Attachment classification, psychophysiology and frontal EEG asymmetry across the lifespan: a review

In recent years research on physiological response and brain reactivity in different patterns of infant and adult attachment has increased. We review research findings regarding associations between attachment classifications and reactivity of the prefrontal cortex, the autonomic nervous system and the hypothalamic-pituitary-adrenocortical axis. Studies indicate that insecure attachment is related to a heightened adrenocortical activity, heart rate and skin conductance in response to stress, which is consistent with the hypothesis that attachment insecurity leads to impaired emotion regulation. Research on frontal EEG asymmetry also shows a clear difference in the emotional arousal between the attachment groups evidenced by specific frontal asymmetry changes. Furthermore, we discuss neurophysiological evidence of attachment organization and present up-to-date findings of EEG-research with adults. Based on the overall patterns of results presented in this article we identify some major areas of interest and directions for future research

Lower oxytocin plasma levels in borderline patients with unresolved attachment trauma

Interpersonal problems and affective dysregulation are core characteristics of borderline personality disorder (BPD). BPD patients predominantly show unresolved attachment representations. The oxytocin (OT) system is associated with human social attachment and affiliative behavior, and OT dysregulation may be related to distinct attachment characteristics. Here, we investigated whether attachment representations are related to peripheral OT levels in BPD patients. Twenty-one female BPD patients and 20 age-, gender-, and education- matched healthy controls (HCs) were assessed with clinical scales and measures of interpersonal and attachment-related characteristics, including the Adult Attachment Projective Picture System (AAP). Plasma OT concentrations were measured prior to and during social exclusion in a virtual ball tossing game (Cyberball). The majority of BPD patients (63.2%) but no HCs showed unresolved (disorganized) attachment representations. In this subgroup of patients, baseline OT plasma levels were significantly lower than in BPD patients with organized attachment representations. This pilot study extends previous findings of altered OT regulation in BPD as a putative key mechanism underlying interpersonal dysregulation. Our results provide first evidence that altered OT plasma levels are related to disorganized attachment representations in BPD patients

Serological response and breakthrough infection after COVID-19 vaccination in patients with cirrhosis and post-liver transplant

BACKGROUND: Vaccine hesitancy and lack of access remain major issues in disseminating COVID-19 vaccination to liver patients globally. Factors predicting poor response to vaccination and risk of breakthrough infection are important data to target booster vaccine programs. The primary aim of the current study was to measure humoral responses to 2 doses of COVID-19 vaccine. Secondary aims included the determination of factors predicting breakthrough infection. METHODS: COVID-19 vaccination and Biomarkers in cirrhosis And post-Liver Transplantation is a prospective, multicenter, observational case-control study. Participants were recruited at 4-10 weeks following first and second vaccine doses in cirrhosis [n = 325; 94% messenger RNA (mRNA) and 6% viral vaccine], autoimmune liver disease (AILD) (n = 120; 77% mRNA and 23% viral vaccine), post-liver transplant (LT) (n = 146; 96% mRNA and 3% viral vaccine), and healthy controls (n = 51; 72% mRNA, 24% viral and 4% heterologous combination). Serological end points were measured, and data regarding breakthrough SARS-CoV-2 infection were collected. RESULTS: After adjusting by age, sex, and time of sample collection, anti-Spike IgG levels were the lowest in post-LT patients compared to cirrhosis (p < 0.0001), AILD (p < 0.0001), and control (p = 0.002). Factors predicting reduced responses included older age, Child-Turcotte-Pugh B/C, and elevated IL-6 in cirrhosis; non-mRNA vaccine in AILD; and coronary artery disease, use of mycophenolate and dysregulated B-call activating factor, and lymphotoxin-α levels in LT. Incident infection occurred in 6.6%, 10.6%, 7.4%, and 15.6% of cirrhosis, AILD, post-LT, and control, respectively. The only independent factor predicting infection in cirrhosis was low albumin level. CONCLUSIONS: LT patients present the lowest response to the SARS-CoV-2 vaccine. In cirrhosis, the reduced response is associated with older age, stage of liver disease and systemic inflammation, and breakthrough infection with low albumin level

Treatment of psychiatric comorbidities and interaction patterns in Coffin‐Siris syndrome: A case report of a 4‐year‐old girl

Key Clinical Message Coffin‐Siris syndrome (CSS) is a rare genetic disorder and often co‐occurs with attention‐deficit hyperactivity disorder (ADHD) and autism spectrum (ASD). The present case study illustrates possible therapeutic interventions of these common psychiatric comorbidities taking into account the family interaction patterns. This can contribute to improve holistic management and overall level of functionality

NICHT-SUIZIDALE SELBSTVERLETZUNGEN BEI STATIONÄREN PATIENTEN DER KINDER- UND JUGENDPSYCHIATRIE: PRÄVALENZ, GESCHLECHTERVERTEILUNG UND KOMORBIDE PSYCHOPATHOLOGIE IN EINER NATURALISTISCHEN KLINISCHEN STICHPROBE

Background: A growing body of research points toward nonsuicidal self-injury (NSSI) in adolescents as an important and frequent health-related risk factor. In 2013, NSSI was proposed in section 3 of the DSM-5 as a new diagnostic entity warranting further study. In line with that goal, the present study was conducted in order to evaluate prevalence, gender distribution and comorbidities of NSSI in a sample of adolescent psychiatric inpatients. Subjects and methods: The study included 130 adolescents (mean age 15.09 years, SD ± 1.47; 71.5% female) undergoing inpatient psychiatric treatment at a specialized facility. The factors assessed were sociodemographic data, the presence of NSSI according to the proposed DSM-5 criteria, clinical psychiatric diagnosis, the presence of suicidality and the presence of personality disorder. Results: A large percentage, 38.5%, of the sample fulfilled DSM-5 criteria for NSSI, and more than half (50.8%) of the adolescents indicated having injured themselves at least once in the past. Patients with NSSI were predominantly young women and clustered in a spectrum of diagnostic entities including not only borderline personality disorders but also substance use disorders and affective disorders. A strong association was found between suicidality (suicidal ideation, history of suicide attempt) and NSSI. Conclusions: In line with previous findings, NSSI among adolescent psychiatric inpatients was found to be a frequent phenomenon associated with a broad spectrum of comorbidities. Moreover, while NSSI is conceptualized as an act without suicidal intent, it commonly occurs in patient groups with suicidal ideation or with a history of suicide attempts.Hintergrund: Eine steigende Zahl von Forschungsarbeiten belegt die Bedeutung von nicht-suizidalen Selbstverletzungen (NSSV) als häufigen und wichtigen gesundheitsbezogenen Risikofaktor bei Jugendlichen. 2013 wurden NSSV im DSM-5 in den Abschnitt 3 der weiter zu beforschenden Entitäten aufgenommen. Das Ziel dieser Studie war dementsprechend, Prävalenz, Geschlechterverteilung und komorbide Psychopathologie in einer Stichprobe von jugendlichen stationären Patienten zu untersuchen. Sample und Methoden: In die Studie wurden 130 Jugendliche (mittleres Alter 15,09 Jahre, SD ± 1,47; 71,5% weiblich) eingeschlossen, die als stationäre Patienten an einer kinderund jugendpsychiatrischen Klinik aufgenommen waren. Neben soziodemographischen Daten waren die erhobenen klinischen Variablen die Prävalenz von NSSV nach den DSM-5 – Kriterien, die klinisch-psychiatrische Diagnose, das Vorliegen einer Persönlichkeitsstörung sowie das Vorliegen von Suizidalität. Resultate: Ein hoher Prozentsatz von 38,5% der stationären Patienten erfüllten die DSM-5-Kriterien für NSSV, mehr als die Hälfte der Jugendlichen (50,8%) gaben an, sich in der Vergangenheit schon einmal selbst verletzt zu haben. NSSV kamen häufiger bei weiblichen Patientinnen vor, und zeigten eine signifikante Häufung in einem Spektrum von klinischen Diagnosen, welches nicht nur Borderline-Persönlichkeitsstörungen sondern auch Suchterkrankungen und affektive Störungen beinhaltete. NSSV waren hochsignifikant mit Suizidalität (Suizidgedanken, Suizidversuch in Anamnese) assoziiert. Schlussfolgerungen: Im Einklang mit bisheriger Literatur zeigten sich NSSV in unserer Studie als ein häufiges Phänomen, welches mit einem breiten Spektrum von komorbiden Störungen assoziiert war. Obwohl NSSV per definitionem ohne suizidale Absicht ausgeführt werden, besteht eine enge Verbindung zu Suizidgedanken sowie Suizidversuchen in der Anamnese

High Prevalence of insecure Attachment in Patients with primary Hypertension

Hypertension is a major cardiovascular (CV) risk factor and is predicted by heightened CV reactivity to stress in healthy individuals. Patients with hypertension also show an altered stress response, while insecure attachment is linked to a heightened stress reactivity as well. This is the first study aiming to assess attachment representations in patients with primary hypertension and to investigate their CV responses when their attachment system is activated.We studied 50 patients (38 men, 12 women) with primary hypertension. The Adult Attachment Projective Picture System (AAP), a widely used and validated interview, was performed to measure the patients’ attachment representations, and to activate their attachment system. Blood pressure and heart rate were measured after ten minutes at rest prior to and directly after the AAP interview. Mood and state anxiety were assessed using the Multidimensional Mood State Questionnaire (MDBF) and the State Trait Anxiety Inventory – State (STAI-S) before and after the experiment. The prevalence of insecure attachment (dismissing, preoccupied, unresolved) in hypertensive patients was predominant (88%), while in non-clinical populations, only about 50% of individuals had insecure attachment patterns.Blood pressure (p<.001), heart rate (p=.016) and rate pressure product (p<.001) significantly increased in response to the attachment interview. Secure attached patients showed the highest rise in systolic blood pressure (p=.020) and the lowest heart rate compared to the other attachment groups (p=.043). However, attachment representation showed no significant group or interaction effects on diastolic blood pressure and rate pressure product.Insecure attachment was highly over-represented in our sample of patients with primary hypertension. Additionally, a robust CV response to the attachment-activating stimulus was observed. Our data suggest that insecure attachment is significantly linked to primary hypertension, which implies the need for further investigations to evaluate attachment insecurity as a possible risk factor for hypertension

Decorated bodies for eternal life: A multidisciplinary study of late Roman Period stucco-shrouded portrait mummies from Saqqara (Egypt).

This study focuses on the multidisciplinary investigation of three stucco-shrouded mummies with mummy portrait from Egypt dating from the late 3rd to the middle of the 4th century AD, corresponding to the late Roman Period. These three mummies were excavated in the early 17th and late 19th centuries in the Saqqara necropolis near the ancient Egyptian capital of Memphis. Two of them experienced an interesting collection history, when they became part of the collection of the Elector of Saxony and King of Poland August II in Dresden, Germany, in 1728. The investigation includes information about the mummies' discovery, collection history and shroud decoration obtained through Egyptological expertise. In addition, information on the state of preservation, technique of artificial mummification, age at death, sex, body height and health of the deceased was achieved through computed tomography (CT) analysis. Research yielded an adult male, a middle-aged female and a young female. Due to the rather poorly preserved bodies of the male and middle-aged female, a specific technique of artificial mummification could not be ascertained. Brain and several internal organs of the well-preserved young female were identified. Wooden boards, beads of necklaces, a hairpin, and metal dense items, such as lead seals, nails and two coins or medallions were discovered. Paleopathological findings included carious lesions, Schmorl's nodes, evidence of arthritis and a vertebral hemangioma. The study revealed insights on the decoration and burial preparation of individuals of upper socioeconomic status living in the late Roman Period, as well as comprehensive bioanthropological information of the deceased