Christian Huchzermeier

Changes in CREB Phosphorylation and BDNF Plasma Levels during Psychotherapy of Depression

Background: The cyclic adenosine monophosphate response element-binding proteins (CREB) and their interaction with brain-derived neurotrophic factor (BDNF) are essential elements in signal transduction pathways important for cellular resilience and neuroplasticity. They play a decisive role in the concept of altered neuroplasticity in major depression. We have previously demonstrated that the increase in phosphorylated CREB (pCREB) in T lymphocytes is significantly associated with clinical improvement in patients treated with antidepressants. In the present study, we focused on patients treated only with psychotherapy to exclude direct pharmacological actions. In addition to pCREB, we also measured the BDNF plasma levels. Methods: pCREB in T lymphocytes was determined by Western blot; the BDNF plasma levels with solid-phase ELISA. Psychopathology was evaluated with the Hamilton Rating Scale for Depression (HAMD). Thirty patients meeting DSM-IV criteria for major depressive episodes (MDE) were recruited into this 6-week study. They received interpersonal psychotherapy (IPT) twice weekly. Results: After 6 weeks of IPT, 17 patients responded (reduction of ≥50% of baseline HAMD); after 1 week of treatment pCREB increased significantly compared to the nonresponder group. Measurement of the BDNF plasma levels revealed no differences between the responder and nonresponder groups. Furthermore, the correlations between BDNF plasma levels and pCREB were not significant. Conclusions: The early increase in pCREB is related to treatment response and does not depend on pharmacological interventions or BDNF plasma levels. For the first time, cellular biological markers could be associated with response to psychotherapy.

The Prevalence of Mental Disorders in a German Sample of Male Incarcerated Juvenile Offenders

The current study investigated the prevalence of mental disorders among incarcerated juvenile offenders in Germany and sought to identify clinically relevant subgroups. In sum, 149 newly incarcerated male juvenile delinquents (M age = 19 years) were included. Diagnostic tools included the German version of the Structured Clinical Interview for DSM-IV and the Psychopathy Checklist—Screening Version. The most prevalent diagnoses in the sample included conduct disorders (81%), Cluster B personality disorders (up to 62%), and substance-related disorders (up to 60%). Moreover, psychopathic features were found among 21% of the participants. Cluster analysis distinguished three subgroups among this group of young offenders. The most problematic consisted of juveniles with multiple psychopathology, including antisocial traits, personality pathology, higher scores on the Psychopathy Checklist, as well as multiple substance abuse. Study outcomes are discussed in light of their implications for the development of effective treatment for juvenile offenders.

Sleep in major depression: relation to memory performance and outcome after interpersonal psychotherapy.

Background: Earlier findings suggest both a link between sleep and memory consolidation and a relationship between abnormal sleep at baseline and poor treatment outcome in major depression after interpersonal psychotherapy (IPT). Methods: Pre-treatment polysomnography was examined in 32 patients with a major depressive episode (mean age = 39.5 years, 20 women). Declarative memory was tested by the Rey-Osterrieth Complex Figure Test and a paired associative word list and procedural learning was assessed by a mirror tracing skill. All patients were treated with IPT according to the manual and did not receive any antidepressant medication. Twenty-three patients took part in a minimum of 12 sessions of IPT. Remission was defined as 2 consecutive weeks with a score <8 on the Hamilton Rating Scale of Depression. Results: Declarative visual memory performance was associated with total sleep time and total amount of rapid eye movement sleep. In IPT remitters (n = 14), there was a trend towards a decrease in rapid eye movement density (first period) and a significant decrease in delta power in pre-treatment sleep in comparison to non-remitters (n = 9). Treatment outcome after IPT was also associated with declarative memory performance at baseline (as a trend). Conclusions: Further indications of a role of sleep in memory processes and of the importance of specific sleep parameters as markers for a positive treatment response to psychotherapy were found.

Psychopathy, intelligence and conviction history

The current study examined the relationship between psychopathy, intelligence and two variables describing the conviction history (length of conviction and number of prior convictions). It was hypothesized that psychopathy factors (interpersonal and antisocial factors assuming a 2-factor model or interpersonal, affective, lifestyle and antisocial factors assuming a 4-factor model) would be related in different ways to IQ scores, length of conviction and number of prior convictions. Psychopathy and IQ were assessed using the PCL:SV and the CFT 20-R respectively. Results indicated no association between interpersonal psychopathy features (Factor 1, two-factor model), IQ and the number of prior convictions but a positive association between Factor 1 and the length of conviction. Antisocial features (Factor 2, two-factor model) were negatively related to IQ and the length of conviction and positively related to the number of prior convictions. Results were further differentiated for the four-factor model of psychopathy. The relationship between IQ and psychopathy features was further assessed by statistically isolating the effects of the two factors of psychopathy. It was found that individuals scoring high on interpersonal features of psychopathy are more intelligent than those scoring high on antisocial features, but less intelligent than those scoring low on both psychopathy features. The results underpin the importance of allocating psychopathic individuals to subgroups on the basis of personality characteristics and criminological features. These subgroups may identify different types of offenders and may be highly valuable for defining treatment needs and risk of future violence.

Are there age-related effects in antisocial personality disorders and psychopathy?

We investigated possible age differences in the frequency of antisocial personality disorder (ASPD), and of psychopathy according to Hares criteria and its constituent features: In a cross-sectional study 226 male violent offenders, detained in adult or youth custody, were investigated using the Psychopathy Checklist Screening Version (PCL:SV) and the SCID II Interview. Their ages ranged from 18 to 59 years. Total PCL:SV score was negatively correlated with age. ANOVA showed that total PCL scores for three age groups differed significantly. Both effects were due entirely to Factor 2 of the PCL. Factor 1 was not related to age. The frequency of ASPD was also lower among older prisoners. The relationship with age was similar to that of PCL:SV Factor 2. These results point to age-related effects in psychopathy and suggest that different aspects of psychopathy follow different developmental courses. The results of our group comparison suggest that the different subfacets of psychopathy are not stable over time to the same extent. In order to make statements about the course of intraindividual development, however, longitudinal studies would be required.

The (in)consistency of changes in brain macrostructure in male paedophiles: A combined T1-weighted and diffusion tensor imaging study

Thus far, four studies have used magnetic resonance imaging (MRI) to test for differences in brain structure between paedophilic (i.e. sexually attracted to pre-pubescent children) and teleiophilic (i.e. sexually attracted to adults) men, revealing divergent results. To re-examine this issue, we acquired high resolution structural T1-weighted and diffusion MRI scans of the brain in 24 paedophilic and 32 teleiophilic men. We performed voxel-based morphometry (VBM) of the T1-weighted images and tract-based spatial statistics (TBSS) of the diffusion tensor imaging data to search for grey and white matter differences between groups. In contrast to previous studies, less than half of the individuals in our paedophilic group had a record of sexual offences against children, as subjects were partially recruited from two outpatient facilities of a child sexual abuse prevention project for self-acknowledged paedophiles. After adjustment for multiple comparisons and controlling for important confounding factors, we did not find any significant grey or white matter differences between the paedophilic and teleiophilic subjects. Together with the inconsistencies in the literature, these results argue against consistent structural differences at the macroanatomical scale between paedophiles and teleiophiles.

Emotion regulation in incarcerated young offenders with psychopathic traits

Core features of psychopathic personality in adults are shallow affectivity and generally low levels of emotional distress. Several studies suggest that these features are also in young people with psychopathic personality traits. The concept of emotion regulation refers to a persons ability to regulate negative emotions to reduce feelings of emotional distress. Since maladaptive emotion regulation has been associated with high levels of emotional distress it may be expected that individuals withpsychopathic personality traits show particularly adaptive strategies for the regulation of negative emotionality. On the basis of these expectations, the current study investigated the relationship between psychopathic traits, self-reported degree of emotional problems, and emotion regulation strategies in 104 incarcerated young offenders. Psychopathic traits were not associated with emotional problems or with adaptive emotion-regulation but were positively related to maladaptive emotion regulation strategies. When scores for each psychopathy factorwere investigated separately, significant disparities were found in emotional symptoms and emotion regulation.

Psychopathy checklist score predicts negative events during the sentences of prisoners with Hare psychopathy: a prospective study at a German prison.

Objective: This study examined the predictive validity of the German translation of the Psychopathy Checklist-Screening Version (PCL-SV) for negative events during the course of the prison sentence of German prisoners. Method: Using the PCL-SV, we investigated 145 offenders in a German prison at the start of their sentences. We then compared the extreme groups identified by the PCL-SV—the high and low scorers—using a prospective design with respect to negative events and factors during the course of the sentences. This involved the standardized collection of data on both objective records of disciplinary incidents and subjective impressions from prison staff on the basis of operationalized criteria. Results: The high scorers were involved in significantly more disciplinary incidents and were also rated significantly less favourably by prison staff than the low scorers. Conclusion: Until now, the PCL has only been shown to predict recidivism following release from prison. The results of our study show that the PCL also has predictive validity for problems during the course of the sentence. It is therefore recommended that the PCL be used routinely at the start of the prison sentence to estimate the likelihood of subsequent difficulties.

Predictive validity of the psychopathy checklist: screening version for intramural behaviour in violent offenders-a prospective study at a secure psychiatric hospital in Germany

Objective: To consider the extent to which the presence of psychopathy, as indicated by the psychopathy checklist: screening version (PCL:SV), can predict intramural behaviour in offenders with mental disorders serving compulsory treatment at a German forensic psychiatric hospital. Method: The PCL:SV was used with 48 offenders detained at a forensic psychiatric hospital in Germany. In a prospective design, objective and subjective measures of behaviour were compared for those identified as high and low scorers on the PCL:SV. Data were obtained from hospital records of disciplinary incidents (objective) and from interviews with case managers and therapists (subjective), according to predefined criteria and in standardized forms. Results: The hospital records of the high scorers indicated they had been involved in significantly more disciplinary incidents than low scorers. Their behaviour was also rated significantly more negative by therapists than the low scorers. Conclusion: Numeorus studies found the psychopathy checklist (PCL) score to be a reliable predictor of recidivism in offenders after release. The present study has demonstrated that the PCL score has also predictive validity for intramural behaviour problems in individuals serving compulsory treatment at a forensic psychiatric hospital. As a result, we recommend the routine use of the PCL with offenders starting a period of compulsory detention to identify those at increased risk for problem behaviour.

A young woman who killed 5 of her own babies: a case of multiple neonaticide

Neonaticide is a rare form of homicide. It is generally classed as manslaughter but differs from other forms of homicide in many respects. The factors favouring its occurrence and the legal position of neonaticide in Germany are discussed. The case is presented of a mother who committed five neonaticides within 8 years. While she was a caring mother for her two oldest children, she killed the five subsequent offspring immediately after giving birth. In the scarce literature on neonaticides, a case of multiple offending is particularly rare. Similarities to, and differences from, other cases of neonaticide in the literature are considered. The psychodynamic context of the offences is examined in order to identify contributing features which could be used to help prevent future occurrences.