Wahrnehmung phasischer physiologischer Aktivierung und Metakognitionen bei generalisierter Angststörung

Physiologische Aktivierung (A.) ist im Erleben von Personen mit GAS und in Störungsmodellen zur GAS bedeutsam, jedoch finden Studien keine Belege für autonome Überaktivierung. Um diese Diskrepanz aufzuklären wurde untersucht (a) ob GAS-Probanden (N=33) phasische autonome A. besser wahrnehmen als Kontrollprobanden (N=34), und (b) ob die Überzeugung, aktiviert zu sein, zur Aufrechterhaltung der GAS-Symptomatik beiträgt. In einer Signalentdeckungsaufgabe zeigten GAS-Probanden eine sensitivere Wahrnehmung unspezifischer Hautleitfähigkeitsfluktuationen. In Exp. II erhielten die Probanden nach einer Sorgeninduktion während einer Entspannung falsche Rückmeldung bezüglich zunehmender A. vs. Entspannung. Nur bei GAS-Probanden verstärkte das A.-Feedback negative metakognitive Überzeugungen über das Sorgen und hielt Sorgen und negative Stimmung aufrecht. Eine überlegene Wahrnehmung phasischer A. und deren katastrophisierende Missinterpretation verstärken folglich Sorgen, negative Stimmung und negative Metakognitionen bei GAS

Assessing metacognitive beliefs about worry

Background Metacognitive beliefs have been proposed to play a key role in initiating and maintaining worry. The Why Worry-Scale-II (WW-II) and Consequences of Worry Scale (COWS) are self-report questionnaires assessing positive and negative metacognitive beliefs. The main goal of this study was to validate German versions of these two questionnaires. Method N = 603 participants completed a questionnaire battery, including the two self-report measures of metacognitive beliefs. We conducted confirmatory factor analyses, calculated internal consistencies, and examined convergent and divergent validity. In addition, the questionnaires’ power in predicting worry, repetitive negative thinking (RNT) and generalized anxiety disorder (GAD) symptoms were investigated. Results The factor structure of the original versions could be replicated for both measures. Furthermore, the translated questionnaires demonstrated excellent internal consistency and evidence of convergent and divergent validity. Importantly they also possessed predictive power in explaining worry, RNT and GAD symptoms, even over and above the Metacognitions Questionnaire-30 (MCQ-30) as the current gold standard. Conclusions Overall, our findings suggest that the WW-II and COWS show solid psychometric properties and are useful in measuring metacognitive beliefs independently from the MCQ-30

The effectiveness of cognitive behavioural therapy for social anxiety disorder in routine clinical practice

Numerous randomized controlled trials have shown cognitive behaviour therapy (CBT) to be effective in treating social anxiety disorder (SAD). Yet, less is known about the effectiveness of CBT for SAD conducted by psychotherapists in training in routine clinical practice. In this study, 231 patients with SAD were treated with CBT under routine conditions and were examined at pre‐ and post‐treatment as well as at 6 and 12 months follow‐up. We applied self‐reports to assess symptoms of SAD (defined as primary outcome), depression and psychological distress (defined as secondary outcome). We conducted both completer and intent‐to‐treat analyses and also assessed the reliability of change with the reliable change index. Results revealed significant reductions in symptoms of SAD between pre‐ and post‐assessments, with effect sizes ranging from d = 0.9 to 1.2. Depending on the SAD specific questionnaire applied, 47.8% to 73.5% of the sample showed a reliable positive change, whereas 1.9% to 3.8% showed a reliable negative change. Depressive symptoms and psychological distress also decreased significantly from pre‐ to post‐assessment, with large effect sizes. Significant treatment gains regarding both primary and secondary outcomes were further observed at 6 and 12 months follow‐up. The current findings based on a large sample of patients suggest that psychotherapists in CBT training working under routine conditions can effectively treat symptoms of SAD, depression and psychological distress.Projekt DEA

Procedural recommendations of cardiac PET/CT imaging:standardization in inflammatory-, infective-, infiltrative-, and innervation (4Is)-related cardiovascular diseases: a joint collaboration of the EACVI and the EANM

With this document, we provide a standard for PET/(diagnostic) CT imaging procedures in cardiovascular diseases that are inflammatory, infective, infiltrative, or associated with dysfunctional innervation (4Is). This standard should be applied in clinical practice and integrated in clinical (multicenter) trials for optimal procedural standardization. A major focus is put on procedures using [18F]FDG, but 4Is PET radiopharmaceuticals beyond [18F]FDG are also described in this document. Whilst these novel tracers are currently mainly applied in early clinical trials, some multicenter trials are underway and we foresee in the near future their use in clinical care and inclusion in the clinical guidelines. Finally, PET/MR applications in 4Is cardiovascular diseases are also briefly described. Diagnosis and management of 4Is-related cardiovascular diseases are generally complex and often require a multidisciplinary approach by a team of experts. The new standards described herein should be applied when using PET/CT and PET/MR, within a multimodality imaging framework both in clinical practice and in clinical trials for 4Is cardiovascular indications.</p

Procedural recommendations of cardiac PET/CT imaging: standardization in inflammatory-, infective-, infiltrative-, and innervation- (4Is) related cardiovascular diseases: a joint collaboration of the EACVI and the EANM: summary

With this summarized document we share the standard for positron emission tomography (PET)/(diagnostic)computed tomography (CT) imaging procedures in cardiovascular diseases that are inflammatory, infective, infiltrative, or associated with dysfunctional innervation (4Is) as recently published in the European Journal of Nuclear Medicine and Molecular Imaging. This standard should be applied in clinical practice and integrated in clinical (multicentre) trials for optimal standardization of the procedurals and interpretations. A major focus is put on procedures using [18F]-2-fluoro-2-deoxyglucose ([18F]FDG), but 4Is PET radiopharmaceuticals beyond [18F]FDG are also described in this summarized document. Whilst these novel tracers are currently mainly applied in early clinical trials, some multicentre trials are underway and we foresee in the near future their use in clinical care and inclusion in the clinical guidelines. Diagnosis and management of 4Is related cardiovascular diseases are generally complex and often require a multidisciplinary approach by a team of experts. The new standards described herein should be applied when using PET/CT and PET/magnetic resonance, within a multimodality imaging framework both in clinical practice and in clinical trials for 4Is cardiovascular indications.</p

Procedural recommendations of cardiac PET/CT imaging: standardization in inflammatory-, infective-, infiltrative-, and innervation (4Is)-related cardiovascular diseases: a joint collaboration of the EACVI and the EANM

With this document, we provide a standard for PET/(diagnostic) CT imaging procedures in cardiovascular diseases that are inflammatory, infective, infiltrative, or associated with dysfunctional innervation (4Is). This standard should be applied in clinical practice and integrated in clinical (multicenter) trials for optimal procedural standardization. A major focus is put on procedures using [18F]FDG, but 4Is PET radiopharmaceuticals beyond [18F]FDG are also described in this document. Whilst these novel tracers are currently mainly applied in early clinical trials, some multicenter trials are underway and we foresee in the near future their use in clinical care and inclusion in the clinical guidelines. Finally, PET/MR applications in 4Is cardiovascular diseases are also briefly described. Diagnosis and management of 4Is-related cardiovascular diseases are generally complex and often require a multidisciplinary approach by a team of experts. The new standards described herein should be applied when using PET/CT and PET/MR, within a multimodality imaging framework both in clinical practice and in clinical trials for 4Is cardiovascular indications.</p

Psychological interventions for generalized anxiety disorder: Effects and predictors in a naturalistic outpatient setting.

ObjectiveNumerous randomized controlled trials (RCTs) demonstrate the efficacy of cognitive behavioral therapy (CBT), metacognitive therapy (MCT), and methods to reduce intolerance of uncertainty (IU-CBT) in the treatment of generalized anxiety disorder (GAD). However, few studies have investigated these treatments under conditions of routine clinical care. The main objective of this study was to investigate the effectiveness of psychotherapy for GAD in an outpatient setting and to identify factors influencing treatment outcome.MethodsFifty-nine GAD patients received naturalistic CBT (including MCT and IU-CBT) in an outpatient clinic and postgraduate training center for psychotherapy. Patients completed self-report questionnaires at the beginning and end of therapy regarding the main outcome worry as well as metacognitions, intolerance of uncertainty, depression, and general psychopathology.ResultsWorry, negative metacognitions, intolerance of uncertainty, depression, and general psychopathology decreased significantly (p's ConclusionsNaturalistic CBT for GAD appears to be effective in routine clinical care for worry as well as depressive symptoms, with particular benefits associated with altering negative metacognitions. However, a recovery rate of only 23% is lower than the rates reported in RCTs. Treatment needs to be improved, especially for patients with more severe GAD and for women

Specifically altered brain responses to threat in generalized anxiety disorder relative to social anxiety disorder and panic disorder

Background: Despite considerable effort, the neurobiological underpinnings of hyper-responsive threat processing specific to patients suffering from generalized anxiety disorder (GAD) remain poorly understood. The current functional magnetic resonance imaging (fMRI) study aims to delineate GAD-specific brain activity during immediate threat processing by comparing GAD patients to healthy controls (HC), to social anxiety disorder (SAD) and to panic disorder (PD) patients. Method: Brain activation and functional connectivity patterns to threat vs. neutral pictures were investigated using event-related fMRI. The sample consisted of 21 GAD, 21 PD, 21 SAD and 21 HC. Results: GAD-specific elevated activity to threat vs. neutral pictures was found in cingulate cortex, dorsal anterior insula/frontal operculum (daI/FO) and posterior dorsolateral prefrontal cortex (dlPFC). Defining these effects as seed regions, we detected GAD-specific increased functional connectivity to threat vs. neutral pictures between posterior dlPFC and ventrolateral prefrontal cortex, between cingulate cortex and amygdala, between cingulate cortex and anterior insula, as well as decreased functional connectivity between daI/FO and mid-dlPFC. Conclusion: The findings present the first evidence for GAD-specific neural correlates of hyper-responsive threat processing, possibly reflecting exaggerated threat sensitivity, maladaptive appraisal and attention-allocation processes

Unexpected Disproportionation of Tetramethylethylenediamine-Supported Perchlorodisilane Cl₃SiSiCl₃

The addition compound Cl₃SiSiCl₃·TMEDA was formed quantitatively by treatment of Cl₃SiSiCl₃ with tetramethylethylenediamine (TMEDA) in pentane at room temperature. The crystal structure of Cl₃SiSiCl₃·TMEDA displays one tetrahedrally and one octahedrally bonded Si atom (monoclinic, <i>P</i>2₁/<i>n</i>). ²⁹Si CP/MAS NMR spectroscopy confirms this structure. Density functional theory (DFT) calculations have shown that the structure of the <i>meridional</i> isomer of Cl₃SiSiCl₃·TMEDA is 6.3 kcal lower in energy than that of <i>facial</i> coordinate species. Dissolving of Cl₃SiSiCl₃·TMEDA in CH₂Cl₂ resulted in an immediate reaction by which oligochlorosilanes Si_<i>n</i>Cl_2<i>n</i> (<i>n</i> = 4, 6, 8, 10; precipitate) and the Cl^–-complexed dianions [Si_<i>n</i>Cl_2<i>n</i>+2]^2– (<i>n</i> = 6, 8, 10, 12; CH₂Cl₂ extract) were formed. The constitutions of these compounds were confirmed by MALDI mass spectrometry. Additionally, single crystals of [Me₃NCH₂CH₂NMe₂]₂[Si₆Cl₁₄] and [Me₃NCH₂CH₂NMe₂]₂[Si₈Cl₁₈] were obtained from the CH₂Cl₂ extract. We found that Cl₃SiSiCl₃·TMEDA reacts with MeCl, forming MeSiCl₃ and the products that had been formed in the reaction of Cl₃SiSiCl₃·TMEDA with CH₂Cl₂. X-ray structure analysis indicates that the structures of [Me₃NCH₂CH₂NMe₂]₂[Si₆Cl₁₄] (monoclinic, <i>P</i>2₁/<i>n</i>) and [Me₃NCH₂CH₂NMe₂]₂[Si₈Cl₁₈] (monoclinic, <i>P</i>2₁/<i>n</i>) contain dianions adopting an “inverse sandwich” structure with inverse polarity and [Me₃NCH₂CH₂NMe₂]⁺ as countercations. Single crystals of SiCl₄·TMEDA (monoclinic, <i>Cc</i>) could be isolated by thermolysis reaction of Cl₃SiSiCl₃·TMEDA (50 °C) in tetrahydrofuran (THF)