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Reducing neuronal size results in less cell membrane and therefore lower input conductance. Smaller neurons are thus more excitable as seen in their voltage responses to current injections in the soma. However, the impact of a neuron’s size and shape on its voltage responses to synaptic activation in dendrites is much less understood. Here we use analytical cable theory to predict voltage responses to distributed synaptic inputs and show that these are entirely independent of dendritic length. For a given synaptic density, a neuron’s response depends only on the average dendritic diameter and its intrinsic conductivity. These results remain true for the entire range of possible dendritic morphologies irrespective of any particular arborisation complexity. Also, spiking models result in morphology invariant numbers of action potentials that encode the percentage of active synapses. Interestingly, in contrast to spike rate, spike times do depend on dendrite morphology. In summary, a neuron’s excitability in response to synaptic inputs is not affected by total dendrite length. It rather provides a homeostatic input-output relation that specialised synapse distributions, local non-linearities in the dendrites and synaptic plasticity can modulate. Our work reveals a new fundamental principle of dendritic constancy that has consequences for the overall computation in neural circuits.
Hintergrund: Depressionen sind häufige, schwere und oft lebensbedrohliche Erkrankungen, bei denen es – trotz sehr guter Behandlungsmethoden – Versorgungslücken gibt. Hierzu tragen Vorbehalte gegen eine leitlinienkonforme pharmako- und/oder psychotherapeutische Behandlung bei. Ziel der Arbeit ist es zu ermitteln, in welchen soziodemographischen Bevölkerungssegmenten diese Vorbehalte besonders ausgeprägt sind.
Methodik: Die Untersuchung basiert auf Online-Befragungen der deutschen Bevölkerung aus den Jahren 2021, 2020 und 2019, darunter 1656 Personen (2021), 1775 Personen (2020) und 1729 Personen (2019) ohne Depressionserfahrungen. Mit einer CHAID-Analyse wurde geprüft, in welchen Bevölkerungssegmenten die Vorbehalte gegen eine leitliniengerechte Behandlung besonders groß sind.
Ergebnisse: Vorbehalte gegen Pharmakotherapie hatten insgesamt 69,8 % der Befragten ohne Depressionserfahrungen. Am größten waren die Vorbehalte unter jüngeren Personen (< 40 Jahre); hier lag der Anteil bei 74,2 %. Vorbehalte gegen Psychotherapie äußerten 31,4 % ohne Depressionserfahrungen; unter Frauen mit geringerer Schulbildung hatten 40,5 % Vorbehalte gegen eine Psychotherapie; unter Männern mit geringerer Schulbildung waren es 39,1 %. Vorbehalte gegen beide Behandlungsformen zeigten 27,7 %. Am größten waren die Vorbehalte unter Männern mit Schulbildung unterhalb der Hochschulreife (34,1 %). Die Ergebnisse sind signifikant (χ2-Test, p < 0,05).
Diskussion: Eine allgemeine Informationsstrategie wäre geeignet, Vorbehalten gegen Pharmakotherapie und Psychotherapie gleichermaßen zu verringern. Für eine spezifische Informationsstrategie müssen die Botschaften hinsichtlich Inhalt und Kommunikationskanälen so gestaltet werden, dass die jüngere Zielgruppe zuverlässig erreicht wird.
Circulating monocytes contribute to inflammatory processes. We here validate abnormal expression of inflammation-related genes in monocytes of a large and well-characterised group of MDD patients, and relate the outcomes to pertinent clinical characteristics. Thirty-two genes of a previously established inflammation-related gene signature were assessed in 197 patients with MDD, and 151 controls collected during the EU-MOODINFLAME project. Monocyte gene- expression data were related to age, sex, BMI, depression severity, childhood adversity (CA) and suicide risk (SR). Three distinct gene profiles were identified within the MDD group (downregulated, mixed upregulated and strongly upregulated genes). Patients in the merged upregulated groups had a significantly higher prevalence of CA and high SR. Using hierarchical clustering of the genes, we found a cluster of mainly cytokine (production)-related genes; patients with SR had a significantly higher expression of this cluster than patients without SR (particularly for IL-6, IL1A and IL1B). Such difference did not emerge for patients with and without CA. A downregulated gene profile was found for patients not exposed to CA and without SR (particularly for glucocorticoid-signalling genes NR3C1a and HSPA1/B). No inflammatory changes were observed for healthy controls exposed to CA. Our data show that inflammatory activation in MDD is not uniform, and that immunologically discernible phenotypes of depression can be linked to CA and high SR. The absence of monocyte inflammatory activation in healthy controls exposed to CA suggests an inflammatory involvement in MDD-prone individuals exposed to early stressors, but not healthy controls.
Purpose: In this study, we examined distress levels and quality of life (QoL) of patients with hematologic malignancies under treatment in an acute setting. We used external- and self-assessment instruments for distress. Additionally, we investigated the relation between distress and QoL as well as whether highly distressed patients differed from less distressed patients concerning their QoL.
Methods: A cross-sectional study with patients of the Medical Clinic II of the University Hospital Frankfurt was conducted. One hundred and nine patients were assessed with an expert rating scale and completed self-report questionnaires. Data were exploratively analyzed and group comparisons between patients who scored above the cut-off of the respective screening instruments and those who did not were conducted.
Results: Patients with hematologic malignancies experience high levels of distress and low QoL. Especially, role and social functioning are affected. Patients suffer most from fatigue, appetite loss, and insomnia. Using established cut-offs, all screening instruments were able to differentiate between patients regarding distress and QoL. Patients scoring above the cut-off were significantly more distressed and had a lower QoL. There was a medium-to-strong correlation between distress and QoL indicators.
Conclusion: Cancer-specific screening instruments seem to be able to identify treatment needs more specifically. They also allowed a better differentiation concerning QoL. The close link between distress and QoL needs to be recognized to enable a holistic approach to treatment and thereby optimize the quality of treatment.
Background: Autism spectrum disorder (ASD) is characterized by impaired social communication and interaction, and stereotyped, repetitive behaviour and sensory interests. To date, there is no effective medication that can improve social communication and interaction in ASD, and effect sizes of behaviour-based psychotherapy remain in the low to medium range. Consequently, there is a clear need for new treatment options. ASD is associated with altered activation and connectivity patterns in brain areas which process social information. Transcranial direct current stimulation (tDCS) is a technique that applies a weak electrical current to the brain in order to modulate neural excitability and alter connectivity. Combined with specific cognitive tasks, it allows to facilitate and consolidate the respective training effects. Therefore, application of tDCS in brain areas relevant to social cognition in combination with a specific cognitive training is a promising treatment approach for ASD. Methods: A phase-IIa pilot randomized, double-blind, sham-controlled, parallel-group clinical study is presented, which aims at investigating if 10 days of 20-min multi-channel tDCS stimulation of the bilateral tempo-parietal junction (TPJ) at 2.0 mA in combination with a computer-based cognitive training on perspective taking, intention and emotion understanding, can improve social cognitive abilities in children and adolescents with ASD. The main objectives are to describe the change in parent-rated social responsiveness from baseline (within 1 week before first stimulation) to post-intervention (within 7 days after last stimulation) and to monitor safety and tolerability of the intervention. Secondary objectives include the evaluation of change in parent-rated social responsiveness at follow-up (4 weeks after end of intervention), change in other ASD core symptoms and psychopathology, social cognitive abilities and neural functioning post-intervention and at follow-up in order to explore underlying neural and cognitive mechanisms. Discussion: If shown, positive results regarding change in parent-rated social cognition and favourable safety and tolerability of the intervention will confirm tDCS as a promising treatment for ASD core-symptoms. This may be a first step in establishing a new and cost-efficient intervention for individuals with ASD.
Beneficial acute effects of resistance exercise on cognitive functions may be modified by exercise intensity or by habitual physical activity. Twenty-six participants (9 female and 17 male; 25.5 ± 3.4 years) completed four resistance exercise interventions in a randomized order on separate days (≥48 h washout). The intensities were set at 60%, 75%, and 90% of the one repetition maximum (1RM). Three interventions had matched workloads (equal resistance*nrepetitions). One intervention applied 75% of the 1RM and a 50% reduced workload (resistance*nrepetitions = 50%). Cognitive attention (Trail Making Test A—TMTA), task switching (Trail Making Test B—TMTB), and working memory (Digit Reading Spans Backward) were assessed before and immediately after exercise. Habitual activity was assessed as MET hours per week using the International Physical Activity Questionnaire. TMTB time to completion was significantly shorter after exercise with an intensity of 60% 1RM and 75% 1RM and 100% workload. Friedman test indicated a significant effect of exercise intensity in favor of 60% 1RM. TMTA performance was significantly shorter after exercise with an intensity of 60% 1RM, 90% 1RM, and 75% 1RM (50% workload). Habitual activity with vigorous intensity correlated positively with the baseline TMTB and Digit Span Forward performance but not with pre- to post-intervention changes. Task switching, based on working memory, mental flexibility, and inhibition, was beneficially influenced by acute exercise with moderate intensity whereas attention performance was increased after exercise with moderate and vigorous intensity. The effect of regular activity had no impact on acute exercise effects.
Background: Increasingly, informal caregivers in Belgium care in group for an older patient. This study aimed to decrease the caregiver burden and to increase the well-being of caregivers and patients by supporting the needs of informal care groups of older patients (≥70 years).
Method: Through an online self-management tool, the groups were supported to make informed choices concerning the care for the older patient, taking into account the standards, values, concerns and needs of every caregiver and patient. A pre-post study was performed.
Results: Although patients and caregivers considered the self-management tool as useful and supportive, no clear evidence for decreased caregiver burden was found. There was a positive trend in group characteristics such as the distribution of tasks, communication and prevalence of conflicts. Caregivers also stated that they took more time for themselves, had less feelings of guilt and experienced less barriers to ask help.
Conclusion: Tailor-made support of informal care groups starts with facilitating and guiding a process to achieve consent within the group to optimise the care for the patient and also for the caregivers. With a shared vision and supported decisions, caregivers can enter into conversations with the professional caregiver to coordinate adjusted support regarding the care needs.
Background and purpose: The ENIGMA-EEG working group was established to enable large-scale international collaborations among cohorts that investigate the genetics of brain function measured with electroencephalography (EEG). In this perspective, we will discuss why analyzing the genetics of functional brain activity may be crucial for understanding how neurological and psychiatric liability genes affect the brain. Methods: We summarize how we have performed our currently largest genome-wide association study of oscillatory brain activity in EEG recordings by meta-analyzing the results across five participating cohorts, resulting in the first genome-wide significant hits for oscillatory brain function located in/near genes that were previously associated with psychiatric disorders. We describe how we have tackled methodological issues surrounding genetic meta-analysis of EEG features. We discuss the importance of harmonizing EEG signal processing, cleaning, and feature extraction. Finally, we explain our selection of EEG features currently being investigated, including the temporal dynamics of oscillations and the connectivity network based on synchronization of oscillations. Results: We present data that show how to perform systematic quality control and evaluate how choices in reference electrode and montage affect individual differences in EEG parameters. Conclusion: The long list of potential challenges to our large-scale meta-analytic approach requires extensive effort and organization between participating cohorts; however, our perspective shows that these challenges are surmountable. Our perspective argues that elucidating the genetic of EEG oscillatory activity is a worthwhile effort in order to elucidate the pathway from gene to disease liability.
22q11.2 Deletion Syndrome (22q11.2DS) is the most common microdeletion in humans, with a heterogenous clinical presentation including medical, behavioural and psychiatric conditions. Previous neuroimaging studies examining the neuroanatomical underpinnings of 22q11.2DS show alterations in cortical volume (CV), cortical thickness (CT) and surface area (SA). The aim of this study was to identify (1) the spatially distributed networks of differences in CT and SA in 22q11.2DS compared to controls, (2) their unique and spatial overlap, as well as (3) their relative contribution to observed differences in CV. Structural MRI scans were obtained from 62 individuals with 22q11.2DS and 57 age-and-gender-matched controls (aged 6–31). Using FreeSurfer, we examined differences in vertex-wise estimates of CV, CT and SA at each vertex, and compared the frequencies of vertices with a unique or overlapping difference for each morphometric feature. Our findings indicate that CT and SA make both common and unique contributions to volumetric differences in 22q11.2DS, and in some areas, their strong opposite effects mask differences in CV. By identifying the neuroanatomic variability in 22q11.2DS, and the separate contributions of CT and SA, we can start exploring the shared and distinct mechanisms that mediate neuropsychiatric symptoms across disorders, e.g. 22q11.2DS-related ASD and/or psychosis/schizophrenia.
Background: Autism spectrum disorder (“autism”) is a highly heterogeneous neurodevelopmental condition with few effective treatments for core and associated features. To make progress we need to both identify and validate neural markers that help to parse heterogeneity to tailor therapies to specific neurobiological profiles. Atypical hemispheric lateralization is a stable feature across studies in autism, but its potential as a neural stratification marker has not been widely examined. Methods: In order to dissect heterogeneity in lateralization in autism, we used the large EU-AIMS (European Autism Interventions—A Multicentre Study for Developing New Medications) Longitudinal European Autism Project dataset comprising 352 individuals with autism and 233 neurotypical control subjects as well as a replication dataset from ABIDE (Autism Brain Imaging Data Exchange) (513 individuals with autism, 691 neurotypical subjects) using a promising approach that moves beyond mean group comparisons. We derived gray matter voxelwise laterality values for each subject and modeled individual deviations from the normative pattern of brain laterality across age using normative modeling. Results: Individuals with autism had highly individualized patterns of both extreme right- and leftward deviations, particularly in language, motor, and visuospatial regions, associated with symptom severity. Language delay explained most variance in extreme rightward patterns, whereas core autism symptom severity explained most variance in extreme leftward patterns. Follow-up analyses showed that a stepwise pattern emerged, with individuals with autism with language delay showing more pronounced rightward deviations than individuals with autism without language delay. Conclusions: Our analyses corroborate the need for novel (dimensional) approaches to delineate the heterogeneous neuroanatomy in autism and indicate that atypical lateralization may constitute a neurophenotype for clinically meaningful stratification in autism.
Sprach- und Sprechstörungen kommen bei zahlreichen Kindern vor und werden in der ICD-11 analog zur ICD-10 als Entwicklungsstörungen im Kapitel 6 (Psychische, Verhaltens- und Entwicklungsstörungen) klassifiziert. International sind bislang die ICD-10-Kriterien nicht von allen Professionen, die sich mit Sprach- und Sprechstörungen klinisch oder im Rahmen der Forschung beschäftigen, akzeptiert. Sie werden einerseits als zu wenig differenziert hinsichtlich der unterschiedlichen Sprachkomponenten vonseiten der Linguistik, Sprachtherapie oder Logopädie erlebt. Zum anderen wird die unklare Abgrenzung organisch bedingter Sprach- und Sprechprobleme von der Sprachentwicklungsstörung vonseiten der Medizin teilweise kritisch bewertet. In dem vorliegenden Artikel wird deshalb einerseits die Klassifikation von Sprach- und Sprechproblemen und -störungen in der ICD-11 im Vergleich zur ICD-10 vorgenommen. Wesentlich erscheint hier die in der ICD-11 neu eingeführte Differenzierung in „primäre“ und „sekundäre“ Neuroentwicklungsstörungen. Zum anderen erfolgt aber auch eine Auseinandersetzung mit dem DSM-5 sowie anderen Klassifikationsvorschlägen vonseiten der englischsprachigen Sprachtherapie (CATALISE-2) und der deutschsprachigen Pädaudiologie („phonologische Wahrnehmungsstörung“) sowie der Vorschlag einer Ergänzung der aktuellen ICD-11-Klassifikation hinsichtlich konkreter sprachlicher Einschränkungen bei einem Kind mit Sprachentwicklungsstörung, basierend auf einer ausführlichen Diagnostik. Wir hoffen, mit dem Artikel so den Weg für eine berufsübergreifende Klassifikation von Sprach- und Sprechstörungen nach ICD-11 zu bahnen, damit perspektivisch alle Berufsgruppen, die Diagnostik und Therapie der betroffenen Personen anbieten, eine vergleichbare Terminologie verwenden. Diese vergleichbare Terminologie soll sowohl die klinische Versorgung verbessern als auch die unterschiedlichen Forschungsansätze und -richtungen vergleichbarer machen.
The major depressive disorder is one of the most common mental illnesses worldwide. Current treatment standards recommend a combined therapy with medication and psychotherapy. As an additive component and to further improvements in treatment, physical activity such as yoga may be integrated into conventional treatment. This study investigates the impact of a 3-month body-oriented yoga in patients with major depressive disorder (MDD). In total, n = 83 patients were included. An intervention group received a vigorous Ashtanga-Yoga three times a week. The waiting-list control group obtained a treatment as usual (TAU). As a primary outcome depression scores (Beck Depression Inventory-II (BDI-II), Montgomery Asberg Depression Rating Scale (MADRS)) were tested at three time points. Secondary outcome was the positive and negative affect [Positive and Negative Affect Scale (PANAS)] and remission rates. To analyze the data, multilevel models and effect sizes were conducted. The results showed an improvement in BDI-II scores for both groups over time [γ = − 3.46, t(165) = − 7.99, p < 0.001] but not between groups [γ = 0.98, t(164) = 1.12, p = 0.263]. An interaction effect (time x group) occurred for MADRS [γ = 2.10, t(164) = 2.10, p < 0.038]. Positive affects improved over time for both groups [γ = 1.65, t(165) = 4.03, p < 0.001]. Negative affects decreased for all over time [γ = − 1.00, t(165) = − 2.51, p = 0.013]. There were no significant group differences in PANAS. Post hoc tests revealed a greater symptom reduction within the first 6 weeks for all measurements. The effect sizes for depression scores showed a positive trend. Remission rates indicated a significant improvement in the yoga group (BDI-II: 46.81%, MADRS: 17.02%) compared to the control group (BDI: 33.33%, MADRS: 8.33%). The findings suggest that there is a trendsetting additive effect of Ashtanga-Yoga after 3 months on psychopathology and mood with a greater improvement at the beginning of the intervention. Further research in this field can help to achieve more differentiated results.
Correction to: Translational Psychiatry https://doi.org/10.1038/s41398-021-01609-y, published online 24 September 2021
Since the publication of the article the authors have noticed mistakes in the text, figures, tables and supplementary materials. The authors apologize for these errors, which have now been corrected in the original article. Please note that these changes do not affect the results of the paper or their interpretation.
Resilience has been defined as the maintenance or quick recovery of mental health during and after times of adversity. How to operationalize resilience and to determine the factors and processes that lead to good long-term mental health outcomes in stressor-exposed individuals is a matter of ongoing debate and of critical importance for the advancement of the field. One of the biggest challenges for implementing an outcome-based definition of resilience in longitudinal observational study designs lies in the fact that real-life adversity is usually unpredictable and that its substantial qualitative as well as temporal variability between subjects often precludes defining circumscribed time windows of inter-individually comparable stressor exposure relative to which the maintenance or recovery of mental health can be determined. To address this pertinent issue, we propose to frequently and regularly monitor stressor exposure (E) and mental health problems (P) throughout a study's observation period [Frequent Stressor and Mental Health Monitoring (FRESHMO)-paradigm]. On this basis, a subject's deviation at any single monitoring time point from the study sample's normative E–P relationship (the regression residual) can be used to calculate that subject's current mental health reactivity to stressor exposure (“stressor reactivity,” SR). The SR score takes into account the individual extent of experienced adversity and is comparable between and within subjects. Individual SR time courses across monitoring time points reflect intra-individual temporal variability in SR, where periods of under-reactivity (negative SR score) are associated with accumulation of fewer mental health problems than is normal for the sample. If FRESHMO is accompanied by regular measurement of potential resilience factors, temporal changes in resilience factors can be used to predict SR time courses. An increase in a resilience factor measurement explaining a lagged decrease in SR can then be considered to index a process of adaptation to stressor exposure that promotes a resilient outcome (an allostatic resilience process). This design principle allows resilience research to move beyond merely determining baseline predictors of resilience outcomes, which cannot inform about how individuals successfully adjust and adapt when confronted with adversity. Hence, FRESHMO plus regular resilience factor monitoring incorporates a dynamic-systems perspective into resilience research.
The cell—cell signaling gene CDH13 is associated with a wide spectrum of neuropsychiatric disorders, including attention-deficit/hyperactivity disorder (ADHD), autism, and major depression. CDH13 regulates axonal outgrowth and synapse formation, substantiating its relevance for neurodevelopmental processes. Several studies support the influence of CDH13 on personality traits, behavior, and executive functions. However, evidence for functional effects of common gene variation in the CDH13 gene in humans is sparse. Therefore, we tested for association of a functional intronic CDH13 SNP rs2199430 with ADHD in a sample of 998 adult patients and 884 healthy controls. The Big Five personality traits were assessed by the NEO-PI-R questionnaire. Assuming that altered neural correlates of working memory and cognitive response inhibition show genotype-dependent alterations, task performance and electroencephalographic event-related potentials were measured by n-back and continuous performance (Go/NoGo) tasks. The rs2199430 genotype was not associated with adult ADHD on the categorical diagnosis level. However, rs2199430 was significantly associated with agreeableness, with minor G allele homozygotes scoring lower than A allele carriers. Whereas task performance was not affected by genotype, a significant heterosis effect limited to the ADHD group was identified for the n-back task. Heterozygotes (AG) exhibited significantly higher N200 amplitudes during both the 1-back and 2-back condition in the central electrode position Cz. Consequently, the common genetic variation of CDH13 is associated with personality traits and impacts neural processing during working memory tasks. Thus, CDH13 might contribute to symptomatic core dysfunctions of social and cognitive impairment in ADHD.
In psychiatry, there has been a growing focus on identifying at-risk populations. For schizophrenia, these efforts have led to the development of early recognition and intervention measures. Despite a similar disease burden, the populations at risk of bipolar disorder have not been sufficiently characterized. Within the BipoLife consortium, we used magnetic resonance imaging (MRI) data from a multicenter study to assess structural gray matter alterations in N = 263 help-seeking individuals from seven study sites. We defined the risk using the EPIbipolar assessment tool as no-risk, low-risk, and high-risk and used a region-of-interest approach (ROI) based on the results of two large-scale multicenter studies of bipolar disorder by the ENIGMA working group. We detected significant differences in the thickness of the left pars opercularis (Cohen’s d = 0.47, p = 0.024) between groups. The cortex was significantly thinner in high-risk individuals compared to those in the no-risk group (p = 0.011). We detected no differences in the hippocampal volume. Exploratory analyses revealed no significant differences in other cortical or subcortical regions. The thinner cortex in help-seeking individuals at risk of bipolar disorder is in line with previous findings in patients with the established disorder and corresponds to the region of the highest effect size in the ENIGMA study of cortical alterations. Structural alterations in prefrontal cortex might be a trait marker of bipolar risk. This is the largest structural MRI study of help-seeking individuals at increased risk of bipolar disorder.
Conduct disorder (CD), a psychiatric disorder characterized by a repetitive pattern of antisocial behaviors, results from a complex interplay between genetic and environmental factors. The clinical presentation of CD varies both according to the individual’s sex and level of callous-unemotional (CU) traits, but it remains unclear how genetic and environmental factors interact at the molecular level to produce these differences. Emerging evidence in males implicates methylation of genes associated with socio-affective processes. Here, we combined an epigenome-wide association study with structural neuroimaging in 51 females with CD and 59 typically developing (TD) females to examine DNA methylation in relation to CD, CU traits, and gray matter volume (GMV). We demonstrate an inverse pattern of correlation between CU traits and methylation of a chromosome 1 region in CD females (positive) as compared to TD females (negative). The identified region spans exon 1 of the SLC25A24 gene, central to energy metabolism due to its role in mitochondrial function. Increased SLC25A24 methylation was also related to lower GMV in multiple brain regions in the overall cohort. These included the superior frontal gyrus, dorsolateral prefrontal cortex, supramarginal gyrus, secondary visual cortex and ventral posterior cingulate cortex, which are regions that have previously been implicated in CD and CU traits. While our findings are preliminary and need to be replicated in larger samples, they provide novel evidence that CU traits in females are associated with methylation levels in a fundamentally different way in CD and TD individuals, which in turn may relate to observable variations in GMV across the brain.
Objective: Prisoners constitute a high-risk group for suicide, with suicide rates about 5 to 8 times higher than in the general population. The first weeks of imprisonment are a particularly vulnerable time, but there is limited knowledge about the risk factors for either early or late suicide events. Methods: Based on a national total sample of prison suicides in Germany between 2005 and 2017, suicides within the first 2 (4 and 8) weeks after reception into prison were matched by age and penalty length with cases that occurred later. Factors that potentially influence the timing of suicide were investigated. Results: The study has shown that 16.7% (31.5%) of all 390 suicides in German prisons occurred within the first two weeks (two months) of imprisonment. Factors that facilitate adaptation to the prison environment (e.g. prior prison experience) were negatively associated with early suicide events. Factors that hindered the adaptation process (e.g. withdrawal from illicit drugs) were observed more frequently in early suicide events than in late ones. These factors are active at different times of imprisonment. Conclusion: At reception, particular attention should be paid to the following factors associated with early suicide events: widowed marital status, lack of prison experience, and drug dependency.
Abstract: The Children's Communication Checklist-2 (CCC-2) is often applied to assess pragmatic language impairment which is highly prevalent in autism spectrum disorder (ASD) and several mental health conditions. We replicated previous findings on the limited applicability of the CCC-2 in clinical samples and the inconsistent findings concerning the factor structure. The aim of the present study was, thus, to develop a concise, simplified, and revised version of the CCC-2 in a large German-speaking sample. Four groups of children and adolescents aged 4 to 17 years were included: ASD (n = 195), intellectual disability (ID, n = 83), diverse mental health conditions (MHC, n = 144) and a typically developing control group (TD, n = 417). We reduced the original number of items from 70 to 39, based on item analysis, exploratory factor analysis and the exclusion of communication-unrelated items. The revised version, CCC-R (α = 0.96), consists of two empirically derived factors: a pragmatic-language (α = 0.96) and a grammatical-semantic-language factor (α = 0.93). All clinical groups (ASD, ID, and MHC) had significantly increased CCC-R total scores, with the highest scores being in the neurodevelopmental disorder groups (ASD and ID). In addition, we found group-specific patterns of elevated pragmatic-language scores in the ASD group and grammatical-semantic scores in the ID group. The CCC-R was comparable to the CCC-2 in distinguishing ASD from the other groups. The CCC-R is proposed as a simplified and easily applied, clinical questionnaire for caregivers, assessing pragmatic language impairments across neurodevelopmental disorders and mental health conditions. Lay Summary: The CCC-2 is a questionnaire designed to identify children who have problems in the social use of language, however, it is limited in its clinical application and exhibits inconsistent factors. We have created a shorter and simpler version of the CCC-2 that we have called the CCC-R which overcomes the previous limitations of the CCC-2. It consists of two subscales: pragmatic language and grammatical-semantic language. The CCC-R can be used as a short and clinically relevant caregiver questionnaire which assesses pragmatic language impairments in children and adolescents. Autism Res 2021, 14: 759–772. © 2021 The Authors. Autism Research published by International Society for Autism Research published by Wiley Periodicals LLC.
Physical inactivity is discussed as one of the most detrimental influences for lifestyle-related medical complications such as obesity, heart disease, hypertension, diabetes and premature mortality in in- and outpatients with major depressive disorder (MDD). In contrast, intervention studies indicate that moderate-to-vigorous-intensity physical activity (MVPA) might reduce complications and depression symptoms itself. Self-reported data on depression [Beck-Depression-Inventory-II (BDI-II)], general habitual well-being (FAHW), self-esteem and physical self-perception (FAHW, MSWS) were administrated in a cross-sectional study with 76 in- and outpatients with MDD. MVPA was documented using ActiGraph wGT3X + ® accelerometers and fitness was measured using cardiopulmonary exercise testing (CPET). Subgroups were built according to activity level (low PA defined as MVPA < 30 min/day, moderate PA defined as MVPA 30–45 min/day, high PA defined as MVPA > 45 min/day). Statistical analysis was performed using a Mann–Whitney U and Kruskal–Wallis test, Spearman correlation and mediation analysis. BDI-II scores and MVPA values of in- and outpatients were comparable, but fitness differed between the two groups. Analysis of the outpatient group showed a negative correlation between BDI-II and MVPA. No association of inpatient MVPA and psychopathology was found. General habitual well-being and self-esteem mediated the relationship between outpatient MVPA and BDI-II. The level of depression determined by the BDI-II score was significantly higher in the outpatient low- and moderate PA subgroups compared to outpatients with high PA. Fitness showed no association to depression symptoms or well-being. To ameliorate depressive symptoms of MDD outpatients, intervention strategies should promote habitual MVPA and exercise exceeding the duration recommended for general health (≥ 30 min/day). Further studies need to investigate sufficient MVPA strategies to impact MDD symptoms in inpatient settings. Exercise effects seem to be driven by changes of well-being rather than increased physical fitness.
Beneficial acute effects of resistance exercise on cognitive functions may be modified by exercise intensity or by habitual physical activity. Twenty-six participants (9 female and 17 male; 25.5 ± 3.4 years) completed four resistance exercise interventions in a randomized order on separate days (≥48 h washout). The intensities were set at 60%, 75%, and 90% of the one repetition maximum (1RM). Three interventions had matched workloads (equal resistance*nrepetitions). One intervention applied 75% of the 1RM and a 50% reduced workload (resistance*nrepetitions = 50%). Cognitive attention (Trail Making Test A—TMTA), task switching (Trail Making Test B—TMTB), and working memory (Digit Reading Spans Backward) were assessed before and immediately after exercise. Habitual activity was assessed as MET hours per week using the International Physical Activity Questionnaire. TMTB time to completion was significantly shorter after exercise with an intensity of 60% 1RM and 75% 1RM and 100% workload. Friedman test indicated a significant effect of exercise intensity in favor of 60% 1RM. TMTA performance was significantly shorter after exercise with an intensity of 60% 1RM, 90% 1RM, and 75% 1RM (50% workload). Habitual activity with vigorous intensity correlated positively with the baseline TMTB and Digit Span Forward performance but not with pre- to post-intervention changes. Task switching, based on working memory, mental flexibility, and inhibition, was beneficially influenced by acute exercise with moderate intensity whereas attention performance was increased after exercise with moderate and vigorous intensity. The effect of regular activity had no impact on acute exercise effects.
Background: Misconceptions about ADHD stigmatize affected people, reduce credibility of providers, and prevent/delay treatment. To challenge misconceptions, we curated findings with strong evidence base. Methods: We reviewed studies with more than 2000 participants or meta-analyses from five or more studies or 2000 or more participants. We excluded meta-analyses that did not assess publication bias, except for meta-analyses of prevalence. For network meta-analyses we required comparison adjusted funnel plots. We excluded treatment studies with waiting-list or treatment as usual controls. From this literature, we extracted evidence-based assertions about the disorder. Results: We generated 208 empirically supported statements about ADHD. The status of the included statements as empirically supported is approved by 80 authors from 27 countries and 6 continents. The contents of the manuscript are endorsed by 366 people who have read this document and agree with its contents. Conclusions: Many findings in ADHD are supported by meta-analysis. These allow for firm statements about the nature, course, outcome causes, and treatments for disorders that are useful for reducing misconceptions and stigma.
Background: Bipolar disorder is associated with circadian disruption and a high risk of suicidal behavior. In a previous exploratory study of patients with bipolar I disorder, we found that a history of suicide attempts was associated with differences between winter and summer levels of solar insolation. The purpose of this study was to confirm this finding using international data from 42% more collection sites and 25% more countries. Methods: Data analyzed were from 71 prior and new collection sites in 40 countries at a wide range of latitudes. The analysis included 4876 patients with bipolar I disorder, 45% more data than previously analyzed. Of the patients, 1496 (30.7%) had a history of suicide attempt. Solar insolation data, the amount of the sun’s electromagnetic energy striking the surface of the earth, was obtained for each onset location (479 locations in 64 countries). Results: This analysis confirmed the results of the exploratory study with the same best model and slightly better statistical significance. There was a significant inverse association between a history of suicide attempts and the ratio of mean winter insolation to mean summer insolation (mean winter insolation/mean summer insolation). This ratio is largest near the equator which has little change in solar insolation over the year, and smallest near the poles where the winter insolation is very small compared to the summer insolation. Other variables in the model associated with an increased risk of suicide attempts were a history of alcohol or substance abuse, female gender, and younger birth cohort. The winter/summer insolation ratio was also replaced with the ratio of minimum mean monthly insolation to the maximum mean monthly insolation to accommodate insolation patterns in the tropics, and nearly identical results were found. All estimated coefficients were significant at p < 0.01. Conclusion: A large change in solar insolation, both between winter and summer and between the minimum and maximum monthly values, may increase the risk of suicide attempts in bipolar I disorder. With frequent circadian rhythm dysfunction and suicidal behavior in bipolar disorder, greater understanding of the optimal roles of daylight and electric lighting in circadian entrainment is needed.
Substantial evidence shows that physical activity and fitness play a protective role in the development of stress related disorders. However, the beneficial effects of fitness for resilience to modern life stress are not fully understood. Potentially protective effects may be attributed to enhanced resilience via underlying psychosocial mechanisms such as self-efficacy expectations. This study investigated whether physical activity and fitness contribute to prospectively measured resilience and examined the mediating effect of general self-efficacy. 431 initially healthy adults participated in fitness assessments as part of a longitudinal-prospective study, designed to identify mechanisms of resilience. Self-efficacy and habitual activity were assessed in parallel to cardiorespiratory and muscular fitness, which were determined by a submaximal step-test, hand strength and standing long jump test. Resilience was indexed by stressor reactivity: mental health problems in relation to reported life events and daily hassles, monitored quarterly for nine months. Hierarchical linear regression models and bootstrapped mediation analyses were applied. We could show that muscular and self-perceived fitness were positively associated with stress resilience. Extending this finding, the muscular fitness–resilience relationship was partly mediated by self-efficacy expectations. In this context, self-efficacy expectations may act as one underlying psychological mechanism, with complementary benefits for the promotion of mental health. While physical activity and cardiorespiratory fitness did not predict resilience prospectively, we found muscular and self-perceived fitness to be significant prognostic parameters for stress resilience. Although there is still more need to identify specific fitness parameters in light of stress resilience, our study underscores the general relevance of fitness for stress-related disorders prevention.
To explore and describe attitudes and opinions towards suicidality in healthcare professionals (HCPs) working with oncological patients. Methods: A 48-item online questionnaire was developed and distributed to HCPs working with cancer patients. Three hundred fifty-four answered questionnaires were analyzed. Results: The majority of HCPs reported that they were able to understand why a cancer patient would commit suicide (87.8%) or would seek help from an assisted suicide organization (ASO; 83.9%). The understandable reasons were pain and physical impairments (51.4%), social isolation (19.8%), loss of control and autonomy (18.1%), terminal disease (17.2%), loss of meaning (15.3%), desperation (14.7%), and psychic distress (9.3%). Personal experiences with suicidality lead only 44.8% of HCPs to believe that thereby they would be better able to understand a patients’ wish for suicide. Religion was negatively associated with understanding of suicide and why a cancer patient would seek help from an ASO. Knowledge of suicidality was positively associated with why a cancer patient would seek help from an ASO. Conclusions: There is still little knowledge in oncology about the relation of HCPs’ attitudes toward suicidality in their patients and how those attitudes influence their behavior, especially care and treatment of patients. More research on this topic is needed. It stands to reason that more education about suicidality in cancer patients seems likely to improve understanding and attitudes and thereby influence care for cancer patients.
Abstract: Neurophysiological measures of preparation and attention are often atypical in ADHD. Still, replicated findings that these measures predict which patients improve after Neurofeedback (NF), reveal neurophysiological specificity, and reflect ADHD-severity are limited. Methods: We analyzed children’s preparatory (CNV) and attentional (Cue-P3) brain activity and behavioral performance during a cued Continuous Performance Task (CPT) before and after slow cortical potential (SCP)-NF or semi-active control treatment (electromyogram biofeedback). Mixed-effects models were performed with 103 participants at baseline and 77 were assessed for pre-post comparisons focusing on clinical outcome prediction, specific neurophysiological effects of NF, and associations with ADHD-severity. Results: Attentional and preparatory brain activity and performance were non-specifically reduced after treatment. Preparatory activity in the SCP-NF group increased with clinical improvement. Several performance and brain activity measures predicted non-specific treatment outcome. Conclusion: Specific neurophysiological effects after SCP-NF were limited to increased neural preparation associated with improvement on ADHD-subscales, but several performance and neurophysiological measures of attention predicted treatment outcome and reflected symptom severity in ADHD. The results may help to optimize treatment.
Interpretation bias and dysfunctional social assumptions are proposed to play a pivotal role in the development and maintenance of social phobia (SP), especially in youth. In this study, we aimed to investigate disorder-specific implicit assumptions of rejection and implicit interpretation bias in youth with severe, chronic SP and healthy controls (CG). Twenty-seven youth with SP in inpatient/day-care treatment (M age = 15.6 years, 74% female) and 24 healthy controls (M age = 15.7 years, 54% female) were included. The Implicit Association Test (IAT) and the Affect Misattribution Procedure (AMP) were completed to assess implicit assumptions and interpretation bias related to the processing of social and affective stimuli. No group differences were observed for the IAT controlling for depressive symptoms in the analyses. However, group differences were found regarding interpretation bias (p = .017, η2p = .137). Correlations between implicit scores and explicit questionnaire results were medium to large in the SP group (r =|.28| to |.54|, pall ≤ .05), but lower in the control group (r =|.04| to |.46|, pall ≤ .05). Our results confirm the finding of an interpretation bias in youth SP, especially regarding the implicit processing of faces, whereas implicit dysfunctional social assumptions of being rejected do not seem to be specific for SP. Future research should investigate the causal relationship of assumptions/interpretation bias and SP.
Sprach- und Sprechstörungen kommen bei zahlreichen Kindern vor und werden in der ICD-11 analog zur ICD-10 als Entwicklungsstörungen im Kapitel 6 (Psychische, Verhaltens- und Entwicklungsstörungen) klassifiziert. International sind bislang die ICD-10-Kriterien nicht von allen Professionen, die sich mit Sprach- und Sprechstörungen klinisch oder im Rahmen der Forschung beschäftigen, akzeptiert. Sie werden einerseits als zu wenig differenziert hinsichtlich der unterschiedlichen Sprachkomponenten vonseiten der Linguistik, Sprachtherapie oder Logopädie erlebt. Zum anderen wird die unklare Abgrenzung organisch bedingter Sprach- und Sprechprobleme von der Sprachentwicklungsstörung vonseiten der Medizin teilweise kritisch bewertet. In dem vorliegenden Artikel wird deshalb einerseits die Klassifikation von Sprach- und Sprechproblemen und -störungen in der ICD-11 im Vergleich zur ICD-10 vorgenommen. Wesentlich erscheint hier die in der ICD-11 neu eingeführte Differenzierung in „primäre“ und „sekundäre“ Neuroentwicklungsstörungen. Zum anderen erfolgt aber auch eine Auseinandersetzung mit dem DSM-5 sowie anderen Klassifikationsvorschlägen vonseiten der englischsprachigen Sprachtherapie (CATALISE-2) und der deutschsprachigen Pädaudiologie („phonologische Wahrnehmungsstörung“) sowie der Vorschlag einer Ergänzung der aktuellen ICD-11-Klassifikation hinsichtlich konkreter sprachlicher Einschränkungen bei einem Kind mit Sprachentwicklungsstörung, basierend auf einer ausführlichen Diagnostik. Wir hoffen, mit dem Artikel so den Weg für eine berufsübergreifende Klassifikation von Sprach- und Sprechstörungen nach ICD-11 zu bahnen, damit perspektivisch alle Berufsgruppen, die Diagnostik und Therapie der betroffenen Personen anbieten, eine vergleichbare Terminologie verwenden. Diese vergleichbare Terminologie soll sowohl die klinische Versorgung verbessern als auch die unterschiedlichen Forschungsansätze und -richtungen vergleichbarer machen.
The pathophysiological role of neural autoantibodies in acute psychotic disorders is receiving increased attention. However, there is still an ongoing debate, whether predominantly psychotic manifestations of autoimmune encephalitides exist that may remain undetected and, thus, untreated. Furthermore, it is discussed if such conditions can be diagnosed based on serum antibody results or if a reliable diagnosis requires additional cerebrospinal fluids (CSF) results. In this study, we screened pairs of serum and CSF samples from antipsychotic-naïve individuals with first-episode schizophrenic psychosis (FEP, n = 103), clinical high risk for psychosis (CHR, n = 47), and healthy volunteers (HV, n = 40) for eight different antibodies against various antigens that have been shown to be associated with autoimmune encephalitides: N-methyl-D-aspartate receptor (NMDAR, NR1 subunits only), glutamic acid decarboxylase (GAD65), leucine-rich glioma inactivated protein 1 (LGI1), contactin-associated protein-like 2 protein (CASPR2), α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor (AMPAR) subunit 1, AMPAR subunit 2, γ-aminobutyric acid-B receptors (GABABR), and glycine receptors. All patients were within the norm with regards to a careful neurological examination, a magnetic resonance imaging (MRI) of the brain, an electroencephalogram (EEG), and routine blood pathology. All CSF samples were autoantibody-negative. In three serum samples of individuals with FEP, we detected low-titer CASPR2 immunoglobulin (Ig) G antibodies (≤1:160, n = 2) and non-IgG antibodies against NMDAR (n = 1) (overall serum-autoantibody prevalence in FEP: 2.91%). However, the IgG titers were below the laboratory cut-off defined for positivity, and non-IgG antibodies are of no clinical relevance. This suggests that there were no cases of autoimmune encephalitis in our cohort. Our results highlight the importance and the high specificity of CSF analysis to reliably detect autoantibodies. They confirm the hypothesis that pure psychotic manifestations of antibody-associated autoimmune encephalitides without any additional neuropsychiatric findings are very rare. However, special attention must be paid to those presenting with atypical mental illnesses with additional neurological symptoms, evidence of clinically-significant cognitive involvement, profound sleep-wake perturbations, seizures, electroencephalographic, or magnetic resonance imaging pathologies to be able to identify cases with autoimmune-mediated psychiatric syndromes.
Das Mammakarzinom ist die häufigste Krebserkrankung der Frau. Aufgrund der zu ver-zeichnenden steigenden Erkrankungs- als auch Überlebensraten werden stetig mehr Frauen mit der Diagnose Brustkrebs und ihren Folgen konfrontiert. Seit den 1990er Jah-ren wird eine kognitive Dysfunktion von Patientinnen nach Krebstherapie in der For-schung diskutiert, wobei die Hintergründe und Zusammenhänge dieses Phänomens bis heute strittig sind. Ziel dieser Arbeit ist die Untersuchung der kognitiven Leistungsfä-higkeit mit einem Fokus auf Aufmerksamkeitsleistungen vor und nach einer adjuvanten Krebstherapie. In diesem Zusammenhang soll besonders der Einfluss von psychischem Stress auf die Aufmerksamkeit und ferner auch die subjektive kognitive Leistungsfähig-keit von Brustkrebspatientinnen beleuchtet werden.
Dazu wurde die Aufmerksamkeitsfähigkeit von 20 Patientinnen, die in der Klinik für Frauenheilkunde und Geburtshilfe des Universitätsklinikums Frankfurt am Main ange-bunden waren, zu jeweils zwei Messzeitpunkten anhand einer neuropsychologischen Testbatterie (Trail-Making Test, NeuroCogFX) untersucht. Die erste Messung erfolgte vor Therapieeinleitung, eine zweite Messung nach Beendigung einer adjuvanten Krebs-therapie. Gleichzeitig wurden Werte zu Depressivität, Angst, krankheitsbezogener Le-bensqualität und der kognitiven Funktionsfähigkeit mittels verschiedener Fragebögen (HADS, EORTC-QLQ C30, EORTC-QLQ BR23) erhoben. Eine Kontrollgruppe von gesunden Probandinnen (N=13) wurde nach den gleichen Vorgaben untersucht.
30% der Patientinnen hatten eine kombinierte Chemotherapie erhalten, eine Radiatio war bei 70% und eine antihormonelle Therapie bei 75% erfolgt. Die Testungen der Pati-entinnen fanden im Mittel 12 (SD 15,4) Tage nach OP statt. Die T2-Messungen erfolg-ten im Mittel 10,3 (SD: 3,2) Monate nach den T1-Messungen für Patientinnen und 7,3 (SD: 1,8) Monate für Kontrollprobandinnen. Alter, IQ und Bildungsniveau waren zwi-schen beiden Gruppen gleich, Unterschiede zeigten sich hinsichtlich der BMI- Werte und der sportlichen Aktivität. Es zeigten sich weder zum ersten noch zum zweiten Messzeitpunkt signifikante Unterschiede der Aufmerksamkeitsleistungen zwischen Pati-entinnen und der Kontrollgruppe. Unterschiede fanden sich lediglich zwischen beiden Zeitpunkten in der einfachen Reaktionszeit mit schlechteren Testleistungen während T2 sowie im TMT Teil B mit besseren Ergebnissen während T2 für beide Gruppen. Hoch-signifikant unterschieden sich dagegen Patientinnen von der Kontrollgruppe mit schlechteren Werten hinsichtlich Angst und Depression, der Lebensqualität sowie der empfundenen kognitiven Funktionen. Dabei war keine signifikante Veränderung der Werte zwischen T1 und T2 messbar. Eine Korrelation zwischen aufmerksamkeitsbezo-genen Testleistungen und psychischem Stress bestand nicht, weiterhin fand sich kein Zusammenhang zwischen subjektiver kognitiver Leistungsfähigkeit und objektiven Testergebnissen. Hochsignifikant korrelierten dagegen schlechtere Werte der subjektiven kognitiven Fähigkeiten mit erhöhten Werten für Angst und Depression.
Auf Grundlage dieser Arbeit lässt sich kein relevanter Einfluss einer adjuvanten Krebs-therapie auf die Aufmerksamkeitsleistungen ableiten. Die Ergebnisse belegen aber signi-fikant erhöhte Werte für Depression und Angst von Brustkrebspatientinnen und den Einfluss von erhöhtem psychischem Stress auf die subjektive kognitive Funktionsfähig-keit. Diesbezüglich sollten zukünftige Behandlungsstrategien auch die subjektive kogni-tive Funktionsfähigkeit und in diesem Zusammenhang auch die spezifische Therapie von psychischem Stress in den Fokus rücken.
The influence of delayed auditory feedback on action evaluation and execution of real-life action-induced sounds apart from language and music is still poorly understood. Here, we examined how a temporal delay impacted the behavioral evaluation and neural representation of hurdling and tap-dancing actions in a functional magnetic resonance imaging (fMRI) experiment, postulating that effects of delay diverge between the two, as we create action-induced sounds intentionally in tap dancing, but incidentally in hurdling. Based on previous findings, we expected that conditions differ regarding the engagement of the supplementary motor area (SMA), posterior superior temporal gyrus (pSTG), and primary auditory cortex (A1). Participants were videotaped during a 9-week training of hurdling and tap dancing; in the fMRI scanner, they were presented with point-light videos of their own training videos, including the original or the slightly delayed sound, and had to evaluate how well they performed on each single trial. For the undelayed conditions, we replicated A1 attenuation and enhanced pSTG and SMA engagement for tap dancing (intentionally generated sounds) vs. hurdling (incidentally generated sounds). Delayed auditory feedback did not negatively influence behavioral rating scores in general. Blood-oxygen-level-dependent (BOLD) response transiently increased and then adapted to repeated presentation of point-light videos with delayed sound in pSTG. This region also showed a significantly stronger correlation with the SMA under delayed feedback. Notably, SMA activation increased more for delayed feedback in the tap-dancing condition, covarying with higher rating scores. Findings suggest that action evaluation is more strongly based on top–down predictions from SMA when sounds of intentional action are distorted.
Objective: This study examines the interrelations of parenting practices, emotional climate, and household chaos in families with children with and without ADHD. In particular, indirect pathways from children’s ADHD symptomatology to inadequate parenting and negative emotional climate via household chaos were investigated. Method: Parenting, emotional climate, and household chaos were assessed using questionnaires and a speech sample of parents of 31 children with and 53 without ADHD, aged 7 to 13 years. Results: Group differences were found for certain parenting dimensions, the parent–child relationship, critical comments, and household chaos. While we found significant indirect effects between children’s ADHD and certain parenting dimensions through household chaos, no effects were found for any aspect of emotional climate. Conclusion: Children’s ADHD symptoms translate into inadequate parenting through household chaos, which underlines the need for interventions to improve household organization skills in parents of children with ADHD.
Interest in time-resolved connectivity in fMRI has grown rapidly in recent years. The most widely used technique for studying connectivity changes over time utilizes a sliding windows approach. There has been some debate about the utility of shorter versus longer windows, the use of fixed versus adaptive windows, as well as whether observed resting state dynamics during wakefulness may be predominantly due to changes in sleep state and subject head motion. In this work we use an independent component analysis (ICA)-based pipeline applied to concurrent EEG/fMRI data collected during wakefulness and various sleep stages and show: 1) connectivity states obtained from clustering sliding windowed correlations of resting state functional network time courses well classify the sleep states obtained from EEG data, 2) using shorter sliding windows instead of longer non-overlapping windows improves the ability to capture transition dynamics even at windows as short as 30 s, 3) motion appears to be mostly associated with one of the states rather than spread across all of them 4) a fixed tapered sliding window approach outperforms an adaptive dynamic conditional correlation approach, and 5) consistent with prior EEG/fMRI work, we identify evidence of multiple states within the wakeful condition which are able to be classified with high accuracy. Classification of wakeful only states suggest the presence of time-varying changes in connectivity in fMRI data beyond sleep state or motion. Results also inform about advantageous technical choices, and the identification of different clusters within wakefulness that are separable suggest further studies in this direction.
Background: Body dysmorphic disorder (BDD) is characterized by an excessive preoccupation with one or more perceived flaws in one’s own appearance. Previous studies provided evidence for deficits in configural and holistic processing in BDD. Preliminary evidence suggests abnormalities at an early stage of visual processing. The present study is the first examining early neurocognitive perception of the own face in BDD by using electroencephalography (EEG). We investigated the face inversion effect, in which inverted (upside-down) faces are disproportionately poorly processed compared to upright faces. This effect reflects a disruption of configural and holistic processing, and in consequence a preponderance of featural face processing.
Methods: We recorded face-sensitive event-related potentials (ERPs) in 16 BDD patients and 16 healthy controls, all unmedicated. Participants viewed upright and inverted (upside-down) images of their own face and an unfamiliar other face, each in two facial emotional expressions (neutral vs. smiling). We calculated the early ERP components P100, N170, P200, N250, and the late positive component (LPC), and compared amplitudes among both groups.
Results: In the early P100, no face inversion effects were found in both groups. In the N170, both groups exhibited the common face inversion effects, with significantly larger N170 amplitudes for inverted than upright faces. In the P200, both groups exhibited larger inversion effects to other (relative to own) faces, with larger P200 amplitudes for other upright than inverted faces. In the N250, no significant group differences were found in face processing. In the LPC, both groups exhibited larger inversion effects to other (relative to own) faces, with larger LPC amplitudes for other inverted than upright faces. These overall patterns appeared to be comparable for both groups. Smaller inversion effects to own (relative to other) faces were observed in none of these components in BDD, relative to controls.
Conclusions: The findings suggest no evidence for abnormalities at all levels of early face processing in our observed sample of BDD patients. Further research should investigate the neural substrates underlying BDD symptomatology.
Rhythmic actions benefit from synchronization with external events. Auditory-paced finger tapping studies indicate the two cerebral hemispheres preferentially control different rhythms. It is unclear whether left-lateralized processing of faster rhythms and right-lateralized processing of slower rhythms bases upon hemispheric timing differences that arise in the motor or sensory system or whether asymmetry results from lateralized sensorimotor interactions. We measured fMRI and MEG during symmetric finger tapping, in which fast tapping was defined as auditory-motor synchronization at 2.5 Hz. Slow tapping corresponded to tapping to every fourth auditory beat (0.625 Hz). We demonstrate that the left auditory cortex preferentially represents the relative fast rhythm in an amplitude modulation of low beta oscillations while the right auditory cortex additionally represents the internally generated slower rhythm. We show coupling of auditory-motor beta oscillations supports building a metric structure. Our findings reveal a strong contribution of sensory cortices to hemispheric specialization in action control.
Working memory (WM) performance varies substantially among individuals but the precise contribution of different WM component processes to these functional limits remains unclear. By analyzing different types of responses in a spatial WM task, we recently demonstrated a functional dissociation between confident and not-confident errors reflecting failures of WM encoding and maintenance, respectively. Here, we use event-related brain potentials to further explore this dissociation. Healthy participants performed a delayed orientation-discrimination task and rated their response confidence for each trial. The encoding-related N2pc component was significantly reduced for confident errors compared to confident correct responses, which is indicative of an encoding failure. In contrast, the maintenance-related contra-lateral delay activity was similar for these response types indicating that in confident error trials, WM representations – potentially the wrong ones – were maintained accurately and with stability throughout the delay interval. However, contra-lateral delay activity measured during the early part of the delay period was decreased for not-confident errors, potentially reflecting compromised maintenance processes. These electrophysiological findings contribute to a refined understanding of the encoding and maintenance processes that contribute to limitations in WM performance and capacity.
Forgetting is a common phenomenon in everyday life. Although it often has negative connotations, forgetting is an important adaptive mechanism to avoid loading the memory storage with irrelevant information. A very important aspect of forgetting is its interaction with emotion. Affective events are often granted special and priority treatment over neutral ones with regards to memory storage. As a consequence, emotional information is more resistant to extinction than neutral information. It has been suggested that intentional forgetting serves as a mechanism to cope with unwanted or disruptive emotional memories and the main goal of this study was to assess forgetting of emotional auditory material using the item-method directed forgetting (DF) paradigm using a forgetting strategy based on mindfulness as a means to enhance DF. Contrary to our prediction, the mindfulness-based strategy not only did not improve DF but reduced it for neutral material. These results suggest that an interaction between processes such as response inhibition and attention is required for intentional forgetting to succeed.
Attractiveness ratings for musicians and non-musicians: An evolutionary-psychology perspective
(2019)
From an evolutionary perspective, musical behavior such as playing an instrument can be considered as part of an individual’s courting behavior. Playing a musical instrument or singing might fulfill a function similar to that of a bird’s colored feathers: attracting attention. Therefore, musicians may be rated as more attractive than non-musicians. In an online survey, 137 volunteers (95 female) with ages ranging from 16 to 39 years rated the attractiveness of fictitious persons of the opposite sex described in short verbal profiles. These profiles differed with respect to whether the described person made music or not. Additionally, the musicians’ profiles varied with regard to whether the described person played music or sang in public or in private only. Results show that musicians’ profiles were not generally rated as more attractive than non-musicians’, but attractiveness did vary according to setting: private musicians were rated as most attractive, followed by non-musicians and public musicians. Furthermore, results indicate that participants who played a musical instrument or sang themselves gave higher ratings to profiles of musicians. But for participants who do not make music themselves, higher attractiveness ratings for musicians playing instruments or sing in private settings were found. These results indicate that the impression of sharing a common interest (making music) and furthermore making music in private instrumental settings seems to make people attractive to other people. No additional support for the sexual selection hypotheses for the evolution of music was provided by the current results. The musical status of the rater affected his or her judgements, with musicians rating other people as more attractive if they share the common interest in making music. Not the display of being a musician seems to be critical for attractiveness ratings but the perceived or imagined similarity by the rater created by information on musicality, fostering the theoretical significance of the communication aspect of music.
Working memory denotes the ability to retain stimuli in mind that are no longer physically present and to perform mental operations on them. Electro- and magnetoencephalography allow investigating the short-term maintenance of acoustic stimuli at a high temporal resolution. Studies investigating working memory for non-spatial and spatial auditory information have suggested differential roles of regions along the putative auditory ventral and dorsal streams, respectively, in the processing of the different sound properties. Analyses of event-related potentials have shown sustained, memory load-dependent deflections over the retention periods. The topography of these waves suggested an involvement of modality-specific sensory storage regions. Spectral analysis has yielded information about the temporal dynamics of auditory working memory processing of individual stimuli, showing activation peaks during the delay phase whose timing was related to task performance. Coherence at different frequencies was enhanced between frontal and sensory cortex. In summary, auditory working memory seems to rely on the dynamic interplay between frontal executive systems and sensory representation regions.
Human deep sleep is characterized by reduced sensory activity, responsiveness to stimuli, and conscious awareness. Given its ubiquity and reversible nature, it represents an attractive paradigm to study the neural changes which accompany the loss of consciousness in humans. In particular, the deepest stages of sleep can serve as an empirical test for the predictions of theoretical models relating the phenomenology of consciousness with underlying neural activity. A relatively recent shift of attention from the analysis of evoked responses toward spontaneous (or “resting state”) activity has taken place in the neuroimaging community, together with the development of tools suitable to study distributed functional interactions. In this review we focus on recent functional Magnetic Resonance Imaging (fMRI) studies of spontaneous activity during sleep and their relationship with theoretical models for human consciousness generation, considering the global workspace theory, the information integration theory, and the dynamical core hypothesis. We discuss the venues of research opened by these results, emphasizing the need to extend the analytic methodology in order to obtain a dynamical picture of how functional interactions change over time and how their evolution is modulated during different conscious states. Finally, we discuss the need to experimentally establish absent or reduced conscious content, even when studying the deepest sleep stages.
Information processing performed by any system can be conceptually decomposed into the transfer, storage and modification of information—an idea dating all the way back to the work of Alan Turing. However, formal information theoretic definitions until very recently were only available for information transfer and storage, not for modification. This has changed with the extension of Shannon information theory via the decomposition of the mutual information between inputs to and the output of a process into unique, shared and synergistic contributions from the inputs, called a partial information decomposition (PID). The synergistic contribution in particular has been identified as the basis for a definition of information modification. We here review the requirements for a functional definition of information modification in neuroscience, and apply a recently proposed measure of information modification to investigate the developmental trajectory of information modification in a culture of neurons vitro, using partial information decomposition. We found that modification rose with maturation, but ultimately collapsed when redundant information among neurons took over. This indicates that this particular developing neural system initially developed intricate processing capabilities, but ultimately displayed information processing that was highly similar across neurons, possibly due to a lack of external inputs. We close by pointing out the enormous promise PID and the analysis of information modification hold for the understanding of neural systems
Memory impairments are a major characteristic of schizophrenia (SZ). In the current study, we used an associative memory task to test the hypothesis that SZ patients and first-degree relatives have altered functional patterns in comparison to healthy controls. We analyzed the fMRI activation pattern during the presentation of a face-name task in 27 SZ patients, 23 first-degree relatives, and 27 healthy controls. In addition, we performed correlation analyses between individual psychopathology, accuracy and reaction time of the task and the beta scores of the functional brain activations. We observed a lower response accuracy and increased reaction time during the retrieval of face-name pairs in SZ patients compared with controls. Deficient performance was accompanied by abnormal functional activation patterns predominantly in DMN regions during encoding and retrieval. No significant correlation between individual psychopathology and neuronal activation during encoding or retrieval of face-name pairs was observed. Findings of first-degree relatives indicated slightly different functional pattern within brain networks in contrast to controls without significant differences in the behavioral task. Both the accuracy of memory performance as well as the functional activation pattern during retrieval revealed alterations in SZ patients, and, to a lesser degree, in relatives. The results are of potential relevance for integration within a comprehensive model of memory function in SZ. The development of a neurophysiological model of cognition in psychosis may help to clarify and improve therapeutic options to improve memory and functioning in the illness.
Our ability to select relevant information from the environment is limited by the resolution of attention – i.e., the minimum size of the region that can be selected. Neural mechanisms that underlie this limit and its development are not yet understood. Functional magnetic resonance imaging (fMRI) was performed during an object tracking task in 7- and 11-year-old children, and in young adults. Object tracking activated canonical fronto-parietal attention systems and motion-sensitive area MT in children as young as 7 years. Object tracking performance improved with age, together with stronger recruitment of parietal attention areas and a shift from low-level to higher-level visual areas. Increasing the required resolution of spatial attention – which was implemented by varying the distance between target and distractors in the object tracking task – led to activation increases in fronto-insular cortex, medial frontal cortex including anterior cingulate cortex (ACC) and supplementary motor area, superior colliculi, and thalamus. This core circuitry for attentional precision was recruited by all age groups, but ACC showed an age-related activation reduction. Our results suggest that age-related improvements in selective visual attention and in the resolution of attention are characterized by an increased use of more functionally specialized brain regions during the course of development.
Representing a phylogenetically old and very basic mechanism of inhibitory neurotransmission, glycine receptors have been implicated in the modulation of behavioral components underlying defensive responding toward threat. As one of the first findings being confirmed by genome-wide association studies for the phenotype of panic disorder and agoraphobia, allelic variation in a gene coding for the glycine receptor beta subunit (GLRB) has recently been associated with increased neural fear network activation and enhanced acoustic startle reflexes. On the basis of two independent healthy control samples, we here aimed to further explore the functional significance of the GLRB genotype (rs7688285) by employing an intermediate phenotype approach. We focused on the phenotype of defensive system reactivity across the levels of brain function, structure, and physiology. Converging evidence across both samples was found for increased neurofunctional activation in the (anterior) insular cortex in GLRB risk allele carriers and altered fear conditioning as a function of genotype. The robustness of GLRB effects is demonstrated by consistent findings across different experimental fear conditioning paradigms and recording sites. Altogether, findings provide translational evidence for glycine neurotransmission as a modulator of the brain’s evolutionary old dynamic defensive system and provide further support for a strong, biologically plausible candidate intermediate phenotype of defensive reactivity. As such, glycine-dependent neurotransmission may open up new avenues for mechanistic research on the etiopathogenesis of fear and anxiety disorders.
Die Einstellung von onkologisch tätigen Ärzten zur psychoonkologischen Versorgung von Krebspatienten
(2015)
Eine Krebserkrankung stellt für die Betroffenen und deren Angehörige eine große körperliche und psychische Belastung dar. Obwohl die psychoonkologische Betreuung den Patienten nachweislich hilft und die Belastung vieler Patienten sehr hoch ist, erhält nur cirka jeder fünfte therapiebedürftig belastete Krebspatient eine psychoonkologische Behandlung. Für die Umsetzung einer flächendeckenden psychoonkologischen Betreuung der Patienten nehmen die onkologisch tätigen Ärzte eine Schlüsselrolle ein. Deshalb ist für die Implementierung und das Gelingen eines Screenings bzw. der psychoonkologischen Versorgung der Patienten das Engagement und die psychosoziale Kompetenz der behandelnden Ärzte eine entscheidende Größe.
Um die Einstellung von onkologisch tätigen Ärzten zur psychoonkologischen Versorgung zu erfassen, wurde ein Fragebogen als Erhebungsinstrument konstruiert. Die Konstruktion des Fragebogens erfolgte auf Grundlage der Theorie des geplanten Handelns nach Ajzen (2002). Zusätzlich zu der Einstellung der behandelten Ärzte erfasst der Fragebogen die Selbstwirksamkeit der Ärzte in Bezug auf psychosoziale Kompetenzen, sowie die organisatorischen Rahmenbedingungen in der Klinik.
Zwischen September und Dezember 2013 wurden an der Universitätsklinik Frankfurt am Main insgesamt 120 Fragebögen an onkologisch tätige Ärzte ausgeteilt von denen 102 beantwortet wurden (Rücklaufquote von ca. 85%). Zur Validierung des Fragebogens wurde die Korrelation einzelner Skalen mit der Skala „Interaktion und Verhalten“ nach Spearman berechnet. Insgesamt korrelierten die Skalen in die zu erwartende Richtung, jedoch waren die Korrelationskoeffizienten geringer ausgeprägt als erhofft (zwischen 0,26 und 0,36). Die interne Konsistenz (nach Cronbachs Alpha) der Skalen erreichte bis auf eine Ausnahme ein akzeptables bis gutes Niveau.
Die Ergebnisse der vorliegenden Studie zeigen keinen Hinweis darauf, dass die Diskrepanz zwischen der hohen Anzahl an belasteten Krebspatienten und der seltenen Inanspruchnahme von psychoonkologischen Behandlungen durch die Einstellung der Ärzte zur Psychoonkologie erklärt werden kann. Im Gegenteil, in dieser Studie wird der psychoonkologischen Versorgung von Patienten eine hohe Wertigkeit zugeschrieben: 76 % der Ärzte sind der Meinung, sie würden, wenn sie selbst erkranken, davon profitieren mit einem Psychoonkologen zu sprechen. Auch empfehlen 79 % der Befragten ihren Freunden oder Angehörigen im Falle einer Krebserkrankung eine psychoonkologische Beratung. Trotz der über die Stichprobe insgesamt sehr positiven Einstellung gegenüber der psychoonkologischen Versorgung, divergieren die Aussagen hinsichtlich der Häufigkeit, in der Skala „Umsetzung und Interaktion“, die erfasst wie häufig psychoonkologische Aspekte in die Behandlung von onkologischen Patienten integriert werden, immens.
Die individuelle Handhabung der Weitergabe von Informationen von Seiten der Ärzte in dieser Studie kann teilweise durch mangelhafte organisatorische Rahmenbedingungen erklärt werden: So gibt fast die Hälfte der Befragten (45 %) an, in ihrer Abteilung gebe es kein standardisiertes Screeningverfahren, um psychisch belastete Patienten zu identifizieren. Ebenso sind bei ca. der Hälfte der Ärzte (45 %) keine klaren Richtlinien vorhanden, wann eine psychoonkologische Beratung indiziert ist.
Die Erkenntnisse dieser Studie geben Hinweise darauf, dass für die Verbesserung der psychoonkologischen Versorgung von Patienten die organisatorischen Rahmenbedingungen an den Kliniken optimiert werden müssen.
Even though extensively investigated, the nature of working memory (WM) deficits in patients with schizophrenia (PSZ) is not yet fully understood. In particular, the contribution of different WM sub-processes to the severe WM deficit observed in PSZ is a matter of debate. So far, most research has focused on impaired WM maintenance. By analyzing different types of errors in a spatial delayed response task (DRT), we have recently demonstrated that incorrect yet confident responses (which we labeled as false memory errors) rather than incorrect/not-confident responses reflect failures of WM encoding, which was also impaired in PSZ. In the present study, we provide further evidence for a functional dissociation between confident and not-confident errors by manipulating the demands on WM maintenance, i.e., the length over which information has to be maintained in WM. Furthermore, we investigate whether these functionally distinguishable WM processes are impaired in PSZ. Twenty-four PSZ and 24 demographically matched healthy controls (HC) performed a spatial DRT in which the length of the delay period was varied between 1, 2, 4, and 6 s. In each trial, participants also rated their level of response confidence. Across both groups, longer delays led to increased rates of incorrect/not-confident responses, while incorrect/confident responses were not affected by delay length. This functional dissociation provides additional support for our proposal that false memory errors (i.e., confident errors) reflect problems at the level of WM encoding, while not-confident errors reflect failures of WM maintenance. Schizophrenic patients showed increased numbers of both confident and not-confident errors, suggesting that both sub-processes of WM—encoding and maintenance—are impaired in schizophrenia. Combined with the delay length-dependent functional dissociation, we propose that these impairments in schizophrenic patients are functionally distinguishable.
Evidence from anatomical and functional imaging studies have highlighted major modifications of cortical circuits during adolescence. These include reductions of gray matter (GM), increases in the myelination of cortico-cortical connections and changes in the architecture of large-scale cortical networks. It is currently unclear, however, how the ongoing developmental processes impact upon the folding of the cerebral cortex and how changes in gyrification relate to maturation of GM/WM-volume, thickness and surface area. In the current study, we acquired high-resolution (3 Tesla) magnetic resonance imaging (MRI) data from 79 healthy subjects (34 males and 45 females) between the ages of 12 and 23 years and performed whole brain analysis of cortical folding patterns with the gyrification index (GI). In addition to GI-values, we obtained estimates of cortical thickness, surface area, GM and white matter (WM) volume which permitted correlations with changes in gyrification. Our data show pronounced and widespread reductions in GI-values during adolescence in several cortical regions which include precentral, temporal and frontal areas. Decreases in gyrification overlap only partially with changes in the thickness, volume and surface of GM and were characterized overall by a linear developmental trajectory. Our data suggest that the observed reductions in GI-values represent an additional, important modification of the cerebral cortex during late brain maturation which may be related to cognitive development.
Event-related potential (ERP) data in monolingual German speakers have shown that sentential metric expectancy violations elicit a biphasic ERP pattern consisting of an anterior negativity and a posterior positivity (P600). This pattern is comparable to that elicited by syntactic violations. However, proficient French late learners of German do not detect violations of metric expectancy in German. They also show qualitatively and quantitatively different ERP responses to metric and syntactic violations. We followed up the questions whether (1) latter evidence results from a potential pitch cue insensitivity in speech segmentation in French speakers, or (2) if the result is founded in rhythmic language differences. Therefore, we tested Spanish late learners of German, as Spanish, contrary to French, uses pitch as a segmentation cue even though the basic segmentation unit is the same in French and Spanish (i.e., the syllable). We report ERP responses showing that Spanish L2 learners are sensitive to syntactic as well as metric violations in German sentences independent of attention to task in a P600 response. Overall, the behavioral performance resembles that of German native speakers. The current data suggest that Spanish L2 learners are able to extract metric units (trochee) in their L2 (German) even though their basic segmentation unit in Spanish is the syllable. In addition Spanish in contrast to French L2 learners of German are sensitive to syntactic violations indicating a tight link between syntactic and metric competence. This finding emphasizes the relevant role of metric cues not only in L2 prosodic but also in syntactic processing.
Metrical patterning and rhyme are frequently employed in poetry but also in infant-directed speech, play, rites, and festive events. Drawing on four line-stanzas from nineteenth and twentieth German poetry that feature end rhyme and regular meter, the present study tested the hypothesis that meter and rhyme have an impact on aesthetic liking, emotional involvement, and affective valence attributions. Hypotheses that postulate such effects have been advocated ever since ancient rhetoric and poetics, yet they have barely been empirically tested. More recently, in the field of cognitive poetics, these traditional assumptions have been readopted into a general cognitive framework. In the present experiment, we tested the influence of meter and rhyme as well as their interaction with lexicality in the aesthetic and emotional perception of poetry. Participants listened to stanzas that were systematically modified with regard to meter and rhyme and rated them. Both rhyme and regular meter led to enhanced aesthetic appreciation, higher intensity in processing, and more positively perceived and felt emotions, with the latter finding being mediated by lexicality. Together these findings clearly show that both features significantly contribute to the aesthetic and emotional perception of poetry and thus confirm assumptions about their impact put forward by cognitive poetics. The present results are explained within the theoretical framework of cognitive fluency, which links structural features of poetry with aesthetic and emotional appraisal.
Recent research suggests that the brain routinely binds together information from gesture and speech. However, most of this research focused on the integration of representational gestures with the semantic content of speech. Much less is known about how other aspects of gesture, such as emphasis, influence the interpretation of the syntactic relations in a spoken message. Here, we investigated whether beat gestures alter which syntactic structure is assigned to ambiguous spoken German sentences. The P600 component of the Event Related Brain Potential indicated that the more complex syntactic structure is easier to process when the speaker emphasizes the subject of a sentence with a beat. Thus, a simple flick of the hand can change our interpretation of who has been doing what to whom in a spoken sentence. We conclude that gestures and speech are integrated systems. Unlike previous studies, which have shown that the brain effortlessly integrates semantic information from gesture and speech, our study is the first to demonstrate that this integration also occurs for syntactic information. Moreover, the effect appears to be gesture-specific and was not found for other stimuli that draw attention to certain parts of speech, including prosodic emphasis, or a moving visual stimulus with the same trajectory as the gesture. This suggests that only visual emphasis produced with a communicative intention in mind (that is, beat gestures) influences language comprehension, but not a simple visual movement lacking such an intention.
Temporal regularity allows predicting the temporal locus of future information thereby potentially facilitating cognitive processing. We applied event-related brain potentials (ERPs) to investigate how temporal regularity impacts pre-attentive and attentive processing of deviance in the auditory modality. Participants listened to sequences of sinusoidal tones differing exclusively in pitch. The inter-stimulus interval (ISI) in these sequences was manipulated to convey either isochronous or random temporal structure. In the pre-attentive session, deviance processing was unaffected by the regularity manipulation as evidenced in three event-related-potentials (ERPs): mismatch negativity (MMN), P3a, and reorienting negativity (RON). In the attentive session, the P3b was smaller for deviant tones embedded in irregular temporal structure, while the N2b component remained unaffected. These findings confirm that temporal regularity can reinforce cognitive mechanisms associated with the attentive processing of deviance. Furthermore, they provide evidence for the dynamic allocation of attention in time and dissociable pre-attentive and attention-dependent temporal processing mechanisms.
Body Integrity Identity Disorder (BIID) ist eine bisher kaum erforschte Störung, bei der die Betroffenen den Wunsch beziehungsweise das Verlangen nach einer Körperbehinderung verspüren. In den meisten Fällen, wie auch in dieser Studie, ist eine Oberschenkelamputation die gewünschte Modifikation. Durch die Amputation erhoffen die Betroffenen endlich sie selbst zu werden, da sie sich mit ihrem realen Körperbild nicht identifizieren können. Ihr vorgestelltes Körperbild ist das eines Amputierten. Die Störung manifestiert sich bereits im Kindesalter. Im Laufe der Zeit nimmt das Verlangen der Amputation zu, so dass es neben der vermehrten Beschäftigung sogar zu lebensgefährlichen Selbstverletzungen im Zuge einer Verwirklichung kommen kann.
Die vorliegende Studie beschäftigt sich erstmalig mittels funktioneller Magnetresonanztomographie mit der neuronalen Repräsentation der Störung BIID beim Anblick des eigenen realen und des gewünschten amputierten Körpers. Für die Studie wurden Fotos von den Probanden und einer fremden Person gemacht und mit einer Software so modifiziert, dass die Probanden in sechs verschiedenen Kategorien sowohl sich selbst real, sowie amputiert und mit Prothese als auch die fremde Person real, amputiert und mit Prothese gezeigt bekamen. Dasselbe Design wurde auch einer gesunden Kontrollgruppe vorgeführt. Aufgrund der Datenmenge wird in dieser Studie nur der reale und der amputierte Körper berücksichtigt.
Es zeigen sich deutliche Aktivierungsunterschiede zwischen der BIID Gruppe und der Kontrollgruppe beim Anblick des eigenen realen Körpers und beim Anblick des eigenen amputierten Körpers. Beim Anblick des eigenen realen Körpers zeigt die Kontrollgruppe gegenüber der BIID Gruppe einen stärkeren Selbstbezug zu ihrem Körper durch Aktivierungen des medialen frontalen Gyrus, des postzentralen Gyrus oder der Amygdala und einen positiver valenzierten Anblick, der sich im Gruppenvergleich durch eine Mehraktivierung im superioren temporalen Gyrus ausdrückt sowie durch die Ergebnisse der post-fMRT-Fragebögen unterstützt wird. Beim Anblick des eigenen amputierten Körpers zeigt sich durch ein fronto-parietales Netzwerk der stärkere Selbstbezug bei der BIID Gruppe. Die deutliche emotionale Involviertheit wird repräsentiert durch große Teile des limbischen Systems sowie durch präfrontale Bereiche. Hinzu kommen Aktivierungen, die eine deutliche Beteiligung des episodisch-autobiographischen und prozeduralen Gedächtnisses zeigen. So ist eine vollständig geplante Bewegungsabfolge der BIID Probanden beim Anblick ihres amputierten Körpers anhand der aktivierten Areale darstellbar, einschließlich der Feinregulationen in den Basalganglien, dem Nucleus ruber und dem Kleinhirn.
Die Ergebnisse zeigen neuronale Netzwerke der Körperrepräsentation, bei denen fehlende Aktivierungen der BIID Probanden beim Anblick des eigenen realen Körpers auf eine Fehlfunktion hindeuten könnten. Sie zeigen aber auch ein Netzwerk aus Erinnerungen und erlernten Prozessen, die mit Hilfe des mesolimbischen Dopaminsystems zur Aufrechterhaltung der Störung beitragen könnten. Zusammengefasst lässt sich sagen, dass das amputierte Wunschkörperbild neuronal stark und breitgefächert verankert ist und viel dominanter repräsentiert ist als das reale Körperbild. Durch die dargestellten Aktivierungen und Regelkreise leiten sich vor allem neue therapeutische Ansätze ab, die zu einer Linderung der Symptome von BIID beitragen könnten und vielleicht auch neue Anstöße in Hinblick auf eine Heilung der Störung liefern.
Primate multisensory object perception involves distributed brain regions. To investigate the network character of these regions of the human brain, we applied data-driven group spatial independent component analysis (ICA) to a functional magnetic resonance imaging (fMRI) data set acquired during a passive audio-visual (AV) experiment with common object stimuli. We labeled three group-level independent component (IC) maps as auditory (A), visual (V), and AV, based on their spatial layouts and activation time courses. The overlap between these IC maps served as definition of a distributed network of multisensory candidate regions including superior temporal, ventral occipito-temporal, posterior parietal and prefrontal regions. During an independent second fMRI experiment, we explicitly tested their involvement in AV integration. Activations in nine out of these twelve regions met the max-criterion (A < AV > V) for multisensory integration. Comparison of this approach with a general linear model-based region-of-interest definition revealed its complementary value for multisensory neuroimaging. In conclusion, we estimated functional networks of uni- and multisensory functional connectivity from one dataset and validated their functional roles in an independent dataset. These findings demonstrate the particular value of ICA for multisensory neuroimaging research and using independent datasets to test hypotheses generated from a data-driven analysis.
Visual perception is highly variable and can be influenced by the surrounding world. Previous research has revealed that body perception can be biased due to adaptation to thin or fat body shapes. The aim of the present study was to show that adaptation to certain body shapes and the resulting perceptual biases transfer across different identities of adaptation and test stimuli. We designed two similar adaptation experiments in which healthy female participants adapted to pictures of either thin or fat bodies and subsequently compared more or less distorted pictures of their own body to their actual body shape. In the first experiment (n = 16) the same identity was used as adaptation and test stimuli (i.e. pictures of the participant’s own body) while in the second experiment (n = 16) we used pictures of unfamiliar thin or fat bodies as adaptation stimuli. We found comparable adaptation effects in both experiments: After adaptation to a thin body, participants rated a thinner than actual body picture to be the most realistic and vice versa. We therefore assume that adaptation to certain body shapes transfers across different identities. These results raise the questions of whether some type of natural adaptation occurs in everyday life. Natural and predominant exposure to certain bodily features like body shape – especially the thin ideal in Western societies – could bias perception for these features. In this regard, further research might shed light on aspects of body dissatisfaction and the development of body image disturbances in terms of eating disorders.
Speech production involves widely distributed brain regions. This MEG study focuses on the spectro-temporal dynamics that contribute to the setup of this network. In 21 participants performing a cue-target reading paradigm, we analyzed local oscillations during preparation for overt and covert reading in the time-frequency domain and localized sources using beamforming. Network dynamics were studied by comparing different dynamic causal models of beta phase coupling in and between hemispheres. While a broadband low frequency effect was found for any task preparation in bilateral prefrontal cortices, preparation for overt speech production was specifically associated with left-lateralized alpha and beta suppression in temporal cortices and beta suppression in motor-related brain regions. Beta phase coupling in the entire speech production network was modulated by anticipation of overt reading. We propose that the processes underlying the setup of the speech production network connect relevant brain regions by means of beta synchronization and prepare the network for left-lateralized information routing by suppression of inhibitory alpha and beta oscillations.
In this study, it is demonstrated that moving sounds have an effect on the direction in which one sees visual stimuli move. During the main experiment sounds were presented consecutively at four speaker locations inducing left or rightward auditory apparent motion. On the path of auditory apparent motion, visual apparent motion stimuli were presented with a high degree of directional ambiguity. The main outcome of this experiment is that our participants perceived visual apparent motion stimuli that were ambiguous (equally likely to be perceived as moving left or rightward) more often as moving in the same direction than in the opposite direction of auditory apparent motion. During the control experiment we replicated this finding and found no effect of sound motion direction on eye movements. This indicates that auditory motion can capture our visual motion percept when visual motion direction is insufficiently determinate without affecting eye movements.
In der vorliegenden Studie wurden Adoptierte auf Merkmale wie Selbstbewusstsein, Widerstandsfähigkeit und Bindungseinstellungen in Abhängigkeit verschiedener möglicher Einflussfaktoren wie beispielsweise Heimaufenthalten untersucht. Mittelpunkt der Forschung war die Exploration der Entwicklung von Persönlichkeitsmerkmalen in Abhängigkeit der verschiedenen Adoptionsformen, die den Kontakt zu den leiblichen Eltern möglich machen oder verhindern. Untersuchungen an erwachsenen Adoptierten sind noch selten, ebenso gibt es keine wissenschaftlichen Studien in Deutschland, die sich mit dem Thema der Adoption befassen. Auch die Forschung auf dem Gebiet der verschiedenen Adoptionsformen und ihrer Auswirkung auf die Entwicklung von Persönlichkeitsmerkmalen bei Adoptierten ist noch sehr jung. Dies wurde mit der vorliegenden Studie deutschlandweit erstmalig in Angriff genommen. Die Ergebnisse zeigten, dass Heimaufenthalte, je häufiger sie sind, zu einer verminderten Widerstandsfähigkeit der Adoptierten führten. Heimaufenthalte konnten als starker Prädiktor für verminderte Resilienz identifiziert werden. Ebenso sanken die Werte auf manchen Skalen der Multidimensionalen Selbstwertskala wie beispielsweise die Wertschätzung der eigenen Leistungsfähigkeit. Adoptierte wurden mit steigender Anzahl an Heimaufenthalten neurotischer. Leider konnte aufgrund mangelhafter Angaben die Dauer der Heimaufenthalte und Aufenthalte in Pflegefamilien nicht in die Auswertung mit einbezogen werden, darüber hinaus auch nicht die Qualität der Erinnerungen an diese Heimaufenthalte. Dennoch lässt sich feststellen, dass Heimaufenthalte das Selbstwertgefühl und die Selbstsicherheit Adoptierter nachhaltig beeinträchtigen können. Sie sollten so gering wie möglich gehalten werden. Auf die Bindungseinstellungen zeigten sie keine Auswirkungen. Hier könnte zukünftig eine genauere Untersuchung des Einflusses von Heimaufenthalten erfolgen, die unter anderem die Dauer und zusätzliche Wechsel von Pflegefamilien mit einbezieht. Bezüglich der Adoptionsformen offene Adoption vs. Inkognitoadoption konnte gezeigt werden, dass es für die Entwicklung der untersuchten Persönlichkeitsmerkmale keine Rolle zu spielen scheint, ob die Adoptierten die Möglichkeit des Kontaktes zu ihren leiblichen Eltern haben oder nicht. Dennoch führte die positive Bewertung dieses Kontaktes zu besseren Ergebnissen bezüglich des Selbstwertes als die negative Bewertung des Kontaktes zu den leiblichen Eltern. Interessant ist, dass Adoptierte, die keine Kontaktmöglichkeit zu ihren leiblichen Eltern hatten, bessere Werte bezogen auf Facetten des Selbstwertgefühles zeigten als Adoptierte, die diesen Kontakt negativ bewerteten. Es scheint, als wäre es für das eigene Selbstbewusstsein gesünder, keinen Kontakt zu haben als ihn letztendlich negativ zu bewerten. Positiv empfundener Kontakt konnte das Selbstwertgefühl und die Bindungseinstellungen nicht zusätzlich verbessern. Allerdings kann keine sinnvolle Konsequenz aus diesen Ergebnissen gezogen werden. Im Voraus ist selten zu beurteilen, wie der / die Adoptierte das Treffen und den Kontakt zu den leiblichen Eltern bewerten wird. Dies hängt mit Sicherheit nicht nur vom Adoptierten selbst, sonder mitunter von einer Anzahl an Faktoren ab, nicht zuletzt von dem Vorhandensein früher Vorurteile und der Unterstützung seitens des Adoptivelternhauses. Es ist nicht verantwortlich und angemessen, aus reiner Spekulation über den möglichen Ausgang eines Kontaktes diesen im Voraus zu verhindern und dem Kind diese Möglichkeit zu versagen. Laut den Ergebnissen ist ein anderes Ereignis im Leben eines Adoptierten für sein Selbstwertgefühl und sein Bindungsverhalten entscheidender. Dies bezieht sich auf die Kommunikation der Adoptiveltern mit ihrem Kind. Wichtigster Prädiktor für ein gesundes Selbstbewusstsein und günstige Bindungseinstellungen war laut den Ergebnissen das Geständnis der Eltern über die Adoption. Eltern, die diesbezüglich offen und ehrlich ihren Kindern gegenüber waren, wurden in ihrem Erziehungsverhalten von diesen als emotional wärmer und weniger kontrollierend bewertet als Eltern, die ihre Kinder nicht über die Adoption aufgeklärt hatten. Adoptierte, die über ihre eigene Adoption nicht aufgeklärt wurden, zeigten vermindertes Selbstwertgefühl, verminderte Widerstandsfähigkeit und schlechtere Bindungseinstellungen, wobei die Skala „Nähe“, das heißt die Messung zur Fähigkeit, andere Menschen an sich heran zu lassen, Werte außerhalb des Normbereiches aufzeigte und man hier sogar von einem pathologisch veränderten Persönlichkeitsmerkmal sprechen kann. Auch das Alter bei Aufklärung spielt eine wichtige Rolle. Frühe Aufklärung über die Adoption, in der vorliegenden Studie wurde ein Zeitpunkt bis zum neunten Lebensjahr als früh definiert, führte zu höherem allgemeinen Selbstwertgefühl und einer erhöhten Widerstandsfähigkeit. Auf die Bindungseinstellungen schien der Zeitpunkt der Aufklärung keine Auswirkung zu haben. Eltern, die ihre Kinder früh über ihre Adoption informierten, wurden als weniger überbehütend und kontrollierend bewertet. Wichtig zu erwähnen ist, dass die Werte bei den Rechnungen der Gruppenvergleiche, mit Ausnahme des oben erwähnten Wertes für die Skala „Nähe“ der Adult Attachment Scale, alle im Normbereich lagen. Es liegen also, auch im Vergleich mit den Normstichproben, keine Befunde vor, die bei der adoptierten Stichprobe auf Pathologien hinweisen. Zu finden sind jedoch leichte Abweichungen von der Norm, die statistisch gesehen von Signifikanz sind und auch inhaltlich wichtige Hinweise auf die Folgen von Adoption liefern. Obwohl der Großteil der Adoptierten (90.3%) über ihre Adoption aufgeklärt worden war und dies laut oben beschriebener Ergebnisse eine günstiger Faktor bezüglich der Entwicklung von Selbstwert und Bindung ist, lässt sich feststellen, dass Adoptierte im Vergleich zu den nicht adoptierten Normstichproben ein vermindertes Selbstwertgefühl und ungünstigere Bindungseinstellungen aufwiesen. Weitere Einflussfaktoren dieser Persönlichkeitsmerkmale im Leben eines Adoptierten müssten zukünftig identifiziert werden. Seelische Vorerkrankungen, wie beispielsweise eine Depression, könnten einen solchen Einflussfaktor darstellen. 20.6% der Adoptierten der vorliegenden Studie gaben an, seelisch erkrankt zu sein, darunter waren 12.1% depressiv, was zu zusätzlichen Rechnungen veranlasste. Bei diesen Berechnungen mit dem Vergleich von depressiven Adoptierten versus seelisch gesunden Adoptierten fiel auf, dass die depressive Gruppe niedrigere Werte auf Skalen des Selbstwertes und der Resilienz aufwies, sowie schlechtere Bindungseinstellungen hatte als die seelisch gesunde Gruppe. Depressive Adoptierte waren zusätzlich neurotischer und bewerteten ihre Elternhäuser als emotional kühler. Ebenso hatten sie mehr Ablehnung und Strafe durch die Mütter erfahren. Besonders hervorzuheben sind jedoch die Ergebnisse auf den Skalen der emotionalen Selbstwertschätzung und der Bindungseinstellung Angst. Hierbei lagen die Werte der depressiven adoptierten Gruppe deutlich außerhalb des Normbereichs und wiesen auf pathologisch veränderte Persönlichkeitsmerkmale hin. Depressive hatten somit deutlich schlechtere Einstellungen gegenüber sich selbst als Adoptierte, die nicht depressiv waren. Ebenso hatten sie eine sehr schlechte Selbstachtung und litten vermehrt unter Ängsten. Es bleibt also die Frage offen, inwiefern seelische Vorerkrankungen, die in der vorliegenden Studie zu einem hohen Prozentsatz vertreten waren, zu den schlechteren Ergebnissen bezüglich Selbstwert und Bindung Adoptierter im Vergleich zu Normstichproben beitragen. Es bleibt offen, ob Adoption alleine ein Risikofaktor für vermindertes Selbstbewusstsein und schlechte Bindungseinstellungen ist oder ob diese Ergebnisse nicht vielmehr durch andere Faktoren, wie seelische Erkrankungen, beeinflusst werden. Abschließend lässt sich feststellen, dass die Ehrlichkeit der Adoptiveltern und der offene Umgang mit dem Thema der Adoption entscheidend zur Bildung eines gesunden Selbstwertes und günstiger Bindungseinstellungen ihres Kindes beitragen. Ebenso sollten Adoptierte nicht lange in Unwissenheit über ihre Herkunft gelassen werden. Ein früher Zeitpunkt der Aufklärung über die eigene Adoption hat positiven Einfluss auf die Entwicklung des Selbstwertes, der Widerstandsfähigkeit und der Bindungseinstellung. Weiterhin ist zu sehen, dass die reine Kontaktmöglichkeit zu den leiblichen Eltern für die Entwicklung von Selbstwertgefühl, Resilienz und Bindung keine entscheidende Rolle zu spielen scheint. Eine offene Adoptionsform alleine, in der der Kontakt zwischen Adoptivfamilie und leiblichen Eltern von Anfang an aufrechterhalten bzw. zu einem späteren Zeitpunkt wieder aufgenommen wird, scheint für die Entwicklung des Adoptivkindesnicht die entscheidende Rolle zu spielen. Interessant bleibt die Frage nach dem Einfluss von Adoption als Risikofaktor für die Entwicklung von seelischen Erkrankungen und hierunter insbesondere Depression. Ein hoher Prozentsatz der Adoptierten dieser Studie gab an, seelisch erkrankt zu sein (20.6%), die häufigste genannte Diagnose darunter war die Depression (12.1%). Die Diagnosehäufigkeiten und Prädiktoren für die Entwicklung von Depressionen müssen zukünftig genauer untersucht werden. Da es sich bei der vorliegenden Studie um eine anonymisierte Fragebogenstudie ohne zusätzliche Führung von Interviews handelte, war es nicht möglich, Fragen zu Angaben der Probanden zu beantworten und Missverständnisse zu klären. Manches Ergebnis, wie die Angabe der Probanden, depressiv zu sein, oder die Untersuchung der Anzahl von Heimaufenthalten schien sehr fraglich. Zukünftige Studien sollten zusätzlich Interviews mit den Teilnehmern beinhalten, da sich so Missverständnisse am leichtesten klären lassen und Rückfragen möglich sind. Zur Erfassung von seelischen und körperlichen Erkrankungen können Testverfahren wie das Brief Symptom Inventory (Franke 2000) und die Hospital Anxiety and Depression Scale (Lingen, Buss, Snaith 2005) verwendet werden. Die Teilnehmerzahl der Studie belief sich auf 165 Probanden. Bei 75.8% der Probanden handelte es sich um weibliche Teilnehmerinnen. Da Studien bereits belegt haben, dass das Geschlecht einen entscheidenden Einfluss auf die Ergebnisse bei Untersuchungen zu Persönlichkeitsmerkmalen hat (Freeark, Rosenberg et al.2005), müsste man die Unterteilung in männliche und weibliche Probandengruppen vornehmen. Aufgrund der zu kleinen Teilnehmerzahl an Männern konnte diesin der vorliegenden Studie nicht geschehen. Ebenso betrifft dies die Einteilung der Probanden in die Altersgruppen bei Aufklärung über die Adoption. Hier konnte aufgrund der kleinen Teilnehmerzahl nur eine Unterteilung in ein Alter bis zum neunten Lebensjahr und ab dem zehnten Lebensjahr erfolgen. Bis zum neunten Lebensjahr durchläuft das Kind jedoch wichtige Entwicklungsschritte auf den Gebieten der Bindung zu Bezugspersonen, Entwicklung eines Selbstbildes und Integration in eine Gemeinschaft, in denen das Kind die Information über die eigene Adoption unterschiedlich verarbeitet. Anhand größerer Teilnehmerzahlen kann eine genauere Einteilung in verschiedene Altersklassen auch vor dem neunten Lebensjahr erfolgen und so der optimale Zeitpunkt der Aufklärung über die Adoption genauer festgelegt werden. Ebenso wichtig wäre eine weitere Einteilung in Inlands- vs. Auslandsadoptionen. Kinder, die aus dem Ausland adoptiert wurden, haben vermehrt Integrationsschwierigkeiten aufgrund ihres andersartigen Erscheinungsbildes, die sich auch auf die Entwicklung von Selbstbewusstsein auswirken können (von Borczyskowski, Hjern et al. 2006). Dies müsste man anhand der Unterteilung in Inlands –und Auslandsadoptionen genauer untersuchen. Die Probanden der vorliegenden Studie gaben an, ein emotional wärmeres und empathischeres Elternhaus gehabt zu haben als die Normstichprobe. Bei der Bewertung des Elternhauses handelt es sich jedoch lediglich um die Einschätzung der Teilnehmer, es ist eine subjektive Bewertung. Über die Qualität der Elternhäuser an sich kann man aus objektiver Sicht keine Aussage machen. Weitere Testverfahren zur Messung der Beziehungsqualitäten zwischen den Adoptierten und ihren Eltern und/oder der Persönlichkeitsmerkmale der Adoptiveltern müssten hierfür herangezogen werden. Ebenso wenig kann mit der Adult Attachment Scale das tatsächliche Bindungsverhalten gemessen werden. Vielmehr gibt dieses Testverfahren einen Hinweis auf die Bindungseinstellungen der Probanden. Zur Untersuchung von Bindungsverhalten liegen keine Testverfahren in Fragebogenform vor, dies müsste auf andere Weise erfolgen, beispielsweise mit Hilfe des Adult Attachment Interviews. Es lässt sich also feststellen, dass zur genaueren Untersuchung von Adoptierten eine größere Teilnehmerzahl erforderlich wird. Eine erweiterte Testbatterie und die Führung von Interviews können Missverständnisse und offene Fragen aus dem Weg räumen und ermöglichen so eine differenziertere Auswertung der Ergebnisse.
Hintergrund: Der Erfüllungsgrad definierter Erwartungen von Patienten sowie deren Angehörigen bestimmt im Wesentlichen den Grad der wahrgenommenen Qualität medizinischer Dienstleistungen im Krankenhaus. Da die Erwartungen intensivmedizinisch betreuter Patienten aufgrund eingeschränkter Mitteilungsfähigkeit oft nur unzureichend systematisch erhoben werden können, wird die Wahrnehmung der Qualität intensivmedizinischer Leistungen im Wesentlichen von Angehörigen beurteilt. Diese Erwartungen und etwaige Differenzen zu den vom medizinischen Personal antizipierten Erwartungen wurden bisher nicht systematisch untersucht. Aus diesem Grund wurde mit Hilfe eines objektiven, validen und reliablen Befragungsinstruments eine Befragung der Angehörigen von Patienten der
Intensivstation C1 des Universitätsklinikums Frankfurt am Main sowie des dort beschäftigten medizinischen Personals durchgeführt.
Material und Methoden: Als Befragungsinstrument wurde ein im Vorfeld validierter anonymisierter Fragebogen gewählt. Nach Genehmigung durch die Ethikkommission des Fachbereiches wurden in einem Befragungszeitraum von vier Monaten zunächst Angehörige intensivmedizinisch betreuter Patienten der Station C1 befragt. Im Anschluss daran wurde nach Genehmigung durch den Vorstand sowie den Personalrat des Klinikums eine Mitarbeiterbefragung des medizinischen Personal der Station C1 durchgeführt. Die Datenerhebung wurde durch Personal realisiert, das weder an der Behandlung der Patienten beteiligt war noch zum Personal der KAIS gehört, um eine Verzerrung im Hinblick auf mutmaßlich erwünschte Antworten zu vermeiden.
Ergebnisse: In dem Befragungszeitraum konnten nach Prüfung der Ausschlusskriterien 170 Angehörige in die Befragung bei einer Rücklaufquote von 94% (160) eingeschlossen werden. Beim medizinischen Personal betrug der Rücklauf unter den Ärzten 71% (30/42), bei den Pflegekräften 45% (46/103) und bei den Außendienstmitarbeitern 83% (5/6). Die Auswertung der einzelnen Fragen ergab Erwartungsdifferenzen bzw. Fehleinschätzungen des medizinischen Personals bezüglich einiger Aspekte: Sowohl die Pflegekräfte als auch das ärztliche Personal schätzen die Zufriedenheit der Angehörigen bezüglich der Gesprächsorganisation und -dauer niedriger ein als die Angehörigen selbst. Ebenso unterschätzten die befragten Ärzte die Angehörigenerwartung bezüglich der Wichtigkeit der behutsamen Mitteilung über den Zustand des Patienten. Bezüglich der Einbindung von Angehörigen in die Therapie des Patienten, unterschätzten die Ärzte das Bedürfnis der Angehörigen soweit möglich als Co- Therapeuten zu fungieren. Widersprüchliche Ergebnisse zeigten sich bei der Frage der Therapieentscheidung: Zwar gaben 90% der Angehörigen an, dass sie Ihre Meinung zu Therapieentscheidungen äußern möchten (selbiges wurde auch von ca. 83% der Ärzte antizipiert), jedoch wollten auch 50% der befragten Angehörigen (ebenso in Übereinstimmung mit 50% der befragten Ärzte), dass der Arzt als Fachmann alleine über die Therapie entscheidet. Im Weiteren liefern die konkreten und repräsentativen Zahlen, eine objektive Grundlage, um Veränderung im Dienstleistungsprozess voranzutreiben und sie somit weiter zu optimieren. Folgende Punkte sollten dabei in der Zukunft aufgegriffen werden und stehen zur Diskussion:
1. Organisation eines festen Ansprechpartners für Angehörige
2. Verstärkte Einbeziehung der Angehörigen als Co-Therapeuten
3. Kommunikation der voraussichtlichen Wartezeit inkl. deren Gründe
4. Verstärktes Anbieten (der Einbeziehung) der Klinikseelsorge
5. Organisation von Verlegungs- bzw. Entlassungsgesprächen
Schlussfolgerung: Die aus dieser Studie gewonnenen Ergebnisse liefern neben der Bestätigung qualitativ stabil und als hochwertig angesehener Prozesse, Ansätze für Optimierungspotentiale im Bereich der Interaktion mit Angehörigen sowie der Organisation des Stationsablaufs. Inwieweit diese Potentiale und den gegebenen Bedingungen umsetzbar sind, bedarf der individuellen Prüfung durch die verantwortlichen Mitarbeiter der Intensivstation C1 sowie durch die Klinikleitung.
Background: Although literature provides support for cognitive behavioral therapy (CBT) as an efficacious intervention for social phobia, more research is needed to improve treatments for children. Methods: Forty four Caucasian children (ages 8-14) meeting diagnostic criteria of social phobia according to the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; APA, 1994) were randomly allocated to either a newly developed CBT program focusing on cognition according to the model of Clark and Wells (n = 21) or a wait-list control group (n = 23). The primary outcome measure was clinical improvement. Secondary outcomes included improvements in anxiety coping, dysfunctional cognitions, interaction frequency and comorbid symptoms. Outcome measures included child report and clinican completed measures as well as a diagnostic interview. Results: Significant differences between treatment participants (4 dropouts) and controls (2 dropouts) were observed at post test on the German version of the Social Phobia and Anxiety Inventory for Children. Furthermore, in the treatment group, significantly more children were free of diagnosis than in wait-list group at post-test. Additional child completed and clinician completed measures support the results. Discussion: The study is a first step towards investigating whether CBT focusing on cognition is efficacious in treating children with social phobia. Future research will need to compare this treatment to an active treatment group. There remain the questions of whether the effect of the treatment is specific to the disorder and whether the underlying theoretical model is adequate. Conclusion: Preliminary support is provided for the efficacy of the cognitive behavioral treatment focusing on cognition in socially phobic children. Active comparators should be established with other evidence-based CBT programs for anxiety disorders, which differ significantly in their dosage and type of cognitive interventions from those of the manual under evaluation (e.g. Coping Cat).
Psychische Störungen überschreiten alle Grenzen – es gibt sie in allen Kulturen, zu allen Zeiten, in allen soziodemografischen Schichten und in jedem Lebensalter. Sie sind häufige Themen sowohl in Talkshows, Fernsehserien und Illustrierten als auch in Literatur, Theater und bildender Kunst. Jeden können sie treffen, und beinahe jeder kennt zumindest eine Person, die an einer klinisch bedeutsamen psychischen Störung leidet. Zu deren Behandlung und Erforschung sowie zur Ausbildung von Psychologischen Psychotherapeuten wurde 1999 am Fachbereich Psychologie und Sportwissenschaften der Universität Frankfurt die Verhaltenstherapie-Ambulanz eingerichtet. Primäres Ziel der universitären Ambulanz ist dabei, die Forschung und Lehre des Fachs »Klinische Psychologie und Psychotherapie « mit der praktischen therapeutischen Arbeit an Klienten zusammenzuführen, um damit die Verbindung aus Forschung, Lehre, Ausbildung und Praxis herzustellen.
Die Vermittlung der Zusammenhänge zwischen psychologischen Funktionen und körperlichen Veränderungen sowie deren Relevanz für die Entstehung und Aufrechterhaltung von Krankheiten stellt ein zentrales Ziel der Ausbildung in Medizinischer Psychologie dar. Zur Veranschaulichung dieser Zusammenhänge führten wir ein Psychophysiologie-Praktikum im ersten vorklinischen Semester ein. Die Studierenden führten in Vierergruppen mit Hilfe ausführlicher schriftlicher Instruktionen jeweils ca. 30 Minuten andauernde praktische Übungen durch, die die folgenden Themen behandelten: (1) Stress (abhängige Variable: Herzrate), (2) "Lügendetektor" (abhängige Variable: Hautleitwertsreaktionen), (3) Biofeedback (abhängige Variable: Hauttemperatur) und (4) Elektroenzephalogramm (abhängige Variable: Amplituden der vier klassischen Frequenzbänder). Die praktischen Übungen wurden durch theoretische Gruppenarbeiten und einen Termin zur Zusammenfassung der Ergebnisse der Übungen ergänzt. Die studentische Evaluation des Praktikums war durchweg positiv. So wurde das Praktikum als Bereicherung des Kurses angesehen, und der selbstbeurteilte Kenntnisstand auf dem Gebiet der Psychophysiologie zeigte eine signifikante Verbesserung. Diese Ergebnisse sowie unsere Eindrücke während des Praktikums bekräftigten unseren Entschluss, ein Psychophysiologie-Praktikum als Teil des Kurses der Medizinischen Psychologie und Medizinischen Soziologie fest zu etablieren.