Reports an error in "Psychological treatment for panic disorder with agoraphobia: A randomized controlled trial to examine the role of therapist-guided exposure in situ in CBT" by Andrew T. Gloster, ...Hans-Ulrich Wittchen, Franziska Einsle, Thomas Lang, Sylvia Helbig-Lang, Thomas Fydrich, Lydia Fehm, Alfons O. Hamm, Jan Richter, George W. Alpers, Alexander L. Gerlach, Andreas Ströhle, Tilo Kircher, Jürgen Deckert, Peter Zwanzger, Michael Höfler and Volker Arolt ( Journal of Consulting and Clinical Psychology, 2011Jun, Vol 793, 406-420). In the article, the name of author Georg W. Alpers was misspelled as George W. Alpers. In Table 2, in the footnote, line two, the criteria should read “MI≤1.8”. The online versions of this article have been corrected. (The following abstract of the original article appeared in record 2011-08726-001.) Objective: Cognitive–behavioral therapy (CBT) is a first-line treatment for panic disorder with agoraphobia (PD/AG). Nevertheless, an understanding of its mechanisms and particularly the role of therapist-guided exposure is lacking. This study was aimed to evaluate whether therapist-guided exposure in situ is associated with more pervasive and long-lasting effects than therapist-prescribed exposure in situ. Method: A multicenter randomized controlled trial, in which 369 PD/AG patients were treated and followed up for 6 months. Patients were randomized to 2 manual-based variants of CBT (T+/T−) or a wait-list control group (WL; n = 68) and were treated twice weekly for 12 sessions. CBT variants were identical in content, structure, and length, except for implementation of exposure in situ: In the T+ variant (n = 163), therapists planned and supervised exposure in situ exercises outside the therapy room; in the T− group (n = 138), therapists planned and discussed patients' in situ exposure exercises but did not accompany them. Primary outcome measures were (a) Hamilton Anxiety Scale, (b) Clinical Global Impression, (c) number of panic attacks, and (d) agoraphobic avoidance (Mobility Inventory). Results: For T+ and T− compared with WL, all outcome measures improved significantly with large effect sizes from baseline to post (range = −0.5 to −2.5) and from post to follow-up (range = −0.02 to −1.0). T+ improved more than T− on the Clinical Global Impression and Mobility Inventory at post and follow-up and had greater reduction in panic attacks during the follow-up period. Reduction in agoraphobic avoidance accelerated after exposure was introduced. A dose–response relation was found for Time × Frequency of Exposure and reduction in agoraphobic avoidance. Conclusions: Therapist-guided exposure is more effective for agoraphobic avoidance, overall functioning, and panic attacks in the follow-up period than is CBT without therapist-guided exposure. Therapist-guided exposure promotes additional therapeutic improvement—possibly mediated by increased physical engagement in feared situations—beyond the effects of a CBT treatment in which exposure is simply instructed. (PsycINFO Database Record (c) 2016 APA, all rights reserved) (Source: journal abstract)
Introduction Obsessive-compulsive disorder (OCD) is a common and chronic condition that can have disabling effects throughout the patient's lifespan. Frequent symptoms among OCD patients include fear ...of contamination and washing compulsions. Several studies have shown a link between contamination fears, disgust over-reactivity, and insula activation in OCD. In concordance with the role of insula in disgust processing, new neural models based on neuroimaging studies suggest that abnormally high activations of insula could be implicated in OCD psychopathology, at least in the subgroup of patients with contamination fears and washing compulsions. Methods In the current study, we used a Brain Computer Interface (BCI) based on real-time functional magnetic resonance imaging (rtfMRI) to aid OCD patients to achieve down-regulation of the Blood Oxygenation Level Dependent (BOLD) signal in anterior insula. Our first aim was to investigate whether patients with contamination obsessions and washing compulsions can learn to volitionally decrease (down-regulate) activity in the insula in the presence of disgust/anxiety provoking stimuli. Our second aim was to evaluate the effect of down-regulation on clinical, behavioural and physiological changes pertaining to OCD symptoms. Hence, several pre- and post-training measures were performed, i.e., confronting the patient with a disgust/anxiety inducing real-world object (Ecological Disgust Test), and subjective rating and physiological responses (heart rate, skin conductance level) of disgust towards provoking pictures. Results Results of this pilot study, performed in 3 patients (2 females), show that OCD patients can gain self-control of the BOLD activity of insula, albeit to different degrees. In two patients positive changes in behaviour in the EDT were observed following the rtfMRI trainings. Behavioural changes were also confirmed by reductions in the negative valence and in the subjective perception of disgust towards symptom provoking images. Conclusion Although preliminary, results of this study confirmed that insula down-regulation is possible in patients suffering from OCD, and that volitional decreases of insula activation could be used for symptom alleviation in this disorder.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Variation in the val super(158)met polymorphism of the COMT gene has been found to be associated with cognitive performance. In functional neuroimaging studies, this dysfunction has been linked to ...signal changes in prefrontal areas. Given the complex modulation and functional heterogeneity of frontal lobe systems, further specification of COMT gene-related phenotypes differing in prefrontally mediated cognitive performance are of major interest. Eighty healthy individuals (54 men, 26 women; mean age 23.3years) performed an overt semantic verbal fluency task while brain activation was measured with functional magnetic resonance imaging (fMRI). COMT val super(158)met genotype was determined and correlated with brain activation measured with fMRI during the task. Although there were no differences in performance, brain activation in the left inferior frontal gyrus Brodmann area 10 was positively correlated with the number of val alleles in the COMT gene. COMT val super(158)met status modulates brain activation during the language production on a semantic level in an area related to executive functions.
The diagnosis of beginning dementia is based mainly on neuropsychological testing. Several measures of EEG spectral composition, coherence and complexity (correlation dimension) have been shown to ...correspond to cognitive function. Only a few studies have evaluated EEG changes in normal aging, and no quantitative study has addressed changes in EEG during cognitive tasks in demented elderly. In this study the quantitative descriptors of EEGs from 31 demented or cognitively impaired elderly persons, 30 healthy elderly (mean age 69 years) and 35 young controls (mean age 31 years) were compared. The EEGs were recorded during two resting conditions (eyes closed and eyes opened) and two tasks (mental arithmetics and a lexical decision). The goal of the study was to evaluate which temporal and spatial EEG descriptors change with cognitive decline and with normal aging, respectively. Cognitive categories (unimpaired, impaired, demented) were based on Structured Interview for the Diagnosis of Dementia of Alzheimer Type (SIDAM) scores. The EEGs were analysed using adaptive segmentation of continuous EEG, which quantifies the succession of distinct stable topographic voltage patterns (EEG microstates). The main findings were a significant increase in the number of ultra-short EEG microstates and, independently, a reduction in the average duration of EEG microstates in the cognitively impaired and demented patients. In addition, cognitive impairment was associated with a reduction or loss of EEG reactivity normally observed when the resting states with closed and with opened eyes are compared. No alterations in temporal or spatial EEG descriptors were found in normal aging. Cognitive tasks did not add to information already obtained during the resting states. The reduction in EEG microstate duration correlated with loss of cognitive function. Temporo-spatial analysis of EEG therefore is a useful indicator of cortical dysfunction in dementia, correlating with the degree of cognitive impairment. Normal aging seems not to be accompanied by changes in temporo-spatial EEG patterns. The data suggest that fragmentation of the electrophysiological processes underlies cognitive dysfunction in Alzheimer's disease.
Abstract Background Differences in personality traits have long been acknowledged as potential risk factors in developing psychiatric disorders. Lately, several susceptibility genes of different ...psychiatric disorders have been linked to personality traits. This has not been done for schizophrenia yet. Neuregulin1 has been repeatedly shown to be associated with schizophrenia and is involved in numerous neurodevelopmental functions such as neuronal migration and myelination. The impact of this gene might also modulate personality traits in healthy subjects. Methods The NRG1 status of 523 healthy subjects was determined with a single nucleotide polymorphism (SNP8NRG221533) which has been described as a tagging marker being part of the core at-risk haplotype for schizophrenia. Genotype was correlated with personality traits using the NEO-FFI questionnaire. Results Subjects with the NRG1 risk allele scored higher on neuroticism ( p < .05) and lower on conscientiousness ( p < .05). Further, interactions of genotype by gender for extraversion ( p < .05), openness ( p < .05) and conscientiousness ( p < .05) were found with men carrying the risk allele scoring the lowest. Conclusions The data indicate that the NRG1 gene which has found to be associated with schizophrenia may also influence personality differences in healthy subjects.
Panic disorder with agoraphobia (PD/AG) is one of the most costly and disabling anxiety disorders with a large range of secondary mental health problems. According to numerous clinical trials, ...cognitive-behavioural therapy (CBT) represents the most effective psychotherapeutic intervention for PD/AG. Little is known about the exact mechanisms of CBT and their neurobiological effects on the fear network. Within the PANIC-NET a unique, large multilevel and multicenter research project was implemented. By carrying out a randomized controlled clinical trial, different CBT components (exposure vs. cognitive techniques) were investigated in 360 patients in order to identify the core active ingredients of CBT. Furthermore, experimental add-on therapy with D-Cycloserine was tested. In an integrated approach, fear-circuit mechanisms were investigated employing psychophysiological techniques, functional neuro-imaging using 3T-fMRI and molecular genetic approaches.
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