"An eye for an eye"?

Humans have evolved strong preferences for equity and fairness. Neuroimaging studies suggest that punishing unfairness is associated with the activation of a neural network comprising the anterior cingulate cortex, anterior insula, the ventral striatum, and the dorsolateral prefrontal cortex (DLPFC). Here, we report the neuronal correlates of retribution and "forgiveness" in a scenario, in which individuals first acted as a recipient in an Ultimatum Game, and subsequently assumed the position of a proposer in a Dictator Game played against the same opponents as in the Ultimatum Game. Most subjects responded in a tit-for-tat fashion, which was accompanied by activation of the ventral striatum, corroborating previous findings that punishing unfair behaviour has a rewarding connotation. Subjects distinguished between the human opponent and computer condition by activation of the ventromedial PFC in the human condition, indicative of mentalising. A substantial number of subjects did not retaliate. Neurally, this "forgiveness" behaviour was associated with the activation of the right (and to a lesser degree left) DLPFC, a region that serves as a cognitive control region and thus may be involved in inhibiting emotional responses against unfairness

Death anxiety and depression in amyotrophic lateral sclerosis patients and their primary caregivers

$\bf Background:$ Given the lethal severity of amyotrophic lateral sclerosis (ALS), the aim of this study was to illuminate the coherence of depression and death anxiety in both ALS patients and caregivers and in how far patients and caregivers are influenced by the mindset of their respective counterpart. $\bf Methods:$ 30 couples of patients (mean age 60.57; 13 women, 17 men) and primary caregivers (mean age 57.33; 16 women, 14 men) were included into the study. Death anxiety was assessed using the newly developed BOFRETTA scale, depression via Beck Depression Inventory, anxiety by means of State Trait Anxiety Inventory and caregivers' exertion using the Caregiver Strain Index. Patients' impairment was assessed with the ALS functional rating scale. $\bf Results:$ We found that while death anxiety was related to depression in both patients and caregivers, death anxiety was related to anxiety only in patients. Caregiver strain correlated with both caregiver‘s depression and anxiety. Moreover, patients' and caregivers’ depression, anxiety and death anxiety correlated to the ones of their counterpart. $\bf Conclusion:$ These results suggest that despite little depressive symptoms in ALS patients the fatal prognosis of the disease takes into account, depression and death anxiety influence each other and might be addressed together in pharmacological and especially psychotherapeutic interventions to the benefit of the patient. Medical professionals should not forget to offer sufficient support to caregivers tending patients affected by depression and death anxiety as they are likely to mirror their patient's feelings

Perioperative Ängste und die Angst vor dem Tod

In der Anästhesiologie wird man häufig mit Patienten konfrontiert, die unter perioperativen Ängsten und speziell der Angst vor dem Tod leiden, dies gilt jedoch nicht nur für die Anästhesiologie, sondern auch für die Psychiatrie und die Psychotherapie. Bislang ist die Literaturlage hierzu begrenzt, und daher werden diesem Übersichtsartikel die wichtigsten Arten von perioperativer Angst, diagnostische Aspekte sowie Risikofaktoren thematisiert. Anxiolytisch werden klassischerweise Benzodiazepine eingesetzt, in den letzten Jahren ist jedoch die präoperative Angst reduzierende Wirkung von z. B. supportiven Gesprächen, Akupunktur, Aromatherapie und Entspannungsverfahren stärker in den Fokus geraten, da Benzodiazepine unter anderen ein postoperatives Delir mit Zunahme von Morbidität und Mortalität fördern. Perioperative Ängste vor dem Tod sollten jedoch klinisch und wissenschaftlich verstärkt in den Blick genommen werden, um nicht nur die Patienten präoperativ besser versorgen, sondern auch um nachteilige Folgen im Verlauf von Operationen und danach reduzieren zu können

The antipsychotic drugs olanzapine and haloperidol modify network connectivity and spontaneous activity of neural networks in vitro\textit {in vitro}

Impaired neural synchronization is a hallmark of psychotic conditions such as schizophrenia. It has been proposed that schizophrenia-related cognitive deficits are caused by an unbalance of reciprocal inhibitory and stimulatory signaling. This supposedly leads to decreased power of induced gamma oscillations during the performance of cognitive tasks. In light of this hypothesis an efficient antipsychotic treatment should modify the connectivity and synchronization of local neural circuits. To address this issue, we investigated a model of hippocampal neuronal networks $\textit {in vitro}$. Inhibitory and excitatory innervation of GABAergic and glutamatergic neurons was quantified using immunocytochemical markers and an automated routine to estimate network connectivity. The first generation (FGA) and second generation (SGA) antipsychotic drugs haloperidol and olanzapine, respectively, differentially modified the density of synaptic inputs. Based on the observed synapse density modifications, we developed a computational model that reliably predicted distinct changes in network activity patterns. The results of computational modeling were confirmed by spontaneous network activity measurements using the multiple electrode array (MEA) technique. When the cultures were treated with olanzapine, overall activity and synchronization were increased, whereas haloperidol had the opposite effect. We conclude that FGAs and SGAs differentially affect the balance between inhibition and excitation in hippocampal networks

Kinematic analysis of handwriting movements in individuals with intellectual disabilities with and without obsessive compulsive symptoms

$\textbf {Theory/calculation:}$ Movement disorders such as disturbances of coordination, clumsiness, and hand-related stereotypies are a frequent phenomenon in individuals with intellectual disabilities (ID). Obsessive-compulsive symptoms are also common in persons with ID. Our aim was to investigate hand motor dysfunction in persons with ID with and without OCD, using a digitizing tablet and the kinematic analysis of handwriting and drawing movements. $\textbf {Methods:}$ We examinedthe hand motor performance of 23 individuals (12 males, 11 females, 42.6 $\pm$ 13.7 years old) with ID of heterogeneous aetiology. All subjects were required to write a sentence and draw circles under various conditions. Kinematic parameters were calculated to quantify hand motion. $\textbf {Results:}$ Individuals with ID exhibit serious hand motor impairments suggestive of bradykinesia, irregularity, and micrographia. More than half of our ID patients (60.9%) displayed obsessive-compulsive symptoms of moderate severity (Y-BOCS total score: 16.6 $\pm$ 8.3). Interestingly, the ID patients with OCD displayed smaller amplitudes of hand motor movements than did patients with no obsessive-compulsive symptoms, while differences observed in the writing and drawing concentric circles trials were significant. $\textbf {Conclusions:}$ The results of this pilot study support the use of kinematic analyses of handwriting movements to evaluate motor abnormalities in patients with ID and comorbid mental illnesses

Der Vergebungsprozess als ein psychotherapeutischer Behandlungsansatz

Nahezu jeder Mensch erlebt im Laufe seines Lebens interpersonale Konflikte, Verletzungen und Kränkungen und kann dabei in unterschiedlichem Maße durch Unversöhnlichkeit und Rachegedanken vereinnahmt und belastet sein. Dabei kann ein «Nichtvergeben können» deutliche Einschränkungen der psychosozialen Funktionalität und Lebensqualität bedingen und mit erhöhter Psychopathologie im Sinne einer posttraumatischen Verbitterungsstörung einhergehen. Vergebung kann als eine Coping-Methode für Kränkungen, Verletzungen, Unrecht und Verbitterung verstanden und auch als eine psychotherapeutische Intervention angesehen werden, die eine nachhaltige Reduktion von Inkonsistenz erzeugt und das personale Wohlbefinden entscheidend verbessert. Im folgenden Übersichtsartikel werden zunächst die verschiedenen Begrifflichkeiten und die psychologisch-theoretischen Modelle zur Vergebung vorgestellt. Daran anschließend werden die Modalitäten der praktischen Anwendung der Vergebungstherapie dargestellt. Zusammenfassend muss jedoch gesagt werden, dass Forschung insbesondere zu "Vergebung" sich noch ganz am Anfang befindet, sodass wirklich valide Aussagen derzeit noch nicht zu treffen sind.Almost every person experiences in the course of their life interpersonal conflicts, injuries, and insults and, to varying degrees, can be burdened by inreconcilability and desire for revenge. ‘Unforgiveness' leads to clear limitations of psychosocial functionality and quality of life and is associated with increased psychopathology in the sense of posttraumatic embitterment disorder (PTED). Therefore, forgiveness can be viewed as a coping mechanism for injuries, injustice, and bitterness, and also as a psychotherapeutic intervention that produces a lasting reduction of intrapsychic inconstinency and improves the personal well-being. In the following review, the various concepts and psychological-theoretical models of forgiveness are described. Subsequently, the modalities of the practical application of forgiveness therapy are presented. In summary, research on 'forgiveness' is still at the beginning so that truly valid conclusions cannot be drawn, yet

Types of ethical problems and expertise in clinical ethics consultation in psychiatry

$\textbf {Background:}$ Ethics consultation has been advocated as a valuable tool in ethically challenging clinical situations in healthcare. It is paramount for the development and implementation of clinical ethics support services (CESS) in psychiatry that interventions can address the moral needs of mental health professionals adequately and communicate the nature of the services clearly. This study explores types of ethical problems and concepts of ethical expertise as core elements of CESS in mental healthcare with the aim of contributing to the further development of ethical support in psychiatry. $\textbf {Methods:}$ We conducted 13 semi-structured interviews with mental health professionals and CESS members and triangulated them with four non-participant observations of ethical case consultations in psychiatry. Data were analyzed according to principles of grounded theory and are discussed from a normative perspective. $\textbf {Results:}$ The analysis of the empirical data reveals a typology of three different ethical problems professionals want to refer to CESS: (1) Dyadic problems based on the relationship between patients and professionals, (2) triangular problems, where a third party is involved and affected as a side effect, and (3) problems on a systemic level. However, CESS members focus largely on types (1) and (2), while the third remains unrecognized or members do not feel responsible for these problems. Furthermore, they reflect a strong inner tension connected to their role as ethical experts which can be depicted as a dilemma. On the one hand, as ethically trained people, they reject the idea that their judgments have expert status. On the other hand, they feel that mental health professionals reach out for them to obtain guidance and that it is their responsibility to offer it. $\textbf {Conclusion:}$ CESS members and professionals in mental healthcare have different ideas of the scope of responsibility of CESS. This contains the risk of misunderstandings and misconceptions and may affect the quality of consultations. It is necessary to adapt concepts of problem solving to practitioners' needs to overcome these problems. Secondly, CESS members struggle with their role as ethical experts. CESS members in psychiatry need to develop a stable professional identity. Theoretical clarification and practical training are needed

P300 and delay-discounting in obsessive–compulsive disorder

Previous research showed that dysfunctions of fronto-striatal neural networks are implicated in the pathophysiology of obsessive–compulsive disorder (OCD). Accordingly, patients with OCD showed altered performances during decision-making tasks. As P300, evoked by oddball paradigms, is suggested to be related to attentional and cognitive processes and generated in the medial temporal lobe and orbitofrontal and cingulate cortices, it is of special interest in OCD research. Therefore, this study aimed to investigate P300 in OCD and its associations with brain activity during decision-making: P300, evoked by an auditory oddball paradigm, was analysed in 19 OCD patients and 19 healthy controls regarding peak latency, amplitude and source density power in parietal cortex areas by sLORETA. Afterwards, using a fMRI paradigm, Blood–oxygen-level-dependent (BOLD) contrast imaging was conducted during a delay-discounting paradigm. We hypothesised differences between groups regarding P300 characteristics and associations with frontal activity during delay-discounting. The P300 did not differ between groups, however, the P300 latency over the P4 electrode correlated negatively with the NEO-FFI score openness to experience in patients with OCD. In healthy controls, P300 source density power correlated with activity in frontal regions when processing rewards, a finding which was absent in OCD patients. To conclude, associations of P300 with frontal brain activation during delay-discounting were found, suggesting a contribution of attentional or context updating processes. Since this association was absent in patients with OCD, the findings could be interpreted as being indeed related to dysfunctions of fronto-striatal neural networks in patients with OCD

Embitterment and metacognition in obsessive–compulsive disorder

$\bf Objective$ Embitterment is a persistent emotion that is known to everybody in reaction to injustice and being let down, associated with feelings of helplessness and hopelessness. People with psychiatric disorders can develop bitterness, which is to be understood as a form of reactive embitterment to the illness. The aim of this explorative study was to investigate the occurrence of embitterment in obsessive–compulsive patients compared to healthy volunteers and in the context of their metacognitions and other biographical and clinical characteristics. $\bf Method$ Following a semi-structured diagnostic interview, a number of measures were administered to 31 patients with obsessive–compulsive disorder (OCD) [ICD-10 F42.X: mean age 35.2 (SD = 10.7) years] and 31 healthy volunteers [mean age 39.1 (SD = 15.0) years]. These measures included the Post-Traumatic Embitterment Disorder questionaire (PTEDq) for measuring embitterment, the Yale-Brown Obsessive–Compulsive Scale, the Metacognition Questionnaire and other psychometric questionnaires such as the Beck Depression Inventory and the State-Trait Anxiety Inventory. $\bf Results$ Patients with OCD scored more than three times higher (mean = 2.0, SD = 1.1) than the healthy participants in the PTEDq (mean = 0.6, SD = 0.8; $\it p$ < 0.001), but the cut-off of < 2.5 for a clinically relevant embitterment disorder was not reached. Dysfunctionally distorted metacognition (MCQ-30), which is a consistent finding in OCD, as well as a generally high degree of clinical impairment were significantly cor related to the degree of embitterment. $\bf Conclusion$ Our findings suggest that embitterment as measured by PTEDq is important in patients with OCD, who are characterized by metacognitive distortions with an injustice of fate as well as a mortification of their self-image. In future, it would be necessary to screen patients with OCD not only for depressive symptoms but also specifically for feelings of embitterment in order to be able to initiate appropriate psychotherapeutic measures at an early stage

Time experience in patients with schizophrenia and affective disorders

$\bf Background$ The experience of time, or the temporal order of external and internal events, is essential for humans. In psychiatric disorders such as depression and schizophrenia, impairment of time processing has been discussed for a long time. $\bf Aims$ In this explorative pilot study, therefore, the subjective time feeling as well as objective time perception were determined in patients with depression and schizophrenia, along with possible neurobiological correlates. $\bf Methods$ Depressed ($\it n$ = 34; 32.4 $\pm$ 9.8 years; 21 men) and schizophrenic patients (($\it n$ = 31; 35.1 $\pm$ 10.7 years; 22 men) and healthy subjects (($\it n$ = 33; 32.8 $\pm$ 14.3 years; 16 men) were tested using time feeling questionnaires, time perception tasks and critical flicker-fusion frequency (CFF) and loudness dependence of auditory evoked potentials (LDAEP) to determine serotonergic neurotransmission. $\bf Results$ There were significant differences between the three groups regarding time feeling and also in time perception tasks (estimation of given time duration) and CFF (the "DOWN" condition). Regarding the LDAEP, patients with schizophrenia showed a significant negative correlation to time experience in terms of a pathologically increased serotonergic neurotransmission with disturbed time feeling. $\bf Conclusions$ Impairment of time experience seems to play an important role in depression and schizophrenia, both subjectively and objectively, and novel neurobiological correlates have been uncovered. It is suggested, therefore, that alteration of experience of time should be increasingly included in the current psychopathological findings