Henrik Kessler’s research while affiliated with Ruhr University Bochum and other places

Background:Structured diagnostic interviews are essential in clinical psychological diagnostics due to their robust psychometric properties. Despite their significance, patient and interviewer acceptance assessment during structured diagnostic interviews is infrequent. Within the domain of posttraumatic stress disorder (PTSD), the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) is the recommended structured diagnostic interview. Understanding the acceptance levels of CAPS-5 among patients and interviewers is essential. This study aimed to investigate the extent to which the CAPS-5 is accepted by military and civilian patients (measured with the Patient Acceptance Questionnaire [PAQ]) and interviewers (measured with the Interviewer Acceptance Questionnaire [IAQ]), and to determine which psychopathology-related variables are significantly correlated with acceptance.Methods:A total of 152 patients and 16 interviewers participated in the study. Descriptive data from the questionnaires were computed. Next, principal component analyses were conducted to investigate the factorial structure of both questionnaires. Internal consistencies were investigated for the identified factors. Subsequently, the associations between the PAQ and IAQ and measures of psychopathology, socially desirable responding, and the interview duration were analyzed using correlation analysis and a stepwise multiple regression analysis. Finally, we investigated possible differences in the responses on the PAQ and the IAQ between military and civilian participants exploratorily.Results:Findings indicate that the German version of the CAPS-5 was highly accepted by patients, irrespective of their symptom severity, the type of index trauma, their demographic background (civilian or military), or the interview duration. Furthermore, interviewer acceptance was also notably high. Conclusion: In summary, the CAPS-5 is rated positively by both patients and interviewers. The results of this study provide further evidence that the CAPS-5 is well-suited as a standard instrument for diagnosing PTSD, and that conducting the interview is unlikely to be experienced as stressful or burdensome by both interviewers and patients.Trial Registration: Trial ID: DRKS00015325 (https://www.drks.de)

Background: Steroid hormone dysregulations have frequently been implicated in posttraumatic stress disorder (PTSD) pathogenesis. However, the translation into naturalistic clinical settings as markers of symptomatology and treatment success remains complex. Particularly, there is little longitudinal data on steroid secretion over the course of interventions. Objective: This study examined the potential of long-term steroid hormone secretion assessed in hair as diagnostic and intervention-related biomarkers among medicated, multimorbid inpatients with PTSD. Method: As part of a secondary analysis of a randomised controlled trial, 54 female inpatients with a primary diagnosis of PTSD received standardised treatment and provided hair samples at pre-treatment, post-treatment, and 3-month follow-up. Cortisol, cortisone, and dehydroepiandrosterone (DHEA) were determined, alongside clinical assessments. Results: Cross-sectional results showed a negative association of pre-treatment DHEA with anxiety symptoms and a trend-level association with lifetime trauma exposure. While inpatients improved in PTSD symptomatology during treatment, neither pre-treatment steroids, nor treatment-induced steroid changes predicted PTSD symptoms at post-treatment or 3-month follow-up. Conclusion: The study highlights the challenges of establishing biomarkers in naturalistic clinical populations. While the association of attenuated DHEA with anxiety symptoms warrants further exploration, our data points towards the potential necessity of patient sub-sample selection to understand, and in the long run clinically target, the endocrine mechanisms in PTSD.

Objective Impairment in personality functioning (PF) has been linked to a number of mental disorders, including eating disorders (EDs). However, the precise relationship between PF and symptom severity, as well as the potential impact on outcome, remains unclear. The study aimed to analyse the association of PF and its change with severity of ED symptomatology as well as outcome of hospital treatment. Method The sample consisted of 397 patients with EDs, treated in 19 university hospitals for Psychosomatic Medicine and Psychotherapy in Germany between 1/2019 and 12/2020. PF was measured with the Structure Questionnaire of the Operationalised Psychodynamic Diagnosis (OPD‐SQ, short version), eating psychopathology with the ED examination questionnaire (EDE‐Q). Outcome was defined as a change in the EDE‐Q total score. We used Latent Change Score Modelling to analyse changes in ED pathology during treatment and a 1‐year follow‐up period. Results A higher level of impairment in PF at admission correlated with more eating psychopathology and a less favourable outcome. Additionally, greater improvement in PF correlated with greater improvements in ED symptomatology at discharge. Conclusion Impairment in PF needs to be part of diagnostic assessments and should be considered an important treatment target for psychotherapeutic interventions. Trial Registration The MEPP study was registered in the German Clinical Trials Register (DRKS, www.drks.de; ID: DRKS00016412)

Introduction Intrusive memories occur frequently after potentially traumatic events and form a core symptom of posttraumatic stress disorder (PTSD) if they persist. The translational approach of visuospatial interventions tries to target those intrusive memories in order to reduce their frequency predominantly using an intervention including as one component the computer game Tetris. Despite promising results, the application of Tetris has critical drawbacks, e.g., potential commercial or copyright issues. Furthermore, it remains unclear whether it is this specific game or, as predicted by theory, a visuospatial task per se that leads to the effect. This study hence aims to compare the effect of Tetris with an alternative, bespoke visuospatial task: Mobilum developed for the current purpose. Methods N = 120 healthy participants watched a trauma film and recorded their intrusive memories in a diary for 6 days. Three days after watching the film, they were randomized to 3 groups and after memory reactivation cue received either Tetris or Mobilum or Control (no task). Prior to intervention 8 participants reported zero intrusive memories to the film and were excluded from further analyses, therefore 112 participants were included in the analysis. Results A mixed Poisson regression model revealed that the Mobilum group had significantly less frequent intrusive memories after the intervention compared to the control condition (approximately 43%, p = 0.0013). There was no significant difference for the Tetris group compared to Control (17% less frequent, p = 0.3798). Discussion Our results suggest that visuospatial tasks other than Tetris—in this case, Mobilum—can also lead to a reduction in intrusive memories when administered 3 days after a trauma film. This strengthens the assumption that it is not specifically the game Tetris, but rather the visuospatial nature of the task, that is responsible for the reduction. Aspects of further investigating the potential of Mobilum as well as clinical implications are discussed.

Background: While available posttraumatic stress disorder (PTSD) treatments are generally successful, 30-40% of patients show limited improvement. The endocannabinoid system may play a role in the aftermath of trauma, in PTSD, and in extinction processes. Therefore, this secondary analysis of a randomized-controlled trial including PTSD inpatients over the course of trauma-focused treatment investigated whether a dysregulated endocannabinoid system is associated with symptom severity and treatment response. Methods: Fifty-four female PTSD inpatients provided hair samples and completed psychometric questionnaires at admission, discharge, and 3-month follow-up. Endocannabinoid (EC: AEA, 1AG/2AG) and N-acylethanolamine (NAE: SEA, OEA, PEA) concentrations were measured in scalp-near 3-cm hair segments. Results: At admission, higher hair AEA correlated with lower depressive and anxiety and higher PTSD symptoms (when controlling for depressive symptoms). Hair NAEs associated with more traumatic experiences. PTSD symptoms improved across treatment, remaining stable at follow-up, but were predicted neither by pre-treatment hair ECs/NAEs nor their changes. Subgroup analyses with those who received exposure treatment tentatively indicated a trend linking higher hair PEA and OEA to lower PTSD symptoms at discharge. Conclusions: Taken together, hair ECs/NAEs may relate differentially to trauma exposure and symptom severity, but not to PTSD inpatient treatment response. Larger-scale research is necessary to confirm this.

Steroid hormone dysregulations have frequently been implicated in posttraumatic stress disorder (PTSD) pathogenesis. However, the translation into naturalistic clinical settings as markers of symptomatology and treatment success remains complex. Particularly, there is little longitudinal data on steroid secretion over the course of interventions. This study examined the potential of long-term steroid hormone secretion assessed in hair as diagnostic and intervention-related biomarkers among medicated, multimorbid inpatients with PTSD. As part of a secondary analysis of a randomized controlled trial, 54 female inpatients with a primary diagnosis of PTSD receiving standardised treatment provided hair samples at pre-treatment, post-treatment, and 3-months follow-up. Cortisol, cortisone, and dehydroepiandrosterone (DHEA) were determined, alongside clinical assessments. Cross-sectional results showed a negative association of pre-treatment DHEA with anxiety symptoms and a trend-level association with lifetime trauma exposure. While inpatients improved in PTSD symptomatology during treatment, neither pre-treatment steroids, nor treatment-induced steroid changes predicted PTSD symptoms at post-treatment or follow-up. The study highlights the challenges of establishing biomarkers in naturalistic clinical populations. While the association of attenuated DHEA with anxiety symptoms warrants further exploration, our data points towards the potential necessity of patient sub-sample selection to understand, and in the long run clinically target, the endocrine mechanisms in PTSD.

Background: Intrusive memories form a core symptom of Posttraumatic Stress Disorder (PTSD). Based on concepts of visuospatial interference and memory-updating accounts, technological innovations aim to attenuate such intrusions using visuospatial interventions. Objective: This study aims to test the effect of a visuospatial Tetris-based intervention versus a verbal condition (Wiki) and a never-targeted control (no intervention) on intrusion frequency. Method: A randomized crossover trial was conducted including N = 38 PTSD patients who had at least 3 distinct intrusive memories of trauma. After both 2 weeks (intervention 1) and 4 weeks (intervention 2), one of the three memories was randomly selected and either the visuospatial intervention (memory reminder of a traumatic memory + Tetris) or verbal condition (reading a Wikipedia article + answering questions) was performed on their first memory in randomized order. In the week 4 session, the patient conducted the other intervention condition on their second memory (crossover). The third memory was never targeted (no intervention). Daily occurrence of intrusions over 8 weeks was collected using a diary and analysed using mixed Poisson regression models. Results: Overall, there was no significant reduction in intrusion frequency from either intervention compared to each other, and to no intervention control (relative risk Tetris/Wiki: 0.947; p = .31; relative risk no intervention/Tetris: 1.060; p = .15; relative risk no intervention/Wiki: 1.004; p = .92). Conclusions: There was no effect of either intervention on intrusions when administered in a crossover design where participants received both interventions. Design shortcomings and consequences for future studies are discussed.

Background The Clinician-Administered PTSD Scale (CAPS-5) is a structured diagnostic interview developed for diagnosing post-traumatic stress disorder (PTSD). To ensure compliance with PTSD inclusion criteria, an initial study investigated the psychometric properties and factorial structure of the German version of CAPS-5 using data collected previously. The present study’s objective was to validate the robustness of the psychometric properties of the German CAPS-5 by assessing its validity within a routine clinical context. Methods A total of 288 participants were recruited for the study. The validity of the German CAPS-5 was assessed using a multi-trait/multi-method design. Additionally, the study explored internal consistency, test-retest reliability, interrater reliability, and the interview’s diagnostic accuracy. Ultimately, a cut-off score was determined through receiver operating characteristics curve (ROC) analyses. Results The study demonstrated good to excellent internal consistency, test-retest reliability, interrater reliability, construct validity, and diagnostic accuracy for the German CAPS-5. Furthermore, the study established a cut-off score of ≥ 40 for the German CAPS-5 sum score. Discussion The German CAPS-5 emerged as a structured diagnostic interview exhibiting good to excellent psychometric properties. The findings indicated solid convergent validity of the German CAPS-5; however, further research is warranted to investigate its divergent validity. Trial registration DRKS00015325 (https://www.drks.de)