TY - JOUR A1 - Deeken, Friederike A1 - Reichert, Markus A1 - Zech, Hilmar A1 - Wenzel, Julia A1 - Wedemeyer, Friederike A1 - Aguilera, Alvaro A1 - Aslan, Acelya A1 - Bach, Patrick A1 - Bahr, Nadja Samia A1 - Ebrahimi, Claudia A1 - Fischbach, Pascale Christine A1 - Ganz, Marvin A1 - Garbusow, Maria A1 - Großkopf, Charlotte M. A1 - Heigert, Marie A1 - Hentschel, Angela A1 - Karl, Damian A1 - Pelz, Patricia A1 - Pinger, Mathieu A1 - Riemerschmid, Carlotta A1 - Rosenthal, Annika A1 - Steffen, Johannes A1 - Strehle, Jens A1 - Weiss,, Franziska A1 - Wieder, Gesine A1 - Wieland, Alfred A1 - Zaiser, Judith A1 - Zimmermann, Sina A1 - Walter, Henrik A1 - Lenz, Bernd A1 - Deserno, Lorenz A1 - Smolka, Michael N. A1 - Liu, Shuyan A1 - Ebner-Priemer, Ulrich Walter A1 - Heinz, Andreas A1 - Rapp, Michael A. T1 - Patterns of Alcohol Consumption Among Individuals With Alcohol Use Disorder During the COVID-19 Pandemic and Lockdowns in Germany JF - JAMA Network Open N2 - Importance Alcohol consumption (AC) leads to death and disability worldwide. Ongoing discussions on potential negative effects of the COVID-19 pandemic on AC need to be informed by real-world evidence. Objective To examine whether lockdown measures are associated with AC and consumption-related temporal and psychological within-person mechanisms. Design, Setting, and Participants This quantitative, intensive, longitudinal cohort study recruited 1743 participants from 3 sites from February 20, 2020, to February 28, 2021. Data were provided before and within the second lockdown of the COVID-19 pandemic in Germany: before lockdown (October 2 to November 1, 2020); light lockdown (November 2 to December 15, 2020); and hard lockdown (December 16, 2020, to February 28, 2021). Main Outcomes and Measures Daily ratings of AC (main outcome) captured during 3 lockdown phases (main variable) and temporal (weekends and holidays) and psychological (social isolation and drinking intention) correlates. Results Of the 1743 screened participants, 189 (119 [63.0%] male; median [IQR] age, 37 [27.5-52.0] years) with at least 2 alcohol use disorder (AUD) criteria according to the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) yet without the need for medically supervised alcohol withdrawal were included. These individuals provided 14 694 smartphone ratings from October 2020 through February 2021. Multilevel modeling revealed significantly higher AC (grams of alcohol per day) on weekend days vs weekdays (β = 11.39; 95% CI, 10.00-12.77; P < .001). Alcohol consumption was above the overall average on Christmas (β = 26.82; 95% CI, 21.87-31.77; P < .001) and New Year’s Eve (β = 66.88; 95% CI, 59.22-74.54; P < .001). During the hard lockdown, perceived social isolation was significantly higher (β = 0.12; 95% CI, 0.06-0.15; P < .001), but AC was significantly lower (β = −5.45; 95% CI, −8.00 to −2.90; P = .001). Independent of lockdown, intention to drink less alcohol was associated with lower AC (β = −11.10; 95% CI, −13.63 to −8.58; P < .001). Notably, differences in AC between weekend and weekdays decreased both during the hard lockdown (β = −6.14; 95% CI, −9.96 to −2.31; P = .002) and in participants with severe AUD (β = −6.26; 95% CI, −10.18 to −2.34; P = .002). Conclusions and Relevance This 5-month cohort study found no immediate negative associations of lockdown measures with overall AC. Rather, weekend-weekday and holiday AC patterns exceeded lockdown effects. Differences in AC between weekend days and weekdays evinced that weekend drinking cycles decreased as a function of AUD severity and lockdown measures, indicating a potential mechanism of losing and regaining control. This finding suggests that temporal patterns and drinking intention constitute promising targets for prevention and intervention, even in high-risk individuals. Y1 - 2022 U6 - https://doi.org/10.1001/jamanetworkopen.2022.24641 SN - 2574-3805 VL - 5 SP - 1 EP - 11 PB - JAMA Network / American Medical Association CY - Chicago, Illinois, USA ET - 8 ER - TY - JOUR A1 - Deeken, Friederike A1 - Rezo, Anna A1 - Hinz, Matthias A1 - Discher, Robert A1 - Rapp, Michael A. T1 - Evaluation of technology-based interventions for informal caregivers of patients with dementia BT - a Meta-Analysis of Randomized Controlled Trials JF - The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry N2 - Objective: The aim of this study was to estimate the efficacy of technology-based interventions for informal caregivers of people with dementia (PWD). Methods: PubMed, PsycINFO, and Cochrane Library databases were searched in August 2018, with no restrictions in language or publication date. Two independent reviewers identified 33 eligible randomized controlled trials (RCTs) conducting a technology-based intervention for informal carers of PWD. Meta-analyses for the outcome measures caregiver depression and caregiver burden were conducted with subgroup analyses according to mode of delivery (telephone, computer/web-based, combined interventions). To assess methodologic quality, the Cochrane risk-of-bias assessment was rated. Results: Meta-analyses revealed a small but significant postintervention effect of technology-based interventions for caregiver depression and caregiver burden. Combined interventions showed the strongest effects. Conclusion: Technology-based interventions have the potential to support informal caregivers of PWD. Because of advantages such as high flexibility and availability, technology-based interventions provide a promising alternative compared with "traditional services," e.g., those for people living in rural areas. More high-quality RCTs for specific caregiver groups are needed. KW - Caregiver KW - dementia KW - technology KW - meta-analysis Y1 - 2019 U6 - https://doi.org/10.1016/j.jagp.2018.12.003 SN - 1064-7481 SN - 1545-7214 VL - 27 IS - 4 SP - 426 EP - 445 PB - Elsevier CY - New York ER - TY - JOUR A1 - Deserno, Lorenz A1 - Beck, Anne A1 - Huys, Quentin J. M. A1 - Lorenz, Robert C. A1 - Buchert, Ralph A1 - Buchholz, Hans-Georg A1 - Plotkin, Michail A1 - Kumakara, Yoshitaka A1 - Cumming, Paul A1 - Heinze, Hans-Jochen A1 - Grace, Anthony A. A1 - Rapp, Michael A. A1 - Schlagenhauf, Florian A1 - Heinz, Andreas T1 - Chronic alcohol intake abolishes the relationship between dopamine synthesis capacity and learning signals in the ventral striatum JF - European journal of neuroscience N2 - Drugs of abuse elicit dopamine release in the ventral striatum, possibly biasing dopamine-driven reinforcement learning towards drug-related reward at the expense of non-drug-related reward. Indeed, in alcohol-dependent patients, reactivity in dopaminergic target areas is shifted from non-drug-related stimuli towards drug-related stimuli. Such hijacked' dopamine signals may impair flexible learning from non-drug-related rewards, and thus promote craving for the drug of abuse. Here, we used functional magnetic resonance imaging to measure ventral striatal activation by reward prediction errors (RPEs) during a probabilistic reversal learning task in recently detoxified alcohol-dependent patients and healthy controls (N=27). All participants also underwent 6-[F-18]fluoro-DOPA positron emission tomography to assess ventral striatal dopamine synthesis capacity. Neither ventral striatal activation by RPEs nor striatal dopamine synthesis capacity differed between groups. However, ventral striatal coding of RPEs correlated inversely with craving in patients. Furthermore, we found a negative correlation between ventral striatal coding of RPEs and dopamine synthesis capacity in healthy controls, but not in alcohol-dependent patients. Moderator analyses showed that the magnitude of the association between dopamine synthesis capacity and RPE coding depended on the amount of chronic, habitual alcohol intake. Despite the relatively small sample size, a power analysis supports the reported results. Using a multimodal imaging approach, this study suggests that dopaminergic modulation of neural learning signals is disrupted in alcohol dependence in proportion to long-term alcohol intake of patients. Alcohol intake may perpetuate itself by interfering with dopaminergic modulation of neural learning signals in the ventral striatum, thus increasing craving for habitual drug intake. KW - alcohol addiction KW - dopamine KW - fMRI KW - PET KW - prediction error Y1 - 2015 U6 - https://doi.org/10.1111/ejn.12802 SN - 0953-816X SN - 1460-9568 VL - 41 IS - 4 SP - 477 EP - 486 PB - Wiley-Blackwell CY - Hoboken ER - TY - JOUR A1 - Drosselmeyer, J. A1 - Rapp, Michael A. A1 - Hadji, P. A1 - Kostev, K. T1 - Depression risk in female patients with osteoporosis in primary care practices in Germany JF - Osteoporosis international N2 - The Summary Thirty-five thousand four hundred eighty-three female osteoporosis patients were compared with 35,483 patients without osteoporosis regarding the incidence of depression. The risk of depression is significantly increased for patients with osteoporosis compared with patients without osteoporosis in primary care practices within Germany. Introduction The objectives of the present study were to analyze the incidence of depression in German female patients with osteoporosis and to evaluate the risk factors for depression diagnosis within this patient population. Methods This study was a retrospective database analysis conducted in Germany utilizing the Disease Analyzer (R) Database (IMS Health, Germany). The study population included 70,966 patients between 40 and 80 years of age from 1072 primary care practices. The observation period was between 2004 and 2013. Follow-up duration was 5 years and was completed in April 2015. A total of 35,483 osteoporosis patients were selected after applying exclusion criteria, and 35,483 controls were chosen and then matched (1:1) to osteoporosis patients based on age, sex, health insurance coverage, depression diagnosis in the past, and follow-up duration after index date. The analyses of depression-free survival were carried out using Kaplan-Meier curves and log-rank tests. Cox proportional hazards models (dependent variable: depression) were used to adjust for confounders. Results Depression diagnoses were presented in 33.0% of the osteoporosis group and 22.7% of the control group after the 5-year follow-up (p < 0.001). Dementia, cancer, heart failure, coronary heart disease, and diabetes were associated with a higher risk of developing depression (p < 0.001). Private health insurance was associated with a lower risk of depression. There was no significant effect of fractures on depression risk. Conclusion The risk of depression is significantly increased for patients with osteoporosis in primary care practices within Germany. KW - Comorbidity KW - Depression risk KW - Osteoporosis KW - Primary care practice Y1 - 2016 U6 - https://doi.org/10.1007/s00198-016-3584-9 SN - 0937-941X SN - 1433-2965 VL - 27 SP - 2739 EP - 2744 PB - Springer CY - London ER - TY - JOUR A1 - Drosselmeyer, Julia A1 - Jacob, Louis A1 - Rathmann, Wolfgang A1 - Rapp, Michael A. A1 - Kostev, Karel T1 - Depression risk in patients with late-onset rheumatoid arthritis in Germany JF - Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation N2 - The goal of this study was to determine the prevalence of depression and its risk factors in patients with late-onset rheumatoid arthritis (RA) treated in German primary care practices. Longitudinal data from general practices (n=1072) throughout Germany were analyzed. Individuals initially diagnosed with RA (2009-2013) were identified, and 7301 patients were included and matched (1:1) to 7301 controls. The primary outcome measure was the initial diagnosis of depression within 5 years after the index date in patients with and without RA. Cox proportional hazards models were used to adjust for confounders. The mean age was 72.2 years (SD: 7.6 years). A total of 34.9 % of patients were men. Depression diagnoses were present in 22.0 % of the RA group and 14.3 % of the control group after a 5-year follow-up period (p < 0.001). In the multivariate regression model, RA was a strong risk factor for the development of depression (HR: 1.55, p < 0.001). There was significant interaction of RA and diagnosed inflammatory polyarthropathies (IP) (RA*IP interaction: p < 0.001). Furthermore, dementia, cancer, osteoporosis, hypertension, and diabetes were associated with a higher risk of developing depression (p values < 0.001). The risk of depression is significantly higher in patients with late-onset RA than in patients without RA for subjects treated in primary care practices in Germany. RA patients should be screened routinely for depression in order to ensure improved treatment and management. KW - Late-onset rheumatoid arthritis KW - Depression KW - Primary care KW - Risk factors KW - Germany Y1 - 2016 U6 - https://doi.org/10.1007/s11136-016-1387-2 SN - 0962-9343 SN - 1573-2649 VL - 26 IS - 2 SP - 437 EP - 443 PB - Springer CY - Dordrecht ER - TY - JOUR A1 - Drosselmeyer, Julia A1 - Rapp, Michael A. A1 - Kostev, Karel T1 - Prevalence and type of antidepressant therapy used by German general practitioners to treat female patients with osteoporosis JF - International journal of clinical pharmacology and therapeutics N2 - Objective: To estimate the prevalence and type of antidepressant medication prescribed by German primary care physicians for patients with depression and osteoporosis. Methods: This study was a retrospective database analysis conducted in Germany utilizing the Disease Analyzer (R) Database (IMS Health, Germany). The study population included 3,488 female osteoporosis patients aged between 40 and 90 years recruited from 1,179 general practitioner practices and who were initially diagnosed with depression during the index period (January 2004 to December 2013). Follow-up lasted up to 12 months and was completed in August 2015. Also included in this study were 3,488 nonosteoporosis controls who were matched (1 : 1) to osteoporosis cases on the basis of age, health insurance coverage, severity of depression, and physician carrying out the diagnosis. Results: After 12 months of followup, 30.1% of osteoporosis and 29.9% of nonosteoporosis patients with mild depression (p = 0.783), 52.4% of osteoporosis and 48.0% of non-osteoporosis patients with moderate depression (p = 0.003), and 39.4% of osteoporosis and 35.1% of nonosteoporosis patients with severe depression (p = 0.147) were being treated with antidepressants. Osteoporosis patients with moderate depression had a higher chance of being prescribed antidepressant therapy at the initial diagnosis (hazard ratio (HR): 1.12, p = 0.014). No differences were found between osteoporosis and nonosteoporosis patients regarding the proportion of patients receiving selective serotonin reuptake inhibitors (SSRI)/serotonin-noradrenaline reuptake inhibitors (SNRI), tricyclic antidepressant (TCA), or other antidepressants. Osteoporosis patients were more often referred to hospitals or psychiatrists for consultation. Conclusion: Osteoporosis patients are more often treated initially with antidepressants than non-osteoporosis patients, especially within the groups of patients with moderate or severe depression. TCA was the most frequently used antidepressant therapy class on initial diagnosis in both patient groups. Osteo-porosis patients receive referrals to hospitals or psychiatrists more often than patients without osteoporosis. KW - depression therapy KW - osteoporosis KW - hospital referral KW - primary care practices Y1 - 2016 U6 - https://doi.org/10.5414/CP202610 SN - 0946-1965 VL - 54 SP - 743 EP - 749 PB - Dustri-Verlag Dr. Karl Feistle CY - Deisenhofen-München ER - TY - JOUR A1 - Friedel, Eva A1 - Schlagenhauf, Florian A1 - Beck, Anne A1 - Dolan, Raymond J. A1 - Huys, Quentin J. M. A1 - Rapp, Michael A. A1 - Heinz, Andreas T1 - The effects of life stress and neural learning signals on fluid intelligence JF - European archives of psychiatry and clinical neuroscience : official organ of the German Society for Biological Psychiatry N2 - Fluid intelligence (fluid IQ), defined as the capacity for rapid problem solving and behavioral adaptation, is known to be modulated by learning and experience. Both stressful life events (SLES) and neural correlates of learning [specifically, a key mediator of adaptive learning in the brain, namely the ventral striatal representation of prediction errors (PE)] have been shown to be associated with individual differences in fluid IQ. Here, we examine the interaction between adaptive learning signals (using a well-characterized probabilistic reversal learning task in combination with fMRI) and SLES on fluid IQ measures. We find that the correlation between ventral striatal BOLD PE and fluid IQ, which we have previously reported, is quantitatively modulated by the amount of reported SLES. Thus, after experiencing adversity, basic neuronal learning signatures appear to align more closely with a general measure of flexible learning (fluid IQ), a finding complementing studies on the effects of acute stress on learning. The results suggest that an understanding of the neurobiological correlates of trait variables like fluid IQ needs to take socioemotional influences such as chronic stress into account. KW - Reinforcement learning KW - Prediction error signal KW - Ventral striatum KW - Stress KW - Intelligence Y1 - 2015 U6 - https://doi.org/10.1007/s00406-014-0519-3 SN - 0940-1334 SN - 1433-8491 VL - 265 IS - 1 SP - 35 EP - 43 PB - Springer CY - Heidelberg ER - TY - JOUR A1 - Friedel, Eva A1 - Sebold, Miriam A1 - Kuitunen-Paul, Sören A1 - Nebe, Stephan A1 - Veer, Ilya M. A1 - Zimmermann, Ulrich S. A1 - Schlagenhauf, Florian A1 - Smolka, Michael N. A1 - Rapp, Michael A. A1 - Walter, Henrik A1 - Heinz, Andreas T1 - How Accumulated Real Life Stress Experience and Cognitive Speed Interact on Decision-Making Processes JF - Frontiers in human neuroscienc N2 - Rationale: Advances in neurocomputational modeling suggest that valuation systems for goal-directed (deliberative) on one side, and habitual (automatic) decision-making on the other side may rely on distinct computational strategies for reinforcement learning, namely model-free vs. model-based learning. As a key theoretical difference, the model-based system strongly demands cognitive functions to plan actions prospectively based on an internal cognitive model of the environment, whereas valuation in the model-free system relies on rather simple learning rules from operant conditioning to retrospectively associate actions with their outcomes and is thus cognitively less demanding. Acute stress reactivity is known to impair model-based but not model-free choice behavior, with higher working memory capacity protecting the model-based system from acute stress. However, it is not clear which impact accumulated real life stress has on model-free and model-based decision systems and how this influence interacts with cognitive abilities. Methods: We used a sequential decision-making task distinguishing relative contributions of both learning strategies to choice behavior, the Social Readjustment Rating Scale questionnaire to assess accumulated real life stress, and the Digit Symbol Substitution Test to test cognitive speed in 95 healthy subjects. Results: Individuals reporting high stress exposure who had low cognitive speed showed reduced model-based but increased model-free behavioral control. In contrast, subjects exposed to accumulated real life stress with high cognitive speed displayed increased model-based performance but reduced model-free control. Conclusion: These findings suggest that accumulated real life stress exposure can enhance reliance on cognitive speed for model-based computations, which may ultimately protect the model-based system from the detrimental influences of accumulated real life stress. The combination of accumulated real life stress exposure and slower information processing capacities, however, might favor model-free strategies. Thus, the valence and preference of either system strongly depends on stressful experiences and individual cognitive capacities. KW - chronic stress KW - model-based learning KW - model-free learning KW - decision making KW - cognitive speed KW - real-life events Y1 - 2017 U6 - https://doi.org/10.3389/fnhum.2017.00302 SN - 1662-5161 VL - 11 SP - 1 EP - 9 PB - Frontiers Research Foundation CY - Lausanne ER - TY - JOUR A1 - Förstner, Bernd Rainer A1 - Böttger, Sarah Jane A1 - Moldavski, Alexander A1 - Bajbouj, Malek A1 - Pfennig, Andrea A1 - Manook, Andre A1 - Ising, Marcus A1 - Pittig, Andre A1 - Heinig, Ingmar A1 - Heinz, Andreas A1 - Mathiak, Klaus A1 - Schulze, Thomas G. A1 - Schneider, Frank A1 - Kamp-Becker, Inge A1 - Meyer-Lindenberg, Andreas A1 - Padberg, Frank A1 - Banaschewski, Tobias A1 - Bauer, Michael A1 - Rupprecht, Rainer A1 - Wittchen, Hans-Ulrich A1 - Rapp, Michael A. A1 - Tschorn, Mira T1 - The associations of positive and negative valence systems, cognitive systems and social processes on disease severity in anxiety and depressive disorders JF - Frontiers in psychiatry N2 - Background Anxiety and depressive disorders share common features of mood dysfunctions. This has stimulated interest in transdiagnostic dimensional research as proposed by the Research Domain Criteria (RDoC) approach by the National Institute of Mental Health (NIMH) aiming to improve the understanding of underlying disease mechanisms. The purpose of this study was to investigate the processing of RDoC domains in relation to disease severity in order to identify latent disorder-specific as well as transdiagnostic indicators of disease severity in patients with anxiety and depressive disorders. Methods Within the German research network for mental disorders, 895 participants (n = 476 female, n = 602 anxiety disorder, n = 257 depressive disorder) were recruited for the Phenotypic, Diagnostic and Clinical Domain Assessment Network Germany (PD-CAN) and included in this cross-sectional study. We performed incremental regression models to investigate the association of four RDoC domains on disease severity in patients with affective disorders: Positive (PVS) and Negative Valance System (NVS), Cognitive Systems (CS) and Social Processes (SP). Results The results confirmed a transdiagnostic relationship for all four domains, as we found significant main effects on disease severity within domain-specific models (PVS: & beta; = -0.35; NVS: & beta; = 0.39; CS: & beta; = -0.12; SP: & beta; = -0.32). We also found three significant interaction effects with main diagnosis showing a disease-specific association. Limitations The cross-sectional study design prevents causal conclusions. Further limitations include possible outliers and heteroskedasticity in all regression models which we appropriately controlled for. Conclusion Our key results show that symptom burden in anxiety and depressive disorders is associated with latent RDoC indicators in transdiagnostic and disease-specific ways. KW - Research Domain Criteria KW - depression KW - anxiety disoders KW - disease severity KW - transdiagnostic KW - RDoC Y1 - 2023 U6 - https://doi.org/10.3389/fpsyt.2023.1161097 SN - 1664-0640 VL - 14 PB - Frontiers Research Foundation CY - Lausanne ER - TY - JOUR A1 - Garbusow, Maria A1 - Ebrahimi, Claudia A1 - Riemerschmid, Carlotta A1 - Daldrup, Luisa A1 - Rothkirch, Marcus A1 - Chen, Ke A1 - Chen, Hao A1 - Belanger, Matthew J. A1 - Hentschel, Angela A1 - Smolka, Michael A1 - Heinz, Andreas A1 - Pilhatsch, Maximilan A1 - Rapp, Michael A. T1 - Pavlovian-to-instrumental transfer across mental disorders BT - a review JF - Neuropsychobiology : international journal of experimental and clinical research in biological psychiatry, pharmacopsychiatry, Biological Psychology/Pharmacopsychology and Pharmacoelectroencephalography N2 - A mechanism known as Pavlovian-to-instrumental transfer (PIT) describes a phenomenon by which the values of environmental cues acquired through Pavlovian conditioning can motivate instrumental behavior. PIT may be one basic mechanism of action control that can characterize mental disorders on a dimensional level beyond current classification systems. Therefore, we review human PIT studies investigating subclinical and clinical mental syndromes. The literature prevails an inhomogeneous picture concerning PIT. While enhanced PIT effects seem to be present in non-substance-related disorders, overweight people, and most studies with AUD patients, no altered PIT effects were reported in tobacco use disorder and obesity. Regarding AUD and relapsing alcohol-dependent patients, there is mixed evidence of enhanced or no PIT effects. Additionally, there is evidence for aberrant corticostriatal activation and genetic risk, e.g., in association with high-risk alcohol consumption and relapse after alcohol detoxification. In patients with anorexia nervosa, stronger PIT effects elicited by low caloric stimuli were associated with increased disease severity. In patients with depression, enhanced aversive PIT effects and a loss of action-specificity associated with poorer treatment outcomes were reported. Schizophrenic patients showed disrupted specific but intact general PIT effects. Patients with chronic back pain showed reduced PIT effects. We provide possible reasons to understand heterogeneity in PIT effects within and across mental disorders. Further, we strengthen the importance of reliable experimental tasks and provide test-retest data of a PIT task showing moderate to good reliability. Finally, we point toward stress as a possible underlying factor that may explain stronger PIT effects in mental disorders, as there is some evidence that stress per se interacts with the impact of environmental cues on behavior by selectively increasing cue-triggered wanting. To conclude, we discuss the results of the literature review in the light of Research Domain Criteria, suggesting future studies that comprehensively assess PIT across psychopathological dimensions. KW - Pavlovian-to-instrumental transfer KW - dimensional psychopathology KW - mental disorders KW - reliability Y1 - 2022 U6 - https://doi.org/10.1159/000525579 SN - 0302-282X SN - 1423-0224 VL - 81 IS - 5 SP - 418 EP - 437 PB - Karger CY - Basel ER -