Claas-Hinrich Lammers

CEREBROSPINAL FLUID CONCENTRATIONS OF CORTICOTROPIN-RELEASING HORMONE, VASOPRESSIN, AND SOMATOSTATIN IN DEPRESSED PATIENTS AND HEALTHY CONTROLS: RESPONSE TO AMITRIPTYLINE TREATMENT

The effect of amitriptyline upon hypothalamic‐pituitary‐adrenal [HPA]‐system‐regulating neuropeptides (corticotropin‐releasing hormone [CRH], vasopressin, somatostatin) was studied in a group of depressed elderly patients and controls. A first lumbar puncture was performed in 37 depressed in‐patients. This was followed by a 6‐week medication phase with amitriptyline. Upon its completion a second cerebrospinal fluid (CSF) sample was obtained in 18 of these 37 patients. In 25 healthy controls a first lumbar puncture was done; eleven of these individuals agreed to take 75 mg/d amitriptyline for 6 weeks and to participate in the follow‐up CSF study. Within the group of depressed patients amitriptyline led to a significant decrease of CSF CRH in treatment responders only (F1,16 = 5.2; P < 0.02). Also, in normal controls CSF CRH concentration tended to decrease with amitriptyline treatment (t‐test; P < 0.09). No effects of amitriptyline upon vasopressin or somatostatin were observed. In normal controls (r = 0.4; P < 0.02) and in patients (r = 0.4; P < 0.03) age correlated positively with baseline CSF somatostatin. A trend for CSF CRH to increase with aging was found only in controls (r = 0.3; P < 0.09); patients did not show a significant association here. Finally, CSF neuropeptide concentration at baseline did not differ between the group of depressed patients and healthy controls. Our study corroborates the evolving concept that antidepressants effect various components of the HPA system with the net result of a reduction in its activity. In addition, we found CSF CRH and CSF somatostatin concentrations to be better reflections of age than of depression and, finally, that during aging and during depression the HPA system changes in similar directions. Depression and Anxiety 8:71–79, 1998.

Testosterone, gonadotropin, and cortisol secretion in male patients with major depression.

OBJECTIVE Previous studies of sex hormone concentrations in depression yielded inconsistent results. However, the activation of the hypothalamic-pituitary-adrenal system seen in depression may negatively affect gonadal function at every level of regulation. The objective of this study was to explore whether major depressive episodes are indeed associated with an alteration of gonadal function. METHODS Testosterone, pulsatile LH secretion, FSH, and cortisol were assessed using frequent sampling during a 24-hour period in 15 male inpatients with major depression of moderate to high severity and in 22 healthy comparison subjects (age range 22-85 years). RESULTS An analysis of covariance model showed that after adjustment for age only, daytime testosterone (p < .01), nighttime testosterone (p < .05), and 24-hour mean testosterone secretion (p < .01) were significantly lower in the depressed male inpatients. There was also a trend for a decreased LH pulse frequency in the depressed patients (p < .08). CONCLUSIONS Gonadal function may be disturbed in men with a depressive episode of moderate to high severity.

Emotional intelligence and mental disorder

Emotional abilities were measured with a performance test of emotional intelligence (The Mayer-Salovey-Caruso Emotional Intelligence Test; Mayer, Salovey, & Caruso, 2002) in patients diagnosed with major depressive disorder, substance abuse disorder, or borderline personality disorder (BPD), and a nonclinical control group. Findings showed that all clinical groups differed from controls with respect to their overall emotional intelligence score, which dovetails with previous findings from self-report measures. Specifically, we found that the ability to understand emotional information and the ability to regulate emotions best distinguished the groups. Findings showed that patients with substance abuse disorder and BPD patients were most impaired.

A neural network reflecting individual differences in cognitive processing of emotions during perceptual decision making

Even simple perceptual decisions are influenced by the emotional content of a stimulus. Recent neuroimaging studies provide evidence about the neural mechanisms of perceptual decision making on emotional stimuli. However, the effect of individual differences in cognitive processing of emotions on perceptual decision making remains poorly understood. Here, we investigated how changes in the fMRI signal during perceptual decision making on facial stimuli covaried with individual differences in the ability to identify and communicate ones emotional state. Although this personality trait covaried with changes in activity in the dorsal anterior cingulate cortex (dACC) during gender decisions on facial expressions, there was no correlation during emotion decisions. Further, we investigated whether individual differences in the ability to cognitively process emotions depend on differences in the functional integration of emotional and cognitive brain regions. We therefore compared task-dependent changes in effective connectivity of dACC in individuals with good and with poor ability to cognitively process emotions using a psychophysiological interaction analysis. We found greater coupling of dACC with prefrontal regions in individuals with good ability to identify and communicate their emotional state. Conversely, individuals with poor ability in this domain showed greater coupling of dACC with the amygdala. Our data indicate that individual differences in the ability to identify and communicate ones emotional state are reflected by altered effective connectivity of the dACC with prefrontal and limbic regions. Thus, we provide neurophysiological evidence for a theoretical model that posits that a discommunication between limbic areas and the neocortex impairs cognitive processing of emotions.

Emotion identification and tension in female patients with borderline personality disorder

OBJECTIVES This study investigates the identification of emotions in patients with borderline personality disorder (BPD), when compared with mentally healthy control subjects. The inability to identify different emotions is considered as an essential component of affect dysregulation in BPD that has rarely been empirically investigated. METHODS In this study, 30 female borderline patients and 28 healthy control participants received a handheld-PC for a 24-hour period that reminded them hourly to enter data. RESULTS When compared with the control group, patients showed pronounced difficulties in emotion identification. Moreover, the data revealed a significant relationship between difficulties in identifying emotions and levels of aversive inner tension for BPD patients, but not for control subjects. CONCLUSIONS Results indicate that the inability to identify different emotions is a problem that characterizes borderline patients in real-life situations. Treatment programs should, therefore, focus on the improvement of emotion identification and regulation.

Perception of Social Participation in Borderline Personality Disorder

Interpersonal dysfunction is a key feature of borderline personality disorder (BPD). Distorted perception of participation in social situations and altered emotional responses could contribute to these typical interpersonal problems in BPD. Thirty patients with BPD were compared with a healthy control group (n = 30) in their perceptions and subjective emotional reactions to situations of social inclusion and exclusion. Participants played Cyberball, a virtual ball-tossing paradigm, in which social inclusion and exclusion are experimentally induced. Control participants reacted with an increase in sadness, anger and overall negative affect when excluded. In BPD patients, social exclusion also induced anger, while general participating in the game seemed to reduce levels of sadness. Compared with healthy controls, BPD patients felt more readily excluded independent of the condition of inclusion or exclusion. In conclusion, patients with BPD displayed a negative bias toward perceived participation in social situations. Key PRACTITIONER MESSAGE: Patients with BPD have a biased perception for exclusion. Virtual ball-tossing games can be used to induce anger in patients with BPD. Participating in a virtual ball-tossing game may reduce levels of sadness in BPD in the short term.

Pulse-Dosing and Conventional Application of Doxepin: Effects on Psychopathology and Hypothalamus-Pituitary-Adrenal (HPA) System

It has been shown that a single pulse-dosing (PD) dose of clomipramine improves depressive symptoms. However, so far PD and conventional (CONV) application of antidepressants have never been directly compared for an extended period. We performed a double-blind study of PD and CONV application of doxepin (DOX) in depressed patients. After a 1-week placebo treatment, nine parents in the PD group received 250 mg of DOX every 6 days and placebo on the other days until day 39. Ten patients in the CONV group received increasing dosages of DOX until day 7 and 250 mg DOX on the other days for 39 days. Three dexamethasone (DEX)-suppression/corticotropin-releasing hormone (CRH)-stimulation tests were completed: (1)during the initial placebo period; (2)on day 9; and (3)on day 21. In the PD group, scores on the Hamilton Rating Scale for Depression (HAM-D) differed from baseline only after day 36 (17.1 +/- 7.0 vs. 22.7 +/- 2.8, p < 0.03). In the CONV group, however, HAM-D scores improved significantly after 2 days (22.8 +/- 7.2 vs. 26.5 +/- 5.7, p < 0.02) and continued to improve until day 39 (7.3 +/- 5.8). From day 25 to 39, there were significant differences between the HAM-D scores of the two groups. In the PD group, the decline of cortisol after DEX pretreatment was nonsignificant (NS) at both follow-up test occasions (35.9 +/- 40.7 vs. 24.0 +/- 20.7 vs. 23.6 +/- 26.6 micrograms/mL). In the CONV group, a significant decrease was observed at the second test (61.8 +/- 61.9 vs. 10.7 +/- 4.2 vs. 19.8 +/- 19 micrograms/mL, p < 0.05, respectively, NS). The area-under-the-curve cortisol response after CRH was attenuated in the PD group (5,667 +/- 2,910 vs. 1,883 +/- 2,178 vs. 2,239 +/- 2,583 [arbitrary unit], p < 0.01, respectively, p < 0.01) and in the CONV group (5,710 +/- 4,734 vs. 1,267 +/- 2,053 vs. 445 +/- 1,016 [arbitrary unit], NS, respectively, p < 0.02. We conclude that CONV application of DOX is clinically superior compared with PD and that both modes of application have attenuating effects on hypothalamus-pituitary-adrenal system activity.

Discrepancies between explicit and implicit self-esteem are linked to symptom severity in borderline personality disorder

The present study examined whether discrepancies between explicit and implicit self-esteem are associated with symptom severity in a sample of patients with borderline personality disorder (BPD). We hypothesized that implicit-explicit self-esteem discrepancies foster autoaggressive behavior and dysphoria, and impair self-perception. We found that the two forms of self-esteem discrepancies, damaged and fragile self-esteem were related to the severity of overall borderline symptoms, autoaggression, dysphoria, and deficits in self-perception. In contrast, more general psychopathological impairment, such as depression, was not related to self-esteem discrepancies. Taken together our results indicate that discrepancies between explicit and implicit self-esteem are associated with certain borderline symptoms that may be based on internal tension. The findings can be interpreted within the framework of self-discrepancies and dichotomous attitudes in patients with BPD.

When grandiosity and vulnerability collide: Implicit and explicit self-esteem in patients with narcissistic personality disorder

BACKGROUND AND OBJECTIVES Narcissistic personality disorder (NPD) is characterized by reports of grandiosity including exaggerated illusions of superiority and entitlement (DSM-IV-TR, APA, 2000). Based on clinical theories (e.g., Kernberg, 1975), many researchers argue that high explicit self-esteem in narcissists masks underlying implicit vulnerability (low implicit self-esteem). Conversely, based on social learning theories (i.e., Millon, 1981), people with NPD are characterized by implicit grandiosity (high implicit self-esteem). We test these competing hypotheses in patients diagnosed with NPD. METHODS The present study examined implicit self-esteem (using an Implicit Association Test) and explicit self-esteem (using a self-report questionnaire) in patients with NPD in comparison to non-clinical and clinical, non-NPD (Borderline Personality Disorder, BPD) control groups. RESULTS Patients with NPD scored lower on explicit self-esteem than non-clinical controls. In comparison to patients with BPD, NPD patients scored higher on explicit and implicit self-esteem. Moreover, within the group of NPD patients, damaged self-esteem (i.e., low explicit, high implicit) was associated with higher narcissistic psychopathology. LIMITATIONS In both clinical groups we included participants seeking psychiatric treatment, which might influence explicit self-esteem. Longitudinal studies are needed to further assess self-esteem stability in NPD patients in comparison to the control groups. CONCLUSIONS Our findings are indicative of vulnerable facets in patients with NPD (i.e., low explicit self-esteem). Furthermore, damaged self-esteem is connected to specific psychopathology within the NPD group. Implications for research on NPD are discussed.

The combined dexamethasone/corticotropin-releasing hormone stimulation test is more closely associated with features of diurnal activity of the hypothalamo-pituitary-adrenocortical system than the dexamethasone suppression test.

BACKGROUND The dexamethasone suppression test (DST) is a widely used endocrine test in psychiatry, but was reported to not allow reliable inferences with regard to the basal activity of the hypothalamo-pituitary-adrenocortical (HPA) system. We compared the association of the standard DST and the combined dexamethasone/corticotropin-releasing hormone (DEX/CRH) challenge with parameters of diurnal cortisol profiles. METHODS We performed a DEX/CRH challenge and 24-hour cortisol profiles in 25 depressed patients (mean age: 47.4 +/- 16.0 years) and 33 age-matched healthy controls (mean age: 51.4 +/- 19.3 years). RESULTS A path analysis showed cortisol area under the curve (AUC) after CRH (= DEX/CRH status) to be dependent upon minimal 24-hour cortisol and evening frequency of pulsatile cortisol release. In contrast, postdexamethasone cortisol (= DST status) was related to 24-hour mean cortisol. Simple linear regressions supported an association of cortisol AUC with several parameters of the diurnal cortisol profiles, which was not true for the standard DST. CONCLUSIONS We conclude that the combined DEX/CRH challenge test is more closely associated with the activity of the HPA system than the standard DST in healthy and depressed subjects.