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ZusammenfassungIn der Geschichte von Psychiatrie und Otologie gibt es Belege, dass psychische und Hörerkrankungen voneinander abhängen können. So wiesen z. B. Emil Kraepelin 1915 und eine 1962 publizierte Leipziger Reihenuntersuchung darauf hin, dass hörerkrankte Menschen häufiger psychisch auffällig werden oder psychisch erkranken als hörgesunde.Wir skizzieren den Fall einer Patientin, die vor und nach der Geburt einer Tochter psychopathologische Auffälligkeiten v. a. in der Aufmerksamkeit, kognitiven Umstellungsfähigkeit und sozialen Kompetenz aufwies. Nach der Diagnose einer beidseitigen mittelgradigen Schallempfindungsschwerhörigkeit und der Versorgung mit Hörgeräten war der psychopathologische Befund unauffällig. Der Fall kann eine Erinnerung dafür sein, dass nach wie vor Hörgeschädigte aufgrund ihrer fehlenden oder eingeschränkten Kommunikationsfähigkeit in der Versorgung durch fachspezifische Grenzen fallen.

In the history of psychiatry and otology, there is evidence that mental and hearing disorders can be interdependent. For example, Emil Kraepelin in 1915 and a Leipzig serial study published in 1962 indicated that hearing-impaired people become psychologically conspicuous or mentally till more often than people whose hearing is not impaired.We outline the case of a patient who showed psychopathological abnormalities before and after giving birth to her daughter, especially in attention, cognitive conversion ability and social competence. After being diagnosed a bilateral moderate sensorineural hearing loss and being provided with hearing aids, no psychopathology was detectable. The case may be a pointer to the fact that hearing-impaired patients still fall through professional boundaries and are not provided with adequate care due to their lack of or limited ability to communicate.In der Geschichte von Psychiatrie und Otologie gibt es Belege, dass psychische und Hörerkrankungen voneinander abhängen können. So wiesen z. B. Emil Kraepelin 1915 und eine 1962 publizierte Leipziger Reihenuntersuchung darauf hin, dass hörerkrankte Menschen häufiger psychisch auffällig werden oder psychisch erkranken als hörgesunde.Wir skizzieren den Fall einer Patientin, die vor und nach der Geburt einer Tochter psychopathologische Auffälligkeiten v. a. in der Aufmerksamkeit, kognitiven Umstellungsfähigkeit und sozialen Kompetenz aufwies. Nach der Diagnose einer beidseitigen mittelgradigen Schallempfindungsschwerhörigkeit und der Versorgung mit Hörgeräten war der psychopathologische Befund unauffällig. Der Fall kann eine Erinnerung dafür sein, dass nach wie vor Hörgeschädigte aufgrund ihrer fehlenden oder eingeschränkten Kommunikationsfähigkeit in der Versorgung durch fachspezifische Grenzen fallen.

Arousal systems are one of the recently announced NIMH Research Domain Criteria to inform future diagnostics and treatment prediction. In major depressive disorder (MDD), altered central nervous system (CNS) wakefulness regulation and an increased sympathetic autonomic nervous system (ANS) activity have been identified as biomarkers with possible discriminative value for prediction of antidepressant treatment response. Therefore, the hypothesis of a more pronounced decline of CNS and ANS-arousal being predictive for a positive treatment outcome to selective-serotonin-reuptake-inhibitor (SSRI) treatment was derived from a small, independent exploratory dataset (N = 25) and replicated using data from the randomized international Study to Predict Optimized Treatment Response in Depression (iSPOT-D). There, 1008 MDD participants were randomized to either a SSRI (escitalopram or sertraline) or a serotonin-norepinephrine-reuptake-inhibitor (SNRI-venlafaxine) arm. Treatment response was established after eight weeks using the 17-item Hamilton Rating Scale for Depression. CNS-arousal (i.e. electroencephalogram-vigilance), ANS-arousal (heart rate) and their change across time were assessed during rest. Responders and remitters to SSRI treatment were characterized by a faster decline of CNS-arousal during rest whereas SNRI responders showed a significant increase of ANS-arousal. Furthermore, SSRI responders/remitters showed an association between ANS- and CNS-arousal regulation in comparison to non-responders/non-remitters while this was not the case for SNRI treatment arm. Since positive treatment outcome to SSRI and SNRI was linked to distinct CNS and ANS-arousal profiles, these predictive markers probably are not disorder specific alterations but reflect the responsiveness of the nervous system to specific drugs. (C) 2015 Elsevier Ltd. All rights reserved.

Structural and metabolic alterations in prefrontal brain areas, including the subgenual (SGPFC), medial (MPFC) and dorsolateral prefrontal cortex (DLPFC), have been shown in major depressive disorder (MDD). Still it remains largely unknown how brain connectivity within these regions is altered at the level of neuronal oscillations. Therefore, the goal was to analyze prefrontal electroencephalographic phase synchronization in MDD and its changes after antidepressant treatment. In 60 unmedicated patients and 60 healthy controls (HC), a 15-min resting electroencephalogram (EEG) was recorded in subjects at baseline and in a subgroup of patients after 2 weeks of antidepressant medication. EEG functional connectivity between the SGPFC and the MPFC/DLPFC was assessed with eLORETA (low resolution brain electromagnetic tomography) by means of lagged phase synchronization. At baseline, patients revealed increased prefrontal connectivity at the alpha frequency between the SGPFC and the left DLPFC/MPFC. After treatment, an increased connectivity between the SGPFC and the right DLPFC/MPFC at the beta frequency was found for MDD. A positive correlation was found for baseline beta connectivity and reduction in scores on the Hamilton depression rating scale. MDD is characterized by increased EEG functional connectivity within frontal brain areas. These EEG markers of disturbed neuronal communication might have potential value as biomarkers.

The anticonvulsant drug lamotrigine (LTG), a sodium channel blocker and inhibitor of glutamate release, has been found to have antidepressant effects in the treatment of bipolar disorder. It is recommended by certain therapy guidelines as a first-line agent for acute and maintenance therapy in bipolar depression, but there have been only some promising results of placebo-controlled trials on its acute antidepressant effects, and the recommendation in therapy guidelines has been reconsidered. On the contrary, positive results for maintenance therapy could be confirmed, and LTG is still a well-tolerated option, especially in patients with predominant depressive episodes. Antimanic effects are not shown in the literature, and its use is not advised in any guidelines that were examined. In conclusion, the findings of the present review article on treatment guidelines for bipolar disorder question the role of LTG in acute depressive states, and critically discusses its use, particularly in acute depressive states.

Large-scale longitudinal multi-site MRI brain morphometry studies are becoming increasingly crucial to characterize both normal and clinical population groups using fully automated segmentation tools. The test-retest reproducibility of morphometry data acquired across multiple scanning sessions, and for different MR vendors, is an important reliability indicator since it defines the sensitivity of a protocol to detect longitudinal effects in a consortium. There is very limited knowledge about how across-session reliability of morphometry estimates might be affected by different 3T MRI systems. Moreover, there is a need for optimal acquisition and analysis protocols in order to reduce sample sizes. A recent study has shown that the longitudinal FreeSurfer segmentation offers improved within session test-retest reproducibility relative to the cross-sectional segmentation at one 3T site using a nonstandard multi-echo MPRAGE sequence. In this study we implement a multi-site 3T MRI morphometry protocol based on vendor provided T1 structural sequences from different vendors (3D MPRAGE on Siemens and Philips, 3D IR-SPGR on GE) implemented in 8 sites located in 4 European countries. The protocols used mild acceleration factors (1.5-2) when possible. We acquired across-session test-retest structural data of a group of healthy elderly subjects (5 subjects per site) and compared the across-session reproducibility of two full-brain automated segmentation methods based on either longitudinal or cross-sectional FreeSurfer processing. The segmentations include cortical thickness, intracranial, ventricle and subcortical volumes. Reproducibility is evaluated as absolute changes relative to the mean (%), Dice coefficient for volume overlap and intraclass correlation coefficients across two sessions. We found that this acquisition and analysis protocol gives comparable reproducibility results to previous studies that used longer acquisitions without acceleration. We also show that the longitudinal processing is systematically more reliable across sites regardless of MRI system differences. The reproducibility errors of the longitudinal segmentations are on average approximately half of those obtained with the cross sectional analysis for all volume segmentations and for entorhinal cortical thickness. No significant differences in reliability are found between the segmentation methods for the other cortical thickness estimates. The average of two MPRAGE volumes acquired within each test-retest session did not systematically improve the across-session reproducibility of morphometry estimates. Our results extend those from previous studies that showed improved reliability of the longitudinal analysis at single sites and/or with non-standard acquisition methods. The multi-site acquisition and analysis protocol presented here is promising for clinical applications since it allows for smaller sample sizes per MRI site or shorter trials in studies evaluating the role of potential biomarkers to predict disease progression or treatment effects.

To overcome the limitations of the syndrome-based diagnostic routine in neuropsychiatric disorder and to provide biomarker-informed decisions for treatment, recently the Research Domain Criteria have been initialized[1]. They include separate criteria for autonomous and arousal systems. Based on findings of altered wakefulness-regulation and autonomous function in major depressive disorder (MDD), the goal of this study therefore was to investigate the predictive value for treatment outcome of central nervous system (CNS) and autonomous nervous system (ANS) arousal and their interaction in a large cohort of patients from the iSPOT-D trial that received either a selective-serotonin reuptake-inhibitor (SSRI) or a serotonin-norepinephrine-reuptake-inhibitor (SNRI). Methods CNS and ANS-arousal (defined by electroencephalogram vigilance and heart rate) and their change over time were assessed during rest. Differences of treatment outcome as defined by the decline of Hamilton Rating Scale for Depression-(HRSD) from baseline to week 8 after treatment initiation for the whole sample and for SSRI and SNRI groups separately were analysed using a binary logistic regression model and repeated measure analysis of variance (ANOVA). Results Responders and remitters were characterized by a steeper decline of CNS-arousal. Subgroup analysis showed that this effect was only present for the SSRI arm whereas SNRI responders showed a more pronounced increase of ANS-arousal. Further, SSRI responders showed a correlation between ANS and CNS measures, SSRI non-responders and the whole SNRI subgroup did not. Conclusions CNS and ANS-arousal during rest predict positive treatment outcome to antidepressant medication. The differences of CNS and ANS-profiles for SSRI or SNRI prediction are interpreted as neurophysiological traits that indicate responsiveness to different drug-classes rather than disorder specific aspects.