Publications by authors named "Andreas Heinz"

647 Publications

[Locked wards in secure homes].

Nervenarzt 2021 Sep 9;92(9):933-934. Epub 2021 Sep 9.

Pandora Verein Selbsthilfe Psychiatrie-Erfahrener e. V. Nürnberg, Findelwiesenstr. 9, 90478, Nürnberg, Deutschland.

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http://dx.doi.org/10.1007/s00115-021-01164-3DOI Listing
September 2021

[Association between substance use and coercive measures on psychiatric wards].

Nervenarzt 2021 Sep 7. Epub 2021 Sep 7.

Klinik für Psychiatrie und Psychotherapie, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Deutschland.

Objective: The intention to minimize coercive measures requires a comprehensive understanding of the influencing factors. The aim of the present work was to examine the association between substance use and the use of coercive measures.

Methods: All coercive measures carried out on acute psychiatric wards of the Charité Campus Mitte in 2019 were examined, with a particular focus on the association with substance use disorders.

Results: In 106 cases (92 patients) out of a total of 1232 cases (1131 patients), coercive measures were used, mainly admissions according to PsychKG (94) and BGB (21), more rarely isolation (23) or mechanical restraint (18). Acute intoxication was present in approximately one third of cases with coercive measures and a history of substance use disorder in two thirds, most often with alcohol and/or cannabis. In contrast, 9% of 1232 treatment cases presented with acute intoxication and 36% with substance use disorders in general.

Conclusion: The present work delivers empirical data confirming the clinically known association between intoxication and the use of coercive measures.
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http://dx.doi.org/10.1007/s00115-021-01181-2DOI Listing
September 2021

[Person-centered care but living in a closed setting? The situation of closed residential facilities in Germany].

Nervenarzt 2021 Sep 3;92(9):941-947. Epub 2021 Aug 3.

Klinik für Psychiatrie und Psychotherapie Charité, Campus Charité-Mitte, Charité - Universitätsmedizin Berlin, Berlin, Deutschland.

Background: The United Nations Convention on the Rights of Persons with Disabilities and the Federal Participation Act state that all human beings have the right to choose where to live. This human right is compromised by the institutional limitations of the community psychiatric system, where persons with severe mental illnesses and with intensive support needs are often housed in closed (i.e. physically locked) living contexts. How can the concept of person-centered care help to solve this conflict?

Objective: Description of the nationwide situation of closed residential facilities and discussion of the person-centered approach as a solution to the problem of closed living contexts.

Methods: Summary of current knowledge on the structural and procedural data of closed residential facilities in Germany, which were collated within the framework of the "Coercive measures in the psychiatric care system-Collation and reduction" (ZIPHER) study.

Results: The empirical data indicate a great need for regionally based care of the target group and a lack of individual arrangements as alternatives to closed living contexts. The necessity for regional care obligations is highlighted by the example of Mecklenburg-Western Pomerania.

Conclusion: The avoidance and reduction of closed accommodation can primarily be achieved by individual arrangements within the framework of person-centered and flexible proposal landscapes. For this the service providers of integration assistance, including the psychiatric hospitals, must be committed to the care of all people in their region. An appropriate accompaniment and refunding by the service provider are also necessary.
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http://dx.doi.org/10.1007/s00115-021-01141-wDOI Listing
September 2021

Evidence for a hijacked brain reward system but no desensitized threat system in quitting-motivated smokers: An fMRI study.

Addiction 2021 Jul 27. Epub 2021 Jul 27.

Campus Charité Mitte, Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Berlin, Germany.

Background And Aims: Several aspects of how quitting-motivated tobacco use disorder (TUD) subjects and never-smokers differ in terms of reward and threat processing remain unresolved. We aimed to examine aberrant reward and threat processes in TUD and the association with smoking characteristics.

Design: A between- and within-subjects functional magnetic resonance imaging (fMRI) experiment with a 2 (groups) × 4 (stimulus type) factorial design. The experimental paradigm had four conditions: pictures of (1) cigarettes served as drug-related-positive cues, (2) food as alternative reward cues, (3) long-term consequences of smoking as drug-related-negative cues and (4) neutral pictures as control.

Setting/participants: Adult participants (n = 38 TUD subjects and n = 42 never-smokers) were recruited in Berlin, Germany.

Measurements: As contrasts of primary interest, the interactions of group × stimulus-type were assessed. Significance threshold correction for multiple testing was carried out with the family-wise error method. Correlation analyses were used to test the association with smoking characteristics.

Findings: The 2 × 2 interaction of smoking status and stimulus type revealed activations in the brain reward system to drug-related-positive cues in TUD subjects (between-subjects effect: P-values ≤ 0.036). As a response to drug-related-negative cues, TUD subjects showed no reduced activation of the aversive brain network. Within the TUD group, a significant negative association was found between response of the aversive brain system to drug-related-negative cues (within-subjects effect: P-values ≤ 0.021) and the number of cigarettes smoked per day (right insula r = -0.386, P = 0.024; left insula r = -0.351, P = 0.042; right ACC r = -0.359, P = 0.037).

Conclusions: Moderate smokers with tobacco use disorder appear to have altered brain reward processing of drug-related-positive (but not negative) cues compared with never smokers.
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http://dx.doi.org/10.1111/add.15651DOI Listing
July 2021

Faster speed of onset of the depressive episode is associated with lower cytokine serum levels (IL-2, -4, -6, -10, TNF-α and IFN-γ) in patients with major depression.

J Psychiatr Res 2021 09 8;141:287-292. Epub 2021 Jul 8.

Department of Psychiatry and Psychotherapy, Charité -Universitätmedizin Berlin, Campus Mitte, Berlin, Germany. Electronic address:

Introduction: Cytokines might play a key role in the pathophysiology of major depressive disorder (MDD). The speed of onset of depressive episodes has been discussed as an important clinical parameter in MDD. The aim of this study was to investigate a potential influence of the speed of onset of the depressive episode on cytokine serum levels.

Method: Serum level of the cytokines interleukin (IL)-2, IL-4, IL-6, IL-8, IL-10, tumor necrosis factor alpha (TNF-α), interferon-gamma (IFN-γ) granulocyte and monocyte colony stimulating factor (GM-CSF) were measured in a total of 92 patients with MDD that did not respond to at least one previous antidepressant treatment. Patients were retrospectively divided in two groups: Faster (≤4 weeks) and slower (>4 weeks) onset of the depressive episode defined as the time passing from the first depressive symptoms to a full-blown depressive episode by using information from a clinical interview.

Results: We found significantly lower serum levels of IL-2, IL-4, IL-6, IL-10, TNF-α and IFN-γ in patients with a faster onset compared to patients with a slower onset of the depressive episodes. Furthermore, lower cytokine serum levels of IL-2, IL-8, IL-10 and IFN-γ were found in patients with a shorter duration (less than 6 months) compared to a longer duration (6-24 months) of the current depressive episode. This effect on cytokines was independent from the effect of the speed of onset of the depressive episode.

Conclusions: Patients with faster onset of the depressive episode might represent a biological subtype of MDD with lower serum levels of IL-2, IL-4, IL-6, IL-10, TNF-α and IFN-γ.
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http://dx.doi.org/10.1016/j.jpsychires.2021.06.033DOI Listing
September 2021

The Role of Implicit and Explicit Staff Attitudes in the Use of Coercive Measures in Psychiatry.

Front Psychiatry 2021 18;12:699446. Epub 2021 Jun 18.

Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité Universitätsmedizin Berlin, Freie Universität Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.

Many determinants leading to the use of different coercive measures in psychiatry have been widely studied and it seems that staff attitudes play a crucial role when it comes to the decision-making process about using coercion. However, research results about staff attitudes and their role in the use of coercive measures are inconsistent. This might be due to a focus on self-report studies asking for explicit answers, which involves the risk of bias. This study aimed to expand research on this topic by examining the impact of explicit and implicit staff attitudes on the use of coercive measures in clinical practice. In addition, the influence of gender, profession (nurses, psychiatrists), and years of professional experience as well as their influence on staff attitudes were examined. An adaption of the implicit association measure, the , with the target category and distracter stimuli describing , as well as the explicit questionnaire was completed by staff ( = 149) on 13 acute psychiatric units in 6 hospitals. Data on coercive measures as well as the total number of treated cases for each unit was collected. Results showed that there was no association between staff's implicit and explicit attitudes toward coercion, and neither measure was correlated with the local frequency of coercive measures. ANOVAs showed a significant difference of the GNAT result for the factor gender ( = 9.32, = 0.003), demonstrating a higher tendency to justify coercion among female staff members (M = -0.23, SD = ±0.35) compared to their male colleagues (M = -0.41, SD = ±0.31). For the SACS, a significant difference was found for the factor profession ( = 7.58, = 0.007), with nurses (M = 2.79, SD = ±1.40) showing a more positive attitude to the use of coercion than psychiatrists (M = 2.15, SD = ±1.11). No significant associations were found regarding the extent of professional experience. Results indicate a complex interaction between implicit and explicit decision-making processes dependent on specific contexts. We propose future research to include primers for more context-related outcomes. Furthermore, differences in gender suggest a need to direct attention toward occupational safety and possible feelings of anxiety in the workplace, especially for female staff members.
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http://dx.doi.org/10.3389/fpsyt.2021.699446DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8249742PMC
June 2021

Association of Cannabis Use During Adolescence With Neurodevelopment.

JAMA Psychiatry 2021 Jun 16. Epub 2021 Jun 16.

Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada.

Importance: Animal studies have shown that the adolescent brain is sensitive to disruptions in endocannabinoid signaling, resulting in altered neurodevelopment and lasting behavioral effects. However, few studies have investigated ties between cannabis use and adolescent brain development in humans.

Objective: To examine the degree to which magnetic resonance (MR) imaging-assessed cerebral cortical thickness development is associated with cannabis use in a longitudinal sample of adolescents.

Design, Setting, And Participants: Data were obtained from the community-based IMAGEN cohort study, conducted across 8 European sites. Baseline data used in the present study were acquired from March 1, 2008, to December 31, 2011, and follow-up data were acquired from January 1, 2013, to December 31, 2016. A total of 799 IMAGEN participants were identified who reported being cannabis naive at study baseline and had behavioral and neuroimaging data available at baseline and 5-year follow-up. Statistical analysis was performed from October 1, 2019, to August 31, 2020.

Main Outcomes And Measures: Cannabis use was assessed at baseline and 5-year follow-up with the European School Survey Project on Alcohol and Other Drugs. Anatomical MR images were acquired with a 3-dimensional T1-weighted magnetization prepared gradient echo sequence. Quality-controlled native MR images were processed through the CIVET pipeline, version 2.1.0.

Results: The study evaluated 1598 MR images from 799 participants (450 female participants [56.3%]; mean [SD] age, 14.4 [0.4] years at baseline and 19.0 [0.7] years at follow-up). At 5-year follow-up, cannabis use (from 0 to >40 uses) was negatively associated with thickness in left prefrontal (peak: t785 = -4.87, cluster size = 1558 vertices; P = 1.10 × 10-6, random field theory cluster corrected) and right prefrontal (peak: t785 = -4.27, cluster size = 1551 vertices; P = 2.81 × 10-5, random field theory cluster corrected) cortices. There were no significant associations between lifetime cannabis use at 5-year follow-up and baseline cortical thickness, suggesting that the observed neuroanatomical differences did not precede initiation of cannabis use. Longitudinal analysis revealed that age-related cortical thinning was qualified by cannabis use in a dose-dependent fashion such that greater use, from baseline to follow-up, was associated with increased thinning in left prefrontal (peak: t815.27 = -4.24, cluster size = 3643 vertices; P = 2.28 × 10-8, random field theory cluster corrected) and right prefrontal (peak: t813.30 = -4.71, cluster size = 2675 vertices; P = 3.72 × 10-8, random field theory cluster corrected) cortices. The spatial pattern of cannabis-related thinning was associated with age-related thinning in this sample (r = 0.540; P < .001), and a positron emission tomography-assessed cannabinoid 1 receptor-binding map derived from a separate sample of participants (r = -0.189; P < .001). Analysis revealed that thinning in right prefrontal cortices, from baseline to follow-up, was associated with attentional impulsiveness at follow-up.

Conclusions And Relevance: Results suggest that cannabis use during adolescence is associated with altered neurodevelopment, particularly in cortices rich in cannabinoid 1 receptors and undergoing the greatest age-related thickness change in middle to late adolescence.
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http://dx.doi.org/10.1001/jamapsychiatry.2021.1258DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8209561PMC
June 2021

Fronto-striatal structures related with model-based control as an endophenotype for obsessive-compulsive disorder.

Sci Rep 2021 Jun 7;11(1):11951. Epub 2021 Jun 7.

Department for Social and Preventive Medicine, University of Potsdam, Potsdam, Germany.

Recent theories suggest a shift from model-based goal-directed to model-free habitual decision-making in obsessive-compulsive disorder (OCD). However, it is yet unclear, whether this shift in the decision process is heritable. We investigated 32 patients with OCD, 27 unaffected siblings (SIBs) and 31 healthy controls (HCs) using the two-step task. We computed behavioral and reaction time analyses and fitted a computational model to assess the balance between model-based and model-free control. 80 subjects also underwent structural imaging. We observed a significant ordered effect for the shift towards model-free control in the direction OCD > SIB > HC in our computational parameter of interest. However less directed analyses revealed no shift towards model-free control in OCDs. Nonetheless, we found evidence for reduced model-based control in OCDs compared to HCs and SIBs via 2nd stage reaction time analyses. In this measure SIBs also showed higher levels of model-based control than HCs. Across all subjects these effects were associated with the surface area of the left medial/right dorsolateral prefrontal cortex. Moreover, correlations between bilateral putamen/right caudate volumes and these effects varied as a function of group: they were negative in SIBs and OCDs, but positive in HCs. Associations between fronto-striatal regions and model-based reaction time effects point to a potential endophenotype for OCD.
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http://dx.doi.org/10.1038/s41598-021-91179-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8185095PMC
June 2021

[Lithium Withdrawal Symptoms - A Systematic Review].

Psychiatr Prax 2021 May 20. Epub 2021 May 20.

Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Psychiatry and Psychotherapy, Berlin, Deutschland.

Background: Withdrawal symptoms of lithium have not been systematically assessed to date.

Aim: Systematic review of withdrawal symptoms after discontinuation of pharmacological treatment with lithium.

Methods: Systematic literature search in PubMed and reference lists of relevant articles. We included clinical trials and case reports.

Results: Out of 249 articles, six met our inclusion criteria, entailing six trials and a case series. Four trials and three case reports point to the existence of a withdrawal syndrome after discontinuation of lithium. Occurrence of symptoms was not dependent on the primary disorder for which lithium was initiated. Frequently reported symptoms were irritability, restlessness and somatic symptoms like vertigo, dizziness or lightheadedness. Symptoms occurred within the first week and were generally mild and self-limiting within weeks.

Conclusion: Current evidence indicates that withdrawal symptoms after discontinuation of lithium can occur. There is a need for controlled studies of high methodological quality in order to assess predictors of and prevention strategies for discontinuation syndromes.
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http://dx.doi.org/10.1055/a-1481-1953DOI Listing
May 2021

Neural correlates of RDoC-specific cognitive processes in a high-functional autistic patient: a statistically validated case report.

J Neural Transm (Vienna) 2021 Jun 18;128(6):845-859. Epub 2021 May 18.

Department of Psychiatry and Psychotherapy CCM, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany.

The level of functioning of individuals with autism spectrum disorder (ASD) varies widely. To better understand the neurobiological mechanism associated with high-functioning ASD, we studied the rare case of a female patient with an exceptional professional career in the highly competitive academic field of Mathematics. According to the Research Domain Criteria (RDoC) approach, which proposes to describe the basic dimensions of functioning by integrating different levels of information, we conducted four fMRI experiments targeting the (1) social processes domain (Theory of mind (ToM) and face matching), (2) positive valence domain (reward processing), and (3) cognitive domain (N-back). Patient's data were compared to data of 14 healthy controls (HC). Additionally, we assessed the subjective experience of our case during the experiments. The patient showed increased response times during face matching and achieved a higher total gain in the Reward task, whereas her performance in N-back and ToM was similar to HC. Her brain function differed mainly in the positive valence and cognitive domains. During reward processing, she showed reduced activity in a left-hemispheric frontal network and cortical midline structures but increased connectivity within this network. During the working memory task patients' brain activity and connectivity in left-hemispheric temporo-frontal regions were elevated. In the ToM task, activity in posterior cingulate cortex and temporo-parietal junction was reduced. We suggest that the high level of functioning in our patient is rather related to the effects in brain connectivity than to local cortical information processing and that subjective report provides a fruitful framework for interpretation.
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http://dx.doi.org/10.1007/s00702-021-02352-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8205905PMC
June 2021

[Impact of the COVID-19 pandemic on the care situation in psychiatric hospitals in Germany].

Nervenarzt 2021 Jun 18;92(6):562-570. Epub 2021 May 18.

Klinik für Psychiatrie und Psychotherapie, LMU Klinikum, Nußbaumstr. 7, 80336, München, Deutschland.

Aim: To assess the structural performance of psychiatric hospitals in Germany during the COVID(coronavirus disease)-19 pandemic, a nationwide survey was launched in March 2020, in which the corona-related changes in care structures during the first wave of the pandemic were collated.

Methods: Data on the care situation were collected by means of a survey in 38 out of 388 contacted psychiatric and psychotherapy hospitals in Germany over the course of 1 month. The changes and adaptations of the care structures, the type of therapy measures applied and care options for people with mental disorders and a COVID-19 infection as well as the legal basis underlying the care for patients unable to consent were documented.

Results: On average, the inpatient treatment capacity of psychiatric hospitals in Germany decreased by approximately 40% compared with prepandemic periods. Day clinic and outpatient services were also only available in a limited form or were even discontinued completely. Specialized wards for patients with COVID-19 infections were available in most of the surveyed clinics (84%).

Conclusion: Psychiatric hospitals were already able to respond quickly and adequately to the crisis situation in the first wave of the pandemic, e.g. by setting up COVID wards; however, the reduction in treatment capacity to 60% has significantly worsened the care situation for people with mental illnesses. Therefore, further efforts should urgently be made to adapt mental health care to the requirements of the pandemic in the long term.
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http://dx.doi.org/10.1007/s00115-021-01129-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8128978PMC
June 2021

[Alcohol as cultural asset-a historical, anthropological, and therapeutic perspective on alcohol consumption and its social role in western societies].

Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2021 Jun 14;64(6):646-651. Epub 2021 May 14.

Klinik für Psychiatrie und Psychotherapie, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin & Berliner Institut für Gesundheitsforschung in der Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland.

Alcohol is the dominant drug in Western societies with a history that spans from the Middle Ages through the colonial times to the present day. The historical variability of its consumption has always influenced the understanding of alcohol-related problems. To this day, public discourse about addiction and the structure of the care system have been shaped by outdated theories, which can contribute to the stigmatization and discrimination of the affected persons. In addition to an overview of the historical development of alcohol consumption, the sociocultural diversity in dealing with and assessing alcohol use in Western societies is examined and its relevance for clinical interventions is assessed. A national task force to reform the healthcare system is recommended in order to fully implement short interventions and other effective procedures in clinical practice.
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http://dx.doi.org/10.1007/s00103-021-03327-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8187196PMC
June 2021

Endocannabinoid Gene × Gene Interaction Association to Alcohol Use Disorder in Two Adolescent Cohorts.

Front Psychiatry 2021 20;12:645746. Epub 2021 Apr 20.

Centre Hospitalier Universitaire Sainte-Justine Research Center, Montreal, QC, Canada.

Genetic markers of the endocannabinoid system have been linked to a variety of addiction-related behaviors that extend beyond cannabis use. In the current study we investigate the relationship between endocannabinoid (eCB) genetic markers and alcohol use disorder (AUD) in European adolescents (14-18 years old) followed in the IMAGEN study ( = 2,051) and explore replication in a cohort of North American adolescents from Canadian Saguenay Youth Study (SYS) ( = 772). Case-control status is represented by a score of more than 7 on the Alcohol Use Disorder Identification Test (AUDIT). First a set-based test method was used to examine if a relationship between the eCB system and AUDIT case/control status exists at the gene level. Using only SNPs that are both independent and significantly associated to case-control status, we perform Fisher's exact test to determine SNP level odds ratios in relation to case-control status and then perform logistic regressions as analysis, while considering various covariates. Generalized multifactor dimensionality reduction (GMDR) was used to analyze the most robust SNP×SNP interaction of the five eCB genes with positive AUDIT screen. While no gene-sets were significantly associated to AUDIT scores after correction for multiple tests, in the case/control analysis, 7 SNPs were significantly associated with AUDIT scores of > 7 ( < 0.05; OR<1). Two SNPs remain significant after correction by false discovery rate (FDR): rs9343525 in (p =0.042, OR = 0.73) and rs507961 in (p = 0.043, OR = 0.78). Logistic regression showed that both rs9353525 () and rs507961 () remained significantly associated with positive AUDIT screens ( < 0.01; OR < 1) after correction for multiple covariables and interaction of covariable × SNP. This result was not replicated in the SYS cohort. The GMDR model revealed a significant three-SNP interaction ( = 0.006) involving rs484061 (), rs4963307 (), and rs7766029 () predicted case-control status, after correcting for multiple covariables in the IMAGEN sample. A binomial logistic regression of the combination of these three SNPs by phenotype in the SYS cohort showed a result in the same direction as seen in the IMAGEN cohort (BETA = 0.501, = 0.06). While preliminary, the present study suggests that the eCB system may play a role in the development of AUD in adolescents.
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http://dx.doi.org/10.3389/fpsyt.2021.645746DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8093566PMC
April 2021

Association of Structural Magnetic Resonance Imaging Measures With Psychosis Onset in Individuals at Clinical High Risk for Developing Psychosis: An ENIGMA Working Group Mega-analysis.

JAMA Psychiatry 2021 Jul;78(7):753-766

Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York.

Importance: The ENIGMA clinical high risk (CHR) for psychosis initiative, the largest pooled neuroimaging sample of individuals at CHR to date, aims to discover robust neurobiological markers of psychosis risk.

Objective: To investigate baseline structural neuroimaging differences between individuals at CHR and healthy controls as well as between participants at CHR who later developed a psychotic disorder (CHR-PS+) and those who did not (CHR-PS-).

Design, Setting, And Participants: In this case-control study, baseline T1-weighted magnetic resonance imaging (MRI) data were pooled from 31 international sites participating in the ENIGMA Clinical High Risk for Psychosis Working Group. CHR status was assessed using the Comprehensive Assessment of At-Risk Mental States or Structured Interview for Prodromal Syndromes. MRI scans were processed using harmonized protocols and analyzed within a mega-analysis and meta-analysis framework from January to October 2020.

Main Outcomes And Measures: Measures of regional cortical thickness (CT), surface area, and subcortical volumes were extracted from T1-weighted MRI scans. Independent variables were group (CHR group vs control group) and conversion status (CHR-PS+ group vs CHR-PS- group vs control group).

Results: Of the 3169 included participants, 1428 (45.1%) were female, and the mean (SD; range) age was 21.1 (4.9; 9.5-39.9) years. This study included 1792 individuals at CHR and 1377 healthy controls. Using longitudinal clinical information, 253 in the CHR-PS+ group, 1234 in the CHR-PS- group, and 305 at CHR without follow-up data were identified. Compared with healthy controls, individuals at CHR exhibited widespread lower CT measures (mean [range] Cohen d = -0.13 [-0.17 to -0.09]), but not surface area or subcortical volume. Lower CT measures in the fusiform, superior temporal, and paracentral regions were associated with psychosis conversion (mean Cohen d = -0.22; 95% CI, -0.35 to 0.10). Among healthy controls, compared with those in the CHR-PS+ group, age showed a stronger negative association with left fusiform CT measures (F = 9.8; P < .001; q < .001) and left paracentral CT measures (F = 5.9; P = .005; q = .02). Effect sizes representing lower CT associated with psychosis conversion resembled patterns of CT differences observed in ENIGMA studies of schizophrenia (ρ = 0.35; 95% CI, 0.12 to 0.55; P = .004) and individuals with 22q11.2 microdeletion syndrome and a psychotic disorder diagnosis (ρ = 0.43; 95% CI, 0.20 to 0.61; P = .001).

Conclusions And Relevance: This study provides evidence for widespread subtle, lower CT measures in individuals at CHR. The pattern of CT measure differences in those in the CHR-PS+ group was similar to those reported in other large-scale investigations of psychosis. Additionally, a subset of these regions displayed abnormal age associations. Widespread disruptions in CT coupled with abnormal age associations in those at CHR may point to disruptions in postnatal brain developmental processes.
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http://dx.doi.org/10.1001/jamapsychiatry.2021.0638DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8100913PMC
July 2021

Prevalence of depressive symptoms and symptoms of post-traumatic stress disorder among newly arrived refugees and asylum seekers in Germany: systematic review and meta-analysis.

BJPsych Open 2021 May 3;7(3):e93. Epub 2021 May 3.

Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin, Charité Universitätsmedizin, Germany.

Background: In total numbers, Germany has faced the largest number of refugees and asylum seekers (RAS) in Europe in the past decade. Although a considerable proportion have experienced traumatic and stressful life events, there is no systematic review to date examining the prevalence of depressive symptoms and post-traumatic stress disorder (PTSD) symptoms in RAS in Germany.

Aims: To calculate the prevalence of depressive symptoms and PTSD symptoms in the general population of RAS living in Germany after the year 2000 and explore the impact of study- and participant-related characteristics on prevalence estimates.

Method: We systematically searched PubMed, CINAHL, PsycINFO, PSYNDEX, Academic Search Complete, Science Direct and Web of Science from January 2000 to May 2020 to identify articles reporting prevalence of depressive symptoms and PTSD in RAS in Germany (PROSPERO registration number: CRD42020182796).

Results: In total, 31 different surveys met inclusion criteria with 20 surveys reporting prevalence estimates of depressive symptoms and 25 surveys symptoms of PTSD. Based on screening tools, the pooled prevalence estimate of PTSD symptoms was 29.9% (95% CI 20.8-38.7%) and of depressive symptoms 39.8% (95% CI 29.8-50.1%). Heterogeneity was large within and between subgroups. In multivariate meta-regressions on depressive symptoms, heterogeneity was largely explained by survey period, length of field period and study quality.

Conclusions: Prevalence rates of depressive symptoms and PTSD symptoms in RAS are notably large. They exceed the prevalence in the general German population. As a result of high heterogeneity, however, pooled prevalence rates should be interpreted with caution.
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http://dx.doi.org/10.1192/bjo.2021.54DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8142547PMC
May 2021

Reward Processing in Novelty Seekers: A Transdiagnostic Psychiatric Imaging Biomarker.

Biol Psychiatry 2021 Jan 30. Epub 2021 Jan 30.

Centre for Population Neuroscience and Stratified Medicine, Institute for Science and Technology of Brain-Inspired Intelligence, Fudan University, Shanghai, China; Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Campus Charité Mitte, Berlin, Germany.

Background: Dysfunctional reward processing is implicated in multiple mental disorders. Novelty seeking (NS) assesses preference for seeking novel experiences, which is linked to sensitivity to reward environmental cues.

Methods: A subset of 14-year-old adolescents (IMAGEN) with the top 20% ranked high-NS scores was used to identify high-NS-associated multimodal components by supervised fusion. These features were then used to longitudinally predict five different risk scales for the same and unseen subjects (an independent dataset of subjects at 19 years of age that was not used in predictive modeling training at 14 years of age) (within IMAGEN, n ≈1100) and even for the corresponding symptom scores of five types of patient cohorts (non-IMAGEN), including drinking (n = 313), smoking (n = 104), attention-deficit/hyperactivity disorder (n = 320), major depressive disorder (n = 81), and schizophrenia (n = 147), as well as to classify different patient groups with diagnostic labels.

Results: Multimodal biomarkers, including the prefrontal cortex, striatum, amygdala, and hippocampus, associated with high NS in 14-year-old adolescents were identified. The prediction models built on these features are able to longitudinally predict five different risk scales, including alcohol drinking, smoking, hyperactivity, depression, and psychosis for the same and unseen 19-year-old adolescents and even predict the corresponding symptom scores of five types of patient cohorts. Furthermore, the identified reward-related multimodal features can classify among attention-deficit/hyperactivity disorder, major depressive disorder, and schizophrenia with an accuracy of 87.2%.

Conclusions: Adolescents with higher NS scores can be used to reveal brain alterations in the reward-related system, implicating potential higher risk for subsequent development of multiple disorders. The identified high-NS-associated multimodal reward-related signatures may serve as a transdiagnostic neuroimaging biomarker to predict disease risks or severity.
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http://dx.doi.org/10.1016/j.biopsych.2021.01.011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8322149PMC
January 2021

Orbitofrontal control of conduct problems? Evidence from healthy adolescents processing negative facial affect.

Eur Child Adolesc Psychiatry 2021 Apr 16. Epub 2021 Apr 16.

Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Square J5, 68159, Mannheim, Germany.

Conduct problems (CP) in patients with disruptive behavior disorders have been linked to impaired prefrontal processing of negative facial affect compared to controls. However, it is unknown whether associations with prefrontal activity during affective face processing hold along the CP dimension in a healthy population sample, and how subcortical processing is affected. We measured functional brain responses during negative affective face processing in 1444 healthy adolescents [M = 14.39 years (SD = 0.40), 51.5% female] from the European IMAGEN multicenter study. To determine the effects of CP, we applied a two-step approach: (a) testing matched subgroups of low versus high CP, extending into the clinical range [N = 182 per group, M = 14.44 years, (SD = 0.41), 47.3% female] using analysis of variance, and (b) considering (non)linear effects along the CP dimension in the full sample and in the high CP group using multiple regression. We observed no significant cortical or subcortical effect of CP group on brain responses to negative facial affect. In the full sample, regression analyses revealed a significant linear increase of left orbitofrontal cortex (OFC) activity with increasing CP up to the clinical range. In the high CP group, a significant inverted u-shaped effect indicated that left OFC responses decreased again in individuals with high CP. Left OFC activity during negative affective processing which is increasing with CP and decreasing in the highest CP range may reflect on the importance of frontal control mechanisms that counteract the consequences of severe CP by facilitating higher social engagement and better evaluation of social content in adolescents.
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http://dx.doi.org/10.1007/s00787-021-01770-1DOI Listing
April 2021

The interaction of child abuse and rs1360780 of the FKBP5 gene is associated with amygdala resting-state functional connectivity in young adults.

Hum Brain Mapp 2021 Jul 5;42(10):3269-3281. Epub 2021 Apr 5.

Department of Psychiatry and Psychotherapy CCM, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.

Extensive research has demonstrated that rs1360780, a common single nucleotide polymorphism within the FKBP5 gene, interacts with early-life stress in predicting psychopathology. Previous results suggest that carriers of the TT genotype of rs1360780 who were exposed to child abuse show differences in structure and functional activation of emotion-processing brain areas belonging to the salience network. Extending these findings on intermediate phenotypes of psychopathology, we examined if the interaction between rs1360780 and child abuse predicts resting-state functional connectivity (rsFC) between the amygdala and other areas of the salience network. We analyzed data of young European adults from the general population (N = 774; mean age = 18.76 years) who took part in the IMAGEN study. In the absence of main effects of genotype and abuse, a significant interaction effect was observed for rsFC between the right centromedial amygdala and right posterior insula (p < .025, FWE-corrected), which was driven by stronger rsFC in TT allele carriers with a history of abuse. Our results suggest that the TT genotype of rs1360780 may render individuals with a history of abuse more vulnerable to functional changes in communication between brain areas processing emotions and bodily sensations, which could underlie or increase the risk for psychopathology.
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http://dx.doi.org/10.1002/hbm.25433DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8193540PMC
July 2021

Model-Based and Model-Free Control Predicts Alcohol Consumption Developmental Trajectory in Young Adults: A 3-Year Prospective Study.

Biol Psychiatry 2021 05 27;89(10):980-989. Epub 2021 Jan 27.

Department of Psychiatry, Technische Universität Dresden, Dresden, Germany; Neuroimaging Center, Technische Universität Dresden, Dresden, Germany. Electronic address:

Background: A shift from goal-directed toward habitual control has been associated with alcohol dependence. Whether such a shift predisposes to risky drinking is not yet clear. We investigated how goal-directed and habitual control at age 18 predict alcohol use trajectories over the course of 3 years.

Methods: Goal-directed and habitual control, as informed by model-based (MB) and model-free (MF) learning, were assessed with a two-step sequential decision-making task during functional magnetic resonance imaging in 146 healthy 18-year-old men. Three-year alcohol use developmental trajectories were based on either a consumption score from the self-reported Alcohol Use Disorders Identification Test (assessed every 6 months) or an interview-based binge drinking score (grams of alcohol/occasion; assessed every year). We applied a latent growth curve model to examine how MB and MF control predicted the drinking trajectory.

Results: Drinking behavior was best characterized by a linear trajectory. MB behavioral control was negatively associated with the development of the binge drinking score; MF reward prediction error blood oxygen level-dependent signals in the ventromedial prefrontal cortex and the ventral striatum predicted a higher starting point and steeper increase of the Alcohol Use Disorders Identification Test consumption score over time, respectively.

Conclusions: We found that MB behavioral control was associated with the binge drinking trajectory, while the MF reward prediction error signal was closely linked to the consumption score development. These findings support the idea that unbalanced MB and MF control might be an important individual vulnerability in predisposing to risky drinking behavior.
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http://dx.doi.org/10.1016/j.biopsych.2021.01.009DOI Listing
May 2021

Neuroimaging evidence for structural correlates in adolescents resilient to polysubstance use: A five-year follow-up study.

Eur Neuropsychopharmacol 2021 Aug 24;49:11-22. Epub 2021 Mar 24.

School of Psychology and Global Brain Health Institute, University College Dublin, Dublin, Ireland.

Early initiation of polysubstance use (PSU) is a strong predictor of subsequent addiction, however scarce individuals present resilience capacity. This neuroimaging study aimed to investigate structural correlates associated with cessation or reduction of PSU and determine the extent to which brain structural features accounted for this resilient outcome. Participants from a European community-based cohort self-reported their alcohol, tobacco and cannabis use frequency at ages 14, 16 and 19 and had neuroimaging sessions at ages 14 and 19. We included three groups in the study: the resilient-to-PSU participants showed PSU at 16 and/or 14 but no more at 19 (n = 18), the enduring polysubstance users at 19 displayed PSU continuation from 14 or 16 (n = 193) and the controls were abstinent or low drinking participants (n = 460). We conducted between-group comparisons of grey matter volumes on whole brain using voxel-based morphometry and regional fractional anisotropy using tract-based spatial statistics. Random-forests machine-learning approach generated individual-level PSU-behavior predictions based on personality and neuroimaging features. Adolescents resilient to PSU showed significant larger grey matter volumes in the bilateral cingulate gyrus compared with enduring polysubstance users and controls at ages 19 and 14 (p<0.05 corrected) but no difference in fractional anisotropy. The larger cingulate volumes and personality trait "openness to experience" were the best precursors of resilience to PSU. Early in adolescence, a larger cingulate gyrus differentiated adolescents resilient to PSU, and this feature was critical in predicting this outcome. This study encourages further research into the neurobiological bases of resilience to addictive behaviors.
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http://dx.doi.org/10.1016/j.euroneuro.2021.03.001DOI Listing
August 2021

Sex differences in neural correlates of common psychopathological symptoms in early adolescence.

Psychol Med 2021 Mar 26:1-11. Epub 2021 Mar 26.

Centre for Population Neuroscience and Stratified Medicine (PONS) and Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK.

Background: Sex-related differences in psychopathology are known phenomena, with externalizing and internalizing symptoms typically more common in boys and girls, respectively. However, the neural correlates of these sex-by-psychopathology interactions are underinvestigated, particularly in adolescence.

Methods: Participants were 14 years of age and part of the IMAGEN study, a large (N = 1526) community-based sample. To test for sex-by-psychopathology interactions in structural grey matter volume (GMV), we used whole-brain, voxel-wise neuroimaging analyses based on robust non-parametric methods. Psychopathological symptom data were derived from the Strengths and Difficulties Questionnaire (SDQ).

Results: We found a sex-by-hyperactivity/inattention interaction in four brain clusters: right temporoparietal-opercular region (p < 0.01, Cohen's d = -0.24), bilateral anterior and mid-cingulum (p < 0.05, Cohen's d = -0.18), right cerebellum and fusiform (p < 0.05, Cohen's d = -0.20) and left frontal superior and middle gyri (p < 0.05, Cohen's d = -0.26). Higher symptoms of hyperactivity/inattention were associated with lower GMV in all four brain clusters in boys, and with higher GMV in the temporoparietal-opercular and cerebellar-fusiform clusters in girls.

Conclusions: Using a large, sex-balanced and community-based sample, our study lends support to the idea that externalizing symptoms of hyperactivity/inattention may be associated with different neural structures in male and female adolescents. The brain regions we report have been associated with a myriad of important cognitive functions, in particular, attention, cognitive and motor control, and timing, that are potentially relevant to understand the behavioural manifestations of hyperactive and inattentive symptoms. This study highlights the importance of considering sex in our efforts to uncover mechanisms underlying psychopathology during adolescence.
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http://dx.doi.org/10.1017/S0033291720005140DOI Listing
March 2021

Predicting Depression Onset in Young People Based on Clinical, Cognitive, Environmental, and Neurobiological Data.

Biol Psychiatry Cogn Neurosci Neuroimaging 2021 Mar 19. Epub 2021 Mar 19.

Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.

Background: Adolescent onset of depression is associated with long-lasting negative consequences. Identifying adolescents at risk for developing depression would enable the monitoring of risk factors and the development of early intervention strategies. Using machine learning to combine several risk factors from multiple modalities might allow prediction of depression onset at the individual level.

Methods: A subsample of a multisite longitudinal study in adolescents, the IMAGEN study, was used to predict future (subthreshold) major depressive disorder onset in healthy adolescents. Based on 2-year and 5-year follow-up data, participants were grouped into the following: 1) those developing a diagnosis of major depressive disorder or subthreshold major depressive disorder and 2) healthy control subjects. Baseline measurements of 145 variables from different modalities (clinical, cognitive, environmental, and structural magnetic resonance imaging) at age 14 years were used as input to penalized logistic regression (with different levels of penalization) to predict depression onset in a training dataset (n = 407). The features contributing the highest to the prediction were validated in an independent hold-out sample (three independent IMAGEN sites; n = 137).

Results: The area under the receiver operating characteristic curve for predicting depression onset ranged between 0.70 and 0.72 in the training dataset. Baseline severity of depressive symptoms, female sex, neuroticism, stressful life events, and surface area of the supramarginal gyrus contributed most to the predictive model and predicted onset of depression, with an area under the receiver operating characteristic curve between 0.68 and 0.72 in the independent validation sample.

Conclusions: This study showed that depression onset in adolescents can be predicted based on a combination multimodal data of clinical characteristics, life events, personality traits, and brain structure variables.
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http://dx.doi.org/10.1016/j.bpsc.2021.03.005DOI Listing
March 2021

[Cohorts in psychiatric research].

Nervenarzt 2021 03 9;92(3):197-198. Epub 2021 Mar 9.

Sozial- und Präventivmedizin, Department Sport- und Gesundheitswissenschaften, Strukturbereich Kognitionswissenschaften, und Fakultät für Gesundheitswissenschaften Brandenburg, Profilbereich für Versorgungsforschung mit Schwerpunkt eHealth, Universität Potsdam, Potsdam, Deutschland.

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http://dx.doi.org/10.1007/s00115-020-01043-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7943493PMC
March 2021

Association of the A118G polymorphism and Pavlovian-to-instrumental transfer: Clinical relevance for alcohol dependence.

J Psychopharmacol 2021 May 16;35(5):566-578. Epub 2021 Mar 16.

Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.

Background: Pavlovian-to-instrumental transfer (PIT) quantifies the extent to which a stimulus that has been associated with reward or punishment alters operant behaviour. In alcohol dependence (AD), the PIT effect serves as a paradigmatic model of cue-induced relapse. Preclinical studies have suggested a critical role of the opioid system in modulating Pavlovian-instrumental interactions. The A118G polymorphism of the gene affects opioid receptor availability and function. Furthermore, this polymorphism interacts with cue-induced approach behaviour and is a potential biomarker for pharmacological treatment response in AD. In this study, we tested whether the polymorphism is associated with the PIT effect and relapse in AD.

Methods: Using a PIT task, we examined three independent samples: young healthy subjects ( = 161), detoxified alcohol-dependent patients ( = 186) and age-matched healthy controls ( = 105). We used data from a larger study designed to assess the role of learning mechanisms in the development and maintenance of AD. Subjects were genotyped for the A118G (rs1799971) polymorphism of the gene. Relapse was assessed after three months.

Results: In all three samples, participants with the minor G-Allele (G+ carriers) showed increased expression of the PIT effect in the absence of learning differences. Relapse was not associated with the polymorphism. Instead, G+ carriers displaying increased PIT effects were particularly prone to relapse.

Conclusion: These results support a role for the opioid system in incentive salience motivation. Furthermore, they inform a mechanistic model of aberrant salience processing and are in line with the pharmacological potential of opioid receptor targets in the treatment of AD.
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http://dx.doi.org/10.1177/0269881121991992DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8155738PMC
May 2021

Online therapy: an added value for inpatient routine care? Perspectives from mental health care professionals.

Eur Arch Psychiatry Clin Neurosci 2021 Mar 16. Epub 2021 Mar 16.

German Association for Psychiatry, Psychotherapy and Psychosomatics E.V. (DGPPN), Reinhardtstraße 27b, 10117, Berlin, Germany.

Internet-delivered interventions can be effective in treating mental disorders. However, their rate of use in German psychiatric inpatient routine care is low. The current study aimed to investigate the attitude of mental health care professionals working in inpatient care regarding internet-delivered interventions, including presumed benefits, barriers and facilitators. In total, 176 health professionals from ten inpatient psychiatric hospitals throughout Germany were surveyed on site. The professionals' attitude towards internet-delivered interventions in inpatient care was assessed by an adapted version of the 'Attitude toward Telemedicine in Psychiatry and Psychotherapy' (ATTiP) questionnaire. To identify benefits, barriers and facilitators, we developed open-response questions that were based on the 'Unified Theory of Acceptance and Use of Technology' (UTAUT) and analyzed by a qualitative content analysis. Professionals reported little experience or knowledge about internet-delivered interventions. Their attitude towards internet-delivered interventions in psychiatric inpatient care was rather indifferent. The most frequently mentioned potential benefits were an optimised treatment structure and patient empowerment; the most frequently anticipated barriers were too severe symptoms of patients, the feared neglect of face-to-face contacts and insufficient technical equipment; and the most frequently mentioned facilitators were high usability of the internet-based intervention, a sufficient functional level of the patient and further education of staff. For successful implementation in the inpatient sector, internet-delivered interventions must be adapted to the special needs of severely mentally ill patients and to the hospital management systems and workflow. In addition, technical preconditions (internet access, devices) must be met. Last, further education of mental health care professionals is needed.
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http://dx.doi.org/10.1007/s00406-021-01251-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7961170PMC
March 2021

Differential predictors for alcohol use in adolescents as a function of familial risk.

Transl Psychiatry 2021 03 4;11(1):157. Epub 2021 Mar 4.

Social and Preventive Medicine, Department of Sports and Health Sciences, Intra-faculty unit "Cognitive Sciences", Faculty of Human Science, and Faculty of Health Sciences Brandenburg, Research Area Services Research and e-Health, University of Potsdam, Potsdam, Germany.

Traditional models of future alcohol use in adolescents have used variable-centered approaches, predicting alcohol use from a set of variables across entire samples or populations. Following the proposition that predictive factors may vary in adolescents as a function of family history, we used a two-pronged approach by first defining clusters of familial risk, followed by prediction analyses within each cluster. Thus, for the first time in adolescents, we tested whether adolescents with a family history of drug abuse exhibit a set of predictors different from adolescents without a family history. We apply this approach to a genetic risk score and individual differences in personality, cognition, behavior (risk-taking and discounting) substance use behavior at age 14, life events, and functional brain imaging, to predict scores on the alcohol use disorders identification test (AUDIT) at age 14 and 16 in a sample of adolescents (N = 1659 at baseline, N = 1327 at follow-up) from the IMAGEN cohort, a longitudinal community-based cohort of adolescents. In the absence of familial risk (n = 616), individual differences in baseline drinking, personality measures (extraversion, negative thinking), discounting behaviors, life events, and ventral striatal activation during reward anticipation were significantly associated with future AUDIT scores, while the overall model explained 22% of the variance in future AUDIT. In the presence of familial risk (n = 711), drinking behavior at age 14, personality measures (extraversion, impulsivity), behavioral risk-taking, and life events were significantly associated with future AUDIT scores, explaining 20.1% of the overall variance. Results suggest that individual differences in personality, cognition, life events, brain function, and drinking behavior contribute differentially to the prediction of future alcohol misuse. This approach may inform more individualized preventive interventions.
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http://dx.doi.org/10.1038/s41398-021-01260-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7933140PMC
March 2021

Examination of the association between exposure to childhood maltreatment and brain structure in young adults: a machine learning analysis.

Neuropsychopharmacology 2021 10 26;46(11):1888-1894. Epub 2021 Feb 26.

Department of Psychiatry and Neuroimaging Center, Technische Universität Dresden, Dresden, Germany.

Exposure to maltreatment during childhood is associated with structural changes throughout the brain. However, the structural differences that are most strongly associated with maltreatment remain unclear given the limited number of whole-brain studies. The present study used machine learning to identify if and how brain structure distinguished young adults with and without a history of maltreatment. Young adults (ages 18-21, n = 384) completed an assessment of childhood trauma exposure and a structural MRI as part of the IMAGEN study. Elastic net regularized regression was used to identify the structural features that identified those with a history of maltreatment. A generalizable model that included 7 cortical thicknesses, 15 surface areas, and 5 subcortical volumes was identified (area under the receiver operating characteristic curve = 0.71, p < 0.001). Those with a maltreatment history had reduced surface areas and cortical thicknesses primarily in fronto-temporal regions. This group also had larger cortical thicknesses in occipital regions and surface areas in frontal regions. The results suggest childhood maltreatment is associated with multiple measures of structure throughout the brain. The use of a large sample without exposure to adulthood trauma provides further evidence for the unique contribution of childhood trauma to brain structure. The identified regions overlapped with regions associated with psychopathology in adults with maltreatment histories, which offers insights as to how these disorders manifest.
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http://dx.doi.org/10.1038/s41386-021-00987-7DOI Listing
October 2021

A Central Clearing Clinic to Provide Mental Health Services for Refugees in Germany.

Front Public Health 2021 1;9:635474. Epub 2021 Feb 1.

Department of Psychiatry, Campus Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany.

To determine migration related distress pattern in refugees and feasibility of a established, central low-threshold outpatient clinic serving more than 80,000 newly arrived refugees in the metropole of Berlin. In an observational cohort study the relative prevalence of major psychiatric disorders by age, place of living within berlin, language and region of origin were assessed in a refugee cohort from 63 nationalities speaking 36 languages. Within 18 months, a total of 3,096 cases with a mean age of 29.7 years (11.7) have been referred from all 12 districts and 165 of 182 subdistricts of Berlin to the CCC. 33.7% of the patients were female. The three most frequent diagnoses were unipolar depression (40.4%), posttraumatic stress disorder (24.3%), and adjustment disorder (19.6%). The present data gives insight into the distribution of mental disorders in a large sample of refugees and provides evidence that a CCC is an effective service to quickly and broadly provide psychiatric consultations and thus to overcome classical barriers refugees usually experience in the host communities. In Berlin, Germany, and Europe treatment resources for this population should focus on stress and trauma related disorders.
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http://dx.doi.org/10.3389/fpubh.2021.635474DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7901997PMC
May 2021

Cortical thickness across the lifespan: Data from 17,075 healthy individuals aged 3-90 years.

Hum Brain Mapp 2021 Feb 17. Epub 2021 Feb 17.

Laboratory of Psychiatric Neuroimaging, Departamento e Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.

Delineating the association of age and cortical thickness in healthy individuals is critical given the association of cortical thickness with cognition and behavior. Previous research has shown that robust estimates of the association between age and brain morphometry require large-scale studies. In response, we used cross-sectional data from 17,075 individuals aged 3-90 years from the Enhancing Neuroimaging Genetics through Meta-Analysis (ENIGMA) Consortium to infer age-related changes in cortical thickness. We used fractional polynomial (FP) regression to quantify the association between age and cortical thickness, and we computed normalized growth centiles using the parametric Lambda, Mu, and Sigma method. Interindividual variability was estimated using meta-analysis and one-way analysis of variance. For most regions, their highest cortical thickness value was observed in childhood. Age and cortical thickness showed a negative association; the slope was steeper up to the third decade of life and more gradual thereafter; notable exceptions to this general pattern were entorhinal, temporopolar, and anterior cingulate cortices. Interindividual variability was largest in temporal and frontal regions across the lifespan. Age and its FP combinations explained up to 59% variance in cortical thickness. These results may form the basis of further investigation on normative deviation in cortical thickness and its significance for behavioral and cognitive outcomes.
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http://dx.doi.org/10.1002/hbm.25364DOI Listing
February 2021

[ICD-11: changes in the diagnostic criteria of substance dependence].

Nervenarzt 2021 Feb 16. Epub 2021 Feb 16.

Klinik für Psychiatrie und Psychotherapie, Charité Universitätsmedizin Berlin, Campus Bonhoefferweg 3, Charitéplatz 1, 10117, Berlin, Deutschland.

Background: In ICD(International Classification of Diseases)-11 the criteria for the diagnosis of substance dependence have been revised.

Objective: Discussion of the advantages and disadvantages of the revised diagnostic criteria.

Material And Methods: Discussion of criteria with respect to neurobiological, social and clinical research.

Results: In the new ICD-11, harmful drug use and substance dependence remain separate diagnostic categories. Regarding substance dependence, the former six diagnostic criteria are condensed into three pairs, two of which must be fulfilled to diagnose this disorder. Within the pairs, one affirmed symptom or aspect is sufficient for the new criterion to be fulfilled. With reference to scientific findings in the field of addiction, this appears to provide advantages as well as disadvantages. The specificity of the diagnosis of substance dependence might get worse compared to ICD-10, because only one symptom of the syndrome pairs has to be fulfilled in each newly constructed pair in order to fulfill the criterion. Therefore, the risk of false positive diagnosis of substance dependence could increase. This is a potential reason for concern because the definition of ICD-10 "persisting substance use despite clear evidence of overtly harmful consequences", is more broadly reworded in ICD-11 as "substance use often continues despite the occurrence of problems". This criterion may hence simply be fulfilled because a substance is illegal in a certain country. In the largest multinational study in 10 countries concerning concordance of diagnostic systems, alcohol dependence was diagnosed approximately 10% more often using ICD-11 compared to ICD-10.

Conclusion: In ICD-11 the well-established distinction between substance dependence and harmful drug use is preserved. Systematic studies are required to assess whether the new diagnostic criteria are clinically helpful or increase social problems by increasing false positive diagnoses of addiction.
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http://dx.doi.org/10.1007/s00115-021-01071-7DOI Listing
February 2021
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