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Rosburg T, Deuring G, Ebner G, Hauch V, Pflueger MO, Stieglitz RD, Calabrese P, Schaub B, Cotar T, Jabat M, Jokeit H, Bollag Y, Mager R. Digitally Assisted Standard Diagnostics in Insurance Medicine (DASDIM): psychometric data in psychiatric work disability evaluations. Disabil Rehabil 2023; 45:4457-4470. [PMID: 36523117 DOI: 10.1080/09638288.2022.2151655] [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: 12/15/2021] [Accepted: 11/20/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE Insurers often commission psychiatric experts to evaluate the eligibility of workers with mental disorders for disability benefits, by estimating their residual work capacity (RWC). We investigated the validity of a standardized, computer-based battery of established diagnostic instruments, for evaluating the personality, cognition, performance, symptom burden, and symptom validity of claimants. METHODS One hundred and fifty-three claimants for benefits were assessed by the assembled test battery, which was applied in addition to a conventional clinical work disability evaluation. RESULTS A principal component analysis of the test and questionnaire battery data revealed six factors (Negative Affectivity, Self-Perceived Work Ability, Behavioral Dysfunction, Working Memory, Cognitive Processing Speed, and Excessive Work Commitment). Claimants with low, medium, and high RWC exclusively varied in the factor Negative Affectivity. Importantly, this factor also showed a strong association to psychiatric ratings of capacity limitations in psychosocial functioning. CONCLUSIONS The findings demonstrate that the used test battery allows a substantiation of RWC estimates and of psychiatric ratings by objective and standardized data. If routinely incorporated in work disability evaluations, the test battery could increase their transparency for all stakeholders (insurers, claimants, medical experts, expert case-coordinators, and legal practitioners) and would open new avenues for research in the field of insurance medicine.Implications for rehabilitationThe residual work capacity (RWC) estimation by medical experts is internationally good practice, but plagued by a relatively low interrater agreement.The current study shows that psychiatric RWC estimates and capacity limitation ratings can be substantiated by data from objective, standardized psychometric instruments.Systematically using such instruments might help to improve the poor interrater agreement for RWC estimates in work disability evaluations.Such data could also be used for adopting vocational trainings and return-to-work programs to the individual needs of workers with mental health problems.
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Affiliation(s)
- Timm Rosburg
- Department of Clinical Research, Evidence-based Insurance Medicine (EbIM) Research & Education, University of Basel Hospital, Basel, Switzerland
- Forensic Department, University of Basel, University Psychiatric Clinics, Basel, Switzerland
| | - Gunnar Deuring
- Forensic Department, University of Basel, University Psychiatric Clinics, Basel, Switzerland
- Center for Affective, Stress and Sleep Disorders, University of Basel, University Psychiatric Clinics, Basel, Switzerland
| | - Gerhard Ebner
- Psychiatric Clinics of the University of Basel, Swiss Insurance Medicine (SIM), Zurich, Switzerland
| | - Valerie Hauch
- Forensic Department, University of Basel, University Psychiatric Clinics, Basel, Switzerland
| | - Marlon O Pflueger
- Forensic Department, University of Basel, University Psychiatric Clinics, Basel, Switzerland
- Faculty of Psychology, University of Basel, Basel, Switzerland
| | | | - Pasquale Calabrese
- Department of Neuropsychology and Behavioral Neurology, Faculty of Psychology, University of Basel, Basel, Switzerland
| | | | | | - Mounira Jabat
- Department of Psychiatry, University of Zurich, Psychiatric University Hospital, Zurich, Switzerland
| | | | - Yvonne Bollag
- University of Basel Hospital, Asim, Basel, Switzerland
| | - Ralph Mager
- Forensic Department, University of Basel, University Psychiatric Clinics, Basel, Switzerland
- Department of Neuropsychology and Behavioral Neurology, Faculty of Psychology, University of Basel, Basel, Switzerland
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Pflueger MO, Mager R, Graf M, Stieglitz RD. Encoding of everyday objects in older adults: Episodic memory assessment in virtual reality. Front Aging Neurosci 2023; 15:1100057. [PMID: 36993909 PMCID: PMC10040840 DOI: 10.3389/fnagi.2023.1100057] [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] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 02/03/2023] [Indexed: 03/14/2023] Open
Abstract
IntroductionAge-related decline in episodic memory performance in otherwise healthy older adults is indisputably evident. Yet, it has been shown that under certain conditions episodic memory performance in healthy older adults’ barely deviates from those seen in young adults. Here we report on the quality of object encoding in an ecologically valid, virtual-reality based memory assessment in a sample of healthy older and younger adults with comparable memory performance.MethodsWe analyzed encoding by establishing both a serial and semantic clustering index and an object memory association network.ResultsAs expected, semantic clustering was superior in older adults without need for additional allocation of executive resources whereas young adults tended more to rely on serial strategies. The association networks suggested a plethora of obvious but also less obvious memory organization principles, some of which indicated converging approaches between the groups as suggested by a subgraph analysis and some of which indicated diverging approaches as suggested by the respective network interconnectivity. A higher interconnectivity was observed in the older adults’ association networks.DiscussionWe interpreted this as a consequence of superior semantic memory organization (extent to which effective semantic strategies diverged within the group). In conclusion, these results might indicate a diminished need for compensatory cognitive effort in healthy older adults when encoding and recalling everyday objects under ecologically valid conditions. Due to an enhanced and multimodal encoding model, superior crystallized abilities might be sufficient to counteract an age-related decline in various other and specific cognitive domains. This approach might potentially elucidate age-related changes in memory performance in both healthy and pathological aging.
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Affiliation(s)
- Marlon O. Pflueger
- University of Basel, Forensic Clinic of the University Psychiatric Clinics, Basel, Switzerland
- *Correspondence: Marlon O. Pflueger,
| | - Ralph Mager
- University of Basel, Forensic Clinic of the University Psychiatric Clinics, Basel, Switzerland
| | - Marc Graf
- University of Basel, Forensic Clinic of the University Psychiatric Clinics, Basel, Switzerland
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Abstract
The present study aimed to differentiate pedophilic child sex offenders (CSOs) from nonoffending controls (CTLs), as well as contact from noncontact CSOs. For this purpose, we investigated 21 contact CSOs, 20 noncontact CSOs (child pornography offenders), as well as 21 CTLs on neuropsychological test measures and indirect test measures of sexual interest. Multiple logistic regression models showed that three parameters of indirect tests and two neuropsychological test parameters allowed the differentiation of CSOs from CTLs with a maximum accuracy of 87%. The profile of contact and noncontact CSOs was remarkably similar and the optimal model for this group differentiation had a maximum accuracy of 66%, with slightly increased levels of risk-taking behavior and greater susceptibility for perceptual interference in contact CSOs than in noncontact CSOs. The findings suggest that standardized, objective methods can support the assessment of sexual offenders against children in forensic psychiatry and legal psychology.
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Affiliation(s)
- Timm Rosburg
- University of Basel, Switzerland
- University Psychiatric Clinics Basel, Switzerland
- University Hospital of Basel, Switzerland
| | - Marlon O Pflueger
- University of Basel, Switzerland
- University Psychiatric Clinics Basel, Switzerland
| | - Andreas Mokros
- University Hospital of Psychiatry Zurich, Switzerland
- FernUniversität in Hagen, Germany
| | - Coralie Boillat
- University of Basel, Switzerland
- University Psychiatric Clinics Basel, Switzerland
| | - Gunnar Deuring
- University of Basel, Switzerland
- University Psychiatric Clinics Basel, Switzerland
| | - Thorsten Spielmann
- University of Basel, Switzerland
- University Psychiatric Clinics Basel, Switzerland
| | - Marc Graf
- University of Basel, Switzerland
- University Psychiatric Clinics Basel, Switzerland
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Stoll CB, Boillat C, Pflueger MO, Graf M, Rosburg T. Psychopathy, Neuroticism, and Abusive Behavior in Low Risk Child Sex Offenders. J Child Sex Abus 2019; 28:990-1006. [PMID: 31225780 DOI: 10.1080/10538712.2019.1630880] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 05/27/2019] [Accepted: 06/01/2019] [Indexed: 06/09/2023]
Abstract
Personality traits are considered as an important aspect in the assessment of child sex offenders (CSOs). The current study sought to elucidate the association between neuroticism, psychopathy, and abusive behavior in low risk CSOs. 43 pedophilic CSOs and 21 controls (CTLs) completed the NEO-Personality Inventory-Revised (NEO-PI-R), Psychopathy Checklist: Screening Version (PCL:SV), and Multiphasic Sex Inventory (MSI). Our results revealed small differences in PCL scores between CSOs and CTLs, with comparatively low levels of psychopathy in both groups. Higher levels of neuroticism were associated with higher PCL scores, in both CSOs and CTLs. However, higher PCL scores in CSOs did not correlate with higher MSI total scores on the subscale child molest. These findings suggest an ambiguous role of psychopathy in CSOs: higher levels of psychopathy co-occur with higher levels of neuroticism, but psychopathy does apparently not modulate abusive behavior, at least not in low risk offenders, as currently investigated.
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Affiliation(s)
- Cedric B Stoll
- Forensics Department, University Psychiatric Clinics Basel, Basel, Switzerland
| | - Coralie Boillat
- Forensics Department, University Psychiatric Clinics Basel, Basel, Switzerland
| | - Marlon O Pflueger
- Forensics Department, University Psychiatric Clinics Basel, Basel, Switzerland
| | - Marc Graf
- Forensics Department, University Psychiatric Clinics Basel, Basel, Switzerland
| | - Timm Rosburg
- Forensics Department, University Psychiatric Clinics Basel, Basel, Switzerland
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Pflueger MO, Stieglitz RD, Lemoine P, Leyhe T. Ecologically relevant episodic memory assessment indicates an attenuated age-related memory loss – A virtual reality study. Neuropsychology 2018; 32:680-689. [DOI: 10.1037/neu0000454] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Pflueger MO, Calabrese P, Studerus E, Zimmermann R, Gschwandtner U, Borgwardt S, Aston J, Stieglitz RD, Riecher-Rössler A. The neuropsychology of emerging psychosis and the role of working memory in episodic memory encoding. Psychol Res Behav Manag 2018; 11:157-168. [PMID: 29785144 PMCID: PMC5953273 DOI: 10.2147/prbm.s149425] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Episodic memory encoding and working memory (WM) deficits are among the first cognitive signs and symptoms in the course of schizophrenia spectrum disorders. However, it is not clear whether the deficit pattern is generalized or specific in nature. We hypothesized that encoding deficits at an early stage of the disease might be due to the more fundamental WM deficits. Methods We examined episodic memory encoding and WM by administering the California Verbal Learning Test, a 2-back task, and the Wisconsin Card Sorting Test in 90 first-episode psychosis (FE) patients and 116 individuals with an at-risk mental state for psychosis (ARMS) compared to 57 healthy subjects. Results Learning progress, but not span of apprehension, was diminished to a similar extent in both the ARMS and the FE. We showed that this was due to WM impairment by applying a structural equation approach. Conclusion Thus, we conclude that verbal memory encoding deficits are secondary to primary WM impairment in emerging psychosis.
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Affiliation(s)
- Marlon O Pflueger
- Department of Forensic Psychiatry, University of Basel Psychiatric Clinics, Basel, Switzerland
| | - Pasquale Calabrese
- Division of Molecular and Cognitive Neuroscience, University of Basel, Basel, Switzerland
| | - Erich Studerus
- Center for Gender Research and Early Detection, University of Basel Psychiatric Hospital, Basel, Switzerland
| | - Ronan Zimmermann
- Department of Neurology and Neurosurgery, Hospital of the University of Basel, Basel, Switzerland
| | - Ute Gschwandtner
- Department of Neurology and Neurosurgery, Hospital of the University of Basel, Basel, Switzerland
| | - Stefan Borgwardt
- Department of Psychiatry (UPK), University of Basel, Basel, Switzerland
| | - Jacqueline Aston
- Center for Gender Research and Early Detection, University of Basel Psychiatric Hospital, Basel, Switzerland
| | - Rolf-Dieter Stieglitz
- Division of Clinical Psychology and Psychiatry, University of Basel, Basel, Switzerland
| | - Anita Riecher-Rössler
- Center for Gender Research and Early Detection, University of Basel Psychiatric Hospital, Basel, Switzerland
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Geissmann L, Gschwind L, Schicktanz N, Deuring G, Rosburg T, Schwegler K, Gerhards C, Milnik A, Pflueger MO, Mager R, de Quervain DJF, Coynel D. Resting-state functional connectivity remains unaffected by preceding exposure to aversive visual stimuli. Neuroimage 2017; 167:354-365. [PMID: 29175611 DOI: 10.1016/j.neuroimage.2017.11.046] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 11/06/2017] [Accepted: 11/21/2017] [Indexed: 01/07/2023] Open
Abstract
While much is known about immediate brain activity changes induced by the confrontation with emotional stimuli, the subsequent temporal unfolding of emotions has yet to be explored. To investigate whether exposure to emotionally aversive pictures affects subsequent resting-state networks differently from exposure to neutral pictures, a resting-state fMRI study implementing a two-group repeated-measures design in healthy young adults (N = 34) was conducted. We focused on investigating (i) patterns of amygdala whole-brain and hippocampus connectivity in both a seed-to-voxel and seed-to-seed approach, (ii) whole-brain resting-state networks with an independent component analysis coupled with dual regression, and (iii) the amygdala's fractional amplitude of low frequency fluctuations, all while EEG recording potential fluctuations in vigilance. In spite of the successful emotion induction, as demonstrated by stimuli rating and a memory-facilitating effect of negative emotionality, none of the resting-state measures was differentially affected by picture valence. In conclusion, resting-state networks connectivity as well as the amygdala's low frequency oscillations appear to be unaffected by preceding exposure to widely used emotionally aversive visual stimuli in healthy young adults.
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Affiliation(s)
- Léonie Geissmann
- Division of Cognitive Neuroscience, Department of Psychology, University of Basel, Birmannsgasse 8, 4055 Basel, Switzerland; Transfaculty Research Platform Molecular and Cognitive Neurosciences (MCN), University of Basel, Birmannsgasse 8, 4055 Basel, Switzerland.
| | - Leo Gschwind
- Division of Cognitive Neuroscience, Department of Psychology, University of Basel, Birmannsgasse 8, 4055 Basel, Switzerland; Transfaculty Research Platform Molecular and Cognitive Neurosciences (MCN), University of Basel, Birmannsgasse 8, 4055 Basel, Switzerland; Division of Molecular Neuroscience, Department of Psychology, University of Basel, Birmannsgasse 8, 4055 Basel, Switzerland
| | - Nathalie Schicktanz
- Division of Cognitive Neuroscience, Department of Psychology, University of Basel, Birmannsgasse 8, 4055 Basel, Switzerland; Transfaculty Research Platform Molecular and Cognitive Neurosciences (MCN), University of Basel, Birmannsgasse 8, 4055 Basel, Switzerland
| | - Gunnar Deuring
- Department of Forensic Psychiatry, University Psychiatric Clinics Basel, Wilhelm Klein-Strasse 27, 4002 Basel, Switzerland
| | - Timm Rosburg
- Department of Forensic Psychiatry, University Psychiatric Clinics Basel, Wilhelm Klein-Strasse 27, 4002 Basel, Switzerland
| | - Kyrill Schwegler
- Division of Cognitive Neuroscience, Department of Psychology, University of Basel, Birmannsgasse 8, 4055 Basel, Switzerland; Transfaculty Research Platform Molecular and Cognitive Neurosciences (MCN), University of Basel, Birmannsgasse 8, 4055 Basel, Switzerland; Psychiatric University Clinics, University of Basel, 4055 Basel, Switzerland
| | - Christiane Gerhards
- Division of Cognitive Neuroscience, Department of Psychology, University of Basel, Birmannsgasse 8, 4055 Basel, Switzerland; Transfaculty Research Platform Molecular and Cognitive Neurosciences (MCN), University of Basel, Birmannsgasse 8, 4055 Basel, Switzerland
| | - Annette Milnik
- Transfaculty Research Platform Molecular and Cognitive Neurosciences (MCN), University of Basel, Birmannsgasse 8, 4055 Basel, Switzerland; Division of Molecular Neuroscience, Department of Psychology, University of Basel, Birmannsgasse 8, 4055 Basel, Switzerland; Psychiatric University Clinics, University of Basel, 4055 Basel, Switzerland
| | - Marlon O Pflueger
- Department of Forensic Psychiatry, University Psychiatric Clinics Basel, Wilhelm Klein-Strasse 27, 4002 Basel, Switzerland
| | - Ralph Mager
- Department of Forensic Psychiatry, University Psychiatric Clinics Basel, Wilhelm Klein-Strasse 27, 4002 Basel, Switzerland
| | - Dominique J F de Quervain
- Division of Cognitive Neuroscience, Department of Psychology, University of Basel, Birmannsgasse 8, 4055 Basel, Switzerland; Transfaculty Research Platform Molecular and Cognitive Neurosciences (MCN), University of Basel, Birmannsgasse 8, 4055 Basel, Switzerland; Psychiatric University Clinics, University of Basel, 4055 Basel, Switzerland
| | - David Coynel
- Division of Cognitive Neuroscience, Department of Psychology, University of Basel, Birmannsgasse 8, 4055 Basel, Switzerland; Transfaculty Research Platform Molecular and Cognitive Neurosciences (MCN), University of Basel, Birmannsgasse 8, 4055 Basel, Switzerland
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Boillat C, Deuring G, Pflueger MO, Graf M, Rosburg T. Neuroticism in child sex offenders and its association with sexual dysfunctions, cognitive distortions, and psychological complaints. Int J Law Psychiatry 2017; 54:83-89. [PMID: 28595809 DOI: 10.1016/j.ijlp.2017.05.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 04/04/2017] [Accepted: 05/17/2017] [Indexed: 06/07/2023]
Abstract
Studies in child sex offenders (CSO) often report deviant personality characteristics. In our study, we investigated neuroticism in CSO and tested the hypothesis that CSO with high neuroticism show more serious abuse behavior and are more likely to exhibit sexual dysfunction and cognitive distortions, as compared to CSO with low neuroticism. A sample of 40 CSO (both child sexual abusers and child sexual material users) was split into two subsamples based on their neuroticism scores, obtained by the NEO-Personality Inventory-Revised (NEO-PI-R) questionnaire. Subsequently, we compared their scores in the Multiphasic Sex Inventory (MSI) questionnaire and Symptom Checklist-90-Revised (SCL-90-R). Our results show that CSO exhibited higher levels of neuroticism than controls, but were still in the normal range. In CSO, neuroticism was associated with sexual dysfunction and cognitive distortions, rather than with more severe abuse behavior. Moreover, neuroticism in this group was linked to a broad range of psychological problems and psychopathological symptoms, such as somatization or anxiety. Our findings suggest that neuroticism even below the level of personality disorder is associated with a broader range of psychological problems in CSO, which should be addressed in therapy.
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Affiliation(s)
- Coralie Boillat
- University of Basel, University Psychiatric Clinics, Department of Forensic Psychiatry, Wilhelm Klein-Strasse 27, 4002 Basel, Switzerland.
| | - Gunnar Deuring
- University of Basel, University Psychiatric Clinics, Department of Forensic Psychiatry, Wilhelm Klein-Strasse 27, 4002 Basel, Switzerland.
| | - Marlon O Pflueger
- University of Basel, University Psychiatric Clinics, Department of Forensic Psychiatry, Wilhelm Klein-Strasse 27, 4002 Basel, Switzerland.
| | - Marc Graf
- University of Basel, University Psychiatric Clinics, Department of Forensic Psychiatry, Wilhelm Klein-Strasse 27, 4002 Basel, Switzerland.
| | - Timm Rosburg
- University of Basel, University Psychiatric Clinics, Department of Forensic Psychiatry, Wilhelm Klein-Strasse 27, 4002 Basel, Switzerland.
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Boillat C, Schwab N, Stutz M, Pflueger MO, Graf M, Rosburg T. Neuroticism as a risk factor for child abuse in victims of childhood sexual abuse. Child Abuse Negl 2017; 68:44-54. [PMID: 28395194 DOI: 10.1016/j.chiabu.2017.03.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 01/24/2017] [Accepted: 03/26/2017] [Indexed: 06/07/2023]
Abstract
Findings on the relationship of experienced sexual abuse and abuse behavior in adulthood are ambiguous. However, associations between experienced abuse and neuroticism as well as between neuroticism and active child abuse have been reported repeatedly. In our study, we compared pedosexual child abusers with consumers of internet child pornography and control subjects with adult-sexual preference with regard to traumatic childhood experience (Childhood Trauma Questionnaire, CTQ), personality traits (NEO - Personality Inventory - Revised, NEO-PI-R), and sexual abnormalities (Multiphasic Sex Inventory, MSI). In an initial analysis, sexual abuse experienced in childhood was not directly linked to sexual abuse behavior in adulthood. However, this relationship was mediated by neuroticism. In a second step, the CTQ scales were conflated and, using a structural equation model, direct links between the overall level of abuse experienced in childhood (generally high CTQ levels) and sexual abuse behavior in adulthood revealed again the mediation by neurotic personality. We conclude that the overall level of abuse experienced in childhood in general, and less sexual abuse experience in particular, modulates the tendency for child sexual abuse behavior in adulthood. Data suggest that, depending on the resilience of an individual, abuse experience during childhood increases the likelihood of developing neurotic personality traits in later life, which are in turn considered to increase the risk of child sexual abuse in child sex offenders.
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Affiliation(s)
- Coralie Boillat
- University Basel, University Psychiatric Clinics, Department of Forensic Psychiatry, Wilhelm Klein-Strasse 27, 4002 Basel, Switzerland
| | - Nathalie Schwab
- University Basel, University Psychiatric Clinics, Department of Forensic Psychiatry, Wilhelm Klein-Strasse 27, 4002 Basel, Switzerland
| | - Matthias Stutz
- University Basel, University Psychiatric Clinics, Department of Forensic Psychiatry, Wilhelm Klein-Strasse 27, 4002 Basel, Switzerland
| | - Marlon O Pflueger
- University Basel, University Psychiatric Clinics, Department of Forensic Psychiatry, Wilhelm Klein-Strasse 27, 4002 Basel, Switzerland
| | - Marc Graf
- University Basel, University Psychiatric Clinics, Department of Forensic Psychiatry, Wilhelm Klein-Strasse 27, 4002 Basel, Switzerland
| | - Timm Rosburg
- University Basel, University Psychiatric Clinics, Department of Forensic Psychiatry, Wilhelm Klein-Strasse 27, 4002 Basel, Switzerland.
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Bernsmeier C, Weisskopf DM, Pflueger MO, Mosimann J, Campana B, Terracciano L, Beglinger C, Heim MH, Cajochen C. Sleep Disruption and Daytime Sleepiness Correlating with Disease Severity and Insulin Resistance in Non-Alcoholic Fatty Liver Disease: A Comparison with Healthy Controls. PLoS One 2015; 10:e0143293. [PMID: 26576055 PMCID: PMC4648512 DOI: 10.1371/journal.pone.0143293] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Accepted: 11/03/2015] [Indexed: 12/29/2022] Open
Abstract
Background & Aims Sleep disturbance is associated with the development of obesity, diabetes and hepatic steatosis in murine models. Hepatic triglyceride accumulation oscillates in a circadian rhythm regulated by clock genes, light-dark cycle and feeding time in mice. The role of the sleep-wake cycle in the pathogenesis of human non-alcoholic fatty liver disease (NAFLD) is indeterminate. We sought to detail sleep characteristics, daytime sleepiness and meal times in relation to disease severity in patients with NAFLD. Methods Basic Sleep duration and latency, daytime sleepiness (Epworth sleepiness scale), Pittsburgh sleep quality index, positive and negative affect scale, Munich Chronotype Questionnaire and an eating habit questionnaire were assessed in 46 patients with biopsy-proven NAFLD and 22 healthy controls, and correlated with biochemical and histological parameters. Results In NAFLD compared to healthy controls, time to fall asleep was vastly prolonged (26.9 vs. 9.8 min., p = 0.0176) and sleep duration was shortened (6.3 vs. 7.2 hours, p = 0.0149). Sleep quality was poor (Pittsburgh sleep quality index 8.2 vs. 4.7, p = 0.0074) and correlated with changes in affect. Meal frequency was shifted towards night-times (p = 0.001). In NAFLD but not controls, daytime sleepiness significantly correlated with liver enzymes (ALAT [r = 0.44, p = 0.0029], ASAT [r = 0.46, p = 0.0017]) and insulin resistance (HOMA-IR [r = 0.5, p = 0.0009]) independent of cirrhosis. In patients with fibrosis, daytime sleepiness correlated with the degree of fibrosis (r = 0.364, p = 0.019). Conclusions In NAFLD sleep duration was shortened, sleep onset was delayed and sleep quality poor. Food-intake was shifted towards the night. Daytime sleepiness was positively linked to biochemical and histologic surrogates of disease severity. The data may indicate a role for sleep-wake cycle regulation and timing of food-intake in the pathogenesis of human NAFLD as suggested from murine models.
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Affiliation(s)
- Christine Bernsmeier
- Division of Gastroenterology and Hepatology, University Hospital Basel, Basel, Switzerland
- Department of Biomedicine, University Hospital Basel, Basel, Switzerland
- * E-mail:
| | - Diego M. Weisskopf
- Centre for Chronobiology, Psychiatric Hospital of the University of Basel, Basel, Switzerland
| | - Marlon O. Pflueger
- Forensic Psychiatric Clinic, Psychiatric Hospital of the University of Basel, Basel, Switzerland
| | - Jan Mosimann
- Centre for Chronobiology, Psychiatric Hospital of the University of Basel, Basel, Switzerland
| | - Benedetta Campana
- Division of Gastroenterology and Hepatology, University Hospital Basel, Basel, Switzerland
- Department of Biomedicine, University Hospital Basel, Basel, Switzerland
| | - Luigi Terracciano
- Institute of Pathology, University Hospital Basel, Basel, Switzerland
| | - Christoph Beglinger
- Division of Gastroenterology and Hepatology, University Hospital Basel, Basel, Switzerland
- Department of Biomedicine, University Hospital Basel, Basel, Switzerland
| | - Markus H. Heim
- Division of Gastroenterology and Hepatology, University Hospital Basel, Basel, Switzerland
- Department of Biomedicine, University Hospital Basel, Basel, Switzerland
| | - Christian Cajochen
- Centre for Chronobiology, Psychiatric Hospital of the University of Basel, Basel, Switzerland
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Pflueger MO, Franke I, Graf M, Hachtel H. Predicting general criminal recidivism in mentally disordered offenders using a random forest approach. BMC Psychiatry 2015; 15:62. [PMID: 25885691 PMCID: PMC4384374 DOI: 10.1186/s12888-015-0447-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 03/18/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Psychiatric expert opinions are supposed to assess the accused individual's risk of reoffending based on a valid scientific foundation. In contrast to specific recidivism, general recidivism has only been poorly considered in Continental Europe; we therefore aimed to develop a valid instrument for assessing the risk of general criminal recidivism of mentally ill offenders. METHOD Data of 259 mentally ill offenders with a median time at risk of 107 months were analyzed and combined with the individuals' criminal records. We derived risk factors for general criminal recidivism and classified re-offences by using a random forest approach. RESULTS In our sample of mentally ill offenders, 51% were reconvicted. The most important predictive factors for general criminal recidivism were: number of prior convictions, age, type of index offence, diversity of criminal history, and substance abuse. With our statistical approach we were able to correctly identify 58-95% of all reoffenders and 65-97% of all committed offences (AUC = .90). CONCLUSIONS Our study presents a new statistical approach to forensic-psychiatric risk-assessment, allowing experts to evaluate general risk of reoffending in mentally disordered individuals, with a special focus on high-risk groups. This approach might serve not only for expert opinions in court, but also for risk management strategies and therapeutic interventions.
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Affiliation(s)
- Marlon O Pflueger
- Department of Forensic Psychiatry, University Psychiatric Clinics, Wilhelm Klein-Str. 27, CH-4012, Basel, Switzerland.
| | - Irina Franke
- Department of Forensic Psychiatry, University Psychiatric Clinics, Wilhelm Klein-Str. 27, CH-4012, Basel, Switzerland.
| | - Marc Graf
- Department of Forensic Psychiatry, University Psychiatric Clinics, Wilhelm Klein-Str. 27, CH-4012, Basel, Switzerland.
| | - Henning Hachtel
- Department of Forensic Psychiatry, University Psychiatric Clinics, Wilhelm Klein-Str. 27, CH-4012, Basel, Switzerland.
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Riecher-Rössler A, Rybakowski JK, Pflueger MO, Beyrau R, Kahn RS, Malik P, Fleischhacker WW. Hyperprolactinemia in antipsychotic-naive patients with first-episode psychosis. Psychol Med 2013; 43:2571-2582. [PMID: 23590895 DOI: 10.1017/s0033291713000226] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Hyperprolactinemia is frequent in patients with schizophrenic psychoses. It is usually regarded as an adverse effect of antipsychotics but has recently also been shown in patients without antipsychotic medication. Our objective was to test whether hyperprolactinemia occurs in antipsychotic-naive first-episode patients (FEPs). METHOD In the framework of the European First Episode Schizophrenia Trial (EUFEST), 249 out of 498 FEPs were eligible for this study, of whom 74 were antipsychotic naive. All patients were investigated regarding their serum prolactin levels with immunoassays standardized against the 3rd International Reference Standard 84/500. RESULTS Twenty-nine (39%) of the 74 antipsychotic-naive patients showed hyperprolactinemia not explained by any other reason, 11 (50%) of 22 women and 18 (35%) of 52 men. CONCLUSIONS Hyperprolactinemia may be present in patients with schizophrenic psychoses independent of antipsychotic medication. It might be stress induced. As enhanced prolactin can increase dopamine release through a feedback mechanism, this could contribute to explaining how stress can trigger the outbreak of psychosis.
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Schulze C, Zimmermann R, Gschwandtner U, Pflueger MO, Rapp C, Studerus E, Riecher-Rössler A. Can cognitive deficits facilitate differential diagnosis between at-risk mental state for psychosis and depressive disorders? Early Interv Psychiatry 2013; 7:381-90. [PMID: 23164358 DOI: 10.1111/eip.12004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [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: 01/05/2012] [Accepted: 07/31/2012] [Indexed: 11/30/2022]
Abstract
AIM Many studies have provided evidence of cognitive deficits in individuals in an 'At Risk Mental State' (ARMS) for psychosis, which makes neuropsychology potentially useful in the early detection of psychosis. As depression is an important differential diagnosis in prodromal states of psychosis, the specificity of neurocognitive deficits in ARMS individuals as compared with non-psychotic depressive disorders is investigated. METHODS Neurocognitive performance of four groups was analysed: 22 ARMS individuals with later transition to psychosis (ARMS-T), 25 ARMS individuals without later transition to psychosis (ARMS-NT), 34 controls with depressive disorders and 76 healthy controls. The subjects were assessed with a neurocognitive test battery covering the domains' intelligence, executive function and attention/ working memory. MANOVAs, ANOVAs and Tukey's tests were applied after adjustment for confounding factors. RESULTS ARMS-T showed significant cognitive deficits in working memory and in certain executive function tasks compared with healthy controls as well as with controls with depression. Controls with depression were only impaired in time per move in the tower of Hanoi test when compared with healthy controls. CONCLUSIONS The psychosis prodrome seems to be associated with cognitive deficits in the domains of working memory and executive function. In contrast, depressive patients showed no cognitive deficits, but slowing in one executive function task. Neurocognitive testing might therefore contribute to the differential diagnosis between prodromal psychosis and depressive disorders.
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Affiliation(s)
- Carla Schulze
- University Psychiatric Outpatient Department, University of Basel Psychiatric Clinics, Basel, Switzerland
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Zimmermann R, Gschwandtner U, Wilhelm FH, Pflueger MO, Riecher-Rössler A, Fuhr P. EEG spectral power and negative symptoms in at-risk individuals predict transition to psychosis. Schizophr Res 2010; 123:208-16. [PMID: 20850950 DOI: 10.1016/j.schres.2010.08.031] [Citation(s) in RCA: 33] [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: 01/06/2010] [Revised: 08/12/2010] [Accepted: 08/22/2010] [Indexed: 10/19/2022]
Abstract
INTRODUCTION EEG power in the delta, theta and beta1 bands has been shown to be positively correlated with negative symptoms in first episode psychotic patients. The present study investigates this correlation in an "at risk mental state for psychosis" (ARMS) with the aim to improve prediction of transition to psychosis. METHODS Thirteen ARMS patients with later transition to psychosis (ARMS-T) and fifteen without (follow-up period of at least 4 years) (ARMS-NT) were investigated using spectral resting EEG data (of 8 electrodes over the fronto-central scalp area placed according to the 10-20 system) and summary score of the Scale for the Assessment of Negative Symptoms (SANS). Linear regressions were used to evaluate the correlation of SANS and EEG power in seven bands (delta, theta, alpha1, alpha2, beta1, beta2, beta3) in both ARMS groups and logistic regressions were used to predict transition to psychosis. Potentially confounding factors were controlled. RESULTS ARMS-T and ARMS-NT showed differential correlations of EEG power and SANS in delta, theta, and beta1 bands (p<.05): ARMS-T showed positive and ARMS-NT negative correlations. Logistic regressions showed that neither SANS score nor EEG spectral power alone predicted transition to psychosis. However, SANS score in combination with power in the delta, theta, beta1, and beta2 bands, respectively, predicted transition significantly (p<.03). CONCLUSIONS ARMS-T and ARMS-NT show differential correlations of SANS summary score and EEG power in delta, theta, and beta bands. Prediction of transition to psychosis is possible using combined information from a negative symptom scale and EEG spectral data.
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Affiliation(s)
- Ronan Zimmermann
- University Psychiatric Outpatient Department, Psychiatric University Clinics, Basel, Switzerland.
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15
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Buehlmann E, Berger GE, Aston J, Gschwandtner U, Pflueger MO, Borgwardt SJ, Radue EW, Riecher-Rössler A. Hippocampus abnormalities in at risk mental states for psychosis? A cross-sectional high resolution region of interest magnetic resonance imaging study. J Psychiatr Res 2010; 44:447-53. [PMID: 19939408 DOI: 10.1016/j.jpsychires.2009.10.008] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2009] [Revised: 09/16/2009] [Accepted: 10/20/2009] [Indexed: 12/18/2022]
Abstract
BACKGROUND Hippocampal volume (HV) reduction is well documented in schizophrenia. However, it is still unclear whether this change is a pre-existing vulnerability factor, a sign of disease progression, a consequence of environmental factors, such as drug use, antipsychotic medication, or malnutrition. The timing of HV changes is not well established, but a lack of macrostructural hippocampal brain abnormalities before disease onset would rather support a neuroprogressive illness model. AIM To investigate the timing of HV changes in emerging psychosis. METHODS A cross-sectional MRI study of manually traced HVs in 37 individuals with an At Risk Mental State (ARMS) for psychosis, 23 individuals with First-Episode Psychosis (FEP), and 22 Healthy Controls (HC) was performed. We compared left and right HVs corrected for whole brain volume across groups using analysis of covariance (ANCOVA) with gender as a covariate. Sixteen of 37 ARMS individuals developed a psychotic disorder during follow up (ARMS-T). The mean duration of follow up in ARMS was 25.1months. RESULTS The overall ANCOVA model comparing left HVs across FEP, ARMS and HC indicated a significant general group effect (p<.05) with largest volumes in ARMS and smallest in FEP. ARMS-T subjects had significantly larger left HVs compared to FE but no HV differences compared to HC (p<0.05). Over all groups, we found an asymmetry between the left and right mean HVs and a strong effect of sex. DISCUSSION The present study suggests that macrostructural hippocampal abnormalities probably occur in the context of the first psychotic breakdown.
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Affiliation(s)
- Eva Buehlmann
- University Hospital Basel, Psychiatric Outpatient Department, Petersgraben 4, CH-4031 Basel, Switzerland
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Riecher-Rössler A, Pflueger MO, Aston J, Borgwardt SJ, Brewer WJ, Gschwandtner U, Stieglitz RD. Efficacy of using cognitive status in predicting psychosis: a 7-year follow-up. Biol Psychiatry 2009; 66:1023-30. [PMID: 19733837 DOI: 10.1016/j.biopsych.2009.07.020] [Citation(s) in RCA: 173] [Impact Index Per Article: 11.5] [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] [Received: 02/09/2009] [Revised: 07/08/2009] [Accepted: 07/10/2009] [Indexed: 11/29/2022]
Abstract
BACKGROUND Despite extensive early detection research in schizophrenic psychoses, methods for identifying at-risk individuals and predicting their transition to psychosis are still unreliable. Moreover, there are sparse data on long-term prediction. We therefore investigated long-term psychosis transition in individuals with an At Risk Mental State (ARMS) and examined the relative efficacy of clinical and neuropsychological status in optimizing the prediction of transition. METHODS Sixty-four individuals with ARMS for psychosis were identified from all referrals to our early detection clinic between March 1, 2000 and February 29, 2004. Fifty-three (83%) were followed up for up to 7 (mean 5.4) years. RESULTS Twenty-one of the 53 staying in follow-up developed psychosis, corresponding to a transition rate of .34 (Kaplan-Meier estimates). Median time to transition was 10 months (range <1-55). Six of all transitions (29%) occurred only after 12 months from referral. Best transition predictors within this population were selected attenuated psychotic symptoms (suspiciousness), negative symptoms (anhedonia/asociality), and cognitive deficits (reduced speed of information processing). With these predictors in an integrated model for predicting transition to psychosis, the overall predictive accuracy was 80.9% with a sensitivity of 83.3% and a specificity of 79.3%. CONCLUSIONS Follow-up of ARMS subjects should exceed the usual 12 months. Prediction of transitions could be improved by a stronger weighting of certain early symptoms and by introducing neurocognitive tests into a stepwise risk assessment. Confirmatory research will hopefully further improve risk algorithm, including psychopathology and neuropsychological performance, for clinical application in early detection clinics.
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