TY  - JOUR
A1  - Sturm, Heidrun
A1  - Wildermuth, Ronja
A1  - Stolz, Regina
A1  - Bertram, L.
A1  - Eschweiler, G. W.
A1  - Thomas, C.
A1  - Rapp, Michael A.
A1  - Joos, S.
T1  - Diverging awareness of postoperative delirium and cognitive dysfunction in German Health Care Providers
JF  - Clinical interventions in agins
N2  - Purpose: Postoperative cognitive dysfunction (POCD) appears in up to 30% of patients suffering from postoperative delirium (POD). Both are associated with higher mortality and postoperative complications, prolonged hospital stays, and increased costs. Multi-modal models with pre-admission risk reduction counselling, perioperative monitoring, and training of multidisciplinary patient care providers have been shown to decrease the prevalence of both. The aim of our study is to understand how far those measures are known and implemented in routine care and to detect potential gaps in the current practice regarding risk communication and information flow between involved caregivers for patients at risk for POD/POCD. Patients and Methods: As part of a multicenter study, seven semi-structured focus group (FG) discussions with nurses and physicians from tertiary care hospitals (surgery, anesthesiology, and orthopedics, n=31) and general practitioners (GPs) in private practice (n=7) were performed. Transcribed discussions were analyzed using qualitative content analysis. Results: POD is present above all in the daily work of nurses, whereas physicians do not perceive it as a relevant problem. Physicians report that no regular risk assessment or risk communication was performed prior to elective surgery. Information about POD often gets lost during hand-offs and is not regularly reported in discharge letters. Thus, persisting cognitive dysfunction is often missed. The importance of standardized documentation and continuous education concerning risks, screening, and treatment was emphasized. The often-suggested pre-OP medication adjustment was seen as less important; in contrast, avoiding withdrawal was regarded as far more important. Conclusion: Altogether, it seems that standards and available best practice concepts are rarely implemented. In contrast to physicians, nurses are highly aware of delirium and ask for standardized procedures and more responsibility. Therefore, raising awareness regarding risks, screening tools, and effective preventive measures for POD/POCD seems an urgent goal. Nurses should have a central role in coordination and care of POD to prevent the risk for POCD.
KW  - cross-sectoral care
KW  - delirium prevention
KW  - postoperative cognitive dysfunction
KW  - POCD
KW  - dementia
KW  - clinical pathways
KW  - risk screening
Y1  - 2019
U6  - https://doi.org/10.2147/CIA.S230800
SN  - 1178-1998
VL  - 14
SP  - 2125
EP  - 2135
PB  - DOVE Medical Press
CY  - Albany
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  - 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  - Pietrek, Anou F.
A1  - Kangas, Maria
A1  - Kliegl, Reinhold
A1  - Rapp, Michael A.
A1  - Heinzel, Stephan
A1  - Van der Kaap-Deeder, Jolene
A1  - Heissel, Andreas
T1  - Basic psychological need satisfaction and frustration in major depressive disorder
JF  - Frontiers in Psychiatry - Mood Disorders
N2  - Basic psychological needs theory postulates that a social environment that satisfies individuals’ three basic psychological needs of autonomy, competence, and relatedness leads to optimal growth and well-being. On the other hand, the frustration of these needs is associated with ill-being and depressive symptoms foremost investigated in non-clinical samples; yet, there is a paucity of research on need frustration in clinical samples. Survey data were compared between adult individuals with major depressive disorder (MDD; n = 115; 48.69% female; 38.46 years, SD = 10.46) with those of a non-depressed comparison sample (n = 201; 53.23% female; 30.16 years, SD = 12.81). Need profiles were examined with a linear mixed model (LMM). Individuals with depression reported higher levels of frustration and lower levels of satisfaction in relation to the three basic psychological needs when compared to non-depressed adults. The difference between depressed and non-depressed groups was significantly larger for frustration than satisfaction regarding the needs for relatedness and competence. LMM correlation parameters confirmed the expected positive correlation between the three needs. This is the first study showing substantial differences in need-based experiences between depressed and non-depressed adults. The results confirm basic assumptions of the self-determination theory and have preliminary implications in tailoring therapy for depression.
KW  - basic need satisfaction and frustration
KW  - depressive symptoms
KW  - clinical sample
KW  - need profiles
KW  - social environment
Y1  - 2022
U6  - https://doi.org/10.3389/fpsyt.2022.962501
SN  - 1664-0640
SP  - 1
EP  - 10
PB  - Frontiers Media S.A.
CY  - Lausanne, Schweiz
ER  - 
TY  - JOUR
A1  - Garbusow, Maria
A1  - Nebe, Stephan
A1  - Sommer, Christian
A1  - Kuitunen-Paul, Sören
A1  - Sebold, Miriam
A1  - Schad, Daniel
A1  - Friedel, Eva
A1  - Veer, Ilya M.
A1  - Wittchen, Hans-Ulrich
A1  - Rapp, Michael A.
A1  - Ripke, Stephan
A1  - Walter, Henrik
A1  - Huys, Quentin J. M.
A1  - Schlagenhauf, Florian
A1  - Smolka, Michael N.
A1  - Heinz, Andreas
T1  - Pavlovian-To-Instrumental Transfer and Alcohol Consumption in Young Male Social Drinkers
BT  - Behavioral, Neural and Polygenic Correlates
JF  - Journal of Clinical Medicine
N2  - In animals and humans, behavior can be influenced by irrelevant stimuli, a phenomenon called Pavlovian-to-instrumental transfer (PIT). In subjects with substance use disorder, PIT is even enhanced with functional activation in the nucleus accumbens (NAcc) and amygdala. While we observed enhanced behavioral and neural PIT effects in alcohol-dependent subjects, we here aimed to determine whether behavioral PIT is enhanced in young men with high-risk compared to low-risk drinking and subsequently related functional activation in an a-priori region of interest encompassing the NAcc and amygdala and related to polygenic risk for alcohol consumption. A representative sample of 18-year old men (n = 1937) was contacted: 445 were screened, 209 assessed: resulting in 191 valid behavioral, 139 imaging and 157 genetic datasets. None of the subjects fulfilled criteria for alcohol dependence according to the Diagnostic and Statistical Manual of Mental Disorders-IV-TextRevision (DSM-IV-TR). We measured how instrumental responding for rewards was influenced by background Pavlovian conditioned stimuli predicting action-independent rewards and losses. Behavioral PIT was enhanced in high-compared to low-risk drinkers (b = 0.09, SE = 0.03, z = 2.7, p < 0.009). Across all subjects, we observed PIT-related neural blood oxygen level-dependent (BOLD) signal in the right amygdala (t = 3.25, p(SVC) = 0.04, x = 26, y = -6, z = -12), but not in NAcc. The strength of the behavioral PIT effect was positively correlated with polygenic risk for alcohol consumption (r(s) = 0.17, p = 0.032). We conclude that behavioral PIT and polygenic risk for alcohol consumption might be a biomarker for a subclinical phenotype of risky alcohol consumption, even if no drug-related stimulus is present. The association between behavioral PIT effects and the amygdala might point to habitual processes related to out PIT task. In non-dependent young social drinkers, the amygdala rather than the NAcc is activated during PIT; possible different involvement in association with disease trajectory should be investigated in future studies.
KW  - Pavlovian-to-instrumental transfer
KW  - amygdala
KW  - alcohol
KW  - polygenic risk
KW  - high risk drinkers
Y1  - 2019
U6  - https://doi.org/10.3390/jcm8081188
SN  - 2077-0383
VL  - 8
IS  - 8
PB  - MDPI
CY  - Basel
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  - 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  - Liu, Shuyan
A1  - Kuschpel, Maxim S.
A1  - Schad, Daniel
A1  - Heinz, Andreas
A1  - Rapp, Michael A.
T1  - Differential Effects of Music and Video Gaming During Breaks on Auditory and Visual Learning
JF  - Cyberpsychology, behavior and social networking
N2  - The interruption of learning processes by breaks filled with diverse activities is common in everyday life. This study investigated the effects of active computer gaming and passive relaxation (rest and music) breaks on auditory versus visual memory performance. Young adults were exposed to breaks involving (a) open eyes resting, (b) listening to music, and (c) playing a video game, immediately after memorizing auditory versus visual stimuli. To assess learning performance, words were recalled directly after the break (an 8:30 minute delay) and were recalled and recognized again after 7 days. Based on linear mixed-effects modeling, it was found that playing the Angry Birds video game during a short learning break impaired long-term retrieval in auditory learning but enhanced long-term retrieval in visual learning compared with the music and rest conditions. These differential effects of video games on visual versus auditory learning suggest specific interference of common break activities on learning.
Y1  - 2015
U6  - https://doi.org/10.1089/cyber.2015.0140
SN  - 2152-2715
SN  - 2152-2723
VL  - 18
IS  - 11
SP  - 647
EP  - 653
PB  - Liebert
CY  - New Rochelle
ER  - 
TY  - JOUR
A1  - Stelzel, Christine
A1  - Schauenburg, Gesche
A1  - Rapp, Michael A.
A1  - Heinzel, Stephan
A1  - Granacher, Urs
T1  - Age-Related Interference between the Selection of Input-Output Modality Mappings and Postural Control-a Pilot Study
JF  - Frontiers in psychology
N2  - Age-related decline in executive functions and postural control due to degenerative processes in the central nervous system have been related to increased fall-risk in old age. Many studies have shown cognitive-postural dual-task interference in old adults, but research on the role of specific executive functions in this context has just begun. In this study, we addressed the question whether postural control is impaired depending on the coordination of concurrent response-selection processes related to the compatibility of input and output modality mappings as compared to impairments related to working-memory load in the comparison of cognitive dual and single tasks. Specifically, we measured total center of pressure (CoP) displacements in healthy female participants aged 19-30 and 66-84 years while they performed different versions of a spatial one-back working memory task during semi-tandem stance on an unstable surface (i.e., balance pad) while standing on a force plate. The specific working-memory tasks comprised: (i) modality compatible single tasks (i.e., visual-manual or auditory-vocal tasks), (ii) modality compatible dual tasks (i.e., visual-manual and auditory-vocal tasks), (iii) modality incompatible single tasks (i.e., visual-vocal or auditory-manual tasks), and (iv) modality incompatible dual tasks (i.e., visual-vocal and auditory-manual tasks). In addition, participants performed the same tasks while sitting. As expected from previous research, old adults showed generally impaired performance under high working-memory load (i.e., dual vs. single one-back task). In addition, modality compatibility affected one-back performance in dual-task but not in single-task conditions with strikingly pronounced impairments in old adults. Notably, the modality incompatible dual task also resulted in a selective increase in total CoP displacements compared to the modality compatible dual task in the old but not in the young participants. These results suggest that in addition to effects of working-memory load, processes related to simultaneously overcoming special linkages between input-and output modalities interfere with postural control in old but not in young female adults. Our preliminary data provide further evidence for the involvement of cognitive control processes in postural tasks.
KW  - cognitive-postural dual task
KW  - postural stability
KW  - working memory
KW  - modality compatibility
KW  - aging
Y1  - 2017
U6  - https://doi.org/10.3389/fpsyg.2017.00613
SN  - 1664-1078
VL  - 8
PB  - Frontiers Research Foundation
CY  - Lausanne
ER  - 
TY  - JOUR
A1  - Nebe, Stephan
A1  - Kroemer, Nils B.
A1  - Schad, Daniel
A1  - Bernhardt, Nadine
A1  - Sebold, Miriam
A1  - Mueller, Dirk K.
A1  - Scholl, Lucie
A1  - Kuitunen-Paul, Sören
A1  - Heinz, Andreas
A1  - Rapp, Michael A.
A1  - Huys, Quentin J. M.
A1  - Smolka, Michael N.
T1  - No association of goal-directed and habitual control with alcohol consumption in young adults
JF  - Addiction biology
N2  - Alcohol dependence is a mental disorder that has been associated with an imbalance in behavioral control favoring model-free habitual over model-based goal-directed strategies. It is as yet unknown, however, whether such an imbalance reflects a predisposing vulnerability or results as a consequence of repeated and/or excessive alcohol exposure. We, therefore, examined the association of alcohol consumption with model-based goal-directed and model-free habitual control in 188 18-year-old social drinkers in a two-step sequential decision-making task while undergoing functional magnetic resonance imaging before prolonged alcohol misuse could have led to severe neurobiological adaptations. Behaviorally, participants showed a mixture of model-free and model-based decision-making as observed previously. Measures of impulsivity were positively related to alcohol consumption. In contrast, neither model-free nor model-based decision weights nor the trade-off between them were associated with alcohol consumption. There were also no significant associations between alcohol consumption and neural correlates of model-free or model-based decision quantities in either ventral striatum or ventromedial prefrontal cortex. Exploratory whole-brain functional magnetic resonance imaging analyses with a lenient threshold revealed early onset of drinking to be associated with an enhanced representation of model-free reward prediction errors in the posterior putamen. These results suggest that an imbalance between model-based goal-directed and model-free habitual control might rather not be a trait marker of alcohol intake per se.
KW  - alcohol
KW  - goal-directed
KW  - reinforcement learning
Y1  - 2017
U6  - https://doi.org/10.1111/adb.12490
SN  - 1355-6215
SN  - 1369-1600
VL  - 23
IS  - 1
SP  - 379
EP  - 393
PB  - Wiley
CY  - Hoboken
ER  - 
TY  - JOUR
A1  - Heinzel, Stephan
A1  - Lorenz, Robert C.
A1  - Quynh-Lam Duong, 
A1  - Rapp, Michael A.
A1  - Deserno, Lorenz
T1  - Prefrontal-parietal effective connectivity during working memory in older adults
JF  - Neurobiology of Aging
N2  - Theoretical models and preceding studies have described age-related alterations in neuronal activation of frontoparietal regions in a working memory (WM)load-dependent manner. However, to date, underlying neuronal mechanisms of these WM load-dependent activation changes in aging remain poorly understood. The aim of this study was to investigate these mechanisms in terms of effective connectivity by application of dynamic causal modeling with Bayesian Model Selection. Eighteen healthy younger (age: 20-32 years) and 32 older (60-75 years) participants performed an n-back task with 3 WM load levels during functional magnetic resonance imaging (fMRI). Behavioral and conventional fMRI results replicated age group by WM load interactions. Importantly, the analysis of effective connectivity derived from dynamic causal modeling, indicated an age-and performance-related reduction in WM load-dependent modulation of connectivity from dorsolateral prefrontal cortex to inferior parietal lobule. This finding provides evidence for the proposal that age-related WM decline manifests as deficient WM load-dependent modulation of neuronal top-down control and can integrate implications from theoretical models and previous studies of functional changes in the aging brain.
KW  - Aging
KW  - Dynamic causal modeling (DCM)
KW  - Effective connectivity
KW  - Functional magnetic resonance imaging (fMRI)
KW  - Working memory
Y1  - 2017
U6  - https://doi.org/10.1016/j.neurobiolaging.2017.05.005
SN  - 0197-4580
SN  - 1558-1497
VL  - 57
SP  - 18
EP  - 27
PB  - Elsevier
CY  - New York
ER  - 
TY  - JOUR
A1  - Heinzel, Stephan
A1  - Rimpel, Jérôme
A1  - Stelzel, Christine
A1  - Rapp, Michael A.
T1  - Transfer Effects to a Multimodal Dual-Task after Working Memory Training and Associated Neural Correlates in Older Adults
BT  - A Pilot Study
JF  - Frontiers in human neuroscience
N2  - Working memory (WM) performance declines with age. However, several studies have shown that WM training may lead to performance increases not only in the trained task, but also in untrained cognitive transfer tasks. It has been suggested that transfer effects occur if training task and transfer task share specific processing components that are supposedly processed in the same brain areas. In the current study, we investigated whether single-task WM training and training-related alterations in neural activity might support performance in a dual-task setting, thus assessing transfer effects to higher-order control processes in the context of dual-task coordination. A sample of older adults (age 60–72) was assigned to either a training or control group. The training group participated in 12 sessions of an adaptive n-back training. At pre and post-measurement, a multimodal dual-task was performed in all participants to assess transfer effects. This task consisted of two simultaneous delayed match to sample WM tasks using two different stimulus modalities (visual and auditory) that were performed either in isolation (single-task) or in conjunction (dual-task). A subgroup also participated in functional magnetic resonance imaging (fMRI) during the performance of the n-back task before and after training. While no transfer to single-task performance was found, dual-task costs in both the visual modality (p < 0.05) and the auditory modality (p < 0.05) decreased at post-measurement in the training but not in the control group. In the fMRI subgroup of the training participants, neural activity changes in left dorsolateral prefrontal cortex (DLPFC) during one-back predicted post-training auditory dual-task costs, while neural activity changes in right DLPFC during three-back predicted visual dual-task costs. Results might indicate an improvement in central executive processing that could facilitate both WM and dual-task coordination.
KW  - working memory
KW  - cognitive training
KW  - modality
KW  - dual-task
KW  - aging
KW  - transfer
KW  - fMRI
KW  - neuroimaging
Y1  - 2017
U6  - https://doi.org/10.3389/fnhum.2017.00085
VL  - 11
PB  - Frontiers Research Foundation
CY  - Lausanne
ER  - 
TY  - JOUR
A1  - Jacob, Louis
A1  - Rapp, Michael A.
A1  - Kostev, Karel
T1  - Long-term use of benzodiazepines in older patients in Germany
BT  - a retrospective analysis
JF  - Therapeutic Advances in Psychopharmacology
N2  - Background: The purpose of this study was to analyze the prevalence of long-term benzodiazepine use in older adults treated in general and neuropsychiatric practices in Germany. Methods: This study included 32,182 patients over the age of 65 years who received benzodiazepine prescriptions for the first time between January 2010 and December 2014 in general and neuropsychiatric practices in Germany. Follow up lasted until July 2016. The main outcome measure was the proportion of patients treated with benzodiazepines for >6 months. Results: The proportion of patients with benzodiazepine therapy for >6 months increased with age (65-70 years: 12.3%; 71-80 years: 15.5%; 81-90 years: 23.7%; >90 years: 31.6%) but did not differ significantly between men (15.5%) and women (17.1%). The proportion of patients who received benzodiazepines for >6 months was higher among those with sleep disorders (21.1%), depression (20.8%) and dementia (32.1%) than among those with anxiety (15.5%). By contrast, this proportion was lower among people diagnosed with adjustment disorders (7.7%) and back pain (3.8%). Conclusion: Overall, long-term use of benzodiazepines is common in older people, particularly in patients over the age of 80 and in those diagnosed with dementia, sleep disorders, or depression.
KW  - benzodiazepines
KW  - Germany
KW  - long-term use
KW  - older people
KW  - risk factors
Y1  - 2017
U6  - https://doi.org/10.1177/2045125317696454
SN  - 2045-1253
SN  - 2045-1261
VL  - 7
IS  - 6/7
SP  - 191
EP  - 200
PB  - Sage Publ.
CY  - London
ER  - 
TY  - JOUR
A1  - Kallies, Gunnar
A1  - Rapp, Michael A.
A1  - Fydrich, Thomas
A1  - Fehm, Lydia
A1  - Tschorn, Mira
A1  - Teran, Christina
A1  - Schwefel, Melanie
A1  - Pietrek, Anou F.
A1  - Henze, Romy
A1  - Hellweg, Rainer
A1  - Ströhle, Andreas
A1  - Heinzel, Stephan
A1  - Heissel, Andreas
T1  - Serum brain-derived neurotrophic factor (BDNF) at rest and after acute aerobic exercise in major depressive disorder
JF  - Psychoneuroendocrinology
N2  - Physiological mechanisms of an anti-depressive effect of physical exercise in major depressive disorder (MDD) seem to involve alterations in brain-derived neurotrophic factor (BDNF) level. However, previous studies which investigated this effect in a single bout of exercise, did not control for confounding peripheral factors that contribute to BDNF-alterations. Therefore, the underlying cause of exercise-induced BDNF-changes remains unclear. The current study aims to investigate serum BDNF (sBDNF)-changes due to a single-bout of graded aerobic exercise in a group of 30 outpatients with MDD, suggesting a more precise analysis method by taking plasma volume shift and number of platelets into account. Results show that exercise-induced increases in sBDNF remain significant (p<.001) when adjusting for plasma volume shift and controlling for number of platelets. The interaction of sBDNF change and number of platelets was also significant (p=.001) indicating larger sBDNF-increase in participants with smaller number of platelets. Thus, findings of this study suggest an involvement of peripheral as well as additional possibly brain-derived mechanisms explaining exercise-related BDNF release in MDD. For future studies in the field of exercise-related BDNF research, the importance of controlling for peripheral parameters is emphasized.
KW  - Brain-derived neurotrophic factor (BDNF)
KW  - Platelets
KW  - Major depressive disorder
KW  - Physical exercise
Y1  - 2018
U6  - https://doi.org/10.1016/j.psyneuen.2018.12.015
SN  - 0306-4530
VL  - 102
SP  - 212
EP  - 215
PB  - Elsevier
CY  - Oxford
ER  - 
TY  - JOUR
A1  - Meiberth, Dix Urs
A1  - Rapp, Michael A.
A1  - Jessen, Frank
T1  - Gedächtnisambulanzstrukturen in Deutschland – Ergebnisse einer Klinikbefragung
JF  - Psychiatrische Praxis
N2  - Ziel der Studie Erfassung der Strukturen zur Frühdiagnostik von Demenzen an Krankenhäusern in Deutschland.

Methodik Fragebogenerhebung.
Ergebnisse 14 % von 1758 kontaktierten Einrichtungen antworteten. 52 % berichteten über ein entsprechendes Angebot, zum großen Teil mit leitlinienorientierten Verfahren, wie Liquordiagnostik. Das Diagnosespektrum umfasste zu 46 % Demenzen und zu 41 % Diagnosen der leichten oder subjektiven kognitiven Störung.

Schlussfolgerung Leitlinienbasierte Diagnostik und Früherkennungskonzepte sind in Gedächtnisambulanzen weitgehend etabliert.
N2  - Objective To assess the structures for early and differential diagnosis of dementia in hospitals in Germany.

Methods Written questionnaire to all German hospitals.

Results 14 % of 1.758 hospitals responded. Of those, 52 % reported to offer a special service for early dementia diagnosis, mostly on an outpatient basis. The applied methods were in agreement with the national guideline for diagnosis and treatment of dementias, including technical diagnostics, such as neuroimaging and cerebrospinal fluid examinations. 46 % of the diagnostic spectrum were dementia. 41 % were either diagnosed as mild cognitive impairment (MCI) or as subjective cognitive decline (SCD).

Conclusion Despite mostly insufficient reimbursement, a large proportion of the responding hospitals offer a specialized service, which largely adheres to guideline-based diagnostic procedures. The concepts of at-risk and prodromal stages of dementia seem to be largely established.
T2  - Memory Clinics in Germany - Results of a Hospital Survey
KW  - dementia
KW  - Alzheimer
KW  - memory clinic
KW  - early diagnosis
KW  - Demenz
KW  - Alzheimer
KW  - Gedächtnisambulanz
KW  - Frühdiagnose
Y1  - 2019
U6  - https://doi.org/10.1055/a-0825-9049
SN  - 0303-4259
SN  - 1439-0876
VL  - 46
IS  - 4
SP  - 213
EP  - 216
PB  - Thieme
CY  - Stuttgart
ER  - 
TY  - JOUR
A1  - Sebold, Miriam
A1  - Spitta, G.
A1  - Gleich, T.
A1  - Dembler-Stamm, T.
A1  - Butler, Oisin
A1  - Zacharias, Kristin
A1  - Aydin, S.
A1  - Garbusow, Maria
A1  - Rapp, Michael A.
A1  - Schubert, Florian
A1  - Buchert, Ralph
A1  - Gallinat, Jürgen
A1  - Heinz, A.
T1  - Stressful life events are associated with striatal dopamine receptor availability in alcohol dependence
JF  - Journal of neural transmission
N2  - Stress plays a key role in modulating addictive behavior and can cause relapse following periods of abstinence. Common effects of stress and alcohol on the dopaminergic system have been suggested, although the precise mechanisms are unclear. Here, we investigated 20 detoxified alcohol-dependent patients and 19 matched healthy controls and assessed striatal D2/D3 availability using [F-18]-fallypride positron emission tomography and stressful life events. We found a strong association between striatal D2/D3 availability and stress in patients, but not in healthy controls. Interestingly, we found increased D2/D3 receptor availability in patients with higher stress levels. This mirrors complex interactions between stress and alcohol intake in animal studies and emphasizes the importance to investigate stress exposure in neurobiological studies of addiction.
KW  - Stressful life events
KW  - Dopamine D2
KW  - D3 receptor
KW  - Positron emission tomography
KW  - Striatum
KW  - Alcohol dependence
Y1  - 2019
U6  - https://doi.org/10.1007/s00702-019-01985-2
SN  - 0300-9564
SN  - 1435-1463
VL  - 126
IS  - 9
SP  - 1127
EP  - 1134
PB  - Springer
CY  - Wien
ER  - 
TY  - JOUR
A1  - Bohlken, Jens
A1  - Weber, Simon A.
A1  - Siebert, Anke
A1  - Forstmeier, Simon
A1  - Kohlmann, Thomas
A1  - Rapp, Michael A.
T1  - Reminiscence therapy for depression in dementia
BT  - An observational study with matched pairs
JF  - GeroPsych - The Journal of gerontopsychology and geriatric psychiatry
N2  - We investigated the efficacy of reminiscence therapy (RT) on symptoms of depression in patients with mild to moderate dementia. Out of 227 patients with mild to moderate dementia from a specialized physician’s office, 27 pairs (N = 54; mean age 79.04 ± 6.16 years) who had either received treatment as usual (TAU) or TAU combined with RT, were matched retrospectively according to age as well as cognitive and depressive symptom scores. After controlling for age and sex, symptoms of depression significantly decreased over time in the RT group compared to TAU (F1,52 = 4.36; p < .05). RT is a promising option for the treatment of depression in mild to moderate dementia. Larger randomized-controlled trials are needed.
KW  - reminiscence
KW  - life story book
Y1  - 2017
U6  - https://doi.org/10.1024/1662-9647/a000175
SN  - 1662-9647
SN  - 1662-971X
VL  - 30
SP  - 145
EP  - 151
PB  - Hogrefe
CY  - Göttingen
ER  - 
TY  - JOUR
A1  - Tschorn, Mira
A1  - Schulze, Susanne
A1  - Förstner, Bernd Rainer
A1  - Holmberg, Christine
A1  - Spallek, Jacob
A1  - Heinz, Andreas
A1  - Rapp, Michael A.
T1  - Predictors and prevalence of hazardous alcohol use in middle-late to late adulthood in Europe
JF  - Aging & mental health
N2  - Objectives: 
Even low to moderate levels of alcohol consumption can have detrimental health consequences, especially in older adults (OA). Although many studies report an increase in the proportion of drinkers among OA, there are regional variations. Therefore, we examined alcohol consumption and the prevalence of hazardous alcohol use (HAU) among men and women aged 50+ years in four European regions and investigated predictors of HAU. 

Methods: 
We analyzed data of N = 35,042 participants of the European SHARE study. We investigated differences in alcohol consumption (units last week) according to gender, age and EU-region using ANOVAs. Furthermore, logistic regression models were used to examine the effect of income, education, marital status, history of a low-quality parent-child relationship and smoking on HAU, also stratified for gender and EU-region. HAU was operationalized as binge drinking or risky drinking (<12.5 units of 10 ml alcohol/week). 

Results: 
Overall, past week alcohol consumption was 5.0 units (+/- 7.8), prevalence of HAU was 25.4% within our sample of European adults aged 50+ years. Male gender, younger age and living in Western Europe were linked to both higher alcohol consumption and higher risks of HAU. Income, education, smoking, a low-quality parent-child relationship, living in Northern and especially Eastern Europe were positively associated with HAU. Stratified analyses revealed differences by region and gender. 

Conclusions: 
HAU was highly prevalent within this European sample of OA. Alcohol consumption and determinants of HAU differed between EU-regions, hinting to a necessity of risk-stratified population-level strategies to prevent HAU and subsequent alcohol use disorders.
KW  - Hazardous alcohol use
KW  - older adults
KW  - middle-aged adults
KW  - Europe
KW  - alcohol
KW  - drug and alcohol abuse
KW  - cross-national
KW  - international studies
KW  - environmental factors
KW  - housing
KW  - rural-urban factors
KW  - epidemiology (mental health)
Y1  - 2022
U6  - https://doi.org/10.1080/13607863.2022.2076208
SN  - 1360-7863
SN  - 1364-6915
VL  - 27
IS  - 5
SP  - 1001
EP  - 1010
PB  - Routledge, Taylor & Francis Group
CY  - Abingdon
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  - 
TY  - JOUR
A1  - Sebold, Miriam
A1  - Chen, Hao
A1  - Önal, Aleyna
A1  - Kuitunen-Paul, Sören
A1  - Mojtahedzadeh, Negin
A1  - Garbusow, Maria
A1  - Nebe, Stephan
A1  - Wittchen, Hans-Ulrich
A1  - Huys, Quentin J. M.
A1  - Schlagenhauf, Florian
A1  - Rapp, Michael A.
A1  - Smolka, Michael N.
A1  - Heinz, Andreas
T1  - Stronger prejudices are associated with decreased model-based control
JF  - Frontiers in psychology
N2  - Background: 
Prejudices against minorities can be understood as habitually negative evaluations that are kept in spite of evidence to the contrary. Therefore, individuals with strong prejudices might be dominated by habitual or "automatic" reactions at the expense of more controlled reactions. Computational theories suggest individual differences in the balance between habitual/model-free and deliberative/model-based decision-making.

Methods: 
127 subjects performed the two Step task and completed the blatant and subtle prejudice scale.

Results: 
By using analyses of choices and reaction times in combination with computational modeling, subjects with stronger blatant prejudices showed a shift away from model-based control. There was no association between these decision-making processes and subtle prejudices.

Conclusion: 
These results support the idea that blatant prejudices toward minorities are related to a relative dominance of habitual decision-making. This finding has important implications for developing interventions that target to change prejudices across societies.
KW  - subtle and blatant prejudice
KW  - immigrant
KW  - social behavior;
KW  - decision-making
KW  - computational modeling
KW  - reinforcement learning
Y1  - 2022
U6  - https://doi.org/10.3389/fpsyg.2021.767022
SN  - 1664-1078
VL  - 12
PB  - Frontiers Research Foundation
CY  - Lausanne
ER  - 
TY  - JOUR
A1  - Herrmann, Matthias L.
A1  - Boden, Cindy
A1  - Maurer, Christoph
A1  - Kentischer, Felix
A1  - Mennig, Eva
A1  - Wagner, Sören
A1  - Conzelmann, Lars O.
A1  - Förstner, Bernd R.
A1  - Rapp, Michael A.
A1  - von Arnim, Christine A. F.
A1  - Denkinger, Michael
A1  - Eschweiler, Gerhard W.
A1  - Thomas, Christine
T1  - Anticholinergic drug exposure increases the risk of delirium in older patients undergoing elective surgery
JF  - Frontiers in medicine
N2  - IntroductionPostoperative delirium (POD) is a common and serious adverse event of surgery in older people. Because of its great impact on patients' safety and quality of life, identification of modifiable risk factors could be useful. Although preoperative medication intake is assumed to be an important modifiable risk factor, the impact of anticholinergic drugs on the occurrence of POD seems underestimated in elective surgery. The aim of this study was to investigate the association between preoperative anticholinergic burden and POD. We hypothesized that a high preoperative anticholinergic burden is an independent, potentially modifiable predisposing and precipitating factor of POD in older people. MethodsBetween November 2017 and April 2019, 1,470 patients of 70 years and older undergoing elective orthopedic, general, cardiac, or vascular surgery were recruited in the randomized, prospective, multicenter PAWEL trial. Anticholinergic burden of a sub-cohort of 899 patients, who did not receive a multimodal intervention for preventing POD, was assessed by two different tools at hospital admission: The established Anticholinergic Risk Scale (ARS) and the recently developed Anticholinergic Burden Score (ABS). POD was detected by confusion assessment method (CAM) and a validated post discharge medical record review. Logistic regression analyses were performed to evaluate the association between anticholinergic burden and POD. ResultsPOD was observed in 210 of 899 patients (23.4%). Both ARS and ABS were independently associated with POD. The association persisted after adjustment for relevant confounding factors such as age, sex, comorbidities, preoperative cognitive and physical status, number of prescribed drugs, surgery time, type of surgery and anesthesia, usage of heart-lung-machine, and treatment in intensive care unit. If a patient was taking one of the 56 drugs listed in the ABS, risk for POD was 2.7-fold higher (OR = 2.74, 95% CI = 1.55-4.94) and 1.5-fold higher per additional point on the ARS (OR = 1.54, 95% CI = 1.15-2.02). ConclusionPreoperative anticholinergic drug exposure measured by ARS or ABS was independently associated with POD in older patients undergoing elective surgery. Therefore, identification, discontinuation or substitution of anticholinergic medication prior to surgery may be a promising approach to reduce the risk of POD in older patients.
KW  - delirium
KW  - acute encephalopathy
KW  - surgery
KW  - anticholinergic
KW  - geriatric
KW  - postoperative
Y1  - 2022
U6  - https://doi.org/10.3389/fmed.2022.871229
SN  - 2296-858X
VL  - 9
PB  - Frontiers Media
CY  - Lausanne
ER  - 
TY  - JOUR
A1  - Sebold, Miriam
A1  - Nebe, Stephan
A1  - Garbusow, Maria
A1  - Guggenmos, Matthias
A1  - Schad, Daniel
A1  - Beck, Anne
A1  - Kuitunen-Paul, Sören
A1  - Sommer, Christian
A1  - Frank, Robin
A1  - Neu, Peter
A1  - Zimmermann, Ulrich S.
A1  - Rapp, Michael A.
A1  - Smolka, Michael N.
A1  - Huys, Quentin J. M.
A1  - Schlagenhauf, Florian
A1  - Heinz, Andreas
T1  - When Habits Are Dangerous: Alcohol Expectancies and Habitual Decision Making Predict Relapse in Alcohol Dependence
JF  - Biological psychiatry : a journal of psychiatric neuroscience and therapeutics ; a publication of the Society of Biological Psychiatry
N2  - BACKGROUND: Addiction is supposedly characterized by a shift from goal-directed to habitual decision making, thus facilitating automatic drug intake. The two-step task allows distinguishing between these mechanisms by computationally modeling goal-directed and habitual behavior as model-based and model-free control. In addicted patients, decision making may also strongly depend upon drug-associated expectations. Therefore, we investigated model-based versus model-free decision making and its neural correlates as well as alcohol expectancies in alcohol-dependent patients and healthy controls and assessed treatment outcome in patients. METHODS: Ninety detoxified, medication-free, alcohol-dependent patients and 96 age-and gender-matched control subjects underwent functional magnetic resonance imaging during the two-step task. Alcohol expectancies were measured with the Alcohol Expectancy Questionnaire. Over a follow-up period of 48 weeks, 37 patients remained abstinent and 53 patients relapsed as indicated by the Alcohol Timeline Followback method. RESULTS: Patients who relapsed displayed reduced medial prefrontal cortex activation during model-based decision making. Furthermore, high alcohol expectancies were associated with low model-based control in relapsers, while the opposite was observed in abstainers and healthy control subjects. However, reduced model-based control per se was not associated with subsequent relapse. CONCLUSIONS: These findings suggest that poor treatment outcome in alcohol dependence does not simply result from a shift from model-based to model-free control but is instead dependent on the interaction between high drug expectancies and low model-based decision making. Reduced model-based medial prefrontal cortex signatures in those who relapse point to a neural correlate of relapse risk. These observations suggest that therapeutic interventions should target subjective alcohol expectancies.
KW  - Alcohol dependence
KW  - Alcohol expectancy
KW  - Goal-directed control
KW  - Medial prefrontal cortex
KW  - Reinforcement learning
KW  - Treatment outcome
Y1  - 2017
U6  - https://doi.org/10.1016/j.biopsych.2017.04.019
SN  - 0006-3223
SN  - 1873-2402
VL  - 82
SP  - 847
EP  - 856
PB  - Elsevier
CY  - New York
ER  - 
TY  - JOUR
A1  - Konrad, Marcel
A1  - Jacob, Louis
A1  - Rapp, Michael A.
A1  - Kostev, Karel
T1  - Treatment of depression in patients with cardiovascular diseases by German psychiatrists
JF  - International journal of clinical pharmacology and therapeutics
N2  - Objective: To estimate the prevalence and the type of antidepressant medication prescribed by German psychiatrists to patients with depression and cardiovascular diseases (CVD). Methods: This study was a retrospective database analysis in Germany using the Disease Analyzer Database (IMS Health, Germany). The study population included 2,288 CVD patients between 40 and 90 years of age from 175 psychiatric practices. The observation period was between 2004 and 2013. Follow-up lasted up to 12 months and ended in April 2015. Also included were 2,288 non-CVD controls matched (1 : 1) to CVD cases on the basis of age, gender, health insurance coverage, depression severity, and diagnosing physician. Results: Mean age was 68.6 years. 46.2% of patients were men, and 5.9% had private health insurance coverage. Mild, moderate, or severe depression was present in 18.7%, 60.7%, and 20.6% of patients, respectively. Most patients had treatment within a year, many of them immediately after depression diagnosis. Patients with moderate and severe depression were more likely to receive treatment than patients with mild depression. There was no difference between CVD and non-CVD in the proportion of patients treated. Nonetheless, CVD patients received selective serotonin reuptake inhibitors / serotonin-noradrenaline reuptake inhibitors (SSRIs/SNRIs) significantly more frequently. Conversely, patients without CVD were more often treated with TCA. Conclusion: There was no association between CVD and the initiation of depression treatment. Furthermore, CVD patients received SSRIs/SNRIs more frequently.
KW  - depression
KW  - cardiovascular diseases
KW  - antidepressant therapy
KW  - psychiatric practices
Y1  - 2016
U6  - https://doi.org/10.5414/CP202591
SN  - 0946-1965
VL  - 54
SP  - 557
EP  - 563
PB  - Dustri-Verlag Dr. Karl Feistle
CY  - Deisenhofen-München
ER  - 
TY  - JOUR
A1  - Garbusow, Maria
A1  - Schad, Daniel
A1  - Sebold, Miriam
A1  - Friedel, Eva
A1  - Bernhardt, Nadine
A1  - Koch, Stefan P.
A1  - Steinacher, Bruno
A1  - Kathmann, Norbert
A1  - Geurts, Dirk E. M.
A1  - Sommer, Christian
A1  - Mueller, Dirk K.
A1  - Nebe, Stephan
A1  - Paul, Soeren
A1  - Wittchen, Hans-Ulrich
A1  - Zimmermann, Ulrich S.
A1  - Walter, Henrik
A1  - Smolka, Michael N.
A1  - Sterzer, Philipp
A1  - Rapp, Michael A.
A1  - Huys, Quentin J. M.
A1  - Schlagenhauf, Florian
A1  - Heinz, Andreas
T1  - Pavlovian-to-instrumental transfer effects in the nucleus accumbens relate to relapse in alcohol dependence
JF  - Addiction biology
N2  - In detoxified alcohol-dependent patients, alcohol-related stimuli can promote relapse. However, to date, the mechanisms by which contextual stimuli promote relapse have not been elucidated in detail. One hypothesis is that such contextual stimuli directly stimulate the motivation to drink via associated brain regions like the ventral striatum and thus promote alcohol seeking, intake and relapse. Pavlovian-to-Instrumental-Transfer (PIT) may be one of those behavioral phenomena contributing to relapse, capturing how Pavlovian conditioned (contextual) cues determine instrumental behavior (e.g. alcohol seeking and intake). We used a PIT paradigm during functional magnetic resonance imaging to examine the effects of classically conditioned Pavlovian stimuli on instrumental choices in n=31 detoxified patients diagnosed with alcohol dependence and n=24 healthy controls matched for age and gender. Patients were followed up over a period of 3 months. We observed that (1) there was a significant behavioral PIT effect for all participants, which was significantly more pronounced in alcohol-dependent patients; (2) PIT was significantly associated with blood oxygen level-dependent (BOLD) signals in the nucleus accumbens (NAcc) in subsequent relapsers only; and (3) PIT-related NAcc activation was associated with, and predictive of, critical outcomes (amount of alcohol intake and relapse during a 3 months follow-up period) in alcohol-dependent patients. These observations show for the first time that PIT-related BOLD signals, as a measure of the influence of Pavlovian cues on instrumental behavior, predict alcohol intake and relapse in alcohol dependence.
KW  - human Pavlovian-to-instrumental transfer
KW  - nucleus accumbens
KW  - relapse in alcohol use disorder
Y1  - 2016
U6  - https://doi.org/10.1111/adb.12243
SN  - 1355-6215
SN  - 1369-1600
VL  - 21
SP  - 719
EP  - 731
PB  - Wiley-Blackwell
CY  - Hoboken
ER  - 
TY  - JOUR
A1  - Stroehle, Andreas
A1  - Schmidt, Dietlinde K.
A1  - Schultz, Florian
A1  - Fricke, Nina
A1  - Staden, Theresa
A1  - Hellweg, Rainer
A1  - Priller, Josef
A1  - Rapp, Michael A.
A1  - Rieckmann, Nina
T1  - Drug and Exercise Treatment of Alzheimer Disease and Mild Cognitive Impairment: A Systematic Review and Meta-Analysis of Effects on Cognition in Randomized Controlled Trials
JF  - The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry
N2  - Objective: Demographic changes are increasing the pressure to improve therapeutic strategies against cognitive decline in Alzheimer disease (AD) and mild cognitive impairment (MCI). Besides drug treatment, physical activity seems to be a promising intervention target as epidemiological and clinical studies suggest beneficial effects of exercise training on cognition. Using comparable inclusion and exclusion criteria, we analyzed the efficacy of drug therapy (cholinesterase inhibitors, memantine, and Ginkgo biloba) and exercise interventions for improving cognition in AD and MCI populations. Methods: We searched The Cochrane Library, EBSCO, OVID, Web of Science, and U.S Food and Drug Administration data from inception through October 30, 2013. Randomized controlled trials in which at least one treatment arm consisted of an exercise or a pharmacological intervention for AD or MCI patients, and which had either a non-exposed control condition or a control condition that received another intervention. Treatment discontinuation rates and Standardized Mean Change score using Raw score standardization (SMCR) of cognitive performance were calculated. Results: Discontinuation rates varied substantially and ranged between 0% and 49% with a median of 18%. Significantly increased discontinuation rates were found for galantamine and rivastigmine as compared to placebo in AD studies. Drug treatments resulted in a small pooled effect on cognition (SMCR: 0.23, 95% CI: 0.20 to 0.25) in AD studies (N = 45, 18,434 patients) and no effect in any of the MCI studies (N = 5, 3,693 patients; SMCR: 0.03, 95% CI: 0.00 to 0.005). Exercise interventions had a moderate to strong pooled effect size (SMCR: 0.83, 95% CI: 0.59 to 1.07) in AD studies (N = 4, 119 patients), and a small effect size (SMCR: 0.20, 95% CI: 0.11 to 0.28) in MCI (N = 6, 443 patients). Conclusions: Drug treatments have a small but significant impact on cognitive functioning in AD and exercise has the potential to improve cognition in AD and MCI. Head-to-head trials with sufficient statistical power are necessary to directly compare efficacy, safety, and acceptability. Combining these two approaches might further increase the efficacy of each individual intervention. Identifier: PROSPERO (2013:CRD42013003910).
KW  - Alzheimer dementia
KW  - mild cognitive impairment
KW  - drug
KW  - exercise
Y1  - 2015
U6  - https://doi.org/10.1016/j.jagp.2015.07.007
SN  - 1064-7481
SN  - 1545-7214
VL  - 23
IS  - 12
SP  - 1234
EP  - 1249
PB  - Elsevier
CY  - New York
ER  - 
TY  - JOUR
A1  - Bohlken, Jens
A1  - Weber, Simon
A1  - Rapp, Michael A.
A1  - Kostev, Karel
T1  - Continuous treatment with antidementia drugs in Germany 2003-2013: a retrospective database analysis
JF  - International psychogeriatrics
N2  - Background: Continuous treatment is an important indicator of medication adherence in dementia. However, long-term studies in larger clinical settings are lacking, and little is known about moderating effects of patient and service characteristics.
 Methods: Data from 12,910 outpatients with dementia (mean age 79.2 years; SD = 7.6 years) treated between January 2003 and December 2013 in Germany were included. Continuous treatment was analysed using Kaplan-Meier curves and log-rank tests. In addition, multivariate Cox regression models were fitted with continuous treatment as dependent variable and the predictors antidementia agent, age, gender, medical comorbidities, physician specialty, and health insurance status.
 Results: After one year of follow-up, nearly 60% of patients continued drug treatment. Donezepil (HR: 0.88; 95% CI: 0.82-0.95) and memantine (HR: 0.85; 0.79-0.91) patients were less likely to be discontinued treatment as compared to rivastigmine users. Patients were less likely to be discontinued if they were treated by specialist physicians as compared to general practitioners (HR: 0.44; 0.41-0.48). Younger male patients and patients who had private health insurance had a lower discontinuation risk. Regarding comorbidity, patients were more likely to be continuously treated with the index substance if a diagnosis of heart failure or hypertension had been diagnosed at baseline.
 Conclusions: Our results imply that besides type of antidementia agent, involvement of a specialist in the complex process of prescribing antidementia drugs can provide meaningful benefits to patients, in terms of more disease-specific and continuous treatment.
KW  - adherence
KW  - cholinesterase inhibitors
KW  - memantine
Y1  - 2015
U6  - https://doi.org/10.1017/S1041610215000654
SN  - 1041-6102
SN  - 1741-203X
VL  - 27
IS  - 8
SP  - 1335
EP  - 1342
PB  - Cambridge Univ. Press
CY  - New York
ER  - 
TY  - JOUR
A1  - Heinzel, Stephan
A1  - Riemer, Thomas G.
A1  - Schulte, Stefanie
A1  - Onken, Johanna
A1  - Heinz, Andreas
A1  - Rapp, Michael A.
T1  - Catechol-O-methyltransferase (COMT) genotype affects age-related changes in plasticity in working memory: a pilot study
JF  - BioMed research international
N2  - Objectives. Recent work suggests that a genetic variation associated with increased dopamine metabolism in the prefrontal cortex (catechol-O-methyltransferase Val158Met; COMT) amplifies age-related changes in working memory performance. Research on younger adults indicates that the influence of dopamine-related genetic polymorphisms on working memory performance increases when testing the cognitive limits through training. To date, this has not been studied in older adults. Method. Here we investigate the effect of COMT genotype on plasticity in working memory in a sample of 14 younger (aged 24-30 years) and 25 older (aged 60-75 years) healthy adults. Participants underwent adaptive training in the n-back working memory task over 12 sessions under increasing difficulty conditions. Results. Both younger and older adults exhibited sizeable behavioral plasticity through training (P < .001), which was larger in younger as compared to older adults (P < .001). Age-related differences were qualified by an interaction with COMT genotype (P < .001), and this interaction was due to decreased behavioral plasticity in older adults carrying the Val/Val genotype, while there was no effect of genotype in younger adults. Discussion. Our findings indicate that age-related changes in plasticity in working memory are critically affected by genetic variation in prefrontal dopamine metabolism.
Y1  - 2014
U6  - https://doi.org/10.1155/2014/414351
SN  - 2314-6133
SN  - 2314-6141
PB  - Hindawi Publishing Corp.
CY  - New York
ER  - 
TY  - JOUR
A1  - Liu, Shuyan
A1  - Schad, Daniel
A1  - Kuschpel, Maxim S.
A1  - Rapp, Michael A.
A1  - Heinz, Andreas
T1  - Music and Video Gaming during Breaks
BT  - Influence on Habitual versus Goal-Directed Decision Making
JF  - PLoS one
N2  - Different systems for habitual versus goal-directed control are thought to underlie human decision-making. Working memory is known to shape these decision-making systems and
their interplay, and is known to support goal-directed decision making even under stress. Here, we investigated if and how decision systems are differentially influenced by breaks filled with diverse everyday life activities known to modulate working memory performance. We used a within-subject design where young adults listened to music and played a video game during breaks interleaved with trials of a sequential two-step Markov decision task, designed to assess habitual as well as goal-directed decision making. Based on a neurocomputational model of task performance, we observed that for individuals with a rather limited
working memory capacity video gaming as compared to music reduced reliance on the goal-directed decision-making system, while a rather large working memory capacity prevented such a decline. Our findings suggest differential effects of everyday activities on key decision-making processes.
KW  - Decision making
KW  - Games
KW  - Working memory
KW  - Video games
KW  - Cognition
KW  - Cognitive impairment
KW  - Music cognition
KW  - Learning
Y1  - 2016
U6  - https://doi.org/10.1371/JOURNAL.PONE.0150165
SN  - 1932-6203
VL  - 11
IS  - 3
SP  - 1
EP  - 12
PB  - Public Library of Science
CY  - Lawrence, Kan.
ER  - 
TY  - JOUR
A1  - Zaytseva, Yuliya
A1  - Korsakova, Natalya
A1  - Gurovich, Isaac Ya
A1  - Heinz, Andreas
A1  - Rapp, Michael A.
T1  - Luria revisited: Complex motor phenomena in first episode schizophrenia and schizophrenia spectrum disorders
JF  - Psychiatry research : the official publication of the International Society for Neuroimaging in Psychiatry
KW  - Luria
KW  - Fist-Edge-Palm test
KW  - Bimanual probe
KW  - Error monitoring
KW  - First psychotic episode
KW  - Schizophrenia
KW  - Schizophrenia spectrum disorders
Y1  - 2014
U6  - https://doi.org/10.1016/j.psychres.2014.08.009
SN  - 0165-1781
VL  - 220
IS  - 1-2
SP  - 145
EP  - 151
PB  - Elsevier
CY  - Clare
ER  - 
TY  - JOUR
A1  - Mell, Thomas
A1  - Jacob, Louis
A1  - Fuhr, Ida
A1  - Dick, Sandra
A1  - Rapp, Michael A.
A1  - Kostev, Karel
T1  - Patterns of benzodiazepine prescribing by neuropsychiatrists and general practitioners for elderly patients in Germany in 2014
JF  - International journal of clinical pharmacology and therapeutics
N2  - Background: The patterns of benzodiazepine prescriptions in older adults are of general and scientific interest as they are not yet well understood. The aim of this study was to compare the prescription patterns of benzodiazepines in elderly people in Germany to determine the share or proportion treated by general practitioners (GP) and neuropsychiatrists (NP). Methods: This study included 31,268 and 6,603 patients between the ages of 65 and 100 with at least one benzodiazepine prescription in 2014 from GP and NP, respectively. Demographic data included age, gender, and type of health insurance coverage. The share of elderly people with benzodiazepine prescriptions was estimated in different age and disease groups for both GP and NP patients. The share of the six most commonly prescribed drugs was also calculated for each type of practice. Results: The share of people taking benzodiazepines prescribed by GP increased from 3.2% in patients aged between 65 and 69 years to 8.6% in patients aged between 90 and 100 years, whereas this share increased from 5.4% to 7.1% in those seen by NP. Benzodiazepines were frequently used by patients suffering from sleep disorders (GP: 33.9%; NP: 5.5%), depression (GP: 17.9%; NP: 29.8%), and anxiety disorders (GP: 14.5%; NP: 22.8%). Lorazepam (30.3%), oxazepam (24.7%), and bromazepam (24.3%) were the three most commonly prescribed drugs for GP patients. In contrast, lorazepam (60.4%), diazepam (14.8%), and oxazepam (11.2%) were those more frequently prescribed to NP patients. Conclusion: Prescription patterns of benzodiazepine in the elderly varied widely between GP and NP.
KW  - benzodiazepines
KW  - prescription patterns
KW  - elderly people
KW  - Germany
Y1  - 2017
U6  - https://doi.org/10.5414/CP202904
SN  - 0946-1965
VL  - 55
SP  - 466
EP  - 471
PB  - Dustri-Verlag Dr. Karl Feistle
CY  - Deisenhofen-München
ER  - 
TY  - JOUR
A1  - Zech, Philipp
A1  - Schuch, Felipe
A1  - Pérez Chaparro, Camilo Germán Alberto
A1  - Kangas, Maria
A1  - Rapp, Michael A.
A1  - Heissel, Andreas
T1  - Exercise, Comorbidities, and Health-Related Quality of Life in People Living with HIV
BT  - The HIBES Cohort Study
JF  - International Journal of Environmental Research and Public Health
N2  - (1) Background: People with HIV (PWH) may perform more than one type of exercise cumulatively. The objective of this study is to investigate recreational exercise and its association with health-related quality of life (HRQOL) and comorbidities in relation to potential covariates. (2) Methods: The HIBES study (HIV-Begleiterkrankungen-Sport) is a cross-sectional study for people with HIV. The differences between non-exercisers versus exercisers (cumulated vs. single type of exercises) were investigated using regression models based on 454 participants. (3) Results: Exercisers showed a higher HRQOL score compared to non-exercisers (Wilcox r = 0.2 to 0.239). Psychological disorders were identified as the main covariate. Participants performing exercise cumulatively showed higher scores in duration, frequency, and intensity when compared to participants performing only one type of exercise. The mental health summary score was higher for the cumulated and single type of exercise if a psychological disorder existed. Duration and intensity were associated with an increase of HRQOL, whilst a stronger association between psychological disorders and exercise variables were evident. Exercise duration (minutes) showed a significant effect on QOL (standardized beta = 0.1) and for participants with psychological disorders (standardized beta = 0.3), respectively. (4) Conclusions: Psychological disorders and other covariates have a prominent effect on HRQOL and its association with exercise. For PWH with a psychological disorder, a stronger relationship between HRQOL with exercise duration and intensity emerged. However, differentiation of high-HRQOL individuals warrants further investigation by considering additional factors.
KW  - HIV
KW  - exercise intensity
KW  - quality of life
KW  - comorbidity
Y1  - 2020
U6  - https://doi.org/10.3390/ijerph17145138
SN  - 1660-4601
SN  - 1661-7827
VL  - 17
IS  - 14
PB  - MDPI AG
CY  - Basel
ER  - 
TY  - JOUR
A1  - Kluge, Ulrike
A1  - Rapp, Michael A.
A1  - Mehran, Nassim
A1  - Abi Jumaa, Jinan
A1  - Aichberger, Marion Christina
T1  - Poverty, migration and mental health
JF  - Der Nervenarzt : Organ der Deutschen Gesellschaft für Psychiatrie, Psychotherapie und Nervenheilkunde ; Mitteilungsblatt der Deutschen Gesellschaft für Neurologie
N2  - Poverty and social exclusion are closely related to an increased risk for the deterioration of mental health. In 2018 approximately 19% of the German population were threatened by poverty and the associated social ostracization. Migrant groups in particular often show an increased risk for poverty and are often exposed to multiple socioeconomic stress factors depending on the context of migration, pre-migration and post-migration social factors. Numerous studies have shown that societal exclusion, precarious living conditions and the residential environment negatively affect mental health beyond the effects of pre-migration risk factors. This article provides a review and discussion on the relationship between mental health, poverty and related constructs, such as social cohesion, social capital and social exclusion in general as well as in specific risk groups, such as migrant and refugee populations.
KW  - Social capital
KW  - Social cohesion
KW  - Migration
KW  - Exclusion
KW  - Residential environment
Y1  - 2019
U6  - https://doi.org/10.1007/s00115-019-00790-2
SN  - 0028-2804
SN  - 1433-0407
VL  - 90
IS  - 11
SP  - 1103
EP  - 1108
PB  - Springer
CY  - New York
ER  - 
TY  - JOUR
A1  - Rapp, Michael A.
T1  - Die Versorgung für die nächste Dekade sichern: Gerontopsychiatrie in der Krise?
T1  - Covering Care for the Next Decade: A Crisis in Geriatric Psychiatry?
JF  - Psychatrische Praxis
N2  - Der demografische Wandel wird nicht nur mit einer rasanten Zunahme der Hochaltrigen einhergehen [1], was für die gerontopsychiatrische Versorgung aufgrund der altersassoziierten Inzidenzraten in erster Linie eine Zunahme an Demenzerkrankungen und Patienten mit Multimorbidität und Gebrechlichkeit bedeutet [2], sondern auch mit einer Zunahme jüngerer alter Menschen vom 65. bis 75. Lebensjahr, was für die Gerontopsychiatrie eine Zunahme der Patienten mit Abhängigkeitserkrankungen, Erkrankungen aus dem schizophrenen Formenkreis und affektiven Erkrankungen bedeutet. Soziale Faktoren werden hier mehr und mehr eine zentrale Rolle spielen, da neben der Qualität der medizinischen Versorgung insbesondere die individuelle soziale Situation der Patienten mit einer erhöhten Morbidität und Mortalität einhergehen wird [3].
Y1  - 2019
U6  - https://doi.org/10.1055/a-0971-5551
SN  - 0303-4259
SN  - 1439-0876
VL  - 46
IS  - 6
SP  - 305
EP  - 306
PB  - Thieme
CY  - Stuttgart
ER  - 
TY  - JOUR
A1  - Rapp, Michael A.
T1  - Alterspsychiatrie ist Teil ganzheitlicher Altersmedizin, kein Teilbereich der Psychiatrie – Kontra
T1  - Not a Sub-Speciality of Psychiatry - Contra
JF  - Psychatrische Praxis
N2  - Wenn in der Medizin vom demografischen Wandel gesprochen wird [1], wird zumeist von einer rasanten Zunahme der Hochaltrigen gesprochen, bei denen aufgrund der differenziellen altersassoziierten Inzidenzraten in erster Linie eine Zunahme an Demenzerkrankungen, kardiovaskulären Erkrankungen, Krebserkrankungen und allgemeiner Multimorbidität und Gebrechlichkeit zu erwarten ist [2]. Dies ist unstrittig richtig, aber nur ein Teil der Folgen des demografischen Wandels für die psychiatrische Versorgung. Diese muss weiterhin die gesamte adulte Lebensspanne im Blick haben, da sonst Versorgungsengpässe bei ohnehin vulnerablen Patienten verstärkt werden, mit Folgen für die Morbidität und Mortalität auf Bevölkerungsebene [3].
Y1  - 2019
U6  - https://doi.org/10.1055/a-0958-8403
SN  - 0303-4259
SN  - 1439-0876
VL  - 46
IS  - 6
SP  - 308
EP  - 309
PB  - Thieme
CY  - Stuttgart
ER  - 
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  - Balta Beylergil, Sinem
A1  - Beck, Anne
A1  - Deserno, Lorenz
A1  - Lorenz, Robert C.
A1  - Rapp, Michael A.
A1  - Schlagenhauf, Florian
A1  - Heinz, Andreas
A1  - Obermayer, Klaus
T1  - Dorsolateral prefrontal cortex contributes to the impaired behavioral adaptation in alcohol dependence
JF  - NeuroImage: Clinical : a journal of diseases affecting the nervous system
N2  - Substance-dependent individuals often lack the ability to adjust decisions flexibly in response to the changes in reward contingencies. Prediction errors (PEs) are thought to mediate flexible decision-making by updating the reward values associated with available actions. In this study, we explored whether the neurobiological correlates of PEs are altered in alcohol dependence. Behavioral, and functional magnetic resonance imaging (fMRI) data were simultaneously acquired from 34 abstinent alcohol-dependent patients (ADP) and 26 healthy controls (HC) during a probabilistic reward-guided decision-making task with dynamically changing reinforcement contingencies. A hierarchical Bayesian inference method was used to fit and compare learning models with different assumptions about the amount of task-related information subjects may have inferred during the experiment. Here, we observed that the best-fitting model was a modified Rescorla-Wagner type model, the “double-update” model, which assumes that subjects infer the knowledge that reward contingencies are anti-correlated, and integrate both actual and hypothetical outcomes into their decisions. Moreover, comparison of the best-fitting model's parameters showed that ADP were less sensitive to punishments compared to HC. Hence, decisions of ADP after punishments were loosely coupled with the expected reward values assigned to them. A correlation analysis between the model-generated PEs and the fMRI data revealed a reduced association between these PEs and the BOLD activity in the dorsolateral prefrontal cortex (DLPFC) of ADP. A hemispheric asymmetry was observed in the DLPFC when positive and negative PE signals were analyzed separately. The right DLPFC activity in ADP showed a reduced correlation with positive PEs. On the other hand, ADP, particularly the patients with high dependence severity, recruited the left DLPFC to a lesser extent than HC for processing negative PE signals. These results suggest that the DLPFC, which has been linked to adaptive control of action selection, may play an important role in cognitive inflexibility observed in alcohol dependence when reinforcement contingencies change. Particularly, the left DLPFC may contribute to this impaired behavioral adaptation, possibly by impeding the extinction of the actions that no longer lead to a reward.
KW  - Alcohol dependence
KW  - Prediction error
KW  - Reinforcement learning
KW  - Reversal learning
KW  - Dorsolateral prefrontal cortex
KW  - Decision-making
Y1  - 2017
U6  - https://doi.org/10.1016/j.nicl.2017.04.010
SN  - 2213-1582
VL  - 15
SP  - 80
EP  - 94
PB  - Elsevier
CY  - Oxford
ER  - 
TY  - JOUR
A1  - Chen, Hao
A1  - Nebe, Stephan
A1  - Mojtahedzadeh, Negin
A1  - Kuitunen-Paul, Soren
A1  - Garbusow, Maria
A1  - Schad, Daniel
A1  - Rapp, Michael A.
A1  - Huys, Quentin J. M.
A1  - Heinz, Andreas
A1  - Smolka, Michael N.
T1  - Susceptibility to interference between Pavlovian and instrumental control is associated with early hazardous alcohol use
JF  - Addiction biology
N2  - Pavlovian-to-instrumental transfer (PIT) tasks examine the influence of Pavlovian stimuli on ongoing instrumental behaviour. Previous studies reported associations between a strong PIT effect, high-risk drinking and alcohol use disorder. This study investigated whether susceptibility to interference between Pavlovian and instrumental control is linked to risky alcohol use in a community sample of 18-year-old male adults. Participants (N = 191) were instructed to 'collect good shells' and 'leave bad shells' during the presentation of appetitive (monetary reward), aversive (monetary loss) or neutral Pavlovian stimuli. We compared instrumental error rates (ER) and functional magnetic resonance imaging (fMRI) brain responses between the congruent and incongruent conditions, as well as among high-risk and low-risk drinking groups. On average, individuals showed a substantial PIT effect, that is, increased ER when Pavlovian cues and instrumental stimuli were in conflict compared with congruent trials. Neural PIT correlates were found in the ventral striatum and the dorsomedial and lateral prefrontal cortices (lPFC). Importantly, high-risk drinking was associated with a stronger behavioural PIT effect, a decreased lPFC response and an increased neural response in the ventral striatum on the trend level. Moreover, high-risk drinkers showed weaker connectivity from the ventral striatum to the lPFC during incongruent trials. Our study links interference during PIT to drinking behaviour in healthy, young adults. High-risk drinkers showed higher susceptibility to Pavlovian cues, especially when they conflicted with instrumental behaviour, indicating lower interference control abilities. Increased activity in the ventral striatum (bottom-up), decreased lPFC response (top-down), and their altered interplay may contribute to poor interference control in the high-risk drinkers.
KW  - high‐risk drinking
KW  - interference control
KW  - Pavlovian‐to‐instrumental transfer
Y1  - 2020
U6  - https://doi.org/10.1111/adb.12983
SN  - 1355-6215
SN  - 1369-1600
VL  - 26
IS  - 4
SP  - 1
EP  - 14
PB  - Wiley
CY  - Hoboken
ER  - 
TY  - JOUR
A1  - Bangeow, Petjo
A1  - Rapp, Michael A.
T1  - Beurteilung und Nutzung der 2016 reformierten Psychotherapierichtlinie
T1  - Assessment and use of 2016 reformed psychotherapeutic guideline
BT  - Teil II : Ost-West- und Stadt-Land-Vergleich
BT  - part II : comparing Eastern and Western Germany as well as urban and rural areas
JF  - Psychiatrische Praxis : Sozialpsychiatrie, klinische Psychiatrie, public mental health, Versorgungsforschung
N2  - Ziel der Studie Dieser Artikel untersucht, inwiefern sich die 2016 reformierte Richtlinie im Stadt-Land- sowie im Ost-West-Vergleich auf die ambulante psychotherapeutische Arbeit und Versorgung auswirkt.
Methodik Eine Onlineumfrage unter vertragsärztlich tätigen TherapeutInnen wurde durchgeführt. Die Fragen bezogen sich auf verschiedene Neuerungen in der Richtlinie.
Ergebnisse Unabhängig von der Region schätzten die Befragten ein, dass die Reform zu keiner verbesserten Versorgung führte.
Im Westen und in der Stadt tätige TherapeutInnen verwiesen PatientInnen nach der Sprechstunde öfter an andere Psychotherapiepraxen, im Osten und auf dem Land tätige hingegen öfter auf andere Hilfeangebote.
Schlussfolgerung Stärkere Anreize für die psychotherapeutische Tätigkeit auf dem Land sind zu schaffen. Abbaumaßnahmen der Ost-West-Ungleichheiten in der Versorgungsdichte scheinen nötig.
N2  - Objective This article investigated whether or not the reformed psychotherapeutic guideline had different effects on outpatient psychotherapeutic work and services comparing urban and rural areas as well as eastern and western Germany.
Methods An online survey of psychotherapists was conducted. The survey included questions on various innovations within the reformed guideline.
Results Regardless of region, therapists stated overall that the reform has not led to improved psychotherapeutic care.
Therapists in the West and in urban areas referred more patients to other psychotherapeutic practices after their consultation. Therapists in the East and in rural areas referred more patients to other institutions and services.
Conclusions Psychotherapeutic work in rural areas should be better incentivized. Interventions to reduce east-west inequalities in the density of service provision seem to be necessary.
KW  - Psychotherapierichtlinie
KW  - Ostdeutschland
KW  - Westdeutschland
KW  - Stadt-Land-Vergleich
KW  - psychotherapy guidelines
KW  - Eastern-Western Germany
KW  - urban-rural
KW  - comparison
Y1  - 2020
U6  - https://doi.org/10.1055/a-1045-9820
SN  - 0303-4259
SN  - 1439-0876
VL  - 47
IS  - 07
SP  - 383
EP  - 387
PB  - Thieme
CY  - Stuttgart
ER  - 
TY  - JOUR
A1  - Block, Andrea
A1  - Schulze, Susanne
A1  - Deeken, Friederike
A1  - Häusler, Andreas
A1  - Rezo, Anna
A1  - Rapp, Michael A.
A1  - Wippert, Pia-Maria
T1  - Effects of inflammatory markers and biographical stress on treatment response in depression
JF  - Psychoneuroendocrinology : an international journal ; the official journal of the International Society of Psychoneuroendocrinology
N2  - Background
Recent research emphasized the role of inflammatory processes in the pathophysiology of depression. Theories hypothesizes that life events (LE) can affect the immune system and trigger depressive symptoms. LE are also considered as one of the best predictors for the onset and course of depressive disorders.

Methods
Observational study across three treatment settings: n=208 depressive patients (75.5%f, M 46.6 y) were examined on depression (BDI-II), life events (ILE) and inflammatory markers (IL-6, CRP, fibrinogen, ICAM-1, TNF-alpha, E-selectin) at baseline (t0), 5-week(t1) and 5-month(t2) follow-up. Effects and interactions were analyzed with regression models.

Results
LE were associated with depressive symptoms at t0 (beta=.209; p=.002) and both follow-ups. Except for CRP, which was linked to depression symptoms at t2 (betai=-.190; p=.032), there were no effects of inflammatory markers on depressive symptoms. At t1, an interaction between CRP and LE in total (beta=-.249; p=.041) was found as well as for LE in the past five years (beta=-.122; p=.027). Similar interactions were found between cumulative LE and ICAM-1 (beta=-.197; p=.003) and IL-6 (beta=-.425; p=.001).

Conclusion
The cumulative burden of LE effects symptoms and treatment outcome in depressive patients. There is some evidence that inflammatory marker may have long-term effects on treatment outcome as they seem to weaken the determining relation between LE and depression.
Y1  - 2021
U6  - https://doi.org/10.1016/j.psyneuen.2021.105535
SN  - 0306-4530
SN  - 1873-3360
VL  - 131
IS  - Supplement
SP  - S24
EP  - S24
PB  - Elsevier
CY  - Oxford
ER  - 
TY  - JOUR
A1  - Bangeow, Petjo
A1  - Rapp, Michael A.
T1  - Beurteilung und Nutzung der 2016 reformierten Psychotherapierichtlinie
BT  - Teil I: Vergleich unter den psychotherapeutischen Richtlinienverfahren
BT  - Part I: A Comparison of the Psychotherapeutic Methods
JF  - Psychiatrische Praxis
N2  - Objective This article investigates how aspects of 2016 reform of the German psychotherapeutic guideline were evaluated and used differently by therapists from three different psychotherapeutic treatment methods. <br /> Methods An online survey was conducted with 987 statutory health insurance approved therapists. The questionnaire focused on various innovations in the guideline. <br /> Results There were significant differences in the use of the broadened authority and of specific treatment services. There were also differences in the application for short-term and long-term psychotherapies as well as in the application to extend short to long-term psychotherapy. <br /> Conclusions Elements of the guideline should be evaluated in relation to the preferred treatment method. Aspects related to the psychotherapeutic work with patients seem to be especially significant.
N2  - Ziel der Studie Dieser Artikel untersucht, inwiefern Aspekte der 2016 reformierten Psychotherapierichtlinie aus Sicht der drei Richtlinienverfahren für die praktische Arbeit unterschiedlich bewertet und genutzt werden. <br /> Methodik Eine Onlineumfrage wurde unter vertragsärztlich tätigen PsychotherapeutInnen (n = 987) durchgeführt. Die Fragen bezogen sich auf die unterschiedlichen Neuerungen in der Psychotherapierichtlinie.
Ergebnisse Signifikante Unterschiede wurden u. a. in der Nutzung der erweiterten Befugnisse sowie in der Abrechnung bestimmter Leistungen deutlich. Die Gruppen unterschieden sich auch in der Beantragung von Behandlungskontingenten. <br /> Schlussfolgerung Es scheint sinnvoll, Elemente der Richtlinienreform aus der Sicht des bevorzugten Behandlungsverfahrens zu evaluieren. Jene Aspekte scheinen bedeutsam, die sich auf die unmittelbare Arbeit mit den PatientInnen beziehen.
T2  - Assessment and Use of 2016 Reformed Psychotherapeutic Guideline
KW  - Psychotherapierichtlinie
KW  - Richtlinienverfahren
KW  - Unterschiede
KW  - psychotherapy guideline
KW  - psychotherapy methods
KW  - differences
Y1  - 2020
U6  - https://doi.org/10.1055/a-1045-9801
SN  - 0303-4259
SN  - 1439-0876
VL  - 47
IS  - 3
SP  - 135
EP  - 141
PB  - Thieme
CY  - Stuttgart
ER  - 
TY  - JOUR
A1  - Brahms, Markus
A1  - Heinzel, Stephan
A1  - Rapp, Michael A.
A1  - Mückstein, Marie
A1  - Hortobágyi, Tibor
A1  - Stelzel, Christine
A1  - Granacher, Urs
T1  - The acute effects of mental fatigue on balance performance in healthy young and older adults – A systematic review and meta-analysis
JF  - Acta Psychologica
N2  - Cognitive resources contribute to balance control. There is evidence that mental fatigue reduces cognitive resources and impairs balance performance, particularly in older adults and when balance tasks are complex, for example when trying to walk or stand while concurrently performing a secondary cognitive task.

We conducted a systematic literature search in PubMed (MEDLINE), Web of Science and Google Scholar to identify eligible studies and performed a random effects meta-analysis to quantify the effects of experimentally induced mental fatigue on balance performance in healthy adults. Subgroup analyses were computed for age (healthy young vs. healthy older adults) and balance task complexity (balance tasks with high complexity vs. balance tasks with low complexity) to examine the moderating effects of these factors on fatigue-mediated balance performance.

We identified 7 eligible studies with 9 study groups and 206 participants. Analysis revealed that performing a prolonged cognitive task had a small but significant effect (SMDwm = −0.38) on subsequent balance performance in healthy young and older adults. However, age- and task-related differences in balance responses to fatigue could not be confirmed statistically.

Overall, aggregation of the available literature indicates that mental fatigue generally reduces balance in healthy adults. However, interactions between cognitive resource reduction, aging and balance task complexity remain elusive.
KW  - Cognitive fatigue
KW  - Exertion
KW  - Tiredness
KW  - Postural control
KW  - Gait
KW  - Sway
Y1  - 2022
U6  - https://doi.org/10.1016/j.actpsy.2022.103540
SN  - 1873-6297
VL  - 225
SP  - 1
EP  - 13
PB  - Elsevier
CY  - Amsterdam
ER  - 
TY  - JOUR
A1  - Zech, Hilmar G.
A1  - Reichert, Markus
A1  - Ebner-Priemer, Ulrich W.
A1  - Tost, Heike
A1  - Rapp, Michael A.
A1  - Heinz, Andreas
A1  - Dolan, Raymond J.
A1  - Smolka, Michael N.
A1  - Deserno, Lorenz
T1  - Mobile data collection of cognitive-behavioral tasks in substance use disorders: Where are we now?
JF  - Neuropsychobiology
N2  - Introduction: Over the last decades, our understanding of the cognitive, motivational, and neural processes involved in addictive behavior has increased enormously. A plethora of laboratory-based and cross-sectional studies has linked cognitive-behavioral measures to between-subject differences in drinking behavior. However, such laboratory-based studies inevitably suffer from small sample sizes and the inability to link temporal fluctuations in task measures to fluctuations in real-life substance use. To overcome these problems, several existing behavioral tasks have been transferred to smartphones to allow studying cognition in the field. Method: In this narrative review, we first summarize studies that used existing behavioral tasks in the laboratory and self-reports of substance use with ecological momentary assessment (EMA) in the field. Next, we review studies on psychometric properties of smartphone-based behavioral tasks. Finally, we review studies that used both smartphone-based tasks and self-reports with EMA in the field. Results: Overall, studies were scarce and heterogenous both in tasks and in study outcomes. Nevertheless, existing findings are promising and point toward several methodological recommendations: concerning psychometrics, studies show that - although more systematic studies are necessary - task validity and reliability can be improved, for example, by analyzing several measurement sessions at once rather than analyzing sessions separately. Studies that use tasks in the field, moreover, show that power can be improved by choosing sampling schemes that combine time-based with event-based sampling, rather than relying on time-based sampling alone. Increasing sampling frequency can further increase power. However, as this also increases the burden to participants, more research is necessary to determine the ideal sampling frequency for each task. Conclusion: Although more research is necessary to systematically study both the psychometrics of smartphone-based tasks and the frequency at which task measures fluctuate, existing studies are promising and reveal important methodological recommendations useful for researchers interested in implementing behavioral tasks in EMA studies.
KW  - Ecological momentary assessment
KW  - Behavioral tasks
KW  - Smartphone
KW  - Substance use
KW  - Addiction
Y1  - 2022
U6  - https://doi.org/10.1159/000523697
SN  - 0302-282X
SN  - 1423-0224
VL  - 81
IS  - 5
SP  - 438
EP  - 450
PB  - Karger
CY  - Basel
ER  -