Wulf Rössler

Charité Universitätsmedizin Berlin | Charité · Charité Department of Psychiatry and Psychotherapy

Positive and negative schizotypy reflect distinct patterns of subclinical traits in the general population associated with neurodevelopmental and schizophrenia-spectrum pathologies. Yet, a comprehensive characterization of the unique and shared neuroanatomical signatures of these schizotypy dimensions is lacking. Leveraging 3D brain MRI data from 2...

Machine learning approaches using structural magnetic resonance imaging (sMRI) can be informative for disease classification, although their ability to predict psychosis is largely unknown. We created a model with individuals at CHR who developed psychosis later (CHR-PS+) from healthy controls (HCs) that can differentiate each other. We also evalua...

Background Schizotypy represents an index of psychosis-proneness in the general population, often associated with childhood trauma exposure. Both schizotypy and childhood trauma are linked to structural brain alterations, and it is possible that trauma exposure moderates the extent of brain morphological differences associated with schizotypy. Met...

Importance The lack of robust neuroanatomical markers of psychosis risk has been traditionally attributed to heterogeneity. A complementary hypothesis is that variation in neuroanatomical measures in individuals at psychosis risk may be nested within the range observed in healthy individuals. Objective To quantify deviations from the normative ran...

Background Deficits of mismatch negativity (MMN) in patients with schizophrenia have been demonstrated many times and there is growing evidence that alterations of MMN already exist in individuals at risk for psychosis. The present study examines differences in MMN between subjects fulfilling ultra-high risk (UHR) or only basic symptoms criteria an...

Objective: We aimed to test the association of 45 single nucleotide polymorphisms (SNPs) and transition to psychiatric disorders in a cohort of individuals with at-risk mental state for psychosis (UHR). Methods: Through general population screening, 88 non-help-seeking UHR subjects and 130 healthy control individuals were genotyped for 45 SNPs r...

Importance: The lack of robust neuroanatomical markers of psychosis risk has been traditionally attributed to heterogeneity. A complementary hypothesis is that variation in neuroanatomical measures in the majority of individuals at psychosis risk may be nested within the range observed in healthy individuals. Objective: To quantify deviations from...

Schizotypy represents an index of psychosis-proneness in the general population often associated with childhood trauma exposure. Both schizotypy and childhood trauma are linked to structural brain alterations, and it is possible that trauma exposure moderates the extent of brain morphological differences associated with schizotypy. We addressed thi...

Individuals at Clinical High Risk for Psychosis (CHR-P) demonstrate heterogeneity in clinical profiles and outcome features. However, the extent of neuroanatomical heterogeneity in the CHR-P state is largely undetermined. We aimed to quantify the neuroanatomical heterogeneity in structural magnetic resonance imaging measures of cortical surface are...

The present study aimed to assess: (1) whether a more active involvement of patients is associated with an improvement of clinical symptoms, global functioning, and quality-of-life; and (2) how patients’ satisfaction with clinical decisions can lead to better outcome after 1 year. Data were collected as part of the study ‘Clinical decision-making a...

Importance: Approaches are needed to stratify individuals in early psychosis stages beyond positive symptom severity to investigate specificity related to affective and normative variation and to validate solutions with premorbid, longitudinal, and genetic risk measures. Objective: To use machine learning techniques to cluster, compare, and comb...

Background Widespread white matter abnormalities are a frequent finding in chronic schizophrenia patients. More inconsistent results have been provided by the sparser literature on at-risk states for psychosis, i.e., emerging subclinical symptoms. However, considering risk as a homogenous construct, as characteristic of earlier studies, may impede...

Neuroanatomical abnormalities have been reported along a continuum from at-risk stages, including high schizotypy, to early and chronic psychosis. However, a comprehensive neuroanatomical mapping of schizotypy remains to be established. The authors conducted the first large-scale meta-analyses of cortical and subcortical morphometric patterns of sc...

Background and objective. Studies exploring longitudinal reciprocal associations between depressive, anxiety, and substance use disorders (DD, AD and SUD, respectively) over long periods of time are mainly lacking. Therefore, the aim of the present study is to test longitudinal associations (i.e. temporal dynamics) between DD, AD and SUD from young...

Homelessness has been in the focus of psychiatric research in Germany to a greater or lesser extent since the beginning of the nineteenth century. Recently, increasing numbers of homeless people in Germany due to the consolidation of poverty, the lack of affordable housing, and the processes of immigration have led again to an increased scientific...

As early detection of symptoms in the subclinical to clinical psychosis spectrum may improve health outcomes, knowing the probabilistic susceptibility of developing a disorder could guide mitigation measures and clinical intervention. In this context, polygenic risk scores (PRSs) quantifying the additive effects of multiple common genetic variants...

Clinical high-risk (CHR) individuals belong to a heterogeneous group, of which only a few will cross the threshold for a clinical diagnosis. Cognitive disturbances are present in CHR subjects and may be indicative of transition. Our study aims to identify such deficits in a representative CHR for psychosis sample. Our sample comprised 92 CHR indivi...

The ‘at risk mental state’ (ARMS) paradigm has been introduced in psychiatry to study prodromal phases of schizophrenia. With time it was seen that the ARMS state can also precede mental disorders other than schizophrenia, such as depression and anxiety. However, several problems hamper the paradigm’s use in preventative medicine, such as varying t...

Importance The ENIGMA clinical high risk (CHR) for psychosis initiative, the largest pooled neuroimaging sample of individuals at CHR to date, aims to discover robust neurobiological markers of psychosis risk. Objective To investigate baseline structural neuroimaging differences between individuals at CHR and healthy controls as well as between par...

Importance: The ENIGMA clinical high risk (CHR) for psychosis initiative, the largest pooled neuroimaging sample of individuals at CHR to date, aims to discover robust neurobiological markers of psychosis risk. Objective: To investigate baseline structural neuroimaging differences between individuals at CHR and healthy controls as well as betwee...

Neuroanatomical abnormalities have been reported along a continuum from at-risk stages, including high schizotypy, to early and chronic psychosis. However, a comprehensive neuroanatomical mapping of schizotypy remains to be established. The authors conducted the first large-scale meta-analyses of cortical and subcortical morphometric patterns of sc...

Background Between unaffected mental health and diagnosable psychiatric disorders, there is a vast continuum of functioning. The hypothesized link between striatal dopamine signaling and psychosis has guided a prolific body of research. However, it has been understudied in the context of multiple interacting factors, subclinical phenotypes, and pre...

Introduction: The public stigma and self-stigma contribute to the dilemma of disclosing or not one's own mental illness diagnosis. Studies suggest that revealing it diminishes stress, besides helping with self-esteem. Honest, Open, Proud (HOP) is a group program that aids in the process of deciding on it, reducing its impact. Considering the releva...

Importance: The ENIGMA clinical high risk for psychosis (CHR) initiative, the largest pooled CHR-neuroimaging sample to date, aims to discover robust neurobiological markers of psychosis risk in a sample with known heterogeneous outcomes. Objective: We investigated baseline structural neuroimaging differences between CHR subjects and healthy contro...

Importance Diverse models have been developed to predict psychosis in patients with clinical high-risk (CHR) states. Whether prediction can be improved by efficiently combining clinical and biological models and by broadening the risk spectrum to young patients with depressive syndromes remains unclear. Objectives To evaluate whether psychosis tra...

Background: The Clinical descriptions and diagnostic guidelines for the ICD-11 Classification of mental and behavioural disorders should soon be finalized. To measure their potential impact, the new proposed definitions of bipolar disorders in ICD-11 were applied to data from the Zurich cohort study and compared with the definitions of ICD-10 and...

Zusammenfassung Ziel der Studie Untersuchung der Wohnsituation, Nutzung des Versorgungssystems und des Substanzgebrauchs bei Patienten1 mit Substanzgebrauchsstörungen in (teil-)stationärer psychiatrischer Behandlung in der Psychiatrischen Universitätsklinik der Charité im St. Hedwig-Krankenhaus. Methode Strukturiertes Interview von 540 Patienten. E...

Background Previous studies among the general population indicated an association between mental illnesses and different forms of financial difficulties, such as indebtedness.Objective Investigation of the financial burden and associated factors among inpatients and day clinic patients in psychiatric care.Material and methodsA total of 488 patients...

This study aims to analyze the relationship between the symptomatic dimensions of psychosis and functioning of individuals at risk for psychosis (ultrahigh risk [UHR]) in a non-help-seeking UHR sample from the general population. The sample is the same as the one used in the Brazilian Subclinical Symptoms and Prodromal Psychosis cohort study. We ap...

Homelessness is an expression of marked social exclusion phenomena and often particularly affects people with mental disorders. Mental disorders often precede the onset of homelessness but can also be a result of homelessness. Different forms of therapeutic and social support interventions have been evaluated in various countries, predominantly wit...

To identify factors associated with the use of shared decision making in routine mental health care in a large multicenter European study. Data have been collected within the study “Clinical decision making and outcome in routine care for people with severe mental illness” (CEDAR), which is a naturalistic, longitudinal, observational study carried...

Objective: To assess the influence of migration on the psychopathological presentation of individuals at ultra-high risk for psychosis (UHR) in São Paulo, Brazil. Methods: This study is part of the Subclinical Symptoms and Prodromal Psychosis (SSAPP) project, a cohort study in São Paulo, Brazil, designed to follow individuals at UHR. After screeni...

Background. The quality of mental health services is crucial for the effectiveness and efficiency of mental healthcare systems, symptom reduction, and quality of life improvements in persons with mental illness. In recent years, particularly care coordination (i.e., the integration of care across different providers and treatment settings) has rece...

Background Access to a bank account is critical for overall participation in social life and an indicator for social integration. Worldwide about 1.7 billion people remain with no access to banking facilities as a form of financial exclusion which represents 31% of the world’s general population. In contrast, in Western countries like Germany, 99%...

In subjects at risk for psychosis, the studies on gray matter volume (GMV) predominantly reported volume loss compared with healthy controls (CON). However, other important morphological measurements such as cortical surface area (CSA) and cortical thickness (CT) were not systematically compared. So far, samples mostly comprised subjects at genetic...

For the first time in the Swiss health care system, this evaluation study examined whether patients with acute psychiatric illness who were admitted for inpatient treatment could be treated in an acute day hospital instead. The acute day hospital is characterized by the possibility of direct admission of patients without preliminary consultation or...

Background Childhood maltreatment is a known risk factor for the development of mental disorders, such as psychotic symptoms. An extensive body of literature about childhood maltreatment and mental health has been developed in wealthy countries, but information about this connection is lacking in developing countries. Aims To explore a possible re...

Background Cortical neuroanatomical abnormalities have been reported along a continuum between individuals with chronic schizophrenia, first-episode psychosis, clinical high risk for psychosis, and healthy individuals self-reporting subclinical psychotic-like experiences (or schizotypy). Recently, the Schizophrenia Working Group within the ENIGMA (...

Background Negative symptoms can be seen to represent a continuum from subclinical manifestations in the general population to severe symptoms in schizophrenia. Neuroanatomical studies show evidence of fronto-striatal structural abnormalities linked to negative symptoms in patients with schizophrenia (Walton et al. 2018). However, it remains an ope...

Objective To examine the association between cannabis use in adolescence and the occurrence of depression, suicidality and anxiety disorders during adulthood. Methods A stratified population-based cohort of young adults (n=591) from Zurich, Switzerland, was retrospectively assessed at age 19/20 for cannabis use in adolescence. The occurrence of de...

Objectives : The emotional Stroop effect is defined as increased reaction times to emotional stimuli compared to neutral ones. It has been often reported in the literature, on both behavioral and neurophysiological level. The goal was to investigate the frontal brain activation in individuals at risk for schizophrenic psychosis and bipolar disorder...

Emerging evidence has attributed altered network coordination between the default mode, central executive, and salience networks (DMN/CEN/SAL) to disturbances seen in schizophrenia, but little is known for at-risk psychosis stages. Moreover, pinpointing impairments in specific network-to-network interactions, although essential to resolve possibly...

Schizophrenia and other psychotic disorders are highly debilitating psychiatric conditions that lack a clear etiology and exhibit polygenic inheritance underlain by pleiotropic genes. The prevailing explanation points to the interplay between predisposing genes and environmental exposure. Accumulated evidence suggests that epigenetic regulation of...

Psychosocial rehabilitation (synonymously referred to as psychiatric rehabilitation) is a field and service within mental health systems that shifted the treatment focus from symptom control to social inclusion by functional recovery. It aims to help individuals with severe mental illness live in the community as independently as possible. Psychoso...

Navigating the future of psychiatry requires a firm understanding of its past. This book is intended as a guide for students and practitioners of psychiatry and psychology who seek to understand the evolution of psychiatry as a scientific discipline. Landmark papers covering a broad array of topics are described and their scientific contributions a...

Objective To determine the housing situation among people seeking psychiatric treatment in relation to morbidity and service utilisation. Design Cross-sectional patient survey. Setting Psychiatric centre with a defined catchment area in Berlin, Germany, March–September 2016. Participants 540 psychiatric inpatients including day clinics (43.2% of...

Dopamine is involved in the pathophysiology of schizophrenia. Disrupted salience processing by the salience network (SN) may be a central link between dysregulated dopamine function and psychotic symptoms. However, dopaminergic influence on the SN and its presumed influence on psychotic and subpsychotic symptoms or psychotic-like experiences in hea...

Introduction: Transient psychotic symptoms in patients with borderline personality disorder seem to be similar to those in patients with psychotic disorders. Especially in the field of early detection of psychosis, this might lead to individuals with borderline personality disorder being wrongly classified as subjects at risk for developing a manif...

Schizophrenia is a complex and chronic neuropsychiatric disorder, with a heritability of around 60–80%. Large (>100 kb) rare (<1%) copy number variants (CNVs) occur more frequently in schizophrenia patients compared to controls. Currently, there are no studies reporting genome‐wide CNVs in clinical high risk for psychosis (CHR‐P) individuals. The a...

Alcohol use disorders (AUD) are often comorbid with other disorders with high levels of impairment, which is of relevance for the development and the progression of the disease. Evidence shows that AUD varies greatly with regard to its aetiology, which might lead to distinct clinical representations with important implications for treatment. The cu...

The prevalence of autumn/winter seasonality in depression has been documented in the longitudinal Zurich cohort study by five comprehensive diagnostic interviews at intervals over more than 20 years (N = 499). Repeated winter major depressive episodes (MDE—unipolar + bipolar) showed a prevalence of 3.44% (5× more women than men), whereas MDE with a...

Background: Individual placement and support (IPS) has proven to be effective for vocational outcomes in people with mental illness. The original concept of IPS requires temporally unlimited provision of support. Using limited placement budgets and investigating factors that predict their effectiveness may inform decisions about resource allocation...

Background The most effective rehabilitation model for job (re-)entry of people with mental illness is supported employment. A barrier to introducing supported employment into standard care is its temporally unlimited provision, which conflicts with health and social legislation in many European countries. Aims To test the impact of different ‘pla...

Anger is prevalent in chronic pain and has been associated with pain perception, disability, behavior and treatment outcome. Objectives were (1) to survey in the context of chronic pain the application (and omission) of validated anger self-report instruments, (2) to discuss the instruments found in the context of emotion theories and (3) to identi...

Introduction: The prevention of schizophrenia and other psychotic disorders has led researchers to focus on early identification of individuals at clinical high risk (CHR) for psychosis and to treat the at-risk symptoms in the pre-psychotic period. Although at-risk symptoms such as attenuated hallucinations or delusions are common in adolescents an...

Background Neuroanatomical studies have provided some evidence for a neurobiological continuity between psychotic symptoms in patients with schizophrenia and subclinical psychotic-like experiences as identified via self-report questionnaires (or schizotypy) in otherwise healthy individuals. Despite a number of structural brain imaging studies publi...

Background Recent efforts to prevent psychosis tried to identify at risk individuals in the community and in clinical settings. For this purpose, ultra-high risk for psychosis (UHR) and clinical high-risk state for psychosis (CHR-P) criteria were developed. The use of such criteria has proven not to be satisfactory, though, for conversion rates gre...

Background: Schizophrenia is one of the most stigmatized psychiatric disorders, and disclosing it is often a source of stress to individuals with the disorder. The Coming Out Proud (COP) group intervention is designed to reduce the stigma's negative impact and help participants decide if they want to disclose their disorder. Aims: To assess the...

Objective: This prospective study addresses risk factors of compulsory re-admission focusing on the role of the patient's subjective symptom distress and perceived social support, based on comprehensive patient and external (clinicians, study staff) assessments. Methods: Of the baseline sample, 168 (71%) patients with serious mental disorders, who...

Background: Some evidence suggests that antidepressants may relate to poor outcomes in depression. The aim of this study was, therefore, to examine, whether antidepressant use may worsen the long-term outcome in real-world psychiatric patients with both primarily affective and non-affective mental disorders. Methods: Based on a total of n = 151 inp...

Objective: Somatosensory evoked potentials (SEPs) enable the investigation of thalamocortical and early cortical processing. Previous studies reported alterations of SEPs in patients with schizophrenia as well as in individuals in the prodromal stage. Moreover, cannabis use as an environmental risk factor for the development of schizophrenia has be...

Background: Many sex workers suffer from mental health problems, but do not seek help. Aim: To examine stigma-related and non stigma-related barriers to care and perceived need for treatment among female sex workers in Switzerland. Methods: Mental health service use, barriers to care, perceived need and presence of illness, symptoms, and psychiatri...

Growing evidence for the spectrum concept of most mental disorders, particularly mood disorders, has challenged the arbitrary distinctions inherent in the contemporary categorical diagnostic classification system. Detection of manic symptoms in the context of episodes of depression is particularly important because of the implications for different...

Objectives Although clinical evidence suggests important differences between unipolar mania and bipolar‐I disorder (BP‐I), epidemiological data are limited. Combining data from 9 population‐based studies, we compared subjects with mania (M) or mania with mild depression (Md) to those with BP‐I with both manic and depressive episodes with respect to...

Background: Employment is an important aspect of psychiatric rehabilitation. The objective of this analysis was to explore how quality of life (QoL) may affect the outcome of supported employment and vice versa. Methods: A total of 116 participants with severe mental disorders were randomly assigned to either 25, 40, or 55 h placement budgets, whic...

Objective: To evaluate perceived needs and difficulties related to instruments for assessing work ability in individuals with mental disorders. Method: We conducted an online survey of 104 German-speaking medico-legal experts (forensic psychiatric and psychology experts, insurance physicians) and therapists. Results: The large majority of responden...

Background Migration is a risk factor for the onset of mental disorders. Epidemiologic studies indicate that there is an increased prevalence of depressive and somatoform disorders in individuals with a Turkish migration background in Germany. Objectives The aim of this review article is to determine the impact of sociocultural factors on depressi...

In the last decades, biological and environmental factors related to psychosis were investigated in individuals at ultra-risk for psychosis (UHR) to predict conversion. Although religion relates to psychosis in a variety of ways, it is understudied in subclinical samples. Therefore, we assessed the interplay between religion and prodromal symptoms...

Aims Associations between stuttering in childhood and a broad spectrum of risk factors, associated factors and comorbidities were examined in two large epidemiological studies. Subtypes of stuttering were then identified based on latent class analysis (LCA). Methods Data were from two representative Swiss population samples: PsyCoLaus (N = 4,874,...