Neural oscillatory responses to performance monitoring differ between high- and low-impulsive individuals, but are unaffected by TMS.

Higher impulsivity may arise from neurophysiological deficits of cognitive control in the prefrontal cortex. Cognitive control can be assessed by time-frequency decompositions of electrophysiological data. We aimed to clarify neuroelectric mechanisms of performance monitoring in connection with impulsiveness during a modified Eriksen flanker task in high- (n = 24) and low-impulsive subjects (n = 21) and whether these are modulated by double-blind, sham-controlled intermittent theta burst stimulation (iTBS). We found a larger error-specific peri-response beta power decrease over fronto-central sites in high-impulsive compared to low-impulsive participants, presumably indexing less effective motor execution processes. Lower parieto-occipital theta intertrial phase coherence (ITPC) preceding correct responses predicted higher reaction time (RT) and higher RT variability, potentially reflecting efficacy of cognitive control or general attention. Single-trial preresponse theta phase clustering was coupled to RT in correct trials (weighted ITPC), reflecting oscillatory dynamics that predict trial-specific behavior. iTBS did not modulate behavior or EEG time-frequency power. Performance monitoring was associated with time-frequency patterns reflecting cognitive control (parieto-occipital theta ITPC, theta weighted ITPC) as well as differential action planning/execution processes linked to trait impulsivity (frontal low beta power). Beyond that, results suggest no stimulation effect related to response-locked time-frequency dynamics with the current stimulation protocol. Neural oscillatory responses to performance monitoring differ between high- and low-impulsive individuals, but are unaffected by iTBS.

Trauma exposure therapy in a pregnant woman suffering from complex posttraumatic stress disorder after childhood sexual abuse: risk or benefit?

Background: Mental disorders during pregnancy are common and affect the health of mother and child. Despite a relatively high prevalence rate, treatment options have not been investigated systematically. Particularly symptoms of posttraumatic stress disorder (PTSD) may increase significantly during the course of pregnancy. However, proper guidelines for psychotherapeutic treatment of PTSD during pregnancy do not exist. Objective: In this article, we aimed at discussing the effects of untreated PTSD on pregnancy and postpartum mother-child bonding as well as exposure therapy during pregnancy. Method: To do so, we present the case of a pregnant woman with complex PTSD following childhood sexual abuse. At the time of hospitalization, the patient was pregnant in the second trimester and reported intrusive re-experiencing of the traumatic events, nightmares, anxiety and helplessness as well as an impairing level of irritability during social situations. After a careful discussion of the case within our department and at the annual conference of the German Association of Psychiatry, Psychotherapy and Psychosomatics, we decided to treat the patient with dialectical behavior therapy for PTSD (DBT-PTSD) including exposure therapy under the regular observation of a gynecologist. Psychometric measurements (Davidson Trauma Scale (DTS) and Borderline Symptom- List-23 (BSL-23) were used to observe the course of treatment regarding common PTSD-symptoms and disturbances in self-organization (DSO). Results: The intensity of intrusions and hyperarousal increased from the date of admission, reached the maximum when exposure started and decreased below baseline-level at the end of treatment. Avoidance behavior continually decreased from the beginning until the end of therapy. Decreased BSL-23 values show major improvements regarding DSO. To our knowledge, the course of pregnancy was not affected by treatment-induced psychological and physical symptoms.Conclusions: DBT- PTSD is a potential treatment option for patients suffering from PTSD during pregnancy. Yet, further (epigenetic) research in this field is urgently needed.

 Antecedentes: Los trastornos mentales durante el embarazo son frecuentes y afectan la salud de la madre y el niño. A pesar de las relativamente altas tasas de prevalencia, las opciones de tratamiento aún no han sido investigadas sistemáticamente. Particularmente los síntomas de trastorno de estrés postraumático (TEPT) pueden aumentar significativamente durante el embarazo. Sin embargo, no existen guías adecuadas de tratamientos psicoterapéuticos para el TEPT durante el embarazo.Objetivo: En este artículo, nuestro objetivo fue discutir los efectos del TEPT no tratado en el embarazo y el vínculo madre-hijo postparto, así como la terapia de exposición durante el embarazo.Método: Para ello, presentamos el caso de una mujer embarazada con TEPT complejo por un abuso sexual en su infancia. Al momento de la hospitalización, la paciente estaba cursando su segundo trimestre de embarazo y reportaba re-experimentación intrusiva de los eventos traumáticos, pesadillas, ansiedad y desesperanza así como tambien empeoramiento de los niveles de irritabilidad en situaciones sociales. Tras una discusión cuidadosa del caso en nuestro departamento y en la reunión anual de la Asociación Alemana de Psiquiatría, Psicoterapia y Psicosomática, decidimos tratar a la paciente con terapia dialéctica conductual para TEPT (DBT-TEPT) incluida la terapia de exposición bajo observación regular de un ginecólogo. Se usaron medidas psicométricas (la Escala de Trauma de Davidson (DTS) y la Lista de síntomas Borderline-23 (BSL-23) para observar el curso del tratamiento con respecto a los síntomas comunes de TEPT y las alteraciones en la auto-organización (DSO). Resultados: La intensidad de las intrusiones e hiperalerta aumentaron desde el ingreso, alcanzando un máximo cuando la exposición comenzó y disminuyeron bajo el nivel basal al final del tratamiento. La conducta evitativa disminuyó continuamente desde el inicio hasta el final de la terapia. Los valores disminuidos del BSL-23 muestran una mejoría importante en relación a la DSO. Hasta donde, el curso del embarazo no se afectó por los síntomas psicológicos y físicos inducidos por el tratamiento. Conclusiones: La DBT-TEPT es una opción de tratamiento potencial para pacientes que sufren de TEPT durante el embarazo. Sin embargo, se necesitan con urgencia más investigaciones (epigenéticas) en este campo.

Performance monitoring and post-error adjustments in adults with attention-deficit/hyperactivity disorder: an EEG analysis

Background: Recently, research into attention-deficit/hyperactivity disorder (ADHD) has focused increasingly on its neurobiological underpinnings, revealing (among other things) frontal lobe alterations. Specifically, action-monitoring deficits have been described, including impaired behavioural adjustments following errors. Our aim was to examine the neurophysiological background of post-error behavioural alterations in an adult ADHD sample for the first time, hypothesizing that people with ADHD would differ from controls in neurophysiological markers of cognitive preparation and stimulus processing, specifically following errors. Methods: In total, 34 people with ADHD and 34 controls participated in an electroencephalography measurement while performing a flanker task. The final number of electroencephalography samples included in the analyses ranged from 23 to 28. We recorded event-related potentials for the erroneous response itself (error-related negativity) and for events following errors (intertrial interval: contingent negative variation; next flanker stimulus: P300). Results: Over frontal electrode sites, error-related negativity amplitudes were significantly reduced in people with ADHD across response conditions. Both groups showed reduced P300 amplitudes on flanker stimuli following errors. Moreover, during the intertrial interval, patients exhibited significantly reduced contingent negative variation, specifically following errors. At the behavioural level, we observed no significant group differences in post-error data. Limitations: Only adults were examined (no longitudinal data). Conclusion: Based on previous reports of post-error behavioural alterations in childhood samples, we conclude that people with ADHD develop compensatory strategies across the lifespan that lead to inconspicuous post-error behaviour in adulthood. Neurophysiologically, however, subtle alterations remain, indicating a perseverance of at least some frontal lobe deficits in people with ADHD who are partially medicated, particularly with respect to action-monitoring and post-error adaptation.

Neurobiological and clinical effects of fNIRS-controlled rTMS in patients with panic disorder/agoraphobia during cognitive-behavioural therapy.

BACKGROUND: A relevant proportion of patients with panic disorder (PD) does not improve even though they receive state of the art treatment for anxiety disorders such as cognitive-behavioural therapy (CBT). At the same time, it is known, that from a neurobiological point of view, PD patients are often characterised by prefrontal hypoactivation. Intermittent Theta Burst Stimulation (iTBS) is a non-invasive type of neurostimulation which can modulate cortical activity and thus has the potential to normalise prefrontal hypoactivity found in PD. We therefore aimed at investigating the effects of iTBS as an innovative add-on to CBT in the treatment for PD. METHODS: In this double-blind, bicentric study, 44 PD patients, randomised to sham or verum stimulation, received 15 sessions of iTBS over the left prefrontal cortex (PFC) in addition to 9 weeks of group CBT. Cortical activity during a cognitive as well as an emotional (Emotional Stroop) paradigm was assessed both at baseline and post-iTBS treatment using functional near-infrared spectroscopy (fNIRS) and compared to healthy controls. RESULTS: In this manuscript we only report the results of the emotional paradigm; for the results of the cognitive paradigm please refer to Deppermann et al. (2014). During the Emotional Stroop test, PD patients showed significantly reduced activation to panic-related compared to neutral stimuli for the left PFC at baseline. Bilateral prefrontal activation for panic-related stimuli significantly increased after verum iTBS only. Clinical ratings significantly improved during CBT and remained stable at follow-up. However, no clinical differences between the verum- and sham-stimulated group were identified, except for a more stable reduction of agoraphobic avoidance during follow-up in the verum iTBS group. LIMITATIONS: Limitations include insufficient blinding, the missing control for possible state-dependent iTBS effects, and the timing of iTBS application during CBT. CONCLUSION: Prefrontal hypoactivity in PD patients was normalised by add-on iTBS. Clinical improvement of anxiety symptoms was not affected by iTBS.

State-dependent altered connectivity in late-life depression: a functional near-infrared spectroscopy study.

There is a large body of evidence showing a substantial relationship between depression and deficits in cognitive functioning. Especially in late-life depression, cognitive impairments are associated with worse treatment progress and are considered a risk factor for neurodegenerative disorders. However, little is known about the differences in neural processing and coupling during rest and cognitive functions in patients with late-life depression compared to healthy elderly individuals. The study at hand aims to investigate the cognitive control network in late-life depression during a cognitive task and at rest by means of functional near-infrared spectroscopy. Hemodynamic responses were measured at rest and during the Trail Making Test using functional near-infrared spectroscopy in a matched sample of 49 depressed and 51 nondepressed elderly subjects (age range: 51-83 years; 64.1 ± 6.58 [mean ± standard deviation]). Functional connectivity (FC) and network metrics were derived from the data and analyzed with respect to differences between the subject groups. Depressed and nondepressed subjects showed significant differences in FC both at rest and during task performance. Depressed subjects showed reduced FC in a left frontopolar cortical network during task performance and increased FC in a left frontoparietal cortical network at rest. Depressed elderly subjects showed altered FC and network organization during different mental states. Higher FC at rest may be an indicator of self-referential processes such as rumination that may reduce FC during task performance due to an overtaxed executive control system.

Does rTMS alter neurocognitive functioning in patients with panic disorder/agoraphobia? An fNIRS-based investigation of prefrontal activation during a cognitive task and its modulation via sham-controlled rTMS.

OBJECTIVES: Neurobiologically, panic disorder (PD) is supposed to be characterised by cerebral hypofrontality. Via functional near-infrared spectroscopy (fNIRS), we investigated whether prefrontal hypoactivity during cognitive tasks in PD-patients compared to healthy controls (HC) could be replicated. As intermittent theta burst stimulation (iTBS) modulates cortical activity, we furthermore investigated its ability to normalise prefrontal activation. METHODS: Forty-four PD-patients, randomised to sham or verum group, received 15 iTBS-sessions above the left dorsolateral prefrontal cortex (DLPFC) in addition to psychoeducation. Before first and after last iTBS-treatment, cortical activity during a verbal fluency task was assessed via fNIRS and compared to the results of 23 HC. RESULTS: At baseline, PD-patients showed hypofrontality including the DLPFC, which differed significantly from activation patterns of HC. However, verum iTBS did not augment prefrontal fNIRS activation. Solely after sham iTBS, a significant increase of measured fNIRS activation in the left inferior frontal gyrus (IFG) during the phonological task was found. CONCLUSION: Our results support findings that PD is characterised by prefrontal hypoactivation during cognitive performance. However, verum iTBS as an "add-on" to psychoeducation did not augment prefrontal activity. Instead we only found increased fNIRS activation in the left IFG after sham iTBS application. Possible reasons including task-related psychophysiological arousal are discussed.