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Meisenzahl E, Wege N, Stegmüller V, Schulte-Körne G, Greimel E, Dannlowski U, Hahn T, Romer G, Romanos M, Deserno L, Klingele C, Theisen C, Kieckhäfer C, Forstner A, Ruhrmann S, Schultze-Lutter F. Clinical high risk state of major depressive episodes: Assessment of prodromal phase, its occurrence, duration and symptom patterns by the instrument the DEpression Early Prediction-INventory (DEEP-IN). J Affect Disord 2024; 351:403-413. [PMID: 38181843 DOI: 10.1016/j.jad.2023.12.084] [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: 06/06/2023] [Revised: 12/20/2023] [Accepted: 12/28/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND To decrease the incidence of major depressive episodes, indicated prevention that targets clinical high-risk individuals with first detectable signs that forecast mental disorder is a highly relevant topic of preventive psychiatry. Still little is known about the prodrome of MDE. The aim of the current study was to identify the occurrence of a clinical high-risk state of depression, its duration and symptom constellation. METHODS Seventy-three patients with a diagnosed affective disorder in partial remission were assessed with our newly developed semi-structured extensive clinical instrument, the DEpression Early Prediction-INventory (DEEP-IN). Within DEEP-IN the course of prodromal symptoms was explored by using a life-chart method. RESULTS The significant majority of patients (93.2 %) reported a prodromal phase. The mean duration was 7.9 months (SD = 12.5). Within the group with an identified prodromal phase, psychopathological (95.6 %) as well as somatic symptoms (88.2 %) were reported. Somatic symptoms showed a moderate-to-strong effect of sex with higher prevalence in females than in males (97.6 % vs 73.1 %; V = 0.370). LIMITATIONS This feasibility study had only a small sample size. CONCLUSIONS The majority of patients with affective disorders reported a clinical prodromal phase with both psychopathological and somatic symptoms that developed months before the onset of the depressive episode. The development of structured instruments for the assessment of depressive risk states is a promising approach for indicated prevention of depression in the future.
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Affiliation(s)
- Eva Meisenzahl
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, LVR Düsseldorf, Düsseldorf, Germany.
| | - Natalia Wege
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, LVR Düsseldorf, Düsseldorf, Germany
| | - Veronika Stegmüller
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, LVR Düsseldorf, Düsseldorf, Germany
| | - Gerd Schulte-Körne
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Ellen Greimel
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Udo Dannlowski
- Institute for Translational Psychiatry, University of Muenster, Muenster, Germany
| | - Tim Hahn
- Institute for Translational Psychiatry, University of Muenster, Muenster, Germany
| | - Georg Romer
- Department of Child Adolescence Psychiatry and Psychotherapy, University of Muenster, Muenster, Germany
| | - Marcel Romanos
- Centre of Mental Health, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Wuerzburg, Wuerzburg, Germany
| | - Lorenz Deserno
- Centre of Mental Health, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Wuerzburg, Wuerzburg, Germany; Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany; Neuroimaging Center, Technical University of Dresden, Dresden, Germany
| | - Cosima Klingele
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Christian Theisen
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, LVR Düsseldorf, Düsseldorf, Germany
| | - Carolin Kieckhäfer
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, LVR Düsseldorf, Düsseldorf, Germany
| | - Andreas Forstner
- Institute of Human Genetics, University of Bonn, School of Medicine & University Hospital Bonn, Bonn, Germany
| | - Stefan Ruhrmann
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Frauke Schultze-Lutter
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, LVR Düsseldorf, Düsseldorf, Germany
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Wenzel J, Badde L, Haas SS, Bonivento C, Van Rheenen TE, Antonucci LA, Ruef A, Penzel N, Rosen M, Lichtenstein T, Lalousis PA, Paolini M, Stainton A, Dannlowski U, Romer G, Brambilla P, Wood SJ, Upthegrove R, Borgwardt S, Meisenzahl E, Salokangas RKR, Pantelis C, Lencer R, Bertolino A, Kambeitz J, Koutsouleris N, Dwyer DB, Kambeitz-Ilankovic L. Transdiagnostic subgroups of cognitive impairment in early affective and psychotic illness. Neuropsychopharmacology 2024; 49:573-583. [PMID: 37737273 PMCID: PMC10789737 DOI: 10.1038/s41386-023-01729-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 08/03/2023] [Accepted: 08/26/2023] [Indexed: 09/23/2023]
Abstract
Cognitively impaired and spared patient subgroups were identified in psychosis and depression, and in clinical high-risk for psychosis (CHR). Studies suggest differences in underlying brain structural and functional characteristics. It is unclear whether cognitive subgroups are transdiagnostic phenomena in early stages of psychotic and affective disorder which can be validated on the neural level. Patients with recent-onset psychosis (ROP; N = 140; female = 54), recent-onset depression (ROD; N = 130; female = 73), CHR (N = 128; female = 61) and healthy controls (HC; N = 270; female = 165) were recruited through the multi-site study PRONIA. The transdiagnostic sample and individual study groups were clustered into subgroups based on their performance in eight cognitive domains and characterized by gray matter volume (sMRI) and resting-state functional connectivity (rsFC) using support vector machine (SVM) classification. We identified an impaired subgroup (NROP = 79, NROD = 30, NCHR = 37) showing cognitive impairment in executive functioning, working memory, processing speed and verbal learning (all p < 0.001). A spared subgroup (NROP = 61, NROD = 100, NCHR = 91) performed comparable to HC. Single-disease subgroups indicated that cognitive impairment is stronger pronounced in impaired ROP compared to impaired ROD and CHR. Subgroups in ROP and ROD showed specific symptom- and functioning-patterns. rsFC showed superior accuracy compared to sMRI in differentiating transdiagnostic subgroups from HC (BACimpaired = 58.5%; BACspared = 61.7%, both: p < 0.01). Cognitive findings were validated in the PRONIA replication sample (N = 409). Individual cognitive subgroups in ROP, ROD and CHR are more informative than transdiagnostic subgroups as they map onto individual cognitive impairment and specific functioning- and symptom-patterns which show limited overlap in sMRI and rsFC. CLINICAL TRIAL REGISTRY NAME: German Clinical Trials Register (DRKS). Clinical trial registry URL: https://www.drks.de/drks_web/ . Clinical trial registry number: DRKS00005042.
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Affiliation(s)
- Julian Wenzel
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany.
| | - Luzie Badde
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Shalaila S Haas
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, NY, USA
| | | | - Tamsyn E Van Rheenen
- Centre for Mental Health, School of Health Sciences, Swinburne University of Technology, Melbourne, VIC, Australia
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne & Melbourne Health, Melbourne, VIC, Australia
| | - Linda A Antonucci
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich, Germany
- Department of Translational Biomedicine and Neuroscience - University of Bari Aldo Moro, Bari, Italy
| | - Anne Ruef
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich, Germany
| | - Nora Penzel
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
- Department of Translational Biomedicine and Neuroscience - University of Bari Aldo Moro, Bari, Italy
| | - Marlene Rosen
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Theresa Lichtenstein
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Paris Alexandros Lalousis
- Institute of Psychiatry, Psychology & Neuroscience, Department of Psychosis Studies, King's College London, London, UK
| | - Marco Paolini
- Department of Radiology, University Hospital, Ludwig-Maximilian University, Munich, Germany
| | - Alexandra Stainton
- Orygen, Melbourne, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Udo Dannlowski
- Institute for Translational Psychiatry, University of Muenster, Münster, Germany
| | - Georg Romer
- Department of Child and Adolescent Psychiatry, University of Münster, Münster, Germany
| | - Paolo Brambilla
- Department of Neuosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Mental Health, University of Milan, Milan, Italy
| | - Stephen J Wood
- Orygen, Melbourne, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
- School of Psychology, University of Birmingham, Birmingham, UK
| | - Rachel Upthegrove
- School of Psychology, University of Birmingham, Birmingham, UK
- Institute of Mental Health and Centre for Human Brain Health, University of Birmingham, Birmingham, UK
| | - Stefan Borgwardt
- Translational Psychiatry Unit (TPU), Department of Psychiatry and Psychotherapy, University of Luebeck, Luebeck, Germany
| | - Eva Meisenzahl
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | | | - Christos Pantelis
- Melbourne Neuropsychiatry Centre, University of Melbourne & Western Health, Melbourne, VIC, Australia
| | - Rebekka Lencer
- Institute for Translational Psychiatry, University of Muenster, Münster, Germany
- Translational Psychiatry Unit (TPU), Department of Psychiatry and Psychotherapy, University of Luebeck, Luebeck, Germany
| | - Alessandro Bertolino
- Department of Translational Biomedicine and Neuroscience - University of Bari Aldo Moro, Bari, Italy
| | - Joseph Kambeitz
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Nikolaos Koutsouleris
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich, Germany
- Institute of Psychiatry, Psychology & Neuroscience, Department of Psychosis Studies, King's College London, London, UK
- Max Planck Institute for Psychiatry, Munich, Germany
| | - Dominic B Dwyer
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Munich, Germany
- Orygen, Melbourne, VIC, Australia
| | - Lana Kambeitz-Ilankovic
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
- Faculty of Psychology and Educational Sciences, Department of Psychology, Ludwig-Maximilian University, Munich, Germany
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Bonnekoh LM, Fellmeth R, Dübbers A, Oesingmann-Weirich S, Fernholz J, Omran H, Romer G. [Case Report of a 14-Year-Old Girl with Addison's Disease Under Initial Presumptive Diagnosis of Anorexia Nervosa: Confusingly Similar and Yet so Different?]. Z Kinder Jugendpsychiatr Psychother 2024. [PMID: 38221850 DOI: 10.1024/1422-4917/a000964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2024]
Abstract
Case Report of a 14-Year-Old Girl with Addison's Disease Under Initial Presumptive Diagnosis of Anorexia Nervosa: Confusingly Similar and Yet so Different? Abstract: Objective: Primary adrenal insufficiency (Addison's disease) is a rare differential diagnosis of anorexia nervosa. This case report presents important differential diagnostic aspects. Methods: We prepared a case report of a 14-year-old female patient according to the CARE guidelines, taking the patient's and the child's parents' view into consideration. Results: The diagnosis of primary adrenocortical insufficiency was reached using specific laboratory diagnostics approximately 9 months after the onset of symptoms, including sudden body weight loss. Significant differential diagnostic aspects were the absence of a body schema disorder and skin hyperpigmentation prominent in the physical examination. The patient experienced a high psychosocial burden because of the unclear diagnosis over 9 months. The diagnosis and substitution therapy with hydrocortisone led to a rapid improvement of the physical and psychological symptoms. Conclusions: This case report emphasizes the importance of a thorough somatic differential diagnosis in the context of a suspected anorexia nervosa.
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Affiliation(s)
- Linda M Bonnekoh
- Klinik für Kinder- und Jugendpsychiatrie, -psychosomatik und-psychotherapie, Universitätsklinikum Münster, Deutschland
| | - Ruth Fellmeth
- Klinik für Kinder- und Jugendpsychiatrie, -psychosomatik und-psychotherapie, Universitätsklinikum Münster, Deutschland
| | - Angelika Dübbers
- Klinik für Kinder- und Jugendmedizin, Allgemeine Pädiatrie, Universitätsklinikum Münster, Deutschland
| | - Sandra Oesingmann-Weirich
- Klinik für Kinder- und Jugendmedizin, Allgemeine Pädiatrie, Universitätsklinikum Münster, Deutschland
| | - Judith Fernholz
- Klinik für Kinder- und Jugendpsychiatrie, -psychosomatik und-psychotherapie, Universitätsklinikum Münster, Deutschland
| | - Heymut Omran
- Klinik für Kinder- und Jugendmedizin, Allgemeine Pädiatrie, Universitätsklinikum Münster, Deutschland
| | - Georg Romer
- Klinik für Kinder- und Jugendpsychiatrie, -psychosomatik und-psychotherapie, Universitätsklinikum Münster, Deutschland
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4
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Stainton A, Chisholm K, Griffiths SL, Kambeitz-Ilankovic L, Wenzel J, Bonivento C, Brambilla P, Iqbal M, Lichtenstein TK, Rosen M, Antonucci LA, Maggioni E, Kambeitz J, Borgwardt S, Riecher-Rössler A, Andreou C, Schmidt A, Schultze-Lutter F, Meisenzahl E, Ruhrmann S, Salokangas RKR, Pantelis C, Lencer R, Romer G, Bertolino A, Upthegrove R, Koutsouleris N, Allott K, Wood SJ. Prevalence of cognitive impairments and strengths in the early course of psychosis and depression. Psychol Med 2023; 53:5945-5957. [PMID: 37409883 PMCID: PMC10520593 DOI: 10.1017/s0033291723001770] [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: 02/28/2023] [Revised: 05/12/2023] [Accepted: 06/01/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND Studies investigating cognitive impairments in psychosis and depression have typically compared the average performance of the clinical group against healthy controls (HC), and do not report on the actual prevalence of cognitive impairments or strengths within these clinical groups. This information is essential so that clinical services can provide adequate resources to supporting cognitive functioning. Thus, we investigated this prevalence in individuals in the early course of psychosis or depression. METHODS A comprehensive cognitive test battery comprising 12 tests was completed by 1286 individuals aged 15-41 (mean age 25.07, s.d. 5.88) from the PRONIA study at baseline: HC (N = 454), clinical high risk for psychosis (CHR; N = 270), recent-onset depression (ROD; N = 267), and recent-onset psychosis (ROP; N = 295). Z-scores were calculated to estimate the prevalence of moderate or severe deficits or strengths (>2 s.d. or 1-2 s.d. below or above HC, respectively) for each cognitive test. RESULTS Impairment in at least two cognitive tests was as follows: ROP (88.3% moderately, 45.1% severely impaired), CHR (71.2% moderately, 22.4% severely impaired), ROD (61.6% moderately, 16.2% severely impaired). Across clinical groups, impairments were most prevalent in tests of working memory, processing speed, and verbal learning. Above average performance (>1 s.d.) in at least two tests was present for 40.5% ROD, 36.1% CHR, 16.1% ROP, and was >2 SDs in 1.8% ROD, 1.4% CHR, and 0% ROP. CONCLUSIONS These findings suggest that interventions should be tailored to the individual, with working memory, processing speed, and verbal learning likely to be important transdiagnostic targets.
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Affiliation(s)
- Alexandra Stainton
- Orygen, Melbourne, Victoria, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | | | - Siân Lowri Griffiths
- Institute for Mental Health and Centre for Human Brain Health, University of Birmingham, Birmingham, UK
| | - Lana Kambeitz-Ilankovic
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
- Faculty of Psychology and Educational Sciences, Department of Psychology, Ludwig-Maximilian University, Munich, Germany
| | - Julian Wenzel
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | | | - Paolo Brambilla
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Mariam Iqbal
- Department of Psychology, Woodbourne Priory Hospital, Birmingham, UK
| | - Theresa K. Lichtenstein
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Marlene Rosen
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Linda A. Antonucci
- Department of Translational Biomedicine and Neuroscience (DiBraiN), University of Bari “Aldo Moro”, Bari, Italy
| | - Eleonora Maggioni
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Joseph Kambeitz
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Stefan Borgwardt
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
- Department of Psychiatry, Psychiatric University Hospital, University of Basel, Basel, Switzerland
| | | | - Christina Andreou
- Department of Psychiatry, Psychiatric University Hospital, University of Basel, Basel, Switzerland
| | - André Schmidt
- Department of Psychiatry, Psychiatric University Hospital, University of Basel, Basel, Switzerland
| | - Frauke Schultze-Lutter
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
- Department of Psychology, Faculty of Psychology, Airlangga University, Surabaya, Indonesia
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Eva Meisenzahl
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Stephan Ruhrmann
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | | | - Christos Pantelis
- Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Melbourne, VIC, Australia
| | - Rebekka Lencer
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Georg Romer
- Department of Child Adolescent Psychiatry and Psychotherapy, University of Münster, Münster, Germany
| | - Alessandro Bertolino
- Department of Translational Biomedicine and Neuroscience (DiBraiN), University of Bari “Aldo Moro”, Bari, Italy
| | - Rachel Upthegrove
- Institute for Mental Health and Centre for Human Brain Health, University of Birmingham, Birmingham, UK
- Birmingham Early Intervention Service, Birmingham Women's and Children NHS Foundation Trust, Birmingham, UK
| | - Nikolaos Koutsouleris
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
- Max-Planck Institute of Psychiatry, Munich, Germany
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Kelly Allott
- Orygen, Melbourne, Victoria, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Stephen J. Wood
- Orygen, Melbourne, Victoria, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
- School of Psychology, University of Birmingham, Edgbaston, UK
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Kleinhaus H, Brähler E, Romer G, Ernst J. [Communicating about Parental Cancer with Minor Children: Necessity, Burden, and Issues from a Parent's Perspective]. Psychother Psychosom Med Psychol 2023; 73:85-88. [PMID: 36413984 DOI: 10.1055/a-1961-1219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND In addition to coping with their own stresses, parents of minor children with cancer face the difficult task of communicating the diagnosis and its effects to their children. The aim of this study is to examine parents' perceptions of conversations with their children and to identify key topics for psychosocial support. METHODS Using a questionnaire, N=82 cancer patients with N=162 minor children were asked about their experiences when talking to their children about the disease. RESULTS Communication about the disease was perceived as necessary by most parents. This was especially the case for older children. With 143 out of 162 children (88.3%), the conversation was held. Of the 82 parents interviewed, 16.5% felt no burden as a result of the talks, 15.2% reported a very high burden. The feeling of not being able to protect the children was perceived as particularly stressful. DISCUSSION Most parents consider communication with the children to be important and seek it. However, many find this difficult, e. g. because they actually want to protect their children. Additional stress can be caused by questions from the children to which the parents cannot give an answer. CONCLUSION Psychosocial support can be helpful here. Experiences discussed by parents can help other parents in similar situations.
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Affiliation(s)
- Hannah Kleinhaus
- Abteilung für Medizinische Psychologie und Medizinische Soziologie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Elmar Brähler
- Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Mainz, Mainz, Germany
| | - Georg Romer
- Klinik für Kinder- und Jugendpsychiatrie, -psychosomatik und -psychotherapie, Universitätsklinikum Münster, Münster, Germany
| | - Jochen Ernst
- Abteilung für Medizinische Psychologie und Medizinische Soziologie, Universitätsklinikum Leipzig, Leipzig, Germany
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Lencer R, Schwarzer J, Meyhoefer I, Antonucci LA, Kambeitz-Ilankovic L, Surmann M, Bienek O, Romer G, Dannlowski U, Hahn T, Korda A, Dwyer DB, Ruef A, Haas SS, Kambeitz J, Salokangas RK, Pantelis C, Schultze-Lutter F, Meisenzahl E, Brambilla P, Bertolino A, Borgwardt S, Upthegrove R, Koutsouleris N. Visual disturbances in recent-onset psychosis and clinical high-risk state for psychosis. J Vis 2022. [DOI: 10.1167/jov.22.14.3529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Nikolaos Koutsouleris
- Ludwig Maximilian University Munich
- Max-Planck-Institute of Psychiatry Munich
- King's College London
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Hädicke M, Föcker M, Romer G, Wiesemann C. Healthcare Professionals' Conflicts When Treating Transgender Youth: Is It Necessary to Prioritize Protection Over Respect? Camb Q Healthc Ethics 2022; 32:1-9. [PMID: 36330826 DOI: 10.1017/s0963180122000251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Increasingly, transgender minors are seeking medical care such as puberty-suppressing or gender-affirming hormone therapies. Yet, whether these interventions should be performed at all is highly controversial. Some healthcare practitioners oppose irreversible interventions, considering it their duty to protect children from harm. Others view minors, like adults, as transgender individuals who must be protected from discrimination. The underlying ethical question is presented as a problem of priority. Is it primarily relevant that minors are involved? Or should decision makers focus on the fact that they treat transgender individuals? The paper explores the relevance for medical practice. We provide results of an interview study with German healthcare professionals. We discuss the general question whether prioritization among different group memberships of the same person is ethically defensible. We conclude that priority conflicts between group memberships of the same person can be deceptive and should be addressed by an intersectional approach. Eventually, we discuss practical implications.
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Affiliation(s)
- Maximiliane Hädicke
- University Medical Center Göttingen, Department of Medical Ethics and History of Medicine, Humboldtallee36, 37073, Göttingen, Germany
| | - Manuel Föcker
- University Medical Center Münster, Clinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Schmeddingstraße 50, 48149Münster, Germany
| | - Georg Romer
- University Medical Center Münster, Clinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Schmeddingstraße 50, 48149Münster, Germany
| | - Claudia Wiesemann
- University Medical Center Göttingen, Department of Medical Ethics and History of Medicine, Humboldtallee36, 37073, Göttingen, Germany
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van Velzen LS, Dauvermann MR, Colic L, Villa LM, Savage HS, Toenders YJ, Zhu AH, Bright JK, Campos AI, Salminen LE, Ambrogi S, Ayesa-Arriola R, Banaj N, Başgöze Z, Bauer J, Blair K, Blair RJ, Brosch K, Cheng Y, Colle R, Connolly CG, Corruble E, Couvy-Duchesne B, Crespo-Facorro B, Cullen KR, Dannlowski U, Davey CG, Dohm K, Fullerton JM, Gonul AS, Gotlib IH, Grotegerd D, Hahn T, Harrison BJ, He M, Hickie IB, Ho TC, Iorfino F, Jansen A, Jollant F, Kircher T, Klimes-Dougan B, Klug M, Leehr EJ, Lippard ETC, McLaughlin KA, Meinert S, Miller AB, Mitchell PB, Mwangi B, Nenadić I, Ojha A, Overs BJ, Pfarr JK, Piras F, Ringwald KG, Roberts G, Romer G, Sanches M, Sheridan MA, Soares JC, Spalletta G, Stein F, Teresi GI, Tordesillas-Gutiérrez D, Uyar-Demir A, van der Wee NJA, van der Werff SJ, Vermeiren RRJM, Winter A, Wu MJ, Yang TT, Thompson PM, Rentería ME, Jahanshad N, Blumberg HP, van Harmelen AL, Schmaal L. Structural brain alterations associated with suicidal thoughts and behaviors in young people: results from 21 international studies from the ENIGMA Suicidal Thoughts and Behaviours consortium. Mol Psychiatry 2022; 27:4550-4560. [PMID: 36071108 PMCID: PMC9734039 DOI: 10.1038/s41380-022-01734-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 06/24/2022] [Accepted: 08/05/2022] [Indexed: 12/14/2022]
Abstract
Identifying brain alterations associated with suicidal thoughts and behaviors (STBs) in young people is critical to understanding their development and improving early intervention and prevention. The ENIGMA Suicidal Thoughts and Behaviours (ENIGMA-STB) consortium analyzed neuroimaging data harmonized across sites to examine brain morphology associated with STBs in youth. We performed analyses in three separate stages, in samples ranging from most to least homogeneous in terms of suicide assessment instrument and mental disorder. First, in a sample of 577 young people with mood disorders, in which STBs were assessed with the Columbia Suicide Severity Rating Scale (C-SSRS). Second, in a sample of young people with mood disorders, in which STB were assessed using different instruments, MRI metrics were compared among healthy controls without STBs (HC; N = 519), clinical controls with a mood disorder but without STBs (CC; N = 246) and young people with current suicidal ideation (N = 223). In separate analyses, MRI metrics were compared among HCs (N = 253), CCs (N = 217), and suicide attempters (N = 64). Third, in a larger transdiagnostic sample with various assessment instruments (HC = 606; CC = 419; Ideation = 289; HC = 253; CC = 432; Attempt=91). In the homogeneous C-SSRS sample, surface area of the frontal pole was lower in young people with mood disorders and a history of actual suicide attempts (N = 163) than those without a lifetime suicide attempt (N = 323; FDR-p = 0.035, Cohen's d = 0.34). No associations with suicidal ideation were found. When examining more heterogeneous samples, we did not observe significant associations. Lower frontal pole surface area may represent a vulnerability for a (non-interrupted and non-aborted) suicide attempt; however, more research is needed to understand the nature of its relationship to suicide risk.
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Grants
- UG3 MH111929 NIMH NIH HHS
- R37 MH101495 NIMH NIH HHS
- R01 MH103291 NIMH NIH HHS
- P41 RR008079 NCRR NIH HHS
- UL1 TR001872 NCATS NIH HHS
- UL1 TR001863 NCATS NIH HHS
- R61 MH111929 NIMH NIH HHS
- RC1 MH088366 NIMH NIH HHS
- R01 MH117601 NIMH NIH HHS
- K23 MH090421 NIMH NIH HHS
- R21 AA027884 NIAAA NIH HHS
- K01 MH106805 NIMH NIH HHS
- R61 AT009864 NCCIH NIH HHS
- R01 MH069747 NIMH NIH HHS
- K01 AA027573 NIAAA NIH HHS
- R01 MH070902 NIMH NIH HHS
- K01 MH117442 NIMH NIH HHS
- R01 MH085734 NIMH NIH HHS
- R21 AT009173 NCCIH NIH HHS
- MQ Brighter Futures Award MQBFC/2 and the U.S. National Institute of Mental Health under Award Number R01MH117601. National Suicide Prevention Research Fund, managed by Suicide Prevention Australia
- MQ Brighter Futures Award MQBFC/2. Interdisziplinäres Zentrum für Klinische Forschung, UKJ
- Italian Ministry of Health grant RC17-18-19-20-21/A
- Instituto de Salud Carlos III through the projects PI14/00639, PI14/00918 and PI17/01056 (Co-funded by European Regional Development Fund/European Social Fund "Investing in your future") and Fundación Instituto de Investigación Marqués de Valdecilla (NCT0235832 and NCT02534363)
- National Institute of Mental Health (K23MH090421), the National Alliance for Research on Schizophrenia and Depression, the University of Minnesota Graduate School, the Minnesota Medical Foundation, and the Biotechnology Research Center (P41 RR008079 to the Center for Magnetic Resonance Research), University of Minnesota, and the Deborah E. Powell Center for Women’s Health Seed Grant, University of Minnesota
- Medical Leader Foundation of Yunnan Province (L2019011) and Famous Doctors Project of Yunnan Province Plan (YNWR-MY-2018-041)
- CJ Martin Fellowship (NHMRC app 1161356). “Investissements d’avenir” ANR-10-IAIHU-06
- German Research Foundation (DFG, grant FOR2107-DA1151/5-1 and DA1151/5-2 to UD, and DFG grants HA7070/2-2, HA7070/3, HA7070/4 to TH)
- Australian National Health and Medical Research Council of Australia (NHMRC) Project Grants 1024570 NHMRC Career Development Fellowships (1061757)
- Medical Faculty Münster, Innovative Medizinische Forschung (Grant IMF KO 1218 06)
- Australian National Medical and Health Research Council (Program Grant 1037196 and Investigator Grant 1177991 to PBM, Project Grant 1066177 to JMF), the Lansdowne Foundation, Good Talk and the Keith Pettigrew Family Bequest (PM) Janette Mary O’Neil Research Fellowship. IHG is supported in part by R37MH101495
- Australian National Health and Medical Research Council of Australia (NHMRC) Project Grants 1064643 (principal investigator, BJH) NHMRC Career Development Fellowships (1124472)
- National Institute of Mental Health (K01MH106805). Klingenstein Third Generation Foundation, the National Institute of Mental Health (K01MH117442), the Stanford Maternal Child Health Research Institute, and the Stanford Center for Cognitive and Neurobiological Imaging. TCH receives partial support from the Ray and Dagmar Dolby Family Fund
- German Research Foundation (DFG, grant FOR2107-JA 1890/7-1 and JA 1890/7-2 to AJ, and DFG, grant FOR2107-KI588/14-1 and FOR2107-KI588/14-2 to TK)
- NIAAA (K01AA027573, R21AA027884) and the American Foundation for Suicide Prevention
- National Institute of Mental Health (R01-MH103291)
- National Center for Complementary and Integrative Health (NCCIH) R21AT009173 and R61AT009864 National Center for Advancing Translational Sciences (CTSI), National Institutes of Health, through UCSF-CTSI UL1TR001872 American Foundation for Suicide Prevention (AFSP) SRG-1-141-18 UCSF Research Evaluation and Allocation Committee (REAC) and J. Jacobson Fund to TTY; by the National Institute of Mental Health (NIMH) R01MH085734 and the Brain and Behavior Research Foundation (formerly NARSAD)
- MQ Brighter Futures Award MQBFC/2 R61MH111929RC1MH088366, R01MH070902, R01MH069747, American Foundation for Suicide Prevention, International Bipolar Foundation, Brain and Behavior Research Foundation, For the Love of Travis Foundation and Women’s Health Research at Yale
- MQ Brighter Futures Award MQBFC/2 Social Safety and Resilience programme of Leiden University
- MQ Brighter Futures Award MQBFC/2 National Institute of Mental Health under Award Number R01MH117601 NHMRC Career Development Fellowship (1140764)
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Affiliation(s)
- Laura S van Velzen
- Orygen, Parkville, VIC, Australia.
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia.
| | - Maria R Dauvermann
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham, UK
- McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Lejla Colic
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany
- German Center for Mental Health, Halle-Jena-Magdeburg, Germany
| | - Luca M Villa
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Hannah S Savage
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia
| | - Yara J Toenders
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Alyssa H Zhu
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey, CA, USA
| | - Joanna K Bright
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey, CA, USA
- Social Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Adrián I Campos
- Department of Genetics & Computational Biology, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
- School of Biomedical Sciences, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
- Institute for Molecular Bioscience, The University of Queensland, St Lucia, QLD, Australia
| | - Lauren E Salminen
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey, CA, USA
| | - Sonia Ambrogi
- Laboratory of Neuropsychiatry, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Rosa Ayesa-Arriola
- Department of Psychiatry, Marqués de Valdecilla University Hospital, IDIVAL, School of Medicine, University of Cantabria, Santander, Spain
- Centro Investigación Biomédica en Red de Salud Mental (CIBERSAM), Sevilla, Spain
| | - Nerisa Banaj
- Laboratory of Neuropsychiatry, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Zeynep Başgöze
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Jochen Bauer
- University Clinic for Radiology, University of Münster, Münster, Germany
| | - Karina Blair
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, USA
| | - Robert James Blair
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, USA
| | - Katharina Brosch
- Department of Psychiatry and Psychotherapy, Marburg University, Marburg, Germany
- CMBB, Marburg, Germany
| | - Yuqi Cheng
- Department of Psychiatry, First Affiliated Hospital of Kunming Medical College, Kunming, China
- Yunnan Province Clinical Research Center for Psychiatry, Kunming, China
| | - Romain Colle
- MOODS Team, CESP, INSERM U1018, Faculté de Médecine, Univ Paris-Saclay, Le Kremlin Bicêtre, 94275, France
- Service Hospitalo-Universitaire de Psychiatrie de Bicêtre, Hôpitaux Universitaires Paris-Saclay, Assistance Publique-Hôpitaux de Paris, Hôpital de Bicêtre, Le Kremlin Bicêtre, F-94275, France
| | - Colm G Connolly
- Department of Biomedical Sciences, Florida State University, Tallahassee, FL, USA
| | - Emmanuelle Corruble
- MOODS Team, CESP, INSERM U1018, Faculté de Médecine, Univ Paris-Saclay, Le Kremlin Bicêtre, 94275, France
- Service Hospitalo-Universitaire de Psychiatrie de Bicêtre, Hôpitaux Universitaires Paris-Saclay, Assistance Publique-Hôpitaux de Paris, Hôpital de Bicêtre, Le Kremlin Bicêtre, F-94275, France
| | - Baptiste Couvy-Duchesne
- Institute for Molecular Bioscience, The University of Queensland, St Lucia, QLD, Australia
- Paris Brain Institute (ICM), Inserm (U1127), CNRS (UMR 7225), Sorbonne University, Inria Paris (Aramis project-team), Paris, France
| | - Benedicto Crespo-Facorro
- Centro Investigación Biomédica en Red de Salud Mental (CIBERSAM), Sevilla, Spain
- Virgen del Rocío University Hospital, IBiS, CSIC, University of Sevilla, Sevilla, Spain
| | - Kathryn R Cullen
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Udo Dannlowski
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Christopher G Davey
- Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia
| | - Katharina Dohm
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Janice M Fullerton
- Neuroscience Research Australia, Randwick, NSW, Australia
- School of Medical Sciences, University of New South Wales, Kensington, NSW, Australia
| | - Ali Saffet Gonul
- SoCAT Lab, Department of Psychiatry, School of Medicine, Ege University, Izmir, Turkey
| | - Ian H Gotlib
- Department of Psychology, Stanford University, Stanford, CA, USA
| | - Dominik Grotegerd
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Tim Hahn
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Ben J Harrison
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia
| | - Mengxin He
- Department of Psychiatry, First Affiliated Hospital of Kunming Medical College, Kunming, China
| | - Ian B Hickie
- Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia
| | - Tiffany C Ho
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, CA, USA
- Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA
| | - Frank Iorfino
- Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia
| | - Andreas Jansen
- Department of Psychiatry and Psychotherapy, Marburg University, Marburg, Germany
- CMBB, Marburg, Germany
- Core-Facility Brainimaging, Faculty of Medicine, University of Marburg, Marburg, Germany
| | - Fabrice Jollant
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany
- MOODS Team, CESP, INSERM U1018, Faculté de Médecine, Univ Paris-Saclay, Le Kremlin Bicêtre, 94275, France
- Université de Paris & GHU Paris Psychiatrie et Neurosciences, Paris, France
- McGill University, Department of Psychiatry, Montréal, QC, Canada
- Academic Hospital (CHU), Nîmes, France
| | - Tilo Kircher
- Department of Psychiatry and Psychotherapy, Marburg University, Marburg, Germany
- CMBB, Marburg, Germany
| | | | - Melissa Klug
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Elisabeth J Leehr
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Elizabeth T C Lippard
- Department of Psychiatry and Behavioral Sciences, Dell Medical School, University of Texas at Austin, Austin, TX, USA
- Institute of Early Life Adversity Research, Dell Medical School, University of Texas at Austin, Austin, TX, USA
- Waggoner Center for Alcohol and Addiction Research, University of Texas at Austin, Austin, TX, USA
- Mulva Clinic for Neuroscience, Dell Medical School, University of Texas at Austin, Austin, TX, USA
| | | | - Susanne Meinert
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
- Institute for Translational Neuroscience, University of Münster, Münster, Germany
| | - Adam Bryant Miller
- Mental Health Risk and Resilience Research Program, RTI International, Research Triangle Park, NC, USA
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Philip B Mitchell
- School of Psychiatry, University of New South Wales, Kensington, NSW, Australia
| | - Benson Mwangi
- Center Of Excellence On Mood Disorders, The University of Texas-Health Science Center at Houston, Houston, TX, USA
- Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences at McGovern Medical School, The University of Texas - Health Science Center at Houston, Houston, TX, USA
| | - Igor Nenadić
- Department of Psychiatry and Psychotherapy, Marburg University, Marburg, Germany
- CMBB, Marburg, Germany
| | - Amar Ojha
- Center for Neuroscience, University of Pittsburgh, Pittsburgh, PA, USA
- Center for the Neural Basis of Cognition, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Julia-Katharina Pfarr
- Department of Psychiatry and Psychotherapy, Marburg University, Marburg, Germany
- CMBB, Marburg, Germany
| | - Fabrizio Piras
- Laboratory of Neuropsychiatry, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Kai G Ringwald
- Department of Psychiatry and Psychotherapy, Marburg University, Marburg, Germany
- CMBB, Marburg, Germany
| | - Gloria Roberts
- School of Psychiatry, University of New South Wales, Kensington, NSW, Australia
| | - Georg Romer
- Department of Child & Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Münster, Münster, Germany
| | - Marsal Sanches
- Center Of Excellence On Mood Disorders, The University of Texas-Health Science Center at Houston, Houston, TX, USA
- Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences at McGovern Medical School, The University of Texas - Health Science Center at Houston, Houston, TX, USA
| | - Margaret A Sheridan
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jair C Soares
- Center Of Excellence On Mood Disorders, The University of Texas-Health Science Center at Houston, Houston, TX, USA
- Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences at McGovern Medical School, The University of Texas - Health Science Center at Houston, Houston, TX, USA
| | - Gianfranco Spalletta
- Laboratory of Neuropsychiatry, IRCCS Santa Lucia Foundation, Rome, Italy
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Frederike Stein
- Department of Psychiatry and Psychotherapy, Marburg University, Marburg, Germany
- CMBB, Marburg, Germany
| | - Giana I Teresi
- Department of Psychology, Stanford University, Stanford, CA, USA
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Diana Tordesillas-Gutiérrez
- Department of Radiology, IDIVAL, Marqués de Valdecilla University Hospital, Santander, Spain
- Advanced Computing and e-Science, Instituto de Física de Cantabria (UC-CSIC), Santander, Spain
| | - Aslihan Uyar-Demir
- SoCAT Lab, Department of Psychiatry, School of Medicine, Ege University, Izmir, Turkey
| | - Nic J A van der Wee
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
- Leiden Institute for Brain and Cognition, Leiden University, Leiden, The Netherlands
| | - Steven J van der Werff
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
- Leiden Institute for Brain and Cognition, Leiden University, Leiden, The Netherlands
- Leids Universitair Behandel- en Expertise Centrum, Leiden, The Netherlands
| | - Robert R J M Vermeiren
- Child and Adolescent Psychiatry Leiden University Medical Center, Leiden, The Netherlands
- Youz: Child and Adolescent Psychiatry, Leiden, The Netherlands
| | - Alexandra Winter
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Mon-Ju Wu
- Center Of Excellence On Mood Disorders, The University of Texas-Health Science Center at Houston, Houston, TX, USA
- Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences at McGovern Medical School, The University of Texas - Health Science Center at Houston, Houston, TX, USA
| | - Tony T Yang
- Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Weill Institute for Neurosciences, UCSF, San Francisco, CA, USA
| | - Paul M Thompson
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey, CA, USA
| | - Miguel E Rentería
- Department of Genetics & Computational Biology, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
- School of Biomedical Sciences, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Neda Jahanshad
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey, CA, USA
| | - Hilary P Blumberg
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
- Child Study Center, Yale School of Medicine, New Haven, CT, USA
| | - Anne-Laura van Harmelen
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Leiden Institute for Brain and Cognition, Leiden University, Leiden, The Netherlands
- Social Security and Resilience Programme, Education and Child Studies, Leiden University, Leiden, The Netherlands
| | - Lianne Schmaal
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
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9
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Lalousis PA, Schmaal L, Wood SJ, Reniers RLEP, Barnes NM, Chisholm K, Griffiths SL, Stainton A, Wen J, Hwang G, Davatzikos C, Wenzel J, Kambeitz-Ilankovic L, Andreou C, Bonivento C, Dannlowski U, Ferro A, Lichtenstein T, Riecher-Rössler A, Romer G, Rosen M, Bertolino A, Borgwardt S, Brambilla P, Kambeitz J, Lencer R, Pantelis C, Ruhrmann S, Salokangas RKR, Schultze-Lutter F, Schmidt A, Meisenzahl E, Koutsouleris N, Dwyer D, Upthegrove R. Neurobiologically Based Stratification of Recent-Onset Depression and Psychosis: Identification of Two Distinct Transdiagnostic Phenotypes. Biol Psychiatry 2022; 92:552-562. [PMID: 35717212 PMCID: PMC10128104 DOI: 10.1016/j.biopsych.2022.03.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 02/04/2022] [Accepted: 03/01/2022] [Indexed: 12/17/2022]
Abstract
BACKGROUND Identifying neurobiologically based transdiagnostic categories of depression and psychosis may elucidate heterogeneity and provide better candidates for predictive modeling. We aimed to identify clusters across patients with recent-onset depression (ROD) and recent-onset psychosis (ROP) based on structural neuroimaging data. We hypothesized that these transdiagnostic clusters would identify patients with poor outcome and allow more accurate prediction of symptomatic remission than traditional diagnostic structures. METHODS HYDRA (Heterogeneity through Discriminant Analysis) was trained on whole-brain volumetric measures from 577 participants from the discovery sample of the multisite PRONIA study to identify neurobiologically driven clusters, which were then externally validated in the PRONIA replication sample (n = 404) and three datasets of chronic samples (Centre for Biomedical Research Excellence, n = 146; Mind Clinical Imaging Consortium, n = 202; Munich, n = 470). RESULTS The optimal clustering solution was two transdiagnostic clusters (cluster 1: n = 153, 67 ROP, 86 ROD; cluster 2: n = 149, 88 ROP, 61 ROD; adjusted Rand index = 0.618). The two clusters contained both patients with ROP and patients with ROD. One cluster had widespread gray matter volume deficits and more positive, negative, and functional deficits (impaired cluster), and one cluster revealed a more preserved neuroanatomical signature and more core depressive symptomatology (preserved cluster). The clustering solution was internally and externally validated and assessed for clinical utility in predicting 9-month symptomatic remission, outperforming traditional diagnostic structures. CONCLUSIONS We identified two transdiagnostic neuroanatomically informed clusters that are clinically and biologically distinct, challenging current diagnostic boundaries in recent-onset mental health disorders. These results may aid understanding of the etiology of poor outcome patients transdiagnostically and improve development of stratified treatments.
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Affiliation(s)
- Paris Alexandros Lalousis
- Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom; Centre for Human Brain Health, University of Birmingham, Birmingham, United Kingdom.
| | - Lianne Schmaal
- Orygen, Parkville, Victoria, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Stephen J Wood
- Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom; Orygen, Parkville, Victoria, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Renate L E P Reniers
- Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom; Centre for Human Brain Health, University of Birmingham, Birmingham, United Kingdom; Institute of Clinical Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Nicholas M Barnes
- Institute of Clinical Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Katharine Chisholm
- Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom; Department of Psychology, Aston University, Birmingham, United Kingdom
| | - Sian Lowri Griffiths
- Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom; Centre for Human Brain Health, University of Birmingham, Birmingham, United Kingdom
| | - Alexandra Stainton
- Orygen, Parkville, Victoria, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Junhao Wen
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Gyujoon Hwang
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Christos Davatzikos
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Julian Wenzel
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Lana Kambeitz-Ilankovic
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | | | - Carolina Bonivento
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy; Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Udo Dannlowski
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Adele Ferro
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy; Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Theresa Lichtenstein
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | | | - Georg Romer
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Marlene Rosen
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Alessandro Bertolino
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Stefan Borgwardt
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany; Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Paolo Brambilla
- Department of Psychiatry, University of Basel, Basel, Switzerland; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Joseph Kambeitz
- Department of Psychiatry and Psychotherapy, Ludwig Maxmilians University, Munich, Germany
| | - Rebekka Lencer
- Institute for Translational Psychiatry, University of Münster, Münster, Germany; Department of Psychiatry, University of Basel, Basel, Switzerland
| | - Christos Pantelis
- Melbourne Neuropsychiatry Centre, University of Melbourne, Melbourne, Victoria, Australia
| | - Stephan Ruhrmann
- Department of Psychiatry, University of Basel, Basel, Switzerland
| | | | - Frauke Schultze-Lutter
- Department of Psychiatry and Psychotherapy, University of Düsseldorf, Düsseldorf, Germany; University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland; Department of Psychology and Mental Health, Faculty of Psychology, Airlangga University, Surabaya, Indonesia
| | - André Schmidt
- Department of Psychiatry, University of Basel, Basel, Switzerland
| | - Eva Meisenzahl
- Department of Psychiatry and Psychotherapy, University of Düsseldorf, Düsseldorf, Germany
| | - Nikolaos Koutsouleris
- Department of Psychiatry and Psychotherapy, Ludwig Maxmilians University, Munich, Germany
| | - Dominic Dwyer
- Department of Psychiatry and Psychotherapy, Ludwig Maxmilians University, Munich, Germany
| | - Rachel Upthegrove
- Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom; Centre for Human Brain Health, University of Birmingham, Birmingham, United Kingdom; Birmingham Early Interventions Service, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom
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10
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Dwyer DB, Buciuman MO, Ruef A, Kambeitz J, Sen Dong M, Stinson C, Kambeitz-Ilankovic L, Degenhardt F, Sanfelici R, Antonucci LA, Lalousis PA, Wenzel J, Urquijo-Castro MF, Popovic D, Oeztuerk OF, Haas SS, Weiske J, Hauke D, Neufang S, Schmidt-Kraepelin C, Ruhrmann S, Penzel N, Lichtenstein T, Rosen M, Chisholm K, Riecher-Rössler A, Egloff L, Schmidt A, Andreou C, Hietala J, Schirmer T, Romer G, Michel C, Rössler W, Maj C, Borisov O, Krawitz PM, Falkai P, Pantelis C, Lencer R, Bertolino A, Borgwardt S, Noethen M, Brambilla P, Schultze-Lutter F, Meisenzahl E, Wood SJ, Davatzikos C, Upthegrove R, Salokangas RKR, Koutsouleris N. Clinical, Brain, and Multilevel Clustering in Early Psychosis and Affective Stages. JAMA Psychiatry 2022; 79:677-689. [PMID: 35583903 PMCID: PMC9118078 DOI: 10.1001/jamapsychiatry.2022.1163] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Importance Approaches are needed to stratify individuals in early psychosis stages beyond positive symptom severity to investigate specificity related to affective and normative variation and to validate solutions with premorbid, longitudinal, and genetic risk measures. Objective To use machine learning techniques to cluster, compare, and combine subgroup solutions using clinical and brain structural imaging data from early psychosis and depression stages. Design, Setting, and Participants A multisite, naturalistic, longitudinal cohort study (10 sites in 5 European countries; including major follow-up intervals at 9 and 18 months) with a referred patient sample of those with clinical high risk for psychosis (CHR-P), recent-onset psychosis (ROP), recent-onset depression (ROD), and healthy controls were recruited between February 1, 2014, to July 1, 2019. Data were analyzed between January 2020 and January 2022. Main Outcomes and Measures A nonnegative matrix factorization technique separately decomposed clinical (287 variables) and parcellated brain structural volume (204 gray, white, and cerebrospinal fluid regions) data across CHR-P, ROP, ROD, and healthy controls study groups. Stability criteria determined cluster number using nested cross-validation. Validation targets were compared across subgroup solutions (premorbid, longitudinal, and schizophrenia polygenic risk scores). Multiclass supervised machine learning produced a transferable solution to the validation sample. Results There were a total of 749 individuals in the discovery group and 610 individuals in the validation group. Individuals included those with CHR-P (n = 287), ROP (n = 323), ROD (n = 285), and healthy controls (n = 464), The mean (SD) age was 25.1 (5.9) years, and 702 (51.7%) were female. A clinical 4-dimensional solution separated individuals based on positive symptoms, negative symptoms, depression, and functioning, demonstrating associations with all validation targets. Brain clustering revealed a subgroup with distributed brain volume reductions associated with negative symptoms, reduced performance IQ, and increased schizophrenia polygenic risk scores. Multilevel results distinguished between normative and illness-related brain differences. Subgroup results were largely validated in the external sample. Conclusions and Relevance The results of this longitudinal cohort study provide stratifications beyond the expression of positive symptoms that cut across illness stages and diagnoses. Clinical results suggest the importance of negative symptoms, depression, and functioning. Brain results suggest substantial overlap across illness stages and normative variation, which may highlight a vulnerability signature independent from specific presentations. Premorbid, longitudinal, and genetic risk validation suggested clinical importance of the subgroups to preventive treatments.
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Affiliation(s)
- Dominic B Dwyer
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Madalina-Octavia Buciuman
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany.,International Max-Planck Research School for Translational Psychiatry, Munich, Germany
| | - Anne Ruef
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
| | - Joseph Kambeitz
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Mark Sen Dong
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
| | - Caedyn Stinson
- Max-Planck School of Cognition, Leipzig, Germany.,Center for Adaptive Rationality, Max Planck Institute for Human Development, Berlin, Germany
| | - Lana Kambeitz-Ilankovic
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany.,Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Franziska Degenhardt
- Institute of Human Genetics, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, Germany.,Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Rachele Sanfelici
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany.,Max-Planck Institute of Psychiatry, Munich, Germany
| | - Linda A Antonucci
- Department of Education, Psychology, Communication, University of Bari Aldo Moro, Bari, Italy
| | - Paris Alexandros Lalousis
- Institute for Mental Health and Centre for Brain Health, University of Birmingham, Birmingham, United Kingdom
| | - Julian Wenzel
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | | | - David Popovic
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany.,International Max-Planck Research School for Translational Psychiatry, Munich, Germany
| | - Oemer Faruk Oeztuerk
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany.,International Max-Planck Research School for Translational Psychiatry, Munich, Germany
| | - Shalaila S Haas
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Johanna Weiske
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
| | - Daniel Hauke
- Department of Psychiatry (Psychiatric University Hospital, UPK), University of Basel, Basel, Switzerland.,Early Intervention Service, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom.,Department of Mathematics and Computer Science, University of Basel, Basel, Switzerland
| | - Susanne Neufang
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | | | - Stephan Ruhrmann
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Nora Penzel
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Theresa Lichtenstein
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Marlene Rosen
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Katharine Chisholm
- Institute for Mental Health and Centre for Brain Health, University of Birmingham, Birmingham, United Kingdom.,Department of Psychology, Aston University, Birmingham, United Kingdom
| | | | - Laura Egloff
- Department of Psychiatry (Psychiatric University Hospital, UPK), University of Basel, Basel, Switzerland
| | - André Schmidt
- Department of Psychiatry (Psychiatric University Hospital, UPK), University of Basel, Basel, Switzerland
| | - Christina Andreou
- Department of Psychiatry (Psychiatric University Hospital, UPK), University of Basel, Basel, Switzerland
| | - Jarmo Hietala
- Department of Psychiatry, University of Turku, Turku, Finland
| | - Timo Schirmer
- GE Healthcare GmbH (previously GE Global Research GmbH), Munich, Germany
| | - Georg Romer
- Department of Child and Adolescent Psychiatry, University of Münster, Münster, Germany
| | - Chantal Michel
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Wulf Rössler
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Carlo Maj
- Institute of Genomic Statistics and Bioinformatics, University of Bonn, Bonn, Germany
| | - Oleg Borisov
- Institute of Genomic Statistics and Bioinformatics, University of Bonn, Bonn, Germany
| | - Peter M Krawitz
- Institute of Genomic Statistics and Bioinformatics, University of Bonn, Bonn, Germany
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany.,Max-Planck Institute of Psychiatry, Munich, Germany
| | - Christos Pantelis
- Melbourne Neuropsychiatry Centre, University of Melbourne & Melbourne Health, Melbourne, Victoria, Australia
| | - Rebekka Lencer
- Department of Psychiatry and Psychotherapy, University of Münster, Münster, Germany.,Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Alessandro Bertolino
- Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Stefan Borgwardt
- Department of Psychiatry (Psychiatric University Hospital, UPK), University of Basel, Basel, Switzerland.,Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Markus Noethen
- Institute of Human Genetics, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, Germany
| | - Paolo Brambilla
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Frauke Schultze-Lutter
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany.,University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.,Department of Psychology, Faculty of Psychology, Airlangga University, Surabaya, Indonesia
| | | | - Stephen J Wood
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia.,Orygen, the National Centre of Excellence for Youth Mental Health, Melbourne, Victoria, Australia
| | - Christos Davatzikos
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia.,Center for Biomedical Image Computing and Analytics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Rachel Upthegrove
- Institute for Mental Health and Centre for Brain Health, University of Birmingham, Birmingham, United Kingdom.,Early Intervention Service, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom
| | | | - Nikolaos Koutsouleris
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany.,Max-Planck Institute of Psychiatry, Munich, Germany.,Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
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11
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Marckhoff M, Siebald M, Timmesfeld N, Janßen M, Romer G, Föcker M. COVID-19: Effects of Pandemic Related Restrictions on Physical Activity, Screen Time, and Mental Well-being in German adolescents. Z Kinder Jugendpsychiatr Psychother 2022; 50:313-326. [PMID: 35343802 DOI: 10.1024/1422-4917/a000867] [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] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Objective: To describe the impact of the COVID-19 pandemic-related restrictions (PR) in April and May 2020 on physical activity (PA), sedentary screen time (SST), and mental well-being (MWB) in German adolescents, and to analyze associations between these variables. Methods: The Münster District Government invited all secondary school students (aged 11-17) in the region to take part in the online survey that assessed PA, SST, and MWB. For data analysis, we calculated descriptive statistics and ran linear regression analysis. Results: 1,038 students (627 [60.4%] female; 14.18 [± 1.97] years) were included in the analysis. During the PR, a marked decline in overall PA (p < .001) and a significant increase (p < .001) in SST were observed. One-third of the students reported worrying more and being less satisfied with their lives since PR. A decrease in life satisfaction (ß = -.524, p < .001) as well as an increase in general worrying (ß = -.336, p = .015) were associated with a decrease in PA during PR. Conclusion: The results show that the restrictions led to a decrease in physical activity, which may have detrimental effects on the students' mental and physical health.
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Affiliation(s)
| | - Milena Siebald
- Department of Child and Adolescent Psychiatry, University Hospital Münster, Germany
| | - Nina Timmesfeld
- Department of Medical Informatics, Biometry, and Epidemiology, Ruhr University Bochum, Germany
| | - Marius Janßen
- Department of Child and Adolescent Psychiatry, University Hospital Münster, Germany
| | - Georg Romer
- Department of Child and Adolescent Psychiatry, University Hospital Münster, Germany
| | - Manuel Föcker
- Department of Child and Adolescent Psychiatry, University Hospital Münster, Germany
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12
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Penzel N, Sanfelici R, Antonucci LA, Betz LT, Dwyer D, Ruef A, Cho KIK, Cumming P, Pogarell O, Howes O, Falkai P, Upthegrove R, Borgwardt S, Brambilla P, Lencer R, Meisenzahl E, Schultze-Lutter F, Rosen M, Lichtenstein T, Kambeitz-Ilankovic L, Ruhrmann S, Salokangas RKR, Pantelis C, Wood SJ, Quednow BB, Pergola G, Bertolino A, Koutsouleris N, Kambeitz J, Dwyer D, Ruef A, Kambeitz-Ilankovic L, Sen Dong M, Erkens A, Gussmann E, Haas S, Hasan A, Hoff C, Khanyaree I, Melo A, Muckenhuber-Sternbauer S, Kohler J, Ozturk OF, Popovic D, Rangnick A, von Saldern S, Sanfelici R, Spangemacher M, Tupac A, Urquijo MF, Weiske J, Wosgien A, Kambeitz J, Ruhrmann S, Rosen M, Betz L, Lichtenstein T, Blume K, Seves M, Kaiser N, Penzel N, Pilgram T, Lichtenstein T, Wenzel J, Woopen C, Borgwardt S, Andreou C, Egloff L, Harrisberger F, Lenz C, Leanza L, Mackintosh A, Smieskova R, Studerus E, Walter A, Widmayer S, Upthegrove R, Wood SJ, Chisholm K, Day C, Griffiths SL, Lalousis PA, Iqbal M, Pelton M, Mallikarjun P, Stainton A, Lin A, Salokangas RKR, Denissoff A, Ellila A, From T, Heinimaa M, Ilonen T, Jalo P, Laurikainen H, Lehtinen M, Luutonen A, Makela A, Paju J, Pesonen H, Armio Säilä RL, Sormunen E, Toivonen A, Turtonen O, Solana AB, Abraham M, Hehn N, Schirmer T, Brambilla P, Altamura C, Belleri M, Bottinelli F, Ferro A, Re M, Monzani E, Percudani M, Sberna M, D’Agostino A, Del Fabro L, Perna G, Nobile M, Alciati A, Balestrieri M, Bonivento C, Cabras G, Fabbro F, Garzitto M, PiCCuin S, Bertolino A, Blasi G, Antonucci LA, Pergola G, Caforio G, Faio L, Quarto T, Gelao B, Romano R, Andriola I, Falsetti A, Barone M, Passatiore R, Sangiuliano M, Lencer R, Surman M, Bienek O, Romer G, Dannlowski U, Meisenzahl E, Schultze-Lutter F, Schmidt-Kraepelin C, Neufang S, Korda A, Rohner H. Pattern of predictive features of continued cannabis use in patients with recent-onset psychosis and clinical high-risk for psychosis. Schizophrenia (Heidelb) 2022; 8:19. [PMID: 35264631 PMCID: PMC8907166 DOI: 10.1038/s41537-022-00218-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 01/31/2022] [Indexed: 11/09/2022]
Abstract
Continued cannabis use (CCu) is an important predictor for poor long-term outcomes in psychosis and clinically high-risk patients, but no generalizable model has hitherto been tested for its ability to predict CCu in these vulnerable patient groups. In the current study, we investigated how structured clinical and cognitive assessments and structural magnetic resonance imaging (sMRI) contributed to the prediction of CCu in a group of 109 patients with recent-onset psychosis (ROP). We tested the generalizability of our predictors in 73 patients at clinical high-risk for psychosis (CHR). Here, CCu was defined as any cannabis consumption between baseline and 9-month follow-up, as assessed in structured interviews. All patients reported lifetime cannabis use at baseline. Data from clinical assessment alone correctly classified 73% (p < 0.001) of ROP and 59 % of CHR patients. The classifications of CCu based on sMRI and cognition were non-significant (ps > 0.093), and their addition to the interview-based predictor via stacking did not improve prediction significantly, either in the ROP or CHR groups (ps > 0.065). Lower functioning, specific substance use patterns, urbanicity and a lack of other coping strategies contributed reliably to the prediction of CCu and might thus represent important factors for guiding preventative efforts. Our results suggest that it may be possible to identify by clinical measures those psychosis-spectrum patients at high risk for CCu, potentially allowing to improve clinical care through targeted interventions. However, our model needs further testing in larger samples including more diverse clinical populations before being transferred into clinical practice.
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Affiliation(s)
- Nora Penzel
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Psychiatry and Psychotherapy, Cologne, Germany.,Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany.,Group of Psychiatric Neuroscience, Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari 'Aldo Moro', Bari, Italy
| | - Rachele Sanfelici
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany.,Max-Planck Institute of Psychiatry, Munich, Germany
| | - Linda A Antonucci
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany.,Department of Education, Psychology, Communication, University of Bari, Bari, Italy
| | - Linda T Betz
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Psychiatry and Psychotherapy, Cologne, Germany
| | - Dominic Dwyer
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
| | - Anne Ruef
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
| | - Kang Ik K Cho
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Paul Cumming
- Department of Nuclear Medicine, Bern University Hospital, Bern, Switzerland.,School of Psychology and Counselling, Queensland University of Technology, Brisbane, QLD, Australia.,International Research Lab in Neuropsychiatry, Neuroscience Research Institute, Samara State Medical University, Samara, Russia
| | - Oliver Pogarell
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
| | - Oliver Howes
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK.,MRC London Institute of Medical Sciences, Hammersmith Hospital, London, W12 0NN, UK.,Institute of Clinical Sciences, Faculty of Medicine, Imperial College London, London, W12 0NN, UK.,South London and Maudsley NHS Foundation Trust, London, SE5 8AF, UK
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany.,Max-Planck Institute of Psychiatry, Munich, Germany
| | - Rachel Upthegrove
- Institute for Mental Health, University of Birmingham, Birmingham, UK.,Early Intervention Service, Birmingham Womens and Childrens NHS Foundation Trust, Birmingham, UK
| | - Stefan Borgwardt
- Department of Psychiatry (UPK), University of Basel, Basel, Switzerland.,Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Paolo Brambilla
- Department of Neurosciences and Mental Health, Fondazione IRCCUS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Rebekka Lencer
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany.,Department of Psychiatry and Psychotherapy, University of Münster, Münster, Germany.,Otto Creutzfeldt Center for Behavioral and Cognitive Neuroscience, University of Münster, Münster, Germany
| | - Eva Meisenzahl
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Frauke Schultze-Lutter
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany.,Department of Psychology, Faculty of Psychology, Airlangga University, Surabaya, Indonesia.,University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Marlene Rosen
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Psychiatry and Psychotherapy, Cologne, Germany
| | - Theresa Lichtenstein
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Psychiatry and Psychotherapy, Cologne, Germany
| | - Lana Kambeitz-Ilankovic
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Psychiatry and Psychotherapy, Cologne, Germany.,Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
| | - Stephan Ruhrmann
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Psychiatry and Psychotherapy, Cologne, Germany
| | | | - Christos Pantelis
- Melbourne Neuropsychiatry Centre, University of Melbourne & Melbourne Health, Melbourne, VIC, Australia
| | - Stephen J Wood
- Institute for Mental Health, University of Birmingham, Birmingham, UK.,Orygen, Melbourne, VIC, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Boris B Quednow
- Experimental and Clinical Pharmacopsychology, Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric Hospital of the University of Zurich, Lenggstr. 31, 8032, Zurich, Switzerland
| | - Giulio Pergola
- Group of Psychiatric Neuroscience, Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari 'Aldo Moro', Bari, Italy
| | - Alessandro Bertolino
- Group of Psychiatric Neuroscience, Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari 'Aldo Moro', Bari, Italy
| | - Nikolaos Koutsouleris
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany.,Max-Planck Institute of Psychiatry, Munich, Germany.,Institute of Psychiatry, Psychology & Neuroscience, Department of Psychosis Studies, King's College London, London, UK
| | - Joseph Kambeitz
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Psychiatry and Psychotherapy, Cologne, Germany.
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Höltermann A, Scharf F, Romer G, Möller-Kallista B. [The Mental Health Problems of Unaccompanied and Accompanied Refugees in Childhood and Adolescence in Germany]. Z Kinder Jugendpsychiatr Psychother 2022; 50:369-381. [PMID: 35225676 DOI: 10.1024/1422-4917/a000855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The Mental Health Problems of Unaccompanied and Accompanied Refugees in Childhood and Adolescence in Germany Abstract. Abstracts: Objective: This articles investigates the psychological distress and stressful life events in unaccompanied minor refugees (UMR) in adolescence and accompanied minor refugees (AMR) in childhood and adolescence living in Germany. Additionally, it analyzes the predictors of psychological distress in the adolescents. Method: We assessed 170 children and adolescents (adolescents: n = 56 UMR, n = 72 AMR; children: n = 42 AMR) using questionnaires on emotional and behavioral problems and stressful life events. In addition, we questioned the adolescents on PTSS (adolescents: self-report; children: caregiver report). Results: 45.8 % UMR (adolescents), 42.4 % AMR (adolescents), and 56.1 % AMR (children) showed emotional and behavioral problems. On average, we identified 7 stressful life events in UMR (adolescents) and 4 in AMR (adolescents, children). UMR (adolescents) reported more emotional problems, more PTSS, and more stressful life events than did AMR (adolescents). 43.8 % UMR (adolescents) and 27.9 % AMR (adolescents) reported PTSS. The number of stressful life events was found to be the most robust predictor for emotional and behavioral problems as well as PTSS in adolescents. Conclusions: The results indicate the need for psychological interventions of refugee minors in Germany.
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Affiliation(s)
- Annelen Höltermann
- Klinik für Kinder- und Jugendpsychiatrie, -psychosomatik und -psychotherapie, Universitätsklinikum Münster
| | - Florian Scharf
- Institut für Psychologie, Westfälische Wilhelms-Universität Münster
| | - Georg Romer
- Klinik für Kinder- und Jugendpsychiatrie, -psychosomatik und -psychotherapie, Universitätsklinikum Münster
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14
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Freff J, Bröker L, Leite Dantas R, Schwarte K, Bühlmeier J, Kraft I, Hinney A, Buhlmann U, Arolt V, Dannlowski U, Romer G, Baune BT, Hebebrand J, Föcker M, Alferink J. Expression of CXCR4 on CD4 + T cells predicts body composition parameters in female adolescents with anorexia nervosa. Front Psychiatry 2022; 13:960905. [PMID: 36226111 PMCID: PMC9549152 DOI: 10.3389/fpsyt.2022.960905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 09/06/2022] [Indexed: 11/30/2022] Open
Abstract
Anorexia nervosa (AN) is a severe eating disorder characterized by excessive weight loss and lack of recognition of the seriousness of the current low body weight. Individuals with AN frequently exhibit an enhanced inflammatory state and altered blood levels of cytokines and chemokines. However, the expression of chemokine receptors in AN and the association with body composition parameters and treatment effects are still unknown. In this study, we examined the expression of CCR4, CCR6, CXCR3, and CXCR4 on peripheral blood T cells in female adolescents with AN before (T0, n = 24) and after 6 weeks of multimodal therapy (T1, n = 20). We also investigated their value to predict body mass index (BMI) and fat mass index (FMI) at baseline. Using multi-parameter flow cytometry, we found increased expression of CCR4, CXCR3, and CXCR4, but not CCR6, on CD4+ T cells in AN at T0 when compared to healthy controls (HC, n = 20). At T1, CXCR3 and CXCR4 expression decreased in AN. We found a close link between CCR4, CCR6 and CXCR4 expression and the adolescent mental health status in the study cohort as determined by the Strengths and Difficulties Questionnaire (SDQ). Specifically, CXCR4 expression correlated positively with emotional symptoms and peer relationship problems, as well as with the total sum score of the SDQ. In addition, CXCR4 expression on CD4+ T cells was a significant predictor of BMI and FMI in female adolescents. Our findings that CXCR4 expression on T cells is altered in adolescents with AN and predicts body composition parameters in adolescents suggest an impact of this chemokine receptor in the pathogenesis of AN.
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Affiliation(s)
- Jana Freff
- Department of Psychiatry, University of Münster, Münster, Germany.,Cells in Motion Interfaculty Cluster, University of Münster, Münster, Germany
| | - Lisa Bröker
- Department of Psychiatry, University of Münster, Münster, Germany.,Cells in Motion Interfaculty Cluster, University of Münster, Münster, Germany
| | - Rafael Leite Dantas
- Department of Psychiatry, University of Münster, Münster, Germany.,Cells in Motion Interfaculty Cluster, University of Münster, Münster, Germany
| | - Kathrin Schwarte
- Department of Psychiatry, University of Münster, Münster, Germany
| | - Judith Bühlmeier
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.,Department of Clinical Psychology and Psychotherapy, University of Münster, Münster, Germany.,Faculty of Natural Sciences, Institute of Nutrition, Consumption and Health, University Paderborn, Paderborn, Germany
| | - Isabelle Kraft
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Anke Hinney
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Ulrike Buhlmann
- Department of Clinical Psychology and Psychotherapy, University of Münster, Münster, Germany
| | - Volker Arolt
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Udo Dannlowski
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Georg Romer
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital Münster, Münster, Germany
| | - Bernhard T Baune
- Department of Psychiatry, University of Münster, Münster, Germany.,Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia.,The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Johannes Hebebrand
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Manuel Föcker
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.,Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital Münster, Münster, Germany
| | - Judith Alferink
- Department of Psychiatry, University of Münster, Münster, Germany.,Cells in Motion Interfaculty Cluster, University of Münster, Münster, Germany
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15
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Tossani E, Verrocchio MC, Romer G, Landi G. Editorial: Transgenerational Effects of Parental Physical and Mental Illnesses on Their Young Offspring's Adjustment: A Psychosomatic Perspective. Front Psychiatry 2022; 13:901177. [PMID: 35573323 PMCID: PMC9099003 DOI: 10.3389/fpsyt.2022.901177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 03/25/2022] [Indexed: 11/25/2022] Open
Affiliation(s)
- Eliana Tossani
- Department of Psychology "Renzo Canestrari", University of Bologna, Bologna, Italy.,Laboratory of Psychosomatics and Clinimetrics, Department of Psychology, University of Bologna, Bologna, Italy
| | - Maria Cristina Verrocchio
- Department of Psychological, Health and Territorial Sciences, University "Gabriele d'Annunzio" of Chieti-Pescara, Chieti, Italy
| | - Georg Romer
- Department of Child and Adolescent Psychiatry, University Hospital Münster, Münster, Germany
| | - Giulia Landi
- Department of Psychology "Renzo Canestrari", University of Bologna, Bologna, Italy.,Laboratory of Psychosomatics and Clinimetrics, Department of Psychology, University of Bologna, Bologna, Italy
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16
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Weitkamp K, Claaßen S, Wiegand-Grefe S, Romer G. Operationalized psychodynamic diagnosis in childhood and adolescence (OPD-CA): Changes across psychodynamic child and adolescent therapy. Nordic Psychology 2021. [DOI: 10.1080/19012276.2021.2001683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Katharina Weitkamp
- Clinical Psychology for Children/Adolescents and Couples/Families, University Zurich, Zurich, Switzerland
| | - Sanna Claaßen
- Insitute of Psychology, Hamburg University, Hamburg, Germany
| | - Silke Wiegand-Grefe
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Centre Hamburg, Hamburg, Germany
| | - Georg Romer
- Department of Child and Adolescent Psychiatry and Psychotherapy and Psychosomatics, University Medical Centre Münster, Münster, Germany
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17
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Romero Frausto H, Roesmann K, Klinkenberg IAG, Rehbein MA, Föcker M, Romer G, Junghoefer M, Wessing I. Increased early motivational response to food in adolescent anorexia nervosa revealed by magnetoencephalography. Psychol Med 2021; 52:1-9. [PMID: 33947486 PMCID: PMC9811273 DOI: 10.1017/s003329172100088x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 02/17/2021] [Accepted: 02/24/2021] [Indexed: 01/21/2023]
Abstract
BACKGROUND It remains unclear to what extent reduced nutritional intake in anorexia nervosa (AN) is a consequence of a reduced motivational response to food. Although self-reports typically suggest AN patients have a reduced appetitive response, behavioral and neurophysiological measures have revealed evidence for both increased and reduced attentional biases towards food stimuli. The mechanisms influencing food perception in AN, might be clarified using time-sensitive magnetoencephalography (MEG) to differentiate the early (more automatic processing) stages from the late (more controlled) stages. METHODS MEG was recorded in 22 partially weight-restored adolescent AN patients and 29 age- and gender-matched healthy control (HC) participants during a rapid serial visual presentation paradigm using 100 high-calorie food, 100 low-calorie food, and 100 non-food pictures. Neural sources of event-related fields were estimated using the L2-Minimum-Norm method and analyzed in early (50-300 ms) and late (350-500 ms) time intervals. RESULTS AN patients rated high-calorie food as less palatable and reported overall less food craving than HC participants. Nevertheless, in response to food pictures AN patients showed relative increased neural activity in the left occipito-temporal and inferior frontal regions in the early time interval. No group differences occurred in the late time interval. CONCLUSIONS MEG results speak against an overall reduced motivational response to food in AN. Instead, relative increased early food processing in the visual cortex suggests greater motivated attention. A greater appetitive response to food might be an adaptive mechanism in a state of undernourishment. Yet, this relative increased food processing in AN was no longer present later, arguably reflecting rapid downregulation.
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Affiliation(s)
- Hugo Romero Frausto
- Department of Child and Adolescent Psychiatry, University Hospital Muenster, Muenster, Germany
| | - Kati Roesmann
- Institute for Clinical Psychology, University of Siegen, Siegen, Germany
- Institute for Biomagnetism and Biosignalanalysis, University Hospital Muenster, Muenster, Germany
- Otto Creutzfeldt Center for Cognitive and Behavioral Neuroscience, University of Muenster, Muenster, Germany
| | - Isabelle A. G. Klinkenberg
- Institute for Biomagnetism and Biosignalanalysis, University Hospital Muenster, Muenster, Germany
- Otto Creutzfeldt Center for Cognitive and Behavioral Neuroscience, University of Muenster, Muenster, Germany
| | - Maimu A. Rehbein
- Institute for Biomagnetism and Biosignalanalysis, University Hospital Muenster, Muenster, Germany
- Otto Creutzfeldt Center for Cognitive and Behavioral Neuroscience, University of Muenster, Muenster, Germany
| | - Manuel Föcker
- Department of Child and Adolescent Psychiatry, University Hospital Muenster, Muenster, Germany
| | - Georg Romer
- Department of Child and Adolescent Psychiatry, University Hospital Muenster, Muenster, Germany
- Otto Creutzfeldt Center for Cognitive and Behavioral Neuroscience, University of Muenster, Muenster, Germany
| | - Markus Junghoefer
- Institute for Biomagnetism and Biosignalanalysis, University Hospital Muenster, Muenster, Germany
- Otto Creutzfeldt Center for Cognitive and Behavioral Neuroscience, University of Muenster, Muenster, Germany
| | - Ida Wessing
- Department of Child and Adolescent Psychiatry, University Hospital Muenster, Muenster, Germany
- Institute for Biomagnetism and Biosignalanalysis, University Hospital Muenster, Muenster, Germany
- Otto Creutzfeldt Center for Cognitive and Behavioral Neuroscience, University of Muenster, Muenster, Germany
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18
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Koutsouleris N, Dwyer DB, Degenhardt F, Maj C, Urquijo-Castro MF, Sanfelici R, Popovic D, Oeztuerk O, Haas SS, Weiske J, Ruef A, Kambeitz-Ilankovic L, Antonucci LA, Neufang S, Schmidt-Kraepelin C, Ruhrmann S, Penzel N, Kambeitz J, Haidl TK, Rosen M, Chisholm K, Riecher-Rössler A, Egloff L, Schmidt A, Andreou C, Hietala J, Schirmer T, Romer G, Walger P, Franscini M, Traber-Walker N, Schimmelmann BG, Flückiger R, Michel C, Rössler W, Borisov O, Krawitz PM, Heekeren K, Buechler R, Pantelis C, Falkai P, Salokangas RKR, Lencer R, Bertolino A, Borgwardt S, Noethen M, Brambilla P, Wood SJ, Upthegrove R, Schultze-Lutter F, Theodoridou A, Meisenzahl E. Multimodal Machine Learning Workflows for Prediction of Psychosis in Patients With Clinical High-Risk Syndromes and Recent-Onset Depression. JAMA Psychiatry 2021; 78:195-209. [PMID: 33263726 PMCID: PMC7711566 DOI: 10.1001/jamapsychiatry.2020.3604] [Citation(s) in RCA: 97] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
IMPORTANCE Diverse models have been developed to predict psychosis in patients with clinical high-risk (CHR) states. Whether prediction can be improved by efficiently combining clinical and biological models and by broadening the risk spectrum to young patients with depressive syndromes remains unclear. OBJECTIVES To evaluate whether psychosis transition can be predicted in patients with CHR or recent-onset depression (ROD) using multimodal machine learning that optimally integrates clinical and neurocognitive data, structural magnetic resonance imaging (sMRI), and polygenic risk scores (PRS) for schizophrenia; to assess models' geographic generalizability; to test and integrate clinicians' predictions; and to maximize clinical utility by building a sequential prognostic system. DESIGN, SETTING, AND PARTICIPANTS This multisite, longitudinal prognostic study performed in 7 academic early recognition services in 5 European countries followed up patients with CHR syndromes or ROD and healthy volunteers. The referred sample of 167 patients with CHR syndromes and 167 with ROD was recruited from February 1, 2014, to May 31, 2017, of whom 26 (23 with CHR syndromes and 3 with ROD) developed psychosis. Patients with 18-month follow-up (n = 246) were used for model training and leave-one-site-out cross-validation. The remaining 88 patients with nontransition served as the validation of model specificity. Three hundred thirty-four healthy volunteers provided a normative sample for prognostic signature evaluation. Three independent Swiss projects contributed a further 45 cases with psychosis transition and 600 with nontransition for the external validation of clinical-neurocognitive, sMRI-based, and combined models. Data were analyzed from January 1, 2019, to March 31, 2020. MAIN OUTCOMES AND MEASURES Accuracy and generalizability of prognostic systems. RESULTS A total of 668 individuals (334 patients and 334 controls) were included in the analysis (mean [SD] age, 25.1 [5.8] years; 354 [53.0%] female and 314 [47.0%] male). Clinicians attained a balanced accuracy of 73.2% by effectively ruling out (specificity, 84.9%) but ineffectively ruling in (sensitivity, 61.5%) psychosis transition. In contrast, algorithms showed high sensitivity (76.0%-88.0%) but low specificity (53.5%-66.8%). A cybernetic risk calculator combining all algorithmic and human components predicted psychosis with a balanced accuracy of 85.5% (sensitivity, 84.6%; specificity, 86.4%). In comparison, an optimal prognostic workflow produced a balanced accuracy of 85.9% (sensitivity, 84.6%; specificity, 87.3%) at a much lower diagnostic burden by sequentially integrating clinical-neurocognitive, expert-based, PRS-based, and sMRI-based risk estimates as needed for the given patient. Findings were supported by good external validation results. CONCLUSIONS AND RELEVANCE These findings suggest that psychosis transition can be predicted in a broader risk spectrum by sequentially integrating algorithms' and clinicians' risk estimates. For clinical translation, the proposed workflow should undergo large-scale international validation.
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Affiliation(s)
- Nikolaos Koutsouleris
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany,Max-Planck Institute of Psychiatry, Munich, Germany,Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Dominic B. Dwyer
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
| | - Franziska Degenhardt
- Institute of Human Genetics, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, Germany,Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Carlo Maj
- Institute of Genomic Statistics and Bioinformatics, University of Bonn, Bonn, Germany
| | | | - Rachele Sanfelici
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany,Max-Planck School of Cognition, Leipzig, Germany
| | - David Popovic
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany,International Max-Planck Research School for Translational Psychiatry, Munich, Germany
| | - Oemer Oeztuerk
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany,International Max-Planck Research School for Translational Psychiatry, Munich, Germany
| | - Shalaila S. Haas
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Johanna Weiske
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
| | - Anne Ruef
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
| | - Lana Kambeitz-Ilankovic
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Linda A. Antonucci
- Department of Education, Psychology, and Communication, University of Bari Aldo Moro, Bari, Italy
| | - Susanne Neufang
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | | | - Stephan Ruhrmann
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Nora Penzel
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Joseph Kambeitz
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Theresa K. Haidl
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Marlene Rosen
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Katharine Chisholm
- Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom
| | - Anita Riecher-Rössler
- Department of Psychiatry, Psychiatric University Hospital, University of Basel, Switzerland
| | - Laura Egloff
- Department of Psychiatry, Psychiatric University Hospital, University of Basel, Switzerland
| | - André Schmidt
- Department of Psychiatry, Psychiatric University Hospital, University of Basel, Switzerland
| | - Christina Andreou
- Department of Psychiatry, Psychiatric University Hospital, University of Basel, Switzerland
| | - Jarmo Hietala
- Department of Psychiatry, University of Turku, Turku, Finland
| | - Timo Schirmer
- GE Healthcare GmbH (previously GE Global Research GmbH), Munich, Germany
| | - Georg Romer
- Department of Child and Adolescent Psychiatry, University of Münster, Münster, Germany
| | - Petra Walger
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, LVR Clinic Düsseldorf, Düsseldorf, Germany
| | - Maurizia Franscini
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Zürich, Zürich, Switzerland
| | - Nina Traber-Walker
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Zürich, Zürich, Switzerland
| | - Benno G. Schimmelmann
- University Hospital of Child and Adolescent Psychiatry, University Hospital Hamburg-Eppendorf, Hamburg, Germany,University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Rahel Flückiger
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Chantal Michel
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Wulf Rössler
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Oleg Borisov
- Institute of Genomic Statistics and Bioinformatics, University of Bonn, Bonn, Germany
| | - Peter M. Krawitz
- Institute of Genomic Statistics and Bioinformatics, University of Bonn, Bonn, Germany
| | - Karsten Heekeren
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland,Department of Psychiatry and Psychotherapy I, LVR Hospital Cologne, Cologne, Germany
| | - Roman Buechler
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland,Department of Neuroradiology, University Hospital of Zurich, Zurich, Switzerland
| | - Christos Pantelis
- Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Melbourne, Australia
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany,Max-Planck Institute of Psychiatry, Munich, Germany
| | | | - Rebekka Lencer
- Department of Psychiatry and Psychotherapy, University of Münster, Münster, Germany,Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Alessandro Bertolino
- Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Stefan Borgwardt
- Department of Psychiatry, Psychiatric University Hospital, University of Basel, Switzerland,Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Markus Noethen
- Institute of Human Genetics, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, Germany
| | - Paolo Brambilla
- Department of Neurosciences and Mental Health, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Stephen J. Wood
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia,Orygen, the National Centre of Excellence for Youth Mental Health, Melbourne, Australia
| | - Rachel Upthegrove
- Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom
| | - Frauke Schultze-Lutter
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany,Department of Psychology and Mental Health, Faculty of Psychology, Airlangga University, Surabaya, Indonesia
| | - Anastasia Theodoridou
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Eva Meisenzahl
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
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19
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Freff J, Schwarte K, Bröker L, Bühlmeier J, Kraft I, Öztürk D, Hinney A, Arolt V, Dannlowski U, Romer G, Baune BT, Hebebrand J, Föcker M, Alferink J. Alterations in B cell subsets correlate with body composition parameters in female adolescents with anorexia nervosa. Sci Rep 2021; 11:1125. [PMID: 33441933 PMCID: PMC7806719 DOI: 10.1038/s41598-020-80693-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 12/15/2020] [Indexed: 12/12/2022] Open
Abstract
Anorexia nervosa (AN) is a severe eating disorder and often associated with altered humoral immune responses. However, distinct B cell maturation stages in peripheral blood in adolescents with AN have not been characterized. Treatment effects and the relationship between clinical and B cell parameters are also not fully understood. Here we investigated the phenotype of circulating B cell subsets and the relationship with body composition in adolescents with AN before (T0, n = 24) and after 6 weeks (T1, n = 20) of treatment. Using multi-parameter flow cytometry, we found increased percentages of antigen-experienced B cells and plasmablasts in patients with AN compared to healthy controls (n = 20). In contrast, percentages of CD1d+CD5+ B cells and transitional B cells with immunoregulatory roles were reduced at T0 and T1. These B cell frequencies correlated positively with fat mass, fat mass index (FMI), free fat mass index, and body mass index standard deviation score. In addition, scavenger-like receptor CD5 expression levels were downregulated on transitional B cells and correlated with fat mass and FMI in AN. Our findings that regulatory B cell subgroups were reduced in AN and their strong relationship with body composition parameters point toward an impact of immunoregulatory B cells in the pathogenesis of AN.
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Affiliation(s)
- Jana Freff
- Department of Mental Health, University of Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany.,Cells in Motion Interfaculty Cluster, University of Münster, 48149, Münster, Germany
| | - Kathrin Schwarte
- Department of Mental Health, University of Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Lisa Bröker
- Department of Mental Health, University of Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany.,Cells in Motion Interfaculty Cluster, University of Münster, 48149, Münster, Germany
| | - Judith Bühlmeier
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital Essen, University of Duisburg-Essen, 45147, Essen, Germany
| | - Isabelle Kraft
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital Essen, University of Duisburg-Essen, 45147, Essen, Germany
| | - Dana Öztürk
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital Essen, University of Duisburg-Essen, 45147, Essen, Germany
| | - Anke Hinney
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital Essen, University of Duisburg-Essen, 45147, Essen, Germany
| | - Volker Arolt
- Department of Mental Health, University of Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Udo Dannlowski
- Department of Mental Health, University of Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Georg Romer
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital Münster, 48149, Münster, Germany
| | - Bernhard T Baune
- Department of Mental Health, University of Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany.,The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Melbourne, 3010, Australia.,Department of Psychiatry, The University of Melbourne, Melbourne, 3010, Australia
| | - Johannes Hebebrand
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital Essen, University of Duisburg-Essen, 45147, Essen, Germany
| | - Manuel Föcker
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital Essen, University of Duisburg-Essen, 45147, Essen, Germany.,Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital Münster, 48149, Münster, Germany
| | - Judith Alferink
- Department of Mental Health, University of Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany. .,Cells in Motion Interfaculty Cluster, University of Münster, 48149, Münster, Germany.
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20
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Inhestern L, Bultmann JC, Johannsen LM, Beierlein V, Möller B, Romer G, Koch U, Bergelt C. Estimates of Prevalence Rates of Cancer Patients With Children and Well-Being in Affected Children: A Systematic Review on Population-Based Findings. Front Psychiatry 2021; 12:765314. [PMID: 34899425 PMCID: PMC8656299 DOI: 10.3389/fpsyt.2021.765314] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 10/20/2021] [Indexed: 11/25/2022] Open
Abstract
This review assessed population-based estimate rates of cancer patients with minor and young adult children (≤ 25 years), children and young adults having a parent with cancer as well as the psychosocial situation and well-being of children and young adults affected by parental cancer. Eighteen publications on population-based studies were included. Studies varied in the age ranges of both cancer patients and children. The prevalence rates of cancer patients having children ranged from 14 to 24.7% depending on the sample structure (e.g., age, gender). Studies reported that between 1.6 and 8.4% of children resp. young adult children have a parent with a history of cancer. Seven publications reported on the psychosocial situation or well-being in children and young adults affected by parental cancer. Estimate rates of psychosocial problems, psychiatric diagnoses or distress ranged between 2.5 and 34% of children depending on the method of measurement and outcome. The differences in the sample structure between the studies impeded the comparison of prevalence rates. However, the findings help to determine the need for specific support services and health care planning. The results emphazise the importance to routinely include issues on the parental role of patients and questions on the well-being and coping of children into psychooncological care. If necessary, support should be provided to families living with a cancer diagnosis.
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Affiliation(s)
- Laura Inhestern
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Lene Marie Johannsen
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Volker Beierlein
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Birgit Möller
- Department of Social Work, Münster University of Applied Sciences, Münster, Germany
| | - Georg Romer
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Münster, Münster, Germany
| | - Uwe Koch
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Corinna Bergelt
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Medical Psychology, University Medicine Greifswald, Greifswald, Germany
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21
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Romer G, Schepker R. Können psychisch kranke Minderjährige freiwillig in ihre Freiheitsentziehung einwilligen? Eine juristische Kontroverse und ihre Implikationen für den Klinikalltag. Z Kinder Jugendpsychiatr Psychother 2020; 48:494-501. [PMID: 33172356 DOI: 10.1024/1422-4917/a000765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Georg Romer
- Klinik für Kinder- und Jugendpsychiatrie, -psychosomatik und -psychotherapie, Universitätsklinikum Münster
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Krege S, Hess J, Güldenring A, Richter E, Lederbogen S, Mengel M, Seppel T, Hetkamp M, Küntscher M, Sollenböhmer K, Henkel UM, Möller B, Romer G, Löwenberg H, Riechardt S. Symposium Genderdysphorie. Urologe A 2020; 59:1320-1330. [DOI: 10.1007/s00120-020-01336-0] [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: 10/23/2022]
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Albers CC, Müller JM, Mehring K, Romer G. Is a mother's recalled parental rearing behavior, her attributions of her child's behavior, and her psychopathology associated with her mother-child relationship quality? Infant Ment Health J 2020; 41:378-392. [PMID: 32057116 DOI: 10.1002/imhj.21850] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND The mother-child relationship quality (MCRQ) may represent a transgenerational transmission mechanism of mental health problems. In this context, we examine the mother's recalled parental rearing behavior, actual attributions of her child's behavior, and her current psychopathology. METHOD A clinical sample of mother-child dyads was assessed with the Questionnaire for the Assessment of Recalled Parental Rearing Behavior, the Parent Cognition Scale, and the Symptom Checklist at the Child Psychiatric Family Day Hospital for preschool children in Münster, Germany, at admission. MCRQ was assessed with the Parent-Infant Relationship Global Assessment Scale, a structured interview with the child (Strukturiertes Interview zur Erfassung der Kind-Eltern-Interaktion), and the Multiperspective Parent-Child Relationship Questionnaire. RESULTS Multiple regression analyses showed no direct association between the mother's recalled parental rearing behavior and any measure of the MCRQ. However, maternal dysfunctional attributions about her child's behavior and her actual psychopathology showed the expected negative associations with the multiperspective measures of MCRQ. The relationship quality assessments did not correlate significantly with each other. CONCLUSION The divergent measures of MCRQ, which seem to assess different aspects, are a barrier to investigate the association between the mother's recalled parental rearing behavior and MCRQ. However, low MCRQ is associated with increased maternal psychopathology and maternal dysfunctional attributions on child behavior.
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Affiliation(s)
- Carolin C Albers
- Department of Child and Adolescent Psychiatry, University Hospital Münster, Münster, Germany
| | - Jörg M Müller
- Department of Child and Adolescent Psychiatry, University Hospital Münster, Münster, Germany
| | - Kathrin Mehring
- Department of Child and Adolescent Psychiatry, University Hospital Münster, Münster, Germany
| | - Georg Romer
- Department of Child and Adolescent Psychiatry, University Hospital Münster, Münster, Germany
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Ramsauer B, Mühlhan C, Lotzin A, Achtergarde S, Mueller J, Krink S, Tharner A, Becker-Stoll F, Nolte T, Romer G. Randomized controlled trial of the Circle of Security-Intensive intervention for mothers with postpartum depression: maternal unresolved attachment moderates changes in sensitivity. Attach Hum Dev 2019; 22:705-726. [PMID: 31726954 DOI: 10.1080/14616734.2019.1689406] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Postpartum depression is related to inadequately sensitive caregiving, putting infants at risk for insecure attachment. Therefore, promoting sensitive maternal caregiving and secure child attachment is particularly important in postpartum depressed mothers and their infants. In this randomized-controlled-trial, we evaluated the efficacy of the Circle of Security-Intensive (COS-I)-intervention in supporting maternal sensitivity and mother-infant-attachment compared to treatment-as-usual (TAU) with unresolved-maternal attachment as a moderator of treatment effect. Eligible mothers with infants (N=72) 4-9 months-old were randomly assigned to treatment (n=36 dyads). Infant attachment was rated at follow-up (child age 16-18 months) (Strange-Situation-procedure). Maternal sensitivity was measured at baseline and follow-up (Mini-Maternal-Behavior-Q-sort). Maternal-unresolved-attachment was assessed at baseline (Adult-Attachment-Interview). We found no significant differences between treatments in infant attachment nor changes in mothers' sensitivity. However, in COS-I, unresolved-mothers exhibited significantly more change in sensitivity than non-unresolved-mothers, whereas in TAU, the opposite was true. These findings may help to optimize clinical use of COS-I.
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Affiliation(s)
- Brigitte Ramsauer
- Medical School Hamburg MSH, University of Applied Sciences and Medical University , Hamburg, Germany.,Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital Muenster , Muenster, Germany
| | - Christine Mühlhan
- Medical School Hamburg MSH, University of Applied Sciences and Medical University , Hamburg, Germany
| | - Annett Lotzin
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf , Hamburg, Germany
| | - Sandra Achtergarde
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital Muenster , Muenster, Germany
| | - Jessica Mueller
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf , Hamburg, Germany
| | - Stephanie Krink
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital Muenster , Muenster, Germany
| | - Anne Tharner
- Department of Clinical Child and Family Studies, Vrije Universiteit Amsterdam , Amsterdam, The Netherlands
| | | | | | - Georg Romer
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital Muenster , Muenster, Germany
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Storm Van's Gravesande K, Calabrese P, Blaschek A, Rostásy K, Huppke P, Rothe L, Mall V, Kessler J, Kalbe E, Dornfeld E, Elpers C, Lohmann H, Weddige A, Hagspiel S, Kirschner J, Brehm M, Blank C, Schubert J, Schimmel M, Pacheè S, Mohrbach M, Karenfort M, Kamp G, Lücke T, Neumann H, Lutz S, Gierse A, Sievers S, Schiffmann H, de Soye I, Trollmann R, Candova A, Rosner M, Neu A, Romer G, Seidel U, John R, Hofmann C, Schulz, Kinder S, Bertolatus A, Scheidtmann K, Lasogga R, Leiz S, Alber M, Kranz J, Bajer-Kornek B, Seidl R, Novak A. The Multiple Sclerosis Inventory of Cognition for Adolescents (MUSICADO): A brief screening instrument to assess cognitive dysfunction, fatigue and loss of health-related quality of life in pediatric-onset multiple sclerosis. Eur J Paediatr Neurol 2019; 23:792-800. [PMID: 31551133 DOI: 10.1016/j.ejpn.2019.08.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 07/23/2019] [Accepted: 08/22/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Screening for cognitive impairment (CI), fatigue and also Health-related quality of life (HRQoL) in patients with pediatric-onset multiple sclerosis (POMS) is of utmost importance in clinical practice. The aim of this study was to establish a new and validated pediatric screening tool "MUSICADO" that is easy to use and time economical. METHODS 106 patients with POMS aged 12-18 years and 210 healthy controls (HCs) stratified for age and education underwent neuropsychological testing including a screening test "Multiple Sclerosis Inventory of Cognition" for adults and 8 standardized cognitive tests and established scales to assess fatigue and HRQoL. RESULTS The phonemic verbal fluency task (RWT "s-words"), the Trail Making Test A (TMT-A), and the Digit Span Forward discriminated significantly between patients and HCs (p = 0.000, respectively) and showed the highest proportion of test failure in patients (24.5%, 17.9%; 15.1%, respectively). Therefore, they were put together to form the cognitive part of the "MUSICADO". After applying a scoring algorithm with balanced weighting of the subtests and age and education correction and a cut-off score for impairment, 35.8% of patients were categorized to be cognitively impaired (specificity: 88.6%). Fatigue was detected in 37.1% of the patients (specificity: 94.0%) and loss of HRQoL in 41.8% (specificity 95.7%) with the screening version, respectively. CONCLUSION The MUSICADO is a newly designed brief and easy to use screening test to help to early identify CI, fatigue, and loss of HRQoL in patients with POMS as cut scores are provided for all three items. Further studies will have to show its usability in independent samples of patients with POMS.
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Affiliation(s)
- K Storm Van's Gravesande
- Department of Pediatrics, Child and Adolescent Psychosomatics, Technische Universität München, Munich, Heigelhofstr. 63, 81377 München, Germany.
| | - P Calabrese
- Neuropsychology and Behavioral Neurology Unit, Division of Molecular and Cognitive Neuroscience, Department of Psychology, University of Basel, Birmannsgasse 8, 4055 Basel, Switzerland
| | - A Blaschek
- Department of Pediatric Neurology and Developmental Medicine, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Lindwurmstrasse 4, 80337 Munich, Germany
| | - K Rostásy
- Pediatric Neurology, Witten/Herdecke University, Children's Hospital Datteln, Dr. Friedrich Steiner Str. 5, 5711 Datteln, Germany
| | - P Huppke
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Neurology, University Medical Center Göttingen, Robert-Koch Strasse 40, 37075 Göttingen, Germany
| | - L Rothe
- Department of Neurology, University Hospital Cologne, Kerpenerstr. 62, 50937 Cologne, Germany
| | - V Mall
- Department of Pediatrics, Child and Adolescent Psychosomatics, Technische Universität München, Munich, Heigelhofstr. 63, 81377 München, Germany
| | - J Kessler
- Department of Neurology, University Hospital Cologne, Kerpenerstr. 62, 50937 Cologne, Germany
| | - E Kalbe
- Department of Medical Psychology ǀ, Neuropsychology and Gender Studies & Center for Neuropsychological Diagnostics and Intervention (CeNDI), University Hospital Cologne, Kerpenerstr. 62, 50937 Cologne, Germany
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Jobs I, Müller JM, Skorozhenina O, Romer G. Homo- and Heterotypic Trajectories in a Preschool to Primary-School Clinical Sample: A Prospective Study Related to Maternal Psychopathology. Front Psychiatry 2019; 10:153. [PMID: 30967803 PMCID: PMC6440442 DOI: 10.3389/fpsyt.2019.00153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 03/01/2019] [Indexed: 11/13/2022] Open
Abstract
Background: Most longitudinal or follow-up mental health studies describe developmental pathways using dimensional measures of psychopathology, but seldom using pathways described by clinical disorders. Objective: We aim to describe diagnostic pathways by homotypic (within the disorder continuity) and heterotypic development (between the disorder continuity), with maternal psychopathology as moderator for both trajectories. Methods: Clinically referred children (0-7 years; N = 83) were assessed at preschool age and at primary-school age through a clinical interview. We built a disorder cluster of emotional disorders (ED; F32, F40, F42, F43, F93.0, F93.1, F93.2, F93.8, F95), behavioral disorders (BD; F68.8, F90, F91, F91.3, F93.3, F93.9, F94), and specific early onset disorders (SEO; F50, F51, F70, F98.0, F98.1, F98.2, F98.8, F98.9). We describe the prevalence, comorbidity, and clinical trajectories of various types of homotypic and heterotypic development. Results: We observed a high rate of comorbidity throughout the study (62.6% at admission and 67.5% at follow-up) and in general, a high continuity of mental health problems from preschool to primary-school age children (69.9% of the sample showed continuity), with 50.6% of the sample showing homotypic and 44.6% showing heterotypic development. Hierarchical multiple regression analyses suggest that heterotypic development may be influenced by maternal psychopathology. Conclusion: Currently, evidence-based mental health guidelines for preschool populations are designed and evaluated assuming a homotypic development. However, our findings indicate that treatment interventions and outcome measures should also be designed and evaluated for heterotypic development especially in case of increased maternal psychopathology.
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Affiliation(s)
- Isabell Jobs
- Department of Child and Adolescent Psychiatry, University Hospital Münster, Münster, Germany
| | - Jörg Michael Müller
- Department of Child and Adolescent Psychiatry, University Hospital Münster, Münster, Germany
- Health Psychology and Applied Diagnostics, University of Wuppertal, Münster, Germany
| | - Olena Skorozhenina
- Department of Child and Adolescent Psychiatry, University Hospital Münster, Münster, Germany
| | - Georg Romer
- Department of Child and Adolescent Psychiatry, University Hospital Münster, Münster, Germany
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Abstract
A secure attachment relationship is facilitated by a mother´s ability to perceive her child´s emotions, especially her child´s fear. Prior studies showed that maternal perception of an own child activated a neural network including amygdala, insula and nucleus accumbens (NAcc). Results for different emotions were inconsistent and there are no reports on children´s fear. The goal of this study was to investigate neural responses of 17 mothers to photos of their own and an unknown preschool child with happy and fearful expressions by functional magnetic resonance imaging (fMRI). Whole brain analyses showed that a fearful (vs. happy) own child elicited larger activity in the visual cortex. Region of interest (ROI) analyses (amygdala, insula, NAcc) revealed stronger responses to a happy (vs. fearful) unknown child, but equally strong responses to one´s own child´s expressions. Moreover, an own (vs. unknown) fearful child elicited larger activity in the insula and NAcc. This suggests that mothers allocated more visual attention towards their own child´s fear, but showed consistent emotional involvement with their own child across expressions. Mothers might respond with stronger empathy and approach motivation towards an own (vs. unknown) fearful child, in line with a key role of fear in the attachment relationship.
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Affiliation(s)
- Ida Wessing
- Department of Child and Adolescent Psychiatry, University Hospital Muenster , Muenster , Germany.,Otto Creutzfeldt Center for Cognitive and Behavioral Neuroscience , Muenster , Germany
| | - Frieda Platzbecker
- Department of Clinical Radiology, Medical Faculty, University of Muenster- and University Hospital Muenster , Muenster , Germany
| | - Mahboobeh Dehghan-Nayyeri
- Department of Clinical Radiology, Medical Faculty, University of Muenster- and University Hospital Muenster , Muenster , Germany.,Department of Psychosomatic Medicine and Psychotherapy, LVR Clinic, Medical Faculty of the Heinrich-Heine-University Duesseldorf , Duesseldorf , Germany
| | - Georg Romer
- Department of Child and Adolescent Psychiatry, University Hospital Muenster , Muenster , Germany
| | - Bettina Pfleiderer
- Otto Creutzfeldt Center for Cognitive and Behavioral Neuroscience , Muenster , Germany.,Department of Clinical Radiology, Medical Faculty, University of Muenster- and University Hospital Muenster , Muenster , Germany
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28
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Dalhoff AW, Romero Frausto H, Romer G, Wessing I. Perceptive Body Image Distortion in Adolescent Anorexia Nervosa: Changes After Treatment. Front Psychiatry 2019; 10:748. [PMID: 31681048 PMCID: PMC6803517 DOI: 10.3389/fpsyt.2019.00748] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 09/18/2019] [Indexed: 11/13/2022] Open
Abstract
One key symptom of anorexia nervosa (AN) is body image distortion (BID). For example, AN patients who are asked to perform body size estimation tasks tend to overestimate their body size; this is thought to indicate a distortion of the perceptive component of body image. Although BID is an important treatment objective, only few treatment approaches explicitly target body image, and even fewer target the perceptive component. Moreover, very little is known about how patients' perceptive body image changes after treatment and related weight gain. Consequently, we investigated changes of the perceptive BID in adolescent AN patients at the beginning (T1) and the end (T2) of inpatient treatment using a body size estimation task. A total of 38 AN patients performed the test for Body Image Distortion in Children and Adolescents (BID-CA) within the first 2 weeks of inpatient treatment and at the end of treatment. The results were compared to 48 healthy control (HC) participants performing the same task once. At T1, AN patients overestimated their body size more than HC, i.e., a total overestimation of 33% in AN patients vs. 11% in HC. At T2, AN patients overestimated their arm size to the same degree that they did at TI, but overestimations for the thigh and waist were reduced, and their overestimations for the waist no longer differed from the HC group. Thus, after treatment, AN patients were partly able to more realistically estimate their body size. Several factors may have influenced the observed changes in body size estimation, including task repetition, deliberate adjustment, growing into their preexisting perceptive body image through weight gain, as well as targeted and non-specific psychotherapeutic treatments. In conclusion, the perceptive BID in adolescent AN patients is persistent but also modifiable. Although diverse factors presumably play a role in changing BID, these findings suggest that AN patients may benefit from targeted treatment of BID.
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Affiliation(s)
- Anke W Dalhoff
- Department of Child and Adolescent Psychiatry, University Hospital, Münster, Germany
| | - Hugo Romero Frausto
- Department of Child and Adolescent Psychiatry, University Hospital, Münster, Germany
| | - Georg Romer
- Department of Child and Adolescent Psychiatry, University Hospital, Münster, Germany
| | - Ida Wessing
- Department of Child and Adolescent Psychiatry, University Hospital, Münster, Germany.,Institute for Biomagnetism and Biosignalanalysis, University Hospital, Münster, Germany
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Weitkamp K, Daniels JK, Baumeister-Duru A, Wulf A, Romer G, Wiegand-Grefe S. Effectiveness Trial of Psychoanalytic Psychotherapy for Children and Adolescents with Severe Anxiety Symptoms in a Naturalistic Treatment Setting. British Journal of Psychotherapy 2018. [DOI: 10.1111/bjp.12363] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Lambert M, Schöttle D, Sengutta M, Ruppelt F, Rohenkohl A, Luedecke D, Nawara LA, Galling B, Falk AL, Wittmann L, Niehaus V, Sarikaya G, Handwerk U, Rothländer W, Rietschel L, Gagern C, Lange B, Meigel-Schleiff C, Naber D, Schulte-Markwort M, Krüger H, Unger HP, Sippel S, Ott S, Romer G, Daubmann A, Wegscheider K, Correll CU, Schimmelmann BG, Bock T, Gallinat J, Karow A. Early detection and integrated care for adolescents and young adults with severe psychotic disorders: rationales and design of the Integrated Care in Early Psychosis Study (ACCESS III). Early Interv Psychiatry 2018; 12:96-106. [PMID: 27618789 DOI: 10.1111/eip.12361] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 05/25/2016] [Accepted: 06/28/2016] [Indexed: 12/18/2022]
Abstract
AIM The Integrated Care in Early Psychosis (ACCESS III) Study examined the efficacy and cost-effectiveness of a combined intervention consisting of strategies to improve early detection and quality of care (integrated care including therapeutic assertive community treatment) in adolescents and young adults in the early phase of a severe psychotic disorder from 2011 to 2014. METHODS This is a prospective, single-centre, 1-year cohort study comparing an intervention condition (early detection plus integrated care, n = 120) to the historical control condition (standard care, SC, n = 105) for adolescents and young adults aged 12-29 years suffering from a severe, early-phase psychotic disorder (i.e. within 2 years of treatment). RESULTS Primary outcome is the rate of combined symptomatic (i.e. Positive and Negative Syndrome Scale (PANSS) criteria) and functional (i.e. Global Assessment of Functioning scale (GAF) ≥ 60 points criterion) remission over at least 6 months at study endpoint. Secondary outcome comprises the comparison of the reduction in the duration of untreated psychosis within the 4-year study duration between integrated care and SC, course of psychopathology, functioning, quality of life, satisfaction with care, cost and quality-adjusted life years (QALYs) in comparison to a historical control group. CONCLUSION To the authors' knowledge, this is the first study assessing the efficacy and cost-effectiveness of a combined intervention consisting of early detection strategies and strategies to improve quality of care in both adolescents and young adults with early-phase psychosis. The results will be published in 2016.
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Affiliation(s)
- Martin Lambert
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Daniel Schöttle
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Mary Sengutta
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Friederike Ruppelt
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Anja Rohenkohl
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Daniel Luedecke
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Luise Antonia Nawara
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Britta Galling
- Psychiatry Research, The Zucker Hillside Hospital, Glen Oaks, New York, USA
| | - Anne-Lena Falk
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Linus Wittmann
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Vivien Niehaus
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Gizem Sarikaya
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Ute Handwerk
- Community Psychiatric Center Eimsbüttel (GPZE), Hamburg, Germany
| | | | - Liz Rietschel
- University Hospital of Child and Adolescent Psychiatry, University of Bern, Bern, Switzerland
| | - Charlotte Gagern
- Department of Clinical Psychology and Psychotherapy, University of Hamburg, Hamburg, Germany
| | - Benjamin Lange
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Christina Meigel-Schleiff
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Dieter Naber
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Michael Schulte-Markwort
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Helmut Krüger
- Community Psychiatric Center Eimsbüttel (GPZE), Hamburg, Germany
| | - Hans-Peter Unger
- Center for Mental Health, Department of Psychiatry, Psychotherapy and Psychosomatics, Hamburg, Germany
| | - Sven Sippel
- Center for Mental Health, Department of Psychiatry, Psychotherapy and Psychosomatics, Hamburg, Germany
| | - Sabine Ott
- Center for Mental Health, Department of Child and Adolescent Psychiatry Psychotherapy and Psychosomatics, Asklepios Hospital Harburg, Hamburg, Germany
| | - Georg Romer
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Muenster, Münster, Germany
| | - Anne Daubmann
- Institute for Biostatistics and Epidemiology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Karl Wegscheider
- Institute for Biostatistics and Epidemiology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | | | - Benno G Schimmelmann
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
- University Hospital of Child and Adolescent Psychiatry, University of Bern, Bern, Switzerland
| | - Thomas Bock
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Jürgen Gallinat
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Anne Karow
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
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Redlich R, Opel N, Bürger C, Dohm K, Grotegerd D, Förster K, Zaremba D, Meinert S, Repple J, Enneking V, Leehr E, Böhnlein J, Winters L, Froböse N, Thrun S, Emtmann J, Heindel W, Kugel H, Arolt V, Romer G, Postert C, Dannlowski U. The Limbic System in Youth Depression: Brain Structural and Functional Alterations in Adolescent In-patients with Severe Depression. Neuropsychopharmacology 2018; 43:546-554. [PMID: 29039414 PMCID: PMC5770774 DOI: 10.1038/npp.2017.246] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [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: 06/08/2017] [Revised: 10/05/2017] [Accepted: 10/09/2017] [Indexed: 02/04/2023]
Abstract
Adolescent-onset major depressive disorder (MDD) is associated with an increased risk of recurrent depressive episodes, suicidal behaviors, and psychiatric morbidity throughout the lifespan. The objective of the present study was to investigate brain structural and functional changes in adolescent patients with MDD. Furthermore, we aimed to clarify the influence of early-life stress on brain function and structure. The study investigated adolescent patients with severe MDD (n=20, mean age=16.0, range=15-18 years) and a control sample of matched healthy adolescents (n=21, mean age=16.6, range=15-18 years). Functional MRI data were obtained using a face-matching paradigm to investigate emotion processing. Structural MRI data were analyzed using voxel-based morphometry (VBM). In line with previous studies on adult MDD, adolescent patients showed elevated amygdala activity to negative and reduced amygdala activity to positive emotional stimuli. Furthermore, MDD patients showed smaller hippocampal volumes compared to healthy adolescents. Higher levels of childhood maltreatment were associated with smaller hippocampal volumes in both depressed patients and healthy controls, whereby no associations between amygdala reactivity and childhood maltreatment were found. Our results suggest that hippocampal alterations in youth MDD patients may at least partly be traced back to higher occurrence of early-life adverse experiences. Regarding the strong morphometric impact of childhood maltreatment and its distinctly elevated prevalence in MDD populations, this study provides an alternative explanation for frequently observed limbic structural abnormalities in depressed patients.
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Affiliation(s)
- Ronny Redlich
- Department of Psychiatry, University of Münster, Münster, Germany,Department of Psychiatry, University of Muenster, Albert-Schweitzer-Campus 1, A9, Muenster 48149, Germany, Tel: +49-251-8357214, Fax: +49-251-8358641, E-mail:
| | - Nils Opel
- Department of Psychiatry, University of Münster, Münster, Germany
| | - Christian Bürger
- Department of Psychiatry, University of Münster, Münster, Germany
| | - Katharina Dohm
- Department of Psychiatry, University of Münster, Münster, Germany
| | | | | | - Dario Zaremba
- Department of Psychiatry, University of Münster, Münster, Germany
| | - Susanne Meinert
- Department of Psychiatry, University of Münster, Münster, Germany
| | - Jonathan Repple
- Department of Psychiatry, University of Münster, Münster, Germany
| | - Verena Enneking
- Department of Psychiatry, University of Münster, Münster, Germany
| | - Elisabeth Leehr
- Department of Psychiatry, University of Münster, Münster, Germany
| | - Joscha Böhnlein
- Department of Psychiatry, University of Münster, Münster, Germany
| | - Lena Winters
- Department of Psychiatry, University of Münster, Münster, Germany
| | - Neele Froböse
- Department of Psychiatry, University of Münster, Münster, Germany
| | - Sophia Thrun
- Department of Psychiatry, University of Münster, Münster, Germany
| | - Julia Emtmann
- Department of Psychiatry, University of Münster, Münster, Germany
| | - Walter Heindel
- Department of Clinical Radiology, University of Münster, Münster, Germany
| | - Harald Kugel
- Department of Clinical Radiology, University of Münster, Münster, Germany
| | - Volker Arolt
- Department of Psychiatry, University of Münster, Münster, Germany
| | - Georg Romer
- Department of Child and Adolescent Psychiatry, University of Münster, Münster, Germany
| | - Christian Postert
- Department of Child and Adolescent Psychiatry, University of Münster, Münster, Germany,Department of Applied Health Sciences, University of Applied Sciences, Bochum, Germany
| | - Udo Dannlowski
- Department of Psychiatry, University of Münster, Münster, Germany
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Lambert M, Schöttle D, Ruppelt F, Rohenkohl A, Sengutta M, Luedecke D, Nawara LA, Galling B, Falk AL, Wittmann L, Niehaus V, Sarikaya G, Rietschel L, Gagern C, Schulte-Markwort M, Unger HP, Ott S, Romer G, Daubmann A, Wegscheider K, Correll CU, Schimmelmann BG, Wiedemann K, Bock T, Gallinat J, Karow A. Early detection and integrated care for adolescents and young adults with psychotic disorders: the ACCESS III study. Acta Psychiatr Scand 2017; 136:188-200. [PMID: 28589683 DOI: 10.1111/acps.12762] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/06/2017] [Indexed: 01/09/2023]
Abstract
OBJECTIVE The objective of the study was to investigate whether a combined intervention composed of early detection plus integrated care (EDIC) enhances outcomes in patients with early psychosis compared to standard care (SC). METHODS ACCESS III is a prospective non-randomized historical control design 1-year study examining the efficacy of EDIC (n = 120) vs. SC (n = 105) in patients aged 12-29 years. Primary outcome was the rate of ≥6 months combined symptomatic and functional remission. Additional outcomes comprised the reduction of DUP and course of psychopathology, functioning, quality of life, and satisfaction with care. RESULTS In observed cases, 48.9% in the EDIC and 15.2% in the SC group reached the primary endpoint. Remission was predicted by EDIC (OR = 6.8, CI: 3.15-14.53, P < 0.001); younger age predicted non-remission (OR = 1.1, CI: 1.01-1.19, P = 0.038). Linear regressions indicated a reduction of DUP in EDIC (P < 0.001), but not in SC (P = 0.41). MMRMs showed significantly larger improvements in PANSS positive (P < 0.001) and GAF (P < 0.01) scores in EDIC vs. SC, and in EDIC over time in CGI-Severity (P < 0.001) and numerically in Q-LES-Q-18 (P = 0.052). CONCLUSIONS EDIC lead to significantly higher proportions of patients achieving combined remission. Moderating variables included a reduction of DUP and EDIC, offering psychotherapeutic interventions.
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Affiliation(s)
- M Lambert
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - D Schöttle
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - F Ruppelt
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - A Rohenkohl
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - M Sengutta
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - D Luedecke
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.,Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, UKE, Hamburg, Germany
| | - L A Nawara
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - B Galling
- The Zucker Hillside Hospital, Psychiatry Research, Glen Oaks, NY, USA
| | - A-L Falk
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - L Wittmann
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - V Niehaus
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - G Sarikaya
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - L Rietschel
- University Hospital of Child and Adolescent Psychiatry, University of Bern, Bern, Switzerland
| | - C Gagern
- Department of Clinical Psychology and Psychotherapy, University of Hamburg, Hamburg, Germany
| | - M Schulte-Markwort
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, UKE, Hamburg, Germany
| | - H-P Unger
- Center for Mental Health, Department of Psychiatry, Psychotherapy and Psychosomatics, Asklepios Hospital Harburg, Hamburg, Germany
| | - S Ott
- Center for Mental Health, Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, Asklepios Hospital Harburg, Hamburg, Germany
| | - G Romer
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Muenster, Münster, Germany
| | - A Daubmann
- Department of Medical Biometry and Epidemiology, UKE, Hamburg, Germany
| | - K Wegscheider
- Department of Medical Biometry and Epidemiology, UKE, Hamburg, Germany
| | - C U Correll
- The Zucker Hillside Hospital, Psychiatry Research, Glen Oaks, NY, USA
| | - B G Schimmelmann
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, UKE, Hamburg, Germany.,University Hospital of Child and Adolescent Psychiatry, University of Bern, Bern, Switzerland
| | - K Wiedemann
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - T Bock
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - J Gallinat
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - A Karow
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.,Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, UKE, Hamburg, Germany
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Inhestern L, Bultmann JC, Beierlein V, Möller B, Romer G, Koch U, Bergelt C. [Parenting Concerns and Psychological Burden in Cancer Patients with Minor and Young Adult Children]. Psychother Psychosom Med Psychol 2017; 67:279-287. [PMID: 28719920 DOI: 10.1055/s-0043-110139] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Background Aim of the study was to analyze parenting concerns in cancer survivors and to identify covariats for parenting concerns. Method In a cross-sectional epidemiological sample of cancer survivors with minor children (n=1416) demographic and disease-related variables and psychological distress (HADS) were assessed. Parenting concerns were assessed using the Parenting Concerns Questionnaire (PCQ). The instrument covers the 3 subscales concerns about the 'practical impact' of the disease on the children, about the 'emotional impact' and concerns about the 'co-parent'. Results 73% of survivors were female; mean age was 47.5 years (SD 5.9). 24% to 71% of patients reporting parenting concerns showed normal levels of anxiety and depression. We identified living alone, younger age of the youngest child, higher tumor stage and suffering from a comorbidity as significantly associated with parenting concerns in all subscales of the PCQ. Low socio-economic status was found to be significantly associated with parenting concerns regarding the emotional and practical impact of the disease. Being a mother was associated with concerns in the subscale co-parent. Discussion Parents with cancer not only suffer from psychological distress but also from parenting concerns about the impact of their disease on their children. Psychological support services should broach the issue of parenting concerns. Families at risk should be identified to allocate tailored support.
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Affiliation(s)
- Laura Inhestern
- Institut und Poliklinik für Medizinische Psychologie, Universitätsklinikum Hamburg-Eppendorf
| | | | - Volker Beierlein
- Institut und Poliklinik für Medizinische Psychologie, Universitätsklinikum Hamburg-Eppendorf
| | - Birgit Möller
- Klinik für Kinder- und Jugendpsychiatrie, -psychosomatik und -psychotherapie, Universitätsklinikum Münster
| | - Georg Romer
- Klinik für Kinder- und Jugendpsychiatrie, -psychosomatik und -psychotherapie, Universitätsklinikum Münster
| | - Uwe Koch
- Institut und Poliklinik für Medizinische Psychologie, Universitätsklinikum Hamburg-Eppendorf
| | - Corinna Bergelt
- Institut und Poliklinik für Medizinische Psychologie, Universitätsklinikum Hamburg-Eppendorf
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Inhestern L, Beierlein V, Bultmann JC, Möller B, Romer G, Koch U, Bergelt C. Anxiety and depression in working-age cancer survivors: a register-based study. BMC Cancer 2017; 17:347. [PMID: 28526007 PMCID: PMC5438539 DOI: 10.1186/s12885-017-3347-9] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 05/11/2017] [Indexed: 11/29/2022] Open
Abstract
Background Anxiety and depression can be a long-term strain in cancer survivors. Little is known about the emotional situation of cancer survivors who have to deal with work- and family-related issues. The purpose of this study was to investigate anxiety and depression in working-age cancer survivors and associated factors. Methods A register-based sample of 3370 cancer survivors (25 to 55 years at time of diagnosis) diagnosed up to six years prior to the survey was recruited from two German cancer registries. Demographic and medical characteristics as well as self-reported measures were used. Results Overall, approximately 40% of the survivors reported moderate to high anxiety scores and approximately 20% reported moderate to high depression scores. Compared to the general population, working-age cancer survivors were more anxious but less depressed (p < .001). Subgroups with regard to time since diagnosis did not differ in anxiety or depression. Anxiety and depression in cancer survivors were associated with various variables. Better social support, family functioning and physical health were associated with lower anxiety and depression. Conclusions Overall, we found higher anxiety levels in cancer survivors of working-age than in the general population. A considerable portion of cancer survivors reported moderate to high levels of anxiety and depression. The results indicate the need for psychosocial screening and psycho-oncological support e.g. in survivorship programs for working-age cancer survivors. Assessing the physical health, social support and family background might help to identify survivors at risk for higher emotional distress.
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Affiliation(s)
- Laura Inhestern
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, W26, 20246, Hamburg, Germany.
| | - Volker Beierlein
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, W26, 20246, Hamburg, Germany
| | - Johanna Christine Bultmann
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, W26, 20246, Hamburg, Germany
| | - Birgit Möller
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Muenster, Muenster, Germany
| | - Georg Romer
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Muenster, Muenster, Germany
| | - Uwe Koch
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, W26, 20246, Hamburg, Germany
| | - Corinna Bergelt
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, W26, 20246, Hamburg, Germany
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Beierlein V, Bultmann JC, Möller B, von Klitzing K, Flechtner HH, Resch F, Herzog W, Brähler E, Führer D, Romer G, Koch U, Bergelt C. Measuring family functioning in families with parental cancer: Reliability and validity of the German adaptation of the Family Assessment Device (FAD). J Psychosom Res 2017; 93:110-117. [PMID: 28107886 DOI: 10.1016/j.jpsychores.2016.11.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 11/18/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The concept of family functioning is gaining importance in psycho-oncology research and health care services. The Family Assessment Device (FAD) is a well-established measure of family functioning. Psychometric properties inherent in the German 51-item adaptation of the FAD are examined in different samples of families with parental cancer. METHODS Acceptance, reliability, and validity of FAD scales are analysed in samples from different study settings (N=1701 cancer patients, N=261 partners, N=158 dependent adolescent children 11 to 18years old). RESULTS Missing items in the FAD scales (acceptance) are rare for adults (<1.1%) and adolescent children (<4.4%). In samples of adults and older adolescents (15 to 18years), all FAD scales except for the Roles scale are significantly reliable (0.75≤Cronbach's α≤0.88). The scales correlate highly (0.46≤Pearson's r≤0.59) with the criterion satisfaction with family life (convergent validity), and have smaller correlations (0.16≤r≤0.49) with measures of emotional distress and subjective well-being (divergent validity). In most FAD scales, adults seeking family counselling report worse family functioning (0.24≤Cohen's d≤0.59) than adults in other samples with parental cancer (discriminative validity). CONCLUSION Overall, the German 51-item adaptation of the FAD reveals good acceptance, reliability, and validity for cancer patients and their relatives. Particularly the scale General Functioning shows excellent psychometric properties. The FAD is suitable in the assessment of families with parental cancer for adults and adolescents older than 11years.
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Affiliation(s)
- Volker Beierlein
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Germany.
| | | | - Birgit Möller
- Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, University Hospital Muenster, Germany.
| | - Kai von Klitzing
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, Leipzig University Hospital, Germany.
| | - Hans-Henning Flechtner
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatic Medicine, Otto-von-Guericke-University, Magdeburg, Germany.
| | - Franz Resch
- Department of Child and Adolescent Psychiatry; Heidelberg University Hospital, Germany.
| | - Wolfgang Herzog
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Germany.
| | - Elmar Brähler
- Department of Medical Psychology and Medical Sociology, Leipzig University Hospital, Germany; Clinic and Policlinic for Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Germany.
| | - Daniel Führer
- Department of Child and Adolescent Psychiatry, Psychosomatic s and Psychotherapy, Charité University Medicine Berlin, Germany.
| | - Georg Romer
- Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, University Hospital Muenster, Germany; Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Germany.
| | - Uwe Koch
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Germany.
| | - Corinna Bergelt
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Germany.
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Abstract
Zusammenfassung. Zielsetzung: In der Entstehung von pathologischem Internetgebrauch (PIG) wird diskutiert, ob das Internetverhalten als Surrogat zur Befriedigung von Bindungsbedürfnissen dienen kann. Dabei wird angenommen, dass die unerfüllten Bindungsbedürfnisse aus unsicheren Bindungsstilen resultieren. Die vorliegende Pilotstudie untersuchte den Zusammenhang zwischen PIG und Bindungsstilen. Methodik: Bei 10 Probanden mit PIG und 10 Probanden einer geschlechts-, alters- und bildungsgematchten Kontrollgruppe erfolgte erstmals eine interviewgestützte Erhebung des Bindungssystems mit dem Attachment Style Interview durch zwei geschulte Rater. Die Definition des PIG erfolgte kategorial mit dem Internetsucht-Interview (Distinguishing Characteristics of Internet Addiction) und dimensional durch die Skalen zum Onlinesucht- und Computerspielverhalten. Ergebnis: Probanden mit PIG wiesen signifikant häufiger unsichere und desorganisierte sowie seltener sichere Bindungsstile auf als gesunde Kontrollprobanden [χ²(2) = 7.505; p = .023]. Schlussfolgerung: Unsichere und desorganisierte Bindungsstile sollten in der multifaktoriellen Ätiopathogenese des PIG als Risikofaktor berücksichtigt werden.
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Affiliation(s)
- Maren Greschner
- Klinik für Kinder- und Jugendpsychiatrie, -psychosomatik und -psychotherapie, Universitätsklinikum Münster
| | - Jörg Michael Müller
- Klinik für Kinder- und Jugendpsychiatrie, -psychosomatik und -psychotherapie, Universitätsklinikum Münster
| | - Katajun Lindenberg
- Institut für Psychologie, Pädagogische Hochschule Heidelberg, Heidelberg
| | - Corinna Reck
- Klinik für Allgemeine Psychiatrie, Zentrum für Psychosoziale Medizin, Universitätsklinikum Heidelberg
- Fakultät für Psychologie und Pädagogik, Department Psychologie, Ludwig-Maximilians-Universität München
| | - Georg Romer
- Klinik für Kinder- und Jugendpsychiatrie, -psychosomatik und -psychotherapie, Universitätsklinikum Münster
| | - Esther Strittmatter
- Klinik für Kinder- und Jugendpsychiatrie, -psychosomatik und -psychotherapie, Universitätsklinikum Münster
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Wessing I, Romer G, Junghöfer M. Hypervigilance-avoidance in children with anxiety disorders: magnetoencephalographic evidence. J Child Psychol Psychiatry 2017; 58:103-112. [PMID: 27605124 DOI: 10.1111/jcpp.12617] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/27/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND An altered pattern of threat processing is deemed critical for the development of anxiety disorders (AD). According to the hypervigilance-avoidance hypothesis, AD patients show hypervigilance to threat cues at early stages of processing but avoid threat cues at later stages of processing. Consistently, adults with AD show enhanced neurophysiological responses to threat in early time windows and reduced responses to threat in late time windows. The presence of such a hypervigilance-avoidance effect and its underlying neural sources remain to be determined in clinically anxious children. METHODS Twenty-three children diagnosed with an AD and 23 healthy control children aged 8-14 years saw faces with angry and neutral expressions while whole-head magnetoencephalography (MEG) was recorded. Neural sources were estimated based on L2-Minimum Norm inverse source modeling and analyzed in early, midlatency, and late time windows. RESULTS In visual cortical regions, early threat processing was relatively enhanced in patients compared to controls, whereas this relation was inverted in a late interval. Consistent with the idea of affective regulation, the right dorsolateral prefrontal cortex revealed relatively reduced inhibition of early threat processing but revealed enhanced inhibition at a late interval in patients. Both visual-sensory and prefrontal effects were correlated with individual trait anxiety. CONCLUSIONS These results support the hypothesis of early sensory hypervigilance followed by later avoidance of threat in anxiety disordered children, presumably modulated by early reduced and later enhanced prefrontal inhibition. This neuronal hypervigilance-avoidance pattern unfolds gradually with increasing trait anxiety, reflecting a progressively biased allocation of attention to threat.
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Affiliation(s)
- Ida Wessing
- Department for Child and Adolescent Psychiatry, University Hospital Münster, Münster, Germany.,Institute for Biomagnetism and Biosignalanalysis, University Hospital Münster, Münster, Germany
| | - Georg Romer
- Department for Child and Adolescent Psychiatry, University Hospital Münster, Münster, Germany
| | - Markus Junghöfer
- Institute for Biomagnetism and Biosignalanalysis, University Hospital Münster, Münster, Germany
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Inhestern L, Bultmann JC, Beierlein V, Möller B, Romer G, Koch U, Bergelt C. Understanding parenting concerns in cancer survivors with minor and young-adult children. J Psychosom Res 2016; 87:1-6. [PMID: 27411745 DOI: 10.1016/j.jpsychores.2016.05.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [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: 02/25/2016] [Revised: 05/20/2016] [Accepted: 05/21/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Parents with cancer are concerned about the impact of their disease on their children. However, parenting concerns and associated factors in cancer survivors have not previously been analyzed. The purpose of this study is to examine parenting concerns and to test a path model for understanding parenting concerns in cancer survivors. METHODS In a cross-sectional study, a total of 1416 parents with cancer (mean age 47.5years, 74% women) having minor or young-adult children were recruited through two cancer registries. Parenting concerns were assessed using the Parenting Concerns Questionnaire. Structural equation modeling (SEM) was used to analyze the associations between social support, parenting confidence, emotional distress, family functioning and parenting concerns. RESULTS Mothers reported higher total parenting concerns than fathers (p<0.001). We observed strong effects of emotional distress and parenting confidence on parenting concerns. Family dysfunctioning was associated with lower concerns. An indirect association between social support and parenting concerns was identified. CONCLUSION Parenting concerns in cancer survivors display the need for interventions and after care programs that focus on affected families with minor and young adult children. The results of the structural path model illustrate the associations between psychological and interactional factors. Supporting parents with cancer in their parenting confidence and strengthen social support and family functioning may not only reduce the long-term burden on the parents themselves but also the burden on the entire family.
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Affiliation(s)
- Laura Inhestern
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | | | - Volker Beierlein
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Birgit Möller
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Muenster, Muenster, Germany
| | - Georg Romer
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Muenster, Muenster, Germany
| | - Uwe Koch
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Corinna Bergelt
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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39
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Inhestern L, Bultmann JC, Beierlein V, Möller B, Romer G, Muriel AC, Moore CW, Koch U, Bergelt C. Psychometric properties of the Parenting Concerns Questionnaire in cancer survivors with minor and young adult children. Psychooncology 2015; 25:1092-8. [PMID: 26677091 DOI: 10.1002/pon.4049] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 11/02/2015] [Accepted: 11/12/2015] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Although cancer patients with minor children have become more of a focus of psycho-oncological research, little is known about specific parenting concerns. Instruments to assess the concerns and worries of parents with cancer are rare. The Parenting Concerns Questionnaire (PCQ) addresses this issue. We analyzed parenting concerns in cancer survivors and evaluated the German version of the PCQ. METHODS A total of 1416 cancer survivors with minor and young adult children (≤21 years) were recruited in a register-based study. Descriptive analyses as well as reliability and validity analyses were conducted. We performed a confirmatory factorial analysis of the factor structure proposed by the authors of the original version on the PCQ. RESULTS Seventy-three percent of the cancer survivors were women, average age was 47.5 years (SD 5.9). Mean time since diagnosis was 44 months (SD 23.4). Between 18 and 31% of survivors reported that they were concerned about their children. The PCQ proved to be a reliable and valid instrument showing medium correlations with standardized measures in expected directions and discriminating between survivors with and without use of psychosocial support services. The factor structure was supported by the confirmatory factorial analysis. CONCLUSIONS Assessing parenting concerns gives an additional insight into the situation of parents with cancer. In our sample of cancer survivors, we identified one out of three survivors being concerned regarding the impact of their illness on their children. The PCQ can be considered as a valid and reliable instrument with regard to identifying concerned parents with cancer. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Laura Inhestern
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Johanna C Bultmann
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Volker Beierlein
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Birgit Möller
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Muenster, Muenster, Germany
| | - Georg Romer
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Muenster, Muenster, Germany
| | | | | | - Uwe Koch
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Corinna Bergelt
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Lotzin A, Romer G, Schiborr J, Noga B, Schulte-Markwort M, Ramsauer B. Gaze Synchrony between Mothers with Mood Disorders and Their Infants: Maternal Emotion Dysregulation Matters. PLoS One 2015; 10:e0144417. [PMID: 26657941 PMCID: PMC4681006 DOI: 10.1371/journal.pone.0144417] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2015] [Accepted: 11/18/2015] [Indexed: 12/31/2022] Open
Abstract
A lowered and heightened synchrony between the mother's and infant's nonverbal behavior predicts adverse infant development. We know that maternal depressive symptoms predict lowered and heightened mother-infant gaze synchrony, but it is unclear whether maternal emotion dysregulation is related to mother-infant gaze synchrony. This cross-sectional study examined whether maternal emotion dysregulation in mothers with mood disorders is significantly related to mother-infant gaze synchrony. We also tested whether maternal emotion dysregulation is relatively more important than maternal depressive symptoms in predicting mother-infant gaze synchrony, and whether maternal emotion dysregulation mediates the relation between maternal depressive symptoms and mother-infant gaze synchrony. We observed 68 mothers and their 4- to 9-month-old infants in the Still-Face paradigm during two play interactions, before and after social stress was induced. The mothers' and infants' gaze behaviors were coded using microanalysis with the Maternal Regulatory Scoring System and Infant Regulatory Scoring System, respectively. The degree of mother-infant gaze synchrony was computed using time-series analysis. Maternal emotion dysregulation was measured by the Difficulties in Emotion Regulation Scale; depressive symptoms were assessed using the Beck Depression Inventory. Greater maternal emotion dysregulation was significantly related to heightened mother-infant gaze synchrony. The overall effect of maternal emotion dysregulation on mother-infant gaze synchrony was relatively more important than the effect of maternal depressive symptoms in the five tested models. Maternal emotion dysregulation fully mediated the relation between maternal depressive symptoms and mother-infant gaze synchrony. Our findings suggest that the effect of the mother's depressive symptoms on the mother-infant gaze synchrony may be mediated by the mother's emotion dysregulation.
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Affiliation(s)
- Annett Lotzin
- University Medical Center Hamburg-Eppendorf, Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, Hamburg, Germany
| | - Georg Romer
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Muenster, Muenster, Germany
| | - Julia Schiborr
- University Medical Center Hamburg-Eppendorf, Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, Hamburg, Germany
| | - Berit Noga
- University Medical Center Hamburg-Eppendorf, Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, Hamburg, Germany
| | - Michael Schulte-Markwort
- University Medical Center Hamburg-Eppendorf, Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, Hamburg, Germany
| | - Brigitte Ramsauer
- University Medical Center Hamburg-Eppendorf, Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, Hamburg, Germany
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41
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Romer G. [Ethical Aspects of Internet-Mediated Research]. Z Kinder Jugendpsychiatr Psychother 2015; 43:297-300. [PMID: 26373382 DOI: 10.1024/1422-4917/a000367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Georg Romer
- 1 Klinik für Kinder- und Jugendpsychiatrie, -psychosomatik und -psychotherapie, Universitätsklinikum Münster
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42
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Strittmatter E, Greschner M, Müller J, Kaess M, Romer G. Bindung und Pathologischer Internetgebrauch. Suchttherapie 2015. [DOI: 10.1055/s-0035-1557608] [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: 10/23/2022]
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43
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Weigel A, Gumz A, Kästner D, Romer G, Wegscheider K, Löwe B. [Prevention and Treatment of Eating Disorders: The Health Care Network Anorexia and Bulimia nervosa]. Psychiatr Prax 2015; 42 Suppl 1:S30-4. [PMID: 26135276 DOI: 10.1055/s-0034-1387651] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The "Health care network anorexia and bulimia nervosa", a subproject of psychenet - the Hamburg network for mental health - aims to decrease the incidence of eating disorders as well as the risk for chronic illness courses. One focal project, therefore, evaluates a school-based prevention manual in a randomized controlled trial. The other one examines the impact of a systemic public health intervention on early treatment initiation in anorexia nervosa. The present article provides an overview about study design and interventions in both focal projects as well as preliminary results.
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Affiliation(s)
- Angelika Weigel
- Institut für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Hamburg-Eppendorf & Schön Klinik Hamburg Eilbek
| | - Antje Gumz
- Institut für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Hamburg-Eppendorf & Schön Klinik Hamburg Eilbek
| | - Denise Kästner
- Institut für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Hamburg-Eppendorf & Schön Klinik Hamburg Eilbek
| | - Georg Romer
- Klinik für Kinder und Jugendpsychiatrie-, psychosomatik und -psychotherapie, Universitätsklinikum Münster
| | - Karl Wegscheider
- Institut für Medizinische Biometrie und Epidemiologie, Universitätsklinikum Hamburg-Eppendorf
| | - Bernd Löwe
- Institut für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Hamburg-Eppendorf & Schön Klinik Hamburg Eilbek
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Lambert M, Schöttle D, Sengutta M, Lüdecke D, Nawara AL, Galling B, Handwerk U, Rothländer W, Falk AL, Rietschel L, Gagern C, Sarikaya G, Wittmann L, Ruppelt F, Daubmann A, Lange B, Naber D, Schulte-Markwort M, Unger HP, Ott S, Romer G, Krüger H, Gallinat J, Wegscheider K, Bock T, Karow A. [Early Detection and Integrated Care in Adolescents and Young Adults with Severe Psychotic Illnesses]. Psychiatr Prax 2015; 42 Suppl 1:S49-53. [PMID: 26135281 DOI: 10.1055/s-0034-1387652] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This is a prospective 1-year follow-up study comparing a combined intervention consisting of multidimensional early detection strategies with age- and interdisciplinary integrated care (intervention group, n = 120) with standard care (historical control group, n = 105) in adolescents and young adults within the early phase of psychosis. Data at study entry indicate a high complexity and severity of illness. Primary outcome is the 6-month rate of combined symptomatic and functional remission at study endpoint.
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Affiliation(s)
- Martin Lambert
- Arbeitsbereich Psychosen, Klinik für Psychiatrie und Psychotherapie, Zentrum für Psychosoziale Medizin, Universitätsklinikum Hamburg-Eppendorf
| | - Daniel Schöttle
- Arbeitsbereich Psychosen, Klinik für Psychiatrie und Psychotherapie, Zentrum für Psychosoziale Medizin, Universitätsklinikum Hamburg-Eppendorf
| | - Mary Sengutta
- Arbeitsbereich Psychosen, Klinik für Psychiatrie und Psychotherapie, Zentrum für Psychosoziale Medizin, Universitätsklinikum Hamburg-Eppendorf
| | - Daniel Lüdecke
- Arbeitsbereich Psychosen, Klinik für Psychiatrie und Psychotherapie, Zentrum für Psychosoziale Medizin, Universitätsklinikum Hamburg-Eppendorf
| | - Antonia-Luise Nawara
- Arbeitsbereich Psychosen, Klinik für Psychiatrie und Psychotherapie, Zentrum für Psychosoziale Medizin, Universitätsklinikum Hamburg-Eppendorf
| | - Britta Galling
- Klinik und Poliklinik für Kinder und Jugendpsychiatrie und -Psychotherapie, Zentrum für Psychosoziale Medizin, Universitätsklinikum Hamburg-Eppendorf
| | - Ute Handwerk
- Gemeindepsychiatrisches Zentrum Eimsbüttel (GPZE), Hamburg
| | | | - Anne-Lena Falk
- Arbeitsbereich Psychosen, Klinik für Psychiatrie und Psychotherapie, Zentrum für Psychosoziale Medizin, Universitätsklinikum Hamburg-Eppendorf
| | - Liz Rietschel
- Universitätsklinik für Kinder- und Jugendpsychiatrie und Psychotherapie, Universitäre Psychiatrische Dienste Bern (UPD)
| | - Charlotte Gagern
- Arbeitsbereich Psychosen, Klinik für Psychiatrie und Psychotherapie, Zentrum für Psychosoziale Medizin, Universitätsklinikum Hamburg-Eppendorf
| | - Gizem Sarikaya
- Arbeitsbereich Psychosen, Klinik für Psychiatrie und Psychotherapie, Zentrum für Psychosoziale Medizin, Universitätsklinikum Hamburg-Eppendorf
| | - Linus Wittmann
- Arbeitsbereich Psychosen, Klinik für Psychiatrie und Psychotherapie, Zentrum für Psychosoziale Medizin, Universitätsklinikum Hamburg-Eppendorf
| | - Friederike Ruppelt
- Arbeitsbereich Psychosen, Klinik für Psychiatrie und Psychotherapie, Zentrum für Psychosoziale Medizin, Universitätsklinikum Hamburg-Eppendorf
| | - Anne Daubmann
- Institut für Medizinische Biometrie und Epidemiologie, Universitätsklinikum Hamburg-Eppendorf
| | - Benjamin Lange
- Arbeitsbereich Psychosen, Klinik für Psychiatrie und Psychotherapie, Zentrum für Psychosoziale Medizin, Universitätsklinikum Hamburg-Eppendorf
| | - Dieter Naber
- Arbeitsbereich Psychosen, Klinik für Psychiatrie und Psychotherapie, Zentrum für Psychosoziale Medizin, Universitätsklinikum Hamburg-Eppendorf
| | - Michael Schulte-Markwort
- Klinik und Poliklinik für Kinder und Jugendpsychiatrie und -Psychotherapie, Zentrum für Psychosoziale Medizin, Universitätsklinikum Hamburg-Eppendorf
| | - Hans-Peter Unger
- Zentrum für seelische Gesundheit, Abteilung für Psychiatrie, Psychotherapie und Psychosomatik, Asklepios Klinik Hamburg-Harburg
| | - Sabine Ott
- Zentrum für seelische Gesundheit, Abteilung für Kinder- und Jugendpsychiatrie, Psychotherapie und Psychosomatik, Asklepios Klinik Hamburg-Harburg
| | - Georg Romer
- Zentrum für seelische Gesundheit, Abteilung für Psychiatrie, Psychotherapie und Psychosomatik, Asklepios Klinik Hamburg-Harburg
| | - Helmut Krüger
- Gemeindepsychiatrisches Zentrum Eimsbüttel (GPZE), Hamburg
| | - Jürgen Gallinat
- Arbeitsbereich Psychosen, Klinik für Psychiatrie und Psychotherapie, Zentrum für Psychosoziale Medizin, Universitätsklinikum Hamburg-Eppendorf
| | - Karl Wegscheider
- Institut für Medizinische Biometrie und Epidemiologie, Universitätsklinikum Hamburg-Eppendorf
| | - Thomas Bock
- Arbeitsbereich Psychosen, Klinik für Psychiatrie und Psychotherapie, Zentrum für Psychosoziale Medizin, Universitätsklinikum Hamburg-Eppendorf
| | - Anne Karow
- Arbeitsbereich Psychosen, Klinik für Psychiatrie und Psychotherapie, Zentrum für Psychosoziale Medizin, Universitätsklinikum Hamburg-Eppendorf
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Wessing I, Rehbein MA, Romer G, Achtergarde S, Dobel C, Zwitserlood P, Fürniss T, Junghöfer M. Cognitive emotion regulation in children: Reappraisal of emotional faces modulates neural source activity in a frontoparietal network. Dev Cogn Neurosci 2015; 13:1-10. [PMID: 25796042 PMCID: PMC6989777 DOI: 10.1016/j.dcn.2015.01.012] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Revised: 01/09/2015] [Accepted: 01/23/2015] [Indexed: 11/17/2022] Open
Abstract
Reappraisal of emotional faces in children was examined with magnetoencephalography. Neural activity in the LPP time-interval was modulated in frontoparietal networks. Occipital activity was reduced with increasing age, indexing neural maturation. A similar reduction was linked to better emotion regulation and less anxiety. This may indicate an age-independent advance in neural maturation.
Emotion regulation has an important role in child development and psychopathology. Reappraisal as cognitive regulation technique can be used effectively by children. Moreover, an ERP component known to reflect emotional processing called late positive potential (LPP) can be modulated by children using reappraisal and this modulation is also related to children's emotional adjustment. The present study seeks to elucidate the neural generators of such LPP effects. To this end, children aged 8–14 years reappraised emotional faces, while neural activity in an LPP time window was estimated using magnetoencephalography-based source localization. Additionally, neural activity was correlated with two indexes of emotional adjustment and age. Reappraisal reduced activity in the left dorsolateral prefrontal cortex during down-regulation and enhanced activity in the right parietal cortex during up-regulation. Activity in the visual cortex decreased with increasing age, more adaptive emotion regulation and less anxiety. Results demonstrate that reappraisal changed activity within a frontoparietal network in children. Decreasing activity in the visual cortex with increasing age is suggested to reflect neural maturation. A similar decrease with adaptive emotion regulation and less anxiety implies that better emotional adjustment may be associated with an advance in neural maturation.
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Affiliation(s)
- Ida Wessing
- Department of Child and Adolescent Psychiatry, University Hospital Münster, Münster, Germany.
| | - Maimu A Rehbein
- Institute for Biomagnetism and Biosignalanalysis, University Hospital Münster, Münster, Germany
| | - Georg Romer
- Department of Child and Adolescent Psychiatry, University Hospital Münster, Münster, Germany
| | - Sandra Achtergarde
- Department of Child and Adolescent Psychiatry, University Hospital Münster, Münster, Germany
| | - Christian Dobel
- Institute for Biomagnetism and Biosignalanalysis, University Hospital Münster, Münster, Germany
| | - Pienie Zwitserlood
- Department of Psychology, Westfälische Wilhelms-Universität Münster, Münster, Germany
| | - Tilman Fürniss
- Department of Child and Adolescent Psychiatry, University Hospital Münster, Münster, Germany
| | - Markus Junghöfer
- Institute for Biomagnetism and Biosignalanalysis, University Hospital Münster, Münster, Germany
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46
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Weigel A, Gumz A, Uhlenbusch N, Wegscheider K, Romer G, Löwe B. Preventing eating disorders with an interactive gender-adapted intervention program in schools: study protocol of a randomized controlled trial. BMC Psychiatry 2015; 15:21. [PMID: 25884195 PMCID: PMC4337195 DOI: 10.1186/s12888-015-0405-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 02/02/2015] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND There are a high number of adolescents who are at risk of developing an eating disorder. There is, therefore, a strong need to implement prevention programs aimed at reducing the incidence of eating disorders at this critical age. Among other factors, successful prevention programs have been shown to be interactive, carried out by professionals, focused on educational as well as psychosocial elements and have taken risk factors as well as resources into account. The objective of this study protocol is to present the design of a new prevention program for eating disorders in schools. METHODS/DESIGN The gender-adapted prevention program extends over six school hours. It contains interactive and educational elements about eating disorders and their treatment. Participants pass through different exercises and reflect on the influences of the media, self-esteem, body perception and individual resources. A cluster-randomized controlled trial is chosen to evaluate the program. Based on an estimated effect size of d = 0.3 a total of 1848 participants are enrolled in the study. Eating disorder risk, internalization of Western beauty ideals, body dissatisfaction, self-concept as well as anxiety and symptoms of depression are measured before and immediately after the intervention as well as at a six-month follow-up. In addition, the intervention group evaluates the different components of the program. DISCUSSION The study intends to test the practicability and efficacy of an interactive, gender-adapted ED prevention program in schools. Moreover, it will provide valuable information about the occurrence of eating disorder risk factors in school-aged children. TRIAL REGISTRATION ISRCTN97989348; Registered 19 December 2012.
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Affiliation(s)
- Angelika Weigel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf & Schön Klinik Hamburg Eilbek, Martinistraße 52, 20246, Hamburg, Germany.
| | - Antje Gumz
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf & Schön Klinik Hamburg Eilbek, Martinistraße 52, 20246, Hamburg, Germany. .,Psychologische Hochschule Berlin, Am Köllnischen Park 2, 10179, Berlin, Germany.
| | - Natalie Uhlenbusch
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf & Schön Klinik Hamburg Eilbek, Martinistraße 52, 20246, Hamburg, Germany.
| | - Karl Wegscheider
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Georg Romer
- Clinic of Children and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Medical Center Münster, Schmeddingstr. 50, 48149, Münster, Germany.
| | - Bernd Löwe
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf & Schön Klinik Hamburg Eilbek, Martinistraße 52, 20246, Hamburg, Germany.
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47
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Rossi ME, Neubauer K, Weigel A, Wendt H, von Rad K, Romer G, Löwe B, Gumz A. [Significance of brief interventions in the healthcare supply chain of eating disorders: a narrative review]. Psychother Psychosom Med Psychol 2015; 65:51-7. [PMID: 24838437 DOI: 10.1055/s-0034-1372570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
So far there is no comprehensive overview on brief outpatient interventions in eating disorders. The specific relevance of psychotherapeutic brief interventions for Anorexia Nervosa, Bulimia Nervosa and Binge Eating Disorder is presented against the background of current healthcare supply chains. This review is based on a literature search that evaluated relevant publications in applicable literature databases. The articles were excerpted and are presented in a narrative overview. In summary, the literature shows a marginal expansion of healthcare provision towards personnel-efficient and cost economic therapeutic solutions for Bulimia Nervosa and Binge Eating Disorder, while the treatment of Anorexia Nervosa is currently determined by more in- and extensive approaches.
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Affiliation(s)
- Maddalena Elisa Rossi
- Universitäre Klinik für Psychosomatische Medizin und Psychotherapie, -Universitätsklinikum Hamburg-Eppendorf und Schön Klinik Hamburg-Eilbek
| | - Karolin Neubauer
- Universitäre Klinik für Psychosomatische Medizin und Psychotherapie, -Universitätsklinikum Hamburg-Eppendorf und Schön Klinik Hamburg-Eilbek
| | - Angelika Weigel
- Universitäre Klinik für Psychosomatische Medizin und Psychotherapie, -Universitätsklinikum Hamburg-Eppendorf und Schön Klinik Hamburg-Eilbek
| | - Hanna Wendt
- Universitäre Klinik für Psychosomatische Medizin und Psychotherapie, -Universitätsklinikum Hamburg-Eppendorf und Schön Klinik Hamburg-Eilbek
| | - Kathrin von Rad
- Universitäre Klinik für Psychosomatische Medizin und Psychotherapie, -Universitätsklinikum Hamburg-Eppendorf und Schön Klinik Hamburg-Eilbek
| | - Georg Romer
- Klinik für Kinder- und Jugendpsychiatrie, -psychosomatik und -psychotherapie, Universitätsklinikum Münster
| | - Bernd Löwe
- Universitäre Klinik für Psychosomatische Medizin und Psychotherapie, -Universitätsklinikum Hamburg-Eppendorf und Schön Klinik Hamburg-Eilbek
| | - Antje Gumz
- Universitäre Klinik für Psychosomatische Medizin und Psychotherapie, -Universitätsklinikum Hamburg-Eppendorf und Schön Klinik Hamburg-Eilbek
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48
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Götze H, Ernst J, Brähler E, Romer G, von Klitzing K. Predictors of quality of life of cancer patients, their children, and partners. Psychooncology 2014; 24:787-95. [PMID: 25488818 DOI: 10.1002/pon.3725] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Revised: 10/27/2014] [Accepted: 10/27/2014] [Indexed: 01/22/2023]
Abstract
OBJECTIVE The objective of this study is to assess the quality of life (QOL) of cancer patients and their family members over 1-year period post therapy. METHODS We evaluated QOL in cancer patients (N = 161) (Short Form-8 Health Survey (SF-8), European Organization for Research and Treatment of Cancer 30- Item Core Quality of Life Questionnaire (EORTC QLQ-C30)), their partners (N = 110) (SF-8), and their children (N = 115) (KIDSCREEN-27) using a longitudinal design (t1: post therapy, t2: 6 months after t1, t3: 12 months after t1). Multiple regression models were employed to examine factors related to QOL. RESULTS After cancer therapy, impairments in the patients' QOL were found primarily in emotional and social areas and also in role functions. We found the highest symptom burden in fatigue (M = 45.21), sleep disturbances (M = 41.04), and financial difficulties (M = 39.2). Partners had lower mental QOL compared with the general population at each assessment point (p < 0.05). No significant difference was found in physical QOL between partners and the general population (p > 0.05). Social support, full-time employment, tumor stage 0-2, time since diagnosis <1 year, and lower levels of anxiety and depression were associated with better QOL in patients. Full-time employment, social support, and lower levels of anxiety and depression had a significant impact on the partners' QOL. Higher levels of anxiety and depression in patients (p = 0.006) adversely influenced children's QOL. CONCLUSIONS Family members' QOL is overall stable over time indicating the need for professional psychosocial support for those family members with low QOL. For the children, new measures are needed to better examine the experience with parental cancer.
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Affiliation(s)
- Heide Götze
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
| | - Jochen Ernst
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
| | - Elmar Brähler
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany.,Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Georg Romer
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Münster, Münster, Germany
| | - Kai von Klitzing
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Leipzig, Leipzig, Germany
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Gumz A, Uhlenbusch N, Weigel A, Wegscheider K, Romer G, Löwe B. Decreasing the duration of untreated illness for individuals with anorexia nervosa: study protocol of the evaluation of a systemic public health intervention at community level. BMC Psychiatry 2014; 14:300. [PMID: 25404427 PMCID: PMC4239321 DOI: 10.1186/s12888-014-0300-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 10/15/2014] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Anorexia nervosa (AN) is a mental disorder with grave burdens for affected individuals as well as for the healthcare system. One of the strongest predictors of a poor outcome is a long Duration of Untreated Illness (DUI), which is defined as the time between the onset of the disease and treatment initiation. Reducing the DUI is an important step to optimize care of individuals with AN. In order to achieve this aim, systemic public health interventions are necessary. Objective of this study is to evaluate a systemic public health intervention at Community level aiming to reduce the DUI in individuals with AN. METHODS/DESIGN The intervention includes the establishment of a network of health care professionals within the area of eating disorders (EDs), the development of an internet-based treatment guide, the presentation of informative short-films about EDs in cinemas and a corresponding poster campaign as well as a special outpatient clinic. For the evaluating study a pre-post between-subject design is chosen. The DUI, and the duration until first contact (DUC) with a health care professional, ED pathology as well as comorbidity are assessed before and after the systemic intervention is carried out. DISCUSSION The study attempts to provide evidence of the effectiveness of an ED-related systematic public health intervention. Additionally, the study will lead to a better understanding of the DUI, which is essential in order to improve care of individuals with AN. TRIAL REGISTRATION Current Controlled Trials ISRCTN44979231 ; Registered 11 November 2011.
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Affiliation(s)
- Antje Gumz
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, Hamburg-Eppendorf & Schön Klinik Hamburg Eilbek, Martinistraße 52, 20246, Hamburg, Germany.
| | - Natalie Uhlenbusch
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, Hamburg-Eppendorf & Schön Klinik Hamburg Eilbek, Martinistraße 52, 20246, Hamburg, Germany.
| | - Angelika Weigel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, Hamburg-Eppendorf & Schön Klinik Hamburg Eilbek, Martinistraße 52, 20246, Hamburg, Germany.
| | - Karl Wegscheider
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Georg Romer
- Department of Children and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Medical Center Münster, Germany, Schmeddingstr 50, Münster, 48149, Germany.
| | - Bernd Löwe
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, Hamburg-Eppendorf & Schön Klinik Hamburg Eilbek, Martinistraße 52, 20246, Hamburg, Germany.
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50
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Bojanowski S, Führer D, Romer G, Bergelt C, von Klitzing K, Brähler E, Keller M, Resch F, Flechtner HH, Lehmkuhl U, Weschenfelder-Stachwitz H. [The mental health of only children and of siblings with cancer - first results of a multicenter study in Germany]. Z Kinder Jugendpsychiatr Psychother 2014; 42:223-32. [PMID: 25005900 DOI: 10.1024/1422-4917/a000295] [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] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Children of parents with cancer are at risk of developing mental disorders. RESULTS from divorce research also reveal that sibling relationships can protect the mental health of children in difficult times. OBJECTIVE Does having a sibling help to cope with an oncological disease of a parent and thus act as a protective factor? METHODS A group of 271 children were examined in a multicenter study. 54 % made use of the offered psychosocial support. Only children (N = 89) and children with siblings (N = 182) were compared with respect to their mental health (Strength and Difficulties Questionnaire, SDQ, parental and self-assessment). RESULTS The group comparison between only children and siblings showed no significant differences in the SDQ (assessed by healthy/ill parent). In the self-assessment 2 % of the only children and 9 % of the siblings showed significant results on the SDQ. The group comparison between only children and children with siblings failed to reveal any important differences in mental health. The study indicates that a negative relationship quality (Sibling Relationship Questionnaire, SRQ) is associated with increased problems in the peer group. CONCLUSIONS The existence of a sibling is not per se a protective factor. Only children do not show more signs of emotional stress than children with siblings.
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Affiliation(s)
- Sabine Bojanowski
- Charité Universitätsmedizin Berlin, CVK, Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters
| | - Daniel Führer
- Charité Universitätsmedizin Berlin, CVK, Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters
| | - Georg Romer
- Universitätsklinikum Hamburg-Eppendorf, Klinik für Kinder- und Jugendpsychiatrie und Psychotherapie
| | - Corinna Bergelt
- Universitätsklinikum Hamburg-Eppendorf, Institut für Medizinische Psychologie
| | - Kai von Klitzing
- Universitätsklinikum Leipzig, Klinik und Poliklinik für Psychiatrie, Psychotherapie und Psychosomatik des Kindes- und Jugendalters
| | - Elmar Brähler
- Universitätsklinikum Leipzig, Selbständige Abteilung Medizinische Psychologie und Medizinische Soziologie
| | - Monika Keller
- Universitätsklinikum Heidelberg, Klinik für Psychosomatische und Allgemeine Klinische Medizin
| | - Franz Resch
- Universitätsklinikum Heidelberg, Klinik für Kinder- und Jugendpsychiatrie
| | - Hans-Henning Flechtner
- Otto-von-Guericke Universität Magdeburg, Klinik für Kinder- und Jugendpsychiatrie und Psychotherapie
| | - Ulrike Lehmkuhl
- Charité Universitätsmedizin Berlin, CVK, Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters
| | - Heike Weschenfelder-Stachwitz
- Charité Universitätsmedizin Berlin, CVK, Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters
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