Neuroimaging in Psychiatry: From Bench to Bedside

This perspective considers the present and the future role of different neuroimaging techniques in the field of psychiatry. After identifying shortcomings of the mainly symptom-focussed diagnostic processes and treatment decisions in modern psychiatry, we suggest topics where neuroimaging methods have the potential to help. These include better understanding of the pathophysiology, improved diagnoses, assistance in therapeutic decisions and the supervision of treatment success by direct assessment of improvement in disease-related brain functions. These different questions are illustrated by examples from neuroimaging studies, with a focus on severe mental and neuropsychiatric illnesses such as schizophrenia and depression. Despite all reservations addressed in the article, we are optimistic that neuroimaging has a huge potential with regard to the above-mentioned questions. We expect that neuroimaging will play an increasing role in the future refinement of the diagnostic process and aid in the development of new therapies in the field of psychiatry

Can intermittent theta burst stimulation as add-on to psychotherapy improve nicotine abstinence? Results from a pilot study

Smoking is among the leading causes of mortality worldwide. Discontinuing smoking can increase life expectancy to the presmoking level. Unaided attempts are often ineffective, strengthening the necessity of cognitive-behavioral therapy (CBT), nicotine replacement or pharmacotherapy. Still, relapse rates are high. Recently, a modulation of nicotine craving, which predicts relapse, through transcranial magnetic stimulation to the prefrontal cortex was shown. In a pilot study, we investigated whether 4 sessions of intermittent theta burst stimulation (iTBS) as add-on treatment to CBT reduces nicotine craving and improves long-term abstinence (at 3, 6 and 12 months). Smokers were randomly assigned to a treatment (n = 38) or a sham group (n = 36). Although we did not find reduced craving, we could show higher abstinence rates in the treatment group at 3 months. At 6 and 12 months abstinence rates did not differ significantly. Results at 12 months, however, have to be interpreted cautiously due to significant differences in the dropout rates between the two groups at this time point. We provide first evidence for a beneficial effect of additional iTBS on intermediate nicotine abstinence; however, the low number of iTBS sessions might have prevented longer effects. More lasting effects might be achieved by iTBS maintenance sessions in analogy to the treatment of depression

Math Anxiety in Combination With Low Visuospatial Memory Impairs Math Learning in Children

Math anxiety impairs academic achievements in mathematics. According to the processing efficiency theory (PET), the adverse effect is the result of reduced processing capacity in working memory (WM). However, this relationship has been examined mostly with correlational designs. Therefore, using an intervention paradigm, we examined the effects of math anxiety on math learning. Twenty-five 5th graders underwent seven training sessions of multiplication over the course of 2 weeks. Children were faster and made fewer errors in solving trained problems than untrained problems after learning. By testing the relationship between math anxiety, WM, and math learning, we found that if children have little or no math anxiety, enough WM resources are left for math learning, so learning is not impeded. If they have high math anxiety and high visuospatial WM, some WM resources are needed to deal with math anxiety but learning is still supported. However, if they have high math anxiety and low visuospatial WM capacity, math learning is significantly impaired. These children have less capacity to learn new math content as cognitive resources are diverted to deal with their math anxiety. We conclude that math anxiety not only hinders children’s performance in the present but potentially has long-lasting consequences, because it impairs not only math performance but also math learning. This intervention study partially supports the PET because only the combination of high math anxiety and low WM capacity seems critical for hindering math learning. Moreover, an adverse effect of math anxiety was observed on performance effectiveness (response accuracy) but not processing efficiency (response time)

Social Cognition in Down Syndrome: Face Tuning in Face-Like Non-Face Images

Individuals with Down syndrome (DS) are widely believed to possess considerable socialization strengths. However, the findings on social cognition capabilities are controversial. In the present study, we investigated whether individuals with DS exhibit shortage in face tuning, one of the indispensable components of social cognition. For this purpose, we implemented a recently developed Face-n-Food paradigm with food-plate images composed of food ingredients such as fruits and vegetables. The key benefit of such face-like non-face images is that single elements do not facilitate face processing. In a spontaneous recognition task, 25 children with DS aged 9 to 18 years were presented with a set of Face-n-Food images bordering on the Giuseppe Arcimboldo style. The set of images was administered in a predetermined order from the least to most resembling a face. In DS individuals, thresholds for recognition of the Face-n-Food images as a face were drastically higher as compared not only with typically developing controls, but also with individuals with autistic spectrum disorders and Williams-Beuren syndrome. This outcome represents a significant step toward better conceptualization of the visual social world in DS and neurodevelopmental disorders in general

ESCAlate – Adaptive treatment approach for adolescents and adults with ADHD: study protocol for a randomized controlled trial

Background: Over the last decade, a wide range of attention-deficit/hyperactivity disorder (ADHD) treatment approaches for adults, including both pharmacological interventions and psychosocial treatments, have been proposed and observed to be efficient. In practice, individual treatment concepts are based on results of clinical studies as well as international guidelines (NICE Guidelines) that recommend a step-by-step treatment approach. Since the evidence supporting this approach is limited, the aim of the present study is to determine an optimal intervention regarding severity levels of ADHD symptomatology conducting a randomized controlled trial. Method: We aim to include 279 ADHD subjects aged between 16 and 45 years. First, participants are randomized to either a face-to-face psychoeducation, telephone assisted self-help (TASH), or a waiting control group (Step 1). All participants assigned to the control group are treated using TASH after a 3-month waiting period. Participants are then allocated to one of three groups, based on their remaining severity level of ADHD symptoms, as (1) full responder, (2) partial responder, or (3) non-responder (Step 2). Full responders receive counseling, partial responders receive either counseling only or counseling and neurofeedback (NF), and non-responders receive either pharmacological treatment only or pharmacological treatment and NF, followed by a 3 month period without intervention. Discussion: The naturalistic sample is one of the study’s advantages, avoiding highly selective inclusion or exclusion criteria. The efficacy of an evidence-based stepped care intervention is explored by primary (reduction of severity of ADHD symptoms) and secondary outcomes (functional outcomes, e.g., quality of life, anger management, enhancement of psychosocial well-being). Predictors of therapeutic response and non-response are being investigated at each step of intervention. Further, sex differences are also being explored. Trial registration: This study is registered by the German Trial Register (reference number: DRKS00008975 ), 23 October 2015

Distribution of Response Time, Cortical, and Cardiac Correlates during Emotional Interference in Persons with Subclinical Psychotic Symptoms

A psychosis phenotype can be observed below the threshold of clinical detection. The study aimed to investigate whether subclinical psychotic symptoms are associated with deficits in controlling emotional interference, and whether cortical brain and cardiac correlates of these deficits can be detected using functional near-infrared spectroscopy (fNIRS). A data set derived from a community sample was obtained from the Zurich Program for Sustainable Development of Mental Health Services. 174 subjects (mean age 29.67 ± 6.41, 91 females) were assigned to four groups ranging from low to high levels of subclinical psychotic symptoms (derived from the Symptom Checklist-90-R). Emotional interference was assessed using the emotional Stroop task comprising neutral, positive, and negative conditions. Statistical distributional methods based on delta plots [behavioral response time (RT) data] and quantile analysis (fNIRS data) were applied to evaluate the emotional interference effects. Results showed that both interference effects and disorder-specific (i.e., group-specific) effects could be detected, based on behavioral RTs, cortical hemodynamic signals (brain correlates), and heart rate variability (cardiac correlates). Subjects with high compared to low subclinical psychotic symptoms revealed significantly reduced amplitudes in dorsolateral prefrontal cortices (interference effect, p < 0.001) and middle temporal gyrus (disorder-specific group effect, p < 0.001), supported by behavioral and heart rate results. The present findings indicate that distributional analyses methods can support the detection of emotional interference effects in the emotional Stroop. The results suggested that subjects with high subclinical psychosis exhibit enhanced emotional interference effects. Based on these observations, subclinical psychosis may therefore prove to represent a valid extension of the clinical psychosis phenotype

Working Memory and Response Inhibition as One Integral Phenotype of Adult ADHD? A Behavioral and Imaging Correlational Investigation

Objective: It is an open question whether working memory (WM) and response inhibition (RI) constitute one integral phenotype in attention deficit hyperactivity disorder (ADHD). Method: The authors investigated 45 adult ADHD patients and 41 controls comparable for age, gender, intelligence, and education during a letter n-back and a stop-signal task, and measured prefrontal oxygenation by means of functional near-infrared spectroscopy. Results: The authors replicated behavioral and cortical activation deficits in patients compared with controls for both tasks and also for performance in both control conditions. In the patient group, 2-back performance was correlated with stop-signal reaction time. This correlation did not seem to be specific for WM and RI as 1-back performance was correlated with go reaction time. No significant correlations of prefrontal oxygenation between WM and RI were found. Conclusion: The authors' findings do not support the hypothesis of WM and RI representing one integral phenotype of ADHD mediated by the prefrontal cortex

Older adults’ coping strategies during the COVID-19 pandemic – a longitudinal mixed-methods study

IntroductionOlder age is a main risk factor for severe COVID-19. In 2020, a broad political debate was initiated as to what extent older adults need special protection and isolation to minimize their risk for SARS-CoV-2 infection. However, isolation might also have indirect negative psychological (e.g., loneliness, stress, fear, anxiety, depression) or physical (e.g., lack of exercise, missing medical visits) consequences depending on individual strategies and personality traits to cope longitudinally with this crisis.MethodsTo examine the impact of individuals’ coping with the pandemic on mental health, a large sample of 880 older adults of the prospective longitudinal cohort TREND study were surveyed six times about their individual coping strategies in the COVID-19 pandemic between May 2020 (05/2020: Mage = 72.1, SDage = 6.4, Range: 58–91 years) and November 2022 in an open response format. The relevant survey question was: “What was helpful for you to get through the last months despite the COVID-19 pandemic? E.g., phone calls, going for a walk, or others.”Results and DiscussionIn total, we obtained 4,561 records containing 20,578 text passages that were coded and assigned to 427 distinct categories on seven levels based on qualitative content analysis using MAXQDA. The results allow new insights into the impact of personal prerequisites (e.g., value beliefs, living conditions), the general evaluation of the pandemic (e.g., positive, irrelevant, stressful) as well as the applied coping strategies (e.g., cognitive, emotional- or problem-focused) to deal with the COVID-19 pandemic by using an adapted Lazarus stress model. Throughout the pandemic emotional-focused as well as problem-focused strategies were the main coping strategies, whereas general beliefs, general living conditions and the evaluation were mentioned less frequently

The Temporal Muscle of the Head Can Cause Artifacts in Optical Imaging Studies with Functional Near-Infrared Spectroscopy

Background: Extracranial signals are themain source of noise in functional near- infrared spectroscopy (fNIRS) as light is penetrating the cortex but also skin and muscles of the head. Aim: Here we performed three experiments to investigate the contamination of fNIRS measurements by temporal muscle activity. Material and methods: For experiment 1, we provoked temporal muscle activity by instructing 31 healthy subjects to clench their teeth three times. We measured fNIRS signals over left temporal and frontal channels with an interoptode distance of 3 cm, in one short optode distance (SOD) channel (1 cm) and electromyography (EMG) over the edge of the temporal muscle. In experiment 2, we screened resting state fNIRS-fMRI (functional magnetic resonance imaging) data of one healthy subject for temporal muscle artifacts. In experiment 3, we screened a dataset of sound-evoked activity (n = 33) using bi-temporal probe-sets and systematically contrasted subjects presenting vs. not presenting artifacts and blocks/events contaminated or not contaminated with artifacts. Results: In experiment 1, we could demonstrate a hemodynamic-response-like increase in oxygenated (O(2)Hb) and decrease in deoxygenated (HHb) hemoglobin with a large amplitude and large spatial extent highly exceeding normal cortical activity. Correlations between EMG, SOD, and fNIRS artifact activity showed only limited evidence for associations on a group level with rather clear associations in a sub-group of subjects. The fNIRS-fMRI experiment showed that during the temporal muscle artifact, fNIRS is completely saturated by muscle oxygenation. Experiment 3 showed hints for contamination of sound-evoked oxygenation by the temporal muscle artifact. This was of low relevance in analyzing the whole sample. Discussion: Temporal muscle activity e. g., by clenching the teeth induces a large hemodynamic-like artifact in fNIRS measurements which should be avoided by specific subject instructions. Data should be screened for this artifact might be corrected by exclusion of contaminated blocks/events. The usefulness of established artifact correction methods should be evaluated in future studies. Conclusion: Temporal muscle activity, e. g., by clenching the teeth is one major source of noise in fNIRS measurements