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Orale Kontrazeptiva wurden 1960 zugelassen und erfreuen sich seitdem einer großen Beliebtheit. So gelten sie als eine der sichersten Verhütungsmethoden und haben auch weitere positive Effekte wie zum Beispiel eine Zyklusregulation und Abschwächen von Menstruationsbeschwerden. Nichtsdestotrotz leiden auch viele Nutzerinnen an Nebenwirkungen. In unserer und weiteren Studien konnte gezeigt werden, dass die Einnahme von oralen Kontrazeptiva die Serumcortisolkonzentration erhöht. Cortisol ist ein Steroidhormon, welches in Stresssituationen nötig ist, um die Homöostase beizubehalten und hat somit einen Einfluss auf den Stoffwechsel. Metabolite sind messbare Bestandteile des Stoffwechsels, da sie als Substrate und Produkte von Stoffwechselwegen Auskunft über die Prozesse des Körpers geben können. Sie unterliegen den vielfältigsten Einflussgrößen. Daher behandelt diese Dissertation den Einfluss von oralen Kontrazeptiva auf die Serumcortisolkonzentration und die Veränderung des Metaboloms. In einem weiteren Schritt wurde die Beeinflussung des Effekts von oralen Kontrazeptiva auf das Metabolom durch Cortisol berechnet.
Die Teilnehmerinnen der Studie waren prämenopausale Frauen, die im Rahmen einer Datenerhebung in der Durchschnittsbevölkerung im Nordosten Deutschlands rekrutiert wurden und zwei unabhängigen Stichproben angehörten (SHIP-TREND und SHIP-2).
Auch hier zeigten sich erhöhte Serumcortisolkonzentrationen bei Frauen, die orale Kontrazeptiva einnahmen. Des Weiteren konnten Metabolitveränderungen festgestellt werden, wie zum Beispiel 12 erhöhte Phosphatidylcholine, fünf erniedrigte und ein erhöhtes Lysophosphatidylcholine, fünf erniedrigte Aminosäuren und ein Carnitin, sowie ein erhöhtes Sphingomyelin. Auf den Großteil dieser Veränderungen hatte Cortisol einen signifikanten Einfluss in der Mediationsanalyse, wogegen die Menstruation nicht als Einflussfaktor nachgewiesen werden konnte.
Diese Studie stellt einen ersten Schritt zur Charakterisierung des Metaboloms bei der Einnahme von oralen Kontrazeptiva dar. Orale Kontrazeptiva haben einen systemischen Effekt und das Profil des Metaboloms könnte bei einer immer weiter individualisierten Medizin dazu beitragen, Frauen mit einem erhöhten Risiko für starke Nebenwirkungen der oralen Kontrazeptiva zu identifizieren, was zu einer Einnahme von besser geeigneten alternativen Verhütungsmethoden führen könnte.
The experience of abuse in the period of childhood and youth is a key stressor that has con-sequences on the developing brain and is associated with the genesis of mental disorders. Childhood abuse and depression often cooccur together and have both been associated with cortical thickness resulting in a difficulty to detangle the influence of each factor. In prior studies, childhood abuse and depression were inconsistently related to whole-brain cortical thickness. Thus, this thesis aims to investigate the link between childhood abuse, depres-sive symptoms, and alterations of the cortex.
Therefore, this study analyses 1,551 individuals of the general population. A significant in-teraction effect of childhood abuse and depressive symptoms is observed for whole-brain cortical thickness. Yet, the results indicate no influence of childhood abuse or depression alone. A thinner cortex was associated with more severe depressive symptoms in the abused, but not in the non-abused group. In non-depressed participants, an increased whole-brain cortex was found in the abused, compared to the non-abused group. Similar interaction effects were observed in 12 out of 34 cortical regions.
The results suggest, in line with prior findings, that depressed individuals with a history of childhood abuse are a specific ecophenotype which is also reflected in specific brain altera-tions. Cortical regions that are distinct associated with the interaction of depressive symp-toms and childhood abuse are involved in various fields such as sensory processing, self-conception, and memory. Greater cortical thickness in subjects with childhood abuse and without depressive symptoms might act compensatory and thus reflect resilience against depressive symptoms.
Practical implications concern the treatment and diagnostic system as well as the im-portance of early prevention programs. An individualised treatment is necessary as various studies found a less favourable outcome in depressive patients with a history of maltreat-ment. Therefore, it seems urgent to assess experiences of childhood abuse at the beginning of psychiatric and psychotherapeutic treatment. In addition, early prevention programs are in need to support vulnerable family systems and thereby strengthening the economic, health and social system.
Abstract
Purpose
Depressive disorders in children and adolescents have an enormous impact on their general quality of life. There is a clear need to effectively treat depression in this age group. Effects of psychotherapy can be enhanced by involving caregivers. In our systematic review and meta‐analysis, we examine for the first time the effects of caregiver involvement in depression‐specific interventions for children and adolescents.
Methods
We included randomized controlled trials examining the effects of interventions for children and adolescents with depression involving their caregivers or families compared to interventions without including caregivers. Primary outcome was the severity of childhood and adolescent depression.
Results
Overall, 19 randomized controlled trials could be included (N = 1553) that were highly heterogeneous regarding outcome measures or the extent of caregiver integration. We were able to include k = 17 studies in our meta‐analysis and find a small but significant effect for family‐involved interventions against active control conditions without family‐involvement at post intervention (α = 0.05, d = 0.34; [0.07; 0.60]; p = .01).
Conclusions
We detected an overall significant but small effect of family/caregivers’ involvement compared to control groups without it. Structured, guideline‐based research is urgently needed to identify for which children/adolescents with depression, under what circumstances, and in what form the family should be effectively involved in their psychotherapy.
Zur Messqualität des Beck-Depressionsinventars (BDI-II) in
unterschiedlichen klinischen Stichproben
(2022)
Zusammenfassung.
Theoretischer Hintergrund: Das BDI-II ist ein
Selbstbeurteilungsinstrument zur Erfassung des Schweregrads einer Depression. Es liegen
kaum Analysen mit Modellen aus der Item-Response-Theorie (IRT) vor.
Fragestellung: Wie hoch ist die Messgenauigkeit des BDI-II über
die unterschiedlichen Ausprägungen des latenten Traits (Depressivität) hinweg
und sind die Kategorien der Items jeweils aufsteigend geordnet? Methode:
Anhand von sechs großen Datensätzen aus verschiedenen klinischen Bereichen
wurden psychometrische Analysen mit dem Graded Response Model durchgeführt.
Ergebnisse: In allen Stichproben fand sich eine hohe interne
Konsistenz. Die Schwellenwerte waren mit Ausnahme von Item 6
(„Bestrafungsgefühle“) geordnet. Gemäß
Testinformationsfunktion misst das BDI-II im mittleren bis hohen Depressionsbereich sehr
gut (Reliabilität > .90) und im unteren Bereich gut.
Schlussfolgerung: Für das BDI-II ergibt sich eine hohe und relativ
gleichbleibende Messpräzision über einen weiten Bereich des latenten Traits,
weshalb es insbesondere im klinischen, aber auch im nicht klinisch relevanten Wertebereich
zur Erhebung des Schweregrades einer Depression gut geeignet ist.
Zusammenfassung. In den letzten Jahrzehnten hat sich durch
randomisiert-kontrollierte Studien (RCTs) eine breite Evidenzbasis von Psychotherapie mit
mittleren bis großen Effekten für verschiedene psychische Störungen
gebildet. Neben der Bestimmung dieser Wirksamkeit („Efficacy“) ebneten
Studien zur Wirksamkeit unter alltäglichen Routinebedingungen
(„Effectiveness“) historisch den Weg zur Entwicklung eines
praxisorientierten Forschungsparadigmas. Im Beitrag wird argumentiert, dass im Rahmen
dieses Paradigmas praxisbasierte Studien eine wertvolle Ergänzung zu RCTs darstellen,
da sie existierende Probleme in der Psychotherapieforschung adressieren können. In
der gegenwärtigen praxisorientierten Forschung liefern dabei neue Ansätze aus
der personalisierten Medizin und Methoden aus der ‚Computational Psychiatry‘
wichtige Anhaltspunkte zur Optimierung von Effekten in der Psychotherapie. Im Kontext der
Personalisierung werden bspw. klinische multivariable Prädiktionsmodelle entwickelt,
welche durch Rückmeldeschleifen an Praktiker_innen kurzfristig ein evidenzbasiertes
Outcome-Monitoring ermöglicht und langfristig das Praxis-Forschungsnetzwerk in
Deutschland stärkt. Am Ende des Beitrags werden zukünftige Richtungen für
die praxisorientierte Forschung im Sinne des ‘Precision Mental Health Care’
-Paradigmas abgeleitet und diskutiert.
Food craving (FC) peaks are highly context-dependent and variable. Accurate prediction of FC might help preventing disadvantageous eating behavior. Here, we examine whether data from 2 weeks of ecological momentary assessment (EMA) questionnaires on stress and emotions (active EMA, aEMA) alongside temporal features and smartphone sensor data (passive EMA, pEMA) are able to predict FCs ~2.5 h into the future in N = 46 individuals. A logistic prediction approach with feature dimension reduction via Best Item Scale that is Cross-Validated, Weighted, Informative and Transparent (BISCWIT) was performed. While overall prediction accuracy was acceptable, passive sensing data alone was equally predictive to psychometric data. The frequency of which single predictors were considered for a model was rather balanced, indicating that aEMA and pEMA models were fully idiosyncratic.
Complex problem solving (CPS) can be interpreted as the number of psychological mechanisms that allow us to reach our targets in difficult situations, that can be classified as complex, dynamic, non-transparent, interconnected, and multilayered, and also polytelic. The previous results demonstrated associations between the personality dimensions neuroticism, conscientiousness, and extraversion and problem-solving performance. However, there are no studies dealing with personality disorders in connection with CPS skills. Therefore, the current study examines a clinical sample consisting of people with personality and/or depressive disorders. As we have data for all the potential personality disorders and also data from each patient regarding to potential depression, we meet the whole range from healthy to impaired for each personality disorder and for depression. We make use of a unique operationalization: CPS was surveyed in a simulation game, making use of the microworld approach. This study was designed to investigate the hypothesis that personality traits are related to CPS performance. Results show that schizotypal, histrionic, dependent, and depressive persons are less likely to successfully solve problems, while persons having the additional behavioral characteristics of resilience, action orientation, and motivation for creation are more likely to successfully solve complex problems.
Objective
Obesity, often associated with non-alcoholic fatty liver disease (NAFLD), is characterized by an imbalance between energy expenditure and food intake, which is also reflected by desensitization of fibroblast growth factor 21 (FGF21). FGF21 is strongly influenced, among others, by TNFα, which is known to be upregulated in obesity-induced inflammation. Successful long-term treatments of NAFLD might be dietary modification, exercise, or fasting.
Materials and methods
Whether succeeded NAFLD recovery is linked with improved FGF21 sensitivity and finally reverted FGF21 resistance was the focus of the present study. For this purpose, mice received a high-fat diet (HFD) for 6 months to establish obesity. Afterward, the mice were subjected to three different weight loss interventions, namely, dietary change to low-fat diet (LFD), treadmill training, and/or time-restricted feeding for additional 6 months, whereas one group remained on HFD.
Results
In addition to the expected decrease in NAFLD activity with dietary change, this was also observed in the HFD group with additional time-restricted feeding. There was also an associated decrease in hepatic TNFα and FGF21 expression and an increase in ß-klotho expression, demonstrated mainly by using principal component analysis. Pearson correlation analysis shows that independent of any intervention, TNFα expression decreased with improved NAFLD recovery. This was accompanied with higher FGF21 sensitivity, as expressed by an increase in β-klotho and FGFR1c expression and concomitantly decreased FGF21 levels.
Conclusion
In summary, we conclude that successful NAFLD therapy is associated with a reversion of the TNFα-triggered FGF21-resistant state or desensitization.
The early-life microbiome (ELM) interacts with the psychosocial environment, in particular during early-life adversity (ELA), defining life-long health trajectories. The ELM also plays a significant role in the maturation of the immune system. We hypothesised that, in this context, the resilience of the oral microbiomes, despite being composed of diverse and distinct communities, allows them to retain an imprint of the early environment. Using 16S amplicon sequencing on the EpiPath cohort, we demonstrate that ELA leaves an imprint on both the salivary and buccal oral microbiome 24 years after exposure to adversity. Furthermore, the changes in both communities were associated with increased activation, maturation, and senescence of both innate and adaptive immune cells, although the interaction was partly dependent on prior herpesviridae exposure and current smoking. Our data suggest the presence of multiple links between ELA, Immunosenescence, and cytotoxicity that occur through long-term changes in the microbiome.
Figural matrices tasks are one of the most prominent item formats used in intelligence tests, and their relevance for the assessment of cognitive abilities is unquestionable. However, despite endeavors of the open science movement to make scientific research accessible on all levels, there is a lack of royalty-free figural matrices tests. The Open Matrices Item Bank (OMIB) closes this gap by providing free and unlimited access (GPLv3 license) to a large set of empirically validated figural matrices items. We developed a set of 220 figural matrices based on well-established construction principles commonly used in matrices tests and administered them to a sample of N = 2572 applicants to medical schools. The results of item response models and reliability analyses demonstrate the excellent psychometric properties of the items. In the discussion, we elucidate how researchers can already use the OMIB to gain access to high-quality matrices tests for their studies. Furthermore, we provide perspectives for features that could additionally improve the utility of the OMIB.