Research Interests: Psychology, Geriatrics, Cognition, Quality of life, Medicine, and 15 moreGermany, Humans, Age, Female, Male, Nursing Home, Clinical Sciences, Randomized Controlled Trial, Geriatric Assessment, Inpatients, Acute Care, Control Group, Health services for the aged, Frail elderly, and Patient readmission
Cognitive behavioural therapy (CBT) and pharmacological treatment with selective serotonin or serotonin-noradrenalin reuptake inhibitors (SSRI/SSNRI) are regarded as efficacious treatments for panic disorder with agoraphobia (PD/AG).... more
Cognitive behavioural therapy (CBT) and pharmacological treatment with selective serotonin or serotonin-noradrenalin reuptake inhibitors (SSRI/SSNRI) are regarded as efficacious treatments for panic disorder with agoraphobia (PD/AG). However, little is known about treatment-specific effects on symptoms and neurofunctional correlates. We used a comparative design with PD/AG patients receiving either two types of CBT (therapist-guided (n=29) or non-guided exposure (n=22)) or pharmacological treatment (SSRI/SSNRI; n=28) as well as a wait-list control group (WL; n=15) to investigate differential treatment effects in general aspects of fear and depression (Hamilton Anxiety Rating Scale HAM-A and Beck Depression Inventory BDI), disorder-specific symptoms (Mobility Inventory MI, Panic and Agoraphobia Scale subscale panic attacks PAS-panic, Anxiety Sensitivity Index ASI, rating of agoraphobic stimuli) and neurofunctional substrates during symptom provocation (Westphal-Paradigm) using functional magnetic resonance imaging (fMRI). Comparisons of neural activation patterns also included healthy controls (n=29). Both treatments led to a significantly greater reduction in panic attacks, depression and general anxiety than the WL group. The CBT groups, in particular, the therapist-guided arm, had a significantly greater decrease in avoidance, fear of phobic situations and anxiety symptoms and reduction in bilateral amygdala activation while the processing of agoraphobia-related pictures compared to the SSRI/SSNRI and WL groups. This study demonstrates that therapist-guided CBT leads to a more pronounced short-term impact on agoraphobic psychopathology and supports the assumption of the amygdala as a central structure in a complex fear processing system as well as the amygdala׳s involvement in the fear system׳s sensitivity to treatment.
Research Interests: Psychology, Fear, Magnetic Resonance Imaging, Medicine, Anxiety, and 15 moreAgoraphobia, Brain, Humans, Female, Cognitive Therapy, Male, Panic Disorder, Panic, Oxygen, Anxiety Sensitivity, ANXIETY, Psychiatric Status Rating Scales, Personality Inventory, Psychology and Cognitive Sciences, and Medical and Health Sciences
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Research Interests: Clinical Psychology, Cognitive Science, Magnetic Resonance Imaging, Borderline Personality Disorder, Language, and 15 moreCognitive Neuroscience, Adult attachment, Brain, Humans, Attachment, Functional Magnetic Resonance Imaging, Female, Male, Clinical Sciences, Adult, Interaction effect, Attachment Representation, Exploratory Study, Magnetic resonance image, and Adult Attachment Projective Picture System
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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,... more
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 ac...
Research Interests: Cognitive Psychology, Cognitive Science, Experimental Psychology, Languages and Linguistics, Magnetic Resonance Imaging, and 15 moreCognitive Neuroscience, Medicine, Brain Mapping, Humans, False Belief, Cerebral Cortex, Comprehension, Functional Magnetic Resonance Imaging, Female, Male, Adult, Inferior frontal gyrus, Human Brain Mapping, Neurosciences, and Angular Gyrus
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.... more
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. 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...
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Depressive Storungen gehen unter anderem mit kognitiven Defiziten einher, vor allem Storungen des Gedachtnisses. Diese konnen teilweise so ausgepragt sein, dass die differenzialdiagnostische Abklarung einer demenziellen Erkrankung... more
Depressive Storungen gehen unter anderem mit kognitiven Defiziten einher, vor allem Storungen des Gedachtnisses. Diese konnen teilweise so ausgepragt sein, dass die differenzialdiagnostische Abklarung einer demenziellen Erkrankung erforderlich ist. Die Abgrenzung depressionsbedingter versus demenziell bedingter Gedachtnisstorungen ist jedoch wahrend einer depressiven Episode auserst schwierig. Umgekehrt ist es in der Differenzialdiagnose von demenziellen Gedachtnisstorungen ebenfalls schwierig, eine zugrundeliegende oder komorbide depressive Storung zu identifizieren. Im folgenden Kapitel werden depressionsbedingte Gedachtnisstorungen in Abgrenzung zu demenziellen Erkrankungen vorgestellt.
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Research Interests: Endocrinology, Biomarkers, Adolescent, Medicine, Heart rate variability, and 15 moreHumans, Internal Medicine, Major Depressive Disorder, Blood Pressure, Aldosterone, Female, Male, Heart rate, Aged, Middle Aged, Biomarker, Adult, Mineralocorticoid Receptor, hydrocortisone, and Medical and Health Sciences
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... more
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 ana...
Research Interests: Depression, Bipolar Disorder, Magnetic Resonance Imaging, Adolescent, Medicine, and 15 moreHumans, Female, Male, Genetic Association Studies, Amygdala, Aged, Middle Aged, Adult, Limbic System, Genetic variation, Fusiform Gyrus, Inpatients, Gray Matter, Cohort Studies, and Medical and Health Sciences
Patients with schizophrenia (SZ) often make aberrant cause and effect inferences in non-social and social situations. Likewise, patients may perceive cause-and-effect relationships abnormally as a result of an alteration in the physiology... more
Patients with schizophrenia (SZ) often make aberrant cause and effect inferences in non-social and social situations. Likewise, patients may perceive cause-and-effect relationships abnormally as a result of an alteration in the physiology of perception. The neural basis for dysfunctions in causality judgements in the context of both physical motion and social motion is unknown. The current study used functional magnetic resonance imaging (fMRI) to investigate a group of patients with SZ and a group of control subjects performing judgements of causality on animated collision sequences (launch-events, Michotte, 1963) and comparable "social" motion stimuli. In both types of animations, similar motion trajectories of the affected object were configured, using parametrical variations of space (angle deviation) and time (delay). At the behavioural level, SZ patients made more physical and less social causal judgements than control subjects, and their judgements were less influen...
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Major depression (MDE) has metabolic and neuroendocrine correlates, which point to a biological overlap between MDE and cardiovascular diseases. Whereas the hypothalamic-pituitary-adrenocortical axis has long been recognized for its... more
Major depression (MDE) has metabolic and neuroendocrine correlates, which point to a biological overlap between MDE and cardiovascular diseases. Whereas the hypothalamic-pituitary-adrenocortical axis has long been recognized for its involvement in depression, the focus was mostly on cortisol/corticosterone, whereas aldosterone appears to be the 'forgotten' stress hormone. Part of the reason for this is that the receptors for aldosterone, the mineralocorticoid receptors (MR), were thought to be occupied by glucocorticoids in most parts of the brain. However, recently it turned out that aldosterone acts selectively in relevant mood-regulating brain areas, without competing with cortisol/corticosterone. These areas include the nucleus of the solitary tract (NTS), the amygdala and the paraventricular nucleus of the hypothalamus. These regions are intimately involved in the close relationship between emotional and vegetative symptoms. Genetic analysis supports the role of aldoste...
Research Interests: Endocrinology, Medicine, Brain, Humans, Internal Medicine, and 15 moreMajor Depressive Disorder, Aldosterone, Hypothalamus, Female, Animals, Corticosterone, Male, Medical Physiology, Clinical Sciences, NMDA, Psychological Stress, Glucocorticoid Receptors, Mineralocorticoid Receptor, Glucocorticoids, and hydrocortisone
Functional imaging studies have shown that individuals with borderline personality disorder (BPD) display prefrontal and amygdala dysfunction while viewing or listening to emotional or traumatic stimuli. The study examined for the first... more
Functional imaging studies have shown that individuals with borderline personality disorder (BPD) display prefrontal and amygdala dysfunction while viewing or listening to emotional or traumatic stimuli. The study examined for the first time the functional neuroanatomy of attachment trauma in BPD patients using functional magnetic resonance imaging (fMRI) during the telling of individual stories. A group of 11 female BPD patients and 17 healthy female controls, matched for age and education, told stories in response to a validated set of seven attachment pictures while being scanned. Group differences in narrative and neural responses to "monadic" pictures (characters facing attachment threats alone) and "dyadic" pictures (interaction between characters in an attachment context) were analyzed. Behavioral narrative data showed that monadic pictures were significantly more traumatic for BPD patients than for controls. As hypothesized BPD patients showed significant...
Research Interests: Cognitive Science, Neuroimaging, Magnetic Resonance Imaging, Borderline Personality Disorder, Neurophysiology, and 15 moreMedicine, Brain, Humans, Attachment, Functional Magnetic Resonance Imaging, Female, Functional Imaging, Amygdala, Clinical Sciences, Adult, Neurosciences, Life Change Events, Anterior cingulate cortex, Adult Attachment Projective Picture System, and Medical and Health Sciences
The purpose of the study was to examine if differences in behavioral effects in terms of facial self-recognition, compared to other identity recognition (familiar, strange) exist. Morphed versions of three facial identities were used in... more
The purpose of the study was to examine if differences in behavioral effects in terms of facial self-recognition, compared to other identity recognition (familiar, strange) exist. Morphed versions of three facial identities were used in the experiment. The subject's own face was morphed with an unknown identity. A face of a highly familar person and of a stranger were also morphed in the same manner. This morphing procedure was repeated six times for each identity, but with six different unknown faces, in which three of the unknown faces were rated as being similar and the other three as dissimilar. The reaction times and categorical boundaries were then measured. The major finding of the study was that there were significant delayed mean reaction times for the morphed images of version "self versus similarly rated unknown faces" in contrast to the images of "self versus dissimilarly rated unknown faces" only. No significant differences were found in any of t...
Research Interests: Neuroscience, Psychology, Cognitive Psychology, Cognitive Science, Perception, and 15 moreVisual perception, Face, Music and identity, Face recognition (Psychology), Facial expression, Medicine, Face perception, Humans, Female, Male, Reaction Time, Self Concept, Adult, Neurosciences, and Similarity Geometry
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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... more
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 ...
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Research Interests: Psychology, Clinical Psychology, Psychiatry, Psychometrics, Bipolar Disorder, and 15 morePrincipal Component Analysis, Language, Medicine, Humans, Mania, Female, Male, Depressive Disorder, Rating Scale, Medical Diagnosis, Middle Aged, Adult, Psychiatric Status Rating Scales, Psychology and Cognitive Sciences, and Medical and Health Sciences
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Klinisch werden Störungen der Sprachproduktion und des Denkens als formale Denkstörungen (FDS) bezeichnet, im Gegensatz zu inhaltlichen Denkstörungen wie z. B. Wahn (▸ Kap. 36) oder Zwangsgedanken. Dazu zählen die Geschwindigkeit der... more
Klinisch werden Störungen der Sprachproduktion und des Denkens als formale Denkstörungen (FDS) bezeichnet, im Gegensatz zu inhaltlichen Denkstörungen wie z. B. Wahn (▸ Kap. 36) oder Zwangsgedanken. Dazu zählen die Geschwindigkeit der Gedankenproduktion, die Art und Weise der Gedankenverknüpfung und die Frage, in welchen Kontext sie gestellt werden. Ebenso beinhaltet der Begriff, mit welcher Auswahl von Begriffen und welcher Syntax
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G72 (syn. DAOA, D-amino acid oxidase activator) is a susceptibility gene for both schizophrenia and bipolar disorder. Diffusion tensor imaging studies hint at changes in fiber tract integrity in both disorders. We aimed to investigate... more
G72 (syn. DAOA, D-amino acid oxidase activator) is a susceptibility gene for both schizophrenia and bipolar disorder. Diffusion tensor imaging studies hint at changes in fiber tract integrity in both disorders. We aimed to investigate whether a G72 susceptibility haplotype causes changes in fiber tract integrity in young healthy subjects. We compared fractional anisotropy in 47 subjects that were either homozygous for the M23/M24 risk haplotype (n = 20) or homozygous for M23(rs3918342)/M24(rs1421292) wild type (n = 27) using diffusion tensor imaging with 3 T. Tract-based spatial statistics, a method especially developed for diffusion data analysis, was used to delineate the major fiber tracts. We found clusters of increased FA values in homozygous risk haplotype carriers in the right periinsular region and in the right inferior parietal lobe (IPL). We did not find clusters indicating decreased FA values. The insula and the IPL have been implicated in both schizophrenia and bipolar pathophysiology. Increased FA values might reflect changes in dendritic morphology as previously described by in vitro studies. These findings further corroborate the hypothesis that a shared gene pool between schizophrenia and bipolar disorder might lead to neuroanatomic changes that confer an unspecific vulnerability for both disorders.
Research Interests: Cognitive Science, Bipolar Disorder, Nonparametric Statistics, Diffusion Tensor Imaging, Adolescent, and 15 moreMedicine, Diffusion MRI, Humans, Female, Male, Clinical Sciences, Middle Aged, Genotype, Adult, Fractional Anisotropy, European Continental Ancestry Group, Neurosciences, Frontal Lobe, Haplotype, and Nerve fibers
Many figurative expressions are fully conventionalized in everyday speech. Regarding the neural basis of figurative language processing, research has predominantly focused on metaphoric expressions in minimal semantic context. It remains... more
Many figurative expressions are fully conventionalized in everyday speech. Regarding the neural basis of figurative language processing, research has predominantly focused on metaphoric expressions in minimal semantic context. It remains unclear in how far metaphoric expressions during continuous text comprehension activate similar neural networks as isolated metaphors. We therefore investigated the processing of similes (figurative language, e.g., “He smokes like a chimney!”) occurring in a short story. Sixteen healthy, male, native German speakers listened to similes that came about naturally in a short story, while blood-oxygenation-level-dependent (BOLD) responses were measured with functional magnetic resonance imaging (fMRI). For the event-related analysis, similes were contrasted with non-figurative control sentences (CS). The stimuli differed with respect to figurativeness, while they were matched for frequency of words, number of syllables, plausibility, and comprehensibility. Similes contrasted with CS resulted in enhanced BOLD responses in the left inferior (IFG) and adjacent middle frontal gyrus. Concrete CS as compared to similes activated the bilateral middle temporal gyri as well as the right precuneus and the left middle frontal gyrus (LMFG). Activation of the left IFG for similes in a short story is consistent with results on single sentence metaphor processing. The findings strengthen the importance of the left inferior frontal region in the processing of abstract figurative speech during continuous, ecologically-valid speech comprehension; the processing of concrete semantic contents goes along with a down-regulation of bilateral temporal regions.
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Whipple disease is a rare multisystemic disorder of infectious aetiology caused by Tropheryma whipplei. Pulmonary hypertension is a rare association for which the underlying pathophysiological mechanism is unclear. Our patient was a... more
Whipple disease is a rare multisystemic disorder of infectious aetiology caused by Tropheryma whipplei. Pulmonary hypertension is a rare association for which the underlying pathophysiological mechanism is unclear. Our patient was a 54-year-old man with a 1-year history of progressive polyarticular arthritis, and worsening respiratory and gastrointestinal symptoms. Pulmonary artery catheterisation demonstrated moderate-to-severe pulmonary hypertension. Duodenal biopsies, with electron microscopy, were diagnostic of Whipple disease. Involvement by Whipple disease was also evident in the stomach, bone marrow and pulmonary pleura. A 2-week course of intravenous ceftriaxone was initiated and this was followed by a 1-year course of trimethoprim/sulfamethoxazole (160/800), once daily. Nine months into antibiotic treatment, a repeat echocardiogram showed normalisation of the size and function of the cardiac chambers, including the right atrium and right ventricle. There was complete resolution of the severe tricuspid insufficiency and pulmonary hypertension. Whipple disease is not generally considered as a possible cause of pulmonary hypertension but such awareness is important given that it may be potentially reversible with antibiotic therapy.
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Research Interests: Magnetic Resonance Imaging, Adolescent, Biological Sciences, Anatomy, Hippocampus, and 15 moreHumans, Major Depressive Disorder, Insula, Female, Male, Amygdala, Adult, Adolescent Psychiatry, Diagnostic Radiology, Gray Matter, Anterior cingulate cortex, Case Control Studies, Depressive, Hippocampal formation, and Hippocampal
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This exploratory study is the first to examine the neural correlates of attachment status in adults. The study examined the feasibility of assessing attachment narratives in the functional magnetic resonance imaging (fMRI) environment by... more
This exploratory study is the first to examine the neural correlates of attachment status in adults. The study examined the feasibility of assessing attachment narratives in the functional magnetic resonance imaging (fMRI) environment by challenging subjects to tell attachment stories to specific attachment pictures from the Adult Attachment Projective (AAP) while being scanned. We investigated theoretically derived hypotheses regarding predicted differences in the brain activation patterns of individuals whose attachment status was organized (resolved) versus disorganized (unresolved) with respect to attachment trauma (e.g., as associated with loss through death, abuse, threat of abandonment). Adult attachment was assessed using the AAP, a new representational attachment measure that we thought might be suitable for use in the fMRI environment. This measure was used to obtain a preliminary picture of the neural processes associated with the activation of attachment in 11 healthy fe...
Research Interests: Clinical Psychology, Cognitive Science, Cognition, Borderline Personality Disorder, Language, and 15 moreCognitive Neuroscience, Adult attachment, Brain, Humans, Attachment, Functional Magnetic Resonance Imaging, Female, Functional Imaging, Clinical Sciences, Adult, Interaction effect, Attachment Representation, Exploratory Study, Magnetic resonance image, and Adult Attachment Projective Picture System
BackgroundAlterations in self-monitoring have been reported in patients with psychotic disorders, but it remains unclear to what degree they represent true indicators of familial vulnerability for psychosis.MethodAn error-correction... more
BackgroundAlterations in self-monitoring have been reported in patients with psychotic disorders, but it remains unclear to what degree they represent true indicators of familial vulnerability for psychosis.MethodAn error-correction action-monitoring task was used to examine self-monitoring in 42 patients with schizophrenia, 32 of their unaffected siblings and 41 healthy controls.ResultsSignificant between-group differences in self-monitoring accuracy were found (χ2=29.3, p<0.0001), patients performing worst and unaffected siblings performing at an intermediate level compared to controls (all between-group differences p<0.05). In the combined group of healthy controls and unaffected siblings, detection accuracy was associated with positive schizotypy as measured by the Structured Interview for Schizotypy – Revised (SIS-R) (β=−0.16, s.e.=0.07, p=0.026), but not with negative schizotypy (β=−0.05, s.e.=0.12, p=0.694). In patients, psychotic symptoms were not robustly associated w...
Research Interests: Psychology, Psychosis, Medicine, Executive Function, Psychological Medicine, and 14 moreSchizotypy, Humans, Female, Male, Siblings, Schizotypal Personality Disorder, Adult, Public health systems and services research, Biological markers, Psychotic Disorders, Antipsychotic, Neurosciences, HUMAN MEDICINE, and Psychomotor Performance
Research Interests: Depression, Medicine, Low Frequency, Mood, Affect, and 15 moreHumans, Female, Male, Frontal Cortex, Learned Helplessness, Electromagnetic phenomena, Adult, Analysis of Variance, Biological activity, Healthy Subjects, Frontal Lobe, Clinical Application, Anagrams, Motor evoked potential, and Medical and Health Sciences
Research Interests: Engineering, Computer Science, Algorithms, Artificial Intelligence, Physics, and 14 moreChemistry, Magnetic Resonance Imaging, Biology, Medicine, Multidisciplinary, Brain, Humans, Automation, Computer Simulation, Segmentation, PLoS one, Reproducibility of Results, Ground Truth, and Databases as topic
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Research Interests: Psychology, Cognitive Science, Anterior Cingulate, Magnetic Resonance Imaging, Medicine, and 15 moreLanguage Processing, Humans, Functional Magnetic Resonance Imaging, Male, Magnetic Resonance, Mental processes, Precuneus, Head Movements, Adult, Neuropsychologia, Neurosciences, Right Handed, Reading Process, Functional Laterality, and Psychomotor Performance
Research Interests: Computer Science, Brain Imaging, Gesture, Magnetic Resonance Imaging, Meaning, and 15 moreMedicine, FMRI, Brain Mapping, Brain, Mentalization, Gestures, Humans, Female, Data acquisition, Male, Mirror Neuron, Gesture Production, Inferior Parietal Lobule, Cingulate cortex, and Medical and Health Sciences
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Research Interests: Anxiety Disorders, Animal Studies, Anxiety, Agoraphobia, Biological Sciences, and 15 moreFemale, Heart rate, Dimensional, Arousal, Genotype, Adult, Anxiety Sensitivity, Functional Neuroimaging, ANXIETY, Case Control Study, Anterior cingulate cortex, Case Control Studies, Avoidance Learning, alleles, and G Protein Coupled Receptors
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Cognitive-behavioral therapy (CBT) is a first-line treatment for panic disorder with agoraphobia (PD/AG). Nevertheless, an understanding of its mechanisms and particularly the role of therapist-guided exposure is lacking. This study was... more
Cognitive-behavioral therapy (CBT) is a first-line treatment for panic disorder with agoraphobia (PD/AG). Nevertheless, an understanding of its mechanisms and particularly the role of therapist-guided exposure is lacking. This study was aimed to evaluate whether therapist-guided exposure in situ is associated with more pervasive and long-lasting effects than therapist-prescribed exposure in situ. A multicenter randomized controlled trial, in which 369 PD/AG patients were treated and followed up for 6 months. Patients were randomized to 2 manual-based variants of CBT (T+/T-) or a wait-list control group (WL; n = 68) and were treated twice weekly for 12 sessions. CBT variants were identical in content, structure, and length, except for implementation of exposure in situ: In the T+ variant (n = 163), therapists planned and supervised exposure in situ exercises outside the therapy room; in the T- group (n = 138), therapists planned and discussed patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; in situ exposure exercises but did not accompany them. Primary outcome measures were (a) Hamilton Anxiety Scale, (b) Clinical Global Impression, (c) number of panic attacks, and (d) agoraphobic avoidance (Mobility Inventory). For T+ and T- compared with WL, all outcome measures improved significantly with large effect sizes from baseline to post (range = -0.5 to -2.5) and from post to follow-up (range = -0.02 to -1.0). T+ improved more than T- on the Clinical Global Impression and Mobility Inventory at post and follow-up and had greater reduction in panic attacks during the follow-up period. Reduction in agoraphobic avoidance accelerated after exposure was introduced. A dose-response relation was found for Time × Frequency of Exposure and reduction in agoraphobic avoidance. Therapist-guided exposure is more effective for agoraphobic avoidance, overall functioning, and panic attacks in the follow-up period than is CBT without therapist-guided exposure. Therapist-guided exposure promotes additional therapeutic improvement--possibly mediated by increased physical engagement in feared situations--beyond the effects of a CBT treatment in which exposure is simply instructed.
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Research Interests: Neuroscience, Psychology, Cognitive Science, Magnetic Resonance Imaging, Face, and 15 moreMedicine, Episodic Memory, Brain Mapping, Brain, Humans, Major Depressive Disorder, Functional Magnetic Resonance Imaging, Female, Male, Adult, Human Brain Mapping, Parahippocampal Gyrus, Neurosciences, Neuropsychological Tests, and photic stimulation
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SummaryThe considerable debate about the justification of coercive measures in psychiatry includes medical, ethical, legal and political arguments, patients' subjective experience of involuntary injections or restraint is barely... more
SummaryThe considerable debate about the justification of coercive measures in psychiatry includes medical, ethical, legal and political arguments, patients' subjective experience of involuntary injections or restraint is barely investigated. A semi-structured interview was used to evaluate retrospective attitudes in 40 (32 schizophrenic) patients, treated involuntarily with injection of neuroleptic drugs or restrained. Of these patients, 48% rated these measures as necessary or positive, 23% as negative, and 30% were indifferent. Only patients with good insight into their disease were able to accept the involuntary treatment retrospectively as positive. Reasons for treatment refusal were inadequacy of the measures (58%), negative previous experience with neuroleptic drugs (47%), eg, akathisia, and reservations against the medical system itself (28%). ‘Fear’ and ‘powerlessness’ were the predominant feelings which patients experienced when confronted with coercive measures. Restr...
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Research Interests: Cognitive Science, Brain Imaging, Magnetic Resonance Imaging, Attention, Language disorders, and 15 moreFMRI, Biological Psychiatry, Brain Mapping, Brain, Humans, Female, Male, Lexical Decision, Clinical Sciences, Adult, Fusiform Gyrus, Anterior cingulate cortex, Case Control Studies, Functional Laterality, and Acoustic Stimulation
Research Interests: Psychology, Cognitive Science, Magnetic Resonance Imaging, Medicine, Brain Mapping, and 15 moreBrain, Humans, Male, Ketamine, Mental Disorders, Clinical Sciences, Precuneus, Oxygen, Adult, Neurosciences, Cognition disorders, Functional Laterality, Psychiatric Status Rating Scales, photic stimulation, and European Archives
The specific etiologies of schizophrenia are largely unknown. Genetic predisposition constitutes an important, however, not exclusive risk factor for the development of schizophrenia. In recent years, a number of candidate genes were... more
The specific etiologies of schizophrenia are largely unknown. Genetic predisposition constitutes an important, however, not exclusive risk factor for the development of schizophrenia. In recent years, a number of candidate genes were identified and have been consistently replicated. Magnetic resonance imaging studies have characterized structural changes in brain morphology, such as ventricular enlargement or volume reduction of the medial temporal structures and the superior temporal gyrus. Several studies have found correlations between gene variants and changes of brain morphology in schizophrenia patients and healthy controls. In this review, publications examining correlations of schizophrenia susceptibility gene polymorphisms and structural brain anomalies in patients and healthy controls are described. An overview and a critical reflection of the current research are outlined. The results of genome-wide studies will soon provide a multitude of additional schizophrenia susceptibility genes. If and to what extent these genes exert an influence on the brain structure in the healthy and the diseased, can be clarified by gene structure correlations. Given the many possible gene-gene and gene-environment interactions, most variants will probably not show simple interactions with sizable effects.