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Kobelt M, Waldhauser GT, Rupietta A, Heinen R, Rau EMB, Kessler H, Axmacher N. The memory trace of an intrusive trauma-analog episode. Curr Biol 2024; 34:1657-1669.e5. [PMID: 38537637 DOI: 10.1016/j.cub.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 12/05/2023] [Accepted: 03/06/2024] [Indexed: 04/25/2024]
Abstract
Intrusive memories are a core symptom of posttraumatic stress disorder. Compared with memories of everyday events, they are characterized by several seemingly contradictory features: intrusive memories contain distinct sensory and emotional details of the traumatic event and can be triggered by various perceptually similar cues, but they are poorly integrated into conceptual memory. Here, we conduct exploratory whole-brain analyses to investigate the neural representations of trauma-analog experiences and how they are reactivated during memory intrusions. We show that trauma-analog movies induce excessive processing and generalized representations in sensory areas but decreased blood-oxygen-level-dependent (BOLD) responses and highly distinct representations in conceptual/semantic areas. Intrusive memories activate generalized representations in sensory areas and reactivate memory traces specific to trauma-analog events in the anterior cingulate cortex. These findings provide the first evidence of how traumatic events could distort memory representations in the human brain, which may form the basis for future confirmatory research on the neural representations of traumatic experiences.
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Affiliation(s)
- M Kobelt
- Department of Neuropsychology, Ruhr-Universität Bochum, Bochum 44801, North Rhine-Westphalia, Germany.
| | - G T Waldhauser
- Department of Neuropsychology, Ruhr-Universität Bochum, Bochum 44801, North Rhine-Westphalia, Germany.
| | - A Rupietta
- Department of Clinical Psychology and Psychotherapy, Ruhr-Universität Bochum, Bochum 44787, North Rhine-Westphalia, Germany
| | - R Heinen
- Department of Neuropsychology, Ruhr-Universität Bochum, Bochum 44801, North Rhine-Westphalia, Germany
| | - E M B Rau
- Department of Neuropsychology, Ruhr-Universität Bochum, Bochum 44801, North Rhine-Westphalia, Germany
| | - H Kessler
- Department of Psychosomatic Medicine and Psychotherapy, Campus Fulda, Universität Marburg, Marburg 35032, Hessen, Germany; Department of Psychosomatic Medicine and Psychotherapy, LWL University Hospital, Ruhr-Universität Bochum, Bochum 44791, North Rhine-Westphalia, Germany
| | - N Axmacher
- Department of Neuropsychology, Ruhr-Universität Bochum, Bochum 44801, North Rhine-Westphalia, Germany.
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Kehyayan A, Thiel JP, Unterberg K, Salja V, Meyer-Wehrmann S, Holmes EA, Matura JM, Dieris-Hirche J, Timmesfeld N, Herpertz S, Axmacher N, Kessler H. The effect of a visuospatial interference intervention on posttraumatic intrusions: a cross-over randomized controlled trial. Eur J Psychotraumatol 2024; 15:2331402. [PMID: 38591762 PMCID: PMC11028024 DOI: 10.1080/20008066.2024.2331402] [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: 07/06/2023] [Accepted: 03/02/2024] [Indexed: 04/10/2024] Open
Abstract
Background: Intrusive memories form a core symptom of Posttraumatic Stress Disorder (PTSD). Based on concepts of visuospatial interference and memory-updating accounts, technological innovations aim to attenuate such intrusions using visuospatial interventions.Objective: This study aims to test the effect of a visuospatial Tetris-based intervention versus a verbal condition (Wiki) and a never-targeted control (no intervention) on intrusion frequency.Method: A randomized crossover trial was conducted including N = 38 PTSD patients who had at least 3 distinct intrusive memories of trauma. After both 2 weeks (intervention 1) and 4 weeks (intervention 2), one of the three memories was randomly selected and either the visuospatial intervention (memory reminder of a traumatic memory + Tetris) or verbal condition (reading a Wikipedia article + answering questions) was performed on their first memory in randomized order. In the week 4 session, the patient conducted the other intervention condition on their second memory (crossover). The third memory was never targeted (no intervention). Daily occurrence of intrusions over 8 weeks was collected using a diary and analysed using mixed Poisson regression models.Results: Overall, there was no significant reduction in intrusion frequency from either intervention compared to each other, and to no intervention control (relative risk Tetris/Wiki: 0.947; p = .31; relative risk no intervention/Tetris: 1.060; p = .15; relative risk no intervention/Wiki: 1.004; p = .92).Conclusions: There was no effect of either intervention on intrusions when administered in a crossover design where participants received both interventions. Design shortcomings and consequences for future studies are discussed.
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Affiliation(s)
- Aram Kehyayan
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Josephine P. Thiel
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Karl Unterberg
- Department of Neuropsychology, Institute of Cognitive Neuroscience, Faculty of Psychology, Ruhr-University Bochum, Bochum, Germany
| | - Vanessa Salja
- Department of Neuropsychology, Institute of Cognitive Neuroscience, Faculty of Psychology, Ruhr-University Bochum, Bochum, Germany
| | - Stefan Meyer-Wehrmann
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Emily A. Holmes
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Jan-Martin Matura
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Jan Dieris-Hirche
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Nina Timmesfeld
- Department of Medical Informatics, Biometry and Epidemiology, Ruhr-University Bochum, Bochum, Germany
| | - Stephan Herpertz
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Nikolai Axmacher
- Department of Neuropsychology, Institute of Cognitive Neuroscience, Faculty of Psychology, Ruhr-University Bochum, Bochum, Germany
| | - Henrik Kessler
- Department of Psychosomatic Medicine and Psychotherapy, Campus Fulda, University of Marburg, Fulda, Germany
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Kessler H, Luna Russo M, King C, Sobrado LF. Laparoscopic low anterior resection for deeply infiltrating endometriosis - a video vignette. Colorectal Dis 2024. [PMID: 38572790 DOI: 10.1111/codi.16944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 10/14/2023] [Accepted: 10/24/2023] [Indexed: 04/05/2024]
Affiliation(s)
- H Kessler
- Department of Colorectal Surgery, Cleveland Clinic, Digestive Disease and Surgery Institute, Cleveland, Ohio, USA
| | - M Luna Russo
- Department of Colorectal Surgery, Cleveland Clinic, Digestive Disease and Surgery Institute, Cleveland, Ohio, USA
| | - C King
- Department of Colorectal Surgery, Cleveland Clinic, Digestive Disease and Surgery Institute, Cleveland, Ohio, USA
| | - L F Sobrado
- Department of Colorectal Surgery, Cleveland Clinic, Digestive Disease and Surgery Institute, Cleveland, Ohio, USA
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Doering S, Herpertz S, Pape M, Hofmann T, Rose M, Imbierowicz K, Geiser F, Bierling AL, Weidner K, Rademacher J, Michalek S, Morawa E, Erim Y, Teigelack P, Teufel M, Hartmann A, Lahmann C, Peters EMJ, Kruse J, von Boetticher D, Herrmann-Lingen C, Nöhre M, de Zwaan M, Dinger U, Friederich HC, Niecke A, Albus C, Zwerenz R, Beutel M, Sattel HC, Henningsen P, Stein B, Waller C, Hake K, Spitzer C, Stengel A, Zipfel S, Weimer K, Gündel H, Kessler H. The multicenter effectiveness study of inpatient and day hospital treatment in departments of psychosomatic medicine and psychotherapy in Germany. Front Psychiatry 2023; 14:1155582. [PMID: 37608994 PMCID: PMC10440687 DOI: 10.3389/fpsyt.2023.1155582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 07/24/2023] [Indexed: 08/24/2023] Open
Abstract
Background Reliable outcome data of psychosomatic inpatient and day hospital treatment with a focus on psychotherapy are important to strengthen ecological validity by assessing the reality of mental health care in the field. This study aims to evaluate the effectiveness of inpatient and day hospital treatment in German university departments of Psychosomatic Medicine and Psychotherapy in a prospective, naturalistic, multicenter design including structured assessments. Methods Structured interviews were used to diagnose mental disorders according to ICD-10 and DSM-IV at baseline. Depression, anxiety, somatization, eating disorder and posttraumatic stress disorder (PTSD) symptoms, as well as personality functioning were assessed by means of questionnaires on admission and at discharge. Results 2,094 patients recruited by 19 participating university hospitals consented to participation in the study. Effect sizes for each of the outcome criteria were calculated for 4-5 sub-groups per outcome domain with differing severity at baseline. Pre-post effect sizes for patients with moderate and high symptom severity at baseline ranged from d = 0.78 to d = 3.61 with symptoms of PTSD, depression, and anxiety showing the largest and somatization as well as personality functioning showing somewhat smaller effects. Conclusions Inpatient and day hospital treatment in German university departments of Psychosomatic Medicine and Psychotherapy is effective under field conditions. Clinical trial registration https://drks.de/search/de/trial/DRKS00016412, identifier: DRKS00016412.
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Affiliation(s)
- Stephan Doering
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna, Austria
- Comprehensive Clinical Center for Neurosciences and Mental Health (C3NMH), Medical University of Vienna, Vienna, Austria
| | - Stephan Herpertz
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Magdalena Pape
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Tobias Hofmann
- Charité Center for Internal Medicine and Dermatology, Department of Psychosomatic Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Matthias Rose
- Charité Center for Internal Medicine and Dermatology, Department of Psychosomatic Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Katrin Imbierowicz
- Department of Psychosomatic Medicine and Psychotherapy, University of Bonn, Bonn, Germany
| | - Franziska Geiser
- Department of Psychosomatic Medicine and Psychotherapy, University of Bonn, Bonn, Germany
| | - Antonie Louise Bierling
- Department of Psychotherapy and Psychosomatic Medicine, Carl Gustav Carus Faculty of Medicine, Technische Universität, Dresden, Germany
- Institute for Material Science and Nanotechnology, Technical University of Dresden, Dresden, Germany
- Department of Clinical Psychology, Friedrich-Schiller University, Jena, Germany
| | - Kerstin Weidner
- Department of Psychotherapy and Psychosomatic Medicine, Carl Gustav Carus Faculty of Medicine, Technische Universität, Dresden, Germany
| | - Jörg Rademacher
- Department of Psychosomatic Medicine and Psychotherapy, LVR-University Hospital, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Silke Michalek
- Department of Psychosomatic Medicine and Psychotherapy, LVR-University Hospital, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Eva Morawa
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Yesim Erim
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Per Teigelack
- Clinic of Psychosomatic Medicine and Psychotherapy, LVR-University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Martin Teufel
- Clinic of Psychosomatic Medicine and Psychotherapy, LVR-University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Armin Hartmann
- Department of Psychosomatic Medicine und Psychotherapy, Center for Mental Health, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Claas Lahmann
- Department of Psychosomatic Medicine und Psychotherapy, Center for Mental Health, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Eva Milena Johanne Peters
- Department of Psychosomatic Medicine and Psychotherapy, Justus-Liebig University of Giessen, Giessen, Germany
- Department of Psychosomatic Medicine and Psychotherapy, Philipps-University of Marburg, Marburg, Germany
| | - Johannes Kruse
- Department of Psychosomatic Medicine and Psychotherapy, Justus-Liebig University of Giessen, Giessen, Germany
- Department of Psychosomatic Medicine and Psychotherapy, Philipps-University of Marburg, Marburg, Germany
| | - Dirk von Boetticher
- Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Centre, Göttingen, Germany
| | - Christoph Herrmann-Lingen
- Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Centre, Göttingen, Germany
| | - Mariel Nöhre
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Martina de Zwaan
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Ulrike Dinger
- Department of Psychosomatic Medicine and Psychotherapy, LVR-University Hospital, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Department of General Internal Medicine and Psychosomatics, University Hospital, Heidelberg University, Heidelberg, Germany
| | - Hans-Christoph Friederich
- Department of General Internal Medicine and Psychosomatics, University Hospital, Heidelberg University, Heidelberg, Germany
| | - Alexander Niecke
- Department of Psychosomatic Medicine and Psychotherapy, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Christian Albus
- Department of Psychosomatic Medicine and Psychotherapy, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Rüdiger Zwerenz
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Manfred Beutel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Heribert Christian Sattel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital, Technical University of Munich, Munich, Germany
| | - Peter Henningsen
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital, Technical University of Munich, Munich, Germany
| | - Barbara Stein
- Department of Psychosomatic Medicine and Psychotherapy, Paracelsus Medical University, Nuremberg General Hospital, Nuremberg, Germany
| | - Christiane Waller
- Department of Psychosomatic Medicine and Psychotherapy, Paracelsus Medical University, Nuremberg General Hospital, Nuremberg, Germany
| | - Karsten Hake
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Rostock, Rostock, Germany
| | - Carsten Spitzer
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Rostock, Rostock, Germany
| | - Andreas Stengel
- Internal Medicine VI, Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Stephan Zipfel
- Internal Medicine VI, Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Katja Weimer
- Department of Psychosomatic Medicine and Psychotherapy, Ulm University Medical Center, Ulm, Germany
| | - Harald Gündel
- Department of Psychosomatic Medicine and Psychotherapy, Ulm University Medical Center, Ulm, Germany
| | - Henrik Kessler
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Hospital, Ruhr-University Bochum, Bochum, Germany
- Department of Psychosomatic Medicine and Psychotherapy, Campus Fulda, University of Marburg, Marburg, Germany
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Kumsta R, Zang JCS, Hummel EM, Müller S, Moser DA, Herpertz S, Kessler H. Treatment-associated mRNA co-expression changes in monocytes of patients with posttraumatic stress disorder. Front Psychiatry 2023; 14:1181321. [PMID: 37426106 PMCID: PMC10326517 DOI: 10.3389/fpsyt.2023.1181321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 05/05/2023] [Indexed: 07/11/2023] Open
Abstract
PTSD is a prevalent mental disorder that results from exposure to extreme and stressful life events and comes at high costs for both the individual and society. Therapeutic treatment presents the best way to deal with PTSD-the mechanisms underlying change after treatment, however, remain poorly understood. While stress and immune associated gene expression changes have been associated with PTSD development, studies investigating treatment effects at the molecular level so far tended to focus on DNA methylation. Here we use gene-network analysis on whole-transcriptome RNA-Seq data isolated from CD14+ monocytes of female PTSD patients (N = 51) to study pre-treatment signatures of therapy response and therapy-related changes at the level of gene expression. Patients who exhibited significant symptom improvement after therapy showed higher baseline expression in two modules involved in inflammatory processes (including notable examples IL1R2 and FKBP5) and blood coagulation. After therapy, expression of an inflammatory module was increased, and expression of a wound healing module was decreased. This supports findings reporting an association between PTSD and dysregulations of the inflammatory and the hemostatic system and mark both as potentially treatment sensitive.
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Affiliation(s)
- Robert Kumsta
- Department of Genetic Psychology, Faculty of Psychology, Ruhr University Bochum, Bochum, Germany
- Department of Behavioural and Cognitive Sciences, Laboratory for Stress and Gene-Environment Interplay, University of Luxemburg, Esch-sur-Alzette, Luxemburg
| | - Johannes C. S. Zang
- Department of Genetic Psychology, Faculty of Psychology, Ruhr University Bochum, Bochum, Germany
| | - Elisabeth M. Hummel
- Department of Genetic Psychology, Faculty of Psychology, Ruhr University Bochum, Bochum, Germany
| | - Svenja Müller
- Department of Genetic Psychology, Faculty of Psychology, Ruhr University Bochum, Bochum, Germany
| | - Dirk A. Moser
- Department of Genetic Psychology, Faculty of Psychology, Ruhr University Bochum, Bochum, Germany
| | - Stephan Herpertz
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Hospital Ruhr-University Bochum, Bochum, Germany
| | - Henrik Kessler
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Hospital Ruhr-University Bochum, Bochum, Germany
- Department of Psychosomatic Medicine and Psychotherapy, Fulda Hospital, University Medicine Marburg Campus Fulda, Fulda, Germany
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Connelly TM, Clancy C, Cheong JY, Jia X, Bhama AR, Lightner A, Kessler H, Valente M, Holubar SD. What is the real morbidity after emergency colectomy for Crohn's disease? A propensity score matched study. Tech Coloproctol 2023; 27:309-315. [PMID: 36376698 DOI: 10.1007/s10151-022-02727-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 11/01/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND In the inflammatory bowel disease literature, emergency surgery for Crohn's disease (CD) is associated with worse postoperative outcomes as compared to elective surgery. Previous studies have compared heterogeneous groups only. We hypothesized that this association would be lost after matched analysis. We aimed to compare matched CD patients undergoing elective vs emergency surgery. METHODS The National Surgical Quality Improvement database (01/2005-12/2019) was utilized to identify adult CD surgical patients. Univariate and conditional logistic regression models were used to analyze unmatched and matched cohorts. Propensity-score matching was performed to match emergency to non-emergency patients 1:1. Our primary outcome was a composite of any complication. Our secondary endpoints were hospital readmission, unplanned reoperation and 30-day morbidity and mortality. RESULTS In the unmatched analyses (n = 12,181/95.28% elective and n = 603/4.72% emergency) of Crohn's patients undergoing colectomy, 20% of elective and 42% of emergency patients experienced a complication (p < 0.001). Over 20 outcomes measured including length of stay (LOS), readmission, infections and respiratory, cardiovascular and renal complications, were worse in the emergency cohort. In the matched analyses (n = 400 emergency/400 elective patients) only the categories of any complication (OR 1.44, 1.06-1.96 95% CI, p = 0.02), any surgical site infection (SSI, OR 1.53, 1.07-2.19 95% CI, p = 0.02), superficial SSI (OR 2.25, 1.14-4.44 95% CI, p = 0.02), organ space SSI (1.58 OR 1.04-2.4 95% CI, p = 0.03), unplanned intubation (OR 5.0, 1.45-17.27 95% CI, p = 0.01), ventilation > 48 h (OR 9.0, 1.4-38.79 95% CI, p = 0.003) and septic shock (OR 4.5, 1.86-10.9 95% CI, p < 0.001) were higher in the emergency cohort. CONCLUSIONS Matching CD patients resulted in a loss of the observed increase in cardiovascular and renal complications, reoperation and LOS following emergency surgery; however, SSIs and respiratory complications remained increased despite matching.
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Affiliation(s)
- T M Connelly
- Digestive Disease and Surgery Institute, Department of Colorectal Surgery, Cleveland Clinic, 9500 Euclid Ave/A 30, Cleveland, OH, 44195, USA
| | - C Clancy
- Digestive Disease and Surgery Institute, Department of Colorectal Surgery, Cleveland Clinic, 9500 Euclid Ave/A 30, Cleveland, OH, 44195, USA
| | - J Y Cheong
- Digestive Disease and Surgery Institute, Department of Colorectal Surgery, Cleveland Clinic, 9500 Euclid Ave/A 30, Cleveland, OH, 44195, USA
| | - X Jia
- Digestive Disease and Surgery Institute, Department of Colorectal Surgery, Cleveland Clinic, 9500 Euclid Ave/A 30, Cleveland, OH, 44195, USA
| | - A R Bhama
- Digestive Disease and Surgery Institute, Department of Colorectal Surgery, Cleveland Clinic, 9500 Euclid Ave/A 30, Cleveland, OH, 44195, USA
| | - A Lightner
- Digestive Disease and Surgery Institute, Department of Colorectal Surgery, Cleveland Clinic, 9500 Euclid Ave/A 30, Cleveland, OH, 44195, USA
| | - H Kessler
- Digestive Disease and Surgery Institute, Department of Colorectal Surgery, Cleveland Clinic, 9500 Euclid Ave/A 30, Cleveland, OH, 44195, USA
| | - M Valente
- Digestive Disease and Surgery Institute, Department of Colorectal Surgery, Cleveland Clinic, 9500 Euclid Ave/A 30, Cleveland, OH, 44195, USA
| | - S D Holubar
- Digestive Disease and Surgery Institute, Department of Colorectal Surgery, Cleveland Clinic, 9500 Euclid Ave/A 30, Cleveland, OH, 44195, USA.
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Hummel EM, Piovesan K, Berg F, Herpertz S, Kessler H, Kumsta R, Moser DA. Mitochondrial DNA as a marker for treatment-response in post-traumatic stress disorder. Psychoneuroendocrinology 2023; 148:105993. [PMID: 36462294 DOI: 10.1016/j.psyneuen.2022.105993] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 11/28/2022] [Accepted: 11/28/2022] [Indexed: 12/05/2022]
Abstract
Post-traumatic stress disorder (PTSD) is a serious mental health condition thought to be mediated by a dysregulated stress response system. Stress, especially chronic stress, affects mitochondrial activity and their efficiency in duplicating their genomes. Human cells contain numerous mitochondria that harbor multiple copies of their own genome, which consist of a mixture of wild type and variant mtDNA - a condition known as mitochondrial heteroplasmy. Number of mitochondrial genomes in a cell and the degree of heteroplasmy may serve as an indicator of mitochondrial allostatic load. Changes in mtDNA copy number and the proportion of variant mtDNA may be related to mental disorders and symptom severity, suggesting an involvement of mitochondrial dysfunction also in PTSD. Therefore, we examined number and composition of mitochondrial DNA before and after six weeks of inpatient psychotherapy treatment in a cohort of 60 female PTSD patients. We extracted DNA from isolated monocytes before and after inpatient treatment and quantified cellular mtDNA using multiplex qPCR. We hypothesized that treatment would lead to changes in cellular mtDNA levels and that change in mtDNA level would be associated with PTSD symptom severity and treatment response. It could be shown that mtDNA copy number and the ratio of variant mtDNA decreased during therapy, however, this change did not correlate with treatment response. Our results suggest that inpatient treatment can reduce signs of mitochondrial allostatic load, which could have beneficial effects on mental health. The quantification of mtDNA and the determination of cellular heteroplasmy could represent valuable biomarkers for the molecular characterization of mental disorders in the future.
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Affiliation(s)
- E M Hummel
- Department of Genetic Psychology, Faculty of Psychology, Ruhr-University Bochum, Universitätsstraße 150, 44801 Bochum, Germany.
| | - K Piovesan
- Department of Genetic Psychology, Faculty of Psychology, Ruhr-University Bochum, Universitätsstraße 150, 44801 Bochum, Germany
| | - F Berg
- Department of Genetic Psychology, Faculty of Psychology, Ruhr-University Bochum, Universitätsstraße 150, 44801 Bochum, Germany
| | - S Herpertz
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Hospital, Ruhr University Bochum, Germany
| | - H Kessler
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Hospital, Ruhr University Bochum, Germany; Department of Psychosomatic Medicine and Psychotherapy, Fulda Hospital, University Medicine Marburg Campus Fulda, Fulda, Germany
| | - R Kumsta
- Department of Genetic Psychology, Faculty of Psychology, Ruhr-University Bochum, Universitätsstraße 150, 44801 Bochum, Germany; Department of Behavioural and Cognitive Sciences, Laboratory for Stress and Gene-Environment nterplay, University of Luxemburg, Porte des Sciences, L-4366 Esch-sur-Alzette, Luxemburg
| | - D A Moser
- Department of Genetic Psychology, Faculty of Psychology, Ruhr-University Bochum, Universitätsstraße 150, 44801 Bochum, Germany.
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Doering S, Herpertz S, Hofmann T, Rose M, Imbierowicz K, Geiser F, Croy I, Weidner K, Rademacher J, Michalek S, Morawa E, Erim Y, Teigelack P, Teufel M, Hartmann A, Lahmann C, Johanne Peters EM, Kruse J, von Boetticher D, Herrmann-Lingen C, Nöhre M, de Zwaan M, Dinger U, Friederich HC, Niecke A, Albus C, Zwerenz R, Beutel M, Roenneberg C, Henningsen P, Stein B, Waller C, Hake K, Spitzer C, Stengel A, Zipfel S, Weimer K, Gündel H, Kessler H. What Kind of Patients Receive Inpatient and Day-Hospital Treatment in Departments of Psychosomatic Medicine and Psychotherapy in Germany? Psychother Psychosom 2023; 92:49-54. [PMID: 36516807 DOI: 10.1159/000527881] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 10/28/2022] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Germany is one of the few countries with a medical specialty of psychosomatic medicine and psychotherapy and many treatment resources of this kind. OBJECTIVE This observational study describes the psychosomatic treatment programs as well as a large sample of day-hospital and inpatients in great detail using structured diagnostic interviews. METHODS Mental disorders were diagnosed according to ICD-10 and DSM-IV by means of Mini-DIPS and SCID-II. In addition to the case records, a modified version of the CSSRI was employed to collect demographic data and service use. The PHQ-D was used to assess depression, anxiety, and somatization. RESULTS 2,094 patients from 19 departments participated in the study after giving informed consent. The sample consisted of a high proportion of "complex patients" with high comorbidity of mental and somatic diseases, severe psychopathology, and considerable social and occupational dysfunction including more than 50 days of sick leave per year in half of the sample. The most frequent diagnoses were depression, somatoform and anxiety disorders, eating disorders, personality disorders, and somato-psychic conditions. CONCLUSIONS Inpatient and day-hospital treatment in German university departments of psychosomatic medicine and psychotherapy is an intensive multimodal treatment for complex patients with high comorbidity and social as well as occupational dysfunction.
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Affiliation(s)
- Stephan Doering
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Stephan Herpertz
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Tobias Hofmann
- Charité Center for Internal Medicine and Dermatology, Department of Psychosomatic Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Matthias Rose
- Charité Center for Internal Medicine and Dermatology, Department of Psychosomatic Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Katrin Imbierowicz
- Department of Psychosomatic Medicine and Psychotherapy, University of Bonn, Bonn, Germany
| | - Franziska Geiser
- Department of Psychosomatic Medicine and Psychotherapy, University of Bonn, Bonn, Germany
| | - Ilona Croy
- Department of Psychotherapy and Psychosomatic Medicine, Carl Gustav Carus Faculty of Medicine, Technische Universität, Dresden, Germany.,Department of Clinical Psychology, Friedrich-Schiller University, Jena, Germany
| | - Kerstin Weidner
- Department of Psychotherapy and Psychosomatic Medicine, Carl Gustav Carus Faculty of Medicine, Technische Universität, Dresden, Germany
| | - Jörg Rademacher
- Department of Psychosomatic Medicine and Psychotherapy, LVR-University Hospital, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Silke Michalek
- Department of Psychosomatic Medicine and Psychotherapy, LVR-University Hospital, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Eva Morawa
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Yesim Erim
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Per Teigelack
- Clinic of Psychosomatic Medicine and Psychotherapy, LVR-University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Martin Teufel
- Clinic of Psychosomatic Medicine and Psychotherapy, LVR-University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Armin Hartmann
- Department of Psychosomatic Medicine und Psychotherapy, Center for Mental Health, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Claas Lahmann
- Department of Psychosomatic Medicine und Psychotherapy, Center for Mental Health, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Eva Milena Johanne Peters
- Department of Psychosomatic Medicine and Psychotherapy, Justus-Liebig University of Giessen, Germany and Department of Psychosomatic Medicine and Psychotherapy, Philipps-University of Marburg, Marburg, Germany
| | - Johannes Kruse
- Department of Psychosomatic Medicine and Psychotherapy, Justus-Liebig University of Giessen, Germany and Department of Psychosomatic Medicine and Psychotherapy, Philipps-University of Marburg, Marburg, Germany
| | - Dirk von Boetticher
- Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Centre, Göttingen, Germany
| | - Christoph Herrmann-Lingen
- Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Centre, Göttingen, Germany
| | - Mariel Nöhre
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Martina de Zwaan
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Ulrike Dinger
- Department of Psychosomatic Medicine and Psychotherapy, LVR-University Hospital, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.,Department of General Internal Medicine and Psychosomatics, University Hospital, Heidelberg University, Heidelberg, Germany
| | - Hans-Christoph Friederich
- Department of General Internal Medicine and Psychosomatics, University Hospital, Heidelberg University, Heidelberg, Germany
| | - Alexander Niecke
- Department of Psychosomatic Medicine and Psychotherapy, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Christian Albus
- Department of Psychosomatic Medicine and Psychotherapy, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Rüdiger Zwerenz
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Manfred Beutel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Casper Roenneberg
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital, Technical University of Munich, Munich, Germany
| | - Peter Henningsen
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital, Technical University of Munich, Munich, Germany
| | - Barbara Stein
- Department of Psychosomatic Medicine and Psychotherapy, Nuremberg General Hospital, Paracelsus Medical University, Nuremberg, Germany
| | - Christiane Waller
- Department of Psychosomatic Medicine and Psychotherapy, Nuremberg General Hospital, Paracelsus Medical University, Nuremberg, Germany
| | - Karsten Hake
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Rostock, Rostock, Germany
| | - Carsten Spitzer
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Rostock, Rostock, Germany
| | - Andreas Stengel
- Internal Medicine VI, Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Stephan Zipfel
- Internal Medicine VI, Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Katja Weimer
- Department of Psychosomatic Medicine and Psychotherapy, Ulm University Medical Center, Ulm, Germany
| | - Harald Gündel
- Department of Psychosomatic Medicine and Psychotherapy, Ulm University Medical Center, Ulm, Germany
| | - Henrik Kessler
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Hospital, Ruhr-University Bochum, Bochum, Germany.,Department of Psychosomatic Medicine and Psychotherapy, Campus Fulda, University of Marburg, Marburg, Germany
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9
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Kehyayan A, Wright P, Marks J, Matura JM, Axmacher N, Herpertz S, Kessler H. The influence of the behavioural inhibition system on the development of PTSD-like symptoms after presentation of a traumatic film in healthy subjects. Eur J Psychotraumatol 2023; 14:2172258. [PMID: 37071087 PMCID: PMC10120539 DOI: 10.1080/20008066.2023.2172258] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2023] Open
Abstract
BACKGROUND The Behavioural Inhibition System (BIS) as a neural system controlling motivation and behaviour, has previously been linked to multiple mental disorders, including Post-traumatic Stress Disorder (PTSD). BIS-sensitivity could increase the likelihood of PTSD development after trauma. However, previous studies have largely measured BIS-sensitivity retrospectively (i.e. after trauma, or even after onset of PTSD). OBJECTIVE The study aims to confirm the relationship between BIS-sensitivity prior to trauma and PTSD symptoms. METHOD After assessment of BIS-sensitivity, N = 119 healthy participants watched a film with visually disturbing material. After 72 h, participants completed a questionnaire on PTSD-related symptoms (PCL-5). RESULTS In a multiple linear regression model, BIS-sensitivity significantly predicted PTSD symptoms, even after controlling for the decrease in mood, as well as for participants' age and sex, two factors that had previously been shown to influence BIS-sensitivity. CONCLUSIONS This is the first study to measure BIS-sensitivity before the occurrence of the (experimental) trauma and strengthens its role as a potential pre-traumatic risk factor.
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Affiliation(s)
- Aram Kehyayan
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Hospital Bochum, Ruhr University Bochum, Bochum, Germany
| | - Pia Wright
- Department of Neuropsychology, Institute of Cognitive Neuroscience, Faculty of Psychology, Ruhr University Bochum, Bochum, Germany
| | - Jessica Marks
- Department of Neuropsychology, Institute of Cognitive Neuroscience, Faculty of Psychology, Ruhr University Bochum, Bochum, Germany
| | - Jan-Martin Matura
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Hospital Bochum, Ruhr University Bochum, Bochum, Germany
| | - Nikolai Axmacher
- Department of Neuropsychology, Institute of Cognitive Neuroscience, Faculty of Psychology, Ruhr University Bochum, Bochum, Germany
| | - Stephan Herpertz
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Hospital Bochum, Ruhr University Bochum, Bochum, Germany
| | - Henrik Kessler
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Hospital Bochum, Ruhr University Bochum, Bochum, Germany
- Department of Psychosomatic Medicine and Psychotherapy, Fulda Hospital, University Medicine Marburg Campus Fulda, Fulda, Germany
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10
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Carey-Love A, Dassel M, Kessler H, Luna-Russo M. Anatomical and Surgical Considerations for Ileocolic Endometriosis. J Minim Invasive Gynecol 2022. [DOI: 10.1016/j.jmig.2022.09.533] [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: 11/27/2022]
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11
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Pape M, Reichrath B, Bottel L, Herpertz S, Kessler H, Dieris-Hirche J. Alexithymia and internet gaming disorder in the light of depression: A cross-sectional clinical study. Acta Psychol (Amst) 2022; 229:103698. [PMID: 35939974 DOI: 10.1016/j.actpsy.2022.103698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 07/12/2022] [Accepted: 08/02/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Social and emotional deficits are assumed to be involved in the development and maintenance of internet gaming disorder (IGD). Alexithymia refers to a personality construct, which is characterized by deficits in emotional awareness and processing. The constructs of alexithymia and depression share similarities, and depression is a common comorbidity of IGD patients. The aim of this study was to analyze the relationship between alexithymia and IGD when controlling for depression symptom severity. Moreover, we compared alexithymia traits of IGD patients with those of non-pathological video gamers. METHODS In a cross-sectional study n = 38 male IGD patients (EG) were recruited at specialized healthcare services in Germany. In addition, n = 39 male non-pathological video gamers (CG) were recruited via social media and bulletin board announcement. Both groups completed questionnaires measuring alexithymia (TAS-20), depression symptom severity (BDI) and IGD severity (s-IAT). RESULTS Alexithymia and depression symptom severity both predicted IGD severity. Yet, when including both factors in multiple regression analysis, only alexithymia predicted IGD severity. The prevalence of alexithymia in the EG was 34.2 % (n = 13). None of the non-pathological video gamers scored above the cut-off indicating alexithymia. IGD patients showed higher traits of alexithymia in general and on each subscale, irrespective of whether or not they were currently consuming video games. As previously observed, depression symptom severity was significantly greater in IGD patients compared to healthy video gamers. Yet, group differences in alexithymia traits remained stable, with a ~29 % decrease of effectiveness in the relationship, when controlling for depression symptom severity and sociodemographic factors. CONCLUSION The results reveal that alexithymia is associated with and predicts IGD severity independently of depression symptom severity. Moreover, alexithymia is highly prevalent in IGD patients.
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Affiliation(s)
- Magdalena Pape
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Hospital, Ruhr University Bochum, Germany.
| | - Benedict Reichrath
- Heinrich Heine University, Department of Clinical Psychology, Düsseldorf, Germany
| | - Laura Bottel
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Hospital, Ruhr University Bochum, Germany
| | - Stephan Herpertz
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Hospital, Ruhr University Bochum, Germany
| | - Henrik Kessler
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Hospital, Ruhr University Bochum, Germany
| | - Jan Dieris-Hirche
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Hospital, Ruhr University Bochum, Germany
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12
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Schmidt AC, Waldhauser GT, Hestermann F, Kehyayan A, Kessler H, Axmacher N. Testing the relationship between empirical paradigms of repression and suppression. Psychoanalytic Psychology 2022. [DOI: 10.1037/pap0000407] [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: 11/08/2022]
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13
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Dieris-Hirche J, Te Wildt BT, Pape M, Bottel L, Steinbüchel T, Kessler H, Herpertz S. Quality of Life in Internet Use Disorder Patients With and Without Comorbid Mental Disorders. Front Psychiatry 2022; 13:862208. [PMID: 35401273 PMCID: PMC8987191 DOI: 10.3389/fpsyt.2022.862208] [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: 01/25/2022] [Accepted: 02/22/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Evidence from clinical studies on quality of life (QoL) in patients suffering from internet use disorders (IUD) is still limited. Furthermore, the impact of additional mental comorbidities on QoL in IUD patients has rarely been investigated yet. MATERIALS AND METHODS In a cross-sectional clinical study 149 male subjects were analyzed for the presence and severity of an IUD as well as other mental disorders by experienced clinicians. The sample consisted of 60 IUD patients with and without comorbid mental disorders, 34 non-IUD patients with other mental disorders, and 55 healthy participants. Standardized clinical interviews (M.I.N.I. 6.0.0) and questionnaires on IUD symptom severity (s-IAT), QoL (WHOQOL-BREF), depression and anxiety symptoms (BDI-II and BAI), and general psychological symptoms (BSI) were used. RESULTS Internet use disorder patients showed significantly reduced QoL compared to healthy controls (Cohen's d = 1.64-1.97). Furthermore, IUD patients suffering from comorbid mental disorders showed significantly decreased levels of physical, social, and environmental QoL compared to IUD patients without any comorbidity (p < 0.05-0.001). Multiple linear regression analyses revealed that low levels of psychological, social and environmental QoL were mainly predicted by symptoms of depression. IUD factors were only significant predictors for the social and physical QoL. DISCUSSION Internet use disorder patients with comorbid mental disorder reported the lowest QoL. Depression symptom severity was the most significant predictor of low QoL in IUD. Strategies to reduce depressive symptoms should therefore be considered in IUD treatment to increase patients' QoL.
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Affiliation(s)
- Jan Dieris-Hirche
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Bert Theodor Te Wildt
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Hospital, Ruhr University Bochum, Bochum, Germany.,Psychosomatic Hospital Diessen Monastery, Dießen am Ammersee, Germany
| | - Magdalena Pape
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Laura Bottel
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Toni Steinbüchel
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Henrik Kessler
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Stephan Herpertz
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Hospital, Ruhr University Bochum, Bochum, Germany
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14
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Woud ML, Blackwell SE, Shkreli L, Würtz F, Cwik JC, Margraf J, Holmes EA, Steudte-Schmiedgen S, Herpertz S, Kessler H. The Effects of Modifying Dysfunctional Appraisals in Posttraumatic Stress Disorder Using a Form of Cognitive Bias Modification: Results of a Randomized Controlled Trial in an Inpatient Setting. Psychother Psychosom 2021; 90:386-402. [PMID: 33621970 DOI: 10.1159/000514166] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 01/04/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Dysfunctional appraisals about traumatic events and their sequelae are a key mechanism in posttraumatic stress disorder (PTSD). Experimental studies have shown that a computerized cognitive training, cognitive bias modification for appraisals (CBM-APP), can modify dysfunctional appraisals and reduce analogue trauma symptoms amongst healthy and subclinical volunteers. OBJECTIVE We aimed to test whether CBM-APP could reduce dysfunctional appraisals related to trauma reactions in PTSD patients, and whether this would lead to improvements in PTSD symptoms. METHODS We compared CBM-APP to sham training in a parallel-arm proof-of-principle double-blind randomized controlled trial amongst 80 PTSD patients admitted to an inpatient clinic. Both arms comprised a training schedule of 8 sessions over a 2-week period and were completed as an adjunct to the standard treatment programme. RESULTS In intention-to-treat analyses, participants receiving CBM-APP showed a greater reduction in dysfunctional appraisals on a scenario task from pre- to posttraining (primary outcome) assessments, compared to those receiving sham training (d = 1.30, 95% CI 0.82-1.80), with between-group differences also found on the Posttraumatic Cognitions Inventory (PTCI; d = 0.85, 95% CI 0.39-1.32) and the PTSD Checklist for DSM-5 (PCL-5; d = 0.68, 95% CI 0.23-1.14), but not for long-term cortisol concentrations (d = 0.25, 95% CI -0.28 to 0.78). Reductions in dysfunctional appraisals assessed via the scenario task correlated with reductions on the PTCI, PCL-5, and hair cortisol concentrations from pre- to posttraining time points. CONCLUSIONS Results support dysfunctional appraisals as a modifiable cognitive mechanism, and that their proximal modification transfers to downstream PTSD symptoms. These findings could open new avenues for improving present therapeutic approaches.
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Affiliation(s)
- Marcella L Woud
- Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-Universität Bochum, Bochum, Germany,
| | - Simon E Blackwell
- Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-Universität Bochum, Bochum, Germany
| | - Lorika Shkreli
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Felix Würtz
- Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-Universität Bochum, Bochum, Germany
| | - Jan Christopher Cwik
- Clinical Psychology and Psychotherapy, Department of Human Sciences, University of Cologne, Cologne, Germany
| | - Jürgen Margraf
- Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-Universität Bochum, Bochum, Germany
| | - Emily A Holmes
- Department of Psychology, Uppsala University, Uppsala, Sweden
- Department of Clinical Neuroscience, Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Susann Steudte-Schmiedgen
- Department of Psychotherapy and Psychosomatic Medicine, Technische Universität Dresden, Dresden, Germany
| | - Stephan Herpertz
- Department of Psychosomatic Medicine and Psychotherapy, LWL University Hospital, Ruhr-Universität Bochum, Bochum, Germany
| | - Henrik Kessler
- Department of Psychosomatic Medicine and Psychotherapy, LWL University Hospital, Ruhr-Universität Bochum, Bochum, Germany
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15
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Wittmann L, Dimitrijevic A, Ehlers A, Foa EB, Kessler H, Schellong J, Burgmer M. Psychometric properties and validity of the German version of the Post-Traumatic Diagnostic Scale for DSM-5 (PDS-5). Eur J Psychotraumatol 2021; 12:1965339. [PMID: 34589176 PMCID: PMC8475123 DOI: 10.1080/20008198.2021.1965339] [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] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The availability of psychometrically sound instruments for the assessment of Post-Traumatic Stress Disorder (PTSD) is indispensable for clinical and scientific work with individuals suffering from trauma-related distress. OBJECTIVE The aim of the present study was to translate the Post-Traumatic Diagnostic Scale for DSM-5 (PDS-5) into German and to evaluate its psychometric properties as well as convergent, discriminant, and factorial validity. METHOD The authorized German translation of the PDS-5 was completed by 270 patients admitted to specialized outpatient trauma clinics. Of these, 57.8% completed the PDS for a second time (mean time between assessments was 12.0 days). In order to examine convergent and discriminant validity of the PDS-5, the Post-traumatic Stress Disorder Checklist for DSM-5 as well as Patient Health Questionnaire subscales assessing depression (PHQ-9), somatization (PHQ-15), and Generalized Anxiety Disorder (GAD-7) were applied. RESULTS The PDS-5 total score showed excellent internal consistency (α = .91) and re-test reliability (rho = .84). Convergent validity was supported by a strong correlation with the total score of the Post-traumatic Stress Disorder Checklist for DSM-5 (PCL-5; rho = .91). Correlations with Patient Health Questionnaire subscales of depression (rho = .81), anxiety (rho = .72), and somatization (rho = .65) were significantly lower (all p < .001) indicating discriminant validity of the PDS-5. Confirmative Factor Analysis did not result in a clear preference for one of the tested models. Defining a diagnostic cut-off value of ≥36 based on ROC analysis resulted in high sensitivity (.92) and specificity (.96) compared to a probable PTSD diagnosis according to the PCL-5. CONCLUSIONS In summary, our results indicate that the German PDS-5 translation provides valid and reliable information concerning both PTSD severity and diagnosis.
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Affiliation(s)
- Lutz Wittmann
- Department of Psychology, International Psychoanalytic University, Berlin, Germany
| | | | - Anke Ehlers
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Edna B Foa
- Center for the Treatment and Study of Anxiety, University of Pennsylvania, Philadephia, PA, USA
| | - Henrik Kessler
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Julia Schellong
- Department of Psychotherapy and Psychosomatic Medicine, Technical University Dresden, Dresden, Germany
| | - Markus Burgmer
- Department of Psychosomatics and Psychotherapy, LWL-Hospital Münster, Münster, Germany.,University Hospital Münster, Münster, Germany
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16
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Jungilligens J, Wellmer J, Schlegel U, Kessler H, Axmacher N, Popkirov S. Impaired emotional and behavioural awareness and control in patients with dissociative seizures. Psychol Med 2020; 50:2731-2739. [PMID: 31625504 DOI: 10.1017/s0033291719002861] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [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] [Indexed: 01/18/2023]
Abstract
BACKGROUND Dissociative seizures (DS) are brief episodes of disrupted awareness and behavioural control that may resemble epileptic seizures. They are thought to arise in the context of impaired emotion processing and disinhibition. In a multi-perspective neuropsychological study, we aim to assess specific metacognitive traits and behavioural features involved in the affective and cognitive underpinnings of DS (emotion recognition and regulation, inhibition, interoception and sense of agency). METHODS Twenty prospectively recruited patients with video-EEG-confirmed DS and 20 healthy controls underwent comprehensive neuropsychological and psychiatric testing using validated questionnaires and structured interviews. Behavioural experimental data was obtained using a custom-made emotional go/no-go task, a digital Libet clock setup and a heartbeat counting paradigm. RESULTS Emotion recognition, as quantified in the emotional go/no-go task, was impaired in the DS group, and correlated with alexithymic traits. Behavioural inhibition, especially under conditions that would require emotion regulation, was also reduced in the emotional go/no-go task compared to controls and was correlated with neuropsychometric measures of emotion regulation. Data from the Libet clock experiment suggested impaired behavioural awareness in DS patients. No evidence of impaired interoceptive awareness was found in the heartbeat counting task. CONCLUSION These results represent comprehensive experimental evidence for alterations in emotional and behavioural awareness and control in patients with DS that yield empirical evidence for current psychopathological models. Our findings offer a more detailed understanding of key pathogenic factors in DS and provide theoretical support for recently developed cognitive-behavioural therapies for DS.
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Affiliation(s)
- Johannes Jungilligens
- Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Bochum, Germany
- Department of Neuropsychology, Faculty of Psychology, Institute of Cognitive Neuroscience, Ruhr University Bochum, Bochum, Germany
| | - Jörg Wellmer
- Ruhr-Epileptology, Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Bochum, Germany
| | - Uwe Schlegel
- Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Bochum, Germany
| | - Henrik Kessler
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Nikolai Axmacher
- Department of Neuropsychology, Faculty of Psychology, Institute of Cognitive Neuroscience, Ruhr University Bochum, Bochum, Germany
| | - Stoyan Popkirov
- Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Bochum, Germany
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17
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Kessler H, Dangellia L, Herpertz S, Kehyayan A. [Digital Media in Psychotherapy - New Approaches and Perspectives in the Treatment of Trauma-Related Disorders]. Psychother Psychosom Med Psychol 2020; 70:371-377. [PMID: 32252120 DOI: 10.1055/a-1120-8976] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This article provides an insight into novel approaches and perspectives using digital technologies in the treatment of trauma-related disorders. Therapy options for patients with trauma-related disorders are not easily available on a global scale and there is a search for new specific therapeutic strategies. In the first part of this article, examples of digital approaches are provided that are based on established analogue treatments and are designed mainly to increase availability and cost-effectiveness of these treatments. In the second part, the focus lies on digital treatments that employ novel approaches, which are e. g. informed by cognitive science, to specifically target particular symptoms in clinical populations after their development in lab studies. Examples given are visuospatial interventions used to reduce intrusive symptoms, or training programmes to increase levels of interference control (to control trauma-related stimuli), or to change automatic dysfunctional cognitions. These interventions will be presented with their respective theoretical frameworks, along with results from first (partially clinical) studies, which are promising concerning acceptance, applicability and effectiveness.
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Affiliation(s)
- Henrik Kessler
- Klinik für Psychosomatische Medizin und Psychotherapie, LWL-Universitätsklinikum Bochum der Ruhr-Universität Bochum
| | - Luisa Dangellia
- Klinik für Psychosomatische Medizin und Psychotherapie, LWL-Universitätsklinikum Bochum der Ruhr-Universität Bochum
| | - Stephan Herpertz
- Klinik für Psychosomatische Medizin und Psychotherapie, LWL-Universitätsklinikum Bochum der Ruhr-Universität Bochum
| | - Aram Kehyayan
- Klinik für Psychosomatische Medizin und Psychotherapie, LWL-Universitätsklinikum Bochum der Ruhr-Universität Bochum
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18
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Cwik JC, Vahle N, Woud ML, Potthoff D, Kessler H, Sartory G, Seitz RJ. Reduced gray matter volume in the left prefrontal, occipital, and temporal regions as predictors for posttraumatic stress disorder: a voxel-based morphometric study. Eur Arch Psychiatry Clin Neurosci 2020; 270:577-588. [PMID: 30937515 DOI: 10.1007/s00406-019-01011-2] [Citation(s) in RCA: 9] [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] [Received: 10/24/2018] [Accepted: 03/26/2019] [Indexed: 02/07/2023]
Abstract
The concept of acute stress disorder (ASD) was introduced as a diagnostic entity to improve the identification of traumatized people who are likely to develop posttraumatic stress disorder (PTSD). Neuroanatomical models suggest that changes in the prefrontal cortex, amygdala, and hippocampus play a role in the development of PTSD. Using voxel-based morphometry, this study aimed to investigate the predictive power of gray matter volume (GMV) alterations for developing PTSD. The GMVs of ASD patients (n = 21) were compared to those of PTSD patients (n = 17) and healthy controls (n = 18) in whole-brain and region-of-interest analyses. The GMV alterations seen in ASD patients shortly after the traumatic event (T1) were also correlated with PTSD symptom severity and symptom clusters 4 weeks later (T2). Compared with healthy controls, the ASD patients had significantly reduced GMV in the left visual cortex shortly after the traumatic event (T1) and in the left occipital and prefrontal regions 4 weeks later (T2); no significant differences in GMV were seen between the ASD and PTSD patients. Furthermore, a significant negative association was found between the GMV reduction in the left lateral temporal regions seen after the traumatic event (T1) and PTSD hyperarousal symptoms 4 weeks later (T2). Neither amygdala nor hippocampus alterations were predictive for the development of PTSD. These data suggest that gray matter deficiencies in the left hemispheric occipital and temporal regions in ASD patients may predict a liability for developing PTSD.
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Affiliation(s)
- Jan Christopher Cwik
- Department of Clinical Psychology and Psychotherapy, Faculty of Human Sciences, Universität zu Köln, Pohligstr. 1, 50969, Cologne, Germany. .,Faculty of Psychology, Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Bochum, Germany.
| | - Nils Vahle
- Department of Psychology and Psychotherapy, University Witten/Herdecke, Witten, Germany
| | - Marcella Lydia Woud
- Faculty of Psychology, Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Bochum, Germany
| | - Denise Potthoff
- Department of Neurology, Center for Neurology and Neuropsychiatry, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany
| | - Henrik Kessler
- Department of Psychosomatic Medicine and Psychotherapy, LWL University Hospital, Ruhr-Universität Bochum, Bochum, Germany
| | - Gudrun Sartory
- Department of Clinical Psychology and Psychotherapy, School of Human and Social Sciences, Bergische Universität Wuppertal, Wuppertal, Germany
| | - Rüdiger J Seitz
- Department of Neurology, Center for Neurology and Neuropsychiatry, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany
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19
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Spies JP, Woud ML, Kessler H, Rau H, Willmund GD, Köhler K, Herpertz S, Blackwell SE, Bovin M, Marx BP, Cwik JC. Psychometric properties of the German version of the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) in clinical routine settings: study design and protocol of a multitrait-multimethod study. BMJ Open 2020; 10:e036078. [PMID: 32571861 PMCID: PMC7311000 DOI: 10.1136/bmjopen-2019-036078] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 04/08/2020] [Accepted: 06/02/2020] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The aim of this study is to investigate the diagnostic accuracy, psychometric properties and clinical utility of the German version of the Clinician-Administered Post-Traumatic Stress Disorder (PTSD) Scale for Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5) (CAPS-5) in routine clinical settings. METHODS AND ANALYSIS This study is a non-interventional, multitrait-multimethod design, multicentre study that will be carried out at German civil and military inpatient and outpatient clinics. A total sample size of n=219 participants who have experienced at least one traumatic event according to criteria as defined in the DSM-5 will be recruited. For the investigation of the diagnostic accuracy and clinical utility of the CAPS-5, participants will be categorised into one of three groups, depending on their traumatic experiences and post-traumatic symptomatology: (1) monotraumatisation with PTSD; (2) multiple traumatisation with PTSD and (3) traumatisation without PTSD. Interviews will be conducted face to face by interviewers in routine clinical settings. All participants will also be asked to complete a comprehensive set of questionnaires in order to investigate different facets of construct validity and clinical utility. First, differences between all three groups in CAPS-5 sum and subscale scores will be investigated. Test-retest reliability and inter-rater reliability will be determined. Internal consistency will be calculated using structural equation modeling (SEM) based internal consistency coefficients. Construct validity will be measured with Spearman's rank correlation analyses and multivariate analyses of variance with Holm-Bonferroni corrected post hoc analysis of variances. In order to test diagnostic accuracy, receiver operating characteristics and sensitivity and specificity analyses will be conducted. The model structure of the German CAPS-5 will be analysed using confirmatory factor analyses. ETHICS AND DISSEMINATION The study received ethical approval by the Ethics Committees of the Faculty of Psychology at the Ruhr-Universität Bochum (reference numbers: 331 and 358). The results of the study will be presented nationally and internationally at scientific conferences and will be published in scientific journals. TRIAL REGISTRATION NUMBER DRKS00015325.
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Affiliation(s)
- Jan-Peter Spies
- Clinical Psychology and Psychotherapy, Universität zu Köln, Köln, Germany
| | - Marcella Lydia Woud
- Faculty of Psychology, Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Bochum, Germany
| | - Henrik Kessler
- Department of Psychosomatic Medicine and Psychotherapy, LWL University Hospital, Ruhr-Universität Bochum, Bochum, Germany
| | - Heinrich Rau
- German Armed Forces Center for Military Mental Health, Berlin, Germany
| | | | - Kai Köhler
- German Armed Forces Center for Military Mental Health, Berlin, Germany
| | - Stephan Herpertz
- Department of Psychosomatic Medicine and Psychotherapy, LWL University Hospital, Ruhr-Universität Bochum, Bochum, Germany
| | - Simon E Blackwell
- Faculty of Psychology, Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Bochum, Germany
| | - Michelle Bovin
- VA Boston Healthcare System, Massachusetts and Boston University School of Medicine, Boston, Massachusetts, USA
| | - Brian P Marx
- VA Boston Healthcare System, Massachusetts and Boston University School of Medicine, Boston, Massachusetts, USA
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Kessler H, Schmidt AC, James EL, Blackwell SE, von Rauchhaupt M, Harren K, Kehyayan A, Clark IA, Sauvage M, Herpertz S, Axmacher N, Holmes EA. Visuospatial computer game play after memory reminder delivered three days after a traumatic film reduces the number of intrusive memories of the experimental trauma. J Behav Ther Exp Psychiatry 2020; 67:101454. [PMID: 31036259 DOI: 10.1016/j.jbtep.2019.01.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 12/11/2018] [Accepted: 01/22/2019] [Indexed: 01/25/2023]
Abstract
OBJECTIVE The experience of intrusive memories is a core clinical symptom of posttraumatic stress disorder (PTSD), and can be distressing in its own right. Notions of dual task interference and reconsolidation-update mechanisms suggest novel approaches to target intrusive memories. This study tested the hypothesis that a single-session cognitive intervention (memory reminder task plus Tetris gameplay) would reduce the occurrence of experimental trauma memories even when delivered 3 days post-trauma. Critically, this study tested effects against two control groups: Reminder-only, and reminder plus another computer game (a form of Quiz). METHODS 86 healthy volunteers (59% female, age M = 24.35, SD = 4.59 years) watched a trauma film and then recorded their intrusive memories in a diary for 3 days (pre-intervention). They then returned to the lab. After presentation of visual reminder cues for the film plus a 10 min wait period (memory reminder task), participants were randomized into one of three task conditions (Tetris game play, Quiz game play, vs. reminder-only). They then kept the diary for a further 3 days (post-intervention). RESULTS As predicted, after the experimental manipulation, the reminder + Tetris group experienced significantly fewer intrusions than the reminder-only group (d = 1.37). Further, the reminder + Tetris group also experienced significantly fewer intrusions than the reminder + Quiz (d = 0.65) group. Contrary to predictions, the reminder + Quiz group experienced significantly fewer intrusions than the reminder-only group (d = 0.69). Prior to the experimental manipulation, there was no significant difference between groups in number of intrusions. Recognition memory test scores for facts of the trauma film after 6 days were comparable between groups. CONCLUSIONS We demonstrated that 3 days after experimental trauma (i.e. after memory consolidation) an intervention comprising a reminder task prior to a 15 min cognitive interference task (one of two computer games) led to a reduction in intrusion occurrence compared to reminder only. We interpret and discuss our findings within the framework of supposed reconsolidation-update mechanisms and competition for limited (visuospatial) working memory resources. Should these effects hold true in clinical populations, this type of simple intervention approach could help contribute to reducing intrusive memories of trauma.
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Affiliation(s)
- Henrik Kessler
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Hospital, Ruhr-University Bochum, Bochum, Germany.
| | - Anna-Christine Schmidt
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Ella L James
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, United Kingdom
| | - Simon E Blackwell
- Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-University Bochum, Bochum, Germany
| | - Marcel von Rauchhaupt
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Katharina Harren
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Aram Kehyayan
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Ian A Clark
- Wellcome Trust Centre for Neuroimaging, Institute of Neurology, University College London, London, United Kingdom
| | - Magdalena Sauvage
- Leibniz Institute for Neurobiology, Functional Architecture of Memory Department, Magdeburg, Germany; Otto-von-Guericke-University Magdeburg, Medical Faculty, Magdeburg, Germany
| | - Stephan Herpertz
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Nikolai Axmacher
- Department of Neuropsychology, Institute of Cognitive Neuroscience, Faculty of Psychology, Ruhr-University Bochum, Bochum, Germany
| | - Emily A Holmes
- Department of Psychology, Uppsala University, Sweden; Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Sweden
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Novello M, Stocchi L, Steele SR, Holubar SD, Duraes LC, Kessler H, Shawki S, Hull LT. Case-matched Comparison of Postoperative Outcomes Following Surgery for Inflammatory Bowel Disease After Exposure to Vedolizumab vs Other Biologics. J Crohns Colitis 2020; 14:185-191. [PMID: 31328222 DOI: 10.1093/ecco-jcc/jjz129] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIM The effects of vedolizumab [VEDO] exposure on perioperative outcomes following surgery for inflammatory bowel disease [IBD] remain controversial. The aim of our study was to compare postoperative morbidity of IBD surgery following treatment with VEDO vs other biologics or no biologics. METHODS An institutional review board-approved, prospectively collected database was queried to identify all patients undergoing abdominal surgery for IBD between August 2012 and May 2017. The impact of VEDO within 12 weeks preoperatively on postoperative morbidity was initially assessed with univariate and multivariable analyses on all patients. A case-matched analysis was then carried out comparing patients exposed to VEDO vs other biologic agents, based on gender, age ± 5 years, diagnosis, date of surgery ± 2 years, and surgical procedure. RESULTS Out of 980 patients, 141 received VEDO. The majority of patients [59%] underwent surgery involving end or diverting ostomy creation. The initial multivariate analysis conducted on all patients indicated that VEDO use was independently associated with increased overall morbidity [p <0.001], but not infectious morbidity [p = 0.30]. However, the case-matched comparison of 95 VEDO-treated patients vs 95 patients treated with adalimumab or infliximab did not indicate any difference in overall morbidity [p = 0.32], infectious complications [p = 0.15], or surgical site infections [p = 0.12]. CONCLUSIONS In a study population having a high rate of surgery involving ostomy creation, the exposure to preoperative VEDO was not associated with an increased morbidity rate when compared with other biologics.
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Affiliation(s)
- M Novello
- Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - L Stocchi
- Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - S R Steele
- Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - S D Holubar
- Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - L C Duraes
- Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - H Kessler
- Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - S Shawki
- Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - L T Hull
- Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
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22
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Serbanescu I, Walter H, Schnell K, Kessler H, Weber B, Drost S, Groß M, Neudeck P, Klein JP, Assmann N, Zobel I, Backenstrass M, Hautzinger M, Meister R, Härter M, Schramm E, Schoepf D. Combining baseline characteristics to disentangle response differences to disorder-specific versus supportive psychotherapy in patients with persistent depressive disorder. Behav Res Ther 2019; 124:103512. [PMID: 31734568 DOI: 10.1016/j.brat.2019.103512] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 09/14/2019] [Accepted: 11/03/2019] [Indexed: 12/24/2022]
Abstract
Does the pre-treatment profile of individuals with persistent depressive disorder (PDD) moderate their benefit from disorder-specific Cognitive Behavioral System of Psychotherapy (CBASP) versus supportive psychotherapy (SP)? We investigated this question by analyzing data from a multi-center randomized clinical trial comparing the effectiveness of 48 weeks of CBASP to SP in n = 237 patients with early-onset PDD who were not taking antidepressant medication. We statistically developed an optimal composite moderator as a weighted combination of 13 preselected baseline variables and used it for identifying and characterizing subgroups for which CABSP may be preferable to SP or vice versa. We identified two distinct subgroups: 58.65% of the patients had a better treatment outcome with CBASP, while the remaining 41.35% had a better outcome with SP. At baseline, patients responding more favorably to CBASP were more severely depressed and more likely affected by moderate-to-severe childhood trauma including early emotional, physical, or sexual abuse, as well as emotional or physical neglect. In contrast, patients responding more favorably to SP had a higher pre-treatment global and social functioning level, a higher life quality and more often a recurrent illness pattern without complete remission between the episodes. These findings emphasize the relevance of considering pre-treatment characteristics when selecting between disorder-specific CBASP and SP for treating PDD. The practical implementation of this approach would advance personalized medicine for PDD by supporting mental health practitioners in their selection of the most effective psychotherapy for an individual patient.
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Affiliation(s)
- Ilinca Serbanescu
- Center for Economics and Neuroscience, University of Bonn, Nachtigallenweg 86, D-53127, Bonn, Germany; Institute of Experimental Epileptology and Cognition Research, University of Bonn, Sigmund-Freud-Strasse 25, D-53127, Bonn, Germany.
| | - Henrik Walter
- Department of Psychiatry and Psychotherapy, Charité-University Medicine Berlin, Charitéplatz 1, D-10117, Berlin, Germany
| | - Knut Schnell
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, vonsiebold Straße 5, D-37075, Göttingen, Germany
| | - Henrik Kessler
- Department of Psychosomatic Medicine and Psychotherapy, LWL University Hospital, Ruhr University Bochum, Alexandrinenstrasse 1-3, D-44791, Bochum, Germany
| | - Bernd Weber
- Center for Economics and Neuroscience, University of Bonn, Nachtigallenweg 86, D-53127, Bonn, Germany; Institute of Experimental Epileptology and Cognition Research, University of Bonn, Sigmund-Freud-Strasse 25, D-53127, Bonn, Germany
| | - Sarah Drost
- Department of Psychiatry and Psychotherapy, CBASP Center of Competence, University of Bonn, Sigmund-Freud-Strasse 25, D-53127, Bonn, Germany
| | - Magdalena Groß
- Department of Psychiatry and Psychotherapy, CBASP Center of Competence, University of Bonn, Sigmund-Freud-Strasse 25, D-53127, Bonn, Germany
| | - Peter Neudeck
- Department of Psychiatry and Psychotherapy, CBASP Center of Competence, University of Bonn, Sigmund-Freud-Strasse 25, D-53127, Bonn, Germany
| | - Jan Philipp Klein
- Department of Psychiatry and Psychotherapy, Lübeck University, Ratzeburger Allee 160, D-23538, Lübeck, Germany
| | - Nele Assmann
- Department of Psychiatry and Psychotherapy, Lübeck University, Ratzeburger Allee 160, D-23538, Lübeck, Germany
| | - Ingo Zobel
- Psychology School at the Fresenius University of Applied Sciences Berlin, Jägerstrasse 32, D-10117, Berlin, Germany
| | - Matthias Backenstrass
- Department of Clinical Psychology and Psychotherapy, University of Heidelberg, Hauptstrasse 47-51, D-69117, Heidelberg, Germany; Institute of Clinical Psychology, Hospital Stuttgart, Prießnitzweg 24, D-70374, Stuttgart, Germany
| | - Martin Hautzinger
- Department of Psychology, Clinical Psychology and Psychotherapy, Eberhard Karls University Tübingen, Schleichstrasse 4, D-72076, Tübingen, Germany
| | - Ramona Meister
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, D-20246, Hamburg, Germany
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, D-20246, Hamburg, Germany
| | - Elisabeth Schramm
- Department of Psychiatry and Psychotherapy, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Hauptstrasse 5, D-79104, Freiburg, Germany
| | - Dieter Schoepf
- Department of Psychiatry and Psychotherapy, CBASP Center of Competence, University of Bonn, Sigmund-Freud-Strasse 25, D-53127, Bonn, Germany; Department of Psychiatry and Psychotherapy, Vitos Weil-Lahn, Mönchberg 8, D-65589, Hadamar, Germany
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Kessler H, Axmacher N, Diers M, Herpertz S. On the Purported Dichotomy Between Fake and Real Symptoms: The Case of Conversion Disorders. Front Psychol 2019; 10:2114. [PMID: 31620053 PMCID: PMC6759484 DOI: 10.3389/fpsyg.2019.02114] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 08/30/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
- Henrik Kessler
- Department of Psychosomatic Medicine and Psychotherapy, LWL University Hospital, Ruhr University Bochum, Bochum, Germany
- *Correspondence: Henrik Kessler
| | - Nikolai Axmacher
- Department of Neuropsychology, Faculty of Psychology, Institute of Cognitive Neuroscience, Ruhr-University Bochum, Bochum, Germany
| | - Martin Diers
- Department of Psychosomatic Medicine and Psychotherapy, LWL University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Stephan Herpertz
- Department of Psychosomatic Medicine and Psychotherapy, LWL University Hospital, Ruhr University Bochum, Bochum, Germany
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24
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de Camargo MGM, Hull TL, Steele SR, Delaney CP, Kessler H. Laparoscopic total abdominal colectomy as first step of three-stage surgical treatment of ulcerative colitis: a systematic approach. Tech Coloproctol 2019; 23:779-780. [PMID: 31289947 DOI: 10.1007/s10151-019-02017-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 04/30/2019] [Accepted: 06/17/2019] [Indexed: 11/26/2022]
Affiliation(s)
- M G M de Camargo
- Department of Colorectal Surgery, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland Clinic Main Campus, Mail Code A30, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - T L Hull
- Department of Colorectal Surgery, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland Clinic Main Campus, Mail Code A30, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - S R Steele
- Department of Colorectal Surgery, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland Clinic Main Campus, Mail Code A30, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - C P Delaney
- Department of Colorectal Surgery, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland Clinic Main Campus, Mail Code A30, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - H Kessler
- Department of Colorectal Surgery, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland Clinic Main Campus, Mail Code A30, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
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Notni J, Wurzer A, Reichart F, Maltsev O, Steiger K, Beck R, Schwaiger M, Wester HJ, Kessler H. A 68Ga-labelled PET probe for selective imaging of αvβ8-integrin. Nucl Med Biol 2019. [DOI: 10.1016/s0969-8051(19)30240-9] [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: 11/30/2022]
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26
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Silva-Velazco J, Stocchi L, Valente MA, Church JM, Liska D, Gorgun E, Kalady MF, Kessler H, Steele SR, Delaney CP. The relationship between mesorectal grading and oncological outcome in rectal adenocarcinoma. Colorectal Dis 2019; 21:315-325. [PMID: 30565830 DOI: 10.1111/codi.14535] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 10/29/2018] [Indexed: 02/08/2023]
Abstract
AIM The prognostic association between mesorectal grading and oncological outcome in patients undergoing resection for rectal adenocarcinoma is controversial. The aim of this retrospective chart review was to determine the individual impact of mesorectal grading on rectal cancer outcomes. METHOD We compared oncological outcomes in patients with complete, near-complete and incomplete mesorectum who underwent rectal excision with curative intent from 2009 to 2014 for Stage cI-III rectal adenocarcinoma. We also assessed the independent association of mesorectal grading and oncological outcome using multivariate models including other relevant variables. RESULTS Out of 505 patients (339 men, median age of 60 years), 347 (69%) underwent a restorative procedure. There were 452 (89.5%), 33 (6.5%) and 20 (4%) patients with a complete, near-complete and incomplete mesorectum, respectively. Local recurrence was seen in 2.4% (n = 12) patients after a mean follow-up of 3.1 ± 1.7 years. Unadjusted 3-year Kaplan-Meier analysis by mesorectal grade showed decreased rates of overall, disease-free and cancer-specific survival and increased rates of overall and distant recurrence with a near-complete mesorectum, while local recurrence was increased in cases of an incomplete mesorectum (all P < 0.05). On multivariate analyses, a near-complete mesorectum was independently associated with decreased cancer-specific survival (hazard ratio 0.26, 95% CI 0.1-0.7; P = 0.007). There were no associations between mesorectal grading and overall survival, disease-free survival, overall recurrence or distant recurrence (all P > 0.05). CONCLUSION Mesorectal grading is independently associated with oncological outcome. It provides unique information for optimizing surgical quality in rectal cancer.
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Affiliation(s)
- J Silva-Velazco
- Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - L Stocchi
- Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - M A Valente
- Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - J M Church
- Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - D Liska
- Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - E Gorgun
- Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - M F Kalady
- Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - H Kessler
- Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - S R Steele
- Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - C P Delaney
- Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Gustafsson UO, Scott MJ, Hubner M, Nygren J, Demartines N, Francis N, Rockall TA, Young-Fadok TM, Hill AG, Soop M, de Boer HD, Urman RD, Chang GJ, Fichera A, Kessler H, Grass F, Whang EE, Fawcett WJ, Carli F, Lobo DN, Rollins KE, Balfour A, Baldini G, Riedel B, Ljungqvist O. Guidelines for Perioperative Care in Elective Colorectal Surgery: Enhanced Recovery After Surgery (ERAS ®) Society Recommendations: 2018. World J Surg 2019; 43:659-695. [PMID: 30426190 DOI: 10.1007/s00268-018-4844-y] [Citation(s) in RCA: 936] [Impact Index Per Article: 187.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND This is the fourth updated Enhanced Recovery After Surgery (ERAS®) Society guideline presenting a consensus for optimal perioperative care in colorectal surgery and providing graded recommendations for each ERAS item within the ERAS® protocol. METHODS A wide database search on English literature publications was performed. Studies on each item within the protocol were selected with particular attention paid to meta-analyses, randomised controlled trials and large prospective cohorts and examined, reviewed and graded according to Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. RESULTS All recommendations on ERAS® protocol items are based on best available evidence; good-quality trials; meta-analyses of good-quality trials; or large cohort studies. The level of evidence for the use of each item is presented accordingly. CONCLUSIONS The evidence base and recommendation for items within the multimodal perioperative care pathway are presented by the ERAS® Society in this comprehensive consensus review.
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Affiliation(s)
- U O Gustafsson
- Department of Surgery, Danderyd Hospital and Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
| | - M J Scott
- Department of Anesthesia, Virginia Commonwealth University Hospital, Richmond, VA, USA
- Department of Anesthesiology, University of Pennsylvania, Philadelphia, USA
| | - M Hubner
- Department of Visceral Surgery, CHUV, Lausanne, Switzerland
| | - J Nygren
- Department of Surgery, Ersta Hospital and Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - N Demartines
- Department of Visceral Surgery, CHUV, Lausanne, Switzerland
| | - N Francis
- Colorectal Unit, Yeovil District Hospital, Higher Kingston, Yeovil, BA21 4AT, UK
- University of Bath, Wessex House Bath, BA2 7JU, UK
| | - T A Rockall
- Department of Surgery, Royal Surrey County Hospital NHS Trust, and Minimal Access Therapy Training Unit (MATTU), Guildford, UK
| | - T M Young-Fadok
- Division of Colon and Rectal Surgery, Department of Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - A G Hill
- Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland Middlemore Hospital, Auckland, New Zealand
| | - M Soop
- Irving National Intestinal Failure Unit, The University of Manchester, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Manchester, UK
| | - H D de Boer
- Department of Anesthesiology, Pain Medicine and Procedural Sedation and Analgesia, Martini General Hospital, Groningen, The Netherlands
| | - R D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - G J Chang
- Department of Surgical Oncology and Department of Health Services Research, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - A Fichera
- Division of Gastrointestinal Surgery, Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - H Kessler
- Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Ohio, USA
| | - F Grass
- Department of Visceral Surgery, CHUV, Lausanne, Switzerland
| | - E E Whang
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - W J Fawcett
- Department of Anaesthesia, Royal Surrey County Hospital NHS Foundation Trust and University of Surrey, Guildford, UK
| | - F Carli
- Department of Anesthesia, McGill University Health Centre, Montreal General Hospital, Montreal, QC, Canada
| | - D N Lobo
- Gastrointestinal Surgery, Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2UH, UK
| | - K E Rollins
- Gastrointestinal Surgery, Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2UH, UK
| | - A Balfour
- Department of Colorectal Surgery, Surgical Services, Western General Hospital, NHS Lothian, Edinburgh, UK
| | - G Baldini
- Department of Anesthesia, McGill University Health Centre, Montreal General Hospital, Montreal, QC, Canada
| | - B Riedel
- Department of Anaesthesia, Perioperative and Pain Medicine, Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Australia
| | - O Ljungqvist
- Department of Surgery, Örebro University and University Hospital, Örebro & Institute of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
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Kessler H, Dangellia L, Kessler R, Mahnke V, Herpertz S, Kehyayan A. Mobilum-a new mobile app to engage visuospatial processing for the reduction of intrusive visual memories. Mhealth 2019; 5:49. [PMID: 31853450 PMCID: PMC6917555 DOI: 10.21037/mhealth.2019.09.15] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Accepted: 09/19/2019] [Indexed: 01/07/2023] Open
Abstract
Intrusive memories are a key symptom of posttraumatic stress disorder (PTSD), a prevalent condition causing considerable personal suffering, and entailing large direct and indirect societal costs. While effective treatment options for PTSD exist, on a global scale they are not readily available to many patients in need. In the last years, several studies have shown that the computer game Tetris can reduce the frequency of intrusive memories in healthy subjects (after a trauma analogue), in populations at high risk of developing PTSD, as well as in patients already suffering from PTSD. The presumed mechanism behind this effect is that both Tetris and intrusions require-and therefore compete for-limited visuospatial working memory resources. In search for a new alternative tool that can engage visuospatial processing as effectively as Tetris, we developed a game named Mobilum. This is an app for Android devices, in which users have to rotate in an imaginative way around a translucent virtual cube in order to decide from which perspective a complex three-dimensional figure inside the cube is seen. Mobilum was developed to investigate whether the intrusion-reducing effect is exclusively inherent to Tetris, or if it can be achieved with another task engaging users in visuospatial processing. Also, unlike available versions of Tetris, Mobilum offers full control over key game parameters (e.g., difficulty, game duration), and is free of copyright and commercial issues. In this method paper, we describe the new Mobilum app, its theoretical background and development. Additionally, the first data on usability and feasibility are reported, as rated by N=16 inpatients. Finally, we will provide an outlook on the next steps necessary to investigate Mobilum's potential as a therapeutic tool.
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Affiliation(s)
- Henrik Kessler
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Luisa Dangellia
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Hospital, Ruhr University Bochum, Bochum, Germany
| | | | | | - Stephan Herpertz
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Aram Kehyayan
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Hospital, Ruhr University Bochum, Bochum, Germany
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Woud ML, Heeren A, Shkreli L, Meyer T, Egeri L, Cwik JC, Zlomuzica A, Kessler H, Margraf J. Investigating the effect of proactive interference control training on intrusive memories. Eur J Psychotraumatol 2019; 10:1611092. [PMID: 31143413 PMCID: PMC6522906 DOI: 10.1080/20008198.2019.1611092] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 04/10/2019] [Accepted: 04/10/2019] [Indexed: 11/30/2022] Open
Abstract
Intrusive re-experiencing is a hallmark symptom of Posttraumatic Stress Disorder (PTSD). According to prominent models of intrusive phenomena, intrusive memories may result from impairments in the efficiency of working memory capacity (WMC), more specifically proactive interference control. Yet, experimental research is scarce. Therefore, the present study aimed to investigate experimentally the role of proactive interference control in intrusive memories. We randomly assigned 57 healthy participants to either receive a high interference control training or a low interference control training. Participants were then exposed to highly distressing film clips. WMC was assessed before and after the training. Intrusion symptoms were assessed directly post-training and after one week using an Intrusion Provocation Task (IPT), a one-week intrusions diary, and the retrospective intrusion subscale of the Impact of Event Sale - Revised (IES-R). Results indicated that both groups reported improvements in WMC and fewer intrusions on the second IPT post-training, with no differences between groups. Similarly, no group differences on intrusions were found at one-week follow-up (i.e., intrusion diary and IES-R). To conclude, these data are not consistent with the hypothesis that WMC plays a role in intrusive re-experiencing. Implications for future research are discussed.
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Affiliation(s)
- Marcella L Woud
- Mental Health Research and Treatment Center, Department of Psychology, Ruhr-Universität Bochum, Bochum, Germany
| | - Alexandre Heeren
- Psychological Sciences Research Institute, Université catholique de Louvain, Louvain-la-Neuve, Belgium.,Clinical Neuroscience Division, Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
| | - Lorika Shkreli
- Mental Health Research and Treatment Center, Department of Psychology, Ruhr-Universität Bochum, Bochum, Germany
| | - Thomas Meyer
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK.,Institute of Psychology, University of Münster, Münster, Germany
| | - Leonie Egeri
- Mental Health Research and Treatment Center, Department of Psychology, Ruhr-Universität Bochum, Bochum, Germany
| | - Jan C Cwik
- Department of Clinical Psychology and Psychotherapy, Faculty of Human Sciences, University of Cologne, Köln, Germany
| | - Armin Zlomuzica
- Mental Health Research and Treatment Center, Department of Psychology, Ruhr-Universität Bochum, Bochum, Germany
| | - Henrik Kessler
- Department of Psychosomatic Medicine and Psychotherapy, Ruhr University Bochum, LWL University Hospital, Bochum, Germany
| | - Jürgen Margraf
- Mental Health Research and Treatment Center, Department of Psychology, Ruhr-Universität Bochum, Bochum, Germany
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Fraioli R, Neubauer S, Rechenmacher F, Bosch BM, Dashnyam K, Kim JH, Perez RA, Kim HW, Gil FJ, Ginebra MP, Manero JM, Kessler H, Mas-Moruno C. Control of stem cell response and bone growth on biomaterials by fully non-peptidic integrin selective ligands. Biomater Sci 2019; 7:1281-1285. [DOI: 10.1039/c8bm01466c] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Integrin selective peptidomimetics tune stem cell behavior in vitro and improve bone formation in rat calvarial defects.
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Kessler H, Holmes EA, Blackwell SE, Schmidt AC, Schweer JM, Bücker A, Herpertz S, Axmacher N, Kehyayan A. Reducing intrusive memories of trauma using a visuospatial interference intervention with inpatients with posttraumatic stress disorder (PTSD). J Consult Clin Psychol 2018; 86:1076-1090. [DOI: 10.1037/ccp0000340] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Nieberler M, Reuning U, Kessler H, Reichart F, Weirich G, Wolff KD. Fluorescence imaging of invasive head and neck carcinoma cells with integrin αvβ6-targeting RGD-peptides: an approach to a fluorescence-assisted intraoperative cytological assessment of bony resection margins. Br J Oral Maxillofac Surg 2018; 56:972-978. [PMID: 30502043 DOI: 10.1016/j.bjoms.2018.11.003] [Citation(s) in RCA: 14] [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] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 11/05/2018] [Indexed: 12/21/2022]
Abstract
We assessed the use of peptides containing arginylglycylaspartic acid (RGD) that target integrin αvβ6 as a potential approach for a fluorescence-assisted intraoperative cytological assessment of bony resection margins (F-AICAB) in patients who had bone-infiltrating squamous cell carcinoma (SCC) of the head and neck. This was assessed to demarcate invasive carcinoma cells that stained for αvβ6. Specimens from bony resection margins (n=362) were defined as either malignant or benign according to the results of cytological and histological examinations. Integrin αvβ6-targeting fluorescence-labelled RGD peptides were added to the cytological samples and the accuracy of the resulting signal assessed by comparing it with the cytological findings. The value of F-AICAB was evaluated to find out if it could help to improve future diagnoses, tests, and treatments. Integrin αvβ6 was strongly expressed in invasive SCC cells and qualified as a marker for bone-infiltrating carcinoma cells. It showed a high affinity to bind to invasive SCC cells and enabled swift and specific demarcation of αvβ6-stained carcinoma cells. It was also diagnostic, with a sensitivity of 100% (95% CI 81.3% to 99.3%), specificity of 98.3% (95% CI 94.4% to 99.0%), positive predictive value of 92% (95% CI 70.2% to 94.3%), and negative predictive value of 100% (95% CI 96.9% to 99.9%), compared with the cytological findings. The targeting of specific integrin subtypes with selective, synthetic ligands, adapted for multimodal imaging, is a promising new approach to diagnosis. Further studies are necessary to provide more evidence for successful clinical translation and to establish the impact on clinical procedures.
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Affiliation(s)
- M Nieberler
- Department of Oral and Maxillofacial Surgery, University Hospital rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81679 Munich, Germany.
| | - U Reuning
- Klinische Forschergruppe der Frauenklinik, University Hospital rechts der Isar, Technischen Universität München, Ismaninger Strasse 22, 81675 München, Germany
| | - H Kessler
- Institute for Advanced Study and Center for Integrated Protein Science (CIPSM), Technische Universität München, Lichtenbergstr. 4, 85747 Garching, Germany
| | - F Reichart
- Institute for Advanced Study and Center for Integrated Protein Science (CIPSM), Technische Universität München, Lichtenbergstr. 4, 85747 Garching, Germany
| | - G Weirich
- Institute of Pathology, Technische Universität München, Trogerstr. 18, 81675 Munich, Germany
| | - K-D Wolff
- Department of Oral and Maxillofacial Surgery, University Hospital rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81679 Munich, Germany
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Buchheim A, Labek K, Taubner S, Kessler H, Pokorny D, Kächele H, Cierpka M, Roth G, Pogarell O, Karch S. Modulation of Gamma Band Activity and Late Positive Potential in Patients with Chronic Depression after Psychodynamic Psychotherapy. Psychother Psychosom 2018; 87:252-254. [PMID: 29768272 DOI: 10.1159/000488090] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 03/02/2018] [Indexed: 11/19/2022]
Affiliation(s)
- Anna Buchheim
- Institute of Psychology, University of Innsbruck, Innsbruck, Austria
| | - Karin Labek
- Institute of Psychology, University of Innsbruck, Innsbruck, Austria
| | - Svenja Taubner
- Institute of Psychosocial Prevention, University Hospital Heidelberg, Heidelberg, Germany
| | - Henrik Kessler
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Dan Pokorny
- Department of Psychosomatic Medicine and Psychotherapy, Ulm University, Ulm, Germany
| | - Horst Kächele
- International Psychoanalytic University, Berlin, Germany
| | - Manfred Cierpka
- Institute of Psychosocial Prevention, University Hospital Heidelberg, Heidelberg, Germany
| | - Gerhard Roth
- Brain Research Institute, University of Bremen, Bremen, Germany
| | - Oliver Pogarell
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Susanne Karch
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
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Kehyayan A, Matura N, Klein K, Schmidt AC, Herpertz S, Axmacher N, Kessler H. Putative Markers of Repression in Patients Suffering From Mental Disorders. Front Psychol 2018; 9:2109. [PMID: 30459684 PMCID: PMC6232250 DOI: 10.3389/fpsyg.2018.02109] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 10/12/2018] [Indexed: 11/13/2022] Open
Abstract
Background: The concept of psychodynamic conflict is essential to psychodynamic theory and therapy. In classical psychodynamic therapy, unconscious conflict themes need to be identified by the therapist and brought to the patient's awareness, in order to work through and ultimately solve them. According to theory, touching upon conflict-related topics leads to arousal, followed by activation of defense mechanisms such as repression. Starting with C.G. Jung's association studies more than 100 years ago, various proposals have been made to investigate psychodynamic conflicts based on free association and psychophysiological measures. This study presents an attempt to identify and differentiate between psychodynamic conflict themes in patients, using an adopted version of Jung's paradigm that had in previous studies been applied to healthy subjects. Method: Seventeen patients suffering from depression and other mental disorders associated freely to different cue sentences. Prior to the experimental procedure, patients' individual psychodynamic conflict types were assessed through clinical interviews. Sentences were either neutral, negative (but not conflict-related), or related to specific types of psychodynamic conflicts. Memory for the first three associations was later tested in an unexpected recall task. Skin conductance response (SCR) was recorded and analyzed together with reaction times (RTs) and self-ratings of emotional valence, arousal, and agreement with cue sentences. Results: Patients showed reduced memory performance for associations to conflict-related sentences in general, compared with negative and neutral sentences. Agreement with conflict-related sentences was lower compared to neutral but not negative sentences. Memory was negatively correlated with RTs and SCR. RTs were longer for conflict types that had been rated as relevant in clinical interviews prior to the association task, compared to the other, non-relevant conflict types. Conclusion: Our study shows that some putative markers of repression of psychodynamic conflicts previously established in healthy participants also occur in patients. Moreover, it provides evidence that general conflict effects differ from specific effects of personally relevant conflicts.
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Affiliation(s)
- Aram Kehyayan
- Department of Psychosomatic Medicine and Psychotherapy, LWL University Hospital, Ruhr-University Bochum, Bochum, Germany,*Correspondence: Aram Kehyayan,
| | - Nathalie Matura
- Department of Psychosomatic Medicine and Psychotherapy, LWL University Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Kerstin Klein
- Department of Neuropsychology, Faculty of Psychology, Institute of Cognitive Neuroscience, Ruhr-University Bochum, Bochum, Germany
| | - Anna-Christine Schmidt
- Department of Psychosomatic Medicine and Psychotherapy, LWL University Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Stephan Herpertz
- Department of Psychosomatic Medicine and Psychotherapy, LWL University Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Nikolai Axmacher
- Department of Neuropsychology, Faculty of Psychology, Institute of Cognitive Neuroscience, Ruhr-University Bochum, Bochum, Germany
| | - Henrik Kessler
- Department of Psychosomatic Medicine and Psychotherapy, LWL University Hospital, Ruhr-University Bochum, Bochum, Germany
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Oehrn CR, Fell J, Baumann C, Rosburg T, Ludowig E, Kessler H, Hanslmayr S, Axmacher N. Direct Electrophysiological Evidence for Prefrontal Control of Hippocampal Processing during Voluntary Forgetting. Curr Biol 2018; 28:3016-3022.e4. [DOI: 10.1016/j.cub.2018.07.042] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 06/22/2018] [Accepted: 07/13/2018] [Indexed: 01/10/2023]
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Cengiz TB, Steele SR, Delaney CP, Kessler H. Laparoscopic Hartmann's reversal surgery in a complex abdomen - a video vignette. Colorectal Dis 2018; 20:648. [PMID: 29679521 DOI: 10.1111/codi.14232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 04/09/2018] [Indexed: 02/08/2023]
Affiliation(s)
- T B Cengiz
- Department of Colorectal Surgery-A30, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - S R Steele
- Department of Colorectal Surgery-A30, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - C P Delaney
- Department of Colorectal Surgery-A30, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - H Kessler
- Department of Colorectal Surgery-A30, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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Woud ML, Blackwell SE, Cwik JC, Margraf J, Holmes EA, Steudte-Schmiedgen S, Herpertz S, Kessler H. Augmenting inpatient treatment for post-traumatic stress disorder with a computerised cognitive bias modification procedure targeting appraisals (CBM-App): protocol for a randomised controlled trial. BMJ Open 2018; 8:e019964. [PMID: 29961004 PMCID: PMC6042580 DOI: 10.1136/bmjopen-2017-019964] [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] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Influential theories of post-traumatic stress disorder (PTSD) suggest that dysfunctional appraisals of trauma play a key role in the maintenance of symptoms, and this suggestion is increasingly supported by research. Experimental studies have indicated that a simple computerised cognitive training procedure, here termed cognitive bias modification-appraisals (CBM-App), can modify trauma-relevant appraisals and reduce analogue trauma symptoms among healthy volunteers. This suggests the possibility that CBM-App could improve outcomes in PTSD via targeting the key process of dysfunctional appraisals, for example, if applied as an adjunct to treatment. METHODS AND ANALYSIS The study is a randomised controlled trial with two parallel arms. It is planned to randomise 80 patients admitted for treatment for PTSD to an inpatient treatment clinic to complete either sessions of CBM-App or a sham-training control condition, the peripheral vision task. Both interventions comprise eight sessions scheduled over a 2-week period and are completed in addition to the standard treatment programme in the clinic. Outcome assessment occurs pretraining, after 1 week of training, post-training, at discharge from the inpatient clinic and 6 weeks and 3 months postdischarge. The primary outcome is dysfunctional trauma-relevant appraisals at post-training, measured using a scenario completion task. Secondary outcomes include symptom measures and hair cortisol. Outcome analyses will be primarily via mixed linear models and conducted with both intention to treat and per protocol samples. ETHICS AND DISSEMINATION The trial has been approved by the Ethics Committee for the Faculty of Psychology, Ruhr-Universität Bochum (approval no 204) and the Ethics Committee for the Faculty of Medicine, Ruhr-Universität Bochum (approval no 15-5477). Results will be published in peer-reviewed journals and will inform future clinical and experimental studies into targeting maladaptive appraisals for the reduction of PTSD symptoms. TRIAL REGISTRATION NUMBER NCT02687555.
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Affiliation(s)
- Marcella L Woud
- Department of Psychology, Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Bochum, Germany
| | - Simon E Blackwell
- Department of Psychology, Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Bochum, Germany
| | - Jan C Cwik
- Department of Psychology, Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Bochum, Germany
| | - Jürgen Margraf
- Department of Psychology, Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Bochum, Germany
| | - Emily A Holmes
- Department for Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Susann Steudte-Schmiedgen
- Department of Psychology, Technische Universität Dresden, Dresden, Germany
- Department of Psychotherapy and Psychosomatic Medicine, Technische Universität Dresden, Dresden, Germany
| | - Stephan Herpertz
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Hospital, Ruhr-Universität Bochum, Bochum, Germany
| | - Henrik Kessler
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Hospital, Ruhr-Universität Bochum, Bochum, Germany
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Bruchertseifer F, Bock M, Kessler H, Schwaiger M, Wester HJ, Haubner R. Synthesis and biological evaluation of a 99mTc-labelled cyclic RGD peptide for imaging the αvβ3 expression. Nuklearmedizin 2018. [DOI: 10.1055/s-0038-1623911] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Summary
Aim: The αvβ3 integrin is involved in tumour induced angiogenesis and tumour metastasis. We describe the synthesis and evaluation of a 99mTc-labelled RGD analogue for the visualisation of αvβ3 integrin expression. Methods: The linear peptides were assembled on a solid support. Cyclisation was performed under high dilution conditions. For conjugation with the chelator peptide, a water soluble carbodiimide was used. Radiolabelling was carried out due to standard procedures with high radiochemical yield and radiochemical purity. For in vivo evaluation, nude mice bearing αvβ3-positive human melanoma M21 and αv-negative human melanoma M21-L or Balb/c mice bearing αv-positive murine osteosarcoma were used. Results: Activity accumulation of 99mTc-DKCK-RGD 240 min p. i. was 1.1% ID/g in the αvβ3-positive melanoma and 0.3% ID/g in the negative control tumour. In the osteosarcoma model 2.2% ID/g was found 240 min p. i. Planar gamma camera images allowed contrasting visualisation of αvβ3-positive tumours 240 min p. i. Blocking of the tumour using the αvβ3-selective pentapeptide cyclo(-ArgGly-Asp-D-Phe-Val-) reduces activity accumulation in the tumour to background level. However, 240 min p. i. highest activity concentration was found in kidneys resulting in low tumour/kidney ratios. Metabolite analysis 240 min p. i. showed approximately 60% intact tracer in kidneys and 80% in the tumour. Only 24% intact tracer was found in blood 30 min p. i. Conclusion: 99mTc-DKCK-RGD allows imaging of αvβ3-positive tumours in mice. However, pharmacokinetics as well as metabolic stability of the tracer have to be improved for potential clinical application.
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Remzi FH, Lavryk OA, Ashburn JH, Hull TL, Lavery IC, Dietz DW, Kessler H, Church JM. Restorative proctocolectomy: an example of how surgery evolves in response to paradigm shifts in care. Colorectal Dis 2017; 19:1003-1012. [PMID: 28481467 DOI: 10.1111/codi.13699] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 02/13/2017] [Indexed: 12/12/2022]
Abstract
AIM Surgical technique constantly evolves in response to the pressure of progress. Ileal pouch anal anastomosis (IPAA) is a good example. We analysed the effect of changes in practice on the technique of IPAA and its outcomes. METHOD Patients undergoing primary IPAA at this institution were divided into three groups by date of the IPAA: those operated from 1983 to 1993, from 1994 to 2004 and from 2005 to 2015. Demographics, patient comorbidity, surgical techniques, postoperative outcomes, pouch function and quality of life were analysed. RESULTS In all, 4525 patients had a primary IPAA. With each decade, increasing numbers of surgeons were involved (decade I, 8; II, 16; III, 31), patients tended to be sicker (higher American Society of Anesthesiologists score) and three-staged pouches became more common. After an initial popularity of the S pouch, J pouches became dominant and a mucosectomy rate of 12% was standard. The laparoscopic technique blossomed in the last decade. 90-day postoperative morbidity by decade was 38.3% vs 50% vs 48% (P < 0.0001), but late morbidity decreased from 74.2% through 67.1% to 30% (P < 0.0001). Functional results improved, but quality of life scores did not. Pouch survival rate at 10 years was maintained (94% vs 95.2% vs 95.2%; P = 0.06). CONCLUSION IPAA is still evolving. Despite new generations of surgeons, a more accurate diagnosis, appropriate staging and the laparoscopic technique have made IPAA a safer, more effective and enduring operation.
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Affiliation(s)
- F H Remzi
- Department of Colorectal Surgery, Digestive Disease and Surgery Institute Cleveland, Cleveland Clinic, Cleveland, Ohio, USA
| | - O A Lavryk
- Department of Colorectal Surgery, Digestive Disease and Surgery Institute Cleveland, Cleveland Clinic, Cleveland, Ohio, USA
| | - J H Ashburn
- Department of Colorectal Surgery, Digestive Disease and Surgery Institute Cleveland, Cleveland Clinic, Cleveland, Ohio, USA
| | - T L Hull
- Department of Colorectal Surgery, Digestive Disease and Surgery Institute Cleveland, Cleveland Clinic, Cleveland, Ohio, USA
| | - I C Lavery
- Department of Colorectal Surgery, Digestive Disease and Surgery Institute Cleveland, Cleveland Clinic, Cleveland, Ohio, USA
| | - D W Dietz
- Department of Colorectal Surgery, Digestive Disease and Surgery Institute Cleveland, Cleveland Clinic, Cleveland, Ohio, USA
| | - H Kessler
- Department of Colorectal Surgery, Digestive Disease and Surgery Institute Cleveland, Cleveland Clinic, Cleveland, Ohio, USA
| | - J M Church
- Department of Colorectal Surgery, Digestive Disease and Surgery Institute Cleveland, Cleveland Clinic, Cleveland, Ohio, USA
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Kessler H, Schmidt AC, Hildenbrand O, Scharf D, Kehyayan A, Axmacher N. Investigating Behavioral and Psychophysiological Reactions to Conflict-Related and Individualized Stimuli as Potential Correlates of Repression. Front Psychol 2017; 8:1511. [PMID: 28959219 PMCID: PMC5603662 DOI: 10.3389/fpsyg.2017.01511] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 08/21/2017] [Indexed: 11/13/2022] Open
Abstract
Background: Repression is considered as a central defense mechanism in psychodynamic theory. It refers to the process by which "unbearable" mental contents (e.g., those related to internal conflicts) are kept out of consciousness. The process of repression is probably closely related to concepts of emotion regulation derived from a different theoretical background. This relationship is particularly relevant because it relates repression to current research in the affective neurosciences as well as to experimental studies on emotion regulation. Due to its complex and highly individual nature, repression has been notoriously difficult to investigate. We investigated repression with an individualized experiment in healthy subjects in order to establish methods to study repression in clinical populations. To this end we operationalized repression using individualized experimental conditions, and then studied potential behavioral [memory and reaction time (RT)] and psychophysiological correlates [skin conductance response (SCR)]. Method: Twenty-nine healthy female subjects were asked to freely associate to individualized cue sentences. Sentences were generated from individual psychodynamic interviews based on operationlized psychodynamic diagnosis (OPD), and were comprised of three different types: positive, negative non-conflictual, and negative conflict-related sentences. Subjects were asked to name the first three associations coming into their mind. Afterward, the remaining time was used for free association. SCR during each association trial and RT of the first given association were recorded. The memory for the first three associations was subsequently tested in an unexpected recall. Results: Associations to conflict-related cue sentences were associated with longer RTs and increased SCRs. Moreover, the unexpected recall task showed memory for these associations to be reduced. Conclusion: We interpret these findings as possible correlates of repression, in line with a history of experimental research into repression using non-individualized cues. Consequently, we suggest that this experimental paradigm could serve to investigate repression in clinical populations.
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Affiliation(s)
- Henrik Kessler
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Hospital, Ruhr-University BochumBochum, Germany
| | - Anna Christine Schmidt
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Hospital, Ruhr-University BochumBochum, Germany
| | | | - Daniela Scharf
- Department of Medical Psychology, University of BonnBonn, Germany
| | - Aram Kehyayan
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Hospital, Ruhr-University BochumBochum, Germany
| | - Nikolai Axmacher
- Department of Neuropsychology, Institute of Cognitive Neuroscience, Faculty of Psychology, Ruhr-University BochumBochum, Germany
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Cwik JC, Kessler H, Herpertz S, Becker G, Janetzky S, Sheverdina A, Westermann K, Teismann T. [Concordance of DSM-5®-Diagnoses Based on Diagnostic Interviews with People with Mental Disorders and Relatives or Friends: Implications for Psychological Autopsy Studies]. Psychother Psychosom Med Psychol 2017; 68:75-81. [PMID: 28958122 DOI: 10.1055/s-0043-118653] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND The evaluation whether a person who died by suicide suffered from a psychiatric disorder poses a diagnostic problem on psychological autopsy studies and is debated controversially. OBJECTIVE Do patients and relatives or friends agree on DSM-5®-diagnoses? METHODS A sample of N=20 inpatients and their relatives or friends were interviewed using a structured-clinical interview. In total agreement on 78 patient-based and 72 relatives- or friends-based diagnoses could be assessed. RESULTS Agreement of patients' and relatives' or friend's diagnoses was low. Moderate concordance was found for the following diagnoses: Posttraumatic Stress Disorder, Somatic Symptom Disorder, Borderline Personality Disorder, and Binge-Eating Disorder. Only for the Persistent Depressive Disorder, the Binge-Eating Disorder, and the Borderline Personality Disorder good positive predictive values (0.75-0.80) were observed. CONCLUSION On the basis of interviews with relatives or friends, no reliable diagnostic decisions can be made.
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Affiliation(s)
- Jan Christopher Cwik
- Psychologische Fakultät, Forschungs- und Behandlungszentrum für psychische Gesundheit, Ruhr-Universität Bochum
| | - Henrik Kessler
- Klinik für Psychosomatische Medizin und Psychotherapie, LWL-Universitätsklinikum der Ruhr-Universität Bochum
| | - Stephan Herpertz
- Klinik für Psychosomatische Medizin und Psychotherapie, LWL-Universitätsklinikum der Ruhr-Universität Bochum
| | - Georgina Becker
- Psychologische Fakultät, Forschungs- und Behandlungszentrum für psychische Gesundheit, Ruhr-Universität Bochum
| | - Sandra Janetzky
- Psychologische Fakultät, Forschungs- und Behandlungszentrum für psychische Gesundheit, Ruhr-Universität Bochum
| | - Anna Sheverdina
- Psychologische Fakultät, Forschungs- und Behandlungszentrum für psychische Gesundheit, Ruhr-Universität Bochum
| | - Katharina Westermann
- Psychologische Fakultät, Forschungs- und Behandlungszentrum für psychische Gesundheit, Ruhr-Universität Bochum
| | - Tobias Teismann
- Psychologische Fakultät, Forschungs- und Behandlungszentrum für psychische Gesundheit, Ruhr-Universität Bochum
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Onder A, Benlice C, Church J, Kessler H, Gorgun E. Short-term outcomes of laparoscopic versus open total colectomy with ileorectal anastomosis: a case-matched analysis from a nationwide database. Tech Coloproctol 2016; 20:767-773. [PMID: 27783175 DOI: 10.1007/s10151-016-1539-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 09/16/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND In the current study, we aimed to compare peri- and postoperative 30-day outcomes of patients undergoing laparoscopic versus open total colectomy with ileorectal anastomosis in a case-matched design using data procedure-targeted database. METHODS Patients who underwent elective total colectomy with ileorectal anastomosis in 2012 and 2013 were identified from the American College of Surgeons National Surgical Quality Improvement Program database. Patients were divided into two groups according to the type of surgical approach (laparoscopic and open). Laparoscopic and open groups were matched (1:1) based on age, gender, diagnosis, body mass index, and American Society of Anesthesiologists classification. Comorbidities, perioperative, and short-term (30-day) postoperative outcomes were compared between the matched groups. RESULTS We identified 1442 patients-549 in the laparoscopic group and 893 patients in the open group. After case matching, there were 326 patients in each group. There were 48 (14.7%) patients who had conversion in the laparoscopic group. The open group had a higher proportion of patients with ascites [0 (0%) vs. 7 (2.1%) p = 0.015], preoperative weight loss [26 (8.0%) vs. 45 (13.8%) p = 0.018], and contaminated wound classifications [Clean/Contaminated 261 (80%) vs. 240 (74%), Contaminated 55 (16.9%) vs. 54 (16.6%), and Dirty/Infected 8 (2.5%) vs. 28 (8.6%), (p = 0.003)]. The laparoscopic group had a significantly longer operative time (242 ± 98 vs. 202 ± 116 min, p < 0.001), shorter hospital stay (9.4 ± 8.5 vs. 13.3 ± 10.7 days, p < 0.001), and lower ileus rate (23.9 vs. 31.0%, p = 0.045) than the open group. After adjusting for covariates, the differences in terms of operative time and hospital stay remained significant [odds ratio (OR): 0.79, confidence interval (CI) 0.74-0.85 and OR 1.36, CI 1.21-1.52, p < 0.001, respectively]. CONCLUSIONS Laparoscopic approach for total colectomy with ileorectal anastomosis is associated with a shorter hospital stay but longer operative time compared with an open approach.
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Affiliation(s)
- A Onder
- Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Ave. A-30, Cleveland, OH, 44195, USA
| | - C Benlice
- Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Ave. A-30, Cleveland, OH, 44195, USA
| | - J Church
- Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Ave. A-30, Cleveland, OH, 44195, USA
| | - H Kessler
- Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Ave. A-30, Cleveland, OH, 44195, USA
| | - E Gorgun
- Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Ave. A-30, Cleveland, OH, 44195, USA.
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Duraes LC, Stocchi L, Rottoli M, Costedio MM, Gorgun E, Kessler H. What are the consequences of enlarging the extraction site to exteriorize a large specimen during laparoscopic surgery for Crohn's enteritis? Colorectal Dis 2016; 18:264-72. [PMID: 26709096 DOI: 10.1111/codi.13248] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 08/17/2015] [Indexed: 02/08/2023]
Abstract
AIM The implications of extraction site enlargement for the removal of large specimens during laparoscopic surgery for Crohn's disease have not been clearly described; such a description is the aim of this study. METHOD An institutional database was queried to identify patients undergoing laparoscopic resection for Crohn's disease through midline incision between 1995 and 2013. Perioperative outcomes were compared among cases completed through their initial extraction site (L), completed after increasing the length of the initial extraction site (IL) for specimen exteriorization, and cases converted to open surgery (C). Univariate and multivariate statistical analyses were performed. RESULTS Out of 309 patients, 52 required IL and 36 required C. Heavier, older, male patients were more likely to require IL or C. There were no differences in disease behaviour (P = 0.260), procedures performed (P = 0.12) or postoperative morbidity (P = 0.33). IL and L groups had a comparable initial length of hospital stay (LOS), which was shorter than in the C group. While there were no significant differences in causes of readmission (P = 0.31), IL had increased readmission rates compared with L [odds ratio (OR) 2.80, P = 0.021] or C (OR 13.89, P = 0.015). When combining initial and readmission LOS, C and IL groups had comparable overall LOS [median ratio (MR) 1.09, P = 0.57], which was significantly longer than in the L group (MR 1.27, P = 0.02). CONCLUSION Extraction site enlargement during laparoscopic surgery for enteric Crohn's disease had no impact on primary LOS. However, the shorter initial LOS was offset by increased readmission rates when compared with formal conversion. The threshold to convert in case of anticipated difficulty due to a large specimen should be low.
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Affiliation(s)
- L C Duraes
- Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA
| | - L Stocchi
- Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA
| | - M Rottoli
- Department of Colorectal Surgery, University College of London Hospital, London, UK
| | - M M Costedio
- Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA
| | - E Gorgun
- Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA
| | - H Kessler
- Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA
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Herranz-Diez C, Mas-Moruno C, Neubauer S, Kessler H, Gil FJ, Pegueroles M, Manero JM, Guillem-Marti J. Tuning Mesenchymal Stem Cell Response onto Titanium-Niobium-Hafnium Alloy by Recombinant Fibronectin Fragments. ACS Appl Mater Interfaces 2016; 8:2517-2525. [PMID: 26735900 DOI: 10.1021/acsami.5b09576] [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] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Since metallic biomaterials used for bone replacement possess low bioactivity, the use of cell adhesive moieties is a common strategy to improve cellular response onto these surfaces. In recent years, the use of recombinant proteins has emerged as an alternative to native proteins and short peptides owing to the fact that they retain the biological potency of native proteins, while improving their stability. In the present study, we investigated the biological effect of two different recombinant fragments of fibronectin, spanning the 8-10th and 12-14th type III repeats, covalently attached to a new TiNbHf alloy using APTES silanization. The fragments were studied separately and mixed at different concentrations and compared to a linear RGD, a cyclic RGD and the full-length fibronectin protein. Cell culture studies using rat mesenchymal stem cells demonstrated that low to medium concentrations (30% and 50%) of type III 8-10th fragment mixed with type III 12-14th fragment stimulated cell spreading and proliferation compared to RGD peptides and the fragments separately. On the other hand, type III 12-14th fragment alone or mixed at low volume percentages ≤50% with type III 8-10th fragment increased alkaline phosphatase levels compared to the other molecules. These results are significant for the understanding of the role of fibronectin recombinant fragments in cell responses and thus to design bioactive coatings for biomedical applications.
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Affiliation(s)
- C Herranz-Diez
- Biomaterials, Biomechanics and Tissue Engineering Group, Department of Materials Science and Metallurgical Engineering, Technical University of Catalonia (UPC), ETSEIB , Diagonal 647, 08028 Barcelona, Spain
| | - C Mas-Moruno
- Biomaterials, Biomechanics and Tissue Engineering Group, Department of Materials Science and Metallurgical Engineering, Technical University of Catalonia (UPC), ETSEIB , Diagonal 647, 08028 Barcelona, Spain
- Centre for Research in NanoEngineering (CRnE)-UPC , c/Pascual i Vila 15, 08028 Barcelona, Spain
| | - S Neubauer
- Institute for Advanced Study and Center for Integrated Protein Science, Department Chemie, Technische Universität München , Lichtenbergstrasse 4, 85747 Garching, Germany
- Max Planck Institute for Intelligent Systems , Heisenbergstrasse 3, 70569 Stuttgart, Germany
| | - H Kessler
- Institute for Advanced Study and Center for Integrated Protein Science, Department Chemie, Technische Universität München , Lichtenbergstrasse 4, 85747 Garching, Germany
- Max Planck Institute for Intelligent Systems , Heisenbergstrasse 3, 70569 Stuttgart, Germany
| | - F J Gil
- Biomaterials, Biomechanics and Tissue Engineering Group, Department of Materials Science and Metallurgical Engineering, Technical University of Catalonia (UPC), ETSEIB , Diagonal 647, 08028 Barcelona, Spain
- Centre for Research in NanoEngineering (CRnE)-UPC , c/Pascual i Vila 15, 08028 Barcelona, Spain
| | - M Pegueroles
- Biomaterials, Biomechanics and Tissue Engineering Group, Department of Materials Science and Metallurgical Engineering, Technical University of Catalonia (UPC), ETSEIB , Diagonal 647, 08028 Barcelona, Spain
- Centre for Research in NanoEngineering (CRnE)-UPC , c/Pascual i Vila 15, 08028 Barcelona, Spain
| | - J M Manero
- Biomaterials, Biomechanics and Tissue Engineering Group, Department of Materials Science and Metallurgical Engineering, Technical University of Catalonia (UPC), ETSEIB , Diagonal 647, 08028 Barcelona, Spain
- Centre for Research in NanoEngineering (CRnE)-UPC , c/Pascual i Vila 15, 08028 Barcelona, Spain
| | - J Guillem-Marti
- Biomaterials, Biomechanics and Tissue Engineering Group, Department of Materials Science and Metallurgical Engineering, Technical University of Catalonia (UPC), ETSEIB , Diagonal 647, 08028 Barcelona, Spain
- Centre for Research in NanoEngineering (CRnE)-UPC , c/Pascual i Vila 15, 08028 Barcelona, Spain
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Herranz-Diez C, Li Q, Lamprecht C, Mas-Moruno C, Neubauer S, Kessler H, Manero J, Guillem-Martí J, Selhuber-Unkel C. Bioactive compounds immobilized on Ti and TiNbHf: AFM-based investigations of biofunctionalization efficiency and cell adhesion. Colloids Surf B Biointerfaces 2015; 136:704-11. [DOI: 10.1016/j.colsurfb.2015.10.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 09/20/2015] [Accepted: 10/06/2015] [Indexed: 10/22/2022]
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Renner G, Janouskova H, Noulet F, Koenig V, Guerin E, Bär S, Nuesch J, Rechenmacher F, Neubauer S, Kessler H, Blandin AF, Choulier L, Etienne-Selloum N, Lehmann M, Lelong-Rebel I, Martin S, Dontenwill M. Integrin α5β1 and p53 convergent pathways in the control of anti-apoptotic proteins PEA-15 and survivin in high-grade glioma. Cell Death Differ 2015; 23:640-53. [PMID: 26470725 DOI: 10.1038/cdd.2015.131] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 07/15/2015] [Accepted: 09/01/2015] [Indexed: 01/07/2023] Open
Abstract
Integrin α5β1 expression is correlated with a worse prognosis in high-grade glioma. We previously unraveled a negative crosstalk between integrin α5β1 and p53 pathway, which was proposed to be part of the resistance of glioblastoma to chemotherapies. The restoration of p53 tumor-suppressor function is under intensive investigations for cancer therapy. However, p53-dependent apoptosis is not always achieved by p53-reactivating compounds such as Nutlin-3a, although full transcriptional activity of p53 could be obtained. Here we investigated whether integrin α5β1 functional inhibition or repression could sensitize glioma cells to Nutlin-3a-induced p53-dependent apoptosis. We discovered that α5β1 integrin-specific blocking antibodies or small RGD-like antagonists in association with Nutlin-3a triggered a caspase (Casp) 8/Casp 3-dependent strong apoptosis in glioma cells expressing a functional p53. We deciphered the molecular mechanisms involved and we showed the crucial role of two anti-apoptotic proteins, phosphoprotein enriched in astrocytes 15 (PEA-15) and survivin in glioma cell apoptotic outcome. PEA-15 is under α5β1 integrin/AKT (protein kinase B) control and survivin is a p53-repressed target. Moreover, interconnections between integrin and p53 pathways were revealed. Indeed PEA-15 repression by specific small-interfering RNA (siRNA)-activated p53 pathway to repress survivin and conversely survivin repression by specific siRNA decreased α5β1 integrin expression. This pro-apoptotic loop could be generalized to several glioma cell lines, whatever their p53 status, inasmuch PEA-15 and survivin protein levels were decreased. Our findings identify a novel mechanism whereby inhibition of α5β1 integrin and activation of p53 modulates two anti-apoptotic proteins crucially involved in the apoptotic answer of glioma cells. Importantly, our results suggest that high-grade glioma expressing high level of α5β1 integrin may benefit from associated therapies including integrin antagonists and repressors of survivin expression.
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Affiliation(s)
- G Renner
- Integrins and Cancer, Faculté de Pharmacie, UMR7213 CNRS, LBP, Tumoral Signaling and Therapeutic Targets Department, Université de Strasbourg, Faculté de Pharmacie, Illkirch, France
| | - H Janouskova
- Integrins and Cancer, Faculté de Pharmacie, UMR7213 CNRS, LBP, Tumoral Signaling and Therapeutic Targets Department, Université de Strasbourg, Faculté de Pharmacie, Illkirch, France
| | - F Noulet
- Integrins and Cancer, Faculté de Pharmacie, UMR7213 CNRS, LBP, Tumoral Signaling and Therapeutic Targets Department, Université de Strasbourg, Faculté de Pharmacie, Illkirch, France
| | - V Koenig
- Integrins and Cancer, Faculté de Pharmacie, UMR7213 CNRS, LBP, Tumoral Signaling and Therapeutic Targets Department, Université de Strasbourg, Faculté de Pharmacie, Illkirch, France
| | - E Guerin
- EA3430, Université de Strasbourg, Strasbourg, France
| | - S Bär
- Tumor Virology Division (F010), Deutsches Krebsforschungszentrum/German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - J Nuesch
- Tumor Virology Division (F010), Deutsches Krebsforschungszentrum/German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - F Rechenmacher
- Department Chemie, Institute for Advanced Study and Center of Integrated Protein Studies, Technische Universität München, Garching, Germany
| | - S Neubauer
- Department Chemie, Institute for Advanced Study and Center of Integrated Protein Studies, Technische Universität München, Garching, Germany
| | - H Kessler
- Department Chemie, Institute for Advanced Study and Center of Integrated Protein Studies, Technische Universität München, Garching, Germany
| | - A-F Blandin
- Integrins and Cancer, Faculté de Pharmacie, UMR7213 CNRS, LBP, Tumoral Signaling and Therapeutic Targets Department, Université de Strasbourg, Faculté de Pharmacie, Illkirch, France
| | - L Choulier
- Integrins and Cancer, Faculté de Pharmacie, UMR7213 CNRS, LBP, Tumoral Signaling and Therapeutic Targets Department, Université de Strasbourg, Faculté de Pharmacie, Illkirch, France
| | - N Etienne-Selloum
- Integrins and Cancer, Faculté de Pharmacie, UMR7213 CNRS, LBP, Tumoral Signaling and Therapeutic Targets Department, Université de Strasbourg, Faculté de Pharmacie, Illkirch, France
| | - M Lehmann
- Integrins and Cancer, Faculté de Pharmacie, UMR7213 CNRS, LBP, Tumoral Signaling and Therapeutic Targets Department, Université de Strasbourg, Faculté de Pharmacie, Illkirch, France
| | - I Lelong-Rebel
- Integrins and Cancer, Faculté de Pharmacie, UMR7213 CNRS, LBP, Tumoral Signaling and Therapeutic Targets Department, Université de Strasbourg, Faculté de Pharmacie, Illkirch, France
| | - S Martin
- Integrins and Cancer, Faculté de Pharmacie, UMR7213 CNRS, LBP, Tumoral Signaling and Therapeutic Targets Department, Université de Strasbourg, Faculté de Pharmacie, Illkirch, France
| | - M Dontenwill
- Integrins and Cancer, Faculté de Pharmacie, UMR7213 CNRS, LBP, Tumoral Signaling and Therapeutic Targets Department, Université de Strasbourg, Faculté de Pharmacie, Illkirch, France
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Oehrn C, Baumann C, Fell J, Lee H, Kessler H, Habel U, Hanslmayr S, Axmacher N. Human Hippocampal Dynamics during Response Conflict. Curr Biol 2015; 25:2307-13. [DOI: 10.1016/j.cub.2015.07.032] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 05/29/2015] [Accepted: 07/13/2015] [Indexed: 12/29/2022]
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Killeen S, Kessler H. Complete mesocolic excision and central vessel ligation for right colon cancers. Tech Coloproctol 2014; 18:1129-31. [PMID: 25332130 DOI: 10.1007/s10151-014-1214-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 07/11/2014] [Indexed: 01/29/2023]
Affiliation(s)
- S Killeen
- Department of Colorectal Surgery, Cleveland Clinic, Cleveland, OH, 44195, USA,
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Gassling V, Kessler H, Klein MO, Detjen AM, Koos B, Limbrecht-Ecklundt K, Traue HC, Wiltfang J, Gerber WD. Normal emotion regulation in adults with cleft lip and palate: An exploratory study. J Craniomaxillofac Surg 2014; 42:1271-6. [DOI: 10.1016/j.jcms.2014.03.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2013] [Revised: 12/27/2013] [Accepted: 03/10/2014] [Indexed: 11/29/2022] Open
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