Peter Falkai

Ludwig-Maximilians-Universität in Munich | LMU · Department of Psychiatry

Intermittent theta burst stimulation (iTBS), a variant of repetitive transcranial magnetic stimulation (rTMS), is an established treatment for adults with major depressive disorder (MDD). Due to its favorable safety profile, iTBS is also a promising early intervention in the transition phase from adolescence to early adulthood, but this has not bee...

Background: A better mechanistic understanding of schizophrenia spectrum disorders is crucial to develop efficient treatment approaches. Therefore, this study investigated longitudinal interrelations between clinical outcomes, brain structure, and somatic health in post-acute individuals from the schizophrenia spectrum. Methods: A sample of 63 post...

Background: As a condition of dysconnectivity, schizophrenia spectrum disorders (SSD) are characterized by positive, negative, and cognitive symptoms. To improve these symptoms in SSD, physical exercise interventions show promise. We examined if reductions of functional dysconnectivity following exercise therapy are associated with clinical improve...

The blood-cerebrospinal fluid barrier (BCB) builds an integral interface between the central nervous system and the periphery and appears to be impaired in a substantial proportion of individuals with schizophrenia-spectrum disorders (SSD). Even though a disruption of the BCB is associated with higher symptom severity, factors linked to BCB disrupt...

Background Electroencephalography (EEG) is a noninvasive, cost-effective, and robust tool, which directly measures in vivo neuronal mass activity with high temporal resolution. Combined with state-of-the-art machine learning (ML) techniques, EEG recordings could potentially yield in silico biomarkers of severe mental disorders. Hypothesis Patholog...

Background and Hypothesis Abnormal psychomotor behavior is a core schizophrenia symptom. However, assessment of motor abnormalities with expert rating scales is challenging. The Positive and Negative Syndrome Scale (PANSS) includes 3 items broadly related to hypokinetic motor behavior. Here, we tested whether a sum score of the PANSS items manneris...

Schizophrenia is a severe mental disorder with a neurodevelopmental origin whose pathophysiological processes are poorly understood. Magnetic resonance imaging studies have shown structural alterations, such as volume loss in the temporal lobe, including the hippocampus and amygdala, thalamus, and frontal and temporal cortex, while other studies ha...

In addition to understanding empathy in an affective and cognitive dimension, the physiological domain plays a crucial role, especially in the emotional dynamics of interpersonal interactions during psychotherapy. Within the complex bio-psycho-social system of cognitive behavioural therapy language, cognition, emotion and physiological states of bo...

Introduction Schizophrenia is a chronic neuropsychiatric disorder that often requires long-term pharmacotherapy to manage symptoms and prevent relapse. There are important clinical differences between early-stage versus late-stage schizophrenia, like the predominant symptomatology. In later stages, negative, cognitive, and anxiety/depressive sympto...

Importance: As an accessible part of the central nervous system, the retina provides a unique window to study pathophysiological mechanisms of brain disorders in humans. Imaging and electrophysiological studies have revealed retinal alterations across several neuropsychiatric and neurological disorders. However, it remains largely unclear whether p...

Background Clinical practice guidelines are crucial for enhancing healthcare quality and patient outcomes. Yet, their implementation remains inconsistent across various professions and disciplines. Previous findings on the implementation of the German guideline for schizophrenia (2019) revealed low adherence rates among healthcare professionals. Ba...

Many bipolar disorder (BD) patients are non-responsive to lithium. The mechanisms underlying lithium (non-)responsiveness are largely unknown. By using gene-set enrichment analysis methods, we found that core clock gene-sets are significantly associated with lithium response. Among the top hits was BHLHE41, a modulator of the molecular clock and ho...

Stratified medicine holds great promise to tailor treatment to the needs of individual patients. While genetics holds great potential to aid patient stratification, it remains a major challenge to operationalize complex genetic risk factor profiles to deconstruct clinical heterogeneity. Contemporary approaches to this problem rely on polygenic risk...

Background Lithium (Li) remains the treatment of choice for bipolar disorders (BP). Its mood-stabilizing effects help reduce the long-term burden of mania, depression and suicide risk in patients with BP. It also has been shown to have beneficial effects on disease-associated conditions, including sleep and cardiovascular disorders. However, the in...

Objective: Patients with borderline personality disorder (BPD) report to be especially prone to social emotions like shame and guilt. At the same time, these emotions seem to play an important role in BPD pathology. The present study aimed to deepen the knowledge about the processes behind shame and guilt in patients with BPD. Methods: Twenty patie...

Background Climate change is one of the greatest threats to health that societies face and can adversely affect mental health. Given the current lack of a European consensus paper on the interplay between climate change and mental health, we signal a need for a pan-European position paper about this topic, written by stakeholders working in mental...

Cognitive symptoms (CS) belong to the most common manifestations of the Post COVID-19 (PC) condition. We sought to objectify CS in PC patients using routine diagnostic assessments: neurocognitive testing (NCT) and brain imaging (BI). Further, we investigated possible associations of CS with patient reported outcomes (PROs), and risk factors for dev...

Zusammenfassung Psychosen aus dem schizophrenen Formenkreis gehen mit deutlichen kognitiven Beeinträchtigungen einher, die nach klinischer Symptomremission oft noch in relevantem Ausmaß persistieren und negative Auswirkungen auf die psychosoziale Funktionsfähigkeit haben. Diese Beeinträchtigungen werden von Betroffenen oft als sehr belastend erlebt...

Background: Optical coherence tomography and electroretinography studies have revealed structural and functional retinal alterations in individuals with schizophrenia spectrum disorders (SSDs). However, it remains unclear which specific retinal layers are affected; how the retina, brain, and clinical symptomatology are connected; and how alteration...

The response variability to repetitive transcranial magnetic stimulation (rTMS) challenges the effective use of this treatment option in patients with schizophrenia. This variability may be deciphered by leveraging predictive information in structural MRI, clinical, sociodemographic, and genetic data using artificial intelligence. We developed and...

Background Depression is a common mental health disorder and the second leading cause of disability worldwide. In people with depression, low depression literacy, which could be characterized by a poor recognition of depressive symptoms and less knowledge about the availability of treatment options, can hinder adequate therapy for depression. Never...

Micro RNAs (miRNAs) play a crucial role as regulators of various biological processes and have been implicated in the pathogenesis of mental disorders such as schizophrenia and bipolar disorders. In this study, we investigate the expression patterns of miRNAs in the PsyCourse Study (n=1,786), contrasting three broad diagnostic groups: Psychotic (Sc...

The link between bipolar disorder (BP) and immune dysfunction remains controversial. While epidemiological studies have long suggested an association, recent research has found only limited evidence of such a relationship. To clarify this, we performed an exploratory study of the contributions of immune-relevant genetic factors to the response to l...

Background Weight gain is a common side effect in psychopharmacology; however, targeted therapeutic interventions and prevention strategies are currently absent in day‐to‐day clinical practice. To promote the development of such strategies, the identification of factors indicative of patients at risk is essential. Methods In this study, we develop...

Exercise interventions are nowadays considered as effective add-on treatments in people with schizophrenia but are usually associated with high dropout rates. Therefore, the present study investigated potential predictors of adherence from a large multicenter study, encompassing two types of exercise training, conducted over a 6-month period with i...

Current approaches to the treatment of schizophrenia have mainly focused on the protein-coding part of the genome; in this context, the roles of microRNAs have received less attention. In the present study, we analyze the microRNAome in the blood and postmortem brains of schizophrenia patients, showing that the expression of miR-99b-5p is downregul...

Background: The evidence for repetitive transcranial magnetic stimulation (rTMS) to treat negative symptoms in schizophrenia (SCZ) is increasing, although variable response rates remain a challenge. Subject´s sex critically influences rTMS´ treatment outcomes. Females with major depressive disorder are more likely to respond to rTMS, while SCZ dat...

Zusammenfassung Hintergrund Aufgrund der hohen Krankheitslast, des frühen Beginns und der oft langfristigen Verläufe zählen psychische Erkrankungen zu den Volkskrankheiten mit wachsender Bedeutung. Das Deutsche Zentrum für Psychische Gesundheit (DZPG) wurde gegründet, um Forschungsbedingungen zu verbessern und versorgungsrelevante Ergebnisse schne...

Background Considering the recently growing number of potentially traumatic events in Europe, the European Psychiatric Association undertook a study to investigate clinicians’ treatment choices for post-traumatic stress disorder (PTSD). Methods The case-based analysis included 611 participants, who correctly classified the vignette as a case of PT...

Lithium is the gold standard treatment for bipolar disorder (BD). However, its mechanism of action is incompletely understood, and prediction of treatment outcomes is limited. In our previous multi-omics study of the Pharmacogenomics of Bipolar Disorder (PGBD) sample combining transcriptomic and genomic data, we found that focal adhesion, the extra...

Symptom heterogeneity characterizes psychotic disorders and hinders the delineation of underlying biomarkers. Here, we identify symptom-based subtypes of recent-onset psychosis (ROP) patients from the multi-center PRONIA (Personalized Prognostic Tools for Early Psychosis Management) database and explore their multimodal biological and functional si...

Background The prevalence of medical illnesses is high among patients with psychiatric disorders. The current study aimed to investigate multi-comorbidity in patients with psychiatric disorders in comparison to the general population. Secondary aims were to investigate factors associated with metabolic syndrome and treatment appropriateness of ment...

We aimed to develop a simple predictive model that enables health care workers (HCWs) to self-assess pandemic-related psychological distress in order to assist them to find psychological support to avert adverse distress-related outcomes. In a pilot study, we recruited and followed longitudinally 220 HCWs at the Hospital of the Ludwig Maximilian Un...

Schizophrenia (SCZ) is a genetically heterogenous psychiatric disorder of highly polygenic nature. Correlative evidence from genetic studies indicate that the aggregated effects of distinct genetic risk factor combinations found in each patient converge onto common molecular mechanisms. To prove this on a functional level, we employed a reductionis...

The sudden appearance and devastating effects of the COVID-19 pandemic resulted in the need for multiple adaptive changes in societies, business operations and healthcare systems across the world. This review describes the development and increased use of digital technologies such as chat bots, electronic diaries, online questionnaires and even vid...

Background and Hypothesis: Previous studies have suggested that choroid plexus (ChP) enlargement occurs in individuals with schizophrenia-spectrum disorders (SSD) and is associated with peripheral inflammation. However, it is unclear whether such an enlargement delineates a biologically defined subgroup of SSD. Moreover, it remains elusive how ChP...

Background: Previous studies investigating disruptions in central nervous system (CNS) barriers in schizophrenia spectrum disorders (SSD) mainly focused on cerebrospinal fluid (CSF) markers, that cannot adequately assess blood-brain barrier (BBB) integrity. Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) represents a sensitive method...

The digitalisation of mental health care is expected to improve the accessibility and quality of specialised treatment services and introduce innovative methods to study, assess, and monitor mental health disorders. In this narrative review and practical recommendation of the European Psychiatric Association (EPA), we aim to help healthcare provide...

Unipolar depression is a prevalent and disabling condition, often left untreated. In the outpatient setting, general practitioners fail to recognize depression in about 50% of cases mainly due to somatic comorbidities. Given the significant economic, social, and interpersonal impact of depression and its increasing prevalence, there is a need to im...

Physical activity (PA) has positive effects on various health aspects and neuronal functions, including neuronal plasticity. Exceeding a certain exercise frequency and duration has been associated with negative effects. Our study investigated the effects of excessive PA with a marathon run (MA) and regular PA (training and recovery phases) on elect...

Background: Lithium (Li) remains the treatment of choice for bipolar disorders (BP). Its mood-stabilizing effects help reduce the long-term burden of mania, depression and suicide risk in patients with BP. It also has been shown to have beneficial effects on disease-associated conditions, including sleep and cardiovascular disorders. However, the i...

Background The European Psychiatric Association (EPA) is an organization that speaks on behalf of its individual members and members of National Psychiatric Associations (NPAs). The aim of this study to identify and investigate current contents of ethical codes and practices in the countries belonging to EPA. Methods The study is an expert survey...

Zusammenfassung Hintergrund Depressive Erkrankungen stellen sehr häufige Beratungsanlässe in der Hausarztpraxis dar. Aktuelle evidenzbasierte Leitlinien für Diagnostik und Therapie von unipolarer Depression unterstützen Hausärzt*Innen bei der Behandlung der Patient*Innen. Ziele der Arbeit Die Nationalen Versorgungsleitlinie (NVL) Unipolare Depres...

Background Suicidality, ranging from passive suicidal thoughts to suicide attempt, is common in major depressive disorder (MDD). However, relatively little is known about patient, illness and treatment characteristics in those with co-occurring MDD and suicidality, including the timing of and factors associated with the offset, continuation or reem...

Zielsetzung: Die vorliegende Studie thematisiert potenzielle Schnittstellenprobleme, indem sie die Nutzung von An-schlussmaßnahmen (AN) bei Patient_innen nach stationärem Alkoholentzug ohne Nahtlosverfahren untersuchte. Methodik: Analysiert wurde die Kontrollgruppe des SmartAssistEntz-Projekts. Dazu wurden 181 Personen drei und sechs Wochen sowie d...

Zusammenfassung Ziel der Studie Der Einfluss von Leitlinien-Empfehlungen und weiterer Faktoren auf die Inanspruchnahme von psychosozialen Therapien bei Menschen mit schweren psychischen Erkrankungen wurde untersucht. Methodik Es wurden Daten einer Querschnittsstudie mit 397 Personen mit schweren psychischen Erkrankungen deskriptiv analysiert. Ergeb...

Zusammenfassung Schizophrene Psychosen sind aufgrund der Einführung von Antipsychotika vor ca. 70 Jahren in Verbindung mit der Implentierung spezifischer Psychotherapien heute deutlich besser behandelbar. Im Bereich der Negativsymptomatik und krankheitsassoziierten kognitiven Defiziten sind die aktuellen Behandlungsmöglichkeiten jedoch weiter limit...

Emerging evidence suggests the usefulness of psychological interventions targeting metacognitive change mechanisms in patients experiencing psychosis. Although many of these patients are treated in acute psychiatric contexts, only few studies have adapted such interventions for acute inpatient settings. The present study aimed to assess the feasibi...

Schizophrenia is a mental disorder characterized by marked heterogeneity at both the phenomenological and neurobiological levels. Its diagnostic disentanglement would lead to more precise treatment and improved prognosis in people with schizophrenia. For this, a deeper understanding of the pathophysiological mechanisms of schizophrenia is needed....

Our aim is to review the most recent evidence on novel antibody therapies for Alzheimer's disease directed against amyloid‐β. This is a joint statement of the European Association of Neurology and the European Psychiatric Association. After numerous unsuccessful endeavors to create a disease‐modifying therapy for Alzheimer's disease, substantial an...

Background and hypothesis: Aerobic exercise interventions in people with schizophrenia have been demonstrated to improve clinical outcomes, but findings regarding the underlying neural mechanisms are limited and mainly focus on the hippocampal formation. Therefore, we conducted a global exploratory analysis of structural and functional neural adap...

This study aims to investigate the barriers and facilitators to guideline adherence for the print format of the German schizophrenia guideline as well as for the concept of a digital living guideline for the first time. For this purpose, the schizophrenia guideline was transferred to a digital guideline format within the web-based tool MAGICapp. An...

Lithium is the gold standard treatment for bipolar disorder (BD). However, its mechanism of action is incompletely understood, and prediction of treatment outcomes is limited. In our previous multi-omics study of the Pharmacogenomics of Bipolar Disorder (PGBD) sample combining transcriptomic and genomic data, we found that focal adhesion, the extra...

The COVID-19 pandemic has posed unprecedented challenges for health care workers (HCWs) worldwide. While the adverse effects of the pandemic on the well-being of HCWs in general have now been established, little is known about the impact on HCWs of psychiatric hospitals (PHCWs). PHCWs are of special interest, given that they faced both an increase...

Depressive disorders have one of the highest disability-adjusted life years (DALYs) of all medical conditions, which led the European Psychiatric Association to propose a policy paper, pinpointing their unmet health care and research needs. The first part focuses on what can be currently done to improve the care of patients with depression, and the...

Background Quantifying depression mainly relies on the use of depression scales, and understanding their factor structure is crucial for evaluating their validity. Methods This post-hoc analysis utilized prospectively collected data from a naturalistic study of 1014 inpatients with major depression. Confirmatory and exploratory factor analyses wer...

Background Quick symptomatic remission after the onset of psychotic symptoms is critical in schizophrenia treatment, determining the subsequent disease course and recovery. In this context, only every second patient with acute schizophrenia achieves symptomatic remission within three months of initiating antipsychotic treatment. The potential indic...

Background: Attachment theory offers an important framework for understanding interpersonal interaction experiences. In the present study, we examined the neural correlates of attachment patterns and oxytocin in schizophrenic patients (SZP) compared to healthy controls (HC) using fMRI. We assumed that male SZP shows a higher proportion of insecure...

The ongoing developments of psychiatric classification systems have largely improved reliability of diagnosis, including that of schizophrenia. However, with an unknown pathophysiology and lacking biomarkers its validity still remains low, requiring further advancements. Research has helped to establish Multiple Sclerosis (MS) as the central nervou...

Background Against the background of missing culturally sensitive mental health care services for refugees, we developed a group intervention (Empowerment ) for refugees at level 3 within the stratified Stepped and Collaborative Care Model of the project Mental Health in Refugees and Asylum Seekers (MEHIRA). We aim to evaluate the effectiveness of...

Lithium is regarded as the first-line treatment for bipolar disorder (BD), a severe and disabling mental health disorder that affects about 1% of the population worldwide. Nevertheless, lithium is not consistently effective, with only 30% of patients showing a favorable response to treatment. To provide personalized treatment options for bipolar pa...