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Flechsenhar A, Levine SM, Müller LE, Herpertz SC, Bertsch K. Oxytocin and social learning in socially anxious men and women. Neuropharmacology 2024; 251:109930. [PMID: 38537867 DOI: 10.1016/j.neuropharm.2024.109930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 03/19/2024] [Accepted: 03/20/2024] [Indexed: 04/05/2024]
Abstract
OBJECTIVE This study extended a classic self-referential learning paradigm by investigating the effects of intranasally-administered oxytocin in high and low socially anxious participants during social learning, as a function of social anxiety levels and sex. METHODS In a randomized double-blinded design, 160 participants were either given intranasal oxytocin (24 I.U.) or placebo. Subsequently, while lying in an MR scanner, participants were shown neutral faces that were paired with positively, neutrally, or negatively valenced self-referential sentences, during which we measured self-reported arousal and sympathy of the facial stimuli, pupil dilation, and changes in the brain-oxygen-level dependent signal. Four-factor mixed analyses of variance with the between-subjects factors group (high socially anxious vs. low socially anxious), substance (oxytocin vs. placebo), and sex (male vs. female) and the within-subjects factor sentence valence (positive vs. neutral vs. negative) were conducted for each measure, respectively. RESULTS Administration of intranasal oxytocin yielded an increase in sympathy ratings in high socially anxious compared to low socially anxious individuals and decreased arousal ratings for positively-conditioned faces in low socially anxious participants. As an objective physiological measure of arousal, pupil dilation mirrored the behavioral results. Oxytocin effects on neural activation in the insula interacted with anxiety levels and sex: low socially anxious individuals yielded lower activation under oxytocin than placebo; the converse was observed in high socially anxious individuals. This interaction also differed between sexes, as men yielded higher activation levels than women. These findings were more prominent for positively- and negatively-conditioned faces. Within the amygdala, high socially anxious men yielded higher activation than high socially anxious women in the left hemisphere, and low socially anxious men yielded higher activation than low socially anxious women from positively- and negatively-conditioned faces, though no influence of oxytocin was detected. CONCLUSION These results suggest oxytocin-induced behavioral, physiological, and neural changes as a function of social learning in socially low and high anxious individuals. These findings challenge the amygdalocentric view of the role of emotions in social learning, instead contributing to the growing body of findings implicating the insula therein, revealing an interaction between oxytocin, sex, and emotional valence. Such discoveries raise an interesting set of questions regarding the computational goals of regions such as the insula in emotional learning and how neural activity can play a diagnostic or prognostic role in social anxiety, potentially leading to new treatment opportunities that may combine oxytocin and neurofeedback differentially for men and women.
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Affiliation(s)
- Aleya Flechsenhar
- Department of Psychology, Ludwig-Maximilians Universität München, Germany; NeuroImaging Core Unit Munich (NICUM), University Hospital, Ludwig-Maximilians Universität München, Germany
| | - Seth M Levine
- Department of Psychology, Ludwig-Maximilians Universität München, Germany; NeuroImaging Core Unit Munich (NICUM), University Hospital, Ludwig-Maximilians Universität München, Germany
| | - Laura E Müller
- Department of General Psychiatry, Center for Psychosocial Medicine, Heidelberg University, Germany
| | - Sabine C Herpertz
- Department of General Psychiatry, Center for Psychosocial Medicine, Heidelberg University, Germany
| | - Katja Bertsch
- Department of Psychology, Ludwig-Maximilians Universität München, Germany; NeuroImaging Core Unit Munich (NICUM), University Hospital, Ludwig-Maximilians Universität München, Germany; Department of Psychology, Julius-Maximilians-Universität Würzburg, Germany.
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Flechsenhar A, Seitz KI, Bertsch K, Herpertz SC. The association between psychopathology, childhood trauma, and emotion processing. Psychol Trauma 2024; 16:S190-S203. [PMID: 35511536 DOI: 10.1037/tra0001261] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Childhood trauma is highly prevalent and can have a negative impact on the development of socioemotional processes resulting in a higher vulnerability for mental disorders in adulthood. Previous studies have associated the severity of childhood trauma with deficits in social functioning, such as a negative attention bias, suggesting altered social information processing as a mechanism underlying the association between childhood trauma and transdiagnostic psychopathologies. METHOD In a cross-sectional setup with a total of 103 participants (26 with major depressive disorder, MDD; 24 with posttraumatic stress disorder, PTSD; 22 with somatic symptom disorder, SDD; and 31 healthy volunteers, HV), this study applied eye tracking in an emotion recognition paradigm. Reaction times, accuracy, and gaze behavior were analyzed for 4 different facial expressions as a function of self-reported childhood trauma and diagnosis. The aim was to investigate to what extent emotion processing is associated with (a) childhood trauma, (b) psychopathology, and (c) respective interacting effects. RESULTS Patients showed higher reaction times and error rates overall in classifying emotions than HVs, especially for the recognition of anger and fear. Individuals with a diagnosis of PTSD and MDD were particularly slow in their response to these emotions. Higher scores of reported childhood trauma were associated with faster responses for classifying anger and fear and slower initiation of eye movements for SSD, MDD, and HVs for anger. CONCLUSION These findings indicate that childhood trauma may contribute to attentional and information-processing biases relevant for social interaction. Identifying individual social deficits offers implications for tailored therapeutic interventions. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
| | - Katja I Seitz
- Department of General Psychiatry, Center for Psychosocial Medicine, Medical Faculty, Heidelberg University
| | - Katja Bertsch
- Department of Psychology, Ludwig-Maximilians-University Munich
| | - Sabine C Herpertz
- Department of General Psychiatry, Center for Psychosocial Medicine, Medical Faculty, Heidelberg University
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Schröpel C, Festl-Wietek T, Herrmann-Werner A, Wittenberg T, Schüttpelz-Brauns K, Heinzmann A, Keis O, Listunova L, Kunz K, Böckers T, Herpertz SC, Zipfel S, Erschens R. How professional and academic pre-qualifications relate to success in medical education: Results of a multicentre study in Germany. PLoS One 2024; 19:e0296982. [PMID: 38457481 PMCID: PMC10923489 DOI: 10.1371/journal.pone.0296982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 12/25/2023] [Indexed: 03/10/2024] Open
Abstract
OBJECTIVE Every year, many applicants want to study medicine. Appropriate selection procedures are needed to identify suitable candidates for the demanding curriculum. Although research on medical school admissions has shown good predictive validity for cognitive selection methods (undergraduate GPA, aptitude tests), the literature on applicants with professional and/or academic experience prior to entering medical school remains slim. In our study, we therefore aimed to examine the association between academic success in medical school and having previously completed vocational training in the medical field, voluntary service (≥11 months) or an academic degree. METHODS Data were collected in a multicentre, cross-sectional study at five medical schools in Germany (Baden-Wuerttemberg) from students during medical school (i.e. 3rd-, 6th-, and 10th-semester and final-year students). Academic success was assessed according to scores on the first and second state examinations, the total number of examinations repeated and the number of semesters beyond the standard period of study. For the analysis we calculated ordinal logistic regression models for each outcome variable of academic success. RESULTS A total of N = 2,370 participants (response rate: RR = 47%) participated in the study. Having completed vocational training was associated with a higher amount of repeated examinations (small effect), while having an academic degree was associated with worse scores on the second state examination (medium effect). No significant association emerged between voluntary service and academic success. CONCLUSION The results indicate that professional and academic pre-qualifications pose no advantage for academic success. Possible associations with the financing of study and living conditions of students with pre-qualifications were analysed and discussed in an exploratory manner. However, the operationalisation of academic success from objective and cognitive data should be critically discussed, as the benefits of prior experience may be captured by personal qualities rather than examination results.
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Affiliation(s)
- Carla Schröpel
- Department of Psychosomatic Medicine and Psychotherapy, Internal Medicine, University Medical Hospital Tuebingen, Tuebingen, Germany
| | - Teresa Festl-Wietek
- Medical Faculty, TIME -Tübingen Institute for Medical Education, University of Tuebingen, Tuebingen, Germany
| | - Anne Herrmann-Werner
- Department of Psychosomatic Medicine and Psychotherapy, Internal Medicine, University Medical Hospital Tuebingen, Tuebingen, Germany
- Medical Faculty, TIME -Tübingen Institute for Medical Education, University of Tuebingen, Tuebingen, Germany
| | - Tim Wittenberg
- Department of General Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Katrin Schüttpelz-Brauns
- Medical Education Research Department, Division for Study and Teaching Development, Medical Faculty Mannheim at Heidelberg University, Heidelberg, Germany
| | - Andrea Heinzmann
- Medical Faculty, Albert-Ludwigs-University Freiburg, Office of the Dean of Studies, Freiburg, Germany
| | - Oliver Keis
- Medical Faculty, Office of the Dean of Studies, Ulm University, Ulm, Germany
| | - Lena Listunova
- Medical Faculty Heidelberg, Heidelberg University, Deanery of Students' Affairs, Heidelberg, Germany
| | - Kevin Kunz
- Medical Faculty, Albert-Ludwigs-University Freiburg, Office of the Dean of Studies, Freiburg, Germany
| | - Tobias Böckers
- Medical Faculty, Office of the Dean of Studies, Ulm University, Ulm, Germany
| | - Sabine C Herpertz
- Department of General Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, Internal Medicine, University Medical Hospital Tuebingen, Tuebingen, Germany
- Deanery of Students' Affairs, University's Faculty of Medicine, Tuebingen, Germany
| | - Rebecca Erschens
- Department of Psychosomatic Medicine and Psychotherapy, Internal Medicine, University Medical Hospital Tuebingen, Tuebingen, Germany
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Schneider I, Herpertz SC, Ueltzhöffer K, Neukel C. Stress and reward in the maternal brain of mothers with borderline personality disorder: a script-based fMRI study. Eur Arch Psychiatry Clin Neurosci 2024; 274:117-127. [PMID: 37354380 PMCID: PMC10786970 DOI: 10.1007/s00406-023-01634-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 05/29/2023] [Indexed: 06/26/2023]
Abstract
Borderline personality disorder (BPD) is associated with altered neural activity in regions of salience and emotion regulation. An exaggerated sensitization to emotionally salient situations, increased experience of emotions, and dysfunctional regulative abilities could be reasons for increased distress also during parenting. Mothers with BPD tend to have less reciprocal mother-child interactions (MCI) and reveal altered cortisol and oxytocin reactivity in the interaction with their child, which could indicate altered processing of stress and reward. Here, we studied underlying neural mechanisms of disrupted MCI in BPD. Twenty-five mothers with BPD and 28 healthy mothers participated in a script-driven imagery functional magnetic resonance imaging (fMRI)-paradigm. Scripts described stressful or rewarding MCI with the own child, or situations in which the mother was alone. Mothers with BPD showed larger activities in the bilateral insula and anterior cingulate cortex (ACC) compared to healthy mothers during the imagination of MCI and non-MCI. Already in the precursory phase while listening to the scripts, a similar pattern emerged with stronger activity in the left anterior insula (AINS), but not in the ACC. This AINS activity correlated negatively with the quality of real-life MCI for mothers with BPD. Mothers with BPD reported lower affect and higher arousal. An exaggerated sensitization to different, emotionally salient situations together with dysfunctional emotion regulation abilities, as reflected by increased insula and ACC activity, might hinder sensitive maternal behavior in mothers with BPD. These results underline the importance for psychotherapeutic interventions to improve emotional hyperarousal and emotion regulation in patients with BPD, especially in affected mothers caring for young children.
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Affiliation(s)
- Isabella Schneider
- Department of General Psychiatry, Center for Psychosocial Medicine, Heidelberg University, Voßstr. 4, 69115, Heidelberg, Germany.
| | - Sabine C Herpertz
- Department of General Psychiatry, Center for Psychosocial Medicine, Heidelberg University, Voßstr. 4, 69115, Heidelberg, Germany
| | - Kai Ueltzhöffer
- European Molecular Biology Laboratory, Genome Biology Unit, Meyerhofstr. 1, 69117, Heidelberg, Germany
| | - Corinne Neukel
- Department of General Psychiatry, Center for Psychosocial Medicine, Heidelberg University, Voßstr. 4, 69115, Heidelberg, Germany
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Seitz KI, Sicorello M, Schmitz M, Valencia N, Herpertz SC, Bertsch K, Neukel C. Childhood Maltreatment and Amygdala Response to Interpersonal Threat in a Transdiagnostic Adult Sample: The Role of Trait Dissociation. Biol Psychiatry Cogn Neurosci Neuroimaging 2024:S2451-9022(24)00016-8. [PMID: 38280631 DOI: 10.1016/j.bpsc.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 01/11/2024] [Accepted: 01/18/2024] [Indexed: 01/29/2024]
Abstract
BACKGROUND Childhood maltreatment (CM) confers risk for different mental disorders as well as transdiagnostic symptoms such as dissociation. Aberrant amygdala response to interpersonal threat may link CM to transdiagnostic psychopathology and has recently been shown to depend on type and developmental timing of CM experiences. Still, most studies on CM and threat-related amygdala response employ categorical disorder-specific perspectives and fail to consider type and timing of CM exposure. We aimed to investigate associations between CM, amygdala response to interpersonal threat, and dimensional psychopathological symptoms including trait dissociation in a transdiagnostic adult sample, specifically considering type, timing, and duration of CM. METHODS We conducted a cross-sectional neuroimaging study in 141 participants with varying levels of CM, including mostly female participants with major depressive disorder (n = 36), posttraumatic stress disorder (n = 34), and somatic symptom disorder (n = 35) and healthy volunteers (n = 36). Participants underwent functional magnetic resonance imaging during an emotional face-matching task, completed the brief German interview version of the Maltreatment and Abuse Chronology of Exposure scale, and answered self-report measures of transdiagnostic CM-related symptoms including trait dissociation. Data were analyzed using a machine learning-based model comparison procedure. RESULTS In our transdiagnostic sample, neither type nor timing or duration of CM predicted amygdala response to interpersonal threat. Instead, trait dissociation predicted blunted bilateral amygdala response and emerged as a possible mediator between CM and amygdala function. CONCLUSIONS Trait dissociation may be an important confounder in the widely documented association between CM and threat-related amygdala response, which should be considered in future longitudinal studies.
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Affiliation(s)
- Katja I Seitz
- Department of General Psychiatry, Center for Psychosocial Medicine, Medical Faculty, Heidelberg University, Heidelberg, Germany; German Center for Mental Health (DZPG), partner site Mannheim, Heidelberg, Ulm, Germany.
| | - Maurizio Sicorello
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Marius Schmitz
- Department of General Psychiatry, Center for Psychosocial Medicine, Medical Faculty, Heidelberg University, Heidelberg, Germany
| | - Noel Valencia
- Department of General Psychiatry, Center for Psychosocial Medicine, Medical Faculty, Heidelberg University, Heidelberg, Germany
| | - Sabine C Herpertz
- Department of General Psychiatry, Center for Psychosocial Medicine, Medical Faculty, Heidelberg University, Heidelberg, Germany; German Center for Mental Health (DZPG), partner site Mannheim, Heidelberg, Ulm, Germany
| | - Katja Bertsch
- Department of General Psychiatry, Center for Psychosocial Medicine, Medical Faculty, Heidelberg University, Heidelberg, Germany; Department of Psychology, Ludwig-Maximilians-University Munich, Munich, Germany; Department of Psychology, Julius-Maximilians-University Wuerzburg, Wuerzburg, Germany
| | - Corinne Neukel
- Department of General Psychiatry, Center for Psychosocial Medicine, Medical Faculty, Heidelberg University, Heidelberg, Germany; German Center for Mental Health (DZPG), partner site Mannheim, Heidelberg, Ulm, Germany
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Schulze A, Streit F, Zillich L, Awasthi S, Hall ASM, Jungkunz M, Kleindienst N, Frank J, Schwarze CE, Dahmen N, Schott BH, Nöthen M, Mobascher A, Rujescu D, Lieb K, Roepke S, Herpertz SC, Schmahl C, Bohus M, Ripke S, Rietschel M, Lis S, Witt S. Evidence for a shared genetic contribution to loneliness and borderline personality disorder. Transl Psychiatry 2023; 13:398. [PMID: 38105248 PMCID: PMC10725864 DOI: 10.1038/s41398-023-02705-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 11/30/2023] [Accepted: 12/05/2023] [Indexed: 12/19/2023] Open
Abstract
Loneliness, influenced by genetic and environmental factors such as childhood maltreatment, is one aspect of interpersonal dysfunction in Borderline Personality Disorder (BPD). Numerous studies link loneliness and BPD and twin studies indicate a genetic contribution to this association. The aim of our study was to investigate whether genetic predisposition for loneliness and BPD risk overlap and whether genetic risk for loneliness contributes to higher loneliness reported by BPD patients, using genome-wide genotype data. We assessed the genetic correlation of genome-wide association studies (GWAS) of loneliness and BPD using linkage disequilibrium score regression and tested whether a polygenic score for loneliness (loneliness-PGS) was associated with case-control status in two independent genotyped samples of BPD patients and healthy controls (HC; Witt2017-sample: 998 BPD, 1545 HC; KFO-sample: 187 BPD, 261 HC). In the KFO-sample, we examined associations of loneliness-PGS with reported loneliness, and whether the loneliness-PGS influenced the association between childhood maltreatment and loneliness. We found a genetic correlation between the GWAS of loneliness and BPD in the Witt2017-sample (rg = 0.23, p = 0.015), a positive association of loneliness-PGS with BPD case-control status (Witt2017-sample: NkR² = 2.3%, p = 2.7*10-12; KFO-sample: NkR² = 6.6%, p = 4.4*10-6), and a positive association between loneliness-PGS and loneliness across patient and control groups in the KFO-sample (β = 0.186, p = 0.002). The loneliness-PGS did not moderate the association between childhood maltreatment and loneliness in BPD. Our study is the first to use genome-wide genotype data to show that the genetic factors underlying variation in loneliness in the general population and the risk for BPD overlap. The loneliness-PGS was associated with reported loneliness. Further research is needed to investigate which genetic mechanisms and pathways are involved in this association and whether a genetic predisposition for loneliness contributes to BPD risk.
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Affiliation(s)
- Anna Schulze
- Department of Clinical Psychology, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
| | - Fabian Streit
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Lea Zillich
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Swapnil Awasthi
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
| | - Alisha S M Hall
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Affective Disorders, Aarhus University Hospital-Psychiatry, Aarhus, Denmark
| | - Martin Jungkunz
- National Center for Tumor Diseases (NCT), NCT Heidelberg, a partnership between DKFZ and Heidelberg University Hospital, German Cancer Research Center (DKFZ) Heidelberg, Heidelberg University, Medical Faculty Heidelberg, Department of Medical Oncology, Section Translational Medical Ethics, Heidelberg, Germany
| | - Nikolaus Kleindienst
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Josef Frank
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Cornelia E Schwarze
- Department of Psychology, Developmental and Biological Psychology Unit, Heidelberg University, Heidelberg, Germany
| | - Norbert Dahmen
- Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Björn H Schott
- Leibniz Institute for Neurobiology, Magdeburg, Germany
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Göttingen, Germany
- German Center for Neurodegenerative Diseases (DZNE), Göttingen, Germany
| | - Markus Nöthen
- Institute of Human Genetics, University Hospital Bonn, Bonn, Germany
| | - Arian Mobascher
- Department of Psychiatry and Psychotherapy, St. Elisabeth Krankenhaus Lahnstein, Lahnstein, Germany
| | - Dan Rujescu
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Klaus Lieb
- Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Stefan Roepke
- Department of Psychiatry and Neuroscience, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Sabine C Herpertz
- Department of General Psychiatry, Center for Psychosocial Medicine, Medical Faculty, Heidelberg University, Heidelberg, Germany
| | - Christian Schmahl
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Martin Bohus
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Department of Clinical Psychology, Ruhr University Bochum, Bochum, Germany
| | - Stephan Ripke
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
- Massachusetts General Hospital and Department of Medicine, Harvard Medical School, Analytic and Translational Genetics Unit, Boston, MA, USA
| | - Marcella Rietschel
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Stefanie Lis
- Department of Clinical Psychology, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Stephanie Witt
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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Steuwe C, Blaß J, Herpertz SC, Drießen M. [Personalized psychotherapy of posttraumatic stress disorder : Overview on the selection of treatment methods and techniques using statistical procedures]. Nervenarzt 2023; 94:1050-1058. [PMID: 37755484 PMCID: PMC10620257 DOI: 10.1007/s00115-023-01549-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/08/2023] [Indexed: 09/28/2023]
Abstract
BACKGROUND A relevant heterogeneity of treatment effects in posttraumatic stress disorder (PTSD) is discussed with respect to the debate about the necessity of phase-based treatment and in light of the new diagnosis of complex PTSD and has recently been proven; however, there has been little personalization in the treatment of PTSD. This article presents the current state of research on the personalized selection of specific psychotherapeutic methods for the treatment of PTSD based on patient characteristics using statistical methods. METHODS A systematic literature search was conducted in the PubMed (including Medline), Embase, Web of Science Core Collection, Google Scholar, PsycINFO and PSYNDEX databases to identify clinical trials and reviews examining personalized treatment for PTSD. RESULTS A total of 13 relevant publications were identified, of which 5 articles were predictor analyses in samples without control conditions and 7 articles showed analyses of randomized controlled trials (RCT) with a post hoc comparison of treatment effects in optimally and nonoptimally assigned patients. In addition, one article was a systematic review on the treatment of patients with comorbid borderline personality order and PTSD. DISCUSSION The available manuscripts indicate the importance and benefits of personalized treatment in PTSD. The relevant predictor variables identified for personalization should be used as a suggestion to investigate them in future prospective studies.
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Affiliation(s)
- Carolin Steuwe
- Universitätsklinik für Psychiatrie und Psychotherapie, Ev. Klinikum Bethel, Universitätsklinikum OWL der Universität Bielefeld, Remterweg 69-71, 33617, Bielefeld, Deutschland.
| | - Jakob Blaß
- Universitätsklinik für Psychiatrie und Psychotherapie, Ev. Klinikum Bethel, Universitätsklinikum OWL der Universität Bielefeld, Remterweg 69-71, 33617, Bielefeld, Deutschland
| | - Sabine C Herpertz
- Klinik für Allgemeine Psychiatrie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Martin Drießen
- Universitätsklinik für Psychiatrie und Psychotherapie, Ev. Klinikum Bethel, Universitätsklinikum OWL der Universität Bielefeld, Remterweg 69-71, 33617, Bielefeld, Deutschland
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Mueller JK, Ahrens KF, Bauer M, Baune BT, Borgwardt S, Deckert J, Domschke K, Ellwanger R, Fallgatter A, Frodl T, Gallinat J, Gottschalk R, Grabe HJ, Hasan A, Herpertz SC, Hurlemann R, Jessen F, Kambeitz J, Kircher T, Kornhuber J, Lieb K, Meyer-Lindenberg A, Rupprecht R, Scherbaum N, Schlang C, Schneider A, Schomerus G, Thoma A, Unterecker S, Walter M, Walter H, Reif A, Reif-Leonhard C. Prevalence of COVID-19 and Psychotropic Drug Treatment in Psychiatric In-patients in Germany in 2020: Results from a Nationwide Pilot Survey. Pharmacopsychiatry 2023; 56:227-238. [PMID: 37944561 DOI: 10.1055/a-2177-3056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
INTRODUCTION In patients with a pre-existing mental disorder, an increased risk for a first manifestation of a psychiatric disorder in COVID-19 patients, a more severe course of COVID-19 and an increased mortality have been described. Conversely, observations of lower COVID-19 incidences in psychiatric in-patients suggested protective effects of psychiatric treatment and/or psychotropic drugs against COVID-19. METHODS A retrospective multi-center study was conducted in 24 German psychiatric university hospitals. Between April and December 2020 (the first and partly second wave of COVID-19), the effects of COVID-19 were assessed on psychiatric in-patient care, the incidence and course of a SARS-CoV-2 infection, and treatment with psychotropic drugs. RESULTS Patients (n=36,322) were admitted to the hospitals. Mandatory SARS-CoV-2 tests before/during admission were reported by 23 hospitals (95.8%), while 18 (75%) conducted regular testing during the hospital stay. Two hundred thirty-two (0.6%) patients were tested SARS-CoV-2-positive. Thirty-seven (16%) patients were receiving medical treatment for COVID-19 at the psychiatric hospital, ten (4.3%) were transferred to an intermediate/intensive care unit, and three (1.3%) died. The most common prescription for SARS-CoV-2-positive patients was for second-generation antipsychotics (n=79, 28.2%) and antidepressants (SSRIs (n=38, 13.5%), mirtazapine (n=36, 12.9%) and SNRIs (n=29, 10.4%)). DISCUSSION Contrary to previous studies, our results showed a low number of infections and mortality in SARS-CoV-2-positive psychiatric patients. Several preventive measures seem effective to protect this vulnerable group. Our observations are compatible with the hypothesis of a protective effect of psychotropic drugs against COVID-19 as the overall mortality and need for specific medical treatment was low.
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Affiliation(s)
- Juliane K Mueller
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Frankfurt/M, Germany
| | - Kira F Ahrens
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Frankfurt/M, Germany
| | - Michael Bauer
- Department of Psychiatry and Psychotherapy, Medical Faculty, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Bernhard T Baune
- Department of Psychiatry, University Hospital Münster, University of Münster, Münster, Germany
| | - Stefan Borgwardt
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Jürgen Deckert
- Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Würzburg, Germany
| | - Katharina Domschke
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | | | - Andreas Fallgatter
- Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health (TüCMH), University of Tübingen, Tübingen, Germany; German Center for Mental Health (DZPG)
| | - Thomas Frodl
- Department of Psychiatry, Otto-von-Guericke University, Magdeburg, Germany
- Department of Psychiatry, Psychotherapy, and Psychosomatics, RWTH, University Aachen, Aachen, Germany
| | - Jürgen Gallinat
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - René Gottschalk
- Health Protection Authority, City of Frankfurt am Main, Germany
| | - Hans J Grabe
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
| | - Alkomiet Hasan
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, University of Augsburg, Bezirkskrankenhaus Augsburg, Augsburg, Germany
| | - Sabine C Herpertz
- Department of General Psychiatry, Center of Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Rene Hurlemann
- Department of Psychiatry, School of Medicine & Health Sciences, University of Oldenburg, Oldenburg, Germany
| | - Frank Jessen
- Department of Psychiatry and Psychotherapy, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Joseph Kambeitz
- Department of Psychiatry and Psychotherapy, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Tilo Kircher
- Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany
| | - Johannes Kornhuber
- Department of Psychiatry and Psychotherapy, University Hospital Erlangen, Friedrich-Alexander-University of Erlangen-Nuremberg, Germany
| | - Klaus Lieb
- Department of Psychiatry and Psychotherapy, University Medical Center Mainz
| | - Andreas Meyer-Lindenberg
- Central Institute of Mental Health, Department of Psychiatry and Psychotherapy, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Rainer Rupprecht
- Department of Psychiatry and Psychotherapy, University Regensburg, Regensburg, Germany
| | - Norbert Scherbaum
- Department of Psychiatry and Psychotherapy, LVR-Hospital Essen, Medical Faculty, University of Duisburg Essen, Essen, Germany
| | | | - Anja Schneider
- Department of Neurodegeneration and Geriatric Psychiatry, University of Bonn, Bonn, Germany
| | - Georg Schomerus
- Department of Psychiatry and Psychotherapy, Leipzig University Medical Center, Leipzig, Germany
| | - Andreas Thoma
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, University of Augsburg, Bezirkskrankenhaus Augsburg, Augsburg, Germany
| | - Stefan Unterecker
- Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Würzburg, Germany
| | - Martin Walter
- Department of Psychiatry and Psychotherapy, University Hospital Jena, Jena, Germany
| | - Henrik Walter
- Charité University Clinic Berlin, Freie Universität Berlin, Humboldt- Universität zu Berlin
| | - Andreas Reif
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Frankfurt/M, Germany
| | - Christine Reif-Leonhard
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Frankfurt/M, Germany
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Levine SM, Merz K, Keeser D, Kunz JI, Barton BB, Reinhard MA, Jobst A, Padberg F, Neukel C, Herpertz SC, Bertsch K, Musil R. Altered amygdalar emotion space in borderline personality disorder normalizes following dialectical behaviour therapy. J Psychiatry Neurosci 2023; 48:E431-E438. [PMID: 37935476 PMCID: PMC10635707 DOI: 10.1503/jpn.230085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 07/24/2023] [Accepted: 09/05/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND Borderline personality disorder (BPD) is a mental health condition characterized by an inability to regulate emotions or accurately process the emotional states of others. Previous neuroimaging studies using classical univariate analyses have tied such emotion dysregulation to aberrant activity levels in the amygdala of patients with BPD. However, multivariate analyses have not yet been used to investigate how representational spaces of emotion information may be systematically altered in patients with BPD. METHODS Patients with BPD performed an emotional face matching task while undergoing MRI before and after a 10-week inpatient program of dialectical behavioural therapy. Representational similarity analysis (RSA) was applied to activity patterns (evoked by angry, fearful, neutral and surprised faces) in the amygdala and temporo-occipital fusiform gyrus of patients with BPD and in the amygdala of healthy controls. RESULTS We recruited 15 patients with BPD (8 females, 6 males, 1 transgender male) to participate in the study, and we obtained a neuroimaging data set for 25 healthy controls for a comparative analysis. The RSA of the amygdala revealed a negative bias in the underlying affective space (in that activity patterns evoked by angry, fearful and neutral faces were more similar to each other than to patterns evoked by surprised faces), which normalized after therapy. This bias-to-normalization effect was present neither in activity patterns of the temporo-occipital fusiform gyrus of patients nor in amygdalar activity patterns of healthy controls. LIMITATIONS Larger samples and additional questionnaires would help to better characterize the association between specific aspects of therapy and changes in the neural representational space. CONCLUSION Our findings suggest a more refined role for the amygdala in the pathological processing of perceived emotions and may provide new diagnostic and prognostic imaging-based markers of emotion dysregulation and personality disorders.Clinical trial registration: DRKS00019821, German Clinical Trials Register (Deutsches Register Klinischer Studien).
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Affiliation(s)
- Seth M Levine
- From the Department of Psychology, LMU Munich, Munich, Germany (Levine, Bertsch); the NeuroImaging Core Unit Munich (NICUM), University Hospital, LMU Munich, Munich, Germany (Levine, Merz, Keeser, Bertsch); the Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany (Merz, Keeser, Kunz, Barton, Reinhard, Jobst, Padberg, Musil); the Department of General Psychiatry, Center for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany (Neukel, Herpertz, Bertsch); and the German Center for Mental Health (DZPG), Munich, Germany (Padberg, Bertsch)
| | - Katharina Merz
- From the Department of Psychology, LMU Munich, Munich, Germany (Levine, Bertsch); the NeuroImaging Core Unit Munich (NICUM), University Hospital, LMU Munich, Munich, Germany (Levine, Merz, Keeser, Bertsch); the Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany (Merz, Keeser, Kunz, Barton, Reinhard, Jobst, Padberg, Musil); the Department of General Psychiatry, Center for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany (Neukel, Herpertz, Bertsch); and the German Center for Mental Health (DZPG), Munich, Germany (Padberg, Bertsch)
| | - Daniel Keeser
- From the Department of Psychology, LMU Munich, Munich, Germany (Levine, Bertsch); the NeuroImaging Core Unit Munich (NICUM), University Hospital, LMU Munich, Munich, Germany (Levine, Merz, Keeser, Bertsch); the Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany (Merz, Keeser, Kunz, Barton, Reinhard, Jobst, Padberg, Musil); the Department of General Psychiatry, Center for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany (Neukel, Herpertz, Bertsch); and the German Center for Mental Health (DZPG), Munich, Germany (Padberg, Bertsch)
| | - Julia I Kunz
- From the Department of Psychology, LMU Munich, Munich, Germany (Levine, Bertsch); the NeuroImaging Core Unit Munich (NICUM), University Hospital, LMU Munich, Munich, Germany (Levine, Merz, Keeser, Bertsch); the Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany (Merz, Keeser, Kunz, Barton, Reinhard, Jobst, Padberg, Musil); the Department of General Psychiatry, Center for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany (Neukel, Herpertz, Bertsch); and the German Center for Mental Health (DZPG), Munich, Germany (Padberg, Bertsch)
| | - Barbara B Barton
- From the Department of Psychology, LMU Munich, Munich, Germany (Levine, Bertsch); the NeuroImaging Core Unit Munich (NICUM), University Hospital, LMU Munich, Munich, Germany (Levine, Merz, Keeser, Bertsch); the Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany (Merz, Keeser, Kunz, Barton, Reinhard, Jobst, Padberg, Musil); the Department of General Psychiatry, Center for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany (Neukel, Herpertz, Bertsch); and the German Center for Mental Health (DZPG), Munich, Germany (Padberg, Bertsch)
| | - Matthias A Reinhard
- From the Department of Psychology, LMU Munich, Munich, Germany (Levine, Bertsch); the NeuroImaging Core Unit Munich (NICUM), University Hospital, LMU Munich, Munich, Germany (Levine, Merz, Keeser, Bertsch); the Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany (Merz, Keeser, Kunz, Barton, Reinhard, Jobst, Padberg, Musil); the Department of General Psychiatry, Center for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany (Neukel, Herpertz, Bertsch); and the German Center for Mental Health (DZPG), Munich, Germany (Padberg, Bertsch)
| | - Andrea Jobst
- From the Department of Psychology, LMU Munich, Munich, Germany (Levine, Bertsch); the NeuroImaging Core Unit Munich (NICUM), University Hospital, LMU Munich, Munich, Germany (Levine, Merz, Keeser, Bertsch); the Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany (Merz, Keeser, Kunz, Barton, Reinhard, Jobst, Padberg, Musil); the Department of General Psychiatry, Center for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany (Neukel, Herpertz, Bertsch); and the German Center for Mental Health (DZPG), Munich, Germany (Padberg, Bertsch)
| | - Frank Padberg
- From the Department of Psychology, LMU Munich, Munich, Germany (Levine, Bertsch); the NeuroImaging Core Unit Munich (NICUM), University Hospital, LMU Munich, Munich, Germany (Levine, Merz, Keeser, Bertsch); the Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany (Merz, Keeser, Kunz, Barton, Reinhard, Jobst, Padberg, Musil); the Department of General Psychiatry, Center for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany (Neukel, Herpertz, Bertsch); and the German Center for Mental Health (DZPG), Munich, Germany (Padberg, Bertsch)
| | - Corinne Neukel
- From the Department of Psychology, LMU Munich, Munich, Germany (Levine, Bertsch); the NeuroImaging Core Unit Munich (NICUM), University Hospital, LMU Munich, Munich, Germany (Levine, Merz, Keeser, Bertsch); the Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany (Merz, Keeser, Kunz, Barton, Reinhard, Jobst, Padberg, Musil); the Department of General Psychiatry, Center for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany (Neukel, Herpertz, Bertsch); and the German Center for Mental Health (DZPG), Munich, Germany (Padberg, Bertsch)
| | - Sabine C Herpertz
- From the Department of Psychology, LMU Munich, Munich, Germany (Levine, Bertsch); the NeuroImaging Core Unit Munich (NICUM), University Hospital, LMU Munich, Munich, Germany (Levine, Merz, Keeser, Bertsch); the Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany (Merz, Keeser, Kunz, Barton, Reinhard, Jobst, Padberg, Musil); the Department of General Psychiatry, Center for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany (Neukel, Herpertz, Bertsch); and the German Center for Mental Health (DZPG), Munich, Germany (Padberg, Bertsch)
| | - Katja Bertsch
- From the Department of Psychology, LMU Munich, Munich, Germany (Levine, Bertsch); the NeuroImaging Core Unit Munich (NICUM), University Hospital, LMU Munich, Munich, Germany (Levine, Merz, Keeser, Bertsch); the Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany (Merz, Keeser, Kunz, Barton, Reinhard, Jobst, Padberg, Musil); the Department of General Psychiatry, Center for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany (Neukel, Herpertz, Bertsch); and the German Center for Mental Health (DZPG), Munich, Germany (Padberg, Bertsch)
| | - Richard Musil
- From the Department of Psychology, LMU Munich, Munich, Germany (Levine, Bertsch); the NeuroImaging Core Unit Munich (NICUM), University Hospital, LMU Munich, Munich, Germany (Levine, Merz, Keeser, Bertsch); the Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany (Merz, Keeser, Kunz, Barton, Reinhard, Jobst, Padberg, Musil); the Department of General Psychiatry, Center for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany (Neukel, Herpertz, Bertsch); and the German Center for Mental Health (DZPG), Munich, Germany (Padberg, Bertsch)
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10
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Wuebken K, Bermpohl F, Boedeker K, Hindi Attar C, Kluczniok D, Schoofs N, Fuchs A, Neukel C, Herpertz SC, Brunner R, Winter SM, Kaess M, Jaite C, Dittrich K. The mediating role of attachment and anger: exploring the impact of maternal early-life maltreatment on child abuse potential. Front Psychiatry 2023; 14:1267038. [PMID: 37965361 PMCID: PMC10641504 DOI: 10.3389/fpsyt.2023.1267038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 10/02/2023] [Indexed: 11/16/2023] Open
Abstract
Background Maternal early-life maltreatment (ELM) increases the risk of subsequent child maltreatment, but the underlying mechanisms of these intergenerational effects remain largely unknown. Identifying these mechanisms is crucial for developing preventive interventions that can break the cycle of abuse. Notably, previous research has shown that ELM often results in attachment insecurity and altered anger characteristics. Therefore, this study determines whether these characteristics mediate the relationship between maternal history of ELM and child abuse potential. Methods The study sample included 254 mothers, of whom 149 had experienced ELM to at least a moderate degree. Maternal ELM was assessed using the Childhood Experience of Care and Abuse (CECA) interview. Attachment insecurity, trait anger and anger expression, and maternal abuse potential were assessed using the Vulnerable Attachment Questionnaire (VASQ), State-Trait Anger Expression Inventory (STAXI), and Child Abuse Potential Inventory (CAPI), respectively. Results The severity of maternal ELM predicted higher child abuse potential, with attachment insecurity and anger suppression mediating this effect. Specifically, higher levels of maternal ELM were associated with greater attachment insecurity and increased anger suppression, resulting in a higher child abuse potential. Although higher levels of trait anger were directly associated with higher child abuse potential, this parameter did not mediate the relationship with ELM. In addition, no significant associations were observed between outwardly expressed anger and ELM or child abuse potential. All analyses were adjusted for maternal mental disorders, years of education, and relationship status. Discussion Attachment insecurity and anger suppression may serve as pathways linking the maternal history of ELM to the risk of child abuse, even when considering maternal psychopathology. Overall, our findings indicate that interventions aimed at strengthening attachment and improving anger suppression may be beneficial for all mothers with ELM history and high child abuse potential, not just those who suffer from mental illness.
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Affiliation(s)
- Karolina Wuebken
- Department of Psychiatry and Psychotherapy, Charité—Universitätsmedizin Berlin, Charité Campus Mitte, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany
| | - Felix Bermpohl
- Department of Psychiatry and Psychotherapy, Charité—Universitätsmedizin Berlin, Charité Campus Mitte, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany
| | - Katja Boedeker
- Adolescent Psychiatry, Psychosomatics and Psychotherapy, Charité—Universitätsmedizin Berlin, Charité Campus Virchow, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany
| | - Catherine Hindi Attar
- Department of Psychiatry and Psychotherapy, Charité—Universitätsmedizin Berlin, Charité Campus Mitte, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany
| | - Dorothea Kluczniok
- Department of Psychiatry and Psychotherapy, Charité—Universitätsmedizin Berlin, Charité Campus Mitte, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany
| | - Nikola Schoofs
- Department of Psychiatry and Psychotherapy, Charité—Universitätsmedizin Berlin, Charité Campus Mitte, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany
| | - Anna Fuchs
- Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Corinne Neukel
- Department of General Psychiatry, Center for Psychosocial Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Sabine C. Herpertz
- Department of General Psychiatry, Center for Psychosocial Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Romuald Brunner
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Sibylle Maria Winter
- Adolescent Psychiatry, Psychosomatics and Psychotherapy, Charité—Universitätsmedizin Berlin, Charité Campus Virchow, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany
| | - Michael Kaess
- Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, Heidelberg University Hospital, Heidelberg, Germany
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Charlotte Jaite
- Adolescent Psychiatry, Psychosomatics and Psychotherapy, Charité—Universitätsmedizin Berlin, Charité Campus Virchow, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany
- Department of Clinical Psychology and Psychotherapy in Childhood and Adolescence, University of Hildesheim, Hildesheim, Germany
| | - Katja Dittrich
- Adolescent Psychiatry, Psychosomatics and Psychotherapy, Charité—Universitätsmedizin Berlin, Charité Campus Virchow, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany
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11
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Schnitzler T, Korn C, C Herpertz S, Fuchs T. Emotion recognition in autism spectrum condition during the COVID-19 pandemic. Autism 2023:13623613231203306. [PMID: 37882152 DOI: 10.1177/13623613231203306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
LAY ABSTRACT In the COVID-19 pandemic, wearing face masks became mandatory to prevent the spread of the virus. However, they restrict the ability to recognize emotions to the upper part of the face. Since individuals with autism spectrum condition often tend to look at the lower half of the face, they may be particularly restricted in emotion recognition by people wearing masks, since they are now forced to look at the upper half of the face. The current study compared the recognition of facially expressed emotions between individuals with and without autism spectrum condition. Each photo was shown in three types, once uncovered, once with face mask, and once with sunglasses. Our results revealed a reduction in accuracy of individuals with autism spectrum condition at recognizing emotions in all three stimulus types and exhibited more difficulties distinguishing anger, fear, pride, and embarrassment. During the emotion recognition task, there was no difference in which facial areas the groups looked at. We did not find evidence that the disadvantages of individuals with autism spectrum condition in emotion recognition were due to looking at different areas of the face.
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12
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Schneider I, Fuchs A, Herpertz SC, Lobo FM. Microsocial analysis of dyadic interactions with toddlers and mothers with borderline personality disorder. Arch Womens Ment Health 2023; 26:589-597. [PMID: 37438620 PMCID: PMC10491556 DOI: 10.1007/s00737-023-01346-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 07/01/2023] [Indexed: 07/14/2023]
Abstract
Borderline personality disorder (BPD) is known for disruptions in mother-child interaction, but possible underlying patterns of micro-behavior are barely understood. This is the first study examining behavioral dyadic synchrony-the coordinated and reciprocal adaptation of behavior-and regulation on a micro-level and relating it to macro-behavior in mothers with BPD and their toddlers. Twenty-five mothers with BPD and 29 healthy mothers participated with their 18- to 36-month-old toddlers in a frustration-inducing paradigm. Mother and toddler behavior was continuously micro-coded for gaze, affect, and vocalization. Synchrony, operationalized as the simultaneous engagement in social gaze and positive affect, and (co-)regulative behaviors and their contingencies were analyzed and associated with borderline symptom severity, the overall quality of interaction, and child internalizing and externalizing behavioral problems. Dyads with mothers with BPD showed significantly less synchrony compared to dyads with healthy mothers. Low synchrony was associated with high BPD symptom severity and low overall interaction quality. Dyads with BPD used the same amount of regulative behaviors as dyads with healthy mothers. Though both groups equally responded to children's negative emotionality, mothers with BPD were less effective in drawing the dyad back into synchrony. For dyads with BPD, regulative behaviors were negatively associated with child externalizing behaviors. BPD symptomology may reduce the effectiveness of mothers' attempts to attune to their child's needs. An emphasis on synchrony and regulative behaviors may be an important therapeutic target for parenting programs in mothers with BPD.
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Affiliation(s)
- Isabella Schneider
- Department of General Psychiatry, Center for Psychosocial Medicine, Heidelberg University Hospital, Voßstr. 4, 69115, Heidelberg, Germany.
| | - Anna Fuchs
- Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, Heidelberg University Hospital, Blumenstr. 8, 69115, Heidelberg, Germany
| | - Sabine C Herpertz
- Department of General Psychiatry, Center for Psychosocial Medicine, Heidelberg University Hospital, Voßstr. 4, 69115, Heidelberg, Germany
| | - Frances M Lobo
- Department of Psychology, The University of North Carolina at Greensboro, 294 Eberhart Building, Greensboro, NC, 27402, USA
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13
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Holm-Hadulla RM, Wendler H, Baracsi G, Storck T, Möltner A, Herpertz SC. Depression and social isolation during the COVID-19 pandemic in a student population: the effects of establishing and relaxing social restrictions. Front Psychiatry 2023; 14:1200643. [PMID: 37608993 PMCID: PMC10440382 DOI: 10.3389/fpsyt.2023.1200643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 07/17/2023] [Indexed: 08/24/2023] Open
Abstract
Introduction In a quasi-naturalistic study design, we evaluate the change in psychopathological syndromes and general well-being after the alleviation of social restrictions. The aim of this study was to investigate the specific relationship between social isolation and depressive syndromes. Methods At two timepoints, the first during maximal social restrictions, the second after social restrictions had widely ended for 9 months, depressive and other syndromes were measured in an online survey addressing the total cohort of students registered at Heidelberg University, Germany via e-mail (n = 27,162). The complete Patient Health Questionnaire (PHQ) was used with nine items for depressive syndromes. In addition, well-being was measured by the Well-Being Index WHO-5. In the quantitative and qualitative part of the study psychopathological syndromes and well-being were related to social isolation and feelings of loneliness. Results After 1.5 years of pandemic-related social restrictions, "major" depressive syndromes were reported by 40.16% of the respondents to the PHQ in a sample of 2,318 university students. 72.52% showed a severely reduced Well-Being-Index. Nine months after the end of social restrictions, "major" depressive syndromes were reported by 28.50% of the participants. Well-being improved after the alleviation of social restrictions, as well: 53.96% showed a Well-Being Index of below 50 vs. 72.52% in the first study. The quantitative and qualitative analysis of the free texts of the respondents suggest that a significant amount of depressive syndromes and reduced well-being are related to social isolation and loneliness. While in the times of the pandemic restrictions the participants mostly reported "loneliness and social isolation" (24.2%) as their main problem, only 7.7% described these as their main problem after social restrictions had been loosened for 9 months. The qualitative analysis hints that at t2 participants were more likely to mention possible ways to actively deal with loneliness than at t1, which might be interpreted along the lines of the decrease in depressive syndromes. Discussion Keeping the self-selection bias in mind our study results suggest that one third of "major" depressive syndromes and one quarter of severely reduced well-being accompany social restrictions or are even caused by them, with loneliness being an important factor. These results should be taken into account by health policies when coping with future pandemics.
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Affiliation(s)
- Rainer Matthias Holm-Hadulla
- Department of General Psychiatry, University Hospital Heidelberg, Heidelberg, Germany
- Department of Psychiatry and Mental Health East, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Hannes Wendler
- Department of Philosophy, University of Cologne, Cologne, Germany
| | - Gabriella Baracsi
- Department of General Psychiatry, University Hospital Heidelberg, Heidelberg, Germany
| | - Timo Storck
- Psychologische Hochschule Berlin, Berlin, Germany
| | - Andreas Möltner
- Dean’s Office of the Medical Faculty of Heidelberg University, Heidelberg, Germany
| | - Sabine C. Herpertz
- Department of General Psychiatry, University Hospital Heidelberg, Heidelberg, Germany
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14
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Flägel K, Manke M, Zimmermann K, Wagener S, Pante SV, Lehmann M, Herpertz SC, Fischer MR, Jünger J. Planetary health as a main topic for the qualification in digital teaching - a project report. GMS J Med Educ 2023; 40:Doc35. [PMID: 37377576 PMCID: PMC10291345 DOI: 10.3205/zma001617] [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] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 10/25/2022] [Accepted: 02/06/2023] [Indexed: 06/29/2023]
Abstract
Aim To do justice to the need for planetary health in medical education, these are the aims of the online elective course "Planetary Health in Medical Education" (ME elective):1. Enable students to plan and realize their own course sessions on planetary health;2. Encourage communication among university medical faculties regarding planetary health in medical education;3. Reinforce competency in digital teaching and amplify the expert role as multiplicator among students pursuing a Master's degree in Medicinal Education (MME). Method The development of the ME elective followed Kern's six-step approach to curriculum development by means of cooperation between the German Medical Students' Association (Bundesvertretung der Medizinstudierenden in Deutschland, abbreviated as bvmd), and the MME study program. Based on general and specific needs analyses, core learning objectives regarding planetary health, medical education and digital education were identified in the National Catalogue of Learning Objectives in Undergraduate Medical Education (NKLM) and the MME study program and relevant teaching methods were selected. Results The ME elective, consisting of two contact hours per week per semester, was established at 13 medical schools as a four-phase course:1. Introduction to medical education using examples from planetary health;2. Lesson planning on a topic in planetary health under the supervision of MME students;3. Course sessions held by the undergraduate students; and4. Networking with the MME study program through participation in digital courses on planetary health and the pilot OSCE on planetary health.A total of 24 students attended the pilot in the 2022 summer semester. Conclusion The topic of planetary health combines interests that span many subjects and semester levels. As a collaborative, interdisciplinary and interprofessional subject, it lends itself to training students in a trans-institutional elective course to become multiplicators.
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Affiliation(s)
- Kristina Flägel
- Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Institut für Allgemeinmedizin, Lübeck, Germany
| | - Mattis Manke
- Bundesvertretung der Medizinstudierenden in Deutschland e. V. (bvmd), Berlin, Germany
| | - Katharina Zimmermann
- Bundesvertretung der Medizinstudierenden in Deutschland e. V. (bvmd), Berlin, Germany
| | - Stefan Wagener
- Universität Heidelberg, Medizinische Fakultät, Studiengang Master of Medical Education (MME), Heidelberg, Germany
| | - Saskia Veronika Pante
- Universität Heidelberg, Medizinische Fakultät, Studiengang Master of Medical Education (MME), Heidelberg, Germany
| | - Mirijam Lehmann
- Universität Heidelberg, Medizinische Fakultät, Studiengang Master of Medical Education (MME), Heidelberg, Germany
| | - Sabine C. Herpertz
- Universität Heidelberg, Medizinische Fakultät, Studiengang Master of Medical Education (MME), Heidelberg, Germany
- Universitätsklinikum Heidelberg, Klinik für Allgemeine Psychiatrie, Heidelberg, Germany
| | - Martin R. Fischer
- Universität Heidelberg, Medizinische Fakultät, Studiengang Master of Medical Education (MME), Heidelberg, Germany
- LMU München, LMU Klinikum, Institut für Didaktik und Ausbildungsforschung in der Medizin, München, Germany
| | - Jana Jünger
- Universität Heidelberg, Medizinische Fakultät, Studiengang Master of Medical Education (MME), Heidelberg, Germany
- Institut für Kommunikations- und Prüfungsforschung gGmbH, Heidelberg, Germany
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15
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Nagy E, Herpertz SC, Schohl K, Zehetmair C, Gebhardt N, Friederich HC, Nikendei C. The refugee and asylum seeker mental health treatment screener (RAS-MT-screener): Feasibility and psychometric properties of a questionnaire detecting refugees' and asylum seekers' need and urgency for mental health treatment. Gen Hosp Psychiatry 2023; 83:43-50. [PMID: 37099868 DOI: 10.1016/j.genhosppsych.2023.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 02/04/2023] [Accepted: 03/23/2023] [Indexed: 04/28/2023]
Abstract
OBJECTIVE Refugees and asylum seekers are highly vulnerable to the development of mental health problems, yet oftentimes their need is underestimated. We aimed to develop a culturally sensitive screening tool for primary care settings assessing the urgency and need for mental health treatment to close this gap. METHOD Items for the screening tool were selected out of an item pool generated by a group of clinical experts based on the data obtained from n = 307 asylum seekers in a refugee state registration and reception center in Germany. Out of these, n = 111 attended a psychosocial walk-in clinic, and clinicians' ratings of urgency and need for mental health treatment were added. RESULTS The resulting questionnaire comprised 8 items assessing urgency and 13 items assessing need for mental health treatment. Sensitivity was =0.74 and specificity =0.70. Participants of clinical and non-clinical samples differ highly significantly (p < .001). Cross-cultural validity was shown by comparing measurement invariance for different countries of origin. CONCLUSION The RAS-MT-Screener is a clinically and cross-culturally valid screening tool in primary care settings for the urgency and need for mental health treatment with acceptable psychometric properties. Future research on its external and construct validity is warranted.
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Affiliation(s)
- Ede Nagy
- Center for Psychosocial Medicine, Department for General Internal Medicine and Psychosomatics, University Hospital of Heidelberg, Heidelberg, Germany.
| | - Sabine C Herpertz
- Center for Psychosocial Medicine, Department of General Psychiatry, University Hospital of Heidelberg, Heidelberg, Germany
| | - Katharina Schohl
- Center for Psychosocial Medicine, Department for General Internal Medicine and Psychosomatics, University Hospital of Heidelberg, Heidelberg, Germany
| | - Catharina Zehetmair
- Center for Psychosocial Medicine, Department for General Internal Medicine and Psychosomatics, University Hospital of Heidelberg, Heidelberg, Germany; Center for Psychosocial Medicine, Department of General Psychiatry, University Hospital of Heidelberg, Heidelberg, Germany
| | - Nadja Gebhardt
- Center for Psychosocial Medicine, Department for General Internal Medicine and Psychosomatics, University Hospital of Heidelberg, Heidelberg, Germany
| | - Hans-Christoph Friederich
- Center for Psychosocial Medicine, Department for General Internal Medicine and Psychosomatics, University Hospital of Heidelberg, Heidelberg, Germany
| | - Christoph Nikendei
- Center for Psychosocial Medicine, Department for General Internal Medicine and Psychosomatics, University Hospital of Heidelberg, Heidelberg, Germany
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16
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Jeung-Maarse H, Schmitgen MM, Schmitt R, Bertsch K, Herpertz SC. Oxytocin effects on amygdala reactivity to angry faces in males and females with antisocial personality disorder. Neuropsychopharmacology 2023; 48:946-953. [PMID: 36941365 PMCID: PMC10156793 DOI: 10.1038/s41386-023-01549-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 01/29/2023] [Accepted: 02/04/2023] [Indexed: 03/23/2023]
Abstract
The amygdala is a key region in current neurocircuitry models of reactive aggression as it is crucially involved in detecting social threat and provocation. An increased amygdala reactivity to angry faces has been reported in aggression-prone individuals and the neuropeptide oxytocin (OT) could dampen anger-related amygdala reactivity in a number of mental disorders. One example is the antisocial personality disorder (ASPD) which has so far only been studied in limited numbers. To address the question whether OT can normalize amygdala hyperreactivity to emotional faces, we conducted a functional magnetic resonance imaging experiment with 20 men and 18 women with ASPD and 20 male and 20 female healthy control (HC) participants in a double-blind, randomized, placebo (PLC)-controlled within-subject design. Participants were exposed to an emotion classification task (fearful, angry, and happy faces) after receiving an intranasal dose (24 IU) of synthetic OT or PLC. We found OT to attenuate right amygdala hyperactivity to angry faces in participants with ASPD to such an extent that the intensity of amygdala activity in the ASPD group in the OT condition decreased to the level of amygdala activity in the PLC condition in the HC group. There was also a trend that OT effects were generally larger in women than in men. These findings suggest that OT differentially modulates the amygdala following social threatening or provoking cues in dependence of psychopathology (ASPD vs. HC) and sex (male vs. female). Particularly female ASPD patients could benefit from OT in the treatment of reactive aggression.
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Affiliation(s)
- Haang Jeung-Maarse
- Department of Psychiatry and Psychotherapy, Evangelisches Klinikum Bethel (EvKB), Bielefeld University, Bielefeld, Germany.
- Department of General Psychiatry, Heidelberg University Hospital, Heidelberg, Germany.
| | - Mike M Schmitgen
- Department of General Psychiatry, Heidelberg University Hospital, Heidelberg, Germany
| | - Ruth Schmitt
- Department of General Psychiatry, Heidelberg University Hospital, Heidelberg, Germany
| | - Katja Bertsch
- Department of General Psychiatry, Heidelberg University Hospital, Heidelberg, Germany
- Department of Psychology, Ludwig Maximilian University of Munich, Munich, Germany
| | - Sabine C Herpertz
- Department of General Psychiatry, Heidelberg University Hospital, Heidelberg, Germany
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17
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Schneider E, Hopf D, Eckstein M, Scheele D, Aguilar-Raab C, Herpertz SC, Grinevich V, Ditzen B. Stress during the COVID-19 Pandemic Moderates Pain Perception and Momentary Oxytocin Levels. J Clin Med 2023; 12:jcm12062333. [PMID: 36983333 PMCID: PMC10056494 DOI: 10.3390/jcm12062333] [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: 03/01/2023] [Revised: 03/13/2023] [Accepted: 03/14/2023] [Indexed: 03/19/2023] Open
Abstract
Self-reported pain levels have been associated with increased stress levels during the COVID-19 pandemic. Less is known about the long-term effects of stress on individuals’ physical and emotional pain levels and their associations with the neuropeptide hormone oxytocin. We aimed to predict momentary pain through individual stress levels and momentary oxytocin levels at genuinely high-stress phases, namely during COVID-related lockdowns. In a cross-sectional (n = 254) and a longitudinal (n = 196) assessment during lockdowns in Germany, participants completed a 2-day ecological momentary assessment (EMA) protocol (collecting six saliva samples on two consecutive days each and simultaneously reporting on stress, physical, and emotional pain levels) in 2020, as well as one year later, in 2021. Hierarchical linear modeling revealed significant positive associations between individuals’ stress levels and physical pain, both cross-sectionally (b = 0.017; t(103) = 3.345; p = 0.001) and longitudinally (b = 0.009; t(110) = 2.025; p = 0.045). Similarly, subjective stress ratings showed significant positive associations with emotional pain on a within-person (b = 0.014; t(63) = 3.594; p < 0.001) as well as on a between-person (b = 0.026; t(122) = 5.191; p < 0.001) level. Participants further displayed significantly lower salivary oxytocin when experiencing higher levels of emotional pain (b = −0.120; t(163) = −2.493; p = 0.014). In addition, high-stress levels significantly moderated the association between physical pain and salivary oxytocin (b = −0.012; t(32) = −2.150; p = 0.039). Based on mechanistic and experimental research, oxytocinergic mechanisms have long been suggested to modulate pain experiences, however, this has not yet been investigated in everyday life. Our data, which was collected from a large sample experiencing continued stress, in this case, during the COVID-19 pandemic, suggests that individuals experience more intense physical pain and elevated stress levels, as shown by particularly low salivary oxytocin concentrations.
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Affiliation(s)
- Ekaterina Schneider
- Center for Psychosocial Medicine, Institute of Medical Psychology, Heidelberg University Hospital, Bergheimer Str. 20, 69115 Heidelberg, Germany
- Institute of Psychology, Faculty of Behavioral and Cultural Studies, Heidelberg University, 69117 Heidelberg, Germany
- Correspondence: (E.S.); (B.D.); Tel.: +49-6221568138 (E.S.); +49-6221568150 (B.D.)
| | - Dora Hopf
- Center for Psychosocial Medicine, Institute of Medical Psychology, Heidelberg University Hospital, Bergheimer Str. 20, 69115 Heidelberg, Germany
- Institute of Psychology, Faculty of Behavioral and Cultural Studies, Heidelberg University, 69117 Heidelberg, Germany
| | - Monika Eckstein
- Center for Psychosocial Medicine, Institute of Medical Psychology, Heidelberg University Hospital, Bergheimer Str. 20, 69115 Heidelberg, Germany
- Institute of Psychology, Faculty of Behavioral and Cultural Studies, Heidelberg University, 69117 Heidelberg, Germany
| | - Dirk Scheele
- Department of Social Neuroscience, Faculty of Psychology, Ruhr-University Bochum, 44791 Bochum, Germany
| | - Corina Aguilar-Raab
- Center for Psychosocial Medicine, Institute of Medical Psychology, Heidelberg University Hospital, Bergheimer Str. 20, 69115 Heidelberg, Germany
- Institute of Psychology, Faculty of Behavioral and Cultural Studies, Heidelberg University, 69117 Heidelberg, Germany
| | - Sabine C. Herpertz
- Center for Psychosocial Medicine, Department of General Psychiatry, Heidelberg University Hospital, 69115 Heidelberg, Germany
| | - Valery Grinevich
- Department of Neuropeptide Research in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, 68159 Mannheim, Germany
| | - Beate Ditzen
- Center for Psychosocial Medicine, Institute of Medical Psychology, Heidelberg University Hospital, Bergheimer Str. 20, 69115 Heidelberg, Germany
- Institute of Psychology, Faculty of Behavioral and Cultural Studies, Heidelberg University, 69117 Heidelberg, Germany
- Correspondence: (E.S.); (B.D.); Tel.: +49-6221568138 (E.S.); +49-6221568150 (B.D.)
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18
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Mielke EL, Koenig J, Herpertz SC, Steinmann S, Neukel C, Kilavuz P, van der Venne P, Bertsch K, Kaess M. Adverse childhood experiences mediate the negative association between borderline personality disorder symptoms and plasma oxytocin. Prog Neuropsychopharmacol Biol Psychiatry 2023; 125:110749. [PMID: 36924878 DOI: 10.1016/j.pnpbp.2023.110749] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 03/12/2023] [Accepted: 03/12/2023] [Indexed: 03/18/2023]
Abstract
Background Interpersonal dysfunction is a core symptom of borderline personality disorder (BPD) and may be closely linked to adverse childhood experiences. According to a recent model on the pathology of BPD, the neuropeptide oxytocin might play an important role in the development and maintenance of the disorder. However, so far, only few studies with small adult samples have reported reduced baseline oxytocin levels in BPD that may be linked to adverse childhood experiences. Methods We examined baseline plasma oxytocin levels in 131 female patients with BPD and 124 non-BPD female controls across a large age span (12-50 years). Additionally, 113 female patients with less than five DSM-IV BPD features were included to examine the association between plasma oxytocin levels and the number of fulfilled BPD criteria. We also explored associations between plasma oxytocin and adverse childhood experiences as well as depressive symptoms in BPD. Results Patients with BPD had reduced plasma oxytocin levels compared to non-BPD controls and this was independent of age. Plasma oxytocin was negatively associated with the number of fulfilled BPD criteria. The exploratory regression model revealed no association between plasma oxytocin and depressive symptoms but an association between plasma oxytocin and adverse childhood experiences, which in fact mediated the relationship between BPD criteria und plasma oxytocin. Conclusion In a large sample of individuals with BPD across a large age span, our results replicate and extend previous reports of reduced plasma oxytocin levels that might be related to adverse childhood experiences thus providing further evidence for a prominent role of oxytocin in BPD.
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Affiliation(s)
- Emilia L Mielke
- Department of General Psychiatry, Center for Psychosocial Medicine, Medical Faculty, University of Heidelberg, Voßstraße 4, 69115 Heidelberg, Germany.
| | - Julian Koenig
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Robert-Koch-Straße 10, 50931 Cologne, Germany; Department of Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, Medical Faculty, University of Heidelberg, Blumenstr. 8, 69115 Heidelberg, Germany; University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bolligenstrasse 111, 3000 Bern 60, Switzerland
| | - Sabine C Herpertz
- Department of General Psychiatry, Center for Psychosocial Medicine, Medical Faculty, University of Heidelberg, Voßstraße 4, 69115 Heidelberg, Germany
| | - Sylvia Steinmann
- Department of Psychosomatics and Psychotherapeutic Medicine, Central Institute of Mental Health Mannheim, University of Heidelberg, J 5, 68159 Mannheim, Germany
| | - Corinne Neukel
- Department of General Psychiatry, Center for Psychosocial Medicine, Medical Faculty, University of Heidelberg, Voßstraße 4, 69115 Heidelberg, Germany
| | - Pelin Kilavuz
- Department of Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, Medical Faculty, University of Heidelberg, Blumenstr. 8, 69115 Heidelberg, Germany
| | - Patrice van der Venne
- Department of Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, Medical Faculty, University of Heidelberg, Blumenstr. 8, 69115 Heidelberg, Germany; Institute of Psychology, University of Heidelberg, Hauptstr. 47- 51, 69117 Heidelberg, Germany
| | - Katja Bertsch
- Department of General Psychiatry, Center for Psychosocial Medicine, Medical Faculty, University of Heidelberg, Voßstraße 4, 69115 Heidelberg, Germany; Department of Psychology, Ludwig-Maximilians-University Munich, Leopoldstr. 13, 80802 Munich, Germany
| | - Michael Kaess
- Department of Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, Medical Faculty, University of Heidelberg, Blumenstr. 8, 69115 Heidelberg, Germany; University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bolligenstrasse 111, 3000 Bern 60, Switzerland
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19
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Iwasaki M, Lefevre A, Althammer F, Clauss Creusot E, Łąpieś O, Petitjean H, Hilfiger L, Kerspern D, Melchior M, Küppers S, Krabichler Q, Patwell R, Kania A, Gruber T, Kirchner MK, Wimmer M, Fröhlich H, Dötsch L, Schimmer J, Herpertz SC, Ditzen B, Schaaf CP, Schönig K, Bartsch D, Gugula A, Trenk A, Blasiak A, Stern JE, Darbon P, Grinevich V, Charlet A. An analgesic pathway from parvocellular oxytocin neurons to the periaqueductal gray in rats. Nat Commun 2023; 14:1066. [PMID: 36828816 PMCID: PMC9958129 DOI: 10.1038/s41467-023-36641-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 02/08/2023] [Indexed: 02/26/2023] Open
Abstract
The hypothalamic neuropeptide oxytocin (OT) exerts prominent analgesic effects via central and peripheral action. However, the precise analgesic pathways recruited by OT are largely elusive. Here we discovered a subset of OT neurons whose projections preferentially terminate on OT receptor (OTR)-expressing neurons in the ventrolateral periaqueductal gray (vlPAG). Using a newly generated line of transgenic rats (OTR-IRES-Cre), we determined that most of the vlPAG OTR expressing cells targeted by OT projections are GABAergic. Ex vivo stimulation of parvocellular OT axons in the vlPAG induced local OT release, as measured with OT sensor GRAB. In vivo, optogenetically-evoked axonal OT release in the vlPAG of as well as chemogenetic activation of OTR vlPAG neurons resulted in a long-lasting increase of vlPAG neuronal activity. This lead to an indirect suppression of sensory neuron activity in the spinal cord and strong analgesia in both female and male rats. Altogether, we describe an OT-vlPAG-spinal cord circuit that is critical for analgesia in both inflammatory and neuropathic pain models.
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Grants
- R01 HL090948 NHLBI NIH HHS
- R01 NS094640 NINDS NIH HHS
- This work was supported by the Centre National de la Recherche Scientifique contract UPR3212, the Université de Strasbourg contract UPR3212; the University of Strasbourg Institute for Advanced Study (USIAS) fellowship 2014-15, Fyssen Foundation research grant 2015, NARSAD Young Investigator Grant 24821, Agence Nationale de la Recherche (ANR, French Research Foundation) grants n° 19-CE16-0011-0 and n° 20-CE18-0031 (to AC); the Graduate School of Pain EURIDOL, ANR-17-EURE-0022 (to AC and ECC); ANR-DFG grant GR 3619/701, PHC PROCOPE and PICS07882 grants (to AC and VG); Deutsche Forschungsgemeinschaft (DFG, German Research Foundation) grants GR 3619/15-1, GR 3619/16-1(to VG); SFB Consortium 1158-2 (to VG, SH and BD); French Japanese governments fellowship B-16012 JM/NH and Subsidy from Nukada Institute for Medical and Biological Research (to MI); Fyssen Foundation fellowship (to AL); Région Grand Est fellowship (to DK); DFG Postdoc Fellowship AL 2466/1-1 (to FA); the Foundation of Prader-Willi Research post-doctoral fellowship (to CPS and FA); DAAD Postdoc Short term research grant 57552337 (to RP); DFG Walter Benjamin Position – Projektnummer 459051339 (to QK). National Heart, Lung, and Blood Institute Grant NIH HL090948, National Institute of Neurological Disorders and Stroke Grant NIH NS094640, and funding provided by the Center for Neuroinflammation and Cardiometabolic Diseases (CNCD) at Georgia State University (to JES). The authors thank Prof. Yulong Li for providing the GRABOTR plasmid, Drs. Romain Goutagny and Vincent Douchamps for in vivo electrophysiology advices, the Chronobiotron UMS 3415 for all animal care and the technical plateau ComptOpt UPR 3212 for behavior technical assistance.
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Affiliation(s)
- Mai Iwasaki
- Centre National de la Recherche Scientifique and University of Strasbourg, Institute of Cellular and Integrative Neuroscience, 67000, Strasbourg, France
| | - Arthur Lefevre
- Centre National de la Recherche Scientifique and University of Strasbourg, Institute of Cellular and Integrative Neuroscience, 67000, Strasbourg, France
- Department of Neuropeptide Research in Psychiatry, Central Institute of Mental Health, University of Heidelberg, Mannheim, 68159, Germany
- Cortical Systems and Behavior Laboratory, University of California, San Diego, La Jolla, CA, 92093, USA
| | - Ferdinand Althammer
- Department of Neuropeptide Research in Psychiatry, Central Institute of Mental Health, University of Heidelberg, Mannheim, 68159, Germany
- Center for Neuroinflammation and Cardiometabolic Diseases, Georgia State University, Atlanta, USA
- Institute of Human Genetics, University Hospital Heidelberg, Heidelberg, Germany
| | - Etienne Clauss Creusot
- Centre National de la Recherche Scientifique and University of Strasbourg, Institute of Cellular and Integrative Neuroscience, 67000, Strasbourg, France
| | - Olga Łąpieś
- Centre National de la Recherche Scientifique and University of Strasbourg, Institute of Cellular and Integrative Neuroscience, 67000, Strasbourg, France
| | - Hugues Petitjean
- Centre National de la Recherche Scientifique and University of Strasbourg, Institute of Cellular and Integrative Neuroscience, 67000, Strasbourg, France
| | - Louis Hilfiger
- Centre National de la Recherche Scientifique and University of Strasbourg, Institute of Cellular and Integrative Neuroscience, 67000, Strasbourg, France
| | - Damien Kerspern
- Centre National de la Recherche Scientifique and University of Strasbourg, Institute of Cellular and Integrative Neuroscience, 67000, Strasbourg, France
| | - Meggane Melchior
- Centre National de la Recherche Scientifique and University of Strasbourg, Institute of Cellular and Integrative Neuroscience, 67000, Strasbourg, France
| | - Stephanie Küppers
- Department of Neuropeptide Research in Psychiatry, Central Institute of Mental Health, University of Heidelberg, Mannheim, 68159, Germany
| | - Quirin Krabichler
- Department of Neuropeptide Research in Psychiatry, Central Institute of Mental Health, University of Heidelberg, Mannheim, 68159, Germany
| | - Ryan Patwell
- Department of Neuropeptide Research in Psychiatry, Central Institute of Mental Health, University of Heidelberg, Mannheim, 68159, Germany
| | - Alan Kania
- Department of Neuropeptide Research in Psychiatry, Central Institute of Mental Health, University of Heidelberg, Mannheim, 68159, Germany
| | - Tim Gruber
- Van Andel Institute, Grand Rapids, MI, USA
| | - Matthew K Kirchner
- Center for Neuroinflammation and Cardiometabolic Diseases, Georgia State University, Atlanta, USA
| | - Moritz Wimmer
- Institute of Human Genetics, University Hospital Heidelberg, Heidelberg, Germany
| | - Henning Fröhlich
- Institute of Human Genetics, University Hospital Heidelberg, Heidelberg, Germany
| | - Laura Dötsch
- Institute of Human Genetics, University Hospital Heidelberg, Heidelberg, Germany
| | - Jonas Schimmer
- Department of Neuropeptide Research in Psychiatry, Central Institute of Mental Health, University of Heidelberg, Mannheim, 68159, Germany
| | - Sabine C Herpertz
- Department of General Psychiatry, Center of Psychosocial Medicine, University of Heidelberg, 69115, Heidelberg, Germany
| | - Beate Ditzen
- Institute of Medical Psychology, Heidelberg University Hospital, 69115, Heidelberg, Germany
- Ruprecht-Karls University Heidelberg, Heidelberg, Germany
| | - Christian P Schaaf
- Institute of Human Genetics, University Hospital Heidelberg, Heidelberg, Germany
- Ruprecht-Karls University Heidelberg, Heidelberg, Germany
| | - Kai Schönig
- Department of Molecular Biology, Central Institute of Mental Health, University of Heidelberg, Mannheim, 68159, Germany
| | - Dusan Bartsch
- Department of Molecular Biology, Central Institute of Mental Health, University of Heidelberg, Mannheim, 68159, Germany
| | - Anna Gugula
- Department of Neurophysiology and Chronobiology, Institute of Zoology and Biomedical Research, Faculty of Biology, Jagiellonian University, Krakow, 30-387, Poland
| | - Aleksandra Trenk
- Department of Neurophysiology and Chronobiology, Institute of Zoology and Biomedical Research, Faculty of Biology, Jagiellonian University, Krakow, 30-387, Poland
| | - Anna Blasiak
- Department of Neurophysiology and Chronobiology, Institute of Zoology and Biomedical Research, Faculty of Biology, Jagiellonian University, Krakow, 30-387, Poland
| | - Javier E Stern
- Center for Neuroinflammation and Cardiometabolic Diseases, Georgia State University, Atlanta, USA
| | - Pascal Darbon
- Centre National de la Recherche Scientifique and University of Strasbourg, Institute of Cellular and Integrative Neuroscience, 67000, Strasbourg, France
| | - Valery Grinevich
- Department of Neuropeptide Research in Psychiatry, Central Institute of Mental Health, University of Heidelberg, Mannheim, 68159, Germany.
- Center for Neuroinflammation and Cardiometabolic Diseases, Georgia State University, Atlanta, USA.
| | - Alexandre Charlet
- Centre National de la Recherche Scientifique and University of Strasbourg, Institute of Cellular and Integrative Neuroscience, 67000, Strasbourg, France.
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20
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Seitz KI, Ueltzhöffer K, Rademacher L, Paulus FM, Schmitz M, Herpertz SC, Bertsch K. Your smile won't affect me: Association between childhood maternal antipathy and adult neural reward function in a transdiagnostic sample. Transl Psychiatry 2023; 13:70. [PMID: 36828811 PMCID: PMC9958053 DOI: 10.1038/s41398-023-02364-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/01/2023] [Accepted: 02/09/2023] [Indexed: 02/26/2023] Open
Abstract
Aberrant activation in the ventral striatum (VS) during reward anticipation may be a key mechanism linking adverse childhood experiences (ACE) to transdiagnostic psychopathology. This study aimed to elucidate whether retrospectively reported ACE, specifically maternal antipathy, relate to monetary and social reward anticipation in a transdiagnostic adult sample. A cross-sectional neuroimaging study was conducted in 118 participants with varying levels of ACE, including 25 participants with posttraumatic stress disorder (PTSD), 32 with major depressive disorder (MDD), 29 with somatic symptom disorder (SSD), and 32 healthy volunteers (HVs). Participants underwent functional magnetic resonance imaging during a monetary and social incentive delay task, and completed a self-report measure of ACE, including maternal antipathy. Neural correlates of monetary and social reward anticipation and their association with ACE, particularly maternal antipathy, were analyzed. Participants showed elevated activation in brain regions underlying reward processing, including the VS, only while anticipating social, but not monetary rewards. Participants reporting higher levels of maternal antipathy exhibited reduced activation in the brain reward network, including the VS, only during social, but not monetary reward anticipation. Group affiliation moderated the association between maternal antipathy and VS activation to social reward anticipation, with significant associations found in participants with PTSD and HVs, but not in those with MDD and SSD. Results were not associated with general psychopathology or psychotropic medication use. Childhood maternal antipathy may confer risk for aberrant social reward anticipation in adulthood, and may thus be considered in interventions targeting reward expectations from social interactions.
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Affiliation(s)
- Katja I. Seitz
- grid.7700.00000 0001 2190 4373Department of General Psychiatry, Center for Psychosocial Medicine, Medical Faculty, Heidelberg University, Heidelberg, Germany
| | - Kai Ueltzhöffer
- grid.7700.00000 0001 2190 4373Department of General Psychiatry, Center for Psychosocial Medicine, Medical Faculty, Heidelberg University, Heidelberg, Germany
| | - Lena Rademacher
- grid.4562.50000 0001 0057 2672Social Neuroscience Lab, Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany ,grid.4562.50000 0001 0057 2672Center of Brain, Behavior and Metabolism (CBBM), University of Lübeck, Lübeck, Germany
| | - Frieder M. Paulus
- grid.4562.50000 0001 0057 2672Social Neuroscience Lab, Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany ,grid.4562.50000 0001 0057 2672Center of Brain, Behavior and Metabolism (CBBM), University of Lübeck, Lübeck, Germany
| | - Marius Schmitz
- grid.7700.00000 0001 2190 4373Department of General Psychiatry, Center for Psychosocial Medicine, Medical Faculty, Heidelberg University, Heidelberg, Germany ,grid.5252.00000 0004 1936 973XDepartment of Psychology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Sabine C. Herpertz
- grid.7700.00000 0001 2190 4373Department of General Psychiatry, Center for Psychosocial Medicine, Medical Faculty, Heidelberg University, Heidelberg, Germany
| | - Katja Bertsch
- grid.7700.00000 0001 2190 4373Department of General Psychiatry, Center for Psychosocial Medicine, Medical Faculty, Heidelberg University, Heidelberg, Germany ,grid.5252.00000 0004 1936 973XDepartment of Psychology, Ludwig-Maximilians-University Munich, Munich, Germany
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21
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Schmitz M, Back SN, Seitz KI, Harbrecht NK, Streckert L, Schulz A, Herpertz SC, Bertsch K. The impact of traumatic childhood experiences on interoception: disregarding one's own body. Borderline Personal Disord Emot Dysregul 2023; 10:5. [PMID: 36788573 PMCID: PMC9930318 DOI: 10.1186/s40479-023-00212-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 02/01/2023] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND Deficient interoception, the processing and perception of internal bodily signals, has been discussed as a mechanism underlying various mental disorders. First results indicate a mediating role of interoception in the interplay of traumatic childhood experiences and adult mental disorders. Traumatic childhood experiences may hinder the adequate processing, integration, and trust in bodily signals that are important in order to understand and regulate own needs and emotions, thereby increasing the vulnerability for mental disorders. However, an overarching study investigating alterations in different interoceptive measures and trauma-related disorders as well as their mediating role between early trauma and emotion dysregulation is still missing. METHODS One hundred thirty-six individuals with varying levels of traumatic childhood experiences who either had a current diagnosis of major depression, posttraumatic stress disorder, or somatic symptom disorder, or no mental disorder, took part in a multidimensional assessment of interoceptive processes, including interoceptive accuracy, sensibility, and awareness. Kruskal-Wallis tests were used to compare groups regarding interoceptive processes and associations with traumatic childhood experiences and emotion dysregulation were analyzed with Spearman correlations. Furthermore, mediation analyses were computed to examine and compare interoceptive processes as potential mediators between traumatic childhood experiences and emotion dysregulation. RESULTS Only body dissociation, a measure for interoceptive sensibility, was significantly reduced in individuals with a current mental disorder. Body dissociation was also the only interoceptive measure significantly associated with traumatic childhood experiences and emotion dysregulation and the only significant mediator in the relationship between traumatic childhood experiences and emotion dysregulation across groups. CONCLUSION Results suggest body dissociation, but not other interoceptive measures, as an important feature linking traumatic childhood experiences to current emotion dysregulation, an important transdiagnostic feature. As body dissociation refers to a habitual non-attendance or disregard of interoceptive signals, integrative therapeutic interventions could help affected individuals to overcome difficulties in emotion perception and regulation. TRIAL REGISTRATION The general study design was preregistered; see the German Clinical Trials Register (DRKS-ID: DRKS00015182). This study's analysis plan was not preregistered.
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Affiliation(s)
- Marius Schmitz
- Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany. .,Department of Psychology, Ludwig-Maximilians-University Munich, Munich, Germany. .,Institute of Psychology, University of Heidelberg, Heidelberg, Germany.
| | - Sarah N Back
- Department of Psychology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Katja I Seitz
- Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany.,Institute of Psychology, University of Heidelberg, Heidelberg, Germany
| | - Nele K Harbrecht
- Department of Psychology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Lena Streckert
- Department of Psychology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - André Schulz
- Department of Behavioural and Cognitive Sciences, Clinical Psychophysiology Laboratory, University of Luxembourg, Esch-Sur-Alzette, Luxembourg
| | - Sabine C Herpertz
- Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Katja Bertsch
- Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany.,Department of Psychology, Ludwig-Maximilians-University Munich, Munich, Germany
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22
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Kubera KM, Schmitgen MM, Hildebrandt V, Neukel C, Otte ML, Sicorello M, Steinmann S, Herpertz SC, Wolf RC. Structural Correlates of Lifetime Voice-Hearing in Patients with Borderline Personality Disorder: A Pilot Study. Neuropsychobiology 2023; 82:72-80. [PMID: 36634631 DOI: 10.1159/000528039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 10/31/2022] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Auditory verbal hallucinations (AVH) are transdiagnostic phenomena that can occur in several mental disorders, including borderline personality disorder (BPD). Despite the transdiagnostic relevance of these symptoms, very little is known about neural signatures of AVH in BPD. METHODS We used structural magnetic resonance imaging to investigate multiple markers of brain morphology in BPD patients presenting with a lifetime history of AVH (AVH, n = 6) versus BPD patients without AVH (nAVH, n = 10) and healthy controls (HC, n = 12). The Computational Anatomy Toolbox (CAT12) was used for surface-based morphometric analyses that considered cortical thickness (CTh), gyrification (CG), and complexity of cortical folding (CCF). Factorial models were used to explore differences between AVH patients and HC, as well as between the patient groups. RESULTS Compared to HC, AVH patients showed distinct abnormalities in key regions of the language network, i.e., aberrant CTh and CG in right superior temporal gyrus and abnormal CCF in left inferior frontal gyrus. Further abnormalities were found in right prefrontal cortex (CTh) and left orbitofrontal cortex (CCF). Compared to nAVH patients, individuals with AVH showed abnormal CTh in right prefrontal cortex, along with CCF differences in right transverse temporal, superior parietal, and parahippocampal gyri. CG differences between the patient groups were found in left orbitofrontal cortex. CONCLUSION The data suggest a transdiagnostic neural signature of voice-hearing that converges on key regions involved in speech generation and perception, memory and executive control. It is possible that cortical features of distinct evolutionary and genetic origin, i.e., CTh and CG/CCF, differently contribute to AVH vulnerability in BPD.
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Affiliation(s)
- Katharina M Kubera
- Department of General Psychiatry, Center for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany,
| | - Mike M Schmitgen
- Department of General Psychiatry, Center for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany
| | - Viviane Hildebrandt
- Geriatric Center, Agaplesion Bethanien Hospital, Heidelberg University, Heidelberg, Germany
| | - Corinne Neukel
- Department of General Psychiatry, Center for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany
| | - Marie-Luise Otte
- Department of General Psychiatry, Center for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany
| | - Maurizio Sicorello
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Sylvia Steinmann
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Sabine C Herpertz
- Department of General Psychiatry, Center for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany
| | - Robert Christian Wolf
- Department of General Psychiatry, Center for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany
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23
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Roth M, Kluczniok D, Roepke S, Heim C, Herpertz SC, Hindi Attar C, Dittrich K, Boedeker K, Winter SM, Ridder NS, Poppinga SK, Bermpohl F. Relationship between Borderline Personality Disorder, Emotional Availability, and Cortisol Output in Mother-Child Dyads. Psychopathology 2023; 56:90-101. [PMID: 35073545 DOI: 10.1159/000521519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 12/09/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Mothers with borderline personality disorder (BPD) often show altered emotional availability toward their own child and heightened stress vulnerability. The aims of the present study were (1) to examine total cortisol output in saliva during mother-child interaction in mothers with BPD and their children and (2) to test whether maternal nonhostility as a subscale of emotional availability mediates the relationship between maternal BPD and child total cortisol output. METHODS We investigated 16 mothers with BPD and 30 healthy control mothers (HC) and 29 children of mothers with BPD and 33 children of HC mothers. Children were between 5 and 12 years old. Salivary cortisol was collected prior to and twice after an episode of a 21-min standardized play situation between mother and child. Nonhostility was rated using the emotional availability scales. Analyses of covariance were computed to test for group differences in total cortisol output (measured with area under the curve with respect to ground). Pearson's correlation was calculated to test the association between maternal and child total cortisol output. To test the second question, a mediation analysis according to Preacher and Hayes was conducted. RESULTS Mothers with BPD and their children had lower total cortisol output. Maternal and child total cortisol output was significantly correlated. Contrary to our hypothesis, maternal nonhostility did not mediate the relationship between BPD and child total cortisol output. CONCLUSION Results imply that the hormonal stress activity of mothers with BPD and their children is altered, which may reflect modified stress regulation and stress vulnerability in mother and child and may impact on mother-child interaction. The finding of a positive association between mother's and child total cortisol output could indicate an intergenerational transmission of these alterations.
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Affiliation(s)
- Maria Roth
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Mitte, Berlin, Germany
| | - Dorothea Kluczniok
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Mitte, Berlin, Germany
| | - Stefan Roepke
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Benjamin Franklin, Berlin, Germany
| | - Christine Heim
- Department of Medical Psychology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Mitte, Berlin, Germany
| | - Sabine C Herpertz
- Department for General Psychiatry, Center of Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Catherine Hindi Attar
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Mitte, Berlin, Germany
| | - Katja Dittrich
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Virchow, Berlin, Germany
| | - Katja Boedeker
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Virchow, Berlin, Germany
| | - Sibylle M Winter
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Virchow, Berlin, Germany
| | - Neele S Ridder
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Mitte, Berlin, Germany
| | - Sina K Poppinga
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Mitte, Berlin, Germany
| | - Felix Bermpohl
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Mitte, Berlin, Germany
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24
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Torinomi C, Lindenberg K, Möltner A, Herpertz SC, Holm-Hadulla RM. Predictors of Students' Mental Health during the COVID-19 Pandemic: The Impact of Coping Strategies, Sense of Coherence, and Social Support. Int J Environ Res Public Health 2022; 19:16423. [PMID: 36554304 PMCID: PMC9778699 DOI: 10.3390/ijerph192416423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/28/2022] [Accepted: 12/05/2022] [Indexed: 06/17/2023]
Abstract
Young people and women seem to suffer more from social restrictions due to the COVID-19 pandemic than do others. Findings from pre-pandemic surveys identified students as a specific risk group for developing anxiety and depressive symptoms. Recent studies have indicated that students especially denoted a decrease in mental health during the pandemic. In a sample of n = 1938 university students (67.6% female), we investigated protective factors that are associated with mental health (defined as the absence of any mental disorder) and more specifically, the absence of major depression during the pandemic despite social restrictions. Investigated protective factors were social support, sense of coherence and situational coping strategies. The results of the multiple logistic regression analyses revealed that male gender, high sense of coherence and specific coping strategies could be identified to be associated with mental health in general and the absence of major depression. Protective coping strategies that were related to mental health in general were lower substance use, lower behavioral disengagement, higher positive reframing and lower self-blame. Protective coping strategies that were associated with the absence of major depression specifically were higher use of instrumental support, lower substance use, lower behavioral disengagement, higher positive reframing, higher emotional support, lower self-blame and lower humor. Social support was related to the absence of major depression, but not to mental health in general. Higher age in university students was associated with better mental health, but not with the absence of major depression specifically. These findings indicate that sense of coherence and situational coping strategies can buffer the adverse effect of social restrictions on mental health and thus, can serve as important resilience factors. Moreover, they highlight the political relevance of promoting specific coping strategies to foster mental health in students encompassing adverse events and social restrictions.
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Affiliation(s)
- Charlotte Torinomi
- Department of Child and Adolescent Psychotherapy, Institute of Psychology, Goethe-University Frankfurt, 60486 Frankfurt, Germany
| | - Katajun Lindenberg
- Department of Child and Adolescent Psychotherapy, Institute of Psychology, Goethe-University Frankfurt, 60486 Frankfurt, Germany
| | - Andreas Möltner
- Dean’s Office, Medical Faculty, Heidelberg University, 69120 Heidelberg, Germany
| | - Sabine C. Herpertz
- Department of General Psychiatry, Centre for Psychosocial Medicine, Heidelberg University Hospital, 69115 Heidelberg, Germany
| | - Rainer M. Holm-Hadulla
- Department of General Psychiatry, Centre for Psychosocial Medicine, Heidelberg University Hospital, 69115 Heidelberg, Germany
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25
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Talia A, Georg A, Siepe B, Gullo S, Miller-Bottome M, Volkert J, Neukel C, Kaess M, Bempohl F, Herpertz SC, Taubner S. An exploratory study on how attachment classifications manifest in group psychotherapy. Res Psychother 2022; 25:653. [PMID: 36373392 PMCID: PMC9893045 DOI: 10.4081/ripppo.2022.653] [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] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 08/29/2022] [Indexed: 11/09/2022]
Abstract
Recently, attachment-informed researchers and clinicians have begun to show that attachment theory offers a useful framework for exploring group psychotherapy. However, it remains unclear whether patients with differing attachment classifications would behave and speak in distinct ways in group therapy sessions. In this study, we conducted an exploratory analysis of the discourse of patients in group therapy who had independently received different classifications with gold standard interview measures of attachment in adults. Each patient participant attended one of three mentalization-based parenting groups. Before treatment, the Adult Attachment Interview (AAI) or the Parent Development Interview (PDI) were administered to each patient, and interviews were transcribed and coded to obtain the patient's attachment classification. Groups included 2, 5, and 5 patients, respectively, and any session was led by at least two co-therapists. A total of 14 group sessions were transcribed verbatim. Sessions were analysed through a semi-inductive method, in order to identify markers that would typify patients of different attachment classifications in session. Through transcript excerpts and narrative descriptions, we report on the differing ways in which patients of different attachment classifications communicate in group psychotherapy, with the therapist and with each other. Our work provides useful information for group therapists and researchers regarding how differences in attachment status may play out in group sessions.
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Affiliation(s)
- Alessandro Talia
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK,Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, East Foreview Building, Forvie Site, Robinson Way, Cambridge, CB2 0SR, UK.
| | - Anna Georg
- University Hospital Heidelberg, Institute for Psychosocial Prevention, Heidelberg, Germany
| | - Björn Siepe
- University Hospital Heidelberg, Institute for Psychosocial Prevention, Heidelberg, Germany
| | - Salvatore Gullo
- Department of Psychological, Pedagogical, Exercise and Training Sciences, University of Palermo, Palermo, Italy
| | | | - Jana Volkert
- Medical School Berlin, Faculty for Natural Sciences, Berlin, Germany
| | - Corinne Neukel
- Department of General Psychiatry, University Hospital Heidelberg, Heidelberg, Germany
| | - Michael Kaess
- Department of Child and Adolescent Psychiatry, University Hospital Bern, Bern, Switzerland,Department of Child and Adolescent Psychiatry, University Hospital Heidelberg, Heidelberg, Germany
| | - Felix Bempohl
- Department of Psychiatry and Neurosciences, Medial University Charité, Berlin, Germany
| | - Sabine C. Herpertz
- Department of General Psychiatry, University Hospital Heidelberg, Heidelberg, Germany
| | - Svenja Taubner
- University Hospital Heidelberg, Institute for Psychosocial Prevention, Heidelberg, Germany
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26
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Holm-Hadulla RM, Mayer CH, Wendler H, Kremer TL, Kotera Y, Herpertz SC. Fear, depression, and well-being during COVID-19 in German and South African students: A cross-cultural comparison. Front Psychol 2022; 13:920125. [PMID: 36405127 PMCID: PMC9671164 DOI: 10.3389/fpsyg.2022.920125] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 09/07/2022] [Indexed: 11/06/2022] Open
Abstract
Various studies have shown a decrease in well-being and an increase in mental health problems during the COVID-19 pandemic; however, only a few studies have explored fear, depression, and well-being cross-culturally during this time. Accordingly, we present the results of a cross-cultural study that (1) compares these mental health scores for German and South African students, (2) compares the correlations among them, and (3) identifies COVID-19 fear, well-being, and depression predictors. German and South African societies differ from each other socio-culturally, politically, and economically. Their university systems also differ to a large extent. University students in both countries completed the Fear of COVID-19 Scale, the World Health Organization-Five Well-Being Index (WHO-5), and the Patient Health Questionnaire-9 (PHQ-9). Welch’s t-test, correlation, and multiple regression analyses were performed. (1) German students were found to have statistically lower levels of COVID-19 fear and depression, but lower levels of general well-being than South African students. (2) In both samples, fear of COVID-19 was negatively correlated with well-being and positively associated with female gender and depression. (3) Additionally, female gender, depression, and lower well-being were identified as predictors of COVID-19 fear in both samples. The findings indicate that the fear of COVID-19 is associated with and varies according to gender, depression, and well-being across cultures, and that the difference in the intensity of fear between German and South African students may be partly explained by cultural and contextual differences. These findings can create a deeper understanding of the pandemic’s impact on student communities and may be used by mental health practitioners and researchers to develop and apply culture-specific interventions.
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Affiliation(s)
- Rainer M. Holm-Hadulla
- Centre for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany
- *Correspondence: Rainer M. Holm-Hadulla,
| | - Claude-Hélène Mayer
- Department of Industrial Psychology and People Management, University of Johannesburg, Johannesburg, South Africa
| | - Hannes Wendler
- Centre for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany
- Department of Philosophy, University of Cologne, Cologne, Germany
| | - Thomas L. Kremer
- Centre for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany
- Central Institute of Mental Health, Heidelberg University, Mannheim, Germany
| | - Yasuhiro Kotera
- School of Health Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Sabine C. Herpertz
- Centre for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany
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27
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Neukel C, Bullenkamp R, Moessner M, Spiess K, Schmahl C, Bertsch K, Herpertz SC. Anger instability and aggression in Borderline Personality Disorder - an ecological momentary assessment study. Borderline Personal Disord Emot Dysregul 2022; 9:29. [PMID: 36244971 PMCID: PMC9575226 DOI: 10.1186/s40479-022-00199-5] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 09/09/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Anger and aggression are core features of Borderline Personality Disorder (BPD), contributing strongly to the individual as well as the societal burden caused by the disorder. Across studies, patients with BPD have shown increased, more frequent and prolonged episodes of anger and reported an increased prevalence of reactive aggression. However, only a few studies have investigated anger and aggression in the patients' everyday lives and did not consider anger instability. In order to contribute knowledge about aggression and its association with anger intensity and anger instability in real-life in BPD the aim of the present study was to better characterize days with and without aggressive behaviors with regard to the patients' experienced anger. METHODS Patients with BPD and high aggression as well as healthy participants took part in an ecological momentary assessment (EMA) study assessing state anger and aggression three times per day over two weeks. Multilevel modeling was conducted and anger instability was operationalized by squared successive differences. RESULTS As expected, patients with BPD reported greater instability in their experienced anger compared to healthy participants. Most interestingly, in the BPD group the occurrence of aggressive behavior was significantly associated with anger intensity as well as anger instability. More precisely, on days when patients with BPD acted out aggressively, they reported higher anger intensity as well as greater anger instability than on days when they did not act out aggressively. CONCLUSION Knowledge about what characterizes days with aggressive behaviors may help to improve interventions to reduce aggressive behavior and thus relieve the burden aggression causes for patients with BPD, their surroundings and society.
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Affiliation(s)
- Corinne Neukel
- Department of General Psychiatry, Medical Faculty, Center for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany.
| | - Robin Bullenkamp
- Department of General Psychiatry, Medical Faculty, Center for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany
| | - Markus Moessner
- Center for Psychotherapy Research, Heidelberg University, Heidelberg, Germany
| | - Karen Spiess
- Department of General Psychiatry, Medical Faculty, Center for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany
| | - Christian Schmahl
- Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, Heidelberg, Germany
| | - Katja Bertsch
- Department of General Psychiatry, Medical Faculty, Center for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany.,Department of Psychology, LMU Munich, Munich, Germany
| | - Sabine C Herpertz
- Department of General Psychiatry, Medical Faculty, Center for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany
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28
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Ueltzhöffer K, Roth C, Neukel C, Bertsch K, Nüssel F, Herpertz SC. Do I care for you or for me? Processing of protected and non-protected moral values in subjects with extreme scores on the Dark Triad. Eur Arch Psychiatry Clin Neurosci 2022; 273:367-377. [PMID: 36208316 PMCID: PMC9547089 DOI: 10.1007/s00406-022-01489-3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 08/29/2022] [Indexed: 11/03/2022]
Abstract
Protected moral values facilitate empathic concern for others, who are exposed to an existential threat, so that one spontaneously helps without taking into account utilitarian cost-benefit considerations. Subjects scoring high on the "Dark Triad" machiavellism, psychopathy, and narcissism are prone to ignore such appeals for selfless help. Until now, data on moral processing and moral decision-making following requests for altruistic help, which directly contrast appeals to protected and non-protected values in subjects with high and low scores on Dark Triad traits, have been missing. In this pilot study 25 healthy subjects with high and 27 with low Dark Triad scores participated in this functional magnetic resonance imaging study. We used a script-driven imagery paradigm to directly contrast requests for selfless help appealing to protected versus non-protected, negotiable moral values. Appeals to protected versus non-protected moral values elicited stronger activations in a large network including insula, amygdala, supramarginal gyrus, and dorsolateral prefrontal cortex. Non-protected values evoked stronger activation in superior frontal sulcus, occipito-temporal junction, and posterior cingulate cortex. During decision-making, high-scorers on the Dark Triad showed increased activations in the superior parietal lobule, precuneus, and intraparietal sulcus. Behaviorally, protected versus non-protected values strongly reduced the reliance on personal cost-benefit calculations in low-scorers, while high-scorers continued to rely on utilitarian deliberations. Data suggest that appeals to protected versus non-protected values activate distinct brain regions associated with strong moral emotions, other-directed cognition, and rule-based decision-making processes. High-scorers display an increased reliance on cost-benefit calculations, which persists even when protected values are threatened.
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Affiliation(s)
- Kai Ueltzhöffer
- grid.7700.00000 0001 2190 4373Department of General Psychiatry, Center for Psychosocial Medicine, Heidelberg University, Voßstraße 2, 69115 Heidelberg, Germany ,grid.83440.3b0000000121901201The Wellcome Centre for Human Neuroimaging, University College London, London, WC1N 3AR UK
| | - Corinna Roth
- grid.7700.00000 0001 2190 4373Department of General Psychiatry, Center for Psychosocial Medicine, Heidelberg University, Voßstraße 2, 69115 Heidelberg, Germany
| | - Corinne Neukel
- grid.7700.00000 0001 2190 4373Department of General Psychiatry, Center for Psychosocial Medicine, Heidelberg University, Voßstraße 2, 69115 Heidelberg, Germany
| | - Katja Bertsch
- grid.7700.00000 0001 2190 4373Department of General Psychiatry, Center for Psychosocial Medicine, Heidelberg University, Voßstraße 2, 69115 Heidelberg, Germany ,grid.5252.00000 0004 1936 973XInstitute of Clinical Psychology and Psychotherapy, LMU München, 80802 Munich, Germany
| | - Friederike Nüssel
- grid.7700.00000 0001 2190 4373German Cancer Center, Heidelberg University, 69117 Heidelberg, Germany
| | - Sabine C. Herpertz
- grid.7700.00000 0001 2190 4373Department of General Psychiatry, Center for Psychosocial Medicine, Heidelberg University, Voßstraße 2, 69115 Heidelberg, Germany
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29
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Rashidi M, Maier E, Dekel S, Sütterlin M, Wolf RC, Ditzen B, Grinevich V, Herpertz SC. Peripartum effects of synthetic oxytocin: The good, the bad, and the unknown. Neurosci Biobehav Rev 2022; 141:104859. [PMID: 36087759 DOI: 10.1016/j.neubiorev.2022.104859] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 08/23/2022] [Accepted: 09/03/2022] [Indexed: 11/30/2022]
Abstract
The first clinical applications of oxytocin (OT) were in obstetrics as a hormone to start and speed up labor and to control postpartum hemorrhage. Discoveries in the 1960s and 1970s revealed that the effects of OT are not limited to its peripheral actions around birth and milk ejection. Indeed, OT also acts as a neuromodulator in the brain affecting fear memory, social attachment, and other forms of social behaviors. The peripheral and central effects of OT have been separately subject to extensive scrutiny. However, the effects of peripheral OT-particularly in the form of administration of synthetic OT (synOT) around birth-on the central nervous system are surprisingly understudied. Here, we provide a narrative review of the current evidence, suggest putative mechanisms of synOT action, and provide new directions and hypotheses for future studies to bridge the gaps between neuroscience, obstetrics, and psychiatry.
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Affiliation(s)
- Mahmoud Rashidi
- Department of General Psychiatry, Heidelberg University, Heidelberg, Germany.
| | - Eduard Maier
- Department of Neuropeptide Research in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Sharon Dekel
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Marc Sütterlin
- Department of Gynecology and Obstetrics, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Robert C Wolf
- Department of General Psychiatry, Heidelberg University, Heidelberg, Germany
| | - Beate Ditzen
- Institute of Medical Psychology, Center for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany
| | - Valery Grinevich
- Department of Neuropeptide Research in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Sabine C Herpertz
- Department of General Psychiatry, Heidelberg University, Heidelberg, Germany
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Seitz KI, Gerhardt S, von Schroeder C, Panizza A, Thekkumthala D, Bertsch K, Herpertz SC, Schmahl C, Schalinski I. Measuring types and timing of childhood maltreatment: The psychometric properties of the KERF-40+. PLoS One 2022; 17:e0273931. [PMID: 36074774 PMCID: PMC9455860 DOI: 10.1371/journal.pone.0273931] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 08/17/2022] [Indexed: 12/03/2022] Open
Abstract
Childhood maltreatment, specifically during sensitive developmental periods, is a major risk factor for poor physical and mental health. Despite its enormous clinical relevance, there is still a lack of scales measuring different types, timing, and duration of childhood maltreatment. The current study sought to validate and determine the psychometric properties of the brief German version of the Maltreatment and Abuse Chronology of Exposure (MACE) scale, the KERF-40. The KERF-40 was administered as an interview (i.e., KERF-40-I) to 287 adult participants with and without mental disorders. Based on item response theory, items of the KERF-40-I were assigned to different types of maltreatment, resulting in a scaled version, the KERF-40+. Test-retest reliability was assessed in a small subsample (n = 14). Convergent and relative predictive validity were measured with correlations of the KERF-40+ and the Childhood Trauma Questionnaire (CTQ) as well as self-report measures of general and trauma-related psychopathology. Rasch analysis and fit statistics yielded a 49-item version, encompassing ten different types of maltreatment. The test-retest reliability of the KERF-40+ was shown to be acceptable to excellent for almost all global and subscale scores (.74 ≤ ρ ≤ 1.00), with the exception of the subscale emotional neglect (ρ = .55). Convergent validity with the CTQ was confirmed for both KERF-40+ global scores (.72 ≤ r ≤ .87) and corresponding subscale scores (.56 ≤ r ≤ .78). Relative predictive validity was reflected by significant small-to-moderate correlations between KERF-40+ global scores and indices of general and trauma-related psychopathology (.24 ≤ r ≤ .45). Taken together, the KERF-40+ appears to be suited for clinicians and researchers interested in retrospectively assessing different types, timing, and duration of childhood maltreatment experiences during sensitive periods in adults.
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Affiliation(s)
- Katja I. Seitz
- Department of General Psychiatry, Center for Psychosocial Medicine, Medical Faculty, Heidelberg University, Heidelberg, Germany
- * E-mail:
| | - Sarah Gerhardt
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Claudius von Schroeder
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Mannheim, Germany
| | - Angelika Panizza
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Mannheim, Germany
| | | | - Katja Bertsch
- Department of General Psychiatry, Center for Psychosocial Medicine, Medical Faculty, Heidelberg University, Heidelberg, Germany
- Department of Psychology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Sabine C. Herpertz
- Department of General Psychiatry, Center for Psychosocial Medicine, Medical Faculty, Heidelberg University, Heidelberg, Germany
| | - Christian Schmahl
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Mannheim, Germany
| | - Inga Schalinski
- Department of Psychology, University of Konstanz, Konstanz, Germany
- Psychologische Hochschule Berlin, Berlin, Germany
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Bonfig J, Herpertz SC, Schneider I. Altered hormonal patterns in borderline personality disorder mother-child interactions. Psychoneuroendocrinology 2022; 143:105822. [PMID: 35709662 DOI: 10.1016/j.psyneuen.2022.105822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 04/28/2022] [Accepted: 06/01/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Oxytocin, cortisol, and testosterone are involved in the processing of reward and stress and greatly influence mother-child interactions. Altered hormonal systems have been associated with borderline personality disorder (BPD), a disorder characterized by interpersonal deficits. Mothers with BPD tend to perceive interactions with the child as less rewarding and more stressful and interactions are often less reciprocal and have more negative states (i.e. constricted, tense, uncoordinated behaviors). Their children are at elevated risk for psychopathologies. Here, we studied underlying hormonal mechanisms of disrupted mother-child interaction in BPD. METHODS Twenty-five mothers with BPD and 29 healthy mothers with their 18- to 36-month-old toddlers participated in a free-play mother-child interaction, which was evaluated with the Coding Interactive Behavior (CIB) Manual. Maternal blood samples were analyzed at baseline for oxytocin, cortisol, and testosterone, and after interaction for oxytocin and cortisol. RESULTS Oxytocin decreased and cortisol remained unchanged in mothers with BPD while healthy mothers showed stable oxytocin and decreased cortisol after interaction. Testosterone basal levels were significantly higher in mothers with BPD. Cortisol reactivity and testosterone levels mediated the association between maternal BPD and dyadic negative states during interaction. CONCLUSIONS These findings suggest that alterations in oxytocin, cortisol, and testosterone contribute to disruptions in mother-child interaction in BPD. Interacting with their child might not result in reward and relief of stress in mothers with BPD in the same way as in healthy mothers. Further research is needed to understand more about dyadic bio-behavioral processes in order to provide targeted parenting support. This could break the cycle of transgenerational transmission and improve maternal and child well-being.
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Affiliation(s)
- Julia Bonfig
- Department of General Psychiatry, Center for Psychosocial Medicine, Heidelberg University, Voßstr. 4, 69115 Heidelberg, Germany
| | - Sabine C Herpertz
- Department of General Psychiatry, Center for Psychosocial Medicine, Heidelberg University, Voßstr. 4, 69115 Heidelberg, Germany
| | - Isabella Schneider
- Department of General Psychiatry, Center for Psychosocial Medicine, Heidelberg University, Voßstr. 4, 69115 Heidelberg, Germany.
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Bertsch K, Buades-Rotger M, Krauch M, Ueltzhöffer K, Kleindienst N, Herpertz SC, Krämer UM. Abnormal processing of interpersonal cues during an aggressive encounter in women with borderline personality disorder: Neural and behavioral findings. J Psychopathol Clin Sci 2022; 131:493-506. [PMID: 35587414 DOI: 10.1037/abn0000756] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Inappropriate aggression is a prominent and clinically relevant interpersonal dysfunction of individuals with borderline personality disorder (BPD). Previous studies have shown that individuals with BPD interpret interpersonal signals in a hostile manner, but it is uncertain how this negativity bias impacts decision-making during aggressive encounters. In the present neuroimaging study, 48 medication-free women with BPD and 28 age- and intelligence-matched women played the Social Threat Aggression Paradigm (STAP), a competitive reaction time task in which the winner delivers an aversive sound blast to the loser. Crucially, in the STAP the alleged opponent displays either an angry or neutral facial expression at the beginning of each trial and selects increasingly loud blasts in order to provoke participants. Relative to healthy controls, women with BPD differentiated less between angry and neutral facial expressions, both in terms of aggressive behavior and of activity in medial prefrontal cortex, amygdala, and temporal pole. On the one hand, and contrary to our hypotheses, neural and behavioral responses to angry faces were reduced in women with BPD compared to healthy women. On the other hand, provocation heightened subsequent amygdala responses to neutral faces in BPD, and this was in turn associated with aggressive behavior, supporting a default negativity bias in BPD. The neurocognitive processes by which these alterations might guide aggressive behavior irrespective of interpersonal cues are presented and discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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C. Herpertz S. In Reply. Dtsch Arztebl Int 2022; 119:492. [PMID: 36342098 PMCID: PMC9664983 DOI: 10.3238/arztebl.m2022.0191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Herpertz SC, Bertsch K. Opportunities and challenges of new classification systems for personality disorders: Commentary on “clinical utility of the AMPD: A 10th year anniversary review”. Personal Disord 2022; 13:380-382. [DOI: 10.1037/per0000578] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Back SN, Schmitz M, Koenig J, Zettl M, Kleindienst N, Herpertz SC, Bertsch K. Reduced vagal activity in borderline personality disorder is unaffected by intranasal oxytocin administration, but predicted by the interaction between childhood trauma and attachment insecurity. J Neural Transm (Vienna) 2022; 129:409-419. [PMID: 35275249 PMCID: PMC9007810 DOI: 10.1007/s00702-022-02482-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 02/22/2022] [Indexed: 12/31/2022]
Abstract
Individuals with borderline personality disorder (BPD) show self-regulatory deficits, associated with reduced heart-rate variability (HRV). However, results on reduced HRV in BPD remain heterogeneous, thus encouraging the search for developmental constructs explaining this heterogeneity. The present study first examined predictors of reduced resting-state HRV in BPD, namely the interaction between self-reported adult attachment insecurity and childhood trauma. Second, we investigated if alterations in resting-state HRV are modified by intranasal oxytocin administration, as oxytocin may enhance HRV and is implicated in the interaction between childhood trauma and disturbed attachment for the pathogenesis of BPD. In a randomized, placebo-controlled trial, 53 unmedicated women with BPD and 60 healthy controls (HC) self-administered either 24 I.U. of oxytocin or placebo and underwent a 4-min electrocardiogram. Our results replicate significantly reduced HRV in women with BPD, explained up to 16% by variations in childhood trauma and attachment insecurity. At high levels of acute attachment insecurity, higher levels of childhood trauma significantly predicted reduced HRV in BPD. However, our results do not support a significant effect of oxytocin on mean HRV, and no interaction effect emerged including childhood trauma and attachment insecurity. Our findings highlight a complex interaction between reduced vagal activity and developmental factors in BPD.
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Affiliation(s)
- Sarah N Back
- Department of Psychology, Ludwig-Maximilians-University Munich, Leopoldstraße 13, 80802, Munich, Germany.
| | - Marius Schmitz
- Department of Psychology, Ludwig-Maximilians-University Munich, Leopoldstraße 13, 80802, Munich, Germany
- Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Julian Koenig
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Max Zettl
- Institute of Psychosocial Prevention, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Nikolaus Kleindienst
- Medical Faculty Mannheim, Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health, Heidelberg University, Mannheim, Germany
| | - Sabine C Herpertz
- Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Katja Bertsch
- Department of Psychology, Ludwig-Maximilians-University Munich, Leopoldstraße 13, 80802, Munich, Germany
- Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
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Seitz KI, Ehler N, Schmitz M, Schmitz SE, Dziobek I, Herpertz SC, Bertsch K. Affective and cognitive theory of mind in posttraumatic stress, major depressive, and somatic symptom disorders: Association with childhood trauma. Br J Clin Psychol 2022; 61:680-700. [PMID: 35102575 DOI: 10.1111/bjc.12357] [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: 07/27/2021] [Revised: 01/12/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Childhood trauma constitutes a major risk factor for adult psychopathology, including posttraumatic stress disorder (PTSD), major depressive disorder (MDD), and somatic symptom disorder (SSD). One potential mechanism linking childhood trauma to adult psychopathology may be alterations in theory of mind (ToM). Given the lack of transdiagnostic studies on the association between childhood trauma and ToM, further research is needed to elucidate whether and how childhood trauma relates to ToM impairments across and within diagnostic boundaries. DESIGN A cross-sectional study design was applied. METHODS A total of 137 individuals with varying levels of childhood trauma took part in this study, encompassing individuals with PTSD (n = 33), MDD (n = 33), SSD (n = 36), and healthy volunteers (HVs; n = 35). To assess ToM performance and childhood trauma, the Movie for the Assessment of Social Cognition was administered along with the Childhood Trauma Questionnaire. RESULTS Only individuals with PTSD, but not individuals with MDD or SSD, showed a worse ToM performance compared to HVs. In the whole sample, childhood trauma correlated negatively with ToM performance. Exploratory group-specific analyses revealed higher levels of childhood trauma to be associated with more excessive ToM errors in individuals with SSD, and notably with an enhanced ToM performance in individuals with MDD. CONCLUSIONS Our results indicate associations between childhood trauma and ToM impairments in a large, transdiagnostic sample. Provided replication in future studies, our findings suggest ToM capacities as a promising treatment target for individuals exposed to severe childhood trauma, at least or particularly with a diagnosis of PTSD. PRACTITIONER POINTS Our results suggest that individuals with a history of severe childhood trauma, at least or particularly with a clinical diagnosis of posttraumatic stress disorder, may benefit from therapeutic approaches targeting theory of mind capacities. Our findings indicate that higher levels of childhood trauma may be linked to a specific 'hypermentalizing' bias in somatic symptom disorder. Our findings further point towards an association between higher levels of childhood trauma and a heightened - rather than a diminished - sensitivity towards interpersonal cues in major depressive disorder. Provided further confirmatory evidence, our findings may support diagnosis-specific approaches in ameliorating theory of mind abilities in individuals with different mental disorders and a history of severe childhood trauma.
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Affiliation(s)
- Katja I Seitz
- Department of General Psychiatry, Center for Psychosocial Medicine, Medical Faculty, Heidelberg University, Germany
| | - Nicola Ehler
- Department of General Psychiatry, Center for Psychosocial Medicine, Medical Faculty, Heidelberg University, Germany
| | - Marius Schmitz
- Department of General Psychiatry, Center for Psychosocial Medicine, Medical Faculty, Heidelberg University, Germany.,Department of Psychology, Ludwig-Maximilians-University Munich, Germany
| | - Sara E Schmitz
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Germany
| | - Isabel Dziobek
- Berlin School of Mind and Brain, Humboldt Universität zu Berlin, Germany.,Department of Psychology, Humboldt Universität zu Berlin, Germany
| | - Sabine C Herpertz
- Department of General Psychiatry, Center for Psychosocial Medicine, Medical Faculty, Heidelberg University, Germany
| | - Katja Bertsch
- Department of General Psychiatry, Center for Psychosocial Medicine, Medical Faculty, Heidelberg University, Germany.,Department of Psychology, Ludwig-Maximilians-University Munich, Germany
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Zietlow AL, Woll CFJ, Nonnenmacher N, Müller M, Labonte V, Ditzen B, Paulus M, Sodian B, Nater UM, Herpertz SC, Reck C. Study protocol of the COMPARE-Interaction study: the impact of maternal comorbid depression and anxiety disorders in the peripartum period on child development. BMJ Open 2022; 12:e050437. [PMID: 35058257 PMCID: PMC8783832 DOI: 10.1136/bmjopen-2021-050437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION To date, there are only few studies that compare the consequences of peripartum maternal depressive disorders (PD) versus depressive with comorbid anxiety disorders (PDCA) for infant and child development. As comorbidity is associated with greater impairment and symptom severity related to the primary diagnosis, comorbidity in mothers might raise their offspring's risk of developing internalising or externalising disorders even more than has been noted in conjunction with PD alone. METHODS AND ANALYSIS This study aims to analyse the impact of parental psychopathology, particularly peripartum depression in mothers with and without comorbid anxiety disorders according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) on child cognitive and socioemotional development. Maternal/paternal psychopathology, mother-infant/father-infant interaction and child development are assessed at four measurement points over the first 2 years (T1: 3-4 months postpartum, T2: 12 months postpartum, T3: 18 months postpartum and T4: 24 months postpartum). The mediating role of mother-infant/father-infant interaction and infant stress reactivity in the relationship between PD/PDCA and infant cognitive and socioemotional development will be analysed. In the ongoing study, 174 families (n=58 mothers with PD, n=58 mothers with PDCA and n=58 healthy controls) will be recruited in inpatient and outpatient centres as well as maternity hospitals in Munich and Heidelberg. ETHICS AND DISSEMINATION This study is implemented in accordance with the current guidelines of the World Medical Association (revised Declaration of Helsinki) and the General Data Protection Regulation of the European Union. The study procedures were approved by the independent ethics committees of the Department of Psychology, Ludwig-Maximilians-University Munich (74_Reck_b) and of the Medical Faculty, University Heidelberg (S-446/2017). Participation is voluntary. A signed written informed consent form must be obtained from each study subject prior to any study-specific procedure. Participants can withdraw from the study at any point in time without giving a reason or being subjected to any future disadvantages. In case of withdrawal from the study, the subject's data and material will be kept unless the participant asks for data removal. Results will be published and disseminated to further the discussion on the effects of maternal PD and PDCA on parent-infant interaction, infant stress reactivity and child development. Furthermore, study results will be presented at international congresses and expert conferences.
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Affiliation(s)
- Anna-Lena Zietlow
- Department of Psychology, School of Social Sciences, University of Mannheim, Mannheim, Germany
| | - Christian Franz Josef Woll
- Department of Psychology, Clinical Psychology of Children and Adolescents, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Nora Nonnenmacher
- Institute of Medical Psychology, Centre of Psychosocial Medicine, Heidelberg University, Heidelberg, Germany
| | - Mitho Müller
- Department of Psychology, Clinical Psychology of Children and Adolescents, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Verena Labonte
- Department of Psychology, Clinical Psychology of Children and Adolescents, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Beate Ditzen
- Institute of Medical Psychology, Centre of Psychosocial Medicine, Heidelberg University, Heidelberg, Germany
| | - Markus Paulus
- Department of Psychology, Developmental and Educational Psychology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Beate Sodian
- Department of Psychology, Developmental and Educational Psychology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Urs M Nater
- Department of Psychology, University of Vienna, Vienna, Austria
| | - Sabine C Herpertz
- Department of General Psychiatry, Centre of Psychosocial Medicine, Heidelberg University, Heidelberg, Germany
| | - Corinna Reck
- Department of Psychology, Clinical Psychology of Children and Adolescents, Ludwig-Maximilians-University Munich, Munich, Germany
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Herpertz SC, Schneider I, Renneberg B, Schneider A. Patients With Personality Disorders in Everyday Clinical Practice–Implications of the ICD-11. Dtsch Arztebl Int 2022:arztebl.m2022.0001. [PMID: 34809749 DOI: 10.3238/arztebl.m2022.0001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Patients with difficult personalities or personality disorders are a special challenge for primary care physicians. Their style of interpersonal interaction is often difficult. As the ICD-11 classification comes into use, a new systematic approach to diagnosis is being introduced that focuses on the patient's functional impairments in everyday life. We describe the implications for the diagnosis and treatment of patients of this type. METHODS This review is based on pertinent publications retrieved by a selective search, with particular attention to primary care and to somatic morbidity and mortality. RESULTS 10-12% of the population suffers from personality disorders. A high degree of psychiatric comorbidity is typical; somatic diseases are also more than twice as common as in the general population. In emergency medicine, persons with personality disorders are more likely than others to present with a suicide attempt. Their lifetime risk of suicide is between 1.4% and 4.5% (the latter for persons with borderline personality disorder). CONCLUSION Primary care physicians have an important role in the initial diagnosis of patients with personality disorders and in the planning of their treatment. Such patients require special care and attention from their physicians in view of their elevated somatic morbidity and mortality. In everyday clinical practice, physicians who encounter patients with complex and persistent mental problems, or just with a difficult style of interpersonal interaction, should consider the possibility of a personality disorder and motivate such patients to undergo psychotherapy, if indicated.
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Herpertz SC, Schneider I, Renneberg B, Schneider A. Patients With Personality Disorders in Everyday Clinical Practice–Implications of the ICD-11. Dtsch Arztebl Int 2022:arztebl.m2021.0356. [PMID: 34809749 DOI: 10.3238/arztebl.m2021.0356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Patients with difficult personalities or personality disorders are a special challenge for primary care physicians. Their style of interpersonal interaction is often difficult. As the ICD-11 classification comes into use, a new systematic approach to diagnosis is being introduced that focuses on the patient's functional impairments in everyday life. We describe the implications for the diagnosis and treatment of patients of this type. METHODS This review is based on pertinent publications retrieved by a selective search, with particular attention to primary care and to somatic morbidity and mortality. RESULTS 10-12% of the population suffers from personality disorders. A high degree of psychiatric comorbidity is typical; somatic diseases are also more than twice as common as in the general population. In emergency medicine, persons with personality disorders are more likely than others to present with a suicide attempt. Their lifetime risk of suicide is between 1.4% and 4.5% (the latter for persons with borderline personality disorder). CONCLUSION Primary care physicians have an important role in the initial diagnosis of patients with personality disorders and in the planning of their treatment. Such patients require special care and attention from their physicians in view of their elevated somatic morbidity and mortality. In everyday clinical practice, physicians who encounter patients with complex and persistent mental problems, or just with a difficult style of interpersonal interaction, should consider the possibility of a personality disorder and motivate such patients to undergo psychotherapy, if indicated.
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40
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Fuchs T, Herpertz SC, Kaess M, Lenzenweger MF. 125 Years of Psychopathology. Psychopathology 2022; 55:127-128. [PMID: 35640547 DOI: 10.1159/000525084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 05/13/2022] [Indexed: 11/19/2022]
Affiliation(s)
- Thomas Fuchs
- Department of General Psychiatry, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Sabine C Herpertz
- Department of General Psychiatry, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Michael Kaess
- Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany.,University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Mark F Lenzenweger
- Department of Psychology, The State University of New York at Binghamton, Binghamton, New York, USA.,Department of Psychiatry, Weill Cornell Medical College, New York, New York, USA
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Andermann M, Izurieta Hidalgo NA, Rupp A, Schmahl C, Herpertz SC, Bertsch K. Behavioral and neurophysiological correlates of emotional face processing in borderline personality disorder: are there differences between men and women? Eur Arch Psychiatry Clin Neurosci 2022; 272:1583-1594. [PMID: 35661904 PMCID: PMC9653371 DOI: 10.1007/s00406-022-01434-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 05/15/2022] [Indexed: 11/28/2022]
Abstract
Emotional dysregulation is a core feature of borderline personality disorder (BPD); it is, for example, known to influence one's ability to read other people's facial expressions. We investigated behavioral and neurophysiological foundations of emotional face processing in individuals with BPD and in healthy controls, taking participants' sex into account. 62 individuals with BPD (25 men, 37 women) and 49 healthy controls (20 men, 29 women) completed an emotion classification task with faces depicting blends of angry and happy expressions while the electroencephalogram was recorded. The cortical activity (late positive potential, P3/LPP) was evaluated using source modeling. Compared to healthy controls, individuals with BPD responded slower to happy but not to angry faces; further, they showed more anger ratings in happy but not in angry faces, especially in those with high ambiguity. Men had lower anger ratings than women and responded slower to angry but not happy faces. The P3/LPP was larger in healthy controls than in individuals with BPD, and larger in women than in men; moreover, women but not men produced enlarged P3/LPP responses to angry vs. happy faces. Sex did not interact with behavioral or P3/LPP-related differences between healthy controls and individuals with BPD. Together, BPD-related alterations in behavioral and P3/LPP correlates of emotional face processing exist in both men and women, supposedly without sex-related interactions. Results point to a general 'negativity bias' in women. Source modeling is well suited to investigate effects of participant and stimulus characteristics on the P3/LPP generators.
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Affiliation(s)
- Martin Andermann
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - Natalie A. Izurieta Hidalgo
- Department for General Psychiatry, Center of Psychosocial Medicine, Heidelberg University Hospital, Heidelberg, Germany ,School of Medicine, Universidad San Francisco de Quito, Quito, Pichincha Ecuador
| | - André Rupp
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - Christian Schmahl
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Sabine C. Herpertz
- Department for General Psychiatry, Center of Psychosocial Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Katja Bertsch
- Department for General Psychiatry, Center of Psychosocial Medicine, Heidelberg University Hospital, Heidelberg, Germany. .,Department of Psychology, Ludwig-Maximilians-University Munich, Leopoldstr. 13, 80802, Munich, Germany. .,NeuroImaging Core Unit Munich (NICUM), University Hospital LMU, Munich, Germany.
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Kramer U, Eubanks CF, Bertsch K, Herpertz SC, McMain S, Mehlum L, Renneberg B, Zimmermann J. Future Challenges in Psychotherapy Research for Personality Disorders. Curr Psychiatry Rep 2022; 24:613-622. [PMID: 36227450 PMCID: PMC9633470 DOI: 10.1007/s11920-022-01379-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
PURPOSE OF REVIEW Individuals with personality disorders are frequently seen in mental health settings. Their symptoms typically reflect a high level of suffering and burden of disease, with potentially harmful societal consequences, including costs related to absenteeism at work, high use of health services, ineffective or harmful parenting, substance use, suicidal and non-suicidal self-harming behavior, and aggressiveness with legal consequences. Psychotherapy is currently the first-line treatment for patients with personality disorders, but the study of psychotherapy in the domain of personality disorders faces specific challenges. RECENT FINDINGS Challenges include knowing what works for whom, identifying which putative mechanisms of change explain therapeutic effects, and including the social interaction context of patients with a personality disorder. By following a dimensional approach, psychotherapy research on personality disorders may serve as a model for the development and study of innovative psychotherapeutic interventions. We recommend developing the following: (a) an evidence base to make treatment decisions based on individual features; (b) a data-driven approach to predictors, moderators, and mechanisms of change in psychotherapy; (c) methods for studying the interaction between social context and psychotherapy.
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Affiliation(s)
- Ueli Kramer
- University of Lausanne, Lausanne, Switzerland. .,University of Windsor, Windsor, Canada.
| | | | - Katja Bertsch
- grid.5252.00000 0004 1936 973XLudwig-Maximilians-Universität Munich, Munich, Germany
| | - Sabine C. Herpertz
- grid.5253.10000 0001 0328 4908Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Shelley McMain
- grid.155956.b0000 0000 8793 5925Centre for Addiction and Mental Health (CAMH) and University of Toronto, Toronto, Canada
| | - Lars Mehlum
- grid.5510.10000 0004 1936 8921National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Babette Renneberg
- grid.14095.390000 0000 9116 4836Freie Universität Berlin, Berlin, Germany
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Seeger FR, Neukel C, Williams K, Wenigmann M, Fleck L, Georg AK, Bermpohl F, Taubner S, Kaess M, Herpertz SC. Parental Mental Illness, Borderline Personality Disorder, and Parenting Behavior: The Moderating Role of Social Support. Curr Psychiatry Rep 2022; 24:591-601. [PMID: 36282473 PMCID: PMC9592879 DOI: 10.1007/s11920-022-01367-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/19/2022] [Indexed: 01/29/2023]
Abstract
PURPOSE OF REVIEW Parental mental disorders, particularly borderline personality disorder (BPD), impair parenting behavior. Consequently, the children exhibit an elevated risk for psychopathology across their lifespan. Social support for parents is thought to moderate the relationship between parental mental illness and parenting behavior. It may dampen negative effects and serve as starting point for preventive interventions. This paper provides a literature overview regarding the impact of social support on the sequelae of parental mental illness and BPD for parenting behavior. RECENT FINDINGS Current literature highlights the increased burden of families with a mentally ill parent and associated changes in parenting behavior like increased hostility and affective dysregulation, especially in the context of parental BPD. Literature further demonstrates the powerful impact of social support in buffering such negative outcomes. The effect of social support seems to be moderated itself by further factors like socioeconomic status, gender, or characteristics of the social network. Social support facilitates positive parenting in mentally ill parents and may be particularly important in parents with BPD. However, social support is embedded within a framework of influencing factors, which need consideration when interpreting scientific results.
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Affiliation(s)
- Fabian R Seeger
- Department of General Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Voßstraße 4, D - 69115, Heidelberg, Germany
| | - Corinne Neukel
- Department of General Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Voßstraße 4, D - 69115, Heidelberg, Germany
| | - Katharina Williams
- Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Marc Wenigmann
- Department of General Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Voßstraße 4, D - 69115, Heidelberg, Germany
| | - Leonie Fleck
- Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Anna K Georg
- Department of Psychosocial Prevention, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Felix Bermpohl
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Svenja Taubner
- Department of Psychosocial Prevention, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Michael Kaess
- Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Sabine C Herpertz
- Department of General Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Voßstraße 4, D - 69115, Heidelberg, Germany.
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Neukel C, Bertsch K, Wenigmann M, Spieß K, Krauch M, Steinmann S, Herpertz SC. A Mechanism-Based Approach to Anti-Aggression Psychotherapy in Borderline Personality Disorder: Group Treatment Affects Amygdala Activation and Connectivity. Brain Sci 2021; 11:brainsci11121627. [PMID: 34942929 PMCID: PMC8699721 DOI: 10.3390/brainsci11121627] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 11/30/2021] [Accepted: 12/07/2021] [Indexed: 11/16/2022] Open
Abstract
Aggression is highly prevalent in borderline personality disorder (BPD). Previous studies have identified specific biobehavioral mechanisms underlying aggression in BPD, threat sensitivity being among them. We composited the mechanism-based anti-aggression psychotherapy (MAAP) in order to target these specific mechanisms, and MAAP was found to be superior to non-specific supportive psychotherapy (NSSP) in reducing aggressive behavior. In the present study, we investigated whether underlying brain mechanisms expected to be involved were affected by MAAP. To this end, n = 33 patients with BPD and overt aggressive behavior (n = 20 in MAAP, n = 13 in NSSP) and n = 25 healthy participants took part in a functional magnetic resonance imaging emotional face-matching task before and after treatment, or at a similar time interval for controls. Overt aggressive behavior was assessed using the overt aggression scale, modified. Results showed a decrease in amygdala activation in response to facial stimuli after MAAP, whereas an increase in amygdala activation was found after NSSP. Furthermore, in the MAAP group, connectivity between amygdala and dorsomedial prefrontal cortex increased from pre- to post-treatment compared to the NSSP group. Hence, the results suggest an impact of MAAP on brain mechanisms underlying the salience circuit in response to threat cues.
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Affiliation(s)
- Corinne Neukel
- Department of General Psychiatry, Center for Psychosocial Medicine, Medical Faculty, Heidelberg University, 69115 Heidelberg, Germany; (K.B.); (M.W.); (K.S.); (M.K.); (S.C.H.)
- Correspondence:
| | - Katja Bertsch
- Department of General Psychiatry, Center for Psychosocial Medicine, Medical Faculty, Heidelberg University, 69115 Heidelberg, Germany; (K.B.); (M.W.); (K.S.); (M.K.); (S.C.H.)
- Department of Psychology, Ludwig-Maximilians-University Munich, 80802 Munich, Germany
| | - Marc Wenigmann
- Department of General Psychiatry, Center for Psychosocial Medicine, Medical Faculty, Heidelberg University, 69115 Heidelberg, Germany; (K.B.); (M.W.); (K.S.); (M.K.); (S.C.H.)
| | - Karen Spieß
- Department of General Psychiatry, Center for Psychosocial Medicine, Medical Faculty, Heidelberg University, 69115 Heidelberg, Germany; (K.B.); (M.W.); (K.S.); (M.K.); (S.C.H.)
| | - Marlene Krauch
- Department of General Psychiatry, Center for Psychosocial Medicine, Medical Faculty, Heidelberg University, 69115 Heidelberg, Germany; (K.B.); (M.W.); (K.S.); (M.K.); (S.C.H.)
- Institute of Medical Psychology, Center for Psychosocial Medicine, Medical Faculty, Heidelberg University, 69115 Heidelberg, Germany
| | - Sylvia Steinmann
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, 68159 Mannheim, Germany;
| | - Sabine C. Herpertz
- Department of General Psychiatry, Center for Psychosocial Medicine, Medical Faculty, Heidelberg University, 69115 Heidelberg, Germany; (K.B.); (M.W.); (K.S.); (M.K.); (S.C.H.)
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Gallinat C, Moessner M, Apondo S, Thomann PA, Herpertz SC, Bauer S. Feasibility of an Intervention Delivered via Mobile Phone and Internet to Improve the Continuity of Care in Schizophrenia: A Randomized Controlled Pilot Study. Int J Environ Res Public Health 2021; 18:12391. [PMID: 34886117 PMCID: PMC8656751 DOI: 10.3390/ijerph182312391] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 11/19/2021] [Accepted: 11/23/2021] [Indexed: 12/02/2022]
Abstract
Schizophrenia is a severe mental illness associated with a heavy symptom burden and high relapse rates. Digital interventions are increasingly suggested as means to facilitate continuity of care, relapse prevention, and long-term disease management for schizophrenia spectrum disorders. In order to investigate the feasibility of a mobile and internet-based aftercare program, a 2-arm randomized controlled pilot study was conducted. The program could be used by patients for six months after inpatient treatment and included psychoeducation, an individual crisis plan, optional counseling via internet chat or phone and a supportive monitoring module. Due to the slow pace of enrollment, recruitment was stopped before the planned sample size was achieved. Reasons for the high exclusion rate during recruitment were analyzed as well as attitudes, satisfaction, and utilization of the program by study participants. The data of 25 randomized patients suggest overall positive attitudes towards the program, high user satisfaction and good adherence to the monitoring module. Overall, the results indicate that the digital program might be suitable to provide support following discharge from intensive care. In addition, the study provides insights into specific barriers to recruitment which may inform future research in the field of digital interventions for severe mental illness.
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Affiliation(s)
- Christina Gallinat
- Center for Psychotherapy Research, University Hospital Heidelberg, 69115 Heidelberg, Germany; (M.M.); (S.B.)
| | - Markus Moessner
- Center for Psychotherapy Research, University Hospital Heidelberg, 69115 Heidelberg, Germany; (M.M.); (S.B.)
| | - Sandra Apondo
- Department of General Psychiatry, University Hospital Heidelberg, 69115 Heidelberg, Germany; (S.A.); (S.C.H.)
| | - Philipp A. Thomann
- Zentrum für Seelische Gesundheit, Gesundheitszentrum Odenwaldkreis GmbH, 64711 Erbach im Odenwald, Germany;
| | - Sabine C. Herpertz
- Department of General Psychiatry, University Hospital Heidelberg, 69115 Heidelberg, Germany; (S.A.); (S.C.H.)
| | - Stephanie Bauer
- Center for Psychotherapy Research, University Hospital Heidelberg, 69115 Heidelberg, Germany; (M.M.); (S.B.)
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Nikendei C, Dinger-Ehrenthal U, Schumacher F, Bugaj TJ, Cranz A, Friedrich HC, Herpertz SC, Terhoeven V. Medical students' mental burden and experiences of voluntary work in COVID-19 patient support and treatment services: a qualitative analysis. GMS J Med Educ 2021; 38:Doc120. [PMID: 34957325 PMCID: PMC8675374 DOI: 10.3205/zma001516] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 06/14/2021] [Accepted: 08/26/2021] [Indexed: 06/14/2023]
Abstract
Aim: Medical training is undergoing a dramatic shift toward alternative training methods due to the SARS-CoV-2 pandemic. This study is the first to examine medical students' expectations, experiences, and mental burden related to volunteering in COVID-19 patient support and treatment services using semi-structured interviews. Methods: In May 2020, all 194 Heidelberg University Medical School students involved in volunteer COVID-19 support and treatment services were invited to participate in a cross-sectional, qualitative interview study. The semi-structured interviews were digitally recorded, transcribed, and then analyzed using Mayring's principles for content analysis. Results: We interviewed 12 medical students (8 female, mean age 23.2 years, mean medical training 3.7 years) working in Heidelberg COVID-19 crises management services, i.e., the Heidelberg Medical Hospital COVID-19 inpatient and outpatient units. The analysis revealed two key themes: "Expectations and structural barriers" and "Experiences and mental burden". The participants reported uncertainty and apprehension before starting their voluntary work. Although they initially found volunteering to be somewhat disorganized, their roles became clearer with time. In addition, they reported good team cohesion, which helped reduce initial concerns and uncertainties. The participants also felt that working in the field had helped them maintain their professional identification while standard medical classes and bedside learning were suspended due to the COVID-19 crises. Overall, they reported little volunteer work-related mental burden. Conclusions: The participants felt that volunteering during the COVID-19 crisis had benefited their professional development. A designated liaison person, psychosocial support, and introductory and accompanying courses could help alleviate initial concerns and interim difficulties in future crisis-related assignments.
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Affiliation(s)
- Christoph Nikendei
- Heidelberg University Hospital, Centre for Psychosocial Medicine, Department for General Internal Medicine and Psychosomatics, Heidelberg, Germany
| | - Ulrike Dinger-Ehrenthal
- Heidelberg University Hospital, Centre for Psychosocial Medicine, Department for General Internal Medicine and Psychosomatics, Heidelberg, Germany
| | - Florian Schumacher
- University of Heidelberg, Medical Faculty, Dean's Office, Heidelberg, Germany
| | - Till J. Bugaj
- Heidelberg University Hospital, Centre for Psychosocial Medicine, Department for General Internal Medicine and Psychosomatics, Heidelberg, Germany
| | - Anna Cranz
- Heidelberg University Hospital, Centre for Psychosocial Medicine, Department for General Internal Medicine and Psychosomatics, Heidelberg, Germany
| | - Hans-Christoph Friedrich
- Heidelberg University Hospital, Centre for Psychosocial Medicine, Department for General Internal Medicine and Psychosomatics, Heidelberg, Germany
| | - Sabine C. Herpertz
- University of Heidelberg, Medical Faculty, Dean's Office, Heidelberg, Germany
- Heidelberg University Hospital, Centre for Psychosocial Medicine, Department for General Psychiatry, Heidelberg, Germany
| | - Valentin Terhoeven
- Heidelberg University Hospital, Centre for Psychosocial Medicine, Department for General Internal Medicine and Psychosomatics, Heidelberg, Germany
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Schneider I, Neukel C, Bertsch K, Fuchs A, Möhler E, Zietlow AL, Brunner R, Wolf RC, Herpertz SC. Early life maltreatment affects intrinsic neural function in mothers. J Psychiatr Res 2021; 143:176-182. [PMID: 34500346 DOI: 10.1016/j.jpsychires.2021.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 08/03/2021] [Accepted: 09/01/2021] [Indexed: 11/16/2022]
Abstract
Early life maltreatment (ELM) has an impact on brain functions involved in parenting and is associated with impaired maternal sensitivity. Here, we investigated the influence of ELM on intrinsic neural function and its associations with maternal sensitivity in mothers without a current episode of a mental disorder. Twenty-seven mothers with ELM and 29 mothers without ELM were examined using resting-state functional magnetic resonance imaging, followed by Amplitude of Low Frequency Fluctuations, regional homogeneity and seed-based functional connectivity analyses. Videotaped interactions between mothers and their school-aged children were conducted to assess maternal sensitivity based on the Emotional Availability Scales. Regional and functional connectivity measures were used to investigate associations between intrinsic activity and emotional availability. Mothers with ELM showed reduced maternal sensitivity and lower intrinsic neural activity in the right superior frontal gyrus, the left precuneus, the left middle occipital gyrus, and the parietal cortex (left angular and right supramarginal gyrus) compared to mothers without ELM (p < .001, whole-brain). Amplitude of Low Frequency Fluctuations in the superior frontal gyrus was positively associated with maternal sensitivity across all participants (p = .002). The data suggest a behavioral and neural signature of ELM even in currently mentally healthy mothers. In particular, effects of ELM were found in distinct brain regions involved in social cognition and executive control. These ELM-related alterations may be associated with maternal behavior.
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Affiliation(s)
- Isabella Schneider
- Department of General Psychiatry, Center for Psychosocial Medicine, Heidelberg University, Voßstr. 4, 69115, Heidelberg, Germany.
| | - Corinne Neukel
- Department of General Psychiatry, Center for Psychosocial Medicine, Heidelberg University, Voßstr. 4, 69115, Heidelberg, Germany
| | - Katja Bertsch
- Department of General Psychiatry, Center for Psychosocial Medicine, Heidelberg University, Voßstr. 4, 69115, Heidelberg, Germany; Department of Psychology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Anna Fuchs
- Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Germany
| | - Eva Möhler
- Department of Child and Adolescent Psychiatry, Saarland University Medical Center, Germany
| | - Anna-Lena Zietlow
- Department of Psychology, School of Social Sciences, University of Mannheim, Mannheim, Germany
| | - Romuald Brunner
- Clinic of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Robert Christian Wolf
- Department of General Psychiatry, Center for Psychosocial Medicine, Heidelberg University, Voßstr. 4, 69115, Heidelberg, Germany
| | - Sabine C Herpertz
- Department of General Psychiatry, Center for Psychosocial Medicine, Heidelberg University, Voßstr. 4, 69115, Heidelberg, Germany
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Neukel C, Bermpohl F, Kaess M, Taubner S, Boedeker K, Williams K, Dempfle A, Herpertz SC. Understanding and breaking the intergenerational cycle of abuse in families enrolled in routine mental health services: study protocol for a randomized controlled trial and two non-interventional trials investigating mechanisms of change within the UBICA II consortium. Trials 2021; 22:749. [PMID: 34711261 PMCID: PMC8555002 DOI: 10.1186/s13063-021-05653-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 09/24/2021] [Indexed: 11/10/2022] Open
Abstract
Background Parents’ mental illness (MI) and parental history of early life maltreatment (ELM) are known to be significant risk factors for poor parenting while poor parenting is a crucial mediator of the intergenerational continuity of child maltreatment. Hence, maltreatment prevention programs for families with an MI parent, which pay particular attention to experiences of ELM in the parent, are urgently needed. Parental mentalizing was previously found to mediate successful parenting. Interventions aimed at improving the parental mentalizing capacity reduced maltreatment risk in parents. The aim of the present study is to investigate the effectiveness of a mentalization-based parenting-counseling in acutely mentally ill parents currently treated at a psychiatric hospital. Methods Mentalization-based parenting-counseling (MB-PC) vs. enhanced standard clinical care (SCC+) will be administered in a cluster-randomized-controlled trial (RCT). Patients treated at psychiatric hospitals with children between 1.5 and 15 years will be included in the trial. MB-PC will be administered as a 12-h combined individual and group program enriched by social counseling (over a course of 5 weeks) as add-on to standard clinical care, while the control condition will be standard clinical care plus a 90-min psychoeducation workshop on positive parenting. Primary efficacy endpoint is self-reported parenting practices at follow-up. Embedded within the RCT will be two sub-studies investigating social cognition and dyadic synchrony as biobehavioral mechanisms of change. Discussion The main goal of the present study is to investigate ways to break the intergenerational continuity of maltreatment by assessing the benefits of a prevention program which aims at improving parenting in vulnerable mothers and fathers. MB-PC is a short, low-cost intervention which can be delivered by nurses and social workers and is applicable to MI patients with children with a broad range of diagnoses. If it is shown to be effective, it can be directly implemented into standard psychiatric hospital care thereby providing help to prevent child maltreatment. Trial registration German Clinical Trials Register DRKS00017398. Registered on 5 July 2019
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Affiliation(s)
- C Neukel
- Department of General Psychiatry, Center for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany.
| | - F Bermpohl
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Campus Charité Mitte, Berlin, Germany, Berlin, Germany
| | - M Kaess
- Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany.,University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - S Taubner
- Department of Psychosocial Prevention, University Hospital of Heidelberg, Heidelberg, Germany
| | - K Boedeker
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Campus Virchow-Klinikum, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Berlin, Germany
| | - K Williams
- Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany
| | - A Dempfle
- Institute of Medical Informatics and Statistics, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - S C Herpertz
- Department of General Psychiatry, Center for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany
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Dittrich K, Boedeker K, Kluczniok D, Hindi Attar C, Winter SM, Roepke S, Heim C, Herpertz SC, Bermpohl F. Elevated inflammatory markers in women with remitted major depressive disorder and the role of early life maltreatment. Brain Behav Immun 2021; 97:219-225. [PMID: 34339804 DOI: 10.1016/j.bbi.2021.07.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 07/07/2021] [Accepted: 07/28/2021] [Indexed: 12/17/2022] Open
Abstract
Major depressive disorder (MDD) has been linked to elevated inflammation markers. It remains unclear whether the elevation of C-reactive protein (CRP) and interleukin-6 (IL-6) levels are not only observable in acute MDD but also in patients after remission. MDD is a common sequela of early life maltreatment (ELM), which has also been associated with elevated inflammation markers. While the majority of studies investigated (acute) MDD and ELM as isolated predictors of inflammation, a few studies found inflammation levels to be more pronounced in patients with MDD that were exposed to ELM. This investigation included both ELM and MDD in one study and aimed at distinguishing between the effects of MDD in remission (rMDD) and ELM and investigating potential accumulative effects on the inflammatory markers CRP and IL-6 in a population of N = 126 women (n = 122 for CRP and n = 66 for IL-6). We further investigated how disorder characteristics (course and severity) and specific types of ELM affect levels of CRP and IL-6. We found that rMDD predicted levels of CRP and IL-6 and physical abuse predicted levels of CRP when considering both predictors simultaneously, while other types of ELM did not. A later onset of MDD and a shorter time interval since the last episode were associated with higher levels of IL-6. Our findings contribute to the existing literature on the association between MDD and inflammation, suggesting that elevated levels of inflammation markers may persist even after remission of MDD. Our findings on physical abuse as a specific predictor of CRP in the presence of rMDD suggest that different types of ELM could result in distinct inflammation profiles.
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Affiliation(s)
- Katja Dittrich
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Campus Virchow-Klinikum, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Berlin, Germany.
| | - Katja Boedeker
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Campus Virchow-Klinikum, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Berlin, Germany
| | - Dorothea Kluczniok
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Campus Charité Mitte, Department of Psychiatry and Neurosciences, Berlin, Germany
| | - Catherine Hindi Attar
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Campus Charité Mitte, Department of Psychiatry and Neurosciences, Berlin, Germany
| | - Sibylle M Winter
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Campus Virchow-Klinikum, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Berlin, Germany
| | - Stefan Roepke
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Campus Benjamin Franklin, Department of Psychiatry and Neurosciences, Berlin, Germany
| | - Christine Heim
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Psychology, Berlin, Germany; Pennsylvania State University, College of Health and Human Development, Department of Biobehavioral Health, PA, USA
| | - Sabine C Herpertz
- University Hospital Heidelberg, Centre for Psychosocial Medicine, General Psychiatry, Heidelberg, Germany
| | - Felix Bermpohl
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Campus Charité Mitte, Department of Psychiatry and Neurosciences, Berlin, Germany
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50
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Hillmann K, Neukel C, Krauch M, Spohn A, Schnell K, Herpertz SC, Bertsch K. Cognitive and Affective Theory of Mind in Female Patients With Borderline Personality Disorder. J Pers Disord 2021; 35:672-690. [PMID: 33107807 DOI: 10.1521/pedi_2020_34_490] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Empirical studies have identified deficits in cognitive and affective theory of mind (ToM) in patients with borderline personality disorder (BPD), but results remain heterogeneous and not much is known about the role of childhood trauma. The current study assessed cognitive and affective ToM in 80 patients with BPD and 41 healthy controls in a false-belief cartoon task. Childhood trauma was measured with the Childhood Trauma Questionnaire (CTQ). Patients with BPD responded slower in all experimental conditions in false-belief situations, but not when false beliefs were resolved; made more errors in the cognitive ToM condition; and reported worse affective states more often in and after false-belief situations. No significant correlations between ToM and childhood trauma could be found. The current study revealed deficits in cognitive and affective ToM in patients with BPD that may be related to a more negative affective state raised by the false-belief stories.
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Affiliation(s)
- Karen Hillmann
- Department of General Psychiatry, Heidelberg University, Germany
| | - Corinne Neukel
- Department of General Psychiatry, Heidelberg University, Germany
| | - Marlene Krauch
- Department of General Psychiatry, Heidelberg University, Germany.,Central Institute of Mental Health, Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty Mannheim/Heidelberg University, Germany
| | - Angelika Spohn
- Central Institute of Mental Health, Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty Mannheim/Heidelberg University, Germany
| | - Knut Schnell
- Asklepios Center for Psychiatry and Psychotherapy Göttingen, Göttingen, Germany
| | | | - Katja Bertsch
- Department of General Psychiatry, Heidelberg University, Germany
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