Kerstin Weidner

Selective serotonin reuptake inhibitors to improve outcome in acute ischemic stroke: possible mechanisms and clinical evidence

Several clinical studies have indicated that selective serotonin reuptake inhibitors (SSRIs) administered in patients after acute ischemic stroke can improve clinical recovery independently of depression. Due to small sample sizes and heterogeneous study designs interpretability was limited in these studies. The mechanisms of action whereby SSRI might improve recovery from acute ischemic stroke are not fully elucidated.

Is type-D a stable construct? An examination of type-D personality in patients before and after cardiac surgery

OBJECTIVE Type-D personality-negative affectivity and social inhibition-are related to poor prognosis in cardiovascular diseases. At present, little is known about type-D personality and its stability before and after cardiac surgery. METHODS One hundred twenty-six patients recommended for coronary bypass and/or valve surgery were examined at pre-surgery and 6 months post-surgery to investigate the stability of type-D (14-item Type-D Scale) and its relationship to anxiety, depression (Hospital Anxiety and Depression Scale) and quality of life (Short Form 12). RESULTS Preoperatively, 26% were assessed to have type-D, while only 11% fulfilled type-D criteria both pre- and post-surgery. Patients were assessed and identified as belonging to one of the four type-D groups: Stable type-D (11%), non-type-D (61%), type-D pre (15%), and type-D post (13%). In comparison to the stable non-type D group, the stable type-D reported more symptoms of anxiety, depression, lower physical quality of life post-surgery, and lower mental quality of life both pre- and post-surgery. When compared to the population at large, stable type-D had more symptoms of depression pre-surgery, and more anxiety as well as lower physical and mental quality of life pre- and post-surgery. CONCLUSION Type-D diagnosis changed in nearly 60% of the cases post-surgery. Only those patients with stable type-D exhibited a relationship to emotional distress, such as anxiety and depression and reduced quality of life. Additional research on the critical cut-off scores and stability of type-D as it relates to critical life events would likely enhance our ability to more effectively diagnose and treat patients who are at high risk for insufficient coping.

Effects of an early intervention on perceived stress and diurnal cortisol in pregnant women with elevated stress, anxiety, and depressive symptomatology

The goal of the present investigation was to examine effects of a cognitive-behavioral group intervention for pregnant women with subclinically elevated stress, anxiety and/or depression on perceived stress and salivary cortisol levels. Expectant mothers were recruited in gynaecologist practices. They participated in a screening, a standardized diagnostic interview (Munich-Composite Diagnostic Interview, M-CIDI), and were randomly assigned to an intervention (N = 21) and treatment as usual control group (N = 40). The intervention consisted of a manualized cognitive-behavioral group program for expectant mothers with subclinically elevated stress, depression, and/or anxiety symptoms. Stress questionnaire (prenatal distress (PDQ), perceived stress (PSS)) as well as diurnal salivary cortisol assessment took place at T1 (antenatal, preintervention), at T2 (antenatal, post-intervention) and T3 (3-month postpartum). Subjects that participated in the intervention exhibited a significant post-treatment change in morning cortisol (cortisol awakening response, CAR) in contrast to control subjects, F(8,51) = 2.300, p = 0.047. Intervention participants showed a smaller CAR subsequent to the intervention, displaying a lessened stress reaction. This effect was not observed in the control group. In contrast, we failed in discovering a significant difference between the research groups regarding the cortisol area under curve parameter (AUC) and the applied subjective stress questionnaires. Evaluation results were thus heterogeneous. Nevertheless, intervention effects on the CAR are promising. Our results suggest that a cognitive-behavioral intervention might lead to an improvement in the biological stress response of pregnant women with subclinically elevated stress, anxiety, or depressive symptoms.

Early intervention in pregnant women with elevated anxiety and depressive symptoms: efficacy of a cognitive-behavioral group program.

To examine whether a cognitive-behavioral group program among pregnant women with elevated levels of anxiety or depression may reduce anxious and depressive symptoms and has a positive impact on risk factors for anxiety disorders and depression. A total of 753 participants were recruited. After completion of the clinical standardized interview, 160 participants were randomized to an intervention group or a control condition. Psychometric assessments took place at T1 (preintervention), T2 (antenatal follow-up), and T3 (3 months postpartum). Analyses included women who took part in all 3 assessments (intervention group, N = 21; control group, N = 53). The subjective program evaluation by the participants was highly positive, but with the exception of a short-term effect on the quality of an intimate partnership (F1/67 = 4.056; P < .05], intervention effects on anxiety or depressive symptoms were not found. However, there was an intervention effect 3 months postpartum for participants with high depressive symptoms at T1 (Edinburgh Postnatal Depression Scale score of ≥10) (F1/69 = 5.410; P < .05). The results argue against a general efficacy of a cognitive-behavioral group program for pregnant women with rather low levels of anxiety and depression. For women with higher depressive symptoms during pregnancy, a cognitive-behavioral group program may have a positive impact on the course of depressive symptoms during the postpartum period.

Egg donation, surrogate mothering, and cloning: attitudes of men and women in Germany based on a representative survey

OBJECTIVE To determine opinions and attitudes of the German general population toward the treatment methods of reproductive medicine: egg donation, surrogate mothering, and reproductive cloning. DESIGN Representative survey. SETTING German general population: face-to-face interviews at home with 2,110 persons, aged 18-50 years. PATIENT(S) Patients were not included. INTERVENTION(S) No interventions took place. MAIN OUTCOME MEASURE(S) Approval and disapproval of treatment methods of reproductive medicine and preimplantation genetic diagnosis were assessed by questionnaires regarding medical, age, reasons, or general. RESULT(S) Overall, the diverse treatment methods of reproductive medicine found comparable rates of approval and disapproval. Legalization of egg donation was approved by a slight majority (50.8%), particularly for medical reasons (35.9%). Surrogate mothering found lower overall rates of approval (43.7%), 28.5% supported an admission for medical reasons. Reproductive cloning was rejected by the vast majority (82.9%). Attitudes to reproductive medicine were affected by age and the individual reproductive experiences. CONCLUSION(S) New techniques in reproductive medicine and their development provide hope and health promises for affected couples but also entail long-term risks and ethical issues. Balancing the individuals right to a reproductive autonomy and choice and ethical standards will constitute a future challenge for society. Results demonstrate considerable uncertainty and information deficits in the community.

Reduced functional connectivity in the thalamo‐insular subnetwork in patients with acute anorexia nervosa

The neural underpinnings of anorexia nervosa (AN) are poorly understood. Results from existing functional brain imaging studies using disorder‐relevant food‐ or body‐stimuli have been heterogeneous and may be biased due to varying compliance or strategies of the participants. In this study, resting state functional connectivity imaging was used. To explore the distributed nature and complexity of brain function we characterized network patterns in patients with acute AN. Thirty‐five unmedicated female acute AN patients and 35 closely matched healthy female participants underwent resting state functional magnetic resonance imaging. We used a network‐based statistic (NBS) approach [Zalesky et al., 2010a] to identify differences between groups by isolating a network of interconnected nodes with a deviant connectivity pattern. Group comparison revealed a subnetwork of connections with decreased connectivity including the amygdala, thalamus, fusiform gyrus, putamen and the posterior insula as the central hub in the patient group. Results were not driven by changes in intranodal or global connectivity. No network could be identified where AN patients had increased coupling. Given the known involvement of the identified thalamo‐insular subnetwork in interoception, decreased connectivity in AN patients in these nodes might reflect changes in the propagation of sensations that alert the organism to urgent homeostatic imbalances and pain‐processes that are known to be severely disturbed in AN and might explain the striking discrepancy between patients actual and perceived internal body state. Hum Brain Mapp 36:1772–1781, 2015.

Affective touch awareness in mental health and disease relates to autistic traits - An explorative neurophysiological investigation.

Affective touch is important for social interaction within families and groups and there is evidence that unmyelinated C tactile fibers are involved in this process. Individuals with autism spectrum disorders show alterations in the perception and processing of affective touch. sThus, we hypothesized that affective touch awareness based on C tactile fiber activation is impaired in individuals with high levels of autistic trait. The pleasantness perception of optimal and suboptimal C tactile stimuli was tested in an explorative study in 70 patients recruited from an outpatient psychotherapy clinic and 69 healthy comparison subjects. All participants completed questionnaires about autistic traits, depressive symptomatology, childhood maltreatment, and about the daily amount of touch. Relative to comparison subjects, patients reported engaging in touch less frequently in daily life and rated touch less pleasant. Reduced valence ratings of touch were explained by childhood maltreatment but not by any particular disorder or depression severity. Among all tested variables, the affective touch awareness correlated with autistic traits only - in patients as well as in comparison subjects. Taken together, individuals with mental health issues have a lower baseline of expression and reception of affective touch. Autistic traits and childhood maltreatment modulate the experience of affective touch.

Fear of Dental Treatment—an Underrecognized Symptom in People With Impaired Mental Health

BACKGROUND In industrialized countries, about 5% to 15% of all adults have a pathologically severe fear of dental treatment, and some 3% avoid going to the dentist altogether. The affected persons may, in turn, suffer from severe dental diseases and their psychosocial effects. Many people with dental phobia have other mental disorders as well. These facts motivated us to study the prevalence of fear of dental treatment in a group of patients being treated by our psychosomatic service. METHOD 212 patients of our psychosomatic service and 95 healthy controls were studied with the Hierarchical Anxiety Questionnaire (HAQ) to determine the intensity of their fear of dental treatment. Mental disorders were diagnosed with structured clinical interviews according to DSM-IV. RESULTS Nearly one patient in three (30.5%, n = 64) suffered from pathologically severe fear of dental treatment; 24 of them (38.5%) had avoided visiting a dentist for longer than one year. Only 4 (4.2%) of the healthy controls were greatly afraid of dental treatment. Certain types of mental disorder were especially highly associated with fear of dental treatment: in particular, anxiety disorders (relative risk [RR] 7.44, 95% confidence interval [CI] 2.68-20.70) and depressive disorders (RR 4.92, 95% CI 1.73-14.05). Patients with post-traumatic stress disorder were affected most commonly: 34 (42%) of these patients were greatly afraid of dental treatment (RR 9.97, 95% CI 3.69-26.90). 75 of the 134 study participants who were afraid of dental treatment (56%) had cancelled a dental appointment, or failed to appear for a scheduled appointment, because of their fears. CONCLUSION Fear of dental treatment commonly accompanies certain types of mental disorder. Patients at high risk should be asked about such fears so that the problem can be recognized early and appropriately treated.

What do you know about reproductive medicine?--results of a German representative survey.

Objective The use of reproductive medical treatments has become increasingly routine in recent years. This paper reports on a study of how different aspects of modern reproductive medicine are perceived by the German population. Design Findings from a nationally representative sample of 2110 men and women aged 18 to 50 are presented. Participants responded to a questionnaire seeking self-report information about attitudes and knowledge regarding different aspects of reproductive medicine. Results The majority of respondents had already heard or read something about reproductive medicine; knowledge gaps were prevalent in men and individuals with lower levels of education. The decrease in female fertility usually was underestimated, whereas both the number of involuntarily childless couples and the success rate of reproductive medical treatment were overestimated. One-third of participants would make use of reproductive medicine to have their own child. Conclusion This study revealed inadequacies in the knowledge of the German general population regarding reproductive medicine. Despite the low interest and poor knowledge of the topic, a broad acceptance of reproductive medical methods was reported. The results illustrate the need for adequate information transfer regarding female fertility as well as success rate and risks of reproductive medical interventions.

A psychosomatic intervention in pregnant in-patient women with prenatal somatic risks

Purpose. This study examined whether a short-term psychosomatic intervention during pregnancy had effects on characteristics of labour and delivery as well as on the long-term course of anxiety, depression and physical complaints in pregnant in-patient women. Methods. All gynaecological and obstetric inpatients of a university hospital, who had either exhibited complications during their pregnancy or were considered high-risk pregnancies, were examined. Symptoms of anxiety and depression (HADS) and physical symptoms (GBB) were assessed by standardised questionnaires. Women with elevated scores on either the HADS or the GBB were randomly assigned to either a treatment group, which had received a psychosomatic intervention or an untreated control group. Of the n = 238 women who were assessed during their stay in our hospital, n = 135 were included in the follow-up 1-year later. Results. More than one-third of the participants (38.7%) had elevated scores of anxiety, depression and/or physical symptoms. The psychosomatic intervention had a significant effect on anxiety scores (p = 0.006), but not on depression scores, physical complaints and characteristics of labour and delivery. Conclusions. Findings suggest that a short-term psychosomatic intervention can have a positive long-term effect on anxiety symptoms. Future studies are needed to show whether the reduction of anxiety symptoms in turn can lead to a reduction of postnatal complications and lower rates of disturbed mother–child interactions.