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Neuroscientific investigation of the detailed neurophysiology of emotion processing is a rapidly progressing field, which has opened discussion on key findings regarding the timing characteristics of the neuronal networks involved. Study designs incorporating quantitative electroencephalography (EEG) and event-related potentials (ERP) have mapped neuronal representations at various stages of emotion processing, identifying early and late stages corresponding to cerebral activity in attention and in appraisal of emotion. Interestingly, in addition to confirming aspects of cerebral cortex involvement, these investigations have also implicated the cerebellum in emotion processing. This has led to research aimed at distinguishing the contributions of cerebellar and cerebral networks and how these may interrelate. With respect to underlying neurophysiological mechanisms, ERP studies confirm that the cerebellum is involved in both early and late stages of processing of salient emotion cues, and also in capturing emotions in facial expressions. Topological analyses indicate direct connections between the vermis, Crus I, and Crus II areas of the cerebellum and the cerebral area of lateral prefrontal cortex. This suggests a broad evolutionary development of large-scale cerebral networks in emotion. In this chapter, we highlight findings to date of neurophysiological activity related to cerebellar participation in emotion processing. The neurophysiological findings, which by inference represent underlying neural activity, emphasize an integrative role of the cerebellum in emotion.

Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): The Burdett Trust for Nursing Background The COVID-19 pandemic affected health care systems profoundly. Inherited cardiac condition (ICC) specialist nurses were redeployed to intensive care or acute settings which either left services with no nurse or a single nurse manning a normally busy service (Bueser 2020). An exponential rise in patients reaching out to patient support charities was seen (Charity Today 2020) and at the peak of the pandemic, nurses based at an ICC charity dealt with 599 inquiries which was a 328% increase in activity. The toll on the mental health of nurses during the pandemic is well documented and programmes have been suggested to address this which includes peer support and psychological support by clinical psychologists Purpose The aim was to develop and strengthen collaborations between ICC specialist nurses in a tertiary hospital and those working in the community charity sector; and provide peer and psychological support to enable consistent high quality patient care. Methods The project was based on Wenger’s (1999) Communities of Practice (COP) framework model of situational learning, collaboration among peers, working to a common purpose. To develop the counselling aspect, a psychotherapist led a scoping exercise with the group. The 4Rs Skilled Helper Programme (SHP) of reflective learning, supervision and continuing professional development was then adapted as a bespoke programme - combining 30 hours of formal counselling, communication and reflective learning skills with equal attention to the normative, formative and restorative components of support and development needed to ensure practitioner health and wellbeing and the safety and quality of patient care Results Nine ICC nurses from a tertiary hospital and 3 from the charity sector participated in the project. Nine nurses undertook the tailored 4RS SHP course, adapting Egan's 3 stage problem-solving, decision-making and opportunity development framework as the vehicle for personalised, psychosocial, time-sensitive decision-making and informed consent for patients, and for the identification of support and development strategies that represent the 'best fit' for both clients and practitioners in their particular social and organisational circumstances. Counselling supervision is ongoing on a whole group, team and individual basis and provides opportunities to discuss collaborations, gain support for challenging clinical cases and work situations; and promoting psychological well-being. Conclusions The COP established through this project alongside the development of a bespoke counselling course and psychological supervision is an exemplar of how nurses can be empowered to continue to provide excellent care despite challenging circumstances. The 4RS SHP course also specifically addresses the competency needs for ICC nurses as move towards a genomics-driven, personalised health care delivery model.

Persons with cognitive impairment(s) are overrepresented in the criminal justice system(CJS) yet many instances of cognitive impairment go undiagnosed. As this article outlines, it would be both desirable and feasible to use automated alerts to flag accused persons who may require assistance in interacting with the CJS either due to a confirmed or likely diagnosis of a cognitive impairment or other relevant condition. A proposed method to develop this alert system is outlined, combining Natural Language Processing (NLP) applied to Electronic Health Records (EHRs) with data linkage (DL)of health and CJS data. Although there are technical barriers, this article focuses on the ethical and legal barriers of this proposed approach. It is concluded that the overall benefits of the proposed alert system would likely outweigh potential adverse outcomes. It is argued that a waiver of consent would be appropriate and that legal barriers, in terms of privacy legislation at both Federal and State levels, which apply varying requirements for the disclosure of personal information, may be overcome in part through de-identification strategies. The examples provided in this paper of criminological data linkage projects support the feasibility of the method proposed.

Background: The ketogenic diet (KD) is a high-fat, low-carbohydrate diet that limits glucose and results in the production of ketones by the liver and their uptake as an alternative energy source by the brain. KD is an evidence-based treatment for intractable epilepsy. KD is also self-administered, with limited evidence of efficacy, for conditions including weight loss, cognitive and memory enhancement, type II diabetes, cancer, neurological and psychiatric disorders. A commonly discussed side effect of KD in media and online forums is “keto flu”, a cluster of transient symptoms generally reported as occurring within the first few weeks of KD. This study aimed to characterize the pattern of symptoms, severity and time course of keto flu as related by users of online forums. Method: Online forums referring to “keto flu”, “keto-induction” or “keto-adaptation” in the URL were identified in Google. Passages describing personal experiences of keto flu were categorized manually with reference to pattern of symptoms, severity, time course and recommended remedies. Results: The search criteria identified 75 online forums, 43 met inclusion criteria and contained 448 posts from 300 unique users. Seventy-three made more than one post (mean 3.12, range 2-11). Descriptors of personal experience of keto flu, reported by 101 of 300 users, included 256 symptom descriptions involving 54 discrete symptoms. Commonest symptoms were ‘flu’, headache, fatigue, nausea, dizziness, ‘brain fog’, gastrointestinal discomfort, decreased energy, feeling faint and heartbeat alterations. Symptom reports peaked in the first and dwindled after four weeks. Resolution of keto flu symptoms was reported by eight users between days 3-30 (median 4.5, IQR 3-15). Severity of symptoms, reported by 60 users in 40 forums, was categorised as mild (N=15), moderate (N=23) or severe (N=22). Eighteen recommended remedies were proposed by 121 individual users in 225 comments. Conclusions: symptoms reported in online forums peaked in week 1 and resolved by week 4. Typically, individual posts provided fragmentary descriptions related to the flow of forum conversations. A composite picture emerged across 101 posts describing personally experienced symptoms. User conversations were generally supportive, sharing remedies for keto flu reflecting assumptions of physiological effects of KD.

Psychiatry is inherently complex and vast amounts of material have been written on the topic. One of the largest collections of the extant material is archived in German Berrios’ personal library. The synthesis of this material has come to life through his rare powers of intellect, eidetic memory, and decades of early morning reading in a variety of languages. Its expression has taken many forms, including a series of conceptual histories on psychiatric topics. Conceptual history teases out the historical semantics of a concept, what it meant to people using the term in different ages, in different languages, against what contextual background. Accompanying German Berrios on these journeys has for many clinicians, academics, and others been a stimulating, thought-provoking, and mind-opening experience. An early adopter of and advocate for information technology in publishing both old and new, Berrios continues to influence the way we think, and his legacy will shape the minds of many people addressing the mysteries in the mind and brain sciences in years to come. This paper attempts to bring together some of the extraordinary characteristics of German the person and his remarkable contributions to scholarship.

Objective Instruments rating risk of harm to self and others are widely used in inpatient forensic psychiatry settings. A potential alternate or supplementary means of risk prediction is from the automated analysis of case notes in Electronic Health Records (EHRs) using Natural Language Processing (NLP). This exploratory study rated presence or absence and frequency of words in a forensic EHR dataset, comparing four reference dictionaries. Seven machine learning algorithms and different time periods of EHR analysis were used to probe which dictionary and which time period were most predictive of risk assessment scores on validated instruments. Materials and methods The EHR dataset comprised de-identified forensic inpatient notes from the Wilfred Lopes Centre in Tasmania. The data comprised unstructured free-text case note entries and serial ratings of three risk assessment scales: Historical Clinical Risk Management-20 (HCR-20), Short-Term Assessment of Risk and Treatability (START) and Dynamic Appraisal of Situational Aggression (DASA). Four NLP dictionary word lists were selected: 6865 mental health symptom words from the Unified Medical Language System (UMLS), 455 DSM-IV diagnoses from UMLS repository, 6790 English positive and negative sentiment words, and 1837 high frequency words from the Corpus of Contemporary American English (COCA). Seven machine learning methods Bagging, J48, Jrip, Logistic Model Trees (LMT), Logistic Regression, Linear Regression and Support Vector Machine (SVM) were used to identify the combination of dictionaries and algorithms that best predicted risk assessment scores. Results The most accurate prediction was attained on the DASA dataset using the sentiment dictionary and the LMT and SVM algorithms. Conclusions NLP, used in conjunction with NLP dictionaries and machine learning, predicted risk ratings on the HCR-20, START, and DASA, based on EHR content. Further research is required to ascertain the utility of NLP approaches in predicting endpoints of actual self-harm, harm to others or victimisation.

Widespread cortical-subcortical networks are involved in the recognition and discrimination of emotional contents of facial and vocal expression, whereby the cerebellum and basal ganglia are two subcortical regions implicated in these networks with limited evidence to their specific contributions. To investigate this we compared patients with circumscribed cerebellar lesions and patients with Parkinson's disease (PD) on an approved test battery. We studied two groups with subcortical disease, focal cerebellar infarction (n = 22) and PD (n = 22), and a neurological control group with focal supratentorial ischemia (SI) (n = 16) were. Assessments were according to inpatient protocols for neuropsychological routine evaluation, including tests of memory, executive function and attention. Participants completed the Tuebingen Affect Battery, a recognized measure of recognition and discrimination of facial and vocal expression of emotion. As a result, cerebellar lesions were associated with greater impairment than PD and SI in recognition and discrimination of cues of both facial and vocal expressions of differing basic emotions. No confounding effect of other cognitive domains, particularly executive function and attention, was found. Taken together, our findings suggest a specific contribution of the cerebellum to cerebral networks that process facial and vocal emotion expression, related to rapid decisions regulating appropriate behavioral responses in social environments.

Background and objectives Computer-aided vicarious exposure (CAVE) for obsessive-compulsive disorder (OCD) is an intervention in which participants learn and rehearse exposure with response prevention (ERP) by directing a character around a virtual world. This study aimed to pilot an online CAVE program for OCD in a community sample with high OCD symptomatology. Methods Participants ( n = 78) were allocated to an intervention group (three 45-min weekly CAVE sessions) or to a waitlist control group. The treatment group were asked to complete three 45-min sessions over a four week period. Results Those who completed at least one CAVE session showed greater improvement on measures of OCD symptomatology at one-month post-treatment ( d = 0.49–0.81) compared to waitlist ( d = 0.01–0.1). Older age, past treatment and higher symptom severity were associated with non-adherence. Limitations These findings should be considered preliminary due to sample size limitations and an absence of an active control group. However, the findings suggest that further development and evaluation of the program is warranted. Conclusions Preliminary findings suggest that online CAVE programs have potential to bridge treatment gaps among those reluctant to attend treatment or engage with in vivo exposure exercises. These programs may also have potential applications as an adjunct to face-to-face or online cognitive behavioural therapy.

Australia has a generally progressive approach to mental health law, reflective of international trends in human rights. Responsibility for most legislation is vested in the six States and two Territories, a total of eight jurisdictions, such that at any given time several new mental health acts are in preparation. In addition there is a model mental health act that promotes common standards. Transfer of orders between jurisdictions relies on Memoranda of Understanding between them, and is patchy. State and Territory legislation is generally cognisant of international treaty obligations, which are themselves the preserve of the Federal Parliament and legislature. UK legislation has had a key influence in Australia, the 1959 Mental Health Act in particular, with its strong emphasis on voluntary hospitalisation, prefacing deinstitutionalisation.

Objectives: The personality trait of sensation seeking (SeSe) is associated with high-risk sports. However, the relationship between SeSe and energy expenditure (EE) has not been examined in detail using objective measures. Methods: Twenty-two female and 21 male healthy participants were assessed for SeSe on the Arnett Inventory of Sensation Seeking (AISS), examining total score and intensity and novelty subscale scores. Total energy expenditure (TEE) per day was calculated using a SenseWear ® armband. Results: Significant positive correlations were found between AISS total and TEE (r = 0.35, p p Conclusions: Self-reported sensation seeking was associated with high total energy expenditure. The pattern of preferred activity in high sensation seekers favors intensity rather than novelty.

Growing evidence supports a mutual relationship between inflammation and major depression. A variety of mechanisms are outlined, indicating how inflammation may be involved in the pathogenesis, course and treatment of major depression. In particular, this review addresses 1) inflammatory cytokines as markers of depression and potential predictors of treatment response, 2) findings that cytokines interact with antidepressants and non-pharmacological antidepressive therapies, such as electroconvulsive therapy, deep brain stimulation and physical activity, 3) the influence of cytokines on the cytochrome (CYP) p450-system and drug efflux transporters, and 4) how cascades of inflammation might serve as antidepressant drug targets. A number of clinical trials have focused on agents with immunmodulatory properties in the treatment of depression, of which this review covers nonsteroidal anti-inflammatory drugs (NSAIDs), cytokine inhibitors, ketamine, polyunsaturated fatty acids, statins and curcumin. A perspective is also provided on possible future immune targets for antidepressant therapy, such as toll-like receptor-inhibitors, glycogen synthase kinase-3 inhibitors, oleanolic acid analogs and minocycline. Concluding from the available data, markers of inflammation may become relevant factors for more personalised planning and prediction of response of antidepressant treatment strategies. Agents with anti-inflammatory properties have the potential to serve as clinically relevant antidepressants. Further studies are required to better define and identify subgroups of patients responsive to inflammatory agents as well as to define optimal time points for treatment onset and duration.

To clarify findings of elevated cytokine levels in major depression (MD), this study aimed to investigate the relationship between serum levels of cytokines, symptoms of MD and antidepressant treatment outcome. At baseline (T0) and 4 weeks following initiation of antidepressant treatment (T1), levels of tumor necrosis factor (TNF)-α, interferon (IFN)-γ, interleukin (IL)-2, IL-4, IL-5, IL-10, IL-12, IL-13, granulocyte-macrophage-colony-stimulating-factor (GM-CSF), CRP and depression ratings HAMD-17 and BDI-II were assessed in 30 patients with MD and 30 age-and sex-matched controls. At T0, in the patient group, cytokines, but not CRP, negatively correlated with individual BDI-II-items, factors and severities and showed both negative and positive correlations with HAMD-17 items. At T1 and within the controls, no such relationships were observed. At T0 and T1, levels of both pro- and anti-inflammatory cytokines were significantly higher in treatment responders (ΔHAMD-17T0-T1≥50%,n=15) compared to non-responders. When controlled for baseline BDI, differences between groups were only found significant for IL-2 at T0. The results suggest cytokines are not generally pro-depressive but rather relate to more specific regulation of symptoms and severities in MD. Together with the association between cytokines and treatment responder status, these data support cytokines as a promising but still controversial biomarker of depression.

Weight gain and metabolic disturbances are common side effects during psychopharmacological treatment with specific antipsychotics and antidepressants. The antipsychotics clozapine and olanzapine, and antidepressants tricyclics and mirtazapine have a high risk of inducing weight gain. Recently discovered pathophysiological mechanisms include antihistaminergic effects, activation of hypothalamic adenosine monophosphate-activated protein kinase (AMPK), modulation of hormonal signaling of ghrelin and leptin, changes in the production of cytokines such as tumor necrosis factor-alpha (TNF)-alpha and adipokines such as adiponektin, and the impact of genes, in particular the melanocortin 4 receptor (MC4R), serotonin 2C receptor (HTR2C), leptin, neuropeptide Y (NPY) and cannabinoid receptor 1 (CNR1) genes. Metabolic changes associated with weight gain include disturbances of glucose and lipid metabolism. Clozapine and olanzapine may, in addition to mechanisms resulting from weight gain, impair glucose metabolism by blockade of the muscarinic M3 receptor (M3R). Antidepressants associated with weight gain appear to have fewer unfavourable effects on glucose and lipid metabolism than the second-generation antipsychotics clozapine and olanzapine. To assess the risk of weight gain and its consequences for the patient's health, assessing body weight changes and metabolic monitoring in the first week of treatment as well as in long-term treatment is recommended.

Aim/Purpose: The primary use of electronic health records (EHRs) is in the care of the individual patient. Secondary research uses employ information in EHRs for purposes beyond that of care of the individual. Secondary research uses may broadly be divided into studies which focus on improving care and treatment of individuals and those which aim to increase knowledge about disease causes, associations and prevalence at a population level. This paper provides a review of studies that have used EHRs to increase knowledge at a population level. It examines the methods used, types of research conducted, difficulties and challenges faced and implications for future research and mental health research in particular.Method: A review was undertaken based on a search for peer-reviewed and recently (i.e. since 2005) published articles with full-text available online.Findings/Results: The studies which have used EHRs to increase knowledge have predominantly involved; (1) data mining to identify biomarkers and gene–...

Australian & New Zealand Journal of Psychiatry, 49(1) Across the developed world, recruitment into all areas of academic medicine has declined, not least psychiatry. For Australia and New Zealand, this will have a serious impact on undergraduate teaching, on postgraduate training and on our continuing contribution to research. In the UK, the Academy of Medical Sciences became sufficiently concerned about the situation in academic psychiatry to deploy a high-level working group to find ways of strengthening it. In America, the National Institute of Mental Health concluded that a decline in the psychiatrist-researcher workforce was ‘harming public needs’ (Institute of Medicine, 2005). It subsequently appointed a National Psychiatry Training Council to seek ways to improve the situation. In Australia and New Zealand, recruitment into academic psychiatry is in the same precarious state, although paradoxically this is occurring at a time when the knowledge base is undergoing unprecedented expansion. We believe that the specialty suffers from an unfavourable image among young graduates who see it as Why academic psychiatry is endangered

Attentional bias towards threat can be demonstrated by enhanced processing of threat-related targets and/or greater interference when threat-related distractors are present. These effects are argued to reflect processing within the orienting and executive control networks of the brain respectively. This study investigated behavioural (RT) and electrophysiological correlates of early selective attention and top-down attentional control among females with high (n = 16) or low (n = 16) spider fear (Mean age = 22 years). Participants completed a novel flanker go/nogo task in which a central schematic flower or spider stimulus was flanked by either congruent or incongruent distractors. Participants responded to green stimuli (go trials) and withheld response to yellow stimuli (nogo trials). High fear participants demonstrated significantly shorter reaction times and greater P1 amplitude to spider targets, suggesting specific hypervigilance towards threat-relevant stimuli. In contrast to predictions, there was little evidence for behavioural interference effects or differences in N2 amplitude when distractor stimuli were threat-relevant.

Background The ketogenic diet (KD) has been used in treatment-resistant epilepsy since the 1920s. It has been researched in a variety of neurological conditions in both animal models and human trials. The aim of this review is to clarify the potential role of KD in psychiatry. Methods Narrative review of electronic databases PubMED, PsychINFO, and Scopus. Results The search yielded 15 studies that related the use of KD in mental disorders including anxiety, depression, bipolar disorder, schizophrenia, autism spectrum disorder (ASD), and attention deficit hyperactivity disorder (ADHD). These studies comprised nine animal models, four case studies, and two open-label studies in humans. In anxiety, exogenous ketone supplementation reduced anxiety-related behaviors in a rat model. In depression, KD significantly reduced depression-like behaviors in rat and mice models in two controlled studies. In bipolar disorder, one case study reported a reduction in symptomatology, while a second case study reported no improvement. In schizophrenia, an open-label study in female patients (n = 10) reported reduced symptoms after 2 weeks of KD, a single case study reported no improvement. In a brief report, 3 weeks of KD in a mouse model normalized pathological behaviors. In ASD, an open-label study in children (n = 30) reported no significant improvement; one case study reported a pronounced and sustained response to KD. In ASD, in four controlled animal studies, KD significantly reduced ASD-related behaviors in mice and rats. In ADHD, in one controlled trial of KD in dogs with comorbid epilepsy, both conditions significantly improved. Conclusion Despite its long history in neurology, the role of KD in mental disorders is unclear. Half of the published studies are based on animal models of mental disorders with limited generalizability to the analog conditions in humans. The review lists some major limitations including the lack of measuring ketone levels in four studies and the issue of compliance to the rigid diet in humans. Currently, there is insufficient evidence for the use of KD in mental disorders, and it is not a recommended treatment option. Future research should include long-term, prospective, randomized, placebo-controlled crossover dietary trials to examine the effect of KD in various mental disorders.

In major depressive disorder, changes in cytokine levels have been reported to play a role in pathogenesis. Therefore, we sought to investigate a broad range of cytokines in depression. We compared serum levels of interleukin (IL)-2, IL-4, IL-5, IL-10, IL-12, IL-13, granulocyte macrophage colony-stimulating factor (GM-CSF), interferon (INF-γ) and tumor necrosis factor (TNF)-α in 64 subjects with current depression and 206 non-depressed subjects. Depressed patients had higher levels of IL-2, IL-5, IL-12, IL-13, GM-CSF, INF-γ and TNF-α, compared to non-depressed subjects. Splitting groups into non-obese (BMI 30) and obese (BMI ≥ 30), the non-obese depressed patients (n = 40) showed elevated IL-5, IL-12, IL-13, GM-CSF, INF-γ and TNF-α levels compared to non-obese and non-depressed subjects (n = 85). The obese and depressed patients (n = 24) showed elevated levels of IL-5, IL-12 and INF-γ compared to obese but not depressed subjects (n = 121). Levels of several cytokines were found to be associated with physical activity, employment status and presence of daily naps. The results support over-expression of pro-inflammatory cytokines in depression and extend the range of cytokines potentially associated with depression to include GM-CSF, IL-5 and IL-13. Changes in these cytokines may contribute to co-morbidity between depression and allergic and asthmatic diseases. The results also suggest inflammatory processes associated with obesity, and support an interaction between cytokine serum concentrations and behavioral aspects of both obesity and depression.

One of my principal goals at the University of Minnesota is to transform the university's entry-level geoscience program into an effective “concluding” geoscience course that provides students with a clear understanding of the many interactions between Earth processes and human society. Although place-based learning appeared to be a promising way to achieve that goal, I was initially concerned whether the urban character of the university's campus and student body, the program's size, and its rapidly overturning instructional staff might limit its effectiveness. To test its effectiveness in such an educational setting, I incorporated elements of place-based learning into a multiyear renovation of the university's Earth Sciences 1001 (ESCI 1001) laboratory program. Over half of the laboratory exercises are now place-based learning that explore historical interactions of Earth processes and Upper Midwest society. Since the initiative's goals differ from those of traditional introductory geoscience ...

A growing literature points to a specific role of the cerebellum in affect processing. However, understanding of affect processing disturbances following discrete cerebellar lesions is limited. We administered the Tübingen Affect Battery to assess recognition of emotional facial expression and emotional prosody in 15 patients with a cerebellar infarction and 10 age-matched controls. On emotional facial expression tasks, patients compared to controls showed impaired selection and matching of facial affect. On prosody tasks, patients showed marked impairments in naming affect and discriminating incongruencies. These deficits were more pronounced for negative affects. Our results confirm a significant role of the cerebellum in processing emotional recognition, a component of social cognition.

The interplay between immune and nervous systems plays a pivotal role in the pathophysiology of depression. In depressive episodes, patients show increased production of pro-inflammatory cytokines such as interleukin (IL)-1β and tumor necrosis factor (TNF)-α. There is limited information on the effect of antidepressant drugs on cytokines, most studies report on a limited sample of cytokines and none have reported effects on IL-22. We systematically investigated the effect of three antidepressant drugs, citalopram, escitalopram and mirtazapine, on secretion of cytokines IL-1β, IL-2, IL-4, IL-6, IL-17, IL-22 and TNF-α in a whole blood assay in vitro, using murine anti-human CD3 monoclonal antibody OKT3, and 5C3 monoclonal antibody against CD40, to stimulate T and B cells respectively. Citalopram increased production of IL-1β, IL-6, TNF-α and IL-22. Mirtazapine increased IL-1β, TNF-α and IL-22. Escitalopram decreased IL-17 levels. The influence of antidepressants on IL-2 and IL-4 levels was not significant for all three drugs. Compared to escitalopram, citalopram led to higher levels of IL-1β, IL-6, IL-17 and IL-22; and mirtazapine to higher levels of IL-1β, IL-17, IL-22 and TNF-α. Mirtazapine and citalopram increased IL-22 production. The differing profile of cytokine production may relate to differences in therapeutic effects, risk of relapse and side effects.

Stress-induced cytokine changes may be the link between stress and the pathogenesis of psychiatric disorders such as depression, and organic diseases such as infections, autoimmune diseases and cancer. We tested the effect of stress on interleukin (IL)-2, IL-4, IL-6, IL-10, IL-22, tumour necrosis factor (TNF)-α and interferon (IFN)-γ serum levels in male Wistar rats. Rats underwent either acute stress by forced swimming (N = 8), chronic restraint stress (N = 8), or were not subjected to any stress (N = 8). IL-2 serum levels were significantly higher in forced swimming, but not in restraint stress rats, compared to non-stressed rats. IL-4, IL-6, IL-10 and TNF-α levels were higher in both forced swimming and restraint stress compared to non-stressed rats. IFN-γ production was significantly decreased by restraint stress, but not by forced swimming. IL-22 was not affected significantly by either stress condition. Alterations in the pro-inflammatory cytokines IL-6 and TNF-α may indicate a pathophysiological pathway from acute and chronic stress to the development of depression. Changes in IL-4 and IL-10 may link acute and chronic stress to autoimmune disorders, allergies or cancer. The reported changes in IFN-γ could provide an explanation for the higher susceptibility to infection seen in life periods associated with sustained levels of stress.

Item does not contain fulltext Over the past three decades, insights into the role of the cerebellum in emotional processing have substantially increased. Indeed, methodological refinements in cerebellar lesion studies and major technological advancements in the field of neuroscience are in particular responsible to an exponential growth of knowledge on the topic. It is timely to review the available data and to critically evaluate the current status of the role of the cerebellum in emotion and related domains. The main aim of this article is to present an overview of current facts and ongoing debates relating to clinical, neuroimaging, and neurophysiological findings on the role of the cerebellum in key aspects of emotion. Experts in the field of cerebellar research discuss the range of cerebellar contributions to emotion in nine topics. Topics include the role of the cerebellum in perception and recognition, forwarding and encoding of emotional information, and the experience and regulation of emotional states in relation to motor, cognitive, and social behaviors. In addition, perspectives including cerebellar involvement in emotional learning, pain, emotional aspects of speech, and neuropsychiatric aspects of the cerebellum in mood disorders are briefly discussed. Results of this consensus paper illustrate how theory and empirical research have converged to produce a composite picture of brain topography, physiology, and function that establishes the role of the cerebellum in many aspects of emotional processing. 25 p.

Background and objectives The aim of the study was to examine habituation of subjective anxiety and electrophysiological correlates of cortical hyper-vigilance during exposure to spider images among high (n = 12) and low (n = 11) spider fear groups. Methods Participants viewed a six-stage hierarchy of spider images. The images used at stage 1 and stage 6 were the same. Subjective anxiety was rated at four intervals during each three-minute exposure stage (0, 60, 120, and 180 s) and event-related potentials (ERPs) were averaged across these epochs (0–60, 60–120, 120–180). Results High spider fearfuls demonstrated greater habituation of self-reported anxiety within and between exposure stages compared to low fearfuls. Consistent with attentional hyper-vigilance, the high-fear group also demonstrated greater P1 amplitude in response to spider images. In both groups, habituation of P1 amplitude was found at later relative to earlier stages, but increased at stage six when the stage 1 image was re-presented, despite low subjective anxiety. Limitations While the passive viewing paradigm mirrored image-based exposure, it was not possible to determine whether participants engaged in avoidance strategies. In addition, further research is needed to assess the relevance of habituation and reinstatement of P1 amplitude to therapeutic outcome. Conclusions Habituation of subjective anxiety during image-based exposure is not necessarily accompanied by a reduction in measures of cortical hyper-vigilance. The reinstatement of the P1 response may indicate either re-activation of previous associations, less avoidance, or a more generalised dishabituation mechanism.

To the Editor: With great interest we read the original article of Chen et al.[1] published in the Chinese Medical Journal comparing serum concentrations of cytokines in patients of Han and Li ethnicity with posttraumatic stress disorder (PTSD). The authors found significantly higher serum concentrations of the cytokines interleukin (IL)-2, IL-6, IL-8, and tumor necrosis factor (TNF)-α in PTSD patients compared to normal controls, and differences in cytokine concentrations according to ethnicity. At the Bundeswehr (German Armed Forces) Hospital in Berlin, Germany, we recently performed a study including 135 male German soldiers of which seventy had been deployed abroad. In the subsample of soldiers deployed abroad, 38 suffered from combat-related PTSD according to the Tenth Revision of the International Classification of Diseases criteria after their deployment, whereas 32 soldiers did not. All seventy subjects were of German ethnicity. TNF-α and its soluble receptors TNF-R p55 and p75 were measured in the serum using an individually arranged Bio-Plex Pro™ human cytokine immunoassay from Bio-Rad, Germany. To compare our study results with those of Chen et al.,[1] we analyzed data of N = 70 soldiers deployed abroad. One-way analysis of variance revealed no statistically significant differences for TNF-α and TNF-R p75 levels between groups (with or without PTSD). Only TNF-R p55 serum concentrations differed significantly (F [1, 66] = 10.76, P = 0.002). For a boxplot of TNF-R p55 levels [Figure 1]. In a consecutive analysis of covariance controlling for age and body mass index (BMI), the difference in TNF-R p55 levels was no longer statistically significant (F [1, 55]

Growing evidence suggests involvement of the tumor necrosis factor (TNF)-α system in the pathophysiology of psychiatric disorders. Research into post-traumatic stress disorder (PTSD) has investigated serum levels of TNF-α, but not to date its soluble receptors sTNF-R p55 and sTNF-R p75. We examined serum levels of TNF-α, sTNF-R p55 and sTNF-R p75 in 135 male German soldiers 70 of whom had been deployed abroad and 65 in Germany only. Post-traumatic stress symptoms were measured using the Post-traumatic Stress Diagnostic Scale (PDS) and the Trier Inventory for the Assessment of Chronic Stress (TICS). Correlational analysis controlling for multiple testing, showed no significant Spearman rank correlations between PDS or TICS scores and serum levels of TNF-α, sTNF-R p55 or sTNF-R p75, either in the full sample or in the group of soldiers who had been deployed abroad. ANCOVAs showed no significant differences between soldiers with or without a PDS-derived diagnosis of PTSD, or between soldiers with or without deployment abroad, after controlling for age, smoking and body mass index (BMI). These results suggest that the TNF-α system, as reflected by TNF-α, sTNF-R p55 and sTNF-R p75 serum levels, does not play a major role in the pathophysiology and development of PTSD symptoms as measured by the PDS and the TICS. However, several methodological and contextual issues have to be considered.

Cortical and subcortical circuits of the brain contain regions of interest involved in grammar processing. Advances in neuroimaging techniques and neuroscience, reflected in a growing literature on the subject, are extending our understanding of how and where the brain processes the many intricacies of grammar in human language. Historically, linguistic functions were conceived as highly localized in specialized brain regions of the dominant cerebral cortex. Thus, the Broca area was responsible for expressive and the Wernicke area for receptive linguistic functions. This view has been revised in favor of more distributed language processing networks involving cortical and subcortical brain structures. Thus the Broca (the left inferior frontal cortex) and Wernicke areas (the left superior temporal cortex) are connected with contralateral cortex, ipsilateral insula, and subcortical brain structures of both hemispheres, such that the left inferior frontal and left superior temporal cortices are substantially involved in large-scale language processing in both comprehension and production of sentences (Friederici, Ruschemeyer, Hahne, & Fiebach, 2003; Shapiro & Caramazza, 2004). Thus, in this contemporary model, grammar processing is not restricted to cerebral cortex, but also engages several subcortical areas, forming part of a large-scaled matrix handling grammatical operations. Whereas motor control functions of these subcortical areas—for example, in the articulation of speech—are well-established in the neuroscience research literature, nonmotor functions, particularly in language domains, have been increasingly studied in linguistic and neuroscience research over the past two decades. As a result, the cerebellum and basal ganglia are now acknowledged to be involved in the cerebral networks that handle distinct grammatical aspects (Booth, Wood, Lu, Houk, & Bitan, 2 007; Friederici, 2004; Kotz, Schwartze, & Schmidt-Kassow, 2009). Clinical, neurophysiological, and neuroimaging studies have confirmed cerebellar contributions to grammar processing in both expressive and receptive domains (Ackermann, Graber, Hertrich, & Daum, 1999; De Smet, Baillieux, De Deyn, Marien, & Paquier, 2007; Fabbro, Moretti, & Bava, 2000; Gasparini et al ., 1999; Justus, 2004; Silveri, Leggio, & Molinari, 1994). In the 1990s, a possible role of the cerebellum in morphological, syntactic, and lexical aspects of grammar was put forward, gathering a variety of cerebellar contributions to grammar. These early studies indicated involvement of the cerebellum in detection of deviations from predicted grammar rules such as subject-verb agreement or canonical word order (Leiner, Leiner, & Dow, 1991, 1993; Silveri et al ., 1994). Subsequent investigations substantiated and extended this view of cerebellar contributions to include motorindependent comprehensive grammar analysis of sentence structure (Adamaszek et al ., 2012; Justus, 2004; Kotz et al ., 2009; Marien et al ., 2001; Witt, Nuhsman, & Deuschl, 2002). Thus, the cerebellum has been described as subserving the detection and marking of time intervals necessary for different sensorimotor and cognitive activities (Ivry & Richardson, 2002; Salman, 2002), the estimation of phonetic and semantic borders of syntagmata, and the maintenance of phrase structure in working memory during processing (Marien et al ., 2001). Precise details of such localized contributions and how they may contribute to large-scale networks integrating activity across multiple brain regions are still being worked out. Current controversies are discussed in this chapter along with a critical overview of the relevant literature.

Stress constitutes a risk factor for diseases where the immune system plays a significant role. Stress is recognized as a possible trigger for flare ups during the course of multiple sclerosis (MS). The disclosure to the patient of the diagnosis of MS, the commencement of immunomodulatory therapy, and the unpredictability and vagaries of disease progression are all sources of stress. Biological stress systems such as the hypothalamic-pituitary-adrenal system and the sympathetic nervous system may influence the pathogenesis and the disease course of MS. The ability to cope with stress may also be impaired, mediated for example by cognitive deficits or loss of abilities and resources as disease progresses or by the high prevalence of concurrent mood disturbances such as depression and chronic fatigue. Psychiatric comorbidities of MS disease or therapy as well as impairments of coping strategies are underrecognized in clinical practice. Treatment plans for depression among MS patients, as the most common psychiatric comorbidity, should be individualized with integrated approaches. Antidepressants are effective for the treatment of depression in MS patients although further clinical research into the neurobiological and psychological bases of depressive disorders in MS patients is clearly needed. In therapy, coping strategies can be enhanced through multidisciplinary assessment of the various challenges and restrictions imposed by the disease and assisting and supporting the patient in addressing these. Exercise, as a form of positive stress (eustress), also has a role in therapy.

This research aimed to examine the effects of moving (videos) versus static (pictures) images on habituation and progression in a hierarchy during online symbolic exposure (OSE) for spider fear. Participants were 351 people with high spider fear who logged on to an OSE website (www.feardrop.com) for self-help purposes. The inclusion of moving images in the exposure hierarchy increased adherence rates relative to static images, particularly among those with lower relative to higher spider fear. Those who viewed moving images at Stage 2 showed higher Subjective Units of Distress Scale (SUDS) ratings overall, but a similar pattern of habituation relative to those who viewed static images. In addition, 71% of participants completed at least one stage of the OSE program, representing an improvement from 30% adherence in previous research that used an earlier version of the program. These findings support the development of tailored exposure hierarchies to maximise adherence and treatment benefit for individual participants.

Background: The aim of this research was to evaluate an online exposure treatment for spider phobia (www.feardrop.com) and to investigate the effects of intermittent versus continuous exposure.Methods: Spider phobic participants (N = 23) completed two 14-minute stages of laboratory-based online exposure. In the first of these stages exposure was either continuous or intermittent (alternating fearrelevant and -irrelevant images). One week later, participants commenced a sixstage home-based graded online exposure task, which was undertaken over 30 days. Subjective Units of Distress Scale (SUDS) ratings were taken throughout all exposure stages. Spider fear was assessed prior to treatment, and at 1-week and 1-month post treatment.Results: Habituation was observed across each stage for both the laboratory and home-based tasks and generalisation of habituation was found between stages. Habituation was not impaired in the alternating fear-relevant and -irrelevant image condition, though subjects experienced less summed anxiety. Adherence rates were low in home-based online exposure. However, participants who completed 30-days post-treatment assessment (n = 14) showed a significant reduction in spider fear as measured by the Fear of Spiders Questionnaire (FSQ).Conclusions: Online exposure produces habituation and generalisation of habituation to spider images as well as longer-term reductions in spider fear. Alternating fear-relevant and -irrelevant exposure is feasible in online exposure and may lead to habituation with less summed anxiety that has implications for tolerability and acceptability. Measures to increase adherence rates and hence dosage delivered are a key consideration for further online exposure research.

Patienten, die an einer Schizophrenie leiden, weisen immunologische Charakteristika auf, die moglicherweise zur Entstehung ihrer Erkrankung beitragen, und immunmodulatorische Medikamente konnen die Symptomatik akut aufgetretener schizophrener Storungen beeinflussen. Antipsychotika wie das Clozapin wirken moglicherweise therapeutisch uber Veranderungen im Immunsystem, sie konnen daruber aber auch zu Nebenwirkungen fuhren.

This research aimed to investigate habituation to spider images during an online exposure treatment (www.feardrop.com) among participants with a high fear of spiders. Participants (N= 392) undertook a 10-stage online exposure treatment with a stage length of either 180 or 360 seconds. Four Subjective Units of Distress Scale (SUDS) ratings were taken throughout each stage. Treatment completion was found to be a significant challenge, with less than one-third (30%) completing at least one stage of the program. Those in the shorter stage length condition were significantly more likely to complete the first stage relative to those in the longer stage length condition (43% vs. 16%). SUDS ratings decreased significantly across time at Stage 1, suggesting habituation of self-reported anxiety and there was an overall reduction in SUDS ratings at the second relative to the first stage, suggesting generalisation of habituation. The greatest habituation was observed among those with high anticipatory anxiety (pre-exposure SUDS rating), high total exposure time, and younger age. There was preliminary evidence for improvement in symptoms of spider fear at post-treatment. Directions for future research include strategies to facilitate treatment completion, evaluation of treatment outcomes, and expansion to include a range of specific fears.