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ABSTRACT: Cue modulation of the startle reflex is a paradigm that has been used to understand the emotional mechanisms involved in alcohol dependence. Attenuation of the startle reflex has been demonstrated when alcohol-dependent subjects are exposed to alcohol-related stimuli. However, the role of clinical variables on the magnitude of this response is unknown. The objective of this study was to determine the relationship between a number of clinical variables-severity of alcoholism, family history of alcoholism (FHA+), personality traits related to the sensitivity to reward-and the startle reflex response when subjects with alcohol dependence were viewing alcohol-related cues. After detoxification, 98 participants completed self-report instruments and had eye blink electromyograms measured to acoustic startle probes [100-millisecond burst of white noise at 95 dB(A)] while viewing alcohol-related pictures, and standardised appetitive, aversive and neutral control scenes. Ninety-eight healthy controls were also assessed with the same instruments. There were significant differences on alcohol-startle magnitude between patients and controls. Comparisons by gender showed that women perceived alcohol cues and appetitive cues more appetitive than men. Male and female patients showed more appetitive responses to alcohol cues when compared with their respective controls. Our patients showed an appetitive effect of alcohol cues that was positively related to severity of alcohol dependence, sensitivity to reward and a FHA+. The data confirmed that the pattern of the modulation of the acoustic startle reflex reveals appetitive effects of the alcohol cues and extended it to a variety of clinical variables.
Addiction Biology 10/2011; · 4.83 Impact Factor
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Sophia Schneider,
Jan Peters,
Uli Bromberg,
Stefanie Brassen,
Stephan F Miedl,
Tobias Banaschewski,
Gareth J Barker,
Patricia Conrod,
Herta Flor,
Hugh Garavan, [......],
Frauke Nees,
Tomas Paus,
Marcella Rietschel,
Trevor W Robbins,
Michael N Smolka,
Rainer Spanagel,
Andreas Ströhle,
Maren Struve,
Gunter Schumann,
Christian Büchel
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ABSTRACT: Increased risk-taking behavior has been associated with addiction, a disorder also linked to abnormalities in reward processing. Specifically, an attenuated response of reward-related areas (e.g., the ventral striatum) to nondrug reward cues has been reported in addiction. One unanswered question is whether risk-taking preference is associated with striatal reward processing in the absence of substance abuse.
Functional and structural MRI was performed in 266 healthy young adolescents and in 31 adolescents reporting potentially problematic substance use. Activation during reward anticipation (using the monetary incentive delay task) and to gray matter density were measured. Risk-taking bias was assessed by the Cambridge Gamble Task.
With increasing risk-taking bias, the ventral striatum showed decreased activation bilaterally during reward anticipation. Voxel-based morphometry showed that greater risk-taking bias was also associated with and partially mediated by lower gray matter density in the same structure. The decreased activation was also observed when participants with virtually any substance use were excluded. The group with potentially problematic substance use showed greater risk taking as well as lower striatal activation relative to matched comparison subjects from the main sample.
Risk taking and functional and structural properties of the reward system in adolescents are strongly linked prior to a possible onset of substance abuse, emphasizing their potential role in the predisposition to drug abuse.
American Journal of Psychiatry 09/2011; 169(1):39-46. · 12.54 Impact Factor
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ABSTRACT: Exercise (EX) and physical activity (PA) have been shown to prevent or delay the onset of several mental disorders and to have therapeutic effects in different groups of psychiatric disorders. This review focuses on studies investigating EX as therapeutic intervention in anxiety disorders, affective disorders, eating disorders, schizophrenia, and substance use disorders. Despite EX being discussed as a potential therapy for several decades, adequately powered randomized, controlled trials are sparse in most disorder groups. Nevertheless, evidence points toward disorder-specific benefits that can be induced by EX/PA. Mechanisms of the therapeutic effects of EX/PA are summarized, including metabolic and physiological as well as psychological aspects. Finally, implications for research and therapeutic practice are illustrated.
Archiv f ur Psychiatrie und Nervenkrankheiten 09/2011; 261 Suppl 2:S186-91. · 2.75 Impact Factor
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Meline Stoy,
Florian Schlagenhauf,
Philipp Sterzer,
Felix Bermpohl,
Claudia Hägele,
Kristina Suchotzki,
Katharina Schmack,
Jana Wrase,
Roland Ricken,
Brian Knutson,
Mazda Adli,
Michael Bauer, Andreas Heinz,
Andreas Ströhle
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ABSTRACT: Major Depressive Disorder (MDD) involves deficits in the reward system. While neuroimaging studies have focused on affective stimulus processing, few investigations have directly addressed deficits in the anticipation of incentives. We examined neural responses during gain and loss anticipation in patients with MDD before and after treatment with a selective serotonin reuptake inhibitor (SSRI). Fifteen adults with MDD and 15 healthy participants, matched for age, verbal IQ and smoking habits, were investigated in a functional magnetic resonance imaging (fMRI) study using a monetary incentive delay task. Patients were scanned drug-free and after 6 weeks of open-label treatment with escitalopram; controls were scanned twice at corresponding time points. We compared the blood oxygenation level dependent (BOLD) response during the anticipation of gain and loss with a neutral condition. A repeated measures ANOVA was calculated to identify effects of group (MDD vs. controls), time (first vs. second scan) and group-by-time interaction. Severity of depression was measured with the Hamilton Rating Scale of Depression and the Beck Depression Inventory. MDD patients showed significantly less ventral striatal activation during anticipation of gain and loss compared with controls before, but not after, treatment. There was a significant group-by-time interaction during anticipation of loss in the left ventral striatum due to a signal increase in patients after treatment. Ventral striatal hyporesponsiveness was associated with the severity of depression and in particular anhedonic symptoms. These findings suggest that MDD patients show ventral striatal hyporesponsiveness during incentive cue processing, which normalizes after successful treatment.
Journal of Psychopharmacology 09/2011; 26(5):677-88. · 3.04 Impact Factor
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Simone Kühn,
Alexander Romanowski,
Christina Schilling,
Tobias Banaschewski,
Alexis Barbot,
Gareth J Barker,
Rüdiger Brühl,
Christian Büchel,
Patricia J Conrod,
Katharina Czech, [......],
Jean-Baptiste Poline,
Jan Reuter,
Marcella Rietschel,
Trevor W Robbins,
Michael N Smolka,
Frauke Nees,
Bernadeta Walaszek,
Gunter Schumann, Andreas Heinz,
Jürgen Gallinat
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ABSTRACT: Dexterity is a fundamental skill in our everyday life. Particularly, the fine-tuning of reaching for objects is of high relevance and crucially coordinated by the cerebellum. Although neuronal cerebellar structures mediate dexterity, classical whole brain voxel-based morphometry (VBM) has not identified structural correlates of dexterity in the cerebellum.
Clusters of gray matter (GM) volume associated with the Purdue Pegboard Dexterity Test, a test of fine motor skills and complex upper limb movements, were identified in a cerebellum-optimized VBM analysis using the Spatially Unbiased Infratentorial (SUIT) toolbox in 65 healthy, right-handed 14-year-olds. For comparison, classical whole brain VBM was performed.
The cerebellum-optimized VBM indicated a significant positive correlation between manual dexterity and GM volume in the right cerebellum Lobule VI, corrected for multiple comparisons and non-stationary smoothness. The classical whole brain VBM revealed positive associations (uncorrected) between dexterity performance and GM volume in the left SMA (BA 6), right fusiform gyrus (BA 20) and left cuneus (BA 18), but not cerebellar structures.
The results indicate that cerebellar GM volumes in the right Lobule VI predict manual dexterity in healthy untrained humans when cerebellum-optimized VBM is employed. Although conventional VBM identified brain motor network areas it failed to detect cerebellar structures. Thus, previous studies might have underestimated the importance of cerebellum in manual dexterity.
NeuroImage 09/2011; 59(2):1615-21. · 5.89 Impact Factor
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ABSTRACT: Alterations of theory of mind (ToM) and empathy were implicated in the formation of psychotic experiences, and deficits in psychosocial functioning of schizophrenia patients. Inspired by concepts of neurocognitive endophenotypes, the existence of a distinct, potentially neurobiologically based social-cognitive vulnerability marker for schizophrenia is a matter of ongoing debate. The fact that previous research on social-cognitive deficits in individuals at risk yielded contradictory results may partly be due to an insufficient differentiation between qualitative aspects of ToM. Thirty-four unaffected first-degree relatives of schizophrenia patients (21 parents, 8 siblings, 5 children; f/m: 30/4; mean age: 48.1 ± 12.7 years) and 34 controls subjects (f/m: 25/9; mean age: 45.9 ± 10.9 years) completed the 'Movie for the Assessment of Social Cognition'-a video-based ToM test-and an empathy questionnaire (Interpersonal Reactivity Index, IRI). Outcome parameters comprised (1) 'cognitive' versus 'emotional' ToM, (2) error counts representing 'undermentalizing' versus 'overmentalizing', (3) empathic abilities and (4) non-social neurocognition. MANCOVA showed impairments in cognitive but not emotional ToM in the relatives' group, when age, gender and neurocognition were controlled for. Relatives showed elevated error counts for 'undermentalizing' but not for 'overmentalizing'. No alterations were detected in self-rated dimensions of empathy. Of all measures of ToM and empathy, only the IRI subscale 'fantasy' was associated with measures of psychotic risk, i.e. a history of subclinical delusional ideation. The present study confirmed subtle deficits in cognitive, but not emotional ToM in first-degree relatives of schizophrenia patients, which were not explained by global cognitive deficits. Findings corroborate the assumption of distinct social-cognitive abilities as an intermediate phenotype for schizophrenia.
Archiv f ur Psychiatrie und Nervenkrankheiten 09/2011; 262(3):217-26. · 2.75 Impact Factor
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Andreas Bechdolf,
Hendrik Müller,
Hartmut Stützer,
Michael Wagner,
Wolfgang Maier,
Marion Lautenschlager, Andreas Heinz,
Walter de Millas,
Birgit Janssen,
Wolfgang Gaebel,
Tanja Maria Michel,
Frank Schneider,
Martin Lambert,
Dieter Naber,
Martin Brüne,
Seza Krüger-Özgürdal,
Thomas Wobrock,
Michael Riedel,
Joachim Klosterkötter
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ABSTRACT: Antipsychotics, cognitive behavioral therapy (CBT), and omega-3-fatty acids have been found superior to control conditions as regards prevention of psychosis in people at-risk of first-episode psychosis. However, no large-scale trial evaluating the differential efficacy of CBT and antipsychotics has been performed yet. In PREVENT, we evaluate CBT, aripiprazole, and clinical management (CM) as well as placebo and CM for the prevention of psychosis in a randomized, double-blind, placebo-controlled trial with regard to the antipsychotic intervention and a randomized controlled trial with regard to the CBT intervention with blinded ratings. The hypotheses are first that CBT and aripiprazole and CM are superior to placebo and CM and second that CBT is not inferior to aripiprazole and CM combined. The primary outcome is transition to psychosis. By November 2010, 156 patients were recruited into the trial. The subjects were substantially functionally compromised (Social and Occupational Functioning Assessment Scale mean score 52.5) and 78.3% presented with a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition axis I comorbid diagnosis. Prior to randomization, 51.5% of the participants preferred to be randomized into the CBT arm, whereas only 12.9% preferred pharmacological treatment. First, assessments of audiotaped treatment sessions confirmed the application of CBT-specific skills in the CBT condition and the absence of those in CM. The overall quality rating of the CBT techniques applied in the CBT condition was good. When the final results of the trial are available, PREVENT will substantially expand the current limited evidence base for best clinical practice in people at-risk (prodromal) of first-episode psychosis.
Schizophrenia Bulletin 09/2011; 37 Suppl 2:S111-21. · 8.80 Impact Factor
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ABSTRACT: Neural correlates of emotional dysregulation in attention-deficit/hyperactivity disorder (ADHD) and persisting influence of Methylphenidate (MPH) still remain insufficiently understood. Decreased activation in the subgenual cingulate and the ventral striatum were found during the perception of positive and negative affective pictures in drug-naïve males with ADHD during childhood (n=10). Males with ADHD during childhood treated with MPH (n=10) did not show any significant differences compared to healthy controls (n=10). Further prospective studies need to clarify direct and indirect mechanisms of MPH treatment that may contribute to emotional processing, which is dysfunctional in males without pharmacological treatment in childhood.
European neuropsychopharmacology: the journal of the European College of Neuropsychopharmacology 08/2011; 21(8):646-54. · 3.68 Impact Factor
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ABSTRACT: The German Algorithm Project, Phase 2 (GAP2) revealed that a standardized stepwise treatment regimen (SSTR) results in better treatment outcomes than treatment as usual (TAU) in depressed inpatients. The objective of this study was a health economic evaluation of SSTR based on a cost effectiveness analysis (CEA).
GAP2 was a randomized controlled study with 148 patients. In an intention to treat (ITT) analysis direct treatment costs for study duration (SD) and total time in hospital (TTH; enrolment to discharge) were calculated based on daily hospital charges followed by a CEA to calculate cost expenditure per remitted patient.
Treatment costs in SSTR compared to TAU were significantly lower for SD (SSTR: 10 830 € ± 8 632 €, TAU: 15 202 € ± 12 483 €; p = 0.026) and did not differ significantly for TTH (SSTR: 21 561 € ± 16 162 €; TAU: 18 248 € ± 13 454; p = 0.208). CEA revealed that the costs per remission in SSTR were significantly lower for SD (SSTR: 20 035 € ± 15 970 €; SSTR: 38 793 € ± 31 853 €; p<0.0001) and TTH (SSTR: 31 285 € ± 23 451 €; TAU: 38 581 € ± 28 449 €, p = 0.041).
Indirect costs were not assessed. Different dropout rates in TAU and SSTR complicated interpretation of data.
An SSTR-based algorithm results in a superior cost effectiveness at no significant extra costs. Implementation of treatment algorithms in inpatient-care may help reduce treatment costs.
Journal of affective disorders 07/2011; 134(1-3):249-56. · 3.76 Impact Factor
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ABSTRACT: Little is known about psychopharmacological prescription practice in low-income countries. The present study aimed for an analysis of pharmacological treatment strategies for inpatients with schizophrenia in Tashkent, the capital city of Uzbekistan, facing a low-income situation as compared with four German cities in a high-income Western situation.
We conducted a cross-sectional quantitative survey of age, gender, diagnoses, and psychotropic medication of 845 urban psychiatric inpatients of the Tashkent psychiatric hospital and of 922 urban psychiatric inpatients in four German cities on 1 day in October 2008. We compared the current treatment strategies for specific diagnostic categories between the two settings.
In Tashkent, patients diagnosed with schizophrenia were treated with clozapine (66%), haloperidol (62%), or both (44%). More than one-third of the patients treated for schizophrenia were prescribed amitriptyline. The usual treatment strategy for schizophrenia was the combination of two or more antipsychotics (67%). In German cities, the preferred antipsychotics for the treatment of schizophrenia were olanzapine (21%), clozapine (20%), quetiapine (17%), risperidone (17%), and haloperidol (14%); the most common treatment strategy for patients with schizophrenia was the combination of antipsychotics and benzodiazepines; 44% of the patients were treated with two or more antipsychotics at a time.
In both settings, psychotropic combination treatments are common for the treatment of schizophrenia contrasting current guideline recommendations. Its rationale and effectiveness needs to be tested in further studies.
Pharmacoepidemiology and Drug Safety 07/2011; 21(2):145-51. · 2.53 Impact Factor
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ABSTRACT: Optimal pharmacotherapy of the alcohol withdrawal syndrome (AWS) in outpatient settings is still a matter of discussion. The aim of this evaluation was to examine the efficacy and tolerability of a combination of levetiracetam and tiapride for outpatient alcohol detoxification.
This was an open-label evaluation. After screening eligibility for outpatient detoxification, 9 alcohol-dependent patients received levetiracetam and tiapride in a flexible dosage regimen up to 2500 and 300 mg/d, respectively, for a maximum of 7 days. Severity of alcohol withdrawal was assessed daily using the Alcohol Withdrawal Syndrome Scale (AWSS).
All patients completed the treatment successfully. The mean initial doses of levetiracetam and tiapride were 2166.7 and 300 mg/d, respectively. AWS as indicated by the AWSS score decreased clearly over 5 days. The combination of levetiracetam and tiapride was well tolerated. Neither treatment discontinuations because of side effects of the medication nor serious medical complications were observed during the detoxification.
The results of this evaluation provide first evidence that the combination of levetiracetam and tiapride might be an effective and safe treatment option for mild to moderate AWS in outpatient settings. Further randomized controlled trials are warranted to confirm these preliminary results.
Journal of Addiction Medicine 06/2011; 5(2):153-6. · 1.95 Impact Factor
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ABSTRACT: Depression is common in patients with medical illness. However, little is known about frequency and clinical relevance of preoperative depression in surgical patients. The objective of this study was to investigate the frequency of depression, essential health risk factors and hospital length of stay (LOS) of patients in preoperative anaesthesiological assessment.
Patients were consecutively screened in the preoperative anaesthesiological assessment clinics. In total, 5429 patients gave written informed consent to perform a computerised self-assessment of lifestyle factors, including alcohol use, tobacco smoking, weight, physical status, physical exercise, sleeping disturbance, subjective health and sense of coherence (SOC). Depression was defined by a WHO-5 well-being score of 13 or less. LOS was obtained from the electronic patient management system.
A clinically relevant depressive state was found in 29.7% of the patients. Patients with depression had a median LOS of 6.0 days as compared to patients with positive well-being who had a LOS of 4.8 days (P < 0.001). Worse subjective health, less physical exercise and experience of SOC, as well as more severe sleeping disturbances were independently and significantly associated with depression (P < 0.001).
Clinically significant depressive states are frequent conditions in surgical patients of preoperative anaesthesiological assessment and are associated with an increased LOS. Different clinical pathways delivering adequate preoperative information according to the needs, considering subjective health and SOC of the patient as well as avoiding immobilisation and sleep disturbances during hospital stay should be considered. Long-term treatment programmes including brief intervention in the hospital and an outpatient concept should be offered.
European Journal of Anaesthesiology 05/2011; 28(10):733-41. · 2.23 Impact Factor
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ABSTRACT: Background: Alcohol abuse has detrimental effects on cerebral function, metabolism, and volume. Some of these effects were found to be at least partially reversible with continued abstinence. Furthermore, it has been reported that there are different effects of alcohol on brain volumes for women compared with men, but the results concerning the interaction between alcohol dependence and gender are inconsistent. With this study, we aimed to further investigate this question by examining the global gray matter (GM) and white matter (WM) changes as well as regional and local GM changes detected by voxel-based morphometry (VBM) in male and female alcoholic patients a few weeks after detoxification and the corresponding changes in a subgroup of these patients 3 months later.Methods: A total of 50 patients, consecutively admitted for alcohol withdrawal treatment, participated in this study and were followed up for at least 3 months into abstinence. High-resolution structural images were processed with SPM8 using an optimized VBM protocol.Results: Global cerebrospinal fluid (CSF) volume was increased and WM and GM volume decreased equally in male and female patients. A gender by diagnosis interaction was found neither for global nor for regional volumes or VBM data. VBM whole brain analysis yielded a significant GM volume loss in the patient group in the cingulate gyrus and the insula in both hemispheres. Region of interest analysis for the initial and 3 months follow-up scans yielded significant gains in regional volumes, particularly the cingulate gyrus and the insula in the group of abstinent patients, whereas no volume change at all is found in the patients who had relapsed.Conclusions: Our study confirms widespread cerebral volume loss in recently detoxified alcoholics. The effects of alcohol dependence seem to have equally adverse effects on brain morphometry in males and females.
Alcoholism Clinical and Experimental Research 05/2011; 35(9):1678 - 1685. · 3.34 Impact Factor
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Susanne Ziefle,
Friederike Egberts,
Sarah Heinze,
Matthias Volkenandt,
Monika Schmid-Wendtner,
Wolfgang Tilgen,
Ruthild Linse,
Jörg Boettjer,
Thomas Vogt,
Konstanze Spieth,
Thomas Eigentler,
Norbert H. Brockmeyer, Andreas Heinz,
Axel Hauschild,
Martin Schaefer
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ABSTRACT: Adjuvant treatment with interferon-α (IFN-α) for patients with malignant melanoma can improve relapse-free and overall survival, but IFN-associated side effects may reduce patient's quality of life. The aim of the study was to prospectively evaluate health-related quality of life (HRQoL) in patients with melanoma before and during Low-Dose IFN-α therapy. In a prospective multicenter trial conducted by the Dermatologic Cooperative Oncology Group, 850 patients with cutaneous stage II malignant melanoma received a standard Low-Dose of IFN-α-2a. We evaluated HRQoL using the European Organization for Research and Treatment of Cancer Quality of Life Core 30 questionnaire at baseline and after 3, 6, and 12 months of IFN-α treatment in 282 patients. Nine of 15 subscales showed significant poorer results after 3 months of adjuvant IFN treatment. Symptoms included reduced physical functioning, reduced cognitive functioning, fatigue, nausea, pain, dyspnea, insomnia, diarrhea, and loss of appetite. We did not find a significant change over time for role, emotional, or social functioning. Only cognitive functioning and dyspnea continuously worsened through the twelfth month. At baseline women had significantly lower scores for physical and emotional functioning and for fatigue compared with men. During treatment, women scored significantly poorer on physical functioning, emotional functioning, fatigue, pain, and constipation subscales. Patients who reported having a bad or very bad QoL before treatment were 5.8 times more likely to discontinue treatment early because of psychiatric problems. We conclude that adjuvant low-dose IFN treatment is associated with significant deterioration of HRQoL. Specific psychosocial care should be offered especially for patients who report lower HRQoL and emotional problems before treatment to prevent early discontinuation.
Journla of Immunotherapy 04/2011; 34(4):403–408. · 3.27 Impact Factor
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ABSTRACT: The mechanisms underlying distortions in sense of agency, i.e. the experience of controlling one's own actions and their consequences, in schizophrenia are not fully understood and have barely been investigated in patients classified as being in a putative psychotic prodrome. This study aims to expound the contribution of early and late illness-related processes. Thirty schizophrenia patients, 30 putatively prodromal patients and 30 healthy controls were instructed to reproduce a computer-generated series of drum sounds on a drum pad. While tapping, subjects heard either their self-produced tones or a computer-controlled reproduction of the drum tone series that used either exactly the same, an accelerated or decelerated tempo. Subjects had to determine the source of agency. Results show similar significant impairments in assigning the source of agency under ambiguous conditions in schizophrenia and putatively prodromal patients and an exaggerated self-attribution bias, both of which were significantly correlated with increased (ego-)psychopathology. Patient groups, however, benefited significantly more than controls from additional sensorimotor cues to agency. Sensorimotor input seems to be a compensatory mechanism involved in correctly attributing agency. We deduce that altered awareness of agency may hold promise as an additional risk factor for psychosis.
Psychiatry Research 04/2011; 186(2-3):170-6. · 2.52 Impact Factor
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MMW Fortschritte der Medizin 04/2011; 153(14):70-2.
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ABSTRACT: Hard-wired, Pavlovian, responses elicited by predictions of rewards and punishments exert significant benevolent and malevolent influences over instrumentally-appropriate actions. These influences come in two main groups, defined along anatomical, pharmacological, behavioural and functional lines. Investigations of the influences have so far concentrated on the groups as a whole; here we take the critical step of looking inside each group, using a detailed reinforcement learning model to distinguish effects to do with value, specific actions, and general activation or inhibition. We show a high degree of sophistication in Pavlovian influences, with appetitive Pavlovian stimuli specifically promoting approach and inhibiting withdrawal, and aversive Pavlovian stimuli promoting withdrawal and inhibiting approach. These influences account for differences in the instrumental performance of approach and withdrawal behaviours. Finally, although losses are as informative as gains, we find that subjects neglect losses in their instrumental learning. Our findings argue for a view of the Pavlovian system as a constraint or prior, facilitating learning by alleviating computational costs that come with increased flexibility.
PLoS Computational Biology 04/2011; 7(4):e1002028. · 5.22 Impact Factor
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ABSTRACT: There is evidence that major depression increases the risk for dementia, but there is conflicting evidence as to whether depression may accelerate cognitive decline in dementia. The authors tested the hypothesis that decline in cognitive function over time is more pronounced in patients with dementia with comorbid depression, when compared with patients with dementia without depression history.
Prospective, longitudinal cohort study of aging.
Nursing home.
Three hundred thirteen elderly nursing home residents (mean age at baseline: 86.99 years, standard deviation = 6.7; 83.1% women). At baseline, 192 residents were diagnosed with dementia, and another 27 developed dementia during follow-up. Thirty residents suffered from major depression at any point during the study, and 48 residents had a history of depression.
The authors measured cognitive decline using change in Mini-Mental State Examination (MMSE) scores over up to 36 months. The authors calculated multilevel regression models to estimate the effects of age, gender, education, dementia status, depression, depression history, and an interaction between dementia and depression, on change in MMSE scores over time.
Beyond the effects of age, gender, and education, residents showed steeper cognitive decline in the presence of dementia (β = -13.69, standard error = 1.38) and depression (β = -4.16, SE = 1.2), which was further accelerated by the presence of both depression and dementia (β = -2.72, SE = 0.65).
In dementia, the presence of depression corresponds to accelerated cognitive decline beyond gender and level of education, suggesting a unique influence of depression on the rate of cognitive decline in dementia.
The American journal of geriatric psychiatry: official journal of the American Association for Geriatric Psychiatry 04/2011; 19(4):357-63. · 3.35 Impact Factor
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ABSTRACT: Narrative exposure therapy (NET) applied by Neuner et al. on populations affected by war and natural disaster is compared to research data and intervention strategies developed by others. Questions are raised about the cultural sensitivity of Neuner's diagnostic instruments, the reductionist focus on PTSD which does not sufficiently take into account the complex after effects of trauma and the comprehensive psychosocial needs of affected populations. Currently available data do not yet provide convincing evidence that NET is effective or superior to other intervention strategies.
Psychiatrische Praxis 04/2011; 38(6):300-5. · 1.64 Impact Factor
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Jan Peters,
Uli Bromberg,
Sophia Schneider,
Stefanie Brassen,
Mareike Menz,
Tobias Banaschewski,
Patricia J Conrod,
Herta Flor,
Jürgen Gallinat,
Hugh Garavan, [......],
Tomas Paus,
Jean-Baptiste Poline,
Trevor W Robbins,
Marcella Rietschel,
Michael Smolka,
Andreas Ströhle,
Maren Struve,
Eva Loth,
Gunter Schumann,
Christian Büchel
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ABSTRACT: Adolescents are particularly vulnerable to addiction, and in the case of smoking, this often leads to long-lasting nicotine dependence. The authors investigated a possible neural mechanism underlying this vulnerability.
Functional MRI was performed during reward anticipation in 43 adolescent smokers and 43 subjects matched on age, gender, and IQ. The authors also assessed group differences in novelty seeking, impulsivity, and reward delay discounting.
In relation to the comparison subjects, the adolescent smokers showed greater reward delay discounting and higher scores for novelty seeking. Neural responses in the ventral striatum during reward anticipation were significantly lower in the smokers than in the comparison subjects, and in the smokers this response was correlated with smoking frequency. Notably, the lower response to reward anticipation in the ventral striatum was also observed in smokers (N=14) who had smoked on fewer than 10 occasions.
The present findings suggest that a lower response to reward anticipation in the ventral striatum may be a vulnerability factor for the development of early nicotine use.
American Journal of Psychiatry 03/2011; 168(5):540-9. · 12.54 Impact Factor
