Gestuftes Vorgehen (Stepped-Care) bei der Behandlung von Patienten mit Depressionen. Bericht über das Gesundheitsnetz Depression im psychenet - Hamburger Netz psychische Gesundheit

Das Gesundheitsnetz Depression ist eines von elf wissenschaftlichen Teilprojekten des vom Bundesministerium für Bildung und Forschung von 2010 bis 2014 geförderten Forschungsnetzwerks "psychenet - Hamburger Netz psychische Gesundheit". Der Forschungsverbund hat zum Ziel, mit neuen Strukturen der sektorenübergreifenden Zusammenarbeit, mit innovativen Behandlungsansätzen und mit der Begleitung von Betroffenen und ihren Angehörigen die Früherkennung und leitliniengerechte Behandlung psychischer Erkrankungen sicherzustellen. Als eines von fünf Gesundheitsnetzen in psychenet ist das Gesundheitsnetz Depression ein Behandlernetzwerk, das Hausärzte, Psychiater, Psychotherapeuten und stationäre Einrichtungen miteinander verbindet. Gemäß der S3 Leitlinie und Nationalen VersorgungsLeitlinie (NVL) "Unipolare Depression" wird ein Modell der gestuften Behandlung (Stepped Care) mit sechs Behandlungsoptionen von unterschiedlicher Intensität umgesetzt und im Rahmen einer randomisiert-kontrollierten Studie evaluiert. Zielsetzung ist es, wissenschaftlich begleitet den Behandlungspfad von Menschen mit Depression in der Routineversorgung zu verbessern

Body connection mediates the relationship between traumatic childhood experiences and impaired emotion regulation in borderline personality disorder

Background: Previous studies revealed an association between traumatic childhood experiences and emotional dysregulation in patients with borderline personality disorder (BPD). However, possible mediating pathways are still not fully understood. The aim of the present study was to investigate the potential mediating role of body connection, describing the awareness of the relationship of bodily and mental states, for the association between a history of traumatic childhood experiences and BPD core symptomatology. Methods: One-hundred-twelve adult female individuals with BPD and 96 healthy female controls (HC) were included. Impaired emotion regulation, traumatic childhood experiences, and BPD symptomatology were assessed with self-report questionnaires. The Scale of Body Connection was used to assess two dimensions of body connection, that is body awareness, describing attendance to bodily information in daily life and noticing bodily responses to emotions and/or environment and body dissociation, describing a sense of separation from one's own body, due to avoidance or emotional disconnection. Mann-Whitney U tests were employed to test for group differences (BPD vs. HC) on the two SBC subscales and associations with clinical symptoms were analyzed with Spearman correlations. We performed mediation analyses in the BPD group to test the assumption that body connection could act as a mediator between a history of traumatic childhood experiences and emotion dysregulation. Results: Individuals with BPD reported significantly lower levels of body awareness and significantly higher levels of body dissociation compared to HC. Body dissociation, traumatic childhood experiences, and emotion dysregulation were significantly positively associated. Further analyses revealed that body dissociation, but not body awareness, significantly and fully mediated the positive relationship between traumatic childhood experiences and impaired emotion regulation in the BPD sample. This mediation survived when trait dissociation, i.e., general dissociative experiences not necessarily related to the body, was statistically controlled for. Conclusion: Certain dimensions of body connection seem to be disturbed in BPD patients, with body dissociation being an important feature linking a history of traumatic childhood experiences to current deficits in emotion regulation

A Mechanism-Based Approach to Anti-Aggression Psychotherapy in Borderline Personality Disorder: Group Treatment Affects Amygdala Activation and Connectivity

Aggression is highly prevalent in borderline personality disorder (BPD). Previous studies have identified specific biobehavioral mechanisms underlying aggression in BPD, threat sensitivity being among them. We composited the mechanism-based anti-aggression psychotherapy (MAAP) in order to target these specific mechanisms, and MAAP was found to be superior to non-specific supportive psychotherapy (NSSP) in reducing aggressive behavior. In the present study, we investigated whether underlying brain mechanisms expected to be involved were affected by MAAP. To this end, n = 33 patients with BPD and overt aggressive behavior (n = 20 in MAAP, n = 13 in NSSP) and n = 25 healthy participants took part in a functional magnetic resonance imaging emotional face-matching task before and after treatment, or at a similar time interval for controls. Overt aggressive behavior was assessed using the overt aggression scale, modified. Results showed a decrease in amygdala activation in response to facial stimuli after MAAP, whereas an increase in amygdala activation was found after NSSP. Furthermore, in the MAAP group, connectivity between amygdala and dorsomedial prefrontal cortex increased from pre- to post-treatment compared to the NSSP group. Hence, the results suggest an impact of MAAP on brain mechanisms underlying the salience circuit in response to threat cues

Heartbeat evoked potentials in patients with post-traumatic stress disorder: an unaltered neurobiological regulation system?

Background: Early life maltreatment is a risk factor for psychiatric disorders, including post-traumatic stress disorder (PTSD). Post-traumatic stress disorder is a severe and heterogeneous disorder with fluctuating states of emotional over- and undermodulation, including hypervigilance, dissociation, and emotion regulation deficits. The perception and regulation of emotions have been linked to interoception, the cortical representation and sensing of inner bodily processes. Although first therapeutic approaches targeting bodily sensations have been found effective in patients with PTSD, and deficits in interoceptive signal representation have been reported in other trauma-related disorders, such as borderline personality disorder (BPD), the role of interoception remains largely unexplored for PTSD. Objective: The objective was to investigate the cortical representation of cardiac interoceptive signals in patients with PTSD and its associations with early life maltreatment, trait dissociation, and emotion dysregulation. Methods: Twenty-four medication-free patients with PTSD and 31 healthy controls (HC) completed a 5-min resting electrocardiogram (ECG) with parallel electroencephalogram (EEG). Heartbeat evoked potential (HEP) amplitudes as a measure for cortical representation of cardiac interoceptive signals were compared between groups and correlated with self-report questionnaires. Results: We did not find significantly different mean HEP amplitudes in patients with PTSD compared to HC, although HEPs of patients with PTSD were descriptively higher. No significant associations between mean HEP amplitudes and early life maltreatment, trait dissociation or emotion dysregulation were obtained within the groups. Conclusion: The current finding does not indicate deficits in interoceptive signal representation at rest in individuals with PTSD. Whether patients with PTSD show altered HEP modulations during emotion regulation tasks and might benefit from therapeutic approaches aiming at changing the perception of bodily signals, needs to be investigated in future studies

Heartbeat evoked potentials in patients with posttraumatic stress disorder: an unaltered neurobiological regulation system?

Background: Early life maltreatment is a risk factor for psychiatric disorders, including posttraumatic stress disorder (PTSD). Posttraumatic stress disorder is a severe and heterogeneous disorder with fluctuating states of emotional over- and undermodulation including hypervigilance, dissociation, and emotion regulation deficits. The perception and regulation of emotions have been linked to interoception, the cortical representation and sensing of inner bodily processes. Although first therapeutic approaches targeting bodily sensations have been found effective in patients with PTSD, and deficits in interoceptive signal representation have been reported in other trauma-related disorders such as borderline personality disorder (BPD), the role of interoception remains largely unexplored for PTSD. Objective: The objective was to investigate the cortical representation of cardiac interoceptive signals in patients with PTSD and its associations with early life maltreatment, trait dissociation, and emotion dysregulation. Methods: Twenty-four medication-free patients with PTSD and 31 healthy controls (HC) completed a 5-min resting electrocardiogram (ECG) with parallel electroencephalogram (EEG). Heartbeat evoked potential (HEP) amplitudes as a measure for cortical representation of cardiac interoceptive signals were compared between groups and correlated with self-report questionnaires. Results: We did not find significantly different mean HEP amplitudes in patients with PTSD compared to HC, although HEPs of patients with PTSD were descriptively higher. No significant associations between mean HEP amplitudes and early life maltreatment, trait dissociation or emotion dysregulation were obtained within the groups. Conclusion: The current finding does not indicate deficits in interoceptive signal representation at rest in individuals with PTSD. Whether patients with PTSD show altered HEP modulations during emotion regulation tasks and might benefit from therapeutic approaches aiming at changing the perception of bodily signals, needs to be investigated in future studies

Adverse childhood experiences mediate the negative association between borderline personality disorder symptoms and plasma oxytocin.

Background Interpersonal dysfunction is a core symptom of borderline personality disorder (BPD) and may be closely linked to adverse childhood experiences. According to a recent model on the pathology of BPD, the neuropeptide oxytocin might play an important role in the development and maintenance of the disorder. However, so far, only few studies with small adult samples have reported reduced baseline oxytocin levels in BPD that may be linked to adverse childhood experiences. Methods We examined baseline plasma oxytocin levels in 131 female patients with BPD and 124 non-BPD female controls across a large age span (12-50 years). Additionally, 113 female patients with less than five DSM-IV BPD features were included to examine the association between plasma oxytocin levels and the number of fulfilled BPD criteria. We also explored associations between plasma oxytocin and adverse childhood experiences as well as depressive symptoms in BPD. Results Patients with BPD had reduced plasma oxytocin levels compared to non-BPD controls and this was independent of age. Plasma oxytocin was negatively associated with the number of fulfilled BPD criteria. The exploratory regression model revealed no association between plasma oxytocin and depressive symptoms but an association between plasma oxytocin and adverse childhood experiences, which in fact mediated the relationship between BPD criteria und plasma oxytocin. Conclusion In a large sample of individuals with BPD across a large age span, our results replicate and extend previous reports of reduced plasma oxytocin levels that might be related to adverse childhood experiences thus providing further evidence for a prominent role of oxytocin in BPD

The RAPSODIE project. First results from the sites of La Peyrouse and Blis (Dordogne)

International audienceEn Europe tempérée, l’essor du phénomène urbain se révèle plus tardif que dans le monde méditerranéen et répond à des dynamiques différentes. Les oppida, qui se développent à partir de la fin du IIe s. a.C., ont longtemps été considérées comme les premières villes d’Europe tempérée. Or, ces dernières décennies, cette idée est remise en question par la multiplication des opérations archéologiques. On caractérise désormais l’existence de dynamiques urbaines antérieures. Il s’agit d’agglomérations ouvertes (sans fortification massive) qui, pour certaines, éclosent d’un bout à l’autre de l’Europe près de 200 ans avant les oppida. Le projet RAPSODIE (appel à projets ESR 2019, Conseil régional de Nouvelle-Aquitaine) s’intéresse particulièrement aux plus anciens de ces sites, occupés dès le IIIe s. a.C. et dont peu sont documentés en Europe. Ces premières villes constituent des objets d’études prioritaires pour cerner l’évolution des sociétés celtiques européennes. Elles concentrent en effet plusieurs innovations majeures : 1- l’essor urbain avec un accroissement démographique sans précédent, une grande superficie d’habitat, une organisation rationalisée de l’espace (places publiques, sanctuaires, quartiers spécialisés, voierie, etc.) ; 2- une production artisanale quasi-industrielle ; 3- d’intenses activités commerciales et économiques marquées par la première apparition de la monnaie dans les échanges courants. Paradoxalement, ces agglomérations ouvertes précoces demeurent largement méconnues et peu explorées. En raison de la concentration significative de ces sites précoces dans le Sud-Ouest de la France, ce secteur constitue une zone-clé pour étudier la genèse du fait urbain en Europe tempérée. En effet, nous avons caractériser cinq sites qui présentent une phase d’occupation semblant remonter au IIIe s. a.C. (la chronologie est caractérisée par le mobilier recueilli en fouilles ou lors de prospection). Ainsi, cinq sites pouvant s’accorder à ce profil sont explorés dans le cadre du projet RAPSODIE : Lacoste, Eysses, Le Mas-d’Agenais, Eymet et La Peyrouse. Les différents procédés employés dans le cadre du projet RAPSODIE (prospections géophysiques, études paléo-environnementales, prospections pédestres, fouilles archéologiques, LiDAR, SIG, etc.) visent à aboutir à une compréhension renouvelée des sites et de leur environnement. Ce programme répond à cinq objectifs principaux : 1- Préciser l’étendue des sites et déterminer s’ils présentent une délimitation matérialisée ; 2- Percevoir des éléments d’organisation interne ; 3- Appréhender le contexte topographique et l’environnement des agglomérations étudiées ; 4- Initier une démarche comparative pour analyser les connexions entre ces sites et les facteurs ayant favorisé leur apparition ; 5- Planifier les opérations archéologiques et confronter l’ensemble des interprétations aux données stratigraphiques issues de fouilles.Le présent article se centre autour des premiers résultats issus des sites de La Peyrouse et de Blis, tous deux situés dans le département de la Dordogne. Bien que les explorations sur ces deux sites n’en soient qu’à leurs débuts, il s’agit de montrer comment les approches intégrées, par le croisement des méthodes, permettent de mieux préciser la nature de ces sites