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Laufer S, Schulze L, Engel S, Klusmann H, Skoluda N, Nater UM, Knaevelsrud C, Schumacher S. Corrigendum to "The effect of an internet-based intervention for depression on cortisol and alpha-amylase" [Psychoneuroendocrinology 152 (2023) 106082]. Psychoneuroendocrinology 2024; 164:107028. [PMID: 38538445 DOI: 10.1016/j.psyneuen.2024.107028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/21/2024]
Affiliation(s)
- S Laufer
- Clinical Psychological Intervention, Department of Education and Psychology, Freie Universit ̈at Berlin, Schwendener Straße 27, Berlin 14195, Germany; Clinical Psychology and Psychotherapy, Institute for Mental Health and Behavioral Medicine, Faculty of Health, HMU Health and Medical University, Olympischer Weg1, Potsdam 14471, Germany.
| | - L Schulze
- Clinical Psychology and Psychotherapy, Department of Education and Psychology, Freie Universit ̈at Berlin, Habelschwerdter Allee 45, Berlin 14195, Germany
| | - S Engel
- Clinical Psychological Intervention, Department of Education and Psychology, Freie Universit ̈at Berlin, Schwendener Straße 27, Berlin 14195, Germany
| | - H Klusmann
- Clinical Psychological Intervention, Department of Education and Psychology, Freie Universit ̈at Berlin, Schwendener Straße 27, Berlin 14195, Germany
| | - N Skoluda
- Department of Clinical Psychology and Health Psychology, Faculty of Psychology, University of Vienna, Liebiggasse 5, Vienna 1010, Austria; Research Platform the Stress of Life (SOLE) - Processes and Mechanisms Underlying Everyday Life Stress, Austria
| | - U M Nater
- Department of Clinical Psychology and Health Psychology, Faculty of Psychology, University of Vienna, Liebiggasse 5, Vienna 1010, Austria; Research Platform the Stress of Life (SOLE) - Processes and Mechanisms Underlying Everyday Life Stress, Austria
| | - C Knaevelsrud
- Clinical Psychological Intervention, Department of Education and Psychology, Freie Universit ̈at Berlin, Schwendener Straße 27, Berlin 14195, Germany
| | - S Schumacher
- Clinical Psychological Intervention, Department of Education and Psychology, Freie Universit ̈at Berlin, Schwendener Straße 27, Berlin 14195, Germany; Clinical Psychology and Psychotherapy, Institute for Mental Health and Behavioral Medicine, Faculty of Health, HMU Health and Medical University, Olympischer Weg1, Potsdam 14471, Germany
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Schumacher S, Mitzlaff B, Mohrmann C, Fiedler KM, Heep A, Beske F, Hoffmann F, Lange M. Characteristics and special challenges of neonatal emergency transports. Early Hum Dev 2024; 192:106012. [PMID: 38648678 DOI: 10.1016/j.earlhumdev.2024.106012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Revised: 04/14/2024] [Accepted: 04/15/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND As a rule, newborns do not require special medical care. If unexpected complications occur peripartum or postpartum, support from and transport to specialised neonatal hospitals might be needed. METHODS In a retrospective study, all transport protocols of a supraregional paediatric‑neonatological maximum care hospital in northwestern Germany from 01.10.2018 through 30.09.2021 were analysed. The particular focus was on transports of newborns (<7 days) and the leading symptoms that led to contact. RESULTS A total of 299 patients were included (average age of 15.4 h, 61.6 % males). The average complete transport time was approximately 2 h. Five leading neonatal diseases (respiratory, infectious, asphyxia, cardiac, haematological) were found to represent the causes of >80 % of transfers. Respiratory adaptation disorders are the main reason for transferring a newborn to a centre, whereas asphyxia is the most severe condition. The various symptoms differ in their time of onset, a factor which must be taken into account in practice. Differences were also found between different types of hospitals: while a large proportion of transports were carried out from maternity hospitals (80.6 %), children transported from children's hospitals were generally more severely ill. DISCUSSION Transfers of neonates, especially from maternity hospitals to neonatal intensive care units due to special neonatal diseases, are not rare. In times of increasingly scarce resources, the effective care of sick or at-risk neonates is essential. For low-population regions, this means professional cooperation between maximum care providers and smaller children's hospitals and maternity-only hospitals.
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Affiliation(s)
- S Schumacher
- Department of Pediatrics, Klinikum Leer, Leer, Germany
| | - B Mitzlaff
- Institute for Emergency Medicine, University Hospital Schleswig-Holstein, Kiel, Germany
| | - C Mohrmann
- Department of Pediatrics, Elisabeth Children's Hospital, University of Oldenburg, Oldenburg, Germany
| | - K M Fiedler
- Department of Pediatrics, Elisabeth Children's Hospital, University of Oldenburg, Oldenburg, Germany
| | - A Heep
- Department of Pediatrics, Elisabeth Children's Hospital, University of Oldenburg, Oldenburg, Germany
| | - F Beske
- Department of Pediatrics, Elisabeth Children's Hospital, University of Oldenburg, Oldenburg, Germany
| | - F Hoffmann
- Department of Healthcare Research, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - M Lange
- Department of Pediatrics, Elisabeth Children's Hospital, University of Oldenburg, Oldenburg, Germany.
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Haering S, Schulze L, Geiling A, Meyer C, Klusmann H, Schumacher S, Knaevelsrud C, Engel S. Higher risk-less data: A systematic review and meta-analysis on the role of sex and gender in trauma research. J Psychopathol Clin Sci 2024; 133:257-272. [PMID: 38619461 DOI: 10.1037/abn0000899] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
Women and men are at different risk for posttraumatic stress disorder (PTSD). It is unclear, however, how studies on PTSD risk factors integrate this knowledge into their research. Moreover, the temporal development of women's higher PTSD risk is unknown. In this systematic review and meta-analysis, we examine how prospective studies on PTSD development (k = 47) consider sex and gender across four domains (samples, terminology, analyses, and reporting). Further, we differentially analyze sex/gender differences within five time intervals from 1 month to 5 years posttrauma. PTSD prevalence (OR = 1.72 [1.27-2.34]) and severity (g = 0.31 [0.09, 0.53]) were increased for women relative to men at 1 month posttrauma already, that is, at the first timepoint of a possible PTSD diagnosis. PTSD severity was elevated for women compared to men across all time intervals, but evidence for increased PTSD prevalence for women relative to men was less stable with longer follow-ups. Despite women's higher PTSD burdens, they were clearly underrepresented in samples (68.3% male, 31.7% female participants). Only 5.0% of studies explained or described their understanding of sex and gender, and only 2.6% used sex as discovery variable, that is, investigating sex-dependent risk mechanisms. Sex and gender aspects in design, data, and discussion were considered by only one-third of studies each. Trauma research falls short of its potential to adequately consider sex and gender. Sex- and gender-sensitive practices can advance rigor, innovation, and equity in psychopathology research. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
- Stephanie Haering
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universitat Berlin
| | - Lars Schulze
- Division of Clinical Psychology and Psychotherapy, Department of Education and Psychology, Freie Universitat Berlin
| | - Angelika Geiling
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universitat Berlin
| | - Caroline Meyer
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universitat Berlin
| | - Hannah Klusmann
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universitat Berlin
| | - Sarah Schumacher
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Faculty of Health, Health and Medical University
| | - Christine Knaevelsrud
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universitat Berlin
| | - Sinha Engel
- Department of Experimental Psychopathology, Institute for Psychology, University of Hildesheim
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Klusmann H, Kapp C, Engel S, Schumacher T, Bücklein E, Knaevelsrud C, Schumacher S. Higher Depressive Symptoms in Irregular Menstrual Cycles: Converging Evidence from Cross-Sectional and Prospective Assessments. Psychopathology 2024:1-8. [PMID: 38194941 DOI: 10.1159/000535565] [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: 12/22/2022] [Accepted: 11/15/2023] [Indexed: 01/11/2024]
Abstract
BACKGROUND Menstrual cycle regularity is an important marker of reproductive health and associated with physiological and psychological illnesses, as well as experiencing stress. We hypothesized that individuals with irregular menstrual cycles report higher depressive symptom severity, after controlling for stress occurrence. METHODS The hypothesis was examined through two measurement approaches: a cross-sectional and a prospective, longitudinal study. In the cross-sectional study, participants (n = 394) reported depressive symptoms and their overall menstrual cycle regularity. In the longitudinal study, participants (n = 77) completed questionnaires on depressive symptoms and stress during the mid-follicular and periovulatory phase of one menstrual cycle. Depressive symptoms were compared between participants with regular and irregular cycles through a Welch t test and an ANCOVA. RESULTS Participants with irregular menstrual cycles reported more depressive symptoms in the cross-sectional analysis. Similarly, in the longitudinal analysis, the group with a current irregular menstrual cycle reported more depressive symptoms after controlling for stress occurrence. When including only complete data sets without multiple imputation (n = 52), the direction of the effects remained but did not reach statistical significance. CONCLUSIONS The results indicate an association between depressive symptoms and menstrual cycle irregularity. Limitations were that although we investigated the menstrual cycle prospectively, it would have been more precise to include two or more cycles and daily sex hormone measurements. Further limitations were the suboptimal statistical power and the data collection during the COVID pandemic. We give recommendations on how to incorporate the association of depressive symptoms and cycle irregularity in future study designs on women's mental health.
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Affiliation(s)
- Hannah Klusmann
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Claudia Kapp
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Sinha Engel
- Department of Experimental Psychopathology, Institute for Psychology, University of Hildesheim, Hildesheim, Germany
| | - Tabea Schumacher
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
- Clinical Psychology and Psychotherapy, Department of Psychology, Faculty of Health, HMU Health and Medical University, Potsdam, Germany
| | - Elise Bücklein
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Universität Ulm, Ulm, Germany
| | - Christine Knaevelsrud
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Sarah Schumacher
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
- Clinical Psychology and Psychotherapy, Department of Psychology, Faculty of Health, HMU Health and Medical University, Potsdam, Germany
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Schumacher S, Klose L, Lambertz J, Lütjohann D, Biemann R, Kuerten S, Fester L. The mitochondrial protease PARL is required for spermatogenesis. Commun Biol 2024; 7:44. [PMID: 38182793 PMCID: PMC10770312 DOI: 10.1038/s42003-023-05703-3] [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: 06/15/2023] [Accepted: 12/13/2023] [Indexed: 01/07/2024] Open
Abstract
Mitochondrial function plays an important role in the maintenance of male fertility. However, the mechanisms underlying mitochondrial defect-related infertility remain mostly unclear. Here we show that a deficiency of PARL (Parl-/-), a mitochondrial protease, causes complete arrest of spermatogenesis during meiosis I. PARL deficiency led to severe downregulation of proteins of respiratory chain complex IV in testes that did not occur in other tested organs, causing a deficit in complex IV activity and ATP production. Furthermore, Parl-/- testes showed an almost complete loss of HSD17B3, a protein of the sER responsible for the last step in testosterone synthesis. While testosterone production appeared to be restored by overexpression of HSD17B12, loss of the canonical testosterone synthesis led to an upregulation of luteinizing hormone (LH) and of LH-regulated responses. These results suggest an important impact of the downstream regulation of mitochondrial defects that manifest in a cell-type-specific manner and extend beyond mitochondria.
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Affiliation(s)
- Sarah Schumacher
- Institute of Neuroanatomy, Medical Faculty, University of Bonn, 53115, Bonn, Germany.
| | - Laura Klose
- Institute of Neuroanatomy, Medical Faculty, University of Bonn, 53115, Bonn, Germany
| | - Jessica Lambertz
- Institute of Neuroanatomy, Medical Faculty, University of Bonn, 53115, Bonn, Germany
| | - Dieter Lütjohann
- Institute of Clinical Chemistry and Clinical Pharmacology, University Hospital Bonn, 53127, Bonn, Germany
| | - Ronald Biemann
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University of Leipzig, 04103, Leipzig, Germany
| | - Stefanie Kuerten
- Institute of Neuroanatomy, Medical Faculty, University of Bonn, 53115, Bonn, Germany
| | - Lars Fester
- Institute of Neuroanatomy, Medical Faculty, University of Bonn, 53115, Bonn, Germany.
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Marrakchi S, Badenco N, Schumacher S, Bennour E, Livarek B, Gandjbakhch E, Hidden-Lucet F. Focus on malignant ventricular premature contractions. Ann Cardiol Angeiol (Paris) 2023; 72:101662. [PMID: 37742408 DOI: 10.1016/j.ancard.2023.101662] [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: 08/08/2023] [Revised: 08/21/2023] [Accepted: 08/21/2023] [Indexed: 09/26/2023]
Abstract
Premature ventricular contractions (PVCs) are common. Although often benign, they can also be associated with increased morbidity and mortality. The aim of this review was to assess the risk evaluation of PVCs in patients with or without structural heart disease and discuss the management of this arrhythmia. Reports published in English were searched in PubMed with the following search terms: premature ventricular contraction, ectopic ventricular beat, ventricular extrasystole, antiarrhythmic drugs, ablation, ventricular arrhythmia, ventricular tachycardia, ventricular fibrillation and torsade de pointe. This analysis suggests that all patients with frequent PVCs should be assessed for PVC burden, symptom status and the presence of structural heart disease. PVCs in patients with structurally normal hearts was once considered a benign phenomenon. Uncommonly, PVCs may provoke life-threatening arrhythmias. Ventricular fibrillation is the initial mode of malignant rapid ventricular arrhythmias (MRVAs). Patients with malignant PVC and PVC burden >10% are at increased risk of MRVA in case of myocardial infarction and heart failure. MRVA is the primary cause of sudden cardiac death in patients with and without structural heart disease. Therapeutic options include medical therapy and catheter ablation, the latter more effective and potentially curable, particularly in patients with left ventricular dysfunction. The timely recognition and effective treatment of malignant PVCs in symptomatic patients with underling cardiomyopathy are mandatory to initiate early therapies before the occurrence of adverse clinical outcomes and to improve the long-term prognosis.
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Affiliation(s)
- S Marrakchi
- Université de Sorbonne, AP-HP, Centre Hospitalo-universitaire Pitié-Salpêtrière, Institut de Cardiology, ICAN, Paris, France; Département de Cardiologie, Hospital André Mignot, Versailles, France; University El Manar, Tunis, Tunisie.
| | - N Badenco
- Université de Sorbonne, AP-HP, Centre Hospitalo-universitaire Pitié-Salpêtrière, Institut de Cardiology, ICAN, Paris, France
| | - S Schumacher
- Université de Sorbonne, AP-HP, Centre Hospitalo-universitaire Pitié-Salpêtrière, Institut de Cardiology, ICAN, Paris, France; Département de Cardiologie, Hospital André Mignot, Versailles, France
| | - E Bennour
- University El Manar, Tunis, Tunisie; Département de Cardiologie, Hospital Abderrahmane Mami Hospital, Tunis, Tunisie
| | - B Livarek
- Département de Cardiologie, Hospital André Mignot, Versailles, France
| | - E Gandjbakhch
- Université de Sorbonne, AP-HP, Centre Hospitalo-universitaire Pitié-Salpêtrière, Institut de Cardiology, ICAN, Paris, France
| | - F Hidden-Lucet
- Université de Sorbonne, AP-HP, Centre Hospitalo-universitaire Pitié-Salpêtrière, Institut de Cardiology, ICAN, Paris, France
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Schumacher S, Laufer S, Fischer S. Fingernail Cortisol: A Biological Signal of Lifetime Major Depressive Disorder. Neuropsychobiology 2023; 82:300-305. [PMID: 37806304 PMCID: PMC10614476 DOI: 10.1159/000531315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 05/25/2023] [Indexed: 10/10/2023]
Abstract
INTRODUCTION Elevated levels of the hypothalamic-pituitary-adrenal axis hormone cortisol are a frequently replicated finding in major depressive disorder (MDD). However, the current state of research is inconclusive as to whether hypercortisolism represents a trait- or state-like biological signal of MDD. The aim of the present study was to investigate, for the first time, whether cortisol in fingernails, a highly accessible tissue, could distinguish currently remitted individuals with MDD from healthy controls. A further aim was to identify potential confounders of nail cortisol. METHODS A total of N = 100 individuals from the general population were recruited. A structured clinical interview was administered, which resulted in two groups: n = 48 with lifetime MDD and n = 52 healthy controls. All participants answered questions on sociodemographic, lifestyle, and psychosocial characteristics. They also grew their nails for 14 days and cut them for the subsequent determination of cortisol. RESULTS The groups differed in their nail cortisol concentrations, such that the individuals with lifetime MDD had significantly higher concentrations than the healthy controls (p = 0.041). Within the group of individuals with lifetime MDD, the number of experienced episodes was significantly correlated with cortisol (p = 0.011). Income emerged as the only significant confounder of cortisol (p = 0.008). CONCLUSION Elevated fingernail cortisol appears to be a biological signal of MDD, even in the absence of a current major depressive episode. Its high accessibility and robustness render it a promising methodology for remote research as well as for the integration of biomarkers into clinical research and practice.
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Affiliation(s)
- Sarah Schumacher
- Clinical Psychology and Psychotherapy, Faculty of Health, Health and Medical University, Potsdam, Germany
- Department of Psychology, Clinical Psychological Intervention, Freie Universität Berlin, Berlin, Germany
| | - Sebastian Laufer
- Clinical Psychology and Psychotherapy, Faculty of Health, Health and Medical University, Potsdam, Germany
| | - Susanne Fischer
- Clinical Psychology and Psychotherapy, Institute of Psychology, University of Zurich, Zurich, Switzerland
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Weber M, Burchert S, Sijbrandij M, Patanè M, Pinucci I, Renneberg B, Knaevelsrud C, Schumacher S. Mental health across two years of the COVID-19 pandemic: a 5-wave longitudinal study in Germany. Front Psychiatry 2023; 14:1229700. [PMID: 37614651 PMCID: PMC10442488 DOI: 10.3389/fpsyt.2023.1229700] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 07/19/2023] [Indexed: 08/25/2023] Open
Abstract
The COVID-19 pandemic has been negatively associated with mental health. However, little is known about the temporal dynamics of mental health in the longer term of the pandemic. We aimed to investigate symptom levels and changes of depression, anxiety, posttraumatic stress, and loneliness spanning two years of the pandemic; and to examine associated risk factors. This five-wave, longitudinal online study from May 2020 to April 2022 included 636 adults (Mage = 39.5 years, SD = 16.11; 84.1% female) from the German general population who completed the international COVID-19 Mental Health Survey. Symptoms of anxiety (Generalized Anxiety Disorder-7; GAD-7), depression (Patient Health Questionnaire-9; PHQ-9), posttraumatic stress (PTSD Checklist for DSM-5; PCL-5), and loneliness ("Do you feel lonely?") were assessed using mixed-effects models. Associations with anxiety and depressive symptoms were examined with having children, student status, financial worries, contamination fear, and loneliness. PHQ-9, GAD-7, PCL-5, and loneliness scores overall decreased throughout the two-year period of the pandemic but exhibited an increase during two national lockdowns. Controlled for significant associations with female gender and younger age, increased PHQ-9 and GAD-7 scores were associated with contamination fear, financial worries, and loneliness. No associations were found with having children and student status. Symptoms of depression, anxiety, posttraumatic stress, and loneliness decreased over time but varied along with the dynamics of the pandemic. Longitudinal monitoring of mental health in vulnerable subgroups is required, especially those of younger age, females, and the financially insecure.
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Affiliation(s)
- Maxi Weber
- Department of Education and Psychology, Clinical Psychology and Psychotherapy, Freie Universität Berlin, Berlin, Germany
| | - Sebastian Burchert
- Department of Education and Psychology, Clinical Psychological Intervention, Freie Universität Berlin, Berlin, Germany
| | - Marit Sijbrandij
- Department of Clinical, Neuro-, and Developmental Psychology, Amsterdam Public Health Institute and WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Vrije Universiteit, Amsterdam, Netherlands
| | - Martina Patanè
- Department of Clinical, Neuro-, and Developmental Psychology, Amsterdam Public Health Institute and WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Vrije Universiteit, Amsterdam, Netherlands
| | - Irene Pinucci
- Department of Clinical, Neuro-, and Developmental Psychology, Amsterdam Public Health Institute and WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Vrije Universiteit, Amsterdam, Netherlands
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Babette Renneberg
- Department of Education and Psychology, Clinical Psychology and Psychotherapy, Freie Universität Berlin, Berlin, Germany
| | - Christine Knaevelsrud
- Department of Education and Psychology, Clinical Psychological Intervention, Freie Universität Berlin, Berlin, Germany
| | - Sarah Schumacher
- Department of Education and Psychology, Clinical Psychological Intervention, Freie Universität Berlin, Berlin, Germany
- Clinical Psychology and Psychotherapy, Institute for Mental Health and Behavioral Medicine, HMU Health and Medical University, Potsdam, Germany
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Klusmann H, Luecking N, Engel S, Blecker MK, Knaevelsrud C, Schumacher S. Menstrual cycle-related changes in HPA axis reactivity to acute psychosocial and physiological stressors - a systematic review and meta-analysis of longitudinal studies. Neurosci Biobehav Rev 2023; 150:105212. [PMID: 37149074 DOI: 10.1016/j.neubiorev.2023.105212] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 04/07/2023] [Accepted: 05/01/2023] [Indexed: 05/08/2023]
Abstract
Sex disparities are evident in the biological response to acute stressors, with a suggested influence of ovarian hormones on hypothalamic-pituitary-adrenal (HPA) axis functioning. This systematic review and meta-analysis investigates differences in HPA axis reactivity to acute psychosocial or physiological stressors between menstrual cycle phases. A systematic literature search of six databases resulted in 12 longitudinal studies (n = 182) examining HPA axis reactivity in healthy, naturally-cycling, non-breastfeeding participants aged between 18 and 45 years in at least two cycle phases. The quality of cortisol and menstrual cycle assessment was rated and a descriptive synthesis and meta-analysis of HPA axis reactivity between two broader and five more precise cycle phases was conducted. Three studies provided sufficient data for the meta-analysis and showed a significant, small-sized effect, indicating higher cortisol reactivity in the luteal than in the follicular cycle phase. More primary studies with high-quality menstrual cycle and cortisol assessment are needed. The review did not receive funding and was pre-registered (PROSPERO; CRD42020181632).
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Affiliation(s)
- Hannah Klusmann
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Schwendenerstraße 27, 14195 Berlin, Germany.
| | - Noemi Luecking
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Schwendenerstraße 27, 14195 Berlin, Germany.
| | - Sinha Engel
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Schwendenerstraße 27, 14195 Berlin, Germany.
| | - Meike Katharina Blecker
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Schwendenerstraße 27, 14195 Berlin, Germany.
| | - Christine Knaevelsrud
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Schwendenerstraße 27, 14195 Berlin, Germany.
| | - Sarah Schumacher
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Schwendenerstraße 27, 14195 Berlin, Germany; Clinical Psychology and Psychotherapy, Institute for Mental Health and Behavioral Medicine, Faculty of Health, HMU Health and Medical University, Olympischer Weg 1, 14471 Potsdam, Germany.
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Laufer S, Schulze L, Engel S, Klusmann H, Skoluda N, Nater UM, Knaevelsrud C, Schumacher S. The effect of an internet-based intervention for depression on cortisol and alpha-amylase. Psychoneuroendocrinology 2023; 152:106082. [PMID: 36989562 DOI: 10.1016/j.psyneuen.2023.106082] [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: 10/20/2022] [Revised: 02/13/2023] [Accepted: 03/11/2023] [Indexed: 03/31/2023]
Abstract
INTRODUCTION Psychotherapeutic interventions for major depressive disorder (MDD) have been suggested to be associated with a normalization of biological stress system (i.e., the hypothalamic-pituitary-adrenal axis and the autonomic nervous system) dysregulation. Furthermore, pre-intervention cortisol parameters have been identified as prescriptive biological markers of treatment success. However, evidence of treatment effects on the biological stress systems is still sparse, and results are heterogeneous. The current study examined the effect of an internet-based intervention for MDD on salivary cortisol and alpha-amylase as well as hair cortisol concentrations. Moreover, the prescriptive capacity of pre-intervention cortisol and alpha-amylase concentrations on treatment response was explored. METHODS Thirty-eight participants suffering from mild to moderate MDD collected saliva and hair samples throughout the intervention. Biological outcome parameters were salivary cortisol and alpha-amylase (awakening response, total diurnal output, diurnal slope) and hair cortisol concentrations. Treatment response was indicated by change in depression severity and perceived chronic stress. RESULTS Treatment response on depression scores or chronic stress was not associated with changes in any of the cortisol or alpha-amylase parameters. Exploratory analysis indicated that non-responders showed a steeper alpha-amylase slope pre-intervention. DISCUSSION The results indicate that changes in depressive symptoms did not correspond to changes of the biological stress systems, contradicting the suggested normalization of dysregulated hypothalamic-pituitary-adrenal axis or autonomic nervous system activity through a psychotherapeutic intervention. However, the results point to a potential role of pre-intervention alpha-amylase slope as a prescriptive marker of treatment response for depression.
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Affiliation(s)
- Sebastian Laufer
- Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Schwendener Straße 27, 14195 Berlin, Germany; Clinical Psychology and Psychotherapy, Institute for Mental Health and Behavioral Medicine, Faculty of Health, HMU Health and Medical University, Olympischer Weg 1, 14471 Potsdam, Germany.
| | - Lars Schulze
- Clinical Psychology and Psychotherapy, Department of Education and Psychology, Freie Universität Berlin, Habelschwerdter Allee 45, 14195 Berlin, Germany
| | - Sinha Engel
- Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Schwendener Straße 27, 14195 Berlin, Germany
| | - Hannah Klusmann
- Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Schwendener Straße 27, 14195 Berlin, Germany
| | - Nadine Skoluda
- Department of Clinical Psychology and Health Psychology, Faculty of Psychology, University of Vienna, Liebiggasse 5, 1010 Vienna, Austria; Research Platform the Stress of Life (SOLE) - Processes and Mechanisms underlying Everyday Life Stress, Austria
| | - Urs M Nater
- Department of Clinical Psychology and Health Psychology, Faculty of Psychology, University of Vienna, Liebiggasse 5, 1010 Vienna, Austria; Research Platform the Stress of Life (SOLE) - Processes and Mechanisms underlying Everyday Life Stress, Austria
| | - Christine Knaevelsrud
- Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Schwendener Straße 27, 14195 Berlin, Germany
| | - Sarah Schumacher
- Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Schwendener Straße 27, 14195 Berlin, Germany; Clinical Psychology and Psychotherapy, Institute for Mental Health and Behavioral Medicine, Faculty of Health, HMU Health and Medical University, Olympischer Weg 1, 14471 Potsdam, Germany
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11
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Engel S, Laufer S, Klusmann H, Schulze L, Schumacher S, Knaevelsrud C. Cortisol response to traumatic stress to predict PTSD symptom development - a systematic review and meta-analysis of experimental studies. Eur J Psychotraumatol 2023; 14:2225153. [PMID: 37401356 DOI: 10.1080/20008066.2023.2225153] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/05/2023] Open
Abstract
Background: Pre-and post-traumatic hypothalamic-pituitary-adrenal (HPA) axis markers have been studied to predict posttraumatic stress disorder (PTSD) risk, but its acute reactivity cannot be measured in real-life settings. Experimental paradigms can depict the cortisol response to stimuli that simulate traumatic events.Objective: To review experimental studies on the cortisol response to traumatic stimuli and the correlation between cortisol and PTSD symptoms.Method: Experimental, (un-)published studies in German or English from any year were eligible if they confronted non-traumatized humans with traumatic stimuli, assessed cortisol before, during or after stimulus presentation and subsequent PTSD symptoms. The literature was searched via PubMed, PubPsych, PsychINFO, PsycArticle, Web of Science, EMBASE, ProQuest and ClinicalTrials.gov up to 16th February 2021. Risk of bias was assessed with the Cortisol Assessment List. Multilevel-meta-analyses were conducted under the random effects model. The standardized mean change (dSMC) indicated the cortisol response. Coefficient r indicated the correlations between cortisol and PTSD symptoms.Results: 14 studies, investigating 1004 individuals, were included. A cortisol response was successfully induced between 21 and 40 min post-presentation onset (kobservations = 25, dSMC = 0.15 [.03; .26]). Cortisol was not associated with overall or cluster-level PTSD symptoms. On a symptom-level, higher pre-presentation onset cortisol was correlated with lower state tension (k = 8, r = -.18 [-.35; -.01]), higher state happiness (k = 8, r = -.34 [-.59; -.03], variable inverted) and lower state anger (k = 9, r = -.14 [-.26; -.01]). Higher post-presentation onset cortisol was correlated with higher state happiness (k = 16, r = -.20 [-.33; -.06]) and lower state sadness (k = 17, r = -.16 [-.25; -.05]), whereas cortisol response was positively correlated with state anxiety (k = 9, r = .16 [0.04; 0.27]).Conclusions: Experimental paradigms effectively induce a cortisol response. Higher basal cortisol, higher cortisol, as measured after traumatic stimulus presentation, and a lower cortisol response were associated with more adaptive emotional reactions. These markers did not predict longer-term PTSD symptoms.
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Affiliation(s)
- Sinha Engel
- Department of Education and Psychology, Division of Clinical Psychological Intervention, Freie Universität Berlin, Berlin, Germany
- Department of Experimental Psychopathology, Institute for Psychology, University of Hildesheim, Hildesheim, Germany
| | - Sebastian Laufer
- Department for Clinical Psychology and Psychotherapy, Institute for Mental Health and Behavioral Medicine, HMU Health and Medical University, Potsdam, Germany
| | - Hannah Klusmann
- Department of Education and Psychology, Division of Clinical Psychological Intervention, Freie Universität Berlin, Berlin, Germany
| | - Lars Schulze
- Division of Clinical Psychology and Psychotherapy, Freie Universität Berlin, Berlin, Germany
| | - Sarah Schumacher
- Department for Clinical Psychology and Psychotherapy, Institute for Mental Health and Behavioral Medicine, HMU Health and Medical University, Potsdam, Germany
| | - Christine Knaevelsrud
- Department of Education and Psychology, Division of Clinical Psychological Intervention, Freie Universität Berlin, Berlin, Germany
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12
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Kuester A, Schumacher S, Niemeyer H, Engel S, Spies J, Weiß D, Muschalla B, Burchert S, Tamm S, Weidmann A, Bohn J, Willmund G, Rau H, Knaevelsrud C. Attentional bias in German Armed Forces veterans with and without posttraumatic stress symptoms - An eye-tracking investigation and group comparison. J Behav Ther Exp Psychiatry 2022; 76:101726. [PMID: 35180658 DOI: 10.1016/j.jbtep.2022.101726] [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: 02/05/2021] [Revised: 12/22/2021] [Accepted: 02/06/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND OBJECTIVES Most eye tracking based paradigms evidence patterns of sustained attention on threat coupled with low evidence for vigilance to or avoidance of threat in posttraumatic stress symptoms (PTSS). Still, eye tracking data on attention bias is particularly limited for military population. This eye tracking study investigated attentional bias in PTSS in a sample of German Armed Forces veterans. METHODS Veterans with deployment-related PTSS (N = 24), veterans with deployment-related traumatization without PTSS (N = 28), and never-deployed healthy veterans (N = 18) were presented with pairs of combat and neutral pictures, pairs of general threat and neutral pictures, and pairs of emotional and neutral faces. Their eye gazes were tracked during a free viewing task. 3 x 3 x 2 mixed general linear model analyses were conducted. Internal consistency of attention bias indicators was calculated for the entire sample and within groups. RESULTS Veterans with PTSS dwelled longer on general threat AOIs in contrast to non-exposed controls and shorter on general threat and combat associated neutral AOIs in contrast to both control groups. Veterans with PTSS entered faster to general threat AOIs than non-exposed controls. Veterans with PTSS showed circumscribed higher attention fluctuation in contrast to controls. Internal consistency varied across attention bias indicators. LIMITATIONS Statistical power was reduced due to recruitment difficulties. CONCLUSIONS Evidence is provided for the maintenance hypothesis in PTSS. No robust evidence is provided for hypervigilant behavior in PTSS. Findings on attention bias variability remain unclear, calling for more investigations in this field.
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Affiliation(s)
- Annika Kuester
- Department of Psychiatry, Psychotherapy and Psychosomatics, Brandenburg Medical School Theodor Fontane, Germany; Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Germany.
| | - Sarah Schumacher
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Germany
| | - Helen Niemeyer
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Germany
| | - Sinha Engel
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Germany
| | - Jan Spies
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Germany
| | - Deborah Weiß
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Germany
| | - Beate Muschalla
- Institute of Psychology, Technische Universität Braunschweig, Germany
| | - Sebastian Burchert
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Germany
| | - Sascha Tamm
- Center for Applied Neuroscience, Division of Experimental and Cognitive Neuropsychology, Department of Education and Psychology, Freie Universität Berlin, Germany
| | - Anke Weidmann
- Theodor Fliedner Foundation, Fliedner Hospital Berlin, Germany
| | - Johannes Bohn
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Germany
| | - Gerd Willmund
- Department for Military Mental Health, German Armed Forces, Military Hospital Berlin, Germany
| | - Heinrich Rau
- Department for Military Mental Health, German Armed Forces, Military Hospital Berlin, Germany
| | - Christine Knaevelsrud
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Germany
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13
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Klusmann H, Schulze L, Engel S, Bücklein E, Daehn D, Lozza-Fiacco S, Geiling A, Meyer C, Andersen E, Knaevelsrud C, Schumacher S. HPA axis activity across the menstrual cycle - a systematic review and meta-analysis of longitudinal studies. Front Neuroendocrinol 2022; 66:100998. [PMID: 35597328 DOI: 10.1016/j.yfrne.2022.100998] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 04/09/2022] [Accepted: 05/07/2022] [Indexed: 12/29/2022]
Abstract
Differential HPA axis function has been proposed to underlie sex-differences in mental disorders; however, the impact of fluctuating sex hormones across the menstrual cycle on HPA axis activity is still unclear. This meta-analysis investigated basal cortisol concentrations as a marker for HPA axis activity across the menstrual cycle. Through a systematic literature search of five databases, 121 longitudinal studies were included, summarizing data of 2641 healthy, cycling participants between the ages of 18 and 45. The meta-analysis showed higher cortisol concentrations in the follicular vs. luteal phase (dSMC = 0.12, p =.004, [0.04 - 0.20]). Comparisons between more precise cycle phases were mostly insignificant, aside from higher concentrations in the menstrual vs. premenstrual phase (dSMC = 0.17, [0.02 - 0.33], p =.03). In all included studies, nine samples used established cortisol parameters to indicate HPA axis function, specifically diurnal profiles (k = 4) and the cortisol awakening response (CAR) (k = 5). Therefore, the meta-analysis highlights the need for more rigorous investigation of HPA axis activity and menstrual cycle phase.
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Affiliation(s)
- Hannah Klusmann
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Schwendenerstraße 27, 14195 Berlin, Germany.
| | - Lars Schulze
- Clinical Psychology and Psychotherapy, Department of Education and Psychology, Freie Universität Berlin, Habelschwerdter Allee 45, 14195 Berlin, Germany.
| | - Sinha Engel
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Schwendenerstraße 27, 14195 Berlin, Germany.
| | - Elise Bücklein
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Universität Ulm, Lise-Meitner-Str. 16, 89081 Ulm, Germany.
| | - Daria Daehn
- Clinical Psychology and Psychotherapy, Department of Education and Psychology, Freie Universität Berlin, Habelschwerdter Allee 45, 14195 Berlin, Germany.
| | - Serena Lozza-Fiacco
- School of Medicine, Department of Psychiatry, University of North Carolina at Chapel Hill, Carolina Crossings Building B, 2218 Nelson Highway, 27517 Chapel Hill, USA.
| | - Angelika Geiling
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Schwendenerstraße 27, 14195 Berlin, Germany.
| | - Caroline Meyer
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Schwendenerstraße 27, 14195 Berlin, Germany.
| | - Elizabeth Andersen
- School of Medicine, Department of Psychiatry, University of North Carolina at Chapel Hill, Carolina Crossings Building B, 2218 Nelson Highway, 27517 Chapel Hill, USA.
| | - Christine Knaevelsrud
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Schwendenerstraße 27, 14195 Berlin, Germany.
| | - Sarah Schumacher
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Schwendenerstraße 27, 14195 Berlin, Germany; Clinical Psychology and Psychotherapy, Department of Psychology, Faculty of Health, HMU Health and Medical University, Olympischer Weg 1, 14471 Potsdam, Germany.
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14
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Schumacher S, Engel S, Klusmann H, Niemeyer H, Küster A, Burchert S, Skoluda N, Rau H, Nater UM, Willmund GD, Knaevelsrud C. Trauma-related but not PTSD-related increases in hair cortisol concentrations in military personnel. J Psychiatr Res 2022; 150:17-20. [PMID: 35344923 DOI: 10.1016/j.jpsychires.2022.02.031] [Citation(s) in RCA: 3] [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: 09/01/2021] [Revised: 01/11/2022] [Accepted: 02/28/2022] [Indexed: 01/10/2023]
Abstract
Dysregulated hypothalamic-pituitary-adrenal (HPA) axis functioning has been associated with posttraumatic stress disorder (PTSD). The current literature is inconsistent regarding this association, possibly due to confounding influences. Hair cortisol concentrations (HCC) allow for retrospective assessment of cumulative HPA axis secretion over several weeks and are considered a trait-like marker of HPA axis activity. Three groups of active and former German Armed Forces service members, comprising PTSD patients (n = 19), healthy controls with deployment-related trauma exposure (n = 10), and non-deployed healthy controls (n = 10) provided samples for HCC analysis. We observed significantly higher HCC in the PTSD and the deployed compared to the non-deployed group. HCC was neither significantly correlated with perceived chronic stress, nor with PTSD severity within patients. The results suggest a differential impact of trauma exposure on HPA axis activity and highlight the notion of cumulative, retrospective cortisol secretion as a psychobiological indicator of trauma exposure. TRIAL REGISTRATION: Australian Clinical Trials Registry (ACTRN12616000956404).
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Affiliation(s)
- Sarah Schumacher
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany; Clinical Psychology and Psychotherapy, Faculty of Health, HMU Health and Medical University, Potsdam, Germany.
| | - Sinha Engel
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Hannah Klusmann
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Helen Niemeyer
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Annika Küster
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Sebastian Burchert
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Nadine Skoluda
- Department of Clinical and Health Psychology, University of Vienna, Vienna, Austria
| | - Heinrich Rau
- Psychotrauma Centre, German Armed Forces Hospital Berlin, Berlin, Germany
| | - Urs M Nater
- Department of Clinical and Health Psychology, University of Vienna, Vienna, Austria
| | | | - Christine Knaevelsrud
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
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15
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Fischer S, Schumacher S, Daniels J. Neurobiological Changes in Posttraumatic Stress Disorder and Their Reversibility by Psychotherapy. Zeitschrift für Klinische Psychologie und Psychotherapie 2022. [DOI: 10.1026/1616-3443/a000650] [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] [Indexed: 11/04/2022]
Abstract
Abstract. Background: Posttraumatic stress disorder (PTSD) is a debilitating illness associated with distressing symptoms and a high societal burden. Objective: To investigate the neurobiological underpinnings of PTSD to improve our understanding of this disorder and its treatment. Methods: This article reviews currently researched mechanisms that can explain the development of PTSD symptoms. It presents key findings on neural (i. e., brain functioning and brain structure), neuroendocrine (i. e., noradrenergic and hypothalamic-pituitary-adrenal axis activity), and related (epi)genetic changes in individuals with PTSD. Furthermore, it presents preliminary research examining the reversibility of these alterations during psychotherapeutic treatment. Results: PTSD is characterized by specific neurobiological alterations, with preliminary findings indicating that at least some of these may normalize during psychotherapy. Discussion: A multidimensional perspective on the development, maintenance, and treatment of PTSD has the potential to improve our understanding of the causal processes underlying the disorder and may ultimately inform the conception of novel treatments.
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Affiliation(s)
- Susanne Fischer
- Clinical Psychology and Psychotherapy, Institute of Psychology, University of Zurich, Switzerland
| | - Sarah Schumacher
- Clinical Psychology and Psychotherapy, Faculty of Health, Health and Medical University, Potsdam, Germany
| | - Judith Daniels
- Clinical Psychology, Faculty of Behavioral and Social Sciences, University of Groningen, The Netherlands
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16
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Laufer S, Engel S, Lupien S, Knaevelsrud C, Schumacher S. The Cortisol Assessment List (CoAL) A tool to systematically document and evaluate cortisol assessment in blood, urine and saliva. Comprehensive Psychoneuroendocrinology 2022; 9:100108. [PMID: 35755928 PMCID: PMC9216417 DOI: 10.1016/j.cpnec.2021.100108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 12/22/2021] [Accepted: 12/22/2021] [Indexed: 10/27/2022] Open
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17
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Schumacher S, Engel S, Niemeyer H, Küster A, Burchert S, Skoluda N, Rau H, Nater UM, Willmund GD, Knaevelsrud C. Salivary Cortisol and Alpha-Amylase in Posttraumatic Stress Disorder and Their Potential Role in the Evaluation of Cognitive Behavioral Treatment Outcomes. J Trauma Stress 2022; 35:78-89. [PMID: 34022094 DOI: 10.1002/jts.22683] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 11/23/2020] [Revised: 03/15/2021] [Accepted: 03/15/2021] [Indexed: 11/08/2022]
Abstract
Alterations in HPA-axis and autonomic nervous system activity have been associated with posttraumatic stress disorder (PTSD) development and maintenance and are potentially associated with trauma-focused cognitive behavioral therapy (TF-CBT) outcomes. We examined the role of salivary cortisol (sCort) and alpha-amylase (sAA) in PTSD and TF-CBT outcomes in German Armed Forces service members (N = 100). Participants categorized as PTSD patients (n = 39), previously deployed healthy controls (n = 33), and nondeployed healthy controls (n = 28) provided diurnal profiles of sCort and sAA; PTSD patients provided samples before, immediately after, and 3 months after an internet-based TF-CBT intervention. No group differences emerged regarding total daily sCort and sAA output or daily slopes, ps = .224-.897, fs = 0.05-0.24. Participants with PTSD demonstrated a significantly attenuated sCort awakening response compared to deployed, p = .021, d = 0.59, but not nondeployed controls, p = .918, d = 0.08. Moreover, a significantly steeper sAA awakening response emerged in PTSD patients, p = .034, d = 0.67, and deployed controls, p = .014, d = 0.80, compared to nondeployed controls. From pretreatment to posttreatment (n = 21) and posttreatment to follow-up (n = 14), stable sCort, ps = .282-.628, fs = 0.34-0.49, and sAA concentrations, ps = .068-.758, fs = 0.24-1.13 paralleled a nonsignificant treatment effect. Both PTSD and trauma exposure were associated with alterations in awakening responses, but further investigation is needed to determine whether the observed correspondence remains when PTSD symptoms significantly decline.
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Affiliation(s)
- Sarah Schumacher
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany.,Clinical Psychology and Psychotherapy, Faculty of Health, HMU Health and Medical University Potsdam, Potsdam, Germany
| | - Sinha Engel
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Helen Niemeyer
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Annika Küster
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Sebastian Burchert
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Nadine Skoluda
- Department of Clinical Psychology of Adulthood, University of Vienna, Vienna, Austria
| | - Heinrich Rau
- Psychotrauma Centre, German Armed Forces Hospital Berlin, Berlin, Germany
| | - Urs M Nater
- Department of Clinical Psychology of Adulthood, University of Vienna, Vienna, Austria
| | | | - Christine Knaevelsrud
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
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18
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Schumacher S, Mertes C, Wohlfahrt Y, Kaltenbach T, Schwab S, Eisenmann B, Kauer R, Bleyer G, Berkelmann-Loehnertz B, Fuchs R. VITIFIT: Aiming for copper reduction in organic viticulture - Improvement of established strategies and new techniques for plant protection against Plasmopara viticola. BIO Web Conf 2022. [DOI: 10.1051/bioconf/20225003008] [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] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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19
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Mertes C, Schumacher S, Kaltenbach T, Bleyer G, Fuchs R. Studies on the resistance of different developmental stages in susceptible and tolerant grapevine cultivars against the pathogen Plasmopara viticola. BIO Web Conf 2022. [DOI: 10.1051/bioconf/20225002001] [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] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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20
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Bleyer G, Steinger M, Schumacher S, Fuchs R, Kassemeyer HH, Krause R. Grapevine Downy Mildew: Long-term development and validation of plant protection strategies based on the forecast model “VitiMeteo Plasmopara”. BIO Web Conf 2022. [DOI: 10.1051/bioconf/20225004006] [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] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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21
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Weber M, Schumacher S, Hannig W, Barth J, Lotzin A, Schäfer I, Ehring T, Kleim B. Long-term Outcomes of Psychological Treatment for Posttraumatic Stress Disorder: A Systematic Review and Meta-Analysis - Corrigendum. Psychol Med 2021; 51:2946. [PMID: 34702377 PMCID: PMC8640361 DOI: 10.1017/s0033291721003214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Maxi Weber
- Division of Clinical Psychology and Psychotherapy, Freie Universität Berlin, Berlin, Germany
| | - Sarah Schumacher
- Division of Clinical Psychological Intervention, Freie Universität Berlin, Berlin, Germany
- Clinical Psychology and Psychotherapy, Health and Medical University, Potsdam, Germany
| | - Wiebke Hannig
- Clinical Psychology and Psychotherapy, Department of Psychology, Philipps University of Marburg, Marburg, Germany
| | - Jürgen Barth
- Institute for Complementary and Integrative Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Annett Lotzin
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ingo Schäfer
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Ehring
- Department of Psychology, LMU Munich, Munich, Germany
| | - Birgit Kleim
- Department of Psychology, University of Zurich, Zurich, Switzerland
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, University of Zurich, Zurich, Switzerland
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22
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Schwartz LP, Devine JK, Hursh SR, Mosher E, Schumacher S, Boyle L, Davis JE, Smith M, Fitzgibbons SC. Biomathematical Modeling Predicts Fatigue Risk in General Surgery Residents. J Surg Educ 2021; 78:2094-2101. [PMID: 33994335 DOI: 10.1016/j.jsurg.2021.04.007] [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] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 03/08/2021] [Accepted: 04/11/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To assess resident fatigue risk using objective and predicted sleep data in a biomathematical model of fatigue. DESIGN 8-weeks of sleep data and shift schedules from 2019 for 24 surgical residents were assessed with a biomathematical model to predict performance ("effectiveness"). SETTING Greater Washington, DC area hospitals RESULTS: As shift lengths increased, effectiveness scores decreased and the time spent below criterion increased. Additionally, 11.13% of time on shift was below the effectiveness criterion and 42.7% of shifts carried excess sleep debt. Sleep prediction was similar to actual sleep, and both predicted similar performance (p ≤ 0.001). CONCLUSIONS Surgical resident sleep and shift patterns may create fatigue risk. Biomathematical modeling can aid the prediction of resident sleep patterns and performance. This approach provides an important tool to help educators in creating work-schedules that minimize fatigue risk.
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Affiliation(s)
| | | | - Steven R Hursh
- Institutes for Behavior Resources, Baltimore, Maryland; Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | | | - Lisa Boyle
- MedStar Georgetown University Hospital, Washington, DC
| | - Jonathan E Davis
- Department of Emergency Medicine, Georgetown University School of Medicine, Washington, DC
| | - Mark Smith
- MedStar Institute for Innovation, Washington, DC
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23
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Sproll KC, Schorn LK, Reising B, Schumacher S, Lommen J, Kübler NR, Knoefel WT, Beier M, Neves RP, Behrens B, Horny K, Stoecklein NH. Genetic analysis of single disseminated tumor cells in the lymph nodes and bone marrow of patients with head and neck squamous cell carcinoma. Mol Oncol 2021; 16:333-346. [PMID: 34719102 PMCID: PMC8763651 DOI: 10.1002/1878-0261.13113] [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: 11/17/2020] [Revised: 07/30/2021] [Accepted: 10/07/2021] [Indexed: 11/29/2022] Open
Abstract
Considering the limited information on the biology and molecular characteristics of disseminated tumor cells (DTCs) in head and neck squamous cell carcinoma (HNSCC), we examined the genomic alterations in DTCs from HNSCCs and their potential clinical relevance. To analyze both the lymphatic and hematogenous routes of tumor cell dissemination, we investigated samples from lymph nodes (LNs) and bone marrow (BM) of 49 patients using immunofluorescence double staining for epithelial cells expressing cytokeratin 18 (KRT18) and/or epithelial cell adhesion molecules (EpCAM, CD326). The identified marker‐positive cells were isolated by micromanipulation followed by single‐cell whole‐genome amplification and metaphase‐based comparative genomic hybridization (mCGH) to determine genome‐wide copy number alterations. The findings were correlated with clinical parameters and follow‐up data. We detected chromosomal aberrations in KRT18‐ and EpCAM‐positive cells from both compartments; BM‐derived cells showed a significantly higher percentage of aberrant genome (PAG) per cell than cells detected in LNs. No significant association was found between DTC data and clinical follow‐up. Genomic profiling of BM‐DTCs revealed genomic alterations typical for HNSCC, suggesting hematogenous dissemination of subclones around the time of surgery. In contrast, DTC data in LNs revealed that several marker‐positive cells were not of malignant origin, indicating the presence of epithelial glandular inclusions in parts of the processed neck LN samples. Therefore, DTC detection of LNs in the neck based only on epithelial markers is not advisable and requires detection of chromosomal instability (CIN), gene mutations, or additional markers, which have yet to be identified. Nevertheless, our investigation paves the way for larger studies to focus on HNSCC BM‐DTCs with high‐resolution methods to gain deeper insights into the biology of hematogenous metastasis in this cancer.
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Affiliation(s)
- Karl Christoph Sproll
- Department of Oral and Maxillofacial Surgery, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Lara K Schorn
- Department of Oral and Maxillofacial Surgery, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Benedikt Reising
- Department of Oral and Maxillofacial Surgery, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Sarah Schumacher
- Department of General, Visceral and Pediatric Surgery, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Julian Lommen
- Department of Oral and Maxillofacial Surgery, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Norbert R Kübler
- Department of Oral and Maxillofacial Surgery, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Wolfram Trudo Knoefel
- Department of General, Visceral and Pediatric Surgery, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Manfred Beier
- Institute for Human Genetics, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Rui P Neves
- Department of General, Visceral and Pediatric Surgery, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Bianca Behrens
- Department of General, Visceral and Pediatric Surgery, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Kai Horny
- Group of Translational Skin Cancer Research (TSCR), University Duisburg-Essen, Essen, Germany.,German Cancer Consortium (DKTK) & German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Nikolas H Stoecklein
- Department of General, Visceral and Pediatric Surgery, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
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Fischer S, Schumacher T, Knaevelsrud C, Ehlert U, Schumacher S. Genes and hormones of the hypothalamic-pituitary-adrenal axis in post-traumatic stress disorder. What is their role in symptom expression and treatment response? J Neural Transm (Vienna) 2021; 128:1279-1286. [PMID: 33825945 PMCID: PMC8423677 DOI: 10.1007/s00702-021-02330-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 03/22/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Less than half of all individuals with post-traumatic stress disorder (PTSD) remit spontaneously and a large proportion of those seeking treatment do not respond sufficiently. This suggests that there may be subgroups of individuals who are in need of augmentative or alternative treatments. One of the most frequent pathophysiological findings in PTSD is alterations in the hypothalamic-pituitary-adrenal (HPA) axis, including enhanced negative feedback sensitivity and attenuated peripheral cortisol. Given the role of the HPA axis in cognition, this pattern may contribute to PTSD symptoms and interfere with key processes of standard first-line treatments, such as trauma-focused cognitive behavioural therapy (TF-CBT). METHODS This review provides a comprehensive summary of the current state of research regarding the role of HPA axis functioning in PTSD symptoms and treatment. RESULTS Overall, there is preliminary evidence that hypocortisolaemia contributes to symptom manifestation in PTSD; that it predicts non-responses to TF-CBT; and that it is subject to change in parallel with positive treatment trajectories. Moreover, there is evidence that genetic and epigenetic alterations within the genes NR3C1 and FKBP5 are associated with this hypocortisolaemic pattern and that some of these alterations change as symptoms improve over the course of treatment. CONCLUSIONS Future research priorities include investigations into the role of the HPA axis in day-to-day symptom variation, the time scale in which biological changes in response to treatment occur, and the effects of sex. Furthermore, before conceiving augmentative or alternative treatments that target the described mechanisms, multilevel studies are warranted.
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Affiliation(s)
- Susanne Fischer
- Institute of Psychology, Clinical Psychology and Psychotherapy, University of Zurich, Binzmuehlestrasse 14/Box 26, 8050, Zurich, Switzerland.
| | - Tabea Schumacher
- Department of Education and Psychology, Division of Clinical Psychological Intervention, Freie Universität Berlin, Berlin, Germany
| | - Christine Knaevelsrud
- Department of Education and Psychology, Division of Clinical Psychological Intervention, Freie Universität Berlin, Berlin, Germany
| | - Ulrike Ehlert
- Institute of Psychology, Clinical Psychology and Psychotherapy, University of Zurich, Binzmuehlestrasse 14/Box 26, 8050, Zurich, Switzerland
| | - Sarah Schumacher
- Department of Education and Psychology, Division of Clinical Psychological Intervention, Freie Universität Berlin, Berlin, Germany
- Health Faculty, Clinical Psychology and Psychotherapy, Health and Medical University Potsdam, Potsdam, Germany
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25
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Weber M, Schumacher S, Hannig W, Barth J, Lotzin A, Schäfer I, Ehring T, Kleim B. Long-term outcomes of psychological treatment for posttraumatic stress disorder: a systematic review and meta-analysis. Psychol Med 2021; 51:1420-1430. [PMID: 34176532 PMCID: PMC8311818 DOI: 10.1017/s003329172100163x] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 02/11/2021] [Accepted: 04/13/2021] [Indexed: 11/15/2022]
Abstract
Several types of psychological treatment for posttraumatic stress disorder (PTSD) are considered well established and effective, but evidence of their long-term efficacy is limited. This systematic review and meta-analysis aimed to investigate the long-term outcomes across psychological treatments for PTSD. MEDLINE, Cochrane Library, PTSDpubs, PsycINFO, PSYNDEX, and related articles were searched for randomized controlled trials with at least 12 months of follow-up. Twenty-two studies (N = 2638) met inclusion criteria, and 43 comparisons of cognitive behavioral therapy (CBT) were available at follow-up. Active treatments for PTSD yielded large effect sizes from pretest to follow-up and a small controlled effect size compared with non-directive control groups at follow-up. Trauma-focused treatment (TFT) and non-TFT showed large improvements from pretest to follow-up, and effect sizes did not significantly differ from each other. Active treatments for comorbid depressive symptoms revealed small to medium effect sizes at follow-up, and improved PTSD and depressive symptoms remained stable from treatment end to follow-up. Military personnel, low proportion of female patients, and self-rated PTSD measures were associated with decreased effect sizes for PTSD at follow-up. The findings suggest that CBT for PTSD is efficacious in the long term. Future studies are needed to determine the lasting efficacy of other psychological treatments and to confirm benefits beyond 12-month follow-up.
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Affiliation(s)
- Maxi Weber
- Division of Clinical Psychology and Psychotherapy, Freie Universität Berlin, Berlin, Germany
| | - Sarah Schumacher
- Division of Clinical Psychological Intervention, Freie Universität Berlin, Berlin, Germany
- Department of Psychology, Philips University of Marburg, Marburg, Germany
| | - Wiebke Hannig
- Clinical Psychology and Psychotherapy, Department of Psychology, Philipps University of Marburg, Marburg, Germany
| | - Jürgen Barth
- Institute for Complementary and Integrative Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Annett Lotzin
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ingo Schäfer
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Ehring
- Department of Psychology, LMU Munich, Munich, Germany
| | - Birgit Kleim
- Department of Psychology, University of Zurich, Zurich, Switzerland
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, University of Zurich, Zurich, Switzerland
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26
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Devine JK, Schwartz LP, Hursh SR, Mosher E, Schumacher S, Boyle L, Davis JE, Smith M, Fitzgibbons S. Trends in Strategic Napping in Surgical Residents by Gender, Postgraduate Year, Work Schedule, and Clinical Rotation. J Surg Educ 2021; 78:1256-1268. [PMID: 33229212 DOI: 10.1016/j.jsurg.2020.11.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 10/06/2020] [Revised: 11/10/2020] [Accepted: 11/15/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To identify surgical resident and clinical rotation attributes which predict on-shift napping through objectively measured sleep patterns and work schedules over a 2-month period. DESIGN In a cross-sectional study, participants provided schedules, completed the Epworth Sleepiness Scale (ESS), and wore sleep-tracking devices (Zulu watch) continuously for 8 weeks. Multiple linear regression predicted percent days with on-shift napping from resident and rotation characteristics. SETTING Greater Washington, DC area hospitals. PARTICIPANTS Twenty-two (n = 22) surgical residents rotating in at least 1 of 5 different clinical rotation categories. RESULTS Residents slept 6 hours within a 24-hour period (370 ± 129 minutes) with normal sleep efficiency (sleep efficiency (SE): 87.13% ± 7.55%). Resident ESS scores indicated excessive daytime sleepiness (11.64 ± 4.03). Ninety-five percent (n = 21) of residents napped on-shift. Residents napped on-shift approximately 32% of their working days and were most likely to nap when working between 23:00 and 05:00 hours. Earlier shift start times predicted less on-shift napping (B = -0.08, SE = 0.04, β = -2.40, t = -2.09, p = 0.05) while working more night shifts (B = 1.55, SE = 0.44, β = 4.12, t = 3.52, p = 0.003) and shifts over 24 hours (B = 1.45, SE = 0.55, β = 1.96, t = 2.63, p = 0.01) predicted more frequent on-shift napping. CONCLUSIONS Residents are taking advantage of opportunities to nap on-shift. Working at night seems to drive on-shift napping. However, residents still exhibit insufficient sleep and daytime sleepiness which could reduce competency and represent a safety risk to themselves and/or patients. These findings will help inform intervention strategies which are tailored to surgical residents using a biomathematical model of fatigue.
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Affiliation(s)
| | | | - Steven R Hursh
- Institutes for Behavior Resources, Baltimore, Maryland; Johns Hopkins University School of Medicine, Baltmore Maryland
| | | | | | - Lisa Boyle
- Medstar Georgetown University Hospital, Washington, DC
| | - Jonathan E Davis
- Georgetown University School of Medicine, Washington, DC; MedStar Health Research Institute, Hyattsville, Maryland
| | - Mark Smith
- MedStar Institutes for Innovation, Washington, DC
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Schumacher S, Bledzka K, Manaserh I, Grondolsky J, Roy R, Gao E, Koch W. Enhanced insulin‐responsive AS160 elicits cardioprotection during metabolic stress. FASEB J 2021. [DOI: 10.1096/fasebj.2021.35.s1.00202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Kamila Bledzka
- Cardiovascular & Metabolic SciencesCleveland ClinicClevelandOH
| | - Iyad Manaserh
- Cardiovascular & Metabolic SciencesCleveland ClinicClevelandOH
| | | | - Rajika Roy
- Center for Translational MedicineLewis Katz School of Medicine at Temple UniversityPhiladelphiaPA
| | - Erhe Gao
- Center for Translational MedicineLewis Katz School of Medicine at Temple UniversityPhiladelphiaPA
| | - Walter Koch
- Center for Translational MedicineLewis Katz School of Medicine at Temple UniversityPhiladelphiaPA
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Bledzka KM, Manserh I, Van Wagoner D, Koch W, Schumacher S. Identifying Sex‐dependent Markers of Heart Failure and Atrial Myopathy. FASEB J 2021. [DOI: 10.1096/fasebj.2021.35.s1.04633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Kamila M. Bledzka
- Cardiovascular & Metabolic SciencesCleveland Clinic, Lerner Research InstituteClevelandOH
| | - Iyad Manserh
- Cardiovascular & Metabolic SciencesCleveland Clinic, Lerner Research InstituteClevelandOH
| | - David Van Wagoner
- Cardiovascular & Metabolic SciencesCleveland Clinic, Lerner Research InstituteClevelandOH
| | - Walter Koch
- Department of Pharmacology and Center for Translational MedicineTemple University School of MedicinePhiladelphiaPA
| | - Sarah Schumacher
- Cardiovascular & Metabolic SciencesCleveland Clinic, Lerner Research InstituteClevelandOH
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Engel S, Schumacher S, Niemeyer H, Kuester A, Burchert S, Klusmann H, Rau H, Willmund GD, Knaevelsrud C. Associations between oxytocin and vasopressin concentrations, traumatic event exposure and posttraumatic stress disorder symptoms: group comparisons, correlations, and courses during an internet-based cognitive-behavioural treatment. Eur J Psychotraumatol 2021; 12:1886499. [PMID: 33968321 PMCID: PMC8078934 DOI: 10.1080/20008198.2021.1886499] [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] [Indexed: 10/24/2022] Open
Abstract
Background: Posttraumatic stress disorder (PTSD) is characterized by impairments in extinction learning and social behaviour, which are targeted by trauma-focused cognitive behavioural treatment (TF-CBT). The biological underpinnings of TF-CBT can be better understood by adding biomarkers to the clinical evaluation of interventions. Due to their involvement in social functioning and fear processing, oxytocin and arginine vasopressin might be informative biomarkers for TF-CBT, but to date, this has never been tested. Objective: To differentiate the impact of traumatic event exposure and PTSD symptoms on blood oxytocin and vasopressin concentrations. Further, to describe courses of PTSD symptoms, oxytocin and vasopressin during an internet-based TF-CBT and explore interactions between these parameters. Method: We compared oxytocin and vasopressin between three groups of active and former male service members of the German Armed Forces (n = 100): PTSD patients (n = 39), deployed healthy controls who experienced a deployment-related traumatic event (n = 33) and non-deployed healthy controls who never experienced a traumatic event (n = 28). PTSD patients underwent a 5-week internet-based TF-CBT. We correlated PTSD symptoms with oxytocin and vasopressin before treatment onset. Further, we analysed courses of PTSD symptoms, oxytocin and vasopressin from pre- to post-treatment and 3 months follow-up, as well as interactions between the three parameters. Results: Oxytocin and vasopressin did not differ between the groups and were unrelated to PTSD symptoms. PTSD symptoms were highly stable over time, whereas the endocrine parameters were not, and they also did not change in mean. Oxytocin and vasopressin were not associated with PTSD symptoms longitudinally. Conclusions: Mainly due to their insufficient intraindividual stability, single measurements of endogenous oxytocin and vasopressin concentrations are not informative biomarkers for TF-CBT. We discuss how the stability of these biomarkers might be increased and how they could be better related to the specific impairments targeted by TF-CBT.
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Affiliation(s)
- Sinha Engel
- Division of Clinical Psychological Intervention, Freie Universität Berlin, Berlin, Germany
| | - Sarah Schumacher
- Division of Clinical Psychological Intervention, Freie Universität Berlin, Berlin, Germany
| | - Helen Niemeyer
- Division of Clinical Psychological Intervention, Freie Universität Berlin, Berlin, Germany
| | - Annika Kuester
- Division of Clinical Psychological Intervention, Freie Universität Berlin, Berlin, Germany
| | - Sebastian Burchert
- Division of Clinical Psychological Intervention, Freie Universität Berlin, Berlin, Germany
| | - Hannah Klusmann
- Division of Clinical Psychological Intervention, Freie Universität Berlin, Berlin, Germany
| | - Heinrich Rau
- Department for Military Mental Health, German Armed Forces, Military Hospital Berlin, Berlin, Germany
| | - Gerd-Dieter Willmund
- Department for Military Mental Health, German Armed Forces, Military Hospital Berlin, Berlin, Germany
| | - Christine Knaevelsrud
- Division of Clinical Psychological Intervention, Freie Universität Berlin, Berlin, Germany
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Carcamo M, Schumacher S, Binder R. Transfer function replacement of phenomenological single-mode equations in semiconductor microcavity modeling. Appl Opt 2020; 59:G112-G119. [PMID: 32749323 DOI: 10.1364/ao.392014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 05/15/2020] [Indexed: 06/11/2023]
Abstract
Semiconductor microcavities are frequently studied in the context of semiconductor lasers and in application-oriented fundamental research on topics such as linear and nonlinear polariton systems, polariton lasers, polariton pattern formation, and polaritonic Bose-Einstein condensates. A commonly used approach to describe theoretical properties includes a phenomenological single-mode equation that complements the equation for the nonlinear optical response (interband polarization) of the semiconductor. Here, we show how to replace the single-mode equation by a fully predictive transfer function method that, in contrast to the single-mode equation, accounts for propagation, retardation, and pulse-filtering effects of the incident light field traversing the distributed Bragg reflector (DBR) mirrors, without substantially increasing the numerical complexity of the solution. As examples, we use cavities containing GaAs quantum wells and transition-metal dichalcogenides (TMDs).
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31
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Fischer S, Schumacher S, Skoluda N, Strahler J. Fingernail cortisol - State of research and future directions. Front Neuroendocrinol 2020; 58:100855. [PMID: 32730860 DOI: 10.1016/j.yfrne.2020.100855] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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: 05/31/2020] [Revised: 07/13/2020] [Accepted: 07/24/2020] [Indexed: 10/23/2022]
Abstract
The extraction of cortisol from fingernails represents a recent advancement in the retrospective, long-term assessment of hypothalamic-pituitaryadrenal (HPA) axis activity: Fingernail cortisol has the potential to overcome some of the major disadvantages of established HPA axis markers. However, the introduction of any novel methodology also raises certain caveats. This review provides a comprehensive summary of the current state of research on fingernail cortisol. It identifies a number of strengths of his novel methodology (e.g., its high feasibility), while also pointing out open questions which currently challenge the interpretability of fingernail findings, in particular regarding the time period of cortisol secretion reflected in fingernail samples, as well as regarding potential determinants or confounders of fingernail cortisol (e.g. sociodemographic, lifestyle, or health characteristics). Clarification of these issues in the context of further methodological studies is necessary to validate the use of fingernail cortisol as a retrospective marker of HPA axis activity.
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Affiliation(s)
- Susanne Fischer
- University of Zurich, Institute of Psychology, Clinical Psychology and Psychotherapy, Zurich, Switzerland.
| | - Sarah Schumacher
- Freie Universität Berlin, Department of Education and Psychology, Division of Clinical Psychological Intervention, Berlin, Germany
| | - Nadine Skoluda
- University of Vienna, Department of Psychology, Clinical Psychology, Vienna, Austria
| | - Jana Strahler
- University of Giessen, Department of Psychology and Sport Sciences, Psychotherapy and Systems Neuroscience, Giessen, Germany
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32
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Engel S, van Zuiden M, Frijling JL, Koch SBJ, Nawijn L, Yildiz RLW, Schumacher S, Knaevelsrud C, Bosch JA, Veltman DJ, Olff M. Early posttraumatic autonomic and endocrine markers to predict posttraumatic stress symptoms after a preventive intervention with oxytocin. Eur J Psychotraumatol 2020; 11:1761622. [PMID: 32922686 PMCID: PMC7448939 DOI: 10.1080/20008198.2020.1761622] [Citation(s) in RCA: 3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Efficient prevention of posttraumatic stress disorder (PTSD) needs to target individuals with an increased risk for adverse outcome after trauma. Prognostic or prescriptive biological markers assessed early posttrauma may inform personalized treatment recommendations. OBJECTIVE To test prognostic and prescriptive effects of early (posttraumatic) autonomic and endocrine markers on PTSD symptom development. METHOD Autonomic and endocrine markers were assessed within 12 days posttrauma and before treatment initiation within a randomized placebo-controlled trial investigating repeated oxytocin administration as preventive intervention for PTSD. Linear mixed effects models were used to test the effects of heart rate (variability), resting cortisol, morning cortisol and cortisol awakening response (CAR), cortisol suppression by dexamethasone and resting oxytocin on PTSD symptoms 1.5, 3 and 6 months posttrauma in men (n = 54), women using hormonal contraception (n = 27) and cycling women (n = 19). RESULTS We found significant prognostic effects of resting oxytocin and cortisol suppression. In women using hormonal contraception, higher oxytocin was associated with higher PTSD symptoms across follow-up. Stronger cortisol suppression by dexamethasone, reflecting increased glucocorticoid receptor feedback sensitivity, was associated with lower PTSD symptoms across follow-up in men, but with higher symptoms at 1.5 months in women using hormonal contraception. These effects were independent of treatment condition. No further significant prognostic or prescriptive effects were detected. CONCLUSION Our exploratory study indicates that resting oxytocin and glucocorticoid receptor feedback sensitivity early posttrauma are associated with subsequent PTSD symptom severity. Notably, prognostic effects depended on sex and hormonal contraception use, emphasizing the necessity to consider these factors in biomedical PTSD research.
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Affiliation(s)
- Sinha Engel
- Amsterdam University Medical Centers, Location Academic Medical Center, Department of Psychiatry, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, The Netherlands.,Division of Clinical Psychological Intervention, Freie Universität Berlin, Berlin, Germany
| | - Mirjam van Zuiden
- Amsterdam University Medical Centers, Location Academic Medical Center, Department of Psychiatry, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, The Netherlands
| | - Jessie L Frijling
- Amsterdam University Medical Centers, Location Academic Medical Center, Department of Psychiatry, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, The Netherlands
| | - Saskia B J Koch
- Amsterdam University Medical Centers, Location Academic Medical Center, Department of Psychiatry, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, The Netherlands.,Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Laura Nawijn
- Amsterdam University Medical Centers, Location Academic Medical Center, Department of Psychiatry, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, The Netherlands.,Department of Psychiatry, Amsterdam University Medical Centers, Location VU University Medical Center, Amsterdam, The Netherlands
| | - Rinde L W Yildiz
- Amsterdam University Medical Centers, Location Academic Medical Center, Department of Psychiatry, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, The Netherlands
| | - Sarah Schumacher
- Division of Clinical Psychological Intervention, Freie Universität Berlin, Berlin, Germany
| | - Christine Knaevelsrud
- Division of Clinical Psychological Intervention, Freie Universität Berlin, Berlin, Germany
| | - Jos A Bosch
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Dick J Veltman
- Department of Psychiatry, Amsterdam University Medical Centers, Location VU University Medical Center, Amsterdam, The Netherlands
| | - Miranda Olff
- Amsterdam University Medical Centers, Location Academic Medical Center, Department of Psychiatry, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, The Netherlands.,Arq Psychotrauma Expert Group, Diemen, The Netherlands
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Schwartz LP, Devine JK, Hursh SR, Mosher E, Schumacher S, Boyle L, Davis JE, Smith M, Fitzgibbons S. 0218 Biomathematical Modeling Predicts Fatigue Risk in General Surgery Residents. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.216] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Fatigue and its effects on performance have long been a concern in medicine. Evidence exists that current duty-hour restrictions for resident trainees have a limited impact on physician wellbeing and patient safety, prompting renewed efforts to address this threat. In this study, sleep patterns of general-surgery residents were used to optimize a biomathematical model of performance for use as a tool for fatigue risk management with residents.
Methods
General surgery residents based at a multi-hospital, general surgery residency program were approached for participation in this study. Enrolled residents wore actigraph devices for 8 weeks and completed subjective sleep assessments. Sleep data and shift schedules were then input into the Sleep, Activity, Fatigue and Task Effectiveness (SAFTE) Model to assess predicted cognitive performance. Performance was compared to an “effectiveness” level of 77 (equivalent to a blood-alcohol content of 0.05g/dL). Eight hours of sleep debt was considered “below reservoir criteria”.
Results
Sleep actigraphy data was collected from 22 general surgery residents. Modeling results showed that as shift lengths increased, effectiveness scores generally decreased, and the time spent below criterion (77) increased. Additionally, 11.13% of time on shift was below the effectiveness criterion and 42.7% of shifts included time spent below the reservoir criterion. Adjustments to the sleep prediction were made based on actual sleep, and performance predictions from actual sleep and the adjusted model were significantly correlated (p<.0001).
Conclusion
Despite adherence to national standards limiting work hours, current surgical resident sleep patterns and shift schedules create concerning levels of fatigue. This study illustrates how biomathematical fatigue models can predict resident physician sleep patterns and performance. Modeling represents a novel and important tool for medical educators seeking to create shift schedules that maintain physician preparedness and minimize fatigue risk.
Support
N/A
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Affiliation(s)
- L P Schwartz
- Institutes for Behavior Resources, Baltimore, MD
| | - J K Devine
- Institutes for Behavior Resources, Baltimore, MD
| | - S R Hursh
- Institutes for Behavior Resources, Baltimore, MD
| | - E Mosher
- MedStar Institute for Innovation, Washington, DC
| | - S Schumacher
- Georgetown University School of Medicine, Washington, DC
| | - L Boyle
- Georgetown University School of Medicine, Washington, DC
| | - J E Davis
- Georgetown University School of Medicine, Washington, DC
| | - M Smith
- MedStar Institute for Innovation, Washington, DC
| | - S Fitzgibbons
- Georgetown University School of Medicine, Washington, DC
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Devine JK, Schwartz LP, Hursh SR, Mosher E, Schumacher S, Boyle L, Davis JE, Smith M, Fitzgibbons S. 0184 Predicting Strategic Napping in Surgical Residents by Individual and Rotation Characteristics. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.182] [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] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Strategic napping, or napping on-shift, is recommended to reduce fatigue in medical residents. The actual prevalence of strategic napping in relation to residents’ workload, schedule, or demographics is largely unquantified. This study objectively measured sleep patterns and work schedules in surgical residents working a variety of service lines over a two-month period in order to identify which resident and service line attributes predict on-shift napping.
Methods
Surgical residents from an academic surgery program in the Washington, DC area provided schedule information, completed the Epworth Sleepiness Scale (ESS), and wore sleep-tracking devices (Zulu Watch) continuously for 8 weeks. Multiple linear regression was performed to predict percent days with on-shift napping from resident demographics (age, gender, post graduate year (PGY), sleep characteristics (ESS, total sleep time (TST), sleep efficiency (SE)), schedule characteristics (shift start time, shift length, rotation length, percent days on-shift, percent night shifts), and service line characteristics (service line category, number of service lines worked).
Results
Twenty-two (n=22) residents completed the study, rotating through at least 1 of 5 different service line categories (Acute Non-Elective Surgery, Elective Surgery, Night Float, Surgical Intensive Care Unit, and Other). Residents slept an average of 6 hours within a 24-hour period (370±129 minutes) with normal SE (87.13%±7.55%). ESS scores indicated excessive daytime sleepiness (11.64±4.03). Ninety-five percent (n=21) of residents napped at least once while on shift. Residents napped on-shift approximately 32% of their working days and were most likely to nap when working between 2300-0500 hours. Earlier shift start times predicted less on-shift napping (B=-0.08,SE=0.04,β=-2.40,t=-2.09,p=0.05) while working more night shifts (B=1.55,SE=0.44,β=4.12,t=3.52,p=0.003) and shifts over 24 hours.
Conclusion
Residents take advantage of opportunities to nap on-shift, particularly when working at night. Despite naps, however, residents exhibit insufficient sleep with excessive daytime sleepiness, representing a safety risk to themselves and their patients.
Support
NA
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Affiliation(s)
- J K Devine
- Institutes for Behavior Resources, Baltimore, MD
| | - L P Schwartz
- Institutes for Behavior Resources, Baltimore, MD
| | - S R Hursh
- Institutes for Behavior Resources, Baltimore, MD
- John Hopkins University School of Medicine, Baltimore, MD
| | - E Mosher
- MedStar Institutes for Innovation, Washington, DC
| | - S Schumacher
- Georgetown University School of Medicine, Washington, DC
| | - L Boyle
- Georgetown University School of Medicine, Washington, DC
| | - J E Davis
- Georgetown University School of Medicine, Washington, DC
| | - M Smith
- MedStar Institutes for Innovation, Washington, DC
| | - S Fitzgibbons
- Georgetown University School of Medicine, Washington, DC
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Niemeyer H, Knaevelsrud C, Schumacher S, Engel S, Kuester A, Burchert S, Muschalla B, Weiss D, Spies J, Rau H, Willmund GD. Evaluation of an internet-based intervention for service members of the German armed forces with deployment-related posttraumatic stress symptoms. BMC Psychiatry 2020; 20:205. [PMID: 32375754 PMCID: PMC7204035 DOI: 10.1186/s12888-020-02595-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 04/12/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The present study was designed to evaluate the efficacy of a therapist-guided internet-based cognitive-behavioral therapy (iCBT) intervention for service members of the German Armed Forces with posttraumatic stress disorder (PTSD). The iCBT was adapted from Interapy, a trauma-focused evidence-based treatment based on prolonged exposure and cognitive restructuring. It lasted for 5 weeks and included 10 writing assignments (twice a week). The program included a reminder function if assignments were overdue, but no multimedia elements. Therapeutic written feedback was provided asynchronously within one working day. METHODS Male active and former military service members were recruited from the German Armed Forces. Diagnoses were assessed with the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) and the Mini-International Neuropsychiatric Interview. Psychopathology was assessed at pre-treatment, post-treatment, and 3-month follow-up. Severity of PTSD was the primary outcome and anxiety was the secondary outcome. Participants were randomly allocated to a treatment group that received iCBT immediately or to a waitlist group that received iCBT after 6 weeks. Due to the overall small sample size (n = 37), the two groups were collapsed for the statistical analyses. Change during the intervention period was investigated using latent-change score models. RESULTS Improvements in the CAPS-5 were small and not statistically significant. For anxiety, small significant improvements were observed from pre- to follow-up assessment. The dropout rate was 32.3%. CONCLUSIONS The low treatment utilization and the high dropout rate are in line with previous findings on treatment of service members. The interpretation of the current null results for the efficacy of iCBT is limited due to the small sample size, however for military samples effect estimates were also smaller in other recent studies. Our results demonstrate the need to identify factors influencing treatment engagement and efficacy in veterans. TRIAL REGISTRATION Australian Clinical Trials Registry ACTRN12616000956404.
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Affiliation(s)
- Helen Niemeyer
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Freie Universität Berlin, Schwendenerstr. 27, 14195, Berlin, Germany.
| | - Christine Knaevelsrud
- grid.14095.390000 0000 9116 4836Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Freie Universität Berlin, Schwendenerstr. 27, 14195 Berlin, Germany
| | - Sarah Schumacher
- grid.14095.390000 0000 9116 4836Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Freie Universität Berlin, Schwendenerstr. 27, 14195 Berlin, Germany
| | - Sinha Engel
- grid.14095.390000 0000 9116 4836Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Freie Universität Berlin, Schwendenerstr. 27, 14195 Berlin, Germany
| | - Annika Kuester
- grid.14095.390000 0000 9116 4836Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Freie Universität Berlin, Schwendenerstr. 27, 14195 Berlin, Germany
| | - Sebastian Burchert
- grid.14095.390000 0000 9116 4836Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Freie Universität Berlin, Schwendenerstr. 27, 14195 Berlin, Germany
| | - Beate Muschalla
- grid.6738.a0000 0001 1090 0254Department of Clinical Psychology, Psychotherapy and Diagnostics, Institute of Psychology, Technische Universität Braunschweig, Braunschweig, Germany
| | - Deborah Weiss
- grid.14095.390000 0000 9116 4836Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Freie Universität Berlin, Schwendenerstr. 27, 14195 Berlin, Germany
| | - Jan Spies
- grid.14095.390000 0000 9116 4836Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Freie Universität Berlin, Schwendenerstr. 27, 14195 Berlin, Germany
| | - Heinrich Rau
- German Armed Forces, Military Hospital Berlin, Department for Military Mental Health, Berlin, Germany
| | - Gerd-Dieter Willmund
- German Armed Forces, Military Hospital Berlin, Department for Military Mental Health, Berlin, Germany
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Engel S, Schumacher S, Niemeyer H, Küster A, Burchert S, Rau H, Willmund GD, Knaevelsrud C. Does Oxytocin Impact the Psychotherapeutic Process? An Explorative Investigation of Internet-Based Cognitive-Behavioral Treatment for Posttraumatic Stress Disorder. Verhaltenstherapie 2020. [DOI: 10.1159/000506028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Höfner K, Hampel C, Kirschner-Hermanns R, Alloussi SH, Bauer RM, Bross S, Bschleipfer T, Goepel M, Haferkamp A, Hüsch T, Kaufmann A, Kiss G, Kranz J, Oelke M, Pannek J, Reitz A, Rutkowski M, Schäfer W, Schulte-Baukloh H, Schumacher S, Seif C, Schultz-Lampel D. [Use of synthetic slings and mesh implants in the treatment of female stress urinary incontinence and prolapse : Statement of the Working Group on Urological Functional Diagnostics and Female Urology of the Academy of the German Society of Urology]. Urologe A 2020; 59:65-71. [PMID: 31741004 DOI: 10.1007/s00120-019-01074-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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] [Indexed: 11/28/2022]
Abstract
Due to a safety alert issued by the US Food and Drug Administration (FDA) in 2011 for transvaginal mesh implants to treat female prolapse as a result of numerous reports of complications such as infection, chronic pain, dyspareunia, vaginal erosion, shrinkage and erosion into other organs nearly all industrial products have been withdrawn from the market in the meantime. The United Kingdom, Australia, and New Zealand extended warnings and prohibitions even on the implantation of midurethral slings (TVT, TOT). In view of these current international controversies regarding the use of implanted materials for the treatment of stress incontinence and prolapse and the lack of clear guidelines for the use of biomaterials, the opinion of the Working Group on Urological Functional Diagnostics and Female Urology should provide clarity. The Opinion is based on the SCENIHR Report of the "European Commission's Scientific Committee on Emerging and Newly Identified Health Risks", the "Consensus Statement of the European Urology Association and the European Urogynaecological Association on the Use of Implanted Materials for Treating Pelvic Organ Prolapse and Stress Urinary Incontinence" and in compliance with relevant EAU and national guidelines and the opinion of the Association for Urogynaecology and Plastic Pelvic Floor Reconstruction (AGUB eV). In addition, recommendations are given for the future handling of implants of slings and meshes for the treatment of stress incontinence and prolapse from a urologic viewpoint.
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Affiliation(s)
- K Höfner
- Urologische Klinik, Evangelisches Krankenhaus Oberhausen, Virchowstr. 20, 46047, Oberhausen, Deutschland.
| | - C Hampel
- Urologische Abteilung, Marien-Hospital Erwitte, Erwitte, Deutschland
| | - R Kirschner-Hermanns
- Neuro-Urologie/Urologie Universitätsklinikum Bonn und Neuro-Urologie, Neurologisches Rehabilitationszentrum der Godeshöhe e. V., Bonn, Deutschland
| | - S H Alloussi
- Abteilung Urologie, Universitätsspital Basel, Basel, Schweiz
| | - R M Bauer
- Urologische Klinik und Poliklinik der Ludwig-Maximilians-Universität München, Campus Großhadern, München, Deutschland
| | - S Bross
- Urologische Klinik, Fürst-Stirum-Klinik Bruchsal, Bruchsal, Deutschland
| | - T Bschleipfer
- Klinik für Urologie, Andrologie und Kinderurologie, Klinikum Weiden/Kliniken Nordoberpfalz AG, Weiden i. d. Oberpfalz, Deutschland
| | - M Goepel
- Klinik für Urologie und Nephrologie, Helios Klinikum Niederberg, Velbert, Deutschland
| | - A Haferkamp
- Urologische Klinik und Poliklinik, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Deutschland
| | - T Hüsch
- Urologische Klinik und Poliklinik, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Deutschland
| | - A Kaufmann
- Zentrum für Kontinenz und Neuro-Urologie, Kliniken Maria Hilf GmbH Mönchengladbach, Mönchengladbach, Deutschland
| | - G Kiss
- Institution Neuro-Urologische Ambulanz, Univ. Klinik f. Urologie Innsbruck, Innsbruck, Österreich
| | - J Kranz
- St.-Antonius Hospital, Klinik für Urologie und Kinderurologie Eschweiler, Eschweiler, Deutschland
- Universitätsklinik und Poliklinik für Urologie, Universitätsklinikum Halle (Saale), Halle (Saale), Deutschland
| | - M Oelke
- Klinik für Urologie, Kinderurologie und Urologische Onkologie, St. Antonius-Hospital Gronau, Gronau, Deutschland
| | - J Pannek
- Neuro-Urologie, Schweizer Paraplegiker-Zentrum Nottwil, Nottwil, Schweiz
- Urologische Klinik, Inselspital, Universitätsspital, Universität Bern, Bern, Schweiz
| | - A Reitz
- KontinenzZentrum Hirslanden Zürich, Zürich, Schweiz
| | - M Rutkowski
- Urologische Klinik, Landesklinikum Korneuburg, Korneuburg, Österreich
| | | | - H Schulte-Baukloh
- Urologie Turmstraße (Gemeinschaftspraxis), Berlin Mitte/Moabit, Deutschland
| | - S Schumacher
- Urology Department, Healthpoint Hospital, Abu Dhabi, Vereinigte Arabische Emirate
| | - C Seif
- Urologiezentrum Alter Markt, Kiel, Deutschland
| | - D Schultz-Lampel
- Kontinenzzentrum Südwest, Schwarzwald-Baar Klinikum Villingen-Schwenningen, Villingen-Schwenningen, Deutschland
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Engel S, Schumacher S, Niemeyer H, Küster A, Burchert S, Rau H, Willmund GD, Knaevelsrud C. Beeinflusst Oxytocin den psychotherapeutischen Prozess? Eine explorative Untersuchung im Kontext einer internetbasierten kognitiv-verhaltenstherapeutischen Behandlung für die posttraumatische Belastungsstörung. Verhaltenstherapie 2020. [DOI: 10.1159/000505303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Spies JP, Cwik JC, Willmund GD, Knaevelsrud C, Schumacher S, Niemeyer H, Engel S, Küster A, Muschalla B, Köhler K, Weiss D, Rau H. Associations Between Difficulties in Emotion Regulation and Post-Traumatic Stress Disorder in Deployed Service Members of the German Armed Forces. Front Psychiatry 2020; 11:576553. [PMID: 33192712 PMCID: PMC7533544 DOI: 10.3389/fpsyt.2020.576553] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 08/27/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Experiencing a traumatic event can lead to post-traumatic stress disorder (PTSD), but not every traumatized person develops PTSD. Several protective and risk factors have been identified in civilians and veterans to explain why some individuals develop PTSD and others do not. However, no research has confirmed the relationship between emotion regulation and PTSD in deployed German Armed Forces service members after a foreign assignment. Previous studies have identified some protective factors, such as social support, social acknowledgment, specific personal values, and posttraumatic growth, as well as risk factors, like moral injury and emotion regulation. Thus, the aim of the present study is to confirm the relationship between emotion regulation and PTSD and to test for factors that are associated with higher severity of PTSD symptoms in such a sample. METHODS A post-hoc secondary analysis was conducted on data collected in a randomized controlled trial. Participants (N = 72) were male active and former military service members that have returned from deployment and were recruited from the German Armed Forces. These participants were separated into two groups according to PTSD diagnosis based on the results of a structured diagnostic interview. Data from evaluation questionnaires administered upon entry into the study were subjected to a cross-sectional analysis. The measures included the severity of PTSD symptoms, clusters of PTSD symptoms, clinical measures, and several measures assessing PTSD-related constructs. Analyses included the Spearman rank correlation coefficient, X2 tests for nominal data, Mann-Whitney U-tests for non-parametric data, and a mediation analysis. RESULTS The results of the mediation analysis revealed that difficulties in emotion regulation were significantly associated with the severity of PTSD symptoms, which was mediated by social acknowledgment and experimental avoidance but not by moral injury. The analyses showed that the severity of PTSD symptoms and all clusters of PTSD symptoms were significantly associated with most of the measured constructs in expectable directions. Participants in the PTSD group showed significantly higher mean scores on questionnaires measuring constructs that have been associated with PTSD, like emotion regulation and moral injury. They also showed lower mean scores in questionnaires for social support and social acknowledgment as a victim or survivor than participants in the non-PTSD group. CONCLUSION The present results show that difficulties in emotion regulation are directly associated with the severity of PTSD symptoms in service members of the German Armed Forces. This association is mediated by social acknowledgment and experimental avoidance, but not by moral injury. Thus, future studies should investigate these potentially crucial factors for better understanding of the development and maintenance of PTSD in service members of the German Armed Forces after deployment to create possible treatment adaptions. CLINICAL TRIAL REGISTRATION Australian Clinical Trials Registry, identifier ACTRN 12616000956404 http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=370924.
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Affiliation(s)
- Jan Peter Spies
- Department of Clinical Psychology and Psychotherapy, Faculty of Human Sciences, University of Cologne, Cologne, Germany.,Department for Military Mental Health, German Armed Forces Military Hospital Berlin, Berlin, Germany.,Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Jan Christopher Cwik
- Department of Clinical Psychology and Psychotherapy, Faculty of Human Sciences, University of Cologne, Cologne, Germany
| | - Gert Dieter Willmund
- Department for Military Mental Health, German Armed Forces Military Hospital Berlin, Berlin, Germany
| | - Christine Knaevelsrud
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Sarah Schumacher
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Helen Niemeyer
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Sinha Engel
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Annika Küster
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Beate Muschalla
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Technische Universität Braunschweig, Braunschweig, Germany
| | - Kai Köhler
- Department for Military Mental Health, German Armed Forces Military Hospital Berlin, Berlin, Germany
| | - Deborah Weiss
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Heinrich Rau
- Department for Military Mental Health, German Armed Forces Military Hospital Berlin, Berlin, Germany
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Engel S, Klusmann H, Laufer S, Pfeifer AC, Ditzen B, van Zuiden M, Knaevelsrud C, Schumacher S. Trauma exposure, posttraumatic stress disorder and oxytocin: A meta-analytic investigation of endogenous concentrations and receptor genotype. Neurosci Biobehav Rev 2019; 107:560-601. [DOI: 10.1016/j.neubiorev.2019.08.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 07/02/2019] [Accepted: 08/07/2019] [Indexed: 01/06/2023]
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Bölükbas S, Greve T, Biancosino C, Eberlein M, Schumacher S, Gödde D, Störkel S, Redwan B. Diode-pumped neodymium:yttrium aluminum garnet laser effects on the visceral pleura in an ex vivo porcine lung model†. Interact Cardiovasc Thorac Surg 2019; 28:339-343. [PMID: 30189016 DOI: 10.1093/icvts/ivy254] [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] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Revised: 07/16/2018] [Accepted: 07/22/2018] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Resection of tumour spread on a very thin visceral pleura might be challenging, and collateral damage to the lung parenchyma might occur. We aimed to develop an operative technique, which might facilitate the parenchyma-sparing destruction of the visceral pleura. This experimental work investigated the effects of a neodymium:yttrium aluminum garnet (Nd:YAG) laser on the visceral pleura in an ex vivo porcine lung model. METHODS We used a diode-pumped Nd:YAG laser (Limax® 120, KLS Martin, Tuttlingen, Germany) to investigate the effects on the visceral pleural in 20 porcine lungs. The laser was applied on a standardized length in 4 different settings: Group I (80 W, 6 s), Group II (80 W, 12 s), Group III (120 W, 6 s) and Group IV (120 W, 12 s). All specimens were analysed histologically. RESULTS The mean thickness of the visceral pleura was 81 ± 10 μm. Increasing power levels and longer application duration resulted in significantly enhanced laser destruction effects. The mean depths of the carbonization zone were 142 ± 42 µm, 378 ± 137 µm, 607 ± 155 µm and 1371 ± 271 μm for Groups I-IV, respectively (P < 0.001). The ratio of carbonization zone to pleural thickness was measured for each section (C/P ratio) to quantify the thermal effects. The corresponding C/P ratio for Groups I-IV were 1.72 ± 0.55, 4.98 ± 1.96, 7.11 ± 1.61 and 17.35 ± 4.35, respectively (P < 0.001). CONCLUSIONS Our study showed that increasing power levels and application duration of the laser lead to a significantly increased carbonization and destruction zones. Further in vivo human studies should evaluate the feasibility of laser application for a potential translational relevance for human use.
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Affiliation(s)
- Servet Bölükbas
- Department of Thoracic Surgery, Kliniken Essen-Mitte Evang. Huyssens-Stiftung/Knappschafts-Krankenhaus, Essen, Germany
| | - Thorsten Greve
- Department of Thoracic Surgery, Helios University Hospital Wuppertal, Wuppertal, Germany
| | - Christian Biancosino
- Department of Thoracic Surgery, Helios University Hospital Wuppertal, Wuppertal, Germany
| | - Michael Eberlein
- Division of Pulmonary, Department of Internal Medicine, Critical Care and Occupational Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Sarah Schumacher
- Institute of Pathology, Helios University Hospital Wuppertal, Wuppertal, Germany
| | - Daniel Gödde
- Institute of Pathology, Helios University Hospital Wuppertal, Wuppertal, Germany
| | - Stephan Störkel
- Institute of Pathology, Helios University Hospital Wuppertal, Wuppertal, Germany
| | - Bassam Redwan
- Division of Thoracic Surgery and Lung Transplantation, Department of Cardiothoracic Surgery, University Hospital of Münster, Münster, Germany
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Engel S, van Zuiden M, Frijling JL, Koch SBJ, Nawijn L, Schumacher S, Knaevelsrud C, Veltman DJ, Olff M. Patterns of Recovery From Early Posttraumatic Stress Symptoms After a Preventive Intervention With Oxytocin: Hormonal Contraception Use Is a Prognostic Factor. Biol Psychiatry 2019; 85:e71-e73. [PMID: 30824111 DOI: 10.1016/j.biopsych.2019.01.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 01/17/2019] [Accepted: 01/18/2019] [Indexed: 01/22/2023]
Affiliation(s)
- Sinha Engel
- Department of Psychiatry, Amsterdam University Medical Centers, Location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Division of Clinical Psychological Intervention, Freie Universität Berlin, Berlin, Germany
| | - Mirjam van Zuiden
- Department of Psychiatry, Amsterdam University Medical Centers, Location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
| | - Jessie L Frijling
- Department of Psychiatry, Amsterdam University Medical Centers, Location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Saskia B J Koch
- Department of Psychiatry, Amsterdam University Medical Centers, Location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, Radboud University Nijmegen, Nijmegen, the Netherlands
| | - Laura Nawijn
- Department of Psychiatry, Amsterdam University Medical Centers, Location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Department of Psychiatry, Amsterdam University Medical Centers, Location VU University Medical Center, VU University, Amsterdam, the Netherlands
| | - Sarah Schumacher
- Division of Clinical Psychological Intervention, Freie Universität Berlin, Berlin, Germany
| | - Christine Knaevelsrud
- Division of Clinical Psychological Intervention, Freie Universität Berlin, Berlin, Germany
| | - Dick J Veltman
- Department of Psychiatry, Amsterdam University Medical Centers, Location VU University Medical Center, VU University, Amsterdam, the Netherlands
| | - Miranda Olff
- Department of Psychiatry, Amsterdam University Medical Centers, Location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Arq Psychotrauma Expert Group, Diemen, the Netherlands
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Engel S, Laufer S, Knaevelsrud C, Schumacher S. The endogenous oxytocin system in depressive disorders: A systematic review and meta-analysis. Psychoneuroendocrinology 2019; 101:138-149. [PMID: 30458371 DOI: 10.1016/j.psyneuen.2018.11.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [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: 05/31/2018] [Revised: 09/10/2018] [Accepted: 11/06/2018] [Indexed: 11/26/2022]
Abstract
The oxytocin system is involved in psychological functions and interacts with biological systems that are altered in patients suffering from depressive disorders. This suggests a possible role of oxytocin in the development and maintenance of depression. We provide the first systematic review and meta-analysis that specifically addresses differences in basal endogenous oxytocin concentrations between patients with depressive disorders and healthy controls. A systematic literature search was conducted to identify studies that measured basal endogenous oxytocin concentrations in depressive patients and healthy controls. We included k = 13 studies (n = 368 patients and n = 346 healthy controls) in the qualitative review and k = 9 studies (n = 273 patients and n = 273 healthy controls) in the meta-analytic procedure. Standardized mean group differences were non-significant (g = -0.02, CI = [-0.41; 0.36]), indicating that depressive patients and healthy controls did not differ in basal endogenous oxytocin concentrations. The overall effect was heterogeneous. Effects within studies showing comparable risks of biases, as rated according to the Newcastle-Ottawa Quality Assessment Scale, were non-significant as well, but homogeneous. The findings suggest that more complex research designs and methodological approaches should be employed to detect and understand a possible role of the oxytocin system in depressive disorders. We provide recommendations for subsequent promising study designs, involving the consideration of illness phase, comorbidities and correlations with psychological functions or symptoms. We point out the strengths of reactivity designs and multidimensional measurement approaches and recommend to linking future research questions to theories of depression.
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Affiliation(s)
- Sinha Engel
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Schwendenerstraße 27, 14195 Berlin, Germany.
| | - Sebastian Laufer
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Schwendenerstraße 27, 14195 Berlin, Germany.
| | - Christine Knaevelsrud
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Schwendenerstraße 27, 14195 Berlin, Germany.
| | - Sarah Schumacher
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Schwendenerstraße 27, 14195 Berlin, Germany.
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Laufer S, Engel S, Knaevelsrud C, Schumacher S. Cortisol and alpha-amylase assessment in psychotherapeutic intervention studies: A systematic review. Neurosci Biobehav Rev 2018; 95:235-262. [DOI: 10.1016/j.neubiorev.2018.09.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 09/25/2018] [Indexed: 01/23/2023]
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Schumacher S, Weiss D, Knaevelsrud C. Dissemination of exposure in the treatment of anxiety disorders and post-traumatic stress disorder among German cognitive behavioural therapists. Clin Psychol Psychother 2018; 25:856-864. [PMID: 30118184 DOI: 10.1002/cpp.2320] [Citation(s) in RCA: 7] [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] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 07/20/2018] [Accepted: 07/21/2018] [Indexed: 01/04/2023]
Abstract
The efficacy of exposure is beyond doubt, which is reflected in guidelines recommending its application in the treatment of anxiety disorders and post-traumatic stress disorder (PTSD). Research suggests exposure to be underutilized in clinical practice in the United States and Europe. A systematic investigation of the dissemination of exposure in Germany is lacking. The present study examined the dissemination and application frequency of exposure among German cognitive behavioural therapists working in routine care. In an online-based survey, 331 psychotherapists provided information on treatment of patients with panic disorder, phobia, and PTSD. By means of multinomial logistic regression analysis, application frequency of exposure (non-users vs. users vs. frequent users) was predicted by various therapist characteristics. Younger age and less negative beliefs about exposure significantly predicted the affiliation to the frequent users group compared to the non-users in the treatment of panic disorder or phobia. Concerning treatment of PTSD, only negative beliefs about exposure was identified as significant predictor. Sex, educational level, and number of exposure sessions performed during clinical training were not of predictive value. Current findings suggest that negative beliefs about exposure and age impact the frequent provision of exposure to patients. Modification of negative attitudes might be achieved through specific training strategies.
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Affiliation(s)
- Sarah Schumacher
- Division of Clinical Psychological Intervention, Freie Universität Berlin, Berlin, Germany
| | - Deborah Weiss
- Division of Clinical Psychological Intervention, Freie Universität Berlin, Berlin, Germany
| | - Christine Knaevelsrud
- Division of Clinical Psychological Intervention, Freie Universität Berlin, Berlin, Germany
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Stuijfzand W, Schumacher S, Driessen R, Lammertsma A, Van Rossum AC, Van De Ven P, Nap AC, Appelman J, Lemkes J, Van Leeuwen M, Van Royen N, Raijmakers P, Knaapen P. P4197Evolution of vasomotor function and myocardial perfusion during three years follow-up after randomization between bioresorbable vascular scaffold and metal drug eluting stent: the VANISH trial. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- W Stuijfzand
- VU University Medical Center, Cardiology, Amsterdam, Netherlands
| | - S Schumacher
- VU University Medical Center, Cardiology, Amsterdam, Netherlands
| | - R Driessen
- VU University Medical Center, Cardiology, Amsterdam, Netherlands
| | - A Lammertsma
- VU University Medical Center, Cardiology, Amsterdam, Netherlands
| | - A C Van Rossum
- VU University Medical Center, Cardiology, Amsterdam, Netherlands
| | - P Van De Ven
- VU University Medical Center, Cardiology, Amsterdam, Netherlands
| | - A C Nap
- VU University Medical Center, Cardiology, Amsterdam, Netherlands
| | - J Appelman
- VU University Medical Center, Cardiology, Amsterdam, Netherlands
| | - J Lemkes
- VU University Medical Center, Cardiology, Amsterdam, Netherlands
| | - M Van Leeuwen
- VU University Medical Center, Cardiology, Amsterdam, Netherlands
| | - N Van Royen
- VU University Medical Center, Cardiology, Amsterdam, Netherlands
| | - P Raijmakers
- VU University Medical Center, Cardiology, Amsterdam, Netherlands
| | - P Knaapen
- VU University Medical Center, Cardiology, Amsterdam, Netherlands
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48
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Antão-Sousa S, Sánchez-Diz P, Abovich M, Alvarez J, Carvalho E, Silva C, Domingues P, Farfán M, Gutierrez A, Pontes L, Porto M, Posada Y, Restrepo T, Rodenbusch R, Santapá O, Schumacher S, Suárez D, Silva C, Vullo C, Pinto N, Gusmão L. Mutation rates and segregation data on 16 Y-STRs: An update to previous GHEP-ISFG studies. Forensic Science International: Genetics Supplement Series 2017. [DOI: 10.1016/j.fsigss.2017.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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49
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Hoffmann M, Pasch S, Schamberger T, Maneck M, Möhlendick B, Schumacher S, Brockhoff G, Knoefel WT, Izbicki J, Polzer B, Stoecklein NH, Klein CA. Diagnostic pathology of early systemic cancer: ERBB2 gene amplification in single disseminated cancer cells determines patient survival in operable esophageal cancer. Int J Cancer 2017; 142:833-843. [PMID: 29044505 DOI: 10.1002/ijc.31108] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 09/07/2017] [Accepted: 09/28/2017] [Indexed: 11/05/2022]
Abstract
Early metastatic dissemination and evolution of disseminated cancer cells (DCCs) outside the primary tumor is one reason for the failure of adjuvant therapies because it generates molecular genotypes and phenotypes different from primary tumors, which still underlie therapy decisions. Since ERBB2 amplification in esophageal DCCs but not in primary tumor cells predict outcome, we aimed to establish an assay with diagnostic reliability for single DCCs or circulating tumor cells. For this, we evaluated copy number alterations of more than 600 single DCCs from multiple cancer types to define reference regions suitable for quantification of target regions, such as ERBB2. We then compared ERBB2 quantitative PCR (qPCR) measurements with fluorescent in situ hybridization (FISH) data of various breast cancer cell lines and identified the aberration-calling threshold. The method was applied to two independent cohorts of esophageal cancer patients from Hamburg (n = 59) and Düsseldorf (n = 53). We found a high correlation between the single cell qPCR assay and the standard FISH assay (R = 0.98) and significant associations between amplification and survival for both patient cohorts (Hamburg (HH), p = 0.033; Düsseldorf (D), p = 0.052; pooled HH + D, p = 0.002) when applied to DCCs of esophageal cancer patients. Detection of a single ERBB2-amplified DCC was the most important risk factor for death from esophageal cancer (relative risk = 4.22; 95% CI = 1.91-9.32; p < 0.001). In our study, we detected ERBB2-amplified cells in 7% of patients. These patients could benefit from anti-ERBB2 targeting therapies.
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Affiliation(s)
- Martin Hoffmann
- Division of Personalized Tumor Therapy, Fraunhofer Institute for Toxicology and Experimental Medicine (ITEM), Regensburg, Germany
| | - Sophie Pasch
- Chair of Experimental Medicine and Therapy Research, University of Regensburg, Germany
| | - Thomas Schamberger
- Chair of Experimental Medicine and Therapy Research, University of Regensburg, Germany
| | - Matthias Maneck
- Chair of Experimental Medicine and Therapy Research, University of Regensburg, Germany
| | - Birte Möhlendick
- Department of General, Visceral and Pediatric Surgery, University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Sarah Schumacher
- Department of General, Visceral and Pediatric Surgery, University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Gero Brockhoff
- Department of Gynecology, Caritas-Hospital St. Josef, University of Regensburg, Germany
| | - Wolfram Trudo Knoefel
- Department of General, Visceral and Pediatric Surgery, University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Jakob Izbicki
- Department of General, Visceral and Thoracic Surgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Bernhard Polzer
- Division of Personalized Tumor Therapy, Fraunhofer Institute for Toxicology and Experimental Medicine (ITEM), Regensburg, Germany
| | - Nikolas H Stoecklein
- Department of General, Visceral and Pediatric Surgery, University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Christoph A Klein
- Division of Personalized Tumor Therapy, Fraunhofer Institute for Toxicology and Experimental Medicine (ITEM), Regensburg, Germany.,Chair of Experimental Medicine and Therapy Research, University of Regensburg, Germany
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50
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Lindenberger BL, Plag J, Schumacher S, Gaudlitz K, Bischoff S, Bobbert T, Dimeo F, Petzold MB, Kirschbaum C, Dudás Z, Ströhle A. Clinical and neurobiological effects of aerobic exercise in dental phobia: A randomized controlled trial. Depress Anxiety 2017; 34:1040-1048. [PMID: 28556577 DOI: 10.1002/da.22659] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 05/04/2017] [Accepted: 05/05/2017] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Physical activity has shown to be effective in anxiety disorders. For specific phobia, no studies are available that systematically examined the effects of an aerobic exercise intervention on phobic fear within a randomized-controlled design. Therefore, we investigated the acute effect of a standardized aerobic training on clinical symptoms of dental phobia as well as on stress-related neurobiological markers. METHODS Within a crossover design, 30 patients with dental phobia (mean age: 34.1 years; mean score of the Dental Anxiety Scale: 18.8) underwent two minor dental interventions separated by 7 days. Dental treatment was performed after 30 min of physical activity at either 20% VO2 max (control) or 70% VO2 max (intervention), respectively. To control for habituation, patients were randomly assigned to one of the two conditions prior to the first intervention. Moreover, saliva samples were collected at five times in order to determine changes in salivary cortisol (sC) and alpha-amylase (sAA) due to treatment. RESULTS In comparison to baseline, aerobic exercise within 70% VO2 max significantly reduced clinical anxiety and sC concentrations before, during, and after the dental treatment. In contrast, the control condition led to decreased sAA levels at different time points of measurement. Habituation occurred at the second study day, independent of the order. CONCLUSIONS Our study provides evidence for an effect of moderate-intense exercise on clinical symptoms and sC in patients with dental phobia. Therefore, acute aerobic exercise might be a simple and low-cost intervention to reduce disorder-specific phobic fear.
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Affiliation(s)
- Brigitt L Lindenberger
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Jens Plag
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Sarah Schumacher
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Katharina Gaudlitz
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Sophie Bischoff
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Thomas Bobbert
- Department of Endocrinology, Campus Charité Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Fernando Dimeo
- Section of Sports Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Moritz B Petzold
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Clemens Kirschbaum
- Department of Biological Psychology, Technische Universität Dresden, Dresden, Germany
| | - Zsuzsa Dudás
- 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
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