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Müller JC, Walter C, Leibold N, Wiedemann K, Kellner M, Demiralay C. Copeptin response to panic provocation with CO 2 in healthy adults. J Psychiatr Res 2023; 165:225-232. [PMID: 37517243 DOI: 10.1016/j.jpsychires.2023.07.006] [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: 05/28/2023] [Revised: 06/27/2023] [Accepted: 07/06/2023] [Indexed: 08/01/2023]
Abstract
Repeated panic attacks are the core symptom of panic disorder and severely stressful for patients. Additional to the psychological response, the physiological symptoms are an important aspect of the experienced panic. However, data on the extent of hypothalamic-pituitary-adrenal (HPA)-axis activation during panic attacks is inconsistent. Therefore, in the present study, we aimed at investigating the stress-axis activity in more detail by including Copeptin (CoP) as a stable surrogate parameter for the vasopressinergic hypothalamic activity during experimentally induced panic attacks in healthy adults (N = 21). During a placebo-controlled panic challenge with 35% CO2 compared to normal air inhalation, we measured CoP and the peripheral effector hormones Adrenocorticotropic Releasing Hormone (ACTH) and cortisol in plasma along with the psychological response to panic anxiety. We analyzed hormonal secretion patterns, their correlations and individual panic ratings over time and explored differences between female and male participants. We found a significant CO2-induced increase of CoP plasma levels and psychological panic symptoms after CO2-administration, while no positive correlations of CoP levels with the peripheral HPA-axis hormones and with panic symptoms were present. No differences between female and male participants concerning their psychological response nor their baseline CoP levels, the release of CoP or its increase during the experiment were found. CoP could be a sensitive indicator for an organism's physiologic acute hypothalamic response during stress and panic attacks.
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Affiliation(s)
- Jana Christina Müller
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martini Straße 52, 20251, Hamburg, Germany.
| | - Charlotte Walter
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martini Straße 52, 20251, Hamburg, Germany
| | - Nicole Leibold
- Department of Psychiatry and Neuropsychology, Maastricht University, P.O. Box 616 (location Vijverdal), 6200, MD, Maastricht, Netherlands
| | - Klaus Wiedemann
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martini Straße 52, 20251, Hamburg, Germany
| | - Michael Kellner
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martini Straße 52, 20251, Hamburg, Germany; Department of Psychiatry and Psychotherapy, University Hospital rechts der Isar, Technical University Munich, Ismaninger Straße 22, 81675, München, Germany
| | - Cüneyt Demiralay
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martini Straße 52, 20251, Hamburg, Germany; Oberberg Tagesklinik Hamburg, Hermannstraße, 20095, Hamburg, Germany
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Agorastos A, Heinig A, Sommer A, Wiedemann K, Demiralay C. Morning salivary dehydroepiandrosterone (DHEA) qualifies as the only neuroendocrine biomarker separating depressed patients with and without prior history of depression: An HPA axis challenge study. J Psychiatr Res 2023; 161:449-454. [PMID: 37059029 DOI: 10.1016/j.jpsychires.2023.04.003] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 04/05/2023] [Indexed: 04/16/2023]
Abstract
BACKGROUND Hypothalamic-pituitary-adrenal (HPA) axis abnormalities in major depression (MDD) have been consistently reported in psychiatry and extend to several neurosteroids. However, recurrence and chronicity may heavily influence HPA axis dynamics in MDD along its course and also explain conflicting results in literature. Thus, the mechanistic understanding of HPA axis (re)activity changes over time could be of major importance for unravelling the dynamic pathophysiology of MDD. METHODS This study simultaneously assessed several baseline and dynamic HPA-axis-related endocrine biomarkers in both saliva (dehydroepiandrosterone, DHEA; sulfated DHEA, DHEA-s; cortisol, CORT) and plasma (CORT; adrenocorticotropic hormone, ACTH; copeptin, CoP) over three consecutive days using overnight HPA axis stimulation (metyrapone) and suppression (dexamethasone) challenges in order to investigate differences between antidepressant-free MDD patients (n = 14) with and without history of prior depressive episodes (i.e., first vs. recurrent episode). RESULTS Our results suggest group differences only with respect to saliva DHEA levels, with recurrent-episode MDD patients showing overall lower saliva DHEA levels across the three days, and statistically significant differences mainly at day 1 (baseline) across all three timepoints (awakening, +30 min, +60 min), even after adjustment for confounders. CONCLUSIONS Our study supports that salivary DHEA levels could represent a significant biomarker of MDD progression and individual stress resilience. DHEA deserves additional attention in the research of pathophysiology, staging and individualized treatment of MDD. Prospective longitudinal studies are needed to evaluate HPA axis reactivity along MDD course and progression to better understand temporal effects on stress-system-related alterations, related phenotypes and appropriate treatment.
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Affiliation(s)
- Agorastos Agorastos
- II. Department of Psychiatry, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, GR-54124, Thessaloniki, Greece; Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, D-20246, Hamburg, Germany; VA Center of Excellence for Stress and Mental Health (CESAMH), VA San Diego Healthcare System, CA, 29161, San Diego, USA.
| | - Alexandra Heinig
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, D-20246, Hamburg, Germany
| | - Anne Sommer
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, D-20246, Hamburg, Germany
| | - Klaus Wiedemann
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, D-20246, Hamburg, Germany
| | - Cüneyt Demiralay
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, D-20246, Hamburg, Germany
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Brasanac J, Ramien C, Gamradt S, Taenzer A, Glau L, Ritter K, Patas K, Agorastos A, Wiedemann K, Demiralay C, Fischer F, Otte C, Bellmann-Strobl J, Friese MA, Tolosa E, Paul F, Heesen C, Weygandt M, Gold SM. Immune signature of multiple sclerosis-associated depression. Brain Behav Immun 2022; 100:174-182. [PMID: 34863857 DOI: 10.1016/j.bbi.2021.11.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 11/18/2021] [Accepted: 11/29/2021] [Indexed: 12/11/2022] Open
Abstract
Multiple neurobiological pathways have been implicated in the pathobiology of major depressive disorder (MDD). The identification of reliable biological substrates across the entire MDD spectrum, however, is hampered by a vast heterogeneity in the clinical presentation, presumably as a consequence of heterogeneous pathobiology. One way to overcome this limitation could be to explore disease subtypes based on biological similarity such as "inflammatory depression". As such a subtype may be particularly enriched in depressed patients with an underlying inflammatory condition, multiple sclerosis (MS) could provide an informative disease context for this approach. Few studies have explored immune markers of MS-associated depression and replications are missing. To address this, we analyzed data from two independent case-control studies on immune signatures of MS-associated depression, conducted at two different academic MS centers (overall sample size of n = 132). Using a stepwise data-driven approach, we identified CD4+CCR7lowTCM cell frequencies as a robust correlate of depression in MS. This signature was associated with core symptoms of depression and depression severity (but not MS severity per se) and linked to neuroinflammation as determined by magnetic resonance imaging (MRI). Furthermore, exploratory analyses of T cell polarization revealed this was largely driven by cells with a TH1-like phenotype. Our findings suggest (neuro)immune pathways linked to affective symptoms of autoimmune disorders such as MS, with potential relevance for the understanding of "inflammatory" subtypes of depression.
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Affiliation(s)
- Jelena Brasanac
- Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt Universität zu Berlin, Berlin Institute of Health (BIH), Klinik für Psychiatrie und Psychotherapie, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany; Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt Universität zu Berlin, Berlin Institute of Health (BIH), NeuroCure Clinical Research Center (NCRC), Charité Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany; Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Campus Buch, Lindenberger Weg 80, 13125 Berlin, Germany
| | - Caren Ramien
- Institut für Neuroimmunologie und Multiple Sklerose (INIMS), Universitätsklinikum Hamburg-Eppendorf, Falkenried, 94, 20251 Hamburg, Germany
| | - Stefanie Gamradt
- Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt Universität zu Berlin, Berlin Institute of Health (BIH), Klinik für Psychiatrie und Psychotherapie, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Aline Taenzer
- Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt Universität zu Berlin, Berlin Institute of Health (BIH), Klinik für Psychiatrie und Psychotherapie, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Laura Glau
- Department of Immunology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Kristin Ritter
- Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt Universität zu Berlin, Berlin Institute of Health (BIH), Klinik für Psychiatrie und Psychotherapie, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Kostas Patas
- Laboratory of Biopathology and Immunology, Eginition University Hospital, Ave. Vassilissis Sophias, 72-74, 115 28 Athens, Greece
| | - Agorastos Agorastos
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Hamburg-Eppendorf, Martinistraße, 52, 20246 Hamburg, Germany; II. Department of Psychiatry, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Lagkada Str, 196, 56430 Thessaloniki, Greece
| | - Klaus Wiedemann
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Hamburg-Eppendorf, Martinistraße, 52, 20246 Hamburg, Germany
| | - Cüneyt Demiralay
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Hamburg-Eppendorf, Martinistraße, 52, 20246 Hamburg, Germany
| | - Felix Fischer
- Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt Universität zu Berlin, Berlin Institute of Health (BIH), Medizinische Klinik m.S. Psychosomatik, Campus Benjamin Franklin, Hindenburgdamm, 30, 12203 Berlin, Germany
| | - Christian Otte
- Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt Universität zu Berlin, Berlin Institute of Health (BIH), Klinik für Psychiatrie und Psychotherapie, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Judith Bellmann-Strobl
- Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt Universität zu Berlin, Berlin Institute of Health (BIH), NeuroCure Clinical Research Center (NCRC), Charité Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany; Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Campus Buch, Lindenberger Weg 80, 13125 Berlin, Germany
| | - Manuel A Friese
- Institut für Neuroimmunologie und Multiple Sklerose (INIMS), Universitätsklinikum Hamburg-Eppendorf, Falkenried, 94, 20251 Hamburg, Germany
| | - Eva Tolosa
- Department of Immunology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Friedemann Paul
- Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt Universität zu Berlin, Berlin Institute of Health (BIH), NeuroCure Clinical Research Center (NCRC), Charité Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany; Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Campus Buch, Lindenberger Weg 80, 13125 Berlin, Germany
| | - Christoph Heesen
- Institut für Neuroimmunologie und Multiple Sklerose (INIMS), Universitätsklinikum Hamburg-Eppendorf, Falkenried, 94, 20251 Hamburg, Germany
| | - Martin Weygandt
- Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt Universität zu Berlin, Berlin Institute of Health (BIH), NeuroCure Clinical Research Center (NCRC), Charité Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany; Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Campus Buch, Lindenberger Weg 80, 13125 Berlin, Germany
| | - Stefan M Gold
- Institut für Neuroimmunologie und Multiple Sklerose (INIMS), Universitätsklinikum Hamburg-Eppendorf, Falkenried, 94, 20251 Hamburg, Germany; Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt Universität zu Berlin, Berlin Institute of Health (BIH), Klinik für Psychiatrie und Psychotherapie, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany; Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt Universität zu Berlin, Berlin Institute of Health (BIH), Medizinische Klinik m.S. Psychosomatik, Campus Benjamin Franklin, Hindenburgdamm, 30, 12203 Berlin, Germany.
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Agorastos A, Heinig A, Wiedemann K, Demiralay C. Inverse autonomic stress reactivity in depressed patients with and without prior history of depression. Eur Psychiatry 2021. [PMCID: PMC9471622 DOI: 10.1192/j.eurpsy.2021.870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Introduction There is a considerable association between major depressive disorder (MDD) and cardiovascular disease, most possibly relying on abnormalities in the autonomic nervous system (ANS)-related cardiac reactivity, although the exact underlying pathophysiological pathway is unclear. Objectives This study tends to shed some additional light on this background by investigating ANS reactivity in MDD with respect to previous depression history through an objective stress challenge paradigm. Methods The study assessed the effects of an overnight hypothalamus-pituitary-adrenal (HPA) axis stimulation with metyrapone (MET) on baseline ANS activity through linear and non-linear heart rate variability (HRV) measures in the morning of two continuous days in a group of 14 physically healthy, antidepressant-free patients with clinical, non-psychotic MDD, to investigate differences in autonomic reactivity with respect to prior MDD history. Results The main findings of this study include statistically significant time x group interactions with respect to several HRV measures, suggesting substantial differences on autonomic reactivity between patients with and without depression history. Hereby, recurrent-episode MDD patients showed lower vagal activity, while first-episode MDD patients increased PNS activity after HPA axis stimulation. Conclusions These findings indicate that HPA axis stimulation in MDD patients leads to inverse vagal response according to MDD history. We suggest that chronic stress system overactivation, as found in MDD, might lead to a progressive inversion of the original stress response through HPA axis and ANS divergence over the course of a recurrent illness. HRV could, thus, represent a significant biomarker in MDD with temporal sensitivity.
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Agorastos A, Sommer A, Wiedemann K, Demiralay C. Vasopressin surrogate marker copeptin as a potential novel endocrine biomarker for antidepressant treatment response in major depression: A pilot study. Eur Psychiatry 2021. [PMCID: PMC9470906 DOI: 10.1192/j.eurpsy.2021.1213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
IntroductionMajor depressive disorder (MDD) constitutes the leading cause of disability worldwide. Although efficacious antidepressant pharmacotherapies exist for MDD, only about 40-60% of the patients respond to initial treatment. However, there is still a lack of robustly established and applicable biomarkers for antidepressant response in everyday clinical practice.ObjectivesThis study targets the assessment of the vasopressin (AVP) surrogate marker Copeptin (CoP), as a potential peripheral hypothalamic-level biomarker of antidepressant treatment response in MDD.MethodsWe measured baseline and dynamic levels of plasma CoP along with plasma ACTH and cortisol (CORT) in drug-naive outpatients with MDD before and after overnight manipulation of the hypothalamic-pituitary-adrenal (HPA) axis [i.e., stimulation (metyrapone) and suppression (dexamethasone)] on three consecutive days and their association with treatment response to 4 weeks of escitalopram treatment.ResultsOur findings suggest significantly higher baseline and post-metyrapone plasma CoP levels in future non-responders, a statistically significant invert association between baseline CoP levels and probability of treatment response and a potential baseline plasma CoP cut-off level of above 2.9 pmol/L for future non-response screening. Baseline and dynamic plasma ACTH and CORT levels showed no association with treatment response.ConclusionsThis pilot study provide first evidence in humans that CoP may represent a novel, clinically easily applicable, endocrine biomarker of antidepressant response, based on a single-measurement, cut-off level. These findings, underline the role of the vasopressinergic system in the pathophysiology of MDD and may represent a significant new tool in the clinical and biological phenotyping of MDD enhancing individual-tailored therapies.
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Miegel F, Demiralay C, Sure A, Moritz S, Hottenrott B, Cludius B, Jelinek L. The Metacognitive Training for obsessive-compulsive disorder: A pilot study. Curr Psychol 2020. [DOI: 10.1007/s12144-020-01158-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
AbstractMore than 50% of patients with obsessive-compulsive disorder (OCD) do not receive first-line psychological treatment such as cognitive-behavioral therapy with exposure and response prevention. To narrow this treatment gap, there is an urgent need for therapies that are easy to disseminate and highly accepted by patients. The aim of the present pilot study was to evaluate the effectiveness of the Metacognitive Group Training for OCD (MCT-OCD). Fifty patients with OCD participated in the MCT-OCD for 4 weeks during their inpatient stay in a single-arm pilot trial. Patients were assessed before and after the intervention and filled out an online survey 6 months after post assessment. Results showed a decrease in obsessive compulsive symptoms according to the Yale-Brown Obsessive Compulsive Scale (primary outcome) from baseline to post assessment with a large effect size. Symptom reduction remained stable over 6 months and was positively correlated with appraisal ratings of the training. The reduction in frequency of obsessive compulsive symptoms, distress due to obsessive compulsive symptoms, cognitive biases, and depressive symptoms remained stable over 6 months after the intervention. Our findings tentatively imply that the MCT-OCD is a promising treatment for OCD patients. A randomized controlled trial is thus warranted to further clarify the efficacy of the MCT-OCD. Trial Registration: German Clinical Trials Register (DRKS-ID: DRKS00012531), date of registration: 16.06.2017.
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Miegel F, Cludius B, Hottenrott B, Demiralay C, Jelinek L. Session-specific effects of the Metacognitive Group Training for Obsessive-Compulsive Disorder: significant results for thought control. Sci Rep 2020; 10:17816. [PMID: 33082393 PMCID: PMC7576173 DOI: 10.1038/s41598-020-73122-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 09/04/2020] [Indexed: 12/16/2022] Open
Abstract
The investigation of the session-specific effects is central for the understanding of psychological interventions. For the present study, we investigated the session-specific effects of the Metacognitive Group Training for Obsessive–Compulsive Disorder (MCT-OCD), which was revised based on data of a pilot study. Thirty-four outpatients with OCD participated in the MCT-OCD once a week over 8 weeks. Different metacognitive beliefs (e.g., thought control) and cognitive beliefs (e.g., intolerance of uncertainty), OC symptoms, as well as associated comorbid symptoms were assessed before and after each session. Linear mixed effects models showed that patients’ obsessions and compulsions, thought control, the belief of being well informed about the disorder, and action fusion improved over the course of the training. The only session-specific effect emerged for thought control, which improved immediately after the respective module. We were able to replicate the findings of the pilot study and thus corroborate the session-specific effect of the module targeting thought control. Moreover, we generated information on the mode of action of the individual modules of the MCT-OCD that allows a more in-depth evaluation of the intervention. Notably, we were able to eliminate the adverse effects of the pilot version of the MCT-OCD. Trial Registration: German Clinical Trials Register (Deutsches Register Klinischer Studien [DRKS]; DRKS-ID: DRKS00013539; registration date: 22/02/2018).
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Affiliation(s)
- Franziska Miegel
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
| | - Barbara Cludius
- LMU Munich, Department of Psychology, Clinical Psychology and Psychotherapy, Munich, Germany
| | - Birgit Hottenrott
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Cüneyt Demiralay
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Lena Jelinek
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
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Miegel F, Demiralay C, Moritz S, Wirtz J, Hottenrott B, Jelinek L. Metacognitive Training for Obsessive-Compulsive Disorder: a study protocol for a randomized controlled trial. BMC Psychiatry 2020; 20:350. [PMID: 32631261 PMCID: PMC7336399 DOI: 10.1186/s12888-020-02648-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 05/04/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND A high number of patients with obsessive-compulsive disorder (OCD) do not receive cognitive-behavioral therapy with exposure and response prevention, which is the most effective treatment for OCD. Therefore, Metacognitive Training for OCD (MCT-OCD) was developed, which is a structured group therapy aiming at the modification of dysfunctional (meta-)cognitive biases, beliefs and coping styles. It can be administered by less trained personnel, thus may reach a higher number of patients. An uncontrolled pilot study (MCT-OCD pilot version) provided first evidence that the training is highly accepted by patients; OC symptoms decreased with a high effect size (η2partial = 0.50). The aim of the present study is to address the shortcomings of the pilot study (e.g., no control group) and to assess the efficacy of the revised version of the MCT-OCD in the framework of a randomized controlled trial. METHODS Eighty patients with OCD will be recruited. After a blinded assessment at baseline (-t1), patients will be randomly assigned either to the intervention group (MCT-OCD; n = 40) or to a care as usual control group (n = 40). The MCT-OCD aims to enhance patients' metacognitive competence in eight modules by addressing dysfunctional (meta-)cognitive biases and beliefs associated with OCD (e.g., intolerance of uncertainty). After 8 weeks, patients will be invited to a post assessment (t1), and then they will receive a follow-up online questionnaire 3 months following t1 (t2). The primary outcome is the Y-BOCS total score, and the secondary outcomes include the HDRS, OCI-R, OBQ-44, MCQ-30, WHOQOL-BREF, BDI-II, and subjective appraisal ratings of the MCT-OCD. We expect that OC symptoms will decrease more in the intervention group compared with the care as usual control group from -t1 to t1 and that treatment gains will be maintained until t2. DISCUSSION The planned study is the first to investigate the MCT-OCD, a promising new treatment, in a randomized controlled trial. The MCT-OCD may help to overcome existing treatment barriers for patients with OCD. TRIAL REGISTRATION German Registry for Clinical Studies ( DRKS00013539 ), 22.02.2018.
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Affiliation(s)
- Franziska Miegel
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
| | - Cüneyt Demiralay
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Janina Wirtz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Birgit Hottenrott
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Lena Jelinek
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
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Abstract
AbstractSeveral studies have stressed a correlation between difficulties in acculturation and mental distress or even mental disorders. The stress related to the process of acculturation can lead to depressive symptoms by way of changes in the activity of the HPA axis. However, it remains difficult to measure acculturation stress, as difficulties in acculturation strongly depend on subjective interpretations of every day experiences. The association between acculturation stress and mental distress was examined in two different migrant groups in Germany, 202 migrants of Russian and 100 of Iranian origin. In both migrant groups a significant correlation between acculturation stress and mental distress was found, yet no significant association between acculturation stress and length of residency in Germany. These findings will have to be replicated with representative samples and also with other migrant groups, both in and out of treatment. Considering the fact that the Russian sample was younger and nonetheless had relatively high acculturation stress scores, prevention of future mental health problems among migrants will have to focus on easing the process of integration into the host society.
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Agorastos A, Sommer A, Heinig A, Wiedemann K, Demiralay C. Vasopressin Surrogate Marker Copeptin as a Potential Novel Endocrine Biomarker for Antidepressant Treatment Response in Major Depression: A Pilot Study. Front Psychiatry 2020; 11:453. [PMID: 32508691 PMCID: PMC7251160 DOI: 10.3389/fpsyt.2020.00453] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 05/05/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Major depressive disorder (MDD) constitutes the leading cause of disability worldwide. Although efficacious antidepressant pharmacotherapies exist for MDD, only about 40-60% of the patients respond to initial treatment. However, there is still a lack of robustly established and applicable biomarkers for antidepressant response in everyday clinical practice. OBJECTIVE This study targets the assessment of the vasopressin (AVP) surrogate marker Copeptin (CoP), as a potential peripheral hypothalamic-level biomarker of antidepressant treatment response in MDD. METHODS We measured baseline and dynamic levels of plasma CoP along with plasma ACTH and cortisol (CORT) in drug-naive outpatients with MDD before and after overnight manipulation of the hypothalamic-pituitary-adrenal (HPA) axis [i.e., stimulation (metyrapone) and suppression (dexamethasone)] on three consecutive days and their association with treatment response to 4 weeks of escitalopram treatment. RESULTS Our findings suggest significantly higher baseline and post-metyrapone plasma CoP levels in future non-responders, a statistically significant invert association between baseline CoP levels and probability of treatment response and a potential baseline plasma CoP cut-off level of above 2.9 pmol/L for future non-response screening. Baseline and dynamic plasma ACTH and CORT levels showed no association with treatment response. CONCLUSIONS This pilot study provide first evidence in humans that CoP may represent a novel, clinically easily applicable, endocrine biomarker of antidepressant response, based on a single-measurement, cut-off level. These findings, underline the role of the vasopressinergic system in the pathophysiology of MDD and may represent a significant new tool in the clinical and biological phenotyping of MDD enhancing individual-tailored therapies.
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Affiliation(s)
- Agorastos Agorastos
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Psychiatry, Division of Neurosciences, Faculty of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece.,VA Center of Excellence for Stress and Mental Health (CESAMH), VA San Diego Healthcare System, San Diego, CA, United States
| | - Anne Sommer
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alexandra Heinig
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Klaus Wiedemann
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Cüneyt Demiralay
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Wallrath MK, Rubel J, Ohls I, Demiralay C, Hechler T. Bottom‐up or top‐down?: The role of child and parent chronic pain and anxiety in the context of parental catastrophizing and solicitousness. Eur J Pain 2019; 24:604-616. [DOI: 10.1002/ejp.1512] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 10/08/2019] [Accepted: 11/22/2019] [Indexed: 11/08/2022]
Affiliation(s)
- Maren K. Wallrath
- Department of Clinical Psychology and Psychotherapy for Children and Adolescents University of Trier Trier Germany
| | - Julian Rubel
- Department of Psychology Justus‐Liebig‐University Gießen Gießen Germany
| | - Isgard Ohls
- Department of Psychiatry and Psychotherapy University Medical Center Hamburg‐Eppendorf Hamburg Germany
| | - Cüneyt Demiralay
- Department of Psychiatry and Psychotherapy University Medical Center Hamburg‐Eppendorf Hamburg Germany
| | - Tanja Hechler
- Department of Clinical Psychology and Psychotherapy for Children and Adolescents University of Trier Trier Germany
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Miegel F, Cludius B, Hottenrott B, Demiralay C, Sure A, Jelinek L. Session-specific effects of the Metacognitive Training for Obsessive-Compulsive Disorder (MCT-OCD). Psychother Res 2019; 30:474-486. [PMID: 31072282 DOI: 10.1080/10503307.2019.1613582] [Citation(s) in RCA: 5] [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] [Indexed: 01/04/2023] Open
Abstract
Objective: Most studies focus on overall treatment effects by assessing symptom severity before and after treatment, but few investigate session-specific effects of an intervention. The aim of the present study was to elucidate session-specific effects of a group therapy for obsessive-compulsive disorder (OCD) that targets cognitive biases known as the Metacognitive Training for OCD (MCT-OCD).Method: In an uncontrolled pilot trial, 44 inpatients with OCD participated in the MCT-OCD once a week over four weeks. Before and after each session, patients answered questionnaires on thought monitoring, control of thoughts, obsessions, compulsions, and mood.Results: Primary analyses using linear mixed-effect models showed that the module on control of thoughts (within-session effect) significantly reduced patients' control of thoughts. Exploratory analyses displayed an improvement in thought monitoring, control of thoughts, obsessions, and compulsions over the treatment period. Control of thoughts decreaed after the module on biased attention/biased cognitive networks and compulsions reduced one week after the module on overestimation of threat/responsibility (between-session effect). More compulsions were reported one week after the module on thought-action fusion/control of thoughts.Conclusions: Certain MCT-OCD modules seemed to improve specific cognitive biases that might in turn act as mechanisms of change. The results are being used to revise the MCT-OCD.
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Affiliation(s)
- Franziska Miegel
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Barbara Cludius
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Birgit Hottenrott
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Cüneyt Demiralay
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anna Sure
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lena Jelinek
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Agorastos A, Heinig A, Stiedl O, Hager T, Sommer A, Müller JC, Schruers KR, Wiedemann K, Demiralay C. Vagal effects of endocrine HPA axis challenges on resting autonomic activity assessed by heart rate variability measures in healthy humans. Psychoneuroendocrinology 2019; 102:196-203. [PMID: 30579237 DOI: 10.1016/j.psyneuen.2018.12.017] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [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: 09/24/2018] [Revised: 11/26/2018] [Accepted: 12/12/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND The hypothalamic-pituitary-adrenal axis (HPA axis) and the autonomic nervous system (ANS) are considered to play the most crucial role in the pathophysiology of stress responsiveness and are increasingly studied together. However, only few studies have simultaneously assessed HPA axis and ANS activity to investigate their direct interaction in pathophysiology, while no study so far has assessed the dynamic interplay between the two systems in healthy subjects through endocrine challenges. METHODS The present study assessed the direct effects of overnight pharmacoendocrine HPA axis challenges with dexamethasone (suppression) and metyrapone (stimulation) on ANS activity at rest as determined by linear and nonlinear measures of heart rate variability (HRV) in 39 young healthy individuals. RESULTS Findings indicated significant effects of metyrapone, but not dexamethasone on autonomic activity at rest based on HRV measures. HRV after metyrapone was overall significantly reduced in comparison to baseline or post-dexamethasone conditions, while the combined metyrapone-related reduction of HRV measures RMSSD, NN50(%) and HF(%) with concomitant increase of the unifractal scaling coefficient αfast value jointly indicated a specifically diminished vagal activity. CONCLUSIONS We provide first data that HPA axis stimulation (metyrapone) is associated with reduced vagal tone, while HPA axis suppression (dexamethasone) has no effect on autonomic modulation of heart function. Our results support a vital role of the parasympathetic nervous system in the interplay between ANS and HPA axis and, thus, in the modulation of stress-related cardiovascular responsiveness and the susceptibility to stress-related disorders.
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Affiliation(s)
- Agorastos Agorastos
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, D-20246, Hamburg, Germany; Department of Psychiatry, Division of Neurosciences, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, GR-54124, Thessaloniki, Greece.
| | - Alexandra Heinig
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, D-20246, Hamburg, Germany
| | - Oliver Stiedl
- Center for Neurogenomics and Cognitive Research, VU University Amsterdam, NL-1081, HV, Amsterdam, the Netherlands; Department of Health, Safety and Environment, VU University Amsterdam, NL-1081, BT, Amsterdam, the Netherlands
| | - Torben Hager
- Center for Neurogenomics and Cognitive Research, VU University Amsterdam, NL-1081, HV, Amsterdam, the Netherlands
| | - Anne Sommer
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, D-20246, Hamburg, Germany
| | - Jana C Müller
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, D-20246, Hamburg, Germany
| | - Koen R Schruers
- School of Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, NL-6200 MD, Maastricht, the Netherlands
| | - Klaus Wiedemann
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, D-20246, Hamburg, Germany
| | - Cüneyt Demiralay
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, D-20246, Hamburg, Germany
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Jelinek L, Zielke L, Hottenrott B, Miegel F, Cludius B, Sure A, Demiralay C. Patients’ Perspectives on Treatment with Metacognitive Training for OCD. Zeitschrift für Neuropsychologie 2018. [DOI: 10.1024/1016-264x/a000211] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Abstract. There is much room for improvement in the treatment of obsessive-compulsive disorder (OCD). The current study introduces a newly developed version of Metacognitive Training for OCD (MCT-OCD), inspired by the self-help intervention myMCT as well as by MCT group programs for other disorders. The current study examines the acceptability of the training. Forty-four patients with OCD received four sessions of MCT-OCD in addition to inpatient treatment. At post assessment, patients provided a subjective appraisal of the training. Analyses revealed high acceptability and added value of the MCT-OCD. The current, preliminary version of the MCT-OCD is promising in terms of patient acceptance. Results will be used to improve current shortcomings of the training and to develop a more comprehensive MCT-OCD.
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Affiliation(s)
- Lena Jelinek
- University Medical Center Hamburg-Eppendorf, Department of Psychiatry and Psychotherapy, Germany
- joint first authors
| | - Lotta Zielke
- University Medical Center Hamburg-Eppendorf, Department of Psychiatry and Psychotherapy, Germany
- joint first authors
| | - Birgit Hottenrott
- University Medical Center Hamburg-Eppendorf, Department of Psychiatry and Psychotherapy, Germany
| | - Franziska Miegel
- University Medical Center Hamburg-Eppendorf, Department of Psychiatry and Psychotherapy, Germany
| | - Barbara Cludius
- University Medical Center Hamburg-Eppendorf, Department of Psychiatry and Psychotherapy, Germany
| | - Anna Sure
- University Medical Center Hamburg-Eppendorf, Department of Psychiatry and Psychotherapy, Germany
| | - Cüneyt Demiralay
- University Medical Center Hamburg-Eppendorf, Department of Psychiatry and Psychotherapy, Germany
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Patas K, Willing A, Demiralay C, Engler JB, Lupu A, Ramien C, Schäfer T, Gach C, Stumm L, Chan K, Vignali M, Arck PC, Friese MA, Pless O, Wiedemann K, Agorastos A, Gold SM. T Cell Phenotype and T Cell Receptor Repertoire in Patients with Major Depressive Disorder. Front Immunol 2018. [PMID: 29515587 PMCID: PMC5826233 DOI: 10.3389/fimmu.2018.00291] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
While a link between inflammation and the development of neuropsychiatric disorders, including major depressive disorder (MDD) is supported by a growing body of evidence, little is known about the contribution of aberrant adaptive immunity in this context. Here, we conducted in-depth characterization of T cell phenotype and T cell receptor (TCR) repertoire in MDD. For this cross-sectional case–control study, we recruited antidepressant-free patients with MDD without any somatic or psychiatric comorbidities (n = 20), who were individually matched for sex, age, body mass index, and smoking status to a non-depressed control subject (n = 20). T cell phenotype and repertoire were interrogated using a combination of flow cytometry, gene expression analysis, and next generation sequencing. T cells from MDD patients showed significantly lower surface expression of the chemokine receptors CXCR3 and CCR6, which are known to be central to T cell differentiation and trafficking. In addition, we observed a shift within the CD4+ T cell compartment characterized by a higher frequency of CD4+CD25highCD127low/− cells and higher FOXP3 mRNA expression in purified CD4+ T cells obtained from patients with MDD. Finally, flow cytometry-based TCR Vβ repertoire analysis indicated a less diverse CD4+ T cell repertoire in MDD, which was corroborated by next generation sequencing of the TCR β chain CDR3 region. Overall, these results suggest that T cell phenotype and TCR utilization are skewed on several levels in patients with MDD. Our study identifies putative cellular and molecular signatures of dysregulated adaptive immunity and reinforces the notion that T cells are a pathophysiologically relevant cell population in this disorder.
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Affiliation(s)
- Kostas Patas
- Institut für Neuroimmunologie und Multiple Sklerose (INIMS), Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Anne Willing
- Institut für Neuroimmunologie und Multiple Sklerose (INIMS), Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Cüneyt Demiralay
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Jan Broder Engler
- Institut für Neuroimmunologie und Multiple Sklerose (INIMS), Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Andreea Lupu
- Institut für Neuroimmunologie und Multiple Sklerose (INIMS), Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany.,Immunomodulation Group, Cantacuzino National Research Institute, Bucharest, Romania
| | - Caren Ramien
- Institut für Neuroimmunologie und Multiple Sklerose (INIMS), Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | | | | | - Laura Stumm
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Kenneth Chan
- Adaptive Biotechnologies, Seattle, WA, Unites States
| | | | - Petra C Arck
- Experimentelle Feto-Maternale Medizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Manuel A Friese
- Institut für Neuroimmunologie und Multiple Sklerose (INIMS), Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Ole Pless
- Fraunhofer IME ScreeningPort, Hamburg, Germany
| | - Klaus Wiedemann
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Agorastos Agorastos
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan M Gold
- Institut für Neuroimmunologie und Multiple Sklerose (INIMS), Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany.,Charité - Universitätsmedizin Berlin, Humboldt Universität zu Berlin, Berlin Institute of Health (BIH), Klinik für Psychiatrie und Psychotherapie, Campus Benjamin Franklin (CBF), Berlin, Germany
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16
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Demiralay C, Agorastos A, Yassouridis A, Jahn H, Wiedemann K, Kellner M. Copeptin - A potential endocrine surrogate marker of CCK-4-induced panic symptoms? Psychoneuroendocrinology 2017; 76:14-18. [PMID: 27871026 DOI: 10.1016/j.psyneuen.2016.11.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 11/05/2016] [Accepted: 11/05/2016] [Indexed: 11/24/2022]
Abstract
Intravenous cholecystokinin-tetrapeptide (CCK-4) administration reliably and dose-dependently provokes panic anxiety in man, accompanied by adrenocorticotropic hormone (ACTH) and cortisol release. Preclinical findings suggest that behavioral and endocrine effects of CCK-4 are mediated via corticotropin-releasing hormone (CRH) release. Anxiogenic stimulation of the central CCK-receptors in man was shown to increase as well vasopressin (AVP), which acts synergistically with CRH as pituitary-adrenocortical axis stimulator during stress. Copeptin (CoP), the C-terminal part of pre-pro-AVP, is released in an equimolar ratio to AVP. It is more stable in the circulation and easier to determine than AVP and it was found to closely mirror the production of AVP. So far, CoP secretion has not been characterized during panic provocation. In 30 healthy male human subjects, we repeatedly measured CoP in plasma during a panic challenge and studied its correlation to Acute Panic Inventory (API) ratings and plasma ACTH and cortisol. CoP levels correlated positively with the increase in API ratings (r=0.41, p=0.03), while ACTH or cortisol did not (r=0.08, p=0.68 and r=0.12, p=0.53, respectively). CoP levels correlated also positively with ACTH (r=0.48, p=0.009) and cortisol (r=0.48, p=0.01) concentrations throughout the CCK-4 challenge. As expected, we found a positive correlation between plasma ACTH and cortisol levels (r=0.57, p=0.001). A vasopressinergic activation during CCK-4 induced panic was demonstrated, which was correlated positively to panic symptoms and pituitary-adrenocortical release. Our findings suggest a role of CoP as a potential surrogate marker of CCK-4 panic symptoms. Further studies are needed to replicate our results and to further clarify the role of CoP as a stress-sensitive hormone in different panic paradigms as well as in panic patients.
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Affiliation(s)
- Cüneyt Demiralay
- University Hospital Hamburg-Eppendorf, Department of Psychiatry and Psychotherapy, Hamburg, Germany.
| | - Agorastos Agorastos
- University Hospital Hamburg-Eppendorf, Department of Psychiatry and Psychotherapy, Hamburg, Germany
| | | | - Holger Jahn
- University Hospital Hamburg-Eppendorf, Department of Psychiatry and Psychotherapy, Hamburg, Germany
| | - Klaus Wiedemann
- University Hospital Hamburg-Eppendorf, Department of Psychiatry and Psychotherapy, Hamburg, Germany
| | - Michael Kellner
- University Hospital Hamburg-Eppendorf, Department of Psychiatry and Psychotherapy, Hamburg, Germany
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Demiralay C, Agorastos A, Jahn H, Kellner M, Yassouridis A, Wiedemann K. Overnight suppression of HPA axis after mineraolocorticoid receptor stimulation: A sleep endocrine study. Psychiatry Res 2015; 227:65-70. [PMID: 25799272 DOI: 10.1016/j.psychres.2015.02.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 01/29/2015] [Accepted: 02/01/2015] [Indexed: 11/19/2022]
Abstract
Nocturnal hyperactivity of hypothalamic-pituitary-adrenal axis (HPA) indicates decreased feedback inhibition with stress-related conditions such as major depression and sleep disorders. To characterize the role of mineralocorticoid (MR) in regulation of HPA axis activity during nocturnal sleep and involvement in sleep architecture, we investigated sleep endocrine effects of the MR agonist fludrocortisone in healthy men after pretreatment with metyrapone to minimize the impact of endogenous cortisol. Subjects (n=8) were treated on three occasions in a single-blinded design in random order with a) metyrapone, b) fludrocortisone after metyrapone, and c) placebo. Polysomnography was recorded and blood samples were drawn for determination of adrenocorticotropic hormone (ACTH) and cortisol during the entire night. After metyrapone administration ACTH was significantly enhanced, while overall nocturnal cortisol secretion remained largely unchanged. Whereas administration of fludrocortisone induced a significant inhibitory effect on basal ACTH and cortisol secretion, no considerable effects on sleep pattern were detectable. While the involvement of MR in sleep regulation needs further study, endocrine findings underline the role of MR in tonic regulation of HPA axis during nocturnal sleep and demonstrate the ability of fludrocortisone to further suppress HPA axis activity overnight. Additional studies would be required to evaluate endocrine and clinical fludrocortisone effects in depressive patients showing HPA hyperactivity.
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Affiliation(s)
- Cüneyt Demiralay
- University Medical Center Hamburg-Eppendorf, Department of Psychiatry and Psychotherapy, Hamburg, Germany.
| | - Agorastos Agorastos
- University Medical Center Hamburg-Eppendorf, Department of Psychiatry and Psychotherapy, Hamburg, Germany
| | - Holger Jahn
- University Medical Center Hamburg-Eppendorf, Department of Psychiatry and Psychotherapy, Hamburg, Germany
| | - Michael Kellner
- University Medical Center Hamburg-Eppendorf, Department of Psychiatry and Psychotherapy, Hamburg, Germany
| | | | - Klaus Wiedemann
- University Medical Center Hamburg-Eppendorf, Department of Psychiatry and Psychotherapy, Hamburg, Germany; Max Planck Institute of Psychiatry, Munich, Germany
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Agorastos A, Kellner M, Stiedl O, Muhtz C, Wiedemann K, Demiralay C. Blunted autonomic reactivity to pharmacological panic challenge under long-term escitalopram treatment in healthy men. Int J Neuropsychopharmacol 2014; 18:pyu053. [PMID: 25522396 PMCID: PMC4376541 DOI: 10.1093/ijnp/pyu053] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Central serotonergic pathways influence brain areas involved in vagal cardiovascular regulation and, thereby, influence sympathetic efferent activity. Selective serotonin reuptake inhibitors (SSRIs) affect multiple serotonergic pathways, including central autonomic pathways. However, only a few studies have assessed SSRI-mediated effects on autonomic reactivity in healthy individuals using heart rate variability (HRV). METHODS The present study assessed the influence of long-term treatment with escitalopram (ESC) on autonomic reactivity to an intravenous application of 50 µg cholecystokinin tetrapeptide (CCK-4) in 30 healthy young men using a double-blind, placebo (PLA)-controlled, randomized, within-subject cross-over design. Main outcome measures were time- and frequency-domain HRV parameters, assessed at both baseline and immediately after CCK-4 application. RESULTS Results showed substantial effects for the treatment × CCK-4 challenge interaction with respect to heart rate (p < 0.001; pη(2) = 0.499), SDNN (p < 0.001; pη(2) = 576), RMSSD (p = 0.015; pη(2) = 194), NN50% (p = 0.008; pη(2) = 0.224), and LF% (p = 0.014; pη(2) = 0.196), and moderate effects with respect HF% (p = 0.099; pη(2) = 0.094), with PLA subjects showing a higher increase in HR and SDNN and a higher decrease in RMSSD, NN50, LF and HF than subjects in the ESC condition. Thus, ESC treatment significantly blunted the autonomic reactivity to CCK-4. Secondary analysis indicated no effect of the 5-HTTLPR polymorphism on CCK-4-induced autonomic response. CONCLUSIONS Our results support findings suggesting an effect of SSRI treatment on autonomic regulation and provide evidence that ESC treatment is associated with blunted autonomic reactivity in healthy men.
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Affiliation(s)
- Agorastos Agorastos
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (Drs Agorastos, Kellner, Muhtz, Wiedemann, and Demiralay); Department of Functional Genomics, Center for Neurogenomics and Cognitive Research, Neuroscience Campus, VU University, Amsterdam, Netherlands (Dr Stiedl); Department of Molecular and Cellular Neurobiology, Center for Neurogenomics and Cognitive Research, Neuroscience Campus, VU University, Amsterdam, Netherlands (Dr Stiedl); Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (Dr Muhtz).
| | - Michael Kellner
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (Drs Agorastos, Kellner, Muhtz, Wiedemann, and Demiralay); Department of Functional Genomics, Center for Neurogenomics and Cognitive Research, Neuroscience Campus, VU University, Amsterdam, Netherlands (Dr Stiedl); Department of Molecular and Cellular Neurobiology, Center for Neurogenomics and Cognitive Research, Neuroscience Campus, VU University, Amsterdam, Netherlands (Dr Stiedl); Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (Dr Muhtz)
| | - Oliver Stiedl
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (Drs Agorastos, Kellner, Muhtz, Wiedemann, and Demiralay); Department of Functional Genomics, Center for Neurogenomics and Cognitive Research, Neuroscience Campus, VU University, Amsterdam, Netherlands (Dr Stiedl); Department of Molecular and Cellular Neurobiology, Center for Neurogenomics and Cognitive Research, Neuroscience Campus, VU University, Amsterdam, Netherlands (Dr Stiedl); Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (Dr Muhtz)
| | - Christoph Muhtz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (Drs Agorastos, Kellner, Muhtz, Wiedemann, and Demiralay); Department of Functional Genomics, Center for Neurogenomics and Cognitive Research, Neuroscience Campus, VU University, Amsterdam, Netherlands (Dr Stiedl); Department of Molecular and Cellular Neurobiology, Center for Neurogenomics and Cognitive Research, Neuroscience Campus, VU University, Amsterdam, Netherlands (Dr Stiedl); Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (Dr Muhtz)
| | - Klaus Wiedemann
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (Drs Agorastos, Kellner, Muhtz, Wiedemann, and Demiralay); Department of Functional Genomics, Center for Neurogenomics and Cognitive Research, Neuroscience Campus, VU University, Amsterdam, Netherlands (Dr Stiedl); Department of Molecular and Cellular Neurobiology, Center for Neurogenomics and Cognitive Research, Neuroscience Campus, VU University, Amsterdam, Netherlands (Dr Stiedl); Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (Dr Muhtz)
| | - Cüneyt Demiralay
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (Drs Agorastos, Kellner, Muhtz, Wiedemann, and Demiralay); Department of Functional Genomics, Center for Neurogenomics and Cognitive Research, Neuroscience Campus, VU University, Amsterdam, Netherlands (Dr Stiedl); Department of Molecular and Cellular Neurobiology, Center for Neurogenomics and Cognitive Research, Neuroscience Campus, VU University, Amsterdam, Netherlands (Dr Stiedl); Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (Dr Muhtz)
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Demiralay C, Agorastos A, Steiger A, Wiedemann K. Sleep EEG effects of anti-gluco- and anti-mineralocorticoids in old-aged men: pilot study. Psychiatry Clin Neurosci 2014; 68:383-7. [PMID: 24397408 DOI: 10.1111/pcn.12142] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Revised: 10/04/2013] [Accepted: 11/12/2013] [Indexed: 11/29/2022]
Abstract
AIM Age-related sleep changes have been associated with altered hypothalamic-pituitary-adrenal axis reactivity and impaired feedback inhibition at the glucocorticoid (GR) and mineralocorticoid (MR) receptor level. To further investigate the specific role of this binary receptor system in the elderly, sleep electroencephalogram (EEG) effects of the MR antagonist spironolactone and GR antagonist mifepristone in old-aged men were compared in this pilot study. METHODS Old-aged healthy men (n = 6, 65-91 years) were treated on three occasions in a single-blinded design in random order with mifepristone, spironolactone and placebo, respectively, and nocturnal sleep EEG was recorded. RESULTS Mifepristone led to increased wake time, decreased stage 2 and rapid eye movement (REM) sleep and prolonged REM sleep latency in the first half of the night, whereas spironolactone had no considerable effects on sleep EEG. CONCLUSION GR antagonism can potentiate age-related sleep pattern alterations and further support the role of impaired GR signaling in age-related changes in sleep architecture.
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Affiliation(s)
- Cüneyt Demiralay
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Agorastos A, Demiralay C, Huber CG. Influence of religious aspects and personal beliefs on psychological behavior: focus on anxiety disorders. Psychol Res Behav Manag 2014; 7:93-101. [PMID: 24648780 PMCID: PMC3956626 DOI: 10.2147/prbm.s43666] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The current paper presents literature relevant to the relationship of religiosity, spirituality, and personal beliefs with mental health and, in particular, anxiety disorders as an empirical narrative review, providing an overview on the most important and clinically relevant research results on the topic. The relationship between religiosity/spirituality, personal beliefs (ie, magical ideation and paranormal beliefs), and mental health has lately been studied extensively, and results have indicated significant associations among these variables. However, scientific approaches to this field are complex and multidimensional, partly leading to poor operationalization, incomparable data, and contradictory results. Literature demonstrates that higher religiosity/spirituality and magical ideation scores have often been associated with increased obsessive–compulsive traits. Similar results could not be confidently replicated for other anxiety disorders. However, it is still unclear if these differences suggest a specific association with obsessive–compulsive traits and reflect deviating etiopathogenetic and cognitive aspects between obsessive–compulsive disorder and other anxiety disorders, or if these results are biased through other factors. Religiosity/spirituality and personal beliefs constitute important parameters of human experience and deserve greater consideration in the psychotherapeutic treatment of psychiatric disorders.
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Affiliation(s)
- Agorastos Agorastos
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Cüneyt Demiralay
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian G Huber
- Department of Psychiatry and Psychotherapy, University of Basel, Basel, Switzerland
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Abstract
OBJECTIVES Peripheral administration of the cholecystokinin (CCK) receptor agonist CCK-4 generates panic and activates the hypothalamic-pituitary-adrenal (HPA) axis. Direct effects at the pituitary and CCK-HPA interactions at higher regulatory sites have been suggested. According to preliminary data, ACTH response to CCK receptor agonists may differ from its response to exogenous CRH by its resistance to cortisol feedback inhibition. To further explore this resistance and to better characterize CCK-4 sites of action, the effects of different glucocorticoid pretreatments on CCK-4-induced panic were compared. METHODS Using a double-blind placebo-controlled design we pretreated healthy males with either dexamethasone (peripheral action) or hydrocortisone (central-peripheral action) each followed by a CCK-4 challenge. Blood levels of ACTH and cortisol were analyzed and panic symptoms were assessed. RESULTS We found a blunted response of ACTH release following CCK-4 injection only after hydrocortisone pretreatment. Dexamethasone however did not affect CCK-4-induced ACTH release relative to baseline. In contrast to dexamethasone, hydrocortisone reduced the severity of CCK-4-induced panic as measured by the Acute Panic Inventory on a trend level. CONCLUSIONS Findings suggest that CCK-4-induced stress hormone release seems susceptible to cortisol-feedback inhibition and argues for a suprapituitary site of CCK action. Effects on panic anxiety were weak but congruent with studies showing that CCK-4-induced HPA axis inhibition is accompanied by a reduction of anxiety after CCK-4.
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Affiliation(s)
- Cüneyt Demiralay
- University Hospital Hamburg-Eppendorf, Department of Psychiatry and Psychotherapy, Hamburg, Germany.
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Demiralay C, Jahn H, Kellner M, Yassouridis A, Wiedemann K. Influence of exogenous atrial natriuretic peptide on the nocturnal hypothalamic-pituitary-adrenal axis and sleep in healthy men. Psychoneuroendocrinology 2010; 35:1438-45. [PMID: 20554120 DOI: 10.1016/j.psyneuen.2010.04.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2009] [Revised: 04/16/2010] [Accepted: 04/23/2010] [Indexed: 10/19/2022]
Abstract
Atrial natriuretic peptide (ANP), originally found in the cardiac atria, is also widely distributed in the central nervous system (CNS) and has been predominantly found in the hypothalamus and the pituitary gland. Previous in vitro and in vivo studies have provided evidence for an inhibitory control of ANP at all regulatory levels of the hypothalamo-pituitary-adrenocortical (HPA) system. In vivo studies in man demonstrated that ANP inhibits stimulated pituitary-adrenal secretion during wakefulness. On the other hand, it has been reported that various neuropeptides not only influence the neuroendocrine compound of sleep, but also exert specific effects on the sleep electroencephalogram (EEG). To further characterize the role of ANP in the regulation of the nocturnal HPA axis activity and consecutive sleep regulation, we investigated sleep-endocrine effects of intravenously administered ANP in healthy men during nocturnal sleep. Eight volunteers underwent three trial conditions in random order and in a single-blind design receiving ANP infusion at the beginning of the 1st or the 2nd half of the night, or placebo. Sleep was assessed by polysomnography and blood samples were drawn in 30-min intervals for determination of adrenocorticotrophic hormone (ACTH) and cortisol during the entire night. While the ACTH and cortisol secretion during ANP infusions remained unchanged, an immediate increase of ACTH and cortisol secretion occurred after each infusion period for approximately 2h without changing basal levels and the circadian course of both hormones. Sleep EEG parameters were neither directly affected by ANP infusions nor by the following ANP-induced ACTH and cortisol secretion. The presence of such clear-cut enhancement of the pituitary-adrenal release indicates a rebound effect of ANP on HPA secretory activity and supports the idea that ANP acts as corticotropin-releasing hormone (CRH)-inhibiting factor.
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Affiliation(s)
- Cüneyt Demiralay
- University Hospital Hamburg-Eppendorf, Department of Psychiatry and Psychotherapy, Hamburg, Germany.
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Kellner M, Muhtz C, Demiralay C, Husemann J, Koelsch W, Yassouridis A, Wiedemann K. PW01-46 - Do selective serotonin re-uptake inhibitors modulate experimental panic elicited by cholecystokinin-tetrapeptide in healthy man? Eur Psychiatry 2010. [DOI: 10.1016/s0924-9338(10)71448-6] [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: 11/30/2022] Open
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24
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Mutschler J, Bilbao A, der Goltz CV, Demiralay C, Jahn H, Wiedemann K, Spanagel R, Kiefer F. Stress-induced alcohol drinking and withdrawal in mice lacking functional natriruetic peptide-A receptors. Pharmacopsychiatry 2009. [DOI: 10.1055/s-0029-1240181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Demiralay C, Zorawski M, Wiedemann K, Jahn H. „A chemical love story“: Treatment of a gamma-butyrolacton (GBL)-dependent chemistry student with diazepam – a case report. Pharmacopsychiatry 2009. [DOI: 10.1055/s-0029-1240098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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26
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Demiralay C, Wiedemann K, Kellner M, Yassouridis A, Jahn H. Influence of exogenous ANP on the nocturnal HPA axis and sleep in healthy men. Pharmacopsychiatry 2009. [DOI: 10.1055/s-0029-1240099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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27
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Kellner M, Muhtz C, Demiralay C, Husemann J, Koelsch W, Yassouridis A, Wiedemann K. Serotonergic modulation of experimental panic elicited by cholecystokinin tetrapeptide in healthy man. Pharmacopsychiatry 2009. [DOI: 10.1055/s-0029-1240147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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28
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Demiralay C, Husemann J, Koelsch W, Yassouridis A, Wiedemann K, Kellner M. Does 5-HTTLPR genotype influence willingness to participate in panic challenges? Depress Anxiety 2009; 26:E68-70. [PMID: 19105220 DOI: 10.1002/da.20450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Kellner M, Muhtz C, Demiralay C, Husemann J, Koelsch W, Yassouridis A, Wiedemann K. The selective serotonin re-uptake inhibitor escitalopram modulates the panic response to cholecystokinin tetrapeptide in healthy men depending on 5-HTTLPR genotype. J Psychiatr Res 2009; 43:642-8. [PMID: 18930474 DOI: 10.1016/j.jpsychires.2008.09.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2008] [Revised: 08/11/2008] [Accepted: 09/03/2008] [Indexed: 11/27/2022]
Abstract
Selective serotonin re-uptake inhibitors, such as escitalopram, are currently the treatment of choice for patients with panic disorder. The panic response to intravenous cholecystokinin tetrapeptide, a potentially useful paradigm for volunteer translational studies, has so far not been investigated in healthy man after respective pre-treatment. In a double-blind, placebo-controlled, randomized, within subject cross-over design 30 healthy young men, 15 each with the long/long or short/short genotype for the serotonin transporter linked polymorphic region, were pre-treated with 10mg/d of escitalopram orally for six weeks and then challenged with 50 microg of cholecystokinin tetrapeptide. The primary outcome measure was the increase of Acute Panic Inventory ratings by cholecystokinin tetrapeptide. The increase of anxiety, tension and stress hormone secretion were secondary outcome measures. A significant treatment by genotype effect on the increases of Acute Panic Inventory ratings emerged. Panic induced by cholecystokinin tetrapeptide was significantly more pronounced in the short/short genotype subjects under escitalopram vs. placebo pre-treatment. With the exception of significantly elevated serum prolactin after escitalopram, no effects in the secondary outcome measures were detected. Contrary to our expectation, no inhibitory effect of escitalopram upon panic symptoms elicited by choleystokinin tetrapeptide could be demonstrated in healthy men. These findings do not support the potential usefulness of this panic model for proof-of-concept studies. The biological underpinnings of the increased panic symptoms after escitalopram in our volunteers with short/short genotype need further research.
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Affiliation(s)
- Michael Kellner
- University Hospital Hamburg-Eppendorf, Department of Psychiatry, Martinistrasse 52, D-20246 Hamburg, Germany.
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30
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Kellner M, Demiralay C, Muhtz C, Husemann J, Kölsch W, Hiemke C, Yassouridis A, Wiedemann K. No effect of six weeks of treatment with escitalopram on mood in healthy volunteers--irrespective of genotype for the promoter of the serotonin transporter. Psychiatry Res 2008; 161:339-43. [PMID: 18962988 DOI: 10.1016/j.psychres.2008.04.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2007] [Revised: 12/07/2007] [Accepted: 04/28/2008] [Indexed: 11/19/2022]
Abstract
Data on emotional effects of chronic antidepressants in normal subjects are scarce and contradictory. Thirty healthy men were given 10 mg/day of escitalopram for 6 weeks in a double-blind, placebo-controlled, within-subject cross-over study. No significant effect on negative affect, positive affect, or state anxiety was detected, irrespective of serotonin transporter gene-linked polymorphism.
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Affiliation(s)
- Michael Kellner
- Department of Psychiatry and Psychotherapy, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
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31
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Haasen C, Levit O, Gelbert A, Foroutan N, Norovjav A, Sinaa M, Demiralay C. Zusammenhang zwischen psychischer Befindlichkeit und Akkulturation bei Migranten. Psychiat Prax 2007; 34:339-42. [DOI: 10.1055/s-2007-971014] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Bäumer T, Demiralay C, Hidding U, Bikmullina R, Helmich RC, Wunderlich S, Rothwell J, Liepert J, Siebner HR, Münchau A. Abnormal plasticity of the sensorimotor cortex to slow repetitive transcranial magnetic stimulation in patients with writer's cramp. Mov Disord 2007; 22:81-90. [PMID: 17089385 DOI: 10.1002/mds.21219] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Previous studies demonstrated functional abnormalities in the somatosensory system, including a distorted functional organization of the somatosensory cortex (S1) in patients with writer's cramp. We tested the hypothesis that these functional alterations render S1 of these patients more susceptible to the "inhibitory" effects of subthreshold 1 Hz repetitive transcranial magnetic stimulation (rTMS) given to S1. Seven patients with writer's cramp and eight healthy subjects were studied. Patients also received rTMS to the motor cortex hand area (M1). As an outcome measure, short-latency afferent inhibition (SAI) was tested. SAI was studied in the relaxed first dorsal interosseous muscle using conditioning electrical stimulation of the index finger and TMS pulses over the contralateral M1. Baseline SAI did not differ between groups. S1 but not M1 rTMS reduced SAI in patients. rTMS had no effects on SAI in healthy subjects. Because SAI is mediated predominantly at a cortical level in the sensorimotor cortex, we conclude that there is an abnormal responsiveness of this area to 1 Hz rTMS in writer's cramp, which may represent a trait toward maladaptive plasticity in the sensorimotor system in these patients.
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Affiliation(s)
- Tobias Bäumer
- Department of Neurology, University of Hamburg, Hamburg, Germany
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33
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Hidding U, Bäumer T, Siebner HR, Demiralay C, Buhmann C, Weyh T, Moll C, Hamel W, Münchau A. MEP latency shift after implantation of deep brain stimulation systems in the subthalamic nucleus in patients with advanced Parkinson's disease. Mov Disord 2006; 21:1471-6. [PMID: 16703590 DOI: 10.1002/mds.20951] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Deep brain stimulation (DBS) into the subthalamic nucleus (STN) is a highly effective treatment for advanced Parkinson's disease (PD). The consequences of STN stimulation on intracortical and corticospinal excitability have been addressed in a few studies using transcranial magnetic stimulation (TMS). Although excitability measurements were compared between the STN stimulation OFF and ON condition, in these experiments, there are no longitudinal studies examining the impact of electrode implantation per se on motor excitability. Here, we explored the effects of STN electrode implantation on resting motor thresholds (RMT), motor evoked potential (MEP) recruitment curves, and MEP onset latencies on 2 consecutive days before and shortly after STN surgery with the stimulator switched off, thus avoiding the effects of chronic DBS on the motor system, in 8 PD patients not taking any dopaminergic medication. After surgery, RMT and MEP recruitment curves were unchanged. In contrast, MEP onset latencies were significantly shorter when examined in relaxed muscles but were unchanged under preactivation. We hypothesize that postoperatively TMS pulses induced small currents in scalp leads underneath the TMS coil connecting the external stimulator with STN electrodes leading to inadvertent stimulation of fast-conducting descending neural elements in the vicinity of the STN, thereby producing submotor threshold descending volleys. These "conditioning" volleys probably preactivated spinal motor neurons leading to earlier suprathreshold activation by the multiple corticospinal volleys produced by TMS of the motor cortex. These TMS effects need to be considered when interpreting results of excitability measurements in PD patients after implantation of STN electrodes.
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Affiliation(s)
- Ute Hidding
- Department of Neurology, University Medical Centre Hamburg-Eppendorf, Germany
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Hidding U, Bäumer T, Demiralay C, Siebner H, Buhmann C, Hamel W, Münchau A. MEP Latenzenverkürzung nach Implantation von STN Elektroden bei Parkinson-Patienten - Präkonditiernierung des Tractus corticospinalis? Akt Neurol 2005. [DOI: 10.1055/s-2005-919367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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35
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Demiralay C, Bäumer T, Hidding U, Helmich R, Wunderlich S, Rothwell J, Liepert J, Siebner H, Münchau A. Slow rTMS to the somatosensory cortex attenuates afferent inhibition in patients with writer's cramp. Akt Neurol 2005. [DOI: 10.1055/s-2005-919361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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36
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Kiefer F, Jahn H, Otte C, Demiralay C, Wolf K, Wiedemann K. Increasing leptin precedes craving and relapse during pharmacological abstinence maintenance treatment of alcoholism. J Psychiatr Res 2005; 39:545-51. [PMID: 15992564 DOI: 10.1016/j.jpsychires.2004.11.005] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2004] [Revised: 11/05/2004] [Accepted: 11/29/2004] [Indexed: 10/25/2022]
Abstract
The appetite regulating peptide leptin has recently been associated with craving for alcohol and lifetime ethanol intake. However, effects of anti-craving drugs on leptin have not been studied until now. The objective of our study was to test the hypothesis whether leptin plasma concentration in abstinent alcohol addicts during treatment with naltrexone vs. acamprosate is associated with abstinence duration and craving for alcohol. Leptin plasma concentration was measured in 160 recently detoxified alcohol addicts during a double-blind, placebo-controlled relapse prevention trial with naltrexone vs. acamprosate vs. naltrexone plus acamprosate. During placebo treatment, increasing leptin plasma concentration was observed, whereas during combined treatment with naltrexone and acamprosate, leptin decreased significantly. The change from baseline of leptin plasma levels after weeks 4, 8 and 12 was inversely correlated with duration of abstinence and, after 4 weeks, positively correlated with self-rated craving. In summary, the study presents first evidence for an association of increasing leptin plasma concentrations with relapse to renewed alcohol intake in detoxified alcoholics. Moreover, there are hints for an interaction between pharmacological anti-craving treatment, plasma concentration of leptin, and abstinence duration.
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Affiliation(s)
- Falk Kiefer
- Department of Addictive Behaviour and Addiction Medicine, Central Institute of Mental Health (CIMH), University of Heidelberg, J5, 68159 Mannheim, Germany.
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Buhmann C, Gorsler A, Bäumer T, Hidding U, Demiralay C, Hinkelmann K, Weiller C, Siebner HR, Münchau A. Abnormal excitability of premotor-motor connections in de novo Parkinson's disease. Brain 2004; 127:2732-46. [PMID: 15509619 DOI: 10.1093/brain/awh321] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The dorsal premotor cortex (PMd) is abnormally active in patients with idiopathic Parkinson's disease. This has been interpreted as a functional correlate of adaptive plasticity within the motor system to compensate for deficient activation of striato-mesial-frontal projections in these patients. Whether abnormal PMd activity influences excitability in the primary motor cortex (M1) in untreated Parkinson's disease patients and how this premotor-motor interaction might be altered by l-dopa is unclear. To this end, we studied the effects of 1 Hz premotor repetitive transcranial magnetic stimulation (rTMS) on M1 excitability in 10 previously untreated non-tremulous Parkinson's disease patients before (day 1) and after (day 8) their first ever l-dopa treatment and compared the results with those of a group of nine age- and sex-matched healthy controls. In each rTMS session, 1200 pulses of 1 Hz rTMS were applied at an intensity of 80% active motor threshold (AMT) to the PMd contralateral to the clinically more affected side in Parkinson's disease patients and to the left PMd in healthy controls. Intracortical paired pulse excitability of ipsilateral M1 was probed using a TMS paired pulse paradigm where subthreshold conditioning pulses (80% of AMT) were given 2-15 ms prior to a suprathreshold test pulse. In Parkinson's disease patients, abnormal baseline intracortical excitability at an interstimulus interval (ISI) of 5 ms was normalized by premotor rTMS. In contrast, rTMS led to an increased excitability at an ISI of 5 ms in healthy controls. Premotor rTMS effects lasted longer (for at least a week) in patients. These results show that the modifiability of premotor-motor connections is abnormal in untreated Parkinson's disease. A single dose of l-dopa reversed, i.e. normalized, the direction of excitability changes in M1 following premotor rTMS in Parkinson's disease patients, suggesting that dopamine depletion directly or indirectly influences premotor-motor interactions in Parkinson's disease. The rTMS conditioning approach described here provides a promising tool to delineate further the excitability changes in frontal motor areas in response to progressive degeneration of nigrostriatal dopaminergic neurons and also to chronic l-dopa treatment in Parkinson's disease.
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Affiliation(s)
- C Buhmann
- Department of Neurology, University of Hamburg, Hamburg, Germany
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von der Kammer H, Demiralay C, Andresen B, Albrecht C, Mayhaus M, Nitsch RM. Regulation of gene expression by muscarinic acetylcholine receptors. Biochem Soc Symp 2002:131-40. [PMID: 11447829 DOI: 10.1042/bss0670131] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In the brain, muscarinic acetylcholine receptors (mAChRs) are involved in higher cognitive functions including synaptic plasticity and memory. In Alzheimer's disease (AD) patients the cholinergic nervous system is severely damaged. In order to reinforce the cholinergic system, clinical tests were started to use cholinomimetic drugs to treat AD patients. To identify the genes involved in mAChR signalling, we used a differential display approach and found 11 genes that were readily activated by mAChR with 1 hour of activation. These included the transcription factors Egr-1, Egr-2, Egr-3, c-Jun, Jun-D and Gos-3; the growth regulator hCyr61; the signalling factors NGFi-B (nerve growth factor induced gene-B) and Etr101; the unknown gene Gig-2 (for G-protein-coupled receptor induced gene 2); and the acetylcholinesterase gene (ACHE). Our data show that multiple immediate-early genes are under the control of mAChRs, and they suggest that these genes play important roles in coupling receptor stimulation to long-term neuronal responses. The results also suggest a feedback mechanism where up-regulated ACHE expression and accelerated breakdown of acetylcholine (ACh) at the cholinergic synapses limits increases in cholinergic transmission. Three hours after m1 mAChR activation a different pattern of gene expression was demonstrated. It included the novel genes Gig-3 and Gig-4, as well as the LIM-only protein LM04. Like ACHE, these genes are target genes which may be under the control of the above immediate-early genes. Together, our data show that muscarinic receptors induce a complex and sustained pattern of gene expression that may be involved in the regulation of cholinergic transmission as well as the control of cellular functions in post-synaptic cholinergic target cells. These results may contribute to a better understanding of the effects and side effects of cholinomimetic treatment in AD patients.
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Affiliation(s)
- H von der Kammer
- Center for Molecular Neurobiology, University of Hamburg, Martinistrasse 51, D-20246 Hamburg, Germany
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von der Kammer H, Mayhaus M, Albrecht C, Andresen B, Klaudiny J, Demiralay C, Nitsch RM. Regulation of gene expression by muscarinic acetylcholine receptors. A comprehensive approach for the identification of regulated genes. Ann N Y Acad Sci 2001; 920:305-8. [PMID: 11193168 DOI: 10.1111/j.1749-6632.2000.tb06939.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- H von der Kammer
- Center for Molecular Neurobiology, University of Hamburg, Martinistr. 5, D-20246 Hamburg, Germany.
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