Alexander Rapp

• Doctor of Medicine
• University of Tübingen

The popularity of balneology and medical climatology among medical students has scarcely been investigated but may represent a pertinent topic for the field. Methods: A survey was conducted among 53 German medical students (80% female; mean age 22.5 years; 39% pre-clinical stage) on attitudes and interest in spa medicine, their associations with th...

Humor has been shown to have protective effects against the increased risk of posttraumatic stress symptomatology in emergency professionals. However, the acceptance of humor in the context of emergency medicine is controversial. The aim of this study is to investigate how often and in what context humor is used by emergency workers and physicians,...

Background In verbal irony we often convey meanings that oppose the literal words. To look behind these words, we need to integrate perspectives of ourselves, others, and their beliefs about us. Although patients with borderline personality disorder (BPD) experience problems in social cognition and schizotypal symptoms, research on irony comprehens...

Background: In verbal irony we often convey meanings that oppose the literal words. To look behind these words, we need to integrate perspectives of ourselves, others, and their beliefs about us. Although patients with borderline personality disorder (BPD) experience problems in social cognition and schizotypal symptoms, research on irony comprehen...

Deficits in the comprehension of nonliteral language such as proverbs have long been considered as a core symptom of schizophrenia. Traditionally, the problems of schizophrenia patients with proverb interpretation, as an example pragmatic language impairment, have been linked to an inability to abstract from the literal words. As patients tend to s...

Objectives: Intended meanings in verbal irony differ from those of the actual words. To look behind these words, we need to integrate perspectives of ourselves, others, and their beliefs about us. Although patients with borderline personality disorder (BPD) experience problems in social cognition and schizotypal symptoms, research on irony comprehe...

Schizophrenia has been associated with structural brain abnormalities and cognitive deficits that partly change during the course of illness. In the present study, cortical thickness in five subregions of the cingulate gyrus was assessed in 44 patients with schizophrenia-spectrum disorder and 47 control persons and related to illness duration and m...

Background: Mental disorders during pregnancy are common and affect the health of mother and child. Despite a relatively high prevalence rate, treatment options have not been investigated systematically. Particularly symptoms of posttraumatic stress disorder (PTSD) may increase significantly during the course of pregnancy. However, proper guideline...

Introduction: Research on social cognition in borderline personality disorder (BPD) repeatedly showed specific impairments in ambiguous context (e.g. facial expressions). But so far, there are no studies examining the effect of ambiguity within our everyday ‘medium’ of social cognition: spoken language. There, ambiguity is particularly apparent whe...

Research on figurative language has a long tradition in psychiatry, as it is employed in psychotherapy and its (mis)comprehension plays a substantial role in differential diagnostics of schizophrenic spectrum disorders. Although often associated with empathy and mentalization, it has never been addressed in borderline personality disorder (BPD). Th...

Irony has repeatedly been suggested as a language based social cognition task. It has been argued to show specific variances in psychiatric disorders and healthy adults with certain personality traits. Above that, irony comprehension is based on a complex interplay of the informational context, the relationship of the conversational partners, and t...

Item statistics for healthy individuals (N = 96) in the irony detection accuracy test tuerony. Percentage of correct answers and item statistics for single items within the categories ironic criticism, ironic praise, literal criticism, and literal praise are presented. Items with 100% of correct answers were excluded from item statistics (ironic cr...

Performance of healthy individuals in the irony detection accuracy test tuerony. Survey of total scores, subscores, and perceived criticism and praise in the total sample (N = 96) and specified for females (n = 59) and males (n = 37).

One version of the Tuebingen Test of Irony Detection Accuracy with the conditions actress and neutral observer. The test follows the presentation of Supplementary Video 1.

Additional analyses for alternative subscales, considering literality and irony as separate values. Mean values and standard deviations for self-involvement (neutral observer/direct interaction) and stereotypes (doctor/actor) on irony detection accuracy for the total population (N = 96).

A simplified version of the original answer sheet, containing a dichotomous scale (ironic vs. literal) and a five-point smiley-based Likert scale (critical to praising).

Video instruction for the Tuebingen Test of Irony Detection Accuracy presenting the social situation in a variation of perspective (direct/neutral observation) and speaker's occupation (doctor/actor). The video shows a combination of the conditions actress (speaker‘s occupation) and neutral observer (perspective).

The latent structure of schizotypy and psychosis-spectrum symptoms remains poorly understood. Furthermore, molecular genetic substrates are poorly defined, largely due to the substantial resources required to collect rich phenotypic data across diverse populations. Sample sizes of phenotypic studies are often insufficient for advanced structural eq...

Background Social cognition tasks with higher ecologically validity could be helpful both as an outcome measure for training and for social cognition impairment in schizophrenia. The comprehension of sarcasm and irony is a candidate for a valid, replicable task. Methods Tests and paradigms as well as studies in schizophrenia are available in Engli...

Miscomprehension of nonliteral (“figurative”) language like metaphors, proverbs, idioms, and ironic expressions by patients with schizophrenia is a phenomenon mentioned already in historical psychiatric descriptions. However, it was only recently that studies did differentiate between novel and conventional metaphors, a factor that is known to infl...

Irony can be seen as a pragmatic form of social cognition and has been reported as being impaired in autism spectrum disorders and schizotypal personality traits. However, no standardised instrument to evaluate different facets of irony comprehension exists and other psychiatric personality dimensions have rarely been examined. This study aims at c...

The present study aimed at investigating neurophysiological markers of language perception in schizophrenia using simultaneous near-infrared spectroscopy (NIRS) and event-related potentials (ERPs), which have been proven to be useful for studying language processing abilities in psychiatric patients. The study shall help to integrate previous findi...

Schizotypy refers to a set of personality traits thought to reflect the subclinical expression of the signs and symptoms of schizophrenia. Here, we review the cognitive and brain functional profile associated with high questionnaire scores in schizotypy. We discuss empirical evidence from the domains of perception, attention, memory, imagery and re...

Difficulties in understanding irony and sarcasm are part of the social cognition deficits in patients with schizophrenia. A number of studies have reported higher error rates during comprehension in patients with schizophrenia. However, the relationships of these impairments to schizotypal personality traits and other language deficits, such as the...

The simultaneous application of different neuroimaging methods combining high temporal and spatial resolution can uniquely contribute to current issues and open questions in the field of pragmatic language perception. In the present study, comprehension of novel metaphors was investigated using near-infrared spectroscopy (NIRS) combined with the si...

Ironic remarks are frequent in everyday language and represent an important form of social cognition. Increasing evidence indicates a deficit in comprehension in schizophrenia. Several models for defective comprehension have been proposed, including possible roles of the medial prefrontal lobe, default mode network, inferior frontal gyri, mirror ne...

Numerous authors have hypothesised that abnormal pathways for language play a key role in the pathophysiology of schizophrenia, a notion that is supported by structural imaging and post-mortem findings especially in patients with thought disorder and auditory verbal hallucinations. Recently, an increasing number of functional magnetic resonance ima...

Attributions are constantly assigned in everyday life. A well-known phenomenon is the self-serving bias: that is, people's tendency to attribute positive events to internal causes (themselves) and negative events to external causes (other persons/circumstances). Here, we investigated the neural correlates of the cognitive processes implicated in se...

Hintergrund: Das auf drei Jahre geplante Projekt SURE (Substitutionsgestützte Rehabilitation) wurde unter dem Eindruck initiiert, dass immer weniger opiatabhängige Menschen eine Abstinenz voraussetzende Rehabilitation wahrnehmen und stattdessen dauerhaft in Substitution verbleiben. Fragestellung: Gelingt es, langjährig Substituierte in einer abstin...

This chapter gives a short overview on why the brain´s functional neuroanatomy of nonliteral language is an interesting topic for several research disciplines. A short introduction of brain lesion research and functional magnetic resonance imaging research on metaphor, metonymy, proverbs, idioms, irony and sarcasm is presented, with a literature in...

Brain Lesion Studies on MetaphorFunctional Magnetic Resonance ResearchAn ALE Meta-AnalysisConclusion References

An increasing number of studies have investigated non-literal language, including metaphors, idioms, metonymy, or irony, with functional magnetic resonance imaging (fMRI). However, key questions regarding its neuroanatomy remain controversial. In this work, we used coordinate-based activation-likelihood estimations to merge available fMRI data on n...

Impaired set-shifting has been reported in patients with anorexia nervosa (AN) and in patients with affective disorders, including major depression. Due to the prevalent comorbidity of major depression in AN, this study aimed to examine the role of depression in set-shifting ability. Fifteen patients with AN without a current comorbid depression, 2...

The knowledge of the specificity of cognitive biases in psychiatric disorders is important in order to develop disorder-specific cognitive models and therapies. This cross-sectional study aimed to investigate the specificity of jumping to conclusions (JTC) and attributional biases (AB) for patients with schizophrenia. Twenty patients with paranoid...

Cognitive behavioural therapy (CBT) is an important treatment in conjunction with psychopharmacotherapy in schizophrenia. However, there is only very little research on the effects of such interventions on brain function. Recent studies have suggested that jumping to conclusions and a specific attributional bias is a predominant cognitive style in...

There is evidence that patients with persecutory delusions tend to attribute excessively hypothetical positive events to internal causes and hypothetical negative events to external causes, arrive at hasty conclusions and fail in gathering and assessing adequate feedback, particularly when emotionally salient material is involved. Research on the n...

Metonymies are exemplary models for complex semantic association processes at the sentence level. We investigated processing of metonymies using event-related functional magnetic resonance imaging (fMRI). During an 1.5Tesla fMRI scan, 14 healthy subjects (12 female) read 124 short German sentences with either literal (like "Africa is arid"), metony...

Behavioral and electrophysiological data indicate compromised stimulus suppression in schizophrenia. The physiological basis of this effect and its contributions to the etiology of the disease are poorly understood. We examined neural and metabolic measures of P50 suppression in 12 patients with schizophrenia and controls. First, whole-head magneto...

The use of nonliteral language in clinical assessment, especially testing the patients' ability to interpret proverbs, has a long tradition in psychiatry. However, its diagnostic sensitivity and specificity in dementias is not yet clear. The aim of this review article is to examine the current evidence on nonliteral/figurative language (proverb, me...

To detect that a conversational turn is intended to be ironic is a difficult challenge in everyday language comprehension. Most authors suggested a theory of mind deficit is crucial for irony comprehension deficits in psychiatric disorders like schizophrenia; however, the underlying pathophysiology and neurobiology are unknown and recent research h...

In 1861 Paul Broca discovered that, in most individuals, the left hemisphere of the brain is dominant for language. Taking language as an example, the first part of this book explains the normal development of bodily asymmetry and lateralization, its association with hand preference, genetic aspects, geographical differences and the influence of ge...

The Neuregulin (NRG1) gene has been associated with schizophrenia, but its functional implications are largely unknown. Our aim was to assess differential brain activation between patients carrying an at-risk allele on the Neuregulin 1 gene and patients without this genetic risk. Neural signal changes between 14 first episode schizophrenia patients...

Having a good "sense of humor" is an important personality characteristic that significantly influences social communication and may represent an important coping strategy. To take things "with humor" does not only represent a state characteristic but also a personality trait that can reliably be assessed with questionnaires like the "state-trait-c...

We investigated processing of metaphoric sentences using event-related functional magnetic resonance imaging (fMRI). Seventeen healthy subjects (6 female, 11 male) read 60 novel short German sentence pairs with either metaphoric or literal meaning and performed two different tasks: judging the metaphoric content and judging whether the sentence has...

A main feature of schizophrenic thought and language disturbance is concretism, the inability to understand the figurative meaning of proverbs and metaphors. Although this is routinely tested during clinical interview, its neural basis is unknown. We investigated processing of metaphoric sentences with functional magnetic resonance imaging (fMRI) i...

Working memory dysfunction is a prominent impairment in patients with schizophrenia. Our aim was to determine cerebral dysfunctions by means of functional magnetic resonance imaging (fMRI) in a large sample of first-episode schizophrenia patients during a working memory task. 75 first-episode schizophrenia patients and 81 control subjects, recruite...

According to traditional European naturopathy garlic is an agent that increases perfusion. In studies with healthy subjects and in-vitro research garlic has shown influences on erythrocyte and thrombocyte aggregation as well as on vasoregulation. However, data on its effects in clinical populations are still lacking. Garlic may be useful for system...

The interrelationships among humor, smiling, and grinning have fascinated philosophers for millennia and neurologists for over a century. A functional dissociation between emotional facial expressions and those under voluntary control was suggested decades ago. Recent functional imaging studies, however, have been somewhat at odds with older studie...

Metaphoric language is used to express meaning that is otherwise difficult to conceptualize elegantly. Beyond semantic analysis, understanding the figurative meaning of a metaphor requires mental linkage of different category domains normally not related to each other. We investigated processing of metaphoric sentences using event-related functiona...

Mismatch negativity is an event-related brain response sensitive to deviations within a sequence of repetitive auditory stimuli. It is thought to reflect short-term sensory memory and is independent of higher-level cognitive processes. Mismatch negativity response is diminished in patients with schizophrenia. Little is known about the mechanisms of...

Ziel der Arbeitsgruppe ist die Erforschung von Genese und Ätiologie psychiatrischer Erkrankungen. Schwerpunkte sind Schizophrenie und Alzheimer-Demenz. Es werden dabei bildgebende Verfahren (fMRT, strukturelles MRT, MEG, EEG) und experimentalpsychologische Verfahren (v.a. Reaktionszeitexperimente) eingesetzt und kognitionspsychologische Modelle zur...

Perception of upright faces relies on configural processing. Therefore recognition of inverted, compared to upright faces is impaired. In a functional magnetic resonance imaging experiment we investigated the neural correlate of a face inversion task. Thirteen healthy subjects were presented with a equal number of upright and inverted faces alterna...

The central auditory system of the human brain uses a variety of mechanisms to analyze auditory scenes, among others, preattentive detection of sudden changes in the sound environment. Electroencephalography (EEG) and magnetoencephalography (MEG) provide a measure to monitor neuronal cortical currents. The mismatch negativity (MMN) or field (MMNm)...