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Wiener M, Bengesser SA, Wagner-Skacel J, Haidacher FNA, Lahousen-Luxenberger T, Wenninger J, Hasiba-Seebacher K, Fellendorf FT, Painold A, Kreuzer K, Butler M, Lackner S, Pilz R, Mörkl S. Impaired implicit learning in adults with anorexia nervosa. Int J Eat Disord 2024; 57:195-200. [PMID: 37870449 DOI: 10.1002/eat.24075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 10/03/2023] [Accepted: 10/03/2023] [Indexed: 10/24/2023]
Abstract
OBJECTIVE Cognitive alterations play an important role in the pathophysiology and treatment of anorexia nervosa (AN). Previous studies suggest that some implicit learning processes may be inhibited in AN. However, this has not yet been fully explored. The purpose of this study is to analyze implicit learning in patients with AN in comparison to healthy controls. METHODS In this pilot-study, a total of 21 patients diagnosed with AN and 21 matched controls were administered the weather prediction task (WPT), a probabilistic implicit category learning task that consists of two sub-variants. During the feedback (FB) version of the task, participants learn associations between tarot cards and weather outcomes via an operant learning model through which they receive immediate FB on their answers, whereas during the paired associate (PA) variant, participants are directly asked to memorize given associations. RESULTS AN patients showed selective impairment on the FB task where they scored significantly lower both in comparison to controls (p = .001) who completed the same task and when compared to their own performance on the PA variant (p = .006). Clinical measures showed no significant correlations with test scores. DISCUSSION Our results demonstrate implicit FB learning deficiencies in adult patients with AN. These impairments may have an impact on the effect of psychotherapeutic interventions and could partially explain the lack of treatment response in AN. Further studies are necessary to derive when and through which mechanisms these alterations originate, and to what extent they should be considered during treatment of the disorder. PUBLIC SIGNIFICANCE Cognitive impairments pose a challenge in the management of anorexia nervosa. Improved comprehension of cognitive alterations could lead to a greater understanding of the disease and adaptation of psychotherapeutic treatments. In this study, we found that implicit feedback learning in anorexia nervosa is impaired compared to healthy controls. This could indicate the necessity of treatment adaptations in the form of therapy tools without feedback and a larger focus on psychoeducation.
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Affiliation(s)
- Markus Wiener
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Susanne A Bengesser
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Jolana Wagner-Skacel
- Department of Medical Psychology, Psychosomatics and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Fiona N A Haidacher
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | | | - Julian Wenninger
- Department of Medical and Chemical Laboratory Diagnostics, LKH Hochsteiermark, Leoben, Austria
| | - Karin Hasiba-Seebacher
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Frederike T Fellendorf
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Annamaria Painold
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Kathrin Kreuzer
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Mary Butler
- Department of Psychiatry and Clinical Neuroscience, University College Cork, Cork, Ireland
| | - Sonja Lackner
- Division of Immunology, Otto Loewi Research Center, Medical University of Graz, Graz, Austria
| | - René Pilz
- Department of Medical Psychology, Psychosomatics and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Sabrina Mörkl
- Department of Medical Psychology, Psychosomatics and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
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Mairinger M, Maget A, Wagner-Skacel J, Mörkl S, Dalkner N, Hellinger T, Birner A, Fellendorf FT, Platzer M, Kreuzer K, Queissner R, Reininghaus B, Lenger M, Fabisch K, Fitz W, Kohlhammer-Dohr A, Krammer A, Holl AK, Painold A, Häussl A, Stross TM, Schmiedhofer F, Tmava-Berisha A, Pahsini K, Marinschek S, Wenninger J, Hamm C, Pilz R, Lehofer M, Amouzadeh-Ghadikolai O, Horvath A, Kainz G, Gallé B, Dinan TG, Butler MI, Reininghaus E, Bengesser S. Gut Microbiome Composition and Its Association with Sleep in Major Psychiatric Disorders. Neuropsychobiology 2023; 82:220-233. [PMID: 37321188 DOI: 10.1159/000530386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 03/14/2023] [Indexed: 06/17/2023]
Abstract
INTRODUCTION Sleep disturbances are highly prevalent across most major psychiatric disorders. Alterations in the hypothalamic-pituitary-adrenal axis, neuroimmune mechanisms, and circadian rhythm disturbances partially explain this connection. The gut microbiome is also suspected to play a role in sleep regulation, and recent studies suggest that certain probiotics, prebiotics, synbiotics, and fecal microbiome transplantation can improve sleep quality. METHODS We aimed to assess the relationship between gut-microbiota composition, psychiatric disorders, and sleep quality in this cross-sectional, cross-disorder study. We recruited 103 participants, 63 patients with psychiatric disorders (major depressive disorder [n = 31], bipolar disorder [n = 13], psychotic disorder [n = 19]) along with 40 healthy controls. Sleep quality was assessed with the Pittsburgh Sleep Quality Index (PSQI). The fecal microbiome was analyzed using 16S rRNA sequencing, and groups were compared based on alpha and beta diversity metrics, as well as differentially abundant species and genera. RESULTS A transdiagnostic decrease in alpha diversity and differences in beta diversity indices were observed in psychiatric patients, compared to controls. Correlation analysis of diversity metrics and PSQI score showed no significance in the patient and control groups. However, three species, Ellagibacter isourolithinifaciens, Senegalimassilia faecalis, and uncultured Blautia sp., and two genera, Senegalimassilia and uncultured Muribaculaceae genus, were differentially abundant in psychiatric patients with good sleep quality (PSQI >8), compared to poor-sleep quality patients (PSQI ≤8). CONCLUSION In conclusion, this study raises important questions about the interconnection of the gut microbiome and sleep disturbances.
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Affiliation(s)
- Marco Mairinger
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria,
| | - Alexander Maget
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Jolana Wagner-Skacel
- Department of Medical Psychology, Psychosomatics and Psychotherapy, Medical University of Graz, Graz, Austria
| | - Sabrina Mörkl
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Nina Dalkner
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Teresa Hellinger
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Armin Birner
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Frederike T Fellendorf
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Martina Platzer
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Kathrin Kreuzer
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Robert Queissner
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Bernd Reininghaus
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Melanie Lenger
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Karin Fabisch
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Werner Fitz
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | | | - Alexandra Krammer
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Anna Katharina Holl
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Annamaria Painold
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Alfred Häussl
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Tatjana Maria Stross
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Franziska Schmiedhofer
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Adelina Tmava-Berisha
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Karoline Pahsini
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Sabine Marinschek
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Julian Wenninger
- Department of Psychiatry, Psychiatric Hospital LKH Graz 2, Graz, Austria
| | - Carlo Hamm
- Department of Psychiatry, Psychiatric Hospital LKH Graz 2, Graz, Austria
| | - René Pilz
- Department of Psychiatry, Psychiatric Hospital LKH Graz 2, Graz, Austria
| | - Michael Lehofer
- Department of Psychiatry, Psychiatric Hospital LKH Graz 2, Graz, Austria
| | | | - Angela Horvath
- Center for Biomarker Research in Medicine, Graz, Austria
- Department of Gastroenterology and Hepatology, Medical University of Graz, Graz, Austria
| | - Gudrun Kainz
- Center for Medical Research, Medical University of Graz, Graz, Austria
| | - Birgit Gallé
- Center for Medical Research, Medical University of Graz, Graz, Austria
| | - Timothy G Dinan
- Department of Psychiatry and Neurobehavioral Science, University College Cork, Cork, Ireland
| | - Mary I Butler
- Department of Psychiatry and Neurobehavioral Science, University College Cork, Cork, Ireland
| | - Eva Reininghaus
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Susanne Bengesser
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
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Fleischmann E, Dalkner N, Fellendorf FT, Bengesser SA, Lenger M, Birner A, Queissner R, Platzer M, Tmava-Berisha A, Maget A, Wagner-Skacel J, Stross T, Schmiedhofer F, Smolle S, Painold A, Reininghaus EZ. The Big Five as Predictors of Cognitive Function in Individuals with Bipolar Disorder. Brain Sci 2023; 13:brainsci13050773. [PMID: 37239245 DOI: 10.3390/brainsci13050773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 04/02/2023] [Accepted: 05/02/2023] [Indexed: 05/28/2023] Open
Abstract
The connection between cognitive function and the "Big Five" personality traits (openness, conscientiousness, extraversion, agreeableness, and neuroticism) in the general population is well known; however, studies researching bipolar disorder (BD) are scarce. Therefore, this study aimed to investigate the Big Five as predictors of executive function, verbal memory, attention, and processing speed in euthymic individuals with BD (cross-sectional: n = 129, including time point t1; longitudinal: n = 35, including t1 and t2). Participants completed the NEO Five-Factor Inventory, the Color and Word Interference Test, the Trail Making Test, the d2 Test of Attention Revised, and the California Verbal Learning Test. The results showed a significant negative correlation between executive function and neuroticism at t1. Changes in cognitive function between t1 and t2 did not correlate with and could not be predicted by the Big Five at t1. Additionally, worse executive function at t2 was predicted by higher neuroticism and lower conscientiousness at t1, and high neuroticism was a predictor of worse verbal memory at t2. The Big Five might not strongly impact cognitive function over short periods; however, they are significant predictors of cognitive function. Future studies should include a higher number of participants and more time in between points of measurement.
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Affiliation(s)
- Eva Fleischmann
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, 8036 Graz, Styria, Austria
| | - Nina Dalkner
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, 8036 Graz, Styria, Austria
| | - Frederike T Fellendorf
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, 8036 Graz, Styria, Austria
| | - Susanne A Bengesser
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, 8036 Graz, Styria, Austria
| | - Melanie Lenger
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, 8036 Graz, Styria, Austria
| | - Armin Birner
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, 8036 Graz, Styria, Austria
| | - Robert Queissner
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, 8036 Graz, Styria, Austria
| | - Martina Platzer
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, 8036 Graz, Styria, Austria
| | - Adelina Tmava-Berisha
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, 8036 Graz, Styria, Austria
| | - Alexander Maget
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, 8036 Graz, Styria, Austria
| | - Jolana Wagner-Skacel
- Department of Medical Psychology and Psychotherapy, Medical University of Graz, 8036 Graz, Styria, Austria
| | - Tatjana Stross
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, 8036 Graz, Styria, Austria
| | - Franziska Schmiedhofer
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, 8036 Graz, Styria, Austria
| | - Stefan Smolle
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, 8036 Graz, Styria, Austria
| | - Annamaria Painold
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, 8036 Graz, Styria, Austria
| | - Eva Z Reininghaus
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, 8036 Graz, Styria, Austria
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Faber PL, Milz P, Reininghaus EZ, Mörkl S, Holl AK, Kapfhammer HP, Pascual-Marqui RD, Kochi K, Achermann P, Painold A. Fundamentally altered global- and microstate EEG characteristics in Huntington's disease. Clin Neurophysiol 2020; 132:13-22. [PMID: 33249251 DOI: 10.1016/j.clinph.2020.10.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 08/25/2020] [Accepted: 10/14/2020] [Indexed: 01/14/2023]
Abstract
OBJECTIVE Huntington's disease (HD) is characterized by psychiatric, cognitive, and motor disturbances. The study aimed to determine electroencephalography (EEG) global state and microstate changes in HD and their relationship with cognitive and behavioral impairments. METHODS EEGs from 20 unmedicated HD patients and 20 controls were compared using global state properties (connectivity and dimensionality) and microstate properties (EEG microstate analysis). For four microstate classes (A, B, C, D), three parameters were computed: duration, occurrence, coverage. Global- and microstate properties were compared between groups and correlated with cognitive test scores for patients. RESULTS Global state analysis showed reduced connectivity in HD and an increasing dimensionality with increasing HD severity. Microstate analysis revealed parameter increases for classes A and B (coverage), decreases for C (occurrence) and D (coverage and occurrence). Disease severity and poorer test performances correlated with parameter increases for class A (coverage and occurrence), decreases for C (coverage and duration) and a dimensionality increase. CONCLUSIONS Global state changes may reflect higher functional dissociation between brain areas and the complex microstate changes possibly the widespread neuronal death and corresponding functional deficits in brain regions associated with HD symptomatology. SIGNIFICANCE Combining global- and microstate analyses can be useful for a better understanding of progressive brain deterioration in HD.
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Affiliation(s)
- Pascal L Faber
- The KEY Institute for Brain-Mind Research, Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry, Zurich, Switzerland
| | - Patricia Milz
- The KEY Institute for Brain-Mind Research, Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry, Zurich, Switzerland
| | - Eva Z Reininghaus
- Department of Psychiatry and Psychotherapy, Medical University of Graz, Graz, Austria
| | - Sabrina Mörkl
- Department of Psychiatry and Psychotherapy, Medical University of Graz, Graz, Austria
| | - Anna K Holl
- Department of Psychiatry and Psychotherapy, Medical University of Graz, Graz, Austria
| | - Hans-Peter Kapfhammer
- Department of Psychiatry and Psychotherapy, Medical University of Graz, Graz, Austria
| | - Roberto D Pascual-Marqui
- The KEY Institute for Brain-Mind Research, Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry, Zurich, Switzerland
| | - Kieko Kochi
- The KEY Institute for Brain-Mind Research, Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry, Zurich, Switzerland
| | - Peter Achermann
- The KEY Institute for Brain-Mind Research, Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry, Zurich, Switzerland
| | - Annamaria Painold
- Department of Psychiatry and Psychotherapy, Medical University of Graz, Graz, Austria.
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Wagner-Skacel J, Dalkner N, Moerkl S, Kreuzer K, Farzi A, Lackner S, Painold A, Reininghaus EZ, Butler MI, Bengesser S. Sleep and Microbiome in Psychiatric Diseases. Nutrients 2020; 12:nu12082198. [PMID: 32718072 PMCID: PMC7468877 DOI: 10.3390/nu12082198] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 07/15/2020] [Accepted: 07/20/2020] [Indexed: 12/29/2022] Open
Abstract
Objectives: Disturbances in the gut–brain barrier play an essential role in the development of mental disorders. There is considerable evidence showing that the gut microbiome not only affects digestive, metabolic and immune functions of the host but also regulates host sleep and mental states through the microbiota–gut–brain axis. The present review summarizes the role of the gut microbiome in the context of circadian rhythms, nutrition and sleep in psychiatric disorders. Methods: A PubMed search (studies published between April 2015–April 2020) was conducted with the keywords: “sleep, microbiome and psychiatry”; “sleep, microbiome and depression”; “sleep, microbiome and bipolar disorder”, “sleep, microbiome and schizophrenia”, “sleep, microbiome and anorexia nervosa”, “sleep, microbiome and substance use disorder”, “sleep, microbiome and anxiety”; “clock gene expression and microbiome”, “clock gene expression and nutrition”. Only studies investigating the relationship between sleep and microbiome in psychiatric patients were included in the review. Results: Search results yielded two cross-sectional studies analyzing sleep and gut microbiome in 154 individuals with bipolar disorder and one interventional study analyzing the effect of fecal microbiota transplantation in 17 individuals with irritable bowel syndrome on sleep. In patients with bipolar disorder, Faecalibacterium was significantly associated with improved sleep quality scores and a significant correlation between Lactobacillus counts and sleep. Conclusion: Translational research on this important field is limited and further investigation of the bidirectional pathways on sleep and the gut microbiome in mood disorders is warranted.
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Affiliation(s)
- Jolana Wagner-Skacel
- Department of Medical Psychology, Medical University of Graz (MUG), 8036 Graz, Austria;
| | - Nina Dalkner
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz (MUG), 8036 Graz, Austria; (N.D.); (S.M.); (K.K.); (A.P.); (E.Z.R.)
| | - Sabrina Moerkl
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz (MUG), 8036 Graz, Austria; (N.D.); (S.M.); (K.K.); (A.P.); (E.Z.R.)
| | - Kathrin Kreuzer
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz (MUG), 8036 Graz, Austria; (N.D.); (S.M.); (K.K.); (A.P.); (E.Z.R.)
| | - Aitak Farzi
- Otto Loewi Research Center (for Vascular Biology, Immunology and Inflammation), Division of Pharmacology, Medical University of Graz (MUG), 8036 Graz, Austria;
| | - Sonja Lackner
- Otto Loewi Research Center (for Vascular Biology, Immunology andI), Division of Immunology and Pathophysiology, Medical University of Graz (MUG), 8036 Graz, Austria;
| | - Annamaria Painold
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz (MUG), 8036 Graz, Austria; (N.D.); (S.M.); (K.K.); (A.P.); (E.Z.R.)
| | - Eva Z. Reininghaus
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz (MUG), 8036 Graz, Austria; (N.D.); (S.M.); (K.K.); (A.P.); (E.Z.R.)
| | - Mary I. Butler
- Department of Psychiatry, University College Cork, T12 YN60 Cork, Ireland;
| | - Susanne Bengesser
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz (MUG), 8036 Graz, Austria; (N.D.); (S.M.); (K.K.); (A.P.); (E.Z.R.)
- Correspondence: ; Tel.: +43-316-86224
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6
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Wagner-Skacel J, Bengesser S, Dalkner N, Mörkl S, Painold A, Hamm C, Pilz R, Rieger A, Kapfhammer HP, Hiebler-Ragger M, Jauk E, Butler MI, Reininghaus EZ. Personality Structure and Attachment in Bipolar Disorder. Front Psychiatry 2020; 11:410. [PMID: 32477186 PMCID: PMC7233168 DOI: 10.3389/fpsyt.2020.00410] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 04/22/2020] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND An impairment of self and interpersonal functioning has an impact on coping strategies, regulation of affect and stress. Little is known so far about the impairment of personality functioning in patients with bipolar disorder (BD). The aim of this study is to assess the effects of personality structure and attachment in BD patients on the symptom burden. METHODS Forty-six patients with the diagnosis of BD were assessed by the 12-item Operationalized Psychodynamic Diagnosis Structure Questionnaire (OPD-SQS), the short version of Experience in Close Relationship-revised (ECR-R-D), and the Brief Symptom Inventory-18 (BSI 18) to determine the level of personality functioning, attachment patterns, and symptom load. RESULTS We observed positive correlations between personality difficulties, insecure attachment, and symptom load in patients with BD. A low level of structural integration and an insecure attachment style in patients with BD were accompanied by a significantly higher symptom load (r = 0.66, p ≤ 0.01). Interestingly, there were no significant differences in the structural integration (T(1.44) = -0.93, p = 0.357) and in the attachment style attachment related avoidance: (T(1,44) = 1.50, p = 0.140); attachment related anxiety (T(1,44) = -0.781, p = 0.439) of study participants with BD when compared to the normative value of the general population. LIMITATIONS Our limitations are the small sample size of our group and the lack of a control group. CONCLUSION In general, our results suggest that there is a link between personality structure and affective dynamics including depressive, anxiety, and somatization symptoms in BD. These findings underline the increasing importance of assessing personality structure and attachment for diagnosis and treatment planning of BD.
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Affiliation(s)
- Jolana Wagner-Skacel
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz (MUG), Graz, Austria
- Department of Medical Psychology and Psychotherapy, MUG, Graz, Austria
| | - Susanne Bengesser
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz (MUG), Graz, Austria
| | - Nina Dalkner
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz (MUG), Graz, Austria
| | - Sabrina Mörkl
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz (MUG), Graz, Austria
| | - Annamaria Painold
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz (MUG), Graz, Austria
| | - Carlo Hamm
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz (MUG), Graz, Austria
| | - René Pilz
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz (MUG), Graz, Austria
| | - Alexandra Rieger
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz (MUG), Graz, Austria
| | - Hans-Peter Kapfhammer
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz (MUG), Graz, Austria
| | - Michaela Hiebler-Ragger
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz (MUG), Graz, Austria
- Gruener Kreis Society, Center for Integrative Addiction Research, Johnsdorf, Austria
| | - Emanuel Jauk
- Institute of Psychology, University of Graz, Graz, Austria
- Clinical Psychology and Behavioral Neuroscience, Technische Universität Dresden, Dresden, Germany
| | - Mary I. Butler
- Department for Psychiatry and Neurobehavioral Science, University College Cork, Cork, Ireland
| | - Eva Z. Reininghaus
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz (MUG), Graz, Austria
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7
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Painold A, Faber PL, Reininghaus EZ, Mörkl S, Holl AK, Achermann P, Saletu B, Saletu-Zyhlarz G, Anderer P, Dalkner N, Birner A, Bengesser S, Kapfhammer HP, Milz P. Reduced Brain Electric Activity and Functional Connectivity in Bipolar Euthymia: An sLORETA Source Localization Study. Clin EEG Neurosci 2020; 51:155-166. [PMID: 31845595 DOI: 10.1177/1550059419893472] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Bipolar disorder (BD) is a chronic illness with a relapsing and remitting time course. Relapses are manic or depressive in nature and intermitted by euthymic states. During euthymic states, patients lack the criteria for a manic or depressive diagnosis, but still suffer from impaired cognitive functioning as indicated by difficulties in executive and language-related processing. The present study investigated whether these deficits are reflected by altered intracortical activity in or functional connectivity between brain regions involved in these processes such as the prefrontal and the temporal cortices. Vigilance-controlled resting state EEG of 13 euthymic BD patients and 13 healthy age- and sex-matched controls was analyzed. Head-surface EEG was recomputed into intracortical current density values in 8 frequency bands using standardized low-resolution electromagnetic tomography. Intracortical current densities were averaged in 19 evenly distributed regions of interest (ROIs). Lagged coherences were computed between each pair of ROIs. Source activity and coherence measures between patients and controls were compared (paired t tests). Reductions in temporal cortex activity and in large-scale functional connectivity in patients compared to controls were observed. Activity reductions affected all 8 EEG frequency bands. Functional connectivity reductions affected the delta, theta, alpha-2, beta-2, and gamma band and involved but were not limited to prefrontal and temporal ROIs. The findings show reduced activation of the temporal cortex and reduced coordination between many brain regions in BD euthymia. These activation and connectivity changes may disturb the continuous frontotemporal information flow required for executive and language-related processing, which is impaired in euthymic BD patients.
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Affiliation(s)
- Annamaria Painold
- Department of Psychiatry and Psychotherapy, Medical University of Graz, Graz, Austria
| | - Pascal L Faber
- Department of Psychiatry, Psychotherapy and Psychosomatics, The KEY Institute for Brain-Mind Research, University Hospital of Psychiatry, Zurich, Switzerland
| | - Eva Z Reininghaus
- Department of Psychiatry and Psychotherapy, Medical University of Graz, Graz, Austria
| | - Sabrina Mörkl
- Department of Psychiatry and Psychotherapy, Medical University of Graz, Graz, Austria
| | - Anna K Holl
- Department of Psychiatry and Psychotherapy, Medical University of Graz, Graz, Austria
| | - Peter Achermann
- Department of Psychiatry, Psychotherapy and Psychosomatics, The KEY Institute for Brain-Mind Research, University Hospital of Psychiatry, Zurich, Switzerland
| | - Bernd Saletu
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Gerda Saletu-Zyhlarz
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Peter Anderer
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Nina Dalkner
- Department of Psychiatry and Psychotherapy, Medical University of Graz, Graz, Austria
| | - Armin Birner
- Department of Psychiatry and Psychotherapy, Medical University of Graz, Graz, Austria
| | - Susanne Bengesser
- Department of Psychiatry and Psychotherapy, Medical University of Graz, Graz, Austria
| | - Hans-Peter Kapfhammer
- Department of Psychiatry and Psychotherapy, Medical University of Graz, Graz, Austria
| | - Patricia Milz
- Department of Psychiatry, Psychotherapy and Psychosomatics, The KEY Institute for Brain-Mind Research, University Hospital of Psychiatry, Zurich, Switzerland
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Bengesser SA, Mörkl S, Painold A, Dalkner N, Birner A, Fellendorf FT, Platzer M, Queissner R, Hamm C, Maget A, Pilz R, Rieger A, Wagner-Skacel J, Reininghaus B, Kapfhammer HP, Petek E, Kashofer K, Halwachs B, Holzer P, Waha A, Reininghaus EZ. Epigenetics of the molecular clock and bacterial diversity in bipolar disorder. Psychoneuroendocrinology 2019; 101:160-166. [PMID: 30465968 DOI: 10.1016/j.psyneuen.2018.11.009] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 11/04/2018] [Accepted: 11/06/2018] [Indexed: 12/31/2022]
Abstract
Objectives The gut microbiome harbors substantially more genetic material than our body cells and has an impact on a huge variety of physiological mechanisms including the production of neurotransmitters and the interaction with brain functions through the gut-brain-axis. Products of microbiota can affect methylation according to preclinical studies. The current investigation aimed at analyzing the correlation between gut microbiome diversity and the methylation of the clock gene ARNTL in individuals with Bipolar Disorder (BD). Methods Genomic DNA was isolated from fasting blood of study participants with BD (n = 32). The methylation analysis of the ARNTL CG site cg05733463 was performed by bisulfite treatment of genomic DNA with the Epitect kit, PCR and pyrosequencing. Additionally, DNA was extracted from stool samples and subjected to 16S rRNA sequencing. QIIME was used to analyze microbiome data. Results Methylation status of the ARNTL CpG position cg05733463 correlated significantly with bacterial diversity (Simpson index: r= -0.389, p = 0.0238) and evenness (Simpson evenness index: r= -0.358, p = 0.044). Furthermore, bacterial diversity differed significantly between euthymia and depression (F(1,30) = 4.695, p = 0.039). Discussion The results of our pilot study show that bacterial diversity differs between euthymia and depression. Interestingly, gut microbiome diversity and evenness correlate negatively with methylation of ARNTL, which is known to regulate monoamine oxidase A transcription. We propose that alterations in overall diversity of the gut microbiome represent an internal environmental factor that has an epigenetic impact on the clock gene ARNTL which is thought to be involved in BD pathogenesis.
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Affiliation(s)
- S A Bengesser
- Medical University of Graz (MUG), Department of Psychiatry and Psychotherapeutic Medicine, Austria
| | - S Mörkl
- Medical University of Graz (MUG), Department of Psychiatry and Psychotherapeutic Medicine, Austria.
| | - A Painold
- Medical University of Graz (MUG), Department of Psychiatry and Psychotherapeutic Medicine, Austria
| | - N Dalkner
- Medical University of Graz (MUG), Department of Psychiatry and Psychotherapeutic Medicine, Austria
| | - A Birner
- Medical University of Graz (MUG), Department of Psychiatry and Psychotherapeutic Medicine, Austria
| | - F T Fellendorf
- Medical University of Graz (MUG), Department of Psychiatry and Psychotherapeutic Medicine, Austria
| | - M Platzer
- Medical University of Graz (MUG), Department of Psychiatry and Psychotherapeutic Medicine, Austria
| | - R Queissner
- Medical University of Graz (MUG), Department of Psychiatry and Psychotherapeutic Medicine, Austria
| | - C Hamm
- Medical University of Graz (MUG), Department of Psychiatry and Psychotherapeutic Medicine, Austria
| | - A Maget
- Medical University of Graz (MUG), Department of Psychiatry and Psychotherapeutic Medicine, Austria
| | - R Pilz
- Medical University of Graz (MUG), Department of Psychiatry and Psychotherapeutic Medicine, Austria
| | - A Rieger
- Medical University of Graz (MUG), Department of Psychiatry and Psychotherapeutic Medicine, Austria
| | - J Wagner-Skacel
- Medical University of Graz (MUG), Department of Psychiatry and Psychotherapeutic Medicine, Austria
| | - B Reininghaus
- Medical University of Graz (MUG), Department of Psychiatry and Psychotherapeutic Medicine, Austria
| | - H P Kapfhammer
- Medical University of Graz (MUG), Department of Psychiatry and Psychotherapeutic Medicine, Austria
| | - E Petek
- MUG, Diagnostic & Research Institute of Human Genetics, Austria
| | | | | | - P Holzer
- MUG, Otto Loewi Research Centre, Austria
| | - A Waha
- University of Bonn, Institute of Neuropathology, Germany
| | - E Z Reininghaus
- Medical University of Graz (MUG), Department of Psychiatry and Psychotherapeutic Medicine, Austria
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9
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Painold A, Mörkl S, Kashofer K, Halwachs B, Dalkner N, Bengesser S, Birner A, Fellendorf F, Platzer M, Queissner R, Schütze G, Schwarz MJ, Moll N, Holzer P, Holl AK, Kapfhammer H, Gorkiewicz G, Reininghaus EZ. A step ahead: Exploring the gut microbiota in inpatients with bipolar disorder during a depressive episode. Bipolar Disord 2019; 21:40-49. [PMID: 30051546 PMCID: PMC6585963 DOI: 10.1111/bdi.12682] [Citation(s) in RCA: 118] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVES There is evidence that the gut microbiota plays a major role in the pathogenesis of diseases of the central nervous system through the gut-brain axis. The aim of the present study was to analyze gut microbiota composition in bipolar disorder (BD) and its relation to inflammation, serum lipids, oxidative stress, tryptophan (TRP)/kynurenine (KYN) levels, anthropometric measurements and parameters of metabolic syndrome. Further, microbial community differences of individuals with BD compared with healthy controls (HC) were explored. METHODS In this cross-sectional study, we performed 16S rRNA gene sequencing of stool samples from 32 BD individuals and 10 HC. Laboratory parameters included inflammatory markers, serum lipids, KYN, oxidative stress and anthropometric measures. Microbial community analysis and correlation to clinical parameters was performed with QIIME, differential abundance analysis of taxa encompassed linear discriminant analysis effect size (LEfSe). RESULTS We found a negative correlation between microbial alpha-diversity and illness duration in BD (R = -0.408, P = 0.021). Furthermore, we identified bacterial clades associated with inflammatory status, serum lipids, TRP, depressive symptoms, oxidative stress, anthropometrics and metabolic syndrome in individuals with BD. LEfSe identified the phylum Actinobacteria (LDA= 4.82, P = 0.007) and the class Coriobacteria (LDA= 4.75, P = 0.010) as significantly more abundant in BD when compared with HC, and Ruminococcaceae (LDA= 4.59, P = 0.018) and Faecalibacterium (LDA= 4.09, P = 0.039) as more abundant in HC when compared with BD. CONCLUSIONS The present findings suggest that causes and/or consequences of BD may also lie outside the brain. Exploratory research of the gut microbiota in affective disorders like BD may identify previously unknown underlying causes, and offer new research and therapeutic approaches to mood disorders.
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Affiliation(s)
- Annamaria Painold
- Department of Psychiatry and Psychotherapeutic MedicineMedical University of GrazGrazAustria
| | - Sabrina Mörkl
- Department of Psychiatry and Psychotherapeutic MedicineMedical University of GrazGrazAustria
| | - Karl Kashofer
- Institute of PathologyMedical University of GrazGrazAustria
| | | | - Nina Dalkner
- Department of Psychiatry and Psychotherapeutic MedicineMedical University of GrazGrazAustria
| | - Susanne Bengesser
- Department of Psychiatry and Psychotherapeutic MedicineMedical University of GrazGrazAustria
| | - Armin Birner
- Department of Psychiatry and Psychotherapeutic MedicineMedical University of GrazGrazAustria
| | - Frederike Fellendorf
- Department of Psychiatry and Psychotherapeutic MedicineMedical University of GrazGrazAustria
| | - Martina Platzer
- Department of Psychiatry and Psychotherapeutic MedicineMedical University of GrazGrazAustria
| | - Robert Queissner
- Department of Psychiatry and Psychotherapeutic MedicineMedical University of GrazGrazAustria
| | - Gregor Schütze
- Institute of Laboratory MedicineMedical Center of Munich University (LMU)MunichGermany
| | - Markus J. Schwarz
- Institute of Laboratory MedicineMedical Center of Munich University (LMU)MunichGermany
| | - Natalie Moll
- Institute of Laboratory MedicineMedical Center of Munich University (LMU)MunichGermany
| | - Peter Holzer
- Institute of Experimental and Clinical PharmacologyMedical University of GrazGrazAustria
| | - Anna K. Holl
- Department of Psychiatry and Psychotherapeutic MedicineMedical University of GrazGrazAustria
| | - Hans‐Peter Kapfhammer
- Department of Psychiatry and Psychotherapeutic MedicineMedical University of GrazGrazAustria
| | | | - Eva Z. Reininghaus
- Department of Psychiatry and Psychotherapeutic MedicineMedical University of GrazGrazAustria
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Mörkl S, Wagner-Skacel J, Lahousen T, Lackner S, Holasek SJ, Bengesser SA, Painold A, Holl AK, Reininghaus E. The Role of Nutrition and the Gut-Brain Axis in Psychiatry: A Review of the Literature. Neuropsychobiology 2018; 79:1-9. [PMID: 30223263 DOI: 10.1159/000492834] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Accepted: 08/11/2018] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Individuals suffering from psychiatric disorders experience high levels of illness burden and a significantly reduced quality of life. Despite targeted psychopharmacological strategies and complementary psychotherapeutic procedures only moderate effects are obtained, and the risk of relapse is high in many patients. Worldwide, psychiatric diseases such as depression are continuously increasing, challenging the personal life of the affected as well as their families, but also whole societies by increasing disability, early retirement and hospitalization. According to current scientific knowledge psychiatric disorders are caused by a multifactorial pathogenesis, including genetics, inflammation and neurotransmitter imbalance; furthermore, also lifestyle-associated factors gain rising importance. In line with this, there is growing evidence that the gut microbiota and nutrition have an impact on the onset and course of psychiatric disorders. AIM This narrative review highlights the important role of nutrition in psychiatric care and underlines the significance of nutritional advice in the multifactorial, biopsychosocial treatment of patients. It focuses on current dietary interventions such as the Mediterranean diet, dietary supplements and modifications of the gut microbiota with pre-, pro- and postbiotics. RESULTS Recent studies support the connection between the quality of diet, gut microbiota and mental health through regulation of metabolic functions, anti-inflammatory and antiapoptotic properties and the support of neurogenesis. Dietary coaching to improve mental health seems to be an additional, cost-effective, practical, nonpharmacological intervention for individuals with psychiatric disorders. CONCLUSION The use of nutritional interventions in psychiatry equips therapists with a promising tool for both the prevention and treatment of psychiatric disorders. Besides pharmacological therapy, psychotherapy and physical activity, nutritional interventions are an important pillar in the multifactorial, biopsychosocial treatment of psychiatric disease and could be used as a potential therapeutic target.
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Affiliation(s)
- Sabrina Mörkl
- Department for Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Jolana Wagner-Skacel
- Department for Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Theresa Lahousen
- Department for Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Sonja Lackner
- Unit of Immunology and Pathophysiology, Otto Loewi Research Center (for Vascular Biology, Immunology and Inflammation), Medical University of Graz, Graz, Austria
| | - Sandra Johanna Holasek
- Unit of Immunology and Pathophysiology, Otto Loewi Research Center (for Vascular Biology, Immunology and Inflammation), Medical University of Graz, Graz, Austria
| | - Susanne Astrid Bengesser
- Department for Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Annamaria Painold
- Department for Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Anna Katharina Holl
- Department for Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Eva Reininghaus
- Department for Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
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Mörkl S, Lackner S, Meinitzer A, Gorkiewicz G, Kashofer K, Painold A, Holl A, Holasek S. [Pilot study: Gut microbiome and intestinal barrier in anorexia nervosa]. Fortschr Neurol Psychiatr 2018; 87:39-45. [PMID: 30049020 DOI: 10.1055/s-0043-123826] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Recent research has shown changes of the intestinal flora in anorexia nervosa (AN) patients. Alpha diversity (AD) represents the number of different bacterial species in the gut. Reduced AD and a leaky gut (zonulin) lead to inflammation and changes in nutrient absorption. METHODS AD was calculated from stool samples of 18 AN patients and 20 normal weight controls (NC) after 16S ribosomal RNA sequencing. Furthermore, Zonulin as an indicator of gut barrier function and inflammation parameters were investigated. RESULTS AN patients had significantly lower AD compared to NC (number of observed species p=0.042, Chao1 Diversity Index p=0.043). Zonulin was not significantly altered in AN patients compared to NC. There were no significant correlations of serum parameters and AD. DISCUSSION Regardless of gut permeability, AN patients showed significantly decreased AD compared to NC. Decreased AD can have an additional negative impact on calorie intake in AN. These results contribute to a better understanding of the illness and the development of new therapeutic options.
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Letmaier M, Grohmann R, Kren C, Toto S, Bleich S, Engel R, Gary T, Papageorgiou K, Konstantinidis A, Holl AK, Painold A, Kasper S. Venous thromboembolism during treatment with antipsychotics: Results of a drug surveillance programme. World J Biol Psychiatry 2018; 19:175-186. [PMID: 28112047 DOI: 10.1080/15622975.2017.1285048] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Venous thromboembolism (VTE) can be a life-threatening medical condition that may lead to leg swelling, respiratory distress and death. METHODS The AMSP (Arzneimittelsicherheit in der Psychiatrie) is a continuous multicentre drug surveillance programme that assesses severe adverse drug reactions during treatment of psychiatric inpatients. We report on a total of 264,422 inpatients who were treated with antipsychotics (APs) and monitored from 1993 to 2011 in 99 psychiatric hospitals. RESULTS During this period VTE events were reported for 89 inpatients, corresponding to an occurrence rate of 34 cases per 100,000 inpatient admissions treated with APs or 43 cases per 10,000 person-years. The occurrence of VTE was greatest in patients over the age of 65 years of age with mood disorders. The chemical class of butyrophenones (48/100,000) followed by atypical APs (36/100,000) showed the highest occurrence rate for VTE compared to thioxanthenes (23/100,000), which were less associated with VTE. If imputed alone, pipamperone (61/100,000) and risperidone (55/100,000) were most frequently associated with VTE. In general, there was no difference in occurrence rate of VTE between high- and low-potency APs. CONCLUSIONS These results suggest that clinicians should consider AP drug exposure as a potential risk factor for VTE for patients older than 65 years. Additionally, the diagnosis of an affective disorder seems to increase the risk for VTE.
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Affiliation(s)
- Martin Letmaier
- a Department of Psychiatry , Medical University of Graz , Graz , Austria
| | - Renate Grohmann
- b Department of Psychiatry , Ludwig-Maximilians-University , Munich , Germany
| | | | - Sermin Toto
- d Department of Psychiatry, Social Psychiatry and Psychotherapy , Hannover Medical School , Hannover , Germany
| | - Stefan Bleich
- d Department of Psychiatry, Social Psychiatry and Psychotherapy , Hannover Medical School , Hannover , Germany
| | - Rolf Engel
- b Department of Psychiatry , Ludwig-Maximilians-University , Munich , Germany
| | - Thomas Gary
- e Department of Angiology , Medical University of Graz , Graz , Austria
| | - Konstantinos Papageorgiou
- f Department of Psychiatry and Psychotherapy, Division of Biological Psychiatry , Medical University of Vienna , Vienna , Austria
| | - Anastasios Konstantinidis
- f Department of Psychiatry and Psychotherapy, Division of Biological Psychiatry , Medical University of Vienna , Vienna , Austria
| | | | - Annamaria Painold
- a Department of Psychiatry , Medical University of Graz , Graz , Austria
| | - Siegfried Kasper
- f Department of Psychiatry and Psychotherapy, Division of Biological Psychiatry , Medical University of Vienna , Vienna , Austria
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13
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Mörkl S, Lackner S, Müller W, Gorkiewicz G, Kashofer K, Oberascher A, Painold A, Holl A, Holzer P, Meinitzer A, Mangge H, Holasek S. Gut microbiota and body composition in anorexia nervosa inpatients in comparison to athletes, overweight, obese, and normal weight controls. Int J Eat Disord 2017; 50:1421-1431. [PMID: 29131365 DOI: 10.1002/eat.22801] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 10/03/2017] [Accepted: 10/24/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Anorexia nervosa (AN) is a heterogeneous eating disorder associated with alterations of body structure and the gut microbiome. We aimed to investigate the gut microbiota composition of a large female cohort including different BMI groups and activity levels along with body composition parameters. METHOD 106 female participants were included in this cross-sectional study: AN patients (n = 18), athletes (n = 20), normal weight (n = 26), overweight (n = 22), and obese women (n = 20). DNA was extracted from stool samples and subjected to 16S rRNA gene analysis. The software Quantitative Insights Into Microbial Ecology (QIIME) was used to analyze data. Additionally, we performed anthropometric assessments, ultrasound measurements of subcutaneous adipose tissue thickness, bioimpedance analysis, administered depression inventories, and ascertained laboratory parameters and dietary intakes. RESULTS Alpha diversity was particularly lower in AN patients and obese participants compared to other groups, while athletes showed highest alpha diversity. Several categories significantly associated with community structure were identified: body fat parameters, serum lipids, CRP, depression scales and smoking. Comparative analysis revealed Coriobacteriaceae as the only enriched phylotype in AN compared to other entities (LDA score >3.5). DISCUSSION This study provides further evidence of intestinal dysbiosis in AN and sheds light on characteristics of the gut microbiome in different BMI and physical activity groups. These insights point to new modulation possibilities of the gut microbiota which could improve the standard therapy of AN.
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Affiliation(s)
- Sabrina Mörkl
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Sonja Lackner
- Institute of Pathophysiology and Immunology, Medical University of Graz, Graz, Austria
| | - Wolfram Müller
- Institute of Biophysics, Medical University of Graz, Graz, Austria
| | | | - Karl Kashofer
- Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Andreas Oberascher
- Institute of Pathophysiology and Immunology, Medical University of Graz, Graz, Austria
| | - Annamaria Painold
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Anna Holl
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Peter Holzer
- Institute of Experimental and Clinical Pharmacology, Medical University of Graz, Graz, Austria
| | - Andreas Meinitzer
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - Harald Mangge
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - Sandra Holasek
- Institute of Pathophysiology and Immunology, Medical University of Graz, Graz, Austria
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Mörkl S, Tmava A, Blesl C, Schmiedhofer F, Wurm WE, Holl A, Painold A. [The power plants of the cell: Treatment of psychiatric symptoms in patients with mitochondriopathy]. Fortschr Neurol Psychiatr 2017; 85:474-478. [PMID: 28841746 DOI: 10.1055/s-0043-113824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Introduction Mitochondriopathies are pathologies of cell organelles, which are essential for the formation of adenosine triphosphate (ATP), which is responsible for cellular energy stock. When mitochondrial mutations occur, symptoms arise frequently in those organs that rely on a continuous energy supply, such as the nervous system. Although psychiatric illness is increasingly prevalent in patients with mitochondrial disease, less attention has been paid to its psychiatric presentations. Case Report We describe a case of a 21-year-old woman who presented in our outpatient department with panic attacks and depression. The patient experienced major side effects after low-dose sertraline therapy. Conclusion Mitochondriopathies belong to the class of rare illnesses in psychiatry; nevertheless, they require adaptations of psychopharmacological therapy. Psychotropic drugs are potential respiratory chain inhibitors and could lead to distinct side effects.
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Dalkner N, Platzer M, Bengesser SA, Birner A, Fellendorf FT, Queissner R, Painold A, Mangge H, Fuchs D, Reininghaus B, Kapfhammer HP, Holasek SJ, Reininghaus EZ. The role of tryptophan metabolism and food craving in the relationship between obesity and bipolar disorder. Clin Nutr 2017; 37:1744-1751. [PMID: 28712531 DOI: 10.1016/j.clnu.2017.06.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 06/22/2017] [Accepted: 06/25/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND & AIMS Individuals with bipolar disorder (BD) have a significantly increased risk of obesity-related conditions. The imbalance between food intake and energy expenditure is assumed to be a major risk factor for obesity in BD. This study analyzed food craving in relation to anthropometric, metabolic, and neurobiological parameters in a well-characterized cohort of euthymic individuals with BD. METHODS One-hundred-thirty-five patients completed the Food-Craving Inventory assessing four categories of food craving (fat, fast-food, sweets and carbohydrate craving). Additionally, clinical, metabolic and anthropometric parameters were assessed. RESULTS Higher levels of fat craving were observed in males, versus females, with BD. High levels of carbohydrate craving positively correlated with kynurenine and the kynurenine-to-tryptophan ratio. Higher serum nitrite and neopterin levels were related to fat craving. Parameters of fat metabolism (triglycerides, high-density lipoprotein) were associated with fat and fast-food craving. Anthropometric measures of obesity (e.g. body mass index, waist-to-hip-ratio) were not related to food craving. CONCLUSIONS Overweight/obese individuals with BD show an increased driving of tryptophan down the kynurenine pathways, as indicated by an increase in the serum kynurenine-to-tryptophan ratio. The driving of tryptophan down the kynurenine pathway is mediated by immune-inflammatory activity and stress. The correlation of increased kynurenine with food craving, especially carbohydrate craving, probably indicates a regulatory deficit in the maintenance of chronic inflammatory processes in obesity and BD. Food craving seems to be of clinical importance in the treatment of metabolic disturbances in BD, although not associated with anthropometric measures of obesity. Rather, food craving correlates with blood metabolic parameters and an increased activation of the kynurenine pathway, both of which are linked to higher affective symptomatology and the development of cardiovascular diseases.
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Affiliation(s)
- N Dalkner
- Department of Psychiatry, Medical University Graz, Austria
| | - M Platzer
- Department of Psychiatry, Medical University Graz, Austria.
| | - S A Bengesser
- Department of Psychiatry, Medical University Graz, Austria
| | - A Birner
- Department of Psychiatry, Medical University Graz, Austria
| | - F T Fellendorf
- Department of Psychiatry, Medical University Graz, Austria
| | - R Queissner
- Department of Psychiatry, Medical University Graz, Austria
| | - A Painold
- Department of Psychiatry, Medical University Graz, Austria
| | - H Mangge
- Research Unit on Lifestyle and Inflammation-associated Risk Biomarkers, Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University Graz, Austria
| | - D Fuchs
- Division of Biological Chemistry, Biocenter, Medical University of Innsbruck, Austria
| | - B Reininghaus
- Therapiezentrum Justuspark, Versicherungsanstalt öffentlich Bediensteter, Bad Hall, Austria
| | - H P Kapfhammer
- Department of Psychiatry, Medical University Graz, Austria
| | - S J Holasek
- Department of Pathophysiology and Immunology, Medical University Graz, Austria
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Lackner N, Bengesser SA, Birner A, Painold A, Fellendorf FT, Platzer M, Reininghaus B, Weiss EM, Mangge H, McIntyre RS, Fuchs D, Kapfhammer HP, Wallner-Liebmann SJ, Reininghaus EZ. Abdominal obesity is associated with impaired cognitive function in euthymic bipolar individuals. World J Biol Psychiatry 2016; 17:535-46. [PMID: 26068130 DOI: 10.3109/15622975.2015.1046917] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVES Overweight/obesity has been implicated to play a role in cognitive deficits in bipolar disorder (BD). This study aims to identify the relationship between body fat distribution and different domains of cognition in BD during euthymia. METHODS A sample of 100 euthymic individuals with BD was measured with a cognitive test battery (i.e., Trail Making Test-A-B/TM-A/B, d2 Test of Attention, Stroop test, California Verbal Learning Test/CVLT) and an anthropometric measures set (body mass index, waist circumference, hip circumference, waist-to-hip-ratio, waist-to-height-ratio, and lipometry). Patient data were compared with a healthy control group (n = 64). RESULTS Results show that overweight patients with BD exhibit lower performance in the TMT-A/B as well as in the free recall performance of the CVLT compared to normal-weight patients with BD and controls. In bipolar individuals, (abdominal) obesity was significantly associated with a poor cognitive performance. In bipolar females, associations with measures of verbal learning and memory were found; in bipolar males, associations with poor performance in the TMT-A/B and in the Stroop interference task were demonstrated. In controls, no associations were found. CONCLUSIONS There are several possible pathways moderating the association between obesity and cognition in BD. Anthropometric and lipometry data underline the substantial mediating impact of body fat distribution on cognition in BD.
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Affiliation(s)
- N Lackner
- a Department of Psychiatry , Medical University Graz , Graz , Austria
| | - S A Bengesser
- a Department of Psychiatry , Medical University Graz , Graz , Austria
| | - A Birner
- a Department of Psychiatry , Medical University Graz , Graz , Austria
| | - A Painold
- a Department of Psychiatry , Medical University Graz , Graz , Austria
| | - F T Fellendorf
- a Department of Psychiatry , Medical University Graz , Graz , Austria
| | - M Platzer
- a Department of Psychiatry , Medical University Graz , Graz , Austria
| | - B Reininghaus
- b Therapiezentrum Justuspark, Versicherungsanstalt öffentlich Bediensteter , Austria
| | - E M Weiss
- c Department of Biological Psychology , Karl-Franzens University Graz , Graz , Austria
| | - H Mangge
- d Research Unit on Lifestyle and Inflammation-associated Risk Biomarkers, Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University Graz , Graz , Austria.,e BioTechMed-Graz , Graz , Austria
| | - R S McIntyre
- f Mood Disorders Psychopharmacology Unit, University of Toronto , Toronto , Canada
| | - D Fuchs
- g Division of Biological Chemistry, Medical University of Innsbruck , Innsbruck , Austria
| | - H P Kapfhammer
- a Department of Psychiatry , Medical University Graz , Graz , Austria
| | - S J Wallner-Liebmann
- h Department of Pathophysiology and Immunology , Medical University Graz , Graz , Austria
| | - E Z Reininghaus
- a Department of Psychiatry , Medical University Graz , Graz , Austria
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Mörkl S, Müller NJ, Blesl C, Wilkinson L, Tmava A, Wurm W, Holl AK, Painold A. Problem solving, impulse control and planning in patients with early- and late-stage Huntington's disease. Eur Arch Psychiatry Clin Neurosci 2016; 266:663-71. [PMID: 27372072 PMCID: PMC5037143 DOI: 10.1007/s00406-016-0707-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 06/11/2016] [Indexed: 12/14/2022]
Abstract
Sub-domains of executive functions, including problems with planning, accuracy, impulsivity, and inhibition, are core features of Huntington's disease. It is known that the decline of cognitive function in Huntington's disease is related to the anatomical progression of pathology in the basal ganglia. However, it remains to be determined whether the severity of executive dysfunction depends on the stage of the disease. To examine the severity of sub-domains of executive dysfunction in early- and late-stage Huntington's disease, we studied performance in the Tower of London task of two groups of Huntington's disease patients (Group 1: early, n = 23, and Group 2: late stage, n = 29), as well as a third group of age, education, and IQ matched healthy controls (n = 34). During the task, we measured the total number of problems solved, total planning time, and total number of breaks taken. One aspect of executive function indexed by the number of solved problems seems to progress in the course of the disease. Late-stage Huntington's disease patients scored significantly worse than early-stage patients and controls, and early-stage patients scored significantly worse than controls on this measure of accuracy. In contrast, late- and early-stage HD patients did not differ in terms of planning time and number of breaks. Early- and late-stage HD pathology has a different impact on executive sub-domains. While accuracy differs between early- and late-stage HD patients, other domains like planning time and number of breaks do not. Striatal degeneration, which is a characteristic feature of the disease, might not affect all aspects of executive function in HD.
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Affiliation(s)
- Sabrina Mörkl
- Department of Psychiatry, Medical University of Graz, Auenbruggerplatz 31/1, 8036, Graz, Austria
| | - Nicole J Müller
- Department of Psychiatry, Medical University of Graz, Auenbruggerplatz 31/1, 8036, Graz, Austria
| | - Claudia Blesl
- Department of Psychiatry, Medical University of Graz, Auenbruggerplatz 31/1, 8036, Graz, Austria.
| | - Leonora Wilkinson
- Behavioral Neurology Unit, National Institute of Neurological Disorders and Stroke, National Institutes of Health, 10 Center Dr., MSC 1440, Bethesda, MD, 20892-1440, USA
| | - Adelina Tmava
- Department of Psychiatry, Medical University of Graz, Auenbruggerplatz 31/1, 8036, Graz, Austria
| | - Walter Wurm
- Department of Psychiatry, Medical University of Graz, Auenbruggerplatz 31/1, 8036, Graz, Austria
| | - Anna K Holl
- Department of Psychiatry, Medical University of Graz, Auenbruggerplatz 31/1, 8036, Graz, Austria
| | - Annamaria Painold
- Department of Psychiatry, Medical University of Graz, Auenbruggerplatz 31/1, 8036, Graz, Austria
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Mörkl S, Blesl C, Tmava A, Wurm W, Holl A, Painold A. Inconsistent decline of executive functions in patients with early and late Huntington's disease. Eur Psychiatry 2016. [DOI: 10.1016/j.eurpsy.2016.01.1332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BackgroundHuntington's disease (HD) is characterized by executive dysfunctions like problems with planning, accuracy, inhibition and impulsivity. During the course of the disease executive function worsens with ongoing pathological changes in the basal ganglia. However, it is not clear whether cognitive dysfunction develops gradually or not during the course of the disease.MethodsWe assessed the development of executive dysfunction in 23 patients with early HD and 29 patients with late HD on the Tower of London (ToL) for the number of solved problems, planning time and number of breaks.ResultsHD patients showed a linear decrease of accuracy (as assessed by number of solved problems) during the course of the disease. Controls scored significantly higher than early stage HD patients and early stage HD patients scored significantly higher than late stage HD patients. In planning time and number of breaks a non-linear decrease was found.ConclusionExecutive dysfunctions in HD are not alone connected to degenerative changes in the striatum as they do not develop gradually and linear during the course of the disease. Obviously, executive function could not be seen as a single component, but as a combination of different abilities, which show a non-linear and non-parallel decline.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Mörkl S, Blesl C, Jahanshahi M, Painold A, Holl A. Impaired probabilistic classification learning with feedback in patients with major depression. Neurobiol Learn Mem 2016; 127:48-55. [DOI: 10.1016/j.nlm.2015.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Revised: 11/30/2015] [Accepted: 12/06/2015] [Indexed: 10/22/2022]
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Lahousen T, Painold A, Luxenberger W, Schienle A, Kapfhammer HP, Ille R. Psychological factors associated with acute and chronic central serous chorioretinopathy. Nord J Psychiatry 2016; 70:24-30. [PMID: 25947110 DOI: 10.3109/08039488.2015.1041156] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Central serous chorioretinopathy (CSC) has been associated with several psychological factors. But previous psychological data are limited and mainly restricted to male patients and small sample size. In this study we investigated psychosomatic complaints, personality factors, life events, and stress coping in acute and chronic recurrent CSC patients. METHODS Ninety-five patients (71 men, 24 women) with either acute or chronic CSC were evaluated regarding critical life events before diagnosis, psychosomatic complaints, personality traits and coping style. The characteristics of CSC patients were compared with a control group comprising 75 patients (46 men, 29 women) suffering from acute or chronic ophthalmic disorders other than CSC. RESULTS Compared with patients of the control group, CSC patients reported more psychosomatic problems, unfavourable stress coping strategies and critical life events as well as elevated tension, aggression, strain, emotional instability and achievement orientation. Except for aggression the observed characteristics were more pronounced in acute than in chronic CSC patients. CONCLUSIONS The appearance of CSC may be associated with an accumulation of stressful life events with an unfavourable coping style and distinctive personality factors. Acute CSC is related to more unfavourable stress coping and more physical complaints compared to its chronic course. Elevated aggression may imply one potential risk factor for CSC manifestation and also may have an adverse effect with its chronification.
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Affiliation(s)
- Theresa Lahousen
- a Theresa Lahousen, Department of Psychiatry, Medical University of Graz , Austria
| | - Annamaria Painold
- b Annamaria Painold, Department of Psychiatry, Medical University of Graz , Austria
| | - Wolfgang Luxenberger
- c Wolfgang Luxenberger, Department of Psychiatry, Medical University of Graz , Austria
| | - Anne Schienle
- d Anne Schienle, Department of Psychology, Karl-Franzens-University of Graz , Austria
| | - Hans-Peter Kapfhammer
- e Hans-Peter Kapfhammer, Department of Psychiatry, Medical University of Graz , Austria
| | - Rottraut Ille
- f Rottraut Ille, Department of Psychology, Karl-Franzens-University of Graz , Austria
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Holl AK, Grohmann R, Letmaier M, Painold A, Mörkl S, Toto S, Kasper S. Pharmacotherapy of anxiety disorders in German-speaking countries: current status and changes between 1994 and 2011. Eur Arch Psychiatry Clin Neurosci 2015; 265:199-208. [PMID: 25138236 DOI: 10.1007/s00406-014-0523-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 08/09/2014] [Indexed: 11/26/2022]
Abstract
Over the past years, international treatment guidelines have been established for the treatment of anxiety disorders. Nevertheless, little is known as to whether the actual inpatient treatment follows these guidelines. The main goal of this study was to answer the question whether patients with anxiety disorder are treated according to treatment guidelines. A total of 2,573 psychiatric inpatients with the diagnosis of anxiety disorder (920 men, 1,653 women) were identified on the basis of the data of the international drug safety programme in psychiatry AMSP. Of these patients, 25.3% presented with phobia, 26.6% with panic disorder, 18.7% with generalized anxiety disorder (GAD), and 29.4% with other diagnoses of anxiety. In all of the patients, 12.7% did not receive any psychotropic medication and 22.9% were not treated with antidepressants. Only 59.3% of patients with GAD, 73.9% of patients with panic disorder, and 52.1% of patients with phobia were treated according to diagnostic guidelines. The majority (60.3%) of all patients received one or two psychotropic drugs, and only 3.7% received five or more psychotropic drugs. In two groups of patients (one group with phobia and one with panic disorder), the annual prescription rate of antidepressants significantly increased over time. The prescription rate for anticonvulsants in patients with GAD increased from 0% in 1997 to 41.7% in 2011, and for antipsychotics, from 40.7% in 1997 to 47.2% in 2011. In particular, patients with GAD were commonly treated with antipsychotics.
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Affiliation(s)
- Anna K Holl
- Department of Psychiatry, Graz Medical University, Auenbruggerplatz 31, 8036, Graz, Austria
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Lackner N, Platzer M, Fellendorf F, Rieger A, Schörkhuber C, Queissner R, Gatkowsky K, Birner A, Bengesser S, Unterweger R, Painold A, Reininghaus B, Weiss E, Wallner-Liebmann S, Kapfhammer H, Reininghaus E. Food Craving in Bipolar Disorder. Eur Psychiatry 2015. [DOI: 10.1016/s0924-9338(15)30437-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Painold A, Faber PL, Milz P, Reininghaus EZ, Holl AK, Letmaier M, Pascual-Marqui RD, Reininghaus B, Kapfhammer HP, Lehmann D. Brain electrical source imaging in manic and depressive episodes of bipolar disorder. Bipolar Disord 2014; 16:690-702. [PMID: 24636537 DOI: 10.1111/bdi.12198] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Accepted: 11/12/2013] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Bipolar disorder (BD) electroencephalographic (EEG) studies have reported varying results. The present study compared EEG in BD during manic and depressive episodes, using brain electrical source imaging [standardized low-resolution electromagnetic tomography (sLORETA)] to assess the cortical spatial distribution of the sources of EEG oscillation frequencies. METHODS Two independent datasets (a total of 95 patients with bipolar I disorder, of whom 59 were female) were analyzed. Dataset #1 comprised 14 patients in a manic as well as a depressive episode. Dataset #2 comprised 26 patients in a manic episode and 55 patients in a depressive episode. From the head surface-recorded EEG, sLORETA cortical activity was computed in eight EEG frequency bands, and compared between mood states in both datasets. The results from the two datasets were combined using conjunction analysis. RESULTS Conjunction analysis yielded significant differences between mood states: In manic compared to depressive states, patients had lesser theta frequency band activity (right-hemispheric lateral lower prefrontal and anterior temporal, mainly Brodmann areas 13, 38, and 47), and greater beta-2 and beta-3 frequency band activity (extended bilateral prefrontal-to-parietal, mainly Brodmann area 6, and the cingulate). CONCLUSIONS The spatial organization of the brain's electrical oscillations differed in patients with BD between manic and depressive mood states. The brain areas implementing the main functions that show opposing abnormalities during manic and depressive episodes were affected by unduly increased or decreased activity (beta or theta). The discussion considers that facilitating (beta) or inhibiting (theta) electrical activity can in either case result in behavioral facilitation or inhibition, depending on the function of the brain area.
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Mörkl S, Painold A, Kapfhammer HP, Holl AK. [Verbal memory in patients with major depression]. Nervenarzt 2014; 85:1128-1132. [PMID: 23979360 DOI: 10.1007/s00115-013-3864-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
INTRODUCTION Patients with major depression commonly report memory deficits but studies on this topic have shown inconsistent results. The aim of this study was to determine whether patients with major depression showed any differences in explicit verbal memory compared to healthy controls. MATERIAL AND METHODS We used the California verbal learning test (CVLT) in order to compare the explicit verbal memory of 30 patients (21 women and 9 men) to a healthy control group (23 women and 10 men). RESULTS The results showed no significant differences between verbal memory performance of patients with major depression and healthy controls. DISCUSSION Verbal memory of depressive patients with antidepressant pharmacotherapy showed no significant differences compared to a healthy control group. It can be assumed that verbal memory in depression depends on variable parameters (e.g. age, severity and duration of depression and medication). More studies with a larger number of patients should be conducted to obtain reliable results about explicit verbal memory in depression.
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Affiliation(s)
- S Mörkl
- Universitätsklinik für Psychiatrie, Medizinische Universität Graz, Auenbruggerplatz 31, 8036, Graz, Österreich
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Holl AK, Wilkinson L, Tabrizi SJ, Painold A, Jahanshahi M. Selective executive dysfunction but intact risky decision-making in early Huntington's disease. Mov Disord 2013; 28:1104-9. [PMID: 23436289 DOI: 10.1002/mds.25388] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Revised: 12/18/2012] [Accepted: 01/10/2013] [Indexed: 11/06/2022] Open
Abstract
Executive dysfunction, including problems with decision-making, inhibition of prepotent responses, and verbal fluency, are main features of Huntington's disease (HD). The decline of executive function in HD is related to the anatomical progression of HD pathology in the basal ganglia, where the earliest changes of neuronal cell death are seen in the dorsolateral caudate. To examine the specific pattern of executive dysfunction in early HD, 18 patients with early HD were assessed on: (1) the Iowa Gambling Task to measure risky decision making, (2) the Stroop test to measure inhibition of prepotent responses, and (3) the verbal fluency test to measure internally guided word search and production, necessitating suppression of retrieval/production of inappropriate words and monitoring of the output. Patients with early HD were significantly impaired on the Stroop and verbal fluency tests relative to controls. However, Iowa Gambling Task performance was comparable across the 2 groups. This pattern of selective executive dysfunction in early HD probably reflects the fact that inhibitory processing involved in both the Stroop and verbal fluency tests recruits the dorsolateral caudate and its cortical connections, which are dysfunctional in early HD, whereas risky decision-making during the Iowa Gambling Task recruits the ventromedial caudate and its connections, which remain spared early on in the disease. The current results demonstrate that the deterioration of executive functioning in HD is variable and that some types of executive processing might already be impaired in early HD, whereas others remain intact.
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Affiliation(s)
- Anna K Holl
- Sobell Department of Motor Neuroscience and Movement Disorders, University College London, Institute of Neurology, London, United Kingdom
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Letmaier M, Painold A, Holl AK, Grohmann R, Vergin H. Severe psychotic exacerbation during combined treatment with aripiprazole/haloperidol after prior treatment with risperidone. Int J Psychiatry Clin Pract 2012; 16:153-6. [PMID: 22211772 DOI: 10.3109/13651501.2011.644300] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Aripiprazole is a new generation antipsychotic drug that shows a partial agonistic activity at D(2) and 5-HT(1A) receptors. This might lead in some cases to an exacerbation of psychotic symptoms due to dopamine agonism. METHODS We report the case of a 39-year-old woman with an ICD-10 defined schizoaffective disorder. RESULTS Risperidone was started to treat psychotic symptoms. Psychotic symptoms disappeared but because of galactorrhoea risperidone needed to be discontinued. Subsequently, an antipsychotic treatment regimen with aripiprazole and haloperidol was prescribed. After initiating aripiprazole and haloperidol the patient's psychotic symptoms increased drastically. Therefore aripiprazole and haloperidol were discontinued. Olanzapine was prescribed and psychotic symptoms declined again. CONCLUSION Concurrent causes for this serious adverse event may be the partial agonistic activity of aripiprazole at D(2) receptors as well as an up-regulation of dopamine receptors during prior treatment with risperidone. Both aspects may have contributed to the severe psychotic exacerbation. Clinicians should be aware of this possible, serious adverse event while switching to aripiprazole or prescribing aripiprazole with other antipsychotics. Because of their lower D(2) receptor affinity quetiapine and clozapine might be a better choice for combined treatment with aripiprazole.
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Affiliation(s)
- Martin Letmaier
- Medical University of Graz, Department of Psychiatry, Graz, Austria.
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Painold A, Milz P, Faber P, Anderer P, Kapfhammer HP, Kochi K, Lehmann D. P-793 - Reduced intracortical functional connectivity in huntington's disease. Eur Psychiatry 2012. [DOI: 10.1016/s0924-9338(12)74960-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Letmaier M, Painold A, Holl AK, Grohmann R, Vergin H. Severe psychotic exacerbation during combined treatment with aripiprazole/haloperidol after prior treatment with risperidone. Pharmacopsychiatry 2011. [DOI: 10.1055/s-0031-1292514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Painold A, Holl AK, Letmaier M, Kapfhammer HP. Pharmacological treatment of psychosis in multiple sclerosis. Pharmacopsychiatry 2011. [DOI: 10.1055/s-0031-1292526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Holl AK, Ille R, Wilkinson L, Otti DV, Hödl E, Herranhof B, Reisinger KM, Müller N, Painold A, Holl EM, Letmaier M, Bonelli RM. Impaired Ideomotor Limb Apraxia in Cortical and Subcortical Dementia: A Comparison of Alzheimer’s and Huntington’s Disease. NEURODEGENER DIS 2011; 8:208-15. [DOI: 10.1159/000322230] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2010] [Accepted: 10/18/2010] [Indexed: 11/19/2022] Open
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Painold A, Anderer P, Holl AK, Letmaier M, Saletu-Zyhlarz GM, Saletu B, Bonelli RM. EEG low-resolution brain electromagnetic tomography (LORETA) in Huntington’s disease. J Neurol 2010; 258:840-54. [DOI: 10.1007/s00415-010-5852-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2010] [Revised: 11/21/2010] [Accepted: 11/25/2010] [Indexed: 01/18/2023]
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