Tilo Kircher

Philipps University of Marburg, Marburg, Hesse, Germany

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Publications (397)1416.88 Total impact

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    ABSTRACT: Previous studies of the dimensional structure of panic attack symptoms have mostly identified a respiratory and a vestibular/mixed somatic dimension. Evidence for additional dimensions such as a cardiac dimension and the allocation of several of the panic attack symptom criteria is less consistent. Clarifying the dimensional structure of the panic attack symptoms should help to specify the relationship of potential risk factors like anxiety sensitivity and fear of suffocation to the experience of panic attacks and the development of panic disorder. Method. In an outpatient multicentre study 350 panic patients with agoraphobia rated the intensity of each of the ten DSM-IV bodily symptoms during a typical panic attack. The factor structure of these data was investigated with nonlinear confirmatory factor analysis (CFA). The identified bodily symptom dimensions were related to panic cognitions, anxiety sensitivity and fear of suffocation by means of nonlinear structural equation modelling (SEM). Results. CFA indicated a respiratory, a vestibular/mixed somatic and a cardiac dimension of the bodily symptom criteria. These three factors were differentially associated with specific panic cognitions, different anxiety sensitivity facets and suffocation fear. Conclusions. Taking into account the dimensional structure of panic attack symptoms may help to increase the specificity of the associations between the experience of panic attack symptoms and various panic related constructs.
    Psychological Medicine 12/2015; 45(8):1675-1685. DOI:10.1017/S0033291714002803 · 5.94 Impact Factor
  • M Stratmann · J Sommer · M Belke · S Knake · T Kircher · C Konrad
    Pharmacopsychiatry 09/2015; 48(06). DOI:10.1055/s-0035-1557996 · 1.85 Impact Factor
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    ABSTRACT: Corticotropin-releasing hormone (CRH) is a major regulator of the hypothalamic-pituitary-adrenal axis. Binding to its receptor CRHR1 triggers the downstream release of the stress response-regulating hormone cortisol. Biochemical, behavioral and genetic studies revealed CRHR1 as a possible candidate gene for mood and anxiety disorders. Here we aimed to evaluate CRHR1 as a risk factor for panic disorder (PD). Allelic variation of CRHR1 was captured by 9 single-nucleotide polymorphisms (SNPs), which were genotyped in 531 matched case/control pairs. Four SNPs were found to be associated with PD, in at least one sub-sample. The minor allele of rs17689918 was found to significantly increase risk for PD in females after Bonferroni correction and furthermore decreased CRHR1 mRNA expression in human forebrains and amygdalae. When investigating neural correlates underlying this association in patients with PD using functional magnetic resonance imaging, risk allele carriers of rs17689918 showed aberrant differential conditioning predominantly in the bilateral prefrontal cortex and safety signal processing in the amygdalae, arguing for predominant generalization of fear and hence anxious apprehension. Additionally, the risk allele of rs17689918 led to less flight behavior during fear-provoking situations but rather increased anxious apprehension and went along with increased anxiety sensitivity. Thus reduced gene expression driven by CRHR1 risk allele leads to a phenotype characterized by fear sensitization and hence sustained fear. These results strengthen the role of CRHR1 in PD and clarify the mechanisms by which genetic variation in CRHR1 is linked to this disorder.Molecular Psychiatry advance online publication, 1 September 2015; doi:10.1038/mp.2015.125.
    Molecular Psychiatry 09/2015; DOI:10.1038/mp.2015.125 · 14.50 Impact Factor
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    ABSTRACT: The neural correlates of theory of mind (ToM) are typically studied using paradigms which require participants to draw explicit, task-related inferences (e.g., in the false belief task). In a natural setup, such as listening to stories, false belief mentalizing occurs incidentally as part of narrative processing. In our experiment, participants listened to auditorily presented stories with false belief passages (implicit false belief processing) and immediately after each story answered comprehension questions (explicit false belief processing), while neural responses were measured with functional magnetic resonance imaging (fMRI). All stories included (among other situations) one false belief condition and one closely matched control condition. For the implicit ToM processing, we modeled the hemodynamic response during the false belief passages in the story and compared it to the hemodynamic response during the closely matched control passages. For implicit mentalizing, we found activation in typical ToM processing regions, that is the angular gyrus (AG), superior medial frontal gyrus (SmFG), precuneus (PCUN), middle temporal gyrus (MTG) as well as in the inferior frontal gyrus (IFG) billaterally. For explicit ToM, we only found AG activation. The conjunction analysis highlighted the left AG and MTG as well as the bilateral IFG as overlapping ToM processing regions for both implicit and explicit modes. Implicit ToM processing during listening to false belief passages, recruits the left SmFG and billateral PCUN in addition to the "mentalizing network" known form explicit processing tasks. Hum Brain Mapp, 2015. © 2015 Wiley Periodicals, Inc.
    Human Brain Mapping 09/2015; DOI:10.1002/hbm.22907 · 5.97 Impact Factor
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    ABSTRACT: Introduction: Obsessive-compulsive disorder (OCD) is a common and chronic condition that can have disabling effects throughout the patient's lifespan. Frequent symptoms among OCD patients include fear of contamination and washing compulsions. Several studies have shown a link between contamination fears, disgust over-reactivity, and insula activation in OCD. In concordance with the role of insula in disgust processing, new neural models based on neuroimaging studies suggest that abnormally high activations of insula could be implicated in OCD psychopathology, at least in the subgroup of patients with contamination fears and washing compulsions. Methods: In the current study, we used a Brain Computer Interface (BCI) based on real-time functional magnetic resonance imaging (rtfMRI) to aid OCD patients to achieve down-regulation of the Blood Oxygenation Level Dependent (BOLD) signal in anterior insula. Our first aim was to investigate whether patients with contamination obsessions and washing compulsions can learn to volitionally decrease (down-regulate) activity in the insula in the presence of disgust/anxiety provoking stimuli. Our second aim was to evaluate the effect of down-regulation on clinical, behavioural and physiological changes pertaining to OCD symptoms. Hence, several pre- and post-training measures were performed, i.e., confronting the patient with a disgust/anxiety inducing real-world object (Ecological Disgust Test), and subjective rating and physiological responses (heart rate, skin conductance level) of disgust towards provoking pictures. Results: Results of this pilot study, performed in 3 patients (2 females), show that OCD patients can gain self-control of the BOLD activity of insula, albeit to different degrees. In two patients positive changes in behaviour in the EDT were observed following the rtfMRI trainings. Behavioural changes were also confirmed by reductions in the negative valence and in the subjective perception of disgust towards symptom provoking images. Conclusion: Although preliminary, results of this study confirmed that insula down-regulation is possible in patients suffering from OCD, and that volitional decreases of insula activation could be used for symptom alleviation in this disorder.
    PLoS ONE 08/2015; 10(8):e0135872. DOI:10.1371/journal.pone.0135872 · 3.23 Impact Factor
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    ABSTRACT: Showing empathy is crucial for social functioning and empathy is related to group membership. The aim of the current study was to investigate the influence of experimentally generated groups on empathy for pain in a functional magnetic resonance imaging (fMRI) paradigm. Thirty healthy participants underwent a minimal group paradigm to create two groups. While BOLD contrast was measured using fMRI, subjects were instructed to empathize with ingroup and outgroup members, who were depicted in a picture paradigm of painful and neutral situations. Behavioral measure of state empathy was measured using a visual analog scale. Furthermore, self-reported trait empathy measures were obtained. Repeated-measures ANOVAs were conducted for fMRI and behavioral data. In addition to a main effect of pain in pain-related areas, a main effect of group in areas belonging to the visual cortex was found. Although there was no ingroup bias for empathy ratings, subjects showed altered neural activation in regions of the right fusiform gyrus, the cerebellum, the hippocampal and amygdala region during the pain×group interaction. Activation in the preceding structures, revealed by the interaction of pain by group, suggests that activation in the pallidum might reflect specific empathy for pain-related regulation processes. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    08/2015; DOI:10.1016/j.pscychresns.2015.08.006
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    ABSTRACT: Adult attachment style (AAS) is a personality trait that affects social cognition. Behavioral data suggest that AAS influences mentalising proficiency, i.e. the ability to predict and explain people's behavior with reference to mental states, but the neural correlates are unknown. We here tested how the AAS dimensions "avoidance" (AV) and "anxiety" (ANX) modulate neural correlates of mentalising. We measured brain activation using fMRI in 164 healthy subjects during an interactive mentalising paradigm (prisoner's dilemma game). AAS was assessed with the Relationship Scales Questionnaire, including the subscales AV and ANX. Our task elicited a strong activation of the mentalising network, including bilateral precuneus, (anterior, middle, and posterior) cingulate cortices, temporal poles, inferior frontal gyri, temporoparietal junctions, superior medial frontal gyri as well as right medial orbital frontal gyrus, superior temporal gyrus, middle frontal gyrus, and amygdala. We found that AV is positively and ANX negatively correlated with task-associated neural activity in the right amygdala, middle frontal gyrus, midcingulate cortex, and superior parietal lobule, and in bilateral inferior frontal gyri. These data suggest that avoidantly attached adults activate brain areas implicated in emotion regulation and cognitive control to a larger extent than anxiously attached individuals during mentalising. Copyright © 2015. Published by Elsevier Ltd.
    Neuroscience 07/2015; 303:462-473. DOI:10.1016/j.neuroscience.2015.06.062 · 3.36 Impact Factor
  • Tilo Kircher
    World psychiatry: official journal of the World Psychiatric Association (WPA) 06/2015; 14(2):184-5. DOI:10.1002/wps.20212 · 14.23 Impact Factor
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    ABSTRACT: Depression is frequent in panic disorder (PD); yet, little is known about its influence on the neural substrates of PD. Difficulties in fear inhibition during safety signal processing have been reported as a pathophysiological feature of PD that is attenuated by depression. We investigated the impact of comorbid depression in PD with agoraphobia (AG) on the neural correlates of fear conditioning and the potential of machine learning to predict comorbidity status on the individual patient level based on neural characteristics. Fifty-nine PD/AG patients including 26 (44%) with a comorbid depressive disorder (PD/AG+DEP) underwent functional magnetic resonance imaging (fMRI). Comorbidity status was predicted using a random undersampling tree ensemble in a leave-one-out cross-validation framework. PD/AG-DEP patients showed altered neural activation during safety signal processing, while +DEP patients exhibited generally decreased dorsolateral prefrontal and insular activation. Comorbidity status was correctly predicted in 79% of patients (sensitivity: 73%; specificity: 85%) based on brain activation during fear conditioning (corrected for potential confounders: accuracy: 73%; sensitivity: 77%; specificity: 70%). No primary depressed patients were available; only medication-free patients were included. Major depression and dysthymia were collapsed (power considerations). Neurofunctional activation during safety signal processing differed between patients with or without comorbid depression, a finding which may explain heterogeneous results across previous studies. These findings demonstrate the relevance of comorbidity when investigating neurofunctional substrates of anxiety disorders. Predicting individual comorbidity status may translate neurofunctional data into clinically relevant information which might aid in planning individualized treatment. The study was registered with the ISRCTN: ISRCTN80046034. Copyright © 2015 Elsevier B.V. All rights reserved.
    Journal of Affective Disorders 06/2015; DOI:10.1016/j.jad.2015.05.052 · 3.38 Impact Factor
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    ABSTRACT: One of the key features of human interpersonal communication is our ability to integrate information communicated by speech and accompanying gestures. However, it is still not fully understood how this essential combinatory process is represented in the human brain. Functional magnetic resonance imaging (fMRI) studies have unanimously attested the relevance of activation in the posterior superior temporal sulcus/middle temporal gyrus (pSTS/MTG), while electroencephalography (EEG) studies have shown oscillatory activity in specific frequency bands to be associated with multisensory integration. In the current study, we used fMRI and EEG to separately investigate the anatomical and oscillatory neural signature of integrating intrinsically meaningful gestures (IMG; e.g. "Thumbs-up gesture") and corresponding speech (e.g., "The actor did a good job"). In both the fMRI (n=20) and EEG (n=20) study, participants were presented with videos of an actor either: performing IMG in the context of a German sentence (GG), IMG in the context of a Russian (as a foreign language) sentence (GR), or speaking an isolated German sentence without gesture (SG). The results of the fMRI experiment confirmed that gesture-speech processing of IMG activates the posterior MTG (GG>GR∩GG>SG). In the EEG experiment we found that the identical integration process (GG>GR∩GG>SG) is related to a centrally-distributed alpha (7-13Hz) power decrease within 700-1400ms post onset of the critical word. These new findings suggest that BOLD response increase in the pMTG and alpha power decrease represent the neural correlates of integrating intrinsically meaningful gestures with their corresponding speech. Copyright © 2015. Published by Elsevier Ltd.
    Neuropsychologia 05/2015; 72:27-42. DOI:10.1016/j.neuropsychologia.2015.04.018 · 3.30 Impact Factor
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    ABSTRACT: Aldosterone and mineralocorticoid receptor (MR)-function have been related to depression. We examined central and peripheral parameters of MR-function in order to characterize their relationship to clinical treatment outcome after six weeks in patients with acute depression. 30 patients with a diagnosis of major depression were examined 3 times over a 6 week period. Aldosterone and cortisol salvia samples were taken at 7.00 a.m. before patients got out of bed. Easy to use e-devices were used to measure markers of central MR function, i.e. slow wave sleep (SWS) and heart-rate variability (HRV). Salt-taste intensity (STI) and salt pleasantness (SP) of a 0.9% salt solution were determined by a newly developed scale. In addition, systolic blood pressure (SBP) and plasma electrolytes were determined as markers for peripheral MR activity. The relationship between the levels of these biomarkers at baseline and the change in clinical outcome parameters (Hamilton depression rating scale (HDRS)-21, anxiety, QIDS and BDI) after 6 weeks of treatment was investigated. A higher aldosterone/cortisol ratio (Aldo/Cort) (n = 17 due to missing values; p < 0.05) and lower SBP (n = 24; p < 0.05) at baseline predicted poor outcome, as measured with the HDRS, independent of gender. Only in male patients higher STI, lower SP, lower SWS (all n = 13) and higher HRV (n = 11) at baseline predicted good outcome p < 0.05). Likewise, in male patients low baseline sodium appears to be predictive for a poor outcome (n = 12; p = 0.05; based on HDRS-6). In conclusion, correlates of higher central MR-activation are associated with poorer clinical improvement, particularly in men. This contrasts with the finding of a peripheral MR-desensitization in more refractory patients. As one potential mechanism to consider, sodium loss on the basis of dysfunctional peripheral MR function and additional environmental factors may trigger increased aldosterone secretion and consequently worse outcome. These markers deserve further study as potential biological correlates for therapy refractory depression. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Journal of Psychiatric Research 04/2015; 96. DOI:10.1016/j.jpsychires.2015.04.012 · 3.96 Impact Factor
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    ABSTRACT: Regulator of G-protein Signaling 2 (RGS2) is a key regulator of G-protein-coupled signaling pathways involved in fear and anxiety. Data from rodent models and genetic analysis of anxiety-related traits and disorders in humans suggest down-regulation of RGS2 expression to be a risk factor for anxiety. Here we investigated, whether genetic variation in microRNAs mediating posttranscriptional down-regulation of RGS2 may be a risk factor for anxiety as well. 75 microRNAs predicted to regulate RGS2 were identified by four bioinformatic algorithms and validated experimentally by luciferase reporter gene assays. Specificity was confirmed for six microRNAs (hsa-miR-1271-5p, hsa-miR-22-3p, hsa-miR-3591-3p, hsa-miR-377-3p, hsa-miR-4717-5p, hsa-miR-96-5p) by disrupting their seed sequence at the 3' untranslated region of RGS2. Hsa-miR-4717-5p showed the most robust effect on RGS2 and regulated two other candidate genes of anxiety disorders (CNR1 and IKBKE) as well. Two SNPs (rs150925, rs161427) within and 1,000 bp upstream of the hostgene of hsa-miR-4717-5p (MIR4717) show a minor allele frequency greater than 0.05. Both were in high linkage disequilibrium (r(2) = 1, D' = 1) and both major (G) alleles showed a trend for association with panic disorder with comorbid agoraphobia in one of two patient/control samples (combined npatients = 497). Dimensional anxiety traits, as described by Anxiety Sensitivity Index (ASI) and Agoraphobic Cognitions Questionnaire (ACQ) were significantly higher among carriers of both major (G) alleles in a combined patient/control sample (ncombined = 831). Taken together, data indicate that MIR4717 regulates human RGS2 and contributes to the genetic risk towards anxiety-related traits. © 2015 Wiley Periodicals, Inc. © 2015 Wiley Periodicals, Inc.
    American Journal of Medical Genetics Part B Neuropsychiatric Genetics 04/2015; 168(4). DOI:10.1002/ajmg.b.32312 · 3.42 Impact Factor
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    Dataset: BAG German
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    ABSTRACT: See: Nagels, A., Kircher, T., Steines, M., Grosvald, M. & Straube, B. A brief self-rating scale for the assessment of individual differences in gesture perception and production. Learn. Individ. Differ. (2015). doi:10.1016/j.lindif.2015.03.008
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    ABSTRACT: Genome-wide association studies have reported an association between NCAN rs1064395 genotype and bipolar disorder. This association was later extended to schizophrenia and major depression. However, the neurobiological underpinnings of these associations are poorly understood. NCAN is implicated in neuronal plasticity and expressed in subcortical brain areas, such as the amygdala and hippocampus, which are critically involved in dysfunctional emotion processing and -regulation across diagnostic boundaries. We hypothesized that the NCAN risk variant is associated with reduced gray matter volumes in these areas. Gray matter structure was assessed by voxel-based morphometry on structural MRI-data in two independent German samples (healthy subjects, n=512; depressed inpatients, n=171). All participants were genotyped for NCAN rs1064395. Hippocampal and amygdala region-of-interest analyses were performed within each sample. Additionally, whole-brain data from the combined sample were analyzed. Risk (A)-allele carriers showed reduced amygdala and hippocampal gray matter volumes in both cohorts with a remarkable spatial overlap. In the combined sample, genotype effects observed for the amygdala and hippocampus survived correction for entire brain volume. Further effects were also observed in the left orbitofrontal cortex and the cerebellum/fusiform gyrus. We conclude that NCAN genotype is associated with limbic gray matter alterations in healthy and depressed subjects in brain areas implicated in emotion perception and -regulation. The present data suggest that NCAN forms susceptibility to neuro-structural deficits in the amygdala, hippocampus, and prefrontal areas independent of disease, which might lead to disorder onset in the presence of other genetic or environmental risk factors.Neuropsychopharmacology accepted article preview online, 24 March 2015. doi:10.1038/npp.2015.86.
    Neuropsychopharmacology: official publication of the American College of Neuropsychopharmacology 03/2015; 40(11). DOI:10.1038/npp.2015.86 · 7.05 Impact Factor
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    ABSTRACT: Gesture production and comprehension have a strong impact on speech comprehension and social communicative functioning. To facilitate research in this area, we created the ‘Brief Assessment of Gesture’ (BAG) tool, a set of 12 subjective statements relating to gesture production and perception in everyday life. Two hundred and twenty German native speakers were asked to rate each statement. Individual differences in empathy were assessed, to disentangle sensitivity to gesture production and perception from general empathic/social functioning. A principal component analysis revealed a four-factor solution, reflecting a production factor and a perception factor, each occurring with and without an empathy component. The current investigation yielded good psychometric results with a high reliability and internal consistency. Our findings suggest that BAG is a straightforward and useful tool to assess individual differences in gesture production and comprehension, as well as related social/empathic functioning. The BAG may serve as an important instrument for research in speech comprehension, cognitive development, language learning and social communicative functioning.
    Learning and Individual Differences 03/2015; DOI:10.1016/j.lindif.2015.03.008 · 1.58 Impact Factor
  • Yunbo Yang · Tilo Kircher · Benjamin Straube
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    ABSTRACT: Psychotherapy changes symptoms through neuroplastic processes in the brain. Neurobiological Models of cognitive behavioral therapy (CBT) effects postulate that the therapeutic changes could be a result of a direct inhibition of bottom-up neural processes and/or enhancement of top-down regulatory brain systems. The current review summarizes recent findings about the neural correlates of CBT in panic disorder, partly supporting and substantially modifying these models. Furthermore, this review focuses on neural biomarkers of therapy response and the neural correlates of genetic moderators of therapy effects. These findings might potentially be useful for person- alized treatment in the future. Finally, we will discuss some future perspectives of the neurosciences in psychotherapy research.
    Zeitschrift für Psychiatrie Psychologie und Psychotherapie 03/2015; 63:79-87. DOI:10.1024/1661-4747/a000226 · 1.99 Impact Factor
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    ABSTRACT: Accumulating evidence from mouse models points to the G protein-coupled receptor RGS2 (regulator of G-protein signaling 2) as a promising candidate gene for anxiety in humans. Recently, RGS2 polymorphisms were found to be associated with various anxiety disorders, e.g., rs4606 with panic disorder (PD), but other findings have been negative or inconsistent concerning the respective risk allele. To further examine the role of RGS2 polymorphisms in the pathogenesis of PD, we genotyped rs4606 and five additional RGS2 tag single nucleotide polymorphisms (SNPs; rs16834831, rs10801153, rs16829458, rs1342809, rs1890397) in two independent PD samples, comprising 531 matched case/control pairs. The functional SNP rs4606 was nominally associated with PD when both samples were combined. The upstream SNP rs10801153 displayed a Bonferroni-resistant significant association with PD in the second and the combined sample (P = 0.006 and P = 0.017). We furthermore investigated the effect of rs10801153 on dimensional anxiety traits, a behavioral avoidance test (BAT), and an index for emotional processing in the respective subsets of the total sample. In line with categorical results, homozygous risk (G) allele carriers displayed higher scores on the Agoraphobic Cognitions Questionnaire (ACQ; P = 0.015) and showed significantly more defensive behavior during fear provoking situations (P = 0.001). Furthermore, significant effects on brain activation in response to angry (P = 0.013), happy (P = 0.042) and neutral faces (P = 0.032) were detected. Taken together, these findings provide further evidence for the potential role of RGS2 as a candidate gene for PD. © 2015 Wiley Periodicals, Inc. © 2015 Wiley Periodicals, Inc.
    American Journal of Medical Genetics Part B Neuropsychiatric Genetics 03/2015; DOI:10.1002/ajmg.b.32299 · 3.42 Impact Factor
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    ABSTRACT: During face-to-face communication, body orientation and coverbal gestures influence how information is conveyed. The neural pathways underpinning the comprehension of such nonverbal social cues in everyday interaction are to some part still unknown. During fMRI data acquisition, 37 participants were presented with video clips showing an actor speaking short sentences. The actor produced speech-associated iconic gestures (IC) or no gestures (NG) while he was visible either from an egocentric (ego) or from an allocentric (allo) position. Participants were asked to indicate via button press whether they felt addressed or not. We found a significant interaction of body orientation and gesture in addressment evaluations, indicating that participants evaluated IC-ego conditions as most addressing. The anterior cingulate cortex (ACC) and left fusiform gyrus were stronger activated for egocentric versus allocentric actor position in gesture context. Activation increase in the ACC for IC-ego>IC-allo further correlated positively with increased addressment ratings in the egocentric gesture condition. Gesture-related activation increase in the supplementary motor area, left inferior frontal gyrus and right insula correlated positively with gesture-related increase of addressment evaluations in the egocentric context. Results indicate that gesture use and body-orientation contribute to the feeling of being addressed and together influence neural processing in brain regions involved in motor simulation, empathy and mentalizing. Hum Brain Mapp, 2015. © 2014 Wiley Periodicals, Inc.
    Human Brain Mapping 01/2015; 36(5). DOI:10.1002/hbm.22746 · 5.97 Impact Factor
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    ABSTRACT: Adaption to changing environments is evolutionarily advantageous. Studies that link genetic and phenotypic expression of flexible adjustment to one's context are largely lacking. In this study, we tested the importance of psychological flexibility, or goal-related context sensitivity, in an interaction between psychotherapy outcome for panic disorder with agoraphobia (PD/AG) and a genetic polymorphism. Given the established role of the 5HTT-LPR polymorphism in behavioral flexibility, we tested whether this polymorphism (short group vs. long group) impacted therapy response as a function of various endophenotypes (i.e., psychological flexibility, panic, agoraphobic avoidance, and anxiety sensitivity). Patients with PD/AG were recruited from a large multicenter randomized controlled clinical trial on cognitive-behavioral therapy. Pre- to post-treatment changes by 5HTT polymorphism were analyzed. 5HTT polymorphism status differentiated pre- to post-treatment changes in the endophenotype psychological flexibility (effect size difference d = 0.4, p < 0.05), but none of the specific symptom-related endophenotypes consistently for both the intent-to-treat sample (n = 228) and the treatment completers (n = 194). Based on the consistency of these findings with existing theory on behavioral flexibility, the specificity of the results across phenotypes, and the consistency of results across analyses (i.e., completer and intent to treat), we conclude that 5HTT polymorphism and the endophenotype psychological flexibility are important variables for the treatment of PD/AG. The endophenotype psychological flexibility may help bridge genetic and psychological literatures. Despite the limitation of the post hoc nature of these analyses, further study is clearly warranted.
    European Archives of Psychiatry and Clinical Neuroscience 01/2015; 265(5). DOI:10.1007/s00406-015-0575-3 · 3.53 Impact Factor
  • H.O. Röttgers · L. Dietzsch · T. Kircher
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    ABSTRACT: The Marburg Forum for Obsessive-Compulsive Disorders is a regional, innovative project to optimise the care for patients with obsessive- compulsive disorder (OCD). Although evidence based psychotherapeutic and pharmacological treatment has improved the outcome over the past years, the national and international treatment guidelines are often not adhered to. The Marburg Forum for Obsessive- Compulsive Disorders is an interdisciplinary network to improve care by enhancing communication between in- and outpatient treatment providers and implementation of multiple other measures for patients, their relatives and therapists. For example courses for lay persons and postgraduate training are arranged as well as regular press releases. By its multilevel approach the Marburg Forum for Obsessive- Compulsive Disorders helps at improving the care of OCD patients.

Publication Stats

7k Citations
1,416.88 Total Impact Points


  • 2007–2015
    • Philipps University of Marburg
      • • Institute for German Linguistics
      • • Fachbereich Psychologie
      Marburg, Hesse, Germany
    • University of Wuerzburg
      • Department of Psychiatry, Psychosomatics, and Psychotherapy
      Würzburg, Bavaria, Germany
    • Ruhr-Universität Bochum
      • Arbeitsgruppe Klinische Psychologie und Psychotherapie
      Bochum, North Rhine-Westphalia, Germany
    • Universität des Saarlandes
      • Klinische Neuropsychologie
      Homburg, Saarland, Germany
    • Psychiatrische Universitätsklinik Zürich
      Zürich, Zurich, Switzerland
    • LWL-Klinik Marsberg
      Marsberg, North Rhine-Westphalia, Germany
    • Universität Heidelberg
      • Department of General Psychiatry
      Heidelburg, Baden-Württemberg, Germany
    • Otto-Friedrich-Universität Bamberg
      Bamberg, Bavaria, Germany
    • Universität Ulm
      • Klinik für Psychiatrie und Psychotherapie III (Ulm)
      Ulm, Baden-Wuerttemberg, Germany
    • University of Cambridge
      Cambridge, England, United Kingdom
    • Humboldt University of Berlin
      • Department of Psychology
      Berlin, Land Berlin, Germany
  • 2013
    • Technische Universität Dresden
      • Department of Psychology
      Dresden, Saxony, Germany
    • Vitos Gießen-Marburg
      Giessen, Hesse, Germany
  • 2005–2011
    • RWTH Aachen University
      • Department of Psychiatry, Psychotherapy and Psychosomatics
      Aachen, North Rhine-Westphalia, Germany
  • 2009
    • The University of York
      • Department of Psychology
      York, ENG, United Kingdom
  • 2005–2009
    • University Hospital RWTH Aachen
      • Department of Neurology
      Aachen, North Rhine-Westphalia, Germany
  • 1997–2009
    • University of Tuebingen
      • • Department of Psychiatry and Psychotherapy
      • • Department of Neurology
      • • Institute of Medical Psychology and Behavioral Neurobiology
      Tübingen, Baden-Wuerttemberg, Germany
  • 2006–2007
    • University of Cologne
      • Department of Psychiatry and Psychotherapy
      Köln, North Rhine-Westphalia, Germany
  • 2004
    • Max Planck Society
      München, Bavaria, Germany
  • 2002
    • University of Nottingham
      Nottigham, England, United Kingdom
  • 2000
    • London Research Institute
      Londinium, England, United Kingdom