Publications by authors named "Michael Kaess"

197 Publications

Maternal bonding impairment predicts personality disorder features in adolescence: The moderating role of child temperament and sex.

Personal Disord 2021 Feb 11. Epub 2021 Feb 11.

Research has shown associations between adverse parenting experiences and (borderline) personality disorder ([B]PD). A biopsychosocial model suggests that child characteristics and the environment interact in the development of symptoms. However, prospective data in this aspect are limited. This study focused on maternal bonding impairment (MBI; 2 weeks postpartum) and its interactions with child temperament (age 5) and child sex as predictors of BPD symptoms and general personality dysfunction in adolescence. Participants were 64 mother-child dyads from a community sample who took part in a 14-year longitudinal study. Higher MBI was a significant predictor of general personality dysfunction as defined in Criterion A of the alternative model for PD of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Interactions showed that the effect of MBI on general personality dysfunction was decreased for children higher in harm avoidance and increased for children higher in novelty seeking. There was also a negative main effect of harm avoidance on (B)PD features. Regarding BPD symptoms, the MBI × Child Sex interaction indicated differential susceptibility. Girls' but not boys' BPD symptoms were dependent on maternal bonding. Our results indicate that children at risk of developing personality pathology can be identified early in life. They stress the importance of early relationship disturbances in the development of personality pathology and refine the understanding of differential susceptibility factors in the context of MBI and PD symptom development. Our findings can be applied to target at-risk dyads for selective early prevention based on temperament and maternal bonding. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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http://dx.doi.org/10.1037/per0000433DOI Listing
February 2021

Maternal bonding impairment predicts personality disorder features in adolescence: The moderating role of child temperament and sex.

Personal Disord 2021 Feb 11. Epub 2021 Feb 11.

Research has shown associations between adverse parenting experiences and (borderline) personality disorder ([B]PD). A biopsychosocial model suggests that child characteristics and the environment interact in the development of symptoms. However, prospective data in this aspect are limited. This study focused on maternal bonding impairment (MBI; 2 weeks postpartum) and its interactions with child temperament (age 5) and child sex as predictors of BPD symptoms and general personality dysfunction in adolescence. Participants were 64 mother-child dyads from a community sample who took part in a 14-year longitudinal study. Higher MBI was a significant predictor of general personality dysfunction as defined in Criterion A of the alternative model for PD of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Interactions showed that the effect of MBI on general personality dysfunction was decreased for children higher in harm avoidance and increased for children higher in novelty seeking. There was also a negative main effect of harm avoidance on (B)PD features. Regarding BPD symptoms, the MBI × Child Sex interaction indicated differential susceptibility. Girls' but not boys' BPD symptoms were dependent on maternal bonding. Our results indicate that children at risk of developing personality pathology can be identified early in life. They stress the importance of early relationship disturbances in the development of personality pathology and refine the understanding of differential susceptibility factors in the context of MBI and PD symptom development. Our findings can be applied to target at-risk dyads for selective early prevention based on temperament and maternal bonding. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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http://dx.doi.org/10.1037/per0000433DOI Listing
February 2021

Autonomic nervous system activity and dialectical behavioral therapy outcome in adolescent borderline personality pathology.

World J Biol Psychiatry 2021 Feb 1:1-17. Epub 2021 Feb 1.

University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.

Objectives: We aimed to investigate whether pre-treatment cardiac autonomic nervous system (ANS) activity, indexed by heart rate (HR) and heart rate variability (HRV) predicts clinical outcome and therapy drop-outs in adolescents with borderline personality (BPD) pathology receiving dialectical behavioural therapy (DBT-A). We further tested for an association between changes in ANS function and clinical outcome over time. Traumatic experiences were considered as potential confounding factor.

Methods:  = 43 (95.4% female, M = 15.5 years) adolescents fulfilling at least sub-threshold criteria for BPD (≥3) were investigated before and after outpatient DBT-A as well as at follow-up.  = 10 patients dropped out of treatment (<50% of treatment sessions). Latent growth curve models were used for analyses.

Results: Greater pre-treatment resting HRV significantly predicted clinical improvement (decrease in BPD pathology/increase of global functioning) over time. Pre-treatment ANS activity was unrelated to treatment drop-out. Further, changes in ANS activity over treatment were associated with changes in clinical outcome.

Conclusion: This study is the first providing evidence that pre-treatment HRV predicts and is related to treatment response in adolescent borderline personality pathology. Implications for the use of ANS measures in clinical practice and directions for future research are discussed.
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http://dx.doi.org/10.1080/15622975.2020.1858155DOI Listing
February 2021

Calendar age and puberty-related development of regional gray matter volume and white matter tracts during adolescence.

Brain Struct Funct 2021 Jan 20. Epub 2021 Jan 20.

Section for Experimental Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Blumenstr. 8, 69115, Heidelberg, Germany.

Background: Adolescence is a critical time for brain development. Findings from previous studies have been inconsistent, failing to distinguish the influence of pubertal status and aging on brain maturation. The current study sought to address these inconsistencies, addressing the trajectories of pubertal development and aging by longitudinally tracking structural brain development during adolescence.

Methods: Two cohorts of healthy children were recruited (cohort 1: 9-10 years old; cohort 2: 12-13 years old at baseline). MRI data were acquired for gray matter volume and white matter tract measures. To determine whether age, pubertal status, both or their interaction best modelled longitudinal data, we compared four multi-level linear regression models to the null model (general brain growth indexed by total segmented volume) using Bayesian model selection.

Results: Data were collected at baseline (n = 116), 12 months (n = 97) and 24 months (n = 84) after baseline. Findings demonstrated that the development of most regional gray matter volume, and white matter tract measures, were best modelled by age. Interestingly, precentral and paracentral regions of the cortex, as well as the accumbens demonstrated significant preference for the pubertal status model. None of the white matter tract measures were better modelled by pubertal status.

Limitations: The major limitation of this study is the two-cohort recruitment. Although this allowed a faster coverage of the age span, a complete per person trajectory over 6 years of development (9-15 years) could not be investigated.

Conclusions: Comparing the impact of age and pubertal status on regional gray matter volume and white matter tract measures, we found age to best predict longitudinal changes. Further longitudinal studies investigating the differential influence of puberty status and age on brain development in more diverse samples are needed to replicate the present results and address mechanisms underlying norm-variants in brain development.
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http://dx.doi.org/10.1007/s00429-020-02208-1DOI Listing
January 2021

Psychophysiological concomitants of personality pathology in development.

Curr Opin Psychol 2020 Dec 13;37:129-133. Epub 2020 Dec 13.

University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland; Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany.

Psychophysiological research methods allow important insights into normative and pathological functioning of the human organism. This position paper briefly reviews existing studies, investigating the psychophysiological concomitants of personality pathology, with an emphasis on developmental aspects. Focussing on measures, indexing autonomic nervous system (ANS) activity at rest, and its reactivity to experimental challenge, the narrative synthesis of the literature highlights current challenges in the field. Findings on the psychophysiological concomitants of personality pathology are mixed. Inconsistencies among studies arise from differences between disorders and heterogeneity within distinct diagnostic categories. The majority of studies addressed borderline personality disorder, illustrating robust alterations in ANS function linked to severe experiences of early maltreatment and trauma, and associated symptoms of dissociation. However, important life-style and secondary health-related factors (i.e. physical activity, smoking) influencing ANS function are frequently neglected. Adapting a dimensional approach to personality pathology and longitudinal research designs seem promising to advance the filed in the years to come.
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http://dx.doi.org/10.1016/j.copsyc.2020.12.004DOI Listing
December 2020

Psychophysiological concomitants of personality pathology in development.

Curr Opin Psychol 2020 Dec 13;37:129-133. Epub 2020 Dec 13.

University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland; Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany.

Psychophysiological research methods allow important insights into normative and pathological functioning of the human organism. This position paper briefly reviews existing studies, investigating the psychophysiological concomitants of personality pathology, with an emphasis on developmental aspects. Focussing on measures, indexing autonomic nervous system (ANS) activity at rest, and its reactivity to experimental challenge, the narrative synthesis of the literature highlights current challenges in the field. Findings on the psychophysiological concomitants of personality pathology are mixed. Inconsistencies among studies arise from differences between disorders and heterogeneity within distinct diagnostic categories. The majority of studies addressed borderline personality disorder, illustrating robust alterations in ANS function linked to severe experiences of early maltreatment and trauma, and associated symptoms of dissociation. However, important life-style and secondary health-related factors (i.e. physical activity, smoking) influencing ANS function are frequently neglected. Adapting a dimensional approach to personality pathology and longitudinal research designs seem promising to advance the filed in the years to come.
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http://dx.doi.org/10.1016/j.copsyc.2020.12.004DOI Listing
December 2020

Psychophysiological concomitants of personality pathology in development.

Curr Opin Psychol 2020 Dec 13;37:129-133. Epub 2020 Dec 13.

University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland; Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany.

Psychophysiological research methods allow important insights into normative and pathological functioning of the human organism. This position paper briefly reviews existing studies, investigating the psychophysiological concomitants of personality pathology, with an emphasis on developmental aspects. Focussing on measures, indexing autonomic nervous system (ANS) activity at rest, and its reactivity to experimental challenge, the narrative synthesis of the literature highlights current challenges in the field. Findings on the psychophysiological concomitants of personality pathology are mixed. Inconsistencies among studies arise from differences between disorders and heterogeneity within distinct diagnostic categories. The majority of studies addressed borderline personality disorder, illustrating robust alterations in ANS function linked to severe experiences of early maltreatment and trauma, and associated symptoms of dissociation. However, important life-style and secondary health-related factors (i.e. physical activity, smoking) influencing ANS function are frequently neglected. Adapting a dimensional approach to personality pathology and longitudinal research designs seem promising to advance the filed in the years to come.
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http://dx.doi.org/10.1016/j.copsyc.2020.12.004DOI Listing
December 2020

Early life maltreatment and resting-state heart rate variability: A systematic review and meta-analysis.

Neurosci Biobehav Rev 2021 01 7;120:307-334. Epub 2020 Nov 7.

University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland; Section for Experimental Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany. Electronic address:

Recent focus on the consequences of early life adversity (ELA) in neurobiological research led to a variety of findings suggesting alterations in several physiological systems, such as the cardiovascular system. In this systematic review and meta-analysis, we focused on the relationship between early life maltreatment (ELM), one form of ELA, and resting vagal activity indexed by resting-state heart rate variability (HRV). A systematic search of the literature yielded 1'264 hits, of which 32 studies reporting data for group comparisons or correlations were included. By quantitative synthesis of existing studies using random-effect models, we found no evidence for a relationship between ELM exposure and resting vagal activity in principal. Conducting meta-regression analyses, however, we found the relationship between ELM and resting vagal activity to significantly vary as a function of both age and the presence of psychopathology. In light of the current multitude of vastly unclear pathways linking ELM to the onset of disease, we emphasize the need for further research and outline several aspects to consider in future studies.
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http://dx.doi.org/10.1016/j.neubiorev.2020.10.026DOI Listing
January 2021

Editorial: Social media use in children and adolescents - on the good or the bad side of the force?

Authors:
Michael Kaess

Child Adolesc Ment Health 2020 11;25(4):199-200

University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.

Children and adolescents spend increasingly large parts of their social life connecting with each other via social networks sites. While this is clearly an achievement and may have helped many of them during difficult COVID-19 lock downs, there is an ongoing political and scientific debate around the potential harm that (excessive) social media use may pose on young individuals. This editorial highlights a systematic review that was published on the topic of social media use and child and adolescent mental health, and sets the results of this review into a current research and public health perspective.
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http://dx.doi.org/10.1111/camh.12432DOI Listing
November 2020

Cortical thickness and resting-state cardiac function across the lifespan: A cross-sectional pooled mega-analysis.

Psychophysiology 2020 Oct 10. Epub 2020 Oct 10.

Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway.

Understanding the association between autonomic nervous system [ANS] function and brain morphology across the lifespan provides important insights into neurovisceral mechanisms underlying health and disease. Resting-state ANS activity, indexed by measures of heart rate [HR] and its variability [HRV] has been associated with brain morphology, particularly cortical thickness [CT]. While findings have been mixed regarding the anatomical distribution and direction of the associations, these inconsistencies may be due to sex and age differences in HR/HRV and CT. Previous studies have been limited by small sample sizes, which impede the assessment of sex differences and aging effects on the association between ANS function and CT. To overcome these limitations, 20 groups worldwide contributed data collected under similar protocols of CT assessment and HR/HRV recording to be pooled in a mega-analysis (N = 1,218 (50.5% female), mean age 36.7 years (range: 12-87)). Findings suggest a decline in HRV as well as CT with increasing age. CT, particularly in the orbitofrontal cortex, explained additional variance in HRV, beyond the effects of aging. This pattern of results may suggest that the decline in HRV with increasing age is related to a decline in orbitofrontal CT. These effects were independent of sex and specific to HRV; with no significant association between CT and HR. Greater CT across the adult lifespan may be vital for the maintenance of healthy cardiac regulation via the ANS-or greater cardiac vagal activity as indirectly reflected in HRV may slow brain atrophy. Findings reveal an important association between CT and cardiac parasympathetic activity with implications for healthy aging and longevity that should be studied further in longitudinal research.
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http://dx.doi.org/10.1111/psyp.13688DOI Listing
October 2020

Trapped in a Glass Bell Jar: Neural Correlates of Depersonalization and Derealization in Subjects at Clinical High-Risk of Psychosis and Depersonalization-Derealization Disorder.

Front Psychiatry 2020 11;11:535652. Epub 2020 Sep 11.

University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.

Background: Depersonalization (DP) and derealization (DR) are symptoms of a disruption of perceptual integration leading to an altered quality of subjective experiences such as feelings of unreality and detachment from the self (DP) or the surroundings (DR). Both DP and DR often occur in concert with other symptoms, for example in subjects at clinical high-risk (CHR) for psychosis, but also appear isolated in the form of DP/DR disorder. Despite evidence that DP/DR causes immense distress, little is known about their neurobiological underpinnings. Therefore, we investigated the neural correlates of DP/DR using pseudo-continuous arterial spin labeling MRI.

Methods: We evaluated the frequency of DP/DR symptoms in a clinical sample (N = 217) of help-seeking individuals from the Early Detection and Intervention Centre for Mental Crisis (CHR, n = 97; clinical controls (CC), n = 91; and first-episode psychosis (FEP), n = 29). Further, in a subsample of those CHR subjects who underwent MRI, we investigated the resting-state regional cerebral blood flow (rCBF). Here, individuals with (n = 21) and without (n = 23) DP/DR were contrasted. Finally, rCBF was measured in a small independent second sample of patients with DP/DR disorder (n = 6) and healthy controls (HC, n = 6).

Results: In the complete clinical sample, significantly higher frequency of DP/DR was found in CHR compared to CC (50.5 16.5%; χ = 24.218, p ≤ 0.001, Cramer's V = 0.359) as well as in FEP compared to CC (37.9 16.5%; χ = 5.960, = 0.015, Cramer's V = 0.223). In MRI, significantly lower rCBF was detected in the left orbitofrontal cortex in CHR with without DP/DR (x/y/z = -16/42/-22, p < 0.05, FWE corrected). In patients with DP/DR disorder, significantly higher rCBF was detected in the left caudate nucleus (x/y/z = -18/-32/18, p < 0.05) compared to HC.

Conclusions: This study shows that DP/DR symptoms are frequently found in CHR subjects. Investigating two separate DP/DR populations with an identical neuroimaging technique, our study also indicates that there may be divergent pathophysiological mechanisms-decreased neuronal activity in the orbitofrontal cortex, but increased activity within the caudate nucleus-leading to a final common pathway with similar psychopathological symptoms. This suggests that both top-down (orbitofrontal cortex) and bottom-up (caudate nucleus) mechanisms could contribute to the emergence of DP/DR.
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http://dx.doi.org/10.3389/fpsyt.2020.535652DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7516266PMC
September 2020

Gender differences in adolescent sleep neurophysiology: a high-density sleep EEG study.

Sci Rep 2020 09 28;10(1):15935. Epub 2020 Sep 28.

University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bolligenstrasse 111, Haus A, 3000, Bern, Switzerland.

During adolescence, differences between males and females in physiology, behavior and risk for psychopathology are accentuated. The goal of the current study was to examine gender differences in sleep neurophysiology using high-density sleep EEG in early adolescence. We examined gender differences in sleep EEG power and coherence across frequency bands for both NREM and REM sleep in a sample of 61 adolescents (31 girls and 30 boys; mean age = 12.48; SD = 1.34). In addition, sleep spindles were individually detected and characterized. Compared to boys, girls had significantly greater spindle activity, as reflected in higher NREM sigma power, spindle amplitude, spindle frequency and spindle density over widespread regions. Furthermore, power in higher frequency bands (16.2-44 Hz) was larger in girls than boys in a state independent manner. Oscillatory activity across frequency bands and sleep states was generally more coherent in females as compared to males, suggesting greater connectivity in females. An exception to this finding was the alpha band during NREM and REM sleep, where coherence was higher (NREM) or not different (REM) in boys compared to girls. Sleep spindles are generated through thalamocortical circuits, and thus, the greater spindle activity across regions in females may represent a stronger thalamocortical circuit in adolescent females as compared to males. Moreover, greater global connectivity in females may reflect functional brain differences with implications for cognition and mental health. Given the pronounced gender differences, our study highlights the importance of taking gender into account when designing and interpreting studies of sleep neurophysiology.
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http://dx.doi.org/10.1038/s41598-020-72802-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7522718PMC
September 2020

Gender differences in adolescent sleep neurophysiology: a high-density sleep EEG study.

Sci Rep 2020 09 28;10(1):15935. Epub 2020 Sep 28.

University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bolligenstrasse 111, Haus A, 3000, Bern, Switzerland.

During adolescence, differences between males and females in physiology, behavior and risk for psychopathology are accentuated. The goal of the current study was to examine gender differences in sleep neurophysiology using high-density sleep EEG in early adolescence. We examined gender differences in sleep EEG power and coherence across frequency bands for both NREM and REM sleep in a sample of 61 adolescents (31 girls and 30 boys; mean age = 12.48; SD = 1.34). In addition, sleep spindles were individually detected and characterized. Compared to boys, girls had significantly greater spindle activity, as reflected in higher NREM sigma power, spindle amplitude, spindle frequency and spindle density over widespread regions. Furthermore, power in higher frequency bands (16.2-44 Hz) was larger in girls than boys in a state independent manner. Oscillatory activity across frequency bands and sleep states was generally more coherent in females as compared to males, suggesting greater connectivity in females. An exception to this finding was the alpha band during NREM and REM sleep, where coherence was higher (NREM) or not different (REM) in boys compared to girls. Sleep spindles are generated through thalamocortical circuits, and thus, the greater spindle activity across regions in females may represent a stronger thalamocortical circuit in adolescent females as compared to males. Moreover, greater global connectivity in females may reflect functional brain differences with implications for cognition and mental health. Given the pronounced gender differences, our study highlights the importance of taking gender into account when designing and interpreting studies of sleep neurophysiology.
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http://dx.doi.org/10.1038/s41598-020-72802-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7522718PMC
September 2020

Effects and moderators of the Olweus bullying prevention program (OBPP) in Germany.

Eur Child Adolesc Psychiatry 2020 Sep 22. Epub 2020 Sep 22.

Department of Child and Adolescents Psychiatry, Centre for Psychosocial Medicine, University Hospital Heidelberg, Blumenstraße 8, 69115, Heidelberg, Germany.

Bullying is a common and significant risk factor for mental and physical health problems. The aim of the outlined study was to evaluate the German version of the Olweus Bullying Prevention Program (OBPP) and to investigate potential moderators of its effectiveness. 23 schools started with the implementation and all students were invited to complete the Olweus Bullying Questionnaire annually. For our analyses, the data from grades 5 to 9 were used (t0: n = 5759; t1: n = 5416; t2: n = 4894). 16 out of the 23 schools completed the 18-months implementation period. The effectiveness of the program statistically depended on its complete implementation (χ = 7.62, p = 0.022). In the group of non-completers, the prevalence of victimization did not change during the observation period of 2 years (χ = 4.64, p = 0.099). In the group of the completer schools, a significant decrease in bullying between t0 and t1 was found for victims (t0: 9.14%; t1: 6.87%; OR = 0.74; 95% CI 0.62-0.88; p = 0.001) and perpetrators (t0: 6.16%; t1: 4.42%; OR = 0.70; 95% CI 0.55-0.89; p = 0.004). After 24 months (t2), this decrease could be retained (victims: t2: 6.83%; OR = 0.73; 95%CI = 0.61-0.88; p = 0.001; perpetrators: t2: 4.63%; OR = 0.72; 95% CI 0.57-0.92; p = 0.009). Furthermore, we found the following moderators of program effectiveness in the completer schools: (1) gender (with a stronger decrease among victimized girls; p = 0.004) and (2) school grade (with a stronger decrease of victimization among grades 5-7; p = 0.028). The German version of the OBPP significantly reduced the bullying prevalence in the completer schools. Effective prevention needs time and resources: fulfilling the 18-months implementation period was the basis for positive results.
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http://dx.doi.org/10.1007/s00787-020-01647-9DOI Listing
September 2020

A plea for the sustained implementation of digital interventions for young people with mental health problems in the light of the COVID-19 pandemic.

J Child Psychol Psychiatry 2020 Sep 14. Epub 2020 Sep 14.

Center for Psychotherapy Research, University Hospital Heidelberg, Heidelberg, Germany.

The coronavirus disease 2019 pandemic and the consequent global lockdown posed a particular challenge for youths with mental health problems. Crucial interference with their everyday lives likely increased psychological distress while accessibility of conventional mental health care was limited. Ongoing online trials offer a unique opportunity to analyse mental health status and help-seeking behaviour of adolescents during the pandemic. The ProHEAD-online trial aims at improving help-seeking behaviour of children and adolescents with significant psychological impairment. From January to May 2020, 1,042 students had access to the ProHEAD-online platform providing information on mental illness, monitoring, peer support and professional counselling. In the week from 11 March, when schools were closed in Germany, a drastic (more than 2 standard deviations) but time-limited increase in utilization of the ProHEAD-online services became apparent. This may indicate a worsened mental health status and an increased help seeking via digital services during the lockdown. Although this finding is purely observational, it speaks to the importance of evidence-based online service in the field of mental health within the current crisis and beyond.
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http://dx.doi.org/10.1111/jcpp.13317DOI Listing
September 2020

Parenting and care: a complex role in the development of mental health.

Eur Child Adolesc Psychiatry 2020 09;29(9):1171-1173

Centre for Psychosocial Medicine, Department of Child and Adolescent Psychiatry, University Hospital Heidelberg, Heidelberg, Germany.

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http://dx.doi.org/10.1007/s00787-020-01633-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7497360PMC
September 2020

Parenting and care: a complex role in the development of mental health.

Eur Child Adolesc Psychiatry 2020 09;29(9):1171-1173

Centre for Psychosocial Medicine, Department of Child and Adolescent Psychiatry, University Hospital Heidelberg, Heidelberg, Germany.

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http://dx.doi.org/10.1007/s00787-020-01633-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7497360PMC
September 2020

Hair cortisol moderates the association between obstetric complications and child wellbeing.

Psychoneuroendocrinology 2020 11 18;121:104845. Epub 2020 Aug 18.

Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health (BIH), Campus Virchow-Klinikum, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Berlin, Germany.

Obstetric complications (OC) may have implications for later health outcomes. However, there is a lack of research examining the association between OC and behavior problems or quality of life (HRQoL). We aimed to close this gap and further investigate functioning of the hypothalamus-pituitary-adrenal (HPA)-axis as a potential physiological vulnerability moderating the association between OC and behavior problems and HRQoL. We investigated 232 mothers and their five to 12-year-old children. Presence of OC during the pre-, peri-, and postnatal phases was determined by interviewing mothers. Children's behavior problems (CBCL, TRF) and HRQoL (Kidscreen rated by mothers and children) were assessed. Children gave 3 cm strands of hair for analysis of hair cortisol (HC). Structural equation modeling analyses with a latent variable of child outcome ("distress"), OC as predictor and HC as a potential moderator were conducted. OC significantly predicted distress (β = .33, p < .01). The model showed a good fit to the data: χ2(14)=15.66, p < .33, CFI=.99, TLI=.99, RMSEA=.02, 90 %CI [.00, .06], SRMR=.04. In addition, HC moderated the association between OC and distress (β=-.32, p < .01). The moderation model also showed a good fit: χ2(14) =7.13, p = .93, CFI=1.00, TLI=1.06, RMSEA=.00, 90 %CI [.00, .02], SRMR=.03. Results indicated that the association between OC and distress was significant only when children had low HC-levels. This was also the case for both externalizing and internalizing behavior problems. Our results underline the notion of OC as a risk factor for child behavior problems and wellbeing and point to an important role of the children's physiological set-up such as HPA-functioning.
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http://dx.doi.org/10.1016/j.psyneuen.2020.104845DOI Listing
November 2020

Psychotic symptoms in borderline personality disorder: developmental aspects.

Curr Opin Psychol 2020 Jul 12;37:26-31. Epub 2020 Jul 12.

University Hospital for Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland; Clinic of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany.

Even though the borderline concept has historically been intertwined with psychosis, psychotic symptoms in people with borderline personality disorder (BPD) have long been marginalized as somehow not real, transient, or 'pseudo' in nature. Dispelling this myth, we summarize recent research indicating that (a) psychotic symptoms in general and auditory verbal hallucinations in particular in people with BPD show more similarities than differences with those symptoms in people with psychotic disorders, and (b) that the co-occurrence of BPD and psychotic symptoms is a marker of severe psychopathology and of risk for poor outcome (e.g. suicidality). We propose the period from puberty to the mid-20s, when both BPD and psychotic features usually emerge for the first time, constitutes a critical time window for early intervention to prevent the development of severe mental disorders in the future. Implications for the treatment of psychotic symptoms in BPD and future research directions in this field are discussed.
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http://dx.doi.org/10.1016/j.copsyc.2020.07.003DOI Listing
July 2020

Age dependency of body mass index distribution in childhood and adolescent inpatients with anorexia nervosa with a focus on DSM-5 and ICD-11 weight criteria and severity specifiers.

Eur Child Adolesc Psychiatry 2020 Jul 14. Epub 2020 Jul 14.

Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Hospital Essen (AöR), University of Duisburg-Essen, Wickenburgstrasse 21, 45147, Essen, Germany.

Both DSM-5 and ICD-11 have provided weight cut-offs and severity specifiers for the diagnosis of anorexia nervosa (AN) in childhood, adolescence and adulthood. The aims of the current study focusing on inpatients aged < 19 years were to assess (1) the relationship between age and body mass index (BMI; kg/m), BMI-centiles, BMI-standard deviation scores (BMI-SDS) and body height-SDS at referral, (2) the percentages of patients fulfilling the DSM-5 and ICD-11 weight criteria and severity categories for AN, and (3) the validity of the AN severity specifiers via analysis of both weight related data at discharge and inpatient treatment duration. The German Registry for Anorexia Nervosa encompassed complete data sets for 469 female patients (mean age = 15.2 years; range 8.9-18.9 years) with a diagnosis of AN (n = 404) or atypical AN (n = 65), who were ascertained at 16 German child and adolescent psychiatric hospitals. BMI at referral increased up to age 15 to subsequently plateau. Approximately one tenth of all patients with AN had a BMI above the fifth centile. The ICD-11 specifier based on a BMI-centile of 0.3 for childhood and adolescent AN entailed two equally sized groups of patients. Discharge data revealed limited validity of the specifiers. Height-SDS was not correlated with age thus stunting had no impact on our data. We corroborate the evidence to use the tenth instead of the fifth BMI-centile as the weight criterion in children and adolescents. Weight criteria should not entail major diagnostic shifts during the transition from adolescence to adulthood. The severity specifiers based on BMI or BMI-centiles do not seem to have substantial clinical validity.
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http://dx.doi.org/10.1007/s00787-020-01595-4DOI Listing
July 2020

Age dependency of body mass index distribution in childhood and adolescent inpatients with anorexia nervosa with a focus on DSM-5 and ICD-11 weight criteria and severity specifiers.

Eur Child Adolesc Psychiatry 2020 Jul 14. Epub 2020 Jul 14.

Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Hospital Essen (AöR), University of Duisburg-Essen, Wickenburgstrasse 21, 45147, Essen, Germany.

Both DSM-5 and ICD-11 have provided weight cut-offs and severity specifiers for the diagnosis of anorexia nervosa (AN) in childhood, adolescence and adulthood. The aims of the current study focusing on inpatients aged < 19 years were to assess (1) the relationship between age and body mass index (BMI; kg/m), BMI-centiles, BMI-standard deviation scores (BMI-SDS) and body height-SDS at referral, (2) the percentages of patients fulfilling the DSM-5 and ICD-11 weight criteria and severity categories for AN, and (3) the validity of the AN severity specifiers via analysis of both weight related data at discharge and inpatient treatment duration. The German Registry for Anorexia Nervosa encompassed complete data sets for 469 female patients (mean age = 15.2 years; range 8.9-18.9 years) with a diagnosis of AN (n = 404) or atypical AN (n = 65), who were ascertained at 16 German child and adolescent psychiatric hospitals. BMI at referral increased up to age 15 to subsequently plateau. Approximately one tenth of all patients with AN had a BMI above the fifth centile. The ICD-11 specifier based on a BMI-centile of 0.3 for childhood and adolescent AN entailed two equally sized groups of patients. Discharge data revealed limited validity of the specifiers. Height-SDS was not correlated with age thus stunting had no impact on our data. We corroborate the evidence to use the tenth instead of the fifth BMI-centile as the weight criterion in children and adolescents. Weight criteria should not entail major diagnostic shifts during the transition from adolescence to adulthood. The severity specifiers based on BMI or BMI-centiles do not seem to have substantial clinical validity.
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http://dx.doi.org/10.1007/s00787-020-01595-4DOI Listing
July 2020

Neuropsychological development in adolescents: Longitudinal associations with white matter microstructure.

Dev Cogn Neurosci 2020 10 30;45:100812. Epub 2020 Jun 30.

University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland; Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany.

Important neuropsychological changes during adolescence coincide with the maturation of white matter microstructure. Few studies have investigated the association between neuropsychological development and white matter maturation longitudinally. We aimed to characterize developmental trajectories of inhibition, planning, emotion recognition and risk-taking and examine whether white matter microstructural characteristics were associated with neuropsychological development above and beyond age. In an accelerated longitudinal cohort design, n = 112 healthy adolescents between ages 9 and 16 underwent cognitive assessment and diffusion MRI over three years. Fractional anisotropy (FA) and mean diffusivity (MD) were extracted for major white matter pathways using an automatic probabilistic reconstruction technique and mixed models were used for statistical analyses. Inhibition, planning and emotion recognition performance improved linearly across adolescence. Risk-taking developed in a quadratic fashion, with stable performance between 9 and 12 and an increase between ages 12 and 16. Including cingulum and superior longitudinal fasciculus FA slightly improved model fit for emotion recognition across age. We found no evidence that FA or MD were related to inhibition, planning or risk-taking across age. Our results challenge the additional value of white matter microstructure to explain neuropsychological development in healthy adolescents, but more longitudinal research with large datasets is needed to identify the potential role of white matter microstructure in cognitive development.
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http://dx.doi.org/10.1016/j.dcn.2020.100812DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7352053PMC
October 2020

International Consensus Statement for the Screening, Diagnosis, and Treatment of Adolescents with Concurrent Attention-Deficit/Hyperactivity Disorder and Substance Use Disorder.

Eur Addict Res 2020 7;26(4-5):223-232. Epub 2020 Jul 7.

Parnassia Addiction Research Centre (PARC), Parnassia Psychiatric Institute, The Hague, The Netherlands.

Background: Childhood attention-deficit/hyperactivity disorder (ADHD) is a risk factor for substance misuse and substance use disorder (SUD) in adolescence and (early) adulthood. ADHD and SUD also frequently co-occur in treatment-seeking adolescents, which complicates diagnosis and treatment and is associated with poor treatment outcomes. Research on the effect of treatment of childhood ADHD on the prevention of adolescent SUD is inconclusive, and studies on the diagnosis and treatment of adolescents with ADHD and SUD are scarce. Thus, the available evidence is generally not sufficient to justify robust treatment recommendations.

Objective: The aim of the study was to obtain a consensus statement based on a combination of scientific data and clinical experience.

Method: A modified Delphi study to reach consensus based upon the combination of scientific data and clinical experience with a multidisciplinary group of 55 experts from 17 countries. The experts were asked to rate a set of statements on the effect of treatment of childhood ADHD on adolescent SUD and on the screening, diagnosis, and treatment of adolescents with comorbid ADHD and SUD.

Results: After 3 iterative rounds of rating and adapting 37 statements, consensus was reached on 36 of these statements representing 6 domains: general (n = 4), risk of developing SUD (n = 3), screening and diagnosis (n = 7), psychosocial treatment (n = 5), pharmacological treatment (n = 11), and complementary treatments (n = 7). Routine screening is recommended for ADHD in adolescent patients in substance abuse treatment and for SUD in adolescent patients with ADHD in mental healthcare settings. Long-acting stimulants are recommended as the first-line treatment of ADHD in adolescents with concurrent ADHD and SUD, and pharmacotherapy should preferably be embedded in psychosocial treatment. The only remaining no-consensus statement concerned the requirement of abstinence before starting pharmacological treatment in adolescents with ADHD and concurrent SUD. In contrast to the majority, some experts required full abstinence before starting any pharmacological treatment, some were against the use of stimulants in the treatment of these patients (independent of abstinence), while some were against the alternative use of bupropion.

Conclusion: This international consensus statement can be used by clinicians and patients together in a shared decision-making process to select the best interventions and to reach optimal outcomes in adolescent patients with concurrent ADHD and SUD.
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http://dx.doi.org/10.1159/000508385DOI Listing
July 2020

Maternal early life maltreatment and psychopathology affect the next generation: Alterations in post-awakening cortisol levels of primary school-aged children.

Dev Psychobiol 2021 Jan 4;63(1):98-107. Epub 2020 Jun 4.

Department of General Psychiatry, Heidelberg University, Heidelberg, Germany.

Early life maltreatment (ELM) has severe and lasting effects on the individual, which might also impact the next generation. On an endocrine level, the hypothalamus-pituitary-adrenal axis has been suggested to play an important role in the interplay between ELM and the development of mental disorders. Several studies have revealed that maternal post-awakening cortisol concentration, maternal sensitivity, maternal ELM and psychopathology are associated with children's cortisol levels. We investigated the post-awakening cortisol concentrations in 6- to 11-year-old children (N = 53) whose mothers either had experienced ELM and had developed a lifetime mental disorder (N = 15 ELM and disorder group), had experienced ELM without developing a mental disorder (N = 12 ELM-only group), or had neither experienced ELM nor developed a mental disorder (N = 26 HC-group). Furthermore, we assessed maternal post-awakening cortisol concentrations, maternal psychopathology, and sensitivity. Multilevel analysis revealed higher cortisol at awakening (S1) levels in children of mothers with ELM and disorder. Maternal cortisol at awakening (S1) also predicted the child's cortisol at awakening (S1), and no effect of maternal sensitivity could be found. The current results replicate an attunement of cortisol levels (S1) between mothers and children and suggest an association between the children's endocrine stress system and maternal factors such as ELM and psychopathology.
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http://dx.doi.org/10.1002/dev.21996DOI Listing
January 2021

Environmental Factors Shape Sleep EEG Connectivity During Early Adolescence.

Cereb Cortex 2020 Oct;30(11):5780-5791

University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern 3000, Switzerland.

Quantifying the degree to which genetic and environmental factors shape brain network connectivity is critical to furthering our understanding of the developing human brain. Sleep, a state of sensory disengagement, provides a unique opportunity to study brain network activity noninvasively by means of sleep electroencephalography (EEG) coherence. We conducted a high-density sleep EEG study in monozygotic (MZ; n = 38; mean age = 12.46; 20 females) and dizygotic (DZ; n = 24; mean age = 12.50; 12 females) twins to assess the heritability of sleep EEG coherence in early adolescence-a period of significant brain rewiring. Structural equation modeling was used to estimate three latent factors: genes, environmental factors shared between twins and environmental factors unique to each twin. We found a strong contribution of unique environmental factors (66% of the variance) and moderate genetic influence (19% of the variance) on sleep EEG coherence across frequencies and sleep states. An exception to this was sleep spindle activity, an index of the thalamocortical network, which showed on average a genetic contribution of 48% across connections. Furthermore, we observed high intraindividual stability of coherence across two consecutive nights suggesting that despite only a modest genetic contribution, sleep EEG coherence is like a trait. Our findings in adolescent humans are in line with earlier findings in animals that show the primordial cerebral map and its connections are plastic and it is through interaction with the environment that the pattern of brain network connectivity is shaped. Therefore, even in twins living together, small differences in the environment may cascade into meaningful differences in brain connectivity.
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http://dx.doi.org/10.1093/cercor/bhaa151DOI Listing
October 2020

Basic symptoms and gray matter volumes of patients at clinical high risk for psychosis.

Psychol Med 2020 May 14:1-9. Epub 2020 May 14.

University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Switzerland.

Background: Clinical high-risk (CHR) for psychosis is indicated by ultra-high risk (UHR) and basic symptom (BS) criteria; however, conversion rates are highest when both UHR and BS criteria are fulfilled (UHR&BS). While BSs are considered the most immediate expression of neurobiological aberrations underlying the development of psychosis, research on neurobiological correlates of BS is scarce.

Methods: We investigated gray matter volumes (GMV) of 20 regions of interest (ROI) previously associated with UHR criteria in 90 patients from the Bern early detection service: clinical controls (CC), first-episode psychosis (FEP), UHR, BS and UHR&BS. We expected lowest GMV in FEP and UHR&BS, and highest volume in CC with UHR and BS in-between.

Results: Significantly, lower GMV was detected in FEP and UHR&BS patients relative to CC with no other significant between-group differences. When ROIs were analyzed separately, seven showed a significant group effect (FDR corrected), with five (inferior parietal, medial orbitofrontal, lateral occipital, middle temporal, precuneus) showing significantly lower GM volume in the FEP and/or UHR&BS groups than in the CC group (Bonferroni corrected). In the CHR group, only COGDIS scores correlated negatively with cortical volumes.

Conclusions: This is the first study to demonstrate that patients who fulfill both UHR and BS criteria - a population that has been associated with higher conversion rates - exhibit more severe GMV reductions relative to those who satisfy BS or UHR criteria alone. This result was mediated by the BS in the UHR&BS group, as only the severity of BS was linked to GMV reductions.
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http://dx.doi.org/10.1017/S0033291720001282DOI Listing
May 2020

[Indicated Stress Prevention for Adolescents in the Group Setting - A manual based on Acceptance- and Commitment-Therapy].

Prax Kinderpsychol Kinderpsychiatr 2020 May;69(3):183-202

Klinik für Kinder- und Jugendpsychiatrie Universitätsklinikum Heidelberg Blumenstraße 8 69115 Heidelberg Deutschland Klinik für Kinder- und Jugendpsychiatrie.

Stress in adolescence has become a topic of interest in recent years. Long-term exposure to stress can play a significant role in the development and maintenance of mental disorders. Previous studies have shown that especially the more severely stressed adolescents benefit from targeted interventions. However, evidence-based treatment concepts targeting this group are scarce. In this article we introduce the first German-language treatment manual for indicated stress prevention, addressing adolescents based on Acceptance and Commitment Therapy (ACT). ACT is part of the third wave of behavioral therapies, designed for treatment across disorders, which makes it suitable for the treatment of chronic stress symptoms. Previous studies show good efficacy of the ACT-approach in the treatment of adult stress and first promising successes in treatment of adolescents in non-German-speaking countries. The focus of our training lies in practical exercises based on ACT which are conveyed by the use of metaphors, art therapy techniques, role plays and group discussions. The concept is complemented by psychoeducation on stress, mindfulness exercises and training in problem solving. Worksheets and tasks for the week facilitate the transfer into everyday life. Alongside the presentation of the treatment manual, first experiences in the implementation of the program are discussed.
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http://dx.doi.org/10.13109/prkk.2020.69.3.183DOI Listing
May 2020

Silence in the psychotherapy of adolescents with borderline personality pathology.

Personal Disord 2021 Mar 23;12(2):160-170. Epub 2020 Apr 23.

Child and Adolescent Psychiatric Research Department.

Silence in psychotherapy has been associated with different, sometimes opposing meanings. This study investigated silence during adolescent identity treatment in adolescent patients with borderline personality pathology. A more active therapeutic approach with less silence is advised in adolescent identity treatment. It was hypothesized that a session with more silence might be negatively perceived by adolescent patients. A total of 382 sessions that involved 21 female patients were analyzed. Silence was automatically detected from audio recordings. Diarization (segmenting an audio according to speaker identity) was performed. The patient's perception of the sessions was measured with the Session Evaluation Questionnaire. The amount of silence in the different speaker-switching patterns was not independent of one other. This finding supports the hypothesis of mutual attunement of patient and therapist concerning the amount of silence in a given session. Sessions with less silence were rated as being both smoother and better. The potential implications for clinical practice are discussed. The investigation of turn-taking and interpersonal temporal dynamics is relevant for psychotherapy research. The topic can be addressed efficiently using automated procedures. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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http://dx.doi.org/10.1037/per0000402DOI Listing
March 2021

[The Association Between Illicit Drug Use, Borderline Personality Disorder and Depression in a Help-Seeking Sample of Adolescents].

Prax Kinderpsychol Kinderpsychiatr 2020 Mar;69(2):126-140

Universitätsklinikum Heidelberg Klinik für Kinder- und Jugendpsychiatrie Blumenstraße 8 69115 Heidelberg Deutschland Klinik für Kinder- und Jugendpsychiatrie - Universitätsklinikum Heidelberg.

Risk-taking behavior is a common phenomenon in adolescence. Even prevalence rates for illicit drug use are considerably high in youth and associated with a range of psychiatric disorders, especially depression and Borderline Personality Disorder (BPD). However, there is a lack of data investigating differences in psychopathology between different substance user groups. Therefore, aim of the study was to investigate occurrence of depression and BPD symptoms in different drug risk groups (no use vs. occasional use vs. frequent use). Further aim of the study was to examine risk profiles regarding single BPD criteria. Data of n = 347 adolescents (81.7 % female, mean age 14.95, SD = 1.50) presenting at the specialized outpatient clinic for risk-taking and self-harming behavior (AtR!Sk) in Heidelberg were analyzed. Results show that BPD is clearly associated with illicit drug use in adolescence. There is no difference between occasional and frequent users in terms of mean number of BPD criteria. However, frequent users differ from occasional users regarding greater number of impulsivity and anger criteria. After adjusting for sociodemographic variables there was no association between drug use and depression. Since even single events of illicit drug use are associated with higher levels of BPD, clinicians should rapidly target to stop consumption. Further, psychotherapeutic interventions for BPD in high-risk consumers should especially focus on facilitating adaptive emotion regulation skills in regards to impulsivity and anger.
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http://dx.doi.org/10.13109/prkk.2020.69.2.126DOI Listing
March 2020