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Subthreshold premenstrual symptoms can be impairing even if the diagnostic criteria for premenstrual dysphoric disorder (PMDD) are not reached. Previous research suggests shared psychological risk factors without a clear differentiation of premenstrual syndrome (PMS) from PMDD. This study focuses on a sample with a wide range of premenstrual symptoms not reaching PMDD-criteria and aims to investigate within-person associations of premenstrual symptoms with daily rumination and perceived stress during the late luteal phase as well as cycle-phase specific associations of habitual mindfulness including present-moment-awareness and acceptance with premenstrual symptoms and impairment. Fifty-six naturally cycling women with self-reported premenstrual symptoms completed an online diary on premenstrual symptoms, rumination and perceived stress over two consecutive menstrual cycles, and baseline questionnaires on habitual present-moment-awareness and acceptance. Multilevel analyses revealed cycle-related variations in premenstrual symptoms and impairment (all ps ps p ≤ .018). Higher habitual present-moment-awareness was linked to lower premenstrual symptom and impairment levels toward the late luteal phase whereas higher habitual acceptance was associated with lower premenstrual functional impairment (p ≤ .015). Premenstrual symptom increases during the late luteal phase in women with PMS seem to be linked to increased daily rumination and perceived stress. Trait present-moment-awareness and acceptance in turn seem to reflect protective factors against premenstrual distress and may represent useful targets for interventions.

Zusammenfassung Ziel der Studie Patient:innen mit komorbid auftretenden Substanzgebrauchsstörungen (SUD) und Borderline-Persönlichkeitsstörung (BPD) sind in ihrer Lebensqualität stark beeinträchtigt. Zusätzlich entstehen durch diese Komorbidität hohe direkte und indirekte Gesundheitskosten. Bisher sind die Behandlungsergebnisse bei dieser Komorbidität unbefriedigend und wirksame Add-on Strategien zu den etablierten Therapiekonzepten fehlen. Das Ziel dieser Studie war es, zu untersuchen, inwiefern Trauma Informed Hatha Yoga als ergänzendes Therapieelement zu einer stationären Dialektisch Behavioralen Therapie Sucht (DBT-S) die Veränderung der inneren Anspannung bei Patient:innen mit einer SUD und einer BPD modifizieren kann. Methodik In diese quasi experimentelle Studie konnten 39 Patient:innen, die an einer SUD und einer BPD leiden, eingeschlossen werden. Alle Patient:innen nahmen zum Studienzeitpunkt an einer zwölfwöchigen stationären psychotherapeutischen Behandlung im Rahmen der Dialektisch Behavioralen Therapie Sucht (DBT-S) teil. Die Teilnehmenden der Interventionsgruppe absolvierten begleitend hierzu für acht Wochen wöchentliche Trauma Informed Hatha Yoga Übungseinheiten. Die Veränderungen der inneren Anspannung der Patient:innen durch die Trauma Informed Hatha Yoga-Übungseinheiten wurden mithilfe einer visuellen Analogskala gemessen (VAS; 0–100). Ergebnisse Bei der Durchführung der Varianzanalyse mit Messwiederholungen bezüglich der Veränderungen der inneren Anspannung (Δ VAS) als abhängige Variable fanden wir einen signifikanten Interaktionseffekt Zeit x Gruppe, also einen unterschiedlichen zeitlichen Verlauf der Veränderungen der inneren Anspannung (Δ VAS) in den beiden Studiengruppen. Die Teilnehmenden der Kontrollgruppe zeigten hierbei im zeitlichen Verlauf signifikant unterschiedliche Veränderungen der inneren Anspannung (Anstiege und Abstiege), wohingegen sich in der Interventionsgruppe die innere Anspannung durch Yoga gleichmäßig reduzierte, Anspannungsspitzen also signifikant besser geglättet werden konnten. Schlussfolgerung Trauma Informed Hatha Yoga in Kombination mit der Teilnahme an einem stationären DBT-S Programm scheint basierend auf unseren Ergebnissen die Variabilität von innerer Anspannung bei Patient:innen mit SUD und BPD effektiver modifizieren zu können als eine alleinige stationäre DBT-S Therapie. Es erscheint daher sinnvoll, Trauma Informed Hatha Therapieeinheiten als ergänzende Elemente in DBT-S Therapiekonzepte zu integrieren.

Psychological stress and physical activity are interrelated, constituting a relevant association to human health, especially in children. However, the association’s nature remains elusive, i.e., why psychological stress predicts both decreased and increased physical activity. To test whether effects vary as a function of the level of analyses, we derived intensive longitudinal data via accelerometers and stress questionnaires from 74 children across 7 days as they went about their daily routines (n = 513 assessments). Multilevel modelling analyses revealed that between children, higher psychological stress predicted decreased physical activity (standardized beta coefficient = −0.14; p = 0.046). Concurrently, within those children, higher psychological stress predicted increased physical activity across days (standardized beta coefficient = 0.09; p = 0.015). Translated to practice, children who experienced more stress than others moved less, but children were more active on days when they experienced heightened stress. This suggests that the analyses level is crucial to the understanding of the association between psychological stress and physical activity and should be considered to receive unequivocal results. If replicated, e.g., including high-frequency sampling and experimental manipulation in everyday life for in-depth insights on underlying mechanisms and causality, our findings may be translated to individually tailored (digital) prevention and intervention strategies which target children’s distress-feelings despite impairing their heightened physical activity in stressful situations and identify tipping points of chronic stress phases. Therefore, we especially call for more intensive longitudinal data approaches to tackle thus far neglected within-subject issues in the field of physical activity, sport and exercise research.

Introduction: Smartphones are often helpful in our everyday lives. Yet, they also tend to interrupt us during other activities. It has been argued that such distractions contribute to attention-deficit/hyperactivity disorder-like symptoms. However, since there are mostly correlational studies, the causal nature of this relationship is unclear. Our aim was to test whether reducing smartphone-related distractions might have a beneficial effect on inattention and hyperactive symptoms. Methods: We conducted a 1-week field experiment with 37 healthy undergraduates and quasi-randomly assigned them to an intervention or control group (CG). The intervention group was given theory-based specific instructions that aimed at reducing smartphone-related distractions, whereas the CG received no intervention. The outcomes of interest were inattention level, hyperactive symptoms, and working memory accuracy. Results: Compared to those in the control condition, participants who limited their smartphone use showed considerable reductions in hyperactive symptoms after 1 week – particularly those who displayed high problematic smartphone use. However, there were no group differences regarding inattention symptoms and working memory accuracy. Discussion: The results give a first hint that strategically reducing smartphone-related distractions via specific but simple use modifications can mitigate hyperactive symptoms. Especially people with problematic smartphone use seem to profit from such an intervention. Remaining questions and directions are discussed.

Exercise interventions in mental disorders have evidenced a mood-enhancing effect. However, the association between physical activity and affect in everyday life has not been investigated in adult individuals with ADHD, despite being important features of this disorder. As physical activity and affect are dynamic processes in nature, assessing those in everyday life with e- diaries and wearables, has become the gold standard. Thus, we used an mHealth approach to prospectively assess physical activity and affect processes in individuals with ADHD and con- trols aged 14–45 years. Participants wore accelerometers across a four-day period and reported their affect via e-diaries twelve times daily. We used multilevel models to identify the within- subject effects of physical activity on positive and negative affect. We split our sample into three groups: 1. individuals with ADHD who were predominantly inattentive ( n = 48), 2. in- dividuals with ADHD having a combined presentation (i.e., being inattentive and hyperactive; n = 95), and 3. controls ( n = 42). Our analyses revealed a significant cross-level interaction (F(2, 135.072) = 5.733, p = 0.004) of physical activity and group on positive affect. In details, all groups showed a positive association between physical activity and positive affect. Indi- viduals with a combined presentation significantly showed the steepest slope of physical ac- tivity on positive affect (slope_inattentive = 0.005, p < 0.001; slope_combined = 0.009, p < 0.001; slope_controls = 0.004, p = 0.008). Our analyses on negative affect revealed a negative associ- ation only in the individuals with a combined presentation (slope = -0.003; p = 0.001). Whether this specifically pronounced association in individuals being more hyperactive might be a mech- anism reinforcing hyperactivity needs to be empirically clarified in future studies., European Commission 667302, ECNP Network

The COVID-19 pandemic strongly impacted people's daily lives. However, it remains unknown how the pandemic situation affects daily-life experiences of individuals with preexisting severe mental illnesses (SMI). In this real-life longitudinal study, the acute onset of the COVID-19 pandemic in Germany did not cause the already low everyday well-being of patients with schizophrenia (SZ) or major depression (MDD) to decrease further. On the contrary, healthy participants’ well-being, anxiety, social isolation, and mobility worsened, especially in healthy individuals at risk for mental disorder, but remained above the levels seen in patients. Despite being stressful for healthy individuals at risk for mental disorder, the COVID-19 pandemic had little additional influence on daily-life well-being in psychiatric patients with SMI. This highlights the need for preventive action and targeted support of this vulnerable population.

BackgroundAlcohol use disorder (AUD) is a critical public health issue with sex-specific characteristics and the need for a better mechanistic understanding. Initial evidence suggests that progesterone can reduce alcohol intake, while estradiol leads to an increase. However, we lack knowledge about how progesterone relative to estradiol influences alcohol use patterns in females and males with AUD.MethodsThis multicenter within-subject study analyzed data on real-life alcohol use (21,438 intensively-sampled smartphone entries), menstrual cycle, and serum progesterone/estradiol ratios (677 blood samples) gathered during a 12-month follow-up in 74 naturally cycling females and 285 males with AUD (mean age: 29.7 and 37.8 years, respectively; data collection: 2020–2022). We used multilevel modelling to identify changes in alcohol use and progesterone/estradiol ratios across the menstrual cycle in females and associations between progesterone/estradiol ratios and alcohol use in males.ResultsDuring the late luteal phase, females showed 0.6- to 0.8-fold lower (predicted) probabilities of binge drinking and 2.8- to 5.6-fold higher mean progesterone/estradiol ratios compared to the menstrual, follicular, and ovulatory phases. Similarly, in males, an increase of 10 units in the progesterone/estradiol ratio was related to 8 and 9% lower probabilities of binge drinking and any alcohol use, respectively.ConclusionsBased on ecologically valid results, this study reveals that higher progesterone/estradiol ratios can protect against problematic alcohol use in females and males with AUD. Therefore, the progesterone/estradiol ratio is a promising treatment target. Translated into clinical practice, our results also indicate that females with AUD may benefit from menstrual cycle phase-tailored treatments.

The coronavirus pandemic has brought about dramatic restrictions to real-life social interactions and a shift towards more online social encounters. Positive social interactions have been highlighted as an important protective factor, with previous studies suggesting an involvement of the amygdala in the relationship between social embeddedness and well-being. The present study investigated the effect of the quality of real-life and online social interactions on mood, and explored whether this association is affected by an individual’s amygdala activity. Sixty-two participants of a longitudinal study took part in a one-week ecological momentary assessment (EMA) during the first lockdown, reporting their momentary well-being and their engagement in real-life and online social interactions eight times per day (N~3,000 observations). Amygdala activity was assessed before the pandemic during an emotion-processing task. Mixed models were calculated to estimate the association between social interactions and well-being, including two-way interactions to test for the moderating effect of amygdala activity.We found a positive relationship between real-life interactions and momentary well-being. In contrast, online interactions had no effect on well-being. Moreover, positive real-life social interactions augmented this social affective benefit, especially in individuals with higher amygdala being more sensitive to the interaction quality.Our findings demonstrate a mood-lifting effect of positive real-life social interactions during the pandemic, which was dependent on amygdala activity before the pandemic. As no corresponding effect was found between online social interactions and well-being, it can be concluded that increased online social interactions may not compensate for the absence of real-life social interactions.

Ziel der Studie Untersuchung der Rate falsch-positiver SIMS-Resultate bei gesunden Kontrollprobanden und Patienten auserhalb eines forensischen oder rehabilitativen Kontexts. Methodik Neben dem SIMS wurden Variablen uber Fremdratings (PANSS, Hamilton-Skala, MMSE) erfasst. Zielpunkte waren die SIMS- Scores bei Gesunden und einzelnen Patientengruppen und die Zusammenhange zwischen dem SIMS-Score und weiteren Variablen. Ergebnisse Patienten mit einer Schizophrenie (n=30) oder einer Depression (n=32) erzielten im Vergleich mit gesunden Probanden (n=36) haufiger SIMS-Scores >16. Patienten mit einer amnestischen Storung (n=15) schnitten im Vergleich hierzu unauffallig ab. Bei depressiven Patienten mit einem auffalligen SIMS-Resultat zeigte sich sowohl ein signifikanter Zusammenhang mit dem Vorliegen einer weiteren psychiatrischen Diagnose als auch eine Korrelation zwischen den Summenwerten auf der Hamilton-Skala und den Werten auf 2 Subskalen des SIMS (NI, AF). Schlussfolgerung Weitere Validierungsstudien des SIMS sind erforderlich, sollte dieses Instrument auch kunftig in der klinischen Praxis angewendet werden. Die Spezifitat des SIMS weist wahrscheinlich eine Abhangigkeit vom Untersuchungskontext auf. Objective Assessment of the rate of false-positive results of the Structured Inventory of Malingered Symptomatology (SIMS) in healthy controls and authentic patients outside the forensic or rehabilitative context. Methods Beyond the SIMS scores, further variables (PANSS, Hamilton scale, MMSE) were obtained. SIMS scores of healthy individuals were compared with the SIMS scores of the different groups of patients. Additionally, correlations between the SIMS scores and other variables were investigated. Results Patients with psychotic disorders (n=30) or depressive episodes (n=32) more frequently achieved SIMS scores >16 as compared to healthy controls. In comparison, patients with amnestic disorders (n=15) had inconspicuous SIMS scores. Depressed patients with positive SIMS results were significantly more likely to be diagnosed with another psychiatric disorder and the scores of these patients on the Hamilton scale were correlated with positive results on 2 subscales of the SIMS (NI, AF). Conclusion If this instrument is to applied in clinical practice in the future, further validation of the SIMS is necessary. The specificity of the SIMS seems to be context-related.

Background The psychological risk factors of premenstrual dysphoric disorder (PMDD) are not fully understood, but initial evidence points to a potential role of unfavorable cognitive emotion regulation (ER-) strategies. Given the symptom cyclicity of PMDD, ambulatory assessment is ideally suited to capture psychological and physiological processes across the menstrual cycle. Our study examines habitual ER-strategies in women with PMDD and their predictive value for the course of mood and basal cortisol across the cycle in affected women. Methods Women with and without PMDD (n = 61 each) were compared regarding habitual mindfulness, reappraisal, and repetitive negative thinking (RNT). Momentary affect and cortisol output were assessed over two consecutive days per cycle phase (menstrual, follicular, ovulatory, late luteal). Results Women with PMDD reported lower mindfulness, less use of reappraisal and stronger RNT than controls (ps < 0.035). In women with PMDD, higher mindfulness and reappraisal and lower RNT predicted decreased negative and increased positive affect across the menstrual cycle (ps < 0.027). However, women using more favorable ER-strategies displayed stronger mood cyclicity, resulting in stronger mood deterioration in the late luteal phase, thereby resembling women with more unfavorable ER-strategies toward the end of the cycle. Lower mindfulness predicted lower cortisol in the menstrual phase. Conclusions Protective ER-strategies seem to be generally linked to better momentary mood in women with PMDD, but do not appear to protect affected women from premenstrual mood deterioration. Habitual mindfulness, in turn, seems to buffer blunted cortisol activity in women with PMDD, especially in the menstrual phase.

Physical activity is beneficial for human physical health and well-being. Accordingly, the association between physical activity and mood in everyday life has been a subject of several Ambulatory Assessment studies. This mechanism has been studied in children, adults, and the elderly, but neglected in adolescents. It is critical to examine this mechanism in adolescents because adolescence plays a key role in human development and adolescents’ physical activity behavior translates into their behavior in adulthood. We investigated adolescents’ mood in relation to distinct physical activities: incidental activity such as climbing stairs; exercise activity, such as skating; and sports, such as playing soccer. We equipped 134 adolescents aged 12-17 years with accelerometers and GPS-triggered electronic diaries to use in their everyday life. Adolescents reported on mood repeatedly in real time across 7 days, and these data were analyzed using multilevel-modeling. After incidental activity, adolescents felt better and more energized. After exercise, adolescents felt better but less calm. After sports, adolescents felt less energized. Analyses of the time course of the effects confirmed our findings. Physical activity influences mood in adolescents’ everyday life, but has distinct effects depending on the kind of physical activity. Our results suggest incidental and exercise activities entail higher post-bout valence compared to sports in competitive settings. These findings may serve as an important empirical basis for the targeted application of distinct physical activities to foster well-being in adolescence.

The self-concept—defined as the cognitive representation of beliefs about oneself—determines how individuals view themselves, others, and their actions. A negative self-concept can drive gaming use and internet gaming disorder (IGD). The assessment of the neural correlates of self-evaluation gained popularity to assess the self-concept in individuals with IGD. This attempt, however, seems to critically depend on the reliability of the investigated task-fMRI brain activation. As first study to date, we assessed test–retest reliability of an fMRI self-evaluation task. Test–retest reliability of neural brain activation between two separate fMRI sessions (approximately 12 months apart) was investigated in N = 29 healthy participants and N = 11 individuals with pathological internet gaming. We computed reliability estimates for the different task contrasts (self, a familiar, and an unknown person) and the contrast (self > familiar and unknown person). Data indicated good test–retest reliability of brain activation, captured by the “self”, “familiar person”, and “unknown person” contrasts, in a large network of brain regions in the whole sample (N = 40) and when considering both experimental groups separately. In contrast to that, only a small set of brain regions showed moderate to good reliability, when investigating the contrasts (“self > familiar and unknown person”). The lower reliability of the contrast can be attributed to the fact that the constituting contrast conditions were highly correlated. Future research on self-evaluation should be cautioned by the findings of substantial local reliability differences across the brain and employ methods to overcome these limitations.

Predicting participation in and success of smoking cessation programs in alcohol dependent patients has yielded heterogeneous results. Moreover, these findings have rarely been based on prospective studies from clinical routine settings. Identifying predictors in prospective studies could help to tailor interventions that increase participation and success rates of smoking cessation therapies for these patients at a high risk for alcohol- and smoking-related morbidities and mortalities.During inpatient alcohol dependence treatment, 99 nicotine dependent patients were recruited. 73 patients chose to participate in a voluntary smoking cessation program. Interviews and questionnaires were used at baseline and at discharge to assess a large set of variables covering smoking and alcohol related factors, general psychopathology, quality of life and personality traits. Multiple logistic regression models were calculated to predict participation in the smoking cessation program and smoking abstinence at follow-up three months after discharge.Participation in the smoking cessation program was predicted by higher stage of change, higher confidence in abstaining from smoking and lower perceived stress. Successful smoking cessation at follow-up was predicted by higher expectations of negative physical feelings due to smoking and lower expectations of temptations to smoke at baseline, and by lower number of daily smoked cigarettes at discharge.Despite the small sample size, this prospective study gives a first indication of clinically relevant predictors of participation in and success of a smoking cessation program by exploring many previously reported predictors simultaneously. The findings and their implications for treatment allocation and optimization are discussed.

The coronavirus (COVID-19) pandemic has confronted millions of people around the world with an unprecedented stressor, affecting physical and mental health. Accumulating evidence suggests that emotional and cognitive self-regulation is particularly needed to effectively cope with stress. Therefore, we investigated the predictive value of affective and inhibitory prefrontal control for stress burden during the COVID-19 crisis. Physical and mental health burden were assessed using an online survey, which was administered to 104 participants of an ongoing at-risk birth cohort during the first wave in April 2020. Two follow-ups were carried out during the pandemic, one capturing the relaxation during summer and the other the beginning of the second wave of the crisis. Prefrontal activity during emotion regulation and inhibitory control were assessed prior to the COVID-19 crisis. Increased inferior frontal gyrus activity during emotion regulation predicted lower stress burden at the beginning of the first and the second wave of the crisis. In contrast, inferior and middle frontal gyrus activity during inhibitory control predicted effective coping only during the summer, when infection rates decreased but stress burden remained unchanged. These findings remained significant when controlling for sociodemographic and clinical confounders such as stressful life events prior to the crisis or current psychopathology. We demonstrate that differential stress-buffering effects are predicted by the neural underpinnings of emotion regulation and cognitive regulation at different stages during the pandemic. These findings may inform future prevention strategies to foster stress coping in unforeseen situations., European Neuropsychopharmacology, 56, ISSN:0924-977X, ISSN:1873-7862

Over the last decades, the assessment of alcohol cue-reactivity gained popularity in addiction research, and efforts were undertaken to establish neural biomarkers. This attempt however depends on the reliability of cue-induced brain activation. Thus, we assessed test-retest reliability of alcohol cue-reactivity and its implications for imaging studies in addiction. We investigated test-retest reliability of alcohol cue-induced brain activation in 144 alcohol-dependent patients over 2 weeks. We computed established reliability estimates, such as intraclass correlation (ICC), Dice and Jaccard coefficients, for the three contrast conditions of interest: 'alcohol', 'neutral' and the 'alcohol versus neutral' difference contrast. We also investigated how test-retest reliability of the different contrasts affected the capacity to establishing associations with clinical data and determining effect size estimates. Whereas brain activation, indexed by the constituting contrast conditions 'alcohol' and 'neutral' separately, displayed overall moderate (ICC > 0.4) to good (ICC > 0.75) test-retest reliability in areas of the mesocorticolimbic system, the difference contrast 'alcohol versus neutral' showed poor overall reliability (ICC

Assessment of the rate of false-positive results of the Structured Inventory of Malingered Symptomatology (SIMS) in healthy controls and authentic patients outside the forensic or rehabilitative context.Beyond the SIMS scores, further variables (PANSS, Hamilton scale, MMSE) were obtained. SIMS scores of healthy individuals were compared with the SIMS scores of the different groups of patients. Additionally, correlations between the SIMS scores and other variables were investigated.Patients with psychotic disorders (n=30) or depressive episodes (n=32) more frequently achieved SIMS scores16 as compared to healthy controls. In comparison, patients with amnestic disorders (n=15) had inconspicuous SIMS scores. Depressed patients with positive SIMS results were significantly more likely to be diagnosed with another psychiatric disorder and the scores of these patients on the Hamilton scale were correlated with positive results on 2 subscales of the SIMS (NI, AF).If this instrument is to applied in clinical practice in the future, further validation of the SIMS is necessary. The specificity of the SIMS seems to be context-related.Untersuchung der Rate falsch-positiver SIMS-Resultate bei gesunden Kontrollprobanden und Patienten außerhalb eines forensischen oder rehabilitativen Kontexts.Neben dem SIMS wurden Variablen über Fremdratings (PANSS, Hamilton-Skala, MMSE) erfasst. Zielpunkte waren die SIMS- Scores bei Gesunden und einzelnen Patientengruppen und die Zusammenhänge zwischen dem SIMS-Score und weiteren Variablen.Patienten mit einer Schizophrenie (n=30) oder einer Depression (n=32) erzielten im Vergleich mit gesunden Probanden (n=36) häufiger SIMS-Scores16. Patienten mit einer amnestischen Störung (n=15) schnitten im Vergleich hierzu unauffällig ab. Bei depressiven Patienten mit einem auffälligen SIMS-Resultat zeigte sich sowohl ein signifikanter Zusammenhang mit dem Vorliegen einer weiteren psychiatrischen Diagnose als auch eine Korrelation zwischen den Summenwerten auf der Hamilton-Skala und den Werten auf 2 Subskalen des SIMS (NI, AF).Weitere Validierungsstudien des SIMS sind erforderlich, sollte dieses Instrument auch künftig in der klinischen Praxis angewendet werden. Die Spezifität des SIMS weist wahrscheinlich eine Abhängigkeit vom Untersuchungskontext auf.

Background:Social integration is a major resilience factor for staying healthy. However, the COVID-19-pandemic led to unprecedented restrictions in social life. The consequences of these social lockdowns on momentary well-being are yet not fully understood.Method:We investigated the individual affective benefit from social interactions in a longitudinal birth cohort study. We used two real-time, real-life ecological momentary assessments once before and once during the initial lockdown of the pandemic (N~6800 total observations) to determine the protective role of social interactions on well-being. Moreover, we used a multimethod approach combining the ecological assessment data with individual risk and resilience factors to analyze the moderating mechanisms of personality, neurobiology and genes.Results:Social contacts were linked to higher positive affect both during normal times and during the COVID-19 pandemic, highlighting the beneficial role of social embedding. Moreover, this relationship was moderated by amygdala volume, neuroticism and polygenic risk for schizophrenia. In detail, participants with a larger left amygdala volume and higher trait neuroticism exhibited an affective benefit from more social interactions prior to the pandemic. This pattern changed during the pandemic with participants with smaller amygdala volumes and lower neurotic traits showing a social affective gain during the pandemic. Moreover, participants with low genetic risk for schizophrenia showed an affective benefit from social interactions irrespective of the time point.Conclusion:Our results highlight the protective role of social integration on momentary well-being. Thereby, we offer new insights into how this relationship is differently affected by a person’s, neurobiology, personality, and genes under adverse circumstances.

Psychiatric morbidity is high in cities, so identifying potential modifiable urban protective factors is important. We show that exposure to urban green space improves well-being in naturally behaving male and female city dwellers, particularly in districts with higher psychiatric incidence and fewer green resources. Higher green-related affective benefit was related to lower prefrontal activity during negative-emotion processing, which suggests that urban green space exposure may compensate for reduced neural regulatory capacity. Tost et al. show that urban green space exposure improves well-being, particularly in people dwelling in relatively deprived areas and showing less prefrontal activity during emotion processing, a neural signature that is linked to mental health risk.

Aufgrund der hohen Pravalenz bei Alkoholabhangigen und der anspruchsvollen und zeitaufwendigen Diagnostik der Aufmerksamkeitsdefizit‑/Hyperaktivitatsstorung (ADHS) wird ein routinemasiges Screening mit Selbstbeurteilungsfragebogen empfohlen. Die psychometrischen Eigenschaften solcher Fragebogen wurden in dieser Patientengruppe bisher kaum untersucht. Bei 402 alkoholabhangigen Patienten in der stationaren Entwohnung wurden die psychometrischen Eigenschaften der ADHS-Selbstbeurteilungsskala (ADHS-SB) und der Wender Utah Rating Scale in der deutschen Kurzversion (WURS-k) untersucht. Bei 85 dieser Patienten war in einer ausfuhrlichen standardisierten Diagnostik eine Erwachsenen-ADHS festgestellt worden. Die ADHS-SB zeigte bei einem Cut-off von ≥15 die besten psychometrischen Eigenschaften (Sensitivitat 75,3 %, Spezifitat 94,0 %, positiver Vorhersagewert [PPV] 77,1 %, negativer Vorhersagewert [NPV] 93,4 %). Die WURS-k zeigte bei dem etablierten Cut-off von ≥30, aber auch bei niedrigeren Cut-offs, keine zufriedenstellenden Ergebnisse mit im Vergleich zur ADHS-SB vielen falsch-positiven Screeningergebnissen. Die Kombination beider Instrumente (ADHS-SB ≥ 15 und/oder WURS-k ≥ 30) zeigte eine hohe Sensitivitat (86,9 %), die jedoch mit einer erhohten Anzahl an falsch-positiven Screeningergebnissen einherging (Spezifitat 87,7 %, PPV 65,2 %). Die ADHS-SB ist geeignet zum routinemasigen ADHS-Screening bei Alkoholabhangigen. Fur eine bessere Sensitivitat sollte ein niedrigerer Cut-off von ≥15 verwendet werden. Die WURS-k ist fur das alleinige ADHS-Screening bei Alkoholabhangigen nicht zu empfehlen. Soll eine moglichst hohe Sensitivitat bei ausreichender Spezifitat erreicht werden, ist eine Kombination von ADHS-SB und WURS-k moglich.

Leptin and ghrelin and a "cross-talk" between both hormones were implicated in the pathophysiology of alcohol dependence, both modulating alcohol craving and drug-seeking. To date, the neurobiological mechanisms underlying those effects are still little-known. We thus investigated the effect of leptin and ghrelin on alcohol cue-induced brain response, alcohol craving and relapse risk in alcohol-dependent subjects. Seventy abstinent alcohol dependent individuals underwent a functional magnetic resonance imaging (fMRI) alcohol cue-reactivity task and patients` alcohol craving was assessed. Plasma levels of leptin, total and acylated, active ghrelin were measured prior to the fMRI session. Additionally, relapse data was collected during a three-month follow-up. Associations between hormone levels, mesolimbic cue-reactivity, alcohol craving and relapse risk were tested. Leptin levels showed a significant negative association to alcohol cue-induced brain response in the striatum and alcohol craving. In addition, there was a significant effect of leptin on time to first heavy relapse in which higher leptin levels predicted longer times to first heavy relapse. Moreover, positive associations between acylated ghrelin and increased cue-reactivity in bilateral insulae as well as increased craving for alcohol during the fMRI task were revealed. Leptin and acylated ghrelin show opposing effects on mesolimbic cue-reactivity and alcohol craving. We suspect that the reduced striatal cue-reactivity might be the neurobiological correlate of leptin's effect on relapse-risk. The reported results further support the relevance of appetite regulating hormones in the pathophysiology of addiction and their potential role as future treatment targets.

Attention-deficit/hyperactivity Disorder (ADHD) and borderline personality disorder (BPD) have overlapping symptoms. We proposed that excessive spontaneous mind wandering (MW-S) might reflect a component of psychopathology that distinguishes ADHD from BPD. Using a questionnaire measure of MW-S and an experience sampling method, we investigated MW-S in daily life, in 28 ADHD, 19 BPD, 22 comorbid ADHD+BPD, and 29 control females. The clinical groups reported heightened frequency and intensity of MW-S compared to controls, but no differences from each other. When controlling for depression and anxiety, significant differences only persisted between controls and ADHD, who also showed elevated intensity of MW-S compared to BPD and comorbid ADHD+BPD. We found no MW-S instability differences amongst clinical cases as well as cases versus controls. Negative content of MW-S was higher in BPD and comorbid ADHD+BPD compared to controls, with no differences between ADHD and controls. When controlling for depression/anxiety, the differences between BPD and comorbid ADHD+BPD and controls dissipated. MW-S is a trans-diagnostic process present in both ADHD and BPD. Yet, the underlying mechanisms of this experience may be driven by anxiety/depression in BPD but reflect a core process in ADHD.

Background: Similar to other countries, the government of Germany has implemented various restrictions of social life in March 2020 to slow the spread of COVID-19 pandemic. This results in millions of people being isolated for long periods, which may increase feelings of worry and anxiety. As the consumption of alcohol and tobacco is an often used dysfunctional strategy to cope with such feelings, these restrictions might cause an increase of consumption. Already at the beginning of the COVID-19 pandemic, the World Health Organization (WHO) warned that increased alcohol consumption during the lockdown can increase the prevalence of alcohol use disorders in the future. However, up to now little is known about the changes in alcohol-drinking behavior and tobacco smoking in the general population during the COVID-19 pandemic. Methods: To address this theme, we investigated the changes in alcohol and tobacco consumption in the German population aged between 18 and 80 years via an online survey. Results: In total, 3,245 persons participated in the survey; 35.5% of them reported an increase in drinking during the lockdown (42.9% did not change their drinking behavior, 21.3% drank less, and 0.3% started drinking). The odds of consuming more alcohol during lockdown were associated with middle age, higher subjective stress due to the COVID-19 pandemic, a lower agreement with the importance of the restrictions, and consuming alcohol more than once per week before the lockdown. Also, 45.8% of the participants increased their smoking during the lockdown. The odds of smoking more during lockdown were associated with higher subjective stress due to the COVID-19 pandemic. Conclusion: These findings suggest that it is important to start campaigns to inform the general population about potential long-term effects of increased alcohol and tobacco consumption and to raise the health-care professionals’ awareness of this topic.

Phantom limb pain (PLP) accounts for a significant reduction in quality of life and is difficult to treat. Prosthesis use has been shown to negatively covary with PLP. Recent research on body perception in amputees suggest that prosthesis ownership, defined as the extent to which a prosthesis is experienced as being part of the body rather than an artificial device foreign to the body, might interact with PLP. We used survey data from 2383 unilateral prosthesis-using upper-limb or lower-limb amputees and performed regression analyses to determine the relationship between prosthesis ownership and PLP. To test for specificity, we examined the role of prosthesis ownership also for residual limb pain (RLP) and nonpainful phantom limb sensations (npPLS). Prosthesis ownership was reduced in older participants and higher in lower-limb compared to upper-limb amputees. A longer residual limb and more frequent prosthesis use as well as a longer time since amputation also yielded higher values. Prostheses based on natural principles were associated with higher prosthesis ownership. Phantom limb pain and RLP were lower with higher prosthesis ownership, and RLP but not PLP was lower when prosthesis use was frequent. There were no significant associations for npPLS. The regression results differ in some aspects from those revealed by univariate analyses, emphasizing the importance of multivariate statistical approaches. Our findings provide insights into the interplay of body- and pain-related sensations after amputation, and could help to develop new treatment approaches for both PLP and RLP.

Introduction: Preclinical studies have shown that calcium seems to be the active component of the anti-craving drug acamprosate (Ca2+ bis-acetyl-homotaurinate). Clinical effects in humans have also indicated an association between increased calcium plasma concentration due to acamprosate treatment and better outcome relating to time to relapse and cumulative abstinence. In contrast, low calcium concentration in alcohol-dependent patients was related with craving for alcohol. The main goal of the trial was to investigate whether an oral calcium administration is able to affect craving, withdrawal, and relapse risk in alcohol-dependent patients. Methods: We conducted a single-blind, randomized, monocentric, controlled clinical two-arm trial in alcohol-dependent patients (Clinical Trials Registration: DRKS00011293). A total of 55 alcohol-dependent subjects received calcium carbonate (800 mg + 5 μg vitamin D) versus sodium bicarbonate (1,000 mg) daily during the 14 days of inpatient alcohol-withdrawal treatment. Results: Based on an intention-to-treat protocol, withdrawal intensity (assessed with CIWA-Ar) in the calcium carbonate group attenuated faster than in the sodium bicarbonate subgroup. Alcohol craving (assessed with OCDS) in the calcium carbonate subgroup was also significantly reduced versus the sodium bicarbonate subgroup. Conclusion: Our data support earlier findings and show that treatment with calcium carbonate during alcohol withdrawal reduces symptoms of alcohol withdrawal as well as alcohol craving in a controlled clinical pilot study. Mode of actions will need to be determined to allow the further development of pharmacological interventions beyond Ca2+ bis-acetyl-homotaurinate.

Introduction: Alcohol dependence (AD) is frequently associated with attention-deficit/hyperactivity disorder (ADHD) as well as with posttraumatic stress disorder (PTSD). Objective: Aim of this study was to investigate whether in patients with AD, ADHD is associated with an increased rate of exposure to potentially traumatic events (PTEs) and PTSD, with increased PTSD severity and higher impact on daily functioning. Methods: Patients with AD were thoroughly assessed for ADHD during long-term residential treatment. Participants also completed the Posttraumatic Diagnostic Scale (PDS). The PDS is a 49-item self-report instrument that assesses exposure to different PTEs, DSM-IV criteria for PTSD, severity of PTSD, and related functional impairment. Results: Of 341 patients with AD, 66 were diagnosed with ADHD (19%). ADHD was associated with a more frequent exposure to PTEs (88 vs. 65%, p < 0.001). In patients with PTEs (n = 237), odds for PTSD were higher in ADHD versus no-ADHD patients (OR 8.9, 95% CI 3.9–20.5). Furthermore, PTSD severity and functional impairment were increased in ADHD patients. Conclusions: ADHD in patients with AD is associated with a higher frequency of PTEs and PTSD with more severe and more impairing PTSD symptoms. In alcohol-dependent patients with ADHD, regular screening for PTSD should be considered.

Objective: ADHD is common in patients with alcohol dependence, but prevalence results are inconsistent. We investigated ADHD prevalence in a complex design to avoid over- or underdiagnosing. Method: Patients with alcohol dependence starting long-term residential treatment were included. A structured interview (Diagnostic Interview for ADHD in Adults [DIVA]) was conducted on all patients. DIVA results indicating childhood or adulthood ADHD were assessed in successive diagnostic interviews by two expert clinicians. Results: 415 of 488 patients had completed the entire diagnostic assessment. ADHD prevalence was 20.5%. DIVA results correlated moderately with experts’ diagnoses. In patients with ADHD, a higher comorbid illicit substance use was prevalent and alcohol dependence started earlier and was more severe. Conclusion: This study provides the largest sample on ADHD prevalence in alcohol dependent inpatients. Despite great efforts to avoid overestimation, we found every fifth patient to have ADHD. ADHD diagnosis should not be based solely on a structured interview but should be clinically confirmed. (J. of Att. Dis. 2020; 24(14) 2072–2083)

Zusammenfassung. Digitalisierung ermöglicht die vielversprechende Integration von Gesundheitsinterventionen in unseren Alltag, u.a. auf Smartphones, und bietet Chancen zur Implementierung von Bewegungsinterventionen, von denen auch insbesondere psychisch Erkrankte profitieren können. Allerdings ist die Kluft zwischen technisch bereits Umsetzbarem und Wissen um Wirkungen im Alltag groß. Beispielsweise wurde gezeigt, dass Sport generell Depressionssymptomen entgegenwirkt. Der spezifische Einfluss von Sportinterventionen auf die Alltags-Stimmung – einem der drei von Depressionen betroffenen Kernbereiche – ist jedoch unzureichend erforscht. Um diesen spezifischen Effekt zu untersuchen und den Weg zu evidenzbasierten Smartphoneinterventionen zu ebnen, statteten wir 15 depressive Personen jeweils drei Tage vor und nach einer zehnwöchigen Sportintervention mit Smartphone-Tagebüchern aus. Die Probanden beantworteten 83.6% aller Stimmungsabfragen. Signifikante Cross-Level-Interaktionen in Mehrebenen-Analysen bestätigten, dass Personen, die zu Interventionsbeginn weniger Sport trieben, größere Stimmungsverbesserungen nach der Intervention zeigten (Gute-Schlechte-Stimmung: b = 5.8; Ruhe-Unruhe: b = 5.3). Diese Pilotergebnisse sollen helfen, den vielversprechenden Weg zu evidenzbasierten sportpsychologischen Interventionen auf dem Smartphone zu ebnen.

Ghrelin has been shown to be involved in the pathophysiology of alcohol dependence, affecting alcohol self-administration and craving. However, the mechanism of action in alcohol dependence still has to be determined. We thus investigated whether ghrelin is associated with mesolimbic cue reactivity to alcohol cues and alcohol craving in recently detoxified alcohol-addicted subjects. We included 41 recently detoxified alcohol-dependent individuals. Functional magnetic resonance imaging (fMRI) was used to study mesolimbic cue reactivity during the presentation of alcohol-related pictures. Additionally, we assessed patients' alcohol craving using the Alcohol Urge Questionnaire and a visual analogue scale. Plasma concentrations of total and acylated (activated) ghrelin were measured in parallel to the fMRI session. The association between ghrelin plasma concentrations, mesolimbic cue reactivity and alcohol craving was assessed by performing correlation and mediation analyses. Alcohol-induced brain response in a network of brain clusters, including the right and left ventral striatum, showed a significant positive association with acylated ghrelin plasma concentration. Additionally, acylated ghrelin was significantly associated with craving. Mediation analyses showed that the association between acylated ghrelin plasma concentration and alcohol craving is mediated by a cue-induced brain response in the ventral striatum. Based on the finding that ghrelin modulates mesolimbic reactivity to alcohol cues, the following should be considered: If alcohol craving and the appetitive status were interrelated, this has to be taken into account when implementing fMRI studies for addictive disorders. Moreover, appetite regulation seems to represent a valid treatment target for reducing cue reactivity in addictive disorders.

Background Addicted Internet users present with higher rates of comorbidities, e.g., attention-deficit hyperactivity disorder (ADHD), depressive, and anxiety disorders. In addition, deficits in self-concept-related characteristics were found in addicted Internet gamers and social network users. The aim of this study was to examine the links between healthy, problematic, and addicted Internet use regarding comorbidities and self-concept-related characteristics. The association between recently developed ADHD-like symptoms without an underlying diagnosis and addictive Internet use was also examined. Methods n = 79 healthy controls, n = 35 problematic, and n = 93 addicted Internet users were assessed for comorbidities, social and emotional competencies, body image, self-esteem, and perceived stress. Apart from an ADHD-diagnosis, recently developed ADHD-like symptoms were also assessed. Results Addicted users showed more self-concept-related deficits and higher rates of comorbidities with ADHD, depressive, and anxiety disorders. Addicted and problematic users showed similarities in the prevalence of cluster B personality disorders and decreased levels of characteristics related to emotional intelligence. Participants with recently developed ADHD-like symptoms scored higher in lifetime and current severity of Internet use compared with those without ADHD symptoms. Addicted participants with recently developed ADHD symptoms showed higher lifetime Internet use severity compared with those without any symptoms. Conclusions Our findings indicate that cluster B personality disorders and premorbid problems in emotional intelligence might present a link between problematic and addictive Internet use. Furthermore, the findings provide a first indication that addictive Internet use is related to ADHD-like symptoms. Symptoms of ADHD should therefore be assessed against the background of possible addicted Internet use.

Hintergrund: Überprüft wurde der Effekt einer kognitiv-behavioralen Gruppentherapie (KBGT) im Rahmen eines Tabakentwöhnungsprogramms auf die Tabakkonsumreduktion und -abstinenz während einer 3-wöchigen stationären, qualifizierten Alkoholentzugsbehandlung. Teilnehmer und Methoden: Von den 73 eingeschlossenen alkoholabhängigen Rauchern mit Rauchabstinenzmotivation entschieden sich 60 Probanden (82,2%) für ein Tabakentwöhnungsprogramm mit KBGT und Tabakentwöhnungsmitteln. 13 Probanden (17,8%), die eine alleinige Therapie mit Tabakentwöhnungsmitteln erhielten, bildeten die Kontrollgruppe. Ergebnisse: Im Vergleich zum Studieneinschluss konnten Probanden mit KBGT ihren durchschnittlichen Tabakkonsum zum Entlassungszeitpunkt und beim Follow-up nach 3 Monaten signifikant reduzieren. Probanden ohne KBGT schafften dies nicht. Zu den beiden Messzeitpunkten erreichten 28,3 bzw. 14,3% der Probanden mit KBGT eine Tabakabstinenz; bei den Teilnehmern ohne KBGT waren es 15,4 bzw. 9,1%. Dieser Unterschied erreichte jedoch keine statistische Signifikanz. Probanden, die zum Entlassungszeitpunkt und zum Follow-up tabakabstinent waren, hatten signifikant häufiger an den KBGT-Sitzungen teilgenommen. Mehr als zwei Drittel der tabakabstinenten Probanden hatten innerhalb von 7 Tagen nach Studieneinschluss einen Rauchstopp erreicht; 92,9% dieser Probanden waren Teilnehmer der KBGT-Gruppe. Schlussfolgerung: Die Bereitschaft zur Teilnahme an einer freiwilligen KBGT war hoch. Dabei zeigten sich signifikant bessere Reduktionsraten und nicht signifikant verbesserte Tabakabstinenzraten bei der Entlassung und im Follow-up. Die Ergebnisse weisen auf einen positiven Zusammenhang zwischen der Tabakabstinenzrate und einem frühzeitigen Rauchstopp bzw. einer höheren Anzahl an besuchten KBGT-Sitzungen bei Rauchern im Rahmen einer stationären Alkoholentzugsbehandlung hin.

Background Recent data suggest that ghrelin is involved in the pathophysiology of alcohol use disorders, affecting alcohol self-administration and craving. Gastric ghrelin secretion is reduced by stomach distension. We now tested the hypothesis whether the clinically well-known effects of high-volume water intake on craving reduction in alcoholism is mediated by acute changes in ghrelin secretion. Methods In this randomized human laboratory study, we included 23 alcohol-dependent male inpatient subjects who underwent alcohol cue exposure. Participants of the intervention group drank 1000 ml of mineral water within 10 min directly thereafter, compared to the participants of the control group who did not. Craving and plasma concentrations of acetylated ghrelin were measured ten times during the 120 min following the alcohol cue exposure session. Results In the intervention group, a significant decrease in acetylated ghrelin in plasma compared to the control group was observed. This decrease was correlated to a reduction in patients’ subjective level of craving. In the control group, no decrease of acetylated ghrelin in plasma and no association between alcohol craving and changes in plasma concentrations of acetylated ghrelin were observed. Conclusions Our results present new evidence that the modulation in the ghrelin system by oral water intake mediates the effects of volume intake with craving reduction in alcohol use disorders. Hence, in addition to pharmacological interventions with ghrelin antagonists, the reduction of physiological ghrelin secretion might be a target for future interventions in the treatment of alcohol craving.

Zusammenfassung. Ziel der Studie: Untersucht wurden die Einstellungen gegenüber Menschen mit Alkoholabhängigkeit und die Akzeptanz neurobiologischer sowie sozialer Krankheitsursachen. Methodik: Mit einem 75-Item Fragebogen wurden die Ansichten von 254 Teilnehmern erfragt und die Einstellungen gegenüber alkoholabhängigen Patienten von Betroffenen und gesunden Menschen verglichen. Die betroffenen alkoholabhängigen Patienten (n = 122) wurden während einer stationären qualifizierten Entzugsbehandlung befragt, nachdem der körperliche Entzug vorüber war. In den Vergleichsgruppen wurden medizinisches Personal (n = 70) sowie Studierende (n = 62) ohne medizinisches Hintergrundwissen befragt. Ergebnisse: Zwischen den Betroffenen und dem medizinischen Personal fanden wir keine Unterschiede bezüglich der Zuschreibung neurobiologischer Faktoren als Ursachen der Alkoholabhängigkeit. Studierende hielten neurobiologische Faktoren für weniger ursächlich für Alkoholabhängigkeit als Betroffenen und als medizinisches Personal. Bezüglich der sozialen Faktoren als Ursachen der Alkoholabhängigkeit ergaben sich keine signifikanten Unterschiede zwischen den drei Gruppen. Die Betroffenen bewerteten die Charaktereigenschaften alkoholabhängiger Patienten insgesamt positiver als das medizinische Personal und die Studierenden.Schlussfolgerung: Betroffene berichten positivere Einstellungen gegenüber Menschen die an einer Alkoholabhängigkeit leiden, als medizinisches Personal und als Studierende.

Borderline personality disorder (BPD) is defined by a pervasive pattern of instability. Although there is ample empirical evidence that unstable self-esteem is associated with a myriad of BPD-like symptoms, self-esteem instability and its temporal dynamics have received little empirical attention in patients with BPD. Even worse, the temporal interplay of affective instability and self-esteem instability has been neglected completely, although it has been hypothesized recently that the lack of specificity of affective instability in association with BPD might be explained by the highly intertwined temporal relationship between affective and self-esteem instability. To investigate self-esteem instability, its temporal interplay with affective instability, and its association with psychopathology, 60 patients with BPD and 60 healthy controls (HCs) completed electronic diaries for 4 consecutive days during their everyday lives. Participants reported their current self-esteem, valence, and tense arousal levels 12 times a day in approximately one-hr intervals. We used multiple state-of-the-art statistical techniques and graphical approaches to reveal patterns of instability, clarify group differences, and examine the temporal interplay of self-esteem instability and affective instability. As hypothesized, instability in both self-esteem and affect was clearly elevated in the patients with BPD. In addition, self-esteem instability and affective instability were highly correlated. Both types of instability were related to general psychopathology. Because self-esteem instability could not fully explain affective instability and vice versa and neither affective instability nor self-esteem instability was able to explain psychopathology completely, our findings suggest that these types of instability represent unique facets of BPD. (PsycINFO Database Record