Asklepios Fachklinikum Tiefenbrunn

Rosdorf bei Gottingen, Germany

Asklepios Fachklinikum Tiefenbrunn

Rosdorf bei Gottingen, Germany
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Hellmann-Regen J.,Charité - Medical University of Berlin | Piber D.,Charité - Medical University of Berlin | Hinkelmann K.,Charité - Medical University of Berlin | Gold S.M.,Universitatsklinikum Hamburg Eppendorf | And 4 more authors.
European Archives of Psychiatry and Clinical Neuroscience | Year: 2013

Depressive syndromes represent a common and often characteristic feature in a number of neurological disorders. One prominent example is the development of post-stroke depression, which can be observed in more than one-third of stroke survivors in the aftermath of an ischemic stroke. Thus, post-stroke depression represents one of the most prevalent, disabling, and potentially devastating psychiatric post-stroke complications. On the other hand, depressive syndromes may also be considered as a risk factor for certain neurological disorders, as recently revealed by a meta-analysis of prospective cohort studies, which demonstrated an increased risk for ischemic events in depressed patients. Moreover, depressive syndromes represent common comorbidities in a number of other neurological disorders such as Parkinson's disease, multiple sclerosis, or epilepsy, in which depression has a strong impact on both quality of life and outcome of the primary neurological disorder. © Springer-Verlag Berlin Heidelberg 2013.

Spitzer C.,Asklepios Fachklinikum Tiefenbrunn | Wingenfeld K.,Charité - Medical University of Berlin | Barnow S.,University of Heidelberg | Grabe H.J.,University of Greifswald
Journal of Psychosomatic Research | Year: 2013

Objective: Rheumatoid arthritis (RA) has been associated with a variety of emotional stressors, but findings remain inconclusive if RA is related to childhood trauma, which is known to have long-lasting negative consequences for physical health decades into adulthood. We investigated the association between childhood trauma and RA by comparing histories of child abuse and neglect between RA patients and adults from the general population in a cross-sectional case-control study. Methods: 331 patients with definite RA and 662 gender- and age-matched adults from the general population were administered the self-report Childhood Trauma Questionnaire (CTQ) for the assessment of emotional, physical and sexual abuse as well as emotional and physical neglect. Results: Adjusting for gender and current depression, RA patients scored significantly higher in all CTQ subscales apart from sexual abuse and physical neglect than the controls. Adjusted odds ratios for these types of childhood trauma were higher in the RA group than in controls ranging from 2.0 for emotional neglect (95% confidence interval [CI]: 1.4-3.0) to 2.6 for emotional abuse (95% CI: 1.4-4.7). Gender-specific analyses revealed basically the same pattern for women, but not for men. Conclusion: Our findings suggest an association between childhood trauma and development of RA, particularly in women. This relationship may be mediated by dysregulations of neuro-endocrine-immune networks, but larger prospective studies are needed to clarify the association between early life stress and the risk for RA in genetically susceptible individuals. © 2012 Elsevier Inc.

Salzer S.,University of Gottingen | Streeck U.,Asklepios Fachklinikum Tiefenbrunn | Jaeger U.,Asklepios Fachklinikum Tiefenbrunn | Masuhr O.,Asklepios Fachklinikum Tiefenbrunn | And 3 more authors.
Journal of Nervous and Mental Disease | Year: 2013

Borderline personality disorder (BPD) is characterized by a wide variety of interpersonal problems. We examined whether there are different characteristic interpersonal patterns in BPD and how these patterns are related to symptom distress and therapeutic alliance. In 228 inpatients with diagnoses of BPD, interpersonal subtypes based on the Inventory of Interpersonal Problems (Horowitz et al., Inventar zur Erfassung Interpersonaler Probleme, 2000) were examined through cluster analyses. The global symptom severity and therapeutic alliance were also assessed. We identified five characteristic interpersonal patterns, which we labeled as follows: Cluster 1, "Vindictive"; Cluster 2, "Moderate Submissive"; Cluster 3, "Nonassertive"; Cluster 4, "Exploitable"; and Cluster 5, "Socially Avoidant." The clusters differed significantly in terms of interpersonal distress, interpersonal differentiation, and severity of global symptoms. The ratings of the therapeutic alliance by therapists during treatment significantly differed between the interpersonal subtypes, and the lowest ratings for patients were in the "Socially Avoidant" cluster. Our results stress the impact of interpersonal style on the appearance and treatment of BPD. Copyright © 2013 by Lippincott Williams &Wilkins.

Sauer C.,University of Heidelberg | Arens E.A.,University of Heidelberg | Stopsack M.,University of Heidelberg | Spitzer C.,Asklepios Fachklinikum Tiefenbrunn | Barnow S.,University of Heidelberg
Psychiatry Research | Year: 2014

Heightened emotional reactivity is one of the core features of borderline personality disorder (BPD). However, recent findings could not provide evidence for a general emotional hyper-reactivity in BPD. The present study examines the emotional responding to self-relevant pictures in dependency of the thematic category (e.g., trauma, interpersonal interaction) in patients with BPD. Therefore, women with BPD (n=31), women with major depression disorder (n=29) and female healthy controls (n=33) rated pictures allocated to thematically different categories (violence, sexual abuse, interaction, non-suicidal self-injury, and suicide) regarding self-relevance, arousal, valence and the urge of non-suicidal self-injury. Compared to both control groups, patients with BPD reported higher self-relevance regarding all categories, but significantly higher emotional ratings only for pictures showing sexual abuse and interpersonal themes. In addition, patients with BPD and comorbid posttraumatic stress disorder showed higher emotional reactivity in violence pictures. Our data provide clear evidence that patients with BPD show a specific emotional hyper-reactivity with respect to schema-related triggers like trauma and interpersonal situations. Future studies are needed to investigate physiological responses to these self-relevant themes in patients with BPD. © 2014 Elsevier Ireland Ltd.

Hinkelmann K.,Charité - Medical University of Berlin | Muhtz C.,University of Hamburg | Dettenborn L.,University of Hamburg | Agorastos A.,University of Hamburg | And 6 more authors.
Psychological Medicine | Year: 2013

Background While impaired memory and altered cortisol secretion are characteristic features of major depression, much less is known regarding the impact of antidepressant medication. We examined whether the cortisol awakening response (CAR) is increased in depressed patients with and without medication compared with healthy controls (HC) and whether CAR is associated with memory function in each group. Method We examined 21 patients with major depression without medication, 20 depressed patients on antidepressant treatment, and 41 age-, sex-and education-matched healthy subjects. We tested verbal (Auditory Verbal Learning Task) and visuospatial (Rey figure) memory and measured CAR on two consecutive days. Results Patient groups did not differ in severity of depression. We found a significant effect of group (p = 0.03) for CAR. Unmedicated patients exhibited a greater CAR compared with medicated patients (p = 0.04) with no differences between patient groups and HC. We found a significant effect of group for verbal (p = 0.03) and non-verbal memory (p = 0.04). Unmedicated patients performed worse compared with medicated patients and HC in both memory domains. Medicated patients and HC did not differ. Regression analyses revealed a negative association between CAR and memory function in depressed patients, but not in HC. Conclusions While in unmedicated depressed patients the magnitude of CAR is associated with impaired memory, medicated patients showed a smaller CAR and unimpaired cognitive function compared with HC. Our findings are compatible with the idea that antidepressants reduce CAR and partially restore memory function even if depressive psychopathology is still present. © 2014 Cambridge University Press .

Kuehl L.K.,Charité - Medical University of Berlin | Hinkelmann K.,Charité - Medical University of Berlin | Muhtz C.,University of Hamburg | Dettenborn L.,University of Hamburg | And 5 more authors.
Psychoneuroendocrinology | Year: 2015

Findings on the association between hypothalamic-pituitary-adrenal (HPA) axis activity and metabolic risk are equivocal. Different methods of measuring HPA activity might indicate adverse vs. beneficial effects of HPA activity on metabolic risk thus contributing to heterogenous findings. In this study, we aimed to determine whether (1) the salivary cortisol awakening response (CAR) as a marker of awakening-induced activation of the HPA axis and (2) hair cortisol as a marker of long-term cortisol secretion are associated with criteria of the metabolic syndrome. Therefore, we recruited 41 healthy individuals (26 women, mean age: 41.2 years) and 44 patients with major depression (28 women, 41.4 years) and assessed CAR and hair cortisol values as well as all criteria of the metabolic syndrome (abdominal obesity, blood pressure, plasma glucose, triglycerides and high-density cholesterol levels) according to the International Diabetes Federation. CAR and hair cortisol values were divided into tertiles. Across groups, participants with hair cortisol or hair cortisone in the highest tertile showed significantly more criteria of the metabolic syndrome compared to participants in the medium or low tertile (F2,64=3.37, p=.04). These results were corroborated by significant positive correlations between mean hair cortisol values with waist circumference (r=.29, p=.03), triglycerides (r=.34, p=.01) and systolic blood pressure (r=.29, p=.04) and between mean hair cortisone and triglycerides (r=.46, p<.01). In contrast, mean CAR values correlated negatively with diastolic (r=-.29, p=.03) and systolic blood pressure (r=-.32, p=.02). Our results indicate that higher hair cortisol and hair cortisone levels but lower CAR values are associated with an unfavorable metabolic and cardiovascular risk profile. © 2014 Elsevier Ltd.

Wingenfeld K.,Franklin University | Wingenfeld K.,University of Hamburg | Driessen M.,Ev. Hospital Bielefeld Bethel | Terfehr K.,University of Hamburg | And 7 more authors.
Psychological Medicine | Year: 2013

Background Stress and cortisol administration are known to have impairing effects on memory retrieval in healthy humans. These effects are reported to be altered in patients with major depressive disorder (MDD) and post-traumatic stress disorder (PTSD) but they have not yet been investigated in borderline personality disorder (BPD). Method In a placebo-controlled cross-over study, 71 women with BPD and 40 healthy controls received either placebo or 10Â mg of hydrocortisone orally before undertaking a declarative memory retrieval task (word list learning) and an autobiographical memory test (AMT). A working memory test was also applied. Results Overall, opposing effects of cortisol on memory were observed when comparing patients with controls. In controls, cortisol had impairing effects on memory retrieval whereas in BPD patients cortisol had enhancing effects on memory retrieval of words, autobiographical memory and working memory. These effects were most pronounced for specificity of autobiographical memory retrieval. Patients with BPD alone and those with co-morbid PTSD showed this effect. We also found that co-morbid MDD influenced the cortisol effects: in this subgroup (BPDÂ +Â MDD) the effects of cortisol on memory were absent. Conclusions The present results demonstrate beneficial effects of acute cortisol elevations on hippocampal-mediated memory processes in BPD. The absence of these effects in patients with co-morbid MDD suggests that these patients differ from other BPD patients in terms of their sensitivity to glucocorticoids (GCs). © 2012 Cambridge University Press.

Dresler T.,University of Tübingen | Dresler T.,University of Würzburg | Attar C.H.,University of Hamburg | Spitzer C.,Asklepios Fachklinikum Tiefenbrunn | And 6 more authors.
Journal of Psychiatric Research | Year: 2012

Although being a standard tool to assess interference effects of disorder-specific words in clinical samples, the neural underpinnings of the emotional Stroop task are still not well understood and have hardly been investigated in experimental case-control studies. We therefore used functional magnetic resonance imaging (fMRI) to examine the attentional bias toward panic-related words in panic disorder (PD) patients and healthy controls. Twenty PD patients (with or without agoraphobia) and 23 healthy controls matched for age and gender performed an event-related emotional Stroop task with panic-related and neutral words while undergoing 3 Tesla fMRI. On the behavioral level, PD patients showed a significant emotional Stroop effect, i.e. color-naming of panic-related words was prolonged compared to neutral words. This effect was not observed in the control group. PD patients further differed from controls on the neural level in showing increased BOLD activity in the left inferior frontal gyrus in response to panic-related relative to neutral words. PD patients showed the expected attentional bias, i.e. an altered processing of disorder-specific stimuli. This emotional Stroop effect was paralleled by increased activation in the left prefrontal cortex which may indicate altered processing of emotional stimulus material. © 2012 Elsevier Ltd.

Crises in adolescence can be explained at least in part by the neurobiological restructurings of the brain that take place in that period. This applies particularly to problems caused by defective control of behaviour and feelings, a lack of control that is associated with defective mentalisation and immediate gratification. Goal-oriented behaviour requires the control of impulses and the delay of gratification, abilities that frequently have to be developed in psychotherapy for this stage of life to turn into a «second chance». The problems referred to are illustrated with reference to the case of a 15-year-old adolescent diagnosed with ADHD. In addition, the author describes the materialisation of a therapeutic process that had a beneficial effect on the young patient.

Fricke-Neef C.,Asklepios Fachklinikum Tiefenbrunn | Spitzer C.,Asklepios Fachklinikum Tiefenbrunn
Nervenarzt | Year: 2013

Classification, diagnostic and therapeutic problems are central to the disease concept of conversion disorders, which are based on the presentation of psychosocial suffering by means of pseudoneurological symptoms without an organic cause. The nosological status in the current diagnostic and statistical manual of mental disorders (DSM-IV) and international classification of diseases (ICD-10) is disputed. Prevalence rates ranging from 0.3 % in the general population to 50 % in high risk clinical samples underline the relevance. Traumatic experiences play a major role in the pathogenesis. High rates of comorbid mental disorders, the danger to end in a chronic course, a high secondary illness gain and a somatic illness concept complicate psychotherapeutic approaches which are clearly indicated. Clinical experiences and open studies indicate that both psychodynamic as well as cognitive-behaviour therapies are effective. © 2013 Springer-Verlag Berlin Heidelberg.

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