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Boehnke T, Franke C, Bauerfeind A, Heinemann K, Kolberg-Liedtke C, Koelkebeck K. Systematic analysis of combined oral contraceptive prescription patterns in psychotropic drug users across twelve European countries. Contraception 2024; 132:110375. [PMID: 38253249 DOI: 10.1016/j.contraception.2024.110375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 11/24/2023] [Accepted: 01/16/2024] [Indexed: 01/24/2024]
Abstract
OBJECTIVE To investigate prescription patterns of combined oral contraceptives (COC) among psychotropic drug users compared to non-psychotropic drug users in routine clinical practice in Europe. STUDY DESIGN A pooled analysis of three large, prospective, multinational cohort studies including women with a new prescription of COC from 12 European countries. We calculated standardized mean differences (SMD) to investigate whether the status of psychotropic drug use (use/no use) or the psychotropic drug class (psycholeptics/psychoanaleptics) is associated with the healthcare professional's choice of a specific type of COC progestin. RESULTS Our analysis comprised 143,069 non-psychotropic drug users and 2174 psychotropic drug users. Progestins with the highest frequency in the cohorts were levonorgestrel (non-psychotropic drug users: 33.8%; psychotropic drug users: 32.4%), nomegestrol/nomegestrol acetate (non-psychotropic drug users: 19.1%; psychotropic drug users: 26.4%), and drospirenone (non-psychotropic drug users: 15.9%; psychotropic drug users: 14.8%). SMD analysis indicated no substantial differences in COC prescription patterns between the two cohorts. However, we observed association signals for users of the herbal antidepressant St. John's wort in that those individuals more often received a prescription for drospirenone and less frequently for nomegestrol/nomegestrol acetate compared to non-psychotropic drug users. CONCLUSIONS Psychotropic drug user status does not seem to affect healthcare professionals' decisions when prescribing COC. However, limited evidence suggests that the risk for drug interactions might differ by progestin type, and some COC might be more suitable for psychotropic drug users than others. Specific guidelines should be conveyed to healthcare professionals to assist them in contraceptive counseling. IMPLICATIONS With exception of St. John's wort, our analysis showed no differential prescription behavior of combined oral contraceptives in psychotropic drug users and non-users. However, healthcare professionals should carefully consider psychotropic drug use in contraceptive counseling as it is still unclear whether drug interactions exist when co-administered with certain oral contraceptives.
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Affiliation(s)
- Tanja Boehnke
- ZEG Berlin - Center for Epidemiology and Health Research, Berlin, Germany.
| | - Christian Franke
- ZEG Berlin - Center for Epidemiology and Health Research, Berlin, Germany
| | - Anja Bauerfeind
- ZEG Berlin - Center for Epidemiology and Health Research, Berlin, Germany
| | - Klaas Heinemann
- ZEG Berlin - Center for Epidemiology and Health Research, Berlin, Germany
| | - Cornelia Kolberg-Liedtke
- Department of Gynecology and Obstetrics, University Hospital Essen, Essen, North Rhine-Westphalia, Germany
| | - Katja Koelkebeck
- LVR-University Hospital Essen, Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Duisburg-Essen, Essen, North Rhine-Westphalia, Germany; Center for Translational Neuro, and Behavioral Sciences, University of Duisburg-Essen, Essen, North Rhine-Westphalia, Germany
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Langenbach BP, Grotegerd D, Mulders PCR, Tendolkar I, van Oort J, Duyser F, van Eijndhoven P, Vrijsen JN, Dannlowski U, Kampmann Z, Koelkebeck K. Autistic and non-autistic individuals show the same amygdala activity during emotional face processing. Mol Autism 2024; 15:2. [PMID: 38200601 PMCID: PMC10782610 DOI: 10.1186/s13229-024-00582-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 01/02/2024] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Autistic and non-autistic individuals often differ in how they perceive and show emotions, especially in their ability and inclination to infer other people's feelings from subtle cues like facial expressions. Prominent theories of autism have suggested that these differences stem from alterations in amygdala functioning and that amygdala hypoactivation causes problems with emotion recognition. Thus far, however, empirical investigations of this hypothesis have yielded mixed results and largely relied on relatively small samples. METHODS In a sample of 72 autistic and 79 non-autistic participants, we conducted a study in which we used the Hariri paradigm to test whether amygdala activation during emotional face processing is altered in autism spectrum disorder, and whether common mental disorders like depression, ADHD or anxiety disorders influence any potential alterations in activation patterns. RESULTS We found no evidence for differences in amygdala activation, neither when comparing autistic and non-autistic participants, nor when taking into account mental disorders or the overall level of functional impairment. LIMITATIONS Because we used one basic emotion processing task in a Dutch sample, results might not generalise to other tasks and other populations. CONCLUSIONS Our results challenge the view that autistic and non-autistic processing of emotional faces in the amygdala is vastly different and call for a more nuanced view of differences between non-autistic and autistic emotion processing.
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Affiliation(s)
- Benedikt P Langenbach
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, LVR-University-Hospital Essen, University of Duisburg-Essen, Virchowstr. 174, 45147, Essen, Germany.
- Center for Translational Neuro- and Behavioral Sciences, University Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany.
| | - Dominik Grotegerd
- Institute for Translational Psychiatry, University of Münster, Albert-Schweitzer-Strasse 11, 48149, Munster, Germany
| | - Peter C R Mulders
- Department of Psychiatry, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
- Donders Center for Cognitive Neuroimaging, Kapittelweg 29, 6525 EN, Nijmegen, The Netherlands
| | - Indira Tendolkar
- Department of Psychiatry, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - Jasper van Oort
- Department of Psychiatry, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - Fleur Duyser
- Department of Psychiatry, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - Philip van Eijndhoven
- Department of Psychiatry, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
- Donders Center for Cognitive Neuroimaging, Kapittelweg 29, 6525 EN, Nijmegen, The Netherlands
| | - Janna N Vrijsen
- Department of Psychiatry, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - Udo Dannlowski
- Institute for Translational Psychiatry, University of Münster, Albert-Schweitzer-Strasse 11, 48149, Munster, Germany
| | - Zarah Kampmann
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, LVR-University-Hospital Essen, University of Duisburg-Essen, Virchowstr. 174, 45147, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences, University Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Katja Koelkebeck
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, LVR-University-Hospital Essen, University of Duisburg-Essen, Virchowstr. 174, 45147, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences, University Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany
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Parola A, Lin JM, Simonsen A, Bliksted V, Zhou Y, Wang H, Inoue L, Koelkebeck K, Fusaroli R. Speech disturbances in schizophrenia: Assessing cross-linguistic generalizability of NLP automated measures of coherence. Schizophr Res 2023; 259:59-70. [PMID: 35927097 DOI: 10.1016/j.schres.2022.07.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 06/29/2022] [Accepted: 07/01/2022] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Language disorders - disorganized and incoherent speech in particular - are distinctive features of schizophrenia. Natural language processing (NLP) offers automated measures of incoherent speech as promising markers for schizophrenia. However, the scientific and clinical impact of NLP markers depends on their generalizability across contexts, samples, and languages, which we systematically assessed in the present study relying on a large, novel, cross-linguistic corpus. METHODS We collected a Danish (DK), German (GE), and Chinese (CH) cross-linguistic dataset involving transcripts from 187 participants with schizophrenia (111DK, 25GE, 51CH) and 200 matched controls (129DK, 29GE, 42CH) performing the Animated Triangles Task. Fourteen previously published NLP coherence measures were calculated, and between-groups differences and association with symptoms were tested for cross-linguistic generalizability. RESULTS One coherence measure, i.e. second-order coherence, robustly generalized across samples and languages. We found several language-specific effects, some of which partially replicated previous findings (lower coherence in German and Chinese patients), while others did not (higher coherence in Danish patients). We found several associations between symptoms and measures of coherence, but the effects were generally inconsistent across languages and rating scales. CONCLUSIONS Using a cumulative approach, we have shown that NLP findings of reduced semantic coherence in schizophrenia have limited generalizability across different languages, samples, and measures. We argue that several factors such as sociodemographic and clinical heterogeneity, cross-linguistic variation, and the different NLP measures reflecting different clinical aspects may be responsible for this variability. Future studies should take this variability into account in order to develop effective clinical applications targeting different patient populations.
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Affiliation(s)
- Alberto Parola
- Department of Linguistics, Semiotics and Cognitive Science, Aarhus University, Aarhus, Denmark; The Interacting Minds Centre, Institute of Culture and Society, Aarhus University, Aarhus, Denmark.
| | - Jessica Mary Lin
- Department of Linguistics, Semiotics and Cognitive Science, Aarhus University, Aarhus, Denmark; The Interacting Minds Centre, Institute of Culture and Society, Aarhus University, Aarhus, Denmark
| | - Arndis Simonsen
- The Interacting Minds Centre, Institute of Culture and Society, Aarhus University, Aarhus, Denmark; Psychosis Research Unit, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Vibeke Bliksted
- The Interacting Minds Centre, Institute of Culture and Society, Aarhus University, Aarhus, Denmark; Psychosis Research Unit, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Yuan Zhou
- Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Huiling Wang
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Lana Inoue
- LVR-Hospital Essen, Department of Psychiatry and Psychotherapy, Hospital and Institute of the University of Duisburg-Essen, Essen, Germany; Center for Translational Neuro- & Behavioral Sciences (C-TNBS), University Duisburg Essen, Germany
| | - Katja Koelkebeck
- LVR-Hospital Essen, Department of Psychiatry and Psychotherapy, Hospital and Institute of the University of Duisburg-Essen, Essen, Germany; Center for Translational Neuro- & Behavioral Sciences (C-TNBS), University Duisburg Essen, Germany
| | - Riccardo Fusaroli
- Department of Linguistics, Semiotics and Cognitive Science, Aarhus University, Aarhus, Denmark; The Interacting Minds Centre, Institute of Culture and Society, Aarhus University, Aarhus, Denmark; Linguistic Data Consortium, University of Pennsylvania, Philadelphia, USA
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Steiner KM, Timmann D, Bingel U, Kunkel A, Spisak T, Schedlowski M, Benson S, Engler H, Scherbaum N, Koelkebeck K. Study protocol: effects of treatment expectation toward repetitive transcranial magnetic stimulation (rTMS) in major depressive disorder-a randomized controlled clinical trial. Trials 2023; 24:553. [PMID: 37620946 PMCID: PMC10464308 DOI: 10.1186/s13063-023-07579-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 08/09/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Patients' expectations toward any given treatment are highly important for the effectiveness of such treatment, as has been demonstrated for several disorders. In particular, in major depressive disorder (MDD), one of the most frequent and most serious mental disorders with severe consequences for the affected, the augmentation of available treatment options could mean a ground-breaking success. Repetitive transcranial magnetic stimulation (rTMS), a new, non-invasive, and well-tolerated intervention with proven effects in the treatment of MDD, appears particularly suitable in this context as it is assumed to exert its effect via structures implicated in networks relevant for both expectation and depression. METHODS All patients will receive rTMS according to its approval. Half of the patients will be randomized to a psychological intervention, which is a comprehensive medical consultation aiming to improve positive treatment expectations; the control group will receive a conventional informed consent discussion (in the sense of a treatment-as-usual condition). As outcome parameters, instruments for both self-assessment and external assessment of depression symptoms will be applied. Furthermore, psycho-immunological parameters such as inflammation markers and the cortisol awakening response in saliva will be investigated. Resting-state functional magnetic resonance imaging (rs fMRI) will be performed to analyze functional connectivity, including the cerebellum, and to identify neuronal predictors of expectation effects. In addition, possible cerebellar involvement will be assessed based on a cerebellar-dependent motor learning paradigm (i.e., eyeblink conditioning). DISCUSSION In this study, the effects of treatment expectations towards rTMS are investigated in patients with MDD. The aim of this study is to identify the mechanisms underlying the expectation effects and, beyond that, to expand the potential of non-invasive and well-tolerated treatments of MDD. TRIAL REGISTRATION German Registry of Clinical Studies (DRKS DRKS00028017. Registered on 2022/03/07. URL: https://www.drks.de/drks_web/ .
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Affiliation(s)
- Katharina M Steiner
- Department of Psychiatry and Psychotherapy, Medical Faculty, LVR-University-Hospital Essen, University of Duisburg-Essen, Virchowstr, 174, 45147, Essen, Germany.
- Department of Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
- Center for Translational Neuro- & Behavioral Sciences (C-TNBS), University Duisburg Essen, Essen, Germany.
| | - Dagmar Timmann
- Department of Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- & Behavioral Sciences (C-TNBS), University Duisburg Essen, Essen, Germany
| | - Ulrike Bingel
- Department of Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- & Behavioral Sciences (C-TNBS), University Duisburg Essen, Essen, Germany
| | - Angelika Kunkel
- Department of Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- & Behavioral Sciences (C-TNBS), University Duisburg Essen, Essen, Germany
| | - Tamas Spisak
- Department of Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- & Behavioral Sciences (C-TNBS), University Duisburg Essen, Essen, Germany
| | - Manfred Schedlowski
- Center for Translational Neuro- & Behavioral Sciences (C-TNBS), University Duisburg Essen, Essen, Germany
- Institute of Medical Psychology and Behavioral Immunobiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Sven Benson
- Center for Translational Neuro- & Behavioral Sciences (C-TNBS), University Duisburg Essen, Essen, Germany
- Institute of Medical Psychology and Behavioral Immunobiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Institute for Medical Education, Essen University Hospital, University Duisburg-Essen, Essen, Germany
| | - Harald Engler
- Center for Translational Neuro- & Behavioral Sciences (C-TNBS), University Duisburg Essen, Essen, Germany
- Institute of Medical Psychology and Behavioral Immunobiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Norbert Scherbaum
- Department of Psychiatry and Psychotherapy, Medical Faculty, LVR-University-Hospital Essen, University of Duisburg-Essen, Virchowstr, 174, 45147, Essen, Germany
- Center for Translational Neuro- & Behavioral Sciences (C-TNBS), University Duisburg Essen, Essen, Germany
| | - Katja Koelkebeck
- Department of Psychiatry and Psychotherapy, Medical Faculty, LVR-University-Hospital Essen, University of Duisburg-Essen, Virchowstr, 174, 45147, Essen, Germany
- Center for Translational Neuro- & Behavioral Sciences (C-TNBS), University Duisburg Essen, Essen, Germany
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Langenbach BP, Koelkebeck K, Knoch D. Mentalising and depression: a mini-review on behavior, neural substrates, and treatment options. Front Psychiatry 2023; 14:1116306. [PMID: 37398589 PMCID: PMC10308027 DOI: 10.3389/fpsyt.2023.1116306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 05/24/2023] [Indexed: 07/04/2023] Open
Abstract
Major depression is one of the most common mental disorders, affecting millions of people around the globe. In recent years, researchers increasingly investigated social cognition in depression and discovered pronounced alterations. A special focus has been put on mentalising or Theory of Mind, the ability to recognize and understand another person's thoughts and feelings. While there is behavioral evidence for deficits in this ability in patients with depression as well as specialized therapeutic interventions, the neuroscientific substrates are only beginning to be understood. In this mini-review, we take a social neuroscience perspective to analyse the importance of altered mentalising in depression and whether it can help to understand the origins and perpetuation of the disorder. We will put a special focus on treatment options and corresponding neural changes to identify relevant paths for future (neuroscientific) research.
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Affiliation(s)
- Benedikt P. Langenbach
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, LVR University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, Essen, Germany
| | - Katja Koelkebeck
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, LVR University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, Essen, Germany
| | - Daria Knoch
- Department of Social Neuroscience and Social Psychology, Institute of Psychology, University of Bern, Bern, Switzerland
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Parola A, Simonsen A, Lin JM, Zhou Y, Wang H, Ubukata S, Koelkebeck K, Bliksted V, Fusaroli R. Voice Patterns as Markers of Schizophrenia: Building a Cumulative Generalizable Approach Via a Cross-Linguistic and Meta-analysis Based Investigation. Schizophr Bull 2023; 49:S125-S141. [PMID: 36946527 PMCID: PMC10031745 DOI: 10.1093/schbul/sbac128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
BACKGROUND AND HYPOTHESIS Voice atypicalities are potential markers of clinical features of schizophrenia (eg, negative symptoms). A recent meta-analysis identified an acoustic profile associated with schizophrenia (reduced pitch variability and increased pauses), but also highlighted shortcomings in the field: small sample sizes, little attention to the heterogeneity of the disorder, and to generalizing findings to diverse samples and languages. STUDY DESIGN We provide a critical cumulative approach to vocal atypicalities in schizophrenia, where we conceptually and statistically build on previous studies. We aim at identifying a cross-linguistically reliable acoustic profile of schizophrenia and assessing sources of heterogeneity (symptomatology, pharmacotherapy, clinical and social characteristics). We relied on previous meta-analysis to build and analyze a large cross-linguistic dataset of audio recordings of 231 patients with schizophrenia and 238 matched controls (>4000 recordings in Danish, German, Mandarin and Japanese). We used multilevel Bayesian modeling, contrasting meta-analytically informed and skeptical inferences. STUDY RESULTS We found only a minimal generalizable acoustic profile of schizophrenia (reduced pitch variability), while duration atypicalities replicated only in some languages. We identified reliable associations between acoustic profile and individual differences in clinical ratings of negative symptoms, medication, age and gender. However, these associations vary across languages. CONCLUSIONS The findings indicate that a strong cross-linguistically reliable acoustic profile of schizophrenia is unlikely. Rather, if we are to devise effective clinical applications able to target different ranges of patients, we need first to establish larger and more diverse cross-linguistic datasets, focus on individual differences, and build self-critical cumulative approaches.
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Affiliation(s)
- Alberto Parola
- Department of Linguistics, Cognitive Science and Semiotics, Aarhus University, Aarhus, Denmark
- The Interacting Minds Center, Institute of Culture and Society, Aarhus University, Aarhus, Denmark
- Department of Psychology, University of Turin, Turin, Italy
| | - Arndis Simonsen
- The Interacting Minds Center, Institute of Culture and Society, Aarhus University, Aarhus, Denmark
- Psychosis Research Unit, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Jessica Mary Lin
- Department of Linguistics, Cognitive Science and Semiotics, Aarhus University, Aarhus, Denmark
- The Interacting Minds Center, Institute of Culture and Society, Aarhus University, Aarhus, Denmark
| | - Yuan Zhou
- Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Huiling Wang
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Shiho Ubukata
- Department of Psychiatry, Kyoto University, Kyoto, Japan
| | - Katja Koelkebeck
- LVR-Hospital Essen, Department of Psychiatry and Psychotherapy, Hospital and Institute of the University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Duisburg-Essen, Germany
| | - Vibeke Bliksted
- The Interacting Minds Center, Institute of Culture and Society, Aarhus University, Aarhus, Denmark
- Psychosis Research Unit, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Riccardo Fusaroli
- Department of Linguistics, Cognitive Science and Semiotics, Aarhus University, Aarhus, Denmark
- The Interacting Minds Center, Institute of Culture and Society, Aarhus University, Aarhus, Denmark
- Linguistic Data Consortium, University of Pennsylvania, Philadelphia, USA
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Suslow T, Lemster A, Koelkebeck K, Kersting A. Interpersonal problems and recognition of facial emotions in healthy individuals. Front Psychiatry 2023; 14:1139051. [PMID: 37139331 PMCID: PMC10149975 DOI: 10.3389/fpsyt.2023.1139051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 03/31/2023] [Indexed: 05/05/2023] Open
Abstract
Background Recognition of emotions in faces is important for successful social interaction. Results from previous research based on clinical samples suggest that difficulties in identifying threat-related or negative emotions can go along with interpersonal problems. The present study examined whether associations between interpersonal difficulties and emotion decoding ability can be found in healthy individuals. Our analysis was focused on two main dimensions of interpersonal problems: agency (social dominance) and communion (social closeness). Materials and methods We constructed an emotion recognition task with facial expressions depicting six basic emotions (happiness, surprise, anger, disgust, sadness, and fear) in frontal and profile view, which was administered to 190 healthy adults (95 women) with a mean age of 23.9 years (SD = 3.8) along with the Inventory of Interpersonal Problems, measures of negative affect and verbal intelligence. The majority of participants were university students (80%). Emotion recognition accuracy was assessed using unbiased hit rates. Results Negative correlations were observed between interpersonal agency and recognition of facial anger and disgust that were independent of participants' gender and negative affect. Interpersonal communion was not related to recognition of facial emotions. Discussion Poor identification of other people's facial signals of anger and disgust might be a factor contributing to interpersonal problems with social dominance and intrusiveness. Anger expressions signal goal obstruction and proneness to engage in conflict whereas facial disgust indicates a request to increase social distance. The interpersonal problem dimension of communion appears not to be linked to the ability to recognize emotions from facial expressions.
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Affiliation(s)
- Thomas Suslow
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany
- *Correspondence: Thomas Suslow,
| | - Alexander Lemster
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany
| | - Katja Koelkebeck
- Department of Psychiatry and Psychotherapy, LVR-Hospital Essen, Institute and Hospital of the University of Duisburg-Essen, Essen, Germany
| | - Anette Kersting
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany
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Wroblewski A, Hollandt M, Yang Y, Ridderbusch IC, Pietzner A, Szeska C, Lotze M, Wittchen HU, Heinig I, Pittig A, Arolt V, Koelkebeck K, Rothkopf CA, Adolph D, Margraf J, Lueken U, Pauli P, Herrmann MJ, Winkler MH, Ströhle A, Dannlowski U, Kircher T, Hamm AO, Straube B, Richter J. Sometimes I feel the fear of uncertainty: How intolerance of uncertainty and trait anxiety impact fear acquisition, extinction and the return of fear. Int J Psychophysiol 2022; 181:125-140. [PMID: 36116610 DOI: 10.1016/j.ijpsycho.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 08/31/2022] [Accepted: 09/06/2022] [Indexed: 11/17/2022]
Abstract
It is hypothesized that the ability to discriminate between threat and safety is impaired in individuals with high dispositional negativity, resulting in maladaptive behavior. A large body of research investigated differential learning during fear conditioning and extinction protocols depending on individual differences in intolerance of uncertainty (IU) and trait anxiety (TA), two closely-related dimensions of dispositional negativity, with heterogenous results. These might be due to varying degrees of induced threat/safety uncertainty. Here, we compared two groups with high vs. low IU/TA during periods of low (instructed fear acquisition) and high levels of uncertainty (delayed non-instructed extinction training and reinstatement). Dependent variables comprised subjective (US expectancy, valence, arousal), psychophysiological (skin conductance response, SCR, and startle blink), and neural (fMRI BOLD) measures of threat responding. During fear acquisition, we found strong threat/safety discrimination for both groups. During early extinction (high uncertainty), the low IU/TA group showed an increased physiological response to the safety signal, resulting in a lack of CS discrimination. In contrast, the high IU/TA group showed strong initial threat/safety discrimination in physiology, lacking discriminative learning on startle, and reduced neural activation in regions linked to threat/safety processing throughout extinction training indicating sustained but non-adaptive and rigid responding. Similar neural patterns were found after the reinstatement test. Taken together, we provide evidence that high dispositional negativity, as indicated here by IU and TA, is associated with greater responding to threat cues during the beginning of delayed extinction, and, thus, demonstrates altered learning patterns under changing environments.
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Affiliation(s)
- Adrian Wroblewski
- Department of Psychiatry and Psychotherapy, Center for Mind, Brain and Behavior - CMBB, Philipps-University Marburg, Germany.
| | - Maike Hollandt
- Department of Psychology, University of Greifswald, Germany
| | - Yunbo Yang
- Department of Psychiatry and Psychotherapy, Center for Mind, Brain and Behavior - CMBB, Philipps-University Marburg, Germany
| | - Isabelle C Ridderbusch
- Department of Psychiatry and Psychotherapy, Center for Mind, Brain and Behavior - CMBB, Philipps-University Marburg, Germany
| | - Anne Pietzner
- Department of Psychology, University of Greifswald, Germany
| | | | - Martin Lotze
- Functional Imaging Unit, Diagnostic Radiology and Neuroradiology of the University Medicine Greifswald, Germany
| | - Hans-Ulrich Wittchen
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Germany; Department of Psychiatry and Psychotherapy, University Hospital, Ludwig Maximilians University Munich, Germany
| | - Ingmar Heinig
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Germany
| | - Andre Pittig
- Translational Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
| | - Volker Arolt
- Institute for Translational Psychiatry, University of Münster, Germany
| | - Katja Koelkebeck
- LVR-Hospital Essen, Department of Psychiatry and Psychotherapy, University of Duisburg-Essen, Germany
| | | | - Dirk Adolph
- Mental Health Research and Treatment Center, Ruhr-University Bochum, Germany
| | - Jürgen Margraf
- Mental Health Research and Treatment Center, Ruhr-University Bochum, Germany
| | - Ulrike Lueken
- Center for Mental Health, Department of Psychiatry, Psychosomatics, and Psychotherapy, University Hospital Wuerzburg, Germany; Department of Psychology, Humboldt-Universität zu Berlin, Germany
| | - Paul Pauli
- Department of Psychology I, Biological Psychology, Clinical Psychology, and Psychotherapy, University of Würzburg, Germany
| | - Martin J Herrmann
- Center for Mental Health, Department of Psychiatry, Psychosomatics, and Psychotherapy, University Hospital Wuerzburg, Germany
| | - Markus H Winkler
- Department of Psychology I, Biological Psychology, Clinical Psychology, and Psychotherapy, University of Würzburg, Germany
| | - Andreas Ströhle
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Germany corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin und Berliner Institut für Gesundheitsforschung, Germany
| | - Udo Dannlowski
- Institute for Translational Psychiatry, University of Münster, Germany
| | - Tilo Kircher
- Department of Psychiatry and Psychotherapy, Center for Mind, Brain and Behavior - CMBB, Philipps-University Marburg, Germany
| | - Alfons O Hamm
- Department of Psychology, University of Greifswald, Germany
| | - Benjamin Straube
- Department of Psychiatry and Psychotherapy, Center for Mind, Brain and Behavior - CMBB, Philipps-University Marburg, Germany
| | - Jan Richter
- Department of Psychology, University of Greifswald, Germany
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9
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Günther V, Kropidlowski A, Schmidt FM, Koelkebeck K, Kersting A, Suslow T. Attentional processes during emotional face perception in social anxiety disorder: A systematic review and meta-analysis of eye-tracking findings. Prog Neuropsychopharmacol Biol Psychiatry 2021; 111:110353. [PMID: 34000291 DOI: 10.1016/j.pnpbp.2021.110353] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 05/11/2021] [Accepted: 05/12/2021] [Indexed: 01/04/2023]
Abstract
Background In recent years, a growing body of eye-tracking research has investigated gaze behavior in individuals with social anxiety during the visual perception of emotional stimuli. The aim of this article was to review and synthesize studies examining attention orientation in patients with clinical social anxiety by means of eye-tracking methodology. Methods Through a systematic search, 30 articles were identified, including 11 studies in which single emotional faces were used as stimuli and seven eligible studies in which threatening faces were paired with neutral stimuli. Meta-analyses were conducted to compare prolonged eye-contact behavior and early attentional biases to threats in individuals with social anxiety disorder (SAD) and healthy controls. Results Moderate group differences were revealed for single face viewing studies, with SAD patients showing significantly reduced eye contact with negative (Hedges' g = -0.67) and positive emotional faces (g = -0.49) compared to that of healthy participants. Type of task and duration of stimulus presentation were (marginally) significant moderators of between-study variance in effect size. Small but significant group differences were found for early attentional biases toward angry faces versus neutral stimuli (g = 0.21) but not toward happy faces versus neutral stimuli (g = 0.05). Preliminary evidence for a hyperscanning strategy in SAD patients relative to healthy controls emerged (g = 0.42). Limitations The number of included studies with face pairings was low, and two studies were excluded due to unavailable data. Conclusions Our results suggest that eye contact avoidance with emotional faces is a prominent feature in SAD patients. Patients might benefit from guidance to learn to make adequate eye contact during therapeutic interventions, such as exposure therapy. SAD patients demonstrated slightly heightened attention allocation toward angry faces relative to that of healthy participants during early processing stages. Threat biases can be potential targets for attention modification training as an adjuvant to other treatments. Future research on early attentional processes may benefit from improved arrangements of paired stimuli to increase the psychometric properties of initial attention indices.
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Affiliation(s)
- Vivien Günther
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany
| | - Adam Kropidlowski
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany
| | - Frank Martin Schmidt
- Department of Psychiatry and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany
| | - Katja Koelkebeck
- LVR-Hospital Essen, Institute and Hospital of the University of Duisburg-Essen, Department of Psychiatry and Psychotherapy, Essen, Germany
| | - Anette Kersting
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany
| | - Thomas Suslow
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany.
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10
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Baessler F, Sartorius N, Javed A, Tasman A, Coskun B, Frydecka D, Kazakova O, Sampogna G, Zhabenko O, Koelkebeck K, Hepdurgun C, Zafar A, Fiorillo A. Training the trainers: Finding new educational opportunities in the virtual world. Asia Pac Psychiatry 2021; 13:e12499. [PMID: 34873842 DOI: 10.1111/appy.12499] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 10/05/2021] [Indexed: 01/11/2023]
Abstract
The COVID-19 pandemic has disrupted scientific gatherings and conferences, opening up opportunities for virtual learning platforms. Realizing the potential of online academic exchanges, the World Psychiatric Association (WPA) also developed virtual avenues and information systems for capacity building of mental health professionals across the world. Among its first such initiatives, the WPA organized a virtual Train the Trainers workshop, where 123 psychiatrists, psychiatric trainees, and educators from 45 countries participated. The innovative and interactive workshop allowed participants to get to know each other, exchange educational and professional experiences, and ask questions or receive advice from experts. Keynote speakers, including WPA President Prof. Afzal Javed and Prof. Norman Sartorius, stressed upon the importance of finding innovative solutions in psychiatry training and the need to improve teaching and training in the field of psychiatry, especially in the provision of leadership and communication skills. Online training methods can provide easy access to academics and students while reducing the organizational and logistical costs. They have the potential to improve educational equality and allow the voice of the underprivileged scientists to be heard across the globe. The devastating impact on access to mental health services during COVID-19 underscores the urgent need for online training, particularly in countries where the ratio of psychiatrists to patients is inadequate and doctors concentrate more on treatment than on research and education. Virtual educational interventions could prove incredibly useful in the future just as they are being successfully utilized in local and regional contexts during the pandemic.
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Affiliation(s)
- Franziska Baessler
- Center for Psychosocial Medicine, Department of General, Internal and Psychosomatic Medicine, Heidelberg University Hospital, Heidelberg, Germany.,Heidelberg Academy of Sciences and Humanities, Heidelberg, Germany
| | - Norman Sartorius
- Association for the Improvement of Mental Health Programmes (AMH), Geneva, Switzerland
| | - Afzal Javed
- Pakistan Psychiatric Research Centre, Fountain House, Lahore, Pakistan
| | - Allan Tasman
- Department of Psychiatry and Behavioural Sciences, University of Louisville, Louisville, Kentucky, USA
| | - Bulent Coskun
- Association for Community Mental Health Promotion, Kocaeli, Turkey
| | - Dorota Frydecka
- Department of Psychiatry, Wroclaw Medical University, Wroclaw, Poland
| | - Olga Kazakova
- Master's Programme in Public Health, Faculty of Medicine, Lund University, Lund, Sweden
| | - Gaia Sampogna
- Department of Psychiatry, University of Campania L. Vanvitelli, Naples, Italy
| | | | - Katja Koelkebeck
- LVR-Hospital Essen, Department of Psychiatry and Psychotherapy, Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - Cenan Hepdurgun
- Department of Psychiatry, School of Medicine, Ege University, Izmir, Turkey
| | - Ali Zafar
- Center for Psychosocial Medicine, Department of General, Internal and Psychosomatic Medicine, Heidelberg University Hospital, Heidelberg, Germany.,Heidelberg Academy of Sciences and Humanities, Heidelberg, Germany
| | - Andrea Fiorillo
- Department of Psychiatry, University of Campania L. Vanvitelli, Naples, Italy
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11
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Pittig A, Heinig I, Goerigk S, Thiel F, Hummel K, Scholl L, Deckert J, Pauli P, Domschke K, Lueken U, Fydrich T, Fehm L, Plag J, Ströhle A, Kircher T, Straube B, Rief W, Koelkebeck K, Arolt V, Dannlowski U, Margraf J, Totzeck C, Schneider S, Neudeck P, Craske MG, Hollandt M, Richter J, Hamm A, Wittchen HU. Efficacy of temporally intensified exposure for anxiety disorders: A multicenter randomized clinical trial. Depress Anxiety 2021; 38:1169-1181. [PMID: 34293223 DOI: 10.1002/da.23204] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/25/2021] [Accepted: 07/12/2021] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The need to optimize exposure treatments for anxiety disorders may be addressed by temporally intensified exposure sessions. Effects on symptom reduction and public health benefits should be examined across different anxiety disorders with comorbid conditions. METHODS This multicenter randomized controlled trial compared two variants of prediction error-based exposure therapy (PeEx) in various anxiety disorders (both 12 sessions + 2 booster sessions, 100 min/session): temporally intensified exposure (PeEx-I) with exposure sessions condensed to 2 weeks (n = 358) and standard nonintensified exposure (PeEx-S) with weekly exposure sessions (n = 368). Primary outcomes were anxiety symptoms (pre, post, and 6-months follow-up). Secondary outcomes were global severity (across sessions), quality of life, disability days, and comorbid depression. RESULTS Both treatments resulted in substantial improvements at post (PeEx-I: dwithin = 1.50, PeEx-S: dwithin = 1.78) and follow-up (PeEx-I: dwithin = 2.34; PeEx-S: dwithin = 2.03). Both groups showed formally equivalent symptom reduction at post and follow-up. However, time until response during treatment was 32% shorter in PeEx-I (median = 68 days) than PeEx-S (108 days; TRPeEx-I = 0.68). Interestingly, drop-out rates were lower during intensified exposure. PeEx-I was also superior in reducing disability days and improving quality of life at follow-up without increasing relapse. CONCLUSIONS Both treatment variants focusing on the transdiagnostic exposure-based violation of threat beliefs were effective in reducing symptom severity and disability in severe anxiety disorders. Temporally intensified exposure resulted in faster treatment response with substantial public health benefits and lower drop-out during the exposure phase, without higher relapse. Clinicians can expect better or at least comparable outcomes when delivering exposure in a temporally intensified manner.
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Affiliation(s)
- Andre Pittig
- Department of Psychology (Biological Psychology Clinical Psychology, and Psychotherapy), Center of Mental Health, University of Würzburg, Würzburg, Germany.,Institute of Clinical Psychology & Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Ingmar Heinig
- Institute of Clinical Psychology & Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Stephan Goerigk
- Institute of Clinical Psychology & Psychotherapy, Technische Universität Dresden, Dresden, Germany.,Department of Psychiatry and Psychotherapy, University Hospital, Ludwig Maximilians University, Munich, Germany
| | - Freya Thiel
- Institute of Clinical Psychology & Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Katrin Hummel
- Institute of Clinical Psychology & Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Lucie Scholl
- Institute of Clinical Psychology & Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Jürgen Deckert
- Department of Psychiatry, Psychosomatics, and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Würzburg, Germany
| | - Paul Pauli
- Department of Psychology (Biological Psychology Clinical Psychology, and Psychotherapy), Center of Mental Health, University of Würzburg, Würzburg, Germany
| | - Katharina Domschke
- Department of Psychiatry, Psychosomatics, and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Würzburg, Germany.,Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Center for Basics in NeuroModulation, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ulrike Lueken
- Department of Psychiatry, Psychosomatics, and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Würzburg, Germany.,Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Thomas Fydrich
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Lydia Fehm
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Jens Plag
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Andreas Ströhle
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Tilo Kircher
- Department of Psychiatry and Psychotherapy & Center for Mind Brain and Behavior - CMBB, Philipps-University Marburg, Marburg, Germany
| | - Benjamin Straube
- Department of Psychiatry and Psychotherapy & Center for Mind Brain and Behavior - CMBB, Philipps-University Marburg, Marburg, Germany
| | - Winfried Rief
- Department of Clinical Psychology and Psychotherapy, Faculty of Psychology & Center for Mind, Brain and Behavior - CMBB, Philipps-University of Marburg, Marburg, Germany
| | - Katja Koelkebeck
- Institute for Translational Psychiatry, University of Muenster, Muenster, Germany
| | - Volker Arolt
- Institute for Translational Psychiatry, University of Muenster, Muenster, Germany
| | - Udo Dannlowski
- Institute for Translational Psychiatry, University of Muenster, Muenster, Germany
| | - Jürgen Margraf
- Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Bochum, Germany
| | - Christina Totzeck
- Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Bochum, Germany
| | - Silvia Schneider
- Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Bochum, Germany
| | - Peter Neudeck
- Institute of Clinical Psychology & Psychotherapy, Technische Universität Dresden, Dresden, Germany.,Protect-AD Study Site Cologne, Cologne, Germany
| | - Michelle G Craske
- Department of Psychology and Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, USA
| | - Maike Hollandt
- Department of Psychology, Biological and Clinical Psychology, University of Greifswald, Greifswald, Germany
| | - Jan Richter
- Department of Psychology, Biological and Clinical Psychology, University of Greifswald, Greifswald, Germany
| | - Alfons Hamm
- Department of Psychology, Biological and Clinical Psychology, University of Greifswald, Greifswald, Germany
| | - Hans-Ulrich Wittchen
- Institute of Clinical Psychology & Psychotherapy, Technische Universität Dresden, Dresden, Germany.,Department of Psychiatry and Psychotherapy, University Hospital, Ludwig Maximilians University, Munich, Germany
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12
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Koelkebeck K, Bauer J, Suslow T, Ohrmann P. Case of Asperger's Syndrome and Lesion of the Right Amygdala: Deficits in Implicit and Explicit Fearful Face Recognition. Front Psychol 2021; 12:677549. [PMID: 34239482 PMCID: PMC8258258 DOI: 10.3389/fpsyg.2021.677549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 05/24/2021] [Indexed: 11/26/2022] Open
Abstract
Introduction: Studies of brain-damaged patients revealed that amygdala lesions cause deficits in the processing and recognition of emotional faces. Patients with autism spectrum disorders (ASD) have similar deficits also related to dysfunctions of the limbic system including the amygdala. Methods: We investigated a male patient who had been diagnosed with Asperger's syndrome. He also presented with a lesion of the right mesial temporal cortex, including the amygdala. We used functional magnetic resonance imaging (fMRI) to investigate neuronal processing during a passive viewing task of implicit and explicit emotional faces. Clinical assessment included a facial emotion recognition task. Results: There was no amygdala activation on both sides during the presentation of masked emotional faces compared to the no-face control condition. Presentation of unmasked happy and angry faces activated the left amygdala compared to the no-face control condition. There was no amygdala activation in response to unmasked fearful faces on both sides. In the facial emotion recognition task, the patient biased positive and neutral expressions as negative. Conclusions: This case report describes a male patient with right amygdala damage and an ASD. He displayed a non-response of the amygdala to fearful faces and tended to misinterpret fearful expressions. Moreover, a non-reactivity of both amygdalae to emotional facial expressions at an implicit processing level was revealed. It is discussed whether the deficient implicit processing of facial emotional information and abnormalities in fear processing could contribute and aggravate the patient's impairments in social behavior and interaction.
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Affiliation(s)
- Katja Koelkebeck
- Department of Psychiatry and Psychotherapy, School of Medicine, University of Muenster, Muenster, Germany
| | - Jochen Bauer
- Department of Psychiatry and Psychotherapy, School of Medicine, University of Muenster, Muenster, Germany
| | - Thomas Suslow
- Department of Psychiatry and Psychotherapy, School of Medicine, University of Muenster, Muenster, Germany
| | - Patricia Ohrmann
- Department of Psychiatry and Psychotherapy, School of Medicine, University of Muenster, Muenster, Germany
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13
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Koelkebeck K, Baessler F, Bittner R, Frodl T, Gradl-Dietsch G, Janowitz D, Jordan KD, Kluge I, Matthes O, Pinilla S, Robitzsch A, Strauß M, Speerforck S, Watzke S, Spitzer P. [Medical education in psychosocial disciplines in times of the COVID-19 pandemic - first experiences]. Fortschr Neurol Psychiatr 2021; 89:573-577. [PMID: 33946123 DOI: 10.1055/a-1480-7258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AIM In specialties that heavily rely on communication skills such as psychiatry, psychotherapy and psychosomatic medicine, teaching in times of the COVID-19 pandemic is especially challenging. In this overview, educators and course directors report their experiences in eteaching and share their innovative solutions. METHODS We present a collection of methods that relate to teaching and assessment as well as student activation. RESULTS A range of helpful tools for teaching were compiled. This includes instructional videos with simulated patients, structured homework to document a mental status examination, structured hand-offs, and practical examinations in video format. Motivational techniques include podcasts with interviews with clinicians and patients and teaching with the use of cinematic material. DISCUSSION Switching to online formats creates opportunities and advantages for the advancement of time- and location-independent learning. A fast conversion in this direction might also pose some disadvantages. A direct patient-student interaction is critical for engaging with transference, countertransference and situational aspects for teaching in psychosocial disciplines. Empirical studies of the effectiveness of these newly developed formats and faculty development for digital teaching are necessary.
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Affiliation(s)
- Katja Koelkebeck
- LVR-Klinikum Essen, Klinik für Psychiatrie und Psychotherapie, Kliniken und Institut der Universität Duisburg-Essen
| | - Franziska Baessler
- Universität Heidelberg, Klinik für Allgemeine Innere Medizin und Psychosomatik
| | - Robert Bittner
- Universität Frankfurt am Main, Klinik für Psychiatrie, Psychosomatik und Psychotherapie
| | - Thomas Frodl
- Universität Magdeburg, Medizinische Fakultät, Universitätsklinik für Psychiatrie und Psychotherapie
| | - Gertraut Gradl-Dietsch
- Klinik für Kinder- und Jugendpsychiatrie, -psychotherapie und -psychosomatik, Kliniken und Institut der Universität Duisburg-Essen
| | - Deborah Janowitz
- Universität Greifswald, Klinik für Psychiatrie und Psychotherapie
| | - Katja-Daniela Jordan
- Universität Zürich, Universitätsspital Zürich, Klinik für Konsiliarpsychiatrie und Psychosomatik
| | - Ina Kluge
- Philipps-Universität Marburg, Fachbereich Medizin, Klinik für Psychiatrie und Psychotherapie, Standort Marburg
| | - Oliver Matthes
- Universität Zürich, Universitätsspital Zürich, Klinik für Konsiliarpsychiatrie und Psychosomatik
| | - Severin Pinilla
- Universität Bern, Universitätsklinik für Alterspsychiatrie und Psychotherapie
| | - Anita Robitzsch
- Klinik für Psychosomatische Medizin und Psychotherapie, Kliniken und Institut der Universität Duisburg-Essen
| | - Maria Strauß
- Universitätsklinikum Leipzig, Klinik für Psychiatrie und Psychotherapie
| | - Sven Speerforck
- Universitätsklinikum Leipzig, Klinik für Psychiatrie und Psychotherapie
| | - Stefan Watzke
- Martin-Luther-Universität Halle-Wittenberg, Medizinische Fakultät, Klinik und Poliklinik für Psychiatrie, Psychotherapie und Psychosomatik
| | - Philipp Spitzer
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Medizinische Fakultät, Klinik für Psychiatrie und Psychotherapie
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14
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Baessler F, Zafar A, Gargot T, da Costa MP, Biskup EM, De Picker L, Koelkebeck K, Riese F, Ryland H, Kazakova O, Birkle S, Kanellopoulos T, Grassl R, Braicu A, Schultz JH, Casanova Dias M. Psychiatry training in 42 European countries: A comparative analysis. Eur Neuropsychopharmacol 2021; 46:68-82. [PMID: 33678470 DOI: 10.1016/j.euroneuro.2021.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 12/15/2020] [Accepted: 02/09/2021] [Indexed: 10/22/2022]
Abstract
Psychiatry qualifications are automatically recognized among European Union (EU) countries despite differences in national training programs. A widening gap between the number of psychiatrists, their competencies and the growing burden of mental illnesses in Europe has renewed calls for international standardization of training. Comprehensive information about training programs is missing, which limits thorough comparisons and undermines development of an actionable strategy to improve and harmonize psychiatry training. This study describes and compares the existing postgraduate psychiatry programs in 42 countries in the European region. Representatives of national psychiatry associations completed a semi-structured, 58-item questionnaire. Training structure and working conditions of each country were compared with population needs calculated by the World Health Organization to determine the European mean and contrasted among pre-2004 and post-2004 EU members and countries with unrecognized qualifications. Differences were tested with nonparametric (Wilcoxon) and parametric (Anova) tests. Median training duration was 60 months, significantly shorter in countries with unrecognized qualifications (48 months, χ²16.5, p < 0.001). In 80% of the countries, placement in a non-psychiatric specialty such as neurology or internal medicine was mandatory. Only 17 countries (40%) stipulated a one-month rotation in substance abuse and 11 (26%) in old-age psychiatry. The overall deficit of training versus population need was 22% for substance abuse and 15% for old-age psychiatry. Salaries were significantly higher in pre-2004 EU members (χ²22.9, p < 0.001) with the highest in Switzerland (€5,000). Significant variations in curricula, training structure and salaries exist in Europe. Harmonization of training standards could offer significant benefits for improving mental healthcare.
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Affiliation(s)
- Franziska Baessler
- Center for Psychosocial Medicine, Department of General Internal and Psychosomatic Medicine, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany.
| | - Ali Zafar
- Center for Psychosocial Medicine, Department of General Internal and Psychosomatic Medicine, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Thomas Gargot
- Psychiatrie de l'Enfant et de l'Adolescent, Pitié Salpêtriére - Charles Foix, Assistance Publique Hôpitaux de Paris, 47/83 boulevard de l'Hôpital, 75013, Paris, France; ISIR, Sorbonne Université, 4 Place Jussieu, 75005, Paris, France; CHART Laboratory - EA 4004, TIM, Paris 8 University, 93526, Saint Denis, France
| | - Mariana Pinto da Costa
- Unit for Social and Community Psychiatry (WHO Collaborating Centre for Mental Health Services Development), Queen Mary University of London, London, United Kingdom; Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal; Hospital de Magalhães Lemos, Porto, Portugal
| | - Ewelina Maria Biskup
- Shanghai University of Medicine and Health Sciences Basic Medical College, Shanghai, China; Division of Internal Medicine, University of Basel, Basel, Switzerland
| | - Livia De Picker
- Collaborative Antwerp Psychiatric Research Institute, University of Antwerp, Antwerp, Belgium; University Psychiatric Department Campus Duffel, Duffel, Belgium
| | - Katja Koelkebeck
- LVR-Hospital Essen, Department of Psychiatry and Psychotherapy, Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - Florian Riese
- University Hospital of Psychiatry Zurich, Lenggstrasse 31, 8032 Zurich, Switzerland
| | - Howard Ryland
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Olga Kazakova
- Psychiatric Department, Psychiatric Clinic of Minsk City, Minsk, Belarus
| | - Sarah Birkle
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Germany
| | - Thanos Kanellopoulos
- Center for Adolescent Medicine and UNESCO Chair on Adolescent Health Care, First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, Aghia Sophia Children`s Hospital, Athens, Greece
| | - Roland Grassl
- University Clinic for Child and Adolescent Psychiatry and Psychotherapy, Vienna, Austria
| | - Alina Braicu
- National Centre for Mental Health, BSMHFT, Birmingham, UK
| | - Jobst-Hendrik Schultz
- Center for Psychosocial Medicine, Department of General Internal and Psychosomatic Medicine, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Marisa Casanova Dias
- Department of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK; Section of Women's Mental Health, Institute of Psychiatry, Psychology, and Neurosciences, King's College London, London, UK
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15
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Koelkebeck K, Andlauer O, Asztalos M, Jovanovic N, Kazakova O, Naughton S, Pantovic-Stefanovic M, Riese F, Pinto da Costa M. Research by Psychiatric Trainees and Early Career Psychiatrists-Results of a Survey From 34 Countries in Europe. Front Psychiatry 2021; 12:718669. [PMID: 34566719 PMCID: PMC8461014 DOI: 10.3389/fpsyt.2021.718669] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 06/01/2021] [Accepted: 08/02/2021] [Indexed: 12/01/2022] Open
Abstract
Clinical psychiatric practice should be intricately linked with research work. Although psychiatric trainees and early career psychiatrists (ECPs) are in the frontline of clinical services, little is known about how much access they have to research opportunities. A semi-structured questionnaire of 35 questions-exploring research goals achieved, facilitators and barriers as well as personal context-was sent to psychiatric trainees and ECPs across Europe. The survey was disseminated through the local committees of the main professional psychiatric societies in Europe. A total of 258 individuals working in 34 European countries participated. The majority (69.8%) were psychiatric trainees within training in adult psychiatry. Most participants (69.0%) were highly interested in research, but faced major obstacles toward their research activities, such as lack of time and funding. They were highly satisfied with mentoring and publishing papers. Only half of the participants, however, had already published a scientific article, and only a few have been able to contribute to randomized clinical trials (20.9%). A large proportion of participants (87.2%) reported to conduct research after or during a mixture of working hours and after working hours. Only one tenth ever received a grant for their work. These findings highlight that the key barriers for the performance of research are lack of time and funding. Psychiatric trainees and ECPs are motivated to perform research but need support and regular opportunities.
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Affiliation(s)
- Katja Koelkebeck
- Department of Psychiatry and Psychotherapy, Medical Faculty, LVR-Hospital Essen, University of Duisburg-Essen, Essen, Germany.,Center for Translational Neuro- and Behavioral Sciences, University Duisburg-Essen, Essen, Germany
| | - Olivier Andlauer
- Early and Quick Intervention in Psychosis (EQUIP), East London NHS Foundation Trust, Donald Winnicot Centre, London, United Kingdom.,Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | | | - Nikolina Jovanovic
- Unit for Social and Community Psychiatry, World Health Organization (WHO) Collaborating Centre for Mental Health Services Development, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | | | | | - Maja Pantovic-Stefanovic
- Department for Affective Disorders, Clinic of Psychiatry, University Clinical Center of Serbia, Belgrade, Serbia
| | - Florian Riese
- University Research Priority Program "Dynamics of Healthy Aging", University of Zurich, Zurich, Switzerland
| | - Mariana Pinto da Costa
- South London and Maudsley NHS Foundation Trust, London, United Kingdom.,Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Porto, Portugal
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16
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Koelkebeck K, Dannlowski U, Ohrmann P, Suslow T, Murai T, Bauer J, Pedersen A, Matsukawa N, Son S, Haidl T, Miyata J. Gray matter volume reductions in patients with schizophrenia: A replication study across two cultural backgrounds. Psychiatry Res Neuroimaging 2019; 292:32-40. [PMID: 31499256 DOI: 10.1016/j.pscychresns.2019.08.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 08/21/2019] [Accepted: 08/30/2019] [Indexed: 01/14/2023]
Abstract
Structural gray matter (GM) volume reductions in patients with schizophrenia have rarely been replicated across two different sites, the impact of culture and clinical characteristics remains unresolved. Hence, we assessed GM volume reductions in patients with schizophrenia using 3 T magnetic resonace imaging to replicate results across two independent and culturally different backgrounds (Germany, Japan), and to investigate the impact of brain volume reductions on clinical characteristics. In total, 163 German (80 patients) and 203 Japanese (83 patients) participants were included in the analysis. Voxel-based morphometry (VBM) was used to investigate structural differences between the groups and across the two sites, comparing local GM volumes. Clinical variables were used to analyze effects unrelated to the socio-cultural background. Across both data sets, widespread GM reductions in frontal and temporal cortical parts were found between patients and controls, indicating strong effects of diagnosis and only small effects of site. The investigation of clinical characteristics revealed the strongest effects for chlorpromazine equivalents on GM volume reductions primarily in the Japanese sample. Although the effects of site are small, several brain regions do not overlap between the two groups. Thus, GM may be affected differently at the two sites in patients with schizophrenia.
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Affiliation(s)
- Katja Koelkebeck
- Department of Psychiatry and Psychotherapy, University of Muenster, School of Medicine, Albert-Schweitzer-Campus 1, Building A9, 48149 Muenster, Germany.
| | - Udo Dannlowski
- Department of Psychiatry and Psychotherapy, University of Muenster, School of Medicine, Albert-Schweitzer-Campus 1, Building A9, 48149 Muenster, Germany
| | - Patricia Ohrmann
- Department of Psychiatry and Psychotherapy, University of Muenster, School of Medicine, Albert-Schweitzer-Campus 1, Building A9, 48149 Muenster, Germany
| | - Thomas Suslow
- University of Leipzig, Department of Psychosomatic Medicine and Psychotherapy, Semmelweisstrasse 10, 04103 Leipzig, Germany
| | - Toshiya Murai
- Department of Psychiatry, University of Kyoto, School of Medicine, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Jochen Bauer
- Institute of Clinical Radiology, Medical Faculty - University of Muenster - and University Hospital Muenster, Albert-Schweitzer-Campus 1, Building A1, 48149 Muenster, Germany
| | - Anya Pedersen
- Clinical Psychology and Psychotherapy, University of Kiel, Olshausenstrasse 62, 24118 Kiel, Germany
| | - Noriko Matsukawa
- Department of Psychiatry, University of Kyoto, School of Medicine, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Shuraku Son
- Department of Psychiatry, University of Kyoto, School of Medicine, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Theresa Haidl
- Department of Psychiatry and Psychotherapy, University of Cologne, Kerpener Strasse 62, 50934 Cologne, Germany
| | - Jun Miyata
- Department of Psychiatry, University of Kyoto, School of Medicine, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
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17
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Fasshauer T, Sprenger A, Silling K, Silberg JE, Vosseler A, Minoshita S, Satoh S, Dorr M, Koelkebeck K, Lencer R. Visual exploration of emotional faces in schizophrenia using masks from the Japanese Noh theatre. Neuropsychologia 2019; 133:107193. [PMID: 31518577 DOI: 10.1016/j.neuropsychologia.2019.107193] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 09/09/2019] [Accepted: 09/09/2019] [Indexed: 01/21/2023]
Abstract
Studying eye movements during visual exploration is widely used to investigate visual information processing in schizophrenia. Here, we used masks from the Japanese Noh theatre to study visual exploration behavior during an emotional face recognition task and a brightness evaluation control task using the same stimuli. Eye movements were recorded in 25 patients with schizophrenia and 25 age-matched healthy controls while participants explored seven photos of Japanese Noh masks tilted to seven different angles. Additionally, participants were assessed on seven upright binary black and white pictures of these Noh masks (Mooney-like pictures), seven Upside-down pictures (180° upside-down turned Mooneys), and seven Neutral pictures. Participants either had to indicate whether they had recognized a face and its emotional expression, or they had to evaluate the brightness of the picture (total N = 56 trials). We observed a clear effect of inclination angle of Noh masks on emotional ratings (p < 0.001) and visual exploration behavior in both groups. Controls made larger saccades than patients when not being able to recognize a face in upside-down Mooney pictures (p < 0.01). Patients also made smaller saccades when exploring pictures for brightness (p < 0.05). Exploration behavior in patients was related to depressive symptom expression during emotional face recognition but not during brightness evaluation. Our findings suggest that visual exploration behavior in patients with schizophrenia is less flexible than in controls depending on the specific task requirements, specifically when exploring physical aspects of the environment.
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Affiliation(s)
- Teresa Fasshauer
- Department of Psychiatry and Psychotherapy, University of Muenster, Germany
| | - Andreas Sprenger
- Department of Neurology, University of Luebeck, Germany; Department of Psychology, University of Luebeck, Germany
| | - Karen Silling
- Department of Psychiatry and Psychotherapy, University of Muenster, Germany
| | | | - Anne Vosseler
- Department of Psychiatry and Psychotherapy, University of Muenster, Germany
| | - Seiko Minoshita
- Department of Psychology, Kawamura Gakuen Woman's University, Abiko, Chiba, Japan
| | - Shinji Satoh
- Institute of Social Psychiatry, 8-12 Onogawa, Tsukuba, Ibaraki, Japan
| | - Michael Dorr
- Chair of Human-Machine Communication, Technical University of Munich, Germany
| | - Katja Koelkebeck
- Department of Psychiatry and Psychotherapy, University of Muenster, Germany; Otto-Creutzfeldt Center for Cognitive and Behavioral Neuroscience, University of Muenster, Germany
| | - Rebekka Lencer
- Department of Psychiatry and Psychotherapy, University of Muenster, Germany; Otto-Creutzfeldt Center for Cognitive and Behavioral Neuroscience, University of Muenster, Germany.
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18
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Koelkebeck K, Vosseler A, Kohl W, Fasshauer T, Lencer R, Satoh S, Kret ME, Minoshita S. Masked ambiguity - Emotion identification in schizophrenia and major depressive disorder. Psychiatry Res 2018; 270:852-860. [PMID: 30551335 DOI: 10.1016/j.psychres.2018.10.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 10/16/2018] [Accepted: 10/17/2018] [Indexed: 11/29/2022]
Abstract
Both patients with schizophrenia and with a major depressive disorder (MDD) display deficits in identifying facial expressions of emotion during acute phases of their illness. However, specific deficit patterns have not yet been reliably demonstrated. Tasks that employ emotionally ambiguous stimuli have recently shown distinct deficit patterns in patients with schizophrenia compared to other mental disorders as well as healthy controls. We here investigate whether a task which uses an ambiguous Japanese (Noh) mask and a corresponding human stimulus generates distinctive emotion attribution patterns in thirty-two Caucasian patients with schizophrenia, matched MDD patients and healthy controls. Results show that patients with schizophrenia displayed reaction time disadvantages compared to healthy controls while identifying sadness and anger. MDD patients were more likely to label stimuli with basic compared to subtle emotional expressions. Moreover, they showed more difficulties assigning emotions to the human stimulus than to the Noh mask. IQ, age and cognitive functioning did not modulate these results. Because overall group differences were not observed, this task is not suitable for diagnosing patients. However, the subtle differences that did emerge might give therapists handles that can be used in therapy.
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Affiliation(s)
- Katja Koelkebeck
- Department of Psychiatry and Psychotherapy, Muenster University, Medical School, Albert-Schweitzer-Campus 1, Building A9, Muenster 48149, Germany.
| | - Anne Vosseler
- Department of Psychiatry and Psychotherapy, Muenster University, Medical School, Albert-Schweitzer-Campus 1, Building A9, Muenster 48149, Germany.
| | - Waldemar Kohl
- Department of Psychiatry and Psychotherapy, Muenster University, Medical School, Albert-Schweitzer-Campus 1, Building A9, Muenster 48149, Germany.
| | - Teresa Fasshauer
- Department of Psychiatry and Psychotherapy, Muenster University, Medical School, Albert-Schweitzer-Campus 1, Building A9, Muenster 48149, Germany.
| | - Rebekka Lencer
- Department of Psychiatry and Psychotherapy, Muenster University, Medical School, Albert-Schweitzer-Campus 1, Building A9, Muenster 48149, Germany.
| | - Shinji Satoh
- Institute of Social Psychiatry, 8-12 Onogawa, Tsukuba, Ibaraki, Japan.
| | - Mariska E Kret
- Leiden University, Cognitive Psychology Unit, Wassenaarseweg 52, Leiden, AK, 2333, The Netherlands; Leiden Institute for Brain and Cognition, Postzone C2-S, P.O. Box 9600, Leiden, RC 2300, The Netherlands.
| | - Seiko Minoshita
- Department of Psychology, Kawamura Gakuen Women's University, Faculty of Liberal Arts, 1133 Sageto, Abiko-city, Chiba 270-1138, Japan.
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19
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Koelkebeck K, Kuegler L, Kohl W, Engell A, Lencer R. Social cognition in schizophrenia: The role of mentalizing in moral dilemma decision-making. Compr Psychiatry 2018; 87:171-178. [PMID: 30415199 DOI: 10.1016/j.comppsych.2018.10.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 10/02/2018] [Accepted: 10/28/2018] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Patients with schizophrenia have difficulties in several aspects of social cognition, e.g. emotion recognition and mentalizing. It is yet unclear if patients also show deficits in moral decision-making and whether the two aspects interact. Deficits in moral decision-making abilities might put patients in disadvantageous positions in every-day interactions. METHOD Twenty-five patients with schizophrenia and twenty-five matched healthy controls participated in six moral dilemma tasks, a standard moral competency test and two mentalizing tasks. In addition, we assessed psychopathology and empathy abilities. In a brief intervention patients were asked to empathize with characters in the moral dilemmas. We expected that the decisions made by patients with schizophrenia would be more out-come-oriented, i.e. utilitarian, as compared to those made by healthy controls. RESULTS Patients and healthy controls did not decide significantly differently on the moral dilemmas and patients showed normal moral competencies. Deficits in mentalizing in patients were replicated. Only in a regression analysis, however, we were able to show that PANSS positive scores and the Comic Strip task scores contributed to the moral decisions. Empathy training did not have an altering influence on decision-making. DISCUSSION Although an overlap between social cognition and moral decision-making networks has been proposed, deficits in moral decision-making and explicit associations with mentalizing were not present in patients. Psychopathology together with mentalizing abilities, however, contributed to decision-making in patients. Our findings suggest that in schizophrenia some aspects, e.g. mentalizing, are more strongly impaired while other aspects, e.g. moral decision-making, are preserved. Further research is needed to elucidate the different aspects forming social cognition and their mutual contributions, specifically in schizophrenia.
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Affiliation(s)
- Katja Koelkebeck
- University of Muenster, School of Medicine, Department of Psychiatry and Psychotherapy, Muenster, Germany.
| | - Lisa Kuegler
- University of Muenster, School of Medicine, Department of Psychiatry and Psychotherapy, Muenster, Germany.
| | - Waldemar Kohl
- University of Muenster, School of Medicine, Department of Psychiatry and Psychotherapy, Muenster, Germany.
| | - Alva Engell
- University of Muenster, School of Medicine, Department of Psychiatry and Psychotherapy, Muenster, Germany.
| | - Rebekka Lencer
- University of Muenster, School of Medicine, Department of Psychiatry and Psychotherapy, Muenster, Germany.
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20
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Mergen J, Keizer A, Koelkebeck K, van den Heuvel MRC, Wagner H. Women with Anorexia Nervosa do not show altered tactile localization compared to healthy controls. Psychiatry Res 2018; 267:446-454. [PMID: 29980123 DOI: 10.1016/j.psychres.2018.06.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 05/23/2018] [Accepted: 06/05/2018] [Indexed: 02/03/2023]
Abstract
Body image disturbance is a key symptom of Anorexia Nervosa (AN). Previous studies found that women with AN overestimate their body size in comparison with healthy controls (HC), at least for unimodal measures involving either only visual input (e.g. distorted photographs technique) or only tactile input (e.g. tactile distance tasks). Distorted body representations are hypothesized to cause this misperception in AN. We here tested whether this overestimation remains present in a novel one-point-localization (OPL) task involving the mapping of a tactile stimulus onto a visual image. Two experiments compared the ability of 27 women with AN and 40 HC to accurately localize a tactile stimulus on a live image of their body. Women with AN and HC did not differ in their performance. Instead, participants in both groups showed systematic distortions in their localization performance. This study suggests that the mapping of a tactile stimulus does not involve a distorted body representation in women with AN compared to HC.
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Affiliation(s)
- Judith Mergen
- Department of Movement Science, Institute of Sport and Exercise Sciences, University of Münster, Münster, Germany; Otto Creutzfeldt Center for Cognitive and Behavioral Neuroscience, University of Münster, Münster, Germany.
| | - Anouk Keizer
- Department of Experimental Psychology, Faculty of Social and Behavioral Sciences, University Utrecht, Utrecht, Netherlands
| | - Katja Koelkebeck
- Otto Creutzfeldt Center for Cognitive and Behavioral Neuroscience, University of Münster, Münster, Germany; Department of Psychiatry and Psychotherapy, University of Münster, Münster, Germany
| | - Maarten R C van den Heuvel
- Department of Movement Science, Institute of Sport and Exercise Sciences, University of Münster, Münster, Germany
| | - Heiko Wagner
- Department of Movement Science, Institute of Sport and Exercise Sciences, University of Münster, Münster, Germany; Otto Creutzfeldt Center for Cognitive and Behavioral Neuroscience, University of Münster, Münster, Germany
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21
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Liedtke C, Kohl W, Kret ME, Koelkebeck K. Emotion recognition from faces with in- and out-group features in patients with depression. J Affect Disord 2018; 227:817-823. [PMID: 29689696 DOI: 10.1016/j.jad.2017.11.085] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 11/08/2017] [Accepted: 11/13/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Previous research has shown that context (e.g. culture) can have an impact on speed and accuracy when identifying facial expressions of emotion. Patients with a major depressive disorder (MDD) are known to have deficits in the identification of facial expressions, tending to give rather stereotypical judgments. While healthy individuals perceive situations which conflict with their own cultural values more negatively, this pattern would be even stronger in MDD patients, as their altered mood results in stronger biases. In this study we investigate the effect of cultural contextual cues on emotion identification in depression. METHODS Emotional faces were presented for 100ms to 34 patients with an MDD and matched controls. Stimulus faces were either covered by a cap and scarf (in-group condition) or by an Islamic headdress (niqab; out-group condition). Speed and accuracy were evaluated. RESULTS Results showed that across groups, fearful faces were identified faster and with higher accuracy in the out-group than in the in-group condition. Sadness was also identified more accurately in the out-group condition. In comparison, happy faces were more accurately (and tended to be faster) identified in the in-group condition. Furthermore, MDD patients were slower, yet not more accurate in identifying expressions of emotion compared to controls. LIMITATIONS All patients were on pharmacological treatment. Participants' political orientation was not included. The experiment differs from real life situations. CONCLUSION While our results underline findings that cultural context has a general impact on emotion identification, this effect was not found to be more prominent in patients with MDD.
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Affiliation(s)
- Carla Liedtke
- University of Muenster, School of Medicine, Department of Psychiatry and Psychotherapy, Albert-Schweitzer-Campus 1, Building A 9, 48149 Muenster, Germany.
| | - Waldemar Kohl
- University of Muenster, School of Medicine, Department of Psychiatry and Psychotherapy, Albert-Schweitzer-Campus 1, Building A 9, 48149 Muenster, Germany.
| | - Mariska Esther Kret
- Leiden University, Cognitive Psychology Unit and Leiden Institute of Brain and Cognition, Postzone C2-S, P.O.Box 9600, 2300 RC Leiden, The Netherlands.
| | - Katja Koelkebeck
- University of Muenster, School of Medicine, Department of Psychiatry and Psychotherapy, Albert-Schweitzer-Campus 1, Building A 9, 48149 Muenster, Germany.
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22
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Rojnic Kuzman M, Andlauer O, Burmeister K, Dvoracek B, Lencer R, Koelkebeck K, Maric NP, Nawka A, Pantovic-Stefanovic M, Riese F, Aukst Margetic B, Bosnjak D, Ruzic MC, Curkovic M, Grubsin J, Madzarac Z, Makaric P, Petric D, Radic K, Savic A. Effective assessment of psychotropic medication side effects using PsyLOG mobile application. Schizophr Res 2018; 192:211-212. [PMID: 28457773 DOI: 10.1016/j.schres.2017.04.038] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 04/19/2017] [Accepted: 04/22/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Martina Rojnic Kuzman
- Zagreb University Hospital Centre, Zagreb, Croatia; Zagreb School of Medicine, Zagreb, Croatia.
| | | | - Kai Burmeister
- Westphalian Wilhelms-University Muenster and University Hospital Muenster, Department of Psychiatry and Psychotherapy, Muenster, Germany
| | - Boris Dvoracek
- Institute of Neuropsychiatric Care (INEP), Prague, Czech Republic; Department of Psychiatry, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Rebekka Lencer
- Westphalian Wilhelms-University Muenster and University Hospital Muenster, Department of Psychiatry and Psychotherapy, Muenster, Germany
| | - Katja Koelkebeck
- Westphalian Wilhelms-University Muenster and University Hospital Muenster, Department of Psychiatry and Psychotherapy, Muenster, Germany
| | - Nadja P Maric
- School of Medicine, University of Belgrade, Belgrade, Serbia; Clinic for Psychiatry, Clinical Center of Serbia, Belgrade, Serbia
| | - Alexander Nawka
- Institute of Neuropsychiatric Care (INEP), Prague, Czech Republic; Department of Psychiatry, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | | | - Florian Riese
- Psychiatric University Hospital Zurich, Zurich, Switzerland
| | - Branka Aukst Margetic
- Zagreb University Hospital Centre, Zagreb, Croatia; Zagreb School of Medicine, Zagreb, Croatia
| | - Dina Bosnjak
- University Psychiatric Hospital Vrapce, Zagreb, Croatia
| | | | | | | | | | - Porin Makaric
- Psychiatric University Hospital Zurich, Zurich, Switzerland
| | | | | | - Aleksandar Savic
- Zagreb School of Medicine, Zagreb, Croatia; University Psychiatric Hospital Vrapce, Zagreb, Croatia
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23
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Wehebrink KS, Koelkebeck K, Piest S, de Dreu CKW, Kret ME. Pupil mimicry and trust - Implication for depression. J Psychiatr Res 2018; 97:70-76. [PMID: 29202275 DOI: 10.1016/j.jpsychires.2017.11.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 11/10/2017] [Accepted: 11/17/2017] [Indexed: 11/15/2022]
Abstract
Individuals suffering from depression often have difficulty trusting others. Previous research has shown a relationship between trust formation and pupil mimicry - the synchronization of pupil sizes between individuals. The current study therefore examined whether pupil mimicry is weaker in depressed individuals and an underlying factor of their low levels of trust. Forty-two patients with major depressive disorder (MDD) and 40 healthy control subjects played trust games with virtual partners. Images of these partners' eye regions were presented to participants before they had to make a monetary investment decision. Partners' pupils either dilated, constricted, or remained static over the course of 4-s interactions. During the task, participants' pupil sizes were recorded with eye-tracking equipment to assess mimicry. The results confirm that patients with MDD were somewhat less trusting than controls and used another's pupillary cues differently when deciding to trust. Specifically, whereas healthy controls trusted partners with dilating pupils more than partners with constricting pupils, patients with MDD particularly trusted partners whose pupils changed in size less, regardless of whether partners' pupils were dilating or constricting. This difference in investment behavior was unrelated to differences in pupil mimicry, which was equally apparent in both groups and fostered trust to the same extent. Whereas lower levels of trust observed in patients with MDD could not be explained by differences in pupil mimicry, our data show that pupil dilation mimicry might help people to trust. These findings provide further evidence for the important role of pupil size and pupil mimicry in interpersonal trust formation and shed light on the pathophysiology of clinically low trust in patients with MDD.
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Affiliation(s)
- Katharina S Wehebrink
- Leiden University, Cognitive Psychology Unit, Wassenaarseweg 52, 2333 AK Leiden, The Netherlands; Leiden Institute for Brain and Cognition (LIBC), 2300 UC Leiden, The Netherlands; University of Muenster, School of Medicine, Department of Psychiatry and Psychotherapy, Albert-Schweitzer-Campus 1, A9, 48149 Muenster, Germany
| | - Katja Koelkebeck
- University of Muenster, School of Medicine, Department of Psychiatry and Psychotherapy, Albert-Schweitzer-Campus 1, A9, 48149 Muenster, Germany
| | - Simon Piest
- Martin-Luther-University Halle-Wittenberg, School of Law and Economics, Große Steinstrasse 73, 06108 Halle (Saale), Germany
| | - Carsten K W de Dreu
- Leiden University, Department of Social Psychology, Wassenaarseweg 52, 2333 AK Leiden, The Netherlands; Leiden Institute for Brain and Cognition (LIBC), 2300 UC Leiden, The Netherlands
| | - Mariska E Kret
- Leiden University, Cognitive Psychology Unit, Wassenaarseweg 52, 2333 AK Leiden, The Netherlands; Leiden Institute for Brain and Cognition (LIBC), 2300 UC Leiden, The Netherlands.
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24
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Kuzman MR, Andlauer O, Burmeister K, Dvoracek B, Lencer R, Koelkebeck K, Nawka A, Riese F. The PsyLOG mobile application: development of a tool for the assessment and monitoring of side effects of psychotropic medication. Psychiatr Danub 2017. [PMID: 28636581 DOI: 10.24869/psyd.2017.214] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Mobile health interventions are regarded as affordable and accessible tools that can enhance standard psychiatric care. As part of the mHealth Psycho-Educational Intervention Versus Antipsychotic-Induced Side Effects (mPIVAS) project (www.psylog.eu), we developed the mobile application "PsyLOG" based on mobile "smartphone" technology to monitor antipsychotic-induced side effects. The aim of this paper is to describe the rationale and development of the PsyLOG and its clinical use. The PsyLOG application runs on smartphones with Android operating system. The application is currently available in seven languages (Croatian, Czech, English, French, German, Japanese and Serbian). It consists of several categories: "My Drug Effects", "My Life Styles", "My Charts", "My Medication", "My Strategies", "My Supporters", "Settings" and "About". The main category "My Drug Effects" includes a list of 30 side effects with the possibility to add three additional side effects. Side effects are each accompanied by an appropriate description and the possibility to rate its severity on a visual analogue scale from 0-100%. The PsyLOG application is intended to enhance the link between patients and mental health professionals, serving as a tool that more objectively monitors side-effects over certain periods of time. To the best of our knowledge, no such applications have so far been developed for patients taking antipsychotic medication or for their therapists.
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Affiliation(s)
- Martina Rojnic Kuzman
- Department of Psychiatry, Zagreb University Hospital Centre, Kispaticeva 12, 10000 Zagreb, Croatia,
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25
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Ahmetspahic D, Schwarte K, Ambrée O, Bürger C, Falcone V, Seiler K, Kooybaran MR, Grosse L, Roos F, Scheffer J, Jörgens S, Koelkebeck K, Dannlowski U, Arolt V, Scheu S, Alferink J. Altered B Cell Homeostasis in Patients with Major Depressive Disorder and Normalization of CD5 Surface Expression on Regulatory B Cells in Treatment Responders. J Neuroimmune Pharmacol 2017; 13:90-99. [PMID: 28905187 DOI: 10.1007/s11481-017-9763-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 08/21/2017] [Indexed: 01/28/2023]
Abstract
Pro-inflammatory activity and cell-mediated immune responses have been widely observed in patients with major depressive disorder (MDD). Besides their well-known function as antibody-producers, B cells play a key role in inflammatory responses by secreting pro- and anti-inflammatory factors. However, homeostasis of specific B cell subsets has not been comprehensively investigated in MDD. In this study, we characterized circulating B cells of distinct developmental steps including transitional, naïve-mature, antigen-experienced switched, and non-switched memory cells, plasmablasts and regulatory B cells by multi-parameter flow cytometry. In a 6-weeks follow-up, circulating B cells were monitored in a small group of therapy responders and non-responders. Frequencies of naïve lgD+CD27- B cells, but not lgD+CD27+ memory B cells, were reduced in severely depressed patients as compared to healthy donors (HD) or mildly to moderately depressed patients. Specifically, B cells with immune-regulatory capacities such as CD1d+CD5+ B cells and CD24+CD38hi transitional B cells were reduced in MDD. Also Bm1-Bm5 classification in MDD revealed reduced Bm2' cells comprising germinal center founder cells as well as transitional B cells. We further found that reduced CD5 surface expression on transitional B cells was associated with severe depression and normalized exclusively in clinical responders. This study demonstrates a compromised peripheral B cell compartment in MDD with a reduction in B cells exhibiting a regulatory phenotype. Recovery of CD5 surface expression on transitional B cells in clinical response, a molecule involved in activation and down-regulation of B cell responses, further points towards a B cell-dependent process in the pathogenesis of MDD.
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Affiliation(s)
- Diana Ahmetspahic
- Department of Psychiatry and Psychotherapy, University of Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany.,Cluster of Excellence EXC 1003, Cells in Motion, University of Münster, Münster, Germany
| | - Kathrin Schwarte
- Department of Psychiatry and Psychotherapy, University of Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany.,Cluster of Excellence EXC 1003, Cells in Motion, University of Münster, Münster, Germany
| | - Oliver Ambrée
- Department of Psychiatry and Psychotherapy, University of Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany.,Department of Behavioural Biology, University of Osnabrück, Osnabrück, Germany
| | - Christian Bürger
- Department of Psychiatry and Psychotherapy, University of Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Vladislava Falcone
- Department of Psychiatry and Psychotherapy, University of Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Katharina Seiler
- Department of Psychiatry and Psychotherapy, University of Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Mehrdad Rahbar Kooybaran
- Department of Psychiatry and Psychotherapy, University of Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany.,Cluster of Excellence EXC 1003, Cells in Motion, University of Münster, Münster, Germany
| | - Laura Grosse
- Department of Psychiatry and Psychotherapy, University of Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Fernand Roos
- Department of Psychiatry and Psychotherapy, University of Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Julia Scheffer
- Department of Psychiatry and Psychotherapy, University of Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Silke Jörgens
- Department of Psychiatry and Psychotherapy, University of Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Katja Koelkebeck
- Department of Psychiatry and Psychotherapy, University of Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Udo Dannlowski
- Department of Psychiatry and Psychotherapy, University of Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Volker Arolt
- Department of Psychiatry and Psychotherapy, University of Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Stefanie Scheu
- Institute of Medical Microbiology and Hospital Hygiene, University of Düsseldorf, Düsseldorf, Germany
| | - Judith Alferink
- Department of Psychiatry and Psychotherapy, University of Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany. .,Cluster of Excellence EXC 1003, Cells in Motion, University of Münster, Münster, Germany. .,Alexianer Hospital for Psychiatry and Psychotherapy, Münster, Germany.
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Heinig I, Pittig A, Richter J, Hummel K, Alt I, Dickhöver K, Gamer J, Hollandt M, Koelkebeck K, Maenz A, Tennie S, Totzeck C, Yang Y, Arolt V, Deckert J, Domschke K, Fydrich T, Hamm A, Hoyer J, Kircher T, Lueken U, Margraf J, Neudeck P, Pauli P, Rief W, Schneider S, Straube B, Ströhle A, Wittchen HU. Optimizing exposure-based CBT for anxiety disorders via enhanced extinction: Design and methods of a multicentre randomized clinical trial. Int J Methods Psychiatr Res 2017; 26:e1560. [PMID: 28322476 PMCID: PMC6877126 DOI: 10.1002/mpr.1560] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 01/30/2017] [Accepted: 02/07/2017] [Indexed: 12/30/2022] Open
Abstract
Exposure-based psychological interventions currently represent the empirically best established first line form of cognitive-behavioural therapy for all types of anxiety disorders. Although shown to be highly effective in both randomized clinical and other studies, there are important deficits: (1) the core mechanisms of action are still under debate, (2) it is not known whether such treatments work equally well in all forms of anxiety disorders, including comorbid diagnoses like depression, (3) it is not known whether an intensified treatment with more frequent sessions in a shorter period of time provides better outcome than distributed sessions over longer time intervals. This paper reports the methods and design of a large-scale multicentre randomized clinical trial (RCT) involving up to 700 patients designed to answer these questions. Based on substantial advances in basic research we regard extinction as the putative core candidate model to explain the mechanism of action of exposure-based treatments. The RCT is flanked by four add-on projects that apply experimental neurophysiological and psychophysiological, (epi)genetic and ecological momentary assessment methods to examine extinction and its potential moderators. Beyond the focus on extinction we also involve stakeholders and routine psychotherapists in preparation for more effective dissemination into clinical practice.
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Affiliation(s)
- Ingmar Heinig
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Andre Pittig
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Jan Richter
- Department of Psychology, Universität Greifswald, Greifswald, Germany
| | - Katrin Hummel
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Isabel Alt
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Kristina Dickhöver
- Center of Mental Health, Department of Biological Psychology, Clinical Psychology, and Psychotherapy, Julius-Maximilians-Universität Würzburg, Würzburg, Germany
| | - Jennifer Gamer
- Center of Mental Health, Department of Biological Psychology, Clinical Psychology, and Psychotherapy, Julius-Maximilians-Universität Würzburg, Würzburg, Germany
| | - Maike Hollandt
- Department of Psychology, Universität Greifswald, Greifswald, Germany
| | - Katja Koelkebeck
- Department of Psychiatry and Psychotherapy, Universitätsklinikum Münster, Münster, Germany
| | - Anne Maenz
- Clinical Psychology and Psychotherapy, Philipps-Universität Marburg, Marburg, Germany
| | - Sophia Tennie
- Clinical Psychology and Psychotherapy, Philipps-Universität Marburg, Marburg, Germany
| | - Christina Totzeck
- Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Bochum, Germany
| | - Yunbo Yang
- Department of Psychiatry and Psychotherapy, Philipps-Universität Marburg, Marburg, Germany
| | - Volker Arolt
- Department of Psychiatry and Psychotherapy, Universitätsklinikum Münster, Münster, Germany
| | - Jürgen Deckert
- Center of Mental Health, Department of Psychiatry, Psychosomatics, and Psychotherapy, University Hospital of Würzburg, Würzburg, Germany
| | - Katharina Domschke
- Center of Mental Health, Department of Psychiatry, Psychosomatics, and Psychotherapy, University Hospital of Würzburg, Würzburg, Germany.,Department of Psychiatry, Universitätsklinikum Freiburg, Freiburg, Germany
| | - Thomas Fydrich
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Alfons Hamm
- Department of Psychology, Universität Greifswald, Greifswald, Germany
| | - Jürgen Hoyer
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Tilo Kircher
- Department of Psychiatry and Psychotherapy, Philipps-Universität Marburg, Marburg, Germany
| | - Ulrike Lueken
- Center of Mental Health, Department of Psychiatry, Psychosomatics, and Psychotherapy, University Hospital of Würzburg, Würzburg, Germany
| | - Jürgen Margraf
- Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Bochum, Germany
| | | | - Paul Pauli
- Center of Mental Health, Department of Biological Psychology, Clinical Psychology, and Psychotherapy, Julius-Maximilians-Universität Würzburg, Würzburg, Germany
| | - Winfried Rief
- Clinical Psychology and Psychotherapy, Philipps-Universität Marburg, Marburg, Germany
| | - Silvia Schneider
- Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Bochum, Germany
| | - Benjamin Straube
- Department of Psychiatry and Psychotherapy, Philipps-Universität Marburg, Marburg, Germany
| | - Andreas Ströhle
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Hans-Ulrich Wittchen
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
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Koelkebeck K, Liedtke C, Kohl W, Alferink J, Kret ME. Attachment style moderates theory of mind abilities in depression. J Affect Disord 2017; 213:156-160. [PMID: 28236693 DOI: 10.1016/j.jad.2017.02.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Revised: 01/03/2017] [Accepted: 02/12/2017] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Being able to understand other people's emotions and intentions is crucial for social interactions and well-being. Deficits in theory of mind (ToM) functioning hamper this ability and have been observed in depression and other neuropsychiatric disorders. However, results of previous research in depression have been inconclusive, possibly due to the presence of comorbid disorders and the disregarding of other modulating factors. METHODS Thirty-eight patients with a major depressive disorder (MDD) and forty healthy matched controls were assessed with a ToM task using animated triangles. Results were correlated with attachment styles, empathy abilities and neurocognitive performance. RESULTS Our findings show that 1) healthy female controls performed significantly stronger on the ToM task than female MDD patients, 2) these performance differences were driven by attachment styles and 3) depression severity did not impact task performance. LIMITATIONS The pharmacological treatment of the majority of patients might limit the generalizability of this study. DISCUSSION Results indicate a gender-specific impact of attachment styles on ToM performance. Future studies should investigate whether impairments in social cognitive tasks pose a risk factor for depression and/or interactional styles or vice versa. Moreover, with regard to remediation programs gender-specific needs should be taken into account.
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Affiliation(s)
- Katja Koelkebeck
- University of Muenster, School of Medicine, Department of Psychiatry and Psychotherapy, Muenster, Germany.
| | - Carla Liedtke
- University of Muenster, School of Medicine, Department of Psychiatry and Psychotherapy, Muenster, Germany
| | - Waldemar Kohl
- University of Muenster, School of Medicine, Department of Psychiatry and Psychotherapy, Muenster, Germany
| | - Judith Alferink
- University of Muenster, School of Medicine, Department of Psychiatry and Psychotherapy, Muenster, Germany; Cluster of Excellence EXC 1003, Cells in Motion, University of Muenster, Muenster, Germany
| | - Mariska Esther Kret
- Leiden University, Faculty of Social and Behavioural Sciences, Institute of Psychology, Cognitive Psychology Unit, Leiden Institute for Brain and Cognition, Leiden, The Netherlands
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28
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Hennion S, Delbeuck X, Koelkebeck K, Brion M, Tyvaert L, Plomhause L, Derambure P, Lopes R, Szurhaj W. A functional magnetic resonance imaging investigation of theory of mind impairments in patients with temporal lobe epilepsy. Neuropsychologia 2016; 93:271-279. [DOI: 10.1016/j.neuropsychologia.2016.11.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 11/04/2016] [Accepted: 11/08/2016] [Indexed: 10/20/2022]
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Abstract
Social cognitive skills are indispensable for successful communication with others. Substantial research has determined deficits in these abilities in patients with mental disorders. In neurobiological development and continuing into adulthood, cross-cultural differences in social cognition have been demonstrated. Moreover, symptomatic patterns in mental disorders may vary according to the cultural background of an individual. Cross-cultural studies can thus help in understanding underlying (biological) mechanisms and factors that influence behavior in health and disease. In addition, studies that apply novel paradigms assessing the impact of culture on cognition may benefit and advance neuroscience research. In this review, the authors give an overview of cross-cultural research in the field of social cognition in health and in mental disorders and provide an outlook on future research directions, taking a neuroscience perspective.
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Affiliation(s)
- Katja Koelkebeck
- a Department of Psychiatry and Psychotherapy , School of Medicine, University of Muenster , Muenster , Germany
| | - Teruhisa Uwatoko
- b Department of Psychiatry , Graduate School of Medicine, Kyoto University , Sakyo-ku, Kyoto , Japan.,c Kyoto University Health Service , Sakyo-ku, Kyoto , Japan
| | - Jiro Tanaka
- d Faculty of Modern Languages and Cultures , Santa Monica College , Santa Monica , CA , USA.,e Adjunct Faculty in Foreign Languages , Los Angeles Valley College , Valley Glen , CA , USA
| | - Mariska Esther Kret
- f The Cognitive Psychology Unit , Leiden University, Institute of Psychology , AK , Leiden
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30
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Koelkebeck K. Psychotherapeutic interventions in consultation-liaison psychiatry implications for psychiatric trainees. Eur Psychiatry 2016. [DOI: 10.1016/j.eurpsy.2016.01.949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
In clinical reality, psychiatric trainees working in consultation and liaison psychiatry (CLP) face a lot of obstacles to gain satisfactory results from their work on somatic wards. Specifically, the deliverance of psychotherapeutic interventions in every-day CLP is a topic of discussion. The talk will present a case of a young anorectic patient that will exemplify the difficulties in delivering psychotherapeutic treatment in every-day clinical work and will outline common difficulties, specifically in relation to interactions with staff of somatic units. The presentation will be wrapped-up by suggestions on how to deal with the most common problems.Disclosure of interestThe author has not supplied his declaration of competing interest.
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31
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Koelkebeck K, Kohl W, Luettgenau J, Triantafillou S, Ohrmann P, Satoh S, Minoshita S. Benefits of using culturally unfamiliar stimuli in ambiguous emotion identification: A cross-cultural study. Psychiatry Res 2015; 228:39-45. [PMID: 25933477 DOI: 10.1016/j.psychres.2015.04.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Revised: 01/12/2015] [Accepted: 04/05/2015] [Indexed: 10/23/2022]
Abstract
A novel emotion recognition task that employs photos of a Japanese mask representing a highly ambiguous stimulus was evaluated. As non-Asians perceive and/or label emotions differently from Asians, we aimed to identify patterns of task-performance in non-Asian healthy volunteers with a view to future patient studies. The Noh mask test was presented to 42 adult German participants. Reaction times and emotion attribution patterns were recorded. To control for emotion identification abilities, a standard emotion recognition task was used among others. Questionnaires assessed personality traits. Finally, results were compared to age- and gender-matched Japanese volunteers. Compared to other tasks, German participants displayed slowest reaction times on the Noh mask test, indicating higher demands of ambiguous emotion recognition. They assigned more positive emotions to the mask than Japanese volunteers, demonstrating culture-dependent emotion identification patterns. As alexithymic and anxious traits were associated with slower reaction times, personality dimensions impacted on performance, as well. We showed an advantage of ambiguous over conventional emotion recognition tasks. Moreover, we determined emotion identification patterns in Western individuals impacted by personality dimensions, suggesting performance differences in clinical samples. Due to its properties, the Noh mask test represents a promising tool in the differential diagnosis of psychiatric disorders, e.g. schizophrenia.
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Affiliation(s)
- Katja Koelkebeck
- Department of Psychiatry and Psychotherapy, Muenster University, Medical School, Muenster, Germany.
| | - Waldemar Kohl
- Department of Psychiatry and Psychotherapy, Muenster University, Medical School, Muenster, Germany
| | - Julia Luettgenau
- Department of Psychiatry and Psychotherapy, Muenster University, Medical School, Muenster, Germany
| | - Susanna Triantafillou
- Department of Psychiatry and Psychotherapy, Muenster University, Medical School, Muenster, Germany
| | - Patricia Ohrmann
- Department of Psychiatry and Psychotherapy, Muenster University, Medical School, Muenster, Germany
| | - Shinji Satoh
- Institute of Social Psychiatry, Tsukuba, Ibaraki, Japan
| | - Seiko Minoshita
- Department of Psychology, Kawamura Gakuen Women׳s University, Faculty of Liberal Arts, Abiko, Chiba, Japan
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32
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Koelkebeck K, Andlauer O, Jovanovic N, Giacco D. Interventions for posttraumatic stress disorder in psychiatric practice across Europe: a trainees' perspective. Eur J Psychotraumatol 2015; 6:27818. [PMID: 26350154 PMCID: PMC4563100 DOI: 10.3402/ejpt.v6.27818] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 07/14/2015] [Accepted: 07/26/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND With an annual prevalence of 0.9-2.6%, posttraumatic stress disorder (PTSD) is very common in clinical practice across Europe. Despite the fact that evidence-based interventions have been developed, there is no evidence on their implementation in clinical practice and in national psychiatric training programmes. OBJECTIVE AND METHOD The Early Career Psychiatrists Committee of the European Psychiatric Association conducted a survey in 23 European countries to explore implementation of evidence-based interventions for PTSD and training options. RESULTS The findings indicate that pharmacotherapy was available in the majority of the participating countries (n=19, 82.8%). However, psychological interventions were much less widespread. For example, psychoeducation was widely available in 52% of the countries (n=12), cognitive-behavioural therapy in 26.2% (n=6), and specific trauma-focused techniques were rarely available. Training on PTSD was part of the official training in 13 countries (56.5%), predominantly in the form of theoretical seminars. CONCLUSIONS Overall, this survey indicates that the treatment for PTSD is largely focused on pharmacotherapy, with psychological evidence-based interventions poorly available, especially outside specialized centres. Poor implementation is linked to the lack of official training in evidence-based interventions for psychiatric trainees across Europe.
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Affiliation(s)
- Katja Koelkebeck
- Department of Psychiatry and Psychotherapy, University of Muenster, Muenster, Germany;
| | - Olivier Andlauer
- Newham Centre for Mental Health, East London NHS Foundation Trust, London, United Kingdom
| | - Nikolina Jovanovic
- Department of Psychiatry, University Hospital Center Zagreb, Zagreb, Croatia
| | - Domenico Giacco
- Unit for Social and Community Psychiatry, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
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Koelkebeck K, Miyata J, Kubota M, Kohl W, Son S, Fukuyama H, Sawamoto N, Takahashi H, Murai T. The contribution of cortical thickness and surface area to gray matter asymmetries in the healthy human brain. Hum Brain Mapp 2014; 35:6011-22. [PMID: 25082171 DOI: 10.1002/hbm.22601] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Revised: 06/18/2014] [Accepted: 07/23/2014] [Indexed: 11/10/2022] Open
Abstract
Human cortical gray matter (GM) is structurally asymmetrical and this asymmetry has been discussed to be partly responsible for functional lateralization of human cognition and behavior. Past studies on brain asymmetry have shown mixed results so far, with some studies focusing on the global shapes of the brain's surface, such as gyrification patterns, while others focused on regional brain volumes. In this study, we investigated cortical GM asymmetries in a large sample of right-handed healthy volunteers (n = 101), using a surface-based method which allows to analyze brain cortical thickness and surface area separately. As a result, substantially different patterns of symmetry emerged between cortical thickness and surface area measures. In general, asymmetry is more prominent in the measure of surface compared to that of thickness. Such a detailed investigation of structural asymmetries in the normal brain contributes largely to our knowledge of normal brain development and also offers insights into the neurodevelopmental basis of psychiatric disorders, such as schizophrenia.
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Affiliation(s)
- Katja Koelkebeck
- Department of Psychiatry and Psychotherapy, School of Medicine, University of Muenster, Muenster, Germany
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Koelkebeck K, Riedel A, Ohrmann P, Biscaldi M, Tebartz van Elst L. [High-functioning autism spectrum disorders in adulthood]. Nervenarzt 2014; 85:891-902. [PMID: 24969950 DOI: 10.1007/s00115-014-4050-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The prevalence of autism spectrum disorders in the general population is approximately 1 %. Some individuals with high-functioning autism graduate from regular schools without autism having been diagnosed and problems only occur when the demands for social competence increase. Then patients often present with secondary psychiatric symptoms, such as depression, anxiety or interpersonal problems. At this time, typical autistic features, such as social interaction deficits, restricted interests and stereotypic behavior can be camouflaged by high compensatory skills, particularly in highly intelligent patients. Therefore, missed or wrong diagnoses are frequent. Interviews, questionnaires and neuropsychological tests might be used to support the diagnosis. In cases where there is evidence for a secondary cause of autistic symptoms, somatic disorders should be excluded. Pharmacological treatment should be symptom-oriented. Individualized psychotherapeutic approaches are becoming increasingly more available; however, pragmatic solutions often need to be deployed.
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Affiliation(s)
- K Koelkebeck
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, Gebäude A9, 48149, Münster, Deutschland,
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35
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Koelkebeck K, Hirao K, Miyata J, Kawada R, Saze T, Dannlowski U, Ubukata S, Ohrmann P, Bauer J, Pedersen A, Fukuyama H, Sawamoto N, Takahashi H, Murai T. Impact of gray matter reductions on theory of mind abilities in patients with schizophrenia. Soc Neurosci 2013; 8:631-9. [PMID: 24047258 DOI: 10.1080/17470919.2013.837094] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
To identify the brain regions involved in the interpretation of intentional movement by patients with schizophrenia, we investigated the association between cerebral gray matter (GM) volumes and performance on a theory of mind (ToM) task using voxel-based morphometry. Eighteen patients with schizophrenia and thirty healthy controls participated in the study. Participants were given a moving shapes task that employs the interpretation of intentional movement. Verbal descriptions were rated according to intentionality. ToM performance deficits in patients were found to be positively correlated with GM volume reductions in the superior temporal sulcus and medial prefrontal cortex. Our findings confirm that divergent brain regions contribute to mentalizing abilities and that GM volume reductions impact behavioral deficits in patients with schizophrenia.
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Affiliation(s)
- Katja Koelkebeck
- a Department of Psychiatry and Psychotherapy, School of Medicine , University of Muenster , Muenster , Germany
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36
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Pedersen A, Wilmsmeier A, Wiedl KH, Bauer J, Kueppers K, Koelkebeck K, Kohl W, Kugel H, Arolt V, Ohrmann P. Anterior cingulate cortex activation is related to learning potential on the WCST in schizophrenia patients. Brain Cogn 2012; 79:245-51. [PMID: 22554566 DOI: 10.1016/j.bandc.2012.03.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Revised: 03/19/2012] [Accepted: 03/20/2012] [Indexed: 10/28/2022]
Abstract
The remediation of executive function in patients with schizophrenia is important in rehabilitation because these skills affect the patient's capacity to function in the community. There is evidence that instructional techniques can improve deficits in the Wisconsin Card Sorting Test (WCST) in some schizophrenia patients. We used a standard test/training phase/standard test format of the WCST to classify 36 schizophrenia patients as high-achievers, learners or non-retainers. All healthy controls performed as high-achievers. An event-related fMRI design assessed neural activation patterns during post-training WCST performance. Patients showed a linear trend between set-shifting related activation in the anterior cingulate cortex and learning potential, i.e. increased activation in high-achievers, a trend for increased activation in learners, and no activation in non-retainers compared to controls. In addition, activation in the temporoparietal cortex was highest in patients classified as learners, whereas in non-retainers activation was increased in the inferior frontal gyrus compared to controls and high-achieving patients. These results emphasize the relevance of the ACC's neural integrity in learning set-shifting strategies for patients with schizophrenia. Also, our results support the hypothesis that compensatory neural activation in patients with schizophrenia helps them to catch up with healthy controls on cognitive tasks.
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Affiliation(s)
- Anya Pedersen
- Department of Psychiatry, School of Medicine, University of Muenster, Germany
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37
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Pedersen A, Koelkebeck K, Brandt M, Wee M, Kueppers KA, Kugel H, Kohl W, Bauer J, Ohrmann P. Theory of mind in patients with schizophrenia: is mentalizing delayed? Schizophr Res 2012; 137:224-9. [PMID: 22406281 DOI: 10.1016/j.schres.2012.02.022] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2011] [Revised: 02/03/2012] [Accepted: 02/19/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Functional imaging studies have used numerous neurocognitive designs to investigate brain activation during theory of mind (ToM) tasks in patients with schizophrenia. The majority of studies asks participants to retrospectively attribute mental states to others. We used a novel animated task to investigate implicit mentalizing online. Because behavioral studies have revealed slower ToM performance reaction times in patients with schizophrenia, we hypothesized that time would influence functional MRI (fMRI) activation patterns also. METHODS We applied the "Moving Shapes" paradigm, which involves two interacting triangles, to a functional MRI block design and investigated the neural activation patterns of 15 patients with schizophrenia and 14 healthy controls. We additionally analyzed the first and second halves of each video separately to assess time-related differences. RESULTS Overall, patients with schizophrenia showed increased activation in the inferior and middle frontal gyri, the superior temporal gyrus, the precuneus and the cerebellum compared with controls during ToM versus non-ToM videos. Most importantly, patients with schizophrenia had predominantly increased activation in ToM-related brain areas during the second half of the ToM paradigm, whereas the activation in areas of the ToM-network in healthy controls occurred during the first half of the presentation. CONCLUSIONS Our results confirm recent findings of significantly stronger neural activations that encompass the fronto-temporo-parietal cerebral areas in patients with schizophrenia compared with controls during ToM tasks. The observation of slower cognitive processing in patients with schizophrenia during mentalizing might explain some of the contradictory imaging findings in these patients and have implications for cognitive remediation.
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Affiliation(s)
- Anya Pedersen
- Department of Psychology, University of Muenster, Germany
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38
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Miyata J, Sasamoto A, Koelkebeck K, Hirao K, Ueda K, Kawada R, Fujimoto S, Tanaka Y, Kubota M, Fukuyama H, Sawamoto N, Takahashi H, Murai T. Abnormal asymmetry of white matter integrity in schizophrenia revealed by voxelwise diffusion tensor imaging. Hum Brain Mapp 2011; 33:1741-9. [PMID: 21976373 DOI: 10.1002/hbm.21326] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2010] [Revised: 03/01/2011] [Accepted: 03/10/2011] [Indexed: 11/07/2022] Open
Abstract
A number of magnetic resonance imaging (MRI) studies have revealed morphological cortical asymmetry in the normal human brain, and reduction or inversion of such hemispheric asymmetry has been reported in schizophrenia. On the other hand, diffusion tensor imaging (DTI) studies have reported inconsistent findings concerning abnormal asymmetry of white matter integrity in schizophrenia. Our aim was to confirm whether there is reduced or inverted asymmetry of white matter integrity in the whole brain in schizophrenia. For this study, 26 right-handed schizophrenia patients, and 32 matched healthy control subjects were investigated. Voxelwise analysis of DTI data was performed using the tract-based spatial statistics. The fractional anisotropy (FA) images were normalized and projected onto the symmetrical white matter skeleton, and the laterality index (LI) of FA, determined by 2 × (left - right)/(left + right), was calculated. The results reveal that schizophrenia patients and healthy controls showed similar patterns of overall FA asymmetries. In the group comparison, patients showed significant reduction of LI in the external capsule (EC), and posterior limb of the internal capsule (PLIC). The EC cluster revealed increased rightward asymmetry, and the PLIC cluster showed reduced leftward asymmetry. Rightward-shift of FA in the EC cluster correlated with negative symptom severity. Considering that the EC cluster includes the uncinate and inferior occipitofrontal fasciculi, which have connections to the orbitofrontal cortex, abnormal asymmetry of white matter integrity in schizophrenia may play a crucial role in the pathogenesis of schizophrenia, through the altered connectivity to the orbitofrontal cortex.
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Affiliation(s)
- Jun Miyata
- Department of Neuropsychiatry, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawaharacho, Kyoto 606-8507, Japan.
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Koelkebeck K, Hirao K, Kawada R, Miyata J, Saze T, Ubukata S, Itakura S, Kanakogi Y, Ohrmann P, Bauer J, Pedersen A, Sawamoto N, Fukuyama H, Takahashi H, Murai T. Transcultural differences in brain activation patterns during theory of mind (ToM) task performance in Japanese and Caucasian participants. Soc Neurosci 2011; 6:615-26. [DOI: 10.1080/17470919.2011.620763] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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40
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Wilmsmeier A, Ohrmann P, Suslow T, Siegmund A, Koelkebeck K, Rothermundt M, Kugel H, Arolt V, Bauer J, Pedersen A. Neural correlates of set-shifting: decomposing executive functions in schizophrenia. J Psychiatry Neurosci 2010; 35:321-9. [PMID: 20731964 PMCID: PMC2928285 DOI: 10.1503/jpn.090181] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Although there is considerable evidence that patients with schizophrenia have impaired executive functions, the neural mechanisms underlying these deficits are unclear. Generation and selection is one of the basic mechanisms of executive functioning. We investigated the neural correlates of this mechanism by means of functional magnetic resonance imaging (fMRI) in patients with schizophrenia and healthy controls. METHODS We used the Wisconsin Card Sorting Test (WCST) in an event-related fMRI study to analyze neural activation patterns during the distinct components of the WCST in 36 patients with schizophrenia and 28 controls. We focused our analyses on the process of set-shifting. After participants received negative feedback, they had to generate and decide on a new sorting rule. RESULTS A widespread activation pattern encompassing the inferior and middle frontal gyrus, parietal, temporal and occipital cortices, anterior cingulate cortex (ACC), supplementary motor area, insula, caudate, thalamus and brainstem was observed in patients with schizophrenia after negative versus positive feedback, whereas in healthy controls, significant activation clusters were more confined to the cortical areas. Significantly increased activation in the rostral ACC after negative feedback and in the dorsal ACC during matching after negative feedback were observed in schizophrenia patients compared with controls. Controls showed activation in the bilateral dorsolateral prefrontal cortex (Brodmann area 46), whereas schizophrenia patients showed activation in the right dorsolateral prefrontal cortex only. LIMITATIONS All patients were taking neuroleptic medication, which has an impact on cognitive function as well as on dopaminergic and serotonergic prefrontal metabolism. CONCLUSION Our data suggest that, in patients with schizophrenia, set-shifting is associated with increased activation in the rostral and dorsal ACC, reflecting higher emotional and cognitive demands, respectively.
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Affiliation(s)
| | - Patricia Ohrmann
- Correspondence to: Dr. P. Ohrmann, Department of Psychiatry, University of Muenster, Albert-Schweitzer-Str. 11, D - 48149 Muenster, Germany;
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41
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Rauch AV, Reker M, Ohrmann P, Pedersen A, Bauer J, Dannlowski U, Harding L, Koelkebeck K, Konrad C, Kugel H, Arolt V, Heindel W, Suslow T. Increased amygdala activation during automatic processing of facial emotion in schizophrenia. Psychiatry Res 2010; 182:200-6. [PMID: 20488680 DOI: 10.1016/j.pscychresns.2010.03.005] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2008] [Revised: 02/17/2010] [Accepted: 03/11/2010] [Indexed: 11/15/2022]
Abstract
Schizophrenia patients show abnormalities in the processing of facial emotion. The amygdala is a central part of a brain network that is involved in the perception of facial emotions. Previous functional neuroimaging studies on the perception of facial emotion in schizophrenia have focused almost exclusively on controlled processing. In the present study, we investigated the automatic responsivity of the amygdala to emotional faces in schizophrenia and its relationship to clinical symptomatology by applying an affective priming task. 3-T fMRI was utilized to examine amygdala responses to sad and happy faces masked by neutral faces in 12 schizophrenia patients and 12 healthy controls. The Positive and Negative Syndrome Scale (PANSS) was administered to assess current symptomatology. Schizophrenia patients exhibited greater automatic amygdala responses to sad and happy faces relative to controls. Amygdala responses to masked sad and happy expressions were positively correlated with the negative subscale of the PANSS. Schizophrenia patients appear to be characterized by amygdalar hyperresponsiveness to negative and positive facial expressions on an automatic processing level. Heightened automatic amygdala responsivity could be involved in the development and maintenance of negative symptoms in schizophrenia.
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Affiliation(s)
- Astrid Veronika Rauch
- Department of Psychiatry, School of Medicine, University of Muenster, Albert-Schweitzer-Str. 11, Muenster, Germany.
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Koelkebeck K, Pedersen A, Suslow T, Kueppers KA, Arolt V, Ohrmann P. Theory of Mind in first-episode schizophrenia patients: correlations with cognition and personality traits. Schizophr Res 2010; 119:115-23. [PMID: 20060686 DOI: 10.1016/j.schres.2009.12.015] [Citation(s) in RCA: 95] [Impact Index Per Article: 6.8] [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: 06/26/2009] [Revised: 12/08/2009] [Accepted: 12/14/2009] [Indexed: 11/18/2022]
Abstract
INTRODUCTION There is substantial evidence for Theory of Mind (ToM) deficits in patients with schizophrenia. Many psychotic symptoms may best be understood in light of an impaired capacity to infer one's own and other persons' mental states and to relate those to executing behavior. The aim of our study was to investigate ToM abilities in first-episode schizophrenia patients and to analyze them in relation to neuropsychological and psychopathological functioning. MATERIALS AND METHODS A modified Moving Shapes paradigm was used to assess ToM abilities in 23 first-episode patients with schizophrenia and 23 matched healthy controls. Participants had to describe animated triangles which moved (1) randomly, (2) goal-directed, or (3) in complex, socially interactive ways (ToM video sequences). Neuropsychological functioning, psychopathology, autistic and alexithymic features as well as empathetic abilities were correlated with ToM performance. RESULTS Compared to healthy controls, first-episode schizophrenia patients gave more incorrect descriptions and used less ToM-related vocabulary when responding to socially complex ToM video sequences. No group differences were revealed for videos with random movements. ToM abilities correlated significantly with positive symptoms, reasoning, verbal memory performance and verbal IQ, but not with empathetic abilities or autistic and alexithymic features. When controlling for reasoning, verbal memory performance and verbal IQ, the correctness of video descriptions was still significantly worse in schizophrenia patients. DISCUSSION The results of our study in first-episode schizophrenia patients underline recent findings on ToM deficits in the early course of schizophrenia. Only a moderate influence of neurocognitive deficits on ToM performance was observed. Impairment in ToM abilities seems to be predominantly independent of clinical state, alexithymia and empathy.
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Affiliation(s)
- Katja Koelkebeck
- Department of Psychiatry, University of Muenster, School of Medicine, Albert-Schweitzer-Strasse 11, 48149 Muenster, Germany.
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Koelkebeck K, Domschke K, Zwanzger P, Hetzel G, Lang D, Arolt V. A case of non-SIADH-induced hyponatremia in depression after treatment with reboxetine. World J Biol Psychiatry 2010; 10:609-11. [PMID: 17965988 DOI: 10.1080/15622970701687311] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Hyponatremia is a well-known side effect of antidepressant treatment with serotonin reuptake inhibitors (SSRI) or combined serotonin and noradrenaline reuptake inhibitors (SNRI), and is linked to the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) in most cases. In contrast, only very few data are available on hyponatremia following treatment with selective noradrenaline reuptake inhibitors (NaRI). In this report, we describe the case of a patient who developed severe hyponatremia after treatment with reboxetine. However, extensive laboratory testing did not reveal inappropriate secretion of ADH, suggesting that SIADH did not account for hyponatremia in our case. Proposing further examination of the underlying pathomechanism of hyponatremia as a side effect of NaRIs, we discuss the importance of careful monitoring of serum sodium levels in patients treated with NaRIs.
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Affiliation(s)
- Katja Koelkebeck
- University of Muenster, Department of Psychiatry, Muenster, Germany.
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Hohoff C, Ponath G, Freitag CM, Kästner F, Krakowitzky P, Domschke K, Koelkebeck K, Kipp F, von Eiff C, Deckert J, Rothermundt M. Risk variants in the S100B gene predict elevated S100B serum concentrations in healthy individuals. Am J Med Genet B Neuropsychiatr Genet 2010; 153B:291-7. [PMID: 19330775 DOI: 10.1002/ajmg.b.30950] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Several lines of evidence suggest an important role of the S100B protein and its coding gene in different neuropathological and psychiatric disorders like dementia, bipolar affective disorders and schizophrenia. To clarify whether a direct link exists between gene and gene product, that is, whether S100B variants directly modulate S100B serum concentration, 196 healthy individuals were assessed for S100B serum concentrations and genotyped for five potentially functional S100B SNPs. Functional variants of the serotonergic genes 5-HT1A and 5-HTT possibly modulating S100B serum levels were also studied. Further, publicly available human postmortem gene expression data were re-analyzed to elucidate the impact of S100B, 5-HT1A and 5-HTT SNPs on frontal cortex S100B mRNA expression. Several S100B SNPs, particularly rs9722, and the S100B haplotype T-G-G-A (including rs2186358-rs11542311-rs2300403-rs9722) were associated with elevated S100B serum concentrations (Bonferroni corrected P < 0.05). Of these, rs11542311 was also associated with S100B mRNA expression directly (Bonferroni corrected P = 0.05) and within haplotype G-A-T-C (rs11542311-rs2839356-rs9984765-rs881827; P = 0.004), again with the G-allele increasing S100B expression. Our results suggest an important role of S100B SNPs on S100B serum concentrations and S100B mRNA expression. It hereby links recent evidence for both, the impact of S100B gene variation on various neurological or psychiatric disorders like dementia, bipolar affective disorders and schizophrenia and the strong relation between S100B serum levels and these disorders.
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Affiliation(s)
- Christa Hohoff
- Department of Psychiatry, University of Muenster, Muenster, Germany.
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Kersting A, Ohrmann P, Pedersen A, Kroker K, Samberg D, Bauer J, Kugel H, Koelkebeck K, Steinhard J, Heindel W, Arolt V, Suslow T. Neural activation underlying acute grief in women after the loss of an unborn child. Am J Psychiatry 2009; 166:1402-10. [PMID: 19884226 DOI: 10.1176/appi.ajp.2009.08121875] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The traumatic loss of an unborn child by induced termination of pregnancy because of fetal malformation is a major life event that causes intense maternal grief. Increasing evidence supports the hypothesis that the same neural structures involved in the experience of physical pain are involved in the experience of social pain and loss. METHOD To investigate neural activation patterns related to acute grief, the authors conducted a functional MRI study of 12 post-termination women and 12 noninduced women who delivered a healthy child. Brain activation was measured while participants viewed pictures of happy baby, happy adult, and neutral adult faces. RESULTS Relative to comparison women, post-termination women showed greater activation in the middle and posterior cingulate gyrus, the inferior frontal gyrus, the middle temporal gyrus, the thalamus, and the brainstem in response to viewing happy baby faces. Functional connectivity between the cingulate gyrus and the thalamus during the processing of happy baby faces was significantly stronger in post-termination women. CONCLUSIONS Overall, acute grief after the loss of an unborn child was closely related to the activation of the physical pain network encompassing the cingulate gyrus, the inferior frontal gyrus, the thalamus, and the brainstem. To the authors' knowledge, the stronger functional thalamocingulate connectivity in post-termination women is the first in vivo demonstration of an involvement of the neural maternal attachment network in grief after the loss of an unborn child.
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Affiliation(s)
- Anette Kersting
- Department of Psychiatry, University of Muenster, Albert-Schweitzer-Strasse 11, Muenster, Germany
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Koelkebeck K, Ohrmann P, Pedersen A, Hetzel G, Arolt V, Suslow T. Erratum to “Finding of abnormal scanning behavior in the Span of Apprehension task in schizophrenia but diagnostic non-specificity of sum scores” [Eur Psychiatry 23 (2008) 29–32]. Eur Psychiatry 2009. [DOI: 10.1016/j.eurpsy.2008.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Pedersen A, Diedrich M, Kaestner F, Koelkebeck K, Ohrmann P, Ponath G, Kipp F, Abel S, Siegmund A, Suslow T, von Eiff C, Arolt V, Rothermundt M. Memory impairment correlates with increased S100B serum concentrations in patients with chronic schizophrenia. Prog Neuropsychopharmacol Biol Psychiatry 2008; 32:1789-92. [PMID: 18718498 DOI: 10.1016/j.pnpbp.2008.07.017] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2008] [Revised: 07/10/2008] [Accepted: 07/26/2008] [Indexed: 01/30/2023]
Abstract
Astrocyte activation indicated by increased S100B is considered a potential pathogenic factor for schizophrenia. To investigate the relationship between astrocyte activation and cognitive performance, S100B serum concentration, memory performance, and psychopathology were assessed in 40 first-episode and 35 chronic schizophrenia patients upon admission and after four weeks of treatment. Chronic schizophrenia patients with high S100B were impaired concerning verbal memory performance (AVLT, Auditory Verbal Learning Test) compared to chronic and first-episode patients with low S100B levels. The findings support the hypothesis that astrocyte activation might contribute to the development of cognitive dysfunction in schizophrenia.
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Affiliation(s)
- Anya Pedersen
- University Medical Faculty, Department of Psychiatry, 48149 Münster, Germany.
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Koelkebeck K, Abdel-Hamid M, Ohrmann P, Brüne M. [Theory of mind in schizophrenia: clinical aspects and empirical research]. Fortschr Neurol Psychiatr 2008; 76:573-82. [PMID: 18833502 DOI: 10.1055/s-2008-1038250] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The term Theory of Mind (ToM) refers to the capacity to infer one's own and other persons' mental states. A substantial body of research has highlighted impaired ToM in a variety of neuropsychiatric disorders, including schizophrenia. There is good empirical evidence that ToM is specifically impaired in schizophrenia and that many psychotic symptoms--for instance, delusions of alien control and persecution--may best be understood in light of a disturbed capacity in patients to relate their own intentions to executing behavior, and to monitor others' intentions. However, it is still under debate if impaired ToM in schizophrenia is a state- or trait marker and whether patients could benefit from cognitive training in this domain. Recently, research has not only emphasized social cognitive deficits in patients, but has also focussed on interactions between ToM with language and other cognitive functions. Furthermore, interest in subprocesses of social cognition in psychotic spectrum disorders (e. g. schizotypy) is growing. The aim of this article is to line out clinical aspects of disturbed social cognition, to clarify terms used in this context as well as to present the latest research approaches into social cognition deficits.
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Affiliation(s)
- K Koelkebeck
- Klinik und Poliklinik für Psychiatrie und Psychotherapie des Universitätsklinikums Münster, Münster.
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Koelkebeck K, Ohrmann P, Pedersen A, Hetzel G, Arolt V, Suslow T. Finding of abnormal scanning behavior in the Span of Apprehension task in schizophrenia but diagnostic non-specificity of sum scores. Eur Psychiatry 2008; 23:29-32. [PMID: 18082378 DOI: 10.1016/j.eurpsy.2007.10.008] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2007] [Revised: 09/05/2007] [Accepted: 10/10/2007] [Indexed: 10/22/2022] Open
Abstract
Deficits in the Span of Apprehension (SOA) task have been discussed controversially as a trait marker of schizophrenia. The task was administered to 47 schizophrenia and 48 depressed patients as well as to 46 controls. Results indicate a non-specificity of the SOA sum scores but differential abnormalities in spatial visual processing.
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Affiliation(s)
- Katja Koelkebeck
- Department of Psychiatry, School of Medicine, University of Muenster, Albert-Schweitzer-Strasse 11, 48149 Muenster, Westphalia, Germany.
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Koelkebeck K, Ohrmann P, Hetzel G, Arolt V, Suslow T. Visual backward masking: deficits in locating targets are specific to schizophrenia and not related to intellectual decline. Schizophr Res 2005; 78:261-8. [PMID: 16154058 DOI: 10.1016/j.schres.2005.01.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2004] [Revised: 01/24/2005] [Accepted: 01/26/2005] [Indexed: 11/21/2022]
Abstract
Visual backward masking deficits have been postulated as potential vulnerability markers for schizophrenia. This study investigated the diagnostic specificity of a location and an identification variant of the backward masking task for schizophrenia and analyzed masking performance during the course of the tasks. The influence of schizophrenia patients' intellectual decline on masking performance was also examined. Twenty-eight schizophrenia patients were compared to 28 patients with unipolar depression and 28 healthy controls on a letter location task and a letter identification task applying a low spatial frequency mask. Schizophrenia patients made significantly more detection errors on the location task than depressives at an interstimulus interval (ISI) of 50 ms and healthy controls at ISIs of 16.7, 33.3, 50, and 66.7 ms. Thus, the location masking dysfunction of schizophrenia patients was distinctive at a rather long interstimulus interval (50 ms). On the identification task the performance of schizophrenia patients did not differ from that of the two control groups. Identification but not location masking performance improved during the course of the task for all groups. Intellectual deterioration of schizophrenia patients was not correlated with location or identification masking performance. Schizophrenia patients are characterized by specific impairments in spatial visual processing which appear to be independent of intellectual decline. Potential explanations of the location masking deficit found in schizophrenia are discussed.
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Affiliation(s)
- Katja Koelkebeck
- Department of Psychiatry, School of Medicine, University of Muenster, Albert-Schweitzer-Strasse 11, 48149, Muenster, Germany.
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