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Regen F, Cosma NC, Otto LR, Clemens V, Saksone L, Gellrich J, Uesekes B, Ta TMT, Hahn E, Dettling M, Heuser I, Hellmann-Regen J. Clozapine modulates retinoid homeostasis in human brain and normalizes serum retinoic acid deficit in patients with schizophrenia. Mol Psychiatry 2021; 26:5417-5428. [PMID: 32488128 PMCID: PMC8589649 DOI: 10.1038/s41380-020-0791-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 05/11/2020] [Accepted: 05/15/2020] [Indexed: 12/24/2022]
Abstract
The atypical antipsychotic clozapine is one of the most potent drugs of its class, yet its precise mechanisms of action remain insufficiently understood. Recent evidence points toward the involvement of endogenous retinoic acid (RA) signaling in the pathophysiology of schizophrenia. Here we investigated whether clozapine may modulate RA-signaling. Effects of clozapine on the catabolism of all-trans RA (at-RA), the biologically most active metabolite of Vitamin A, were assessed in murine and human brain tissue and peripheral blood-derived mononuclear cells (PBMC). In patients with schizophrenia with and without clozapine treatment and matched healthy controls, at-RA serum levels and blood mRNA expression of retinoid-related genes in PBMCs were quantified. Clozapine and its metabolites potently inhibited RA catabolism at clinically relevant concentrations. In PBMC-derived microsomes, we found a large interindividual variability of the sensitivity toward the effects of clozapine. Furthermore, at-RA and retinol serum levels were significantly lower in patients with schizophrenia compared with matched healthy controls. Patients treated with clozapine exhibited significantly higher at-RA serum levels compared with patients treated with other antipsychotics, while retinol levels did not differ between treatment groups. Similarly, in patients without clozapine treatment, mRNA expression of RA-inducible targets CYP26A and STRA6, as well as at-RA/retinol ratio, were significantly reduced. In contrast, clozapine-treated patients did not differ from healthy controls in this regard. Our findings provide the first evidence for altered peripheral retinoid homeostasis in schizophrenia and suggest modulation of RA catabolism as a novel mechanism of action of clozapine, which may be useful in future antipsychotic drug development.
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Affiliation(s)
- Francesca Regen
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Psychiatry, Campus Benjamin Franklin, Berlin, Germany
| | - Nicoleta-Carmen Cosma
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Psychiatry, Campus Benjamin Franklin, Berlin, Germany
| | - Lisa R Otto
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Psychiatry, Campus Benjamin Franklin, Berlin, Germany
| | - Vera Clemens
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Psychiatry, Campus Benjamin Franklin, Berlin, Germany
| | - Lana Saksone
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Psychiatry, Campus Benjamin Franklin, Berlin, Germany
| | - Janine Gellrich
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Psychiatry, Campus Benjamin Franklin, Berlin, Germany
| | - Berk Uesekes
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Psychiatry, Campus Benjamin Franklin, Berlin, Germany
| | - Thi Minh Tam Ta
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Psychiatry, Campus Benjamin Franklin, Berlin, Germany
| | - Eric Hahn
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Psychiatry, Campus Benjamin Franklin, Berlin, Germany
| | - Michael Dettling
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Psychiatry, Campus Benjamin Franklin, Berlin, Germany
| | - Isabella Heuser
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Psychiatry, Campus Benjamin Franklin, Berlin, Germany
| | - Julian Hellmann-Regen
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Psychiatry, Campus Benjamin Franklin, Berlin, Germany.
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Martensen LK, Hahn E, Duc CT, Schomerus G, Böge K, Dettling M, Angermeyer MC, Nguyene VT, Ta TMT. Impact and differences of illness course perception on the desire for social distance towards people with symptoms of depression or schizophrenia in Hanoi, Vietnam. Asian J Psychiatr 2020; 50:101973. [PMID: 32120231 DOI: 10.1016/j.ajp.2020.101973] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 01/06/2020] [Accepted: 02/09/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Public stigma against psychiatric disorders leads to delayed treatment utilization and worsens treatment outcome. This study analyses the impact of expectations regarding the course of illness and attribution as medical illness on the desire for social distance towards schizophrenia and depression in Vietnam. METHODS In 2013, a survey (n = 771) using unlabelled vignettes either depicting a person with symptoms typical for schizophrenia or major depression was carried out in Hanoi. All respondents had to indicate whether the person was suffering from a medical illness or not. As an indicator of public stigma, the desire for social distance was measured. A possible correlation between expectations towards the course of illness and social distance was evaluated using a linear regression model. RESULTS 85 % of respondents endorsed that the person depicted in the schizophrenia vignette had a mental illness, compared to only 60 %, who were confronted with the depression vignette. This attribution of mental illness was correlated with higher levels of desire for social distance only in the schizophrenia vignette. While in the case of schizophrenia negative prognostic perceptions were associated with more desire for social distance, in the event of depression, it was only the expectation of lifelong dependency. Moreover, only for depression, positive expectations towards the course of illness correlated with less desire for social distance. CONCLUSION These results indicate an impact of prognostic expectations on the desire for social distance and support strategies that aim at maintaining social integration and strengthening autonomy.
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Affiliation(s)
- Lara Kim Martensen
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin
| | - Eric Hahn
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin
| | - Cao Tien Duc
- Department of Psychiatry and Psychological Medicine, 103 Military Hospital, Military Medical University, Hanoi, Vietnam
| | - Georg Schomerus
- Department of Psychiatry, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Kerem Böge
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin
| | - Michael Dettling
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin
| | | | | | - Thi Minh Tam Ta
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin; Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Str. 2, 10178 Berlin, Germany.
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Wolf S, Hahn E, Wingenfeld K, Nguyen MH, von Poser A, Nguyen TH, Hanewald B, Böge K, Bajbouj M, Dettling M, Nguyen VT, Ta TMT. Mental Health Determinants Among a Psychiatric Outpatient Sample of Vietnamese Migrants in Germany. Front Psychiatry 2020; 11:580103. [PMID: 33424659 PMCID: PMC7785831 DOI: 10.3389/fpsyt.2020.580103] [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] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 10/20/2020] [Indexed: 12/19/2022] Open
Abstract
Background: Mental health risk-factors for Asian migrants have been studied almost exclusively in the US, Canada, and Australia but not in European countries. Therefore, we aimed to identify sociodemographic, clinical, and migration-surrounding factors associated with experienced mental distress among Vietnamese migrants in Germany. Method: 305 Vietnamese migrants utilizing Germany's first Vietnamese psychiatric outpatient clinic filled out at admission the Brief-Symptom-Inventory 18 (BSI-18) as well as a questionnaire on 22 potential mental health determinants. Using a multiple linear regression model, we identified those sociodemographic, clinical, and migration-surrounding factors that were significantly related to the Global Severity Index (GSI) of the BSI-18. Results: The factors unemployment (B = -6.32, p = 0.014), financial problems (B = -10.71, p < 0.001), no or only little religious involvement (B = -3.23, p = 0.002), no psychiatric precontact (B = -7.35, p = 0.004), previous migration experiences (B = 8.76, p = 0.002), and perceived discrimination (B = 6.58, p = 0.011) were found to significantly increase the level of mental distress according to the BSI-GSI. Conclusion: Based on these results, we were able to construct a mental health risk-profile for Vietnamese migrants in Germany, which aims to detect candidates for psychiatric problems earlier and supply them with customized prevention and therapy options.
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Affiliation(s)
- Simon Wolf
- Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Eric Hahn
- Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Katja Wingenfeld
- Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Main Huong Nguyen
- Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Anita von Poser
- Institute of Social and Cultural Anthropology, Freie Universität Berlin, Berlin, Germany
| | - Thi Hoa Nguyen
- Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Department of Psychiatry, Hanoi Medical University, Hanoi, Vietnam
| | - Bernd Hanewald
- Department of Psychiatry and Psychotherapy, Universitätsklinikum Gießen and Marburg, Gießen, Germany
| | - Kerem Böge
- Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Malek Bajbouj
- Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Michael Dettling
- Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Van Tuan Nguyen
- Department of Psychiatry, Hanoi Medical University, Hanoi, Vietnam
| | - Thi Minh Tam Ta
- Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany
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Franke ML, Lersner UV, Essel OQ, Adorjan K, Schomerus G, Gómez-Carrillo A, Tam Ta TM, Böge K, Mobashery M, Dettling M, Diefenbacher A, Angermeyer MC, Hahn E. The relationship between causal beliefs and desire for social distance towards people with schizophrenia and depression: Results from a survey of young Ghanaian adults. Psychiatry Res 2019; 271:220-225. [PMID: 30502558 DOI: 10.1016/j.psychres.2018.11.030] [Citation(s) in RCA: 5] [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: 04/23/2018] [Revised: 11/14/2018] [Accepted: 11/14/2018] [Indexed: 12/01/2022]
Abstract
This study examines attitudes of the young Ghanaian population regarding the relationship between causal beliefs and desire for social distance from people with symptoms of schizophrenia and depression. Respondents (n = 507) were presented with depression and schizophrenia symptoms using unlabeled case vignettes. A factor analysis examined three factors for causal beliefs, and multiple linear regression analysis on the desire for social distance was conducted. The desire for social distance was higher when symptoms in both case-vignettes were attributed to childhood adversities and overall lower when respondents lived in northern regions of Ghana. Only, for vignettes depicting schizophrenia, mental illness attribution was associated with more desire for social distance. Significant gender effects were found for depression vignettes only: female respondents reported significantly more desire for social distance, whereas female gendered vignettes were associated with less desire for social distance by respondents of both genders.
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Affiliation(s)
- Miriam Leona Franke
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Germany; Institute of Psychology, Humboldt University Berlin, Germany; Department of Psychiatry, Psychotherapy, and Psychosomatics, Evang. Hospital Königin Elisabeth Herzberge, Berlin, Germany.
| | | | | | - Kristina Adorjan
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University Munich, Germany; Center for International Health, Ludwig Maximilian University Munich, Germany; Institute of Psychiatric Phenomics and Genomics, Munich, Germany.
| | - Georg Schomerus
- Department of Psychiatry, University Medicine Greifswald, Germany.
| | - Ana Gómez-Carrillo
- Department of Psychiatry, Charité - Universitätsmedizin Berlin, Campus Mitte, Germany.
| | - Thi Minh Tam Ta
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Germany.
| | - Kerem Böge
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Germany.
| | - Mahan Mobashery
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Germany; Institute of Psychology, Humboldt University Berlin, Germany.
| | - Michael Dettling
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Germany.
| | - Albert Diefenbacher
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Evang. Hospital Königin Elisabeth Herzberge, Berlin, Germany.
| | | | - Eric Hahn
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Germany; Department of Psychiatry, Psychotherapy, and Psychosomatics, Evang. Hospital Königin Elisabeth Herzberge, Berlin, Germany.
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5
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Böge K, Hahn E, Cao TD, Fuchs LM, Martensen LK, Schomerus G, Dettling M, Angermeyer M, Nguyen VT, Ta TMT. Treatment recommendation differences for schizophrenia and major depression: a population-based study in a Vietnamese cohort. Int J Ment Health Syst 2018; 12:70. [PMID: 30473728 PMCID: PMC6234672 DOI: 10.1186/s13033-018-0247-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 11/02/2018] [Indexed: 11/10/2022] Open
Abstract
Background In Vietnam, the mental health care infrastructure is on the verge of transformation with an increase in the demand for access to adequate and effective mental health care services. Public attitudes towards mental illness, as well as corresponding treatment options influence help-seeking behaviors of patients and caregivers, affecting the course of their treatment. This study assesses attitudes towards treatment options for depression and schizophrenia, as the two most common psychiatric disorders in Vietnam, accounting for at least 75% of all psychiatric inpatients. Methods A general population-based survey was conducted in Hanoi, Vietnam between April and August 2013. Participants received a description of a person with symptoms of either depression (n = 326) or schizophrenia (n = 403) and were asked to give recommendations for adequate sources of mental health support and treatment options. Multiple analyses on a single item level compared the likelihood of recommendation between schizophrenia and depression. Results Overall, respondents recommended health care services, ranging from seeking mental health care professionals, psychotherapists, and psychiatrists for both disorders. Psychotherapy was the most favored treatment method, whereas further treatment options, such as concentration and relaxation exercises, meditation or yoga and psychotropic medication were also endorsed as helpful. For the schizophrenia vignette condition, psychotherapy, visiting a psychiatrist or psychotherapist received stronger endorsement rates as compared to the depression vignette. Furthermore, ECT, Feng Shui-based practices, praying and visiting natural healers were recommended less by respondents for the depression vignette in comparison with the schizophrenia vignette. Conclusions The Vietnamese public endorsed evidence-based treatment recommendations from a variety of treatments options. Differences in the treatment recommendations between depression and schizophrenia reflected the perceived severity of each disorder. Further developments of the Vietnamese mental health care system concerning mental health care providers, as well as the legal regulations surrounding the provision of psychotherapy are needed.
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Affiliation(s)
- Kerem Böge
- 1Department of Psychiatry and Psychotherapy, Charité University Medicine Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Eric Hahn
- 1Department of Psychiatry and Psychotherapy, Charité University Medicine Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Tien Duc Cao
- Department of Psychiatry and Psychological Medicine, Hospital 103, Military Medical University, Hanoi, Vietnam
| | - Lukas Marian Fuchs
- 1Department of Psychiatry and Psychotherapy, Charité University Medicine Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Lara Kim Martensen
- 1Department of Psychiatry and Psychotherapy, Charité University Medicine Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Georg Schomerus
- 3Center for Public Mental Health, Untere Zeile 13, 3482 Gösing am Wagram, Austria
| | - Michael Dettling
- 1Department of Psychiatry and Psychotherapy, Charité University Medicine Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Matthias Angermeyer
- 4Department of Psychiatry, Ernst Moritz Arndt University, Greifswald, Germany
| | - Van Tuan Nguyen
- 5Department of Psychiatry, Hanoi Medical University, Hanoi, Vietnam
| | - Thi Minh Tam Ta
- 1Department of Psychiatry and Psychotherapy, Charité University Medicine Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany.,6Berlin Institute of Health, Berlin, Germany
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Martensen LK, Hahn E, Cao TD, Schomerus G, Nguyen MH, Böge K, Nguyen TD, Mungee A, Dettling M, Angermeyer MC, Ta TMT. Impact of perceived course of illness on the desire for social distance towards people with symptoms of schizophrenia in Hanoi, Vietnam. Psychiatry Res 2018; 268:206-210. [PMID: 30055410 DOI: 10.1016/j.psychres.2018.05.046] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 04/01/2018] [Accepted: 05/21/2018] [Indexed: 11/29/2022]
Abstract
In Vietnam, stigmatisation and discrimination of patients with mental illness are highly prevalent. This study explores whether the perception of course of illness of people with symptoms indicating schizophrenia is associated with the desire for social distance in the Vietnamese public. A population-based survey (n = 455) using unlabelled vignettes for schizophrenia was carried out in the Hanoi municipality in 2013. First, a factor analysis was performed to group items indicating perception of prognosis. Second, a linear regression analysis was used to search for correlations between these expectations and desire for social distance. The factor analysis revealed three independent factors of perception of course of illness: (1) loss of social integration and functioning, (2) lifelong dependency on others, and (3) positive expectations towards treatment outcome. Both factors with negative prognostic perceptions (1&2) were associated with more desire for social distance. The results indicate a link between social acceptance and the perceived ability to maintain a social role including a capability of reciprocity within the Vietnamese society. Additionally, these findings highlight the importance of preserving social functioning in any treatment approach for patients with schizophrenia, which includes psychosocial intervention and rehabilitation programs.
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Affiliation(s)
- Lara Kim Martensen
- Department of Psychiatry and Psychotherapy, Charité University Hospital, Campus Benjamin Franklin, Berlin, Germany.
| | - Eric Hahn
- Department of Psychiatry and Psychotherapy, Charité University Hospital, Campus Benjamin Franklin, Berlin, Germany
| | - Tien Duc Cao
- Department of Psychiatry and Psychological Medicine, 103 Military Hospital, Military Medical University, Hanoi, Vietnam
| | - Georg Schomerus
- Department of Psychiatry, Ernst Moritz Arndt University, Greifswald, Germany
| | - Main Huong Nguyen
- Department of Psychiatry and Psychotherapy, Charité University Hospital, Campus Benjamin Franklin, Berlin, Germany
| | - Kerem Böge
- Department of Psychiatry and Psychotherapy, Charité University Hospital, Campus Benjamin Franklin, Berlin, Germany
| | - Tat Dinh Nguyen
- Department of Psychiatry and Psychological Medicine, 103 Military Hospital, Military Medical University, Hanoi, Vietnam
| | - Aditya Mungee
- Department of Psychiatry and Psychotherapy, Charité University Hospital, Campus Benjamin Franklin, Berlin, Germany
| | - Michael Dettling
- Department of Psychiatry and Psychotherapy, Charité University Hospital, Campus Benjamin Franklin, Berlin, Germany
| | | | - Thi Minh Tam Ta
- Department of Psychiatry and Psychotherapy, Charité University Hospital, Campus Benjamin Franklin, Berlin, Germany
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7
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Laqua C, Hahn E, Böge K, Martensen LK, Nguyen TD, Schomerus G, Cao TD, Dettling M, von Poser A, Lanca JC, Diefenbacher A, Angermeyer MC, Ta TMT. Public attitude towards restrictions on persons with mental illness in greater Hanoi area, Vietnam. Int J Soc Psychiatry 2018. [PMID: 29521191 DOI: 10.1177/0020764018763685] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND AIMS In recent years, there has been a growing awareness of the need to protect human rights in psychiatry. Within the last years, considerable effort has been made to reduce restrictive measures in mental health settings. Reducing restrictive measures within mental health care has also moved increasingly into the focus of public debate. This study aims, for the first time in a Southeast Asian sample, to explore whether socio-demographic factors affect public attitudes toward restrictions on mentally ill people in Hanoi, Vietnam. METHODS A general population-based survey (self-report questionnaire) was carried out in 2013 in the greater Hanoi area. The survey sample ( N = 813) was recruited according to the latest published census (2009) and micro-census (2013) in Vietnam and Hanoi with regard to the socio-demographic factors gender, age, urbanity, household size and marital status. Multinomial logistic regressions for odds ratios with 95% confidence intervals were calculated to examine the influence of epidemiological variables, like gender and age, on the public attitude toward restrictions imposed on mentally ill people in Vietnam. RESULTS This study found, for the first time in a large Vietnamese sample, that gender and age were associated with public attitudes toward restrictions on mentally ill people. In detail, significantly fewer men endorsed compulsory admission to a hospital and abortion than Vietnamese women. In addition, endorsement of abortion was significantly higher in older people. CONCLUSION The results offer some insight into roles of women in the Vietnamese society and might reflect the traditional gender expectations in Vietnamese families. Moreover, the results emphasize the need for supporting female psychiatric patients and their families within their communities and in the Vietnamese society.
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Affiliation(s)
- Carolin Laqua
- 1 Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Eric Hahn
- 1 Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Berlin, Germany.,2 Department of Psychiatry, Psychotherapy and Psychosomatic, Evangelisches Krankenhaus Königin Elisabeth Herzberge, Berlin, Germany
| | - Kerem Böge
- 1 Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Lara K Martensen
- 1 Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Tat Dinh Nguyen
- 3 Department of Psychiatry and Psychological Medicine, 103 Military Hospital, Military Medical University, Hanoi, Vietnam
| | - Georg Schomerus
- 4 Department of Psychiatry, Ernst Moritz Arndt University Greifswald, Greifswald, Germany
| | - Tien Duc Cao
- 3 Department of Psychiatry and Psychological Medicine, 103 Military Hospital, Military Medical University, Hanoi, Vietnam
| | - Michael Dettling
- 1 Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Anita von Poser
- 5 Department of Social and Cultural Anthropology, Free University Berlin, Germany
| | | | - Albert Diefenbacher
- 2 Department of Psychiatry, Psychotherapy and Psychosomatic, Evangelisches Krankenhaus Königin Elisabeth Herzberge, Berlin, Germany
| | | | - Thi Minh Tam Ta
- 1 Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Berlin, Germany
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8
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Ta TMT, Böge K, Cao TD, Schomerus G, Nguyen TD, Dettling M, Mungee A, Martensen LK, Diefenbacher A, Angermeyer MC, Hahn E. Public attitudes towards psychiatrists in the metropolitan area of Hanoi, Vietnam. Asian J Psychiatr 2018; 32:44-49. [PMID: 29207317 DOI: 10.1016/j.ajp.2017.11.031] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 11/27/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Mental health associated stigmatization remains problematic in low and middle-income countries, thus preventing patients from adequate access to psychiatric care. Public attitudes towards psychiatrists have not been examined in many countries, especially not in Vietnam where merely one psychiatrist per 300.000 population is available. The study aims to explore attitudes towards psychiatrists in the Hanoi municipality and to identify socio-demographical factors that influence these attitudes. METHODS Between April and August 2013, a general population-based survey was carried out in the greater Hanoi area, Vietnam. The sample of 817 participants was stratified according to the latest Vietnamese census (2009) and micro-census (2013) with regards to socio-demographic factors. Multivariate analyses were conducted to determine the influence of these factors on attitudes towards psychiatrists. RESULTS Gender and religious beliefs significantly influenced public attitudes towards psychiatrists. Male participants reported significantly more negative perception towards psychiatrists compared to female respondents. Participants following a religion reported significantly more negative attitudes toward psychiatrists than those without self-reported religious attainment. CONCLUSIONS Negative attitudes towards psychiatrists are associated with religious beliefs and gender affiliation in the greater Hanoi area. A strategy that involves religious institutions in raising awareness about mental health issues while considering public's socio-cultural attitudes may pave the way for greater potentialities of adequate psychiatric care, destigmatize the mental health system, and care provider.
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Affiliation(s)
- Thi Minh Tam Ta
- Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany.
| | - Kerem Böge
- Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Tien Duc Cao
- Department of Psychiatry and Psychological Medicine, Hospital 103, Military Medical University, Hanoi, Vietnam
| | - Georg Schomerus
- Department of Psychiatry, Ernst Moritz Arndt University Greifswald, Germany
| | - Tat Dinh Nguyen
- Department of Psychiatry and Psychological Medicine, Hospital 103, Military Medical University, Hanoi, Vietnam
| | - Michael Dettling
- Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Aditya Mungee
- Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Lara Kim Martensen
- Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Albert Diefenbacher
- Department of Psychiatry, Psychotherapy and Psychosomatic, Evang. Hospital Königin Elisabeth Herzberge, Berlin, Germany
| | | | - Eric Hahn
- Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany; Department of Psychiatry, Psychotherapy and Psychosomatic, Evang. Hospital Königin Elisabeth Herzberge, Berlin, Germany
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Böge K, Zieger A, Mungee A, Tandon A, Fuchs LM, Schomerus G, Tam Ta TM, Dettling M, Bajbouj M, Angermeyer M, Hahn E. Perceived stigmatization and discrimination of people with mental illness: A survey-based study of the general population in five metropolitan cities in India. Indian J Psychiatry 2018; 60:24-31. [PMID: 29736059 PMCID: PMC5914258 DOI: 10.4103/psychiatry.indianjpsychiatry_406_17] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [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] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND India faces a significant gap between the prevalence of mental illness among the population and the availability and effectiveness of mental health care in providing adequate treatment. This discrepancy results in structural stigma toward mental illness which in turn is one of the main reasons for a persistence of the treatment gap, whereas societal factors such as religion, education, and family structures play critical roles. This survey-based study investigates perceived stigma toward mental illness in five metropolitan cities in India and explores the roles of relevant sociodemographic factors. MATERIALS AND METHODS Samples were collected in five metropolitan cities in India including Chennai (n = 166), Kolkata (n = 158), Hyderabad (n = 139), Lucknow (n = 183), and Mumbai (n = 278). Stratified quota sampling was used to match the general population concerning age, gender, and religion. Further, sociodemographic variables such as educational attainment and strength of religious beliefs were included in the statistical analysis. RESULTS Participants displayed overall high levels of perceived stigma. Multiple linear regression analysis found a significant effect of gender (P < 0.01), with female participants showing higher levels of perceived stigma compared to male counterparts. CONCLUSION Gender differences in cultural and societal roles and expectations could account for higher levels of perceived stigma among female participants. A higher level of perceived stigma among female participants is attributed to cultural norms and female roles within a family or broader social system. This study underlines that while India as a country in transition, societal and gender rules still impact perceived stigma and discrimination of people with mental illness.
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Affiliation(s)
- Kerem Böge
- Department of Psychiatry and Psychotherapy, Charité University Hospital, Campus Benjamin Franklin, Berlin, Germany
| | - Aron Zieger
- Department of Psychiatry and Psychotherapy, Charité University Hospital, Campus Benjamin Franklin, Berlin, Germany
| | - Aditya Mungee
- Department of Psychiatry and Psychotherapy, Charité University Hospital, Campus Benjamin Franklin, Berlin, Germany
| | - Abhinav Tandon
- AKT Neuropsychiatric Centre, Allahabad, Uttar Pradesh, India
| | - Lukas Marian Fuchs
- Department of Psychiatry and Psychotherapy, Charité University Hospital, Campus Benjamin Franklin, Berlin, Germany
| | - Georg Schomerus
- Department of Psychiatry, Ernst Moritz Arndt University, Greifswald, Germany
| | - Thi Minh Tam Ta
- Department of Psychiatry and Psychotherapy, Charité University Hospital, Campus Benjamin Franklin, Berlin, Germany
| | - Michael Dettling
- Department of Psychiatry and Psychotherapy, Charité University Hospital, Campus Benjamin Franklin, Berlin, Germany
| | - Malek Bajbouj
- Department of Psychiatry and Psychotherapy, Charité University Hospital, Campus Benjamin Franklin, Berlin, Germany
| | - Matthias Angermeyer
- Center for Public Mental Health, Untere 12 Zeile 13, A-3482 Gö-sing am Wagram, Austria
| | - Eric Hahn
- Department of Psychiatry, Ernst Moritz Arndt University, Greifswald, Germany
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Nguyen MH, Hahn E, Wingenfeld K, Graef-Calliess IT, von Poser A, Stopsack M, Burian H, Dreher A, Wolf S, Dettling M, Burian R, Diefenbacher A, Ta TMT. Acculturation and severity of depression among first-generation Vietnamese outpatients in Germany. Int J Soc Psychiatry 2017; 63:708-716. [PMID: 29056084 DOI: 10.1177/0020764017735140] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Challenges of migration, particularly concerning the process of acculturation are associated with an increased risk of mental illness. Vietnamese migrants constitute the largest Southeast Asian migrant group in Germany, yet there is no data on the relationship between the mental health status and acculturation among this population. AIMS Therefore, the present study examines the relationship between two well-established dimensions of acculturation, that is, dominant society immersion (DSI) and ethnic society immersion (ESI), the four resulting acculturation strategies (integration, assimilation, separation and marginalization), and severity of depression. METHODS A sample of N = 113 first-generation Vietnamese outpatients from a psychiatric outpatient clinic for Vietnamese migrants in Germany was studied regarding their self-reported depressive symptoms (Beck Depression Inventory-II (BDI-II)) and acculturation (Stephenson Multigroup Acculturation Scale (SMAS)). RESULTS Consistent with the hypotheses, patients reported less severe depressive symptoms, when they reported higher orientation toward the German and the Vietnamese society. Moreover, the results showed that integrated patients reported a lower severity of depression compared to marginalized patients, who reported the highest severity of depression. CONCLUSIONS The findings indicate that among a sample of first-generation Vietnamese patients with depression, an orientation to both, the mainstream society and one's heritage society might serve as a potential resource. The rejection of any orientation to any society is associated with an increased risk for depression.
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Affiliation(s)
- Main Huong Nguyen
- 1 Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Eric Hahn
- 1 Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany.,2 Department of Psychiatry, Psychotherapy and Psychosomatics, Evangelical Hospital Königin Elisabeth Herzberge, Berlin, Germany
| | - Katja Wingenfeld
- 1 Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Iris T Graef-Calliess
- 3 Center for Transcultural Psychiatry & Psychotherapy, Wahrendorff Clinic, Sehnde-Hannover, Germany.,4 Research Group for Social and Transcultural Psychiatry and Psychotherapy, Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Anita von Poser
- 5 Department of Political and Social Sciences, Institute of Social and Cultural Anthropology, Freie Universität Berlin, Berlin, Germany
| | - Malte Stopsack
- 6 Department of Clinical Psychology and Psychotherapy, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - Hannah Burian
- 2 Department of Psychiatry, Psychotherapy and Psychosomatics, Evangelical Hospital Königin Elisabeth Herzberge, Berlin, Germany
| | - Annegret Dreher
- 2 Department of Psychiatry, Psychotherapy and Psychosomatics, Evangelical Hospital Königin Elisabeth Herzberge, Berlin, Germany
| | - Simon Wolf
- 1 Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Michael Dettling
- 1 Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Ronald Burian
- 2 Department of Psychiatry, Psychotherapy and Psychosomatics, Evangelical Hospital Königin Elisabeth Herzberge, Berlin, Germany
| | - Albert Diefenbacher
- 2 Department of Psychiatry, Psychotherapy and Psychosomatics, Evangelical Hospital Königin Elisabeth Herzberge, Berlin, Germany
| | - Thi Minh Tam Ta
- 1 Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
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Zieger A, Mungee A, Schomerus G, Ta TMT, Weyers A, Böge K, Dettling M, Bajbouj M, von Lersner U, Angermeyer MC, Tandon A, Hahn E. Attitude toward psychiatrists and psychiatric medication: A survey from five metropolitan cities in India. Indian J Psychiatry 2017; 59:341-346. [PMID: 29085094 PMCID: PMC5659085 DOI: 10.4103/psychiatry.indianjpsychiatry_190_17] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Stigmatization and overall scarcity of psychiatrists and other mental health-care professionals remain a huge public health challenge in low- and middle-income countries, more specifically in India. Most patients seek help from faith healers, and awareness about psychiatrists and treatment methods is often lacking. Our study aims to explore public attitudes toward psychiatrists and psychiatric medication in five Indian metropolitan cities and to identify factors that could influence these attitudes. MATERIALS AND METHODS Explorative surveys in the context of public attitudes toward psychiatrists and psychiatric medication were conducted using five convenience samples from the general population in Chennai (n = 166), Kolkata (n = 158), Hyderabad (n = 139), Lucknow (n = 183), and Mumbai (n = 278). We used a quota sample with respect to age, gender, and religion using the census data from India as a reference. RESULTS Mean scores indicate that attitudes toward psychiatrists and psychiatric medication are overall negative in urban India. Negative attitudes toward psychiatrists were associated with lower age, lower education, and strong religious beliefs. Negative attitudes toward psychotropic medication were associated with lower age, male gender, lower education, and religion. CONCLUSION In line with the National Mental Health Policy of India, our results support the perception that stigma is widespread. Innovative public health strategies are needed to improve the image of psychiatrists and psychiatric treatment in society and ultimately fill the treatment gap in mental health.
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Affiliation(s)
- Aron Zieger
- Department of Psychiatry and Psychotherapy, Charité University Hospital, Campus Benjamin Franklin, Berlin, Germany
| | - Aditya Mungee
- Department of Psychiatry and Psychotherapy, Charité University Hospital, Campus Benjamin Franklin, Berlin, Germany
| | - Georg Schomerus
- Department of Psychiatry, Ernst Moritz Arndt University, Greifswald, Germany
| | - Thi Minh Tam Ta
- Department of Psychiatry and Psychotherapy, Charité University Hospital, Campus Benjamin Franklin, Berlin, Germany
| | - Aino Weyers
- Department of Psychiatry and Psychotherapy, Charité University Hospital, Campus Benjamin Franklin, Berlin, Germany
| | - Kerem Böge
- Department of Psychiatry and Psychotherapy, Charité University Hospital, Campus Benjamin Franklin, Berlin, Germany
| | - Michael Dettling
- Department of Psychiatry and Psychotherapy, Charité University Hospital, Campus Benjamin Franklin, Berlin, Germany
| | - Malek Bajbouj
- Department of Psychiatry and Psychotherapy, Charité University Hospital, Campus Benjamin Franklin, Berlin, Germany
| | - Ulrike von Lersner
- Department of Psychiatry, Ernst Moritz Arndt University, Greifswald, Germany
| | | | - Abhinav Tandon
- AKT Neuropsychiatric Centre, Allahabad, Uttar Pradesh, India
| | - Eric Hahn
- Department of Psychiatry and Psychotherapy, Charité University Hospital, Campus Benjamin Franklin, Berlin, Germany
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Nguyen M, Hahn E, Burian R, Dettling M, Diefenbacher A, Ta T. Acculturation strategies and severity of depression among Vietnamese migrants. Eur Psychiatry 2017. [DOI: 10.1016/j.eurpsy.2017.02.300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
AimsMigration with its long-term changes and the resulting task to adjust to the new environment has been associated with an increased risk for mental health problems. This study aims to gain further insight on the relationship between the fours acculturations strategies (integration, assimilation, separation, marginalization) and severity of depression.MethodsA total of n = 79 first generation Vietnamese outpatients from a psychiatric outpatient clinic for Vietnamese migrants in Germany were investigated regarding self-reported depressive symptoms (patient health questionnaire-9) and acculturation (Stephenson multigroup acculturation scale; SMAS).ResultsPatients with an integration acculturation strategy reported lower severity of depression compared to marginalized patients, who reported the highest severity of depression.ConclusionThe results implicate that the integration of both the mainstream society and the ethnic society might serve as a resource, whereas the rejection of both societies might increase the risk of depression.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Dreher A, Hahn E, Ta T, Nguyen M, Diefenbacher A, Burian R, Dettling M. Differences in symptom expression between Vietnamese and German patients utilizing a psychiatric outpatient service using the PHQ. Eur Psychiatry 2017. [DOI: 10.1016/j.eurpsy.2017.02.287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
ObjectiveDespite a large body of work on somatic symptom presentation among people of Asian descent, research has shown heterogeneous results. Examining symptom presentation in clinically and ethnically well-characterized populations constitutes a first step towards better understanding differing patterns symptom of presentation. This is the first larger study aiming to compare Vietnamese and German psychiatric outpatients regarding symptom presentation.Methods110 Vietnamese and 109 German patients seeking psychiatric treatment at two outpatient clinic services in Berlin were asked to complete the patient health questionnaire (PHQ). Comparisons of Vietnamese and German patients were conducted using independent t-tests. The somatic symptom module (PHQ-15), the depression module (PHQ-9) and the original PHQ-modules examining anxiety and psychosocial stress levels were compared for both groups using multivariate analysis. Categorical variables were evaluated using Chi2 analysis. Crohnbach's alpha was calculated separately for both groups and all PHQ modules.ResultsVietnamese patients endorsed significantly higher levels of somatic symptoms overall and on individual somatic items, such as pain-related disturbancies. Yet, German and Vietnamese patients did not differ in terms of depression severity. Vietnamese patients with fewer German language skills showed a significantly higher tendency for somatization. While German patients showed higher total scores on the anxiety- and stress-modules of the PHQ, this difference was not statistically significant. Vietnamese and German patients showed comparable Crohnbach's alpha for all subscales.ConclusionAs data was collected from both groups upon the first visit to an outpatient clinic, the symptoms reported could be reflective of culture related symptom awareness when feeling discomfort in the context of mental illness.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Ta T, Wolf S, Nguyen M, Dettling M, Hahn E. Relationship between migration-stressors and self-reported symptoms of depression in an outpatient sample of Vietnamese migrants in Germany. Eur Psychiatry 2017. [DOI: 10.1016/j.eurpsy.2017.02.301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
IntroductionVietnamese migrants under the influence of migration-related stressors (MRS) represent a vulnerable group within the mental health care system in Germany.AimsFirst study examining the relationship between the quantity of experienced MRS and the severity of self-reported symptoms of depression in a Vietnamese outpatient-sample.Methods137 first-generation Vietnamese migrants diagnosed with depression were asked to complete the BDI-II and 24 questions about stressful experiences related to the migration process. Linear regression models was performed to examine the influence of the MRS-quantity on BDI-II total score and on BDI-II subscales (Buckley et al., 2001).ResultsA higher number of experienced MRS was found to be related to a higher BDI-II total score, as well as to a higher score on the cognitive subscale in particular. Regarding the cognitive depression-dimension the BDI-II items pessimism, past failure, guilt feelings, punishment feelings and suicidal thoughts were positively related to the MRS-quantity.Discussion and conclusionA dose-response-relationship was found, with a higher number of MRS being related to a higher severity level of self-reported depressiveness as well as to a higher level of cognitive depression-symptoms in particular. The increase in suicidal ideations in the light of MRS-exposure is in line with findings from other migrant populations. Therapeutic interventions may focus (more) on depressive cognitions as a result of recurring MRS-experiences. Special attention should be placed on suicidal thoughts being boosted by MRS.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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15
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Deuschle M, Gotthardt U, Schweiger U, Dettling M, Holsboer F, Heuser I. Hypothalamic-Pituitary-Adrenocortical Dysfunction in Elderly, Male Marathon Runners: Feedback Sensitivity, Stress Response, and Effects on Verbal Memory. Neuroendocrinology 2017; 105:150-156. [PMID: 27677093 DOI: 10.1159/000450856] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 08/27/2016] [Indexed: 11/19/2022]
Abstract
Animal studies suggest that repeated episodes of elevated glucocorticoids lead to a dysregulation of the hypothalamic-pituitary-adrenal (HPA) system at a suprapituitary level, and to impaired mnemonic function. We compared cognitive tests, as well as feedback integrity and stress responsivity of the HPA system, between 11 elderly, male marathon runners - a model of repeated HPA system activation - and 10 sedentary controls. The marathon runners had significantly increased baseline, stress, and post-stress ACTH - but not cortisol - concentrations. Also, suppression of ACTH by 3 mg dexamethasone was impaired in the athletes compared to the control subjects, while the ACTH and cortisol response to additional CRH did not differ between the 2 groups. Finally, long-term verbal memory was impaired in the athletes compared to the controls. Regarding the HPA system, these findings are in accordance with an acquired suprapituitary feedback disturbance in marathon runners; however, the similar glucocorticoid concentrations in the 2 groups may be due to reduced adrenal sensitivity to ACTH. Together with impaired verbal memory, these data support the assumption that repeated episodes of HPA system activity may exert negative effects at the level of the hippocampus.
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16
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Ta TMT, Zieger A, Schomerus G, Cao TD, Dettling M, Do XT, Mungee A, Diefenbacher A, Angermeyer MC, Hahn E. Influence of urbanity on perception of mental illness stigma: a population based study in urban and rural Hanoi, Vietnam. Int J Soc Psychiatry 2016; 62:685-695. [PMID: 27887028 DOI: 10.1177/0020764016670430] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND AIMS To examine, for the first time in Vietnam, whether urbanity of respondents among other socio-demographic factors affects the public perception of stigma attached to persons with mental illness in Hanoi. METHODS A general population-based survey was carried out in 2013 in the greater Hanoi area. The perception of stigma attached to people with mental illness was elicited using Link's perceived discrimination and devaluation scale (PDDS) carried out in Vietnamese language. The survey sample (n = 806) was stratified for gender, urban/rural location, age, household size and marital status, in accordance with the 2013 Vietnamese census. RESULTS Comparing the total score of the PDDS and its single items, we found less perceived stigma and discrimination among the rural population of Hanoi and in respondents who reported religious attainment to either Buddhism or Christianity. Logistic regression analyses found no significant influences of gender, age, household size or marital status regarding the perceived stigma toward persons with mental illness. CONCLUSION Less negative perception of stigma attached to persons with mental illness that was observed among the rural population in the Hanoi area may be interpreted in the light of possibly more demanding living conditions in modern urban Vietnam with less opportunities for mentally ill patients and points toward a dynamic interaction with rapidly changing living conditions in Asian megacities.
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Affiliation(s)
- Thi Minh Tam Ta
- Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Germany
| | - Aron Zieger
- Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Germany
| | - Georg Schomerus
- Department of Psychiatry, Ernst Moritz Arndt University Greifswald, Germany.,HELIOS Hanseklinikum Stralsund, Germany
| | - Tien Duc Cao
- Department of Psychiatry and Psychological Medicine, Hospital 103, Military Academy of Medicine, Hanoi, Vietnam
| | - Michael Dettling
- Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Germany
| | - Xuan Tinh Do
- Department of Psychiatry and Psychological Medicine, Hospital 103, Military Academy of Medicine, Hanoi, Vietnam
| | - Aditya Mungee
- Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Germany
| | - Albert Diefenbacher
- Department of Psychiatry, Psychotherapy and Psychosomatic, Ev. Krankenhaus Königin Elisabeth Herzberge, Berlin, Germany
| | | | - Eric Hahn
- Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Germany.,Department of Psychiatry, Psychotherapy and Psychosomatic, Ev. Krankenhaus Königin Elisabeth Herzberge, Berlin, Germany
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17
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Zieger A, Mungee A, Schomerus G, Ta TMT, Dettling M, Angermeyer MC, Hahn E. Perceived stigma of mental illness: A comparison between two metropolitan cities in India. Indian J Psychiatry 2016; 58:432-437. [PMID: 28197001 PMCID: PMC5270269 DOI: 10.4103/0019-5545.196706] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
PURPOSE An increasing number of comparative studies are conducted on the stigmatization of persons with mental illness, in particular with regard to regional and diachronic variation. So far, there have been no studies comparing stigmatization of persons with mental illness in two different regions of India. Therefore, we examined the differences in perception of stigma attached to mental illnesses in Kolkata and Chennai, with regard to cultural and geographical differences to better understand the roots and origins of this issue. MATERIALS AND METHODS Explorative surveys in the context of public attitudes toward people with mental disorders were conducted among conveniently selected members of the general population in Chennai (n = 166) and Kolkata (n = 158) with identical methodology. Link's perceived devaluation-discrimination measure was used. The samples were matched for age, gender, and education. RESULTS The calculated sum score indicated that respondents from Kolkata had a higher level of perceived discrimination toward persons with mental illness than respondents from Chennai (P = 0.043). Furthermore, regression analysis revealed that lower perceived stigma was associated with stronger religious devotion (P = 0.049) and higher educational attainment (P = 0.001) in both cities. DISCUSSION The results showed that perceived stigma was higher in Kolkata than in Chennai. The correlation of higher stigma with lower education was in line with the previous research, and interestingly, it was found that higher stigma correlated with weaker religious devotion. Further studies exploring a wider variety of factors may provide us with a better understanding of the roots of perceived stigma in India.
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Affiliation(s)
- Aron Zieger
- Department of Psychiatry and Psychotherapy, Charité University of Medicine Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Aditya Mungee
- Department of Psychiatry and Psychotherapy, Charité University of Medicine Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Georg Schomerus
- Department of Psychiatry, Ernst Moritz Arndt University, Greifswald, Stralsund, Germany; Department of Psychiatry, HELIOS Hanseklinikum, Stralsund, Germany
| | - Thi Minh Tam Ta
- Department of Psychiatry and Psychotherapy, Charité University of Medicine Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Michael Dettling
- Department of Psychiatry and Psychotherapy, Charité University of Medicine Berlin, Campus Benjamin Franklin, Berlin, Germany
| | | | - Eric Hahn
- Department of Psychiatry and Psychotherapy, Charité University of Medicine Berlin, Campus Benjamin Franklin, Berlin, Germany
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Möhring N, Shen C, Hahn E, Ta TMT, Dettling M, Neuhaus AH. Mirror neuron deficit in schizophrenia: Evidence from repetition suppression. Schizophr Res 2015; 168:174-9. [PMID: 26232239 DOI: 10.1016/j.schres.2015.07.035] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 07/07/2015] [Accepted: 07/19/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND Schizophrenia is associated with impaired cognition, especially cognition in social contexts. The mirror neuron system (MNS) serves as an important neuronal basis for social cognitive skills; however, previous investigations on the integrity of MNS function in schizophrenia remain approximate. METHODS We employed a repetition suppression paradigm that allows for measuring neuronal responses to gesture observation and gesture execution. Cross-modal repetition suppression, i.e., adaptation between observe/execute and execute/observe conditions, was defined as the decisive experimental condition characterizing the unique sensori-motor properties of mirror neurons. Event-related potentials (ERPs) were assessed in 15 schizophrenia patients and 15 matched controls. RESULTS We isolated an ERP signature of specific adaptation effects to identical hand gestures. Of critical importance, this ERP signature indicated intact intra-modal adaptive pattern, i.e., observe/observe and execute/execute, of comparable magnitude between groups, but deficient cross-modal adaptation, i.e., observe/execute and execute/observe, in schizophrenia patients. CONCLUSION Our data provide robust evidence that pure perception and execution of hand gestures are relatively intact in schizophrenia. In contrast, visuo-motor transformation processes mediated by the MNS seem to be specifically disturbed in schizophrenia. These results unambiguously demonstrate MNS deficits in schizophrenia and extend our understanding of the neuronal bases of social dysfunction in this disorder.
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Affiliation(s)
- Nicole Möhring
- Department of Psychiatry, Charité University Medicine Berlin, Germany
| | - Christina Shen
- Department of Psychiatry, Charité University Medicine Berlin, Germany
| | - Eric Hahn
- Department of Psychiatry, Charité University Medicine Berlin, Germany
| | - Thi Minh Tam Ta
- Department of Psychiatry, Charité University Medicine Berlin, Germany
| | - Michael Dettling
- Department of Psychiatry, Charité University Medicine Berlin, Germany
| | - Andres H Neuhaus
- Department of Psychiatry, Charité University Medicine Berlin, Germany.
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Affiliation(s)
- Michael Dettling
- Psychiatry and Psychotherapy, Charité-University Medicine Berlin, Germany
| | - Ion Anghelescu
- Department of Psychiatry, Clinic Dr Fontheim, Liebenburg, Germany
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20
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Affiliation(s)
- Michael Dettling
- Department of Psychiatry and Psychotherapy, University Clinic Charite, Berlin 14050, Germany.
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Ahlers E, Hahn E, Ta TMT, Goudarzi E, Dettling M, Neuhaus AH. Smoking improves divided attention in schizophrenia. Psychopharmacology (Berl) 2014; 231:3871-7. [PMID: 24668036 DOI: 10.1007/s00213-014-3525-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Accepted: 02/26/2014] [Indexed: 12/24/2022]
Abstract
RATIONALE Smoking is highly prevalent in schizophrenia, and there is evidence for beneficial effects on neurocognition. Smoking is therefore hypothesized a self-medication in schizophrenia. Although much effort is devoted to characterize those cognitive domains that potentially benefit from smoking, divided attention has not yet been investigated. OBJECTIVES The aim of this study was to analyze the interactional effects of diagnosis of schizophrenia and smoking history on divided attention. METHODS We investigated behavioral measures of divided attention in a sample of 48 schizophrenic patients and 48 controls (24 current smokers and non-smokers each) carefully matched for age, sex, education, verbal IQ, and smoking status with general linear models. RESULTS Most important within the scope of this study, significant interactions were found for valid reactions and errors of omission: Performance substantially increased in smoking schizophrenic patients, but not in controls. Further, these interactions were modified by sex, driven by female schizophrenic patients who showed a significant behavioral advantage of smokers over non-smokers, other than male schizophrenic patients or healthy controls who did not express this sex-specific pattern. CONCLUSIONS Results suggest a positive effect of smoking history on divided attention in schizophrenic patients. This study provides first evidence that the complex attention domain of divided attention is improved by smoking, which further substantiates the self-medication hypothesis of smoking in schizophrenia, although this has been shown mainly for sustained and selective attention. Gender-specific effects on cognition need to be further investigated.
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Affiliation(s)
- Eike Ahlers
- Department of Psychiatry, Charité University Medicine, Campus Benjamin Franklin, Eschenallee 3, 14050, Berlin, Germany,
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Shen C, Popescu FC, Hahn E, Ta TT, Dettling M, Neuhaus AH. Neurocognitive pattern analysis reveals classificatory hierarchy of attention deficits in schizophrenia. Schizophr Bull 2014; 40:878-85. [PMID: 23934819 PMCID: PMC4059438 DOI: 10.1093/schbul/sbt107] [Citation(s) in RCA: 15] [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] [Indexed: 11/14/2022]
Abstract
Attention deficits, among other cognitive deficits, are frequently observed in schizophrenia. Although valid and reliable neurocognitive tasks have been established to assess attention deficits in schizophrenia, the hierarchical value of those tests as diagnostic discriminants on a single-subject level remains unclear. Thus, much research is devoted to attention deficits that are unlikely to be translated into clinical practice. On the other hand, a clear hierarchy of attention deficits in schizophrenia could considerably aid diagnostic decisions and may prove beneficial for longitudinal monitoring of therapeutic advances. To propose a diagnostic hierarchy of attention deficits in schizophrenia, we investigated several facets of attention in 86 schizophrenia patients and 86 healthy controls using a set of established attention tests. We applied state-of-the-art machine learning algorithms to determine attentive test variables that enable an automated differentiation between schizophrenia patients and healthy controls. After feature preranking, hypothesis building, and hypothesis validation, the polynomial support vector machine classifier achieved a classification accuracy of 90.70% ± 2.9% using psychomotor speed and 3 different attention parameters derived from sustained and divided attention tasks. Our study proposes, to the best of our knowledge, the first hierarchy of attention deficits in schizophrenia by identifying the most discriminative attention parameters among a variety of attention deficits found in schizophrenia patients. Our results offer a starting point for hierarchy building of schizophrenia-associated attention deficits and contribute to translating these concepts into diagnostic and therapeutic practice on a single-subject level.
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Affiliation(s)
- Christina Shen
- Department of Psychiatry and Psychotherapy, Charité University Medicine, Berlin, Germany
| | - Florin C. Popescu
- Fraunhofer Institute for Open Communication Systems FOKUS, Berlin, Germany
| | - Eric Hahn
- Department of Psychiatry and Psychotherapy, Charité University Medicine, Berlin, Germany
| | - Tam T.M. Ta
- Department of Psychiatry and Psychotherapy, Charité University Medicine, Berlin, Germany
| | - Michael Dettling
- Department of Psychiatry and Psychotherapy, Charité University Medicine, Berlin, Germany
| | - Andres H. Neuhaus
- Department of Psychiatry and Psychotherapy, Charité University Medicine, Berlin, Germany;,*To whom correspondence should be addressed; Department of Psychiatry and Psychotherapy, Charité University Medicine, Campus Benjamin Franklin, Eschenallee 3, 14050 Berlin, Germany; tel: 49-30-8445-8412, fax: 49-30-8445-8393; e-mail:
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Ta TMT, Neuhaus AH, Burian R, Schomerus G, von Poser A, Diefenbacher A, Röttger-Rössler B, Dettling M, Hahn E. [Mental Health Care Utilization of First Generation Vietnamese Migrants in Germany]. Psychiatr Prax 2014; 42:267-73. [PMID: 24858434 DOI: 10.1055/s-0034-1370008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Vietnamese migrants underutilize and are a "hard to reach group" within the existing mental health care system in Germany. METHODS We analyzed migration related and clinical data for all first-time Vietnamese migrants seeking psychiatric help, within the first 30 months of a newly established outpatient clinic, offering culture-sensitive psychiatric treatment in native Vietnamese language. RESULTS Most first time patients were female, first generation Vietnamese migrants with poor German language skills. Only 1 /3 of all patients had a psychiatric history, while this number was higher in patients with schizophrenia. Over time, more first time patients with depression were seeking psychiatric care, accompanied with an increase of non-professional referrals within the Vietnamese communities. CONCLUSION This first study on mental health care utilization in Vietnamese migrants in Germany points towards the fact that "migrants" cannot be considered as a homogeneous group. Mental health care utilization must be evaluated for specific migrant groups, and can be initially improved if offered in native language and when it is referred to by members of migrant communities.
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Affiliation(s)
- Thi Minh Tam Ta
- Klinik und Hochschulambulanz für Psychiatrie und Psychotherapie, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin
| | - Andres H Neuhaus
- Klinik und Hochschulambulanz für Psychiatrie und Psychotherapie, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin
| | - Ronald Burian
- Abteilung für Psychiatrie, Psychotherapie und Psychosomatik, Evangelisches Krankenhaus Königin Elisabeth Herzberge, Berlin
| | - Georg Schomerus
- Klinik und Poliklinik für Psychiatrie und Psychotherapie der Universitätsmedizin Greifswald am HELIOS-Hanseklinikum Stralsund
| | | | - Albert Diefenbacher
- Abteilung für Psychiatrie, Psychotherapie und Psychosomatik, Evangelisches Krankenhaus Königin Elisabeth Herzberge, Berlin
| | | | - Michael Dettling
- Klinik und Hochschulambulanz für Psychiatrie und Psychotherapie, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin
| | - Eric Hahn
- Klinik und Hochschulambulanz für Psychiatrie und Psychotherapie, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin
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Hahn E, Vollath A, Ta TTM, Hahn C, Kuehl LK, Dettling M, Neuhaus AH. Assessing long-term test-retest reliability of the CPT-IP in schizophrenia. PLoS One 2014; 9:e84780. [PMID: 24416285 PMCID: PMC3885596 DOI: 10.1371/journal.pone.0084780] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Accepted: 11/19/2013] [Indexed: 11/23/2022] Open
Abstract
Background The Continuous Performance Test-Identical Pairs version (CPT-IP) is a well-established measure of sustained attention, and its more challenging versions are particularly suited to detect subtle processing deficits in patients with schizophrenia. However, while there are few longitudinal samples for the CPT-IP, no study has addressed stability for more than two month in patients with schizophrenia. Assessing long-term test-retest reliability of the CPT-IP would facilitate the ability of clinicians to draw conclusions from studies involving interventions as long term cognitive or pharmacological treatments. The present study assessed 12 month test-retest reliability for the two most challenging versions of CPT-IP (4-digit and shapes) in a matched sample of clinically stable schizophrenia outpatients and healthy controls. Methods Fifty clinically stable schizophrenia outpatients and 50 healthy controls were assessed with the CPT-IP for the 4-digit and shape conditions. From these, 40 patients and 47 controls were reassessed with an average interval of 12.3 months between test sessions. Test-retest reliability was analyzed with Pearson correlations and results were compared with previous data involving healthy controls and short-term studies in patients with schizophrenia. Results Especially d’ and hit rate discriminated well between patients with schizophrenia and healthy controls for both CPT-IP conditions and at both test sessions. Healthy controls demonstrated sufficient long term test-retest correlations of d’, hit rate and reaction time for both the 4-digit and shape conditions. However, in schizophrenia patients, long-term reliability correlations were at best moderate for d’ and hit rate only. Conclusions The current study provides further evidence that d’ and hit rate yield consistent cross-sectional discrimination sensitivity. At best moderate long-term test-retest reliability of d’ in schizophrenia outpatients may be not sufficient for practical use of this measure in long term clinical trials.
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Affiliation(s)
- Eric Hahn
- Department of Psychiatry and Psychotherapy, Charité-University Medicine, Campus Benjamin Franklin, Berlin, Germany
- * E-mail:
| | - Andrea Vollath
- Department of Psychiatry and Psychotherapy, Charité-University Medicine, Campus Benjamin Franklin, Berlin, Germany
| | - Tam T. M. Ta
- Department of Psychiatry and Psychotherapy, Charité-University Medicine, Campus Benjamin Franklin, Berlin, Germany
| | - Constanze Hahn
- Department of Biopsychology, Ruhr University, Bochum, Germany
| | - Linn K. Kuehl
- Department of Psychiatry and Psychotherapy, Charité-University Medicine, Campus Benjamin Franklin, Berlin, Germany
| | - Michael Dettling
- Department of Psychiatry and Psychotherapy, Charité-University Medicine, Campus Benjamin Franklin, Berlin, Germany
| | - Andres H. Neuhaus
- Department of Psychiatry and Psychotherapy, Charité-University Medicine, Campus Benjamin Franklin, Berlin, Germany
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Ahlers E, Hahn E, Ta T, Shen C, Dettling M, Neuhaus A. Smoking improves divided attention in schizophrenia. Pharmacopsychiatry 2013. [DOI: 10.1055/s-0033-1353262] [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: 10/26/2022]
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Kuehl LK, Brandt ES, Hahn E, Dettling M, Neuhaus AH. Exploring the time course of N170 repetition suppression: A preliminary study. Int J Psychophysiol 2013; 87:183-8. [DOI: 10.1016/j.ijpsycho.2012.12.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Revised: 12/17/2012] [Accepted: 12/21/2012] [Indexed: 11/27/2022]
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Anghelescu I, Dettling M. Neuron number in children with autism. JAMA 2012; 307:783; author reply 783-4. [PMID: 22357826 DOI: 10.1001/jama.2012.191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Hahn C, Hahn E, Dettling M, Güntürkün O, Ta TMT, Neuhaus AH. Effects of smoking history on selective attention in schizophrenia. Neuropharmacology 2012; 62:1897-902. [PMID: 22245543 DOI: 10.1016/j.neuropharm.2011.12.032] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Revised: 12/14/2011] [Accepted: 12/30/2011] [Indexed: 12/24/2022]
Abstract
Smoking prevalence is highly elevated in schizophrenia compared to the general population and to other psychiatric populations. Evidence suggests that smoking may lead to improvements of schizophrenia-associated attention deficits; however, large-scale studies on this important issue are scarce. We examined whether sustained, selective, and executive attention processes are differentially modulated by long-term nicotine consumption in 104 schizophrenia patients and 104 carefully matched healthy controls. A significant interaction of 'smoking status' × 'diagnostic group' was obtained for the domain of selective attention. Smoking was significantly associated with a detrimental conflict effect in controls, while the opposite effect was revealed for schizophrenia patients. Likewise, a positive correlation between a cumulative measure of nicotine consumption and conflict effect in controls and a negative correlation in patients were found. These results provide evidence for specific directional effects of smoking on conflict processing that critically dissociate with diagnosis. The data supports the self-medication hypothesis of smoking in schizophrenia and suggests selective attention as a specific cognitive domain targeted by nicotine consumption. A potential mechanistic model explaining these findings is discussed.
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Affiliation(s)
- Constanze Hahn
- Department of Biopsychology, Ruhr University, Bochum, Germany
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Hahn E, Ta TMT, Hahn C, Kuehl LK, Ruehl C, Neuhaus AH, Dettling M. Test-retest reliability of Attention Network Test measures in schizophrenia. Schizophr Res 2011; 133:218-22. [PMID: 22000937 DOI: 10.1016/j.schres.2011.09.026] [Citation(s) in RCA: 20] [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: 07/11/2011] [Revised: 09/10/2011] [Accepted: 09/18/2011] [Indexed: 10/16/2022]
Abstract
BACKGROUND The Attention Network Test (ANT) is a well established behavioral measure in neuropsychological research to assess three different facets of selective attention, i.e., alerting, orienting, and conflict processing. Although the ANT has been applied in healthy individuals and various clinical populations, data on retest reliability are scarce in healthy samples and lacking for clinical populations. The objective of the present study was a longitudinal assessment of relevant ANT network measures in healthy controls and schizophrenic patients. METHODS Forty-five schizophrenic patients and 55 healthy controls were tested with ANT in a test-retest design with an average interval of 7.4 months between test sessions. Test-retest reliability was analyzed with Pearson and Intra-class correlations. RESULTS Healthy controls revealed moderate to high test-retest correlations for mean reaction time, mean accuracy, conflict effect, and conflict error rates. In schizophrenic patients, moderate test-retest correlations for mean reaction time, orienting effect, and conflict effect were found. The analysis of error rates in schizophrenic patients revealed very low test-retest correlations. CONCLUSIONS The current study provides converging statistical evidence that the conflict effect and mean reaction time of ANT yield acceptable test-retest reliabilities in healthy controls and, investigated longitudinally for the first time, also in schizophrenia. Obtained differences of alerting and orienting effects in schizophrenia case-control studies should be considered more carefully. The analysis of error rates revealed heterogeneous results and therefore is not recommended for case control studies in schizophrenia.
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Affiliation(s)
- Eric Hahn
- Department of Psychiatry and Psychotherapy, Charité University Medicine, Campus Benjamin Franklin, Berlin, Germany.
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Hahn E, Hahn C, Dettling M, Güntürkün O, Ta T, Neuhaus A. Smoking and double dissociation of prefrontal cognition in schizophrenia. Pharmacopsychiatry 2011. [DOI: 10.1055/s-0031-1292490] [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: 10/17/2022]
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Neuhaus AH, Hahn E, Hahn C, Ta TMT, Opgen-Rhein C, Urbanek C, Dettling M. Visual P3 amplitude modulation deficit in schizophrenia is independent of duration of illness. Schizophr Res 2011; 130:210-5. [PMID: 21382693 DOI: 10.1016/j.schres.2011.02.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [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: 09/13/2010] [Revised: 02/08/2011] [Accepted: 02/08/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND In the search for markers of schizophrenia, functional deficits during inhibition have been a major focus. In previous studies, we found a reduced amplitude modulation of the visual P3 component of the event-related potential (ERP) in schizophrenic patients during inhibition in the Attention Network Test (ANT). The objective of the present study was to explore whether this deficit exhibits properties of a trait or state marker of schizophrenia. METHODS Eighteen recent onset inpatients and eighteen chronic schizophrenic outpatients as well as 36 healthy controls, including a young adult and an old adult group to match recent onset and chronic illness groups for age and sex, were included. Participants were tested with ANT while 32-channel electroencephalogram was recorded and visual P3 amplitudes were analyzed. Amplitude modulation was defined as the variation of P3 amplitude at Pz as a function of ANT flanker conditions. RESULTS There were no significant behavioral between-group differences in terms of alerting, orienting, and inhibition. Mean visual P3 was significantly lower in schizophrenic patients than in healthy controls. Parietal P3 amplitude was significantly less modulated in both recent onset (-0.035) and chronic schizophrenic patients (-0.081) compared with young (-0.588; p<0.05) and older healthy controls, respectively (-0.556; p<0.05). No correlations were obtained between P3 modulation and clinical or demographic variables. CONCLUSION The results provide evidence that the observed deficit of visual P3 amplitude modulation is independent of duration of illness and age and may contain properties of a trait marker of schizophrenia.
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Affiliation(s)
- Andres H Neuhaus
- Department of Psychiatry and Psychotherapy, Charité University Medicine, Campus Benjamin Franklin, Berlin, Germany.
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Hahn C, Neuhaus AH, Pogun S, Dettling M, Kotz SA, Hahn E, Brüne M, Güntürkün O. Smoking reduces language lateralization: A dichotic listening study with control participants and schizophrenia patients. Brain Cogn 2011; 76:300-9. [PMID: 21524559 DOI: 10.1016/j.bandc.2011.03.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2011] [Revised: 03/21/2011] [Accepted: 03/22/2011] [Indexed: 12/30/2022]
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Athanasiou MC, Dettling M, Cascorbi I, Mosyagin I, Salisbury BA, Pierz KA, Zou W, Whalen H, Malhotra AK, Lencz T, Gerson SL, Kane JM, Reed CR. Candidate gene analysis identifies a polymorphism in HLA-DQB1 associated with clozapine-induced agranulocytosis. J Clin Psychiatry 2011; 72:458-63. [PMID: 20868635 DOI: 10.4088/jcp.09m05527yel] [Citation(s) in RCA: 105] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2009] [Accepted: 09/16/2009] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Clozapine is considered to be the most efficacious drug to treat schizophrenia, although it is underutilized, partially due to a side effect of agranulocytosis. This analysis of 74 candidate genes was designed to identify an association between sequence variants and clozapine-induced agranulocytosis (CIA). METHOD Blood and medical history were collected for 33 CIA cases and 54 clozapine-treated controls enrolled between April 2002 and December 2003. Significant markers from 4 genes were then assessed in an independently collected case-control cohort (49 CIA cases, 78 controls). RESULTS Sequence variants in 5 genes were found to be associated with CIA in the first cohort: HLA-DQB1, HLA-C, DRD1, NTSR1, and CSF2RB. Sequence variants in HLA-DQB1 were also found to be associated with CIA in the second cohort. After refinement analyses of sequence variants in HLA-DQB1, a single SNP (single nucleotide polymorphism), 6672G>C, was found to be associated with risk for CIA; the odds of CIA are 16.9 times greater in patients who carry this marker compared to those who do not. CONCLUSIONS A sequence variant (6672G>C) in HLA-DQB1 is associated with increased risk for CIA. This marker identifies a subset of patients with an exceptionally high risk of CIA, 1,175% higher than the overall clozapine-treated population under the current blood-monitoring system. Assessing risk for CIA by testing for this and other genetic variants yet to be determined may be clinically useful when deciding whether to begin or continue treatment with clozapine.
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Neuhaus AH, Karl C, Hahn E, Trempler NR, Opgen-Rhein C, Urbanek C, Hahn C, Ta TMT, Dettling M. Dissection of early bottom-up and top-down deficits during visual attention in schizophrenia. Clin Neurophysiol 2011; 122:90-8. [DOI: 10.1016/j.clinph.2010.06.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2010] [Revised: 04/19/2010] [Accepted: 06/13/2010] [Indexed: 11/29/2022]
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Neuhaus AH, Popescu FC, Grozea C, Hahn E, Hahn C, Opgen-Rhein C, Urbanek C, Dettling M. Single-subject classification of schizophrenia by event-related potentials during selective attention. Neuroimage 2010; 55:514-21. [PMID: 21182969 DOI: 10.1016/j.neuroimage.2010.12.038] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2010] [Accepted: 12/13/2010] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Executive dysfunction has repeatedly been proposed as a robust and promising substrate of analytical approaches in the research of neurocognitive markers of schizophrenia. Here, we present a mixed model- and data-driven classification approach by applying a task that targets executive dysfunction in schizophrenia and by investigating relevant event-related potential (ERP) features with machine learning classifiers. METHODS Forty schizophrenic patients and forty matched healthy controls completed the Attention Network Test while an electroencephalogram was recorded. Target-locked N1 and P3 ERP components were constructed and submitted to different classification analyses without a priori hypotheses. Standardized source localization was applied to estimate neural sources of N1 and P3 deficits in schizophrenia. RESULTS We obtained a classification accuracy of 79% using only very few ERP components. Central P3 components following compatible and incompatible trials and right parietal N1 latencies averaged across targets and were sufficient for classification. P3 deficits were associated with anterior cingulate cortex dysfunction, while right posterior current density deficits were observed in schizophrenia during the N1 time frame. CONCLUSIONS The data exemplarily show how automated inference may be applied to classify a pathological state in single subjects without prior knowledge of their diagnoses. While classification accuracy may be optimized by application of other executive paradigms, this approach illustrates the potential of machine learning algorithms for the identification of biomarkers that are independent of clinical assessments. Conversely, data suggest a pathophysiological mechanism that includes early visual and late executive deficits during response inhibition in schizophrenia.
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Affiliation(s)
- Andres H Neuhaus
- Department of Psychiatry and Psychotherapy, Charité University Medicine, Campus Benjamin Franklin, Berlin, Germany.
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Neuhaus AH, Trempler NR, Hahn E, Luborzewski A, Karl C, Hahn C, Opgen-Rhein C, Urbanek C, Schaub R, Dettling M. Evidence of specificity of a visual P3 amplitude modulation deficit in schizophrenia. Schizophr Res 2010; 124:119-26. [PMID: 20805022 DOI: 10.1016/j.schres.2010.08.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2010] [Revised: 06/26/2010] [Accepted: 08/02/2010] [Indexed: 11/15/2022]
Abstract
BACKGROUND In a previous study, we found a reduced amplitude modulation of the visual P3 component of the event-related potential (ERP) in schizophrenic patients compared with healthy controls during inhibition in the Attention Network Test (ANT). The objective of the present study was to replicate this finding and to explore whether this cortical processing deficit is specific to schizophrenia. METHODS Sixteen schizophrenic patients, sixteen depressive patients, and sixteen healthy controls matched for age, sex, and education were included. Participants were tested with the ANT, a test of selective attention that provides behavioral estimates for alerting, orienting, and inhibition. 32-Channel electroencephalogram was recorded and visual P3 amplitudes were topographically analyzed and compared between groups. RESULTS There were no significant behavioral between-group differences in terms of mean reaction time, accuracy, and ANT effects alerting, orienting, and inhibition. Absolute visual P3 amplitude was not reduced in schizophrenia or depression. P3 amplitude modulation was defined as P3 amplitude at Pz as a function of ANT flanker conditions. We found a parietal P3 amplitude modulation deficit in schizophrenic patients (-.015) that was absent in both healthy controls (-.705; p = .002) and depressive patients (-1.022; p = .001). CONCLUSION The results provide evidence that a deficit of visual P3 amplitude modulation distinguishes schizophrenia from healthy and disease controls and provides greater discriminative power than absolute visual P3 amplitude.
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Affiliation(s)
- Andres H Neuhaus
- Department of Psychiatry and Psychotherapy, Charité University Medicine, Campus Benjamin Franklin, Berlin, Germany.
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Opgen-Rhein C, Brandl EJ, Müller DJ, Neuhaus AH, Tiwari AK, Sander T, Dettling M. Association of HTR2C, but not LEP or INSIG2, genes with antipsychotic-induced weight gain in a German sample. Pharmacogenomics 2010; 11:773-80. [DOI: 10.2217/pgs.10.50] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background: Drug-induced bodyweight gain (BWG) is a serious concern in pharmacotherapy with second-generation antipsychotics. The interindividual variability is likely to be modulated by genetic factors. In the past, pharmacogenetic studies yielded conflicting results, and none of the identified genetic alterations exerts sufficient predictive value for this severe side effect of psychopharmacotherapy. Aim: We aimed to contribute to the replication and extension of prior association findings and investigated the genes encoding serotonin 2C receptor (HTR2C), insulin-induced gene 2 (INSIG2) and leptin (LEP). Patients & methods: We investigated the association of HTR2C, LEP and INSIG2 SNPs with antipsychotic-induced BWG in 128 German schizophrenic patients. Genotyping was performed for nine SNPs (HTR2C: rs498207, rs3813928, rs6318 and rs3813929; INSIG2: rs17587100, rs10490624, rs17047764 and rs7566605; LEP: rs7799039). Association analysis included logistic regression analysis and Pearson´s χ2 tests. Results: We report a significant association of three HTR2C SNPs (rs498207, rs3813928 and rs3813929) and of the respective haplotype with antipsychotic-induced BWG. Regarding the X-chromosomal SNP rs498207, individuals with AA/A genotype gained more weight than those with GG/G genotype. The association observed with the SNP rs498207 was also significant after correcting for multiple testing (p = 0.0196). No association was found for INSIG2 and LEP SNPs. Conclusion: The results contribute to the accumulating evidence for an association of the X-chromosomal HTR2C gene with antipsychotic-induced BWG. The proposed underlying mechanisms include decreased HTR2C gene expression with reduced 5-HT-modulated activation of hypothalamic proopiomelanocortin-neurons, and inverse 5-HT2C agonism in the presence of D2 receptor antagonism.
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Affiliation(s)
| | - Eva Janina Brandl
- Department of Psychiatry & Psychotherapy, Charité University Medicine Berlin, Campus Benjamin Franklin, Eschenallee 3, 14050 Berlin, Germany
| | - Daniel J Müller
- Neurogenetics Section, CAMH, Department of Psychiatry, University of Toronto, ON, Canada
| | - Andres H Neuhaus
- Department of Psychiatry & Psychotherapy, Charité University Medicine Berlin, Campus Benjamin Franklin, Eschenallee 3, 14050 Berlin, Germany
| | - Arun K Tiwari
- Neurogenetics Section, CAMH, Department of Psychiatry, University of Toronto, ON, Canada
| | - Thomas Sander
- Cologne Center for Genomics, University of Cologne, Cologne, Germany
| | - Michael Dettling
- Department of Psychiatry & Psychotherapy, Charité University Medicine Berlin, Campus Benjamin Franklin, Eschenallee 3, 14050 Berlin, Germany
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Neuhaus AH, Urbanek C, Opgen-Rhein C, Hahn E, Ta TMT, Koehler S, Gross M, Dettling M. Event-related potentials associated with Attention Network Test. Int J Psychophysiol 2010; 76:72-9. [PMID: 20184924 DOI: 10.1016/j.ijpsycho.2010.02.005] [Citation(s) in RCA: 111] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2009] [Revised: 02/07/2010] [Accepted: 02/13/2010] [Indexed: 11/26/2022]
Abstract
Selective visual attention is thought to be comprised of distinct neuronal networks that serve different attentional functions. The Attention Network Test (ANT) has been introduced to allow for assessment of alerting, orienting, and response inhibition. Information on associated measures of neural processing during ANT is still scarce. We topographically analyzed top-down ANT effects on visual event-related potential morphology in 44 healthy participants. Significant reaction time effects were obtained for all attention networks. Posterior cue-locked target N1 amplitude was significantly increased during both alerting and orienting. P3 amplitude was significantly modulated at frontal and parietal leads as a function of inhibition. Our data suggests that attentional mechanisms of alerting and orienting are employed simultaneously at early stages of the visual processing stream to amplify perceptual discrimination and load onto the same ERP component. Fronto-parietal modulations of P3 amplitude seem to mirror both response inhibition and visual target detection and may be interesting markers for further studies.
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Affiliation(s)
- Andres H Neuhaus
- Department of Psychiatry and Psychotherapy, Charité University Medicine, Campus Benjamin Franklin, Eschenallee 3, 14050 Berlin, Germany.
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Urbanek C, Neumann K, Schoenhoff M, Dettling M. FC03-07 - Future strategies for vocational rehabilitation in schizophrenia. Eur Psychiatry 2010. [DOI: 10.1016/s0924-9338(10)70193-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Urbanek C, Weinges-Evers N, Bellmann-Strobl J, Bock M, Dörr J, Hahn E, Neuhaus AH, Opgen-Rhein C, Thi Minh Tam Ta, Herges K, Pfueller CF, Radbruch H, Wernecke KD, Ohlraun S, Zipp F, Dettling M, Paul F. Attention Network Test reveals alerting network dysfunction in multiple sclerosis. Mult Scler 2009; 16:93-9. [DOI: 10.1177/1352458509350308] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Attention is one of the cognitive domains typically affected in multiple sclerosis. The Attention Network Test was developed to measure the function of the three distinct attentional networks, alerting, orienting, and executive control. The Attention Network Test has been performed in various neuropsychiatric conditions, but not in multiple sclerosis. Our objective was to investigate functions of attentional networks in multiple sclerosis by means of the Attention Network Test. Patients with relapsing—remitting multiple sclerosis (n = 57) and healthy controls (n = 57) matched for age, sex, and education performed the Attention Network Test. Significant differences between patients and controls were detected in the alerting network (p = 0.003), in contrast to the orienting (p = 0.696) and the conflict (p = 0.114) network of visual attention. Mean reaction time in the Attention Network Test was significantly longer in multiple sclerosis patients than in controls (p = 0.032), Multiple sclerosis patients benefited less from alerting cues for conflict resolution compared with healthy controls. The Attention Network Test revealed specific alterations of the attention network in multiple sclerosis patients which were not explained by an overall cognitive slowing.
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Affiliation(s)
- Carsten Urbanek
- Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin, Charité University Medicine Berlin, Berlin, Germany
| | - Nicholetta Weinges-Evers
- Cecilie Vogt Clinic, Charité University Medicine Berlin, Berlin, Germany, NeuroCure Clinical Research Center, Charité University Medicine Berlin, Berlin, Germany
| | - Judith Bellmann-Strobl
- Cecilie Vogt Clinic, Charité University Medicine Berlin, Berlin, Germany, NeuroCure Clinical Research Center, Charité University Medicine Berlin, Berlin, Germany
| | - Markus Bock
- Cecilie Vogt Clinic, Charité University Medicine Berlin, Berlin, Germany, NeuroCure Clinical Research Center, Charité University Medicine Berlin, Berlin, Germany
| | - Jan Dörr
- Cecilie Vogt Clinic, Charité University Medicine Berlin, Berlin, Germany, NeuroCure Clinical Research Center, Charité University Medicine Berlin, Berlin, Germany
| | - Eric Hahn
- Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin, Charité University Medicine Berlin, Berlin, Germany
| | - Andres H Neuhaus
- Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin, Charité University Medicine Berlin, Berlin, Germany
| | - Carolin Opgen-Rhein
- Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin, Charité University Medicine Berlin, Berlin, Germany
| | - Thi Minh Tam Ta
- Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin, Charité University Medicine Berlin, Berlin, Germany
| | - Katja Herges
- Cecilie Vogt Clinic, Charité University Medicine Berlin, Berlin, Germany
| | - Caspar F Pfueller
- Cecilie Vogt Clinic, Charité University Medicine Berlin, Berlin, Germany, NeuroCure Clinical Research Center, Charité University Medicine Berlin, Berlin, Germany
| | - Helena Radbruch
- Cecilie Vogt Clinic, Charité University Medicine Berlin, Berlin, Germany
| | - Klaus D Wernecke
- Sostana GmbH and Charité University Medicine Berlin, Berlin, Germany
| | - Stephanie Ohlraun
- NeuroCure Clinical Research Center, Charité University Medicine Berlin, Berlin, Germany
| | - Frauke Zipp
- Cecilie Vogt Clinic, Charité University Medicine Berlin, Berlin, Germany
| | - Michael Dettling
- Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin, Charité University Medicine Berlin, Berlin, Germany
| | - Friedemann Paul
- Cecilie Vogt Clinic, Charité University Medicine Berlin, Berlin, Germany, , NeuroCure Clinical Research Center, Charité University Medicine Berlin, Berlin, Germany
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Neuhaus AH, Opgen-Rhein C, Urbanek C, Gross M, Hahn E, Ta TMT, Koehler S, Dettling M. Spatiotemporal mapping of sex differences during attentional processing. Hum Brain Mapp 2009; 30:2997-3008. [PMID: 19172632 DOI: 10.1002/hbm.20724] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Functional neuroimaging studies have increasingly aimed at approximating neural substrates of human cognitive sex differences elicited by visuospatial challenge. It has been suggested that females and males use different behaviorally relevant neurocognitive strategies. In females, greater right prefrontal cortex activation has been found in several studies. The spatiotemporal dynamics of neural events associated with these sex differences is still unclear. We studied 22 female and 22 male participants matched for age, education, and nicotine with 29-channel-electroencephalogram recorded under a visual selective attention paradigm, the Attention Network Test. Visual event-related potentials (ERP) were topographically analyzed and neuroelectric sources were estimated. In absence of behavioral differences, ERP analysis revealed a novel frontal-occipital second peak of visual N100 that was significantly increased in females relative to males. Further, in females exclusively, a corresponding central ERP component at around 220 ms was found; here, a strong correlation between stimulus salience and sex difference of the central ERP component amplitude was observed. Subsequent source analysis revealed increased cortical current densities in right rostral prefrontal (BA 10) and occipital cortex (BA 19) in female subjects. This is the first study to report on a tripartite association between sex differences in ERPs, visual stimulus salience, and right prefrontal cortex activation during attentional processing.
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Affiliation(s)
- Andres H Neuhaus
- Department of Psychiatry and Psychotherapy, Charité University Medicine, Campus Benjamin Franklin, Berlin, Germany.
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Urbanek C, Neuhaus AHM, Opgen-Rhein C, Strathmann S, Wieseke N, Schaub R, Hahn E, Dettling M. Attention network test (ANT) reveals gender-specific alterations of executive function in schizophrenia. Psychiatry Res 2009; 168:102-9. [PMID: 19464736 DOI: 10.1016/j.psychres.2008.04.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [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: 08/16/2007] [Revised: 04/02/2008] [Accepted: 04/05/2008] [Indexed: 11/28/2022]
Abstract
The Attention Network Test (ANT) provides measures for three different components of visual attention: executive control (=conflict inhibition), orienting, and alerting. There is reasonable evidence that alterations of attention-mainly in the executive/conflict domain-are associated with susceptibility to psychiatric illness. Specific impairments may be a characteristic for a medical condition such as schizophrenia and thus shift our understanding from a neuropsychological endophenotype to a more precise genetic understanding of this disorder. Study subjects comprised 35 schizophrenic patients and 35 healthy controls (13 female and 22 male in both groups). The ANT was administered to all participants and rated individual responses for the three factors (alerting, orienting, and conflict) and their respective ratios relative to mean reaction times. With regard to gender differences, group comparisons were performed for schizophrenic patients vs. healthy controls. Significant differences between patients and controls could be detected for mean reaction time (639 vs. 538 ms) and for conflict ratio (0.158 vs. 0.191). The latter difference mainly resulted from gender-specific variances of the conflict network in opposite directions. The executive function as represented by the conflict network of visual attention of the ANT is affected in schizophrenia. We have detected hitherto unreported gender-specific differences between healthy controls and schizophrenic patients. Especially as regards the conflict network, the ANT offers a promising methodology to detect a neuropsychological endophenotype of schizophrenia.
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Affiliation(s)
- Carsten Urbanek
- Department of Psychiatry and Psychotherapy, Charité Campus Benjamin Franklin, University Medicine Berlin, Berlin, Germany.
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Neuhaus AH, Opgen-Rhein C, Urbanek C, Hahn E, Ta TMT, Seidelsohn M, Strathmann S, Kley F, Wieseke N, Sander T, Dettling M. COMT Val 158 Met polymorphism is associated with cognitive flexibility in a signal discrimination task in schizophrenia. Pharmacopsychiatry 2009; 42:141-4. [PMID: 19585392 DOI: 10.1055/s-0028-1112132] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Associations between the well-known functional single nucleotide polymorphism Val (158)Met in the gene encoding catechol- O-methyltransferase (COMT) and cognitive do-mains affected in schizophrenia are inconsistent regarding directionality and specific impact and call for a more fundamental cognitive endophenotype. Recent studies suggest that the COMT genotype contributes to cognitive flexibility, a fundamental cognitive ability that potentially influences an individual's performance in a variety of other neurocognitive tasks. METHODS We investigated the association between COMT Val (158)Met genotype and cognitive flexibility as assessed by signal discrimination in the Continuous Performance Test - Identical Pairs version in a cohort of 111 German schizophrenic patients. RESULTS COMT genotype was significantly associated with signal discrimination index d' in schizophrenia. The Val/Val genotype was associated with the highest and the Met/Met genotype with the lowest scores; heterozygous individuals displayed an intermediate performance. CONCLUSIONS Our data suggest that allelic variation at the COMT Val (158)Met locus may influence signal discrimination capacity in schizophrenia and confirm that Val loading, probably due to decreased prefrontal dopamine availability, is associated with greater cognitive flexibility, which in turn may influence other cognitive measures that have been associated with COMT to date.
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Affiliation(s)
- A H Neuhaus
- Department of Psychiatry, Charité University Medicine, Campus Benjamin Franklin, Berlin, Germany.
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Opgen-Rhein C, Neuhaus AH, Urbanek C, Hahn E, Sander T, Dettling M. Executive attention in schizophrenic males and the impact of COMT Val108/158Met genotype on performance on the attention network test. Schizophr Bull 2008; 34:1231-9. [PMID: 18199630 PMCID: PMC2632487 DOI: 10.1093/schbul/sbm155] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [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] [Indexed: 12/13/2022]
Abstract
BACKGROUND Executive control of attention in schizophrenia has recently been assessed by means of the Attention Network Test (ANT). In the past, for tasks assessing executive attention, findings in schizophrenia have been contradictory, among others suggesting a lack of increased stimulus interference effects. Attention and executive functioning are substantially influenced by candidate genes of schizophrenia, including the functional single-nucleotide polymorphism catechol-o-methyltransferase (COMT) Val108/158Met, with task-dependent, specific effects of Met allele load on cognitive function. Therefore, we aimed at investigating executive attention in schizophrenic patients (SZP) as compared with healthy controls (HC), and to assess the specific impact of COMT Val108/158Met on executive attention, using ANT. METHODS We applied ANT to 63 SZP and 40 HC. We calculated a general linear model to investigate the influence of affection status and the COMT Val108/158Met genotype on executive attention as assessed by the ANT. RESULTS Multivariate analysis of variance revealed a significant effect of group on executive attention. SZP exhibited smaller conflict effects in the ANT. Met allele load significantly modulated executive attention efficiency, with homozygous Met individuals showing low overall reaction time but increased effects conflicting stimulus information in executive attention. CONCLUSIONS Our data suggest a disease-related dissociation of executive attention with reduced conflict effects in SZP. Furthermore, they support the hypothesis of differential tonic-phasic dopamine activation and specific dopamine level effects in different cognitive tasks, which helps interpreting contradictory findings of Met allele load on cognitive performance. Disease status seems to modulate the impact of COMT Val108/158Met on cognitive performance.
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Affiliation(s)
- Carolin Opgen-Rhein
- Department of Psychiatry and Psychotherapy, Charité-University Medicine Berlin, Campus Benjamin Franklin, Berlin, Germany.
| | - Andres H. Neuhaus
- Department of Psychiatry and Psychotherapy, Charité-University Medicine Berlin, Campus Benjamin Franklin, Eschenallee 3, 14050 Berlin, Germany
| | - Carsten Urbanek
- Department of Psychiatry and Psychotherapy, Charité-University Medicine Berlin, Campus Benjamin Franklin, Eschenallee 3, 14050 Berlin, Germany
| | - Eric Hahn
- Department of Psychiatry and Psychotherapy, Charité-University Medicine Berlin, Campus Benjamin Franklin, Eschenallee 3, 14050 Berlin, Germany
| | - Thomas Sander
- Max-Delbrüeck Center for Molecular Medicine, Berlin-Buch, Germany
| | - Michael Dettling
- Department of Psychiatry and Psychotherapy, Charité-University Medicine Berlin, Campus Benjamin Franklin, Eschenallee 3, 14050 Berlin, Germany
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Dettling M, Opgen-Rhein C, Anghelescu I. Escitalopram, problem-solving therapy, and poststroke depression. JAMA 2008; 300:1757; author reply 1758-9. [PMID: 18854529 DOI: 10.1001/jama.300.15.1757-b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Opgen-Rhein C, Sahin I, Möhlig M, Wetter T, Dettling M. Metabolic changes in patients undergoing treatment with atypical antipsychotics – a prospective investigation. Exp Clin Endocrinol Diabetes 2008. [DOI: 10.1055/s-0028-1096336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abstract
Clozapine-induced agranulocytosis (CiA) is a potentially life-threatening pharmacological adverse drug reaction, which limits a broader application of this highly effective atypical antipsychotic in schizophrenic patients. Although this adverse reaction has been well known for almost 30 years, only few genetically based determinants can be identified to date. Furthermore, owing to rare occurrence, specific clinical course and complexity of pathomechanisms of antipsychotic-induced agranulocytosis, only a few of the findings met the criteria of replication. The most promising susceptibility genes for CiA include genes involved in the human leukocyte antigen system and in specific metabolizing enzyme systems. However, complex idiosyncratic drug reactions such as CiA are considered to be determined by multiple, possibly interacting genetic variations, rather than by a single causative variant.
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Affiliation(s)
- Carolin Opgen-Rhein
- Department of Psychiatry and Psychotherapy, Charité-University Medicine Berlin, Eschenallee 3, 14050 Berlin, Germany
| | - Michael Dettling
- Department of Psychiatry and Psychotherapy, Charité-University Medicine Berlin, Eschenallee 3, 14050 Berlin, Germany
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