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Colla M, Offenhammer B, Scheerer H, Kronenberg G, Vetter S, Mutschler J, Mikoteit T, Bankwitz A, Adank A, Schaekel L, Eicher C, Brühl AB, Seifritz E. Oral prolonged-release ketamine in treatment-resistant depression - A double-blind randomized placebo-controlled multicentre trial of KET01, a novel ketamine formulation - Clinical and safety results. J Psychiatr Res 2024; 173:124-130. [PMID: 38522166 DOI: 10.1016/j.jpsychires.2024.03.002] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 02/26/2024] [Accepted: 03/03/2024] [Indexed: 03/26/2024]
Abstract
INTRODUCTION We investigated the antidepressant effects of a novel oral prolonged-release formulation of racemic ketamine (KET01) in patients suffering from treatment-resistant depression (TRD) as add-on therapy. MATERIAL AND METHODS Patients were randomized to an additional 160 mg/day or 240 mg/day KET01 or placebo for 14 days. The primary endpoint was change in Montgomery-Åsberg Depression Rating Scale (MADRS) scores from baseline to day 15. For treatment group comparisons, we used ANOVA with pairwise least squares mean difference tests in a mixed model repeated measures analysis. RESULTS Twenty-seven patients completed the double-blind protocol before trial premature termination due to poor recruitment during the COVID-19 pandemic. Mean (SD) MADRS scores on day 15 were 23 (10.32) in placebo, 25 (8.28) with 160 mg/day and 17 (10.32) with 240 mg/day KET01. MADRS change was numerically larger but statistically non-significant in the 240 mg/day KET01 group vs placebo on day 7 (-5.67; p = 00.106) and day 15 was (difference: 4.99; p = 00.15). In exploratory analysis, baseline leukocyte count correlated with response to KET01 (p = 00.01). Distribution of adverse event rates were comparable between the treatment arms. Safety analysis did not identify increased risk of suicidality, dissociation, hear rate, systolic and diastolic blood pressure associated with trial treatment. DISCUSSION Our results suggest that adjunctive oral administration of prolonged-release ketamine at a dose of 240 mg/day shows a positive, although statistically non-significant, trend towards antidepressant efficacy, however, the benefit could not be confirmed due to premature trial termination. Given its ease of use and low side effects, further trials are warranted to investigate this route of ketamine administration as a promising potential treatment of TRD.
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Affiliation(s)
- M Colla
- Department of Adult Psychiatry and Psychotherapy, Psychiatric University Clinic Zurich and University of Zurich, Switzerland.
| | - B Offenhammer
- Department of Adult Psychiatry and Psychotherapy, Psychiatric University Clinic Zurich and University of Zurich, Switzerland
| | - H Scheerer
- Department of Adult Psychiatry and Psychotherapy, Psychiatric University Clinic Zurich and University of Zurich, Switzerland
| | - G Kronenberg
- Department of Adult Psychiatry and Psychotherapy, Psychiatric University Clinic Zurich and University of Zurich, Switzerland
| | - S Vetter
- Department of Adult Psychiatry and Psychotherapy, Psychiatric University Clinic Zurich and University of Zurich, Switzerland
| | - J Mutschler
- Psychiatric Hospital Meiringen, Meiringen, Switzerland; Psychiatric Services Lucerne, Lucerne, Switzerland
| | - T Mikoteit
- Psychiatric Services Solothurn and University of Basel, Solothurn, Switzerland
| | - A Bankwitz
- Department of Adult Psychiatry and Psychotherapy, Psychiatric University Clinic Zurich and University of Zurich, Switzerland
| | - A Adank
- Department of Adult Psychiatry and Psychotherapy, Psychiatric University Clinic Zurich and University of Zurich, Switzerland
| | - L Schaekel
- Department of Adult Psychiatry and Psychotherapy, Psychiatric University Clinic Zurich and University of Zurich, Switzerland
| | - C Eicher
- Department of Adult Psychiatry and Psychotherapy, Psychiatric University Clinic Zurich and University of Zurich, Switzerland
| | - A B Brühl
- Department of Adult Psychiatry and Psychotherapy, Psychiatric University Clinic Zurich and University of Zurich, Switzerland; University Psychiatric Clinics, University of Basel, Basel, Switzerland
| | - E Seifritz
- Department of Adult Psychiatry and Psychotherapy, Psychiatric University Clinic Zurich and University of Zurich, Switzerland
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Zakiei A, Sadeghi-Bahmani D, Khazaie H, Lorestani Z, Sadeghi M, Korani D, Sahraei Z, Komasi S, Stanga Z, Brühl AB, Brand S. Associations between Sleep Disturbances, Personality Traits and Self-Regulation in a Sample of Healthy Adults. J Clin Med 2024; 13:2143. [PMID: 38610908 PMCID: PMC11012523 DOI: 10.3390/jcm13072143] [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: 01/04/2024] [Revised: 03/18/2024] [Accepted: 04/03/2024] [Indexed: 04/14/2024] Open
Abstract
Background: Scientific evidence and everyday experience show that sleep disturbances and self-regulation as a proxy of stress reactivity are linked. Particular personality traits such as neuroticism, internalizing and externalizing problems are also associated with sleep disturbances. Here, we combined self-regulation and personality traits and associated these variables with subjective sleep disturbances. Methods: A total of 846 adults (mean age: 33.7 years; 78.7% females) completed questionnaires covering sleep disturbances, self-regulation and personality traits. Results: Higher scores for sleep disturbances were associated with higher scores for externalization, internalization, and instability and with lower scores for stability (all trait variables) and with poorer self-regulation (state variable). The regression model showed that higher scores for externalization and internalization (traits), and lower scores for self-regulation (state) predicted higher scores for sleep disturbance. Next, self-regulation had both a direct effect on sleep disturbance, and an indirect effect via personality traits. Conclusions: Sleep disturbances were related to both state (i.e., self-regulation) and trait (e.g., internalization and instability) dimensions. The current data analysis leapfrogs the state-trait dichotomy discussion and reconciles the state-and-trait approach in the prediction of poor sleep, though self-regulation appeared to have both direct and indirect effects on sleep disturbances.
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Affiliation(s)
- Ali Zakiei
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah 6719851115, Iran; (A.Z.); (H.K.); (S.K.)
| | - Dena Sadeghi-Bahmani
- Department of Psychology, Stanford University, Stanford, CA 94305, USA;
- Department of Epidemiology and Population Health, Stanford University, Stanford, CA 94305, USA
| | - Habibolah Khazaie
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah 6719851115, Iran; (A.Z.); (H.K.); (S.K.)
| | - Zeinab Lorestani
- Department of Clinical Psychology, Islamic Azad University of Kermanshah, Kermanshah 6719851115, Iran; (Z.L.); (M.S.); (D.K.); (Z.S.)
| | - Mohammad Sadeghi
- Department of Clinical Psychology, Islamic Azad University of Kermanshah, Kermanshah 6719851115, Iran; (Z.L.); (M.S.); (D.K.); (Z.S.)
| | - Dariuosh Korani
- Department of Clinical Psychology, Islamic Azad University of Kermanshah, Kermanshah 6719851115, Iran; (Z.L.); (M.S.); (D.K.); (Z.S.)
| | - Zeinab Sahraei
- Department of Clinical Psychology, Islamic Azad University of Kermanshah, Kermanshah 6719851115, Iran; (Z.L.); (M.S.); (D.K.); (Z.S.)
| | - Saeid Komasi
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah 6719851115, Iran; (A.Z.); (H.K.); (S.K.)
| | - Zeno Stanga
- Division of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, University Hospital, University of Berne, 3010 Berne, Switzerland;
- Centre of Competence for Military and Disaster Medicine, Swiss Armed Forces, 3008 Berne, Switzerland
| | - Annette B. Brühl
- Center for Affective, Stress and Sleep Disorders, Psychiatric Hospital of the University of Basel, 4002 Basel, Switzerland;
| | - Serge Brand
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah 6719851115, Iran; (A.Z.); (H.K.); (S.K.)
- Center for Affective, Stress and Sleep Disorders, Psychiatric Hospital of the University of Basel, 4002 Basel, Switzerland;
- Division of Sport Science and Psychosocial Health, Department of Sport, Exercise, and Health, Department of Medicine, University of Basel, 4052 Basel, Switzerland
- School of Medicine, Tehran University of Medical Sciences, Tehran 1417466191, Iran
- Substance Abuse Prevention Research Center, Kermanshah University of Medical Sciences, Kermanshah 6719851115, Iran
- Center for Disaster Psychiatry and Disaster Psychology, Centre of Competence for Military and Disaster Medicine, Swiss Armed Forces, 4002 Basel, Switzerland
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Hashemian SS, Golshani S, Firoozabadi K, Firoozabadi A, Fichter C, Dürsteler KM, Brühl AB, Khazaie H, Brand S. 2D:4D-ratios among individuals with amphetamine use disorder, antisocial personality disorder and with both amphetamine use disorder and antisocial personality disorder. J Psychiatr Res 2024; 170:81-89. [PMID: 38113678 DOI: 10.1016/j.jpsychires.2023.12.004] [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: 10/11/2023] [Revised: 12/01/2023] [Accepted: 12/06/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND There is sufficient evidence that the index-finger-to-ring-finger-ratio (2D:4D-ratio) is associated with testosterone and estrogen exposure during the fetal stage. More specifically, a lower 2D:4D-ratio (that is; a shorter index finger, compared to a longer ring finger) was associated with a prenatally higher testosterone and lower estrogen exposure during the first trimester of the fetal stage. At a behavioral level, among adults, a lower 2D:4D-ratio was associated with a higher competitive performance among both female and male professional athletes, and with personality traits such as higher scores for mental toughness, dark triad traits, and aggressive behavior, and internet use disorder. Here, we tested, if 2D:4D-ratios differed among three clinical samples of individuals with amphetamine use disorder (AUD), antisocial personality disorder (ASPD), or both AUD and ASPD (AUD + ASPD), and when compared to healthy controls. METHOD The sample consisted of 44 individuals (mean age: 32.95 years; 22.7% females) diagnosed either with AUD (n = 25), ASPD (n = 10) or both AUD + ASPD (n = 9), and of 36 healthy controls (mean age: 23.28; 25% females). After a thorough clinical assessment, participants provided the scans of their right-hand palm to measure the lengths of their index finger and ring finger. Further, participants with AUD, ASPD and both AUD + ASPD completed a series of self-rating questionnaires on Dark Triad traits, narcissism sensitivity, and intolerance of uncertainty. RESULTS Compared to healthy controls, participants with AUD, ASPD, or AUD + ASPD showed statistically significantly lower 2D:4D-ratios. Participants with AUD + ASPD showed statistically significantly lowest 2D:4D-ratios, compared to participants with AUD and compared to healthy controls. For the clinical sample, a lower 2D:4D-ratio was associated with higher Dark Triad traits. 2D:4D-ratios were unrelated to narcissism sensitivity or intolerance of uncertainty. Higher scores for Dark Triad traits were associated with higher scores for narcissism sensitivity and intolerance of uncertainty. CONCLUSIONS Compared to healthy controls, individuals with amphetamine use disorder and concomitant antisocial personality disorder (AUD + ASPD) appeared to have been exposed to particularly high prenatal testosterone and particularly low estrogen concentrations, which, at a behavioral level, might have led to a fast life history for immediate resource acquisition.
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Affiliation(s)
- Seyed Sepehr Hashemian
- Centre de Recherche Charles-Le Moyne, Longueuil, Québec, Canada; Faculty of Medicine and Health Sciences, Université de Sherbrooke, Longueuil, Québec, Canada
| | | | - Kimia Firoozabadi
- Faculty of Medical Sciences, UCL Medical School, University College London, London, WC1E 6BT, UK
| | - Ali Firoozabadi
- Research Center for Psychiatry and Behavioral Sciences, Department of Psychiatry, Hafez Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Christian Fichter
- Department of Psychology, Kalaidos Private University of Applied Sciences, Zurich, Switzerland
| | - Kenneth M Dürsteler
- Psychiatric Clinics, Division of Substance Use Disorders, University of Basel, 4002, Basel, Switzerland; Center for Addictive Disorders, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, 8001, Zurich, Switzerland
| | - Annette B Brühl
- Center for Affective, Stress and Sleep Disorders (ZASS), Psychiatric University Hospital Basel, 4002, Basel, Switzerland
| | - Habibolah Khazaie
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Serge Brand
- Kermanshah University of Medical Sciences, Kermanshah, Iran; Center for Affective, Stress and Sleep Disorders (ZASS), Psychiatric University Hospital Basel, 4002, Basel, Switzerland; Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran; Department of Sport, Exercise and Health, Division of Sport Science and Psychosocial Health, University of Basel, Basel, Switzerland; School of Medicine, Tehran University of Medical Sciences, Tehran, Iran; Center for Disaster Psychiatry and Disaster Psychology, Psychiatric University Hospital Basel, Basel, Switzerland; Center of Competence for Military and Disaster Medicine of the Swiss Armed Forces, Switzerland.
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Hauser J, Sarlon J, Liwinski T, Brühl AB, Lang UE. Listening to music during intranasal (es)ketamine therapy in patients with treatment-resistant depression correlates with better tolerability and reduced anxiety. Front Psychiatry 2024; 15:1327598. [PMID: 38322143 PMCID: PMC10844460 DOI: 10.3389/fpsyt.2024.1327598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 01/04/2024] [Indexed: 02/08/2024] Open
Abstract
Background Although the effectiveness of (es)ketamine for therapy-resistant depression (TRD) has been established, potential treatment-limiting factors include side effects like dissociation, anxiety, or elevated blood pressure. Music can reduce stress and negative emotions as anxiety. This study aimed to investigate the impact of listening to music during intranasal (es)ketamine administration on both tolerability and efficacy. Methods Records of 494 sessions (of 37 patients) with intranasal (es)ketamine administration, each containing data of blood pressure measurements, DSS-IV (dissociation symptoms scale-IV), anxiety and euphoria analogue scale, MADRS (Montgomery-Åsberg Depression Rating Scale) and BDI (Beck's Depression Inventory) were evaluated. Results The between-group analysis, comparing participants who listened to music with those who did not, revealed significant differences in the administered dose (p-value: 0.003, mean: 131.5 mg with music vs. 116.7 mg without music), scores on the DSS Item 1 (p-value: 0.005, mean: 3 points vs. 2.4 points), levels of anxiety (p-value: <0.001, mean: 0.4 points vs. 1.4 points), and measurements of maximal systolic blood pressure after administration (p-value: 0.017, mean: 137.9 mmHg vs. 140.3 mmHg). Listening to music had no impact on the MARDS-change score between the sessions. Limitations Key limitations include a non-randomized naturalistic design and the non-standardized selection of music, which was based on individual patient preferences. Conclusion Listening to music during intranasal (es)ketamine therapy appears to be linked to reduced anxiety and lower blood pressure, stable or increased dissociation levels, and improved tolerance for higher doses. These findings could potentially contribute to the optimization of (es)ketamine therapy, both in terms of treatment efficacy and managing side effects.
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Affiliation(s)
- Johannes Hauser
- University of Basel, Basel, Switzerland
- University Psychiatric Clinics (UPK), Basel, Switzerland
| | - Jan Sarlon
- University of Basel, Basel, Switzerland
- University Psychiatric Clinics (UPK), Basel, Switzerland
| | - Timur Liwinski
- University of Basel, Basel, Switzerland
- University Psychiatric Clinics (UPK), Basel, Switzerland
| | - Annette B. Brühl
- University of Basel, Basel, Switzerland
- University Psychiatric Clinics (UPK), Basel, Switzerland
| | - Undine E. Lang
- University of Basel, Basel, Switzerland
- University Psychiatric Clinics (UPK), Basel, Switzerland
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Ersche KD, Stochl J, Brühl AB, Gurnell M. Evidence of Hypothalamic-Pituitary-Adrenal and -Gonadal Dysfunction in Cocaine-Addicted Men. Eur Addict Res 2024; 30:114-120. [PMID: 38219711 DOI: 10.1159/000535584] [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: 04/03/2023] [Accepted: 11/28/2023] [Indexed: 01/16/2024]
Abstract
INTRODUCTION Regular cocaine use has been associated with hormonal dysfunction including hypogonadism, which can lead to fatigue, reduced stamina, sexual dysfunction, and impaired quality of life. However, cocaine's endocrine effects are largely under-reported in the scientific addiction literature and, in many cases, are not addressed within treatment services. The low profile of these adverse effects might be attributable to a lack of awareness and linkage with cocaine use, such that they are recognized only when an acute/emergency problem arises. METHODS We assessed endocrine diurnal function (adrenocorticotrophic hormone [ACTH], cortisol, and testosterone) in 26 healthy and 27 cocaine-dependent men and examined changes in hormone levels in response to a single 40 mg dose of the noradrenaline re-uptake inhibitor atomoxetine in a double-blind, placebo-controlled experimental medicine study. RESULTS When compared with healthy controls, diurnal and atomoxetine-induced changes in ACTH and cortisol showed greater variability in cocaine-dependent men. Interestingly, despite an exaggerated rise in ACTH following atomoxetine, an attenuated cortisol response was observed, and one-third of cocaine-dependent men had subnormal testosterone levels. CONCLUSION Our findings point to a potential disconnection between the pituitary and adrenal responses in cocaine-dependent men, a higher rate of hypogonadism, and a pressing need for more research into the endocrine effects of cocaine and their clinical implications.
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Affiliation(s)
- Karen D Ersche
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Department of Addictive Behaviour and Addiction Medicine, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jan Stochl
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Department of Kinanthropology, Charles University, Prague, Czechia
| | - Annette B Brühl
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Department of Psychiatry, University Hospital of Psychiatry, University of Basel, Basel, Switzerland
| | - Mark Gurnell
- Metabolic Research Laboratories, Wellcome-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK
- NIHR Cambridge Biomedical Research Centre, Cambridge University Hospitals, Cambridge, UK
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Liwinski T, Lang UE, Brühl AB, Schneider E. Exploring the Therapeutic Potential of Gamma-Aminobutyric Acid in Stress and Depressive Disorders through the Gut-Brain Axis. Biomedicines 2023; 11:3128. [PMID: 38137351 PMCID: PMC10741010 DOI: 10.3390/biomedicines11123128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 11/16/2023] [Accepted: 11/21/2023] [Indexed: 12/24/2023] Open
Abstract
Research conducted on individuals with depression reveals that major depressive disorders (MDDs) coincide with diminished levels of the inhibitory neurotransmitter γ-aminobutyric acid (GABA) in the brain, as well as modifications in the subunit composition of the primary receptors (GABAA receptors) responsible for mediating GABAergic inhibition. Furthermore, there is substantial evidence supporting the significant role of GABA in regulating stress within the brain, which is a pivotal vulnerability factor in mood disorders. GABA is readily available and approved as a food supplement in many countries. Although there is substantial evidence indicating that orally ingested GABA may affect GABA receptors in peripheral tissues, there is comparatively less evidence supporting its direct action within the brain. Emerging evidence highlights that oral GABA intake may exert beneficial effects on the brain and psyche through the gut-brain axis. While GABA enjoys wide consumer acceptance in Eastern Asian markets, with many consumers reporting favorable effects on stress regulation, mood, and sleep, rigorous independent research is still largely lacking. Basic research, coupled with initial clinical findings, makes GABA an intriguing neuro-nutritional compound deserving of clinical studies in individuals with depression and other psychological problems.
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Affiliation(s)
| | | | | | - Else Schneider
- University Psychiatric Clinics Basel, Clinic for Adults, University of Basel, CH-4002 Basel, Switzerland; (T.L.); (U.E.L.); (A.B.B.)
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Sarlon J, Brühl AB, Lang UE, Kordon A. Electrophysiological correlates of mindfulness in patients with major depressive disorder. Front Neurosci 2022; 16:971958. [PMID: 36312017 PMCID: PMC9606782 DOI: 10.3389/fnins.2022.971958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 09/21/2022] [Indexed: 11/22/2022] Open
Abstract
Objectives Mindfulness-based interventions (MBI) can reduce both stress and depressive symptoms. However, the impact of mindfulness on stress level in depressed subjects remains unclear. This study aims to assess electrophysiological correlates of mindfulness in patients with major depressive disorder (MDD) at baseline, under stress exposure, and in relaxation following stress exposure. Methods Perceived mindfulness was assessed with the Freiburger Mindfulness Inventory (FMI) in 89 inpatients (mean age 51) with MDD [mean Beck Depression Inventory (BDI) 30]. Electrophysiological parameters [resting heart rate (RHR), heart rate variability (HRV), respiration rate, skin conductance, and skin temperature] were recorded at 5-min baseline, 1-min stress exposure, and 5-min self-induced relaxation. Results Freiburger Mindfulness Inventory was strongly inversely correlated with symptom severity measured by BDI (r = –0.53, p < 0.001). No correlations between FM score and electrophysiological parameters in any of the three conditions (baseline, stress exposure, relaxed state) could be found. The factor openness was associated with higher VLF (very low frequency of HRV) in the baseline condition. However, this correlation was no more significant after regression analysis when corrected for respiratory rate, age, and sex. Conclusion Autonomous nervous reactivity in depression was not associated with perceived mindfulness as measured by FMI score and presented electrophysiological parameters, despite the strong inverse correlation between state mindfulness and symptom severity.
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Affiliation(s)
- Jan Sarlon
- Department of Adult Psychiatry, University of Basel, University Psychiatric Clinics (UPK), Basel, Switzerland
- Oberbergklinik Hornberg, Hornberg, Germany
- *Correspondence: Jan Sarlon,
| | - Annette B. Brühl
- Department of Adult Psychiatry, University of Basel, University Psychiatric Clinics (UPK), Basel, Switzerland
| | - Undine E. Lang
- Department of Adult Psychiatry, University of Basel, University Psychiatric Clinics (UPK), Basel, Switzerland
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Schneider E, Liwinski T, Imfeld L, Lang UE, Brühl AB. Who is afraid of Christmas? The effect of Christmas and Easter holidays on psychiatric hospitalizations and emergencies-Systematic review and single center experience from 2012 to 2021. Front Psychiatry 2022; 13:1049935. [PMID: 36713912 PMCID: PMC9874097 DOI: 10.3389/fpsyt.2022.1049935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 12/21/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Major holidays such as Christmas and New Year's Eve are regular occasions for get-togethers in families and other social groups. Socially, these days are often loaded with memories and expectations but also involve the potential for interpersonal tension and conflicts and disappointments. In addition, loneliness might also be most intense during these days. All these factors might lead to the expectation of increased mental distress and subsequently increased help-seeking in psychiatric contexts resulting in emergency psychiatric contacts, psychiatric hospitalizations, and even suicidal behavior. But is there evidence for increased psychiatric emergencies and hospitalizations around the days of Christmas? METHODS The existing evidence is systematically reviewed here (studies in PubMed in English investigating annual and Christmas-related variations in suicide (attempts), psychiatric emergencies and hospitalizations, last search date (13.07.2022) and complemented by an analysis of acute admissions at the University Psychiatry Clinics Basel, Switzerland, around Christmas and Easter holidays compared to the other days of the year. Easter was chosen as a comparison holiday. RESULTS In 25 reviewed studies, Christmas holidays were not associated with increased utilization of emergency psychiatric services. In contrast, hospitalizations were lower on Christmas and other holidays than the rest of the year. Analyzing the annual variation of 26,088 hospitalizations in our center between 2012 and 2021 revealed the same pattern. CONCLUSION The assumption of increased utilization of psychiatric emergency services on Christmas and other major holidays is not confirmed by multiple studies around the globe in various socio-cultural and medical settings. The study is registered in the international prospective register for systematic reviews (PROSPERO; 351057). SYSTEMATIC REVIEW REGISTRATION https://www.crd.york.ac.uk/prospero/, identifier 351057.
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Affiliation(s)
- Else Schneider
- University Psychiatric Clinics Basel, Clinic for Adults, University of Basel, Basel, Switzerland
| | - Timur Liwinski
- University Psychiatric Clinics Basel, Clinic for Adults, University of Basel, Basel, Switzerland
| | - Lukas Imfeld
- University Psychiatric Clinics Basel, Clinic for Adults, University of Basel, Basel, Switzerland
| | - Undine E Lang
- University Psychiatric Clinics Basel, Clinic for Adults, University of Basel, Basel, Switzerland
| | - Annette B Brühl
- University Psychiatric Clinics Basel, Clinic for Adults, University of Basel, Basel, Switzerland
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Haugg A, Manoliu A, Sladky R, Hulka LM, Kirschner M, Brühl AB, Seifritz E, Quednow BB, Herdener M, Scharnowski F. Disentangling craving- and valence-related brain responses to smoking cues in individuals with nicotine use disorder. Addict Biol 2022; 27:e13083. [PMID: 34363643 PMCID: PMC9285426 DOI: 10.1111/adb.13083] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 03/17/2021] [Accepted: 07/21/2021] [Indexed: 11/30/2022]
Abstract
Tobacco smoking is one of the leading causes of preventable death and disease worldwide. Most smokers want to quit, but relapse rates are high. To improve current smoking cessation treatments, a better understanding of the underlying mechanisms of nicotine dependence and related craving behaviour is needed. Studies on cue‐driven cigarette craving have been a particularly useful tool for investigating the neural mechanisms of drug craving. Here, functional neuroimaging studies in humans have identified a core network of craving‐related brain responses to smoking cues that comprises of amygdala, anterior cingulate cortex, orbitofrontal cortex, posterior cingulate cortex and ventral striatum. However, most functional Magnetic Resonance Imaging (fMRI) cue‐reactivity studies do not adjust their stimuli for emotional valence, a factor assumed to confound craving‐related brain responses to smoking cues. Here, we investigated the influence of emotional valence on key addiction brain areas by disentangling craving‐ and valence‐related brain responses with parametric modulators in 32 smokers. For one of the suggested key regions for addiction, the amygdala, we observed significantly stronger brain responses to the valence aspect of the presented images than to the craving aspect. Our results emphasize the need for carefully selecting stimulus material for cue‐reactivity paradigms, in particular with respect to emotional valence. Further, they can help designing future research on teasing apart the diverse psychological dimensions that comprise nicotine dependence and, therefore, can lead to a more precise mapping of craving‐associated brain areas, an important step towards more tailored smoking cessation treatments.
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Affiliation(s)
- Amelie Haugg
- Psychiatric University Hospital Zurich Zurich Switzerland
- Faculty of Psychology University of Vienna Vienna Austria
| | - Andrei Manoliu
- Psychiatric University Hospital Zurich Zurich Switzerland
- McLean Hospital Belmont Massachusetts USA
- Harvard Medical School Harvard University Boston Massachusetts USA
| | - Ronald Sladky
- Faculty of Psychology University of Vienna Vienna Austria
| | - Lea M. Hulka
- Psychiatric University Hospital Zurich Zurich Switzerland
| | - Matthias Kirschner
- Psychiatric University Hospital Zurich Zurich Switzerland
- Montreal Neurological Institute McGill University Montreal Canada
| | | | - Erich Seifritz
- Psychiatric University Hospital Zurich Zurich Switzerland
| | | | | | - Frank Scharnowski
- Psychiatric University Hospital Zurich Zurich Switzerland
- Faculty of Psychology University of Vienna Vienna Austria
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Roth CB, Papassotiropoulos A, Brühl AB, Lang UE, Huber CG. Psychiatry in the Digital Age: A Blessing or a Curse? Int J Environ Res Public Health 2021; 18:8302. [PMID: 34444055 PMCID: PMC8391902 DOI: 10.3390/ijerph18168302] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 07/31/2021] [Accepted: 08/03/2021] [Indexed: 12/23/2022]
Abstract
Social distancing and the shortage of healthcare professionals during the COVID-19 pandemic, the impact of population aging on the healthcare system, as well as the rapid pace of digital innovation are catalyzing the development and implementation of new technologies and digital services in psychiatry. Is this transformation a blessing or a curse for psychiatry? To answer this question, we conducted a literature review covering a broad range of new technologies and eHealth services, including telepsychiatry; computer-, internet-, and app-based cognitive behavioral therapy; virtual reality; digital applied games; a digital medicine system; omics; neuroimaging; machine learning; precision psychiatry; clinical decision support; electronic health records; physician charting; digital language translators; and online mental health resources for patients. We found that eHealth services provide effective, scalable, and cost-efficient options for the treatment of people with limited or no access to mental health care. This review highlights innovative technologies spearheading the way to more effective and safer treatments. We identified artificially intelligent tools that relieve physicians from routine tasks, allowing them to focus on collaborative doctor-patient relationships. The transformation of traditional clinics into digital ones is outlined, and the challenges associated with the successful deployment of digitalization in psychiatry are highlighted.
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Affiliation(s)
- Carl B. Roth
- University Psychiatric Clinics Basel, Clinic for Adults, University of Basel, Wilhelm Klein-Strasse 27, CH-4002 Basel, Switzerland; (A.P.); (A.B.B.); (U.E.L.); (C.G.H.)
| | - Andreas Papassotiropoulos
- University Psychiatric Clinics Basel, Clinic for Adults, University of Basel, Wilhelm Klein-Strasse 27, CH-4002 Basel, Switzerland; (A.P.); (A.B.B.); (U.E.L.); (C.G.H.)
- Transfaculty Research Platform Molecular and Cognitive Neurosciences, University of Basel, Birmannsgasse 8, CH-4055 Basel, Switzerland
- Division of Molecular Neuroscience, Department of Psychology, University of Basel, Birmannsgasse 8, CH-4055 Basel, Switzerland
- Biozentrum, Life Sciences Training Facility, University of Basel, Klingelbergstrasse 50/70, CH-4056 Basel, Switzerland
| | - Annette B. Brühl
- University Psychiatric Clinics Basel, Clinic for Adults, University of Basel, Wilhelm Klein-Strasse 27, CH-4002 Basel, Switzerland; (A.P.); (A.B.B.); (U.E.L.); (C.G.H.)
| | - Undine E. Lang
- University Psychiatric Clinics Basel, Clinic for Adults, University of Basel, Wilhelm Klein-Strasse 27, CH-4002 Basel, Switzerland; (A.P.); (A.B.B.); (U.E.L.); (C.G.H.)
| | - Christian G. Huber
- University Psychiatric Clinics Basel, Clinic for Adults, University of Basel, Wilhelm Klein-Strasse 27, CH-4002 Basel, Switzerland; (A.P.); (A.B.B.); (U.E.L.); (C.G.H.)
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11
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Savulich G, Bowden-Jones O, Stephenson R, Brühl AB, Ersche KD, Robbins TW, Sahakian BJ. "Hot" and "Cold" Cognition in Users of Club Drugs/Novel Psychoactive Substances. Front Psychiatry 2021; 12:660575. [PMID: 33841219 PMCID: PMC8024487 DOI: 10.3389/fpsyt.2021.660575] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 02/25/2021] [Indexed: 11/13/2022] Open
Abstract
Novel psychoactive substances (NPS) are popular "club/party" drugs that first attracted attention in the UK in 2009 and remained legal until the 2016 Psychoactive Substances Act criminalized their distribution. Unlike "traditional" illicit drugs, very little is known about the influence of their analogs on neuropsychological functioning. We characterized the cognitive and emotional profile of NPS/polydrug users using the Cambridge Neuropsychological Test Automated Battery (CANTAB) and EMOTICOM test battery in adult male (aged 20-49 years) recreational users without psychiatric comorbidities (n = 27; "psychonauts"), service users attending a UK specialist "Club Drug" Clinic for problematic use (n = 20) and healthy control volunteers without significant drug-taking histories (n = 35). Tasks were selected to distinguish "hot" cognitive processes that are highly influenced by emotion from "cold" cognitive processes that are largely independent of emotional influence. Both user groups reported significantly higher sensation-seeking traits compared with non-users. Recreational NPS users demonstrated more risk-taking behavior compared with controls and treatment-seeking NPS users showed poorer learning, episodic memory and response inhibition compared with the other two groups. These effects persisted, when controlling for age, intelligence, alcohol and cannabis use severity, nicotine dependence, trait anxiety, depression, childhood adversity, impulsivity, and sensation seeking. Overall, recreational NPS users showed elevated "hot" (emotion-laden) cognition in the absence of "cold" (non-emotional) cognitive deficits, whereas "cold" cognitive dysfunction was pronounced in individuals seeking treatment for problematic NPS use. High trait impulsivity and poor self-control may confer additional risk to NPS/polydrug use severity and separate those seeking treatment from those using NPS recreationally.
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Affiliation(s)
- George Savulich
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom.,Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, United Kingdom
| | - Owen Bowden-Jones
- Club Drug Clinic, Central and North West London National Health Service (NHS) Foundation Trust, London, United Kingdom.,University College London, London, United Kingdom
| | | | - Annette B Brühl
- University Hospital of Psychiatry, University of Basel, Basel, Switzerland
| | - Karen D Ersche
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom.,Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, United Kingdom
| | - Trevor W Robbins
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, United Kingdom.,Department of Psychology, University of Cambridge, Cambridge, United Kingdom
| | - Barbara J Sahakian
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom.,Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, United Kingdom
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12
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Manoliu A, Haugg A, Sladky R, Hulka L, Kirschner M, Brühl AB, Seifritz E, Quednow B, Herdener M, Scharnowski F. SmoCuDa: A Validated Smoking Cue Database to Reliably Induce Craving in Tobacco Use Disorder. Eur Addict Res 2021; 27:107-114. [PMID: 32854096 DOI: 10.1159/000509758] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Accepted: 05/04/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Cue-reactivity paradigms provide valuable insights into the underlying mechanisms of nicotine craving in nicotine-dependent subjects. In order to study cue-driven nicotine craving, robust and validated stimulus datasets are essential. OBJECTIVES The aim of this study was to generate and validate a large set of individually rated smoking-related cues that allow for assessment of different stimulus intensities along the dimensions craving, valence, and arousal. METHODS The image database consisted of 330 visual cues. Two hundred fifty smoking-associated pictures (Creative Commons license) were chosen from online databases and showed a widespread variety of smoking-associated content. Eighty pictures from previously published databases were included for cross-validation. Forty volunteers with tobacco use disorder rated "urge-to-smoke," "valence," and "arousal" for all images on a 100-point visual analogue scale. Pictures were also labelled according to 18 categories such as lit/unlit cigarettes in mouth, cigarette end, and cigarette in ashtray. RESULTS Ratings (mean ± SD) were as follows: urge to smoke, 44.9 ± 13.2; valence, 51.2 ± 7.6; and arousal, 54.6 ± 7.1. All ratings, particularly "urge to smoke," were widely distributed along the whole scale spectrum. CONCLUSIONS We present a novel image library of well-described smoking-related cues, which were rated on a continuous scale along the dimensions craving, valence, and arousal that accounts for inter-individual differences. The rating software, image database, and their ratings are publicly available at https://smocuda.github.io.
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Affiliation(s)
- Andrei Manoliu
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland, .,Wellcome Centre for Human Neuroimaging, University College London, London, United Kingdom, .,Max Planck University College London Centre for Computational Psychiatry and Ageing Research, London, United Kingdom,
| | - Amelie Haugg
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland.,Neuroscience Center Zurich, University of Zurich and Swiss Federal Institute of Technology, Zurich, Switzerland
| | - Ronald Sladky
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland.,Department of Basic Psychological Research and Research Methods, Faculty of Psychology, University of Vienna, Vienna, Austria.,Department of Cognition, Emotion, and Methods in Psychology, Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Lea Hulka
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Matthias Kirschner
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland.,Montreal Neurological Institute, McGill University, Montreal, Québec, Canada
| | - Annette B Brühl
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland.,Behavioural and Clinical Neuroscience Institute and Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Boris Quednow
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Marcus Herdener
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Frank Scharnowski
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland.,Neuroscience Center Zurich, University of Zurich and Swiss Federal Institute of Technology, Zurich, Switzerland.,Department of Basic Psychological Research and Research Methods, Faculty of Psychology, University of Vienna, Vienna, Austria.,Zurich Center for Integrative Human Physiology (ZIHP), University of Zurich, Zurich, Switzerland
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13
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Manoliu A, Sladky R, Scherpiet S, Jäncke L, Kirschner M, Haugg A, Bolsinger J, Kraehenmann R, Stämpfli P, Scharnowski F, Herwig U, Seifritz E, Brühl AB. Dopaminergic neuromodulation has no detectable effect on visual-cue induced haemodynamic response function in the visual cortex: A double-blind, placebo-controlled functional magnetic resonance imaging study. J Psychopharmacol 2021; 35:100-102. [PMID: 33307959 DOI: 10.1177/0269881120972341] [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] [Indexed: 11/16/2022]
Abstract
The aim of this study was to investigate the effect of acute dopamine agonistic and antagonistic manipulation on the visual-cue induced blood oxygen level-dependent signal response in healthy volunteers. Seventeen healthy volunteers in a double-blind placebo-controlled cross-over design received either a dopamine antagonist, agonist or placebo and underwent functional magnetic resonance imaging. Using classical inference and Bayesian statistics, we found no effect of dopaminergic modulation on properties of visual-cue induced blood oxygen level-dependent signals in the visual cortex, particularly on distinct properties of the haemodynamic response function (amplitude, time-to-peak and width). Dopamine-related effects modulating the neurovascular coupling in the visual cortex might be negligible when measured via functional magnetic resonance imaging.
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Affiliation(s)
- Andrei Manoliu
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland.,Wellcome Centre for Human Neuroimaging, University College London, London, UK
| | - Ronald Sladky
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland.,Social, Cognitive and Affective Neuroscience (SCAN) Unit, Department of Cognition, Emotion, and Methods in Psychology, Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Sigrid Scherpiet
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland
| | - Lutz Jäncke
- Psychological Institute, University of Zurich, Zurich, Switzerland
| | - Matthias Kirschner
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland.,Montreal Neurological Institute, McGill University, Montreal, Canada
| | - Amelie Haugg
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland
| | - Julia Bolsinger
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland
| | - Rainer Kraehenmann
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland
| | - Philipp Stämpfli
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland
| | - Frank Scharnowski
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland.,Neuroscience Center Zürich, University of Zürich, Zurich, Switzerland.,Department of Cognition, Emotion, and Methods in Psychology, Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Uwe Herwig
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland.,Psychiatrisches Zentrum Appenzell Ausserrhoden, Herisau, Switzerland
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland
| | - Annette B Brühl
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland.,Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
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14
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Brühl AB, d'Angelo C, Sahakian BJ. Neuroethical issues in cognitive enhancement: Modafinil as the example of a workplace drug? Brain Neurosci Adv 2020; 3:2398212818816018. [PMID: 32166175 PMCID: PMC7058249 DOI: 10.1177/2398212818816018] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Indexed: 12/01/2022] Open
Abstract
The use of cognitive-enhancing drugs by healthy individuals has been a feature for much of recorded history. Cocaine and amphetamine are modern cases of drugs initially enthusiastically acclaimed for enhancing cognition and mood. Today, an increasing number of healthy people are reported to use cognitive-enhancing drugs, as well as other interventions, such as non-invasive brain stimulation, to maintain or improve work performance. Cognitive-enhancing drugs, such as methylphenidate and modafinil, which were developed as treatments, are increasingly being used by healthy people. Modafinil not only affects ‘cold’ cognition, but also improves ‘hot’ cognition, such as emotion recognition and task-related motivation. The lifestyle use of ‘smart drugs’ raises both safety concerns as well as ethical issues, including coercion and increasing disparity in society. As a society, we need to consider which forms of cognitive enhancement (e.g. pharmacological, exercise, lifelong learning) are acceptable and for which groups under what conditions and by what methods we would wish to improve and flourish.
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Affiliation(s)
- Annette B Brühl
- Department of Psychiatry, Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK.,Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Camilla d'Angelo
- Department of Psychiatry, Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
| | - Barbara J Sahakian
- Department of Psychiatry, Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
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15
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Savulich G, Hezemans FH, van Ghesel Grothe S, Dafflon J, Schulten N, Brühl AB, Sahakian BJ, Robbins TW. Acute anxiety and autonomic arousal induced by CO 2 inhalation impairs prefrontal executive functions in healthy humans. Transl Psychiatry 2019; 9:296. [PMID: 31719527 PMCID: PMC6851177 DOI: 10.1038/s41398-019-0634-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 10/08/2019] [Accepted: 10/20/2019] [Indexed: 11/09/2022] Open
Abstract
Acute anxiety impacts cognitive performance. Inhalation of air enriched with carbon dioxide (CO2) in healthy humans provides a novel experimental model of generalised anxiety, but has not previously been used to assess cognition. We used inhalation of 7.5% CO2 to induce acute anxiety and autonomic arousal in healthy volunteers during neuropsychological tasks of cognitive flexibility, emotional processing and spatial working memory in a single-blind, placebo-controlled, randomized, crossover, within-subjects study. In Experiment 1 (n = 44), participants made significantly more extra-dimensional shift errors on the Cambridge Neuropsychological Test Automated Battery (CANTAB) Intra-Extra Dimensional Set Shift task under CO2 inhalation compared with 'normal' air. Participants also had slower latencies when responding to positive words and made significantly more omission errors for negative words on the CANTAB Affective Go/No-go task. In Experiment 2 (n = 28), participants made significantly more total errors and had poorer heuristic search strategy on the CANTAB Spatial Working Memory task. In both experiments, CO2 inhalation significantly increased negative affect; state anxiety and fear; symptoms of panic; and systolic blood pressure/heart rate. Overall, CO2 inhalation produced robust anxiogenic effects and impaired fronto-executive functions of cognitive flexibility and working memory. Effects on emotional processing suggested a mood-congruent slowing in processing speed in the absence of a negative attentional bias. State-dependent effects of anxiety on cognitive-emotional interactions in the prefrontal cortex warrant further investigation.
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Affiliation(s)
- George Savulich
- Department of Psychiatry, University of Cambridge, School of Clinical Medicine, Cambridge, UK
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
| | - Frank H Hezemans
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | | | - Jessica Dafflon
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
| | - Norah Schulten
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
| | - Annette B Brühl
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
| | - Barbara J Sahakian
- Department of Psychiatry, University of Cambridge, School of Clinical Medicine, Cambridge, UK
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
| | - Trevor W Robbins
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK.
- Department of Psychology, University of Cambridge, Cambridge, UK.
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16
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Herwig U, Opialla S, Cattapan K, Wetter TC, Jäncke L, Brühl AB. Emotion introspection and regulation in depression. Psychiatry Res Neuroimaging 2018; 277:7-13. [PMID: 29778804 DOI: 10.1016/j.pscychresns.2018.04.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 12/04/2017] [Revised: 04/13/2018] [Accepted: 04/20/2018] [Indexed: 01/13/2023]
Abstract
Depressed patients suffer from an impairment to voluntarily influence and regulate their unpleasant emotional state. Strengthening the mental ability to interfere with dysfunctional emotion processing may be beneficial in treating depression. According to models of emotion processing this may be done by successful down-regulation of enhanced amygdala activity. We investigated short periods of intentional emotion-introspection compared with cognitive self-reflection as two domains of self-awareness in terms of effects on emotion regulation. Thirty depressed patients performed twelve second periods of emotion-introspection, self-reflection and a neutral condition during functional magnetic resonance imaging. We analyzed brain activation in the patients with depression by means of whole brain, region of interest and connectivity analyses. Amygdala activity decreased during emotion-introspection relative to self-reflection and to the neutral condition, whereby left amygdala was inversely activated relative to the left insula. Insula activity itself was correlated with medial and dorsolateral prefrontal cortex (PFC) activation. In conclusion, depressed patients are able to down-regulate amygdala activity by emotion-introspection. This may be interpreted as well-working emotion regulation supposedly induced by PFC connections mediated via insula. The finding supports the application of emotion-introspection, a mindfulness-related process, in a clinical setting as an element of psychotherapy to train and improve emotion regulation.
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Affiliation(s)
- Uwe Herwig
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry, Zürich, Switzerland; Department of Psychiatry and Psychotherapy III, University of Ulm, Ulm, Germany; Clinic for Psychiatry and Psychotherapy AR, Herisau, Switzerland.
| | - Sarah Opialla
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry, Zürich, Switzerland
| | - Katja Cattapan
- Sanatorium Kilchberg/Zürich, Private Hospital of Psychiatry, Kilchberg, Switzerland; University Hospital of Psychiatry, University of Bern, Bern, Switzerland
| | - Thomas C Wetter
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Lutz Jäncke
- Department of Neuropsychology, University of Zürich, Zürich, Switzerland
| | - Annette B Brühl
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry, Zürich, Switzerland
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17
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Manoliu A, Bosch OG, Brakowski J, Brühl AB, Seifritz E. The potential impact of biochemical mediators on telomere attrition in major depressive disorder and implications for future study designs: A narrative review. J Affect Disord 2018; 225:630-646. [PMID: 28889049 DOI: 10.1016/j.jad.2017.08.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 05/30/2017] [Accepted: 08/10/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Major depressive disorder (MDD) has been proposed to represent a "disease of premature aging", which is associated with certain biomarkers of cellular ageing and numerous other age-related diseases. Over the last decade, telomere length (TL) arose as a surrogate for cellular aging. Recent data suggests that TL might be reduced in patients with MDD, however, results are still inconclusive. This might be explained by the lack of assessment of potential biochemical mediators that are directly associated with telomere shortening and frequently observed in patients with MDD. METHODS A narrative review was performed. The PubMed database was searched for relevant studies. RESULTS We identified four major mediators, which are recurrently reported in patients with MDD and are associated with reduced TL: inflammation/oxidative stress, dysregulation of the hypothalamic-pituitary-adrenal axis, metabolic dysbalance including insulin resistance, and decreased brain-derived neurotrophic factor. These mediators are also mutually associated and were not systematically assessed in current studies investigating TL and MDD, which might explain inconclusive findings across current literature. Finally, we discuss possible ways to assess those mediators and potential implications of such approaches for future research. LIMITATIONS The majority of identified studies had cross-sectional designs and used heterogeneous methods to assess TL and associated relevant biochemical mediators. CONCLUSIONS A better understanding of the complex interactions between biochemical mediators, somatic comorbidities and shortened telomeres in patients with MDD might further specify the pathophysiology-based conceptualization and, based on that, personalized treatment of MDD.
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Affiliation(s)
- Andrei Manoliu
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital, University of Zurich, Lenggstrasse 31, CH-8032 Zurich, Switzerland.
| | - Oliver G Bosch
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital, University of Zurich, Lenggstrasse 31, CH-8032 Zurich, Switzerland
| | - Janis Brakowski
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital, University of Zurich, Lenggstrasse 31, CH-8032 Zurich, Switzerland
| | - Annette B Brühl
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital, University of Zurich, Lenggstrasse 31, CH-8032 Zurich, Switzerland; Department of Psychiatry and Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital, University of Zurich, Lenggstrasse 31, CH-8032 Zurich, Switzerland
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18
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Vaghi MM, Hampshire A, Fineberg NA, Kaser M, Brühl AB, Sahakian BJ, Chamberlain SR, Robbins TW. Hypoactivation and Dysconnectivity of a Frontostriatal Circuit During Goal-Directed Planning as an Endophenotype for Obsessive-Compulsive Disorder. Biol Psychiatry Cogn Neurosci Neuroimaging 2017; 2:655-663. [PMID: 29167834 PMCID: PMC5684958 DOI: 10.1016/j.bpsc.2017.05.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 05/30/2017] [Accepted: 05/30/2017] [Indexed: 12/01/2022]
Abstract
Background The symptoms of obsessive-compulsive disorder (OCD) have been postulated to result from impaired executive functioning and excessive habit formation at the expense of goal-directed control and have been objectively demonstrated using neuropsychological tests in such patients. This study tested whether there is functional hypoactivation as well as dysconnectivity of discrete frontostriatal pathways during goal-directed planning in patients with OCD and in their unaffected first-degree relatives. Methods In total, 21 comorbidity-free patients with OCD, 19 clinically asymptomatic first-degree relatives of these patients, and 20 control participants were tested on a functional magnetic resonance optimized version of the Tower of London task. Group differences in brain activation during goal-directed planning were measured together with associated frontostriatal functional connectivity. Results Patients with OCD and their clinically asymptomatic relatives manifested hypoactivation of the right dorsolateral prefrontal cortex during goal-directed planning coupled with reduced functional connectivity between this cortical region and the basal ganglia (putamen). Conclusions Hypoactivation of cortical regions associated with goal-directed planning and associated frontostriatal dysconnectivity represent a candidate endophenotype for OCD. These findings accord with abnormalities in neural networks supporting the balance between goal-directed and habitual behavior, with implications for recent neuropsychological theories of OCD and the major neurobiological model for this disorder.
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Affiliation(s)
- Matilde M Vaghi
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, United Kingdom.,Department of Psychology, University of Cambridge, Cambridge, United Kingdom
| | - Adam Hampshire
- Cognitive Computational and Clinical Neurosciences Laboratory, Imperial College London, London, United Kingdom
| | - Naomi A Fineberg
- National Treatment Service for OCD (England and Wales), Hertfordshire, United Kingdom
| | - Muzaffer Kaser
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Annette B Brühl
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, United Kingdom.,Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom.,Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry, Zurich, Switzerland
| | - Barbara J Sahakian
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, United Kingdom.,Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Samuel R Chamberlain
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, United Kingdom.,Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom.,Cambridge and Peterborough NHS Foundation Trust, Cambridge, United Kingdom
| | - Trevor W Robbins
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, United Kingdom.,Department of Psychology, University of Cambridge, Cambridge, United Kingdom
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19
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Dhum M, Herwig U, Opialla S, Siegrist M, Brühl AB. Evolutionary and Modern Image Content Differentially Influence the Processing of Emotional Pictures. Front Hum Neurosci 2017; 11:415. [PMID: 28878638 PMCID: PMC5572336 DOI: 10.3389/fnhum.2017.00415] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Accepted: 08/02/2017] [Indexed: 11/17/2022] Open
Abstract
From an evolutionary perspective, environmental threats relevant for survival constantly challenged human beings. Current research suggests the evolution of a fear processing module in the brain to cope with these threats. Recently, humans increasingly encountered modern threats (e.g., guns or car accidents) in addition to evolutionary threats (e.g., snakes or predators) which presumably required an adaptation of perception and behavior. However, the neural processes underlying the perception of these different threats remain to be elucidated. We investigated the effect of image content (i.e., evolutionary vs. modern threats) on the activation of neural networks of emotion processing. During functional magnetic resonance imaging (fMRI) 41 participants watched affective pictures displaying evolutionary-threatening, modern-threatening, evolutionary-neutral and modern-neutral content. Evolutionary-threatening stimuli evoked stronger activations than modern-threatening stimuli in left inferior frontal gyrus and thalamus, right middle frontal gyrus and parietal regions as well as bilaterally in parietal regions, fusiform gyrus and bilateral amygdala. We observed the opposite effect, i.e., higher activity for modern-threatening than for evolutionary-threatening stimuli, bilaterally in the posterior cingulate and the parahippocampal gyrus. We found no differences in subjective arousal ratings between the two threatening conditions. On the valence scale though, subjects rated modern-threatening pictures significantly more negative than evolutionary-threatening pictures, indicating a higher level of perceived threat. The majority of previous studies show a positive relationship between arousal rating and amygdala activity. However, comparing fMRI results with behavioral findings we provide evidence that neural activity in fear processing areas is not only driven by arousal or valence, but presumably also by the evolutionary content of the stimulus. This has also fundamental methodological implications, in the sense to suggest a more elaborate classification of stimulus content to improve the validity of experimental designs.
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Affiliation(s)
- Matthias Dhum
- Department of Consumer Behavior, Institute of Environmental Decisions, ETHZurich, Switzerland
| | - Uwe Herwig
- Department of Consumer Behavior, Institute of Environmental Decisions, ETHZurich, Switzerland
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry, University of ZurichZurich, Switzerland
- Department of Psychiatry and Psychotherapy III, University of UlmUlm, Germany
| | - Sarah Opialla
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry, University of ZurichZurich, Switzerland
| | - Michael Siegrist
- Department of Consumer Behavior, Institute of Environmental Decisions, ETHZurich, Switzerland
| | - Annette B. Brühl
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry, University of ZurichZurich, Switzerland
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20
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Affiliation(s)
- A B Brühl
- Department of Psychiatry and Behavioural and Clinical Neuroscience Institute,University of Cambridge,Cambridge,UK
| | - B J Sahakian
- Department of Psychiatry and Behavioural and Clinical Neuroscience Institute,University of Cambridge,Cambridge,UK
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21
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Bas-Hoogendam JM, Blackford JU, Brühl AB, Blair KS, van der Wee NJ, Westenberg PM. Neurobiological candidate endophenotypes of social anxiety disorder. Neurosci Biobehav Rev 2016; 71:362-378. [DOI: 10.1016/j.neubiorev.2016.08.040] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 07/15/2016] [Accepted: 08/31/2016] [Indexed: 02/07/2023]
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22
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Savulich G, Piercy T, Brühl AB, Fox C, Suckling J, Rowe JB, O'Brien JT, Sahakian BJ. Focusing the Neuroscience and Societal Implications of Cognitive Enhancers. Clin Pharmacol Ther 2016; 101:170-172. [PMID: 27557349 DOI: 10.1002/cpt.457] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 07/19/2016] [Accepted: 08/14/2016] [Indexed: 11/11/2022]
Abstract
Cognitive enhancement can benefit the individual and society, but also has associated risks and ethical concerns. Cognitive-enhancing drugs are used in the treatment of neuropsychiatric disorders. Nonpharmacological strategies are also emerging, which have the potential to improve motivational deficits associated with neuropsychiatric symptoms and should be prioritized for development. The increasing lifestyle use of "smart" and other drugs indicates the desire for healthy people to improve themselves. Safety and ethical implications are discussed.
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Affiliation(s)
- G Savulich
- Department of Psychiatry, University of Cambridge, Cambridge, UK.,Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
| | - T Piercy
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - A B Brühl
- Department of Psychiatry, University of Cambridge, Cambridge, UK.,Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK.,Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - C Fox
- Department of Psychological Sciences, Norwich Medical School, University of East Anglia, Norwich, UK
| | - J Suckling
- Department of Psychiatry, University of Cambridge, Cambridge, UK.,Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
| | - J B Rowe
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK.,Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.,MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - J T O'Brien
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - B J Sahakian
- Department of Psychiatry, University of Cambridge, Cambridge, UK.,Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
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23
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Michels L, Scherpiet S, Stämpfli P, Herwig U, Brühl AB. Baseline Perfusion Alterations Due to Acute Application of Quetiapine and Pramipexole in Healthy Adults. Int J Neuropsychopharmacol 2016; 19:pyw067. [PMID: 27466220 PMCID: PMC5137281 DOI: 10.1093/ijnp/pyw067] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 07/01/2016] [Accepted: 07/22/2016] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The dopaminergic system is implicated in many mental processes and neuropsychiatric disorders. Pharmacologically, drugs with dopamine receptor antagonistic and agonistic effects are used, but their effects on functional brain metabolism are not well known. METHODS In this randomized crossover, placebo-controlled, and rater-blinded study, 25 healthy adults received an acute dose placebo substance (starch), quetiapine (dopamine receptor antagonist), or pramipexole (dopamine agonist of the nonergoline class) 1 hour before the experiment. Background-suppressed 2D pseudo-continuous arterial spin labeling was used to examine whole-brain baseline cerebral blood flow differences induced by the 3 substances. RESULTS We found that quetiapine reduced perfusion in the occipital (early visual areas) and bilateral cerebellar cortex relative to placebo. In contrast, quetiapine enhanced cerebral blood flow (relative to placebo) in the striatal system (putamen and caudate nucleus) but also in the supplementary motor area, insular-, prefrontal- as well as in the pre- and postcentral cortex. Pramipexole increased cerebral blood flow compared with placebo in the caudate nucleus, putamen, middle frontal, supplementary motor area, and brainstem (substantia nigra), but reduced cerebral blood flow in the posterior thalamus, cerebellum, and visual areas. Pramipexole administration resulted in stronger cerebral blood flow relative to quetiapine in the hypothalamus, cerebellum, and substantia nigra. CONCLUSIONS Our results indicate that quetiapine and pramipexole differentially modulate regional baseline cerebral blood flow. Both substances act on the dopaminergic system, although they affect distinct regions. Quetiapine altered dopaminergic function in frontal, striatal, and motor regions. In contrast, pramipexole affected cerebral blood flow of the nigrostriatal (striatum and substantia nigra) dopaminergic, but less the fronto-insular system.
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Affiliation(s)
- Lars Michels
- Institute of Neuroradiology, University Hospital Zurich, Zurich, Switzerland (Dr Michels); MR-Center, University Children's Hospital Zurich, Zurich, Switzerland (Dr Michels); Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland (Drs Scherpiet, Stämpfli, Herwig, and Brühl); Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK (Dr Brühl). .,L.M. and S.S. are shared first authors.
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24
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Brühl AB, Sahakian BJ. Drugs, games, and devices for enhancing cognition: implications for work and society. Ann N Y Acad Sci 2016; 1369:195-217. [PMID: 27043232 DOI: 10.1111/nyas.13040] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [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: 11/12/2015] [Revised: 02/15/2016] [Accepted: 02/18/2016] [Indexed: 12/11/2022]
Abstract
As work environments change, the demands on working people change. Cognitive abilities in particular are becoming progressively more important for work performance and successful competition in a global environment. However, work-related stress, performance over long hours, lack of sleep, shift work, and jet lag affect cognitive functions. Therefore, an increasing number of healthy people are reported to use cognitive-enhancing drugs, as well as other interventions, such as noninvasive brain stimulation, to maintain or improve work performance. This review summarizes research on pharmacological and technical methods as well as cognitive training, including game apps for the brain, in healthy people. In neuropsychiatric disorders, impairments in cognitive functions can drastically reduce the chances of returning to work; therefore, this review also summarizes findings from pharmacological and cognitive-training studies in neuropsychiatric disorders.
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Affiliation(s)
- Annette B Brühl
- Department of Psychiatry, and Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, United Kingdom.,Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zürich, Switzerland
| | - Barbara J Sahakian
- Department of Psychiatry, and Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, United Kingdom
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25
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Herwig U, Dhum M, Hittmeyer A, Opialla S, Scherpiet S, Keller C, Brühl AB, Siegrist M. Neural Signaling of Food Healthiness Associated with Emotion Processing. Front Aging Neurosci 2016; 8:16. [PMID: 26903859 PMCID: PMC4748030 DOI: 10.3389/fnagi.2016.00016] [Citation(s) in RCA: 6] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 01/21/2016] [Indexed: 12/30/2022] Open
Abstract
The ability to differentiate healthy from unhealthy foods is important in order to promote good health. Food, however, may have an emotional connotation, which could be inversely related to healthiness. The neurobiological background of differentiating healthy and unhealthy food and its relations to emotion processing are not yet well understood. We addressed the neural activations, particularly considering the single subject level, when one evaluates a food item to be of a higher, compared to a lower grade of healthiness with a particular view on emotion processing brain regions. Thirty-seven healthy subjects underwent functional magnetic resonance imaging while evaluating the healthiness of food presented as photographs with a subsequent rating on a visual analog scale. We compared individual evaluations of high and low healthiness of food items and also considered gender differences. We found increased activation when food was evaluated to be healthy in the left dorsolateral prefrontal cortex and precuneus in whole brain analyses. In ROI analyses, perceived and rated higher healthiness was associated with lower amygdala activity and higher ventral striatal and orbitofrontal cortex activity. Females exerted a higher activation in midbrain areas when rating food items as being healthy. Our results underline the close relationship between food and emotion processing, which makes sense considering evolutionary aspects. Actively evaluating and deciding whether food is healthy is accompanied by neural signaling associated with reward and self-relevance, which could promote salutary nutrition behavior. The involved brain regions may be amenable to mechanisms of emotion regulation in the context of psychotherapeutic regulation of food intake.
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Affiliation(s)
- Uwe Herwig
- Clinic for Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry in ZürichZürich, Switzerland; Department of Consumer Behaviour, Institute for Environmental Decisions, ETH ZürichZürich, Switzerland
| | - Matthias Dhum
- Department of Consumer Behaviour, Institute for Environmental Decisions, ETH Zürich Zürich, Switzerland
| | - Anna Hittmeyer
- Clinic for Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry in Zürich Zürich, Switzerland
| | - Sarah Opialla
- Clinic for Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry in Zürich Zürich, Switzerland
| | - Sigrid Scherpiet
- Clinic for Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry in Zürich Zürich, Switzerland
| | - Carmen Keller
- Department of Consumer Behaviour, Institute for Environmental Decisions, ETH Zürich Zürich, Switzerland
| | - Annette B Brühl
- Clinic for Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry in ZürichZürich, Switzerland; Department of Consumer Behaviour, Institute for Environmental Decisions, ETH ZürichZürich, Switzerland
| | - Michael Siegrist
- Department of Consumer Behaviour, Institute for Environmental Decisions, ETH Zürich Zürich, Switzerland
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26
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Emmert K, Kopel R, Sulzer J, Brühl AB, Berman BD, Linden DEJ, Horovitz SG, Breimhorst M, Caria A, Frank S, Johnston S, Long Z, Paret C, Robineau F, Veit R, Bartsch A, Beckmann CF, Van De Ville D, Haller S. Meta-analysis of real-time fMRI neurofeedback studies using individual participant data: How is brain regulation mediated? Neuroimage 2015; 124:806-812. [PMID: 26419389 DOI: 10.1016/j.neuroimage.2015.09.042] [Citation(s) in RCA: 106] [Impact Index Per Article: 11.8] [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: 06/09/2015] [Revised: 08/16/2015] [Accepted: 09/19/2015] [Indexed: 10/23/2022] Open
Abstract
An increasing number of studies using real-time fMRI neurofeedback have demonstrated that successful regulation of neural activity is possible in various brain regions. Since these studies focused on the regulated region(s), little is known about the target-independent mechanisms associated with neurofeedback-guided control of brain activation, i.e. the regulating network. While the specificity of the activation during self-regulation is an important factor, no study has effectively determined the network involved in self-regulation in general. In an effort to detect regions that are responsible for the act of brain regulation, we performed a post-hoc analysis of data involving different target regions based on studies from different research groups. We included twelve suitable studies that examined nine different target regions amounting to a total of 175 subjects and 899 neurofeedback runs. Data analysis included a standard first- (single subject, extracting main paradigm) and second-level (single subject, all runs) general linear model (GLM) analysis of all participants taking into account the individual timing. Subsequently, at the third level, a random effects model GLM included all subjects of all studies, resulting in an overall mixed effects model. Since four of the twelve studies had a reduced field of view (FoV), we repeated the same analysis in a subsample of eight studies that had a well-overlapping FoV to obtain a more global picture of self-regulation. The GLM analysis revealed that the anterior insula as well as the basal ganglia, notably the striatum, were consistently active during the regulation of brain activation across the studies. The anterior insula has been implicated in interoceptive awareness of the body and cognitive control. Basal ganglia are involved in procedural learning, visuomotor integration and other higher cognitive processes including motivation. The larger FoV analysis yielded additional activations in the anterior cingulate cortex, the dorsolateral and ventrolateral prefrontal cortex, the temporo-parietal area and the visual association areas including the temporo-occipital junction. In conclusion, we demonstrate that several key regions, such as the anterior insula and the basal ganglia, are consistently activated during self-regulation in real-time fMRI neurofeedback independent of the targeted region-of-interest. Our results imply that if the real-time fMRI neurofeedback studies target regions of this regulation network, such as the anterior insula, care should be given whether activation changes are related to successful regulation, or related to the regulation process per se. Furthermore, future research is needed to determine how activation within this regulation network is related to neurofeedback success.
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Affiliation(s)
- Kirsten Emmert
- Department of Radiology and Medical Informatics, University of Geneva, Geneva, Switzerland; Medical Image Processing Laboratory, Institute of Bioengineering, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland.
| | - Rotem Kopel
- Department of Radiology and Medical Informatics, University of Geneva, Geneva, Switzerland; Medical Image Processing Laboratory, Institute of Bioengineering, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - James Sulzer
- Department of Mechanical Engineering, University of Texas at Austin, Austin, TX, USA
| | - Annette B Brühl
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland; Department of Psychiatry, Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
| | - Brian D Berman
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - David E J Linden
- MRC Centre for Neuropsychiatric Genetics & Genomics, Cardiff University School of Medicine, Cardiff University, Cardiff, UK
| | - Silvina G Horovitz
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Markus Breimhorst
- Department of Neurology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Andrea Caria
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tuebingen, Germany
| | - Sabine Frank
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tuebingen, Germany
| | | | - Zhiying Long
- State Key Laboratory of Cognitive Neuroscience and Learning & IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China
| | - Christian Paret
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University Mannheim, Germany; Department for Neuroimaging, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University Mannheim, Germany
| | - Fabien Robineau
- Laboratory for Neurology and Imaging of Cognition, Department of Neurosciences, University of Geneva, Switzerland
| | - Ralf Veit
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tuebingen, Germany; Institute for Diabetes Research and Metabolic Diseases, Helmholtz Center Munich, University of Tübingen, Tübingen, Germany
| | - Andreas Bartsch
- Department of Neuroradiology, University of Heidelberg, Heidelberg, Germany; Department of Neuroradiology, University of Würzburg, Würzburg, Germany; FMRIB Centre, University of Oxford, Oxford, UK; Department of Radiology, Bamberg Hospital, Germany
| | - Christian F Beckmann
- Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, Radboud University Nijmegen, The Netherlands; Radboud University Medical Centre, Department of Cognitive Neuroimaging, Nijmegen, The Netherlands; Oxford Centre for Functional MRI of the Brain, Nuffield Department of Clinical Neuroscience, University of Oxford, UK
| | - Dimitri Van De Ville
- Department of Radiology and Medical Informatics, University of Geneva, Geneva, Switzerland; Medical Image Processing Laboratory, Institute of Bioengineering, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Sven Haller
- Affidea Centre de Diagnostique Radiologique de Carouge CDRC, Geneva, Switzerland; Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden; Department of Neuroradiology, University Hospital Freiburg, Germany; Faculty of Medicine of the University of Geneva, Switzerland
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Abstract
This review explains the mechanism of functional magnetic resonance imaging in general and specifically introduces real-time functional magnetic resonance imaging as a method for training self-regulation of brain activity. Using real-time functional magnetic resonance imaging neurofeedback, participants can acquire control over their own brain activity. In patients with neuropsychiatric disorders, this control can potentially have therapeutic implications. In this review, the technical requirements are presented and potential applications and limitations are discussed.
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Affiliation(s)
- Annette B Brühl
- University of Cambridge, Behavioural and Clinical Neuroscience Institute and Department of Psychiatry, Downing site, Cambridge, United Kingdom; Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland.
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28
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Opialla S, Lutz J, Scherpiet S, Hittmeyer A, Jäncke L, Rufer M, Grosse Holtforth M, Herwig U, Brühl AB. Neural circuits of emotion regulation: a comparison of mindfulness-based and cognitive reappraisal strategies. Eur Arch Psychiatry Clin Neurosci 2015; 265:45-55. [PMID: 24902936 DOI: 10.1007/s00406-014-0510-z] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [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: 10/01/2013] [Accepted: 05/24/2014] [Indexed: 12/25/2022]
Abstract
Dealing with one's emotions is a core skill in everyday life. Effective cognitive control strategies have been shown to be neurobiologically represented in prefrontal structures regulating limbic regions. In addition to cognitive strategies, mindfulness-associated methods are increasingly applied in psychotherapy. We compared the neurobiological mechanisms of these two strategies, i.e. cognitive reappraisal and mindfulness, during both the cued expectation and perception of negative and potentially negative emotional pictures. Fifty-three healthy participants were examined with functional magnetic resonance imaging (47 participants included in analysis). Twenty-four subjects applied mindfulness, 23 used cognitive reappraisal. On the neurofunctional level, both strategies were associated with comparable activity of the medial prefrontal cortex and the amygdala. When expecting negative versus neutral stimuli, the mindfulness group showed stronger activations in ventro- and dorsolateral prefrontal cortex, supramarginal gyrus as well as in the left insula. During the perception of negative versus neutral stimuli, the two groups only differed in an increased activity in the caudate in the cognitive group. Altogether, both strategies recruited overlapping brain regions known to be involved in emotion regulation. This result suggests that common neural circuits are involved in the emotion regulation by mindfulness-based and cognitive reappraisal strategies. Identifying differential activations being associated with the two strategies in this study might be one step towards a better understanding of differential mechanisms of change underlying frequently used psychotherapeutic interventions.
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Affiliation(s)
- Sarah Opialla
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Lenggstrasse 31, 8032, Zurich, Switzerland
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29
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Schumacher S, Herwig U, Baur V, Mueller-Pfeiffer C, Martin-Soelch C, Rufer M, Brühl AB. Psychophysiological Responses During the Anticipation of Emotional Pictures. J PSYCHOPHYSIOL 2015. [DOI: 10.1027/0269-8803/a000129] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The present study sought to investigate peripheral physiological responses to the anticipation of explicitly and ambiguously cued emotional pictures. Emotionally positive and negative as well as neutral pictures were presented to 32 healthy subjects. At the beginning of an anticipation period they were cued about the valence of the upcoming picture (neutral, positive, negative, or ambiguous). Skin conductance, heart rate, and zygomaticus and corrugator electromyogram responses were measured during anticipation and perception. Responses specific to the emotional conditions were observed during anticipation as well as during perception. During the anticipation of ambiguously cued pictures, responses were similar to responses elicited by anticipating negative pictures. In line with results from brain imaging studies, peripheral physiological responses could be interpreted to reflect a negative bias for ambiguous events.
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Affiliation(s)
- Sonja Schumacher
- Department of Psychiatry and Psychotherapy, University Hospital Zurich, Switzerland
| | - Uwe Herwig
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Switzerland
- Department of Psychiatry and Psychotherapy III, University of Ulm, Germany
| | - Volker Baur
- Department of Psychiatry and Psychotherapy, University Hospital Zurich, Switzerland
| | - Christoph Mueller-Pfeiffer
- Department of Psychiatry and Psychotherapy, University Hospital Zurich, Switzerland
- Center of Education and Research (COEUR), Psychiatric Services of the County of St. Gallen-North, Wil, Switzerland
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Chantal Martin-Soelch
- Department of Psychiatry and Psychotherapy, University Hospital Zurich, Switzerland
- Division of Clinical and Health Psychology, Department of Psychology, University of Fribourg, Switzerland
| | - Michael Rufer
- Department of Psychiatry and Psychotherapy, University Hospital Zurich, Switzerland
| | - Annette B. Brühl
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Switzerland
- Department of Psychiatry and Behavioural and Clinical Neuroscience Institute, University of Cambridge, United Kingdom
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30
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Abstract
BACKGROUND Self-referential emotions such as shame/guilt and pride provide evaluative information about persons themselves. In addition to emotional aspects, social and self-referential processes play a role in self-referential emotions. Prior studies have rather focused on comparing self-referential and other-referential processes of one valence, triggered mostly by external stimuli. In the current study, we aimed at investigating the valence-specific neural correlates of shame/guilt and pride, evoked by the remembrance of a corresponding autobiographical event during functional magnetic resonance imaging. METHOD A total of 25 healthy volunteers were studied. The task comprised a negative (shame/guilt), a positive (pride) and a neutral condition (expecting the distractor). Each condition was initiated by a simple cue, followed by the remembrance and finished by a distracting picture. RESULTS Pride and shame/guilt conditions both activated typical emotion-processing circuits including the amygdala, insula and ventral striatum, as well as self-referential brain regions such as the bilateral dorsomedial prefrontal cortex. Comparing the two emotional conditions, emotion-processing circuits were more activated by pride than by shame, possibly due to either hedonic experiences or stronger involvement of the participants in positive self-referential emotions due to a self-positivity bias. However, the ventral striatum was similarly activated by pride and shame/guilt. In the whole-brain analysis, both self-referential emotion conditions activated medial prefrontal and posterior cingulate regions, corresponding to the self-referential aspect and the autobiographical evocation of the respective emotions. CONCLUSION Autobiographically evoked self-referential emotions activated basic emotional as well as self-referential circuits. Except for the ventral striatum, emotional circuits were more active with pride than with shame.
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Affiliation(s)
- Lilian Roth
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zürich, Zürich, Switzerland
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31
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Lutz J, Herwig U, Opialla S, Hittmeyer A, Jäncke L, Rufer M, Grosse Holtforth M, Brühl AB. Mindfulness and emotion regulation--an fMRI study. Soc Cogn Affect Neurosci 2013; 9:776-85. [PMID: 23563850 DOI: 10.1093/scan/nst043] [Citation(s) in RCA: 155] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Mindfulness--an attentive non-judgmental focus on present experiences--is increasingly incorporated in psychotherapeutic treatments as a skill fostering emotion regulation. Neurobiological mechanisms of actively induced emotion regulation are associated with prefrontally mediated down-regulation of, for instance, the amygdala. We were interested in neurobiological correlates of a short mindfulness instruction during emotional arousal. Using functional magnetic resonance imaging, we investigated effects of a short mindfulness intervention during the cued expectation and perception of negative and potentially negative pictures (50% probability) in 24 healthy individuals compared to 22 controls. The mindfulness intervention was associated with increased activations in prefrontal regions during the expectation of negative and potentially negative pictures compared to controls. During the perception of negative stimuli, reduced activation was identified in regions involved in emotion processing (amygdala, parahippocampal gyrus). Prefrontal and right insular activations when expecting negative pictures correlated negatively with trait mindfulness, suggesting that more mindful individuals required less regulatory resources to attenuate emotional arousal. Our findings suggest emotion regulatory effects of a short mindfulness intervention on a neurobiological level.
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Affiliation(s)
- Jacqueline Lutz
- Department for Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zürich, CH-8032 Zürich, Switzerland, Department of Psychiatry and Psychotherapy III, University of Ulm, D-89075 Ulm, Germany, Department of Neuropsychology, Institute of Psychology, University of Zürich, CH-8050 Zürich, Switzerland, Department of Psychiatry and Psychotherapy, University Hospital Zürich, CH-8091 Zürich, Switzerland, and Department of Psychology, Psychotherapy of Affective Disorders, University of Zürich, CH-8050 Zürich, Switzerland
| | - Uwe Herwig
- Department for Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zürich, CH-8032 Zürich, Switzerland, Department of Psychiatry and Psychotherapy III, University of Ulm, D-89075 Ulm, Germany, Department of Neuropsychology, Institute of Psychology, University of Zürich, CH-8050 Zürich, Switzerland, Department of Psychiatry and Psychotherapy, University Hospital Zürich, CH-8091 Zürich, Switzerland, and Department of Psychology, Psychotherapy of Affective Disorders, University of Zürich, CH-8050 Zürich, SwitzerlandDepartment for Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zürich, CH-8032 Zürich, Switzerland, Department of Psychiatry and Psychotherapy III, University of Ulm, D-89075 Ulm, Germany, Department of Neuropsychology, Institute of Psychology, University of Zürich, CH-8050 Zürich, Switzerland, Department of Psychiatry and Psychotherapy, University Hospital Zürich, CH-8091 Zürich, Switzerland, and Department of Psychology, Psychotherapy of Affective Disorders, University of Zürich, CH-8050 Zürich, Switzerland
| | - Sarah Opialla
- Department for Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zürich, CH-8032 Zürich, Switzerland, Department of Psychiatry and Psychotherapy III, University of Ulm, D-89075 Ulm, Germany, Department of Neuropsychology, Institute of Psychology, University of Zürich, CH-8050 Zürich, Switzerland, Department of Psychiatry and Psychotherapy, University Hospital Zürich, CH-8091 Zürich, Switzerland, and Department of Psychology, Psychotherapy of Affective Disorders, University of Zürich, CH-8050 Zürich, Switzerland
| | - Anna Hittmeyer
- Department for Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zürich, CH-8032 Zürich, Switzerland, Department of Psychiatry and Psychotherapy III, University of Ulm, D-89075 Ulm, Germany, Department of Neuropsychology, Institute of Psychology, University of Zürich, CH-8050 Zürich, Switzerland, Department of Psychiatry and Psychotherapy, University Hospital Zürich, CH-8091 Zürich, Switzerland, and Department of Psychology, Psychotherapy of Affective Disorders, University of Zürich, CH-8050 Zürich, Switzerland
| | - Lutz Jäncke
- Department for Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zürich, CH-8032 Zürich, Switzerland, Department of Psychiatry and Psychotherapy III, University of Ulm, D-89075 Ulm, Germany, Department of Neuropsychology, Institute of Psychology, University of Zürich, CH-8050 Zürich, Switzerland, Department of Psychiatry and Psychotherapy, University Hospital Zürich, CH-8091 Zürich, Switzerland, and Department of Psychology, Psychotherapy of Affective Disorders, University of Zürich, CH-8050 Zürich, Switzerland
| | - Michael Rufer
- Department for Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zürich, CH-8032 Zürich, Switzerland, Department of Psychiatry and Psychotherapy III, University of Ulm, D-89075 Ulm, Germany, Department of Neuropsychology, Institute of Psychology, University of Zürich, CH-8050 Zürich, Switzerland, Department of Psychiatry and Psychotherapy, University Hospital Zürich, CH-8091 Zürich, Switzerland, and Department of Psychology, Psychotherapy of Affective Disorders, University of Zürich, CH-8050 Zürich, Switzerland
| | - Martin Grosse Holtforth
- Department for Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zürich, CH-8032 Zürich, Switzerland, Department of Psychiatry and Psychotherapy III, University of Ulm, D-89075 Ulm, Germany, Department of Neuropsychology, Institute of Psychology, University of Zürich, CH-8050 Zürich, Switzerland, Department of Psychiatry and Psychotherapy, University Hospital Zürich, CH-8091 Zürich, Switzerland, and Department of Psychology, Psychotherapy of Affective Disorders, University of Zürich, CH-8050 Zürich, Switzerland
| | - Annette B Brühl
- Department for Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zürich, CH-8032 Zürich, Switzerland, Department of Psychiatry and Psychotherapy III, University of Ulm, D-89075 Ulm, Germany, Department of Neuropsychology, Institute of Psychology, University of Zürich, CH-8050 Zürich, Switzerland, Department of Psychiatry and Psychotherapy, University Hospital Zürich, CH-8091 Zürich, Switzerland, and Department of Psychology, Psychotherapy of Affective Disorders, University of Zürich, CH-8050 Zürich, Switzerland
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Abstract
BACKGROUND Self-referential cognitions are important for self-monitoring and self-regulation. Previous studies have addressed the neural correlates of self-referential processes in response to or related to external stimuli. We here investigated brain activity associated with a short, exclusively mental process of self-reflection in the absence of external stimuli or behavioural requirements. Healthy subjects reflected either on themselves, a personally known or an unknown person during functional magnetic resonance imaging (fMRI). The reflection period was initialized by a cue and followed by photographs of the respective persons (perception of pictures of oneself or the other person). RESULTS Self-reflection, compared with reflecting on the other persons and to a major part also compared with perceiving photographs of one-self, was associated with more prominent dorsomedial and lateral prefrontal, insular, anterior and posterior cingulate activations. Whereas some of these areas showed activity in the "other"-conditions as well, self-selective characteristics were revealed in right dorsolateral prefrontal and posterior cingulate cortex for self-reflection; in anterior cingulate cortex for self-perception and in the left inferior parietal lobe for self-reflection and -perception. CONCLUSIONS Altogether, cingulate, medial and lateral prefrontal, insular and inferior parietal regions show relevance for self-related cognitions, with in part self-specificity in terms of comparison with the known-, unknown- and perception-conditions. Notably, the results are obtained here without behavioural response supporting the reliability of this methodological approach of applying a solely mental intervention. We suggest considering the reported structures when investigating psychopathologically affected self-related processing.
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Affiliation(s)
- Uwe Herwig
- Department for Social and General Psychiatry Zurich West, University Hospital of Psychiatry Zurich, Zurich, Switzerland
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Mutschler J, Rüsch N, Schönfelder H, Herwig U, Brühl AB, Grosshans M, Rössler W, Russmann H. Agomelatine for Depression in Schizophrenia: A Case-Series. Psychopharmacol Bull 2012; 45:35-43. [PMID: 27738367 PMCID: PMC5044474] [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] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVES Agomelatine, a melatonin (MT1/MT2) receptor agonist and 5-HT2C receptor antagonist, is a new antidepressant and a potential therapeutic option for major depressive episodes and negative symptoms in persons with schizophrenia. We investigated such treatment outcomes with respect to antidepressant efficacy, safety, and tolerability. METHODS We report a consecutive case series of seven patients with schizophrenia and comorbid major depressive symptoms who received agomelatine for a period of at least six weeks in addition to stable doses of antipsychotic agents. General psychopathology, positive, negative and depressive symptoms were assessed with standardized interviews. Relevant blood parameters were assessed. RESULTS Depressive symptoms improved significantly. Positive symptoms remained stable, while negative symptoms and global psychopathology improved significantly. Agomelatine was well tolerated in most patients. CONCLUSIONS Our findings provide initial evidence that agomelatine is safe and efficacious in treating depressive symptoms in patients with schizophrenia. Furthermore, agomelatine seems to be effective for the treatment of negative symptoms. Randomized controlled trials are necessary to confirm these first observations.
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Affiliation(s)
- Jochen Mutschler
- Drs. Mutschler, MD, Rüsch, MD, Schönfelder, MD, Herwig, MD, Brühl, MD, Rössler, MD, Russmann, MD, Department of General and Social Psychiatry, Psychiatric University Hospital Zürich, Militärstrasse 8, Zürich, Switzerland. Dr. Grosshans, MD, Department of Addictive Behaviour and Addiction Medicine, Central Institute of Mental Health, University of Heidelberg, Mannheim J5, Germany
| | - Nicolas Rüsch
- Drs. Mutschler, MD, Rüsch, MD, Schönfelder, MD, Herwig, MD, Brühl, MD, Rössler, MD, Russmann, MD, Department of General and Social Psychiatry, Psychiatric University Hospital Zürich, Militärstrasse 8, Zürich, Switzerland. Dr. Grosshans, MD, Department of Addictive Behaviour and Addiction Medicine, Central Institute of Mental Health, University of Heidelberg, Mannheim J5, Germany
| | - Herdis Schönfelder
- Drs. Mutschler, MD, Rüsch, MD, Schönfelder, MD, Herwig, MD, Brühl, MD, Rössler, MD, Russmann, MD, Department of General and Social Psychiatry, Psychiatric University Hospital Zürich, Militärstrasse 8, Zürich, Switzerland. Dr. Grosshans, MD, Department of Addictive Behaviour and Addiction Medicine, Central Institute of Mental Health, University of Heidelberg, Mannheim J5, Germany
| | - Uwe Herwig
- Drs. Mutschler, MD, Rüsch, MD, Schönfelder, MD, Herwig, MD, Brühl, MD, Rössler, MD, Russmann, MD, Department of General and Social Psychiatry, Psychiatric University Hospital Zürich, Militärstrasse 8, Zürich, Switzerland. Dr. Grosshans, MD, Department of Addictive Behaviour and Addiction Medicine, Central Institute of Mental Health, University of Heidelberg, Mannheim J5, Germany
| | - Annette B Brühl
- Drs. Mutschler, MD, Rüsch, MD, Schönfelder, MD, Herwig, MD, Brühl, MD, Rössler, MD, Russmann, MD, Department of General and Social Psychiatry, Psychiatric University Hospital Zürich, Militärstrasse 8, Zürich, Switzerland. Dr. Grosshans, MD, Department of Addictive Behaviour and Addiction Medicine, Central Institute of Mental Health, University of Heidelberg, Mannheim J5, Germany
| | - Martin Grosshans
- Drs. Mutschler, MD, Rüsch, MD, Schönfelder, MD, Herwig, MD, Brühl, MD, Rössler, MD, Russmann, MD, Department of General and Social Psychiatry, Psychiatric University Hospital Zürich, Militärstrasse 8, Zürich, Switzerland. Dr. Grosshans, MD, Department of Addictive Behaviour and Addiction Medicine, Central Institute of Mental Health, University of Heidelberg, Mannheim J5, Germany
| | - Wulf Rössler
- Drs. Mutschler, MD, Rüsch, MD, Schönfelder, MD, Herwig, MD, Brühl, MD, Rössler, MD, Russmann, MD, Department of General and Social Psychiatry, Psychiatric University Hospital Zürich, Militärstrasse 8, Zürich, Switzerland. Dr. Grosshans, MD, Department of Addictive Behaviour and Addiction Medicine, Central Institute of Mental Health, University of Heidelberg, Mannheim J5, Germany
| | - Heike Russmann
- Drs. Mutschler, MD, Rüsch, MD, Schönfelder, MD, Herwig, MD, Brühl, MD, Rössler, MD, Russmann, MD, Department of General and Social Psychiatry, Psychiatric University Hospital Zürich, Militärstrasse 8, Zürich, Switzerland. Dr. Grosshans, MD, Department of Addictive Behaviour and Addiction Medicine, Central Institute of Mental Health, University of Heidelberg, Mannheim J5, Germany
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Herwig U, Brühl AB, Viebke MC, Scholz RW, Knoch D, Siegrist M. Neural correlates of evaluating hazards of high risk. Brain Res 2011; 1400:78-86. [PMID: 21645880 DOI: 10.1016/j.brainres.2011.05.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2010] [Revised: 05/11/2011] [Accepted: 05/12/2011] [Indexed: 12/01/2022]
Abstract
In personal and in society related context, people often evaluate the risk of environmental and technological hazards. Previous research addressing neuroscience of risk evaluation assessed particularly the direct personal risk of presented stimuli, which may have comprised for instance aspects of fear. Further, risk evaluation primarily was compared to tasks of other cognitive domains serving as control conditions, thus revealing general risk related brain activity, but not such specifically associated with estimating a higher level of risk. We here investigated the neural basis on which lay-persons individually evaluated the risk of different potential hazards for the society. Twenty healthy subjects underwent functional magnetic resonance imaging while evaluating the risk of fifty more or less risky conditions presented as written terms. Brain activations during the individual estimations of 'high' against 'low' risk, and of negative versus neutral and positive emotional valences were analyzed. Estimating hazards to be of high risk was associated with activation in medial thalamus, anterior insula, caudate nucleus, cingulate cortex and further prefrontal and temporo-occipital areas. These areas were not involved according to an analysis of the emotion ratings. In conclusion, we emphasize a contribution of the mentioned brain areas involved to signal high risk, here not primarily associated with the emotional valence of the risk items. These areas have earlier been reported to be associated with, beside emotional, viscerosensitive and implicit processing. This leads to assumptions of an intuitive contribution, or a "gut-feeling", not necessarily dependent of the subjective emotional valence, when estimating a high risk of environmental hazards.
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Affiliation(s)
- Uwe Herwig
- Psychiatric University Hospital Zürich, Switzerland.
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Abstract
Daily we cope with upcoming potentially disadvantageous events. Therefore, it makes sense to be prepared for the worst case. Such a 'pessimistic' bias is reflected in brain activation during emotion processing. Healthy individuals underwent functional neuroimaging while viewing emotional stimuli that were earlier cued ambiguously or unambiguously concerning their emotional valence. Presentation of ambiguously announced pleasant pictures compared with unambiguously announced pleasant pictures resulted in increased activity in the ventrolateral prefrontal, premotor and temporal cortex, and in the caudate nucleus. This was not the case for the respective negative conditions. This indicates that pleasant stimuli after ambiguous cueing provided 'unexpected' emotional input, resulting in the adaptation of brain activity. It strengthens the hypothesis of a 'pessimistic' bias of brain activation toward ambiguous emotional events.
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Affiliation(s)
- Tina Kaffenberger
- Clinic for General and Social Psychiatry, Psychiatric University Hospital Zurich, CH-8006 Zurich, Switzerland.
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Abstract
BACKGROUND Preparing for potentially threatening events in the future is essential for survival. Anticipating the future to be unpleasant is also a cognitive key feature of depression. We hypothesized that 'pessimism'-related emotion processing would characterize brain activity in major depression.MethodDuring functional magnetic resonance imaging, depressed patients and a healthy control group were cued to expect and then perceive pictures of known emotional valences--pleasant, unpleasant and neutral--and stimuli of unknown valence that could have been either pleasant or unpleasant. Brain activation associated with the 'unknown' expectation was compared with the 'known' expectation conditions. RESULTS While anticipating pictures of unknown valence, activation patterns in depressed patients within the medial and dorsolateral prefrontal areas, inferior frontal gyrus, insula and medial thalamus were similar to activations associated with expecting unpleasant pictures, but not with expecting positive pictures. The activity within a majority of these areas correlated with the depression scores. Differences between healthy and depressed persons were found particularly for medial and dorsolateral prefrontal and insular activations. CONCLUSIONS Brain activation in depression during expecting events of unknown emotional valence was comparable with activation while expecting certainly negative, but not positive events. This neurobiological finding is consistent with cognitive models supposing that depressed patients develop a 'pessimistic' attitude towards events with an unknown emotional meaning. Thereby, particularly the role of brain areas associated with the processing of cognitive and executive control and of the internal state is emphasized in contributing to major depression.
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Affiliation(s)
- U Herwig
- Psychiatric University Hospital Zürich, Switzerland.
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