Body, Mind & Spirit Articles and Latest News

Hypofrontality in schizophrenic patients and its relevance for the choice of antipsychotic medication: An event-related potential study.

World J Biol Psychiatry. 2011 Apr 26;

Authors: Ehlis AC, Pauli P, Herrmann MJ, Plichta MM, Zielasek J, Pfuhlmann B, Stöber G, Ringel T, Jabs B, Fallgatter AJ

Abstract Objectives. One of the neurobiological core features of schizophrenic illnesses is a hypo-functionality of the frontal cortex (”cerebral hypofrontality”). The two major classes of antipsychotic medication differ regarding their impact on frontal lobe function and metabolism, with a presumably more positive effect of “atypical” compared to “typical” agents. To date, neurobiological markers reliably predicting the treatment response to different antipsychotics are lacking. The present study, therefore, aimed at establishing a neurophysiological marker of frontal lobe function (NoGo-Anteriorization, NGA) as a predictor of the treatment response to first- and second-generation antipsychotics. Methods. Seventy-six schizophrenic patients were examined three times over a 6-week study period. Patients were treated with first- or second-generation antipsychotics, and NGA, neurocognitive performance, and symptomatology were assessed on admission as well as during two follow-up measurements. Results. Baseline NGA values significantly predicted the treatment response to typical and atypical antipsychotics; however, the direction of this prediction was dependent on the antipsychotic drug regimen. Moreover, atypical antipsychotics had a superior impact on neurocognitive performance and self-reported quality of life. Conclusions. The NGA might be a useful tool in developing individualized treatment strategies based on pathophysiological aspects of schizophrenic illnesses that can be easily determined in clinical routine settings.

PMID: 21517702 [PubMed - as supplied by publisher]

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Psychiatric comorbidity in cardiovascular inpatients: costs, net gain, and length of hospitalization.

J Psychosom Res. 2011 Feb;70(2):135-9

Authors: Hochlehnert A, Niehoff D, Wild B, Jünger J, Herzog W, Löwe B

Although psychiatric comorbidity often goes undetected and untreated in cardiovascular patients, it is not clear whether the costs for a special treatment of psychiatric comorbidity are appropriately reflected in the reimbursement system. To investigate the economic impact of psychiatric comorbidity, we compared costs, returns, net gain, and duration of hospitalization in cardiovascular inpatients with and without psychiatric comorbidity.

PMID: 21262415 [PubMed - indexed for MEDLINE]

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Reliable integrative assessment of health care needs in elderly persons: the INTERMED for the Elderly (IM-E).

J Psychosom Res. 2011 Feb;70(2):169-78

Authors: Wild B, Lechner S, Herzog W, Maatouk I, Wesche D, Raum E, Müller H, Brenner H, Slaets J, Huyse F, Söllner W

With the increasing prevalence of multiple conditions in older age, the high prevalence of mental disorders, and the many social challenges facing elderly people, a high-risk patient group in need of interdisciplinary (biological, psychological, and social) care is emerging. The INTERMED interview is an integrative assessment method that identifies patients with complex health care needs. The aim of this study was to develop and evaluate the INTERMED for the Elderly (IM-E), specifically for use in populations of elderly persons.

PMID: 21262420 [PubMed - indexed for MEDLINE]

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Outcome of parent-physician communication skills training for pediatric residents.

Patient Educ Couns. 2011 Jan;82(1):94-9

Authors: Nikendei C, Bosse HM, Hoffmann K, Möltner A, Hancke R, Conrad C, Huwendiek S, Hoffmann GF, Herzog W, Jünger J, Schultz JH

communication skills represent an essential component of clinical competence. In the field of pediatrics, communication between physicians and patients’ parents is characterized by particular difficulties. To investigate the effects of a parent-physician communication skills training program on OSCE performance and self-efficacy in a group control design.

PMID: 20144522 [PubMed - indexed for MEDLINE]

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Stress, atopy and allergy: A re-evaluation from a psychoneuroimmunologic persepective.

Dermatoendocrinol. 2011 Jan;3(1):37-40

Authors: Liezmann C, Klapp B, Peters EM

Since the early days of psychosomatic thinking, atopic disease was considered exemplary. In the 70s and 80s numerous reports stated increased anxiety, depression or ill stresscoping in atopics in correlation with enhanced disease activity. Employed patient groups however were small and diverse and controls rare. Therefore, the question remained, whether psychopathological findings in atopics were of pathogenetic relevance or an epiphenomenon of chronic inflammatory disease. Recently, the discussion has been revived and refocused by psychoneuroimmunological findings. We now know that atopic disease is characterized by an imbalance of the classical stress-axis response along the hypothalamus-pituitary-adrenal axis (HPA) and the sympathetic axis (SA). This imbalance can be found shoulder-to-shoulder with enhanced expression of newly emerging neuroendocrine stress mediators such as substance P (SP) and nerve growth factor that form up to a third stress axis (neurotrophin neuropeptide axis: NNA). Together they can alter the inflammatory as well as the neuroendocrine stress-response on several levels. In skin, the immediate inflammatory response to stress involves neuropeptide release and mast cell degranulation, in short neurogenic inflammation. Systemically, antigen-presentation and TH2 cytokine bias are promoted under the influence of cortisol and neuropeptides. Imbalanced stress-responsiveness may therefore be at the core of exacerbated allergic disease and deserves re-evaluation of therapeutic options such as neutralization of SP-signaling by antagonists against its receptor NK1, cortisol treatment as supplementation and relaxation techniques to balance the stress-response.

PMID: 21519408 [PubMed - in process]

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The influence of emotional associations on the neural correlates of semantic priming.

Hum Brain Mapp. 2011 Apr 21;

Authors: Sass K, Habel U, Sachs O, Huber W, Gauggel S, Kircher T

Emotions influence our everyday life in several ways. With the present study, we wanted to examine the impact of emotional information on neural correlates of semantic priming, a well-established technique to investigate semantic processing. Stimuli were presented with a short SOA of 200 ms as subjects performed a lexical decision task during fMRI measurement. Seven experimental conditions were compared: positive/negative/neutral related, positive/negative/neutral unrelated, nonwords (all words were nouns). Behavioral data revealed a valence specific semantic priming effect (i.e., unrelated > related) only for neutral and positive related word pairs. On a neural level, the comparison of emotional over neutral relations showed activation in left anterior medial frontal cortex, superior frontal gyrus, and posterior cingulate. Interactions for the different relations were located in left anterior part of the medial frontal cortex, cingulate regions, and right hippocampus (positive > neutral + negative) and left posterior part of medial frontal cortex (negative > neutral + positive). The results showed that emotional information have an influence on semantic association processes. While positive and neutral information seem to share a semantic network, negative relations might induce compensatory mechanisms that inhibit the spread of activation between related concepts. The neural correlates highlighted a distributed neural network, primarily involving attention, memory and emotion related processing areas in medial fronto-parietal cortices. The differentiation between anterior (positive) and posterior part (negative) of the medial frontal cortex was linked to the type of affective manipulation with more cognitive demands being involved in the automatic processing of negative information. Hum Brain Mapp, 2011. © 2010 Wiley-Liss, Inc.

PMID: 21520342 [PubMed - as supplied by publisher]

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Neural correlates of the perception of dynamic versus static facial expressions of emotion.

Psychosoc Med. 2011;8:Doc03

Authors: Kessler H, Doyen-Waldecker C, Hofer C, Hoffmann H, Traue HC, Abler B

Aim: This study investigated brain areas involved in the perception of dynamic facial expressions of emotion. Methods: A group of 30 healthy subjects was measured with fMRI when passively viewing prototypical facial expressions of fear, disgust, sadness and happiness. Using morphing techniques, all faces were displayed as still images and also dynamically as a film clip with the expressions evolving from neutral to emotional. Results: Irrespective of a specific emotion, dynamic stimuli selectively activated bilateral superior temporal sulcus, visual area V5, fusiform gyrus, thalamus and other frontal and parietal areas. Interaction effects of emotion and mode of presentation (static/dynamic) were only found for the expression of happiness, where static faces evoked greater activity in the medial prefrontal cortex. Conclusions: Our results confirm previous findings on neural correlates of the perception of dynamic facial expressions and are in line with studies showing the importance of the superior temporal sulcus and V5 in the perception of biological motion. Differential activation in the fusiform gyrus for dynamic stimuli stands in contrast to classical models of face perception but is coherent with new findings arguing for a more general role of the fusiform gyrus in the processing of socially relevant stimuli.

PMID: 21522486 [PubMed - in process]

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Enduring emotions: James L. Halliday and the invention of the psychosocial.

Isis. 2009 Dec;100(4):827-38

Authors: Hayward R

Emotions maintain an ambivalent position in the economy of science. In contemporary debates they are variously seen as hardwired biological responses, cultural artifacts, or uneasy mixtures of the two. At the same time, there is a tension between the approaches to emotion developed in modern psychotherapies and in the history of science. While historians see the successful ascription of affective states to individuals and populations as a social and technical achievement, the psychodynamic practitioner treats these enduring associations as pathological accidents that need to be overcome. This short essay uses the career of the Glaswegian public health investigator James L. Halliday to examine how debates over the ontological status of the emotions and their durability allow them to travel between individual identity and political economy, making possible new kinds of psychological intervention.

PMID: 20380350 [PubMed - indexed for MEDLINE]

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A brief history of placebos and clinical trials in psychiatry.

Can J Psychiatry. 2011 Apr;56(4):193-7

Authors: Shorter E

The history of placebos in psychiatry can be understood only in the context of randomized controlled trials (RCTs). Placebo treatments are as old as medicine itself, and are particularly effective in dealing with psychosomatic symptoms. In psychiatry, placebos have mainly been featured in clinical drug trials. The earliest controlled trial in psychiatry (not involving drugs) occurred in 1922, followed by the first crossover studies during the 1930s. Meanwhile the concept of randomization was developed during the interwar years by British statistician Ronald A Fisher, and introduced in 3 trials of tuberculosis drugs between 1947 and 1951. These classic studies established the RCT as the gold standard in pharmaceutical trials, and its status was cemented during the mid-1950s. Nevertheless, while the placebo became established as a standard measure of drug action, placebo treatments became stigmatized as unethical. This is unfortunate, as they constitute one of the most powerful therapies in psychiatry. In recent years, moreover, the dogma of the placebo-controlled trial as the only acceptable data for drug licensing is also being increasingly discredited. This backlash has had 2 sources: one is the recognition that the US Food and Drug Administration has been too lax in permitting trials controlled with placebos alone, rather than also using an active agent as a test of comparative efficacy. In addition, there is evidence that in the hands of the pharmaceutical industry, the scientific integrity of RCTs themselves has been degraded into a marketing device. The once-powerful placebo is thus threatened with extinction.

PMID: 21507275 [PubMed - in process]

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Genetic variation in the choline O-acetyltransferase gene in depression and Alzheimer’s disease: The VITA and Milano studies.

J Psychiatr Res. 2011 Apr 18;

Authors: Grünblatt E, Andreas R, Susanne J, Daniela G, Heike W, Elio S, Cathrin S, Ildiko W, Rainer MK, Klaus H, Walter D, Heinz TK, Jürgen D, Peter F, Peter R

Linkage studies point to the long arm of chromosome 10 being a susceptibility region for Alzheimer’s disease (AD). Additionally, the gene choline O-acetyltransferase (CHAT) located on chromosome 10 was discussed for conveying risk towards AD, but the results are ambiguous. We examined a possible association of nineteen single-nucleotide polymorphisms (SNPs) in the CHAT gene in a longitudinal cohort study, the Vienna Tansdanube Aging (VITA)-study, in which all subjects were 75 years old at baseline. For replication, we used a more heterogeneous case-control sample from Milano with early and late AD. Nominal allelic and genotypic associations with AD risk in the cross-sectional VITA sample were found for rs3810950 (p = 0.038 for genotype, OR = 1.66 95% CI 1.03-2.68, p = 0.052 allele-wise). When combining both VITA- and Milano study rs3810950 was significantly associated with AD (p(combined) = 0.01634; power = 82%). This association was highly significant for APOEε4 carriers (p = 0.009 for genotype, OR = 3.21 95% CI 1.43-7.19 p = 0.007 allele-wise). Furthermore, an association of rs1880676 with AD was specific to carriers of the APOEε4 risk allele (p = 0.008, genotype; OR = 3.47 95% CI 1.50-8.01 p = 0.005 allele-wise). For depressive symptoms, we found a nominally significant association of rs3810950 with minor and major depression (p = 0.023, genotype; p = 0.008, allele). Applying Benjamini and Hochberg correction these associations could not be confirmed and also not be replicated in the more heterogeneous Milano sample. While our data therefore do not seem to support a major role for CHAT genetic variation in geriatric depression and AD, there might be a minor contribution in geriatric patients with depression and late onset AD, in particular those carrying the APOEε4 genotype.

PMID: 21507424 [PubMed - as supplied by publisher]

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