Search

In this study we addressed the question of the extent to which irregularities in genetic diversity might separate patients with major psychiatric disorders from healthy controls. Genetic diversity was quantified per gene through multidimensional “gene vectors” assembled from 4-8 polymorphic SNPs located within each of 100 candidate genes. The number of different genotypic patterns observed per gene was called the gene’s “diversity index”. Our sample was comprised of 1,698 subjects from Central Europe (1,431 psychiatric patients, 267 healthy controls), all genotyped for 549 specifically selected SNPs. The evaluation of the diversity indices of the 100 candidate genes resulted in a mean value of 109.4±82.8, ranging from 18 to 476. Highly significant deviations from “normal” diversity values were detected for (1) major depression (n=596): a significant reduction (p

Introduction Recent research suggests that traumatized patients are characterized by disrupted resting‐state functional connectivity. We examined whether neural networks involved in resting‐state change over the course of a phase‐oriented inpatient treatment for complex traumatized and dissociative disorder patients. We also investigated associations between these network alterations and clinical symptoms and emotion regulation skills. Methods Pre‐ and post‐treatment, electroencephalography (EEG) was recorded during resting‐state in patients (n = 23) with a complex dissociative disorder (CDD) or complex posttraumatic stress disorder (cPTSD). Patients also completed clinical and emotion regulation questionnaires. To reduce variance in the collected data, patients were exclusively tested as one prototypical dissociative part referred to as Apparently Normal Part (ANP). Functional network connectivity was examined and compared with a matched healthy control group (n = 37), also measured twice. Results Prior to treatment and compared with controls, patients had a significantly lower functional connectivity strength within eyes‐open and eyes‐closed resting‐state networks in the theta and alpha frequency band. Following treatment, functional connectivity strength within these networks was comparable to the control group and comprised areas belonging to the default mode network (DMN) and prefrontal as well as anterior cingulate control regions. Treatment‐related network normalizations in the theta frequency band were associated with a self‐reported increase in the use of cognitive reappraisal strategies and reduction in emotion regulation difficulties. Conclusion Phase‐oriented trauma treatment can strengthen resting‐state network connectivity and can increase the capacity of complex traumatized and dissociative patients as ANP to handle emotional challenges effectively., We examined whether neural networks involved in resting‐state change over the course of an inpatient treatment for complex traumatized and dissociative disorder patients. Prior to treatment and compared with matched‐healthy controls, patients revealed a significantly lower functional network connectivity between regions belonging to the DMN and prefrontal and anterior cingulate areas. Trauma treatment normalized patients' networks, and these changes were associated with an enhanced emotion regulation capacity.

In dem Beitrag «Mendelismus bei Psychosen, speziell bei der Schizophrenie» setzt sich Paul Eugen Bleuler (1857–1939) mit Rudins Schrift «Zur Vererbung und Neuentstehung der Dementia praecox» auseinander.

Objectives: We investigated whether patients with complex interpersonal trauma engage neural networks that are commonly activated during cognitive reappraisal and responding naturally to affect-laden images. In this naturalistic study, we examined whether trauma treatment not only reduces symptoms but also changes neural networks involved in emotional control. Methods: Before and after eight weeks of phase-oriented inpatient trauma treatment, patients (n = 28) with complex posttraumatic stress disorder (cPTSD) and complex dissociative disorders (CDD) performed a cognitive reappraisal task while electroencephalography (EEG) was registered. Patients were measured as a prototypical dissociative part that aims to fulfill daily life goals while avoiding traumatic memories and associated dissociative parts. Matched healthy controls (n = 38) were measured twice as well. We examined task-related functional connectivity and assessed self-reports of clinical symptoms and emotion regulation skills. Results: Prior to treatment and compared to controls, patients showed hypoconnectivity within neural networks involved in emotional downregulation while reappraising affect-eliciting pictures as well as viewing neutral and affect-eliciting pictures. Following treatment, connectivity became normalized in these networks comprising regions associated with cognitive control and memory. Additionally, patients showed a treatment-related reduction of negative but not of positive dissociative symptoms. Conclusions: This is the first study demonstrating that trauma-focused treatment was associated with favorable changes in neural networks involved in emotional control. Emotional overregulation manifesting as negative dissociative symptoms was reduced but not emotional underregulation, manifesting as positive dissociative symptoms. Keywords: Complex trauma, Dissociation, Electroencephalography, Functional brain network, Network-based statistic, Trauma treatment, Emotion regulation

Interview mit Prof. Dr. med. Anita Riecher-Rossler anlasslich der Verleihung des Constance Pascale – Helen Boyle Prize durch die European Psychiatric Association (EPA).

Suicide is a worldwide phenomenon. This review is based on a literature search of the World Health Organization (WHO) databases and PubMed. According to the WHO, in 2015, about 800,000 suicides were documented worldwide, and globally 78% of all completed suicides occur in low- and middle-income countries. Overall, suicides account for 1.4% of premature deaths worldwide. Differences arise between regions and countries with respect to the age, gender, and socioeconomic status of the individual and the respective country, method of suicide, and access to health care. During the second and third decades of life, suicide is the second leading cause of death. Completed suicides are three times more common in males than females; for suicide attempts, an inverse ratio can be found. Suicide attempts are up to 30 times more common compared to suicides; they are however important predictors of repeated attempts as well as completed suicides. Overall, suicide rates vary among the sexes and across lifetimes, whereas methods differ according to countries. The most commonly used methods are hanging, self-poisoning with pesticides, and use of firearms. The majority of suicides worldwide are related to psychiatric diseases. Among those, depression, substance use, and psychosis constitute the most relevant risk factors, but also anxiety, personality-, eating- and trauma-related disorders as well as organic mental disorders significantly add to unnatural causes of death compared to the general population. Overall, the matter at hand is relatively complex and a significant amount of underreporting is likely to be present. Nevertheless, suicides can, at least partially, be prevented by restricting access to means of suicide, by training primary care physicians and health workers to identify people at risk as well as to assess and manage respective crises, provide adequate follow-up care and address the way this is reported by the media. Suicidality represents a major societal and health care problem; it thus should be given a high priority in many realms.

Only very few data exist concerning hospital architecture in psychiatry/child and adolescent psychiatry. Previous data suggest that architectural improvements do reduce the application of coercive measures as well as reducing aggressive behavior, endangerment of self and others, and provoking changes in the kind and frequency of medication. In order to improve the overall hospital environment of inpatient treatment, the Center for Child and Adolescent Psychiatry and Psychotherapy of Clienia Littenheid AG developed a spatial and communication concept named “Lino Castle.” In cooperation with patients, their parents as well as members of the multidisciplinary team, we implemented a concept that serves to ameliorate the recovery process of the children and adolescents. “Lino Castle” is deeply rooted in the history of the local village and aims to allow patients to feel at ease for the duration of their stay. It hosts seven characters that serve as guardians and protectors of the individual wards and represent various types of disorders and emotional states. The respective architectural concept grew out of the storyline of “Lino Castle” and combines colors, forms, materials, graphics, and furniture to ensure an environment conducive to healing and reduced anxiety. With the implementation of “Lino Castle,” we observed that the number of admissions and hospital occupancy increased significantly, whereas the length of stay and the ratio of involuntary admissions in closed wards decreased. We presume that this turn of events is due to higher commitment, acceptance, and less aggressive behavior in the patients, and to higher motivation and work satisfaction in the staff. Es gibt nur wenige Daten über Krankenhausarchitektur in psychiatrischen Kliniken. Die bisherigen Daten weisen darauf hin, dass architektonische Verbesserungen die Anwendung von Zwangsmaßnahmen verringern und zu einer Verminderung von aggressivem Verhalten, Selbst- und Fremdgefährdung und einer Veränderung in der Art und Häufigkeit einer Medikation führen. Mit dem Ziel, die Krankenhausumgebung der stationären Behandlung zu verbessern, hat das Zentrum für Kinder- und Jugendpsychiatrie und -psychotherapie der Clienia Littenheid AG das Raum- und Kommunikationskonzept „Burg Lino“ entwickelt. Gemeinsam mit den Patientinnen und Patienten, ihren Eltern und den Mitarbeitenden des multidisziplinären Teams entstand ein Konzept, das den Genesungsprozess von Kindern und Jugendlichen unterstützen und ihnen den stationären Aufenthalt erleichtern soll. Das architektonische Raumkonzept leitet sich aus der Geschichte von „Burg Lino“ ab und vereinigt Farben, Formen, Materialien, Grafiken und Möbel, um einen Genesungsprozess anzustoßen und eine angstreduzierende Umgebung zu schaffen. Mit Umsetzung von „Burg Lino“ stellten wir eine signifikante Zunahme stationärer Aufnahmen und der Belegung fest. Die Verweildauern und der Anteil der Behandlungstage unfreiwilliger Aufnahmen im fakultativ geschlossenen Bereich nahmen hingegen ab. Wir vermuten, dass diese Veränderungen Folge eines höheren Commitments, einer höheren Akzeptanz und geringeren Aggressivität bei den Patienten sowie einer höheren Motivation und Zufriedenheit bei den Mitarbeitenden ist.

Background Neurological soft signs (NSS) represent minor neurological signs which indicate non-specific cerebral dysfunction. Numerous studies have confirmed their presence in schizophrenia across all stages of the disease. NSS have been looked at as an endophenotype or a trait phenomenon for many decades. However, during the past years studies increasingly reported on fluctuations of the NSS scores. To shade further light on the question whether NSS represent a state or a trait component or both, a review of longitudinal studies on schizophrenia patients was performed, because only measurements at two or more points in time can answer the question at hand. Methods A search of studies which had assessed NSS in adult schizophrenia patients and included at least one follow-up examination was undertaken. Studies which had been published between January 1966 and June 2017 and listed in relevant databases were included. Due to the fact, that ongoing brain maturation lasts until adulthood and is paralleled by a loss of those NSS which are present in childhood, studies on teenagers were excluded. Results Twenty-nine follow-up studies were identified which overall used well-known instruments for the investigation of NSS. Patients were at different disease stages. All expressed abnormally increased NSS, however to different extents. An NSS reduction during the course was detected in most first episode patients and those with a remitting course whereas chronically ill patients exhibited stable or increasing NSS scores. The change over time could for the most part be attributed to changes in the motor system subscales and to a lesser amount to sensory integration scales. As opposed to the earlier notion that medication evokes or worsens NSS, studies largely agreed on a positive interrelation between medication response and improvement of NSS. The type of antipsychotic was of small importance and when side-effects were commented on there was a weak relationship with NSS. On the other hand, studies gave some hints at relationships between NSS and symptoms, i.e. negative and cognitive symptoms. Discussion The reviewed studies confirmed the presence of abnormal, i.e. elevated NSS in patients diagnosed with schizophrenia. Studies disagreed on the amount of abnormalities in NSS. However, subgroups emerged with either stable or fluctuating properties of NSS. The latter speaks very much in favor of a state-trait dichotomy being present in NSS and thus challenges the view that NSS depict an endophenotype.

Spumaretroviruses or foamy viruses constitute a distinct subfamily of retroviruses. The biology of foamy viruses within the authentic host, their mode of transmission, and disease potential in the authentic host or after zoonotic transmission into human or other species are almost unknown. Using feline foamy virus (FFV) as model system, we established modular enzyme-linked immunosorbent assays (ELISA) suited to determine feline IgG and IgM antibody responses against structural and non-structural FFV proteins. We validated the ELISAs with standard reference sera. In 99 cats admitted to a Swiss veterinary hospital, overall FFV Gag antibody prevalence was 36%, reactivity against Env and the non-structural protein Bet each was about 25%, and 19% of the sera were directed against all three FFV antigens. With one exception, all Bet- and/or Env-positive sera were also positive for Gag. In this small epidemiological pilot study, FFV antibodies were not significantly associated with clinical disease.

Neurological soft signs (NSS) comprise subtle deficits in sensory integration, motor coordination, and sequencing of complex motor acts, which are typically observed in the majority of schizophrenia patients, including chronic cases and neuroleptic-naïve first-episode patients. However, recent studies clearly demonstrate that NSS are not a static feature of schizophrenia but vary in the clinical course of the disorder. This effect was investigated in a meta-analysis based on 17 longitudinal studies published between 1992 and 2012. Studies included between 10 and 93 patients with schizophrenia spectrum disorders (total number 787) with follow-up periods between 2 and 208 weeks. Beside the Neurological Examination Scale, the Cambridge Neurological Inventory and the Heidelberg NSS Scale were used to assess NSS. All but three studies found NSS to decrease in parallel with remission of psychopathological symptoms. This effect was more pronounced in patients with a remitting compared to a non-remitting, chronic course (Cohen's d 0.81 vs. 0.15) and was significantly correlated with length of the follow-up period (r = -0.64) but not with age (r = 0.28). NSS scores did not decrease to the level typically observed in healthy controls. From a clinical perspective, NSS may therefore be used to identify subjects at risk to develop schizophrenia and to monitor disease progression.

Schizophrenia is a serious brain disease of uncertain etiology. A role for retroviruses in the etiopathogenesis of some cases of schizophrenia has been postulated on the basis of clinical and epidemiological observations. We found sequences homologous to retroviral pol genes in the cell-free cerebrospinal fluids (CSFs) of 10 of 35 (29%) individuals with recent-onset schizophrenia or schizoaffective disorder. Retroviral sequences also were identified in the CSFs of 1 of 20 individuals with chronic schizophrenia. However, retroviral sequences were not identified in any of the CSFs obtained from 22 individuals with noninflammatory neurological diseases or from 30 individuals without evidence of neurological or psychiatric diseases (χ 2 = 19.25, P < 0.001). The nucleotide sequences identified in the CSFs of the individuals with schizophrenia or schizoaffective disorder were related to those of the human endogenous retroviral (HERV)-W family of endogenous retroviruses and to other retroviruses in the murine leukemia virus genus. Transcription of RNA homologous to members of the HERV-W family of retroviruses also was found to be up-regulated differentially in the frontal cortex regions of brains obtained postmortem from individuals with schizophrenia, as compared with corresponding tissue from individuals without psychiatric diseases. The transcriptional activation of certain retroviral elements within the central nervous system may be associated with the development of schizophrenia in at least some individuals. The further characterization of retroviral elements within the central nervous system of individuals with schizophrenia might lead to improved methods for the diagnosis and management of this disorder.

The frontal hypothesis of aging predicts an age-related decline in cognitive functions requiring inhibitory or attentional regulation. In Alzheimer's disease, preattentive gating out of redundant information is impaired. Our study aimed to examine changes associated with physiological aging in both pre- and early attentive inhibition of recurrent acoustic information. Using a passive double-click paradigm, we recorded mid-latency (P30-P50) and late-latency (N100 and P200) evoked potentials in healthy young (26 ± 5 years) and healthy elderly subjects (72 ± 5 years). Physiological aging did not affect auditory gating in amplitude measures. Both age groups exhibited clear inhibition in preattentive P50 and attention-modulated (N100) components, whereas P30 was not attenuated. Irrespective of age, the magnitude of inhibition differed significantly, being most pronounced for N100 gating. Inhibition of redundant information seems to be preserved with physiological aging. Early attentive N100 gating showed the maximum effect. Further studies are warranted to evaluate sensory gating as a suitable biomarker of underlying neurodegenerative disease.

We previously reported on the differential presence of transcripts related to the human endogenous retrovirus (HERV)-W family in cerebrospinal fluid and plasma from patients with first-episode schizophrenia compared with control individuals. Whether this is a consequence of qualitative or quantitative differences in transcription of genomic regions harboring HERV-W elements is not known. The purpose of the present study was therefore to characterize the transcribed HERV-W elements in mononuclear cells obtained from 30 patients first hospitalized for schizophrenia-related psychosis and from 26 healthy control individuals. We observed elevated total levels of HERV-W gag (2.1-fold, P < 0.01) but not env transcripts in the cells of patients compared with controls. By using the melting temperatures of the amplicons as a proxy marker for sequence identity, no absolute qualitative differences was detected between the two groups. Mapping of the detected transcripts identified several intronic and intergenic HERV-W elements transcribed in the cells, including elements previously considered transcriptionally silent. Element-specific assays revealed elevated levels of intronic transcripts containing HERV-W gag sequence from the putative gene PTD015 on chromosome 11q13.5 (1.6-fold, P < 0.05) in the patients compared with the controls. Thus, studies aiming to further understanding of complex human disease such as schizophrenia may need to be extended beyond the strictly protein-coding fraction of the transcriptome.

HERV-W-related RNA detected in plasma from individuals with recent-onset schizophrenia or schizoaffective disorder

Schizophrenia is a pervasive neuropsychiatric disease of uncertain etiology. Previous studies have postulated that retroviruses may contribute to the etiology of some cases of schizophrenia. We examined the possible relationship between retroviral infection and schizophrenia by measuring antibodies to a number of different primate retroviruses in the sera of individuals undergoing their first hospitalization for this disease. Sera from patients with first onset schizophrenia and matched healthy controls were analyzed by immunoblot and enzyme linked immunosorbent assays using purified retrovirus antigens to identify and quantify antibodies reactive with retrovirus proteins. A significantly increased incidence of antibodies reactive to gag encoded proteins of Mason-Pfizer monkey virus (MPMV), baboon endogenous virus (BaEV) and simian retrovirus type 5 (SRV-5) was observed in the sera of schizophrenia patients compared to controls. The reactivity of the cases and controls displayed the greatest differences in terms of antibodies to the proteins of Mason-Pfizer monkey virus. Employing an algorithm of enzyme linked immunosorbent assay reactivity followed by immunoblot confirmation, we found that MPMV antibodies in 28.9% of the individuals with first episode schizophrenia patients as compared to 3.7% of the unaffected controls (P