Publications by authors named "Andrea Jobst"

29 Publications

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The role of oxytocin in delay of gratification and flexibility in non-social decision making.

Elife 2021 04 6;10. Epub 2021 Apr 6.

Department of Psychology, Ludwig Maximilian University Munich, Munich, Germany.

Oxytocin is well-known for its impact on social cognition. This specificity for the social domain, however, has been challenged by findings suggesting a domain-general allostatic function for oxytocin by promoting future-oriented and flexible behavior. In this pre-registered study, we tested the hypothesized domain-general function of oxytocin by assessing the impact of intranasal oxytocin (24 IU) on core aspects of human social (inequity aversion) and non-social decision making (delay of gratification and cognitive flexibility) in 49 healthy volunteers (within-subject design). In intertemporal choice, patience was higher under oxytocin than under placebo, although this difference was evident only when restricting the analysis to the first experimental session (between-group comparison) due to carry-over effects. Further, oxytocin increased cognitive flexibility in reversal learning as well as generosity under conditions of advantageous but not disadvantageous inequity. Our findings show that oxytocin affects both social and non-social decision making, supporting theoretical accounts of domain-general functions of oxytocin.
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http://dx.doi.org/10.7554/eLife.61844DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8024008PMC
April 2021

Borderline Personality Features in Patients With Persistent Depressive Disorder and Their Effect on CBASP Outcome.

Front Psychiatry 2021 12;12:608271. Epub 2021 Mar 12.

Department of Psychiatry and Psychotherapy, LMU University Hospital Munich, Munich, Germany.

The Cognitive Behavioral Analysis System of Psychotherapy (CBASP) was developed for the treatment of persistent depressive disorder (PDD), where comorbid personality disorders (PD) are common. In contrast to other PD, comorbid borderline personality disorder (BPD) is often regarded as an exclusion criterion for CBASP. In clinical settings, however, subthreshold BPD symptoms are prevalent in PDD and may not be obvious at an initial assessment prior to therapy. As data on their impact on CBASP outcome are very limited, this naturalistic study investigates BPD features in PDD and their relevance for the therapeutic outcome of a multimodal CBASP inpatient program. Sixty patients (37 female, mean age 38.3, SD 11.9 years) meeting DSM-5 criteria for PDD underwent a 10 weeks CBASP inpatient program. BPD features (i.e., number of fulfilled DSM-5 criteria) together with childhood maltreatment and rejection sensitivity were assessed on admission. Before and after treatment, severity of depressive symptoms was measured using the Montgomery-Asberg Depression Rating Scale (MADRS) and the Beck Depression Inventory (BDI-II). BPD symptoms were assessed using the Borderline Personality Disorder Severity Index (BPDSI-IV) and the Borderline Symptom List (BSL-23). Intercorrelations of baseline characteristics and symptom change during treatment were analyzed. Patients with PDD met a mean of 1.5 (SD 1.6) BPD criteria with 4 patients fulfilling ≥5 criteria. BPD symptoms and depressive symptoms showed a strong correlation, and BPD symptoms were additionally correlated with emotional abuse and rejection sensitivity. There was no association between BPD features at baseline and improvement on the MADRS, however, BPD features tended to be associated with a lower response according to the BDI-II score after 10 weeks of treatment. Furthermore, BPD symptoms (i.e., abandonment, impulsivity and affective instability) were reduced after 10 weeks of CBASP treatment. BPD symptoms are prevalent in patients with PDD and highly intertwined with the experience of depressive symptoms. In this naturalistic study in PDD, BPD features at baseline did not limit the clinical response to CBASP. Future studies may extend the spectrum of PDD to comorbid subsyndromal or even syndromal BPD in order to develop tailored psychotherapeutic treatment for these complex affective disorders.
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http://dx.doi.org/10.3389/fpsyt.2021.608271DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8006327PMC
March 2021

Loneliness, Social Isolation and Their Difference: A Cross-Diagnostic Study in Persistent Depressive Disorder and Borderline Personality Disorder.

Front Psychiatry 2020 17;11:608476. Epub 2020 Dec 17.

Department of Psychiatry and Psychotherapy, LMU University Hospital Munich, Munich, Germany.

Interpersonal difficulties are a key feature of persistent depressive disorder (PDD) and borderline personality disorder (BPD). Caught in a vicious circle of dysfunctional interpersonal transaction, PDD and BPD patients are at great risk of experiencing prolonged loneliness. Loneliness, in turn, has been associated with the development of mental disorders and chronic illness trajectories. Besides, several factors may contribute to the experience of loneliness across the lifespan, such as social network characteristics, a history of childhood maltreatment (CM), and cognitive-affective biases such as rejection sensitivity (RS). This cross-diagnostic study approached the topic of perceived loneliness by comparing PDD and BPD patients with healthy controls (HC) in its interplay with symptom burden, social network characteristics, RS as well as CM. Thirty-four PDD patients (DSM-5; 15 female, M = 38.2, SD = 12.3), 36 BPD patients (DSM-5; 19 female, M = 28.8, SD = 9.2), and 70 age- and gender-matched HC were assessed cross-sectionally using the following self-report measures: UCLA Loneliness Scale, Social Network Index (SNI; size, diversity, and embeddedness), Beck Depression Inventory (BDI-II), Borderline Symptom List (BSL-23), Childhood Trauma Questionnaire (CTQ), and Rejection Sensitivity Questionnaire (RSQ). Both patient groups reported significantly higher levels of perceived loneliness, symptom severity, and smaller social network characteristics compared to HC. Loneliness was significantly correlated with severity of self-reported clinical symptoms in PDD and at trend level in BPD. Besides, loneliness tended to be related to social network characteristics for all groups except PDD patients. Both PDD and BPD patients showed higher RS as well as CTQ scores than HC. A history of emotional abuse and emotional neglect was associated with loneliness, and this association was mediated by RS as demonstrated by an exploratory mediation analysis. Loneliness is highly prevalent in PDD and BPD patients and contributes to the overall symptom burden. Interestingly, loneliness showed an association with prior experiences of CM as well as current RS. We therefore propose a comprehensive model on how intra- und interpersonal aspects may interplay in the dynamics of loneliness in light of CM. Finally, this model may have further implications for psychotherapeutic interventions.
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http://dx.doi.org/10.3389/fpsyt.2020.608476DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7773662PMC
December 2020

The vicious circle of social exclusion and psychopathology: a systematic review of experimental ostracism research in psychiatric disorders.

Eur Arch Psychiatry Clin Neurosci 2020 Aug 4;270(5):521-532. Epub 2019 Oct 4.

Department of Psychiatry and Psychotherapy, University Hospital, LMU, Nussbaumstr. 7, 80336, Munich, Germany.

Social exclusion (ostracism) is a major psychosocial factor contributing to the development and persistence of psychiatric disorders and is also related to their social stigma. However, its specific role in different disorders is not evident, and comprehensive social psychology research on ostracism has rather focused on healthy individuals and less on psychiatric patients. Here, we systematically review experimental studies investigating psychological and physiological reactions to ostracism in different responses of psychiatric disorders. Moreover, we propose a theoretical model of the interplay between psychiatric symptoms and ostracism. A systematic MEDLINE and PsycINFO search was conducted including 52 relevant studies in various disorders (some of which evaluated more than one disorder): borderline personality disorder (21 studies); major depressive disorder (11 studies); anxiety (7 studies); autism spectrum disorder (6 studies); schizophrenia (6 studies); substance use disorders (4 studies); and eating disorders (2 studies). Psychological and physiological effects of ostracism were assessed with various experimental paradigms: e.g., virtual real-time interactions (Cyberball), social feedback and imagined scenarios. We critically review the main results of these studies and propose the overall concept of a vicious cycle where psychiatric symptoms increase the chance of being ostracized, and ostracism consolidates or even aggravates psychopathology. However, the specificity and stability of reactions to ostracism, their neurobiological underpinnings, determinants, and moderators (e.g., attachment style, childhood trauma, and rejection sensitivity) remain elusive.
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http://dx.doi.org/10.1007/s00406-019-01074-1DOI Listing
August 2020

Response to ostracism in patients with chronic depression, episodic depression and borderline personality disorder a study using Cyberball.

J Affect Disord 2020 01 3;260:254-262. Epub 2019 Sep 3.

Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany.

Background: Social exclusion (ostracism) can lead to interactional frustration and may play an important role as trigger and symptom amplifier in affective disorders. To investigate immediate emotional and behavioral reactions as well as coping, social exclusion can be mimicked in experimental situations, e.g. in the Cyberball paradigm, a virtual ball tossing game which is well established in social psychology. The present cross-diagnostic study compares the responses to social exclusion in patients with chronic depression (CD), episodic depression (ED) and borderline personality disorder (BPD) in comparison to a healthy control group.

Methods: After baseline characterization, 120 participants (29 patients with CD, 20 with ED, 28 with BPD and 43 healthy controls) played Cyberball with two virtual players and complete exclusion after three times receiving the ball. Thereafter, standard questionnaires were applied for measuring needs, threats, inner tension, emotions and behavioral intentions.

Results: Patients with CD showed a higher intensity of ostracism and aversive impact, as well as the wish to escape the situation (behavioral intention) compared to ED. In most categories, CD and ED had scores between BPD and healthy controls (with this sequence) and with BPD patients showing the largest difference to healthy controls.

Limitations: The assessment did neither include objective behavioral measures (which is a general limitation in the majority of studies using Cyberball) nor any biological variables. The sample sizes of the diagnostic subgroups were moderate.

Conclusions: These findings support the hypothesis that social exclusion situations lead to a more aversive emotional and behavioral reaction in CD compared to ED. Psychological and biological underpinnings of these reactions should be addressed in future transdiagnostic studies. Moreover, psychotherapy in CD should focus on specific needs of CD patients for developing a functional coping in threatening interpersonal situations.
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http://dx.doi.org/10.1016/j.jad.2019.09.021DOI Listing
January 2020

Evaluation of a Master of Science in Integrated Clinical and Community Mental Health (MSc ICCMH) program in Ethiopia.

Ger Med Sci 2018 18;16:Doc04. Epub 2018 Dec 18.

Center for International Health, LMU, Munich, Germany.

The shortage of trained manpower in the field of mental health remains a significant obstacle to the treatment of people with mental illnesses in low and middle-income countries. In 2010, a new program for non-physician clinicians was established at Jimma University to address this shortage in Ethiopia. This study aimed to assess the competency, satisfaction, and involvement level of graduates of the program. A cross-sectional study was conducted among the graduates of the program. Data were collected with a semi-structured, self-administered questionnaire that was developed for the study. Responses were recorded on a Likert scale to assess graduates' competency and satisfaction level. The quantitative data were summarized by descriptive statistics, including means, standard deviations, and frequencies. Qualitative data were transcribed and analyzed thematically. Until June 2015, 32 trainees had graduated from the MSc ICCMH program; 87.5% (n=28) of these graduates participated in the study. Almost all (96.4%, n=27) graduates were working in public institutions. The majority (75%, n=21) were directly engaged in the clinical care of patients. Also, two-thirds of the graduates (67.9%, n=19) were involved in mental health research. All of the graduates felt confident in conducting psychiatric assessments of adults and identifying and managing common mental disorders (100%, n=28). Similarly, 100% (n=28) of the graduates reported that they felt confident in identifying and managing severe mental illnesses. The outcome of the program is a considerable workforce of skilled mental health professionals. The majority of graduates were retained within the public mental health service. Brain drain does not appear to be a challenge among non-physician mental health specialists. The findings on the self-perceived competencies mirror the amount of clinical exposure during the training. With a minimal revision of the curriculum, the level of satisfaction and competencies can be enhanced.
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http://dx.doi.org/10.3205/000266DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6317302PMC
April 2019

Predicting instructed simulation and dissimulation when screening for depressive symptoms.

Eur Arch Psychiatry Clin Neurosci 2020 Mar 12;270(2):153-168. Epub 2018 Dec 12.

Department of Psychological Methodology and Assessment, Ludwig-Maximilians-University Munich, Munich, Germany.

The intentional distortion of test results presents a fundamental problem to self-report-based psychiatric assessment, such as screening for depressive symptoms. The first objective of the study was to clarify whether depressed patients like healthy controls possess both the cognitive ability and motivation to deliberately influence results of commonly used screening measures. The second objective was the construction of a method derived directly from within the test takers' responses to systematically detect faking behavior. Supervised machine learning algorithms posit the potential to empirically learn the implicit interconnections between responses, which shape detectable faking patterns. In a standardized design, faking bad and faking good were experimentally induced in a matched sample of 150 depressed and 150 healthy subjects. Participants completed commonly used questionnaires to detect depressive and associated symptoms. Group differences throughout experimental conditions were evaluated using linear mixed-models. Machine learning algorithms were trained on the test results and compared regarding their capacity to systematically predict distortions in response behavior in two scenarios: (1) differentiation of authentic patient responses from simulated responses of healthy participants; (2) differentiation of authentic patient responses from dissimulated patient responses. Statistically significant convergence of the test scores in both faking conditions suggests that both depressive patients and healthy controls have the cognitive ability as well as the motivational compliance to alter their test results. Evaluation of the algorithmic capability to detect faking behavior yielded ideal predictive accuracies of up to 89%. Implications of the findings, as well as future research objectives are discussed. Trial Registration The study was pre-registered at the German registry for clinical trials (Deutsches Register klinischer Studien, DRKS; DRKS00007708).
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http://dx.doi.org/10.1007/s00406-018-0967-2DOI Listing
March 2020

Self-esteem fully mediates positive life events and depressive symptoms in a sample of 173 patients with affective disorders.

Psychol Psychother 2020 03 28;93(1):21-35. Epub 2018 Nov 28.

Department of Psychological Methodology and Assessment, Ludwig-Maximilians-University Munich, Germany.

Objectives: Previous research showed that positive and negative life events influence the development of depression. However, it is less clear how life events interact with depressive symptoms and self-esteem.

Design And Methods: The present study aimed to investigate the mediating effects of self-esteem on the relationship between life events and depressive symptoms in adulthood. The Traumatic Antecedent Questionnaire, Multidimensional Self-esteem Scale (MSWS), and Becks Depression Inventory were administered in 173 psychiatric inpatients (mean age 39.69 ± 14.56 years, ranging from 18 to 76 years). At the time of assessment, all patients suffered from depressive symptoms caused by an affective disorder (major depression, bipolar I, dysthymia).

Results: Path analyses showed that the individual level of self-esteem (measured by MSWS) fully mediated the association between positive life events and depressive symptoms.

Conclusions: The current study indicates that future therapy programmes for patients with depressive symptoms could include interventions focusing on the improvement of self-esteem, as increasing self-esteem may be beneficial for recovery.

Practitioner Points: To date, this is the first study exploring the pathways from positive/negative life events to depressive symptoms. The relationship between positive life experiences and depressive symptoms was fully mediated by self-esteem. Strengthening self-esteem in therapy might lower the vulnerability for depression.
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http://dx.doi.org/10.1111/papt.12205DOI Listing
March 2020

Event-Related Potentials Are Associated With Unexpected Gain and Loss: Using a Gambling Paradigm.

Clin EEG Neurosci 2019 May 27;50(3):154-160. Epub 2018 Nov 27.

1 Department of Psychiatry and Psychotherapy, University Hospital, Ludwig Maximilians University, Munich, Germany.

Objective: Previous neuroimaging studies have described altered activity in brain areas associated with reward processing following reward or punishment. This study examines the extent to which feedback-based experience of gain and loss is associated with electrophysiological correlates.

Methods: Twenty-nine healthy participants used a gambling task that focused on actual nonpredictable gains and losses. During the task, an electroencephalography recording was performed in order to assess reward processing. Event-related potentials were analyzed when participants were receiving gain/loss feedback.

Results: Event-related potentials revealed higher feedback-related negativity for both overall gain and loss compared with a neutral condition in fronto-centro-parietal electrodes. P3 potentials were significantly increased for high gains/losses compared to neutral and small gains/losses.

Conclusion: These results indicate that the paradigm is suitable to evoke specific patterns of reward-related electrophysiological responses. The wavelet analysis showed that electroencephalography frequency variations depended on the amount of gains/losses.

Significance: This gambling paradigm is appropriate to measure aspects of feedback processing and could help analyze disease-specific alterations of the reward system in patients.
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http://dx.doi.org/10.1177/1550059418814987DOI Listing
May 2019

[Inpatient Treatment of Complex PTSD Following Childhood Abuse: Effectiveness and Predictors of Treatment Outcome].

Psychother Psychosom Med Psychol 2019 Mar 30;69(3-04):114-122. Epub 2018 May 30.

Klinik und Poliklink für Psychiatrie und Psychotherapie, Ludwig-Maximilians-Universität, München.

Background: There is a lack of studies investigating the effectiveness of inpatient trauma-focused psychotherapy of complex post-traumatic stress disorder. The first aim of this retrospective investigation was to analyze the course of PTSD. Second, possible predictors of treatment response were investigated.

Methods: 150 inpatients of Clinic St. Irmingard with complex PTSD following childhood physical and childhood sexual abuse were assessed regarding childhood abuse, PTSD symptomatology, mindfulness, dissociation and general psychopathology. Differences in pre and post scores were analyzed using regression analyses. A classification tree was used to identify predictors of response.

Results: The significant reduction of PTSD symptoms corresponded to a large effect (d=1.8) and a reponse rate of 52% according to the reliable change index (p<0.05). Effect sizes for other symptoms were medium to large (0.5
Conclusions: Trauma-focused inpatient treatment is safe and effective for patients with complex PTSD under naturalistic conditions. Yet, despite significant improvements there is a high rate of nonresponse. Future studies should further investigate the negative predictors of treatment outcome we identified. Possible ways to reduce nonresponse are discussed.
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http://dx.doi.org/10.1055/a-0591-3962DOI Listing
March 2019

The Role of Self-Esteem in Depression: A Longitudinal Study.

Behav Cogn Psychother 2019 Mar 25;47(2):244-250. Epub 2018 Apr 25.

Department of Psychological Methodology and Assessment,Ludwig-Maximilians-University,Munich,Germany.

Background: Based on the vulnerability model, several studies indicate that low self-esteem seems to contribute to depressive symptoms.

Aims: The aim of this study was to treat depressive symptoms in a cognitive behavioural group therapy, focusing on the enhancement of self-esteem, and to explore co-variation in depressive symptoms and the level of self-esteem.

Method: The Multidimensional Self-esteem Scale (MSWS) and the Beck Depression Inventory (BDI) were administered to 147 psychiatric in-patients with current depressive symptoms due to an affective disorder (major depression, bipolar I, dysthymia). Self-esteem was measured pre-treatment (t0) and post-treatment (t4, after 5 weeks of eight group sessions); the BDI was applied weekly. A linear mixed growth analysis was conducted to estimate the change in depressive symptoms including interactions with self-esteem.

Results: Within the 5 weeks of group therapy, depressive symptoms showed a linear decline, which was stronger for patients with higher gains in self-esteem between t0 and t4. Self-esteem at t0 was unrelated to the change in depression but predicted self-esteem at t4.

Conclusions: Treating depressive symptoms in a cognitive behavioural group therapy in a naturalistic setting might have a positive effect on the process of recovery. Moreover, depressive symptoms and level of self-esteem seemed to co-vary.
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http://dx.doi.org/10.1017/S1352465818000243DOI Listing
March 2019

The effect of oxytocin on group formation and strategic thinking in men.

Horm Behav 2018 04 9;100:100-106. Epub 2018 Apr 9.

University of Munich, Department of Economics, Geschwister-Scholl-Platz 1, 80539 Munich, Germany.

Decision-making in groups is a remarkable and decisive element of human societies. Humans are able to organize themselves in groups, engage in collaborative decision-making processes and arrive at a binding agreement, even in the absence of unanimous consent. However, the transfer of decision-making autonomy requires a willingness to deliberately expose oneself to the decisions of others. A lack of trust in the abilities of others or of the underlying decision-making process, i.e. public trust, can lead to a breakdown of organizations in political or economic domains. Recent studies indicate that the biological basis of trust on an individual level is related to Oxytocin, an endogenous neuropeptide and hormone, which is also associated with pro-social behavior and positive conflict resolution. However, little is known about the effects of Oxytocin on the inclination of individuals to form or join groups and to deliberately engage in collaborative decision-making processes. Here, we show that intranasal administration of Oxytocin (n = 60) compared to placebo (n = 60) in males causes an adverse effect on the choice for forming groups in the presence of a competitive environment. In particular, Oxytocin negatively affects the willingness to work collaboratively in a p-Beauty contest game, whereas the effect is most pronounced for participants with relatively high strategic sophistication. Since our data provide initial evidence that Oxytocin has a positive effect on strategic thinking and performance in the p-Beauty contest game, we argue that the adverse effect on group formation might be rooted in an enhanced strategic sophistication of participants treated with Oxytocin.
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http://dx.doi.org/10.1016/j.yhbeh.2018.02.003DOI Listing
April 2018

Oxytocin promotes altruistic punishment.

Soc Cogn Affect Neurosci 2017 11;12(11):1740-1747

Department of Economics, Ludwig-Maximilians University Munich, Germany.

The role of neuromodulators in the enforcement of cooperation is still not well understood. Here, we provide evidence that intranasal applied oxytocin, an important hormone for modulating social behavior, enhances the inclination to sanction free-riders in a social dilemma situation. Contrary to the notion of oxytocin being a pro-social hormone, we found that participants treated with oxytocin exhibited an amplification of self-reported negative social emotions such as anger towards free-riders, ultimately resulting in higher magnitude and frequency of punishment of free-riders compared to placebo. Furthermore, we found initial evidence that oxytocin contributes to the positive effects of a punishment institution by rendering cooperation preferable in the oxytocin condition for even the most selfish players when punishment was available. Together, these findings imply that the neural circuits underlying altruistic punishment are partly targeted by the oxytonergic system and highlight the importance of neuromodulators in group cohesion and norm enforcement within social groups.
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http://dx.doi.org/10.1093/scan/nsx101DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5714236PMC
November 2017

Cognitive Behavioral Analysis System of Psychotherapy as group psychotherapy for chronically depressed inpatients: a naturalistic multicenter feasibility trial.

Eur Arch Psychiatry Clin Neurosci 2018 Dec 27;268(8):783-796. Epub 2017 Sep 27.

Philipps-University Marburg, Marburg, Germany.

The Cognitive Behavioral Analysis System of Psychotherapy (CBASP) is a relatively new approach in the treatment of chronic depression (CD). Adapted as group psychotherapy for inpatients, CBASP is attracting increasing attention. In this naturalistic multicenter trial, we investigated its feasibility after 10 sessions of CBASP group therapy over a treatment time of at least 5 to a maximum of 10 weeks. Treatment outcome was additionally assessed. Across four centers, 116 inpatients with CD (DSM-IV-TR) attended CBASP group psychotherapy. Feasibility was focused on acceptance, and evaluated for patients and therapists after five (t1) and ten sessions (t2) of group psychotherapy. Observer- and self-rating scales (Hamilton Depression Rating Scale-24 items, HDRS; Beck Depression Inventory-II, BDI-II; World Health Organization Quality of Life assessment, WHOQOL-BREF) were applied before group psychotherapy (t0) and at t2. Dropouts were low (10.3%). Patients' evaluation improved significantly from t1 to t2 with a medium effect size (d = 0.60). Most of the patients stated that the group had enriched their treatment (75.3%), that the size (74.3%) and duration (72.5%) were 'optimal' and 37.3% wished for a higher frequency. Patients gave CBASP group psychotherapy an overall grade of 2 ('good'). Therapists' evaluation was positive throughout, except for size of the group. Outcome scores of HDRS, BDI-II, and WHOQOL-BREF were significantly reduced from t0 to t2 with medium to large effect sizes (d = 1.48; d = 1.11; d = 0.67). In this naturalistic open-label trial, CBASP, when applied as inpatient group psychotherapy, was well accepted by patients and therapists. The results point towards a clinically meaningful effect of inpatient treatment with CBASP group psychotherapy on depression and quality of life. Other potential factors that could have promoted symptom change were discussed. A future controlled study could investigate the safety and efficacy of CBASP group psychotherapy for inpatients.
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http://dx.doi.org/10.1007/s00406-017-0843-5DOI Listing
December 2018

The Detrimental Effects of Oxytocin-Induced Conformity on Dishonesty in Competition.

Psychol Sci 2017 Jun 7;28(6):751-759. Epub 2017 Apr 7.

4 Institute for Advanced Studies, Vienna, Austria.

Justifications may promote unethical behavior because they constitute a convenient loophole through which people can gain from immoral behavior and preserve a positive self-image at the same time. A justification that is widely used is rooted in conformity: Unethical choices become more permissible because one's peers are expected to make the same unethical choices. In the current study, we tested whether an exogenous alteration of conformity led to a lower inclination to adhere to a widely accepted norm (i.e., honesty) under the pressure of competition. We took advantage of the well-known effects of intranasally applied oxytocin on affiliation, in-group conformity, and in-group favoritism in humans. We found that conformity was enhanced by oxytocin, and this enhancement had a detrimental effect on honesty in a competitive environment but not in a noncompetitive environment. Our findings contribute to recent evidence showing that competition may lead to unethical behavior and erode moral values.
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http://dx.doi.org/10.1177/0956797617695100DOI Listing
June 2017

Oxytocin course over pregnancy and postpartum period and the association with postpartum depressive symptoms.

Arch Womens Ment Health 2016 08 20;19(4):571-9. Epub 2016 Jun 20.

Department of Psychiatry and Psychotherapy, Ludwig Maximilian University, Nussbaumstr. 7, 80336, Munich, Germany.

During the postpartum period, women are at higher risk of developing a mental disorder such as postpartum depression (PPD), a disorder that associates with mother-infant bonding and child development. Oxytocin is considered to play a key role in mother-infant bonding and social interactions and altered oxytocin plasma concentrations were found to be associated with PPD. In the present study, we evaluated oxytocin plasma levels and depressive symptoms during pregnancy and the postpartum period in healthy women. We evaluated 100 women twice during pregnancy (weeks 35 and 38) and three times in the postpartum period (within 2 days and 7 weeks and 6 months after delivery) by measuring oxytocin plasma levels with enzyme-linked immunosorbent assay (ELISA) and assessing depressive symptoms with the Montgomery-Asberg Depression Rating Scale. Oxytocin plasma levels significantly increased from the 35th week of gestation to 6 months postpartum in all women. However, levels decreased from the 38th week of gestation to 2 days after delivery in participants with postpartum depressive symptoms, whereas they continuously increased in the group without postpartum depressive symptoms; the difference between the course of oxytocin levels in the two groups was significant (Δt2-t3: t = 2.14; p = 0.036*). Previous depressive episodes and breastfeeding problems predicted postpartum depressive symptoms. Our results indicate that alterations in the oxytocin system during pregnancy might be specific for women who develop postpartum depressive symptoms. Future studies should investigate whether oxytocin plasma levels might have predictive value in women at high risk for PPD.
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http://dx.doi.org/10.1007/s00737-016-0644-2DOI Listing
August 2016

Lower Oxytocin Plasma Levels in Borderline Patients with Unresolved Attachment Representations.

Front Hum Neurosci 2016 30;10:125. Epub 2016 Mar 30.

Department of Psychology, Freie Universität BerlinBerlin, Germany; Department of Clinical Psychology II, Institute of Psychology, University of InnsbruckInnsbruck, Austria.

Interpersonal problems and affective dysregulation are core characteristics of borderline personality disorder (BPD). BPD patients predominantly show unresolved attachment representations. The oxytocin (OT) system is associated with human social attachment and affiliative behavior, and OT dysregulation may be related to distinct attachment characteristics. Here, we investigated whether attachment representations are related to peripheral OT levels in BPD patients. Twenty-one female BPD patients and 20 age-, gender-, and education-matched healthy controls (HCs) were assessed with clinical scales and measures of interpersonal and attachment-related characteristics, including the Adult Attachment Projective Picture System (AAP). Plasma OT concentrations were measured prior to and during social exclusion in a virtual ball tossing game (Cyberball). The majority of BPD patients (63.2%) but no HCs showed unresolved (disorganized) attachment representations. In this subgroup of patients, baseline OT plasma levels were significantly lower than in BPD patients with organized attachment representations. This pilot study extends previous findings of altered OT regulation in BPD as a putative key mechanism underlying interpersonal dysregulation. Our results provide first evidence that altered OT plasma levels are related to disorganized attachment representations in BPD patients.
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http://dx.doi.org/10.3389/fnhum.2016.00125DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4811864PMC
April 2016

Psychiatrische Frischzellenkur für Äthiopien.

MMW Fortschr Med 2016 Jan;158(1):24-25

Klinik und Poliklinik für Psychiatrie und Psychotherapie, Nußbaumstr. 7, D-80336, München, Deutshcland.

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http://dx.doi.org/10.1007/s15006-016-7688-0DOI Listing
January 2016

Transcutaneous noninvasive vagus nerve stimulation (tVNS) in the treatment of schizophrenia: a bicentric randomized controlled pilot study.

Eur Arch Psychiatry Clin Neurosci 2015 Oct 26;265(7):589-600. Epub 2015 Jul 26.

Department of Psychiatry and Psychotherapy, Georg-August-University Göttingen, Göttingen, Germany.

Despite many pharmacological and psychosocial treatment options, schizophrenia remains a debilitating disorder. Thus, new treatment strategies rooted in the pathophysiology of the disorder are needed. Recently, vagus nerve stimulation (VNS) has been proposed as a potential treatment option for various neuropsychiatric disorders including schizophrenia. The objective of this study was to investigate for the first time the feasibility, safety and efficacy of transcutaneous VNS in stable schizophrenia. A bicentric randomized, sham-controlled, double-blind trial was conducted from 2010 to 2012. Twenty schizophrenia patients were randomly assigned to one of two treatment groups. The first group (active tVNS) received daily active stimulation of the left auricle for 26 weeks. The second group (sham tVNS) received daily sham stimulation for 12 weeks followed by 14 weeks of active stimulation. Primary outcome was defined as change in the Positive and Negative Symptom Scale total score between baseline and week 12. Various other secondary measures were assessed to investigate safety and efficacy. The intervention was well tolerated with no relevant adverse effects. We could not observe a statistically significant difference in the improvement of schizophrenia psychopathology during the observation period. Neither psychopathological and neurocognitive measures nor safety measures showed significant differences between study groups. Application of tVNS was well tolerated, but did not improve schizophrenia symptoms in our 26-week trial. While unsatisfactory compliance questions the feasibility of patient-controlled neurostimulation in schizophrenia, the overall pattern of symptom change might warrant further investigations in this population.
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http://dx.doi.org/10.1007/s00406-015-0618-9DOI Listing
October 2015

Effects of social exclusion on emotions and oxytocin and cortisol levels in patients with chronic depression.

J Psychiatr Res 2015 Jan 10;60:170-7. Epub 2014 Nov 10.

Department of Psychiatry und Psychotherapy, Ludwig Maximilian University, Munich, Germany. Electronic address:

Objective: Patients with chronic depression (CD) experience a high burden of disease, severe co-morbidity, and increased mortality. Although interpersonal dysfunction is a hallmark of CD, the underlying mechanisms are largely unexplored. Oxytocin (OT) has been proposed to play a crucial role in the social deficits of mental disorders and has been found to be dysregulated after social exclusion (ostracism) in patients with borderline personality disorder. This study investigated how social exclusion affects emotions, OT levels, and cortisol (CT) levels in CD patients.

Method: Twenty-one patients diagnosed with CD and 21 healthy controls (HC) matched for gender, age, and education underwent repeated neuroendocrine measurements in a standardized laboratory setting while playing Cyberball, a virtual ball-tossing game that mimics a social exclusion situation. Emotional reactions, plasma OT and cortisol levels were assessed at baseline and 5, 15, and 40 min after Cyberball.

Results: At baseline, there were no group differences in OT levels. Immediately after playing Cyberball, plasma OT levels showed divergent changes in CD patients and HC; the difference in direction of change was significant with a reduction in CD patients compared to HC (p = .035*); CT levels did not differ between groups at any time point, but decreased over time. Patients showed more threatened emotional needs and increased negative emotions, especially anger and resentment, and showed higher sensitivity to ambiguous threat of social exclusion than healthy controls.

Conclusions: CD patients react to ostracism with pronounced negative emotions. The reduction in OT levels in CD patients after social exclusion may contribute to their interpersonal dysfunction and their difficulty in coping adequately with aversive social cues.
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http://dx.doi.org/10.1016/j.jpsychires.2014.11.001DOI Listing
January 2015

Quality of life in Ethiopia's street youth at a rehabilitation center and the association with trauma.

J Trauma Stress 2014 Oct;27(5):593-601

Department of Psychiatry and Psychotherapy, Ludwig Maximilian University, Munich, Germany.

Quality of life (QOL) tends to be lower among the homeless than the general population, and traumatic events experienced on the streets have a negative impact on QOL. Low-income countries face a high number of street youth, yet little research has been performed so far on QOL, trauma, and posttraumatic stress disorder (PTSD) among this group. This study aimed at examining the QOL of a sample of Ethiopian street youth within a rehabilitation program and at exploring whether the street youth have experienced traumatic events and show posttraumatic stress symptoms. We interviewed 84 street youths with the World Health Organization Quality of Life Questionnaire (WHOQOL-BREF) and the Diagnostic Interview for Children and Adolescents (DICA). Mean QOL scores differed significantly between the groups assessed at the beginning and at the end of the program (Cohen's d = 0.48). Eighty-three percent of the Ethiopian street youths had experienced traumatic events, and 25.0% met criteria for PTSD according to the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders. QOL did not differ between those with and without PTSD symptoms. These findings show the high rate of traumatic events among Ethiopian street youth and the importance for rehabilitation programs that focus on improving QOL. The results of the study may have cultural limitations.
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http://dx.doi.org/10.1002/jts.21953DOI Listing
October 2014

Oxytocin and vasopressin levels are decreased in the plasma of male schizophrenia patients.

Acta Neuropsychiatr 2014 Dec 7;26(6):347-55. Epub 2014 Oct 7.

1Department of Psychiatry and Psychotherapy,Ludwig Maximilian University,Munich,Germany.

Objective: Impaired social functioning and autistic symptoms are characteristics of schizophrenia. The social hormones oxytocin (OT) and arginine-vasopressin (AVP) both modulate social interaction and therefore may be involved in the pathogenesis of schizophrenia. We investigated whether men with schizophrenia show altered OT and AVP levels compared with healthy controls (HC) and whether autism symptoms are associated with OT levels.

Methods: Forty-one men with non-acute schizophrenia and 45 matched HC were enrolled. Schizophrenia was assessed with the Positive and Negative Syndrome Scale (PANSS). Blood samples were collected on 2 days, and plasma OT and AVP levels were measured by ELISA immunoassay.

Results: The schizophrenia patients had significantly lower plasma OT levels than the HC; a similar trend was found for AVP. Plasma OT levels were associated with severe life events, fewer important attached persons, and a higher score on the PANSS negative scale; the most dominant PANSS items were 'preoccupation', 'emotional withdrawal', and 'passive/apathetic social withdrawal'.

Conclusion: These findings support an association between the social hormones OT and AVP and schizophrenia. We suggest that OT metabolism may be altered in schizophrenia, but other possible causes for decreased plasma OT levels in schizophrenia patients include decreased OT synthesis, mRNA expression, and translation. Especially the 'autistic' symptoms of schizophrenia seem to be closely linked to an altered metabolism of OT, the 'attachment' hormone.
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http://dx.doi.org/10.1017/neu.2014.20DOI Listing
December 2014

Tourette syndrome is associated with insecure attachment and higher aggression.

Int J Neurosci 2015 3;125(7):521-5. Epub 2014 Sep 3.

1Department of Psychiatry and Psychotherapy, Ludwig Maximilian University, Munich, Germany.

This study explored the degree to which adult patients with Tourette syndrome (TS) exhibit particular attachment styles and the possible association between the underlying attachment dimensions and forms of aggression. Fifty-three TS patients (ages 17-72 years) and 54 matched healthy controls completed the Experiences in Close Relationships-Revised Scale (ECR-R) and the Aggression Questionnaire (AQ). The data were analysed with ANOVA F-tests, t-tests, and Pearson's correlation coefficient. TS patients showed significantly higher scores in relationship anxiety ( p < 0.001) and relationship avoidance ( p = 0.001) in the ECR-R and significantly higher aggression scores in the AQ ( p < 0.001). The total AQ score correlated significantly with the ECR-R dimension anxiety ( p < 0.001). These are the first findings on TS patients' attachment styles and anger symptoms. It remains unclear whether attachment anxiety and avoidance are risk factors for TS or whether the disorder itself induces attachment disorders. Prospective studies with detailed attachment interviews would help to explore this issue.
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http://dx.doi.org/10.3109/00207454.2014.951040DOI Listing
April 2016

Social exclusion leads to divergent changes of oxytocin levels in borderline patients and healthy subjects.

Psychother Psychosom 2014 24;83(4):252-4. Epub 2014 Jun 24.

Department of Psychiatry und Psychotherapy, Ludwig Maximilian University, Munich, Germany.

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http://dx.doi.org/10.1159/000358526DOI Listing
March 2015

Prenatal immunologic predictors of postpartum depressive symptoms: a prospective study for potential diagnostic markers.

Eur Arch Psychiatry Clin Neurosci 2014 Oct 5;264(7):615-24. Epub 2014 Mar 5.

Department of Psychiatry and Psychotherapy, Ludwig Maximilian University, Nussbaumstrasse 7, 80336, Munich, Germany,

In postpartum depression (PPD), immunologic changes have been proposed to be involved in the disease pathology. The study evaluates the regulation of the innate and adaptive immune response over the course of late pregnancy and postpartum period and their association with the development of postpartum depressive symptoms. Furthermore, prenatal immunologic markers for a PPD were investigated. Hundred pregnant women were included. At 34th and 38th week of pregnancy as well as 2 days, 7 weeks and 6 months postpartum, immune parameters (neopterin, regulatory T cells, CXCR1, CCR2, MNP1 and CD11a) were measured by flow cytometry/ELISA, and the psychopathology was evaluated. We found that regulatory T cells were significantly increased prenatal (p=0.011) and postnatal (p=0.01) in mothers with postnatal depressive symptoms. The decrease in CXCR 1 after delivery was significantly higher in mother with postnatal depressive symptoms (p=0.032). Mothers with postnatal depressive symptoms showed already prenatal significantly elevated neopterin levels (p=0.049). Finally, regulatory T cells in pregnancy strongly predict postnatal depressive symptoms (p=0.004). The present study revealed that prenatal and postnatal immunologic parameters are associated with postpartum depressive symptoms in mothers. In addition, we found immune markers that could eventually be the base for a biomarker set that predicts postnatal depressive symptoms already during pregnancy.
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http://dx.doi.org/10.1007/s00406-014-0494-8DOI Listing
October 2014

Content Validity of the Comprehensive ICF Core Set for Chronic Obstructive Pulmonary Diseases: An International Delphi Survey.

Open Respir Med J 2013 5;7:33-45. Epub 2013 Apr 5.

Institute for Health and Rehabilitation Sciences (IHRS), Ludwig Maximilians Universität, Munich, Germany ; ICF Research Branch, WHO FIC CC Germany (DIMDI) at SPF, Nottwil, Switzerland and at IHRS, Ludwig Maximilians Universität, Munich, Germany.

Introduction: The "Comprehensive ICF Core Set for Chronic Obstructive Pulmonary Diseases (COPD)" is an application of the International Classification of Functioning, Disability and Health (ICF) and represents the typical spectrum of problems in functioning of patients with COPD. The objective of this study was to validate this ICF Core Set from the perspective of physicians.

Materials And Methodology: Physicians experienced in COPD treatment were asked about the patients' problems treated by physicians in patients with COPD in a three-round electronic mail survey using the Delphi technique. Responses were linked to the ICF.

Results: Seventy-six physicians in 44 countries gave a total of 1330 responses that were linked to 148 different ICF categories. Nine ICF categories were not represented in the Comprehensive ICF Core Set for COPD although at least 75% of the participants have rated them as important. Nineteen concepts were linked to the not yet developed ICF component personal factors and seventeen concepts were not covered by the ICF.

Conclusion: The high percentage of ICF categories represented in the ICF Core Set for COPD indicates satisfactory content validity from the perspective of the physicians. However, some issues were raised that were not covered and need to be investigated further.
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http://dx.doi.org/10.2174/1874306401307010033DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3636487PMC
June 2013

Feasibility and variability of measuring the Lung Clearance Index in a multi-center setting.

Pediatr Pulmonol 2012 Jul 13;47(7):649-57. Epub 2011 Dec 13.

Marien Hospital Wesel, Children's Hospital and Research Institute, Wesel, Germany.

The Lung Clearance Index (LCI) is superior to spirometry in detecting early lung disease in cystic fibrosis (CF) and correlates with structural lung changes seen on CT scans. The LCI has the potential to become a novel outcome parameter for clinical and research purposes. However longitudinal studies are required to further prove its prognostic value. Multi-center design is likely to facilitate realization of such studies. Therefore the aim of the present study was to assess multi-center feasibility and inter-center variability of LCI measurements in healthy children and adolescents. Comparative measurements were performed in unselected patients with CF to confirm previous single-center results. LCI measurements were performed in eight centers using the EasyOne Pro, MBW Module (ndd Medical Technologies, Zurich, Switzerland). The overall success rate for LCI measurements was 75.5%, leaving 102/151 measurements in healthy volunteers and 139/183 measurements in patients with CF for final analysis. Age ranged between 4 and 24 years. Mean LCI (range of means among centers) was 6.3 (6.0-6.5) in healthy volunteers and thus normal. Inter-center variability of center means was 2.9%, ANOVA including Schffé procedure demonstrated no significant inter-center differences (P > 0.05). Mean LCI (range of means among centers) was 8.2 (7.4-8.9) in CF and thus abnormal. Our study demonstrates good multi-center feasibility and low inter-center variability of the LCI in healthy volunteers when measured with the EasyOne Pro MBW module. Our data confirm published LCI data in CF. However, central coordination, quality control, regular training, and supervision during the entire study appear essential for successfully performing multi-center trials.
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http://dx.doi.org/10.1002/ppul.21610DOI Listing
July 2012

[Psychotherapists' attitudes towards the treatment of patients with borderline personality disorder].

Psychother Psychosom Med Psychol 2010 Mar-Apr;60(3-4):126-31. Epub 2009 May 18.

Klinik und Poliklinik für Psychiatrie und Psychotherapie, Klinikum rechts der Isar, München.

A questionnaire was sent to a representative sample of 300 psychotherapists working in Munich, consisting of a short case report on a prototypical BPD patient, 21 questions on sociodemographic data and suggestions on the treatment of BPD. 58% replied to the questionnaire. 22% of the therapists stated not to treat BPD patients on principle. 66% declared not to offer therapy to new patients, due to being booked out. Specific therapeutic approaches for the treatment of BPD were recommended by 51%, but only offered by 3%. Psychotherapists in private practice often experience anxiety and show some prejudice towards the treatment of patients with BPD. The introduction of specialized treatment programs like DBT and TFP has led to a high degree of publicity and acceptance, but the number of trained therapists is still low even in a city like Munich.
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http://dx.doi.org/10.1055/s-0029-1220764DOI Listing
June 2010