1
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Campana M, Schneider-Axmann T, Wobrock T, Malchow B, Langguth B, Landgrebe M, Eichhammer P, Frank E, Cordes J, Wölwer W, Gaebel W, Winterer G, Hajak G, Ohmann C, Verde PE, Rietschel M, Ahmed R, Mortazavi M, Strube W, Falkai P, Hasan A, Wagner E. Assessing the impact of sex on high-frequency repetitive transcranial magnetic stimulation´s clinical response in schizophrenia - results from a secondary analysis. World J Biol Psychiatry 2024; 25:233-241. [PMID: 38493362 DOI: 10.1080/15622975.2024.2327028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 03/03/2024] [Indexed: 03/18/2024]
Abstract
BACKGROUND The evidence for repetitive transcranial magnetic stimulation (rTMS) to treat negative symptoms in schizophrenia (SCZ) is increasing, although variable response rates remain a challenge. Subject´s sex critically influences rTMS´ treatment outcomes. Females with major depressive disorder are more likely to respond to rTMS, while SCZ data is scarce. METHODS Using data from the 'rTMS for the Treatment of Negative Symptoms in Schizophrenia' (RESIS) trial we assessed the impact of sex on rTMS´ clinical response rate from screening up to 105 days after intervention among SCZ patients. The impact of resting motor threshold (RMT) on response rates was also assessed. RESULTS 157 patients received either active or sham rTMS treatment. No significant group differences were observed. Linear mixed model showed no effects on response rates (all p > 0.519). Apart from a significant sex*time interaction for the positive subscale of the positive and negative syndrome scale (PANSS) scores (p = 0.032), no other significant effects of sex on continuous PANSS scores were observed. RMT had no effect on response rate. CONCLUSION In the largest rTMS trial on the treatment of SCZ negative symptoms we did not observe any significant effect of sex on treatment outcomes. Better assessments of sex-related differences could improve treatment individualisation.
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Affiliation(s)
- Mattia Campana
- Department of Psychiatry and Psychotherapy, LMU University Hospital Munich, Munich, Germany
| | | | - Thomas Wobrock
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Goettingen, Germany
- County Hospitals Darmstadt-Dieburg, Groß-Umstadt, Germany
| | - Berend Malchow
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Goettingen, Germany
| | - Berthold Langguth
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Michael Landgrebe
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
- Department of Psychiatry, Psychosomatics and Psychotherapy, kbo-Lech-Mangfall-Klinik Agatharied, Germany
| | - Peter Eichhammer
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Elmar Frank
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Joachim Cordes
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
- Department of Psychiatry and Psychotherapy, The Florence-Nightingale-Hospital, Düsseldorf, Germany
| | - Wolfgang Wölwer
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Wolfgang Gaebel
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Georg Winterer
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité- Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Göran Hajak
- Department of Psychiatry, Psychosomatics and Psychotherapy, Bamberg, Germany
| | | | - Pablo E Verde
- Coordination Centre for Clinical Trials, Heinrich-Heine University, Düsseldorf, Germany
| | - Marcella Rietschel
- Department of Genetic Epidemiology in Psychiatry, Institute of Central Mental Health, Medical Faculty Mannheim, University of Heidelberg, Germany
| | - Raees Ahmed
- University Medical Center Goettingen, Goettingen, Germany
| | - Matin Mortazavi
- Deparment of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, University of Augsburg, Augsburg, Germany
| | - Wolfgang Strube
- Deparment of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, University of Augsburg, Augsburg, Germany
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, LMU University Hospital Munich, Munich, Germany
- Max Planck Institute of Psychiatry, Munich, Germany
- DZPG (German Center for Mental Health), Augsburg, Germany
| | - Alkomiet Hasan
- Deparment of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, University of Augsburg, Augsburg, Germany
- DZPG (German Center for Mental Health), Augsburg, Germany
| | - Elias Wagner
- Deparment of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, University of Augsburg, Augsburg, Germany
- Evidence-based Psychiatry and Psychotherapy, Faculty of Medicine, University of Augsburg, Augsburg, Germany
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2
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Kamp D, Hartmann N, Frommann N, Lowe A, Pintgen L, Weide K, Wölwer W. The relationship between empathy, theory of mind and facial affect recognition in schizophrenia patients. Int J Neurosci 2024:1-5. [PMID: 38441493 DOI: 10.1080/00207454.2024.2327415] [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: 09/16/2022] [Accepted: 03/02/2024] [Indexed: 03/12/2024]
Abstract
Although impairments in social cognition are a core feature in schizophrenia, the relationship between its subcomponents is less clear. Nineteen schizophrenia patients and 20 matched healthy controls were tested for emotion recognition, and for the cognitive and affective subcomponents of empathy and theory of mind (ToM). Patients scored significantly worse than controls on cognitive empathy and both subcomponents of ToM. Group differences disappeared for cognitive empathy and affective ToM when emotion recognition was included as a covariate. Our results indicate that emotion recognition is an important factor involved in the deficits on higher levels of social cognition in schizophrenia.
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Affiliation(s)
- Daniel Kamp
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University Düsseldorf, LVR-Klinikum Düsseldorf, Düsseldorf, Germany
| | - Nora Hartmann
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University Düsseldorf, LVR-Klinikum Düsseldorf, Düsseldorf, Germany
| | - Nicole Frommann
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University Düsseldorf, LVR-Klinikum Düsseldorf, Düsseldorf, Germany
| | - Agnes Lowe
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University Düsseldorf, LVR-Klinikum Düsseldorf, Düsseldorf, Germany
| | - Lisa Pintgen
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University Düsseldorf, LVR-Klinikum Düsseldorf, Düsseldorf, Germany
| | - Karolin Weide
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University Düsseldorf, LVR-Klinikum Düsseldorf, Düsseldorf, Germany
| | - Wolfgang Wölwer
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University Düsseldorf, LVR-Klinikum Düsseldorf, Düsseldorf, Germany
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3
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Maurus I, Roell L, Lembeck M, Papazova I, Greska D, Muenz S, Wagner E, Campana M, Schwaiger R, Schneider-Axmann T, Rosenberger K, Hellmich M, Sykorova E, Thieme CE, Vogel BO, Harder C, Mohnke S, Huppertz C, Roeh A, Keller-Varady K, Malchow B, Walter H, Wolfarth B, Wölwer W, Henkel K, Hirjak D, Schmitt A, Hasan A, Meyer-Lindenberg A, Falkai P. Exercise as an add-on treatment in individuals with schizophrenia: Results from a large multicenter randomized controlled trial. Psychiatry Res 2023; 328:115480. [PMID: 37716320 DOI: 10.1016/j.psychres.2023.115480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 09/07/2023] [Accepted: 09/09/2023] [Indexed: 09/18/2023]
Abstract
Current treatment methods do not achieve recovery for most individuals with schizophrenia, and symptoms such as negative symptoms and cognitive deficits often persist. Aerobic endurance training has been suggested as a potential add-on treatment targeting both physical and mental health. We performed a large-scale multicenter, rater-blind, parallel-group randomized controlled clinical trial in individuals with stable schizophrenia. Participants underwent a professionally supervised six-month training comprising either aerobic endurance training (AET) or flexibility, strengthening, and balance training (FSBT, control group), follow-up was another six months. The primary endpoint was all-cause discontinuation (ACD); secondary endpoints included effects on psychopathology, cognition, functioning, and cardiovascular risk. In total, 180 participants were randomized. AET was not superior to FSBT in ACD and most secondary outcomes, with dropout rates of 59.55% and 57.14% in the six-month active phase, respectively. However, both groups showed significant improvements in positive, general, and total symptoms, levels of functioning and in cognitive performance. A higher training frequency additionally promoted further memory domains. Participants with higher baseline cognitive abilities were more likely to respond to the interventions. Our results support integrating exercise into schizophrenia treatment, while future studies should aim to develop personalized training recommendations to maximize exercise-induced benefits.
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Affiliation(s)
- Isabel Maurus
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany.
| | - Lukas Roell
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany; Neuroimaging Core Unit Munich (NICUM), University Hospital, LMU Munich, Munich, Germany
| | - Moritz Lembeck
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Irina Papazova
- Department of Psychiatry, Psychotherapy and Psychosomatics of the University Augsburg, Medical Faculty, University of Augsburg, Bezirkskrankenhaus Augsburg, Augsburg, Germany
| | - David Greska
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Susanne Muenz
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Elias Wagner
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Mattia Campana
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Rebecca Schwaiger
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Thomas Schneider-Axmann
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Kerstin Rosenberger
- Institute of Medical Statistics and Computational Biology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Martin Hellmich
- Institute of Medical Statistics and Computational Biology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Eliska Sykorova
- Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Germany
| | - Cristina E Thieme
- Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Germany
| | - Bob O Vogel
- Department of Psychiatry and Psychotherapy, University Hospital Charité Berlin, Berlin, Germany
| | - Carolin Harder
- Department of Psychiatry and Psychotherapy, University Hospital Charité Berlin, Berlin, Germany
| | - Sebastian Mohnke
- Department of Psychiatry and Psychotherapy, University Hospital Charité Berlin, Berlin, Germany
| | - Charlotte Huppertz
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Germany
| | - Astrid Roeh
- Department of Psychiatry, Psychotherapy and Psychosomatics of the University Augsburg, Medical Faculty, University of Augsburg, Bezirkskrankenhaus Augsburg, Augsburg, Germany
| | | | - Berend Malchow
- Department of Psychiatry and Psychotherapy, University Hospital Göttingen, Göttingen, Germany
| | - Henrik Walter
- Department of Psychiatry and Psychotherapy, University Hospital Charité Berlin, Berlin, Germany
| | - Bernd Wolfarth
- Department of Sports Medicine, University Hospital Charité Berlin, Berlin, Germany
| | - Wolfgang Wölwer
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Duesseldorf, Germany
| | - Karsten Henkel
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Germany
| | - Dusan Hirjak
- Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Germany
| | - Andrea Schmitt
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany; Laboratory of Neuroscience (LIM27), Institute of Psychiatry, University of Sao Paulo, São Paulo, Brazil
| | - Alkomiet Hasan
- Department of Psychiatry, Psychotherapy and Psychosomatics of the University Augsburg, Medical Faculty, University of Augsburg, Bezirkskrankenhaus Augsburg, Augsburg, Germany
| | | | - Peter Falkai
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany; Max Planck Institute of Psychiatry, Munich, Germany
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4
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Schuster T, Lowe A, Weide K, Kamp D, Riesbeck M, Bechdolf A, Brockhaus-Dumke A, Hurlemann R, Muthesius A, Klingberg S, Hellmich M, Schmied S, Meyer-Lindenberg A, Wölwer W. Feasibility of six-month outpatient cognitive remediation in schizophrenia: Experience from the randomized controlled integrated social cognition and social skills therapy study. Schizophr Res Cogn 2023; 33:100285. [PMID: 37159610 PMCID: PMC10163670 DOI: 10.1016/j.scog.2023.100285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 04/11/2023] [Accepted: 04/11/2023] [Indexed: 05/11/2023]
Abstract
Patients with schizophrenia often have cognitive impairments that contribute to diminished psychosocial functioning. Cognitive remediation therapy (CRT) has proven efficacy and is recommended by evidence-based treatment guidelines. Important moderators of efficacy include integration of CRT into a psychiatric rehabilitation concept and patient attendance at a sufficient number of therapy sessions. These conditions can probably best be met in an outpatient setting; however, outpatient treatment is prone to higher rates of treatment discontinuation and outpatient settings are not as well protected as inpatient ones and less closely supervised.The present study investigated the feasibility of outpatient CRT in schizophrenia over a six-month period. Adherence to scheduled sessions and safety parameters were assessed in 177 patients with schizophrenia randomly assigned to one of two matched CRT programs.Results showed that 58.8 % of participants completed the CRT (>80 % of scheduled sessions) and 72.9 % completed at least half the sessions. Predictor analysis revealed a high verbal intelligence quotient as favorable for good adherence, but this factor had only low general predictive power. During the six-month treatment phase, serious adverse events occurred in 15.8 % (28/177) of the patients, which is a comparable rate to that reported in the literature.Our findings support the feasibility of six-month outpatient CRT in schizophrenia in terms of adherence to scheduled sessions and safety. Trial registration number NCT02678858, DRKS00010033.
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Affiliation(s)
- Tim Schuster
- Department of Psychiatry and Psychotherapy, Medical Faculty, University of Düsseldorf, Germany
- Corresponding author at: Department of Psychiatry and Psychotherapy, Medical Faculty, University of Düsseldorf/LVR Klinikum Düsseldorf, Bergische Landstrasse 2, 40629 Düsseldorf, Germany.
| | - Agnes Lowe
- Department of Psychiatry and Psychotherapy, Medical Faculty, University of Düsseldorf, Germany
| | - Karolin Weide
- Department of Psychiatry and Psychotherapy, Medical Faculty, University of Düsseldorf, Germany
| | - Daniel Kamp
- Department of Psychiatry and Psychotherapy, Medical Faculty, University of Düsseldorf, Germany
| | - Mathias Riesbeck
- Department of Psychiatry and Psychotherapy, Medical Faculty, University of Düsseldorf, Germany
| | - Andreas Bechdolf
- Vivantes Klinikum Am Urban, Berlin, Germany
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Campus Charité Mitte, Germany
| | | | - René Hurlemann
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany
- Department of Psychiatry and Psychotherapy, University of Oldenburg, Oldenburg, Germany
| | - Ana Muthesius
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
| | - Stefan Klingberg
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Martin Hellmich
- Institute of Medical Statistics and Bioinformatics, University of Cologne, Cologne, Germany
| | - Sabine Schmied
- Clinical Trials Center, University of Cologne, Cologne, Germany
| | | | - Wolfgang Wölwer
- Department of Psychiatry and Psychotherapy, Medical Faculty, University of Düsseldorf, Germany
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5
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Wölwer W, Frommann N, Lowe A, Kamp D, Weide K, Bechdolf A, Brockhaus-Dumke A, Hurlemann R, Muthesius A, Klingberg S, Hellmich M, Schmied S, Meyer-Lindenberg A. Efficacy of Integrated Social Cognitive Remediation vs. Neurocognitive Remediation in Improving Functional Outcome in Schizophrenia: Concept and Design of a Multicenter, Single-Blind RCT (The ISST Study). Front Psychiatry 2022; 13:909370. [PMID: 35800017 PMCID: PMC9253387 DOI: 10.3389/fpsyt.2022.909370] [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: 03/31/2022] [Accepted: 05/17/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Although clinically effective treatment is available for schizophrenia, recovery often is still hampered by persistent poor psychosocial functioning, which in turn is limited by impairments in neurocognition, social cognition, and social behavioral skills. Although cognitive remediation has shown general efficacy in improving cognition and social functioning, effects still need to be improved and replicated in appropriately powered, methodologically rigorous randomized controlled trials (RCTs). Existing evidence indicates that effects can most likely be optimized by combining treatment approaches to simultaneously address both social cognitive and social behavioral processes. OBJECTIVES To assess whether Integrated Social Cognitive and Behavioral Skill Therapy (ISST) is more efficacious in improving functional outcome in schizophrenia than the active control treatment Neurocognitive Remediation Therapy (NCRT). METHODS The present study is a multicenter, prospective, rater-blinded, two-arm RCT being conducted at six academic study sites in Germany. A sample of 180 at least partly remitted patients with schizophrenia are randomly assigned to either ISST or NCRT. ISST is a compensatory, strategy-based program that targets social cognitive processes and social behavioral skills. NCRT comprises mainly drill and practice-oriented neurocognitive training. Both treatments consist of 18 sessions over 6 months, and participants are subsequently followed up for another 6 months. The primary outcome is all-cause discontinuation over the 12-month study period; psychosocial functioning, quality of life, neurocognitive and social cognitive performance, and clinical symptoms are assessed as secondary outcomes at baseline before randomization (V1), at the end of the six-month treatment period (V6), and at the six-month follow-up (V12). DISCUSSION This RCT is part of the German Enhancing Schizophrenia Prevention and Recovery through Innovative Treatments (ESPRIT) research network, which aims at using innovative treatments to enhance prevention and recovery in patients with schizophrenia. Because this study is one of the largest and methodologically most rigorous RCTs on the efficacy of cognitive remediation approaches in schizophrenia, it will not only help to identify the optimal treatment options for improving psychosocial functioning and thus recovery in patients but also allow conclusions to be drawn about factors influencing and mediating the effects of cognitive remediation in these patients. TRIAL REGISTRATION ClinicalTrials.gov NCT02678858, German Study Register DRKS 00010033.
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Affiliation(s)
- Wolfgang Wölwer
- Department of Psychiatry and Psychotherapy, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - Nicole Frommann
- Department of Psychiatry and Psychotherapy, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - Agnes Lowe
- Department of Psychiatry and Psychotherapy, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - Daniel Kamp
- Department of Psychiatry and Psychotherapy, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - Karolin Weide
- Department of Psychiatry and Psychotherapy, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - Andreas Bechdolf
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine Incorporating FRITZ and Soulspace, Vivantes Klinikum Am Urban, Berlin, Germany
| | - Anke Brockhaus-Dumke
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Rheinhessen-Fachklinik Alzey, Alzey, Germany.,Department of Psychiatry and Psychotherapy, LVR-Klinik Bonn, Bonn, Germany
| | - Rene Hurlemann
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany.,Department of Psychiatry and Psychotherapy, University of Oldenburg, Oldenburg, Germany
| | - Ana Muthesius
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
| | - Stefan Klingberg
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Martin Hellmich
- Institute of Medical Statistics and Computational Biology, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Sabine Schmied
- Clinical Trials Center, University of Cologne, Cologne, Germany
| | - Andreas Meyer-Lindenberg
- Department of Psychiatry and Psychotherapy, Central Institute for Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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6
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Campana M, Wagner E, Wobrock T, Langguth B, Landgrebe M, Eichhammer P, Frank E, Cordes J, Wölwer W, Winterer G, Gaebel W, Hajak G, Ohmann C, Verde PE, Rietschel M, Malchow B, Ahmed R, Strube W, Häckert J, Schneider-Axmann T, Falkai P, Hasan A. Effects of high-frequency prefrontal rTMS on heart frequency rates and blood pressure in schizophrenia. J Psychiatr Res 2021; 140:243-249. [PMID: 34119909 DOI: 10.1016/j.jpsychires.2021.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/27/2021] [Accepted: 06/04/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Repetitive transcranial magnetic stimulation (rTMS) is a safe non-invasive neuromodulation technique used for the treatment of various neuropsychiatric disorders. The effect of rTMS applied to the cortex on autonomic functions has not been studied in detail in patient cohorts, yet patients who receive rTMS may have disease-associated impairments in the autonomic system and may receive medication that may pronounce autonomic dysfunctions. METHODS Using data from the 'rTMS for the Treatment of Negative Symptoms in Schizophrenia' (RESIS) trial we evaluated the effect of rTMS applied to the left dorsolateral prefrontal cortex (DLPFC) on autonomic nervous system-related parameters such as blood pressure (BP) and heart rate (HR) in both reclining and standing postures from screening up to 105 days after intervention among patients with schizophrenia. RESULTS 157 patients received either active (n = 76) or sham (n = 81) rTMS treatment. Apart from gender no significant group differences were observed. During intervention, Linear Mixed Model (LMM) analyses showed no significant time × group interactions nor time effects for any of the variables (all p > 0.055). During the whole trial beside a significant time × group interaction for diastolic BP (p = 0.017) in the standing posture, no significant time × group interactions for other variables (all p > 0.140) were found. CONCLUSION These secondary analyses of the largest available rTMS trial on the treatment of negative symptoms in schizophrenia did not show a significant effect of active rTMS compared to sham rTMS on heart rate or blood pressure, neither during the intervention period nor during the follow-up period.
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Affiliation(s)
- Mattia Campana
- Department of Psychiatry and Psychotherapy, Klinikum der Universität München, Ludwig-Maximilians-University, München, Germany.
| | - Elias Wagner
- Department of Psychiatry and Psychotherapy, Klinikum der Universität München, Ludwig-Maximilians-University, München, Germany
| | - Thomas Wobrock
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Germany; County Hospitals Darmstadt-Dieburg, Groß-Umstadt, Germany
| | - Berthold Langguth
- Department of Psychiatry and Psychotherapy, University of Regensburg, Germany
| | - Michael Landgrebe
- Department of Psychiatry and Psychotherapy, University of Regensburg, Germany; Department of Psychiatry, Psychosomatics and Psychotherapy, Kbo-Lech-Mangfall-Klinik Agatharied, Germany
| | - Peter Eichhammer
- Department of Psychiatry and Psychotherapy, University of Regensburg, Germany
| | - Elmar Frank
- Department of Psychiatry and Psychotherapy, University of Regensburg, Germany
| | - Joachim Cordes
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Wolfgang Wölwer
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Georg Winterer
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité- Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Wolfgang Gaebel
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Göran Hajak
- Department of Psychiatry, Psychosomatics and Psychotherapy, Sozialstiftung Bamberg, Bamberg, Germany
| | | | - Pablo E Verde
- Coordination Centre for Clinical Trials, Heinrich-Heine University, Düsseldorf, Germany
| | - Marcella Rietschel
- Department of Genetic Epidemiology in Psychiatry, Institute of Central Mental Health, Medical Faculty Mannheim, University of Heidelberg, Germany
| | - Berend Malchow
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Germany
| | - Raees Ahmed
- University Medical Center, Goettingen, Germany
| | - Wolfgang Strube
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, University of Augsburg, BKH, Augsburg, Germany
| | - Jan Häckert
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, University of Augsburg, BKH, Augsburg, Germany
| | - Thomas Schneider-Axmann
- Department of Psychiatry and Psychotherapy, Klinikum der Universität München, Ludwig-Maximilians-University, München, Germany
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, Klinikum der Universität München, Ludwig-Maximilians-University, München, Germany
| | - Alkomiet Hasan
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, University of Augsburg, BKH, Augsburg, Germany
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7
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Maurus I, Hasan A, Schmitt A, Roeh A, Keeser D, Malchow B, Schneider-Axmann T, Hellmich M, Schmied S, Lembeck M, Keller-Varady K, Papazova I, Hirjak D, Topor CE, Walter H, Mohnke S, Vogel BO, Wölwer W, Schneider F, Henkel K, Meyer-Lindenberg A, Falkai P. Aerobic endurance training to improve cognition and enhance recovery in schizophrenia: design and methodology of a multicenter randomized controlled trial. Eur Arch Psychiatry Clin Neurosci 2021; 271:315-324. [PMID: 32748261 PMCID: PMC8257533 DOI: 10.1007/s00406-020-01175-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 07/22/2020] [Indexed: 12/20/2022]
Abstract
Even today, patients with schizophrenia often have an unfavorable outcome. Negative symptoms and cognitive deficits are common features in many patients and prevent recovery. In recent years, aerobic endurance training has emerged as a therapeutic approach with positive effects on several domains of patients' health. However, appropriately sized, multicenter randomized controlled trials that would allow better generalization of results are lacking. The exercise study presented here is a multicenter, rater-blind, two-armed, parallel-group randomized clinical trial in patients with clinically stable schizophrenia being conducted at five German tertiary hospitals. The intervention group performs aerobic endurance training on bicycle ergometers three times per week for 40-50 min/session (depending on the intervention week) for a total of 26 weeks, and the control group performs balance and tone training for the same amount of time. Participants are subsequently followed up for 26 weeks. The primary endpoint is all-cause discontinuation; secondary endpoints include psychopathology, cognition, daily functioning, cardiovascular risk factors, and explorative biological measures regarding the underlying mechanisms of exercise. A total of 180 patients will be randomized. With currently 162 randomized participants, our study is the largest trial to date to investigate endurance training in patients with schizophrenia. We hypothesize that aerobic endurance training has beneficial effects on patients' mental and physical health, leading to lower treatment discontinuation rates and improving disease outcomes. The study results will provide a basis for recommending exercise interventions as an add-on therapy in patients with schizophrenia.The study is registered in the International Clinical Trials Database (ClinicalTrials.gov identifier [NCT number]: NCT03466112) and in the German Clinical Trials Register (DRKS-ID: DRKS00009804).
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Affiliation(s)
- Isabel Maurus
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336, Munich, Germany.
| | - Alkomiet Hasan
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336, Munich, Germany
- Department of Psychiatry and Psychosomatics of the University Augsburg, Bezirkskrankenhaus Augsburg, University of Augsburg, Augsburg, Germany
| | - Andrea Schmitt
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336, Munich, Germany
- Laboratory of Neuroscience (LIM27), Institute of Psychiatry, University of Sao Paulo, São Paulo, Brazil
| | - Astrid Roeh
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336, Munich, Germany
| | - Daniel Keeser
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336, Munich, Germany
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Berend Malchow
- Department of Psychiatry and Psychotherapy, University Hospital Göttingen, Göttingen, Germany
| | - Thomas Schneider-Axmann
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336, Munich, Germany
| | - Martin Hellmich
- Faculty of Medicine, Institute of Medical Statistics and Computational Biology, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Sabine Schmied
- Faculty of Medicine, Clinical Trials Centre Cologne, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Moritz Lembeck
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336, Munich, Germany
| | | | - Irina Papazova
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336, Munich, Germany
| | - Dusan Hirjak
- Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, Heidelberg, Germany
| | - Cristina E Topor
- Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, Heidelberg, Germany
| | - Henrik Walter
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Sebastian Mohnke
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Bob O Vogel
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Wolfgang Wölwer
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Duesseldorf, Germany
| | - Frank Schneider
- University Hospital, Heinrich-Heine University, Düsseldorf, Germany
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, RWTH, Aachen, Germany
| | - Karsten Henkel
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, RWTH, Aachen, Germany
| | - Andreas Meyer-Lindenberg
- Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, Heidelberg, Germany
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336, Munich, Germany
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Maurus I, Hasan A, Schmitt A, Roeh A, Keeser D, Malchow B, Schneider-Axmann T, Hellmich M, Schmied S, Lembeck M, Keller-Varady K, Papazova I, Hirjak D, Topor CE, Walter H, Mohnke S, Vogel BO, Wölwer W, Schneider F, Henkel K, Meyer-Lindenberg A, Falkai P. Correction to: Aerobic endurance training to improve cognition and enhance recovery in schizophrenia: design and methodology of a multicenter randomized controlled trial. Eur Arch Psychiatry Clin Neurosci 2021; 271:1405-1406. [PMID: 34226950 PMCID: PMC8429360 DOI: 10.1007/s00406-021-01289-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Isabel Maurus
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336, Munich, Germany.
| | - Alkomiet Hasan
- grid.5252.00000 0004 1936 973XDepartment of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336 Munich, Germany ,grid.7307.30000 0001 2108 9006Department of Psychiatry and Psychosomatics of the University Augsburg, Bezirkskrankenhaus Augsburg, University of Augsburg, Augsburg, Germany
| | - Andrea Schmitt
- grid.5252.00000 0004 1936 973XDepartment of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336 Munich, Germany ,grid.11899.380000 0004 1937 0722Laboratory of Neuroscience (LIM27), Institute of Psychiatry, University of Sao Paulo, São Paulo, Brazil
| | - Astrid Roeh
- grid.5252.00000 0004 1936 973XDepartment of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336 Munich, Germany
| | - Daniel Keeser
- grid.5252.00000 0004 1936 973XDepartment of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336 Munich, Germany ,grid.5252.00000 0004 1936 973XDepartment of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Berend Malchow
- grid.411984.10000 0001 0482 5331Department of Psychiatry and Psychotherapy, University Hospital Göttingen, Göttingen, Germany
| | - Thomas Schneider-Axmann
- grid.5252.00000 0004 1936 973XDepartment of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336 Munich, Germany
| | - Martin Hellmich
- grid.6190.e0000 0000 8580 3777Faculty of Medicine, Institute of Medical Statistics and Computational Biology, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Sabine Schmied
- grid.6190.e0000 0000 8580 3777Faculty of Medicine, Clinical Trials Centre Cologne, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Moritz Lembeck
- grid.5252.00000 0004 1936 973XDepartment of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336 Munich, Germany
| | - Katriona Keller-Varady
- grid.10423.340000 0000 9529 9877Institute of Sports Medicine, Hannover Medical School, Hannover, Germany
| | - Irina Papazova
- grid.5252.00000 0004 1936 973XDepartment of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336 Munich, Germany
| | - Dusan Hirjak
- grid.7700.00000 0001 2190 4373Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, Heidelberg, Germany
| | - Cristina E. Topor
- grid.7700.00000 0001 2190 4373Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, Heidelberg, Germany
| | - Henrik Walter
- grid.7468.d0000 0001 2248 7639Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Sebastian Mohnke
- grid.7468.d0000 0001 2248 7639Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Bob O. Vogel
- grid.7468.d0000 0001 2248 7639Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Wolfgang Wölwer
- grid.411327.20000 0001 2176 9917Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Duesseldorf, Germany
| | - Frank Schneider
- grid.14778.3d0000 0000 8922 7789University Hospital, Heinrich-Heine University, Düsseldorf, Germany ,grid.1957.a0000 0001 0728 696XDepartment of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, RWTH, Aachen, Germany
| | - Karsten Henkel
- grid.1957.a0000 0001 0728 696XDepartment of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, RWTH, Aachen, Germany
| | - Andreas Meyer-Lindenberg
- grid.7700.00000 0001 2190 4373Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, Heidelberg, Germany
| | - Peter Falkai
- grid.5252.00000 0004 1936 973XDepartment of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336 Munich, Germany
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9
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Pytlik N, Soll D, Hesse K, Moritz S, Bechdolf A, Herrlich J, Kircher T, Klingberg S, Landsberg MW, Müller BW, Wiedemann G, Wittorf A, Wölwer W, Wagner M, Mehl S. Problems in measuring the JTC-bias in patients with psychotic disorders with the fish task: a secondary analysis of a baseline assessment of a randomized controlled trial. BMC Psychiatry 2020; 20:554. [PMID: 33228583 PMCID: PMC7685639 DOI: 10.1186/s12888-020-02959-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 11/16/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The jumping to conclusions bias (JTC) is considered to be an important causal factor in theoretical models for the formation and maintenance of delusions. However, recent meta-analytic findings show a rather equivocal pattern of results regarding associations between JTC and delusions. Thus, the present study aims to investigate in a large sample whether the JTC-bias is more pronounced in patients with psychotic disorders in comparison to controls and whether the JTC bias is associated with a more severe delusional conviction, persecutory delusions, and positive symptoms in general. METHODS Patients with psychotic disorders (n = 300) enrolled in a therapy trial and healthy controls (n = 51) conducted a variant of the beads task (fish task) as a measure for the JTC-bias at the start of the trial. Further, clinical interviews were used to assess patients' delusional severity and delusional conviction. RESULTS There were no statistically significant differences between patients with psychotic disorders (with 53% displaying the JTC-bias) and controls (41%). Furthermore, there were no statistically significant correlations between JTC measures and persecutory delusions, delusional conviction, and positive symptoms. CONCLUSIONS We found no differences in JTC between patients with psychotic disorders and healthy controls, which is in part in line with meta-analytic findings using a wide range of JTC task variants. Interestingly, patients with psychotic disorders displayed JTC rates commonly found in the literature, while healthy control subjects showed an unexpectedly high level of JTC. The task variant we used in the present study (fish task) is discussed as a potential reason for our results, as it may induce a more deliberative reasoning style in controls as compared to the traditional beads task. Furthermore, possible implications for the measurement of the JTC-bias, in general, are discussed. TRIAL REGISTRATION ISRCTN29242879 ( isrctn.com ), date of registration: April 12th 2006, retrospectively registered.
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Affiliation(s)
- Nico Pytlik
- Department of Psychiatry and Psychotherapy & Center for Mind, Brain and Behavior (MCMBB), Philipps-University, Rudolf-Bultmann-Str. 8, 35039, Marburg, Germany.
| | - Daniel Soll
- grid.10253.350000 0004 1936 9756Department of Psychiatry and Psychotherapy & Center for Mind, Brain and Behavior (MCMBB), Philipps-University, Rudolf-Bultmann-Str. 8, 35039 Marburg, Germany
| | - Klaus Hesse
- grid.10392.390000 0001 2190 1447Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Steffen Moritz
- grid.9026.d0000 0001 2287 2617Department of Psychiatry and Psychotherapy, University of Hamburg, Hamburg, Germany
| | - Andreas Bechdolf
- grid.6190.e0000 0000 8580 3777Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany ,grid.433867.d0000 0004 0476 8412Department of Psychiatry and Psychotherapy, Vivantes Klinikum am Urban - Teaching Hospital Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Jutta Herrlich
- grid.7839.50000 0004 1936 9721Department of Psychiatry, Psychosomatics and Psychotherapy, University of Frankfurt, Frankfurt, Germany
| | - Tilo Kircher
- grid.10253.350000 0004 1936 9756Department of Psychiatry and Psychotherapy & Center for Mind, Brain and Behavior (MCMBB), Philipps-University, Rudolf-Bultmann-Str. 8, 35039 Marburg, Germany
| | - Stefan Klingberg
- grid.10392.390000 0001 2190 1447Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Martin W. Landsberg
- grid.10388.320000 0001 2240 3300Department of Psychiatry and Psychotherapy, Friedrich-Wilhelms University of Bonn, Bonn, Germany
| | - Bernhard W. Müller
- grid.5718.b0000 0001 2187 5445Department of Psychiatry and Psychotherapy, University of Duisburg-Essen, Essen, Germany
| | - Georg Wiedemann
- Departmenf of Psychiatry and Psychotherapy, Hospital Fulda, Fulda, Germany
| | - Andreas Wittorf
- grid.10392.390000 0001 2190 1447Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Wolfgang Wölwer
- grid.411327.20000 0001 2176 9917Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University of Düsseldorf, Düsseldorf, Germany
| | - Michael Wagner
- grid.7839.50000 0004 1936 9721Department of Psychiatry, Psychosomatics and Psychotherapy, University of Frankfurt, Frankfurt, Germany
| | - Stephanie Mehl
- grid.10253.350000 0004 1936 9756Department of Psychiatry and Psychotherapy & Center for Mind, Brain and Behavior (MCMBB), Philipps-University, Rudolf-Bultmann-Str. 8, 35039 Marburg, Germany ,grid.7839.50000 0004 1936 9721Department of Psychiatry, Psychosomatics and Psychotherapy, University of Frankfurt, Frankfurt, Germany
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10
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Kössler T, Weber KS, Wölwer W, Hoyer A, Strassburger K, Burkart V, Szendroedi J, Roden M, Müssig K. Associations between cognitive performance and Mediterranean dietary pattern in patients with type 1 or type 2 diabetes mellitus. Nutr Diabetes 2020; 10:10. [PMID: 32238800 PMCID: PMC7113267 DOI: 10.1038/s41387-020-0111-z] [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] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 02/20/2020] [Accepted: 02/21/2020] [Indexed: 11/30/2022] Open
Abstract
Diabetes mellitus has been associated with impaired cognitive performance, particularly in verbal memory. Mediterranean diets (MedD) may lead to improvements in overall and single cognitive functions. We hypothesised that adherence to MedD associates with better performance in verbal memory in patients with type 1 or type 2 diabetes. Thus, we performed a cross-sectional analysis including patients with recently diagnosed type 1 (n = 75) or type 2 diabetes (n = 118), metabolically healthy individuals (n = 41) and individuals with type 1 (n = 44) or type 2 diabetes (n = 62) of at least five years after diagnosis. Participants underwent comprehensive metabolic phenotyping and cognitive testing. Adherence to the Modified Mediterranean diet scale (MMDS) was computed from a food frequency questionnaire. Among patients with type 2 diabetes with a known diabetes duration ≥5 years, closer adherence to the MMDS was associated with higher score in verbal memory after adjustment for potential confounders (P = 0.043). Adherence to the MMDS did not relate to verbal memory in recently diagnosed type 2 diabetes (P = 0.275), recently diagnosed or longer-standing type 1 diabetes (P = 0.215 and P = 0.626, respectively) or metabolically healthy individuals (P = 0.666). In conclusion, closer adherence to MedD may exert beneficial effects on cognitive performance in the course of type 2 diabetes.
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Affiliation(s)
- Theresa Kössler
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany.,Division of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany.,German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Katharina S Weber
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany.,German Center for Diabetes Research (DZD), München-Neuherberg, Germany.,Institute of Epidemiology, University of Kiel, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Wolfgang Wölwer
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Annika Hoyer
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany.,Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Klaus Strassburger
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany.,Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Volker Burkart
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany.,German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Julia Szendroedi
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany.,Division of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany.,German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Michael Roden
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany.,Division of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany.,German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Karsten Müssig
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany. .,Division of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany. .,German Center for Diabetes Research (DZD), München-Neuherberg, Germany.
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Mehl S, Hesse K, Schmidt AC, Landsberg MW, Soll D, Bechdolf A, Herrlich J, Kircher T, Klingberg S, Müller BW, Wiedemann G, Wittorf A, Wölwer W, Wagner M. Theory of mind, emotion recognition, delusions and the quality of the therapeutic relationship in patients with psychosis - a secondary analysis of a randomized-controlled therapy trial. BMC Psychiatry 2020; 20:59. [PMID: 32041577 PMCID: PMC7011563 DOI: 10.1186/s12888-020-2482-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 02/04/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Cognitive models of psychosis postulate an important role of Theory of mind (ToM) in the formation and maintenance of delusions, but research on this plausible conjecture has gathered conflicting findings. In addition, it is still an open question whether problems in emotion recognition (ER) are associated with delusions. We examined the association of problems in ToM and ER with different aspects of delusions in a large sample of patients with psychosis enrolled in a therapy trial. This also enabled us to explore the possible impact of ToM and ER on one part of patients' social life: the quality of their therapeutic relationship. METHODS Patients with psychotic disorders and delusions and/or hallucinations (n = 185) and healthy controls (n = 48) completed a ToM picture sequencing task and an ER task. Subsequently, patients were enrolled in a randomized-controlled Cognitive Behavior Therapy (CBT) trial (ISRCTN29242879). Patients and therapists rated the quality of the therapeutic relationship during the first five sessions of therapy. RESULTS In comparison to controls, patients were impaired in both ToM and ER. Patients with deficits in ER experienced more severe delusional distress, whereas ToM problems were not related to delusions. In addition, deficits in ER predicted a less favorable therapeutic relationship and interactional problems viewed by the therapist. Impaired ER also moderated (increased) the negative influence of delusions on the therapeutic relationship and interactional difficulties viewed by the therapist. CONCLUSIONS Cognitive models on the formation and maintenance of delusions should consider ER as a potential candidate that might be related to the formation and maintenance of delusional distress, whereas problems in ToM might not be directly related to delusions and secondary dimensions of delusions. In addition, problems in ER in patients with psychosis might have an impact on the quality of the therapeutic relationship and patients with problems in ER are more likely to be viewed as problematic by their therapists. Nevertheless, training ER might be a way to improve the quality of the therapeutic relationship and potentially the effectiveness of CBT or other interventions for patients with psychosis.
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Affiliation(s)
- Stephanie Mehl
- Department of Psychiatry and Psychotherapy, University of Bonn, Sigmund-Freud-Straße 25, 53105, Bonn, Germany. .,Department of Psychiatry and Psychotherapy, Philipps-University of Marburg, Rudolf-Bultmann-Straße 8, 35039, Marburg, Germany.
| | - Klaus Hesse
- grid.10392.390000 0001 2190 1447Department of Psychiatry and Psychotherapy, University of Tübingen, Calwerstraße 14, 72076 Tübingen, Germany
| | - Anna-Christine Schmidt
- grid.10388.320000 0001 2240 3300Department of Psychiatry and Psychotherapy, University of Bonn, Sigmund-Freud-Straße 25, 53105 Bonn, Germany
| | - Martin W. Landsberg
- grid.10388.320000 0001 2240 3300Department of Psychiatry and Psychotherapy, University of Bonn, Sigmund-Freud-Straße 25, 53105 Bonn, Germany
| | - Daniel Soll
- grid.10253.350000 0004 1936 9756Department of Psychiatry and Psychotherapy, Philipps-University of Marburg, Rudolf-Bultmann-Straße 8, 35039 Marburg, Germany
| | - Andreas Bechdolf
- grid.6190.e0000 0000 8580 3777Department of Psychiatry and Psychotherapy, University of Cologne, Gleuler Straße, 50931 Köln, Germany ,Department of Psychiatry and Psychotherapy, Vivantes Hospital Berlin, Dieffenbachstraße 1, 10967 Berlin, Germany
| | - Jutta Herrlich
- grid.7839.50000 0004 1936 9721Department of Psychiatry, Psychosomatic and Psychotherapy, University of Frankfurt, Heinrich-Hoffmann-Straße 10, 60528 Frankfurt am Main, Germany
| | - Tilo Kircher
- grid.10253.350000 0004 1936 9756Department of Psychiatry and Psychotherapy, Philipps-University of Marburg, Rudolf-Bultmann-Straße 8, 35039 Marburg, Germany
| | - Stefan Klingberg
- grid.10392.390000 0001 2190 1447Department of Psychiatry and Psychotherapy, University of Tübingen, Calwerstraße 14, 72076 Tübingen, Germany
| | - Bernhard W. Müller
- grid.5718.b0000 0001 2187 5445Department of Psychiatry and Psychotherapy, University of Duisburg- Essen, Virchowstraße 147, 45147 Essen, Germany
| | - Georg Wiedemann
- Department of Psychiatry and Psychotherapy, Hospital Fulda, Pacelliallee 4, 36043 Fulda, Germany
| | - Andreas Wittorf
- grid.10392.390000 0001 2190 1447Department of Psychiatry and Psychotherapy, University of Tübingen, Calwerstraße 14, 72076 Tübingen, Germany
| | - Wolfgang Wölwer
- grid.411327.20000 0001 2176 9917Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University of Düsseldorf, Bergische Landstraße 2, 40629 Düsseldorf, Germany
| | - Michael Wagner
- grid.10388.320000 0001 2240 3300Department of Psychiatry and Psychotherapy, University of Bonn, Sigmund-Freud-Straße 25, 53105 Bonn, Germany
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12
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Kleineidam L, Frommann I, Ruhrmann S, Klosterkötter J, Brockhaus-Dumke A, Wölwer W, Gaebel W, Maier W, Wagner M, Ettinger U. Antisaccade and prosaccade eye movements in individuals clinically at risk for psychosis: comparison with first-episode schizophrenia and prediction of conversion. Eur Arch Psychiatry Clin Neurosci 2019; 269:921-930. [PMID: 30635714 DOI: 10.1007/s00406-018-0973-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 12/19/2018] [Indexed: 02/03/2023]
Abstract
Saccadic eye movements are well-described markers of cerebral function and have been widely studied in schizophrenia spectrum populations. However, less is known about saccades in individuals clinically at risk for schizophrenia. Therefore, we studied individuals in an at-risk mental state (ARMS) (N = 160), patients in their first episode of schizophrenia (N = 32) and healthy controls (N = 75). N = 88 ARMS participants showed an early at-risk mental state (E-ARMS), defined by cognitive-perceptive basic symptoms (COPER) or a combination of risk and loss of function, whereas N = 72 were in a late at-risk mental state (L-ARMS), defined by attenuated psychotic symptoms or brief limited intermittent psychotic symptoms. We examined prosaccades, reflecting overt attentional shifts, and antisaccades, measuring inhibitory control, as well as their relationship as an indicator of the interplay of bottom-up and top-down influences. L-ARMS but not E-ARMS participants had increased antisaccade latencies compared to controls. First-episode patients had higher antisaccade error rates compared to E-ARMS participants and controls, and increased latencies compared to all other groups. Prosaccade latencies did not differ between groups. We observed the expected negative correlation between prosaccade latency and antisaccade error rate, indicating that individuals with shorter prosaccade latencies made more antisaccade errors. The magnitude of the association did not differ between groups. No saccadic measure predicted conversion to psychosis within 2 years. These findings confirm the existence of antisaccade impairments in patients with schizophrenia and provide evidence that volitional response generation in the antisaccade task may be affected even before onset of clinically overt psychosis.
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Affiliation(s)
- Luca Kleineidam
- Department of Psychiatry and Psychotherapy, University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany.,Department for Neurodegenerative Diseases and Geriatric Psychiatry, University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - Ingo Frommann
- Department of Psychiatry and Psychotherapy, University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany.,Department for Neurodegenerative Diseases and Geriatric Psychiatry, University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - Stephan Ruhrmann
- Department of Psychiatry and Psychotherapy, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Joachim Klosterkötter
- Department of Psychiatry and Psychotherapy, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Anke Brockhaus-Dumke
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Rheinhessen-Fachklinik Alzey, Dautenheimer Landstraße 66, 55232, Alzey, Germany
| | - Wolfgang Wölwer
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Wolfgang Gaebel
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Wolfgang Maier
- Department of Psychiatry and Psychotherapy, University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany.,Department for Neurodegenerative Diseases and Geriatric Psychiatry, University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - Michael Wagner
- Department of Psychiatry and Psychotherapy, University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany. .,Department for Neurodegenerative Diseases and Geriatric Psychiatry, University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany.
| | - Ulrich Ettinger
- Department of Psychology, University of Bonn, Kaiser-Karl-Ring 9, 53111, Bonn, Germany
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13
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Chaturvedi SK, Manche Gowda S, Ahmed HU, Alosaimi FD, Andreone N, Bobrov A, Bulgari V, Carrà G, Castelnuovo G, de Girolamo G, Gondek T, Jovanovic N, Kamala T, Kiejna A, Lalic N, Lecic-Tosevski D, Minhas F, Mutiso V, Ndetei D, Rabbani G, Somruk S, Srikanta S, Taj R, Valentini U, Vukovic O, Wölwer W, Cimino L, Nouwen A, Lloyd C, Sartorius N. More anxious than depressed: prevalence and correlates in a 15-nation study of anxiety disorders in people with type 2 diabetes mellitus. Gen Psychiatr 2019; 32:e100076. [PMID: 31552386 PMCID: PMC6738670 DOI: 10.1136/gpsych-2019-100076] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 07/11/2019] [Accepted: 07/14/2019] [Indexed: 01/02/2023] Open
Abstract
Background Anxiety disorder, one of the highly disabling, prevalent and common mental disorders, is known to be more prevalent in persons with type 2 diabetes mellitus (T2DM) than the general population, and the comorbid presence of anxiety disorders is known to have an impact on the diabetes outcome and the quality of life. However, the information on the type of anxiety disorder and its prevalence in persons with T2DM is limited. Aims To assess the prevalence and correlates of anxiety disorder in people with type 2 diabetes in different countries. Methods People aged 18–65 years with diabetes and treated in outpatient settings were recruited in 15 countries and underwent a psychiatric interview with the Mini-International Neuropsychiatric Interview. Demographic and medical record data were collected. Results A total of 3170 people with type 2 diabetes (56.2% women; with mean (SD) duration of diabetes 10.01 (7.0) years) participated. The overall prevalence of anxiety disorders in type 2 diabetic persons was 18%; however, 2.8% of the study population had more than one type of anxiety disorder. The most prevalent anxiety disorders were generalised anxiety disorder (8.1%) and panic disorder (5.1%). Female gender, presence of diabetic complications, longer duration of diabetes and poorer glycaemic control (HbA1c levels) were significantly associated with comorbid anxiety disorder. A higher prevalence of anxiety disorders was observed in Ukraine, Saudi Arabia and Argentina with a lower prevalence in Bangladesh and India. Conclusions Our international study shows that people with type 2 diabetes have a high prevalence of anxiety disorders, especially women, those with diabetic complications, those with a longer duration of diabetes and poorer glycaemic control. Early identification and appropriate timely care of psychiatric problems of people with type 2 diabetes is warranted.
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Affiliation(s)
- Santosh K Chaturvedi
- Department of Psychiatry, National Institute of Mental Health and Neuro-Sciences, Bangalore, India
| | - Shayanth Manche Gowda
- Department of Psychiatry, National Institute of Mental Health and Neuro-Sciences, Bangalore, India
| | - Helal Uddin Ahmed
- Child Adolescent and Family Psychiatry, National Institute of Mental Health, Dhaka, Bangladesh
| | - Fahad D Alosaimi
- Department of Psychiatry, King Saud University, Riyadh, Saudi Arabia
| | | | - Alexey Bobrov
- National Research Centre for Psychiatry and Narcology, Moscow, Russia
| | - Viola Bulgari
- IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | | | | | | | - Tomasz Gondek
- Department of Psychiatry, Wroclaw Medical University, Wroclaw, Poland
| | | | - Thummala Kamala
- Samatvam Endocrinology Diabetes Center and Jnana Sanjeevini Diabetes Hospital and Medical Center, Bangalore, India
| | | | | | | | - Fareed Minhas
- Center for Global Mental Health, Rawalpindi, Pakistan
| | | | | | - Golam Rabbani
- Child Adolescent and Family Psychiatry, National Institute of Mental Health, Dhaka, Bangladesh
| | | | - Sathyanarayana Srikanta
- Samatvam Endocrinology Diabetes Center and Jnana Sanjeevini Diabetes Hospital and Medical Center, Bangalore, India
| | - Rizwan Taj
- Pakistan Institute of Medical Sciences, Islamabad, Pakistan
| | - Umberto Valentini
- IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | | | - Wolfgang Wölwer
- Department of Psychiatry and Psychotherapy, Medical Faculty, University of Düsseldorf, Dusseldorf, Germany
| | | | - Arie Nouwen
- Department of Psychiatry, National Institute of Mental Health and Neuro-Sciences, Bangalore, India.,Child Adolescent and Family Psychiatry, National Institute of Mental Health, Dhaka, Bangladesh.,Department of Psychiatry, King Saud University, Riyadh, Saudi Arabia.,IRCCS Ospedale Sacro Cuore Don Calabria, Negrar, Italy.,National Research Centre for Psychiatry and Narcology, Moscow, Russia.,IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy.,University of Milano-Bicocca, Bicocca, Italy.,Department of Psychology, Catholic University, Milan, Italy.,Department of Psychiatry, Wroclaw Medical University, Wroclaw, Poland.,Institute of Mental Health, Belgrade, Serbia.,Samatvam Endocrinology Diabetes Center and Jnana Sanjeevini Diabetes Hospital and Medical Center, Bangalore, India.,University of Lower Silesia, Wroclaw, Poland.,Center for Global Mental Health, Rawalpindi, Pakistan.,University of Nairobi, Nairobi, Kenya.,Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Pakistan Institute of Medical Sciences, Islamabad, Pakistan.,Department of Psychiatry and Psychotherapy, Medical Faculty, University of Düsseldorf, Dusseldorf, Germany.,ProConsult, Owings Mills, Maryland, USA
| | - Cathy Lloyd
- Department of Psychiatry, National Institute of Mental Health and Neuro-Sciences, Bangalore, India.,Child Adolescent and Family Psychiatry, National Institute of Mental Health, Dhaka, Bangladesh.,Department of Psychiatry, King Saud University, Riyadh, Saudi Arabia.,IRCCS Ospedale Sacro Cuore Don Calabria, Negrar, Italy.,National Research Centre for Psychiatry and Narcology, Moscow, Russia.,IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy.,University of Milano-Bicocca, Bicocca, Italy.,Department of Psychology, Catholic University, Milan, Italy.,Department of Psychiatry, Wroclaw Medical University, Wroclaw, Poland.,Institute of Mental Health, Belgrade, Serbia.,Samatvam Endocrinology Diabetes Center and Jnana Sanjeevini Diabetes Hospital and Medical Center, Bangalore, India.,University of Lower Silesia, Wroclaw, Poland.,Center for Global Mental Health, Rawalpindi, Pakistan.,University of Nairobi, Nairobi, Kenya.,Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Pakistan Institute of Medical Sciences, Islamabad, Pakistan.,Department of Psychiatry and Psychotherapy, Medical Faculty, University of Düsseldorf, Dusseldorf, Germany.,ProConsult, Owings Mills, Maryland, USA
| | - Norman Sartorius
- Department of Psychiatry, National Institute of Mental Health and Neuro-Sciences, Bangalore, India.,Child Adolescent and Family Psychiatry, National Institute of Mental Health, Dhaka, Bangladesh.,Department of Psychiatry, King Saud University, Riyadh, Saudi Arabia.,IRCCS Ospedale Sacro Cuore Don Calabria, Negrar, Italy.,National Research Centre for Psychiatry and Narcology, Moscow, Russia.,IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy.,University of Milano-Bicocca, Bicocca, Italy.,Department of Psychology, Catholic University, Milan, Italy.,Department of Psychiatry, Wroclaw Medical University, Wroclaw, Poland.,Institute of Mental Health, Belgrade, Serbia.,Samatvam Endocrinology Diabetes Center and Jnana Sanjeevini Diabetes Hospital and Medical Center, Bangalore, India.,University of Lower Silesia, Wroclaw, Poland.,Center for Global Mental Health, Rawalpindi, Pakistan.,University of Nairobi, Nairobi, Kenya.,Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Pakistan Institute of Medical Sciences, Islamabad, Pakistan.,Department of Psychiatry and Psychotherapy, Medical Faculty, University of Düsseldorf, Dusseldorf, Germany.,ProConsult, Owings Mills, Maryland, USA
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14
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Wagner E, Wobrock T, Kunze B, Langguth B, Landgrebe M, Eichhammer P, Frank E, Cordes J, Wölwer W, Winterer G, Gaebel W, Hajak G, Ohmann C, Verde PE, Rietschel M, Ahmed R, Honer WG, Siskind D, Malchow B, Strube W, Schneider-Axmann T, Falkai P, Hasan A. Efficacy of high-frequency repetitive transcranial magnetic stimulation in schizophrenia patients with treatment-resistant negative symptoms treated with clozapine. Schizophr Res 2019; 208:370-376. [PMID: 30704862 DOI: 10.1016/j.schres.2019.01.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 01/17/2019] [Accepted: 01/19/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Repetitive transcranial magnetic stimulation (rTMS) is a promising augmentation treatment for schizophrenia, however there are few controlled studies of rTMS augmentation of clozapine. METHODS Using data from the 'rTMS for the Treatment of Negative Symptoms in Schizophrenia' (RESIS) trial we examined the impact of rTMS on PANSS total, general, positive and negative symptoms among participants on clozapine. rTMS was applied to the left dorsolateral prefrontal cortex (DLPFC) for five treatment sessions/week for 3-weeks as augmentation for patients with a predominant negative syndrome of schizophrenia, as rated on PANSS. RESULTS 26 participants from the RESIS trial were on clozapine, receiving active (N=12) or sham (N=14) rTMS treatment. In our Linear Mixed Model (LMM) analysis, time×group interactions were significant in the PANSS positive subscale (p=0.003) (not being the corresponding behavioral output for DLPFC stimulation), the PANSS general subscale (p<0.001), the PANSS total scale (p=0.015), but not the PANSS negative subscale (p=0.301) (primary endpoint of the RESIS trial), when all PANSS measurements from screening to day 105 were included. Descriptive data suggests that in the active group the improvement was more pronounced compared to the sham rTMS group. CONCLUSIONS In this largest available clozapine cohort, active rTMS may be more effective than sham rTMS when added to clozapine for positive and total psychotic symptoms. These findings should be interpreted with caution given this is a secondary analysis with a limited number of participants.
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Affiliation(s)
- Elias Wagner
- Department of Psychiatry and Psychotherapy, Klinikum der Universität München, University Hospital, LMU Munich, Germany.
| | - Thomas Wobrock
- Department of Psychiatry and Psychotherapy, Georg-August-University Goettingen, Germany; County Hospitals Darmstadt-Dieburg, Groß-Umstadt, Germany
| | - Birgit Kunze
- Department of Psychiatry and Psychotherapy, Georg-August-University Goettingen, Germany
| | - Berthold Langguth
- Department of Psychiatry and Psychotherapy, University of Regensburg, Germany
| | - Michael Landgrebe
- Department of Psychiatry and Psychotherapy, University of Regensburg, Germany; Department of Psychiatry, Psychosomatics and Psychotherapy, kbo-Lech-Mangfall-Klinik Agatharied, Germany
| | - Peter Eichhammer
- Department of Psychiatry and Psychotherapy, University of Regensburg, Germany
| | - Elmar Frank
- Department of Psychiatry and Psychotherapy, University of Regensburg, Germany
| | - Joachim Cordes
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Wolfgang Wölwer
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Georg Winterer
- Experimental & Clinical Research Center (ECRC), Department of Anesthesiology and Operative Intensive Care Medicine, Charité - University Medicine Berlin, Germany
| | - Wolfgang Gaebel
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Göran Hajak
- Department of Psychiatry, Psychosomatics and Psychotherapy, Sozialstiftung Bamberg, Bamberg, Germany
| | | | - Pablo E Verde
- Coordination Centre for Clinical Trials, Heinrich-Heine University, Düsseldorf, Germany
| | - Marcella Rietschel
- Department of Genetic Epidemiology in Psychiatry, Institute of Central Mental Health, Medical Faculty Mannheim, University of Heidelberg, Germany
| | - Raees Ahmed
- Studienzentrum, Universitätsmedizin Göttingen, Germany
| | - William G Honer
- Institute of Mental Health, The University of British Columbia, Canada
| | - Dan Siskind
- School of Medicine, University of Queensland, Brisbane, Australia; Metro South Addiction and Mental Health Service, Brisbane, Australia
| | - Berend Malchow
- Department of Psychiatry and Psychotherapy, University Hospital Jena, Germany
| | - Wolfgang Strube
- Department of Psychiatry and Psychotherapy, Klinikum der Universität München, University Hospital, LMU Munich, Germany
| | - Thomas Schneider-Axmann
- Department of Psychiatry and Psychotherapy, Klinikum der Universität München, University Hospital, LMU Munich, Germany
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, Klinikum der Universität München, University Hospital, LMU Munich, Germany
| | - Alkomiet Hasan
- Department of Psychiatry and Psychotherapy, Klinikum der Universität München, University Hospital, LMU Munich, Germany
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15
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Kamp D, Engelke C, Wobrock T, Wölwer W, Winterer G, Schmidt-Kraepelin C, Gaebel W, Langguth B, Landgrebe M, Eichhammer P, Frank E, Hajak G, Ohmann C, Verde PE, Rietschel M, Raees A, Honer WG, Malchow B, Schneider-Axmann T, Falkai P, Hasan A, Cordes J. Left prefrontal high-frequency rTMS may improve movement disorder in schizophrenia patients with predominant negative symptoms - A secondary analysis of a sham-controlled, randomized multicenter trial. Schizophr Res 2019; 204:445-447. [PMID: 30249471 DOI: 10.1016/j.schres.2018.09.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 05/11/2018] [Revised: 09/13/2018] [Accepted: 09/16/2018] [Indexed: 11/18/2022]
Affiliation(s)
- Daniel Kamp
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany.
| | - Christina Engelke
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany.
| | - Thomas Wobrock
- Department of Psychiatry and Psychotherapy, Georg-August-University Göttingen, Göttingen, Germany; Department of Psychiatry and Psychotherapy, County Hospitals Darmstadt-Dieburg, Groß-Umstadt, Germany.
| | - Wolfgang Wölwer
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany.
| | - Georg Winterer
- Clinical Neuroscience Research Group, Experimental and Clinical Research Center (ECRC), Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
| | - Christian Schmidt-Kraepelin
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany.
| | - Wolfgang Gaebel
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany.
| | - Berthold Langguth
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany.
| | - Michael Landgrebe
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany; Department of Psychiatry, Psychosomatics and Psychotherapy, kbo-Lech-Mangfall-Klinik Agatharied, Agatharied, Germany.
| | - Peter Eichhammer
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany.
| | - Elmar Frank
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany.
| | - Göran Hajak
- Department of Psychiatry, Psychosomatics and Psychotherapy, Sozialstiftung Bamberg, Bamberg, Germany.
| | | | - Pablo E Verde
- Coordination Centre for Clinical Trials, Heinrich-Heine University, Düsseldorf, Germany.
| | - Marcella Rietschel
- Department of Genetic Epidemiology in Psychiatry, Institute of Central Mental Health, Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany.
| | - Ahmed Raees
- Referat Klinische Studien Management, University Medical Center Göttingen, Germany.
| | - William G Honer
- Department of Genetic Epidemiology in Psychiatry, Institute of Mental Health, The University of British Columbia, Vancouver, BC, Canada.
| | - Berend Malchow
- Department of Psychiatry and Psychotherapy, University Hospital Jena, Jena, Germany.
| | | | - Peter Falkai
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany.
| | - Alkomiet Hasan
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany.
| | - Joachim Cordes
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany.
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16
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Kampka N, Frommann N, Henning U, Schwark R, Wölwer W, Pietrowsky R, Luckhaus C. Oxytocin reactivity to an emotional challenge paradigm and its relation to social-cognitive functions in healthy volunteers. J Neural Transm (Vienna) 2018; 126:211-218. [DOI: 10.1007/s00702-018-1955-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 11/06/2018] [Indexed: 12/16/2022]
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17
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Müller H, de Millas W, Gaebel W, Herrlich J, Hasan A, Janssen B, Juckel G, Karow A, Kircher T, Kiszkenow-Bäker S, Klingberg S, Klosterkötter J, Krüger-Özgürdal S, Lambert M, Lautenschlager M, Maier W, Michel TM, Mehl S, Müller BW, Pützfeld V, Rausch F, Riedel M, Sartory G, Schneider F, Wagner M, Wiedemann G, Wittorf A, Wobrock T, Wölwer W, Zink M, Bechdolf A. Negative schemata about the self and others and paranoid ideation in at-risk states and those with persisting positive symptoms. Early Interv Psychiatry 2018; 12:1157-1165. [PMID: 28524542 DOI: 10.1111/eip.12433] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 12/13/2016] [Accepted: 01/19/2017] [Indexed: 01/24/2023]
Abstract
BACKGROUND The objective of this study is to test the conflicting theories concerning the association of negative self and other schemata and paranoid ideation. METHODS A risk-based approach, including risk stratification, is used to gain insight into the association of the negative self and other schemata that may be shared by individuals or differentiate between individuals at clinical high risk (CHR) for a first-episode psychosis and those with full-blown psychosis. The dataset includes a sample of individuals at CHR (n = 137) and a sample of individuals with persisting positive symptoms (PPS, n = 211). The CHR sample was subdivided according to a prognostic index yielding 4 CHR sub-classes with increasing risk for transition to psychosis. RESULTS Negative beliefs about the self were associated with paranoid ideation in CHR and a lower risk state. In the highest risk state and full-blown psychosis, there is an association with negative beliefs about others. CONCLUSION These findings are in line with theories suggesting a switch from a predominantly activated negative self-schema to a malevolent others-schema in association with paranoid ideation along the risk-continuum. However, due to methodological limitations these results should be replicated by future studies.
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Affiliation(s)
- Hendrik Müller
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
| | - Walter de Millas
- Department of Psychiatry and Psychotherapy, Charité University Medicine Campus Mitte, Berlin, Germany
| | - Wolfgang Gaebel
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Duesseldorf, Germany
| | - Jutta Herrlich
- Department of Psychiatry, Psychosomatics and Psychotherapy, Goethe-University of Frankfurt am Main, Frankfurt am Main, Germany
| | - Alkomiet Hasan
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Birgit Janssen
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Duesseldorf, Germany
| | - Georg Juckel
- Department of Psychiatry, Psychotherapy, and Preventive Medicine, Ruhr University Bochum, Bochum, Germany
| | - Anne Karow
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Tilo Kircher
- Department of Psychiatry and Psychotherapy, Philipps-University of Marburg, Marburg, Germany
| | - Stefanie Kiszkenow-Bäker
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Duesseldorf, Germany
| | - Stefan Klingberg
- Department of Psychiatry and Psychotherapy, Eberhard-Karls-University of Tuebingen, Tuebingen, Germany
| | | | - Seza Krüger-Özgürdal
- Department of Psychiatry, Psychotherapy, and Preventive Medicine, Ruhr University Bochum, Bochum, Germany
| | - Martin Lambert
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Marion Lautenschlager
- Department of Psychiatry and Psychotherapy, Charité University Medicine Campus Mitte, Berlin, Germany
| | - Wolfgang Maier
- Department of Psychiatry and Psychotherapy, Rhineland Friedrich Wilhelms University of Bonn, Bonn, Germany
| | - Tanja Maria Michel
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen, Aachen, Germany
| | - Stefanie Mehl
- Department of Psychiatry and Psychotherapy, Philipps-University of Marburg, Marburg, Germany
| | - Bernhard W Müller
- Department for Psychiatry and Psychotherapy, LVR-Clinic Essen, Faculty of Medicine, University of Duisburg-Essen, Duisburg, Germany
| | - Verena Pützfeld
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
| | - Franziska Rausch
- Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Michael Riedel
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Gudrun Sartory
- Department of Clinical Psychology, University of Wuppertal, Wuppertal, Germany
| | - Frank Schneider
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen, Aachen, Germany
| | - Michael Wagner
- Department of Psychiatry and Psychotherapy, Rhineland Friedrich Wilhelms University of Bonn, Bonn, Germany
| | - Georg Wiedemann
- Department of Psychiatry, Psychosomatics and Psychotherapy, Goethe-University of Frankfurt am Main, Frankfurt am Main, Germany
| | - Andreas Wittorf
- Department of Psychiatry and Psychotherapy, Eberhard-Karls-University of Tuebingen, Tuebingen, Germany
| | - Thomas Wobrock
- Department of Psychiatry and Psychotherapy, Georg-August-University Goettingen, Goettingen, Germany
| | - Wolfgang Wölwer
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Duesseldorf, Germany
| | - Mathias Zink
- Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Andreas Bechdolf
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany.,Department of Psychiatry, Psychotherapy and Psychosomatics, Vivantes Clinic am Urban and Vivantes Clinic im Friedrichshain, Academic Hospital Charité, Berlin, Germany
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18
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Koutsouleris N, Wobrock T, Guse B, Langguth B, Landgrebe M, Eichhammer P, Frank E, Cordes J, Wölwer W, Musso F, Winterer G, Gaebel W, Hajak G, Ohmann C, Verde PE, Rietschel M, Ahmed R, Honer WG, Dwyer D, Ghaseminejad F, Dechent P, Malchow B, Kreuzer PM, Poeppl TB, Schneider-Axmann T, Falkai P, Hasan A. Predicting Response to Repetitive Transcranial Magnetic Stimulation in Patients With Schizophrenia Using Structural Magnetic Resonance Imaging: A Multisite Machine Learning Analysis. Schizophr Bull 2018; 44:1021-1034. [PMID: 28981875 PMCID: PMC6101524 DOI: 10.1093/schbul/sbx114] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND The variability of responses to plasticity-inducing repetitive transcranial magnetic stimulation (rTMS) challenges its successful application in psychiatric care. No objective means currently exists to individually predict the patients' response to rTMS. METHODS We used machine learning to develop and validate such tools using the pre-treatment structural Magnetic Resonance Images (sMRI) of 92 patients with schizophrenia enrolled in the multisite RESIS trial (http://clinicaltrials.gov, NCT00783120): patients were randomized to either active (N = 45) or sham (N = 47) 10-Hz rTMS applied to the left dorsolateral prefrontal cortex 5 days per week for 21 days. The prediction target was nonresponse vs response defined by a ≥20% pre-post Positive and Negative Syndrome Scale (PANSS) negative score reduction. RESULTS Our models predicted this endpoint with a cross-validated balanced accuracy (BAC) of 85% (nonresponse/response: 79%/90%) in patients receiving active rTMS, but only with 51% (48%/55%) in the sham-treated sample. Leave-site-out cross-validation demonstrated cross-site generalizability of the active rTMS predictor despite smaller training samples (BAC: 71%). The predictive pre-treatment pattern involved gray matter density reductions in prefrontal, insular, medio-temporal, and cerebellar cortices, and increments in parietal and thalamic structures. The low BAC of 58% produced by the active rTMS predictor in sham-treated patients, as well as its poor performance in predicting positive symptom courses supported the therapeutic specificity of this brain pattern. CONCLUSIONS Individual responses to active rTMS in patients with predominant negative schizophrenia may be accurately predicted using structural neuromarkers. Further multisite studies are needed to externally validate the proposed treatment stratifier and develop more personalized and biologically informed rTMS interventions.
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Affiliation(s)
- Nikolaos Koutsouleris
- Department of Psychiatry and Psychotherapy, Klinikum der Universität München, Ludwig-Maximilians-Universität, Munich,To whom correspondence should be addressed; Professor for Neurodiagnostic Applications in Psychiatry, Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Nussbaumstr. 7, D-80336 Munich, Germany; tel: 0049-(0)-89-4400-55885, fax: 0049-(0)-89-4400-55776, e-mail:
| | - Thomas Wobrock
- Department of Psychiatry and Psychotherapy, Georg-August-University Goettingen,County Hospitals Darmstadt-Dieburg, Groß-Umstadt
| | - Birgit Guse
- Department of Psychiatry and Psychotherapy, Georg-August-University Goettingen
| | - Berthold Langguth
- Department of Psychiatry and Psychotherapy, University of Regensburg
| | - Michael Landgrebe
- Department of Psychiatry and Psychotherapy, University of Regensburg,Department of Psychiatry, Psychosomatics and Psychotherapy, kbo-Lech-Mangfall-Klinik Agatharied, Germany
| | - Peter Eichhammer
- Department of Psychiatry and Psychotherapy, University of Regensburg
| | - Elmar Frank
- Department of Psychiatry and Psychotherapy, University of Regensburg
| | - Joachim Cordes
- Department of Psychiatry and Psychotherapy, Heinrich-Heine University, Düsseldorf
| | - Wolfgang Wölwer
- Department of Psychiatry and Psychotherapy, Heinrich-Heine University, Düsseldorf
| | - Francesco Musso
- Department of Psychiatry and Psychotherapy, Heinrich-Heine University, Düsseldorf
| | - Georg Winterer
- Experimental & Clinical Research Center (ECRC), Charite – University Medicine Berlin
| | - Wolfgang Gaebel
- Department of Psychiatry and Psychotherapy, Heinrich-Heine University, Düsseldorf
| | - Göran Hajak
- European Clinical Research Infrastructure Network (ECRIN), Düsseldorf, Germany,Coordination Centre for Clinical Trials, Heinrich-Heine-University, Düsseldorf
| | - Christian Ohmann
- Coordination Centre for Clinical Trials, Heinrich-Heine University, Düsseldorf
| | - Pablo E Verde
- Coordination Centre for Clinical Trials, Heinrich-Heine University, Düsseldorf
| | - Marcella Rietschel
- Department of Genetic Epidemiology in Psychiatry, Institute of Central Mental Health, Medical Faculty Mannheim, University of Heidelberg
| | - Raees Ahmed
- Referat Klinische Studien Management, Georg-August-University Goettingen
| | - William G Honer
- Institute of Mental Health, The University of British Columbia, Vancouver, Canada
| | - Dominic Dwyer
- Department of Psychiatry and Psychotherapy, Klinikum der Universität München, Ludwig-Maximilians-Universität, Munich
| | - Farhad Ghaseminejad
- Institute of Mental Health, The University of British Columbia, Vancouver, Canada
| | - Peter Dechent
- Department of Cognitive Neurology, Georg-August-University Goettingen
| | - Berend Malchow
- Department of Psychiatry and Psychotherapy, Klinikum der Universität München, Ludwig-Maximilians-Universität, Munich
| | - Peter M Kreuzer
- Department of Psychiatry and Psychotherapy, University of Regensburg
| | - Tim B Poeppl
- Department of Psychiatry and Psychotherapy, University of Regensburg
| | - Thomas Schneider-Axmann
- Department of Psychiatry and Psychotherapy, Klinikum der Universität München, Ludwig-Maximilians-Universität, Munich
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, Klinikum der Universität München, Ludwig-Maximilians-Universität, Munich
| | - Alkomiet Hasan
- Department of Psychiatry and Psychotherapy, Klinikum der Universität München, Ludwig-Maximilians-Universität, Munich
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19
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Lloyd CE, Nouwen A, Sartorius N, Ahmed HU, Alvarez A, Bahendeka S, Basangwa D, Bobrov AE, Boden S, Bulgari V, Burti L, Chaturvedi SK, Cimino LC, Gaebel W, de Girolamo G, Gondek TM, de Braude MG, Guntupalli A, Heinze MG, Ji L, Hong X, Khan A, Kiejna A, Kokoszka A, Kamala T, Lalic NM, Lecic Tosevski D, Mankovsky B, Li M, Musau A, Müssig K, Ndetei D, Rabbani G, Srikanta SS, Starostina EG, Shevchuk M, Taj R, Vukovic O, Wölwer W, Xin Y. Prevalence and correlates of depressive disorders in people with Type 2 diabetes: results from the International Prevalence and Treatment of Diabetes and Depression (INTERPRET-DD) study, a collaborative study carried out in 14 countries. Diabet Med 2018; 35:760-769. [PMID: 29478265 DOI: 10.1111/dme.13611] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/21/2018] [Indexed: 01/23/2023]
Abstract
AIMS To assess the prevalence and management of depressive disorders in people with Type 2 diabetes in different countries. METHODS People with diabetes aged 18-65 years and treated in outpatient settings were recruited in 14 countries and underwent a psychiatric interview. Participants completed the Patient Health Questionnaire and the Problem Areas in Diabetes scale. Demographic and medical record data were collected. RESULTS A total of 2783 people with Type 2 diabetes (45.3% men, mean duration of diabetes 8.8 years) participated. Overall, 10.6% were diagnosed with current major depressive disorder and 17.0% reported moderate to severe levels of depressive symptomatology (Patient Health Questionnaire scores >9). Multivariable analyses showed that, after controlling for country, current major depressive disorder was significantly associated with gender (women) (P<0.0001), a lower level of education (P<0.05), doing less exercise (P<0.01), higher levels of diabetes distress (P<0.0001) and a previous diagnosis of major depressive disorder (P<0.0001). The proportion of those with either current major depressive disorder or moderate to severe levels of depressive symptomatology who had a diagnosis or any treatment for their depression recorded in their medical records was extremely low and non-existent in many countries (0-29.6%). CONCLUSIONS Our international study, the largest of this type ever undertaken, shows that people with diabetes frequently have depressive disorders and also significant levels of depressive symptoms. Our findings indicate that the identification and appropriate care for psychological and psychiatric problems is not the norm and suggest a lack of the comprehensive approach to diabetes management that is needed to improve clinical outcomes.
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Affiliation(s)
- C E Lloyd
- The Open University, School of Health, Wellbeing and Social Care, UK
| | - A Nouwen
- Department of Psychology, Middlesex University, UK
| | - N Sartorius
- Association for the Improvement of Mental Health Programmes, Switzerland
| | - H U Ahmed
- Child Adolescent & Family Psychiatry, National Institute of Mental Health (NIMH), Dhaka, Bangladesh
| | - A Alvarez
- Hospital Italiano de Buenos Aires, Argentina
| | - S Bahendeka
- Mother Kevin Post Graduate Medical School, Uganda Martyrs University, Kampala, Uganda
| | - D Basangwa
- Mother Kevin Post Graduate Medical School, Uganda Martyrs University, Kampala, Uganda
| | - A E Bobrov
- Federal Medical Research Centre for Psychiatry and Narcology, Moscow, Russia
| | - S Boden
- The Open University, School of Health, Wellbeing and Social Care, UK
| | - V Bulgari
- Psychiatric Epidemiology and Evaluation Unit, Saint John of God Clinical Research Centre, Brescia, Italy
- PhD School in Psychology, Catholic University of the Sacred Heart, Milan, Italy
| | - L Burti
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy
| | - S K Chaturvedi
- National Institute of Mental Health & Neurosciences, Bangalore, India
| | | | - W Gaebel
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - G de Girolamo
- Psychiatric Epidemiology and Evaluation Unit, Saint John of God Clinical Research Centre, Brescia, Italy
| | - T M Gondek
- Department of Psychiatry, Wroclaw Medical University, Wroclaw, Poland
| | | | - A Guntupalli
- School of Health, Wellbeing and Social Care, The Open University, UK
| | - M G Heinze
- Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - L Ji
- People's Hospital, Peking University, Beijing, China
| | - X Hong
- Department of Psychological Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - A Khan
- Pakistan Institute of Medical Sciences, Pakistan
| | - A Kiejna
- University of Lower Silesia, Wroclaw, Poland
- Department of Psychiatry, Medical University, Wroclaw, Poland
| | - A Kokoszka
- II Department of Psychiatry, Medical University of Warsaw, Warszawa, Poland
| | - T Kamala
- Diabetes Centre and Jnana Sanjeevini Medical Centre, Bangalore, India
| | - N M Lalic
- Clinic for Endocrinology, Belgrade University School of Medicine, Serbian Academy of Sciences and Arts, Belgrade
| | - D Lecic Tosevski
- Institute of Mental Health, Belgrade University School of Medicine, Serbian Academy of Sciences and Arts, Belgrade, Serbia
| | - B Mankovsky
- Department of Diabetology, National Medical Academy for Postgraduate Education, Ukraine
| | - M Li
- School of Nursing, Peking University, Beijing, China
| | - A Musau
- Africa Mental Health Foundation, Kenya
| | - K Müssig
- Institute for Clinical Diabetology, German Diabetes Centre
- Leibniz Centre for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Department of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
- German Centre for Diabetes Research (DZD), München-Neuherberg, Germany
| | - D Ndetei
- University of Nairobi, Africa Mental Health Foundation, Kenya
| | - G Rabbani
- Popular Medical College, Dhaka, Bangladesh
| | - S S Srikanta
- Samatvam Endocrinology Diabetes Centre and Jnana Sanjeevini Medical Centre, Bangalore, India
| | - E G Starostina
- Department of Endocrinology, Moscow Regional Clinical and Research Institute, Russia
| | - M Shevchuk
- Department of Diabetology, National Medical Academy for Postgraduate Education, Kiev, Ukraine
| | - R Taj
- Pakistan Institute of Medical Sciences, Pakistan
| | - O Vukovic
- Institute of Mental Health, Belgrade University School of Medicine, Serbian Academy of Sciences and Arts, Belgrade, Serbia
| | - W Wölwer
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Y Xin
- Clinical Research Centre, Peking University Sixth Hospital, Clinical Research Centre, Peking University Institute of Mental Health, Key Laboratory of Mental Health, Ministry of Health (Peking University), National Clinical Research Centre for Mental Disorders (Peking University Sixth Hospital), Beijing, China
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20
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Hansbauer M, Wobrock T, Kunze B, Langguth B, Landgrebe M, Eichhammer P, Frank E, Cordes J, Wölwer W, Winterer G, Gaebel W, Hajak G, Ohmann C, Verde PE, Rietschel M, Ahmed R, Honer WG, Malchow B, Strube W, Schneider-Axmann T, Falkai P, Hasan A. Efficacy of high-frequency repetitive transcranial magnetic stimulation on PANSS factors in schizophrenia with predominant negative symptoms - Results from an exploratory re-analysis. Psychiatry Res 2018; 263:22-29. [PMID: 29482042 DOI: 10.1016/j.psychres.2018.02.030] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 02/13/2018] [Accepted: 02/14/2018] [Indexed: 10/18/2022]
Abstract
Repetitive transcranial magnetic stimulation (rTMS) applied to the left frontal lobe is discussed to be a promising add-on treatment for negative symptoms in schizophrenia. The Positive and Negative Syndrome Scale (PANSS) has been used as outcome parameter in several previous rTMS trials, but studies focusing on PANSS factor analyses are lacking. For this purpose, we used the available PANSS data of the 'rTMS for the Treatment of Negative Symptoms in Schizophrenia' (RESIS) trial to calculate different literature-based PANSS factors and to re-evaluate the impact of rTMS on negative symptoms in this trial. In an exploratory re-analysis of published data from the RESIS study (Wobrock et al. 2015), we tested the impact of rTMS applied to the left dorsolateral prefrontal cortex on two PANSS factors for negative symptoms in psychotic disorders as well as on a PANSS five-factor consensus model intending to show that active rTMS treatment improves PANSS negative symptom subscores. In accordance to the original analysis, all PANSS factors showed an improvement over time in the active and, to a considerable extent, also in the sham rTMS group. However, comparing the data before and directly after the rTMS intervention, the PANSS excitement factor improved in the active rTMS group significantly more than in the sham group, but this finding did not persist if follow-up data were taken into account. These additional analyses extend the previously reported RESIS trial results showing unspecific improvements in the PANSS positive subscale in the active rTMS group. Our PANSS factor-based approach to investigate the impact of prefrontal rTMS on different negative symptom domains confirmed no overall beneficial effect of the active compared to sham rTMS.
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Affiliation(s)
- Maximilian Hansbauer
- Department of Psychiatry and Psychotherapy, Klinikum der Universität München, Ludwig-Maximilians-University, München, Germany.
| | - Thomas Wobrock
- Department of Psychiatry and Psychotherapy, Georg-August-University Goettingen, Germany; County Hospitals Darmstadt-Dieburg, Groß-Umstadt, Germany
| | - Birgit Kunze
- Department of Psychiatry and Psychotherapy, Georg-August-University Goettingen, Germany
| | - Berthold Langguth
- Department of Psychiatry and Psychotherapy, University of Regensburg, Germany
| | - Michael Landgrebe
- Department of Psychiatry and Psychotherapy, University of Regensburg, Germany; Department of Psychiatry, Psychosomatics and Psychotherapy, kbo-Lech-Mangfall-Klinik Agatharied, Germany
| | - Peter Eichhammer
- Department of Psychiatry and Psychotherapy, University of Regensburg, Germany
| | - Elmar Frank
- Department of Psychiatry and Psychotherapy, University of Regensburg, Germany
| | - Joachim Cordes
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Wolfgang Wölwer
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Georg Winterer
- Experimental & Clinical Research Center (ECRC), Charite - University Medicine Berlin, Germany
| | - Wolfgang Gaebel
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Göran Hajak
- Department of Psychiatry, Psychosomatics and Psychotherapy, Sozialstiftung Bamberg, Bamberg, Germany
| | | | - Pablo E Verde
- Coordination Centre for Clinical Trials, Heinrich-Heine University, Düsseldorf, Germany
| | - Marcella Rietschel
- Department of Genetic Epidemiology in Psychiatry, Institute of Central Mental Health, Medical Faculty Mannheim, University of Heidelberg, Germany
| | - Raees Ahmed
- Referat Klinische Studien Management, Universitätsmedizin Göttingen, Germany
| | - William G Honer
- Institute of Mental Health, The University of British Columbia, Vancouver, BC, Canada
| | - Berend Malchow
- Department of Psychiatry and Psychotherapy, Klinikum der Universität München, Ludwig-Maximilians-University, München, Germany
| | - Wolfgang Strube
- Department of Psychiatry and Psychotherapy, Klinikum der Universität München, Ludwig-Maximilians-University, München, Germany
| | - Thomas Schneider-Axmann
- Department of Psychiatry and Psychotherapy, Klinikum der Universität München, Ludwig-Maximilians-University, München, Germany
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, Klinikum der Universität München, Ludwig-Maximilians-University, München, Germany
| | - Alkomiet Hasan
- Department of Psychiatry and Psychotherapy, Klinikum der Universität München, Ludwig-Maximilians-University, München, Germany
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21
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van Gemert T, Wölwer W, Weber KS, Hoyer A, Strassburger K, Bohnau NT, Brüggen M, Ovelgönne K, Gössmann EM, Burkart V, Szendrödi J, Roden M, Müssig K. Eingeschränkte kognitive Funktion bei Menschen mit neu-diagnostiziertem Typ-2 aber nicht Typ-1-Diabetes. DIABETOL STOFFWECHS 2018. [DOI: 10.1055/s-0038-1641778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- T van Gemert
- Klinik für Endokrinologie und Diabetologie, Medizinische Fakultät, Heinrich-Heine-Universität, Düsseldorf, Germany
- Institut für Klinische Diabetologie, Deutsches Diabetes-Zentrum, Leibniz-Zentrum für Diabetesforschung an der Heinrich-Heine-Universität, Düsseldorf, Germany
- Deutsches Zentrum für Diabetesforschung (DZD), München-Neuherberg, Germany
| | - W Wölwer
- Klinik für Psychiatrie und Psychotherapie, Medizinische Fakultät, Heinrich-Heine-Universität, Düsseldorf, Germany
| | - KS Weber
- Institut für Klinische Diabetologie, Deutsches Diabetes-Zentrum, Leibniz-Zentrum für Diabetesforschung an der Heinrich-Heine-Universität, Düsseldorf, Germany
- Deutsches Zentrum für Diabetesforschung (DZD), München-Neuherberg, Germany
| | - A Hoyer
- Deutsches Zentrum für Diabetesforschung (DZD), München-Neuherberg, Germany
- Institut für Biometrie und Epidemiologie, Deutsches Diabetes-Zentrum, Leibniz-Zentrum für Diabetesforschung an der Heinrich-Heine-Universität, Düsseldorf, Germany
| | - K Strassburger
- Deutsches Zentrum für Diabetesforschung (DZD), München-Neuherberg, Germany
- Institut für Biometrie und Epidemiologie, Deutsches Diabetes-Zentrum, Leibniz-Zentrum für Diabetesforschung an der Heinrich-Heine-Universität, Düsseldorf, Germany
| | - NT Bohnau
- Institut für Klinische Diabetologie, Deutsches Diabetes-Zentrum, Leibniz-Zentrum für Diabetesforschung an der Heinrich-Heine-Universität, Düsseldorf, Germany
- Deutsches Zentrum für Diabetesforschung (DZD), München-Neuherberg, Germany
| | - M Brüggen
- Institut für Klinische Diabetologie, Deutsches Diabetes-Zentrum, Leibniz-Zentrum für Diabetesforschung an der Heinrich-Heine-Universität, Düsseldorf, Germany
- Deutsches Zentrum für Diabetesforschung (DZD), München-Neuherberg, Germany
| | - K Ovelgönne
- Institut für Klinische Diabetologie, Deutsches Diabetes-Zentrum, Leibniz-Zentrum für Diabetesforschung an der Heinrich-Heine-Universität, Düsseldorf, Germany
- Deutsches Zentrum für Diabetesforschung (DZD), München-Neuherberg, Germany
| | - EM Gössmann
- Institut für Klinische Diabetologie, Deutsches Diabetes-Zentrum, Leibniz-Zentrum für Diabetesforschung an der Heinrich-Heine-Universität, Düsseldorf, Germany
- Deutsches Zentrum für Diabetesforschung (DZD), München-Neuherberg, Germany
| | - V Burkart
- Institut für Klinische Diabetologie, Deutsches Diabetes-Zentrum, Leibniz-Zentrum für Diabetesforschung an der Heinrich-Heine-Universität, Düsseldorf, Germany
- Deutsches Zentrum für Diabetesforschung (DZD), München-Neuherberg, Germany
| | - J Szendrödi
- Klinik für Endokrinologie und Diabetologie, Medizinische Fakultät, Heinrich-Heine-Universität, Düsseldorf, Germany
- Institut für Klinische Diabetologie, Deutsches Diabetes-Zentrum, Leibniz-Zentrum für Diabetesforschung an der Heinrich-Heine-Universität, Düsseldorf, Germany
- Deutsches Zentrum für Diabetesforschung (DZD), München-Neuherberg, Germany
| | - M Roden
- Klinik für Endokrinologie und Diabetologie, Medizinische Fakultät, Heinrich-Heine-Universität, Düsseldorf, Germany
- Institut für Klinische Diabetologie, Deutsches Diabetes-Zentrum, Leibniz-Zentrum für Diabetesforschung an der Heinrich-Heine-Universität, Düsseldorf, Germany
- Deutsches Zentrum für Diabetesforschung (DZD), München-Neuherberg, Germany
| | - K Müssig
- Klinik für Endokrinologie und Diabetologie, Medizinische Fakultät, Heinrich-Heine-Universität, Düsseldorf, Germany
- Institut für Klinische Diabetologie, Deutsches Diabetes-Zentrum, Leibniz-Zentrum für Diabetesforschung an der Heinrich-Heine-Universität, Düsseldorf, Germany
- Deutsches Zentrum für Diabetesforschung (DZD), München-Neuherberg, Germany
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22
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Kamp D, Engelke C, Wobrock T, Kunze B, Wölwer W, Winterer G, Schmidt-Kraepelin C, Gaebel W, Langguth B, Landgrebe M, Eichhammer P, Frank E, Hajak G, Ohmann C, Verde PE, Rietschel M, Raees A, Honer WG, Malchow B, Schneider-Axmann T, Falkai P, Hasan A, Cordes J. Letter to the Editor: Influence of rTMS on smoking in patients with schizophrenia. Schizophr Res 2018; 192:481-484. [PMID: 28578924 DOI: 10.1016/j.schres.2017.05.036] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 04/12/2017] [Revised: 05/26/2017] [Accepted: 05/27/2017] [Indexed: 11/24/2022]
Affiliation(s)
- Daniel Kamp
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany.
| | - Christina Engelke
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany.
| | - Thomas Wobrock
- Department of Psychiatry and Psychotherapy, Georg-August-University Göttingen, Göttingen, Germany; Department of Psychiatry and Psychotherapy, County Hospitals Darmstadt-Dieburg, Groß-Umstadt, Germany.
| | - Birgit Kunze
- Department of Psychiatry and Psychotherapy, Georg-August-University Göttingen, Göttingen, Germany.
| | - Wolfgang Wölwer
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany.
| | - Georg Winterer
- Experimental and Clinical Research Centre, Charité-Universitätsmedizin Berlin, Berlin, Germany.
| | - Christian Schmidt-Kraepelin
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany.
| | - Wolfgang Gaebel
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany.
| | - Berthold Langguth
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany.
| | - Michael Landgrebe
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany; Department of Psychiatry, Psychosomatics and Psychotherapy, kbo-Lech-Mangfall-Klinik Agatharied, Agatharied, Germany.
| | - Peter Eichhammer
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany.
| | - Elmar Frank
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany.
| | - Göran Hajak
- Department of Psychiatry, Psychosomatics and Psychotherapy, Sozialstiftung Bamberg, Bamberg, Germany.
| | | | - Pablo E Verde
- Coordination Centre for Clinical Trials, Heinrich-Heine University, Düsseldorf, Germany.
| | - Marcella Rietschel
- Department of Genetic Epidemiology in Psychiatry, Institute of Central Mental Health, Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany.
| | - Ahmed Raees
- Department of Medicine, University Göttingen, Referat Klinische Studien Management, Göttingen, Germany.
| | - William G Honer
- Department of Genetic Epidemiology in Psychiatry, Institute of Mental Health, The University of British Columbia, Vancouver, BC, Canada.
| | - Berend Malchow
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany.
| | | | - Peter Falkai
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany.
| | - Alkomiet Hasan
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany.
| | - Joachim Cordes
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany.
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23
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Hörrmann F, Trendler G, Schmidt M, Häfner H, Maier W, Wagner M, Gaebel W, Wölwer W, Klosterkötter J, Schultze-Lutter F, Bechdolf A, Ruhrmann S, Möller HJ, Bottlender R, Maurer K. Früherkennung des Psychoserisikos mit dem Early Recognition Inventory (ERIraos). ACTA ACUST UNITED AC 2018. [DOI: 10.1055/s-0038-1626434] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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
ZusammenfassungDie Frühintervention bei schizophrenen Psychosen kann entweder im initialen Prodrom oder in der beginnenden ersten Episode stattfinden. Dies setzt eine zuverlässige Früherkennung von Risikopersonen voraus. Wir berichten über den Aufbau des zweistufigen Früherkennungsinventars ERIraos, bestehend aus einer Checkliste als Screeninginstrument und einer umfassenden Symptomliste und weiteren modularen Komponenten. Es werden erste Ergebnisse zur Reliabilität der Checkliste und zu ihrer Übereinstimmungsvalidität mit den interventionsrelevanten Einschlusskriterien berichtet.
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Riedel M, Bottlender R, von Wilmsdorff M, Wölwer W, Gaebel W, Möller HJ, Maier W, Jäger M. Medikamentöse Akutbehandlung schizophrener Ersterkrankungen. ACTA ACUST UNITED AC 2018. [DOI: 10.1055/s-0038-1626437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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
ZusammenfassungAtypische Neuroleptika werden heute für die Behandlung von Patienten mit schizophrenen Erkrankungen als Therapie der ersten Wahl empfohlen, da sie gegenüber den typischen Neuroleptika deutliche Vorteile hinsichtlich des Wirkungsspektrums und des Nebenwirkungsprofils aufweisen. Dies trifft insbesondere für ersterkrankte Patienten zu, da für diese Patientengruppe im Vergleich zu Mehrfacherkrankten ein höheres Risiko für extrapyramidal-motorische Nebenwirkungen beschrieben wurde. Ob die Vorteile der atypischen Neuroleptika aber auch nachweisbar sind, wenn typische Neuroleptika in niedrigen Dosierungen eingesetzt werden, ist bisher empirisch unzureichend geprüft. Vor diesem Hintergrund wurden im Rahmen einer multizentrischen, doppelblinden, randomisierten klinischen Studie des Kompetenznetz Schizophrenie die Effekte von Risperidon und Haloperidol im Niedrigdosisbereich (Tagesdosen von 2 mg bis maximal 8 mg für beide Medikamente) in der Akutbehandlung ersterkrankter Patienten verglichen.
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Weber R, Herrlich J, Wiedemann G, Wölwer W, Buchkremer G, Klingberg S, Wittorf A. Therapieakzeptanz und Therapiebeziehung in der frühen Phase der Verhaltenstherapie bei Negativsymptomatik der Schizophrenie. ACTA ACUST UNITED AC 2018. [DOI: 10.1055/s-0038-1627233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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
ZusammenfassungGegenstand und Ziel: Die Studie überprüfte die Durchführbarkeit und Akzeptanz einer ambulanten kognitiven Verhaltenstherapie bei Negativsymptomatik der Schizophrenie. Ein zusätzlicher Fokus lag auf der Analyse der therapeutischen Beziehung (TB) und deren Vorhersage aus klinisch- psychopathologischen Merkmalen. Material und Methoden: 49 Patienten mit Schizophrenie wurden randomisiert entweder einer kognitiven Verhaltenstherapie (KVT; Experimentalgruppe) oder einer kognitiven Remediation (KR; Kontrollgruppe) zugewiesen. Die Sitzungen wurden anhand von Stundenprotokollen und Patienten- bzw. Therapeutenstundenbögen dokumentiert. Analysiert wurde die frühe Therapiephase. Ergebnisse: Die Stundenprotokolle zeigten, dass die Therapeuten die KVT manualgetreu durchführen konnten. Die Analysen der Stundenbögen erbrachten, dass die Patienten die TB in der KVT als positiv und besser als in der KR beurteilten. Patienten- und Therapeuteneinschätzungen der TB zeigten keine Korrelation. Eine mildere Positivsymptomatik war mit einer besseren Beurteilung der TB durch den Patienten assoziiert. Eine stärkere Negativsymptomatik prädizierte eine ungünstigere Beurteilung der TB durch den Therapeuten. Schlussfolgerungen und klinische Relevanz: Die Studie ist ein erster Indikator für die Durchführbarkeit und Akzeptanz der KVT bei Negativsymptomatik. Positiv- und Negativsymptomatik bergen Implikationen für die Entwicklung der TB.
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van Gemert T, Wölwer W, Weber KS, Hoyer A, Strassburger K, Bohnau NT, Brüggen MA, Ovelgönne K, Gössmann EM, Burkart V, Szendroedi J, Roden M, Müssig K. Cognitive Function Is Impaired in Patients with Recently Diagnosed Type 2 Diabetes, but Not Type 1 Diabetes. J Diabetes Res 2018; 2018:1470476. [PMID: 30159333 PMCID: PMC6109580 DOI: 10.1155/2018/1470476] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 05/27/2018] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE To test whether cognitive function is impaired in early states of diabetes and to identify possible risk factors for cognitive impairment. METHODS A cross-sectional analysis within the German Diabetes Study included patients with type 1 or type 2 diabetes within the first year after diagnosis or five years after study inclusion and metabolically healthy individuals. Participants underwent comprehensive metabolic phenotyping and testing of different domains of cognitive function. Linear regression models were used to compare cognition test outcomes and to test associations between cognitive function and possible influencing factors within the groups. RESULTS In participants with recently diagnosed diabetes, verbal memory was poorer in patients with type 2 diabetes (P = 0.029), but not in type 1 diabetes (P = 0.156), when compared to healthy individuals. Five years after diagnosis, type 2 diabetes patients also showed lower verbal memory than those with type 1 diabetes (P = 0.012). In addition to crystallized intelligence, a higher body mass index among individuals with recently diagnosed type 2 diabetes and male sex among individuals with recently diagnosed type 1 diabetes were associated with impaired verbal memory (all P < 0.05). CONCLUSION Verbal memory is impaired in individuals with recently diagnosed type 2 diabetes and likely associated with higher body mass. This trial is registered with the trial registration number NCT01055093.
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Affiliation(s)
- Theresa van Gemert
- Division of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Institute for Diabetes Research, Heinrich Heine University, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), Neuherberg, München, Germany
| | - Wolfgang Wölwer
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Katharina S. Weber
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Institute for Diabetes Research, Heinrich Heine University, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), Neuherberg, München, Germany
| | - Annika Hoyer
- German Center for Diabetes Research (DZD), Neuherberg, München, Germany
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Institute for Diabetes Research, Heinrich Heine University, Düsseldorf, Germany
| | - Klaus Strassburger
- German Center for Diabetes Research (DZD), Neuherberg, München, Germany
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Institute for Diabetes Research, Heinrich Heine University, Düsseldorf, Germany
| | - Nora T. Bohnau
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Institute for Diabetes Research, Heinrich Heine University, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), Neuherberg, München, Germany
| | - Marie A. Brüggen
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Institute for Diabetes Research, Heinrich Heine University, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), Neuherberg, München, Germany
| | - Katharina Ovelgönne
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Institute for Diabetes Research, Heinrich Heine University, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), Neuherberg, München, Germany
| | - Eva-Maria Gössmann
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Institute for Diabetes Research, Heinrich Heine University, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), Neuherberg, München, Germany
| | - Volker Burkart
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Institute for Diabetes Research, Heinrich Heine University, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), Neuherberg, München, Germany
| | - Julia Szendroedi
- Division of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Institute for Diabetes Research, Heinrich Heine University, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), Neuherberg, München, Germany
| | - Michael Roden
- Division of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Institute for Diabetes Research, Heinrich Heine University, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), Neuherberg, München, Germany
| | - Karsten Müssig
- Division of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Institute for Diabetes Research, Heinrich Heine University, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), Neuherberg, München, Germany
| | - GDS Group
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Institute for Diabetes Research, Heinrich Heine University, Düsseldorf, Germany
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Hasan A, Wobrock T, Guse B, Langguth B, Landgrebe M, Eichhammer P, Frank E, Cordes J, Wölwer W, Musso F, Winterer G, Gaebel W, Hajak G, Ohmann C, Verde PE, Rietschel M, Ahmed R, Honer WG, Dechent P, Malchow B, Castro MFU, Dwyer D, Cabral C, Kreuzer PM, Poeppl TB, Schneider-Axmann T, Falkai P, Koutsouleris N. Structural brain changes are associated with response of negative symptoms to prefrontal repetitive transcranial magnetic stimulation in patients with schizophrenia. Mol Psychiatry 2017; 22:857-864. [PMID: 27725655 DOI: 10.1038/mp.2016.161] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 07/06/2016] [Accepted: 08/04/2016] [Indexed: 12/13/2022]
Abstract
Impaired neural plasticity may be a core pathophysiological process underlying the symptomatology of schizophrenia. Plasticity-enhancing interventions, including repetitive transcranial magnetic stimulation (rTMS), may improve difficult-to-treat symptoms; however, efficacy in large clinical trials appears limited. The high variability of rTMS-related treatment response may be related to a comparably large variation in the ability to generate plastic neural changes. The aim of the present study was to determine whether negative symptom improvement in schizophrenia patients receiving rTMS to the left dorsolateral prefrontal cortex (DLPFC) was related to rTMS-related brain volume changes. A total of 73 schizophrenia patients with predominant negative symptoms were randomized to an active (n=34) or sham (n=39) 10-Hz rTMS intervention applied 5 days per week for 3 weeks to the left DLPFC. Local brain volume changes measured by deformation-based morphometry were correlated with changes in negative symptom severity using a repeated-measures analysis of covariance design. Volume gains in the left hippocampal, parahippocampal and precuneal cortices predicted negative symptom improvement in the active rTMS group (all r⩽-0.441, all P⩽0.009), but not the sham rTMS group (all r⩽0.211, all P⩾0.198). Further analyses comparing negative symptom responders (⩾20% improvement) and non-responders supported the primary analysis, again only in the active rTMS group (F(9, 207)=2.72, P=0.005, partial η 2=0.106). Heterogeneity in clinical response of negative symptoms in schizophrenia to prefrontal high-frequency rTMS may be related to variability in capacity for structural plasticity, particularly in the left hippocampal region and the precuneus.
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Affiliation(s)
- A Hasan
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
| | - T Wobrock
- Department of Psychiatry and Psychotherapy, Georg-August-University Göttingen, Göttingen, Germany.,Department of Psychiatry and Psychotherapy, County Hospitals Darmstadt-Dieburg, Groß-Umstadt, Germany
| | - B Guse
- Department of Psychiatry and Psychotherapy, Georg-August-University Göttingen, Göttingen, Germany
| | - B Langguth
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - M Landgrebe
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany.,Department of Psychiatry, Psychosomatics and Psychotherapy, kbo-Lech-Mangfall-Klinik Agatharied, Agatharied, Germany
| | - P Eichhammer
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - E Frank
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - J Cordes
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - W Wölwer
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - F Musso
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - G Winterer
- Experimental and Clinical Research Centre, The Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - W Gaebel
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - G Hajak
- Department of Psychiatry, Psychosomatics and Psychotherapy, Sozialstiftung Bamberg, Bamberg, Germany
| | - C Ohmann
- European Clinical Research Network, Düsseldorf, Germany
| | - P E Verde
- Coordination Centre for Clinical Trials, Heinrich-Heine University, Düsseldorf, Germany
| | - M Rietschel
- Department of Genetic Epidemiology in Psychiatry, Institute of Central Mental Health, Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany
| | - R Ahmed
- Institut für anwendungsorientierte Forschung und klinische Studien GmbH, Göttingen, Germany
| | - W G Honer
- Department of Genetic Epidemiology in Psychiatry, Institute of Mental Health, The University of British Columbia, Vancouver, BC, Canada
| | - P Dechent
- Department of Cognitive Neurology, Georg-August-University Goettingen, Goettingen, Germany
| | - B Malchow
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
| | - M F U Castro
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
| | - D Dwyer
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
| | - C Cabral
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
| | - P M Kreuzer
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - T B Poeppl
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - T Schneider-Axmann
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
| | - P Falkai
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
| | - N Koutsouleris
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
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Hasan A, Guse B, Cordes J, Wölwer W, Winterer G, Gaebel W, Langguth B, Landgrebe M, Eichhammer P, Frank E, Hajak G, Ohmann C, Verde PE, Rietschel M, Ahmed R, Honer WG, Malchow B, Karch S, Schneider-Axmann T, Falkai P, Wobrock T. Cognitive Effects of High-Frequency rTMS in Schizophrenia Patients With Predominant Negative Symptoms: Results From a Multicenter Randomized Sham-Controlled Trial. Schizophr Bull 2016; 42:608-18. [PMID: 26433217 PMCID: PMC4838079 DOI: 10.1093/schbul/sbv142] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [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: 12/24/2022]
Abstract
Cognitive impairments are one of the main contributors to disability and poor long-term outcome in schizophrenia. Proof-of-concept trials indicate that repetitive transcranial magnetic stimulation (rTMS) applied to the left dorsolateral prefrontal cortex (DLPFC) has the potential to improve cognitive functioning. We analyzed the effects of 10-Hz rTMS to the left DLPFC on cognitive deficits in schizophrenia in a large-scale and multicenter, sham-controlled study. A total of 156 schizophrenia patients with predominant negative symptoms were randomly assigned to a 3-week intervention (10-Hz rTMS, 15 sessions, 1000 stimuli per session) with either active or sham rTMS. The Rey Auditory Verbal Learning Test, Trail Making Test A and B, Wisconsin Card Sorting Test, Digit Span Test, and the Regensburg Word Fluency Test were administered before intervention and at day 21, 45, and 105 follow-up. From the test results, a neuropsychological composite score was computed. Both groups showed no differences in any of the outcome variables before and after intervention. Both groups improved markedly over time, but effect sizes indicate a numeric, but nonsignificant superiority of active rTMS in certain cognitive tests. Active 10-Hz rTMS applied to the left DLPFC for 3 weeks was not superior to sham rTMS in the improvement of various cognitive domains in schizophrenia patients with predominant negative symptoms. This is in contrast to previous preliminary proof-of-concept trials, but highlights the need for more multicenter randomized controlled trials in the field of noninvasive brain stimulation.
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Affiliation(s)
- Alkomiet Hasan
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany; These authors contributed equally to the article.
| | - Birgit Guse
- Department of Psychiatry and Psychotherapy, Georg-August-University Göttingen, Göttingen, Germany; These authors contributed equally to the article
| | - Joachim Cordes
- Department of Psychiatry and Psychotherapy, Heinrich-Heine University, Düsseldorf, Germany
| | - Wolfgang Wölwer
- Department of Psychiatry and Psychotherapy, Heinrich-Heine University, Düsseldorf, Germany
| | - Georg Winterer
- The Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Wolfgang Gaebel
- Department of Psychiatry and Psychotherapy, Heinrich-Heine University, Düsseldorf, Germany
| | - Berthold Langguth
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Michael Landgrebe
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany; Department of Psychiatry, Psychosomatics and Psychotherapy, kbo-Lech-Mangfall-Klinik, Agatharied, Germany
| | - Peter Eichhammer
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Elmar Frank
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Göran Hajak
- Department of Psychiatry, Psychosomatics and Psychotherapy, Sozialstiftung Bamberg, Bamberg, Germany
| | - Christian Ohmann
- Coordination Centre for Clinical Trials, Heinrich-Heine University, Düsseldorf, Germany
| | - Pablo E Verde
- Coordination Centre for Clinical Trials, Heinrich-Heine University, Düsseldorf, Germany
| | - Marcella Rietschel
- Department of Genetic Epidemiology in Psychiatry, Institute of Central Mental Health, Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Raees Ahmed
- Institut für anwendungsorientierte Forschung und klinische Studien GmbH, Göttingen, Germany
| | - William G Honer
- Institute of Mental Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Berend Malchow
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
| | - Susanne Karch
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
| | | | - Peter Falkai
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
| | - Thomas Wobrock
- Department of Psychiatry and Psychotherapy, Georg-August-University Göttingen, Göttingen, Germany; County Hospitals Darmstadt-Dieburg, Groß-Umstadt, Germany
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Gaebel W, Riesbeck M, Wölwer W, Klimke A, Eickhoff M, von Wilmsdorff M, de Millas W, Maier W, Ruhrmann S, Falkai P, Sauer H, Schmitt A, Riedel M, Klingberg S, Möller HJ. Predictors for symptom re-exacerbation after targeted stepwise drug discontinuation in first-episode schizophrenia: Results of the first-episode study within the German research network on schizophrenia. Schizophr Res 2016; 170:168-76. [PMID: 26607102 DOI: 10.1016/j.schres.2015.10.024] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 10/12/2015] [Accepted: 10/20/2015] [Indexed: 11/15/2022]
Abstract
BACKGROUND After a first episode in schizophrenia guidelines recommend antipsychotic maintenance treatment (MT) for at least 1year. Recent RCTs on subsequent targeted intermittent treatment (IT) after stepwise drug discontinuation yielded noticeably higher relapse rates than during MT also in first-episode patients. Nevertheless, about 50% of patients remain stable under IT. Given the potential adverse effects of antipsychotics and the preference of many patients to discontinue drugs, valid predictors for the feasibility of IT are urgently needed to support decision making. METHODS Based on a one-year RCT phase comparing MT with IT in first-episode patients after 1year of MT, conducted within the German Research Network on Schizophrenia (GRNS), predictors for deterioration under IT in 19 feasible patients were identified by logistic regression analysis. RESULTS Deterioration occurred in 10 patients (52.6%). Univariate analyses indicated a lower PANSS positive score after acute treatment as well as after one year of MT as significant predictors; in multivariate logistic regression, in addition to the lower PANSS positive score after acute treatment, reaching enduring remission and having had a deterioration both during MT evolved as significant predictors and indicate a higher risk for deterioration. CONCLUSIONS Although limited by the small sample size, our findings suggest that patients who show a favorable response and full and enduring symptom remission during antipsychotic treatment, as well as those with marked deterioration despite MT should rather be recommended to remain on treatment because they are at higher risk for symptom re-exacerbation after (stepwise) drug discontinuation.
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Affiliation(s)
- Wolfgang Gaebel
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Duesseldorf, Germany.
| | - Mathias Riesbeck
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Duesseldorf, Germany
| | - Wolfgang Wölwer
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Duesseldorf, Germany
| | - Ansgar Klimke
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Duesseldorf, Germany; Department of Psychiatry and Psychotherapy, Vitos Waldkrankenhaus Köppern, Germany
| | - Matthias Eickhoff
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Duesseldorf, Germany; Department of Psychiatry, Westfalia Clinics, Warstein/Lippstadt, Germany
| | - Martina von Wilmsdorff
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Duesseldorf, Germany
| | - Walter de Millas
- Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Campus CharitéMitte, Berlin, Germany
| | - Wolfgang Maier
- Department of Psychiatry and Psychotherapy, University of Bonn, Germany
| | - Stephan Ruhrmann
- Department of Psychiatry and Psychotherapy, University of Cologne, Germany
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, University of Göttingen, Germany; Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Germany
| | - Heinrich Sauer
- Department of Psychiatry and Psychotherapy, Jena-University-Hospital, Germany
| | - Andrea Schmitt
- Central Institute of Mental Health, Mannheim, University of Heidelberg, Germany; Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Germany
| | - Michael Riedel
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Germany; Vinzenz von Paul Hospital, Germany
| | - Stefan Klingberg
- Department of Psychiatry and Psychotherapy, University of Tübingen, Germany
| | - Hans-Jürgen Möller
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Germany
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Hesse K, Kriston L, Mehl S, Wittorf A, Wiedemann W, Wölwer W, Klingberg S. The Vicious Cycle of Family Atmosphere, Interpersonal Self-concepts, and Paranoia in Schizophrenia-A Longitudinal Study. Schizophr Bull 2015; 41:1403-12. [PMID: 25925392 PMCID: PMC4601709 DOI: 10.1093/schbul/sbv055] [Citation(s) in RCA: 21] [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] [Indexed: 01/30/2023]
Abstract
Recent cognitive models of paranoid delusions highlight the role of self-concepts in the development and maintenance of paranoia. Evidence is growing that especially interpersonal self-concepts are relevant in the genesis of paranoia. In addition, negative interpersonal life-experiences are supposed to influence the course of paranoia. As dysfunctional family atmosphere corresponds with multiple distressing dyadic experiences, it could be a risk factor for the development and maintenance of paranoia. A total of 160 patients with a diagnosis of schizophrenia were assessed twice within 12 months. Standardized questionnaires and symptom rating scales were used to measure interpersonal self-concepts, perceived family atmosphere, and paranoia. Data were analyzed using longitudinal cross-lagged structural equation models. Perceived negative family atmosphere was associated with the development of more pronounced negative interpersonal self-concepts 12 months later. Moreover, paranoia was related to negative family atmosphere after 12 months as well. As tests revealed that reversed associations were not able to explain the data, we found evidence for a vicious cycle between paranoia, family atmosphere, and interpersonal self-concepts as suggested by theoretical/cognitive model of paranoid delusions. Results suggest that broader interventions for patients and their caretakers that aim at improving family atmosphere might also be able to improve negative self-concepts and paranoia.
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Affiliation(s)
- Klaus Hesse
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany;
| | - Levente Kriston
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stephanie Mehl
- Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany
| | - Andreas Wittorf
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Wolfgang Wiedemann
- Department of Psychiatry and Psychotherapy, Klinikum-Fulda, Fulda, Germany
| | - Wolfgang Wölwer
- Department of Psychiatry and Psychotherapy, Medical Faculty University of Düsseldorf, Germany
| | - Stefan Klingberg
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
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Stroth S, Kamp D, Drusch K, Frommann N, Wölwer W. Training of Affect Recognition impacts electrophysiological correlates of facial affect recognition in schizophrenia: Analyses of fixation-locked potentials. World J Biol Psychiatry 2015. [PMID: 26212691 DOI: 10.3109/15622975.2015.1051110] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Training of Affect Recognition (TAR) is a useful approach to restoring cognitive function in schizophrenic patients. Along with improving visual exploration of faces and altering central information processing in relevant brain areas, TAR attenuates impairments in facial affect recognition. In the present study, we investigate the effects of TAR on early electrophysiological correlates of facial affect recognition in schizophrenia. METHODS The study population comprised 12 schizophrenic patients and 14 healthy controls. In each individual, we carried out EEG, concomitant measurements of scanning eye movements and fixation-based low resolution electromagnetic tomography (sLORETA) analyses of brain electric activity. All analyses were performed at baseline and after participation in TAR. RESULTS In patients, brain activation patterns significantly changed after completing the TAR. Functional improvements were particularly pronounced in the superior parietal and inferior parietal lobes, where trained patients showed a larger increase in activation than untrained healthy controls. CONCLUSIONS The TAR activates compensatory brain processes involved in the perception, attention and evaluation of emotional stimuli. This may underlie the established behavioral effects of the TAR in schizophrenic patients, which include improvements in facial affect recognition and alterations of visual exploration strategies.
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Affiliation(s)
- Sanna Stroth
- a Department of Psychiatry and Psychotherapy , Medical Faculty, Heinrich Heine University Düsseldorf , Düsseldorf , Germany
| | - Daniel Kamp
- a Department of Psychiatry and Psychotherapy , Medical Faculty, Heinrich Heine University Düsseldorf , Düsseldorf , Germany
| | - Katharina Drusch
- a Department of Psychiatry and Psychotherapy , Medical Faculty, Heinrich Heine University Düsseldorf , Düsseldorf , Germany
| | - Nicole Frommann
- a Department of Psychiatry and Psychotherapy , Medical Faculty, Heinrich Heine University Düsseldorf , Düsseldorf , Germany
| | - Wolfgang Wölwer
- a Department of Psychiatry and Psychotherapy , Medical Faculty, Heinrich Heine University Düsseldorf , Düsseldorf , Germany
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Hesse K, Kriston L, Wittorf A, Herrlich J, Wölwer W, Klingberg S. Longitudinal relations between symptoms, neurocognition, and self-concept in schizophrenia. Front Psychol 2015; 6:917. [PMID: 26191025 PMCID: PMC4490211 DOI: 10.3389/fpsyg.2015.00917] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 06/19/2015] [Indexed: 12/18/2022] Open
Abstract
Objective: Cognitive models suggest that the self-concept of persons with psychosis can be fundamentally affected. Self-concepts were found to be related to different symptom domains when measured concurrently. Longitudinal investigations to disentangle the possible causal associations are rare. Method: We examined a sample of 160 people with a diagnosis of schizophrenia who took part in a psychotherapy study. All participants had the DSM-IV diagnosis of a schizophrenia and pronounced negative symptoms. Neurocognition, symptoms, and self-concepts were assessed at two time points 12 months apart. Structural equation modeling was used to test whether symptoms influence self-concepts (scar-model) or self-concepts affect symptoms (vulnerability model). Results: Negative symptoms correlated concurrently with self-concepts. Neurocognitive deficits are associated with more negative self-concepts 12 months later. Interpersonal self-concepts were found to be relevant for paranoia. Conclusion: The findings implicate that if deficits in neurocognition are present, fostering a positive self-concept should be an issue in therapy. Negative interpersonal self-concept indicates an increased risk for paranoid delusions in the course of 1 year. New aspects for cognitive models in schizophrenia and clinical implications are discussed.
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Affiliation(s)
- Klaus Hesse
- Department of Psychiatry and Psychotherapy, University of Tübingen Tübingen, Germany
| | - Levente Kriston
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf Hamburg, Germany
| | - Andreas Wittorf
- Department of Psychiatry and Psychotherapy, University of Tübingen Tübingen, Germany
| | - Jutta Herrlich
- Department of Psychiatry and Psychotherapy, University of Frankfurt Frankfurt, Germany
| | - Wolfgang Wölwer
- Department of Psychiatry and Psychotherapy, Medical Faculty, University of Duesseldorf Duesseldorf, Germany
| | - Stefan Klingberg
- Department of Psychiatry and Psychotherapy, University of Tübingen Tübingen, Germany
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Wobrock T, Guse B, Cordes J, Wölwer W, Winterer G, Gaebel W, Langguth B, Landgrebe M, Eichhammer P, Frank E, Hajak G, Ohmann C, Verde PE, Rietschel M, Ahmed R, Honer WG, Malchow B, Schneider-Axmann T, Falkai P, Hasan A. Left prefrontal high-frequency repetitive transcranial magnetic stimulation for the treatment of schizophrenia with predominant negative symptoms: a sham-controlled, randomized multicenter trial. Biol Psychiatry 2015; 77:979-88. [PMID: 25582269 DOI: 10.1016/j.biopsych.2014.10.009] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 09/16/2014] [Accepted: 10/04/2014] [Indexed: 01/06/2023]
Abstract
BACKGROUND Investigators are urgently searching for options to treat negative symptoms in schizophrenia because these symptoms are disabling and do not respond adequately to antipsychotic or psychosocial treatment. Meta-analyses based on small proof-of-principle trials suggest efficacy of repetitive transcranial magnetic stimulation (rTMS) for the treatment of negative symptoms and call for adequately powered multicenter trials. This study evaluated the efficacy of 10-Hz rTMS applied to the left dorsolateral prefrontal cortex for the treatment of predominant negative symptoms in schizophrenia. METHODS A multicenter randomized, sham-controlled, rater-blinded and patient-blinded trial was conducted from 2007-2011. Investigators randomly assigned 175 patients with schizophrenia with predominant negative symptoms and a high-degree of illness severity into two treatment groups. After a 2-week pretreatment phase, 76 patients were treated with 10-Hz rTMS applied 5 days per week for 3 weeks to the left dorsolateral prefrontal cortex (added to the ongoing treatment), and 81 patients were subjected to sham rTMS applied similarly. RESULTS There was no statistically significant difference in improvement in negative symptoms between the two groups at day 21 (p = .53, effect size = .09) or subsequently through day 105. Also, symptoms of depression and cognitive function showed no differences in change between groups. There was a small, but statistically significant, improvement in positive symptoms in the active rTMS group (p = .047, effect size = .30), limited to day 21. CONCLUSIONS Application of active 10-Hz rTMS to the left dorsolateral prefrontal cortex was well tolerated but was not superior compared with sham rTMS in improving negative symptoms; this is in contrast to findings from three meta-analyses.
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Affiliation(s)
- Thomas Wobrock
- Department of Psychiatry and Psychotherapy (TW, BG), Georg-August-Universtat Goettingen, Goettingen; Centre of Mental Health (TW), County Hospitals Darmstadt-Dieburg, Groß-Umstadt.
| | - Birgit Guse
- Department of Psychiatry and Psychotherapy (TW, BG), Georg-August-Universtat Goettingen, Goettingen
| | - Joachim Cordes
- Department of Psychiatry and Psychotherapy, Heinrich-Heine University, Düsseldorf; Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich, Heine University, Düsseldorf
| | - Wolfgang Wölwer
- Department of Psychiatry and Psychotherapy, Heinrich-Heine University, Düsseldorf; Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich, Heine University, Düsseldorf
| | - Georg Winterer
- Department of Psychiatry and Psychotherapy, Heinrich-Heine University, Düsseldorf; Charité-Universitätsmedizin Berlin, Berlin
| | - Wolfgang Gaebel
- Department of Psychiatry and Psychotherapy, Heinrich-Heine University, Düsseldorf; Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich, Heine University, Düsseldorf
| | - Berthold Langguth
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg
| | - Michael Landgrebe
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg; Department of Psychiatry, Psychosomatics and Psychotherapy, kbo-Lech-Mangfall-Klinik, Agatharied
| | - Peter Eichhammer
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg
| | - Elmar Frank
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg
| | - Göran Hajak
- Department of Psychiatry, Psychosomatics and Psychotherapy, Sozialstiftung Bamberg, Bamberg
| | - Christian Ohmann
- Coordination Centre for Clinical Trials, Heinrich-Heine University, Düsseldorf
| | - Pablo E Verde
- Coordination Centre for Clinical Trials, Heinrich-Heine University, Düsseldorf
| | - Marcella Rietschel
- Department of Genetic Epidemiology in Psychiatry, Institute of Central Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim
| | - Raees Ahmed
- Institut für anwendungsorientierte Forschung und klinische Studien GmbH, Goettingen, Germany
| | - William G Honer
- Department of Psychiatry and Institute of Mental Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Berend Malchow
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-Universtat, Munich, Germany
| | | | - Peter Falkai
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-Universtat, Munich, Germany
| | - Alkomiet Hasan
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-Universtat, Munich, Germany
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Luckhaus C, Frommann N, Wölwer W. Training of Affect Recognition in Schizophrenia Patients with Violent Offences: Treatment Effects and Electrophysiological Correlates. Eur Psychiatry 2015. [DOI: 10.1016/s0924-9338(15)30594-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Mehl S, Landsberg MW, Schmidt AC, Cabanis M, Bechdolf A, Herrlich J, Loos-Jankowiak S, Kircher T, Kiszkenow S, Klingberg S, Kommescher M, Moritz S, Müller BW, Sartory G, Wiedemann G, Wittorf A, Wölwer W, Wagner M. Why do bad things happen to me? Attributional style, depressed mood, and persecutory delusions in patients with schizophrenia. Schizophr Bull 2014; 40:1338-46. [PMID: 24743864 PMCID: PMC4193715 DOI: 10.1093/schbul/sbu040] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Theoretical models postulate an important role of attributional style (AS) in the formation and maintenance of persecutory delusions and other positive symptoms of schizophrenia. However, current research has gathered conflicting findings. In a cross-sectional design, patients with persistent positive symptoms of schizophrenia (n = 258) and healthy controls (n = 51) completed a revised version of the Internal, Personal and Situational Attributions Questionnaire (IPSAQ-R) and assessments of psychopathology. In comparison to controls, neither patients with schizophrenia in general nor patients with persecutory delusions (n = 142) in particular presented an externalizing and personalizing AS. Rather, both groups showed a "self-blaming" AS and attributed negative events more toward themselves. Persecutory delusions were independently predicted by a personalizing bias for negative events (beta = 0.197, P = .001) and by depression (beta = 0.152, P = .013), but only 5% of the variance in persecutory delusions could be explained. Cluster analysis of IPSAQ-R scores identified a "personalizing" (n = 70) and a "self-blaming" subgroup (n = 188), with the former showing slightly more pronounced persecutory delusions (P = .021). Results indicate that patients with schizophrenia and patients with persecutory delusions both mostly blamed themselves for negative events. Nevertheless, still a subgroup of patients could be identified who presented a more pronounced personalizing bias and more severe persecutory delusions. Thus, AS in patients with schizophrenia might be less stable but more determined by individual and situational characteristics that need further elucidation.
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Affiliation(s)
- Stephanie Mehl
- Department of Psychiatry and Psychotherapy, Philipps-University, Marburg, Germany; Department of Psychiatry and Psychotherapy, Rhineland Friedrich Wilhelms University, Bonn, Germany;
| | - Martin W. Landsberg
- Department of Psychiatry and Psychotherapy, Rhineland Friedrich Wilhelms University, Bonn, Germany
| | - Anna-Christine Schmidt
- Department of Psychiatry and Psychotherapy, Rhineland Friedrich Wilhelms University, Bonn, Germany
| | - Maurice Cabanis
- Department of Psychiatry and Psychotherapy, Philipps-University, Marburg, Germany
| | - Andreas Bechdolf
- Department of Psychiatry and Psychotherapy, University of Cologne, Nordrhein-Westfalen, Germany
| | - Jutta Herrlich
- Department of Psychiatry, Psychosomatics and Psychotherapy, University of Frankfurt, Hessen, Germany
| | - Stephanie Loos-Jankowiak
- Clinic for Psychiatry and Psychotherapy, University of Duisburg- Essen, Nordrhein-Westfalen, Germany
| | - Tilo Kircher
- Department of Psychiatry and Psychotherapy, Philipps-University, Marburg, Germany
| | - Stephanie Kiszkenow
- Department of Psychiatry and Psychotherapy, University of Düsseldorf, LVR-Clinic Düsseldorf, Nordrhein-Westfalen, Germany
| | - Stefan Klingberg
- Department of Psychiatry and Psychotherapy, University of Tübingen, Baden-Wuertenberg, Germany
| | - Mareike Kommescher
- Department of Psychiatry and Psychotherapy, University of Cologne, Nordrhein-Westfalen, Germany
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University of Hamburg, Hamburg, Germany
| | - Bernhard W. Müller
- Clinic for Psychiatry and Psychotherapy, University of Duisburg- Essen, Nordrhein-Westfalen, Germany
| | - Gudrun Sartory
- Department of Psychology, University of Wuppertal, Nordrhein-Westfalen, Germany
| | | | - Andreas Wittorf
- Department of Psychiatry and Psychotherapy, University of Tübingen, Baden-Wuertenberg, Germany
| | - Wolfgang Wölwer
- Department of Psychiatry and Psychotherapy, University of Düsseldorf, LVR-Clinic Düsseldorf, Nordrhein-Westfalen, Germany
| | - Michael Wagner
- Department of Psychiatry and Psychotherapy, Rhineland Friedrich Wilhelms University, Bonn, Germany
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Drusch K, Stroth S, Kamp D, Frommann N, Wölwer W. Effects of Training of Affect Recognition on the recognition and visual exploration of emotional faces in schizophrenia. Schizophr Res 2014; 159:485-90. [PMID: 25248938 DOI: 10.1016/j.schres.2014.09.003] [Citation(s) in RCA: 23] [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: 04/30/2014] [Revised: 08/12/2014] [Accepted: 09/03/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Schizophrenia patients have impairments in facial affect recognition and display scanpath abnormalities during the visual exploration of faces. These abnormalities are characterized by fewer fixations on salient feature areas and longer fixation durations. The present study investigated whether social-cognitive remediation not only improves performance in facial affect recognition but also normalizes patients' gaze behavior while looking at faces. METHODS Within a 2 × 2-design (group × time), 16 schizophrenia patients and 16 healthy controls performed a facial affect recognition task with concomitant infrared oculography at baseline (T0) and after six weeks (T1). Between the measurements, patients completed the Training of Affect Recognition (TAR) program. The influence of the training on facial affect recognition (percent of correct answers) and gaze behavior (number and mean duration of fixations into salient or non-salient facial areas) was assessed. RESULTS In line with former studies, at baseline patients showed poorer facial affect recognition than controls and aberrant scanpaths, and after TAR facial affect recognition was improved. Concomitant with improvements in performance, the number of fixations in feature areas ('mouth') increased while fixations in non-feature areas ('white space') decreased. However, the change in fixation behavior did not correlate with the improvement in performance. CONCLUSIONS After TAR, patients pay more attention to facial areas that contain information about a displayed emotion. Although this may contribute to the improved performance, the lack of a statistical correlation implies that this factor is not sufficient to explain the underlying mechanism of the treatment effect.
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Affiliation(s)
- Katharina Drusch
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich Heine University Düsseldorf, Bergische Landstrasse 2, 40629 Düsseldorf, Germany.
| | - Sanna Stroth
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich Heine University Düsseldorf, Bergische Landstrasse 2, 40629 Düsseldorf, Germany
| | - Daniel Kamp
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich Heine University Düsseldorf, Bergische Landstrasse 2, 40629 Düsseldorf, Germany
| | - Nicole Frommann
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich Heine University Düsseldorf, Bergische Landstrasse 2, 40629 Düsseldorf, Germany
| | - Wolfgang Wölwer
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich Heine University Düsseldorf, Bergische Landstrasse 2, 40629 Düsseldorf, Germany
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Zäske H, Freimüller L, Wölwer W, Gaebel W. Antistigma-Kompetenz in der psychiatrischen Versorgung: Ergebnisse der Pilotierung einer berufsgruppenübergreifenden Weiterbildung. Fortschr Neurol Psychiatr 2014; 82:586-92. [DOI: 10.1055/s-0034-1385130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- H. Zäske
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, LVR-Klinikum Düsseldorf, Heinrich-Heine-Universität, Medizinische Fakultät, Düsseldorf
| | | | - W. Wölwer
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, LVR-Klinikum Düsseldorf, Heinrich-Heine-Universität, Medizinische Fakultät, Düsseldorf
| | - W. Gaebel
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, LVR-Klinikum Düsseldorf, Heinrich-Heine-Universität, Medizinische Fakultät, Düsseldorf
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Wölwer W, Lowe A, Brinkmeyer J, Streit M, Habakuck M, Agelink MW, Mobascher A, Gaebel W, Cordes J. Repetitive Transcranial Magnetic Stimulation (rTMS) Improves Facial Affect Recognition in Schizophrenia. Brain Stimul 2014; 7:559-63. [DOI: 10.1016/j.brs.2014.04.011] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 04/17/2014] [Accepted: 04/30/2014] [Indexed: 12/24/2022] Open
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Frommann N, Stroth S, Brinkmeyer J, Wölwer W, Luckhaus C. Facial affect recognition performance and event-related potentials in violent and non-violent schizophrenia patients. Neuropsychobiology 2014; 68:139-45. [PMID: 24051542 DOI: 10.1159/000353252] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Accepted: 05/27/2013] [Indexed: 11/19/2022]
Abstract
We investigated whether male inpatients with schizophrenia and a history of hands-on violent offences (forensic schizophrenic, FOS) are more impaired in emotion recognition than matched schizophrenia patients without any history of violence (general psychiatric schizophrenic, GPS). This should become apparent in performance in psychometry and in scalp event-related brain potentials (ERPs) evoked by pictures of facial affect. FOS and GPS (each n = 19) were matched concerning age, intelligence, comorbid addiction, medication and illness duration. FOS revealed significantly poorer affect recognition (AR) performance, especially of neutral and fear stimuli. Analysis of ERPs revealed a significant interaction of hemisphere, electrode position and group of the N250 component. Post hoc analysis of group effect showed significantly larger amplitudes in FOS at FC3. These results support the hypothesis that in FOS emotional faces are more salient and evoke higher arousal. Larger impairment in AR performance combined with higher salience and arousal may contribute to the occurrence of violent acts in schizophrenia patients.
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Affiliation(s)
- Nicole Frommann
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich Heine University of Düsseldorf, Düsseldorf, Germany
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Wölwer W, Lowe A, Frommann N. [Training of social-cognitive functions--new approaches towards the avoidance of psychosocial disabilities in schizophrenia]. Fortschr Neurol Psychiatr 2014; 82:203-9. [PMID: 24710676 DOI: 10.1055/s-0034-1366205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Impairments in social cognitive processes are present across the course of schizophrenia despite clinically efficacious traditional treatment and contribute to poor functional outcome. Thus, during the last decade specialised social cognitive remediation programmes have been developed, which achieve improvements in social cognition with large effect sizes. In contrast, remediation targeting basic cognition seems neither necessary nor sufficient for such improvements. Associated with improved social cognitive performance, first studies also hint to improved social functioning. Although only moderate in effect size, these improvements are still somewhat larger than those described for basic cognition training and social skills training. In the case that such promising effects can be replicated and enhanced, in future social-cognitive remediation may become a valuable complement to traditional treatment in schizophrenia.
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Gaebel W, Buchkremer G, Häfner H, Klosterkötter J, Maier W, Wölwer W. 12 Jahre Kompetenznetz Schizophrenie: Ergebnisse und Perspektiven. Fortschr Neurol Psychiatr 2014; 82:191-202. [DOI: 10.1055/s-0034-1366193] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- W. Gaebel
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf
| | - G. Buchkremer
- Klinik für Psychiatrie und Psychotherapie, Universität Tübingen
| | - H. Häfner
- Arbeitsgruppe Schizophrenieforschung, Zentralinstitut für Seelische Gesundheit Mannheim
| | | | - W. Maier
- Klinik für Psychiatrie und Psychotherapie, Universität Bonn
| | - W. Wölwer
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf
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Gaebel W, Riesbeck M, Wölwer W, Klimke A, Eickhoff M, von Wilmsdorff M, Heuser I, Maier W, Klosterkötter J, Falkai P, Schlösser R, Schmitt A, Riedel M, Klingberg S, Köpcke W, Ohmann C, Möller HJ. Rates and predictors of remission in first-episode schizophrenia within 1 year of antipsychotic maintenance treatment. Results of a randomized controlled trial within the German Research Network on Schizophrenia. Schizophr Res 2014; 152:478-86. [PMID: 23643327 DOI: 10.1016/j.schres.2013.04.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Revised: 03/21/2013] [Accepted: 04/12/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Full and sustained symptom remission is a major treatment objective after a first-episode in schizophrenia. Findings regarding differences in remission between first- and second-generation antipsychotics are inconclusive. This study aimed to provide rates and predictors of remission in first-episode schizophrenia and to identify symptoms that prevent remission. METHODS Prevalence rates of "symptomatic remission" (symptom criteria only) and "enduring remission" (symptom and 6-month time criteria), defined according to Andreasen et al. (2005), were determined in first-episode patients participating in a RCT by the German Research Network on Schizophrenia (GRNS) that compared post-acute, 1-year maintenance treatment with risperidone or haloperidol. Respective predictors at baseline were identified by logistic and Cox regression analysis. RESULTS Prevalence rates were 91.5% for symptomatic remission (n=152/166 eligible patients) and 58.6% for enduring remission (n=65 of 111 patients who continued for at least 6 months; 39.2% of all 166 patients included), with no significant differences between risperidone and haloperidol in either type of remission. Enduring remission often was not reached because of negative symptoms: After 6 months, 40.5% of the patients had at least 1 negative symptom, whereas only 10.8% of the patients had "persisting" positive symptoms. Of the different predictors identified in univariate analyses, (lower) negative symptoms and participating in standardized psychological treatment remained significant in multivariate (stepwise forward) analyses for enduring remission. CONCLUSIONS By far most of the first-episode patients reached a temporary state of full symptomatic remission within 1 year of antipsychotic treatment. However, only about 50% achieved sustained, enduring remission. Negative symptoms are still a major treatment obstacle to enduring remission in schizophrenia.
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Affiliation(s)
- Wolfgang Gaebel
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Duesseldorf, Germany.
| | - Mathias Riesbeck
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Duesseldorf, Germany
| | - Wolfgang Wölwer
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Duesseldorf, Germany
| | - Ansgar Klimke
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Duesseldorf, Germany; Department of Psychiatry and Psychotherapy, Vitos Waldkrankenhaus Köppern, Germany
| | - Matthias Eickhoff
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Duesseldorf, Germany; Department of Psychiatry, Westfalia Clinics, Warstein/Lippstadt, Germany
| | - Martina von Wilmsdorff
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Duesseldorf, Germany
| | - Isabella Heuser
- Department of Psychological Medicine, Charité-Campus Benjamin Franklin, Berlin, Germany
| | - Wolfgang Maier
- Department of Psychiatry and Psychotherapy, University of Bonn, Germany
| | | | - Peter Falkai
- Department of Psychiatry and Psychotherapy, University of Göttingen, Germany; Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
| | - Ralf Schlösser
- Department of Psychiatry and Psychotherapy, University of Jena, Germany; AHG Römhild Clinic, Germany
| | - Andrea Schmitt
- Central Institute of Mental Health, Mannheim, University of Heidelberg, Germany; Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
| | - Michael Riedel
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
| | - Stefan Klingberg
- Department of Psychiatry and Psychotherapy, University of Tübingen, Germany
| | - Wolfgang Köpcke
- Department of Medical Informatics and Biomathematics, University of Münster, Germany
| | - Christian Ohmann
- Coordinating Centre for Clinical Trials, Heinrich-Heine-University, Düsseldorf, Germany
| | - Hans-Jürgen Möller
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
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Krug A, Cabanis M, Pyka M, Pauly K, Kellermann T, Walter H, Wagner M, Landsberg M, Shah NJ, Winterer G, Wölwer W, Brinkmeyer J, Müller BW, Kärgel C, Wiedemann G, Herrlich J, Vogeley K, Schilbach L, Rapp A, Klingberg S, Kircher T. Attenuated prefrontal activation during decision-making under uncertainty in schizophrenia: a multi-center fMRI study. Schizophr Res 2014; 152:176-83. [PMID: 24325976 DOI: 10.1016/j.schres.2013.11.007] [Citation(s) in RCA: 23] [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: 06/27/2013] [Revised: 11/04/2013] [Accepted: 11/11/2013] [Indexed: 10/25/2022]
Abstract
Decisions are called decisions under uncertainty when either prior information is incomplete or the outcomes of the decision are unclear. Alterations in these processes related to decisions under uncertainty have been linked to delusions. In patients with schizophrenia, the underlying neural networks have only rarely been studied. We aimed to disentangle the neural correlates of decision-making and relate them to neuropsychological and psychopathological parameters in a large sample of patients with schizophrenia and healthy subjects. Fifty-seven patients and fifty-seven healthy volunteers from six centers had to either indicate via button-press from which of two bottles red or blue balls were drawn (decision-making under uncertainty condition), or indicate whether eight red balls had been presented (baseline condition) while BOLD signal was measured with fMRI. Patients based their decisions on less conclusive evidence and had decreased activations in the underlying neural network, comprising of medial and lateral frontal as well as parietal areas, as compared to healthy subjects. While current psychopathology was not correlated with brain activation, positive symptoms led to longer decision latencies in patients. These results suggest that decision-making under uncertainty in schizophrenia is affected by a complex interplay of aberrant neural activation. Furthermore, reduced neuropsychological functioning in patients was related to impaired decision-making and task performance was modulated by distinct positive symptoms.
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Affiliation(s)
- A Krug
- Department of Psychiatry and Psychotherapy, Philipps University, Marburg, Germany.
| | - M Cabanis
- Department of Psychiatry and Psychotherapy, Philipps University, Marburg, Germany
| | - M Pyka
- Department of Psychiatry and Psychotherapy, Philipps University, Marburg, Germany
| | - K Pauly
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Medical School, RWTH Aachen University, Aachen, Germany
| | - T Kellermann
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Medical School, RWTH Aachen University, Aachen, Germany
| | - H Walter
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Berlin, Germany
| | - M Wagner
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany
| | - M Landsberg
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany
| | - N J Shah
- Institute of Neuroscience and Medicine, Medical Imaging Physics (INM4), Research Centre Juelich, Germany; Department of Neurology, Faculty of Medicine, JARA, RWTH Aachen University, Aachen, Germany
| | - G Winterer
- Cologne Center for Genomics, University of Cologne, Köln, Germany
| | - W Wölwer
- Department of Psychiatry and Psychotherapy, Heinrich Heine University, Rhineland State Clinics for Psychiatry, Düsseldorf, Germany
| | - J Brinkmeyer
- Department of Psychiatry and Psychotherapy, Heinrich Heine University, Rhineland State Clinics for Psychiatry, Düsseldorf, Germany
| | - B W Müller
- LVR-Hospital Essen, Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Duisburg-Essen, Rhineland State Clinics for Psychiatry, Essen, Germany
| | - C Kärgel
- LVR-Hospital Essen, Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Duisburg-Essen, Rhineland State Clinics for Psychiatry, Essen, Germany
| | - G Wiedemann
- Clinic of Psychiatry and Psychotherapy, Clinical Center, Fulda, Germany
| | - J Herrlich
- Department of Psychiatry and Psychotherapy, Johann Wolfgang Goethe University, Frankfurt/Main, Germany
| | - K Vogeley
- Department of Psychiatry and Psychotherapy, University of Cologne, Köln, Germany; Institute for Neurosciences and Medicine, Cognitive Neuroscience (INM3), Research Center Juelich, Germany
| | - L Schilbach
- Department of Psychiatry and Psychotherapy, University of Cologne, Köln, Germany
| | - A Rapp
- Department of Psychiatry and Psychotherapy, Eberhard Karls University, Tübingen, Germany
| | - S Klingberg
- Department of Psychiatry and Psychotherapy, Eberhard Karls University, Tübingen, Germany
| | - T Kircher
- Department of Psychiatry and Psychotherapy, Philipps University, Marburg, Germany
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Sachs G, Winklbaur B, Jagsch R, Frommann N, Wölwer W. EPA-1288 - Training of affect recognition in schizophrenia. Eur Psychiatry 2014. [DOI: 10.1016/s0924-9338(14)78516-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Konnopka A, Stuhldreher N, Klingberg S, Wittorf A, Bechdolf A, Müller BW, Sartory G, Wagner M, Wiedemann G, Wölwer W, Heinrich S, König HH. [Determinants of direct cost in schizophrenia patients with persistent positive symptoms]. Psychiatr Prax 2013; 41:215-20. [PMID: 24089318 DOI: 10.1055/s-0033-1349463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To analyze direct costs and cost determinants in psychotic patients with persistent positive symptoms (PPS). METHODS A total of 330 patients with PPS were recruited via 6 university clinics and interviewed about service utilization in the previous 3 months. After monetary valuation, costs were analyzed via generalized linear mixed models with gamma distribution and log-link function to identify determinants of direct costs. RESULTS The mean costs were 7,065 € and resulted predominantly from psychiatric hospital care (63 %), assisted living (17 %) and complementary services (8 %). We found statistically significant associations between direct costs and an increasing score of the negative subscale of the Positive and Negative Syndrome Scale (+ 2,484 € per point, p < 0.001) and experiencing less than one social contact per week (- 2,272 €, p = 0.003). CONCLUSION PPS incurred substantial direct costs which primarily resulted from hospital treatment, and were strongly associated with symptom severity.
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Drusch K, Lowe A, Fisahn K, Brinkmeyer J, Musso F, Mobascher A, Warbrick T, Shah J, Ohmann C, Winterer G, Wölwer W. Effects of nicotine on social cognition, social competence and self-reported stress in schizophrenia patients and healthy controls. Eur Arch Psychiatry Clin Neurosci 2013; 263:519-27. [PMID: 23081705 DOI: 10.1007/s00406-012-0377-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2011] [Accepted: 10/05/2012] [Indexed: 12/18/2022]
Abstract
More than 80 % of patients diagnosed with schizophrenia are nicotine-dependent. Self-medication of cognitive deficits and an increased vulnerability to stress are discussed as promoting factors for the development of nicotine dependence. However, the effects of nicotine on social cognition and subjective stress responses in schizophrenia are largely unexplored. A 2 × 2-factorial design (drug × group) was used to investigate the effects of nicotine versus placebo in smoking schizophrenia patients and healthy controls after 24 h of abstinence from smoking. Participants performed a facial affect recognition task and a semi-standardized role-play task, after which social competence and self-reported stress during social interaction were assessed. Data analysis revealed no significant group differences in the facial affect recognition task. During social interaction, healthy controls showed more non-verbal expressions and a lower subjective stress level than schizophrenia patients. There were no significant effects of nicotine in terms of an enhanced recognition of facial affect, more expressive behaviour or reduced subjective stress during social interaction. While schizophrenia patients unexpectedly recognized facial affect not significantly worse than healthy controls, the observed group differences in subjective stress and non-verbal expression during social interaction in the role-play situation are in line with previous findings. Contrary to expectations derived from the self-medication hypothesis, nicotine showed no significant effects on the dependent variables, perhaps because of the dosage used and the delay between the administration of nicotine and the performance of the role-play.
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Affiliation(s)
- Katharina Drusch
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich Heine University Düsseldorf, LVR Klinikum Düsseldorf, Bergische Landstraße 2, 40629, Düsseldorf, Germany.
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Luckhaus C, Frommann N, Stroth S, Brinkmeyer J, Wölwer W. Training of affect recognition in schizophrenia patients with violent offences: behavioral treatment effects and electrophysiological correlates. Soc Neurosci 2013; 8:505-14. [PMID: 23879268 DOI: 10.1080/17470919.2013.820667] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Violent offenders with schizophrenia have a particularly poor performance level in facial affect recognition. Nineteen male schizophrenia patients, who had been committed to psychiatric hospital detention because of violent offences and lack of criminal responsibility, were recruited to receive the Training of Affect Recognition (TAR). Performance in the Pictures of Facial Affect (PFA)-test and event-related potentials (ERPs) were registered in a pre-post-treatment design. TAR was feasible with a very high treatment effect (Cohen's d = 1.88), which persisted for 2 months post-treatment. ERPs remained unchanged post- vs. pre-treatment, while low resolution brain electromagnetic tomography (LORETA) revealed activation decreases in left-hemispheric parietal-temporal-occipital regions at 172 msec and activation increases in right dorsolateral prefrontal cortex and anterior cingulate at 250 msec. Possibly, violent offenders with schizophrenia are particularly amenable to TAR because of a high level of dysfunction at baseline. Post- vs. pre-treatment changes of neural activity (LORETA) may mirror a gain of efficiency in structural face decoding and a shift towards a more reflective mode of emotional face decoding, relying on increased frontal brain activity. Functional magnetic resonance imaging (BOLD-fMRI) -data from another study further supports this notion. TAR treatment might enable subjects with schizophrenia and a disposition to violence to reach a higher degree of deliberation of their reactive behavior to facial affect stimuli.
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Affiliation(s)
- Christian Luckhaus
- a Department of Psychiatry and Psychotherapy, Medical Faculty , Heinrich-Heine-University , Düsseldorf , Germany
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Schennach R, Riesbeck M, Mayr A, Seemüller F, Maier W, Klingberg S, Heuser I, Klosterkötter J, Gastpar M, Schmitt A, Sauer H, Schneider F, Jäger M, Wölwer W, Gaebel W, Möller HJ, Riedel M. Should early improvement be re-defined to better predict the maintenance of response in first-episode schizophrenia patients? Acta Psychiatr Scand 2013; 127:474-81. [PMID: 22957829 DOI: 10.1111/acps.12006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the predictive validity of early response in first-episode schizophrenia within a 1-year follow-up trial and to compare the resulting cutoff to the currently proposed early response definition (20% improvement by week 2). METHOD Receiver operator characteristic (ROC) analyses were used to identify the predictive validity of the psychopathological improvement of treatment from week 1 to week 8, regarding the maintenance of response until week 52 as well as to define the most reasonable cutoff in 132 first-episode patients. The Youden Index (maximum of sensitivity and specificity) was used to compare the newly developed and the commonly used early response definition. RESULTS Starting with week 6, a reasonable validity to predict the maintenance of response was found (area under the curve = 0.721) with the best fitting cutoff being a 51.6% PANSS total score improvement. Using this cutoff 74 patients (56%) were correctly identified to become responder and maintain response during follow-up (sensitivity: 0.747). The Youden Index was higher applying the newly developed early response cutoff featuring higher specificity compared to the commonly used early response definition. CONCLUSION Regarding long-term treatment, it seems more appropriate to base predictions of the patient's maintenance of response not before 6 weeks of treatment.
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Affiliation(s)
- R Schennach
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich Department of Psychiatry and Psychotherapy, University of Göttingen, Germany.
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Wölwer W, Toeller V, Klingberg S, Gaebel W. [Specialised treatment in first episode schizophrenia: concepts and results]. Fortschr Neurol Psychiatr 2013; 81:276-283. [PMID: 23695792 DOI: 10.1055/s-0032-1330507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Multifaceted evidence suggests that patients in the early phase of a psychotic disorder need a specific treatment strategy meeting their specific needs and problems in this "critical" phase of the disorder. The present review summarises this evidence and presents early treatment approaches according to already internationally established different models, while in Germany comparable concepts are only in a pilot stage. Previous evaluation studies showed a superior efficacy of such early treatment approaches compared to conventional standard treatment in terms of both clinical outcome and in relation to the total costs of treatment. Questions remain, however, especially with regard to the specificity and durability of such effects, and with regard to the effective treatment components. Before similar programmes can be broadly established in Germany, a consensus on their indispensable characteristics and appropriate quality indicators should be achieved.
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Affiliation(s)
- W Wölwer
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf.
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Wölwer W, Brinkmeyer J, Stroth S, Streit M, Bechdolf A, Ruhrmann S, Wagner M, Gaebel W. Neurophysiological correlates of impaired facial affect recognition in individuals at risk for schizophrenia. Schizophr Bull 2012; 38:1021-9. [PMID: 21402721 PMCID: PMC3446235 DOI: 10.1093/schbul/sbr013] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [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: 11/13/2022]
Abstract
BACKGROUND Impairments in facial affect recognition are well documented in individuals suffering from schizophrenia. The aim of the present study was to characterize potential impairments in affect recognition and their electrophysiological correlates in at-risk individuals. Such characterization should add to the question whether the neural processes underlying facial affect recognition deficits might be part of a basic neural dysfunction reflecting a vulnerability factor of schizophrenia. METHODS To test facial affect recognition, a digitized series of pictures of facial affect, previously used in related studies, was presented to 37 at-risk individuals and 32 healthy controls. Simultaneously, event-related potentials (ERPs) were recorded to investigate electrophysiological activity during the task. RESULTS At-risk individuals showed significant impairments in facial affect recognition and reduced amplitudes in the ERP components P100, N170, and N250. Furthermore, prodromal signs in these individuals were associated with a poorer task performance and a diminished N250 amplitude. CONCLUSIONS The findings suggest that impairments in facial affect recognition precede the onset of the initial psychotic episode. The impairments are associated with neurophysiological abnormalities similar to those observed in manifest schizophrenia and therefore may serve as indicators of vulnerability for developing schizophrenia.
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Affiliation(s)
- Wolfgang Wölwer
- Department of Psychiatry and Psychotherapy, University of Düsseldorf, Düsseldorf, Germany.
| | - Jürgen Brinkmeyer
- Department of Psychiatry and Psychotherapy, University of Düsseldorf, Düsseldorf, Germany
| | - Sanna Stroth
- Department of Psychiatry and Psychotherapy, University of Düsseldorf, Düsseldorf, Germany
| | - Marcus Streit
- Department of Psychiatry and Psychotherapy, University of Düsseldorf, Düsseldorf, Germany
| | - Andreas Bechdolf
- Department of Psychiatry, University of Cologne, Cologne, Germany
| | - Stephan Ruhrmann
- Department of Psychiatry, University of Cologne, Cologne, Germany
| | - Michael Wagner
- Department of Psychiatry, University of Bonn, Bonn, Germany
| | - Wolfgang Gaebel
- Department of Psychiatry and Psychotherapy, University of Düsseldorf, Düsseldorf, Germany
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