Erlebte Genderdysphorie und psychisches Wohlbefinden bei transsexuellen Personen

Die vorliegende Arbeit untersucht das Konstrukt der Genderdysphorie sowohl theoretisch, als auch empirisch. In der fünften Revision des Diagnostic and Statistical Manual of Mental Disorders (DSM) soll es die bisherige Diagnose „Gender Identity Disorder“ (GID) ablösen. Diese Neuerung geht mit einem Paradigmenwechsel einher, nachdem „Transsexualität“ nicht länger als psychiatrische Störung, sondern als natürliche Variation menschlich-geschlechtlichen Erlebens betrachtet wird. In diesem Zuge stellt Genderdysphorie das Leiden unter einer nichtpathologischen transsexuellen Entwicklung dar, für das konkrete Definitionen und Instrumente der Erfassung in Zukunft von Bedeutung sind. Im Forschungsprojekt „ENIGI – European Network fort he Investigation of Gender Incongruence“, innerhalb dessen die vorliegende Arbeit entstand, wird Genderdysphorie mittels unterschiedlicher Fragebögen erfasst. Zwei Instrumente, die „Utrecht Gender Dysphoria Scale“ (UGDS) und das „Gender Identity/ Gender Dysphoria Questionnaire for Adolsescents and Adults“ (GII) wurden explizit auf ihre Definitionen von Genderdysphorie sowie die Übereinstimmung mit der sie diese erfassen untersucht. Zusätzlich wurde der Zusammenhang von Genderdysphorie und Geschlechtsidentität untersucht. Es wurde festgestellt, dass Genderdysphorie in den beiden Fragebögen unterschiedlich konzeptionalisiert wurde, was zu leicht voneinander abweichenden Ergebnissen in den Subgruppen nach Geschlecht und Alter zu dem Geschlechtsinkongruenz zum ersten mal bemerkt wurde, führte. Während die UGDS in Genderdysphorie die Ablehnung des eigenen Körpers und eine gegengeschlechtliche Identifizierung sieht, definiert das GII sie als pathologisches Gegenstück einer (gesunden) Geschlechtsidentität. Die Untersuchung des Zusammenhanges zwischen Genderdysphorie und Geschlechtsidentität zeigten Unterschiede in den einzelnen Subgruppen. Zusätzlich wurde ein nur sehr geringes Maß an selbst-berichteter Psychopathologie bei den Teilnehmenden gefunden. Am deutlichsten traten Depressionen und Angst-bezogene psychische Probleme auf, allerdings nur in einem geringen Maß. Zusammenfassend zeigte sich, dass beide Instrumente sich zur Erfassung von Genderdysphorie als nützlich für die zukünftige Forschung erwiesen, dass allerdings eine Überarbeitung hinsichtlich ihrer Definitionen und ihres Inhaltes in Anlehnung an die neue Diagnose nötig erscheint.The study at hand aimed to examine the construct of gender dysphoria both theoretically and empirically. Since gender dysphoria will become the new diagnosis for gender identity disorder (GID) in the upcoming 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), accompanied by a paradigm shift, perceiving “Transsexuality” no longer as psychiatric condition but natural variation of gender expression, obliging definitions and valid measurements become more important in the future. Within the “European Initiative for the Investigation of Gender Incongruence” (ENIGI) it is measured as part of the diagnostic process via different instruments. Two measures, the “Utrecht Gender Dysphoria Scale” (UGDS) and the “Gender Identity/ Gender Dysphoria Questionnaire for Adolescents and Adults” (GII) were explicitly examined for their definitions of gender dysphoria and evaluated for their congruence in seizing it. Furthermore, the connections between gender dysphoria and gender identity as well as psychological wellbeing were observed. Gender dysphoria was found to be differently defined in the two instruments which lead to slightly different findings in the subgroups of gender and age of onset. While the UGDS defines Gender dysphoria as the rejection of one´s body and cross-gender identification the GII conceptualizes it as the pathological counterpart of a (healthy) gender identity. The relation between gender dysphoria and gender identity revealed differences in subgroups as well. Finally only a very low level of self-reported psychopathology was found. Depression and anxiety related problems could be detected within this sample although still relatively low. Ultimately both measures of gender dysphoria seem to be useful instruments for future practice, but they also are in need of refinement with regard to contents and adaption to the new concept of gender dysphoria as used in DSM-5

Persuasions of archaeology : the achievements and grandeur of the Omrids at their royal cities of Samaria and Jezreel

Our perception, of the Omrid kings of the Kingdom oflsrael in the ninth century BCE, is based on the Books of 1 and 2 Kings in the Hebrew Bible. The Biblical author's concentration, on Omrid apostasy rather than on their abilities and accomplishments, has robbed these competant monarchs of the prominence allotted to kings like David and Solomon. Recent archaeological excavations, in conjunction with extra-Biblical sources, have however projected a different image. Excavations at the royal Omrid cities of Samaria, and especially Jezreel, have indicated that Omri, and his son Ahab, had erected immense and grandiose structures. These edifices bear testimony to periods of peace, stability and great economic prosperity. The Omrids deserve new assessments as to their accomplishments, and therefore, by means of visible and tangible structural remains, I wish to promote the persuasion of archaeology as vindication of Omrid grandeur and achievement at Samaria and Jezreel.Biblical and Ancient StudiesM.A. (Biblical Studies

The Association of Relationship Status and Sex-Life Satisfaction With Body Dissatisfaction and Drive for Muscularity in Male Weight-Lifters

Relationship status and sexuality are linked to body image concerns, but research on the connection to men’s drive for muscularity (DfM) is scarce. Extreme DfM can lead to a pathological preoccupation with muscularity and problematic eating/exercising behavior. This study investigated the relation of relationship status, relationship duration, and satisfaction with sex-life in weight-lifting men via an online survey (N = 270). Using cross-sectional data, we found that single weight-lifting men and those dissatisfied with their sex-life were more dissatisfied with their muscularity and showed stronger DfM than those in a relationship and satisfied men. Longer relationship duration was associated with less dissatisfaction with muscularity and less DfM while relationship satisfaction was not. Thus, being in a relationship and sexual satisfaction are related to less body dissatisfaction and DfM. Further research should use dyadic study designs to investigate both partners exercising and eating behavior in relation to each other

Prevalence of c-KIT mutations in gonadoblastoma and dysgerminomas of patients with disorders of sex development (DSD) and ovarian dysgerminomas

Activating c-KIT mutations (exons 11 and 17) are found in 10-40% of testicular seminomas, the majority being missense point mutations (codon 816). Malignant ovarian dysgerminomas represent similar to 3% of all ovarian cancers in Western countries, resembling testicular seminomas, regarding chromosomal aberrations and c-KIT mutations. DSD patients with specific Y-sequences have an increased risk for Type II Germ Cell Tumor/Cancer, with gonadoblastoma as precursor progressing to dysgerminoma. Here we present analysis of c-KIT exon 8, 9, 11, 13 and 17, and PDGFRA exon 12, 14 and 18 by conventional sequencing together with mutational analysis of c-KIT codon 816 by a sensitive and specific LightCycler melting curve analysis, confirmed by sequencing. The results are combined with data on TSPY and OCT3/4 expression in a series of 16 DSD patients presenting with gonadoblastoma and dysgerminoma and 15 patients presenting pure ovarian dysgerminomas without DSD. c-KIT codon 816 mutations were detected in five out of the total of 31 cases (all found in pure ovarian dysgerminomas). A synonymous SNP (rs 5578615) was detected in two patients, one DSD patient (with bilateral disease) and one patient with dysgerminoma. Next to these, three codon N822K mutations were detected in the group of 15 pure ovarian dysgerminomas. In total activating c-KIT mutations were found in 53% of ovarian dysgerminomas without DSD. In the group of 16 DSD cases a N505I and D820E mutation was found in a single tumor of a patient with gonadoblastoma and dysgerminoma. No PDGFRA mutations were found. Positive OCT3/4 staining was present in all gonadoblastomas and dysgerminomas investigated, TSPY expression was only seen in the gonadoblastoma/dysgerminoma lesions of the 16 DSD patients. This data supports the existence of two distinct but parallel pathways in the development of dysgerminoma, in which mutational status of c-KIT might parallel the presence of TSPY

Prevalence of c-KIT Mutations in Gonadoblastoma and Dysgerminomas of Patients with Disorders of Sex Development (DSD) and Ovarian Dysgerminomas

Activating c-KIT mutations (exons 11 and 17) are found in 10-40% of testicular seminomas, the majority being missense point mutations (codon 816). Malignant ovarian dysgerminomas represent ~3% of all ovarian cancers in Western countries, resembling testicular seminomas, regarding chromosomal aberrations and c-KIT mutations. DSD patients with specific Y-sequences have an increased risk for Type II Germ Cell Tumor/Cancer, with gonadoblastoma as precursor progressing to dysgerminoma. Here we present analysis of c-KIT exon 8, 9, 11, 13 and 17, and PDGFRA exon 12, 14 and 18 by conventional sequencing together with mutational analysis of c-KIT codon 816 by a sensitive and specific LightCycler melting curve analysis, confirmed by sequencing. The results are combined with data on TSPY and OCT3/4 expression in a series of 16 DSD patients presenting with gonadoblastoma and dysgerminoma and 15 patients presenting pure ovarian dysgerminomas without DSD. c-KIT codon 816 mutations were detected in five out of the total of 31 cases (all found in pure ovarian dysgerminomas). A synonymous SNP (rs 5578615) was detected in two patients, one DSD patient (with bilateral disease) and one patient with dysgerminoma. Next to these, three codon N822K mutations were detected in the group of 15 pure ovarian dysgerminomas. In total activating c-KIT mutations were found in 53% of ovarian dysgerminomas without DSD. In the group of 16 DSD cases a N505I and D820E mutation was found in a single tumor of a patient with gonadoblastoma and dysgerminoma. No PDGFRA mutations were found. Positive OCT3/4 staining was present in all gonadoblastomas and dysgerminomas investigated, TSPY expression was only seen in the gonadoblastoma/dysgerminoma lesions of the 16 DSD patients. This data supports the existence of two distinct but parallel pathways in the development of dysgerminoma, in which mutational status of c-KIT might parallel the presence of TSPY

Genome-wide association study of response to cognitive-behavioural therapy in children with anxiety disorders

Background Anxiety disorders are common, and cognitive–behavioural therapy (CBT) is a first-line treatment. Candidate gene studies have suggested a genetic basis to treatment response, but findings have been inconsistent. Aims To perform the first genome-wide association study (GWAS) of psychological treatment response in children with anxiety disorders (n = 980). Method Presence and severity of anxiety was assessed using semi-structured interview at baseline, on completion of treatment (post-treatment), and 3 to 12 months after treatment completion (follow-up). DNA was genotyped using the Illumina Human Core Exome-12v1.0 array. Linear mixed models were used to test associations between genetic variants and response (change in symptom severity) immediately post-treatment and at 6-month follow-up. Results No variants passed a genome-wide significance threshold (P = 5×10−8) in either analysis. Four variants met criteria for suggestive significance (P<5×10−6) in association with response post-treatment, and three variants in the 6-month follow-up analysis. Conclusions This is the first genome-wide therapygenetic study. It suggests no common variants of very high effect underlie response to CBT. Future investigations should maximise power to detect single-variant and polygenic effects by using larger, more homogeneous cohorts

PESQUISA SOBRE ARQUITETURA ECLÉTICA EM SANTA CRUZ DO SUL E MÍDIAS EXTERIORES

A cidade de Santa Cruz do Sul, localizada na região central do Rio Grande do Sul, possui uma arquitetura eclética com grande valor artístico e histórico para o estado e para a região do Vale do Rio Pardo. O projeto de pesquisa “Qualidade visual do patrimônio arquitetônico eclético na paisagem urbana da área central de Santa Cruz do Sul: o impacto das mídias exteriores” tem como objetivo realizar um diagnóstico referente aos elementos de mídias exteriores utilizados em edificações consideradas patrimônio arquitetônico e pertencentes ao período eclético da arquitetura, avaliando seus respectivos impactos na qualidade visual da edificação. Este artigo compreende uma descrição sintética da primeira etapa da pesquisa referente à revisão bibliográfica sobre os temas arquitetura eclética e mídias exteriores, discorrendo sobre alguns dos principais conceitos teóricos, sobre as classificações e tipologias utilizadas. Apresenta-se, ainda, outros métodos utilizados para a realização do trabalho como os de levantamentos patrimoniais preliminares, sua classificação e alguns dos principais resultados já obtidos

Clinical predictors of response to cognitive-behavioral therapy in pediatric anxiety disorders: the genes for treatment (GxT) study.

OBJECTIVE The Genes for Treatment study is an international, multisite collaboration exploring the role of genetic, demographic, and clinical predictors in response to cognitive-behavioral therapy (CBT) in pediatric anxiety disorders. The current article, the first from the study, examined demographic and clinical predictors of response to CBT. We hypothesized that the child's gender, type of anxiety disorder, initial severity and comorbidity, and parents' psychopathology would significantly predict outcome. METHOD A sample of 1,519 children 5 to 18 years of age with a primary anxiety diagnosis received CBT across 11 sites. Outcome was defined as response (change in diagnostic severity) and remission (absence of the primary diagnosis) at each time point (posttreatment, 3-, 6-, and/or 12-month follow-up) and analyzed using linear and logistic mixed models. Separate analyses were conducted using data from posttreatment and follow-up assessments to explore the relative importance of predictors at these time points. RESULTS Individuals with social anxiety disorder (SoAD) had significantly poorer outcomes (poorer response and lower rates of remission) than those with generalized anxiety disorder (GAD). Although individuals with specific phobia (SP) also had poorer outcomes than those with GAD at posttreatment, these differences were not maintained at follow-up. Both comorbid mood and externalizing disorders significantly predicted poorer outcomes at posttreatment and follow-up, whereas self-reported parental psychopathology had little effect on posttreatment outcomes but significantly predicted response (although not remission) at follow-up. CONCLUSION SoAD, nonanxiety comorbidity, and parental psychopathology were associated with poorer outcomes after CBT. The results highlight the need for enhanced treatments for children at risk for poorer outcomes

Non-mental diseases associated with ADHD across the lifespan:Fidgety Philipp and Pippi Longstocking at risk of multimorbidity?

Several non-mental diseases seem to be associated with an increased risk of ADHD and ADHD seems to be associated with increased risk for non-mental diseases. The underlying trajectories leading to such brain-body co-occurrences are often unclear - are there direct causal relationships from one disorder to the other, or does the sharing of genetic and/or environmental risk factors lead to their occurring together more frequently or both? Our goal with this narrative review was to provide a conceptual synthesis of the associations between ADHD and non-mental disease across the lifespan. We discuss potential shared pathologic mechanisms, genetic background and treatments in co-occurring diseases. For those co-occurrences for which published studies with sufficient sample sizes exist, meta-analyses have been published by others and we discuss those in detail. We conclude that non-mental diseases are common in ADHD and vice versa and add to the disease burden of the patient across the lifespan. Insufficient attention to such co-occurring conditions may result in missed diagnoses and suboptimal treatment in the affected individuals