sciences University, Institute of Psychology, Hall in Tyrol, Austria
| | - Josef Marksteiner
- General Hospital for Psychiatry and Psychotherapy, Hall in Tyrol, Austria
| | | | - Erik Danay
- UMIT-Health and Life Sciences University, Institute of Psychology, Hall in Tyrol, Austria
| |
Collapse
|
37
|
Oberacher H, Arnhard K, Linhart C, Diwo A, Marksteiner J, Humpel C. Targeted Metabolomic Analysis of Soluble Lysates from Platelets of Patients with Mild Cognitive Impairment and Alzheimer’s Disease Compared to Healthy Controls: Is PC aeC40:4 a Promising Diagnostic Tool? J Alzheimers Dis 2017; 57:493-504. [DOI: 10.3233/jad-160172] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Herbert Oberacher
- Department of Legal Medicine and Core Facility Metabolomics, Medical University of Innsbruck, Austria
| | - Kathrin Arnhard
- Department of Legal Medicine and Core Facility Metabolomics, Medical University of Innsbruck, Austria
| | - Caroline Linhart
- Department of Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck, Austria
| | - Angela Diwo
- Department of Psychiatry and Psychotherapy A, Hall State Hospital, Austria
| | - Josef Marksteiner
- Department of Psychiatry and Psychotherapy A, Hall State Hospital, Austria
| | - Christian Humpel
- Laboratory of Psychiatry and Experimental Alzheimer’s Research, Medical University of Innsbruck, Austria
| |
Collapse
|
38
|
Weiss EM, Singewald E, Baldus C, Hofer E, Marksteiner J, Nasrouei S, Ruepp B, Kapfhammer HP, Fitz W, Mai C, Bauer A, Papousek I, Holzer P. Differences in psychological and somatic symptom cluster score profiles between subjects with Idiopathic environmental intolerance, major depression and schizophrenia. Psychiatry Res 2017; 249:187-194. [PMID: 28113122 DOI: 10.1016/j.psychres.2016.12.057] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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] [Received: 06/15/2016] [Revised: 11/29/2016] [Accepted: 12/28/2016] [Indexed: 11/24/2022]
Abstract
Idiopathic Environmental Intolerance (IEI) has been associated with psychogenic factors and an increased number of comorbid psychiatric disorders such as depression and anxiety disorder. The purpose of the current study was to examine a possible overlap of psychological and somatic symptoms between subjects with IEI and patients with major depression and schizophrenia as well as to specify characteristic differences. The different symptom clusters included symptoms of chemical intolerance, neurotoxicity and psychological distress as well as measurements of mental health such as anxiety, depression, somatoform symptoms, and schizophrenia-specific disturbances in cognitive domains. IEI patients reported higher overall levels in physical symptoms such as chemical intolerance, neurotoxicity and somatic symptoms not attributable to an organic cause. Schizophrenia patients showed higher overall levels in self-experienced disturbances in several schizophrenia-specific cognitive domains, whereas general psychological distress, anxiety and depression were rated highest by patients with major depression. Importantly, the groups markedly differed in the shapes of profiles of various symptom clusters. Our results provide evidence that IEI patients can be distinguished on the phenomenological level from patients with major depression or schizophrenia, and that distinct domains of psychological and somatic symptoms are particularly problematic in specific diagnostic groups.
Collapse
Affiliation(s)
- Elisabeth M Weiss
- Department of Psychology, Biological Psychology Unit, University of Graz, Austria.
| | - Evelin Singewald
- Department of Psychiatry and Psychotherapy A, LKH Hall, Austria; Research Unit of Translational Neurogastroenterology, Institute of Experimental and Clinical Pharmacology, Medical University of Graz, Universitätsplatz 4, A-8010 Graz, Austria
| | - Claudia Baldus
- Department of Psychology, Biological Psychology Unit, University of Graz, Austria
| | - Ellen Hofer
- Department of Psychology, Biological Psychology Unit, University of Graz, Austria
| | | | - Sarah Nasrouei
- Department of Psychiatry and Psychotherapy A, LKH Hall, Austria
| | - Beatrix Ruepp
- Department of Psychiatry and Psychotherapy A, LKH Hall, Austria
| | - Hans-Peter Kapfhammer
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Austria
| | - Werner Fitz
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Austria
| | - Christoph Mai
- Umweltmedizin, Fachkliniken Nordfriesland, Bredstedt, Germany
| | - Anke Bauer
- Umweltmedizin, Fachkliniken Nordfriesland, Bredstedt, Germany
| | - Ilona Papousek
- Department of Psychology, Biological Psychology Unit, University of Graz, Austria
| | - Peter Holzer
- Research Unit of Translational Neurogastroenterology, Institute of Experimental and Clinical Pharmacology, Medical University of Graz, Universitätsplatz 4, A-8010 Graz, Austria; BioTechMed-Graz, Krenngasse 37/1, 8010 Graz, Austria
| |
Collapse
|
39
|
Likar R, Pipam W, Neuwersch S, Köstenberger M, Pinter G, Gatternig C, Marksteiner J. [Pain measurement in cognitively impaired patients with the Doloshort scale]. Schmerz 2017; 29:440-4. [PMID: 26024644 DOI: 10.1007/s00482-015-0006-4] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Until recently the measurement of pain in cognitively impaired patients represented a neglected field in the diagnostics and treatment of pain. Investigations indicate a prevalence of pain in nursing home residents of between 45 % and 80 %. MATERIAL AND METHODS This study investigated the reliability of the German translation of the Doloshort scale and compared it with the visual analog scale (VS). The aim of this study was to determine the practical applicability of this scale in the clinical routine and to calculate the intrarater reliability (retest) and interrater reliability. RESULTS The interrater and intrarater reliability of the Doloshort scale was between 0.949 and 0.970. There was a highly significant correlation between the values of the Doloshort scale and the VAS. CONCLUSION The Doloshort scale is a well suited measurement instrument for the evaluation of pain in cognitively impaired patients. Because of the short form only simple instructions are necessary and it has a high acceptance with users.
Collapse
Affiliation(s)
- R Likar
- Abteilung für Anästhesie und Allgemeine Intensivmedizin, Klinikum Klagenfurt am Wörthersee, Feschnigstr. 11, 9020, Klagenfurt am Wörthersee, Österreich,
| | | | | | | | | | | | | |
Collapse
|
40
|
Canazei M, Pohl W, Bauernhofer K, Papousek I, Lackner HK, Bliem HR, Marksteiner J, Weiss EM. Psychophysiological Effects of a Single, Short, and Moderately Bright Room Light Exposure on Mildly Depressed Geriatric Inpatients: A Pilot Study. Gerontology 2017; 63:308-317. [DOI: 10.1159/000455231] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 12/20/2016] [Indexed: 11/19/2022] Open
Abstract
Background: Light interventions typically exert their mood-related effects during morning bright light exposures over several weeks. Evidence about immediate ambient room light effects on depressed individuals is still sparse. Objective: The present study aimed at examining the acute effects of a single moderately bright room light exposure on mood, and behavioural and cardiac stress reactions of mildly depressed geriatric inpatients during a short cognitive stimulation and while resting. Methods: Twenty-one inpatients were tested in a balanced cross-over design on 2 consecutive days under either conventional room light (standard light) or artificial sunlight conditions for 30 min. Room illumination was implemented with an artificial skylight, which perfectly imitated solar indoor illumination (e.g., cloudless sky and bright artificial sun). Light-induced changes of mood, heart rate, and heart rate variability were recorded while performing a perseveration test (acted as cognitive stimulation) twice. Additionally, light-related behaviour was observed during a resting period between the cognitive tests and various subjective ratings were obtained. Results: Compared to standard light, exposure to artificial sunlight had a subjective calming effect over time (p = 0.029) as well as decreased heart rate and increased vagal tone (root mean squared of successive inter-beat intervals), both under cognitive workload and in resting conditions. Effect sizes of reported cardiac reactions were large. Cognitive variables were not influenced by light. Additionally, under the higher corneal illuminance of the artificial sunlight, patients perceived stronger glare (p = 0.030) and kept their eyes closed for longer times (p = 0.033) during the resting period. However, patients did not avoid bright light exposure while resting but voluntarily stayed within the area directly lit by the artificial sun nearly all the time (97%). Conclusion: To our knowledge, this study for the first time demonstrated immediate psychophysiological effects of a single, short room light exposure in mildly depressed geriatric inpatients during a short cognitive stimulation and while resting. The findings complement reported evidence on immediate alerting and mood-related effects of bright light exposures.
Collapse
|
41
|
San L, Marksteiner J, Zwanzger P, Figuero MA, Romero FT, Kyropoulos G, Peixoto AB, Chirita R, Boldeanu A. State of Acute Agitation at Psychiatric Emergencies in Europe: The STAGE Study. Clin Pract Epidemiol Ment Health 2016; 12:75-86. [PMID: 27857778 PMCID: PMC5084082 DOI: 10.2174/1745017901612010075] [Citation(s) in RCA: 27] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 09/19/2016] [Accepted: 09/22/2016] [Indexed: 11/22/2022]
Abstract
Background: Agitation is an array of syndromes and types of behaviors that are common in patients with psychiatric disorders. In Europe, the estimation of prevalence of agitation has been difficult due to the lack of standard studies or systematic data collection done on this syndrome. Objective: An observational, cross-sectional, multicenter study aimed to assess the prevalence of agitation episodes in psychiatric emergencies in different European countries. Method: For 1 week, all episodes of acute agitation that were attended to at the psychiatric emergency room (ER) or Acute Inpatient Unit (AIU) in the 27 participating centers were registered. The clinical characteristics and management of the agitation episode were also described. A descriptive analysis was performed. Results: A total of 334 agitation episodes out of 7295 psychiatric emergencies were recorded, giving a prevalence rate of 4.6% (95% CI: 4.12-5.08). Of them, 172 [9.4% (95% CI: 8.2-10.9)] were attended at the ER and 162 [2.8% (95% CI: 2.4-3.3)] at AIU. Only data from 165 episodes of agitation (those with a signed informed consent form) was registered and described in this report. The most common psychiatric conditions associated with agitation were schizophrenia, bipolar disorder and personality disorder. The management of agitation included from non-invasive to more coercive measures (mechanical, physical restraint or seclusion) that were unavoidable in more than half of the agitation episodes (59.5%). Conclusion: The results show that agitation is a common symptom in the clinical practice, both in emergency and inpatient psychiatric departments. Further studies are warranted to better recognize (using a standardized definition) and characterize agitation episodes.
Collapse
Affiliation(s)
- Luis San
- Hospital Sant Joan de Déu, Department of Child and Adolescent Psychiatry, Barcelona, Spain
| | - Josef Marksteiner
- LKH Hall, Department of Psychiatry and Psychotherapy, Milser Strasse 10-12. A-6060, Hall in Tirol, Austria
| | - Peter Zwanzger
- Kbo-Inn-Salzach Clinic for Psychiatry, Psychotherapy, Neurology and Psychosomatic Medicine, Gabersee 7, 83512, Wasserburg am Inn, Germany
| | - María Aragüés Figuero
- Hospital Universitario 12 de Octubre, Department of Psychiatry, Avda de Córdoba, s/n, 28041, Madrid, Spain
| | - Francisco Toledo Romero
- Hospital Clínico Universitario Virgen de la Arrixaca, Department of Psychiatry Acute Unit, Ctra. Madrid-Cartagena, s/n, 30120 Murcia, Spain
| | - Grigorios Kyropoulos
- General Hospital of Thessaloniki "Papanikolaou", Psychiatric Clinic Department of Psychiatry, Eksoxi - 57010, Thessaloniki, Greece
| | - Alberto Bessa Peixoto
- Hospital de Braga, Department of Psychiatry, Sete Fontes, 4710-243 São Victor, Braga, Portugal
| | - Roxana Chirita
- Psychiatric Clinical Hospital Socola, Department of Psychiatry, Șoseaua Bucium 36, 700282, Iasi, Romania
| | | |
Collapse
|
42
|
Fuchs M, Kemmler G, Steiner H, Marksteiner J, Haring C, Miller C, Hausmann A, Sevecke K. Child and adolescent psychiatry patients coming of age: a retrospective longitudinal study of inpatient treatment in Tyrol. BMC Psychiatry 2016; 16:225. [PMID: 27391233 PMCID: PMC4938986 DOI: 10.1186/s12888-016-0910-x] [Citation(s) in RCA: 11] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 06/15/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mental illness is a common phenomenon at all ages. Various independent studies have shown that psychopathology is often expressed on a continuum from youth to adulthood. The aim of our study was to demonstrate a) the frequency of admission of former child and adolescent psychiatry inpatients (CAP-IP) to adult inpatient mental health facilities, and b) a potential longitudinal diagnostic shift. This is the first Austrian study designed to shed light on these issues. METHODS Nearly 1000 inpatient cases at a specialized child and adolescent care center were analyzed. These cases were then tracked using data matching with registry data from adult psychiatric institutions. Overall, our observational period was 23 years. RESULTS 26 % of our sample of former CAP-IP used psychiatric inpatient mental health services as adults, thus indicating chronicity or reoccurrence. In line with previous literature, there were patients who stayed in the same diagnostic category as well as patients with a diagnostic shift from childhood to adulthood. CONCLUSIONS Childhood and adolescence is a very important period for early intervention and prevention of mental illness. Our findings support the notion of the continuity of psychopathology from youth into adulthood.
Collapse
Affiliation(s)
- Martin Fuchs
- Department of Child and Adolescent Psychiatry, Center of Psychiatry and Psychotherapy, Medical University of Innsbruck, Christoph Probst Platz, Innrain 52, 6020, Innsbruck, Austria.
| | - Georg Kemmler
- Department of General and Social Psychiatry, Center of Psychiatry and Psychotherapy, Medical University of Innsbruck, Innrain 52, 6020 Innsbruck, Austria
| | - Hans Steiner
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305-5101 USA
| | - Josef Marksteiner
- Department of Psychiatry, LKH Hall, Milser Str. 10, 6060 Hall in Tirol, Austria
| | - Christian Haring
- Department of Psychiatry, LKH Hall, Milser Str. 10, 6060 Hall in Tirol, Austria
| | - Carl Miller
- Department of Psychiatry, Bezirkskrankenhaus Kufstein, Endach 27, 6330 Kufstein, Austria
| | - Armand Hausmann
- Department of General and Social Psychiatry, Center of Psychiatry and Psychotherapy, Medical University of Innsbruck, Innrain 52, 6020 Innsbruck, Austria
| | - Kathrin Sevecke
- Department of Child and Adolescent Psychiatry, Center of Psychiatry and Psychotherapy, Medical University of Innsbruck, Christoph Probst Platz, Innrain 52, 6020 Innsbruck, Austria
| |
Collapse
|
43
|
Plagg B, Ehrlich D, Kniewallner KM, Marksteiner J, Humpel C. Increased Acetylation of Histone H4 at Lysine 12 (H4K12) in Monocytes of Transgenic Alzheimer's Mice and in Human Patients. Curr Alzheimer Res 2016; 12:752-60. [PMID: 26159193 DOI: 10.2174/1567205012666150710114256] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 05/30/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND Alzheimer's disease (AD) is a neurodegenerative disorder characterized by amyloid-β (Aβ) plaque formation, tau pathology, neurodegeneration and inflammatory processes. Monocytes are involved in inflammation in AD and are recruited to the diseased brain. Recently it has been shown that aberrant epigenetic processes including acetylation are associated with the development of AD. The aim of the present study was to examine acetylation of histone H4 at lysine 12 (H4K12) in monocytes in two transgenic AD mouse models (the triple transgenic 3xTg and a model overexpressing amyloid-precursor protein APP with the Swedish-Dutch-Iowa mutations), and to compare with monocytes isolated from human patients with mild cognitive impairment (MCI) and AD. METHODS Mouse and human monocytes were selectively isolated with a positive (PluriSelect) respectively with a negative selection method (Miltenyi). Histones were extracted and acetylation of H4K12 was analyzed by a quantification fluorometric kit. Moreover, monocyte cytokine release was measured and cell death analyzed by FACS using incorporation of 7-AAD. RESULTS Our data show a significant increase of monocytic H4K12 acetylation in both transgenic AD mouse models early during development of the plaque deposition in the brain. In line with these data we found significantly elevated acetylation of H4K12 in human patients with MCI but not in patients with AD. Further we observed that the monocytes of AD mice and of AD patients were significantly more vulnerable to cell damage (as seen by 7-AAD incorporation in FACS analysis) and displayed an enhanced release of pro-inflammatory cytokines (MIP2 and TNFα). CONCLUSION Our findings indicate that epigenetic changes in peripheral monocytes are an early event in AD-pathology. Thus H4K12 acetylation may be considered as a novel biomarker for early changes in AD development.
Collapse
Affiliation(s)
| | | | | | | | - Christian Humpel
- Department of Psychiatry and Psychotherapy, Anichstr. 35, A-6020 Innsbruck, Austria.
| |
Collapse
|
44
|
Rominger C, Bleier A, Fitz W, Marksteiner J, Fink A, Papousek I, Weiss EM. Auditory top-down control and affective theory of mind in schizophrenia with and without hallucinations. Schizophr Res 2016; 174:192-196. [PMID: 27197903 DOI: 10.1016/j.schres.2016.05.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [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: 02/18/2016] [Revised: 04/24/2016] [Accepted: 05/06/2016] [Indexed: 12/19/2022]
Abstract
Social cognitive impairments may represent a core feature of schizophrenia and above all are a strong predictor of positive psychotic symptoms. Previous studies could show that reduced inhibitory top-down control contributes to deficits in theory of mind abilities and is involved in the genesis of hallucinations. The current study aimed to investigate the relationship between auditory inhibition, affective theory of mind and the experience of hallucinations in patients with schizophrenia. In the present study, 20 in-patients with schizophrenia and 20 healthy controls completed a social cognition task (the Reading the Mind in the Eyes Test) and an inhibitory top-down Dichotic Listening Test. Schizophrenia patients with greater severity of hallucinations showed impaired affective theory of mind as well as impaired inhibitory top-down control. More dysfunctional top-down inhibition was associated with poorer affective theory of mind performance, and seemed to mediate the association between impairment to affective theory of mind and severity of hallucinations. The findings support the idea of impaired theory of mind as a trait marker of schizophrenia. In addition, dysfunctional top-down inhibition may give rise to hallucinations and may further impair affective theory of mind skills in schizophrenia.
Collapse
Affiliation(s)
- Christian Rominger
- Department of Psychology, Biological Psychology Unit, University of Graz, Austria
| | - Angelika Bleier
- Department of Psychology, Biological Psychology Unit, University of Graz, Austria
| | - Werner Fitz
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Austria
| | | | - Andreas Fink
- Department of Psychology, Biological Psychology Unit, University of Graz, Austria
| | - Ilona Papousek
- Department of Psychology, Biological Psychology Unit, University of Graz, Austria
| | - Elisabeth M Weiss
- Department of Psychology, Biological Psychology Unit, University of Graz, Austria.
| |
Collapse
|
45
|
Willis M, Trieb M, Leitner I, Wietzorrek G, Marksteiner J, Knaus HG. Small-conductance calcium-activated potassium type 2 channels (SK2, KCa2.2) in human brain. Brain Struct Funct 2016; 222:973-979. [PMID: 27357310 PMCID: PMC5334391 DOI: 10.1007/s00429-016-1258-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 06/20/2016] [Indexed: 12/02/2022]
Abstract
SK2 (KCa2.2) channels are voltage-independent Ca2+-activated K+ channels that regulate neuronal excitability in brain regions important for memory formation. In this study, we investigated the distribution and expression of SK2 channels in human brain by Western blot analysis and immunohistochemistry. Immunoblot analysis of human brain indicated expression of four distinct SK2 channel isoforms: the standard, the long and two short isoforms. Immunohistochemistry in paraffin-embedded post-mortem brain sections was performed in the hippocampal formation, amygdala and neocortex. In hippocampus, SK2-like immunoreactivity could be detected in strata oriens and radiatum of area CA1-CA2 and in the molecular layer. In the amygdala, SK2-like immunoreactivity was highest in the basolateral nuclei, while in neocortex, staining was mainly found enriched in layer V. Activation of SK2 channels is thought to regulate neuronal excitability in brain by contributing to the medium afterhyperpolarization. However, SK2 channels are blocked by apamin with a sensitivity that suggests heteromeric channels. The herein first shown expression of SK2 human isoform b in brain could explain the variability of electrophysiological findings observed with SK2 channels.
Collapse
Affiliation(s)
- Michael Willis
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
| | - Maria Trieb
- Division of Molecular and Cellular Pharmacology, Medical University Innsbruck, Peter Mayr Strasse 1, 6020, Innsbruck, Austria
| | - Irmgard Leitner
- Division of Molecular and Cellular Pharmacology, Medical University Innsbruck, Peter Mayr Strasse 1, 6020, Innsbruck, Austria
| | - Georg Wietzorrek
- Division of Molecular and Cellular Pharmacology, Medical University Innsbruck, Peter Mayr Strasse 1, 6020, Innsbruck, Austria
| | - Josef Marksteiner
- Department of Psychiatry and Psychotherapy A, Landeskrankenhaus Hall in Tirol, Milser Strasse 10, 6060, Hall in Tirol, Austria
| | - Hans-Günther Knaus
- Division of Molecular and Cellular Pharmacology, Medical University Innsbruck, Peter Mayr Strasse 1, 6020, Innsbruck, Austria
| |
Collapse
|
46
|
Kniewallner KM, Ehrlich D, Kiefer A, Marksteiner J, Humpel C. Platelets in the Alzheimer's disease brain: do they play a role in cerebral amyloid angiopathy? Curr Neurovasc Res 2015; 12:4-14. [PMID: 25557380 PMCID: PMC4442621 DOI: 10.2174/1567202612666150102124703] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 12/15/2014] [Accepted: 12/16/2014] [Indexed: 01/08/2023]
Abstract
Alzheimer’s disease (AD) is characterized by extracellular beta-amyloid plaques and
intracellular tau tangles. AD-related pathology is often accompanied by vascular changes. The predominant
vascular lesions in AD are cerebral amyloid angiopathy (CAA) and arteriosclerosis. Platelets circulate
along the vessel wall responding immediately to vascular injury. The aim of the present study was to
explore the presence and migration of platelets (thrombocytes) to sites of small vascular bleedings and/or
to beta-amyloid plaques in the brain. We infused fluorescently labeled red PKH26 mouse platelets into
transgenic Alzheimer mice overexpressing APP with Swedish/Dutch/Iowa mutations (APP_SDI) and
explored if platelets migrate into the brain. Further we studied whether platelets accumulate in the vicinity
of β-amyloid plaques. Our animal data shows that infused platelets are found in the liver and partly in the lung, while in
the brain platelets were visible to a minor degree. In mice, we did not observe a significant association of platelets with
beta-amyloid plaques or vessels. In the brain of Alzheimer postmortem patients platelets could be detected by
immunohistochemistry for CD41 and CD62P, but the majority was found in vessels with or without beta-amyloid load,
and only a few single platelets migrated deeper into the brain. Our findings suggest that platelets do not migrate into the
brains of Alzheimer disease but are concentrated in brain vessels.
Collapse
Affiliation(s)
| | | | | | | | - Christian Humpel
- Deparment of Psychiatry and Psychotherapy, Anichstr. 35, A-6020 Innsbruck, Austria.
| |
Collapse
|
47
|
Klavins K, Koal T, Dallmann G, Marksteiner J, Kemmler G, Humpel C. The ratio of phosphatidylcholines to lysophosphatidylcholines in plasma differentiates healthy controls from patients with Alzheimer's disease and mild cognitive impairment. Alzheimers Dement (Amst) 2015; 1:295-302. [PMID: 26744734 PMCID: PMC4700585 DOI: 10.1016/j.dadm.2015.05.003] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Metabolomic processes have been identified as being strongly linked to the development of Alzheimer's disease (AD). Thus, lipid metabolites appear to be highly useful as diagnostic substrates for the diagnosis of AD and mild cognitive impairment (MCI) in plasma. METHODS We analyzed plasma samples from controls (n = 35), MCI (n = 33), and AD patients (n = 43) using the AbsoluteIDQ p180 Kit (Biocrates Life Sciences), which included quantitative analysis of 40 acylcarnitines, 21 amino acids, 19 biogenic amines, 15 sphingolipids, 90 glycerophospholipids, and sum of hexoses. RESULTS We found that individual lipid metabolites can differentiate controls from MCI and AD with relevant significance. However, the ratio between PC aa C34:4 and lysoPC a C18:2 differentiates controls from MCI (P = .0000007) and from AD (P = .0000009) with greater significance. CONCLUSIONS The results provide evidence that the ratio of these two lipid metabolites is useful for diagnosing MCI and AD with an accuracy of 82%-85%.
Collapse
Affiliation(s)
| | | | | | | | - Georg Kemmler
- Department of Psychiatry and Psychotherapy, University Clinic of General and Social Psychiatry, Medical University of Innsbruck, Innsbruck, Austria
| | - Christian Humpel
- Department of Psychiatry and Psychotherapy, University Clinic of General and Social Psychiatry, Medical University of Innsbruck, Innsbruck, Austria
| |
Collapse
|
48
|
Corker EA, Beldie A, Brain C, Jakovljevic M, Jarema M, Karamustafalioglu O, Marksteiner J, Mohr P, Prelipceanu D, Vasilache A, Waern M, Sartorius N, Thornicroft G. Experience of stigma and discrimination reported by people experiencing the first episode of schizophrenia and those with a first episode of depression: The FEDORA project. Int J Soc Psychiatry 2015; 61:438-45. [PMID: 25298225 DOI: 10.1177/0020764014551941] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [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: 11/17/2022]
Abstract
AIM To record and measure the nature and severity of stigma and discrimination experienced by people during a first episode of schizophrenia and those with a first episode of major depressive disorder. METHODS The Discrimination and Stigma Scale (DISC-12) was used in a cross-sectional survey to elicit service user reports of anticipated and experienced discrimination by 150 people with a diagnosis of first-episode schizophrenia and 176 with a diagnosis of first-episode major depressive disorder in seven countries (Austria, Croatia, Czech Republic, Poland, Romania, Sweden and Turkey). RESULTS Participants with a diagnosis of major depressive disorder reported discrimination in a greater number of life areas than those with schizophrenia, as rated by the total DISC-12 score (p = .03). With regard to specific life areas, participants with depression reported more discrimination in regard to neighbours, dating, education, marriage, religious activities, physical health and acting as a parent than participants with schizophrenia. Participants with schizophrenia reported more discrimination with regard to the police compared to participants with depression. CONCLUSION Stigma and discrimination because of mental illness change in the course of the mental diseases. Future research may take a longitudinal perspective to better understand the beginnings of stigmatisation and its trajectory through the life course and to identify critical periods at which anti-stigma interventions can most effectively be applied.
Collapse
Affiliation(s)
- Elizabeth A Corker
- Health Service and Population Research Department, Institute of Psychiatry, King's College London, London, UK
| | - Alina Beldie
- Al. Obregia Clinical Psychiatric Hospital, Bucharest, Romania
| | - Cecilia Brain
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden Nå Ut-teamet, Psychosis Clinic, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Miro Jakovljevic
- Department of Psychiatry, University Hospital Zagreb, Zagreb, Croatia
| | - Marek Jarema
- Institute of Psychiatry and Neurology, Warszawa, Poland
| | | | | | - Pavel Mohr
- Prague Psychiatric Center, Prague, Czech Republic
| | - Dan Prelipceanu
- Al. Obregia Clinical Psychiatric Hospital, Bucharest, Romania
| | | | - Margda Waern
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden Nå Ut-teamet, Psychosis Clinic, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Norman Sartorius
- Association for Mental Health Service Improvement, Geneva, Switzerland
| | - Graham Thornicroft
- Health Service and Population Research Department, Institute of Psychiatry, King's College London, London, UK
| | | |
Collapse
|
49
|
Pusswald G, Lehrner J, Hagmann M, Dal-Bianco P, Benke T, Marisa Loitfelder, Marksteiner J, Mosbacher J, Ransmayr G, Sanin G, Schmidt R. Gender-Specific Differences in Cognitive Profiles of Patients with Alzheimer’s Disease: Results of the Prospective Dementia Registry Austria (PRODEM-Austria). J Alzheimers Dis 2015; 46:631-7. [DOI: 10.3233/jad-150188] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Gisela Pusswald
- Department of Neurology, Medical University of Vienna, Austria
| | - Johann Lehrner
- Department of Neurology, Medical University of Vienna, Austria
| | - Michael Hagmann
- Department of Medical Statistics and Informatics, Medical University of Vienna, Austria
| | | | - Thomas Benke
- Department of Neurology, Medical University of Innsbruck, Austria
| | - Marisa Loitfelder
- Department of Neurology, Division of Neurogeriatrics, Medical University of Graz, Austria
| | - Josef Marksteiner
- Department of Psychiatry and Psychotherapy, Regional Hospital Hall in Tirol, Austria
| | - Jochen Mosbacher
- Department of Neurology, Division of Neurogeriatrics, Medical University of Graz, Austria
| | | | - Guenter Sanin
- Department of Neurology, Medical University of Innsbruck, Austria
| | - Reinhold Schmidt
- Department of Neurology, Division of Neurogeriatrics, Medical University of Graz, Austria
| | | |
Collapse
|
50
|
Defrancesco M, Marksteiner J, Fleischhacker WW, Blasko I. Use of Benzodiazepines in Alzheimer's Disease: A Systematic Review of Literature. Int J Neuropsychopharmacol 2015; 18:pyv055. [PMID: 25991652 PMCID: PMC4648159 DOI: 10.1093/ijnp/pyv055] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 05/12/2015] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Benzodiazepines are frequently prescribed in patients with Alzheimer's disease. Unfortunately, studies evaluating their benefits and risks in these patients are limited. METHODS Clinical trials focusing on the effect of benzodiazepines on cognitive functions, disease progression, behavioral symptoms, sleep disturbances, and the general frequency of benzodiazepine use were included in this review. Published articles from January 1983 to January 2015 were identified using specific search terms in MEDLINE and PubMed Library according to the recommendations of The Strengthening the Reporting of Observational Studies in Epidemiology initiative. RESULTS Of the 657 articles found, 18 articles met predefined selection criteria and were included in this review (8 on frequency, 5 on cognitive functions, 5 on behavioral and sleep disturbances). The frequency of benzodiazepine use ranged from 8.5% to 20%. Five studies reported accelerated cognitive deterioration in association with benzodiazepine use. Two studies reported clinical efficacy for lorazepam and alprazolam to reduce agitation in Alzheimer's disease patients. No evidence was found for an improvement of sleep quality using benzodiazepines. CONCLUSION This systematic review shows a relatively high prevalence of benzodiazepine use but limited evidence for clinical efficacy in Alzheimer's disease patients. However, there is a paucity of methodologically high quality controlled clinical trials. Our results underscore a need for randomized controlled trials in this area.
Collapse
Affiliation(s)
- Michaela Defrancesco
- Memory Clinic (Dr Defrancesco), and Division of General and Social Psychiatry (Drs Fleischhacker and Blasko), Department of Psychiatry and Psychotherapy, Innsbruck Medical University, Innsbruck, Austria; Department of Psychiatry and Psychotherapy A, Landeskrankenhaus Hall, Hall, Austria (Dr Marksteiner); Division of Biological Psychiatry, Department of Psychiatry and Psychotherapy, Innsbruck Medical University, Innsbruck, Austria (Dr Fleischhacker)
| | - Josef Marksteiner
- Memory Clinic (Dr Defrancesco), and Division of General and Social Psychiatry (Drs Fleischhacker and Blasko), Department of Psychiatry and Psychotherapy, Innsbruck Medical University, Innsbruck, Austria; Department of Psychiatry and Psychotherapy A, Landeskrankenhaus Hall, Hall, Austria (Dr Marksteiner); Division of Biological Psychiatry, Department of Psychiatry and Psychotherapy, Innsbruck Medical University, Innsbruck, Austria (Dr Fleischhacker)
| | - W Wolfgang Fleischhacker
- Memory Clinic (Dr Defrancesco), and Division of General and Social Psychiatry (Drs Fleischhacker and Blasko), Department of Psychiatry and Psychotherapy, Innsbruck Medical University, Innsbruck, Austria; Department of Psychiatry and Psychotherapy A, Landeskrankenhaus Hall, Hall, Austria (Dr Marksteiner); Division of Biological Psychiatry, Department of Psychiatry and Psychotherapy, Innsbruck Medical University, Innsbruck, Austria (Dr Fleischhacker)
| | - Imrich Blasko
- Memory Clinic (Dr Defrancesco), and Division of General and Social Psychiatry (Drs Fleischhacker and Blasko), Department of Psychiatry and Psychotherapy, Innsbruck Medical University, Innsbruck, Austria; Department of Psychiatry and Psychotherapy A, Landeskrankenhaus Hall, Hall, Austria (Dr Marksteiner); Division of Biological Psychiatry, Department of Psychiatry and Psychotherapy, Innsbruck Medical University, Innsbruck, Austria (Dr Fleischhacker)
| |
Collapse
|