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Neukel C, Bermpohl F, Kaess M, Taubner S, Boedeker K, Williams K, Dempfle A, Herpertz SC. Understanding and breaking the intergenerational cycle of abuse in families enrolled in routine mental health services: study protocol for a randomized controlled trial and two non-interventional trials investigating mechanisms of change within the UBICA II consortium. Trials 2021; 22:749. [PMID: 34711261 PMCID: PMC8555002 DOI: 10.1186/s13063-021-05653-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 09/24/2021] [Indexed: 11/10/2022] Open
Abstract
Background Parents’ mental illness (MI) and parental history of early life maltreatment (ELM) are known to be significant risk factors for poor parenting while poor parenting is a crucial mediator of the intergenerational continuity of child maltreatment. Hence, maltreatment prevention programs for families with an MI parent, which pay particular attention to experiences of ELM in the parent, are urgently needed. Parental mentalizing was previously found to mediate successful parenting. Interventions aimed at improving the parental mentalizing capacity reduced maltreatment risk in parents. The aim of the present study is to investigate the effectiveness of a mentalization-based parenting-counseling in acutely mentally ill parents currently treated at a psychiatric hospital. Methods Mentalization-based parenting-counseling (MB-PC) vs. enhanced standard clinical care (SCC+) will be administered in a cluster-randomized-controlled trial (RCT). Patients treated at psychiatric hospitals with children between 1.5 and 15 years will be included in the trial. MB-PC will be administered as a 12-h combined individual and group program enriched by social counseling (over a course of 5 weeks) as add-on to standard clinical care, while the control condition will be standard clinical care plus a 90-min psychoeducation workshop on positive parenting. Primary efficacy endpoint is self-reported parenting practices at follow-up. Embedded within the RCT will be two sub-studies investigating social cognition and dyadic synchrony as biobehavioral mechanisms of change. Discussion The main goal of the present study is to investigate ways to break the intergenerational continuity of maltreatment by assessing the benefits of a prevention program which aims at improving parenting in vulnerable mothers and fathers. MB-PC is a short, low-cost intervention which can be delivered by nurses and social workers and is applicable to MI patients with children with a broad range of diagnoses. If it is shown to be effective, it can be directly implemented into standard psychiatric hospital care thereby providing help to prevent child maltreatment. Trial registration German Clinical Trials Register DRKS00017398. Registered on 5 July 2019
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Affiliation(s)
- C Neukel
- Department of General Psychiatry, Center for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany.
| | - F Bermpohl
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Campus Charité Mitte, Berlin, Germany, Berlin, Germany
| | - M Kaess
- Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany.,University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - S Taubner
- Department of Psychosocial Prevention, University Hospital of Heidelberg, Heidelberg, Germany
| | - K Boedeker
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Campus Virchow-Klinikum, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Berlin, Germany
| | - K Williams
- Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany
| | - A Dempfle
- Institute of Medical Informatics and Statistics, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - S C Herpertz
- Department of General Psychiatry, Center for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany
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Schneider E, Müller LE, Ditzen B, Herpertz SC, Bertsch K. Oxytocin and social anxiety: Interactions with sex hormones. Psychoneuroendocrinology 2021; 128:105224. [PMID: 33878602 DOI: 10.1016/j.psyneuen.2021.105224] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 03/01/2021] [Accepted: 04/06/2021] [Indexed: 11/24/2022]
Abstract
Oxytocin has been associated with anxiolytic and stress reducing effects in a number of studies. Less is known about the associations of endogenous oxytocin concentrations and their interaction with other hormones such as sex hormones in relation to self-reported anxiety levels. In this study, endogenous oxytocin and sex hormone levels were analyzed in 99 high (51 women) and 100 low (50 women) socially anxious individuals. Regression analyses showed that women with high oxytocin and estradiol levels reported a lower total Liebowitz Social Anxiety Score (LSAS) as well as a lower score on the subscale LSAS Fear. This association of hormonal interaction with social anxiety scores was significant in the subsample of high socially anxious women. In men there were no significant associations for endogenous hormones with LSAS scores. These findings suggest that in women the link between oxytocin and anxiety might be dependent on basal anxiety levels as well as on individual sex hormone levels.
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Affiliation(s)
- E Schneider
- Institute of Medical Psychology, Center for Psychosocial Medicine, Heidelberg University Hospital, Heidelberg, Germany; Ruprecht-Karls University Heidelberg, Germany.
| | - L E Müller
- Clinic of Psychosomatic and Psychotherapy, Hospital Darmstadt, Germany; Department of General Psychiatry, Center for Psychosocial Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - B Ditzen
- Institute of Medical Psychology, Center for Psychosocial Medicine, Heidelberg University Hospital, Heidelberg, Germany; Ruprecht-Karls University Heidelberg, Germany
| | - S C Herpertz
- Department of General Psychiatry, Center for Psychosocial Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - K Bertsch
- Department of General Psychiatry, Center for Psychosocial Medicine, Heidelberg University Hospital, Heidelberg, Germany; Department of Psychology, Ludwig-Maximilians-University Munich, Munich, Germany
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Herpertz SC, Matzke B, Hillmann K, Neukel C, Mancke F, Jaentsch B, Schwenger U, Honecker H, Bullenkamp R, Steinmann S, Krauch M, Bauer S, Borzikowsky C, Bertsch K, Dempfle A. A mechanism-based group-psychotherapy approach to aggressive behaviour in borderline personality disorder: findings from a cluster-randomised controlled trial. BJPsych Open 2020; 7:e17. [PMID: 33308363 PMCID: PMC7791567 DOI: 10.1192/bjo.2020.131] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Aggressive behaviour is a prevalent and harmful phenomenon in patients with borderline personality disorder (BPD). However, no short-term, low-cost programme exists that specifically focuses on aggression. AIMS Attuning therapy modules to pathogenetic mechanisms that underlie reactive aggression in BPD, we composed a 6 week mechanism-based anti-aggression psychotherapy (MAAP) approach for the group setting, which we tested against a non-specific supportive psychotherapy (NSSP). METHOD A cluster-randomised two-arm parallel-group phase II trial of N = 59 patients with BPD and overt aggressive behaviour was performed (German Registry for Clinical Trials, DRKS00009445). The primary outcome was the externally directed overt aggression score of the Modified Overt Aggression Scale (M-OAS) post-treatment (adjusted for pre-treatment overt aggression). Secondary outcomes were M-OAS irritability, M-OAS response rate and ecological momentary assessment of anger post-treatment and at 6 month follow-up, as well as M-OAS overt aggression score at follow-up. RESULTS Although no significant difference in M-OAS overt aggression between treatments was found post-treatment (adjusted difference in mean 3.49 (95% CI -5.32 to 12.31, P = 0.22), the MAAP group showed a clinically relevant decrease in aggressive behaviour of 65% on average (versus 33% in the NSSP group), with particularly strong improvement among those with the highest baseline aggression. Most notably, significant differences in reduction in overt aggression between MAAP and NSSP were found at follow-up. CONCLUSIONS Patients with BPD and aggressive behaviour benefited from a short group psychotherapy, with improvements particularly visible at 6 month follow-up. Further studies are required to show whether these effects are specific to MAAP.
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Affiliation(s)
- S C Herpertz
- Department of General Psychiatry, Heidelberg University Hospital, Germany
| | - B Matzke
- Department of General Psychiatry, Heidelberg University Hospital, Germany; and Sana HANSE-Klinikum Wismar GmbH, Germany
| | - K Hillmann
- Department of General Psychiatry, Heidelberg University Hospital, Germany
| | - C Neukel
- Department of General Psychiatry, Heidelberg University Hospital, Germany
| | - F Mancke
- Department of General Psychiatry, Heidelberg University Hospital, Germany
| | - B Jaentsch
- Institute of Clinical Psychology at Klinikum Stuttgart, Germany
| | - U Schwenger
- Department of General Psychiatry, Heidelberg University Hospital, Germany
| | - H Honecker
- Department of General Psychiatry, Heidelberg University Hospital, Germany
| | - R Bullenkamp
- Department of General Psychiatry, Heidelberg University Hospital, Germany
| | - S Steinmann
- Department of Psychosomatics and Psychotherapeutic Medicine, Central Institute of Mental Health Mannheim, University of Heidelberg, Germany
| | - M Krauch
- Department of General Psychiatry, Heidelberg University Hospital, Germany
| | - S Bauer
- Institute of Medical Informatics and Statistics, University Hospital Schleswig-Holstein, Campus Kiel, Germany; and Center of Psychotherapy, Institute for Psychosocial Prevention, Germany
| | - C Borzikowsky
- Institute of Medical Informatics and Statistics, University Hospital Schleswig-Holstein, Campus Kiel, Germany; and Center of Psychotherapy, Institute for Psychosocial Prevention, Germany
| | - K Bertsch
- Department of Clinical Psychology and Psychotherapy, LMU München, and Department of General Psychiatry, Heidelberg University Hospital, Germany
| | - A Dempfle
- Institute of Medical Informatics and Statistics, University Hospital Schleswig-Holstein, Campus Kiel, Germany
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Brakemeier EL, Herpertz SC. [Innovative psychotherapy research: towards an evidence-based and process-based individualized and modular psychotherapy]. Nervenarzt 2019; 90:1125-1134. [PMID: 31659372 DOI: 10.1007/s00115-019-00808-9] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Psychotherapy has been proven to be effective; however, this statement applies in particular to the "average patient" in randomized controlled trials. As a considerable proportion of patients do not show any benefits despite the constant development of new therapy methods and the mechanisms of action are still too little understood, innovative psychotherapy research has to address both problems. In addition, the idea of personalization that originated in somatic medicine or - from our point of view more appropriately - individualization or person-centering should be taken up. After providing an overview of further developments in psychotherapy beyond disorder-specific methods, this article presents an evidence- and process-based individualized and modular psychotherapy as a visionary goal of psychotherapeutic research: Beyond syndromes and disorders, as many biopsychosocial characteristics as possible and the processes and mechanisms underlying the mental problems should be analyzed and bundled in an individual comprehensive functional analysis. Based on this functional analysis, evidence-based techniques and modules should be selected. The individual response during the course of therapy should be continuously documented, so that feedback helps to determine the further therapeutic procedure. In order to pursue this vision, studies are needed that are oriented towards the individual patient, investigate the central mechanisms of action and generate large translational datasets. These should be analyzed by ideographic analyses and reduce the gap between research and practice, thus contributing to the paradigm of a practice research network, which is now consistently moving to the centre of research.
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Affiliation(s)
- E-L Brakemeier
- Lehrstuhl Klinische Psychologie und Psychotherapie, Institut für Psychologie, Universität Greifswald, Franz-Mehring-Straße 47, 17489, Greifswald, Deutschland.
- Klinische Psychologie und Psychotherapie, Fachbereich Psychologie, Philipps-Universität Marburg, Gutenbergstr. 18, 35037, Marburg, Deutschland.
- Schön Klinik Bad Arolsen, Bad Arolsen, Deutschland.
| | - S C Herpertz
- Klinik für Allgemeine Psychiatrie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
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Neukel C, Hillmann K, Bertsch K, Bermpohl F, Kluczniok D, Möhler E, Reck C, Resch F, Kaess M, Brunner R, Herpertz SC. [Impact of early life maltreatment of women on the mother-child relationship : Data from mother-child dyads from Heidelberg and Berlin]. Nervenarzt 2019; 90:235-242. [PMID: 30643951 DOI: 10.1007/s00115-018-0662-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Early life maltreatment can have severe and long-lasting consequences for the directly affected individual as well as for the next generation. Data from our research including mother-child dyads from Heidelberg and Berlin show that early life maltreatment is associated with behavioral and neural changes including personality traits and attachment style of the affected mothers that negatively affect their relationship with their child. The children of these mothers affected by early life maltreatment have an elevated risk to be maltreated and to develop mental disorders. They also show a heightened cortisol concentration and a reduced inhibition control. It seems to be of importance whether the mother has experienced early life maltreatment but is resilient, meaning that she has not developed a mental disorder (up to the time of examination) or whether in addition to the early life maltreatment she has developed a mental disorder later in life. Children of mothers with early life maltreatment and a lifetime mental disorder seem to be especially exposed to stress and show the greatest impairments and risks. Based on the existing data from our research practical and clinical implications are discussed and one possible intervention in the form of a training of mentalization competencies for parents is presented.
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Affiliation(s)
- C Neukel
- Klinik für Allgemeine Psychiatrie, Universitätsklinikum Heidelberg, Voßstraße 4, 69115, Heidelberg, Deutschland.
| | - K Hillmann
- Klinik für Allgemeine Psychiatrie, Universitätsklinikum Heidelberg, Voßstraße 4, 69115, Heidelberg, Deutschland
| | - K Bertsch
- Klinik für Allgemeine Psychiatrie, Universitätsklinikum Heidelberg, Voßstraße 4, 69115, Heidelberg, Deutschland
| | - F Bermpohl
- Psychiatrische Universitätsklinik der Charité im St. Hedwig-Krankenhaus, Große Hamburger Str. 5-11, 10115, Berlin, Deutschland
| | - D Kluczniok
- Psychiatrische Universitätsklinik der Charité im St. Hedwig-Krankenhaus, Große Hamburger Str. 5-11, 10115, Berlin, Deutschland
| | - E Möhler
- Klinik für Kinder- und Jugendpsychiatrie, Universitätsklinikum Heidelberg, Voßstraße 4, 69115, Heidelberg, Deutschland
| | - C Reck
- Lehr- und Forschungseinheit Klinische Psychologie des Kindes- und Jugendalters & Beratungspsychologie, LMU München, Leopoldstr. 13, 80802, München, Deutschland
| | - F Resch
- Klinik für Kinder- und Jugendpsychiatrie, Universitätsklinikum Heidelberg, Voßstraße 4, 69115, Heidelberg, Deutschland
| | - M Kaess
- Klinik für Kinder- und Jugendpsychiatrie, Universitätsklinikum Heidelberg, Voßstraße 4, 69115, Heidelberg, Deutschland
- Universitätsklinik für Kinder- und Jugendpsychiatrie und Psychotherapie, Universität Bern, Bolligenstraße 111, Stöckli, 3000, Bern 60, Schweiz
| | - R Brunner
- Klinik für Kinder- und Jugendpsychiatrie, Universitätsklinikum Heidelberg, Voßstraße 4, 69115, Heidelberg, Deutschland
- Klinik und Poliklinik für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie, Universität Regensburg, Universitätsstraße 84, 93053, Regensburg, Deutschland
| | - S C Herpertz
- Klinik für Allgemeine Psychiatrie, Universitätsklinikum Heidelberg, Voßstraße 4, 69115, Heidelberg, Deutschland
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Abstract
ZusammenfassungDie Übertragung des seltenen Dermatozoenwahns auf andere Personen kommt in etwa 5 bis 15% der Fälle vor. Es wird der Fall einer 72-jährigen Frau beschrieben, die den Dermatozoenwahn ihres schizophrenen Sohnes übernahm. Bei der Mutter war das Wahnkriterium der Unkorrigierbarkeit im Gegensatz zum Sohn jedoch nicht vollständig erfüllt. Erst nach Besserung der schizophrenen Symptomatik und des Dermatozoenwahns beim Sohn, kam es auch zur vollständigen Remission bei der Mutter. Die andauernde soziale Isolation von Sohn und Mutter förderte das Auftreten einer Folie á deux. Die möglichen Umstände, die zum induzierten Dermatozoenwahn führen, werden anhand dieses Falles diskutiert. Obwohl beim Dermatozoenwahn per definitionem ein Wahn vorliegt, ist die Wahngewissheit bei den induzierten Partnern im Vergleich zu den primär Erkrankten nicht immer derart ausgeprägt, sodass im Einzelfall eher überwertige Ideen vorliegen. Daraus können sich gezielte therapeutische Alternativen zur neuroleptischen Behandlung ergeben.
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Huhn D, Lauter J, Roesch Ely D, Koch E, Möltner A, Herzog W, Resch F, Herpertz SC, Nikendei C. Performance of International Medical Students In psychosocial medicine. BMC Med Educ 2017; 17:111. [PMID: 28693486 PMCID: PMC5504851 DOI: 10.1186/s12909-017-0950-z] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 06/26/2017] [Indexed: 05/23/2023]
Abstract
BACKGROUND Particularly at the beginning of their studies, international medical students face a number of language-related, social and intercultural challenges. Thus, they perform poorer than their local counterparts in written and oral examinations as well as in Objective Structured Clinical Examinations (OSCEs) in the fields of internal medicine and surgery. It is still unknown how international students perform in an OSCE in the field of psychosocial medicine compared to their local fellow students. METHODS All students (N = 1033) taking the OSCE in the field of psychosocial medicine and an accompanying written examination in their eighth or ninth semester between 2012 and 2015 were included in the analysis. The OSCE consisted of four different stations, in which students had to perform and manage a patient encounter with simulated patients suffering from 1) post-traumatic stress disorder, 2) schizophrenia, 3) borderline personality disorder and 4) either suicidal tendency or dementia. Students were evaluated by trained lecturers using global checklists assessing specific professional domains, namely building a relationship with the patient, conversational skills, anamnesis, as well as psychopathological findings and decision-making. RESULTS International medical students scored significantly poorer than their local peers (p < .001; η2 = .042). Within the specific professional domains assessed, they showed poorer scores, with differences in conversational skills showing the highest effect (p < .001; η2 = .053). No differences emerged within the multiple-choice examination (p = .127). CONCLUSION International students showed poorer results in clinical-practical exams in the field of psychosocial medicine, with conversational skills yielding the poorest scores. However, regarding factual and practical knowledge examined via a multiple-choice test, no differences emerged between international and local students. These findings have decisive implications for relationship building in the doctor-patient relationship.
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Affiliation(s)
- D. Huhn
- Department of General Internal Medicine and Psychosomatics, Centre for Psychosocial Medicine, University Hospital Heidelberg, Thibautstraße 4, D-69115 Heidelberg, Germany
| | - J. Lauter
- Department of General Internal Medicine and Psychosomatics, Centre for Psychosocial Medicine, University Hospital Heidelberg, Thibautstraße 4, D-69115 Heidelberg, Germany
| | - D. Roesch Ely
- Department of General Psychiatry, Centre for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - E. Koch
- Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - A. Möltner
- Competence Centre for Examinations in Medicine, Heidelberg, Baden-Württemberg Germany
| | - W. Herzog
- Department of General Internal Medicine and Psychosomatics, Centre for Psychosocial Medicine, University Hospital Heidelberg, Thibautstraße 4, D-69115 Heidelberg, Germany
| | - F. Resch
- Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - S. C. Herpertz
- Department of General Psychiatry, Centre for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - C. Nikendei
- Department of General Internal Medicine and Psychosomatics, Centre for Psychosocial Medicine, University Hospital Heidelberg, Thibautstraße 4, D-69115 Heidelberg, Germany
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Adorjan K, Steinert T, Flammer E, Deister A, Koller M, Zinkler M, Herpertz SC, Häfner S, Hohl-Radke F, Beine KH, Falkai P, Gerlinger G, Pogarell O, Pollmächer T. Zwangsmaßnahmen in deutschen Kliniken für Psychiatrie und Psychotherapie. Nervenarzt 2016; 88:802-810. [DOI: 10.1007/s00115-016-0261-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Bohus M, Schmahl C, Herpertz SC, Lieb K, Berger M, Roepke S, Heinz A, Gallinat J, Lyssenko L. Leitliniengerechte stationäre psychiatrisch-psychotherapeutische Behandlung der Borderline-Persönlichkeitsstörung. Nervenarzt 2016; 87:739-45. [PMID: 27271516 DOI: 10.1007/s00115-016-0132-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- M Bohus
- Institut für Psychiatrische und Psychosomatische Psychotherapie, Zentralinstitut für Seelische Gesundheit, Universität Heidelberg, J 5, 68156, Mannheim, Deutschland.
- Fakultät für Gesundheit, Universität Antwerpen, Antwerpen, Belgien.
| | - C Schmahl
- Klinik für Psychosomatische Medizin und Psychotherapie, Zentralinstitut für Seelische Gesundheit, Universität Heidelberg, Mannheim, Deutschland
| | - S C Herpertz
- Klinik für Allgemeine Psychiatrie, Zentrum für Psychosoziale Medizin, Universitätsklinikum Heidelberg, Universität Heidelberg, Heidelberg, Deutschland
| | - K Lieb
- Klinik für Psychiatrie und Psychotherapie der Universitätsmedizin Mainz, Mainz, Deutschland
| | - M Berger
- Klinik für Psychiatrie und Psychotherapie, Universität Freiburg, Freiburg, Deutschland
| | - S Roepke
- Klinik für Psychiatrie und Psychotherapie, Charité-Universitätsmedizin Berlin, Berlin, Deutschland
| | - A Heinz
- Klinik für Psychiatrie und Psychotherapie, Charité-Universitätsmedizin Berlin, Berlin, Deutschland
| | - J Gallinat
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - L Lyssenko
- Institut für Psychiatrische und Psychosomatische Psychotherapie, Zentralinstitut für Seelische Gesundheit, Universität Heidelberg, J 5, 68156, Mannheim, Deutschland
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Schnell K, Hochlehnert A, Berger M, Wolff J, Radtke M, Schramm E, Normann C, Herpertz SC. Leitlinienentsprechende stationäre psychiatrisch-psychotherapeutische Behandlung der chronischen Depression. Nervenarzt 2016; 87:278-85. [PMID: 26940212 DOI: 10.1007/s00115-016-0084-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- K Schnell
- Klink für Allgemeine Psychiatrie, Universitätsklinikum Heidelberg, Voßstr. 4, 69115, Heidelberg, Deutschland.
| | - A Hochlehnert
- Zentrum für Psychosoziale Medizin, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - M Berger
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - J Wolff
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - M Radtke
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - E Schramm
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - C Normann
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - S C Herpertz
- Klink für Allgemeine Psychiatrie, Universitätsklinikum Heidelberg, Voßstr. 4, 69115, Heidelberg, Deutschland
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Normann C, Wolff J, Hochlehnert A, Klein JP, Hohagen F, Lieb K, Deckert J, Falkai P, Berger M, Herpertz SC. [Resource use and financing of guideline-adherent psychotherapeutic inpatient care]. Nervenarzt 2016; 86:534-41. [PMID: 25877042 DOI: 10.1007/s00115-015-4309-6] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND The financing of psychiatric psychotherapeutic care in Germany is determined by the German psychiatric staffing regulations which are unchanged since 1991. Psychotherapy was established after 1991 as an effective and indispensable treatment of mental and behavioral disorders. AIMS AND OBJECTIVES The aim of this study was to empirically investigate the use of psychiatrists' and psychologists' working time for psychotherapy in guideline-adherent hospital care. A further aim was to compare these results to the resources defined by the German psychiatric staffing regulations and in the new prospective payment system for psychiatry and psychosomatics in Germany. MATERIAL AND METHODS University hospitals for psychiatry and psychotherapy were asked to retrospectively provide data of patients for which guideline-adherent care was possible. Participating institutions provided both data describing the staff time utilization of psychotherapeutic services provided by psychiatrists and psychologists and patient classifications according to the German psychiatric staffing regulations and the new prospective payment system for psychiatry and psychosomatics. RESULTS Resources defined by the German psychiatric staffing regulations covered a mean of only 71 min of psychotherapy per patient and week while the actual mean intensity of psychotherapeutic care provided by the participating hospitals was 194 min per patient and week. The associated use of staff time was 102 min per patient and week. Both figures increased during an inpatient episode. The resources defined by the German psychiatric staffing regulations covered only 70 % of medical and psychological personnel. The current configuration of the new prospective payment system for psychiatry and psychosomatics covered only 59 % of staff time. CONCLUSION The results of this study provide another unambiguous recommendation to adjust the out-dated German psychiatric staffing regulations to the current evidence and S3 guidelines for psychiatric psychotherapeutic hospital care. In particular, more resources are required for the provision of psychotherapeutic care.
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Affiliation(s)
- C Normann
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Freiburg, Hauptstr. 5, 79104, Freiburg, Deutschland,
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Abstract
Despite the high prevalence of mental illness in Germany, elderly people are significantly under-represented in psychotherapeutic treatment. This is not only due to their own reservations about psychotherapy but also to a greater extent a reflection of the models of old age in our society. Deficit-oriented theories dating back to the origins of psychotherapy in the last century are still widespread leading to fear of contact with consultants and therapists.The specific methods of psychotherapeutic work with older patients are presented. Methodologically, the treatment of elderly patients with depressive disorders has been elaborately worked out. In addition, detailed psychotherapeutic programs have also been developed for anxiety disorders, trauma-related diseases and dementia. Overall, relatively little research has been done in the field of geriatric psychotherapy despite the fact that from the scientific and clinical perspectives, different approaches or methods, such as cognitive-behavioral therapy, interpersonal therapy, psychodynamic therapy, as well as systemic therapy, can be considered effective and may be applied to the entire spectrum of mental disorders in old age.
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Affiliation(s)
- D Koethe
- Klinik für Allgemeine Psychiatrie, Universität Heidelberg, Heidelberg, Deutschland,
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13
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Brieger P, Kling Lourenço P, Steinert T, Längle G, Lemke U, Herpertz SC, Croissant D, Becker T, Kilian R. [Involuntary psychiatric hospital admissions: a comparison between five hospitals in three German federal states]. Nervenarzt 2013; 85:606-13. [PMID: 23979361 DOI: 10.1007/s00115-013-3865-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND There is considerable variance in involuntary psychiatric hospital admission rates both in Europe and Germany. In a prospective comparison between five hospitals in three German federal states we assessed and analyzed involuntary psychiatric hospital admissions, including the patient's perspective. MATERIAL AND METHOD All involuntarily admitted patients were assessed by an independent researcher. Clinical data, patient and psychiatrist views were documented with different instruments including the McArthur admission experience survey. RESULTS In this study 104 out of 244 involuntarily admitted patients gave informed consent. We found considerable differences between study centres concerning involuntary admission quotas (3.2-25.8% of all hospital admissions) and involuntary admission rates (16.6-97.6 per year per 100,000 inhabitants). Hospitals in the state of Baden-Württemberg had the lowest involuntary admission rates while they were highest in Bavaria. In Baden-Württemberg involuntarily admitted patients were more likely to suffer from chronic schizophrenia, they were more severely ill and experienced the involuntary hospital admission as more strenuous. There were no differences between centres concerning frequency of dangerous behavior or self-harm. CONCLUSION We found a high variance across regions concerning the reasons for, frequencies and legal basis of involuntary hospital admissions. Regional differences of legal frameworks and service organization can explain this only to a limited amount. Transparency, legal certainty and reflection of stakeholder roles are a future necessity. Furthermore, there is a need for stringent compliance with legal regulations and coherent documentation.
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Affiliation(s)
- P Brieger
- Bezirkskrankenhaus Kempten, Akademisches Lehrkrankenhaus der Universität Ulm, Freudental 1, 87435, Kempten (Allgäu), Deutschland,
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14
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Abstract
BACKGROUND The neuropeptide oxytocin (OT) has positive effects on the processing of emotional stimuli such as facial expressions. To date, research has focused primarily on conditions of overt visual attention. METHOD We investigated whether a single intranasal dose of OT (24 IU) would modulate the allocation of attentional resources towards positive and negative facial expressions using a dot-probe paradigm in a sample of 69 healthy men. Attentional capacity for these facial cues was limited by presentation time (100 or 500 ms). In addition, we controlled for overt visual attention by recording eye movements using a remote eye tracker. RESULTS Reaction times (RTs) in the dot-probe paradigm revealed a pronounced shift of attention towards happy facial expressions presented for 100 ms after OT administration, whereas there were no OT-induced effects for longer presentation times (500 ms). The results could not be attributed to modulations of overt visual attention as no substance effects on gazes towards the facial target were observed. CONCLUSIONS The results suggest that OT increased covert attention to happy faces, thereby supporting the hypothesis that OT modulates early attentional processes that might promote prosocial behavior.
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Affiliation(s)
- G Domes
- Department of Psychology, University of Freiburg, Germany.
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15
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Abstract
Affect dysregulation and impulsivity are the main topics of neurobiological research in borderline personality disorder. Affect dysregulation subsumes enhanced resting arousal, increased emotional responsiveness as well as deficient emotional regulation and is associated with structural and functional abnormalities in a prefrontal-limbic network, above all orbitofrontal hypoactivity and amygdalar as well as insular hyperactivity. Impulsivity describes a lack of future-oriented problem solving style as well as a decreased threshold for motoric responses and is associated with decreased serotonergic activity in the ventral prefrontal cortex. Future research has to clarify how specific the findings of borderline personality disorder are and how far temperament dimensions, such as neuroticism can explain the neurobiological deviations from the norm.
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Affiliation(s)
- S C Herpertz
- Klinik für Allgemeine Psychiatrie, Zentrum für Psychosoziale Medizin, Universitätsklinikum Heidelberg, Voßstraße 2, Heidelberg, Germany.
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16
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Alexopoulos P, Topalidis S, Irmisch G, Prehn K, Jung SU, Poppe K, Sebb H, Perneczky R, Kurz A, Bleich S, Herpertz SC. Homocysteine and cognitive function in geriatric depression. Neuropsychobiology 2010; 61:97-104. [PMID: 20090379 DOI: 10.1159/000275821] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2009] [Accepted: 08/11/2009] [Indexed: 11/19/2022]
Abstract
BACKGROUND/OBJECTIVES Cognitive dysfunction is a common aspect of the spectrum of symptoms of geriatric depression. High homocysteine levels have been linked to cognitive decline in neuropsychiatric disorders. The present study investigated possible associations between cognitive impairment observed in geriatric depression and homocysteine levels. METHODS The performance of 25 mentally healthy individuals and 40 patients with geriatric depression in terms of language processing, processing speed, concentration and attention was assessed with the Stroop Test and the d2 Test of Attention. Serum homocysteine was determined with an enzyme immunoassay. RESULTS The performance of depressed patients was significantly worse in language processing (p = 0.001) and processing speed (p < 0.0001). Depressed patients with high levels of homocysteine performed better than patients with homocysteine concentrations <or=11.7 micromol/l in both cognitive domains (p = 0.006 and 0.009, respectively). Moreover, homocysteine level was positively associated with language processing (p = 0.002) and processing speed (p = 0.002). CONCLUSIONS These findings indicate that under the special circumstances of geriatric depression (perturbation of glutamatergic transmission and glutamate metabolism), homocysteine is positively associated with the performance in language processing and processing speed.
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Affiliation(s)
- P Alexopoulos
- Department of Psychiatry and Psychotherapy, University of Rostock, Rostock, Germany. panos.alexopoulos @ lrz.tu-muenchen.de
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17
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Habermeyer V, Herpertz SC. [Diagnosis and therapy of personality disorders]. Fortschr Neurol Psychiatr 2009; 77:532-546. [PMID: 19415586 DOI: 10.1055/s-0028-1109377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- V Habermeyer
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universität Rostock, Gehlsheimer Strasse 20, Rostock
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18
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Abstract
Since its first use in medical literature the meaning of the term autism has constantly changed. An historical overview indicates that in both adult and child psychiatry autism was first used to refer to a symptom of schizophrenia. Later on the use of the term in child psychiatry took a different independent course, which led to present-day conceptualization of autism, mainly due to the work of Leo Kanner and Hans Asperger. Currently autism and autistic disorders are regarded as severe developmental disorders and, due to their stable nature, have gained considerable attention in adult psychiatry. In order to better understand this development, the path from onset to reception is traced via Kanner and Asperger. In the search for central characteristics of autism, one finds restrictions in social communication and interaction, which can be explained by fundamental deficits in social cognition. These restrictions in social cognition can be considered the central characteristic of autism - one which has been a constant since the phenomenon was first described. Our historical review considers to what extent experimental psychopathological research can deepen our understanding of the disorder.
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Affiliation(s)
- E Kumbier
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Zentrum für Nervenheilkunde der Universität Rostock, Gehlsheimer Str. 20, 18147 Rostock.
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19
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Kumbier E, Haack K, Herpertz SC. [Franz Günther von Stockert between politics and science--a study in the history of the neurology and psychiatry in the GDR]. Fortschr Neurol Psychiatr 2009; 77:285-8. [PMID: 19418386 DOI: 10.1055/s-0028-1109400] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
1945 marked the beginning of the so-called anti-fascist democratic transformation in the Soviet occupied zone and later GDR, which also included radical reforms in the higher education system. The aim of these reforms was to establish a "new intelligence" that was to spread Marxist-Leninist teaching in universities and colleges. However, in practice the new rulers had to rely on the old "erudite elite" which led to considerable problems. Against this socio-political background this study analyses the affairs at the neuropsychiatric clinic Gehlsheim at Rostock University, in particular those around Franz Günther von Stockert (1899-1967), who was head of the department between 1954 and 1958. Archival sources, not accessible till now, shed light on the background and motives that finally led to his dismissal and short-term imprisonment, and the consequences for the clinic. The analysis of this example also shows how external factors can influence science and the disciplinary differentiation. This case from the field of psychiatry and neurology is a contribution to the broader history of science in the GDR until 1961.
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Affiliation(s)
- E Kumbier
- Klinik und Poliklinik für Psychiatrie und Psychotherapie Universität Rostock, Gehlsheimer Strasse 20, Rostock.
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20
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Hauenstein K, Wagner S, Lischke A, Berger C, Domes G, Herpertz SC. Untersuchung Neuromodulatorischer Effekte von exogen appliziertem Oxytocin auf die Wahrnehmung von emotionalen Gesichtern und Szenen bei Frauen mittels fMRT. ROFO-FORTSCHR RONTG 2009. [DOI: 10.1055/s-0029-1221368] [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] [Indexed: 10/20/2022]
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21
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Abstract
Autism today is a widely used term, yet what is understood by autism has changed considerably since first being introduced in scientific discourse almost 100 years ago. Autism is one example for the influence of the psychoanalytic school of Sigmund Freud on scientific psychiatry at the beginning of the 20th century. In particular psychoanalysis had an impact on Eugen Bleuler's concept of schizophrenia. The Swiss psychiatrist did not only acknowledge and follow a biological, but also a psychological approach to psychiatry and thus opened up his subject to psychoanalytic thoughts. This paper provides insights into the term's conceptual history--or, more specifically and precisely--sheds light on the expansion of the term's scope, which has gotten to be used for more and more symptoms and phenomena. When Bleuler first presented the term autism, he used it to refer to a classical schizophrenic symptom. Since, however, Bleuler was not very specific and exclusive in his definition, the term was soon used for other phenomena as well, such as to describe a schizoid symptom in the sense of today's schizoid personality disorder (schizoid autism). The concepts of autistic hebephrenia and depressive autism are further examples how the term was used and give insight into how the contents behind the term changed, got less and less specific and widened its scope. Due to its growing vagueness its suitability and usability as a psychopathological term decreased. This process further was strengthened when the word autism got more and more widely used in colloquial language for different aspects of day-to-day routine and thinking. Thus in psychiatry today, autism is exclusively used in connection with the so-called autism spectrum disorders, but has, as other formerly exclusively technical terms, different and rather unspecific meanings in everyday communication.
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Affiliation(s)
- E Kumbier
- AG Geschichte der Nervenheilkunde an der Klinik für Psychiatrie und Psychotherapie, Universität Rostock, Gehlsheimer Strasse 20, Rostock.
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22
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Abstract
Autism spectrum disorders (autism, Asperger's syndrome, high-functioning autism) are characterized by a common pattern of marked impairments in social interactions. Deficits have been described in face processing, facial emotion recognition, and social attribution ("theory of mind") or generally speaking in social cognition. Some studies have shown that these impairments are already detectable in early childhood, leading to the assumption that the underlying cause is an early disruption of neuronal development. Accordingly, neuroimaging data have revealed alterations of structure and function in the brains of autistic children, adolescents, and adults. The present review gives a systematic overview of the existing literature on functional imaging studies using experimental paradigms of social cognition, i.e. face discrimination, facial emotion recognition, and theory of mind in autistic disorders.
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Affiliation(s)
- G Domes
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Zentrum für Nervenheilkunde der Universität Rostock, Gehlsheimer Strasse 20, 18147 Rostock
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23
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Lampe K, Konrad K, Kroener S, Fast K, Kunert HJ, Herpertz SC. Neuropsychological and behavioural disinhibition in adult ADHD compared to borderline personality disorder. Psychol Med 2007; 37:1717-1729. [PMID: 17506923 DOI: 10.1017/s0033291707000517] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Although attention-deficit/hyperactivity disorder (ADHD) is thought to be an inhibitory disorder, the question remains of how specific the inhibitory deficit is in adults and whether it distinguishes ADHD from borderline personality disorder (BPD), with which it shares several clinical features, particularly impulsiveness. METHOD The study assessed various motor and cognitive inhibitory functions (inhibition of prepotent, ongoing and interfering responses) in addition to working memory in adult ADHD patients with and without BPD, compared to subjects with BPD alone and controls. In addition, questionnaire data on various aspects of impulsiveness and anger regulation were assessed in all groups. RESULTS ADHD patients performed worse than BPD individuals and controls in two inhibitory tasks: the stop signal task and the conflict module of the Attentional Network Task (ANT). In addition, they exhibited longer reaction times (RTs) and higher intra-individual variance in nearly all attentional tasks. The co-morbid group exhibited poor performance on the stop signal task but not on the conflict task. The BPD group barely differed from controls in neuropsychological performance but overlapped with ADHD in some behavioural problems, although they were less severe on the whole. CONCLUSIONS Impaired inhibition is a core feature in adults with ADHD. In addition, slow RTs and high intra-individual variance in performance may reflect deficits in the regulation of activation and effort in ADHD patients. ADHD and BPD share some symptoms of behavioural dysregulation without common cognitive deficits, at least in the attentional realm.
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Affiliation(s)
- K Lampe
- Department of Psychiatry and Psychotherapy, RWTH Aachen, University Hospital, Rostock, Germany
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24
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Alexopoulos P, Nadler K, Cramer B, Herpertz SC, Kurz A. [Validation of a short test (3MS-R) for detecting Alzheimer's disease]. Fortschr Neurol Psychiatr 2007; 75:728-36. [PMID: 17607642 DOI: 10.1055/s-2007-980062] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND The Modified Mini-Mental State Examination-revised (3MS-R) is a brief cognitive test designed to detect cognitive impairment, which is often used in Canada and USA. OBJECTIVE To assess the accuracy of the 3MS-R in identifying Alzheimer's disease (AD) in comparison with the conventional Mini-Mental State Examination (MMSE) in a German-speaking population. SUBJECTS The study refers to 31 patients with early AD and 5 patients with moderate dementia of AD etiology, as well as to 46 age-matched cognitively normal participants. METHOD The 3MS-R and the MMSE were validated against an expert diagnosis based on a comprehensive diagnostic workup. The 3MS scores were adjusted for educational attainment. Statistical analysis was performed using the Receiver Operating Characteristics (ROC). RESULTS ROC curves demonstrated the superiority of the ACE over the MMSE in identifying AD (Area under the Curve: 3MS-R vs. MMSE: 0.995 vs.0.953). The optimal cut-off score for the 3MS for detecting AD was 88 and had a sensitivity of 98% and a specificity of 94%. The German version of the 3MS-R is a short and practical but accurate test battery for the identification of AD. The effectiveness of the German version of the test in detecting other forms of dementias or mild cognitive impairment could be a task for future studies.
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Affiliation(s)
- P Alexopoulos
- Psychiatrie und Psychotherapie Klinik, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen.
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25
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Abstract
In 1850 the mentally disordered Sergeant Maximilian Joseph Sefeloge (1821-1859) tried to assassinate the Prussian King Friedrich Wilhelm IV (1795-1861). Besides clarification of the political background to the assassination, the question of the delinquent's criminal responsibility has been posed from the very beginning. For the first time Sefeloge's case is examined from a medicohistorical perspective. Due to the importance of the circumstances, a forensic scientist and three well-known psychiatrists made this forensic examination. These medical professionals seemed particularly competent because of their common experience with psychiatric patients. This unique case from nineteenth century Germany is exemplary in that the psychiatrist was generally accepted as an expert witness to evaluate crimes in the context of unclear mental conditions. From there the development of forensic psychiatry could proceed without hindrance.
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Affiliation(s)
- K Haack
- AG Geschichte der Nervenheilkunde an der Klinik und Poliklinik für Psychiatrie und Psychotherapie , Universität Rostock, Rostock
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26
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Schnell K, Dietrich T, Schnitker R, Daumann J, Herpertz SC. Processing of autobiographical memory retrieval cues in borderline personality disorder. J Affect Disord 2007; 97:253-9. [PMID: 16837057 DOI: 10.1016/j.jad.2006.05.035] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2005] [Revised: 05/30/2006] [Accepted: 05/31/2006] [Indexed: 01/18/2023]
Abstract
BACKGROUND Affective dysregulation in borderline personality disorder (BPD) in response to both external stimuli and memories has been shown to be associated with functional alterations of limbic and prefrontal brain areas. This study aimed to examine neuronal networks involved in autobiographical memory retrieval using standardized stimuli that gain autobiographical significance by illustrating marked solitary and social situations of human life. METHODS Using event-related functional Magnetic Resonance Imaging (fMRI), we examined the processing of pictures from the Thematic Apperception Test (TAT) in 14 BPD patients and 14 controls. RESULTS In both groups, TAT stimuli activated brain areas known to be involved in autobiographical memory retrieval. BPD subjects lacked differential amygdala, orbitofrontal and cingulate activations for TAT versus neutral stimuli. In the TAT condition, compared to controls, BPD subjects displayed increased BOLD responses in the bilateral orbitofrontal and insular regions, in the left anterior cingulate and medial prefrontal cortex, as well as in the parietal and parahippocampal areas, consistent with a more aversive and arousing experience assessed by self-reports. CONCLUSIONS Increased BOLD responses during TAT processing in BPD subjects were in line with previously reported changes in anterior cingulate and orbitofrontal cortices, which are known to be involved in memory retrieval. However, BPD subjects displayed hyperactivation in these areas for both TAT and neutral stimuli. The deficit of selective activation of areas involved in autobiographical memory retrieval suggests a general tendency towards a self-referential mode of information processing in BPD, or a failure to switch between emotionally salient and neutral stimuli.
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Affiliation(s)
- K Schnell
- Department of Psychiatry and Psychotherapy, Cologne University, Germany
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27
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Hauenstein K, Grossmann A, Krüger A, Domes G, Berger C, Herpertz SC. Funktionelle Magnetresonanztomographie in der Diagnostik von Borderline Persönlichkeitsstörungen. ROFO-FORTSCHR RONTG 2007. [DOI: 10.1055/s-2007-977153] [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] [Indexed: 10/21/2022]
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Abstract
Deviant behavior is gaining in clinical importance if it is founded on stable, characteristic, and enduring patterns of psychopathologically relevant personality traits which have their onset in childhood or adolescence. The classification of these traits shows variations, so that a distinction between the ICD-10 diagnosis of dis-social personality disorder, DSM-IV diagnosis of antisocial personality disorder, and the concept "psychopathy" is necessary. Our knowledge about the biological basis of antisocial behavior includes neurophysiologic, psychophysiologic, and genetic findings. Also relevant are results of neurotransmitter studies and structural resp. functional neuroimaging findings. Psychosocial risk factors include parental deficits, rejection, disregard, unstable relations, and abuse. Efficient psychotherapeutic treatment is cognitive-behavioral. Pharmacologic treatment is largely "off-label". The diagnosis of antisocial and dis-social personality disorders allows no conclusions on criminal responsibility. In addition to psychiatric diagnostics, considerations on the severity of the disorder and its effects on the ability to inhibit actions are necessary.
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Affiliation(s)
- E Habermeyer
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Zentrum für Nervenheilkunde der Universität Rostock, Gehlsheimer Strasse 20, 18147 Rostock, Deutschland.
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29
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Herpertz SC, Koetting K. Startle response in inpatients with borderline personality disorder vs. healthy controls. J Neural Transm (Vienna) 2005; 112:1097-106. [PMID: 15666039 DOI: 10.1007/s00702-004-0249-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2004] [Accepted: 10/19/2004] [Indexed: 10/25/2022]
Abstract
Startle response is found to be enhanced in conditions that are accompanied by intense emotions, high levels of anxiety in particular. We assessed the autonomous and behavioral component of the startle reflex in a sample of 28 unmedicated inpatients with borderline personality disorder (BPD) compared to 28 controls. Amplitudes of electrodermal and startle response as well as habituation were measured in response to 15 bursts of white noise (100-db, 40-ms). We assessed prepulse inhibition to study gating capacities in BPD, with each prepulse (70-db, 30-msec) delivered 100 ms before the startling tone. In contrast to our hypothesis, our study revealed neither enhanced amplitudes of autonomic and electromyographic startle responses nor differences in habituation compared to healthy controls. In addition, no deficit in prepulse inhibition was found in BPD. In summary, our data indicate normal response to unconditioned threatening stimuli as well as normal gating capacities in BPD.
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Affiliation(s)
- S C Herpertz
- Department of Psychiatry and Psychotherapy, Rostock University, Germany
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30
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Herpertz SC, Mueller B, Wenning B, Qunaibi M, Lichterfeld C, Herpertz-Dahlmann B. Autonomic responses in boys with externalizing disorders. J Neural Transm (Vienna) 2003; 110:1181-95. [PMID: 14523630 DOI: 10.1007/s00702-003-0026-6] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Autonomous hyporesponsiveness in children appears to be an indicator of a greater future likelihood of antisocial behavior. Since externalizing disorders are suggested to implicate a risk of antisocial behavior in later life, psychophysiological measurements were assessed commonly used in the realm of antisocial behavior. METHOD Arousal measures and electrodermal responses to orienting and startling stimuli were assessed in 8-13 year old boys diagnosed with attention deficit/hyperactivity disorder (ADHD), conduct disorder (CD), the comorbid condition of ADHD+CD, and in controls. The eyeblink response to startling stimuli was also recorded. RESULTS Children with CD and ADHD+CD showed decreased electrodermal responses and accelerated habituation in all paradigms compared to children with ADHD alone and controls. CONCLUSION CD boys with and without ADHD showed a widely analogous response pattern which is highly similar to that found in antisocial adults. Data suggest that it is CD that sharply rises the risk of unfavorable, antisocial development, whether it occurs alone or comorbid with ADHD.
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Affiliation(s)
- S C Herpertz
- Department of Psychiatry and Psychotherapy, Rostock University, Germany.
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31
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Herpertz SC, Dietrich T, Werth U, Qunaibi M, Lukas G, Schuerkens A, Kunert HJ, Freese R, Flesch M, Mueller-Isberner R, Osterheider M, Sass H. Affect regulation in borderline personality disorder: experimental findings from psychophysiology and functional neuroimaging. Acta Neuropsychiatr 2002; 14:71-5. [PMID: 26983968 DOI: 10.1034/j.1601-5215.2002.140204.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Intense and rapidly changing mood states are a major feature of borderline personality disorder (BPD), which is thought to arise from affective vulnerability. OBJECTIVE There have been only a few studies investigating affective processing in BPD, and particularly neither psychophysiological nor neurofunctional correlates of abnormal emotional processing have been identified so far. METHODS Studies are reported using psychophysiological or functional neuroimaging methodology. RESULTS The psychophysiological study did not indicate a general emotional hyperresponsiveness in BPD. Low autonomic arousal seemed to reflect dissociative states in borderline subjects experiencing intense emotions. In the functional magnetic resonance imaging study enhanced amygdala activation was found in BPD, and it is suggested to reflect the intense and slowly subsiding emotions commonly observed in response to even low-level stressors. CONCLUSIONS Implications for psychotherapy are discussed.
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Affiliation(s)
- S C Herpertz
- 1Department of Psychiatry and Psychotherapy, Aachen Technical University (RWTH)
| | - T Dietrich
- 1Department of Psychiatry and Psychotherapy, Aachen Technical University (RWTH)
| | - U Werth
- 1Department of Psychiatry and Psychotherapy, Aachen Technical University (RWTH)
| | - M Qunaibi
- 1Department of Psychiatry and Psychotherapy, Aachen Technical University (RWTH)
| | - G Lukas
- 1Department of Psychiatry and Psychotherapy, Aachen Technical University (RWTH)
| | - A Schuerkens
- 1Department of Psychiatry and Psychotherapy, Aachen Technical University (RWTH)
| | - H-J Kunert
- 1Department of Psychiatry and Psychotherapy, Aachen Technical University (RWTH)
| | - R Freese
- 2Haina Forensic Psychiatric Hospital and Westphalian Center for Forensic Psychiatry, Lippstadt, Germany
| | - M Flesch
- 2Haina Forensic Psychiatric Hospital and Westphalian Center for Forensic Psychiatry, Lippstadt, Germany
| | - R Mueller-Isberner
- 2Haina Forensic Psychiatric Hospital and Westphalian Center for Forensic Psychiatry, Lippstadt, Germany
| | - M Osterheider
- 2Haina Forensic Psychiatric Hospital and Westphalian Center for Forensic Psychiatry, Lippstadt, Germany
| | - H Sass
- 1Department of Psychiatry and Psychotherapy, Aachen Technical University (RWTH)
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Herpertz SC, Wenning B, Mueller B, Qunaibi M, Sass H, Herpertz-Dahlmann B. Psychophysiological responses in ADHD boys with and without conduct disorder: implications for adult antisocial behavior. J Am Acad Child Adolesc Psychiatry 2001; 40:1222-30. [PMID: 11589536 DOI: 10.1097/00004583-200110000-00017] [Citation(s) in RCA: 94] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Several studies have demonstrated that the presence of attention-deficit/hyperactivity disorder (ADHD) in childhood increases the risk of antisocial behavior developing in adulthood. However, because previous research did not consider comorbid conduct disorder (CD), the question of whether ADHD by itself or only the association of ADHD with CD implies a risk of adult antisocial behavior developing is still under discussion. METHOD Because several characteristics of psychophysiological response had been shown to be associated with future increased likelihood of adult antisocial behavior, autonomic arousal as well as electrodermal responses to orienting and aversive stimuli were assessed in 26 boys with ADHD+CD compared with 21 boys with ADHD alone and 21 controls. RESULTS Boys with a comorbid condition of ADHD+CD showed a decrement of autonomic responses and a more rapid habituation to orienting and aversive startling stimuli compared with age-matched children with ADHD alone. CONCLUSIONS Boys with ADHD+CD show a psychophysiological response pattern that is very similar to that reported in antisocial personalities. These findings give further support for a high persistence of antisocial behavior from childhood to adulthood, while no evidence was found that ADHD itself is associated with a predisposition to antisocial behavior.
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Affiliation(s)
- S C Herpertz
- Department of Psychiatry and Psychotherapy, Aachen Technical University, Aachen, Germany.
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Herpertz SC, Dietrich TM, Wenning B, Krings T, Erberich SG, Willmes K, Thron A, Sass H. Evidence of abnormal amygdala functioning in borderline personality disorder: a functional MRI study. Biol Psychiatry 2001; 50:292-8. [PMID: 11522264 DOI: 10.1016/s0006-3223(01)01075-7] [Citation(s) in RCA: 363] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Intense and rapidly changing mood states are a major feature of borderline personality disorder (BPD); however, there have only been a few studies investigating affective processing in BPD, and in particular no neurofunctional correlates of abnormal emotional processing have been identified so far. METHODS Six female BPD patients without additional major psychiatric disorder and six age-matched female control subjects underwent functional magnetic resonance imaging (fMRI) to measure regional cerebral hemodynamic changes following brain activity when viewing 12 standardized emotionally aversive slides compared to 12 neutral slides, which were presented in random order. RESULTS Our main finding was that BPD subjects but not control subjects were characterized by an elevated blood oxygenation level dependent fMRI signal in the amygdala on both sides. In addition, activation of the medial and inferolateral prefrontal cortex was seen in BPD patients. Both groups showed activation in the temporo-occipital cortex including the fusiform gyrus in BPD subjects but not in control subjects. CONCLUSIONS Enhanced amygdala activation in BPD is suggested to reflect the intense and slowly subsiding emotions commonly observed in response to even low-level stressors. Borderline subjects' perceptual cortex may be modulated through the amygdala leading to increased attention to emotionally relevant environmental stimuli.
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Affiliation(s)
- S C Herpertz
- Department of Psychiatry and Psychotherapy, Medical Faculty of Aachen Technical University-RWTH, Aachen, Germany
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Herpertz SC, Werth U, Lukas G, Qunaibi M, Schuerkens A, Kunert HJ, Freese R, Flesch M, Mueller-Isberner R, Osterheider M, Sass H. Emotion in criminal offenders with psychopathy and borderline personality disorder. Arch Gen Psychiatry 2001; 58:737-45. [PMID: 11483139 DOI: 10.1001/archpsyc.58.8.737] [Citation(s) in RCA: 252] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Criminal offenders with a diagnosis of psychopathy or borderline personality disorder (BPD) share an impulsive nature but tend to differ in their style of emotional response. This study aims to use multiple psychophysiologic measures to compare emotional responses to unpleasant and pleasant stimuli. METHODS Twenty-five psychopaths as defined by the Hare Psychopathy Checklist and 18 subjects with BPD from 2 high-security forensic treatment facilities were included in the study along with 24 control subjects. Electrodermal response was used as an indicator of emotional arousal, modulation of the startle reflex as a measure of valence, and electromyographic activity of the corrugator muscle as an index of emotional expression. RESULTS Compared with controls, psychopaths were characterized by decreased electrodermal responsiveness, less facial expression, and the absence of affective startle modulation. A higher percentage of psychopaths showed no startle reflex. Subjects with BPD showed a response pattern very similar to that of controls, ie, they showed comparable autonomic arousal, and their startle responses were strongest to unpleasant slides and weakest to pleasant slides. However, corrugator electromyographic activity in subjects with BPD demonstrated little facial modulation when they viewed either pleasant or unpleasant slides. CONCLUSIONS The results support the theory that psychopaths are characterized by a pronounced lack of fear in response to aversive events. Furthermore, the results suggest a general deficit in processing affective information, regardless of whether stimuli are negative or positive. Emotional hyporesponsiveness was specific to psychopaths, since results for offenders with BPD indicate a widely adequate processing of emotional stimuli.
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Affiliation(s)
- S C Herpertz
- Department of Psychiatry and Psychotherapy of the Medical Faculty, Aachen Technical University, Pauwelsstr. 30, D-52057 Aachen, Germany.
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Müller B, Wewetzer C, Jans T, Holtkamp K, Herpertz SC, Warnke A, Remschmidt H, Herpertz-Dahlmann B. [Personality disorders and psychiatric comorbidity in obsessive-compulsive disorder and anorexia nervosa]. Fortschr Neurol Psychiatr 2001; 69:379-87. [PMID: 11584688 DOI: 10.1055/s-2001-16511] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
The aim of this prospective longitudinal study was to examine the course of adolescent anorexia nervosa and obsessive-compulsive disorder (OCD) (fulfilling DSM-III-R criteria) to compare psychiatric comorbidity and personality disorders of both groups. Because anorexia nervosa patients are mainly female, we compared them only with female OCD patients. Ten years after discharge the whole sample (32 female patients; 100%) of a group of 39 (32 female; 7 male) anorexia nervosa patients could be reexamined personally. 25 (61%) female patients of a group of 116 patients (41 female; 75 male) with obsessive-compulsive disorder were also reexamined. The anorexia nervosa patients were interviewed using the Structured Interview for Anorexia and Bulimia nervosa (SIAB [39]) to assess eating disorder symptomatology. To examine comorbid psychiatric disorders we used the Composite International Diagnostic Interview, WHO [44] and SCID-II [45] for personality disorders. One fourth of the patients with anorexia nervosa (AN) and 20% of the patients with obsessive-compulsive disorder had a personality disorder according to DSM-III-R. Most of them were "Cluster C"-personality disorders (AN: 28%; OCD: 20%). In the group of the female OCD patients 8% schizoid, 4% schizotype and 12% paranoid personality disorders were observed. The most prevalent psychiatric disorders were anxiety (AN: 28%; OCD: 20%) and affective disorders (AN: 16%; OCD: 16%). Our results support the view that in the course of anorexia nervosa and in obsessive-compulsive disorder there is a high prevalence of psychiatric comorbidity and "Cluster C"-personality disorders according to DSM-III-R. These results might confirm a model of a high vulnerability of the serotonergic neurotransmitter system in patients with anorexia nervosa or OCD.
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Affiliation(s)
- B Müller
- Klinik für Kinder- und Jugendpsychiatrie und -psychotherapie, Universitätsklinikum Rheinisch-Westfälische Technische Hochschule Aachen.
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Herpertz SC, Schwenger UB, Kunert HJ, Lukas G, Gretzer U, Nutzmann J, Schuerkens A, Sass H. Emotional responses in patients with borderline as compared with avoidant personality disorder. J Pers Disord 2001; 14:339-51. [PMID: 11204341 DOI: 10.1521/pedi.2000.14.4.339] [Citation(s) in RCA: 87] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The aim of this study was to assess psychophysiological affect correlates, in addition to the usual self-report in borderline personality disorder (BPD) compared with avoidant personality disorder (APD) and normal controls (NCs), when responding to standardized experimental stimuli. In 24 BPD female patients, 23 APD female patients, and 27 female NCs, skin conductance response (SCR), heart rate (HR) change, and startle response were recorded while the subjects viewed slides with emotional content. Neither the self-report nor the psychophysiological data supported the hypothesis that affective responses of BPD individuals are generally stronger than those with APD. BPD patients showed no potentiation of the affective modulation of the startle reflex and their electrodermal reactivity was lower than in either the APD subjects or the NCs. The hypothesis of a general affective hyperresponsivity could not be confirmed. Low somatic arousal in BPD can interfere with the anticipation of signal stimuli and may explain the exaggerated openness borderline personalities show to stimuli, particularly in interpersonal situations.
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Affiliation(s)
- S C Herpertz
- Department of Psychiatry and Psychotherapy, Technical University of Aachen, Pauwelsstr. 30, D-52057 Aachen, Germany.
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Herpertz SC, Kunert HJ, Schürkens A, Steinmeyer EM, Sass H, Freese R, Flesch M, Müller-Isberner R, Osterheider M. [Impulse control and affect regulation in personality disorders]. Psychother Psychosom Med Psychol 2000; 50:435-42. [PMID: 11130144 DOI: 10.1055/s-2000-8152] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
In borderline and antisocial personality disorder there is a close interaction between affect dysregulation and impulse control disorder. Different approaches are presented that focus on affective responses to experimental stimuli in these personality disorders. Results suggest that in borderline personality disorder intense emotional responses occur in the context of specific stressors, in particular fear of being abandoned. Evidence for a general emotional hyperreactivity was not found; on the contrary, female borderline subjects rather showed reduced emotional arousal. Regarding the psychopathic subtype of antisocial personality disorder, results provided strong support for the theory of emotional detachment, which may predispose to violence through a lack of feeling of fear or also of compassion which could counteract violent impulses. Consequences for psychotherapy in BPD are considered.
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Affiliation(s)
- S C Herpertz
- Klinik für Psychiatrie und Psychotherapie des Universitätsklinikums, RWTH Aachen.
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Abstract
Aside from an antisocial life-style, the concept of psychopathy is based on character features which can be described in terms of specific patterns of interpersonal, behavioral, and, in particular, affective characteristics. Concluding from studies which have dealt with the affective domain in psychopaths, emotional deficiency may predispose to violence in several ways. (1) Poor conditioning implicates a failure to review the harmful consequences of one's actions leading to a deficit of avoidance behavior. (2) Emotional detachment prevents experiencing feelings, which naturally inhibit the acting out of violent impulses. (3) Emotional deficiency is closely associated with a general underarousal, leading to sensation seeking. Current data suggest that there may be a close association between difficulties in emotional processing and poor prefrontal functioning. From a psychosocial perspective, psychopaths were shown to have been exposed to severe familial and societal difficulties. Whether biological or environmental factors dominate in the etiology of this personality disorder, psychopathy does not per se justify the assumption of decreased legal responsibility.
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Affiliation(s)
- S C Herpertz
- Department of Psychiatry and Psychothraphy, University Hospital of Aachen, Germany.
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Abstract
OBJECTIVE The aim of the study was to investigate affective responses to emotional stimuli in subjects with borderline personality disorder. METHOD Twenty-four female patients with borderline personality disorder and 27 normal female comparison subjects were examined. The test stimuli were a set of standardized photographic slides with pleasant, neutral, or unpleasant emotional valence. In addition to self-reports, emotional reactions to the slides were measured by heart rate, skin conductance, and startle response. Psychometric tests for various aspects of impulsiveness were also completed. RESULTS Neither self-report nor physiological data gave any evidence that the borderline patients showed more intense affective responses than did the normal subjects. The borderline subjects did not produce higher levels of startle amplitude, and while viewing unpleasant slides, they showed a startle potentiation effect that was largely similar to that of the comparison group. In fact, the borderline patients showed low electrodermal responses to all three stimulus categories, which points to physiological underarousal. CONCLUSIONS The results do not agree with the hypothesis that there is a fundamental, biologically based affective hyperresponsiveness in borderline personality disorder, as is suggested by current theories of affect dysregulation in the disorder. Autonomic underarousal may seriously interfere with a flexible adaptation to environmental stimuli.
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Affiliation(s)
- S C Herpertz
- Clinic for Psychiatry and Psychotherapy, Technical University of Aachen, Germany.
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