Intensive Longitudinal Social Sensing in Patients With Psychosis Spectrum Disorders: An Exploratory Pilot Study

BACKGROUND

Psychosis spectrum disorders are characterized by significant alterations in social functioning, which is a major factor for patient recovery. Despite its importance, objectively quantifying the complex day-to-day social behavior in real-life settings has rarely been attempted. Here, we conducted a pilot study with wearable sensors that passively and continuously register interactions with other participants. We hypothesized that the amount and pattern of social interaction was associated with the severity of psychotic symptoms.

STUDY DESIGN

We recruited 7 patients with psychosis spectrum disorders and 18 team members from a Soteria-style ward. Each participant wore a radio frequency identification badge, sending and receiving signals from nearby badges, allowing passive quantification of social interactions. In addition, symptom severity was assessed weekly by the Positive and Negative Syndrome Scale (PANSS).

STUDY RESULTS

During an 11-week period, we identified 17 970 interactions among patients and staff. On average, patients spent 2.6 h per day interacting, capturing relevant aspects of daily social life. Relative daily interaction time, average interaction duration, and clustering coefficient, a measure of local network integration, were significantly associated with lower PANSS scores. Self-reported interaction time did not correlate with measured interaction time or with PANSS, indicating the importance of objective markers.

CONCLUSIONS

This pilot study demonstrates the feasibility of passively recording social interaction of patients and staff at high resolution and for a long observation period in a real-life setting in a psychiatric department. We show links between quantified social interaction and psychopathology that may facilitate development and personalization of targeted treatments.

Randomized controlled trial of individualized arousal-biofeedback for children and adolescents with disruptive behavior disorders (DBD)

Disruptive behavior disorders [including conduct disorder (CD) and oppositional defiant disorder (ODD)] are common childhood and adolescent psychiatric conditions often linked to altered arousal. The recommended first-line treatment is multi-modal therapy and includes psychosocial and behavioral interventions. Their modest effect sizes along with clinically and biologically heterogeneous phenotypes emphasize the need for innovative personalized treatment targeting impaired functions such as arousal dysregulation. A total of 37 children aged 8-14 years diagnosed with ODD/CD were randomized to 20 sessions of individualized arousal biofeedback using skin conductance levels (SCL-BF) or active treatment as usual (TAU) including psychoeducation and cognitive-behavioral elements. The primary outcome was the change in parents´ ratings of aggressive behavior measured by the Modified Overt Aggression Scale. Secondary outcome measures were subscales from the Child Behavior Checklist, the Inventory of Callous-Unemotional traits, and the Reactive-Proactive Aggression Questionnaire. The SCL-BF treatment was neither superior nor inferior to the active TAU. Both groups showed reduced aggression after treatment with small effects for the primary outcome and large effects for some secondary outcomes. Importantly, successful learning of SCL self-regulation was related to reduced aggression at post-assessment. Individualized SCL-BF was not inferior to active TAU for any treatment outcome with improvements in aggression. Further, participants were on average able to self-regulate their SCL, and those who best learned self-regulation showed the highest clinical improvement, pointing to specificity of SCL-BF regulation for improving aggression. Further studies with larger samples and improved methods, for example by developing BF for mobile use in ecologically more valid settings are warranted.

Exploring real-time functional magnetic resonance imaging neurofeedback in adolescents with disruptive behavior disorder and callous unemotional traits

INTRODUCTION

Adolescents with increased callous unemotional traits (CU traits) in the context of disruptive behavior disorder (DBD) show a persistent pattern of antisocial behavior with shallow affect and a lack of empathy or remorse. The amygdala and insula as regions commonly associated with emotion processing, empathy and arousal are implicated in DBD with high CU traits. While behavioral therapies for DBD provide significant but small effects, individualized treatments targeting the implicated brain regions are missing.

METHODS

In this explorative randomized controlled trial we randomly assigned twenty-seven adolescents with DBD to individualized real-time functional magnetic resonance neurofeedback (rtfMRI-NF) or behavioral treatment as usual (TAU). Visual feedback of either amygdala or insula activity was provided during rtfMRI-NF by gauges and included a simple and concurrent video run plus a transfer run. A linear mixed model (LMM) was applied to determine improvement of self-regulation. Specificity was assessed by correlating individual self-regulation improvement with clinical outcomes.

RESULTS

The rtfMRI-NF (n = 11) and TAU (n = 10) completers showed comparable and significant clinical improvement indicating neither superiority nor inferiority of rtfMRI-NF. The exploratory LMM revealed successful learning of self-regulation along the course of training for participants who received feedback from the amygdala. A significant exploratory correlation between individual target region activity in the simple run and clinical improvement was found for one dimension of DBD.

CONCLUSIONS

This exploratory study demonstrated feasibility and suggests clinical efficacy of individualized rtfMRI-NF comparable to active TAU for adolescents with DBD and increased CU traits. Further studies are needed to confirm efficacy, specificity and to clarify underlying learning mechanisms.

Pooled retrospective analysis of 70 mg erenumab in episodic and chronic migraine: a two tertiary headache centers experience during clinical practice

Erenumab is a monoclonal antibody, targeted against the calcitonin gene-related peptide (CGRP) receptor. Clinical studies have demonstrated prophylactic efficacy in both episodic (EM) and chronic migraine (CM). The aim of the present study is to evaluate the efficacy of treatment in tertiary headache centers under real-life conditions. In a retrospective analysis, the period of 3 months before and after initiation of erenumab therapy was compared. Relevant parameters (headache days, headache intensity, headache duration, acute medication, previous prophylaxis treatments) were collected from medical charts of all migraine patients (N = 82) who started treatment with erenumab between November 1st 2018 and May 1st 2019 at two tertiary headache centers in Germany. The sample included 68 female (82.9%) and 14 male patients aged between 22 and 78 years (mean 51.1 years, SD 10.5 years). Of these patients, 57.3% met the criteria for CM and 56.9% overused acute medication. Under therapy with erenumab, a significant reduction of headache days was observed from the first month on. The effect was most pronounced in the third month with a decrease in monthly headache days from 16.6 to 11.6 days (p < 0.001). There was also a significant reduction in reported headache intensity (p = 0.004) and average duration of headache attacks (p = 0.016). The 50% responder rate in patients with CM was lower in the first month compared to EM but then increased similarly to EM. Patients with medication overuse (MO) also responded to the therapy. There was a reduction in medication overuse from 57% at baseline to 29% after therapy (p = 0.011). Overall, a positive result of treatment with erenumab can be shown in a highly selected sample with severely affected migraine patients and a refractory course prior to treatment. This re-confirms the clinical trial data also for this highly selected group.

Efficacy of Omega-3/Omega-6 Fatty Acids in Preschool Children at Risk of ADHD: A Randomized Placebo-Controlled Trial

Objective: To evaluate the efficacy of an Omega-3/Omega-6 fatty acid supplement in preschool children at risk for ADHD. Method: Forty preschool children with elevated levels of ADHD symptoms were randomly assigned to either a verum or a placebo group. Children in the verum group received a 4-month treatment with Omega-3/Omega-6 fatty acids. Outcome measures comprised parent- and teacher-rated ADHD symptoms, which were the primary outcome variables, internalizing and externalizing problems, and intellectual abilities. Results: Intention-to-treat analyses of covariance, controlling for age and baseline data, revealed effects on parent- and teacher-rated ADHD symptoms (primary outcomes; parent ratings: F = 4.51, df = 1, p = .04, d = 0.63; teacher ratings: F = 4.67, df = 1, p = .04, d = 0.70), parent-rated internalizing symptoms (F = 8.47, df = 1, p < .01, d = 0.63), and parent- and teacher-rated externalizing symptoms (parent ratings: F = 4.58, df = 1, p = .04, d = 0.54; teacher ratings: F = 5.99, df = 1, p = .02, d = 0.79). Analyses involving only cases with available data yielded significant moderate effects on teacher-rated inattention symptoms (F = 4.60, df = 1, p = .04, d = 0.79) and parent-rated internalizing problems (F = 6.04, df = 1, p = .02, d = 0.57). Conclusion: The intention-to-treat analyses provide some evidence for positive effects of Omega-3/Omega-6 fatty acids. However, the results require replication in larger samples to allow for firm conclusions for practice.

COMT Val158Met Polymorphism and Social Impairment Interactively Affect Attention-Deficit Hyperactivity Symptoms in Healthy Adolescents

The dopaminergic system has been shown to have substantial effects on the etiology of attention-deficit hyperactivity disorder (ADHD). However, while some studies found a significant direct effect, others did not. In this context, social behavior might play an important role as a factor that is related both to the dopaminergic system and ADHD. In a large epidemiological sample of adolescents (N = 462; 16-17 years), we assessed the level of ADHD symptoms using the Strengths and Difficulties Questionnaire, social behavior using the Social Responsiveness Scale, and the allelic distribution of the dopaminergic catechol-O-methyltransferase (COMT) Val158Met polymorphism. We found a significant association between COMT and social impairment, insofar as Met-allele carriers showed increased levels of social impairment. Moreover, social impairment significantly determined an association between COMT and ADHD (explained variance: 19.09%). This effect did not significantly differ between males and females. COMT and social impairment might interactively affect ADHD symptomatology, and could thus represent significant gene-phenotypic risk factors for ADHD symptomatology. This might have interesting implications for prevention and intervention strategies with a focus on social behavior in genetically at-risk individuals.

Changing patterns in surgery for chronic renal artery occlusive diseases

We report 66 patients undergoing 69 operations for chronic renal artery occlusive diseases operated on at two institutions between January 1985 and June 1990. Etiology was atherosclerosis in 59 patients (90%); fibromuscular disease in four (6%), and three children with nonfibromuscular disease stenosis (4%). Atherosclerosis was local in 10 and generalized in 49 (83% of all patients). Fifty operations (72%) were for salvage of renal function. Average serum creatinine was 2.3 mg/dl and was elevated in 46 patients (70%). Donor arteries for reconstruction were aorta 20 (29%), aortic graft 16 (23%), and other abdominal arteries 33 (48%). Twenty-one patients had concomitant vascular procedures including 16 aortic replacements. The two operative deaths (3%) followed aortic replacements. Three grafts (4%) occluded before discharge from the hospital. Eighty-six percent of patients undergoing renal salvage avoided long-term dialysis. In past decades fibromuscular disease and localized atherosclerosis were the most frequent renal artery occlusive diseases undergoing surgery, hypertension was the predominant indication, and the most frequent operation was aortorenal bypass. As a result of improved pharmacologic management of hypertension and the development of percutaneous transluminal dilation, most patients in this series had far advanced generalized atherosclerosis, and renal salvage was the most frequent indication for operation. As a consequence of the severity of the atherosclerosis, 48% of operations avoided the aorta, 23% replaced the aorta, and aortorenal bypass was used in only 29%.

Simultaneous measurement of epinephrine-induced platelet aggregation in 14 plasma samples

A method is described for the simultaneous measurement of epinephrine-induced platelet aggregation in 14 different plasma samples in 15 min. It is based upon discontinuous registration of platelet aggregation and computer evaluation of the data. The samples are placed in holders mounted over magnetic stirring bars in a 37 degrees C water bath and the extinction is measured by removing the samples one after the other, placing them in a Braun Universal Aggregometer and returning them to their holders in the water bath. The time required to reach 37% of maximal aggregation was chosen as the evaluation criterion. It sufficed for the determination of aggregation sensitivity. This method for the first time permits measurement of a complete titration curve rapidly and under identical conditions and can be used to show the influence of a wide range of aggregation inducers and the concurrent effects of inducers plus various blocking agents. A correlation between aggregation sensitivity and alpha 2-receptor binding capacity in platelets, measured by competitive radioactive binding, was established in samples from 10 healthy volunteers. One group exhibited high aggregation sensitivity coupled with high alpha 2-binding capacity and the other showed low sensitivity with low binding capacity.

Interpretation of Doppler segmental pressures in peripheral vascular occlusive disease

Measurement of Doppler segmental arterial pressures in the lower extremity using narrow pneumatic cuffs has become a standard noninvasive diagnostic technique. Correlation between arteriographic and noninvasive studies was available for 345 aortoiliac segments and 326 femoropopliteal segments. If stenoses of 50% or greater and occlusions were considered hemodynamically significant, the sensitivity to aortoiliac disease was 97%, but only 67% to femoropopliteal disease. The specificity for hemodynamically insignificant disease was 50% and 68%, respectively. Accuracy was influenced by the presence of associated aortoiliac or femoropopliteal disease. The sensitivity to hemodynamically significant femoropopliteal disease was 55% if there was associated aortoiliac disease, and 89% in its absence. In the presence of significant femoropopliteal disease, specificity for the absence of aortoiliac disease decreased from 70% to 41%.

Ligation of patent ductus arteriosus in premature infants

In the operating room, 66 preterm infants weighing between 710 and 2,700 gm (23 less than 1,000 gm) underwent ligation of a patent ductus arteriosus (PDA). Respiratory distress syndrome was present in 53 patients; the rest had apnea-bradycardia syndrome. PDA ligation was indicated for intractable congestive heart failure in 52 patients or progressive respiratory failure in 14. There were no intraoperative deaths. Fifteen infants died 1 to 120 days postoperatively. Seven deaths resulted from intracranial bleeding, 3 from diffuse coagulopathy, and 1 from respiratory failure. The condition of patients with heart failure improved postoperatively, with the mean left atrium to aorta ratio reduced from 1.56 to 1.02 (p = 0.05). Respiratory function improved in 25 patients extubated by the third postoperative day. Late follow-up (one to five years) of the 51 survivors showed 1 late death. Seventeen survivors had roentgenographic evidence of bronchopulmonary dysplasia. Infants with bronchopulmonary dysplasia required longer postoperative ventilation (mean, 21.5 days compared with 4.75 days). Twenty-four infants were normal. Ligation of PDA in preterm infants has low intraoperative risk and improves the condition of those with heart and respiratory failure. Late follow-up showed good recovery of nearly two-thirds of the patients.

Inhibition of the sympathetic nervous system by 5,6-dihydroxy-2-dimethylamino tetralin (M-7), apomorphine and dopamine

M-7, in doses of 1 mug/kg, reduces the resting heart rate of anesthetized dogs and cats. In similar dose ranges, M-7 blocks reflex activation of the sympathetic nervous system. Experimental procedures included bilateral carotid occlusion in the dog and central stimulation of vagi and right sciatic nerves in the cat. M-7 inhibits the response to postganglionic stimulation of the right cardioaccelerator nerve if the frequency of stimulation is 2 Hz; no inhibition is observed with a frequency of 18Hz. The inhibitory action of M-7 is antagonized by haloperidol, 50 mug/kg, or chlorpromazine, 150 mug/kg. Similar inhibitory actions and frequency specificity were observed in vitro using the right atrium of the cat and nerve stimulation. In cats, nerve stimulation was inhibited by apomorphine. Dopamine, in the presence of cocaine, also inhibited low-frequency nerve stimulation. It is postulated that prejunctional sympathetic nerves innervating the heart have dopamine receptors that serve as inhibitory role in transmission.