overview and meta-analysis of neuroimaging studies on motor conversion disorder

Background Conversion Disorders (CD) are prevalent functional disorders. Although the pathogenesis is still not completely understood, an interaction of genetic, neurobiological, and psychosocial factors is quite likely. The aim of this study is to provide a systematic overview on imaging studies on CDs and investigate neuronal areas involved in Motor Conversion Disorders (MCD). Methods A systematic literature search was conducted on CD. Subsequently a meta-analysis of functional neuroimaging studies on MCD was implemented using an Activation Likelihood Estimation (ALE). We calculated differences between patients and healthy controls as well as between affected versus unaffected sides in addition to an overall analysis in order to identify neuronal areas related to MCD. Results Patients with MCD differ from healthy controls in the amygdala, superior temporal lobe, retrosplenial area, primary motor cortex, insula, red nucleus, thalamus, anterior as well as dorsolateral prefrontal and frontal cortex. When comparing affected versus unaffected sides, temporal cortex, dorsal anterior cingulate cortex, supramarginal gyrus, dorsal temporal lobe, anterior insula, primary somatosensory cortex, superior frontal gyrus and anterior prefrontal as well as frontal cortex show significant differences. Conclusions Neuronal areas seem to be involved in the pathogenesis, maintenance or as a result of MCD. Areas that are important for motor-planning, motor-selection or autonomic response seem to be especially relevant. Our results support the emotional unawareness theory but also underline the need of more support by conduction imaging studies on both CD and MCD

Chronic Pain and Sleep Disorders in Primary Care.

BACKGROUND: Chronic pain (CP) and sleep disorders (SD) are highly prevalent in the general population. However, comprehensive data regarding the prevalence and characteristics of pain and SD in primary care are rare. METHODS: From N = 578 patients N = 570 were included within 8 weeks (mean age: 50.8 ± 18.7 years, females: 289). Sociodemographic data, Insomnia Severity Index (ISI), and parts of a self-report questionnaire for pain (Multidimensional German Pain Questionnaire) were recorded and additional medical information (pain medication, sleep medication) was gathered from the patient charts. RESULTS: Of the total sample, 33.2% (n = 189) suffer from CP (pain ≥ 6 months) and 29.1% (n = 166) from SD. 45.5% of the CP patients suffer from SD and 26.5% from clinical insomnia (ISI ≥ 15). SD (β = 0.872, SE = 0.191,  t = 4,572, p < 0.001, CI [0.497; 1.246]) and older age (β = 0.025, SE = 0.005, t = 5.135, p < 0.001, CI [0.015; 0.035]) were significantly associated with pain experience. CONCLUSION: About a quarter of CP patients suffer from clinical insomnia. The suggested bidirectional relation should be considered during comprehensive assessment and treatment of patients

A Randomized Controlled Trial on Functional Relaxation as an Adjunct to Psychoeducation for Stress

This randomized controlled trial investigated whether adding the psychodynamically based body-oriented psychotherapy “Functional Relaxation” (FR) to psychoeducation (PE) is more effective than PE alone to reduce stress and stress-associated complaints. Eighty-one participants with elevated stress-levels, ≥50 points on the global scale of the Perceived Stress Questionnaire (PSQ), received either 10 sessions of manualized FR + PE (n = 42) or two sessions of manualized PE alone (n = 39) in a group setting. Six FR trainers took part in this study. Stress-level (PSQ) was the primary outcome and secondary outcomes were depression (PHQ-9) and somatization (PHQ-15). Multilevel models for discontinuous change revealed that FR + PE was more helpful to reduce stress-levels than PE from pre-treatment to post-treatment (t0 → t1) as well as from pre-treatment to 6-month follow-up (t0 → t2) (both p &lt; 0.05) with effect sizes (d) being medium for PE (dt0 → t1 = 0.57; dt0 → t2 = 0.67) and large for FR + PE (dt0 → t1 = 1.57; dt0 → t2 = 1.39). Moreover, FR + PE affected depression and somatization more positively than did PE from t0 to t1 as well as from t0 to t2 (all p &lt; 0.05). Effect sizes for depression were small to medium for PE (dt0 → t1 = 0.52; dt0 → t2 = 0.37) and large for FR + PE (dt0 → t1 = 1.04; dt0 → t2 = 0.95). Effect sizes for somatization were small for PE (dt0 → t1 = 0.18; dt0 → t2 = 0.19) and medium to large for FR + PE (dt0 → t1 = 0.73; dt0 → t2 = 0.93). In summary, the combination of FR and PE was more effective than PE alone. The results of the present trial provide first evidence of FR as a potent component of stress interventions. Adding FR to such interventions might better help prevent clinically relevant disorders such as depression or somatization

Neural correlates of somatoform disorders from a meta-analytic perspective on neuroimaging studies.

Somatoform disorders (SD) are common medical disorders with prevalence rates between 3.5% and 18.4%, depending on country and medical setting. SD as outlined in the ICD-10 exhibits various biological, social, and psychological pathogenic factors. Little is known about the neural correlates of SD. The aims of this meta-analysis are to identify neuronal areas that are involved in SD and consistently differ between patients and healthy controls. We conducted a systematic literature research on neuroimaging studies of SD. Ten out of 686 studies fulfilled the inclusion criteria and were analyzed using activation likelihood estimation. Five neuronal areas differ between patients with SD and healthy controls namely the premotor and supplementary motor cortexes, the middle frontal gyrus, the anterior cingulate cortex, the insula, and the posterior cingulate cortex. These areas seem to have a particular importance for the occurrence of SD. Out of the ten studies two did not contribute to any of the clusters. Our results seem to largely overlap with the circuit network model of somatosensory amplification for SD. It is conceivable that functional disorders, independent of the clinical impression, show similar neurobiological processes. While overlaps do occur it is necessary to understand single functional somatic syndromes and their aetiology for future research, terminology, and treatment guidelines

Neural correlates of conversion disorder: overview and meta-analysis of neuroimaging studies on motor conversion disorder.

BACKGROUND: Conversion Disorders (CD) are prevalent functional disorders. Although the pathogenesis is still not completely understood, an interaction of genetic, neurobiological, and psychosocial factors is quite likely. The aim of this study is to provide a systematic overview on imaging studies on CDs and investigate neuronal areas involved in Motor Conversion Disorders (MCD). METHODS: A systematic literature search was conducted on CD. Subsequently a meta-analysis of functional neuroimaging studies on MCD was implemented using an Activation Likelihood Estimation (ALE). We calculated differences between patients and healthy controls as well as between affected versus unaffected sides in addition to an overall analysis in order to identify neuronal areas related to MCD. RESULTS: Patients with MCD differ from healthy controls in the amygdala, superior temporal lobe, retrosplenial area, primary motor cortex, insula, red nucleus, thalamus, anterior as well as dorsolateral prefrontal and frontal cortex. When comparing affected versus unaffected sides, temporal cortex, dorsal anterior cingulate cortex, supramarginal gyrus, dorsal temporal lobe, anterior insula, primary somatosensory cortex, superior frontal gyrus and anterior prefrontal as well as frontal cortex show significant differences. CONCLUSIONS: Neuronal areas seem to be involved in the pathogenesis, maintenance or as a result of MCD. Areas that are important for motor-planning, motor-selection or autonomic response seem to be especially relevant. Our results support the emotional unawareness theory but also underline the need of more support by conduction imaging studies on both CD and MCD

La psicoterapia sulla strada verso l'accademizzazione?

Zusammenfassung: Bereits seit einigen Jahren fordert das Bundesministerium für Gesundheit in Deutschland eine Psychotherapie-Direktausbildung. Damit könnte Psychotherapie, vergleichbar mit Medizin oder Psychologie, studiert werden. In Österreich gibt es ähnliche Überlegungen. Der Artikel befasst sich mit der Frage, welche Vor- und Nachteile eine solche Akademisierung gegenüber der aktuellen Psychotherapieausbildung hätte. Sowohl für die aktuelle Psychotherapieausbildung als auch für die Akademisierung lassen sich Vor- und Nachteile anführen. Zudem muss der Begriff der Akademisierung klarifiziert werden. Welche Veränderungen auch kommen, für sie gelten die drei folgenden Anforderungen: Die Veränderungen sollten ausführlich und sachlich diskutiert werden, auf dem bisherigen Wissen aufbauen und entsprechend evaluiert sein oder werden. Schlüsselwörter: Psychotherapie, Psychotherapiewissenschaft, Psychotherapieforschung, AkademisierungSummary: For some years the German Federal Ministry of Health has been calling for psychotherapy training to be provided directly by universities. This would make it possible for psychotherapy to be studied at university, like medicine and psychology. In Austria thoughts are also following a similar trend. The article addresses the question as to the potential advantages and disadvantages of such an academisation of psychotherapy training as compared to the current training settings. Both the current form of training and the academisation have advantages and disadvantages. The concept of academisation also needs to be clarified. Whatever changes take place, the following three requirements apply: The changes should be discussed in detail and objectively, built on the knowledge accumulated to date and be or have been appropriately evaluated. Keywords: Psychotherapy, psychotherapeutic science, psychotherapy research, academisationRiassunto: Già da alcuni anni il Ministero tedesco per la salute chiede una formazione diretta in psicoterapia. Ciò consentirebbe di studiare psicoterapia in modo simile a quanto avviene per la medicina o la psicologia. Anche in Austria sono in atto riflessioni simili. L'articolo si occupa della domanda dei vantaggi e degli svantaggi che una tale accademizzazione avrebbe rispetto all'attuale formazione in psicoterapia. Sia per l'attuale formazione psicoterapeutica che per l'accademizzazione è possibile identificare vantaggi e svantaggi. Va inoltre chiarito il concetto di accademizzazione. Indipendentemente dall'evoluzione che seguirà, questi cambiamenti vanno 1) discussi dettagliatamente e oggettivamente, 2) devono basarsi sulle conoscenze attuali e 3) devono essere stati valutati o venir valutati sulla base di queste nozioni. Parole chiave: psicoterapia, scienze psicoterapeutiche, ricerca psicoterapeutica, accademizzazion

Development and Initial Validation of a Brief Questionnaire on the Patients’ View of the In-Session Realization of the Six Core Components of Acceptance and Commitment Therapy

Background: Assessing in-session processes is important in psychotherapy research. The aim of the present study was to create and evaluate a short questionnaire capturing the patients’ view of the in-session realization of the six core components of Acceptance and Commitment Therapy (ACT). Method: In two studies, psychotherapy patients receiving ACT (Study 1: n = 87) or Cognitive-Behavioral Therapy (CBT) (Study 2, Sample 1: n = 115; Sample 2: n = 156) completed the ACT session questionnaire (ACT-SQ). Therapists were n = 9 ACT therapists (Study 1) and n = 77 CBT trainee therapists (Study 2). Results: Factor structure: Exploratory factor analyses suggested a one-factor solution for the ACT-SQ. Reliability: Cronbach’s alpha of the ACT-SQ was good (Study 1: α = .81; Study 2, Sample 1: α = .84; Sample 2: α = .88). Convergent validity: The ACT-SQ was positively correlated with validated psychotherapeutic change mechanisms (p \u3c .05). Criterion validity: Higher ACT-SQ scores were associated with better treatment outcomes (p \u3c .05). Conclusion: The study provides preliminary evidence for the reliability and validity of the ACT-SQ to assess the in-session realization of the six core components of ACT in the patients’ view. Further validation studies and ACT-SQ versions for therapists and observers are necessary

Why are some cases not on track? An item analysis of the assessment for signal cases (ASC) during inpatient psychotherapy

Within the Routine Outcome Monitoring System “OQ‐Analyst”, the questionnaire “Assessment for Signal Cases” (ASC) supports therapists in detecting potential reasons for not‐on‐track trajectories. Factor analysis and a machine learning algorithm (Lasso with 10‐fold cross‐validation) were applied and potential predictors of not‐on‐track classifications were tested using logistic multilevel modelling methods. The factor analysis revealed a shortened (30‐item) version of the ASC with good internal consistency (α = 0.72 – 0.89) and excellent predictive value (AUC = 0.98; +PV = 0.95; ‐PV = 0.94). Item‐level analyses showed that interpersonal problems captured by specific ASC items (not feeling able to speak about problems with family members; feeling rejected or betrayed) are the most important predictors of not‐on‐track trajectories

The effect of age, gender, income, work, and physical activity on mental health during coronavirus disease (COVID-19) lockdown in Austria

Background: The impact of Coronavirus disease (COVID-19) and the governmental restrictions on mental health have been reported for different countries. This study evaluated mental health during COVID-19 lockdown in Austria and the effect of age, gender, income, work, and physical activity. Methods: An online survey was performed through Qualtrics (R) after four weeks of lockdown in Austria to recruit a representative sample regarding gender, age, education, and region. Indicators of mental health were quality of life (WHO-QOL BREF), well-being (WHO-5), depression (PHQ-9), anxiety (GAD-7), stress (PSS-10), and sleep quality (ISI). Results: In total, N = 1005 individuals were included (53% women). 21% scored above the cut off >= 10 points (PHQ-9) for moderate depressive symptoms, 119% scored above the cut-off >= 10 points (GAD-7) for moderate anxiety symptoms, and 16% above the cut-off >= 15 points (ISI) for clinical insomnia. ANOVAs, Bonferroni-corrected post-hoc tests, and t-tests showed highest mental health problems in adults under 35 years, women, people with no work, and low income (all p-values<.05). Comparisons with a large Austrian sample recruited within the ATHIS 2014 study showed increases of depression and decreases of quality of life in times of COVID-19 as compared to before COVID-19. Conclusions: Depressive symptoms (21%) and anxiety symptoms (19%) are higher during COVID-19 compared to previous epidemiological data. 16% rated over the cut-off for moderate or severe clinical insomnia. The COVID-19 pandemic and lockdown seems particularly stressful for younger adults (< 35 years), women, people without work, and low income

Metabolomics in Psychiatric Disorders: What We Learn from Animal Models

Biomarkers are a recent research target within biological factors of psychiatric disorders. There is growing evidence for deriving biomarkers within psychiatric disorders in serum or urine samples in humans, however, few studies have investigated this differentiation in brain or cerebral fluid samples in psychiatric disorders. As brain samples from humans are only available at autopsy, animal models are commonly applied to determine the pathogenesis of psychiatric diseases and to test treatment strategies. The aim of this review is to summarize studies on biomarkers in animal models for psychiatric disorders. For depression, anxiety and addiction disorders studies, biomarkers in animal brains are available. Furthermore, several studies have investigated psychiatric medication, e.g., antipsychotics, antidepressants, or mood stabilizers, in animals. The most notable changes in biomarkers in depressed animal models were related to the glutamate-&gamma;-aminobutyric acid-glutamine-cycle. In anxiety models, alterations in amino acid and energy metabolism (i.e., mitochondrial regulation) were observed. Addicted animals showed several biomarkers according to the induced drugs. In summary, animal models provide some direct insights into the cellular metabolites that are produced during psychiatric processes. In addition, the influence on biomarkers due to short- or long-term medication is a noticeable finding. Further studies should combine representative animal models and human studies on cerebral fluid to improve insight into mental disorders and advance the development of novel treatment strategies