Publications by authors named "Julia Diemer"

18 Publications

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[Development of virtual reality as an exposure technique].

Nervenarzt 2019 Jul;90(7):715-723

kbo-Inn-Salzach-Klinikum, Gabersee 7, 83512, Wasserburg am Inn, Deutschland.

Background: Virtual reality (VR) has been investigated as a medium for exposure therapy of anxiety disorders for 20 years. Various meta-analyses have provided convincing evidence of the therapeutic efficacy of exposure therapy in VR.

Objective: In recent years VR technology and its applications have considerably improved. Therefore, the current state of the art of VR exposure therapy is presented.

Material And Methods: This article provides a narrative review of current research on VR exposure therapy for anxiety disorders and major directions of development in this area.

Results: After an almost exclusive focus on specific phobias in the early days, research on more complex anxiety disorders (particularly on social anxiety disorder) is increasing. In addition, VR has become established as an experimental method to probe psychopathological processes and to elucidate the mechanism of action of (VR) exposure therapy.

Conclusion: There is still a need for more research into VR exposure therapy, especially in complex anxiety disorders (e. g. panic disorder, agoraphobia and social anxiety disorder) and trauma-related disorders. Furthermore, VR has become established as a research tool. The rapid technological development gives reason to expect a continuing increase in VR research, in clinical as well as basic research.
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http://dx.doi.org/10.1007/s00115-019-0678-6DOI Listing
July 2019

[Evaluation of a neuropsychological test battery with psychiatric and psychosomatic patients].

Fortschr Neurol Psychiatr 2018 06 28;86(6):348-355. Epub 2018 Jun 28.

kbo-Inn-Salzach-Klinikum.

Neuropsychological assessment should be an integral component of clinical psychiatric diagnostics. Yet, the commonly used tests have not been investigated adequately for this population so far. The current study evaluated a clinically approved neuropsychological test battery by analyzing data on 226 mentally ill patients using factor and regression analyses. The extraction of three factors (Speed, Memory, and Executive Functions) proved to be adequate as the tests could be allocated properly. Regression analysis revealed an economical basis assessment consisting of three tests (TAP Alertness, VLMT, and Matrices Test). Based on acceptance, economy, and factorial structure aspects, we recommend the investigated test battery for neuropsychological assessment of psychiatric and psychosomatic patients.
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http://dx.doi.org/10.1055/s-0043-119796DOI Listing
June 2018

Neurobiological and clinical effects of fNIRS-controlled rTMS in patients with panic disorder/agoraphobia during cognitive-behavioural therapy.

Neuroimage Clin 2017 22;16:668-677. Epub 2017 Sep 22.

Mood and Anxiety Disorders Research Unit, Department of Psychiatry and Psychotherapy, Albert-Schweitzer-Campus 1, University of Muenster, Muenster, Germany.

Background: A relevant proportion of patients with panic disorder (PD) does not improve even though they receive state of the art treatment for anxiety disorders such as cognitive-behavioural therapy (CBT). At the same time, it is known, that from a neurobiological point of view, PD patients are often characterised by prefrontal hypoactivation. Intermittent Theta Burst Stimulation (iTBS) is a non-invasive type of neurostimulation which can modulate cortical activity and thus has the potential to normalise prefrontal hypoactivity found in PD. We therefore aimed at investigating the effects of iTBS as an innovative add-on to CBT in the treatment for PD.

Methods: In this double-blind, bicentric study, 44 PD patients, randomised to sham or verum stimulation, received 15 sessions of iTBS over the left prefrontal cortex (PFC) in addition to 9 weeks of group CBT. Cortical activity during a cognitive as well as an emotional (Emotional Stroop) paradigm was assessed both at baseline and post-iTBS treatment using functional near-infrared spectroscopy (fNIRS) and compared to healthy controls.

Results: In this manuscript we only report the results of the emotional paradigm; for the results of the cognitive paradigm please refer to Deppermann et al. (2014). During the Emotional Stroop test, PD patients showed significantly reduced activation to panic-related compared to neutral stimuli for the left PFC at baseline. Bilateral prefrontal activation for panic-related stimuli significantly increased after verum iTBS only. Clinical ratings significantly improved during CBT and remained stable at follow-up. However, no clinical differences between the verum- and sham-stimulated group were identified, except for a more stable reduction of agoraphobic avoidance during follow-up in the verum iTBS group.

Limitations: Limitations include insufficient blinding, the missing control for possible state-dependent iTBS effects, and the timing of iTBS application during CBT.

Conclusion: Prefrontal hypoactivity in PD patients was normalised by add-on iTBS. Clinical improvement of anxiety symptoms was not affected by iTBS.
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http://dx.doi.org/10.1016/j.nicl.2017.09.013DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5650598PMC
June 2018

Distress=stress? Disentangling the different components of emotional experience.

Authors:
Julia Diemer

Psychoneuroendocrinology 2017 08 30;82:187-188. Epub 2017 Mar 30.

kbo-Inn-Salzach-Hospital, 83512 Wasserburg am Inn, Germany. Electronic address:

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http://dx.doi.org/10.1016/j.psyneuen.2017.03.024DOI Listing
August 2017

Diaphragmatic breathing during virtual reality exposure therapy for aviophobia: functional coping strategy or avoidance behavior? a pilot study.

BMC Psychiatry 2017 01 18;17(1):29. Epub 2017 Jan 18.

Department of Psychology (Clinical Psychology and Psychotherapy), University of Regensburg, Universitätsstraße 31, 93053, Regensburg, Germany.

Background: Although there is solid evidence for the efficacy of in vivo and virtual reality (VR) exposure therapy for a specific phobia, there is a significant debate over whether techniques promoting distraction or relaxation have impairing or enhancing effects on treatment outcome. In the present pilot study, we investigated the effect of diaphragmatic breathing (DB) as a relaxation technique during VR exposure treatment.

Method: Twenty-nine patients with aviophobia were randomly assigned to VR exposure treatment either with or without diaphragmatic breathing (six cycles per minute). Subjective fear ratings, heart rate and skin conductance were assessed as indicators of fear during both the exposure and the test session one week later.

Results: The group that experienced VR exposure combined with diaphragmatic breathing showed a higher tendency to effectively overcome the fear of flying. Psychophysiological measures of fear decreased and self-efficacy increased in both groups with no significant difference between the groups.

Conclusions: Our findings indicate that diaphragmatic breathing during VR exposure does not interfere with the treatment outcome and may even enhance treatment effects of VR exposure therapy for aviophobic patients.

Trial Registration: Retrospectively registered. ClinicalTrials.gov NCT02990208 . Registered 07 December 2016.
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http://dx.doi.org/10.1186/s12888-016-1181-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5242013PMC
January 2017

Trier Social Stress Test in vivo and in virtual reality: Dissociation of response domains.

Int J Psychophysiol 2016 12 12;110:47-55. Epub 2016 Oct 12.

Department of Psychology (Differential Psychology and Behavioural Genetic Research Group), University of Regensburg, Regensburg, Germany.

The Trier Social Stress Test (TSST) is considered a reliable paradigm for inducing psychosocial stress. Virtual reality (VR) has successfully been applied to ensure a greater degree of efficiency and standardization in the TSST. Studies using the TSST in VR (VR-TSST) have reported significant stress reactions, with subjective and peripheral physiological reactions comparable to those in response to the in vivo TSST and with lower cortisol reactions. The current study examined whether an additional virtual competitive factor triggers larger stress responses than a standard VR-TSST. Forty-five male participants were randomly assigned to either in vivo TSST, VR-TSST (VR) or VR-TSST with a virtual competitor (VR+). A significant increase of self-reported stress, electrodermal activity, and heart rate indicated a pronounced stress reaction with no differences between groups. For salivary cortisol, however, responder rates differed significantly between groups, with in vivo participants showing overall higher response rates (86%) than participants of both VR groups (VR: 33%, VR+: 47%). In contrast, participants of both VR groups judged the task significantly more challenging than did in vivo TSST participants. In sum, our results indicate successful stress induction in all experimental conditions, and a marked dissociation of salivary cortisol levels on the one hand, and the physiological and psychological stress reactions on the other hand. The competitive scenario did not significantly enhance stress reactions. VR technology may serve as a standardized tool for inducing social stress in experimental settings, but further research is needed to clarify why the stress reaction as assessed by cortisol differs from peripheral and subjective stress reactions in VR.
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http://dx.doi.org/10.1016/j.ijpsycho.2016.10.008DOI Listing
December 2016

Emotional processing and rTMS: does inhibitory theta burst stimulation affect the human startle reflex?

J Neural Transm (Vienna) 2016 10 13;123(10):1121-31. Epub 2016 May 13.

Department of Psychiatry and Psychotherapy, University of Muenster, Albert-Schweitzer-Campus 1, Gebaeude A9, 48149, Muenster, Germany.

Repetitive transcranial magnetic stimulation (rTMS) enables the local and non-invasive modulation of cortical activity and has proved to achieve antidepressant effects. To a lesser extent, rTMS is investigated as a treatment option for anxiety disorders. As the prefrontal cortex and the amygdala represent key components of human emotion regulation, we investigated how prefrontally applied rTMS affects the responsiveness of the subcortical amygdala during a fear-relevant study paradigm to examine potential cortico-limbic effects. Sham-controlled, randomised inhibitory rTMS (continuous theta burst stimulation, TBS) was applied to 102 healthy subjects (female = 54) over the right dorsolateral prefrontal cortex. Subsequently, the emotion-potentiated (unpleasant, neutral, and pleasant International Affective Picture System pictures) acoustic startle response was investigated. Subjective anxiety ratings (anxiety sensitivity, trait and state anxiety) were considered. Picture category affected the startle magnitude as expected for both TBS intervention groups (highest startle response for unpleasant, lowest for pleasant pictures). However, no modulatory effects of TBS on startle potentiation were discerned. No significant interaction effects of TBS intervention, subjective anxiety ratings, and gender were identified. Interestingly, startle habituation was influenced by TBS intervention on a trend-level, with verum TBS leading to an accelerated habituation. We found no evidence for the hypothesis that prefrontal inhibitory TBS affects the responsiveness of the amygdala during the presentation of emotionally relevant stimuli in healthy subjects. Instead, we found accelerated habituation under verum TBS on a statistical trend-level. Hence, some preliminary hints for modulatory effects of inhibitory TBS on basic learning mechanisms could be found.
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http://dx.doi.org/10.1007/s00702-016-1568-8DOI Listing
October 2016

Representation of Patients' Hand Modulates Fear Reactions of Patients with Spider Phobia in Virtual Reality.

Front Psychol 2016 29;7:268. Epub 2016 Feb 29.

Clinical Psychology and Psychotherapy, Department of Psychology, University of Regensburg Regensburg, Germany.

Embodiment (i.e., the involvement of a bodily representation) is thought to be relevant in emotional experiences. Virtual reality (VR) is a capable means of activating phobic fear in patients. The representation of the patient's body (e.g., the right hand) in VR enhances immersion and increases presence, but its effect on phobic fear is still unknown. We analyzed the influence of the presentation of the participant's hand in VR on presence and fear responses in 32 women with spider phobia and 32 matched controls. Participants sat in front of a table with an acrylic glass container within reaching distance. During the experiment this setup was concealed by a head-mounted display (HMD). The VR scenario presented via HMD showed the same setup, i.e., a table with an acrylic glass container. Participants were randomly assigned to one of two experimental groups. In one group, fear responses were triggered by fear-relevant visual input in VR (virtual spider in the virtual acrylic glass container), while information about a real but unseen neutral control animal (living snake in the acrylic glass container) was given. The second group received fear-relevant information of the real but unseen situation (living spider in the acrylic glass container), but visual input was kept neutral VR (virtual snake in the virtual acrylic glass container). Participants were instructed to touch the acrylic glass container with their right hand in 20 consecutive trials. Visibility of the hand was varied randomly in a within-subjects design. We found for all participants that visibility of the participant's hand increased presence independently of the fear trigger. However, in patients, the influence of the virtual hand on fear depended on the fear trigger. When fear was triggered perceptually, i.e., by a virtual spider, the virtual hand increased fear. When fear was triggered by information about a real spider, the virtual hand had no effect on fear. Our results shed light on the significance of different fear triggers (visual, conceptual) in interaction with body representations.
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http://dx.doi.org/10.3389/fpsyg.2016.00268DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4770191PMC
March 2016

Fear and physiological arousal during a virtual height challenge--effects in patients with acrophobia and healthy controls.

J Anxiety Disord 2016 Jan 10;37:30-9. Epub 2015 Nov 10.

Department of Psychiatry, University Hospital Münster, Albert-Schweitzer-Str. 11, 48149 Münster, Germany; Inn-Salzach-Hospital, Gabersee 7, 83512 Wasserburg am Inn, Germany; Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University of Munich, Nussbaumstr. 7, 80336 Munich, Germany.

Virtual reality (VR) exposure therapy is becoming increasingly established, but the mode of action is not well understood. One potential efficacy factor might be physiological arousal. To investigate arousal during VR exposure, we exposed 40 patients with acrophobia and 40 matched healthy controls to a VR height challenge and assessed subjective (fear ratings) and physiological (heart rate, skin conductance level, salivary cortisol) fear reactions. Patients experienced a significant increase of subjective fear, heart rate and skin conductance level. Unexpectedly, controls, who reported no subjective fear, also showed an increase in heart rate and skin conductance. There was no increase in salivary cortisol levels in either group. Physiological arousal in acrophobic patients, in contrast to subjective fear, might not be stronger than that of controls confronted with height cues in VR, indicating marked discordance across symptom domains. The lack of a cortisol response in a clearly stressful paradigm warrants further study.
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http://dx.doi.org/10.1016/j.janxdis.2015.10.007DOI Listing
January 2016

The impact of perception and presence on emotional reactions: a review of research in virtual reality.

Front Psychol 2015 30;6:26. Epub 2015 Jan 30.

Clinical Psychology and Psychotherapy, Department of Psychology, University of Regensburg Regensburg, Germany.

Virtual reality (VR) has made its way into mainstream psychological research in the last two decades. This technology, with its unique ability to simulate complex, real situations and contexts, offers researchers unprecedented opportunities to investigate human behavior in well controlled designs in the laboratory. One important application of VR is the investigation of pathological processes in mental disorders, especially anxiety disorders. Research on the processes underlying threat perception, fear, and exposure therapy has shed light on more general aspects of the relation between perception and emotion. Being by its nature virtual, i.e., simulation of reality, VR strongly relies on the adequate selection of specific perceptual cues to activate emotions. Emotional experiences in turn are related to presence, another important concept in VR, which describes the user's sense of being in a VR environment. This paper summarizes current research into perception of fear cues, emotion, and presence, aiming at the identification of the most relevant aspects of emotional experience in VR and their mutual relations. A special focus lies on a series of recent experiments designed to test the relative contribution of perception and conceptual information on fear in VR. This strand of research capitalizes on the dissociation between perception (bottom-up input) and conceptual information (top-down input) that is possible in VR. Further, we review the factors that have so far been recognized to influence presence, with emotions (e.g., fear) being the most relevant in the context of clinical psychology. Recent research has highlighted the mutual influence of presence and fear in VR, but has also traced the limits of our current understanding of this relationship. In this paper, the crucial role of perception on eliciting emotional reactions is highlighted, and the role of arousal as a basic dimension of emotional experience is discussed. An interoceptive attribution model of presence is suggested as a first step toward an integrative framework for emotion research in VR. Gaps in the current literature and future directions are outlined.
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http://dx.doi.org/10.3389/fpsyg.2015.00026DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4311610PMC
February 2015

Does rTMS alter neurocognitive functioning in patients with panic disorder/agoraphobia? An fNIRS-based investigation of prefrontal activation during a cognitive task and its modulation via sham-controlled rTMS.

Biomed Res Int 2014 18;2014:542526. Epub 2014 Mar 18.

Department of Psychiatry and Psychotherapy, University of Tuebingen, Calwerstr 14, 72076 Tuebingen, Germany ; Graduate School LEAD, University of Tuebingen, Europastr. 6, 72072 Tuebingen, Germany ; Cluster of Excellence CIN, University of Tuebingen, Otfried-Mueller-Str. 25, 72076 Tuebingen, Germany.

Objectives: Neurobiologically, panic disorder (PD) is supposed to be characterised by cerebral hypofrontality. Via functional near-infrared spectroscopy (fNIRS), we investigated whether prefrontal hypoactivity during cognitive tasks in PD-patients compared to healthy controls (HC) could be replicated. As intermittent theta burst stimulation (iTBS) modulates cortical activity, we furthermore investigated its ability to normalise prefrontal activation.

Methods: Forty-four PD-patients, randomised to sham or verum group, received 15 iTBS-sessions above the left dorsolateral prefrontal cortex (DLPFC) in addition to psychoeducation. Before first and after last iTBS-treatment, cortical activity during a verbal fluency task was assessed via fNIRS and compared to the results of 23 HC.

Results: At baseline, PD-patients showed hypofrontality including the DLPFC, which differed significantly from activation patterns of HC. However, verum iTBS did not augment prefrontal fNIRS activation. Solely after sham iTBS, a significant increase of measured fNIRS activation in the left inferior frontal gyrus (IFG) during the phonological task was found.

Conclusion: Our results support findings that PD is characterised by prefrontal hypoactivation during cognitive performance. However, verum iTBS as an "add-on" to psychoeducation did not augment prefrontal activity. Instead we only found increased fNIRS activation in the left IFG after sham iTBS application. Possible reasons including task-related psychophysiological arousal are discussed.
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http://dx.doi.org/10.1155/2014/542526DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3976939PMC
December 2014

Virtual reality exposure in anxiety disorders: impact on psychophysiological reactivity.

World J Biol Psychiatry 2014 Aug 25;15(6):427-42. Epub 2014 Mar 25.

Department of Psychiatry, Depression and Anxiety Research Unit, University Hospital Muenster , Muenster , Germany.

Objectives: Anxiety disorders are among the most frequently encountered psychiatric disorders. Recommended treatments include cognitive behavioural therapy (CBT) and/or medication. In recent years, beneficial effects of virtual reality (VR) exposure therapy have been shown, making this technique a promising addition to CBT. However, the ability of VR to mimic threatening stimuli in a way comparable to in vivo cues has been discussed. In particular, it has been questioned whether VR is capable of provoking psychophysiological symptoms of anxiety. Since psychophysiological arousal is considered a prerequisite for effective exposure treatment, this systematic review aims to evaluate the evidence for the potential of VR exposure to evoke and modulate psychophysiological fear reactions.

Methods: PubMed and PsycINFO/Academic Search Premier databases were searched. Thirty-eight studies investigating challenge or habituation effects were included.

Results: VR exposure does provoke psychophysiological arousal, especially in terms of electrodermal activity. Results on psychophysiological habituation in VR are inconclusive. Study design and methodological rigour vary widely.

Conclusions: Despite several limitations, this review provides evidence that VR exposure elicits psychophysiological fear reactions in patients and healthy subjects, rendering VR a promising treatment for anxiety disorders, and a potent research tool for future investigations of psychophysiological processes and their significance during exposure treatment.
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http://dx.doi.org/10.3109/15622975.2014.892632DOI Listing
August 2014

Acute shift in glutamate concentrations following experimentally induced panic with cholecystokinin tetrapeptide--a 3T-MRS study in healthy subjects.

Neuropsychopharmacology 2013 Aug 5;38(9):1648-54. Epub 2013 Mar 5.

Mood and Anxiety Disorders Research Unit, Department of Psychiatry and Psychotherapy, University of Muenster, Muenster, Germany.

According to preclinical studies, glutamate has been implicated in the pathogenesis of anxiety. In order to elucidate the role of glutamate in anxiety and panic in humans, brain glutamate+glutamine (Glx) levels were measured during cholecystokinin-tetrapeptide (CCK-4)-induced panic using magnetic resonance spectroscopy (MRS). Eighteen healthy subjects underwent a CCK-4 challenge. MR spectra were obtained from the anterior cingulate cortex (ACC) using a single voxel point-resolved spectroscopy method and analyzed using LCModel. A combined fitting of Glx was performed. Panic was assessed using the Acute Panic Inventory (API) and Panic Symptom Scale (PSS) scores. Moreover, hypothalamic-pituitary-adrenal axis stimulation was monitored throughout the challenge. There was a significant panic response following CCK-4 as revealed by a marked increase in both the panic scores (API: F(1,17)=149.41; p<0.0001; PSS: F(1,17)=88.03; p<0.0001) and heart rate (HR: F(1,17)=72.79; p<0.0001). MRS measures showed a significant increase of brain Glx/creatine (Glx/Cr) levels peaking at 2-10 min after challenge (F(1,17)=15.94; p=0.001). There was also a significant increase in CCK-4-related cortisol release (F(6,11)=8.68; p=0.002). Finally, significant positive correlations were found between baseline Glx/Cr and both APImax (r=0.598; p=0.009) and maximum heart rate (HR(max)) during challenge (r=0.519; p=0.027). Our results suggest that CCK-4-induced panic is accompanied by a significant glutamate increase in the bilateral ACC. The results add to the hypothesis of a disturbance of the inhibitory-excitatory equilibrium and suggest that apart from static alterations rapid and dynamic neurochemical changes might also be relevant for the neural control of panic attacks.
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http://dx.doi.org/10.1038/npp.2013.61DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3717541PMC
August 2013

Acute anxiolytic effects of quetiapine during virtual reality exposure--a double-blind placebo-controlled trial in patients with specific phobia.

Eur Neuropsychopharmacol 2013 Nov 30;23(11):1551-60. Epub 2013 Jan 30.

Department of Psychiatry, University of Muenster, Germany.

Anxiety disorders are among the most frequent psychiatric disorders. With regard to pharmacological treatment, antidepressants, the calcium modulator pregabalin and benzodiazepines are recommended according to current treatment guidelines. With regard to acute states of anxiety, so far practically only benzodiazepines provide an immediate anxiolytic effect. However, the risk of tolerance and dependency limits the use of this class of medication. Therefore, there is still a need for alternative pharmacologic strategies. Increasing evidence points towards anxiety-reducing properties of atypical antipsychotics, particularly quetiapine. Therefore, we aimed to evaluate the putative acute anxiolytic effects of this compound, choosing the induction of acute anxiety in patients with specific phobia as a model for the evaluation of ad-hoc anxiolytic properties in a proof-of-concept approach. In a randomized, double-blind, placebo-controlled study, 58 patients with arachnophobia were treated with a single dose of quetiapine XR or placebo prior to a virtual reality spider challenge procedure. Treatment effects were monitored using rating scales for acute anxiety as well as measurements of heart rate and skin conductance. Overall, quetiapine showed significant anxiolytic effects compared to placebo. However, effects were not seen on the primary outcome measure (VAS Anxiety), but were limited to somatic anxiety symptoms. Additionally, a significant reduction of skin conductance was observed. Further exploratory analyses hint towards a mediating role of the (COMT) val158met genotype on treatment response. The present results thus suggest a possible suitability of quetiapine in the acute treatment of anxiety, particularly with regard to somatic symptoms.
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http://dx.doi.org/10.1016/j.euroneuro.2013.01.001DOI Listing
November 2013

Differences in saccadic eye movements in subjects at high and low risk for panic disorder.

Curr Pharm Des 2012 ;18(35):5685-90

Mood and Anxiety Disorders Research Unit, Department of Psychiatry, University of Munster, Albert- Schweitzer-Campus 1, 48149 Muenster, Germany.

Background: Panic disorder (PD) has a strong genetic component showing high heritability rates and familial aggregation. Moreover, there is evidence for associations between parental PD and patterns of psychopathology. So far, little is known about possible endophenotypes representing premorbid vulnerability markers in high-risk subjects for PD. In the present study, we investigated saccadic eye movement (SEM) as an index of CNS inhibitory function in subjects at high risk for PD.

Methods: 132 healthy children at high and low familial risk for PD were included in the study. Basal SEM parameters were obtained using an electro-oculography (EOG) based system measuring peak saccadic eye velocity (pSEV), latency and accuracy. Moreover, with regard to self rating scales, state-trait-anxiety (STAI-C), childhood behavioral inhibition (CSRI), and anxiety sensitivity (CASI) were assessed.

Results: There was a significant overall difference for basal SEM parameters across groups as revealed by MANCOVA (F7,118=2.184, p=.040). A significant influence was found for the covariate age, while gender and puberty status had no influence on SEM. High-risk (HR) subjects showed significantly lower pSEV. Moreover, levels of state and trait anxiety were higher in HR children (F1=5.429, p=.021).

Discussion: In our sample, measurement of pSEV allowed discrimination between children at high and low risk for PD. Since these results argue for possible alterations of saccadic function in high risk subjects, differences in underlying neurobiological mechanisms might be discussed as a possible endophenotype of PD.
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http://dx.doi.org/10.2174/138161212803530934DOI Listing
May 2013

Dopamine D₃ receptor gene variation: impact on electroconvulsive therapy response and ventral striatum responsiveness in depression.

Int J Neuropsychopharmacol 2013 Aug 18;16(7):1443-59. Epub 2011 Nov 18.

Department of Psychiatry, University of Muenster, Germany.

Dysfunction of dopamine D₃ receptors, particularly in the mesocorticolimbic system, has been linked to the pathogenesis of major depression. Preclinical data show enhanced D₃ receptor binding in the striatum upon antidepressant medication and electroconvulsive therapy (ECT). Thus, the potential impact of dopamine D₃ receptor gene (DRD3) variation on ECT outcome in treatment-resistant major depression was evaluated by applying a combined molecular and imaging genetic approach. Altogether, 10 representative variants covering 95.4% of DRD3 gene variation were investigated for association with response to ECT in a sample of 104 (71 female, 33 male) Caucasian patients with pharmacorefractory major depression. Additionally, ventral striatum responsiveness to happy faces was assessed in two independent samples of depressed patients (total N=54) by means of functional magnetic resonance imaging at 3 T. Significant association of DRD3 rs3732790, rs3773679 and rs9817063 variants with response (uncorrected p=0.02-0.03) and remission (uncorrected p=0.01) after ECT was discerned. Logistic regression analyses revealed association of rs3732790 (uncorrected p=0.009; corrected p=0.045) and rs3773679 (uncorrected p=0.009; corrected p=0.045) with remission when applying a recessive model of inheritance. The rs3732790T allele conferring a more favourable treatment response was furthermore found to be associated with stronger striatal responsiveness to happy facial expressions (sample 1: cluster-corrected p=0.002; sample 2: p=0.023). In summary, the present study suggests some impact of DRD3 gene variation on ECT response, potentially mediated by alteration of striatal engagement during the processing of emotionally rewarding stimuli.
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http://dx.doi.org/10.1017/S1461145711001659DOI Listing
August 2013

COMT val158met influence on electroconvulsive therapy response in major depression.

Am J Med Genet B Neuropsychiatr Genet 2010 Jan;153B(1):286-90

Department of Psychiatry, University of Muenster, Muenster, Germany.

There is strong evidence for a genetic contribution to the pathogenesis of depression, with the functional catechol-O-methyltransferase (COMT) val158met polymorphism having been suggested as a potential susceptibility factor. In the present study, the effect of COMT val158met on response to electroconvulsive therapy (ECT) was analyzed in a sample of 104 Caucasian patients (f = 71, m = 33) with pharmacologically treatment-resistant Major Depression. The higher active COMT 158val allele was found to be associated with (1) higher pre-ECT severity of depression and (2) better treatment response to ECT particularly regarding the core symptoms of depression as well as sleep-related symptoms. These findings were restricted to the female subgroup of patients. In summary, the present study supports a potentially gender-specific significant impact of COMT gene variation on electroconvulsive therapy response, with COMT 158val risk allele carriers suffering from more severe, pharmacologically less efficiently treatable depression and thus possibly deriving greater benefit from ECT in the first place.
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http://dx.doi.org/10.1002/ajmg.b.30949DOI Listing
January 2010

Occurence of ultra-rapid cycling during electroconvulsive therapy in bipolar depression.

World J Biol Psychiatry 2009 ;10(4 Pt 3):987-90

Department of Psychiatry and Psychotherapy, University of Muenster, Muenster, Germany.

Background: Treatment of bipolar depression with antidepressants has often been reported to be associated with a certain risk of rapid cycling (RC). Also, non-pharmacological treatment approaches such as sleep deprivation or light therapy can induce affective shifts. Moreover, during electroconvulsive therapy (ECT), which is considered a powerful antidepressant treatment, manic switches and episodes of rapid cycling can occur.

Methods: Here we report the case of a 66-year-old female patient with bipolar depression, who underwent electroconvulsive therapy because of a therapy-refractory depressive episode.

Results: During ECT, highly frequent mood alternations were observed, fulfilling the criteria of ultra rapid cycling (URC). These symptoms were successfully treated with lithium carbonate while ECT was continued.

Conclusion: To our knowledge, this is the first case report of URC during ECT. URC might be considered a rare but potential side effect of ECT. In our case, lithium was used successfully for the treatment of URC and might be suggested in similar cases, where anticonvulsants are not the first choice of treatment. However, in view of the risk of cognitive side effects the combination of ECT and lithium requires a careful clinical monitoring.
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http://dx.doi.org/10.1080/15622970802626572DOI Listing
March 2010