Pre-aging of the Olfactory Bulb in Major Depression With High Comorbidity of Mental Disorders

Recent studies suggest that accelerated aging of the brain is a neuroanatomical signature of the state of mental diseases. In major depression, this pre-aging effect is negatively associated with the duration since the first onset of the disease. The olfactory bulb (OB) shrinks with age in healthy subjects and patients with mental diseases show reduced OB volumes, especially those with major depression. It is unclear whether this OB reduction in mental diseases resembles a pre-aging process and whether it is associated to the duration since the onset of the mental disease. To this aim, we investigated OB volume in 73 patients (mean-age 40.4 years, SD = 12.1 years, 57 women) with major depression and mixed comorbid mental diseases (diagnoses ranged from 1 to 6, median: 3) and 51 healthy controls (mean-age 39.2 years, SD = 13.0 years, 26 women) matched for age and sex. Patient’s first onset of disease ranged from 15 to 53 years (mean 24.2 years). All participants underwent structural MR imaging with a spin-echo T2-wheighted sequence covering the anterior and middle segments of the skull base. All results were corrected for total intracranial volume (TIV) and sex. Individual OB volume was calculated by planimetric manual contouring and the pronounced diameter change in transition from bulb to tract was used as the distal demarcation of the OB. Inter-rater correlation between two independent persons analyzing the data was high (IRC = 0.81, p < 0.005). An age-dependent decline of the OB volume was confirmed in healthy controls (r = −0.34, p < 0.05). However, this pattern was altered in patients where the OB volume was not related to age, but to the duration since the onset of the mental disease (r = −0.25, p < 0.05). This association remained stable when controlling for age. Additionally, analyses of age sub-groups revealed that the association between duration since the onset of the mental disease and OB volume was mainly driven by the group aged 50 years and above (r = −0.68; p < 0.01). We conclude that there are time windows where the OB volume is susceptible for the effects of a mental disease, e.g., depression. These effects result in cumulative pre-aging in the OB in older patients with mental diseases

Deactivation of default mode network during touch

Interpersonal touch possesses a strong affective component, which immediately evokes attention. The neural processing of such touch is moderated by specialized C-tactile nerve fibers in the periphery and results in central activation of somatosensory areas as well as regions involved in social processing, such as the superior temporal gyrus (STG). In the present functional neuroimaging investigation, we tested the hypothesis that the attention grasping effect of interpersonal touch as compared to impersonal touch is reflected in a more-pronounced deactivation of the default mode network (DMN). Using functional magnetic resonance imaging, we investigated the neural processing of interpersonal relative to impersonal touch conditions that were furthermore modulated by stroking velocity in order to target c-tactile nerve fibers to a different extent. A sample of 30 healthy participants (19 women, mean age 40.5 years) was investigated. In the impersonal touch, participants were stroked with a brush on the forearm. In the interpersonal touch condition, the experimenter performed the stroking with the palm of his hand. Interpersonal touch was rated as more pleasant and intense than impersonal touch and led to a stronger blood oxygen level dependent (BOLD) signal increase in the somatosensory cortex SII extending to the superior temporal cortex. Over all touch conditions, this activation was coupled in time to the deactivation of prominent nodes of the DMN. Although deactivation of the DMN was most pronounced for interpersonal touch conditions, the direct comparison did not show significant differences in DMN deactivation between interpersonal and impersonal touch or between different stroking velocities. We therefore conclude that all applied touch conditions deactivate the DMN and the strong connection to areas which code the contextual and social characteristics of affective touch may explain the attention grasping effect of touch.Funding Agencies|Graduate Academy of TU Dresden; German Academic Exchange Service within the frame of the IPID4all program; Excellence Initiative by the German Federal Government; Excellence Initiative by the German State Government</p

Intensive Expositionsbehandlung bei Angststörungen in einem spezialisierten tagesklinischen Versorgungssetting

Hintergrund: Angststörungen sind häufig, oft chronifizierend, jedoch auch gut behandelbar. Leitlinienbehandlung ist die auf Exposition fokussierende Verhaltenstherapie. In der ambulanten Versorgungspraxis finden Expositionen jedoch selten statt. Die Angst-Tagesklinik am Universitätsklinikum Dresden realisiert die evidenzbasierte Behandlung von Angststörungen. In einer 5-wöchigen Kurzzeitbehandlung werden wöchentlich 4 begleitete und zeitoffene Expositionssitzungen durchgeführt. Untersucht wurden die Symptomverläufe und die Responder-Raten. Methoden: Zu Therapieaufnahme und -ende sowie zur Katamnese nach 3 Monaten und 1 Jahr wurde die Entwicklung der Symptombelastung bei n = 332 PatientInnen untersucht, die von 2009 bis 2015 behandelt wurden. Etwa zwei Drittel waren psychotherapeutisch vorbehandelt. Eingesetzt wurden spezifische etablierte Fragebögen. Berechnet wurden Mixed Models, Effektstärken und Responder-Raten. Ergebnisse: 90% der PatientInnen schlossen die Behandlung regulär ab. Es zeigten sich signifikante Linderungen bei Belastungen durch Angst- und depressive Symptome. Die höchsten Effektstärken um 0,9 ergaben sich bei verhaltensbezogenen Skalen und besonders bei den Agoraphobien und Panikstörungen, die die größte Störungsgruppe ausmachen. Die Responseraten lagen bei 60%. Zu den Katamnesezeitpunkten waren die Symptomverbesserungen stabil und bei den kognitiven Symptomen weiter steigend. Schlussfolgerungen: Die Behandlung in spezialisierten (teil)stationären Versorgungssettings mit Fokus auf hochfrequente Exposition, wie hier beispielhaft vorgestellt, zeigt eine gute Akzeptanz und gute bis sehr gute und längerfristig stabile Veränderungen der Symptombelastung. Diese Settings erfordern eine besondere strukturelle Ausstattung und Ressourcen.Intensive Exposure-Based Treatment of Anxiety Disorders in a Specialized Patient-Centered Day Hospital Background: Anxiety disorders are highly prevalent, often chronic, but effectively treatable by cognitive-behavioral therapy, especially by exposure therapy. However, exposure treatments rarely occur in outpatient healthcare. The day hospital for anxiety disorders at the University Hospital Dresden implemented an evidence-based treatment. Every week, 4 guided time-open exposure sessions, not timelimited, are conducted during the 5-week treatment period. Improvements in symptomatology and response rates were examined. Methods: The symptomatology of n = 332 patients, treated from 2009 till 2015, was assessed at pretreatment and posttreatment, and at the follow-ups after 3 months and 1 year. Two-thirds had previously had other psycho therapy treatments. Established questionnaires were used. Data was analyzed by calculating mixed models, effect sizes, and response rates. Results: 90% of the patients finished the treatment regularly. Significant improvements occurred in anxiety and depressive symptoms. The strongest effect sizes of about 0.9 were achieved for behavioral scales, especially for symptoms of agoraphobia and panic disorder, the most frequent disorders in the sample. The response rates were 60%. Improvements remained stable at the follow-ups and even increased further for cognitive symptoms. Conclusions: Specialized day hospital healthcare settings, like the one presented here, are associated with good to very good and stable improvements and also with good acceptance. These therapeutic settings require specific structural equipment and resources