Publications by authors named "Peter Falkai"

484 Publications

Behandlung und Therapieerfolg in der forensischen Psychiatrie.

Fortschr Neurol Psychiatr 2021 Oct 19;89(10):481-482. Epub 2021 Oct 19.

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http://dx.doi.org/10.1055/a-1556-7953DOI Listing
October 2021

Interplay between the genetics of personality traits, severe psychiatric disorders and COVID-19 host genetics in the susceptibility to SARS-CoV-2 infection.

BJPsych Open 2021 Nov 7;7(6):e188. Epub 2021 Oct 7.

Department of Psychiatry, Psychotherapy and Psychosomatics, Augsburg University, Medical Faculty, Germany.

Background: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, with its impact on our way of life, is affecting our experiences and mental health. Notably, individuals with mental disorders have been reported to have a higher risk of contracting SARS-CoV-2. Personality traits could represent an important determinant of preventative health behaviour and, therefore, the risk of contracting the virus.

Aims: We examined overlapping genetic underpinnings between major psychiatric disorders, personality traits and susceptibility to SARS-CoV-2 infection.

Method: Linkage disequilibrium score regression was used to explore the genetic correlations of coronavirus disease 2019 (COVID-19) susceptibility with psychiatric disorders and personality traits based on data from the largest available respective genome-wide association studies (GWAS). In two cohorts (the PsyCourse ( = 1346) and the HeiDE ( = 3266) study), polygenic risk scores were used to analyse if a genetic association between, psychiatric disorders, personality traits and COVID-19 susceptibility exists in individual-level data.

Results: We observed no significant genetic correlations of COVID-19 susceptibility with psychiatric disorders. For personality traits, there was a significant genetic correlation for COVID-19 susceptibility with extraversion ( = 1.47 × 10; genetic correlation 0.284). Yet, this was not reflected in individual-level data from the PsyCourse and HeiDE studies.

Conclusions: We identified no significant correlation between genetic risk factors for severe psychiatric disorders and genetic risk for COVID-19 susceptibility. Among the personality traits, extraversion showed evidence for a positive genetic association with COVID-19 susceptibility, in one but not in another setting. Overall, these findings highlight a complex contribution of genetic and non-genetic components in the interaction between COVID-19 susceptibility and personality traits or mental disorders.
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http://dx.doi.org/10.1192/bjo.2021.1030DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8503053PMC
November 2021

Genetic risk for psychiatric illness is associated with the number of hospitalizations of bipolar disorder patients.

J Affect Disord 2021 Sep 28;296:532-540. Epub 2021 Sep 28.

Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany; Center for Mind, Brain and Behavior (CMBB), Marburg, Germany.

Objectives: Bipolar disorder (BD) has a highly heterogeneous clinical course that is characterized by relapses and increased health care utilization in a significant fraction of patients. A thorough understanding of factors influencing illness course is essential for predicting disorder severity and developing targeted therapies.

Methods: We performed polygenic score analyses in four cohorts (N = 954) to test whether the genetic risk for BD, schizophrenia, or major depression is associated with a severe course of BD. We analyzed BD patients with a minimum illness duration of five years. The severity of the disease course was assessed by using the number of hospitalizations in a mental health facility and a composite measure of longitudinal illness severity (OPCRIT item 90).

Results: Our analyses showed that higher polygenic scores for BD (β = 0.11, SE = 0.03, p = 1.17 × 10) and schizophrenia (β = 0.09, SE = 0.03, p = 4.24 × 10), but not for major depression, were associated with more hospitalizations. None of the investigated polygenic scores was associated with the composite measure of longitudinal illness severity (OPCRIT item 90).

Limitations: We could not account for non-genetic influences on disease course. Our clinical sample contained more severe cases.

Conclusions: This study demonstrates that the genetic risk burden for psychiatric illness is associated with increased health care utilization, a proxy for disease severity, in BD patients. The findings are in line with previous observations made for patients diagnosed with schizophrenia or major depression. Therefore, in the future psychiatric disorder polygenic scores might become helpful for stratifying patients with high risk of a chronic manifestation and predicting disease course.
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http://dx.doi.org/10.1016/j.jad.2021.09.073DOI Listing
September 2021

A microRNA signature that correlates with cognition and is a target against cognitive decline.

EMBO Mol Med 2021 Oct 11:e13659. Epub 2021 Oct 11.

German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany.

While some individuals age without pathological memory impairments, others develop age-associated cognitive diseases. Since changes in cognitive function develop slowly over time in these patients, they are often diagnosed at an advanced stage of molecular pathology, a time point when causative treatments fail. Thus, there is great need for the identification of inexpensive and minimal invasive approaches that could be used for screening with the aim to identify individuals at risk for cognitive decline that can then undergo further diagnostics and eventually stratified therapies. In this study, we use an integrative approach combining the analysis of human data and mechanistic studies in model systems to identify a circulating 3-microRNA signature that reflects key processes linked to neural homeostasis and inform about cognitive status. We furthermore provide evidence that expression changes in this signature represent multiple mechanisms deregulated in the aging and diseased brain and are a suitable target for RNA therapeutics.
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http://dx.doi.org/10.15252/emmm.202013659DOI Listing
October 2021

Exercise as a model to identify microRNAs linked to human cognition: a role for microRNA-409 and microRNA-501.

Transl Psychiatry 2021 10 8;11(1):514. Epub 2021 Oct 8.

German Center for Neurodegenerative Diseases, Department for Epigenetics and Systems Medicine in Neurodegenerative Diseases, Von Siebold Str 3A, 37075, Goettingen, Germany.

MicroRNAs have been linked to synaptic plasticity and memory function and are emerging as potential biomarkers and therapeutic targets for cognitive diseases. Most of these data stem from the analysis of model systems or postmortem tissue from patients which mainly represents an advanced stage of pathology. Due to the in-accessibility of human brain tissue upon experimental manipulation, it is still challenging to identify microRNAs relevant to human cognition, which is however a key step for future translational studies. Here, we employ exercise as an experimental model for memory enhancement in healthy humans with the aim to identify microRNAs linked to memory function. By analyzing the circulating smallRNAome we find a cluster of 18 microRNAs that are highly correlated to cognition. MicroRNA-409-5p and microRNA-501-3p were the most significantly regulated candidates. Functional analysis revealed that the two microRNAs are important for neuronal integrity, synaptic plasticity, and morphology. In conclusion, we provide a novel approach to identify microRNAs linked to human memory function.
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http://dx.doi.org/10.1038/s41398-021-01627-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8501071PMC
October 2021

Unstable Belief Formation and Slowed Decision-making: Evidence That the Jumping-to-Conclusions Bias in Schizophrenia Is Not Linked to Impulsive Decision-making.

Schizophr Bull 2021 Sep 23. Epub 2021 Sep 23.

Department of Psychiatry, Psychotherapy and Psychosomatics of the University Augsburg, Medical Faculty, University of Augsburg, Bezirkskrankenhaus Augsburg, Augsburg, Germany.

Background: Jumping-to-conclusions (JTC) is a prominent reasoning bias in schizophrenia (SCZ). While it has been linked to not only psychopathological abnormalities (delusions and impulsive decision-making) but also unstable belief formation, its origin remains unclear. We here directly test to which extend JTC is associated with delusional ideation, impulsive decision-making, and unstable belief formation.

Methods: In total, 45 SCZ patients were compared with matched samples of 45 patients with major depressive disorder (MDD) and 45 healthy controls (HC) as delusions and JTC also occur in other mental disorders and the general population. Participants performed a probabilistic beads task. To test the association of JTC with measures of delusions (Positive and Negative Syndrome Scale [PANSS]positive, PANSSpositive-factor, and Peter Delusions Inventory [PDI]), Bayesian linear regressions were computed. For the link between JTC and impulsive decision-making and unstable beliefs, we conducted between-group comparisons of "draws to decision" (DTD), "decision times" (DT), and "disconfirmatory evidence scores" (DES).

Results: Bayesian regression obtained no robust relationship between PDI and DTD (all |R2adj| ≤ .057, all P ≥ .022, all Bayes Factors [BF01] ≤ 0.046; α adj = .00833). Compared with MDD and HC, patients with SCZ needed more time to decide (significantly higher DT in ambiguous trials: all P ≤ .005, r2 ≥ .216; numerically higher DT in other trials). Further, SCZ had unstable beliefs about the correct source jar whenever unexpected changes in bead sequences (disconfirmatory evidence) occurred (compared with MDD: all P ≤ .004 and all r2 ≥ .232; compared with HC: numerically higher DES). No significant correlation was observed between DT and DTD (all P ≥ .050).

Conclusions: Our findings point toward a relationship of JTC with unstable belief formation and do not support the assumption that JTC is associated with impulsive decision-making.
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http://dx.doi.org/10.1093/schbul/sbab108DOI Listing
September 2021

Efficacy and safety of clozapine in psychotic disorders-a systematic quantitative meta-review.

Transl Psychiatry 2021 09 22;11(1):487. Epub 2021 Sep 22.

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

A recent increase in the literature regarding the evidence base for clozapine has made it increasingly difficult for clinicians to judge "best evidence" for clozapine use. As such, we aimed at elucidating the state-of-the-art for clozapine with regard to efficacy, effectiveness, tolerability, and management of clozapine and clozapine-related adverse events in neuropsychiatric disorders. We conducted a systematic PRISMA-conforming quantitative meta-review of available meta-analytic evidence regarding clozapine use. Primary outcome effect sizes were extracted and transformed into relative risk ratios (RR) and standardized mean differences (SMD). The methodological quality of meta-analyses was assessed using the AMSTAR-2 checklist. Of the 112 meta-analyses included in our review, 61 (54.5%) had an overall high methodological quality according to AMSTAR-2. Clozapine appears to have superior effects on positive, negative, and overall symptoms and relapse rates in schizophrenia (treatment-resistant and non-treatment-resistant subpopulations) compared to first-generation antipsychotics (FGAs) and to pooled FGAs/second-generation antipsychotics (SGAs) in treatment-resistant schizophrenia (TRS). Despite an unfavorable metabolic and hematological adverse-event profile compared to other antipsychotics, hospitalization, mortality and all-cause discontinuation (ACD) rates of clozapine surprisingly show a pattern of superiority. Our meta-review outlines the superior overall efficacy of clozapine compared to FGAs and most other SGAs in schizophrenia and suggests beneficial efficacy outcomes in bipolar disorder and Parkinson's disease psychosis (PDP). More clinical studies and subsequent meta-analyses are needed beyond the application of clozapine in schizophrenia-spectrum disorders and future studies should be directed into multidimensional clozapine side-effect management to foster evidence and to inform future guidelines.
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http://dx.doi.org/10.1038/s41398-021-01613-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8458455PMC
September 2021

The clinical relevance of formal thought disorder in the early stages of psychosis: results from the PRONIA study.

Eur Arch Psychiatry Clin Neurosci 2021 Sep 17. Epub 2021 Sep 17.

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

Background: Formal thought disorder (FTD) has been associated with more severe illness courses and functional deficits in patients with psychotic disorders. However, it remains unclear whether the presence of FTD characterises a specific subgroup of patients showing more prominent illness severity, neurocognitive and functional impairments. This study aimed to identify stable and generalizable FTD-subgroups of patients with recent-onset psychosis (ROP) by applying a comprehensive data-driven clustering approach and to test the validity of these subgroups by assessing associations between this FTD-related stratification, social and occupational functioning, and neurocognition.

Methods: 279 patients with ROP were recruited as part of the multi-site European PRONIA study (Personalised Prognostic Tools for Early Psychosis Management; www.pronia.eu). Five FTD-related symptoms (conceptual disorganization, poverty of content of speech, difficulty in abstract thinking, increased latency of response and poverty of speech) were assessed with Positive and Negative Symptom Scale (PANSS) and the Scale for the Assessment of Negative Symptoms (SANS).

Results: The results with two patient subgroups showing different levels of FTD were the most stable and generalizable clustering solution (predicted clustering strength value = 0.86). FTD-High subgroup had lower scores in social (p < 0.001) and role (p < 0.001) functioning, as well as worse neurocognitive performance in semantic (p < 0.001) and phonological verbal fluency (p < 0.001), short-term verbal memory (p = 0.002) and abstract thinking (p = 0.010), in comparison to FTD-Low group.

Conclusions: Clustering techniques allowed us to identify patients with more pronounced FTD showing more severe deficits in functioning and neurocognition, thus suggesting that FTD may be a relevant marker of illness severity in the early psychosis pathway.
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http://dx.doi.org/10.1007/s00406-021-01327-yDOI Listing
September 2021

Novel Gyrification Networks Reveal Links with Psychiatric Risk Factors in Early Illness.

Cereb Cortex 2021 Sep 14. Epub 2021 Sep 14.

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

Adult gyrification provides a window into coordinated early neurodevelopment when disruptions predispose individuals to psychiatric illness. We hypothesized that the echoes of such disruptions should be observed within structural gyrification networks in early psychiatric illness that would demonstrate associations with developmentally relevant variables rather than specific psychiatric symptoms. We employed a new data-driven method (Orthogonal Projective Non-Negative Matrix Factorization) to delineate novel gyrification-based networks of structural covariance in 308 healthy controls. Gyrification within the networks was then compared to 713 patients with recent onset psychosis or depression, and at clinical high-risk. Associations with diagnosis, symptoms, cognition, and functioning were investigated using linear models. Results demonstrated 18 novel gyrification networks in controls as verified by internal and external validation. Gyrification was reduced in patients in temporal-insular, lateral occipital, and lateral fronto-parietal networks (pFDR < 0.01) and was not moderated by illness group. Higher gyrification was associated with better cognitive performance and lifetime role functioning, but not with symptoms. The findings demonstrated that gyrification can be parsed into novel brain networks that highlight generalized illness effects linked to developmental vulnerability. When combined, our study widens the window into the etiology of psychiatric risk and its expression in adulthood.
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http://dx.doi.org/10.1093/cercor/bhab288DOI Listing
September 2021

HLA-DRB1 and HLA-DQB1 genetic diversity modulates response to lithium in bipolar affective disorders.

Sci Rep 2021 09 8;11(1):17823. Epub 2021 Sep 8.

Department of Psychiatry & Center of Sleep Disorders, National Taiwan University Hospital, Taipei, Taiwan.

Bipolar affective disorder (BD) is a severe psychiatric illness, for which lithium (Li) is the gold standard for acute and maintenance therapies. The therapeutic response to Li in BD is heterogeneous and reliable biomarkers allowing patients stratification are still needed. A GWAS performed by the International Consortium on Lithium Genetics (ConLiGen) has recently identified genetic markers associated with treatment responses to Li in the human leukocyte antigens (HLA) region. To better understand the molecular mechanisms underlying this association, we have genetically imputed the classical alleles of the HLA region in the European patients of the ConLiGen cohort. We found our best signal for amino-acid variants belonging to the HLA-DRB1*11:01 classical allele, associated with a better response to Li (p < 1 × 10; FDR < 0.09 in the recessive model). Alanine or Leucine at position 74 of the HLA-DRB1 heavy chain was associated with a good response while Arginine or Glutamic acid with a poor response. As these variants have been implicated in common inflammatory/autoimmune processes, our findings strongly suggest that HLA-mediated low inflammatory background may contribute to the efficient response to Li in BD patients, while an inflammatory status overriding Li anti-inflammatory properties would favor a weak response.
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http://dx.doi.org/10.1038/s41598-021-97140-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8426488PMC
September 2021

Toward Generalizable and Transdiagnostic Tools for Psychosis Prediction: An Independent Validation and Improvement of the NAPLS-2 Risk Calculator in the Multisite PRONIA Cohort.

Biol Psychiatry 2021 Nov 6;90(9):632-642. Epub 2021 Jul 6.

Institute of Mental Health, University of Birmingham, Birmingham, United Kingdom; School of Psychology, University of Birmingham, Birmingham, United Kingdom.

Background: Transition to psychosis is among the most adverse outcomes of clinical high-risk (CHR) syndromes encompassing ultra-high risk (UHR) and basic symptom states. Clinical risk calculators may facilitate an early and individualized interception of psychosis, but their real-world implementation requires thorough validation across diverse risk populations, including young patients with depressive syndromes.

Methods: We validated the previously described NAPLS-2 (North American Prodrome Longitudinal Study 2) calculator in 334 patients (26 with transition to psychosis) with CHR or recent-onset depression (ROD) drawn from the multisite European PRONIA (Personalised Prognostic Tools for Early Psychosis Management) study. Patients were categorized into three risk enrichment levels, ranging from UHR, over CHR, to a broad-risk population comprising patients with CHR or ROD (CHR|ROD). We assessed how risk enrichment and different predictive algorithms influenced prognostic performance using reciprocal external validation.

Results: After calibration, the NAPLS-2 model predicted psychosis with a balanced accuracy (BAC) (sensitivity, specificity) of 68% (73%, 63%) in the PRONIA-UHR cohort, 67% (74%, 60%) in the CHR cohort, and 70% (73%, 66%) in patients with CHR|ROD. Multiple model derivation in PRONIA-CHR|ROD and validation in NAPLS-2-UHR patients confirmed that broader risk definitions produced more accurate risk calculators (CHR|ROD-based vs. UHR-based performance: 67% [68%, 66%] vs. 58% [61%, 56%]). Support vector machines were superior in CHR|ROD (BAC = 71%), while ridge logistic regression and support vector machines performed similarly in CHR (BAC = 67%) and UHR cohorts (BAC = 65%). Attenuated psychotic symptoms predicted psychosis across risk levels, while younger age and reduced processing speed became increasingly relevant for broader risk cohorts.

Conclusions: Clinical-neurocognitive machine learning models operating in young patients with affective and CHR syndromes facilitate a more precise and generalizable prediction of psychosis. Future studies should investigate their therapeutic utility in large-scale clinical trials.
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http://dx.doi.org/10.1016/j.biopsych.2021.06.023DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8500930PMC
November 2021

Cerebrospinal Fluid Pathologies in Schizophrenia-Spectrum Disorder-A Retrospective Chart Review.

Schizophr Bull 2021 Sep 4. Epub 2021 Sep 4.

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

Background: The role of inflammatory processes in the etiology of schizophrenia is increasingly being investigated. A link between psychosis and inflammation measured with different biomarkers has been reported in the literature and needs to be further explored. To investigate the presence of inflammatory biomarkers in first-episode psychosis (FEP) we analyzed the largest available FEP cohort to date regarding routine CSF and blood diagnostics.

Methods: We report a retrospective analysis of clinical data from all inpatients that were admitted to our tertiary care hospital with a ICD-10 diagnosis of F2x (schizophrenia-spectrum) between January 1, 2008 and August 1, 2018 and underwent a lumbar puncture.

Results: A total of n = 314 FEP patients were included in our sample. 42.7% patients (134/314) showed cerebrospinal fluid (CSF) alterations. Oligoclonal bands in the CSF were present in 21.8% of patients (67/307) with 12.4% (27/217) of patients presenting OCBs type 2 or 3. 15.8% (49/310) of our cohort revealed signs of blood-brain-barrier (BBB) dysfunction with increased albumin ratios. Mean serum CRP levels were 2.4 mg/l (SD = 9.5). CRP elevation was present in 116/280 cases (41.4%).

Conclusions: This large retrospective analysis on FEP cohort greatly enriches the clinical data available on this population and contributes to the discussion around inflammation in psychosis. Of note, even though several inflammatory alterations were found both in CSF and in blood tests, we found no evidence for a significant relationship between peripheral inflammation and inflammatory CSF. Furthermore, no significant relationship between CSF alterations and peripheral inflammation measured with CRP could be established.
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http://dx.doi.org/10.1093/schbul/sbab105DOI Listing
September 2021

The COVID-19 Pandemic Mental Health Questionnaire (CoPaQ): psychometric evaluation and compliance with countermeasures in psychiatric inpatients and non-clinical individuals.

BMC Psychiatry 2021 08 31;21(1):426. Epub 2021 Aug 31.

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

Background: The COVID-19 pandemic has greatly impacted people's lives across a broad spectrum of psychosocial domains. We report the development and psychometric evaluation of the self-report COVID-19 Pandemic Mental Health Questionnaire (CoPaQ), which assesses COVID-19 contamination anxiety, countermeasure necessity and compliance, mental health impact, stressor impact, social media usage, interpersonal conflicts, paranoid ideations, institutional & political trust, conspiracy beliefs, and social cohesion. Further, we illustrate the questionnaire's utility in an applied example investigating if higher SARS-Cov-2 infection rates in psychiatric patients could be explained by reduced compliance with preventive countermeasures.

Methods: A group of 511 non-clinical individuals completed an initial pool of 111 CoPaQ items (Open Science Framework: https://osf.io/3evn9/ ) and additional scales measuring psychological distress, well-being, and paranoia to assess construct validity and lifetime mental health diagnosis for criterion validity. Factor structure was determined by exploratory factor analyses and validated by conducting confirmatory factor analysis in the accompanying longitudinal sample (n = 318) and an independent psychiatric inpatient sample primarily admitted for major depressive-, substance abuse-, personality-, and anxiety disorders (n = 113). Internal consistency was assessed by Cronbach's Alpha and McDonald's Omega. For the applied research example, Welch t-tests and correlational analyses were conducted.

Results: Twelve out of 16 extracted subscales were retained in the final questionnaire version, which provided preliminary evidence for adequate psychometric properties in terms of factor structure, internal consistency, and construct and criterion validity. Our applied research example showed that patients exhibited greater support for COVID-19 countermeasures than non-clinical individuals. However, this requires replication in future studies.

Conclusions: We demonstrate that the CoPaQ is a comprehensive and valid measure of the psychosocial impact of the pandemic and could allow to a degree to disentangle the complex psychosocial phenomena of the pandemic as exemplified by our applied analyses.
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http://dx.doi.org/10.1186/s12888-021-03425-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8406012PMC
August 2021

In-depth profiling of COVID-19 risk factors and preventive measures in healthcare workers.

Infection 2021 Aug 11. Epub 2021 Aug 11.

Faculty of Medicine, National Reference Center for Retroviruses, Max Von Pettenkofer Institute and Gene Center, Virology, LMU München, Munich, Germany.

Purpose: To determine risk factors for coronavirus disease 2019 (COVID-19) in healthcare workers (HCWs), characterize symptoms, and evaluate preventive measures against SARS-CoV-2 spread in hospitals.

Methods: In a cross-sectional study conducted between May 27 and August 12, 2020, after the first wave of the COVID-19 pandemic, we obtained serological, epidemiological, occupational as well as COVID-19-related data at a quaternary care, multicenter hospital in Munich, Germany.

Results: 7554 HCWs participated, 2.2% of whom tested positive for anti-SARS-CoV-2 antibodies. Multivariate analysis revealed increased COVID-19 risk for nurses (3.1% seropositivity, 95% CI 2.5-3.9%, p = 0.012), staff working on COVID-19 units (4.6% seropositivity, 95% CI 3.2-6.5%, p = 0.032), males (2.4% seropositivity, 95% CI 1.8-3.2%, p = 0.019), and HCWs reporting high-risk exposures to infected patients (5.5% seropositivity, 95% CI 4.0-7.5%, p = 0.0022) or outside of work (12.0% seropositivity, 95% CI 8.0-17.4%, p < 0.0001). Smoking was a protective factor (1.1% seropositivity, 95% CI 0.7-1.8% p = 0.00018) and the symptom taste disorder was strongly associated with COVID-19 (29.8% seropositivity, 95% CI 24.3-35.8%, p < 0.0001). An unbiased decision tree identified subgroups with different risk profiles. Working from home as a preventive measure did not protect against SARS-CoV-2 infection. A PCR-testing strategy focused on symptoms and high-risk exposures detected all larger COVID-19 outbreaks.

Conclusion: Awareness of the identified COVID-19 risk factors and successful surveillance strategies are key to protecting HCWs against SARS-CoV-2, especially in settings with limited vaccination capacities or reduced vaccine efficacy.
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http://dx.doi.org/10.1007/s15010-021-01672-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8354838PMC
August 2021

Decreased Serum Brain-Derived Neurotrophic Factor Concentrations 72 Hours Following Marathon Running.

Front Physiol 2021 15;12:668454. Epub 2021 Jul 15.

Department of Psychiatry and Psychotherapy, Klinikum der Universität München, Ludwig-Maximilians University Munich, Munich, Germany.

Physical exercise has been linked to beneficial effects on brain plasticity. One potential key mechanism for this relationship is an exercise-induced increase of brain-derived neurotrophic factor (BDNF). However, the kinetics of BDNF in athletes during training phase, extreme exercise competition, and recovery period have not been investigated so far. We assessed serum BDNF concentrations in 51 marathon runners (23% female, mean age 43 years) in a longitudinal study design over a period of 6 months. Assessments were conducted during the training period before the marathon and after the marathon race during short-term (24 to 72 h) and long-term (3 months) follow-ups. Potential confounders (fitness level, sex, and platelet count) were included in subsequent linear-model analyses. Linear mixed-model analyses revealed a main effect of time for BDNF concentrations over the study period ( = 4.296, = 0.003). Values decreased significantly with the lowest values at 72 h after the marathon compared to baseline ( = 0.025), a finding that was more pronounced in the larger male cohort. Prolonged exercise induces a significant decrease in serum BDNF concentration 72 h post-exercise. We assume that this observation is mainly driven by regenerative mechanisms and a higher muscular utilization.
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http://dx.doi.org/10.3389/fphys.2021.668454DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8320388PMC
July 2021

Brief Report: Specificity of Interpersonal Synchrony Deficits to Autism Spectrum Disorder and Its Potential for Digitally Assisted Diagnostics.

J Autism Dev Disord 2021 Jul 31. Epub 2021 Jul 31.

Department of Psychiatry and Psychotherapy, Medical Faculty, LMU Munich, Nussbaumstrasse 7, Munich, Germany.

Reliably diagnosing autism spectrum disorders (ASD) in adulthood poses a challenge to clinicians due to the absence of specific diagnostic markers. This study investigated the potential of interpersonal synchrony (IPS), which has been found to be reduced in ASD, to augment the diagnostic process. IPS was objectively assessed in videos of diagnostic interviews in a representative referral population from two specialized autism outpatient clinics. In contrast to the current screening tools that could not reliably differentiate, we found a significant reduction of IPS in interactions with individuals later diagnosed with ASD (n = 16) as opposed to those not receiving a diagnosis (n = 23). While these findings need to be validated in larger samples, they nevertheless underline the potential of digitally-enhanced diagnostic processes for ASD.
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http://dx.doi.org/10.1007/s10803-021-05194-3DOI Listing
July 2021

Differential psychological response to the COVID-19 pandemic in psychiatric inpatients compared to a non-clinical population from Germany.

Eur Arch Psychiatry Clin Neurosci 2021 Jul 15. Epub 2021 Jul 15.

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

The COVID-19 pandemic is an inherently stressful situation, which may lead to adverse psychosocial outcomes in various populations. Yet, individuals may not be affected equally by stressors posed by the pandemic and those with pre-existing mental disorders could be particularly vulnerable. To test this hypothesis, we assessed the psychological response to the pandemic in a case-control design. We used an age-, sex- and employment status-matched case-control sample (n = 216) of psychiatric inpatients, recruited from the LMU Psychiatry Biobank Munich study and non-clinical individuals from the general population. Participants completed validated self-report measures on stress, anxiety, depression, paranoia, rumination, loneliness, well-being, resilience, and a newly developed index of stressors associated with the COVID-19 pandemic. Multiple linear regression analyses were conducted to assess the effects of group, COVID-19-specific stressors, and their interaction on the different psychosocial outcomes. While psychiatric inpatients reported larger mental health difficulties overall, the impact of COVID-19-specific stressors was lower in patients and not associated with worse psychological functioning compared to non-clinical individuals. In contrast, depressive symptoms, rumination, loneliness, and well-being were more strongly associated with COVID-19-specific stressors in non-clinical individuals and similar to the severity of inpatients for those who experienced the greatest COVID-19-specific stressor impact Contrary to expectations, the psychological response to the pandemic may not be worse in psychiatric inpatients compared to non-clinical individuals. Yet, individuals from the general population, who were hit hardest by the pandemic, should be monitored and may be in need of mental health prevention and treatment efforts.
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http://dx.doi.org/10.1007/s00406-021-01291-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8282176PMC
July 2021

A genome-wide association study of the longitudinal course of executive functions.

Transl Psychiatry 2021 07 10;11(1):386. Epub 2021 Jul 10.

AMEOS Clinical Center Hildesheim, Hildesheim, 31135, Germany.

Executive functions are metacognitive capabilities that control and coordinate mental processes. In the transdiagnostic PsyCourse Study, comprising patients of the affective-to-psychotic spectrum and controls, we investigated the genetic basis of the time course of two core executive subfunctions: set-shifting (Trail Making Test, part B (TMT-B)) and updating (Verbal Digit Span backwards) in 1338 genotyped individuals. Time course was assessed with four measurement points, each 6 months apart. Compared to the initial assessment, executive performance improved across diagnostic groups. We performed a genome-wide association study to identify single nucleotide polymorphisms (SNPs) associated with performance change over time by testing for SNP-by-time interactions using linear mixed models. We identified nine genome-wide significant SNPs for TMT-B in strong linkage disequilibrium with each other on chromosome 5. These were associated with decreased performance on the continuous TMT-B score across time. Variant rs150547358 had the lowest P value = 7.2 × 10 with effect estimate beta = 1.16 (95% c.i.: 1.11, 1.22). Implementing data of the FOR2107 consortium (1795 individuals), we replicated these findings for the SNP rs150547358 (P value = 0.015), analyzing the difference of the two available measurement points two years apart. In the replication study, rs150547358 exhibited a similar effect estimate beta = 0.85 (95% c.i.: 0.74, 0.97). Our study demonstrates that longitudinally measured phenotypes have the potential to unmask novel associations, adding time as a dimension to the effects of genomics.
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http://dx.doi.org/10.1038/s41398-021-01510-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8272719PMC
July 2021

Improvement in daily functioning after aerobic exercise training in schizophrenia is sustained after exercise cessation.

Eur Arch Psychiatry Clin Neurosci 2021 Oct;271(7):1201-1203

Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians-University Munich, Nussbaumstrasse 7, 80336, Munich, Germany.

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http://dx.doi.org/10.1007/s00406-021-01282-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8429390PMC
October 2021

The progression of disorder-specific brain pattern expression in schizophrenia over 9 years.

NPJ Schizophr 2021 Jun 14;7(1):32. Epub 2021 Jun 14.

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

Age plays a crucial role in the performance of schizophrenia vs. controls (SZ-HC) neuroimaging-based machine learning (ML) models as the accuracy of identifying first-episode psychosis from controls is poor compared to chronic patients. Resolving whether this finding reflects longitudinal progression in a disorder-specific brain pattern or a systematic but non-disorder-specific deviation from a normal brain aging (BA) trajectory in schizophrenia would help the clinical translation of diagnostic ML models. We trained two ML models on structural MRI data: an SZ-HC model based on 70 schizophrenia patients and 74 controls and a BA model (based on 561 healthy individuals, age range = 66 years). We then investigated the two models' predictions in the naturalistic longitudinal Northern Finland Birth Cohort 1966 (NFBC1966) following 29 schizophrenia and 61 controls for nine years. The SZ-HC model's schizophrenia-specificity was further assessed by utilizing independent validation (62 schizophrenia, 95 controls) and depression samples (203 depression, 203 controls). We found better performance at the NFBC1966 follow-up (sensitivity = 75.9%, specificity = 83.6%) compared to the baseline (sensitivity = 58.6%, specificity = 86.9%). This finding resulted from progression in disorder-specific pattern expression in schizophrenia and was not explained by concomitant acceleration of brain aging. The disorder-specific pattern's progression reflected longitudinal changes in cognition, outcomes, and local brain changes, while BA captured treatment-related and global brain alterations. The SZ-HC model was also generalizable to independent schizophrenia validation samples but classified depression as control subjects. Our research underlines the importance of taking account of longitudinal progression in a disorder-specific pattern in schizophrenia when developing ML classifiers for different age groups.
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http://dx.doi.org/10.1038/s41537-021-00157-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8203625PMC
June 2021

[Inpatient Psychiatric Treatment in the Corona-crisis by Psychologists and Psychiatrists in Home-office and in the Clinic].

Fortschr Neurol Psychiatr 2021 Sep 14;89(9):424-432. Epub 2021 Jun 14.

Psychiatrie und Psychotherapie, LMU Klinikum der Universität München Medizinische Klinik und Poliklinik IV, München, Germany.

Since the emergence of the new coronavirus (COVID-19) pandemic in March 2020, many people in Germany have become ill. This meant a challenge for the care of mentally ill hospitalized patients. There was a social shut-down in Bavaria with a decrease in social contacts. The present study deals with psychiatric care provided to these patients by psychologists and psychiatrists working in the home office and in the clinic. Psychologists from the Department of Psychiatry and Psychotherapy at LMU Munich, together with physicians working in the clinic, established telephone-based patient care for inpatients during the acute crisis in the home office during quarantine, in which 23 patients with depressive and schizophrenic disorders participated. Psychologists then worked in the hospital with 98 hospitalized patients. Current distress and its stresses were addressed and new therapeutic components were integrated into care. The feasibility of home office, its possibilities and limitations are presented. In this study, care concepts for hospitalized patients with affective and schizophrenic disorders as well as current stress factors and psychotherapeutic concepts will be addressed. The current approach was positively evaluated by patients and physicians and is thus promising in the current situation. With the exception of patients in the acute ward, all patients and even older ones benefited from this measure. During the crisis from March to August, all psychologists worked on full-time positions with the usual treatment frequency of 1-2 sessions a week, which was especially important for elderly individuals. During the acute COVID-19 crisis, there was a pause only in the treatment of ward-wide groups and family groups. Psychologists, like physicians and nurses, had a system-relevant role to play.
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http://dx.doi.org/10.1055/a-1483-9904DOI Listing
September 2021

Effects of high-frequency prefrontal rTMS on heart frequency rates and blood pressure in schizophrenia.

J Psychiatr Res 2021 08 7;140:243-249. Epub 2021 Jun 7.

Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, University of Augsburg, BKH, Augsburg, Germany.

Background: Repetitive transcranial magnetic stimulation (rTMS) is a safe non-invasive neuromodulation technique used for the treatment of various neuropsychiatric disorders. The effect of rTMS applied to the cortex on autonomic functions has not been studied in detail in patient cohorts, yet patients who receive rTMS may have disease-associated impairments in the autonomic system and may receive medication that may pronounce autonomic dysfunctions.

Methods: Using data from the 'rTMS for the Treatment of Negative Symptoms in Schizophrenia' (RESIS) trial we evaluated the effect of rTMS applied to the left dorsolateral prefrontal cortex (DLPFC) on autonomic nervous system-related parameters such as blood pressure (BP) and heart rate (HR) in both reclining and standing postures from screening up to 105 days after intervention among patients with schizophrenia.

Results: 157 patients received either active (n = 76) or sham (n = 81) rTMS treatment. Apart from gender no significant group differences were observed. During intervention, Linear Mixed Model (LMM) analyses showed no significant time × group interactions nor time effects for any of the variables (all p > 0.055). During the whole trial beside a significant time × group interaction for diastolic BP (p = 0.017) in the standing posture, no significant time × group interactions for other variables (all p > 0.140) were found.

Conclusion: These secondary analyses of the largest available rTMS trial on the treatment of negative symptoms in schizophrenia did not show a significant effect of active rTMS compared to sham rTMS on heart rate or blood pressure, neither during the intervention period nor during the follow-up period.
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http://dx.doi.org/10.1016/j.jpsychires.2021.06.010DOI Listing
August 2021

Effects of Marathon Running on Cognition and Retinal Vascularization: A Longitudinal Observational Study.

Med Sci Sports Exerc 2021 Oct;53(10):2207-2214

Department of Psychiatry and Psychotherapy, Klinikum der Universität München, Ludwig-Maximilians University Munich, Munich, GERMANY.

Introduction: Physical activity has beneficial effects on both cardiovascular and neurocognitive parameters, and these two modalities are known to interact at rest. However, findings on their interaction during exercise are inconclusive.

Purpose: Therefore, this longitudinal study aimed to investigate the effects of different forms of exercise (training period, marathon race, and recovery period) on both parameters and their interaction.

Methods: We included 100 marathon runners (MA) (mean ± SD age = 43.6 ± 10.0 yr, 80 males) and 46 age- and sex-matched sedentary controls (SC, for baseline comparison). Over the 6-month study period with six visits (12 and 2 wk before the marathon; immediately, 24 h, 72 h, and 12 wk after the marathon), we assessed cognitive parameters by evaluating the 1- to 3-back d prime, the d2 task, and the Trail Making Tests A (TMT A) and B (TMT B), and the retinal vessel parameters by assessing arteriolar-to-venular ratio (AVR), central retinal arteriolar equivalent (CRAE), and central retinal venular equivalent (CRVE).

Results: In the long-term analysis, 3-back d prime correlated positively with AVR (P = 0.024, B = 1.86, SE = 0.824) and negatively with CRVE (P = 0.05, B = -0.006, SE = 0.003), and TMT B correlated negatively with CRAE (P = 0.025, B = -0.155, SE = 0.069), even after correcting for age and systolic blood pressure as possible confounders. Acute effects were inconsistent with maximal cognitive improvement 24 h after the marathon. AVR was significantly smaller in SC compared with MA.

Conclusion: Chronic exercise seems to prime the central nervous system for acute, intensive bouts of exercise. Our findings indicate a possible relationship between cognitive performance in high-demand tasks and retinal vasculature and support the idea of a neuroplastic effect of exercise.
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http://dx.doi.org/10.1249/MSS.0000000000002699DOI Listing
October 2021

Differential gene regulation in the anterior cingulate cortex and superior temporal cortex in schizophrenia: A molecular network approach.

Schizophr Res 2021 06 15;232:1-10. Epub 2021 May 15.

Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nußbaumstrasse 7, 80336 Munich, Germany; International Max Planck Research School for Translational Psychiatry (IMPRS-TP), Kraepelinstr. 2-10, 80804 Munich, Germany.

The closely connected anterior cingulate cortex (ACC) and superior temporal cortex (STC) are important for higher cognitive functions. Both brain regions are disturbed in schizophrenia, i.e., functional and structural alterations have been reported. This postmortem investigation in brains from patients with schizophrenia and controls compared gene expression in the left ACC and left STC. Most differentially expressed genes were unique to each brain region, but some clusters of genes were equally dysregulated in both, giving rise to a more general disease-specific pattern of gene regulation. The data was used to construct a molecular network of the genes identically expressed in both regions as primary nodes and the metabolically connected genes as secondary nodes. The network analysis identified downregulated clusters of immune-associated gene products and upregulated clusters belonging to the ubiquitin-proteasome system. These findings could help to identify new potential therapeutic targets for future approaches.
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http://dx.doi.org/10.1016/j.schres.2021.04.014DOI Listing
June 2021

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

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

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

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

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

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

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

Association of Age, Antipsychotic Medication, and Symptom Severity in Schizophrenia With Proton Magnetic Resonance Spectroscopy Brain Glutamate Level: A Mega-analysis of Individual Participant-Level Data.

JAMA Psychiatry 2021 Jun;78(6):667-681

Department of Psychiatry, Columbia University, New York State Psychiatric Institute, New York.

Importance: Proton magnetic resonance spectroscopy (1H-MRS) studies indicate that altered brain glutamatergic function may be associated with the pathophysiology of schizophrenia and the response to antipsychotic treatment. However, the association of altered glutamatergic function with clinical and demographic factors is unclear.

Objective: To assess the associations of age, symptom severity, level of functioning, and antipsychotic treatment with brain glutamatergic metabolites.

Data Sources: The MEDLINE database was searched to identify journal articles published between January 1, 1980, and June 3, 2020, using the following search terms: MRS or magnetic resonance spectroscopy and (1) schizophrenia or (2) psychosis or (3) UHR or (4) ARMS or (5) ultra-high risk or (6) clinical high risk or (7) genetic high risk or (8) prodrome* or (9) schizoaffective. Authors of 114 1H-MRS studies measuring glutamate (Glu) levels in patients with schizophrenia were contacted between January 2014 and June 2020 and asked to provide individual participant data.

Study Selection: In total, 45 1H-MRS studies contributed data.

Data Extraction And Synthesis: Associations of Glu, Glu plus glutamine (Glx), or total creatine plus phosphocreatine levels with age, antipsychotic medication dose, symptom severity, and functioning were assessed using linear mixed models, with study as a random factor.

Main Outcomes And Measures: Glu, Glx, and Cr values in the medial frontal cortex (MFC) and medial temporal lobe (MTL).

Results: In total, 42 studies were included, with data for 1251 patients with schizophrenia (mean [SD] age, 30.3 [10.4] years) and 1197 healthy volunteers (mean [SD] age, 27.5 [8.8] years). The MFC Glu (F1,1211.9 = 4.311, P = .04) and Glx (F1,1079.2 = 5.287, P = .02) levels were lower in patients than in healthy volunteers, and although creatine levels appeared lower in patients, the difference was not significant (F1,1395.9 = 3.622, P = .06). In both patients and volunteers, the MFC Glu level was negatively associated with age (Glu to Cr ratio, F1,1522.4 = 47.533, P < .001; cerebrospinal fluid-corrected Glu, F1,1216.7 = 5.610, P = .02), showing a 0.2-unit reduction per decade. In patients, antipsychotic dose (in chlorpromazine equivalents) was negatively associated with MFC Glu (estimate, 0.10 reduction per 100 mg; SE, 0.03) and MFC Glx (estimate, -0.11; SE, 0.04) levels. The MFC Glu to Cr ratio was positively associated with total symptom severity (estimate, 0.01 per 10 points; SE, 0.005) and positive symptom severity (estimate, 0.04; SE, 0.02) and was negatively associated with level of global functioning (estimate, 0.04; SE, 0.01). In the MTL, the Glx to Cr ratio was positively associated with total symptom severity (estimate, 0.06; SE, 0.03), negative symptoms (estimate, 0.2; SE, 0.07), and worse Clinical Global Impression score (estimate, 0.2 per point; SE, 0.06). The MFC creatine level increased with age (estimate, 0.2; SE, 0.05) but was not associated with either symptom severity or antipsychotic medication dose.

Conclusions And Relevance: Findings from this mega-analysis suggest that lower brain Glu levels in patients with schizophrenia may be associated with antipsychotic medication exposure rather than with greater age-related decline. Higher brain Glu levels may act as a biomarker of illness severity in schizophrenia.
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http://dx.doi.org/10.1001/jamapsychiatry.2021.0380DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8060889PMC
June 2021

The Interplay Between Postsynaptic Striatal D2/3 Receptor Availability, Adversity Exposure and Odd Beliefs: A [11C]-Raclopride PET Study.

Schizophr Bull 2021 Aug;47(5):1495-1508

Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, Zurich Program for Sustainable Development of Mental Health Services (ZInEP), University of Zurich, Zurich, Switzerland.

Background: Between unaffected mental health and diagnosable psychiatric disorders, there is a vast continuum of functioning. The hypothesized link between striatal dopamine signaling and psychosis has guided a prolific body of research. However, it has been understudied in the context of multiple interacting factors, subclinical phenotypes, and pre-postsynaptic dynamics.

Method: This work investigated psychotic-like experiences and D2/3 dopamine postsynaptic receptor availability in the dorsal striatum, quantified by in vivo [11C]-raclopride positron emission tomography, in a sample of 24 healthy male individuals. Additional mediation and moderation effects with childhood trauma and key dopamine-regulating genes were examined.

Results: An inverse relationship between nondisplaceable binding potential and subclinical symptoms was identified. D2/3 receptor availability in the left putamen fully mediated the association between traumatic childhood experiences and odd beliefs, that is, inclinations to see meaning in randomness and unfounded interpretations. Moreover, the effect of early adversity was moderated by a DRD2 functional variant (rs1076560). The results link environmental and neurobiological influences in the striatum to the origination of psychosis spectrum symptomology, consistent with the social defeat and diathesis-stress models.

Conclusions: Adversity exposure may affect the dopamine system as in association with biases in probabilistic reasoning, attributional style, and salience processing. The inverse relationship between D2/3 availability and symptomology may be explained by endogenous dopamine occupying the receptor, postsynaptic compensatory mechanisms, and/or altered receptor sensitivity. This may also reflect a cognitively stabilizing mechanism in non-help-seeking individuals. Future research should comprehensively characterize molecular parameters of dopamine neurotransmission along the psychosis spectrum and according to subtype profiling.
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http://dx.doi.org/10.1093/schbul/sbab034DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8379534PMC
August 2021

Employment status and desire for work in severe mental illness: results from an observational, cross-sectional study.

Soc Psychiatry Psychiatr Epidemiol 2021 Sep 16;56(9):1657-1667. Epub 2021 Apr 16.

Medical Faculty, Institute of Social Medicine, Occupational Health and Public Health (ISAP), University of Leipzig, Philipp-Rosenthal-Straße 55, 04103, Leipzig, Germany.

Purpose: People with a severe mental illness (SMI) are at particular risk of occupational exclusion. Among the approaches to occupational rehabilitation, supported employment (SE) has been proven to be the most effective. A requirement to enter SE-programs is that individuals must want to seek competitive employment. The aim of this work is to investigate the relationship between serious mental illness and the desire to work including potential predictors.

Methods: This is a cross-sectional observational study of patients with SMI aged 18-65 years (n = 397). Patients were interviewed by trained staff using standardised instruments. The relationship between potential predictors and a strong preference for employment were analysed using a hierarchic binary logistic regression model.

Results: Only about one-quarter (27.9%) of SMI patients is in competitive employment. Another quarter is unemployed (25.9%). Results show that the desire for competitive employment is strong among more than half of the SMI patients. Among the unemployed, two-thirds express a strong desire for work. These individuals are an ideal target group for SE interventions. Comorbid chronic physical illness, diagnosis, and the subjectively judged ability to work are associated with the desire for work.

Conclusion: Our data confirm a substantial exclusion of individuals with SMI from the workforce. In general, care needs for workplace interventions are not being met and leave much room for improvement. In addition to employment status, the desire for work should be routinely assessed.

Study Registration: The study was registered in the German Clinical Trials Register (DRKS) ( https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00015801 ) and under the WHO-Platform "International Clinical Trials Registry Platform" (ICTRP) ( https://apps.who.int/trialsearch/Trial2.aspx?TrialID=DRKS00015801 ) under the registration number DRKS00015801 before the start of recruitment (Registration date: 21.02.2019).
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http://dx.doi.org/10.1007/s00127-021-02088-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8429146PMC
September 2021

Eighth Kraepelin Symposium-Translation in Psychiatry and Psychotherapy: A Life-Long Necessity.

Schizophr Bull 2021 04;47(3):580-582

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

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http://dx.doi.org/10.1093/schbul/sbab020DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8084421PMC
April 2021
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