Matthias Vogel

The effects of shift work on physical and mental health

Occupational engagement is a pre-requisite for continuous income opportunities. Among the changing social circumstances work-related conditions play an increasingly eminent role in psychological and mental well-being. The public discusses the question of a possible association between the demands of modern work life and the increases of psychological, psychosomatic and cardiovascular disorders. Given the socioeconomic implications of psychiatric and psychosomatic suffering in the general population, there is a need to further elucidate the causes of their increasing incidence. From a medical point of view, any organization of work disrupting the phased circadian rhythms for bio-psycho-social processes and functioning of the individual are interesting against the background of clock genes and certain biological functions that are organized in a circadian fashion. The authors review the influence of shift work as a form of systematic desynchronization of inner clock systems on the endocrine, the physical, and the mental level. The significance of the findings in the field is discussed along with future directions of conclusive research.

Decreased Levels of Dopamine D3 Receptor mRNA in Schizophrenic and Bipolar Patients

Previous studies found an elevation of the dopamine D3 receptor (DRD3) mRNA as determined in peripheral lymphocytes in schizophrenic patients. The aim of this study was to test the hypothesis of elevated DRD3 mRNA in schizophrenia compared to bipolar disorder. Twenty-four patients, 13 schizophrenic and 11 bipolar, were included according to DSM-IV criteria. Psychometric measures were conducted using the Scale for the Assessment of Positive Symptoms, Scale for the Assessment of Negative Symptoms, Brief Psychiatric Rating Scale, Montgomery-Åsberg Depression Rating Scale and Young Mania Rating Scale. mRNA was isolated from lymphocytes of venous blood samples and DRD3 mRNA was quantified using real-time reverse transcription PCR. We found a decrease in DRD3 mRNA in 13 schizophrenic (p = 0.009) and 11 bipolar (p = 0.023) patients as compared to controls. Medication history and severity of positive symptoms did not significantly influence DRD3 expression. Higher levels of DRD3 mRNA were correlated with negative schizophrenic symptoms. Interestingly, after treatment of patients with antipsychotics, DRD3 mRNA levels increased to similar levels as those of healthy controls. Bipolar patients, however, showed a slower increase in DRD3 mRNA levels after 3 weeks of therapy. Our findings suggest that the expression of DRD3 mRNA is reduced in schizophrenia and bipolar disorder, supporting the hypothesis of distorted homeostasis of dopamine receptor subtypes in psychotic disorder. The observed diminution was not specific for schizophrenia but also for bipolar disorder requiring further analysis of the regulatory factors involved in dopamine receptor subtype expression.

Association of Childhood Neglect with Adult Dissociation in Schizophrenic Inpatients

Background: Dissociation is often related to previous trauma and also occurs frequently in schizophrenia. Dissociation and psychosis may reflect a posttraumatic syndrome in some patients with schizophrenia. Sampling and Methods: In total, 80 patients diagnosed with schizophrenia were investigated by means of the Childhood Trauma Questionnaire (CTQ), the Dissociative Experience Scale and the Symptom Check List 90-R. CTQ subscales and groups reporting high and low dissociation were compared using MANOVA. Results: Childhood traumatic experiences were frequent [mean CTQ total score = 45.4 ± 17.5 (SD)]. Physical neglect was clearly associated with high dissociation, whereas abuse was not. Furthermore, there was a significant association of physical neglect with psychopathological distress not fully accounted for by dissociation. Conclusions: Dissociation may be specifically linked to childhood physical neglect in patients diagnosed with schizophrenia. Dissociation alone may not explain the effects of childhood maltreatment on adult psychopathology in schizophrenia; however, conclusions from the present study are limited due to its cross-sectional design.

Differential effects of childhood abuse and neglect: Mediation by posttraumatic distress in neurotic disorder and negative symptoms in schizophrenia?

Dissociation, though understood as a response to trauma, lacks a proven etiology. The assumption of a dose-response relationship between trauma, dissociation and Schneiderian symptoms led to the proposal of a dissociative subtype of schizophrenia characterized by severe child maltreatment, dissociation and psychosis. Child maltreatment and dissociation are common features of neurotic disorders as well, and the link between trauma, dissociation, and hallucinations is not specific for schizophrenia. This study compares childhood abuse and neglect, posttraumatic distress and adult dissociation in patients with psychotic vs. non-psychotic disorder. Thirty-five participants with non-psychotic disorder and twenty-five with schizophrenia were analyzed using the Scale for the Assessment of Positive Symptoms (SAPS), the Scale for the Assessment of Negative Symptoms (SANS), the Montgomery-Åsberg Depression Rating Scale (MADRS), the Posttraumatic Stress Diagnostic Scale PDS (PDS), the Childhood Trauma Questionnaire (CTO) and the Arbeitsgemeinschaft Methodik und Dokumentation in der Psychiatrie (AMDP)-module on dissociation. Trauma and clinical syndromes were compared by means of T-testing and logistic regression between 1) the diagnoses and 2) groups with and without post-traumatic stress disorder (PTSD), marked dissociation and psychotic symptoms. While non-psychotic disorder was related to abuse, schizophrenia showed an association with neglect. Childhood trauma predicted posttraumatic symptomatology and negative symptoms. Childhood abuse and neglect may effectuate different outcomes in neurotic and psychotic disorder. The underlying mechanisms, including dissociation, dovetail with cognitive, emotional and behavioural changes involved in depression, posttraumatic distress and chronic schizophrenia symptoms rather than being directly linked to trauma.

Psychopathology and alexithymia in severe mental illness: the impact of trauma and posttraumatic stress symptoms

ObjectiveTo empirically investigate whether or not symptoms of posttraumatic stress disorder (PTSD) are essential for transferring the negative effects of trauma on the severity of severe mental illness (SMI) as recently suggested by an interactive model.MethodsAbout 122 inpatients with either schizophrenia or major affective disorder were administered the Posttraumatic Diagnostic Scale, the Symptom Checklist and the Toronto Alexithymia Scale.ResultsAt least one trauma was reported by 83 participants (68%) and 28 patients (23%) reported symptoms of current PTSD. Those SMI subjects with current PTSD sympoms had significantly more psychopathological distress and alexithymic features than those with a trauma exposure but without PTSD symptoms and those patients without any traumatic experiences.DiscussionIn line with prior research, our data indicate that patients with SMI have frequently been exposed to traumatic events and that a third suffers from current posttraumatic stress symptoms. Despite some methodological limitations our findings support the interactive model, which posits that a comorbid PTSD increases the symptom severity of SMI. More attention should be directed at assessing trauma and PTSD in SMI patients and at developing therapeutic interventions.

A more proximal impact of dissociation than of trauma and posttraumatic stress disorder on schneiderian symptoms in patients diagnosed with schizophrenia

BACKGROUND Dissociation is often related to psychologic trauma and is also commonly correlated with posttraumatic stress disorder (PTSD). Schneiderian symptoms occur in dissociative disorder and PTSD, whereas dissociation and trauma are also frequent in patients with schizophrenia. Dissociation and schneiderian symptoms may reflect posttraumatic symptomatology in some patients diagnosed with schizophrenia who might not develop PTSD. METHOD Seventy-one patients completed an interview assessing symptoms of schizophrenia, depression, dissociative disorder, and PTSD. Data were collected using the Positive and Negative Syndrome Scale, the Montgomery-Asberg Depression Rating Scale, the Arbeitsgemeinschaft Methodik und Dokumentation in der Psychiatrie scale for dissociation, and a Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition-based questionnaire. Multiple analysis of covariance was used to compare psychopathologic measures between groups with or without PTSD criteria A1 and A2, PTSD, and high and low levels of dissociation, controlling for substance abuse. RESULT Trauma and dissociation were associated with more severe symptoms of schizophrenia. Especially high dissociation was associated with an increase in symptom load, whereas criterion A and PTSD had little or no such effect. DISCUSSION In the present study, those with more severe schizophrenic and depressive symptoms were also characterized by high dissociation. The possible relation to trauma and schizophrenic diathesis is discussed along with the limitations of the study.

The Role of Trauma and PTSD-Related Symptoms for Dissociation and Psychopathological Distress in Inpatients with Schizophrenia

Background: To investigate the relationship between dissociative experiences, psychopathological distress, a history of trauma and posttraumatic symptoms in adult schizophrenia. Methods: Eighty-seven schizophrenic inpatients returned self-questionnaires [Dissociative Experience Scale (DES); Symptom Checklist (SCL-90-R); PTSD Symptom Scale (PDS)]. Based upon this self-rating, 14 of the participants fulfilled the cut-off definition of PTSD according to DSM-IV criteria, 43 had a history of trauma without a self-rated diagnosis of PTSD. DES scores were also compared to a convenience sample of 297 non-clinical controls. Results: We found no significant impact of trauma alone but a significant influence of posttraumatic symptomatology on the level of current psychopathological distress (GSI) and the DES subscale absorption. However, in logistic regression, posttraumatic symptomatology was associated with GSI but not with DES. Schizophrenic patients even without trauma or posttraumatic symptoms had significantly higher scores in all three DES subscales than non-clinical controls. Conclusion: Pronounced posttraumatic symptoms in schizophrenia are associated with severe additional psychopathological distress whereas the increase in dissociation (absorption) in this group of patients may be secondary to the increase in symptom load. However, schizophrenia itself seems to be associated independently from trauma and pathological posttraumatic conditions with a broad range of dissociative symptoms.

Detachment, Compartmentalization, and Schizophrenia: Linking Dissociation and Psychosis by Subtype

To explain the phenomenological overlap between dissociation and schizophrenia, a dissociative subtype of schizophrenia has been proposed as a possibility. Dissociation is often believed to be organized on a continuum, although 2 qualitatively different phenomena can be distinguished in theory, research, and clinical practice: (a) states of separation from self or environment (detachment dissociation) and (b) inaccessibility of normally accessible mental contents (compartmentalization dissociation). This study used the Positive and Negative Syndrome Scale (PANSS) and the Association for Methodology and Documentation in Psychiatry module for the interview assessment of dissociation to investigate the relationships between PANSS subscales, detachment dissociation, and compartmentalization dissociation in a sample of 72 patients with schizophrenia. A confirmatory factor analysis sustained the bipartite model, yielding factors that grouped dissociative items around amnesia and depersonalization/derealization. The latter factor also contained identity disturbances and was therefore not entirely consistent with the theoretical formulations of detachment dissociation. It is important to note that the structure of those factors may be influenced by the symptoms of schizophrenia to which they were specifically linked: The factor containing depersonalization/derealization was connected to the positive symptoms subscale of the PANSS, whereas the factor containing amnesia was associated with the negative subscale. Hence, a dichotomy of dissociation is confirmed inasmuch as its subtypes are as distinguishable as PANSS subscales. This has implications on theoretical and clinical levels.

[The Operationalized Psychodynamic Diagnostics System (OPD-2): validity of the Axis I "Experience of illness and prerequisites for treatment"].

The Operationalized Psychodynamic Diagnostics System (OPD) was introduced in order to allow for operationalized and reproducible psychoanalytic diagnoses. A revised version of the instrument was published in 2006. Validation studies are lacking for its Axis I, in particular. The aim of the present study is to investigate the validity of Axis I, as well as to test the underlying factors for their plausibility. The instrument was applied to 263 inpatients by trained raters. For testing their validity, OPD measures were compared to a similar self-rating questionnaire (Questionnaire of measuring the motivation for psychotherapy). These measures corresponded well, and the intercategorial differences between different patient groups (split by sex, age and ICD-10 diagnosis) according to our expectations. Moreover, we established feasible factors. Thus, our results show good validity, and a plausible internal structure of the Axis I.

Attrition and Outcome in Group Psychotherapy among Traumatized and Non-Traumatized Inpatients

Objective: To examine the impact of correlates of trauma on the appropriateness for group therapy (GT) in 60 participants based on the similarity of the exclusion criteria for GT to the features of posttraumatic disturbances and borderline personality. Method: We assessed the correlates of trauma (PTSD, complex PTSD, dissociation), features of BPD, psychopathological distress and the readiness for GT. Results: There were inverse correlations between the motivation for GT and multiple symptoms, as well as weak associations with the correlates of trauma. Pessimistic expectations of GT and dissociative amnesia were linked to worse outcomes, while phobic anxiety predicted continuation of therapy. Conclusion: Dissociative amnesia and the expectation of GT are potential targets for pre-group preparation for trauma-related disorders.