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Andrei Manoliu,
Valentin Riedl,
Andriy Zherdin,
Mark Mühlau,
Dirk Schwerthöffer,
Martin Scherr,
Henning Peters,
Claus Zimmer,
Hans Förstl, Josef Bäuml,
Afra M Wohlschläger,
Christian Sorg
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ABSTRACT: In schizophrenia, consistent structural and functional changes have been demonstrated for the insula including aberrant salience processing, which is critical for psychosis. Interactions within and across default mode and central executive network (DMN, CEN) are impaired in schizophrenia. The question arises whether these 2 types of changes are related. Recently, the anterior insula has been demonstrated to control DMN/CEN interactions. We hypothesized that aberrant insula and DMN/CEN activity in schizophrenia is associated with an impaired dependence of DMN/CEN interactions on anterior insular salience network (SN) activity. Eighteen patients with schizophrenia during psychosis and 20 healthy controls were studied by resting-state-fMRI and psychometric examination. High-model-order independent component analysis of fMRI data revealed spatiotemporal patterns of synchronized ongoing blood-oxygenation-level-dependent (BOLD) activity including SN, DMN, and CEN. Scores of functional and time-lagged connectivity across networks' time courses were calculated. Connectivity scores and spatial network maps were compared between groups and related with patients' hallucination and delusion severity. Spatial BOLD-synchronicity was altered in patients' SN, DMN, and CEN, including decreased activity in the right anterior insula (rAI). Patients' functional connectivity between DMN and CEN was increased and related with hallucinations severity. Importantly, patients' time-lagged connectivity between SN and DMN/CEN was reduced, and decreased rAI activity of the SN was associated with both hallucinations and increased functional connectivity between DMN and CEN. Data provide evidence for an aberrant dependence of DMN/CEN interactions on anterior insular SN activity, linking impaired insula, DMN, CEN activity, and psychosis in schizophrenia.
Schizophrenia Bulletin 03/2013; · 8.80 Impact Factor
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International Journal of Geriatric Psychiatry 07/2012; 27(7):765-8. · 2.42 Impact Factor
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Christian Sorg,
Andrei Manoliu,
Susanne Neufang,
Nicholas Myers,
Henning Peters,
Dirk Schwerthöffer,
Martin Scherr,
Mark Mühlau,
Claus Zimmer,
Alexander Drzezga,
Hans Förstl, Josef Bäuml,
Tom Eichele,
Afra M Wohlschläger,
Valentin Riedl
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ABSTRACT: Striatal dysfunction is thought to be a fundamental element in schizophrenia. Striatal dopamine dysfunction impacts on reward processing and learning and is present even at rest. Here, we addressed the question whether and how spontaneous neuronal activity in the striatum is altered in schizophrenia. We therefore assessed intrinsic striatal activity and its relation with disorder states and symptom dimensions in patients with schizophrenia. We performed resting-state functional (rs-fMRI) and structural magnetic resonance imaging as well as psychometric assessment in 21 schizophrenic patients during psychosis. On average 9 months later, we acquired follow-up data during psychotic remission and with comparable levels of antipsychotic medication. Twenty-one age- and sex-matched healthy controls were included in the study. Independent component analysis of fMRI data yielded spatial maps and time-courses of coherent ongoing blood-oxygen-level-dependent signal fluctuations, which were used for group comparisons and correlation analyses with scores of the positive and negative syndrome scale. During psychosis, coherent intrinsic activity of the striatum was increased in the dorsal part and correlated with positive symptoms such as delusion and hallucination. In psychotic remission of the same patients, activity of the ventral striatum was increased and correlated with negative symptoms such as emotional withdrawal and blunted affect. Results were controlled for volumetric and medication effects. These data provide first evidence that in schizophrenia intrinsic activity is changed in the striatum and corresponds to disorder states and symptom dimensions.
Schizophrenia Bulletin 01/2012; · 8.80 Impact Factor
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ABSTRACT: Several risk factors for schizophrenia have yet been identified. The aim of our study was to investigate how certain childhood and adolescent risk factors predict the age of onset of psychosis in patients with and without a familial component (i.e. a relative with schizophrenia or schizoaffective disorder).
Aside from the age of onset of psychosis, we examined the risk factors for schizophrenia including obstetric complications, birth during winter or spring, behavioral deviances or delayed motor and speech development, exposure to adverse life events and exposure to substance use within a group of 100 patients (45 female, 55 male) with a mean age (± standard deviation) of 35.15 ± 13.21.
Birth complications and cannabis abuse are predictors for an earlier onset of schizophrenia in patients with non-familial schizophrenia. No environmental risk factors for an earlier age of onset in familial schizophrenia have been identified.
Certain environmental risk factors for schizophrenia seem to have an impact on the age of onset of psychosis in non-familial schizophrenia, they do not seem to have an impact on familial schizophrenia.
Nordic journal of psychiatry 08/2011; 66(2):107-14. · 0.99 Impact Factor
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ABSTRACT: BACKGROUND. Verbal learning and memory is often compromised in patients with schizophrenia who prefer encoding words in order of their presentation (serial clustering) rather than using semantic categories (semantic clustering). METHOD. One hundred and four in-patients with schizophrenia were assessed twice with the California Verbal Learning Test. RESULTS. Patients showed significantly less semantic than serial clustering at both assessment times. Usage of encoding strategies were not stable over time. An increase in semantic clustering improved recall and recognition performance. CONCLUSIONS. Patients with schizophrenia should be taught to use the more effective encoding strategy of semantic clustering in order to improve their memory performance.
Journal of Neuropsychology 03/2011; 5(Pt 1):56-72. · 1.74 Impact Factor
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ABSTRACT: ECT is an effective and safe therapy with fast response for depressive disorders. Nevertheless it's mostly used for therapy resistance. In antidepressive treatments fast response may be related with antidepressive efficacy. We studied, if earlier ECT could result in a shorter hospital stay period after the treatment.
The hospital stay period after ECT and CGI-changes of 34 depressed patients with immediate ECT were compared to those of 19 patients, who had to wait for this treatment while being treated conservatively in another psychiatric hospital without ECT-possibility.
Patients with early ECT could be dismitted from hospital at a mean of 57 days after the first ECT, patients who had to wait for this treatment at a mean of 100 days after the first ECT. CGI-changes were similar in both groups.
Early use of ECT may reduce hospital stay periods in depressed patients.
Psychiatrische Praxis 10/2010; 38(2):77-81. · 1.64 Impact Factor
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ABSTRACT: Despite the notion that randomized controlled trials are regarded as the gold standard in psychotherapy research, questions about their generalizability have been raised. This paper focuses on the differences between participants and eligible nonparticipants of a randomized controlled trial for patients with borderline personality disorder (BPD).
One hundred forty-two patients were screened, and 122 were found eligible for study participation. Out of these, 64 patients (52.5%) gave informed consent and were included in the study.
The 58 eligible nonparticipants showed a lower level of functioning (global assessment of functioning score), had a history of more outpatient treatment attempts and were living alone more often. Regarding acute symptoms and severity of BPD as indexed by suicide attempts, inpatient treatments, substance abuse and history of trauma, no differences between the groups could be detected. Moreover, participants showed significantly more eating disorders, whereas nonparticipants presented more affective and anxiety disorders.
The results indicate that lower psychosocial functioning and comorbid affective and anxiety disorders decrease BPD patients' willingness to participate in an RCT.
Psychopathology 01/2010; 43(6):369-72. · 1.82 Impact Factor
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ABSTRACT: Studies on psychoeducation in schizophrenia demonstrate significant effects on rehospitalization rates, compliance and knowledge. Within the framework of the Munich COGPIP study we examined whether borderline intellectual disability in patients with schizophrenia limits the benefit from psychoeducational groups. A total of 116 inpatients with schizophrenic or schizoaffective disorders were recruited for the COGPIP study. A manualized, interactive psychoeducational programme of eight sessions (4 weeks) was initiated. Measures of knowledge, adherence and the concept of illness were completed before and after the groups. The short-term outcome of 22 participants with schizophrenia and borderline intellectual disability (IQ 70-85) was compared with the outcome of 75 participants with schizophrenia and IQ > 85. Results showed that individuals with schizophrenia and borderline intellectual disability could be successfully integrated into general psychoeducational groups. The conclusion is that borderline intellectual disability should not be an exclusion criterion for participation in such groups.
Journal of Intellectual Disabilities 12/2009; 13(4):305-20.
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ABSTRACT: Lack of insight into illness of patients with schizophrenia is often a big problem for relatives. Therefore, information was collected on how relatives assess the patients' insight into illness and their current treatment situation. This assessment was compared with the relatives' feelings of well-being.
Questionnaire-assisted exploration of 84 relatives, who participated in an information session about lack of insight into illness.
73 % of patients had a lack of insight into illness according to their relatives. Of these, 79 % were male, the mean duration of inpatient treatment was 12 months, 56 % used an antipsychotic medication and 80 % were "quite/very ill". Of the patients with insight into illness, 45 % were male (p < 0.01), the duration of inpatient treatment was significantly longer (29 months; p < 0.05), 86 % used antipsychotics (p < 0.05) and only 42 % were judged as "quite/very ill" (p < 0.01). Only 49 % of relatives from the first group, but 67 % of relatives from the second group described their feelings of well-being as "very good / good" (p < 0.05).
The lack of insight into illness requires greater scientific attention in order to develop better treatment options along with greater relief for relatives.
Psychiatrische Praxis 09/2009; 36(8):373-8. · 1.64 Impact Factor
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ABSTRACT: Weight gain and metabolic disturbances are growing side effects of a modern antipsychotic therapy. Different programs were developed to reduce them. This article gives an overview of existing and evaluated programs.
A literature research was made through PubMed. Relevant reviews and intervention studies were identified.
Studies with the main outcome variable of weight reductions are numerous, even randomised controlled trials. Short-term weight loss under antipsychotic treatment is possible, but there is still a lack of long-term studies. Life style interventions, which include e. g. physical exercise, are not that common. Also, interventions such as wellness-activities, which contribute by means of adequate motivation strategies to an enhancement of the general well-being, are still missing. Present results turned out to be positive.
Further programs which exceed weight management are required. There is necessity for more studies with consistent outcome variables and methods, especially long-term programs.
Psychiatrische Praxis 09/2009; 37(1):7-19. · 1.64 Impact Factor
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ABSTRACT: To introduce a psychoeducational program for patients of at-risk mental state and its preliminary evaluation.
The psychoeducational program was designed as a purely informative intervention and consisted of seven 1-h sessions. Sixteen at-risk mental state patients (mean age 26+/-4.9 years, 12 males/4 females, mean score on prodromal psychopathology (Bonn Scale for Assessment of predictive Basis Symptoms [BSABS-P] 18.6+/-13.3) were investigated.
Comparisons of means before and after psychoeducation showed a significant reduction in psychopathology and fatalistic LoC as well as an improvement in knowledge, global functioning and various areas of QoL. A qualitative evaluation of the psychoeducational program also showed advantages from patients' perspectives.
This study provides empirical evidence for benefits of psychoeducation with patients of at-risk mental state for schizophrenia but is exploratory and has some limitations, e.g. the small sample size. Therefore the results have to be replicated in a randomized controlled trial in order to be able to demonstrate conclusively the effectiveness of psychoeducation in the pre-psychotic phase.
Results from this preliminary study suggest that psychoeducation is a promising intervention for patients of at-risk mental state for schizophrenia, and therefore worthy of more investigations.
Patient Education and Counseling 01/2009; 76(1):138-42. · 2.31 Impact Factor
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ABSTRACT: We describe a 62-year-old patient with a chronic delusional disorder who presented with severely matted hair ("plica polonica"). Until the late 19th century such dreadlocks were considered as cause, consequence and treatment of mental disease. The historical development of "plica polonica" is briefly reviewed as an example of early and once popular psychiatric disease concepts.
Neuropsychiatrie: Klinik, Diagnostik, Therapie und Rehabilitation: Organ der Gesellschaft Österreichischer Nervenärzte und Psychiater 02/2008; 22(2):124-6. · 1.38 Impact Factor
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Josef Bäuml
Psychiatrische Praxis 12/2007; 34(8):387. · 1.64 Impact Factor
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ABSTRACT: Case report about a 29-year old US-American patient who suddenly flew to Germany due to a schizoaffektive disorder. During a stay in our psychiatric hospital she refused food, liquid and medication because of fear of being poisoned. After four days her general condition had worsened rapidly so that parenteral nutrition was discussed. Surprisingly her poisoning delusion could be overcome by offering American "Junk-Food". From this moment on compliance in taking of medication improved too, so that renormalisation of her condition was achieved.
Psychiatrische Praxis 12/2007; 34(8):400-2. · 1.64 Impact Factor
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European Psychiatry 11/2007; 22(7):479-80. · 2.77 Impact Factor
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ABSTRACT: The microtubule-associated protein tau gene (MAPT) contains two extended haplotypes, H1 and H2, which have been linked with sporadic tauopathies. However, there is little evidence as to how these haplotypes may influence the clinical features of the disease. The aim of this study was to investigate the MAPT haplotypes in relation to risk for, and functional alterations of glucose metabolism in, patients with frontotemporal dementia (FTD).
The authors investigated MAPT haplotypes in 142 individuals with FTD and 292 comparison subjects. Additionally, in a subset of 41 individuals with FTD and 16 comparison subjects, the authors undertook functional [ (18)F]fluorodeoxyglucose positron emission tomography (PET) imaging.
MAPT haplotype distribution did not differ significantly between individuals with FTD and comparison subjects. However, the H2 haplotype was clinically associated with an earlier age at onset of FTD, which presented in a dose-dependent manner. Correspondingly, PET analysis revealed functional differences in glucose utilization patterns between MAPT haplotypes, with H2 carriers having a more pronounced hypometabolism in frontal brain areas than H1 carriers, which could not be accounted for by differences in duration of illness.
While the extended MAPT H1 and H2 haplotypes do not appear to confer risk for disease development, the H2 haplotype appears to modify age at onset and functionally shows a more severe decline of glucose utilization in frontal brain areas.
American Journal of Psychiatry 11/2007; 164(10):1577-84. · 12.54 Impact Factor
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ABSTRACT: It has been argued that the efficacy superiority found in meta-analyses for some of the atypical antipsychotics is an artifact of higher dropout rates due to side effects in the haloperidol group combined with last-observation-carried-forward (LOCF) analyses. We therefore reanalyzed a number of pivotal studies comparing new generation antipsychotics (NGAs) and conventional antipsychotics (CAs). A total of 5 studies (n = 1271) comparing amisulpride and 3 studies (n = 2454) comparing olanzapine with CAs were reanalyzed using original patient data. We applied 4 different models: LOCF, completer analysis, LOCF but excluding dropouts due to adverse events, and LOCF but excluding all dropouts with the exception of dropouts related to efficacy. Effect sizes expressed as standardized mean differences between NGAs and CAs based on the 4 different analysis models were compared. The overall results were not different irrespective of the model used. Single studies, however, showed higher effect sizes when LOCF instead of other models was used. Overall, it does not seem that higher dropout rates due to side effects in the haloperidol groups together with LOCF analyses consistently biased the results in favor of amisulpride and olanzapine. Because the results of the single studies, however, showed that this may occasionally be the case, future studies should look at the data from different angles applying sensitivity analyses, and they may use alternative statistics such as mixed models, which need to be developed further. Ultimately, strategies to reduce dropout rates are needed.
Schizophrenia Bulletin 02/2007; 33(1):183-91. · 8.80 Impact Factor
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Josef Bäuml
Psychiatrische Praxis 12/2006; 33(8):379-82. · 1.64 Impact Factor
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ABSTRACT: Psychoeducation can reduce rehospitalization rates and mental health costs in schizophrenia. The aims of this study were to investigate the percentage of patients and family members participating in psychoeducation in the year 2003 and to evaluate how psychoeducation was conducted.
Part I of a 2-part postal survey was sent to the heads of all psychiatric institutions in Germany, Austria, and Switzerland; part II was sent directly to the moderators of psychoeducational groups. Responses were analyzed using descriptive statistics.
Psychoeducation was offered in 86% of the responding institutions and in 84% of these for schizophrenia (response quotas: part I, 54%; part II, 55%). A mean of 21% of the patients with schizophrenia and 2% of their family members had taken part in psychoeducation in the responding institutions in the year 2003.
Many readmissions and thus significant costs to the health system and substantial human suffering could be avoided if more patients and their family members participated in psychoeducation. New approaches to offering more psychoeducation would consist in integration of the entire psychiatric team into psychoeducation and peer-to-peer strategies.
Schizophrenia Bulletin 11/2006; 32(4):765-75. · 8.80 Impact Factor
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ABSTRACT: Psychoeducation was originally conceived as a composite of numerous therapeutic elements within a complex family therapy intervention. Patients and their relatives were, by means of preliminary briefing concerning the illness, supposed to develop a fundamental understanding of the therapy and further be convinced to commit to more long-term involvement. Since the mid 1980s, psychoeducation in German-speaking countries has evolved into an independent therapeutic program with a focus on the didactically skillful communication of key information within the framework of a cognitive-behavioral approach. Through this, patients and their relatives should be empowered to understand and accept the illness and cope with it in a successful manner. Achievement of this basic-level competency is considered to constitute an "obligatory-exercise" program upon which additional "voluntary-exercise" programs such as individual behavioral therapy, self-assertiveness training, problem-solving training, communication training, and further family therapy interventions can be built. Psychoeducation looks to combine the factor of empowerment of the affected with scientifically founded treatment expertise in as efficient a manner as possible. A randomized multicenter study based in Munich showed that within a 2-year period such a program was related to a significant reduction in rehospitalization rates from 58% to 41% and also a shortening of intermittent days spent in hospital from 78 to 39 days. Psychoeducation, in the form of an obligatory-exercise program, should be made available to all patients suffering from a schizophrenic disorder and their families.
Schizophrenia Bulletin 11/2006; 32 Suppl 1:S1-9. · 8.80 Impact Factor
