1,721,175 research outputs found
Psychosocial stress experience and DNA methylation in humans - implications for stress-adaptation and -resilience
Full text linkAbstract: Background: Psychosocial stress, especially early in life, is a risk factor for mental disorders. Recent evidence suggests that stress-related changes in epigenetic patterns, including DNA methylation, could mediate this association.
Aim: to examine a potential association between psychosocial stress exposure and DNA methylation of two stress-related genes: the oxytocin receptor (OXTR) and the brain-derived neurotrophic factor (BDNF).
Methods: We investigated DNA methylation in three target sequences: OXTR1, OXTR2 and BDNF. The psychosocial stressors included: (1) maternal stress during pregnancy (prenatal stress, N=39); (2) low versus high maternal care during childhood (maternal care, N=85) and (3) acute psychosocial stress (N=83). In the prenatal stress study, DNA methylation of OXTR1 was quantified in cord-blood cells. In the maternal care and acute psychosocial stress study, DNA methylation of OXTR1, OXTR2 and BDNF was quantified in peripheral blood cells of adults.
Results: (1) Several indicators of increased prenatal stress predicted higher DNA methylation of OXTR1. (2) Adults reporting low maternal care showed increased OXTR2 DNA methylation compared to those reporting high maternal care. (3) Exposure to acute psychosocial stress was associated with dynamic changes in DNA methylation of OXTR – DNA methylation increased from pre- to post-stress in OXTR1 and decreased from post-stress to follow up in OXTR1 and OXTR2. Some of these changes might have been due to variations in blood cell count.
Discussion: Exposure to psychosocial stress was associated with target sequence-specific changes in OXTR DNA methylation. These results could contribute to our understanding of epigenetic processes involved in stress-adaptation. ---------- Zusammenfassung:
Hintergrund: Psychosozialer Stress, insbesondere während der frühen Entwicklung, ist ein
Risikofaktor für psychische Erkrankungen. Dieser Zusammenhang könnte durch stress- assoziierte epigenetische Veränderungen, z.B. in der DNA Methylierung, mediiert werden.
Ziel: ein potentieller Zusammenhang zwischen verschiedenen psychosozialen Stressoren und der DNA Methylierung zweier stress-assoziierter Gene zu untersuchen: dem Oxytozin Rezeptor (OXTR) und dem Brain-Derived Neurotrophic Factor (BDNF).
Methode: DNA Methylierung wurde in drei DNA Zielsequenzen gemessen: OXTR1, OXTR2 und BDNF. Die untersuchten psychosozialen Stressoren waren: (1) mütterlicher Stress während der Schwangerschaft (pränataler Stress, N=39); (2) mütterliche Zuwendung in der Kindheit (N=85) und (3) akuter psychosozialer Stress im Erwachsenenalter (N=83). In der Studie zu pränatalem Stress wurde DNA Methylierung von OXTR1 im Nabelschnurblut gemessen; in den Studien zu mütterlicher Zuwendung und akutem psychosoziale Stress wurde DNA Methylierung von OXTR1, OXTR2 und BDNF in peripherem Blut gemessen.
Resultate: (1) Mehrere Indikatoren von pränatalem Stress sagten eine stärkere OXTR1 DNA Methylierung vorher. (2) Erwachsene, welche von wenig mütterlicher Zuwendung berichteten, hatten eine stärkere Methylierung in OXTR2 im Vergleich zu denjenigen mit mehr Zuwendung. (3) Akuter psychosozialer Stress war mit dynamischen Veränderungen in OXTR DNA Methylierung assoziiert: eine Erhöhung von Prä-Stress zu Post-Stress in OXTR1 und eine Erniedrigung von Post-Stress zu Follow-Up in OXTR1 und OXTR2, wobei einige dieser Veränderungen allenfalls durch Variationen in der Blutzell-Verteilung zustande kamen.
Diskussion: Psychosozialer Stress war assoziiert mit Veränderungen in der DNA Methylierung des OXTR. Die Resultate könnten zu einem besseren Verständnis von epigenetischen Stress-Adaptionsmechanismen beitragen
Therapeutic leave and coercive measures in inpatient psychiatry a clinical and health economic viewpoint
Full text linkIn inpatient psychiatric care, readmissions and coercive measures can be problematic in various
aspects. More research on treatment variables is needed to improve the quality of care and reduce
readmission and coercive measures. Inpatient care is also a large cost driver of healthcare
systems. With a global increasing economic burden of mental ill health, health economic analyses
are warranted to promote policy change according to scientific evidence. This dissertation,
therefore, integrates a clinical and health-economic perspective to examine two treatment
variables in inpatient care: therapeutic leave and staff resources relating them to readmission,
direct inpatient costs, and coercive measures. Therapeutic leave (TL) is an established practice
in inpatient psychiatry. However, research on its association with readmission and inpatient costs
is scarce. Studies have addressed the association between staff resources and coercion but yield
limited and heterogeneous results.
Study 1 assessed the readmission risk of patients with TL during their inpatient stay compared to
patients without TL applying a survival analysis. The results showed a significantly longer
cumulative survival and a reduced hazard of readmission for patients with TL compared to patients
without TL. Study 2 was a follow-up study of Study 1 and examined whether there is an association
between TL and direct inpatient costs in the months following discharge. We applied a Tweedie
regression model. Study 2 showed TL is associated with lower direct inpatient costs after
discharge. Study 3 examined how efficiently psychiatric clinics maximize inpatient cases without
seclusion and restraint with their given staff number of full-time equivalents. The results suggest
that clinics are relatively efficient at maximizing cases without coercion. However, changes in
management and careful consideration of team composition are necessary to further increase
cases without seclusion and restraint.
In conclusion, Study 1 and Study 2 add to the limited knowledge of TL in relation to readmission
risk and direct healthcare costs. In addition, Study 3 sheds more light on staff-related factors in
reducing coercive methods. By integrating a clinical and health-economic perspective, this
dissertation considers an ever-present and growing conflict between economic motives and a
patient-oriented psychiatry lead in line with ethical principles. This dissertation's results imply a
link between TL during inpatient treatment, a lower readmission risk, and lower direct inpatient
costs after discharge. Regarding TL, randomized controlled trials are needed to assess the
causality of our results. We still need to better understand the underlying mechanisms of TL. More
health economic analyses, especially including indirect costs, are required. TL might be a suitable
intervention to improve the quality of care. Whilst our results of Study 3 show that clinics are
relatively efficient at maximizing cases without coercion, economic and ethical considerations
regarding staff numbers in psychiatric clinics need to be balanced out. Coercive measures should
never, even implicitly, be driven by monetary factors. When it comes to the integrity of human
beings, ethical considerations must outweigh economic motives
The comorbidity of anxiety disorders and physical diseases : an epidemiological approach
Full text linkAbstract
Background: Anxiety disorders are highly comorbid with other mental disorders. This has important implications for individuals’ burden, etiology of the comorbid diseases and treatment. Knowledge about the comorbidity with physical diseases in the community, however, is limited, especially for specific anxiety disorders. This dissertation evaluates the comorbidity of specific anxiety disorders and noncommunicable and communicable physical diseases in the general population. Further, it investigates the association of comorbidity with measures of burden, namely, quality of life and disability.
Method: Data of the German Health Interview and Examination Survey (GHS), a representative general population survey from Germany with 4,181 subjects aged 18-65 years, were used. Anxiety disorders were diagnosed using the Munich-Composite International Diagnostic Interview (DIA-X/M-CIDI), noncommunicable physical diseases were assessed through a self-report questionnaire and a standardized medical interview, and communicable physical diseases through a self-report questionnaire.
Results: Both obsessive-compulsive disorder (OCD) and specific phobia were associated with migraine and respiratory diseases. Additionally, subthreshold forms of OCD were associated with specific noncommunicable physical diseases. Agoraphobia, specific phobia, and generalized anxiety disorder were all associated with whooping cough. The documented comorbidity was associated with increased disability and decreased quality of life.
Discussion: The detected comorbidity patterns may contribute to a better understanding of the psychobiological pathways of comorbidity. Further, increased burden of individuals affected underlines the need for studies evaluating the effect of treatment in comorbid cases.
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Zusammenfassung
Hintergrund: Angststörungen weisen eine hohe Komorbidität mit anderen psychischen Störungen auf. Dies hat wichtige Implikationen für die Belastung der Betroffenen, sowie für die Ätiologie und Therapie der komorbiden Störungen. Die Datenlage zur Komorbidität mit körperlichen Erkrankungen in der Bevölkerung ist jedoch für spezifische Angststörungen eingeschränkt. Die vorliegende Dissertation untersucht den Zusammenhang zwischen spezifischen Angststörungen und nichtübertragbaren und übertragbaren körperlichen Erkrankungen in der Bevölkerung. Weiter wird die Assoziation der Komorbidität mit Lebensqualität und Beeinträchtigung untersucht.
Methode: Analysiert wurden die Daten des Bundesgesundheitssurvey, einer repräsentativen Bevölkerungsstichprobe Deutschlands mit 4’181 Probanden im Alter von 18-65 Jahren. Angststörungen wurden mit dem DIA-X/M-CIDI Interview erhoben, nichtübertragbare körperliche Erkrankungen mit einem ärztlichen Interview, sowie mit einem Fragebogen und übertragbare körperliche Erkrankungen mit einem Fragebogen.
Resultate: Sowohl die Zwangsstörung als auch die Spezifische Phobie traten gehäuft mit Migräne und Atemwegserkrankungen auf. Auch subklinische Formen der Zwangsstörung waren mit spezifischen, nichtübertragbaren körperlichen Erkrankungen assoziiert. Agoraphobie, Spezifische Phobie und Generalisierte Angststörung gingen mit erhöhten Prävalenzraten von Keuchhusten einher. Komorbidität war mit erhöhter Beeinträchtigung und niedrigerer Lebensqualität assoziiert.
Diskussion: Die Komorbidiätsmuster können zu einem besseren Verständnis der zugrundeliegenden Mechanismen beitragen. Die assoziierte Belastung unterstreicht die Bedeutung weiterer Forschung zur Wirksamkeit der Therapie bei komorbiden Erkrankungen.
Investigating unwanted intrusive thoughts in laboratory settings and a natural environment
Full text linkUnwanted intrusive thoughts (UITs) are essential to research of obsessive-compulsive disorder. This thesis aimed (1) to replicate results of a previous study in which rumination about a UIT maintained the urge to neutralize the UIT, (2) to evaluate the validity of a counter-app method in assessment of UIT frequency, and (3) to examine in what aspects exam-related UITs and related neutralizing behaviors (ER-UITs-N) are analogous to obsessions and compulsions. In study one, we temporarily activated a UIT in N = 105 students and randomly assigned them to rumination about the UIT, rumination about negative mood, or distraction. We assessed distress, urge to neutralize, depressed mood, and UIT frequency. In the next study, we activated a UIT in N = 142 students and assessed the UIT frequency with the counter-app method and three other measures (convergent validity criteria). We also assessed discriminant and predictive validity criteria. Finally, we assessed severity of ER-UITs-N, obsessive-compulsive symptoms, anxiety, distress, urge to neutralize, depressed mood, and stress in N = 29 students using the ecological momentary assessment. Rumination about the UIT maintained the urge to neutralize and distress compared to rumination about negative mood and distraction. Correlations between the counter-app frequency and the validity criteria supported convergent and predictive, but not discriminant, validity of the counter-app method. The severity of ER-UITs-N was positively associated with obsessive-compulsive symptoms, anxiety, distress, urge to neutralize, and stress, but not with depressed mood. Results suggest that rumination about UITs might contribute to their persistence. The counter-app method validly assesses UIT frequency but is not appropriate when the differentiation of frequency from other constructs (e.g., duration) is needed. Finally, the ER-UITs-N seem analogous to obsessions and compulsions in some aspects (e.g., association with distress), but not all (e.g., no relation to depressed mood)
From mental-physical comorbidity to somatic symptoms - insights gained from research on symptoms of mental disorders
Full text linkAbstract in English
Background: Mental health and physical health are substantially associated with each other. The early recognition of co-occurring mental-physical conditions, as well as the early recognition of pathophysiological mechanisms underlying somatic symptoms, might be of special relevance for a better understanding of early phases of disorder development and hence prevention.
Aim: To examine associations between symptoms of mental disorders (depressive symptoms and gambling behavior) and physical diseases, as well as associations between somatic symptoms and sensory responsiveness.
Methods: We estimated (1) the association between depressive symptoms and physical diseases (N = 14,348), (2) the association between gambling and physical diseases (N = 11,385), and (3) the association of sensory responsiveness with somatic symptoms and illness anxiety (N = 205). Logistic regression analyses were conducted to estimate the associations in studies (1) and (2). To estimate the associations in study (3) we conducted a linear multiple regression model. We controlled for potential confounders in all three studies.
Results: (1) Depressive symptoms were associated with Arthrosis and Arthritis and any physical disease. (2) Gambling in the past 12 months was associated with Diabetes, Arthrosis and Arthritis, High blood pressure, allergies like Hay Fever, and any physical disease. (3) Increased sensory responsiveness was associated with increased scores of the overall illness anxiety scale and its constituent subscale disease conviction.
Discussion: Symptoms of mental disorders were associated with physical diseases and increased sensory responsiveness was associated with illness anxiety. Scrutinizing these associations might contribute to a better understanding of mental-physical comorbidity and might therefore have implications for early recognition, treatment and health care policy.-----------Abstract in German
Hintergrund: Psychische und körperliche Gesundheit sind stark miteinander verbunden. Die Früherkennung von gemeinsam auftretenden psychisch-körperlichen Erkrankungen, sowie somatischen Symptomen zugrundeliegenden pathophysiologischen Mechanismen, könnte zu einem besseren Verständnis der frühen Krankheitsentwicklung und somit der Prävention beitragen.
Ziel: Untersuchung der Zusammenhänge zwischen Symptomen psychischer Störungen (depressive Symptome und Glücksspielverhalten) und körperlichen Erkrankungen, sowie der Zusammenhänge zwischen somatischen Symptomen und sensorischer Empfindlichkeit.
Methode: Untersucht wurden die Assoziation zwischen (1) depressiven Symptomen und körperlichen Erkrankungen (N = 14,348), (2) Glücksspielverhalten und körperlichen Erkrankungen (N = 11,385), und (3) sensorischer Empfindlichkeit und somatischen Symptomen oder Krankheitsangst (N = 205). Assoziationen in Studie (1) und (2) wurden anhand logistischer Regressionen geschätzt. In Studie (3) wurde ein lineares multiples Regressionsmodells verwendet. Potenzielle Störvariablen wurden in allen drei Studien kontrolliert.
Resultate: (1) Depressive Symptome waren mit Arthrose und Arthritis und irgendeiner körperlichen Erkrankung assoziiert. (2) Glücksspiele spielen in den letzten 12 Monaten war mit Diabetes, Arthrose und Arthritis, hohem Blutdruck, Allergien wie Heuschnupfen und irgendeiner körperlichen Erkrankung assoziiert. (3) Erhöhte sensorische Empfindlichkeit war mit höheren Werten auf der allgemeinen Krankheitsangstskala und der Unterskala Krankheitsüberzeugung assoziiert.
Diskussion: Symptome psychischer Störungen waren assoziiert mit körperlichen Erkrankungen und erhöhte sensorische Empfindlichkeit war assoziiert mit Krankheitsangst. Die eingehende Untersuchung dieser Zusammenhänge könnte zu einem besseren Verständnis psychisch-körperlicher Komorbiditäten beitragen und somit Implikationen für die Früherkennung, Behandlung und Gesundheitspolitik haben
Prediction of Social Psychiatric and Treatment Related Outcomes in the Spectrum of Psychotic Disorders
Full text linkPsychotic disorders are severe and potentially disabling mental disorders which rank among the world's top 10 causes of chronic disability and produce high healthcare costs. First-line treatment with antipsychotic medication is associated with only medium effect sizes for positive symptoms and several limitations. Research has thus increasingly embraced new and complementary treatment approaches, namely the early detection and intervention research and the development of psychological interventions. This thesis aimed to address unresolved research questions in these areas. Article 1 and 2 focused on the early detection and intervention of psychotic disorders and investigated predictors of study drop-out, service disengagement, and long-term clinical and functional outcome in patients at clinical high risk for psychosis (CHR-P). Article 3 analyzed moderators of individualized Metacognitive Training (MCT+), a theory-driven intervention designed to improve delusional symptom severity. In Article 1, 36% of CHR-P patients dropped out and/or disengaged within 5 years. A late study inclusion period, associated with more frequent follow-ups and higher participation burden, was predictive for higher risk of drop-out and disengagement. In Article 2, remission from CHR-P status after 10 years was estimated as 51%. Better baseline psychosocial functioning was associated with a higher rate of remission. However, only a minority of patients fully recovered clinically and functionally. In Article 3, the occurrence of the jumping-to-conclusions bias and low self-esteem were associated with larger improvements over time in MCT+ compared to an active control intervention. Article 1 and 2 underline the importance of individually tailored treatment planning and call for the right balance between too high-frequency assessments on one hand, and a lack of treatment care for patients experiencing long-term clinical symptoms and functional impairments on the other. The findings of Article 3 provide useful criteria for selecting patients who might particularly benefit from MCT+
Applications of the network perspective in clinical psychology and psychotherapy
No full textThe complex network perspective is becoming increasingly popular in the field of clinical psychology and psychotherapy and assumes that the occurrence of a mental disorder can be characterized by the activation of a network of interrelated elements (previously termed ‘symptoms’). This perspective adopts an advanced computational method, network analysis (NA), which gives empirical data a new framework with the aim of extracting information relevant to clinical research and practice. In this thesis, we describe three applications of NA in clinical psychology and psychotherapy. First, we examined multimorbidity patterns as a function of psychopathology severity levels. We found that major mental symptom domain interrelations become consistent at and above a subthreshold level suggesting that specific patterns emerge as psychopathology severity levels increase. Second, we scrutinized how mental health (MH) service use is related to transdiagnostic symptom networks. Findings suggest that after adjusting for potential confounding by indication for service use, there was no indication of an association in overall connectivity or network structure of networks with versus without MH services use. However, selected structurally important symptoms differed consistently between networks with versus without MH service use indicating that more granular network characteristics on the node level may complement and enrich traditional outcomes in clinical research. Third, we applied dynamic NA techniques to model temporal and cross-sectional associations of symptoms and affective, cognitive, and behavioral elements in patients with Globus Sensations (GS) over the course of psychotherapy. We found that GS were not temporally associated with any affective, cognitive, and behavioral elements. We did find indications for potential causal pathways between catastrophizing cognitions and bodily weakness as well as GS and somatic distress, which may reflect temporal associations in patients with GS in the context of treatment. Our findings have several implications for clinical research and practice and further provide a theoretical basis and guidance for future research using cross-sectional and dynamical NA in the context of clinical psychology and psychotherapy
Daily social interactions and values-consistent behavior in clinical and non-clinical individuals.
Full text linkLittle is known about patients’ daily social interactions, the lack thereof, or their values
in daily life. Especially if social areas and affect are concerned, as in patients diagnosed with
major depressive disorder (MDD) or social phobia (SP), this merits further investigation. What
is valued in daily life can further impact social interactions. What patients value in daily life
and to what degree they behave accordingly (i.e., exhibit values-consistent behavior) is
currently unknown. Thus, the aim of this thesis was to examine (1) social interactions in
relation to affect, (2) having social interactions (proportion, and quality of social interactions)
versus not having social interactions (wishing for, and avoiding social interactions), and (3)
values in daily life. Using event-sampling methodology, participants’ daily behavior was
sampled in their natural environment. Types of social interactions, negative affect (NA),
positive affect (PA), and the quality and avoidance of social interactions were investigated in
patients diagnosed with MDD (n = 118) or SP (n = 47), and in a control group (CG, n = 119),
while daily values-consistent behavior was examined in transdiagnostic in- and outpatients (n
= 100). Results show that the MDD and SP group engaged more often in technological (e.g.,
phone, Internet) interactions than the CG, which engaged more often in face-to-face
interactions. NA was positively associated with technological interactions, whereas PA was
positively associated with face-to-face interactions. Compared to the CG, both the MDD and
the SP group reported a lower quality of their social interactions, and generally avoided social
interactions more often. Both in- and outpatients reported more values-consistent behavior if
the behavior was judged as important or if it was embedded in a social context. Findings
indicate that the association between technological interactions and NA should be considered
when developing or applying clinical technological interventions. Further, understanding what
reinforces social interactions in patients might facilitate the incorporation of important and
social values into clinical work. This might then increase patients’ values-consistent behavior
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