Estimating ordinal reliability for Likert-type and ordinal item response data: A conceptual, empirical, and practical guide

This paper provides a conceptual, empirical, and practical guide for estimating ordinal reliability coefficients for ordinal item response data (also referred to as Likert, Likert-type, ordered categorical, or rating scale item responses). Conventionally, reliability coefficients, such as Cronbach’s alpha, are calculated using a Pearson correlation matrix. Ordinal reliability coefficients, such as ordinal alpha, use the polychoric correlation matrix (Zumbo, Gadermann, & Zeisser, 2007). This paper presents (i) the theoretical-psychometric rationale for using an ordinal version of coefficient alpha for ordinal data; (ii) a summary of findings from a simulation study indicating that ordinal alpha more accurately estimates reliability than Cronbach\u27s alpha when data come from items with few response options and/or show skewness; (iii) an empirical example from real data; and (iv) the procedure for calculating polychoric correlation matrices and ordinal alpha in the freely available software program R. We use ordinal alpha as a case study, but also provide the syntax for alternative reliability coefficients (such as beta or omega). Accessed 35,197 times on https://pareonline.net from January 17, 2012 to December 31, 2019. For downloads from January 1, 2020 forward, please click on the PlumX Metrics link to the right

Interpersonal Change During Inpatient CBASP Treatment: Focus on Group Therapy

Background: The Cognitive Behavioral Analysis System of Psychotherapy (CBASP) has been tailored specifically to the demands of patients with persistent depressive disorder (PDD). According to the CBASP model, PDD patients are supposed to live perceptually disconnected from their social environment, which consequently maintains depression. While initially developed as an individual treatment modality, the adaptation for group therapy yields an important interpersonal space. However, little is known about the specific factors that contribute to patients' benefit from the CBASP group modality. Methods: The analyzed sample comprised N = 87 PDD patients who completed a 12 week multimodal inpatient treatment including 2 weekly CBASP-specific individual and group sessions, respectively, as well as CBASP-unspecific medical contacts, pharmacotherapy and complementary therapies. Group sessions included trainings in situational analysis and interpersonal skills. Interpersonal change over therapy was examined based on the patients' self-perceived interpersonal problems (IIP) and the impact messages as perceived by their individual therapists (IMI). Pre and post-treatment data were compared using within-sample t-tests. Additionally, patients evaluated CBASP group therapy on a feedback form. They were invited to reflect on individual benefits and its helpful and unhelpful aspects. Qualitative content analysis with inductive category development was used to analyze feedback. Inter-rater reliability was computed to confirm categories before summarizing the frequencies of reported factors. Results: Self-perceived interpersonal distress significantly decreased over therapy. Patients reported reduced interpersonal problems and therapists reported more friendly and dominant impact messages. Interestingly, patients who showed a significant depressive symptom reduction described higher change scores. Regarding qualitative data, patients reported five main benefits from group therapy: Gain in social competence, self-confidence, self-reflection, interpersonal dynamics, and optimism/universality. Patients responding to CBASP identified significantly more factors than non-responders. Conclusions: Compared to studies with individual CBASP only, the present findings suggest that CBASP group therapy may contribute to the improvement of interpersonal behavior. Group therapy is discussed as a potential boosting effect for individual CBASP. However, as the present data were collected in a multimodal inpatient setting without competitor, randomized controlled trials are warranted that investigate the specific benefits of the group modality or the combined individual and group therapy over individual CBASP only

Does adult ADHD interact with COMT val 158 met genotype to influence working memory performance?

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Efficacy and acceptability of third-wave psychotherapies in the treatment of depression: a network meta-analysis of controlled trials

IntroductionIn recent decades, various new psychotherapy approaches have been developed in an effort to overcome issues of non-response, referred to as “third-wave psychotherapies.” How third-wave therapies perform in comparison to each other, to classical CBT, or other common comparators in the treatment of depression has not yet been systematically assessed.MethodsWe firstly determined the scope of the term “third-wave” by conducting a systematic search. The identified approaches were then used as search terms for the systematic review and network meta-analysis (NMA). We searched MEDLINE, CENTRAL, PsychINFO and Web of Science from inception until 31 July 2022. We assessed randomized controlled trials comparing third-wave psychotherapies to each other, CBT, treatment as usual (TAU), medication management, active control conditions, or waitlist (WL) in adult populations with depressive disorders. The treatments included were acceptance and commitment therapy, behavioral activation, cognitive behavioral analysis system of psychotherapy, dialectical behavioral therapy, mindfulness-based cognitive therapy, meta-cognitive therapy, positive psychotherapy and schema therapy. The primary outcome was depression severity (efficacy) at study endpoint, and the secondary outcome was all-cause discontinuation (acceptability). This review was registered in PROSPERO, identifier CRD42020147535.ResultsOf 7,971 search results, 55 trials were included in our NMA (5,827 patients). None of the third-wave therapies were more efficacious than CBT but most were superior to TAU [standardized mean differences (SMD) ranging between 0.42 (95% CI −0.37; 1.19) and 1.25 (0.48; 2.04)]. Meta-cognitive therapy (MCT) was more efficacious than three other third-wave therapy approaches. None of the third-wave treatments were more acceptable than WL or CBT. Twenty-seven percent of the trials were rated as low risk of bias. Confidence in the evidence was largely low according to GRADE. Inconsistency emerged for a small number of comparisons.InterpretationsThird-wave therapies are largely efficacious and acceptable alternatives to CBT when compared to TAU, with few differences between them. The evidence so far does not point toward superiority or inferiority over CBT. Patient-level research may offer possibilities for tailoring individual psychotherapies to the needs of individual patients and future trials should make this data available. The evidence base needs to be broadened by sufficiently powered trials

Measuring social-emotional development in middle childhood: the Middle Years Development Instrument

This paper discusses the conceptualization, development, validation, and application of the Middle Years Development Instrument (MDI) – a population-based child self-report tool that assesses children\u27s social-emotional development and well-being in the context of their home, school, and neighborhood. The MDI is administered at a population-level to 4th and 7th grade students within participating public school districts across British Columbia, Canada. Children respond to items in five domains: (1) social-emotional development, (2) connectedness to peers and adults, (3) school experiences, (4) physical health and well-being, and (5) constructive use of after-school time. Results are aggregated for schools and communities and reported back in comprehensive reports and community maps to inform planning and decision making at local and regional levels. Shared testimonials exemplify how MDI results have been used by educators, community organizers, and city planners as a catalyst for promoting children\u27s social and emotional competence and facilitating collaboration between schools and communities

The opioid epidemic in rural northern New England: An approach to epidemiologic, policy, and legal surveillance

The opioid crisis presents substantial challenges to public health in New England\u27s rural states, where access to pharmacotherapy for opioid use disorder (OUD), harm reduction, HIV and hepatitis C virus (HCV) services vary widely. We present an approach to characterizing the epidemiology, policy and resource environment for OUD and its consequences, with a focus on eleven rural counties in Massachusetts, New Hampshire and Vermont between 2014 and 2018. We developed health policy summaries and logic models to facilitate comparison of opioid epidemic-related polices across the three states that could influence the risk environment and access to services. We assessed sociodemographic factors, rates of overdose and infectious complications tied to OUD, and drive-time access to prevention and treatment resources. We developed GIS maps and conducted spatial analyses to assess the opioid crisis landscape. Through collaborative research, we assessed the potential impact of available resources to address the opioid crisis in rural New England. Vermont\u27s comprehensive set of policies and practices for drug treatment and harm reduction appeared to be associated with the lowest fatal overdose rates. Franklin County, Massachusetts had good access to naloxone, drug treatment and SSPs, but relatively high overdose and HIV rates. New Hampshire had high proportions of uninsured community members, the highest overdose rates, no HCV surveillance data, and no local access to SSPs. This combination of factors appeared to place PWID in rural New Hampshire at elevated risk. Study results facilitated the development of vulnerability indicators, identification of locales for subsequent data collection, and public health interventions

Psychopathological features and therapeutic implications in chronic depression

Chronische Depressionen sind als Subtyp depressiver Erkrankungen durch eine persistierende depressive Symptomatik von mindestens zwei Jahren charakterisiert. Im Unterschied zu nicht chronischen Verlaufsformen weisen die Betroffenen u.a. ein geringeres Ersterkrankungsalter, längere Behandlungsverläufe und eine höhere Therapieresistenz auf. Von ätiologischer Bedeutung für chronische Depressionen scheint eine erhöhte Rate an Kindheitstraumatisierungen zu sein, insbesondere in Form emotionaler Vernachlässigung und emotionalem Missbrauch. Diese wiederkehrenden Erfahrungen erlebter Hilflosigkeit werden mit negativen Auswirkungen auf die Entwicklung affektiver und kognitiver Schemata assoziiert, die die Aufrechterhaltung depressiver Symptome sowie psychopathologische Besonderheiten der Betroffenen mit chronischen Depressionen erklären könnten. Unter dieser Hypothese wurden im Rahmen der vorliegenden Habilitationsschrift fünf Studien zusammengetragen, die sich mit psychopathologischen Besonderheiten der Affektivität und Kognition von chronischen Depressionen beschäftigen und den Einfluss einer störungsspezifischen Psychotherapie auf die Psychopathologie von chronischen Depressionen untersuchen. In Studie 1 wurden zwei experimentelle Untersuchungen zum Einfluss zweier verschiedener Arten von negativer Stimmungsinduktion durchgeführt. Dabei zeigte sich unter einer spezifischen Stimmungsinduktion, bei der individuelle auditive Traumaskripte basierend auf erlebten Kindheitstraumatisierungen für die Stimmungsinduktion benutzt wurden, eine erhöhte affektive und kognitive Reaktivität in der Patient:innengruppe. Unter einer unspezifischen Stimmungsinduktion mit Hilfe von emotional negativen Bildern und trauriger Musik dagegen, ließ sich keine signifikante Veränderung der Affektivität und der Kognition detektieren. Betroffene mit chronischen Depressionen zeigten hier im Gegensatz zu gesunden Kontrollpersonen eine abgestumpfte Reaktivität (engl. blunted emotional reactivity). Diesen Befund aufgreifend, wurde in Studie 2 untersucht, ob es sich bei der abgestumpften Reaktivität auf emotionale Reize um ein psychopathologisches Charakteristikum der chronischen Depressionen handelt. Dabei zeigte sich hypothesenkonform, dass Betroffene, die sich im Erkrankungsverlauf, nicht der Erkrankungsschwere, unterschieden eine hohe affektive Reaktivität auf eine unspezifische Stimmungsinduktion zeigten, die mit der Antwort gesunder Kontrollpersonen vergleichbar war. Demnach scheint eine abgestumpfte Reaktivität auf emotionale Reize ein psychopathologisches Charakteristikum der chronischen Depressionen im Gegensatz zu nicht-chronischen Verläufen zu sein. Aus diesen beiden eigenen Befunden sowie weiteren, allerdings heterogenen Befunden aus der Literatur, ergab sich die Frage, ob die reduzierte affektive und kognitive Reaktivität auf emotionale soziale Reize Auswirkungen auf die soziale Funktionsfähigkeit von Betroffenen mit chronischen Depressionen hat, die u.a. durch die hohe Rate an Einsamkeit und sozial-vermeidendem Verhalten in dieser Gruppe nahegelegt werden. In Studie 3 wurde hierzu Empathiefähigkeit in Form eines Selbstberichts (subjektiv) sowie in Form eines computerisierten Verhaltensexperiments (objektiv) untersucht. Dabei gaben beide Gruppen, Betroffene mit chronischer und nicht-chronischer Depression, subjektive Defizite ihrer Empathiefähigkeit an, welche sich entgegen der Hypothese jedoch nicht objektiv bestätigen ließen. Es zeigte sich in dieser Versuchsanordnung demnach kein spezifisches Empathiedefizit assoziiert mit chronischen Depressionen, obwohl ein eingeschränktes soziales Funktionsniveau, das Ausdruck eines Empathiedefizits sein könnte, für die Betroffenen als charakteristisch angenommen wird. Das Cognitive Behavioral Analysis System of Psychotherapy (CBASP) ist mit einem interpersonellen Fokus speziell für diese interpersonellen Besonderheiten dieser Betroffenengruppe konzipiert worden. Es adressiert dysfunktionale kognitiv-affektive Schemata, um Betroffenen dabei zu helfen, zwischenmenschliche Situationen zu bewältigen und soziales Vermeidungsverhalten zu überwinden. CBASP wurde ursprünglich als Einzeltherapie für das ambulante Setting entwickelt. In Studie 4 konnte repliziert werden, dass die Adaptation für ein multidisziplinäres stationäres Setting vergleichbar effektiv und auch im Rahmen einer Akutstation umsetzbar ist. Im Einklang mit den CBASP Modellannahmen konnte hierbei außerdem gezeigt werden, dass die Verringerung der Depressivität in Zusammenhang mit einer Verbesserung der zwischenmenschlichen Probleme steht. Sofern Empathiefähigkeit also bedeutsam für die Verbesserung der interpersonellen Probleme ist, kann angenommen werden, dass Betroffene mit chronischen Depressionen sehr wohl ein Empathiedefizit aufweisen, welches jedoch unter der Versuchsanordnung in Studie 3 nicht zu detektieren war. In Studie 5 wurde daher erneut ein objektives Verfahren der Empathiefähigkeit eingesetzt, welches diesmal jedoch unter einer emotionalen Stresssituation getestet wurde. Hierbei fungierte die in Studie 1 bereits erfolgreich eingesetzte Reaktivierung von Kindheitstraumatisierungen zur Stimmungsinduktion als individueller Stressor. In der Tat konnte unter dieser Bedingung ein Defizit der kognitiven Empathiefähigkeit im Vergleich zu gesunden Personen ermittelt werden. Es ließ sich zudem im Einklang mit dem theoretischen CBASP-Modell zeigen, dass es zu einer Verbesserung der Empathiefähigkeit im Rahmen einer Behandlung mit CBASP kommt, welche wiederum mit der Verbesserung der depressiven Krankheitsschwere assoziiert war. Zusammenfassend betonen die Ergebnisse dieser fünf Studien die klinische Relevanz spezifischer Therapieformen für Betroffene mit chronischen Depressionen, mittels derer gezielt affektive und kognitive Schemata adressiert werden, die mit Einschränkungen der sozialen Funktionsfähigkeit assoziiert sind. Unklar ist bislang ob sich das unter Laborbedingungen gezeigte Empathiedefizit von Betroffenen mit chronischen Depressionen auch in realen Interaktionen darstellen lässt und ob dies spezifisch mit CBASP oder unspezifisch auch mit anderen etablierten Therapieverfahren verbessert werden kann. Der Ausblick dieser Arbeit stellt daher mögliche Ansätze zukünftiger Forschungsdesigns dar, mit deren Hilfe interpersonelle Probleme alltagsnäher untersucht und für die Therapieevaluation verwendet werden können.Chronic depression is a subtype of depressive disorders characterized by depressive symptoms that persist for at least two years. Compared to non-chronic forms of depression, patients suffer from an earlier disease onset, longer treatment duration and higher rates of treatment resistance. Childhood traumatization, particularly emotional neglect and emotional abuse, is supposed to increase the likelihood of depression chronicity. According to the cognitive model of depression, these recurrent episodes of helplessness are assumed to give rise to dysfunctional affective and cognitive schemata that increase the individual’s vulnerability to depression and maintain the depressive state. According to this hypothesis, the present thesis encompasses five studies on psychopathological features of chronic depression and on the impact of a therapeutic approach specifically developed for patients with chronic depression, i.e. the Cognitive Behavioral Analysis System of Psychotherapy (CBASP). In study 1, two experiments on two different mood induction procedures were conducted. An individual mood induction based on an autobiographical episode of childhood traumatization increased affective and cognitive reactivity in patients with chronic depression, while an unspecific mood induction with pictures and sad music did not evoke statistically significant affective or cognitive reactions in patients in contrast to a healthy control group. Such blunted emotional reactivity was hypothesized to represent a specific psychopathological characteristic of chronic depression. Therefore, study 2 investigated the same experiment including patients with an equal symptom severity but non-chronic form of depression. In line with our hypothesis, patients with non-chronic depression showed high affective reactivity comparable to healthy controls. This finding supports the assumption of emotional bluntedness to be specific to chronic depression. These results, together with heterogeneous reports from the literature, raised the question whether reduced affective and cognitive reactions to emotional stimuli interfere with social functionality in patients with chronic depression. Therefore, in study 3 affective and cognitive empathy were investigated via self-report (subjective) and via a computerized empathy task (objective). Both patient groups (chronic and non-chronic depression), reported subjective empathy deficits, however, contrary to the hypotheses, there were no objective deficits in comparison to a healthy control group. Thus, we did not find reduced empathy in patients with chronic depression, although interventions specifically tailored to these patients assume social dysfunctions as relevant factor in the etiology and maintenance of chronicity. In this regard, CBASP addresses dysfunctional cognitive and affective schemas to help patients to cope with social interactions and to reduce social-avoidance behavior. Originally, CBASP was developed for individual outpatient sessions. Study 4 investigated an adoption of CBASP to a multidisciplinary inpatient treatment format. We replicated previous results on the effectiveness and feasibility of the inpatient treatment on a general acute psychiatric unit and showed that reduction in depressive severity was associated with a reduction in interpersonal problems, as the CBASP model predicts. The reduction in interpersonal problems was assumed to be related to an increased empathic functioning. Therefore, we investigated cognitive and affective empathy a second time, but changed the experimental design of study 3 by inducing emotional stress while performing the empathy task. For stress induction, we used the autobiographical mood induction procedure that turned out to increase affective and cognitive reactivity in study 1. We suggested that impairments in empathy may become apparent only when patients are in stressful emotional situations. Indeed, study 5 revealed that patients with chronic depression exhibited reduced empathy in comparison to healthy controls, as expected. Moreover, empathic functioning normalized over CBASP treatment, as a function of the reduction in depressive severity, as the CBASP model predicts. Such reduced cognitive and emotional empathy are supposed to exacerbate real-life interpersonal conflicts, which may in turn contribute to the chronicity of depression. In summary, the results of the five studies demonstrate the clinical relevance of specific interventions for patients with chronic depression that target affective and cognitive schemas related to social functioning. It is a matter of debate, whether such deficits under laboratory conditions can be transferred to deficits in real-life interactions and whether there are other interventions despite CBASP that increase empathic functioning in patients with chronic depression. The outlook of the present thesis introduces future applications for investigating social interactions in daily routine and for the evaluation of therapy

Modulation des Furchtnetzwerkes: Vorklinische Studien zur Stimulation des Präfrontalkortex

Pavlovian fear conditioning describes a form of associative learning in which a previously neutral stimulus elicits a conditioned fear response after it has been temporally paired with an aversive consequence. Once acquired, the fear response can be extinguished by repeatedly presenting the former neutral stimulus in the absence of the aversive consequence. Although most patients suffering from anxiety disorders cannot recall a specific conditioned association between a formerly neutral stimulus and the feeling of anxiety, the produced behavioral symptoms, such as avoidance or safety behavior to prevent the anticipated aversive consequence are commonly exhibited in all anxiety disorders. Moreover, there is considerable similarity between the neural structures involved in fear and extinction in the rodent and in the human. Translational research thus contributes to the understanding of neural circuitries involved in the development and maintenance of anxiety disorders, and further provides hypotheses for improvements in treatment strategies aiming at inhibiting the fear response. Since the failure to appropriately inhibit or extinguish a fear response is a key feature of pathological anxiety, the present preclinical research focuses on the interplay between the amygdala and the medial prefrontal cortex (mPFC) during fear learning with particular regard to the prefrontal recruitment during fear extinction and its recall. By firstly demonstrating an increased mPFC activity over the time course of extinction learning with functional near-infrared spectroscopy, the main study of this dissertation focused on repetitive transcranial magnetic stimulation (rTMS) as brain stimulation technique suitable to enhance extinction learning. Since hypofrontality is assumed to underlie the maintenance of pathological anxiety, rTMS application revealed an increased mPFC activity, which resulted in a decreased fear response on the behavioral level both during extinction learning as well as during the recall of extinction 24 hours later and in the absence of another stimulation. The following attempt to improve the generalization of extinction with rTMS from an extinguished stimulus to a second stimulus which was reinforced but not extinguished was at least partially evidenced. By revealing an increased prefrontal activity to the non-extinguished stimulus, the active and the placebo rTMS condition, however, did not differ on behavioral parameters. These preclinical findings were discussed in the light of genetic and environmental risk factors with special regard to the combination of a risk variant of the neuropeptide S receptor 1 gene polymorphism (NPSR1 rs324981) and anxiety sensitivity. While the protective homozygous AA genotype group showed no correlation with anxiety sensitivity, the NPSR1 T genotype group exhibited an inverse correlation with anxiety sensitivity in the presence of emotionally negative stimuli. In light of other findings assuming a role of the NPSR1 T allele in panic disorder, the revealed hypofrontality was discussed to define a risk group of patients who might particularly benefit from an augmentation of exposure therapy with rTMS. Taken together, the presented studies support the central role of the prefrontal cortex in fear extinction and suggest the usefulness of rTMS as an augmentation strategy to exposure therapy in order to decrease therapy relapse rates. The combination of rTMS and extinction has been herein evidenced to modulate fear processes in a preclinical approach thereby establishing important implications for the design of future clinical studies.Die Furchtkonditionierung nach Pavlov beschreibt einen assoziativen Lernmechanismus bei dem ein ursprünglich neutraler Stimulus nach wiederholter kontingenter Darbietung mit einem aversiven Stimulus zu einer konditionierten Furchtreaktion führt, die darauffolgend allein durch den nun konditionierten Reiz ausgelöst werden kann. Obwohl die meisten Angstpatienten keine initiale Reiz-Reaktionsverbindung erinnern können, gelten die Mechanismen der Furchtkonditionierung als Erklärungsmodelle für die Entstehung und Aufrechterhaltung von Angststörungen. Evidenz erhalten sie zudem durch den Einsatz und die Wirksamkeit expositionsbasierter Methoden in der Behandlung von Angststörungen. Ihnen liegt die Extinktion einer erworbenen konditionierten Reaktion zugrunde, bei der der konditionierte Reiz wiederholt ohne seine erwartete aversive Konsequenz dargeboten wird. Dies führt in der Folge zu einer abnehmenden Furchtreaktion. Da die neuronalen Strukturen, die in den Erwerb und die Extinktion einer konditionierten Furchtreaktion involviert sind, weitgehend speziesübergreifend sind, lassen sich aus Tiermodellen wertvolle Hypothesen zur Verbesserung bestehender Behandlungsstrategien mit dem Ziel der Reduktion der erworbenen Furchtreaktion generieren. Eine unzureichende Inhibition bzw. Extinktion der Furchtreaktion gilt als Charakteristikum von pathologischer Angst. Die im Rahmen dieser Dissertation vorgestellten Studien beschäftigen sich mit dem zugrundliegenden neurobiologischen Ungleichgewicht zwischen der Amygdala und dem Präfrontalkortex, das als ursächlich für die Aufrechterhaltung pathologischer Angst vermutet wird. Zunächst wird hierbei eine Untersuchung vorgestellt, bei der die zunehmende Beteiligung des Präfrontalkortex' über den Verlauf eines Extinktionstrainings erstmals mit der funktionellen Nahinfrarot- Spektroskopie dargestellt werden konnte. Da zunehmende Evidenz auf eine unzureichende präfrontale Kortexaktivierung bei pathologischer Angst hindeutet, beschäftigt sich die Hauptstudie dieser Dissertation mit der Fragestellung, ob die Aktivität des Präfrontalkortex' mit Hilfe der repetitiven transkraniellen Magnetstimulation (rTMS) gesteigert werden kann. In Analogie zu tierexperimentellen Untersuchungen konnte in einer Gruppe gesunder Probanden nach einer Stimulation mit rTMS verglichen mit einer Placebobedingung eine verringerte Furchtreaktion gezeigt werden, die auch während des Abrufs des Extinktionsgedächtnis nach 24 Stunden und unabhängig von einer erneuten Stimulation noch nachweisbar war. In einem nächsten Schritt wurde, wiederum in Anlehnung an tierexperimentelle Studien, die Generalisierung eines Extinktionstrainings auf einen ebenfalls konditionierten, aber nicht extingierten Stimulus untersucht. Hierbei zeigte sich eine partielle Bestätigung der Hypothesen. So konnten zwar auf behavioraler Ebene keine Gruppenunterschiede zwischen einer aktiven und einer Placebobedingung detektiert werden, in der aktiven Gruppe ließ sich 24 Stunden nach der Stimulation jedoch eine erhöhte präfrontale Kortexaktivierung auf den nicht-extingierten Stimulus zeigen. Diese Studienergebnisse werden auf Basis einer weiteren Arbeit zu Gen-Umwelt-Einflüssen diskutiert. Hierbei konnte eine Konstellation bestehend aus der Risikovariante (T Allel) des Neuropeptid S Rezeptor Gens (NPSR1 rs324981) und einer erhöhten Angstsensitivität im Unterschied zu einer homozygoten AA Genotyp-Gruppe mit einer verringerten präfrontalen Kortexaktivierung auf negative emotionale Stimuli assoziiert werden. Unter Einbezug des literarischen Kontexts zu NPSR1 und dem Auftreten der Panikstörung legen diese Ergebnisse nahe, dass insbesondere solche und ähnliche Risikogruppen von einer Augmentationsstrategie mit rTMS profitieren könnten. Zusammenfassend bestätigen die vorliegenden Studien die Rolle des Präfrontalkortex bei der Furchtextinktion und legen den Einsatz der rTMS für die Verbesserung der Expositionstherapie nahe. Aus diesen präklinischen Arbeiten werden Hinweise für die Umsetzung von klinischen Studien generiert, die über die Augmentation von Exposition mit rTMS zu einer Rückfallreduktion bei der Therapie von Angststörungen beitragen könnten

Persistent depressive disorder across the adult lifespan: results from clinical and population-based surveys in Germany

Background Although the individual and economic disease burden of depression is particularly high for long-term symptoms, little is known of the lifetime course of chronic depression. Most evidence derives from clinical samples, and the diagnostic distinction between persistent depressive disorder (PDD) and non-chronic major depression (NCMDD) is still debated. Thus, we examined characteristics of PDD among clinical vs. non-clinical cases, and the associated disease burden at a population level. Methods Data were drawn from the mental health module of the German Health Interview and Examination Survey for Adults (DEGS1-MH, 2009–2012, n = 4483) and a clinical sample of PDD inpatients at Charité – Universitätsmedizin Berlin (2018–2019, n = 45). The DSM-5 definition of PDD was operationalized a priori to the study using interview-based DSM-IV diagnoses of dysthymia and major depression lasting at least 2 years in both surveys. Additional depression characteristics (depression onset, self-classified course, suicidality, comorbid mental disorders, treatment history and current depressive symptoms [Patient Health Questionnaire-9]) were assessed. In the DEGS1-MH, health-related quality of life (Short Form Health Survey-36, SF-36), chronic somatic conditions, number of sick days (past 12 months) or days with limitations in normal daily life activities (past 4 weeks), and health service utilization (past 12 months) were compared for PDD vs. NCMDD. Results PDD cases from the clinical sample had a significantly earlier depression onset, a higher proportion of self-classification as persistent course, and treatment resistance than PDD and NCMDD cases in DEGS1-MH. At a population level, PDD cases showed worse outcomes compared with NCMDD cases in terms of somatic comorbidity, SF-36 mental component score, and activity limitations owing to mental health problems, as well as a higher risk for outpatient mental health care contact. Conclusions The distinction between PDD and NCMDD proposed for DSM-5 seems warranted. Early onset depression, self-classification as persistent depressive course, and treatment resistance are suggested as markers of more severe and chronic depression courses. At a population level, PDD is associated with remarkably higher individual and economic disease burden than NCMDD, highlighting the need to improve medical recognition of chronic courses and establish specific treatment concepts for chronic depression.Peer Reviewe