Publications by authors named "Bettina Pfleiderer"

86 Publications

Medical education too: sexual harassment within the educational context of medicine - insights of undergraduates.

BMC Med Educ 2021 Feb 1;21(1):81. Epub 2021 Feb 1.

Institute for Clinical Radiology, Medical Faculty, Westfalian Wilhelm University of Münster, Medical Women's International Association, Münster, Germany.

Background: Assessment of the presence and characteristics of sexual harassment in academic medicine is a global issue. Only limited international data are available so far.

Methods: Aim: To assess the extent of sexual harassment and identify the perpetrators in the student population of the medical school of Münster, Germany. A survey was undertaken, using the Medical Women's International Association sexual harassment questionnaire translated into German. The anonymous online questionnaire was sent as a link to all medical undergraduates at Münster Medical School via a mailing list between 1 October and 30 November 2018. Identifying or potentially identifying data were not collected. Data were analysed by descriptive statistical methods such as categorical variables. Baseline characteristics, e.g. answers by male or female medical students, were correlated with their individual sexual harassment experiences and perpetrator groups by means of univariate analysis.

Results: A total of 2162 medical students were asked to participate, with 623 (28.8%) completing the survey. Sexual harassment is a significant issue among medical students at Münster Medical School with over half (58.9%) of all undergraduates being exposed to sexually harassing behaviour. In total, 31.8% of all participants reported having experienced unwanted physical sexual contact such as unwanted physical touching, with 87.6% of the victims being female. Overall, 41.3% personally experienced verbal sexual harassment of which 87.4% were female. Furthermore, 8.5% of undergraduates faced forced sexual contact such as oral, anal or vaginal penetration, intercourse and rape, with all victims being female. Perpetrators in these cases were mostly male medical superiors (7.0%) and male patients (18.3%). In general, most perpetrators were patients, followed by medical superiors and educators, and less frequently by colleagues.

Conclusions: Sexual harassment in medical education and the medical workplace is a significant problem in a German medical school. Most students experiencing sexual harassment are females. Female students also experience the more serious forms of sexual harassment more often.
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http://dx.doi.org/10.1186/s12909-021-02497-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7852293PMC
February 2021

Probing the relevance of the hippocampus for conflict-induced memory improvement.

Neuroimage 2021 02 13;226:117563. Epub 2020 Nov 13.

Department of Neuropsychology, Institute of Cognitive Neuroscience, Faculty of Psychology, Ruhr University Bochum, Universitätsstr. 150, 44801 Bochum, Germany. Electronic address:

The hippocampus plays a key role for episodic memory. In addition, a small but growing number of studies has shown that it also contributes to the resolution of response conflicts. It is less clear how these two functions are related, and how they are affected by hippocampal lesions in patients with mesial temporal lobe epilepsy (MTLE). Previous studies suggested that conflict stimuli might be better remembered, but whether the hippocampus is critical for supporting this interaction between conflict processing and memory formation is unknown. Here, we tested 19 patients with MTLE due to hippocampal sclerosis and 19 matched healthy controls. Participants performed a face-word Stroop task during functional magnetic resonance imaging (fMRI) followed by a recognition task for the faces. We tested whether memory performance and activity in brain regions implicated in long-term memory were modulated by conflict during encoding, and whether this differed between MTLE patients and controls. In controls, we largely replicated previous findings of improved memory for conflict stimuli. While MTLE patients showed response time slowing during conflict trials as well, they did not exhibit a memory benefit. In controls, neural activity of conflict resolution and memory encoding interacted within a hippocampal region of interest. Here, left hippocampal recruitment was less efficient for memory performance in incongruent trials than in congruent trials, suggesting an intrahippocampal competition for limited resources. They also showed an involvement of precuneus and posterior cingulate cortex during conflict resolution. Both effects were not observed in MTLE patients, where activation of the precuneus and posterior cingulate cortex instead predicted later memory. Further research is needed to find out whether our findings reflect widespread functional reorganization of the episodic memory network due to hippocampal dysfunction.
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http://dx.doi.org/10.1016/j.neuroimage.2020.117563DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7836234PMC
February 2021

The modulating impact of cigarette smoking on brain structure in panic disorder: a voxel-based morphometry study.

Soc Cogn Affect Neurosci 2020 Oct;15(8):849-859

Department of Psychology, Humboldt-Universität zu Berlin, Berlin 10117, Germany.

Cigarette smoking increases the likelihood of developing anxiety disorders, among them panic disorder (PD). While brain structures altered by smoking partly overlap with morphological changes identified in PD, the modulating impact of smoking as a potential confounder on structural alterations in PD has not yet been addressed. In total, 143 PD patients (71 smokers) and 178 healthy controls (62 smokers) participated in a multicenter magnetic resonance imaging (MRI) study. T1-weighted images were used to examine brain structural alterations using voxel-based morphometry in a priori defined regions of the defensive system network. PD was associated with gray matter volume reductions in the amygdala and hippocampus. This difference was driven by non-smokers and absent in smoking subjects. Bilateral amygdala volumes were reduced with increasing health burden (neither PD nor smoking > either PD or smoking > both PD and smoking). As smoking can narrow or diminish commonly observed structural abnormalities in PD, the effect of smoking should be considered in MRI studies focusing on patients with pathological forms of fear and anxiety. Future studies are needed to determine if smoking may increase the risk for subsequent psychopathology via brain functional or structural alterations.
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http://dx.doi.org/10.1093/scan/nsaa103DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7543937PMC
October 2020

Neural correlates of NOS1 ex1f-VNTR allelic variation in panic disorder and agoraphobia during fear conditioning and extinction in fMRI.

Neuroimage Clin 2020 23;27:102268. Epub 2020 Apr 23.

Department of Psychiatry and Psychotherapy & Center for Mind, Brain and Behavior - CMBB, Philipps-Universität Marburg, Marburg, Germany.

Neuronal nitric oxide synthase (NOS-I) impacts on fear/anxiety-like behavior in animals. In humans, the short (S) allele of a functional promotor polymorphism of NOS1 (NOS1 ex1f-VNTR) has been shown to be associated with higher anxiety and altered fear conditioning in healthy subjects in the amygdala and hippocampus (AMY/HIPP). Here, we explore the role of NOS1 ex1f-VNTR as a pathophysiological correlate of panic disorder and agoraphobia (PD/AG). In a sub-sample of a multicenter cognitive behavioral therapy (CBT) randomized controlled trial in patients with PD/AG (n = 48: S/S-genotype n=15, S/L-genotype n=21, L/L-genotype n=12) and healthy control subjects, HS (n = 34: S/S-genotype n=7, S/L-genotype n=17, L/L-genotype=10), a differential fear conditioning and extinction fMRI-paradigm was used to investigate how NOS1 ex1f-VNTR genotypes are associated with differential neural activation in AMY/HIPP. Prior to CBT, L/L-allele carriers showed higher activation than S/S-allele carriers in AMY/HIPP. A genotype × diagnosis interaction revealed that the S-allele in HS was associated with a pronounced deactivation in AMY/HIPP, while patients showed contrary effects. The interaction of genotype × stimulus type (CS+, conditioned stimulus associated with an aversive stimulus vs. CS-, unassociated) showed effects on differential learning in AMY/HIPP. All effects were predominately found during extinction. Genotype associated effects in patients were not altered after CBT. Low statistical power due to small sample size in each subgroup is a major limitation. However, our findings provide first preliminary evidence for dysfunctional neural fear conditioning/extinction associated with NOS1 ex1f-VNTR genotype in the context of PD/AG, shedding new light on the complex interaction between genetic risk, current psychopathology and treatment-related effects.
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http://dx.doi.org/10.1016/j.nicl.2020.102268DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7200443PMC
April 2020

Approaching altered inhibitory control in phenylketonuria: A functional MRI study with a Go-NoGo task in young female adults.

Eur J Neurosci 2020 Oct 16;52(8):3951-3962. Epub 2020 May 16.

Department of General Pediatrics, University Hospital Muenster, Muenster, Germany.

Subtle executive function deficits, particularly regarding inhibitory control, have been reported in patients with phenylketonuria (PKU) despite early dietary treatment. Purpose of this study was to assess whether young female adults with PKU exhibit altered neural activity underlying such deficits, particularly in a fronto-parietal cognitive control network (CCN). Behavioural data and functional magnetic resonance imaging (fMRI) data were acquired during a Go-NoGo task in 16 young adult patients with PKU and 17 control subjects. Hypothesis-driven analyses of behavioural and fMRI data in the CCN were supplemented by exploratory whole brain activation analyses. PKU patients exhibited a trend towards higher errors of commission. Patients exhibited marginally increased activation associated with inhibitory control in only one CCN core region (right middle frontal gyrus, p = .043). Whole brain analyses revealed widespread relatively increased activation in adults with PKU in the main task contrast (NoGo > Go). This increased activation was mainly observed outside the CCN and largely overlapped with the default mode network (DMN). In conclusion, only subtle inhibitory control deficits and associated brain activity differences were observed in young adults with PKU. Thus, this work adds to the notion that this particular population seems to be only slightly affected by such cognitive deficits. While there were also only minimal increases when compared to healthy subjects in brain activity in a cognitive control network, we observed more widespread activation increases outside this network. These results support the assumption of DMN dysfunction in PKU.
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http://dx.doi.org/10.1111/ejn.14738DOI Listing
October 2020

Reduced hippocampal recruitment during response conflict resolution in mesial temporal lobe epilepsy.

Neuroimage 2020 06 12;213:116723. Epub 2020 Mar 12.

Department of Neuropsychology, Institute of Cognitive Neuroscience, Faculty of Psychology, Ruhr University Bochum, Germany. Electronic address:

Recent evidence suggests that the human hippocampus (HC) is not only involved in the processing of motivationally relevant approach-avoidance conflicts but is also engaged in the resolution of more general response conflicts as measured in the Stroop paradigm. Here we investigated whether neural activity in the HC is necessary for successful response conflict resolution. We compared hippocampal recruitment during an auditory Stroop paradigm in 20 patients with mesial temporal lobe epilepsy (MTLE) due to hippocampal sclerosis and 20 age-matched healthy controls using functional magnetic resonance imaging (fMRI). We analyzed hippocampal activation and behavioral performance in conflict trials relative to non-conflict trials. Moreover, functional connectivity (FC) analyses with left and right HCs as seeds were performed. Subjects' regional gray matter volumes were analyzed based on high-resolution T2-weighted MRI scans. The current study replicated previous results showing increased activation in left HC during the processing of conflict trials in healthy subjects. By contrast, MTLE patients showed higher behavioral costs of response conflict resolution and reduced conflict-related HC activation. In patients with left MTLE, left HC activation was predictive of faster conflict-related response times (RTs). By contrast, right HC activation was related to RT slowing, suggestive of a maladaptive compensation attempt in MTLE patients. Our results provide evidence that left hippocampal activation is required for the successful resolution of response conflicts.
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http://dx.doi.org/10.1016/j.neuroimage.2020.116723DOI Listing
June 2020

Effect of CBT on Biased Semantic Network in Panic Disorder: A Multicenter fMRI Study Using Semantic Priming.

Am J Psychiatry 2020 03 16;177(3):254-264. Epub 2019 Dec 16.

Department of Psychiatry and Psychotherapy and Marburg Center for Mind, Brain, and Behavior, Philipps-University Marburg, Marburg, Germany (Yang, Konrad, Straube, Kircher); Department of Psychiatry, Psychosomatics, and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, University of Würzburg, Würzburg, Germany (Lueken, Herrmann, Deckert); Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany (Lueken); Department of Biological and Clinical Psychology, University of Greifswald, Greifswald, Germany (Richter, Hamm); Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany (Wittmann, Ströhle); Department of Psychiatry, Agaplesion Diakonieklinikum Rotenburg (Wümme), Germany (Konrad); Department of Clinical Radiology, University of Münster, Münster, Germany (Pfleiderer); Christoph-Dornier-Foundation for Clinical Psychology, Bremen, Germany (Lang); Department of Psychiatry and Psychotherapy, University of Hamburg, Hamburg, Germany (Lang); Functional Imaging Unit, Institute for Diagnostic Radiology and Neuroradiology, University of Greifswald, Greifswald, Germany (Lotze); Department of Psychiatry, University of Münster, Münster, Germany (Arolt); and Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany (Wittchen).

Objective: Cognitive-behavioral therapy (CBT) has been hypothesized to act by reducing the pathologically enhanced semantic, anxiety-related associations of patients with panic disorder. This study investigated the effects of CBT on the behavioral and neural correlates of the panic-related semantic network in patients with panic disorder.

Methods: An automatic semantic priming paradigm specifically tailored for panic disorder, in which panic symptoms (e.g., "dizziness") were primed by panic triggers (e.g., "elevator") compared with neutral words (e.g., "bottle"), was performed during functional MRI scanning with 118 patients with panic disorder (compared with 150 healthy control subjects) before and 42 patients (compared with 52 healthy control subjects) after an exposure-based CBT. Neural correlates were investigated by comparing 103 pairs of matched patients and control subjects at the baseline (for patients) or T1 (for control subjects) assessment and 39 pairs at the posttreatment or T2 assessment.

Results: At baseline or T1, patients rated panic-trigger/panic-symptom word pairs with higher relatedness and higher negative valence compared with healthy control subjects. Patients made faster lexical decisions to the panic-symptom words when they were preceded by panic-trigger words. This panic-priming effect in patients (compared with control subjects) was reflected in suppressed neural activation in the left and right temporal cortices and insulae and enhanced activation in the posterior and anterior cingulate cortices. After CBT, significant clinical improvements in the patient group were observed along with a reduction in relatedness and negative valence rating and attenuation of neural activation in the anterior cingulate cortex for processing of panic-trigger/panic-symptom word pairs.

Conclusions: The findings support a biased semantic network in panic disorder, which is normalized after CBT. Attenuation of anterior cingulate cortex activation for processing of panic-related associations provides a potential mechanism for future therapeutic interventions.
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http://dx.doi.org/10.1176/appi.ajp.2019.19020202DOI Listing
March 2020

Association of NPSR1 gene variation and neural activity in patients with panic disorder and agoraphobia and healthy controls.

Neuroimage Clin 2019 21;24:102029. Epub 2019 Oct 21.

Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany.

Introduction: The neurobiological mechanisms behind panic disorder with agoraphobia (PD/AG) are not completely explored. The functional A/T single nucleotide polymorphism (SNP) rs324981 in the neuropeptide S receptor gene (NPSR1) has repeatedly been associated with panic disorder and might partly drive function respectively dysfunction of the neural "fear network". We aimed to investigate whether the NPSR1 T risk allele was associated with malfunctioning in a fronto-limbic network during the anticipation and perception of agoraphobia-specific stimuli.

Method: 121 patients with PD/AG and 77 healthy controls (HC) underwent functional magnetic resonance imaging (fMRI) using the disorder specific "Westphal-Paradigm". It consists of neutral and agoraphobia-specific pictures, half of the pictures were cued to induce anticipatory anxiety.

Results: Risk allele carriers showed significantly higher amygdala activation during the perception of agoraphobia-specific stimuli than A/A homozygotes. A linear group x genotype interaction during the perception of agoraphobia-specific stimuli showed a strong trend towards significance. Patients with the one or two T alleles displayed the highest and HC with the A/A genotype the lowest activation in the inferior orbitofrontal cortex (iOFC).

Discussion: The study demonstrates an association of the NPSR1rs324981 genotype and the perception of agoraphobia-specific stimuli. These results support the assumption of a fronto-limbic dysfunction as an intermediate phenotype of PD/AG.
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http://dx.doi.org/10.1016/j.nicl.2019.102029DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6854061PMC
September 2020

Subtle changes of gray matter volume in fibromyalgia reflect chronic musculoskeletal pain rather than disease-specific effects.

Eur J Neurosci 2019 12 12;50(12):3958-3967. Epub 2019 Sep 12.

Department of Psychosomatics and Psychotherapy, University Hospital Münster, Münster, Germany.

Fibromyalgia syndrome (FMS) is a chronic pain syndrome. Neuroimaging studies provided evidence of altered gray matter volume (GMV) in FMS but, similarly, in chronic pain of other origin as well. Therefore, the purpose of this study was to evaluate the disease specificity of GMV alterations in FMS by direct comparison. Structural MRI data of the brain were acquired in 25 females with FMS and two different control groups: 21 healthy subjects and 23 patients with osteoarthritis. Regional GMVs were compared by voxel-based morphometry and additional ROI-analyses. In conclusion, we did not identify significant GMV alterations in either FMS or OA patients compared to healthy controls when adopting a conservative statistical approach with multiple comparison correction. However, even under a more liberal approach no FMS-specific GMV changes were found because both pain groups presented increased gray matter volumes in the precentral gyrus and decreased GMV in the angular gyrus/middle occipital gyrus and middle temporal gyrus in comparison with healthy controls. Since no differences between both pain groups could be detected cortical GMV changes in FMS should not be interpreted as FMS-specific but might rather reflect changes in chronic pain in general. This previously held notion is confirmed in this study by direct comparison with a control group consisting of another pain disorder.
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http://dx.doi.org/10.1111/ejn.14558DOI Listing
December 2019

Association of rs7688285 allelic variation coding for GLRB with fear reactivity and exposure-based therapy in patients with panic disorder and agoraphobia.

Eur Neuropsychopharmacol 2019 10 20;29(10):1138-1151. Epub 2019 Aug 20.

Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany; Center for Mind, Brain and Behavior (CMBB), University of Marburg and Justus Liebig University Giessen, Germany.

The gene coding for glycine receptor β subunits (GLRB) has been found to be related to panic disorder and agoraphobia (PD/AG) and to be associated with altered insular BOLD activation during fear conditioning, as an intermediate phenotype of defensive system reactivity in healthy subjects. In a multicenter clinical trial on PD/AG patients we investigated in three sub-samples whether GLRB allelic variation (A/G; A-allele identified as «risk») in the single nucleotide polymorphism rs7688285 was associated with autonomic (behavioral avoidance test BAT; n = 267 patients) and neural (differential fear conditioning; n = 49 patients, n = 38 controls) measures, and furthermore with responding towards exposure-based cognitive behavioral therapy (CBT, n = 184 patients). An interaction of genotype with current PD/AG diagnosis (PD/AG vs. controls; fMRI data only) and their modification after CBT was tested as well. Exploratory fMRI results prior to CBT, revealed A-allele carriers irrespective of diagnostic status to show overall higher BOLD activation in the hippocampus, motor cortex (MC) and insula. Differential activation in the MC, anterior cingulate cortex (ACC) and insula was found in the interaction genotype X diagnosis. Differential activation in ACC and hippocampus was present in differential fear learning. ACC activation was modified after treatment, while no overall rs7688285 dependent effect on clinical outcomes was found. On the behavioral level, A-allele carriers showed pronounced fear reactivity prior to CBT which partially normalized afterwards. In sum, rs7688285 variation interacts in a complex manner with PD/AG on a functional systems level and might be involved in the development of PD/AG but not in their treatment.
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http://dx.doi.org/10.1016/j.euroneuro.2019.07.133DOI Listing
October 2019

Sex differences in the pharmacology of itch therapies-a narrative review.

Curr Opin Pharmacol 2019 06 9;46:122-142. Epub 2019 Jul 9.

Department of Dermatology, University Hospital Basel, Switzerland. Electronic address:

Background: Chronic itch is the most common skin-related condition, associated with a high psychosocial and economic burden. In recent years, increasing evidence of sex differences in the perception, clinical presentation and treatment requirements of itch points towards potential benefits when using sex-adapted therapies. It is well-known that body composition, absorption, metabolism, elimination and adverse drug reactions (ADRs) differ between sexes, but only little is known about the impact of sex in the pharmacology of itch treatments, which could help to rationalise sex-adapted treatment strategies.

Aim: To evaluate and review sex effects in the pharmacokinetics and /-dynamics of drugs used to treat itch.

Methods: In this narrative review we performed a PubMed and MEDLINE (Ovid) search using the terms (itch OR pruritus) AND (gender OR sex) AND (drug OR medication OR pharmacokinetics OR pharmacodynamics). Additional searches were performed for the topical and systemic drugs recommended by the European Guideline on Chronic Pruritus.

Results: We found numerous reports with variable levels of evidence of sex effects with respect to the pharmacokinetics and/or pharmacodynamics of 14 drug classes used for the treatment of itch, including a total of 19 systemic and 3 topical drugs. Women seem to present higher plasma levels of several drugs used in itch treatment, including tri- and tetracyclic antidepressants (e.g. doxepin, amitriptyline, mirtazapine), serotonin reuptake inhibitors (e.g. paroxetine, sertraline, fluoxetine), immunosuppressive drugs (e.g. cyclosporine, mycophenolate mofetil), serotonin receptor antagonists (e.g. ondansetron) and betablockers (e.g. propranolol). Adverse drug reactions (ADRs) were generally more common in women. Being female was reported to be an independent risk factor for QTc-prolongation associated with antihistamines and tetracyclic antidepressants. Additionally, women seem to be more prone to sedative effects of antihistamines, and to suffer from a higher frequency as well as severity of side effects with systemic calcineurin inhibitors, opioid agonists, and opioid antagonists. Women were also sensitised more often to topically applied drugs. Of note, apart from only one experimental study with capsaicin, none of these reports were designed specifically to assess the effect of sex (and gender) in the treatment of itch.

Discussion/conclusion: Our review supports previous reports that sex is of importance in the pharmacokinetics and /-dynamics of several drugs used to treat itch although those drugs were mostly evaluated for non-itch indications. However, the results are limited by methodological limitations evident in most studies such as underrepresentation of women in clinical trials. This emphasises the need to study the impact of sex (and gender) in future itch trials to yield better outcomes and prevent ADRs in both sexes.
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http://dx.doi.org/10.1016/j.coph.2019.05.008DOI Listing
June 2019

Maternal perception of children's fear: A fMRI study in mothers of preschool children.

Soc Neurosci 2019 12 19;14(6):739-750. Epub 2019 Mar 19.

Otto Creutzfeldt Center for Cognitive and Behavioral Neuroscience , Muenster , Germany.

A secure attachment relationship is facilitated by a mother´s ability to perceive her child´s emotions, especially her child´s fear. Prior studies showed that maternal perception of an own child activated a neural network including amygdala, insula and nucleus accumbens (NAcc). Results for different emotions were inconsistent and there are no reports on children´s fear. The goal of this study was to investigate neural responses of 17 mothers to photos of their own and an unknown preschool child with happy and fearful expressions by functional magnetic resonance imaging (fMRI). Whole brain analyses showed that a fearful (vs. happy) own child elicited larger activity in the visual cortex. Region of interest (ROI) analyses (amygdala, insula, NAcc) revealed stronger responses to a happy (vs. fearful) unknown child, but equally strong responses to one´s own child´s expressions. Moreover, an own (vs. unknown) fearful child elicited larger activity in the insula and NAcc. This suggests that mothers allocated more visual attention towards their own child´s fear, but showed consistent emotional involvement with their own child across expressions. Mothers might respond with stronger empathy and approach motivation towards an own (vs. unknown) fearful child, in line with a key role of fear in the attachment relationship.
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http://dx.doi.org/10.1080/17470919.2019.1592773DOI Listing
December 2019

Impact of pressure as a tactile stimulus on working memory in healthy participants.

PLoS One 2019 14;14(3):e0213070. Epub 2019 Mar 14.

Medical Faculty and Institute of Clinical Radiology, University Hospital Muenster, Muenster, Germany.

Studies on cross-modal interaction have demonstrated attenuated as well as facilitated effects for both neural responses as well as behavioral performance. The goals of this pilot study were to investigate possible cross-modal interactions of tactile stimulation on visual working memory and to identify possible neuronal correlates by using functional magnetic resonance imaging (fMRI). During fMRI, participants (n = 12 females, n = 12 males) performed a verbal n-back task (0-back and 2-back tasks) while tactile pressure to the left thumbnail was delivered. Participants presented significantly lower behavioral performances (increased error rates, and reaction times) during the 2-back task as compared to the 0-back task. Task performance was independent of pressure in both tasks. This means that working memory performance was not impacted by a low salient tactile stimulus. Also in the fMRI data, no significant interactions of n-back x pressure were observed. In conclusion, the current study found no influence of tactile pressure on task-related brain activity during n-back (0-back and 2-back) tasks.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0213070PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6417705PMC
December 2019

The impact of depressive comorbidity on neural plasticity following cognitive-behavioral therapy in panic disorder with agoraphobia.

J Affect Disord 2019 02 4;245:451-460. Epub 2018 Nov 4.

Center of Mental Health, Department of Psychiatry, Psychosomatics, and Psychotherapy, University Hospital Würzburg, Würzburg, Germany; Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany.

Background: Depressive disorders are a frequent comorbidity of panic disorder with agoraphobia (PD/AG). Cognitive-behavioral therapy (CBT) for PD/AG effectively reduces anxiety and depressive symptoms, irrespective of comorbidities. However, as depressive comorbidities can confound fear circuitry activation (i.e. amygdalae, insulae, anterior cingulate cortex) in PD/AG, we investigated whether comorbid depressive disorders alter neural plasticity following CBT.

Methods: Within a randomized, controlled clinical trial on exposure-based CBT, forty-two PD/AG patients including fifteen (35.7%) with a comorbid depressive disorder (PD/AG + DEP) participated in a longitudinal functional magnetic resonance imaging (fMRI) study. A differential fear conditioning task was used as probe of interest. A generalized psycho-physiological interaction analysis (gPPI) served to study functional connectivity patterns.

Results: After CBT, only PD/AG patients without comorbid depressive disorders (PD/AG-DEP) showed reduced activation in the left inferior frontal gyrus (IFG) extending to the insula. While PD/AG-DEP patients showed enhanced functional connectivity (FC) between the left IFG and subcortical structures (anterior cingulate cortex, thalamus and midbrain), PD/AG + DEP patients exhibited increased FC between the left IFG and cortical structures (prefrontal, parietal regions). In both groups, FC decreased following CBT.

Limitations: Primary depressed and medicated patients were excluded. Major depression and dysthymia were collapsed.

Conclusions: Reduced activation in the left IFG, as previously shown in PD/AG, appears to be a specific substrate of CBT effects in PD/AG-DEP patients only. Differential patterns of FC pertaining to fear circuitry networks in patients without depression vs. cognitive networks in patients with comorbid depression may point towards different pathways recruited by CBT as a function of comorbidity.
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http://dx.doi.org/10.1016/j.jad.2018.11.026DOI Listing
February 2019

Clinical and Neurofunctional Substrates of Cognitive Behavioral Therapy on Secondary Social Anxiety Disorder in Primary Panic Disorder: A Longitudinal fMRI Study.

Psychother Psychosom 2019 26;88(1):48-51. Epub 2018 Oct 26.

Center of Mental Health, Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Würzburg, Würzburg, Germany.

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http://dx.doi.org/10.1159/000493756DOI Listing
April 2019

Effects of Cognitive Behavioral Therapy on Neural Processing of Agoraphobia-Specific Stimuli in Panic Disorder and Agoraphobia.

Psychother Psychosom 2018 28;87(6):350-365. Epub 2018 Sep 28.

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

Background: Patients suffering from panic disorder and agoraphobia are significantly impaired in daily life due to anxiety about getting into a situation due to apprehension about experiencing a panic attack, especially if escape may be difficult. Dysfunctional beliefs and behavior can be changed with cognitive behavioral therapy; however, the neurobiological effects of such an intervention on the anticipation and observation of agoraphobia-specific stimuli are unknown.

Methods: We compared changes in neural activation by measuring the blood oxygen level-dependent signal of 51 patients and 51 healthy controls between scans before and those after treatment (group by time interaction) during anticipation and observation of agoraphobia-specific compared to neutral pictures using 3-T fMRI.

Results: A significant group by time interaction was observed in the ventral striatum during anticipation and in the right amygdala during observation of agoraphobia-specific pictures; the patients displayed a decrease in ventral striatal activation during anticipation from pre- to posttreatment scans, which correlated with clinical improvement measured with the Mobility Inventory. During observation, the patients displayed decreased activation in the amygdala. These activational changes were not observed in the matched healthy controls.

Conclusions: For the first time, neural effects of cognitive behavioral therapy were shown in patients suffering from panic disorder and agoraphobia using disorder-specific stimuli. The decrease in activation in the ventral striatum indicates that cognitive behavioral therapy modifies anticipatory anxiety and may ameliorate abnormally heightened salience attribution to expected threatening stimuli. The decreased amygdala activation in response to agoraphobia-specific stimuli indicates that cognitive behavioral therapy can alter the basal processing of agoraphobia-specific stimuli in a core region of the fear network.
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http://dx.doi.org/10.1159/000493146DOI Listing
December 2018

Development and initial Experience of an online Exchange Platform on Sex and Gender Aspects in Medicine: "GenderMed-Wiki".

GMS J Med Educ 2018 15;35(3):Doc32. Epub 2018 Aug 15.

University of Muenster, Institute of Clinical Radiology, Muenster, Germany.

Knowledge about sex/gender aspects in medicine is often lacking, even though this serves as base for individualized patient-centered care. Thus we developed an online exchange platform on sex and gender aspects in medicine: "GenderMed-Wiki" [www.gendermed-wiki.de]. This was funded by the German Federal Ministry of Education and Research (BMBF; FKZ: 01FP1506). Our goal is to facilitate the integration of sex and gender in all areas of medicine. Therefore we evaluated if "GenderMed-Wiki" is suitable to provide knowledge on sex and gender aspects in medicine adequately. Qualitative evaluation of "GenderMed-Wiki" was done 6 months after project start by 4 focus groups with a total of 30 participants (students, lecturers, physicians, and the public). The discussions in each focus group were minuted, requirements pooled and new categories derived inductively. After further optimization of the platform a quantitative survey was done by an online questionnaire (SoSci Survey). 149 students of the medical faculties of Muenster and Duisburg-Essen (as well as students of dentistry from the medical faculty of Muenster) participated (return rate of 3.3%). Evaluation of the content of the articles was done by assessing three professional articles: Sex/gender and medicine (both study courses medicine and dentistry), depression (medicine only) and periodontitis (dentistry only). The results were reported in relative and absolute frequencies and associations were assessed by Chi-Quadrat-tests. Four categories which needed further optimization were deducted from the responses given by our focus groups prior to evaluation: . Most of the students found "GenderMed-Wiki" to be informative, however they didn´t think it to be relevant for their current studies. In contrast, many thought that the platform may be useful when working as physicians. Students who reported that topics related to sex and gender were not of importance to them, evaluated the platform more neutrally and answered questions related to sex/gender in depression more often incorrectly. Focus groups are a useful approach to identify necessary changes in projects in a systematic way. After further optimizations, "GenderMed-Wiki" seems to be suitable to facilitate the integration of sex/gender into medical teachings. It is of importance, however, to change the attitude of students towards sex/gender sensitive medicine (e.g. by integration into the medical curriculum), since this influences strongly how this platform is perceived and how someone deals with its contents.
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http://dx.doi.org/10.3205/zma001178DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6120162PMC
November 2018

Improving female physician's careers in academic medicine: Chances and challenges.

Best Pract Res Clin Anaesthesiol 2018 Mar 30;32(1):15-23. Epub 2018 Apr 30.

zeb.business school at Steinbeis University Berlin, Germany. Electronic address:

University hospitals are involved in the care of critically ill patients, pregraduate and postgraduate education, and medical research with an increasing demand on physicians due to a higher burden of disease. The number of female physicians is increasing; however, young female physicians are less willing to work at university hospitals under the given conditions. They often do not find appropriate working conditions in mostly hierarchically structured university hospitals. Institutional structures involuntarily erect barriers against the recruitment, retention, and career progression of women. Gendered working conditions remain firmly fixed, and this is even more challenging - overt discrimination has been replaced by less visible mostly implicit stereotypes and prejudices against women. Having children is an additional "career stopper" for female physicians: those with children are less likely to be promoted and have a lower income. Regulatory measures should act in several directions: cultural gender equality policies, family support policies, and active work policies.
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http://dx.doi.org/10.1016/j.bpa.2018.04.006DOI Listing
March 2018

Assessment of Quality of Life in Chronic Pruritus: Relationship Between ItchyQoL and Dermatological Life Quality Index in 1,150 Patients.

Acta Derm Venereol 2018 01;98(1):142-143

Department of Psychosomatics and Psychotherapy, University of Münster, Domagkstrasse 22, DE-48149 Münster, Germany.

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http://dx.doi.org/10.2340/00015555-2782DOI Listing
January 2018

Medicine Goes Female: Protocol for Improving Career Options of Females and Working Conditions for Researching Physicians in Clinical Medical Research by Organizational Transformation and Participatory Design.

JMIR Res Protoc 2017 Aug 2;6(8):e152. Epub 2017 Aug 2.

Department of Clinical Radiology, Chair of the Research Group Cognition & Gender, University Hospital Muenster, Muenster, Germany.

Background: All European countries need to increase the number of health professionals in the near future. Most efforts have not brought the expected results so far. The current notion is that this is mainly related to the fact that female physicians will clearly outnumber their male colleagues within a few years in nearly all European countries. Still, women are underrepresented in leadership and research positions throughout Europe.

Objectives: The MedGoFem project addresses multiple perspectives with the participation of multiple stakeholders. The goal is to facilitate the implementation of Gender Equality Plans (GEP) in university hospitals; thereby, transforming the working conditions for women working as researchers and highly qualified physicians simultaneously. Our proposed innovation, a crosscutting topic in all research and clinical activities, must become an essential part of university hospital strategic concepts.

Methods: We capture the current status with gender-sensitive demographic data concerning medical staff and conduct Web-based surveys to identify cultural, country-specific, and interdisciplinary factors conducive to women's academic success. Individual expectations of employees regarding job satisfaction and working conditions will be visualized based on "personal construct theory" through repertory grids. An expert board working out scenarios and a gender topic agenda will identify culture-, nation-, and discipline-specific aspects of gender equality. University hospitals in 7 countries will establish consensus groups, which work on related topics. Hospital management supports the consensus groups, valuates group results, and shares discussion results and suggested measures across groups. Central findings of the consensus groups will be prepared as exemplary case studies for academic teaching on research and work organization, leadership, and management.

Results: A discussion group on gender equality in academic medicine will be established on an internationally renowned open-research platform. Project results will be published in peer-reviewed journals with high-impact factors. In addition, workshops on gender dimension in research using the principles of Gendered Innovation will be held. Support and consulting services for hospitals will be introduced in order to develop a European consulting service.

Conclusions: The main impact of the project will be the implementation of innovative GEP tailored to the needs of university hospitals, which will lead to measurable institutional change in gender equality. This will impact the research at university hospitals in general, and will improve career prospects of female researchers in particular. Simultaneously, the gender dimension in medical research as an innovation factor and mandatory topic will be strengthened and integrated in each individual university hospital research activity. Research funding organizations can use the built knowledge to include mandatory topics for funding applications to enforce the use and implementation of GEP in university hospitals.
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http://dx.doi.org/10.2196/resprot.7632DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5559648PMC
August 2017

Sample heterogeneity in unipolar depression as assessed by functional connectivity analyses is dominated by general disease effects.

J Affect Disord 2017 11 27;222:79-87. Epub 2017 Jun 27.

University Hospital Münster, Department of Clinical Radiology, Münster, Germany; University of Münster, Otto Creutzfeldt Center for Cognitive and Behavioral Neuroscience, Münster, Germany.

Objectives: Combinations of resting-state fMRI and machine-learning techniques are increasingly employed to develop diagnostic models for mental disorders. However, little is known about the neurobiological heterogeneity of depression and diagnostic machine learning has mainly been tested in homogeneous samples. Our main objective was to explore the inherent structure of a diverse unipolar depression sample. The secondary objective was to assess, if such information can improve diagnostic classification.

Materials And Methods: We analyzed data from 360 patients with unipolar depression and 360 non-depressed population controls, who were subdivided into two independent subsets. Cluster analyses (unsupervised learning) of functional connectivity were used to generate hypotheses about potential patient subgroups from the first subset. The relationship of clusters with demographical and clinical measures was assessed. Subsequently, diagnostic classifiers (supervised learning), which incorporated information about these putative depression subgroups, were trained.

Results: Exploratory cluster analyses revealed two weakly separable subgroups of depressed patients. These subgroups differed in the average duration of depression and in the proportion of patients with concurrently severe depression and anxiety symptoms. The diagnostic classification models performed at chance level.

Limitations: It remains unresolved, if subgroups represent distinct biological subtypes, variability of continuous clinical variables or in part an overfitting of sparsely structured data.

Conclusions: Functional connectivity in unipolar depression is associated with general disease effects. Cluster analyses provide hypotheses about potential depression subtypes. Diagnostic models did not benefit from this additional information regarding heterogeneity.
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http://dx.doi.org/10.1016/j.jad.2017.06.055DOI Listing
November 2017

Distraction From Itch Shows Brainstem Activation Without Reduction in Experimental Itch Sensation.

Acta Derm Venereol 2017 Oct;97(9):1074-1080

Department of Psychosomatics and Psychotherapy, University of Münster, Domagkstrasse 22, DE-48149 Münster, Germany.

The central processing of itch is not completely understood. This is the first study to use functional magnetic resonance imaging (fMRI) to examine the central modulation by distraction of experimentally induced itch. A total of 33 healthy volunteers were examined with fMRI. Periods of itch induction without distraction and itch with distraction by a Stroop task (psychological test, where the participants have to decide if the colour of the writing corresponds to the written word, for example if "red" is written in red or not) were counterbalanced during the scanning to examine task-specific changes in blood oxygenation level dependent-signal. The intensity of the subjects' itch sensation, desire to scratch and pain sensation were evaluated. Distraction by a Stroop task did not reduce itch intensity or urge to scratch. However, the Stroop task led to significantly higher activation of the left brainstem when it followed the "pure" itch sensation. Itch and pain seem to have similar inhibition pathways, particularly concerning brainstem activation during distraction. But as itch sensation, in contrast to pain, could not be sufficiently reduced by distraction, both entities might have different modulation systems.
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http://dx.doi.org/10.2340/00015555-2732DOI Listing
October 2017

Support Vector Machine Analysis of Functional Magnetic Resonance Imaging of Interoception Does Not Reliably Predict Individual Outcomes of Cognitive Behavioral Therapy in Panic Disorder with Agoraphobia.

Front Psychiatry 2017 9;8:99. Epub 2017 Jun 9.

Department of Clinical Radiology, University Hospital Münster, Münster, Germany.

Background: The approach to apply multivariate pattern analyses based on neuro imaging data for outcome prediction holds out the prospect to improve therapeutic decisions in mental disorders. Patients suffering from panic disorder with agoraphobia (PD/AG) often exhibit an increased perception of bodily sensations. The purpose of this investigation was to assess whether multivariate classification applied to a functional magnetic resonance imaging (fMRI) interoception paradigm can predict individual responses to cognitive behavioral therapy (CBT) in PD/AG.

Methods: This analysis is based on pretreatment fMRI data during an interoceptive challenge from a multicenter trial of the German PANIC-NET. Patients with DSM-IV PD/AG were dichotomized as responders ( = 30) or non-responders ( = 29) based on the primary outcome (Hamilton Anxiety Scale Reduction ≥50%) after 6 weeks of CBT (2 h/week). fMRI parametric maps were used as features for response classification with linear support vector machines (SVM) with or without automated feature selection. Predictive accuracies were assessed using cross validation and permutation testing. The influence of methodological parameters and the predictive ability for specific interoception-related symptom reduction were further evaluated.

Results: SVM did not reach sufficient overall predictive accuracies (38.0-54.2%) for anxiety reduction in the primary outcome. In the exploratory analyses, better accuracies (66.7%) were achieved for predicting interoception-specific symptom relief as an alternative outcome domain. Subtle information regarding this alternative response criterion but not the primary outcome was revealed by univariate comparisons.

Conclusion: In contrast to reports on other neurofunctional probes, SVM based on an interoception paradigm was not able to reliably predict individual response to CBT. Results speak against the clinical applicability of this technique.
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http://dx.doi.org/10.3389/fpsyt.2017.00099DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5465291PMC
June 2017

Diagnostic classification of unipolar depression based on resting-state functional connectivity MRI: effects of generalization to a diverse sample.

J Neural Transm (Vienna) 2017 05 31;124(5):589-605. Epub 2016 Dec 31.

Department of Clinical Radiology, University Hospital Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Germany.

In small, selected samples, an approach combining resting-state functional connectivity MRI and multivariate pattern analysis has been able to successfully classify patients diagnosed with unipolar depression. Purposes of this investigation were to assess the generalizability of this approach to a large clinically more realistic sample and secondarily to assess the replicability of previously reported methodological feasibility in a more homogeneous subgroup with pronounced depressive symptoms. Two independent subsets were drawn from the depression and control cohorts of the BiDirect study, each with 180 patients with and 180 controls without depression. Functional connectivity either among regions covering the gray matter or selected regions with known alterations in depression was assessed by resting-state fMRI. Support vector machines with and without automated feature selection were used to train classifiers differentiating between individual patients and controls in the entire first subset as well as in the subgroup. Model parameters were explored systematically. The second independent subset was used for validation of successful models. Classification accuracies in the large, heterogeneous sample ranged from 45.0 to 56.1% (chance level 50.0%). In the subgroup with higher depression severity, three out of 90 models performed significantly above chance (60.8-61.7% at independent validation). In conclusion, common classification methods previously successful in small homogenous depression samples do not immediately translate to a more realistic population. Future research to develop diagnostic classification approaches in depression should focus on more specific clinical questions and consider heterogeneity, including symptom severity as an important factor.
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http://dx.doi.org/10.1007/s00702-016-1673-8DOI Listing
May 2017

Neural correlates of individual differences in anxiety sensitivity: an fMRI study using semantic priming.

Soc Cogn Affect Neurosci 2016 08 12;11(8):1245-54. Epub 2016 Mar 12.

Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany.

Individuals with high anxiety sensitivity (AS) have an increased risk of developing anxiety disorders and are more biased in how they process fear-related stimuli. This study investigates the neural correlates of fear-related words and word associations in high- and low-AS individuals. We used a semantic priming paradigm during functional magnetic resonance imaging in which three types of target words (fear symptoms, e.g. 'dizziness'; neutral, e.g. 'drink'; and pseudowords, e.g. 'salkom') were preceded by two types of prime words (fear-triggers, e.g. 'elevator'; and neutral, e.g. 'bottle'). Subjects with high AS rated fear-symptom words (vs neutral words) as more unpleasant than low-AS individuals; they also related these words more strongly to fear-triggers and showed prolonged reaction times. During the processing of fear-symptom words, greater activation in the left anterior insula was observed in high-AS subjects than in low-AS subjects. Lower activation in the left inferior frontal gyrus, angular gyrus, fusiform gyrus and bilateral amygdalae was found in high-AS subjects when fear-symptom words were preceded by fear-trigger words. The findings suggest that cognitive biases and the anterior insula play a crucial role in high-AS individuals. Furthermore, semantic processes may contribute to high AS and the risk of developing anxiety disorders.
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http://dx.doi.org/10.1093/scan/nsw024DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4967792PMC
August 2016

Coordinate-based (ALE) meta-analysis of brain activation in patients with fibromyalgia.

Hum Brain Mapp 2016 May 11;37(5):1749-58. Epub 2016 Feb 11.

Department of Psychosomatics and Psychotherapy, University Hospital Münster, Münster, Germany.

There are an increasing number of neuroimaging studies that allow a better understanding of symptoms, neural correlates and associated conditions of fibromyalgia. However, the results of these studies are difficult to compare, as they include a heterogeneous group of patients, use different stimulation paradigms, tasks, and the statistical evaluation of neuroimaging data shows high variability. Therefore, this meta-analytic approach aimed at evaluating potential alterations in neuronal brain activity or structure related to pain processing in fibromyalgia syndrome (FMS) patients, using quantitative coordinate-based "activation likelihood estimation" (ALE) meta-analysis. 37 FMS papers met the inclusion criteria for an ALE analysis (1,264 subjects, 274 activation foci). A pooled ALE analysis of different modalities of neuroimaging and additional analyses according functional and structural changes indicated differences between FMS patients and controls in the insula, amygdala, anterior/mid cingulate cortex, superior temporal gyrus, the primary and secondary somatosensory cortex, and lingual gyrus. Our analysis showed consistent results across FMS studies with potential abnormalities especially in pain-related brain areas. Given that similar alterations have already been demonstrated in patients with other chronic pain conditions and the lack of adequate control groups of chronic pain subjects in most FMS studies, it is not clear however, whether these findings are associated with chronic pain in general or are unique features of patients with FMS. Hum Brain Mapp 37:1749-1758, 2016. © 2016 Wiley Periodicals, Inc.
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http://dx.doi.org/10.1002/hbm.23132DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6867581PMC
May 2016

Facing the fear--clinical and neural effects of cognitive behavioural and pharmacotherapy in panic disorder with agoraphobia.

Eur Neuropsychopharmacol 2016 Mar 22;26(3):431-44. Epub 2016 Jan 22.

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

Introduction: Cognitive behavioural therapy (CBT) and pharmacological treatment with selective serotonin or serotonin-noradrenalin reuptake inhibitors (SSRI/SSNRI) are regarded as efficacious treatments for panic disorder with agoraphobia (PD/AG). However, little is known about treatment-specific effects on symptoms and neurofunctional correlates.

Experimental Procedures: We used a comparative design with PD/AG patients receiving either two types of CBT (therapist-guided (n=29) or non-guided exposure (n=22)) or pharmacological treatment (SSRI/SSNRI; n=28) as well as a wait-list control group (WL; n=15) to investigate differential treatment effects in general aspects of fear and depression (Hamilton Anxiety Rating Scale HAM-A and Beck Depression Inventory BDI), disorder-specific symptoms (Mobility Inventory MI, Panic and Agoraphobia Scale subscale panic attacks PAS-panic, Anxiety Sensitivity Index ASI, rating of agoraphobic stimuli) and neurofunctional substrates during symptom provocation (Westphal-Paradigm) using functional magnetic resonance imaging (fMRI). Comparisons of neural activation patterns also included healthy controls (n=29).

Results: Both treatments led to a significantly greater reduction in panic attacks, depression and general anxiety than the WL group. The CBT groups, in particular, the therapist-guided arm, had a significantly greater decrease in avoidance, fear of phobic situations and anxiety symptoms and reduction in bilateral amygdala activation while the processing of agoraphobia-related pictures compared to the SSRI/SSNRI and WL groups.

Discussion: This study demonstrates that therapist-guided CBT leads to a more pronounced short-term impact on agoraphobic psychopathology and supports the assumption of the amygdala as a central structure in a complex fear processing system as well as the amygdala's involvement in the fear system's sensitivity to treatment.
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http://dx.doi.org/10.1016/j.euroneuro.2016.01.004DOI Listing
March 2016

Itch Perception and Skin Reactions as Modulated by Verbal Suggestions: Role of Participant's and Investigator's Sex.

Acta Derm Venereol 2016 Jun;96(5):619-23

Department of Psychosomatics and Psychotherapy, Competence Center Chronic Pruritus, University Hospital Münster, DE-48149 Münster, Germany.

This study investigated sex-specific differences in itch perception and skin reactions, as modulated by verbal suggestions, and the role of the investigator's sex. Healthy volunteers (50 males, 50 females), divided into 4 groups, were tested by male and female investigators. Itch was induced via prick testing with sodium chloride and histamine in 4 runs; 2 control conditions (with no exaggerated verbal comments about expected itch) and 2 experimental conditions (with exaggerated verbal comments). After 5 min, wheal and flare reactions were measured and itch intensity was rated by subjects on a numerical rating scale. Exaggerated verbal suggestions resulted in higher itch intensity ratings in the sodium chloride and histamine condition, and higher unpleasantness ratings and a wheal of greater extent in the sodium chloride condition, as well as a flare of greater extent in the histamine condition. The magnitude of the differences between the exaggerated verbal suggestion conditions and respective control conditions was only significantly different between male and female investigators concerning flare size in the histamine condition. There were no differences between male and female participants. Therefore, sex differences may play only a minor role in nocebo-induced itch perception.
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http://dx.doi.org/10.2340/00015555-2336DOI Listing
June 2016

Major depressive disorder: Findings of reduced homotopic connectivity and investigation of underlying structural mechanisms.

Hum Brain Mapp 2016 Mar 24;37(3):1209-17. Epub 2015 Dec 24.

Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany.

Depression has been associated with various alterations in magnetic resonance imaging (MRI) derived resting-state functional connectivity. Recently, homotopic connectivity, defined as functional connectivity between homotopic regions across hemispheres, has been reported to be reduced in patients with major depressive disorder (MDD). However, little is known about structural factors underlying alterations of homotopic connectivity, which would contribute to the understanding of the altered neurophysiological architecture in patients with MDD. We compared 368 patients with MDD and 461 never-depressed controls regarding voxel-mirrored homotopic connectivity (VMHC) and potential underlying mechanisms such as the structural connectivity of the corpus callosum, measured by DTI-derived fractional anisotropy (FA), and left-right symmetries in homotopic gray matter volumes. Compared to controls, patients with MDD exhibited reduced VMHC in the cuneus, putamen, superior temporal gyrus, insula, and precuneus. Within these regions, no differences in left-right symmetries in homotopic gray matter volumes were evident across cohorts. FA of the corpus callosum correlated with VMHC in the entire sample. However, patients with MDD and controls did not differ with regard to callosal FA. The findings indicate that MDD is associated with a loss of interhemispheric synchrony in regions known to be implicated in self-referential and reward processing. They also suggest that additional mechanisms are implicated in altered homotopic connectivity of patients with MDD, other than direct callosal fiber pathways or asymmetries in homotopic gray matter volumes.
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http://dx.doi.org/10.1002/hbm.23097DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6867499PMC
March 2016

Intraepidermal Nerve Fibre Density is Decreased in Lesional and Inter-lesional Prurigo Nodularis and Reconstitutes on Healing of Lesions.

Acta Derm Venereol 2016 Mar;96(3):404-6

Moscow Scientific and Practical Center of Dermatovenerology and Cosmetology, , Moscow, Russia.

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http://dx.doi.org/10.2340/00015555-2232DOI Listing
March 2016