Search

The routine in-depth characterization of patients with methods of clinical and scale-based examination, neuropsychology, based on biomaterials, and sensor-based information opens up transformative possibilities on the way to personalized diagnostics, treatment and prevention in psychiatry, psychotherapy, and psychosomatics. Effective integration of the additional temporal and logistical effort into everyday care as well as the acceptance by patients are critical to the success of such an approach but there is little evidence on this to date. We report here on the establishment of the Diagnosis and Admission Center (DAZ) at the Central Institute of Mental Health (ZI) in Mannheim. The DAZ is an outpatient unit upstream of other care structures for clinical and scientific phenotyping across diagnoses as a starting point for data-driven, individualized pathways to further treatment, diagnostics or research. We describe the functions, goals, and implementation of the newly created clinical scientific translational structure, provide an overview of the patient populations it has reached, and provide data on its acceptance. In this context, the close integration with downstream clinical processes enables a better coordinated and demand-oriented allocation. In addition, DAZ enables a faster start of disorder-specific diagnostics and treatment. Since its launch in April 2021 up to the end of 2022, 1021 patients underwent psychiatric evaluation at DAZ during a pilot phase. The patient sample corresponded to a representative sample from standard care and the newly established processes were regarded as helpful by patients. In summary, the DAZ uniquely combines the interests and needs of patient with the collection of scientifically relevant data. [ABSTRACT FROM AUTHOR]

The determination of conditions for the reproducible growth of well diffracting crystals is a critical step in every biocrystallographic study. On the occasion of a new structural biology project, several advanced crystallogenesis approaches were tested in order to increase the success rate of crystallization. These methods included screening by microseed matrix screening, optimization by counter‐diffusion and crystal detection by trace fluorescent labeling, and are easily accessible to any laboratory. Their combination proved to be particularly efficient in the case of the target, a 48 kDa CCA‐adding enzyme from the psychrophilic bacterium Planococcus halocryophilus. A workflow summarizes the overall strategy, which led to the production of crystals that diffracted to better than 2 Å resolution and may be of general interest for a variety of applications. Advanced crystallogenesis methods, including microseed matrix screening, crystallization optimization by counter‐diffusion and crystal detection by trace fluorescent labeling, were used in combination to successfully produce various diffracting crystal forms of a CCA‐adding enzyme from the psychrophilic bacterium Planococcus halocryophilus. [ABSTRACT FROM AUTHOR]

The characteristic NIR-absorption lines of methane and ethane are being acquired simultaneously and their concentrations are determined using a tunable DFB laser diode. This paper reports on the development of a hand-held and low-power sensor, based on direct absorption spectroscopy for leak detection (methane), natural gas identification and lower-explosion-limit (LEL) measurements (methane and ethane). The algorithm corrects for ambient temperature and pressure. At normal conditions and constant operation a battery-lifetime of 8+ h is achieved. [Copyright &y& Elsevier]

The mitochondrial genome of the nematode Romanomermis culicivorax encodes for miniaturized hairpin-like tRNA molecules that lack D- as well as T-arms, strongly deviating from the consensus cloverleaf. The single tRNA nucleotidyltransferase of this organism is fully active on armless tRNAs, while the human counterpart is not able to add a complete CCA-end. Transplanting single regions of the Romanomermis enzyme into the human counterpart, we identified a beta-turn element of the catalytic core that—when inserted into the human enzyme—confers full CCA-adding activity on armless tRNAs. This region, originally identified to position the 3′-end of the tRNA primer in the catalytic core, dramatically increases the enzyme's substrate affinity. While conventional tRNA substrates bind to the enzyme by interactions with the T-arm, this is not possible in the case of armless tRNAs, and the strong contribution of the beta-turn compensates for an otherwise too weak interaction required for the addition of a complete CCA-terminus. This compensation demonstrates the remarkable evolutionary plasticity of the catalytic core elements of this enzyme to adapt to unconventional tRNA substrates. [ABSTRACT FROM AUTHOR]

Current studies demonstrate a comparably high prevalence of attention deficit-hyperactivity disorder (ADHD) in advanced age. Older people affected by ADHD suffer from a severe burden of psychiatric and somatic comorbidities as well as substantial impairment of social functioning and subjective well-being. The diagnostic differentiation from neurodegenerative diseases is particularly difficult in this age group. This narrative review summarizes the current knowledge about the epidemiology of ADHD in advanced age and possible relationships between ADHD and the risk for neurodegeneration. Furthermore, recommendations for diagnostics and treatment options of ADHD in advanced age are presented. [ABSTRACT FROM AUTHOR]

DiGeorge's syndrome is one of the most frequent microdeletion syndromes and is associated with a high risk for neuropsychiatric disorders of intelligence, social communication and executive functioning as well as psychotic disorders. The male patient described here represents one of the rare descriptions of Tourette's syndrome on the basis of a 22q11.2 microdeletion syndrome. The following two case studies demonstrate the variety of related clinical presentations. A characterization of these patients in a clinical and scientific context by the means of Research Domain Criteria (RDoC) enables a transdiagnostic description of overlapping as well as specific neuropsychiatric functional impairments. Possibly, this dimensional characterization might also facilitate a more exact differentiation of pleiotropic associations between genotype and phenotype. [ABSTRACT FROM AUTHOR]

Background: Autism spectrum disorder (ASD) is a chronic neurodevelopmental condition with a prevalence rate above 1%, characterized by deficits in social communication and interaction; restrictive, repetitive patterns of behavior, interests, or activities; and a preference for sameness and routines. The majority of adult ASD patients suffer from comorbid conditions such as depression and anxiety. Therapy options for adult ASD patients are lacking, with presently no available evidence-based interventions in Germany. Recently, two interventions to improve social responsiveness have been published. FASTER ("Freiburger Asperger-Spezifische Therapie für ERwachsene" = Freiburg Asperger-specific therapy for adults) is a manualized group psychotherapy program including three modules on psychoeducation, stress regulation management, and non-verbal and verbal social communication training with videotaped tasks. SCOTT&EVA ("Social Cognition Training Tool", and its enhancement "Emotionen Verstehen und Ausdruecken" = understanding and expressing emotions) is a computer-based training program to enhance social cognition including video and audio material of emotional expressions and complex real-life social situations. Initial studies for both programs have shown good feasibility and efficacy.Methods: Three hundred sixty adult participants with an autism spectrum disorder (ASD) will take part in a randomized controlled three-armed multi-center trial to prove the efficacy of manualized group psychotherapy and a manualized computer-based training program. Both interventions will be compared with a treatment as usual (TAU) group, aiming to establish evidence-based psychotherapy approaches for adult individuals with ASD. The primary outcome is evaluated by parents, spouses, or others who have sufficient insight into the respective participant's social communication and interaction, and will be measured with the Social Responsiveness Scale. First, each of both interventions will be compared to TAU. If at least one of the differences is significant, both interventions will be compared against each other. The primary outcome will be measured at baseline (T0) and 4 months after baseline (T1).Discussion: The trial is the first to validate psychiatric therapeutic and training interventions for adult ASD patients in Germany. A trial is needed because the prevalence of ASD in adulthood without intellectual disability is high, and no evidence-based intervention can be offered in Germany.Trial Registration: German Clinical Trial Register DRKS00017817 . Registered on 20 April 2020. [ABSTRACT FROM AUTHOR]

The article informs how the subgenual cingulate cortex mediates real-life effects of nonexercise activity on energy. It also mentions showing a specific association of nonexercise activity with energy in two independent samples mediated by the subgenual part of the anterior cingulate cortex (sgACC) by combining neuroimaging with ecological assessment of activity and Global Positioning System (GPS)-triggered smartphone diaries.

The overall conditions for the treatment of patients with psychiatric disorders have changed and place new demands on therapy concepts and procedures. This concerns both the legal conditions of the treatment as well as the content and economic conditions for a patient-oriented diagnostic work-up and therapy. The Central Institute for Mental Health (CIMH) in Mannheim is currently implementing a track concept that takes these changes into account and aims to overcome sectoral boundaries in favor of treatment continuity. [ABSTRACT FROM AUTHOR]

The pineal gland, as part of the human epithalamus, is the main production site of peripheral melatonin, which promotes the modulation of sleep patterns, circadian rhythms and circadian preferences (morningness vs. eveningness). The present study analyses the pineal gland volume (PGV) and its association with circadian preferences and symptom severity in adult ADHD patients compared to healthy controls. PGV was determined manually using high-resolution 3 T MRI (T1-magnetization prepared rapid gradient echo) in medication free adult ADHD patients ( N =74) compared to healthy controls ( N =86). Moreover, the Morningness–Eveningness Questionnaire (MEQ), the ADHD Diagnostic Checklist and the Wender–Utah Rating Scale were conducted. PGV differed between both groups (patients: 59.9±33.8 mm 3 ; healthy controls: 71.4±27.2 mm 3 , P =0.04). In ADHD patients, more eveningness types were revealed (patients: 29%; healthy controls: 17%; P= 0.05) and sum scores of the MEQ were lower (patients: 45.8±11.5; healthy controls 67.2±10.1; P <0.001). Multiple regression analyses indicated a positive correlation of PGV and MEQ scores in ADHD ( β =0.856, P= 0.003) but not in healthy controls ( β =0.054, P= 0.688). Patients’ MEQ scores ( β =−0.473, P =0.003) were negatively correlated to ADHD symptoms. The present results suggest a linkage between the PGV and circadian preference in adults with ADHD and an association of the circadian preference to symptom severity. This may facilitate the development of new chronobiological treatment approaches for the add-on treatment in ADHD. [ABSTRACT FROM AUTHOR]

This study explores the association of neuropsychological functioning with ADHD-symptoms and psychosocial functioning in a clinical sample of 131 adults with ADHD. Neuropsychological functioning was assessed with the computerized Test Battery of Attentional Performance (TAP). Overall psychosocial impairment was assessed with the Global Assessment of Functioning Scale (GAF). Neuropsychological performance was impaired in 39.6 % of the ADHD-patients meeting a predefined impairment criterion of a perfomance reduction of 1.5 standard deviations below normative controls in &nvge; 2 TAP-subtests; 28.4 % of the patients showed regular performance in all neuropsychological tests. Severity of neuropsychological impairment was inversely correlated to severity of psychosocial impairment (GAF score; = -.24, p < .001) but not to childhood or adult ADHD symptoms. Overall severity of neuropsychological impairment explained 10 % (p < .05) of variance of psychosocial impairment. [ABSTRACT FROM AUTHOR]

Precision psychiatry stands to benefit from the latest digital technologies for assessment and analyses to tailor treatment towards individuals. Insights into dynamic psychological processes as they unfold in humans' everyday life can critically add value in understanding symptomatology and environmental stressors to provide individualized treatment where and when needed. Towards this goal, ambulatory assessment encompasses methodological approaches to investigate behavioral, physiological, and biological processes in humans' everyday life. It combines repeated assessments of symptomatology over time, e.g., via Ecological Momentary Assessment (e.g., smartphone-diaries), with monitoring of physical behavior, environmental characteristics (such as geolocations, social interactions) and physiological function via sensors, e.g., mobile accelerometers, global-positioning-systems, and electrocardiography. In this review, we expand on promises of ambulatory assessment in the investigation of mental states (e.g., real-life, dynamical and contextual perspective), on chances for precision psychiatry such as the prediction of courses of psychiatric disorders, detection of tipping points and critical windows of relapse, and treatment effects as exemplified by ongoing projects, and on future avenues of how ambulatory interventions can benefit personalized care for psychiatric patients (e.g., through real-time feedback in everyday life). Ambulatory assessment is a key contributor to precision psychiatry, opening up promising avenues in research, diagnoses, prevention and treatment. [ABSTRACT FROM AUTHOR]