Complementary sensory and associative microcircuitry in primary olfactory cortex.

The three-layered primary olfactory (piriform) cortex is the largest component of the olfactory cortex. Sensory and intracortical inputs converge on principal cells in the anterior piriform cortex (aPC). We characterize organization principles of the sensory and intracortical microcircuitry of layer II and III principal cells in acute slices of rat aPC using laser-scanning photostimulation and fast two-photon population Ca(2+) imaging. Layer II and III principal cells are set up on a superficial-to-deep vertical axis. We found that the position on this axis correlates with input resistance and bursting behavior. These parameters scale with distinct patterns of incorporation into sensory and associative microcircuits, resulting in a converse gradient of sensory and intracortical inputs. In layer II, sensory circuits dominate superficial cells, whereas incorporation in intracortical circuits increases with depth. Layer III pyramidal cells receive more intracortical inputs than layer II pyramidal cells, but with an asymmetric dorsal offset. This microcircuit organization results in a diverse hybrid feedforward/recurrent network of neurons integrating varying ratios of intracortical and sensory input depending on a cell's position on the superficial-to-deep vertical axis. Since burstiness of spiking correlates with both the cell's location on this axis and its incorporation in intracortical microcircuitry, the neuronal output mode may encode a given cell's involvement in sensory versus associative processing.

COVID-19 vaccination rates in hospitalized mentally ill patients compared to the general population in Germany: Results from the COVID Ψ Vac study.

BACKGROUND: Mental illness is known to come along with a large mortality gap compared to thegeneral population and it is a risk for COVID-19 related morbidity andmortality. Achieving high vaccination rates in people with mental illness is therefore important. Reports are conflicting on whether vaccination rates comparable to those of the general population can be achieved and which variables represent risk factors for nonvaccination in people with mental illness. METHODS: The COVID Ψ Vac study collected routine data on vaccination status, diagnostic groups, sociodemographics, and setting characteristics from in- and day-clinic patients of 10 psychiatric hospitals in Germany in August 2021. Logistic regression modeling was used to determine risk factors for nonvaccination. RESULTS: Complete vaccination rates were 59% (n = 776) for the hospitalized patients with mental illness versus 64% for the regionally and age-matched general population. Partial vaccination rates were 68% (n = 893) for the hospitalised patients with mental illness versus 67% for the respective general population and six percentage (n = 74) of this hospitalized population were vaccinated during the hospital stay. Rates showed a large variation between hospital sites. An ICD-10 group F1, F2, or F4 main diagnosis, younger age, and coercive accommodation were further risk factors for nonvaccination in the model. CONCLUSIONS: Vaccination rates were lower in hospitalized people with mental illness than in the general population. By targeting at-risk groups with low-threshold vaccination programs in all health institutions they get in contact with, vaccination rates comparable to those in the general population can be achieved.

To whose good? Directions and gaps in psychiatric research.

BACKGROUND: Psychiatry's evidence-, implementation-, and treatment-gaps. AIMS: The aim of this study is to uncover current trends and gaps in psychiatric research. Understanding where psychiatric research is going and where there might be blind spots is important to better align it with global mental health challenges and with service users' needs. METHOD: 10 top-ranking scientific journals (highest impact factors) in psychiatry were identified for 3 years (1999, 2009, 2019) using Clarivate Analytics. Metadata of all papers published by these journals in the index years were downloaded, and the relevance and relatedness of terms from all titles and abstracts were computed and visualized using VOSviewer. RESULTS: In 1999, prominent themes included schizophrenia and novel antipsychotics as well as research on families. Ten and 20 years later, neurobiological research, especially genetic and animal studies, had gained importance. Social and psychological themes were less present across all three time points. CONCLUSIONS: In high-ranking psychiatric journals, neurobiological research appears to gain importance while social themes are under-represented. In view of challenges such as implementation gaps, marginalization of people with severe mental illness and mental health risks through social inequality, there seems to be a dissociation between research and patient needs. We suggest a systems approach to bring together different kinds of knowledge.

Migration, Identity, and Threatened Mental Health: Examples from Contemporary Fiction.

In 2015, the world saw 244 million international migrants. Migration has been shown to be both a protective and a risk factor for mental health, depending on circumstances. Furthermore, culture has an impact on perceptions and constructions of mental illness and identity, both of which can be challenged through migration. Using a qualitative research approach, we analysed five internationally acclaimed and influential novels and one theatre play that focus on aspects of identity, migration, and threatened mental health. As a mirror of society, fiction can help to understand perceptions of identity and mental suffering on an intrapsychic and societal level, while at the same time society itself can be influenced by works of fiction. Fiction is also increasingly used for didactic purposes in medical education. We found that the works of fiction discussed embrace a multifaceted biopsychosocial concept of mental illness. Constructs such as unstable premigration identity, visible minority status (in the host country) and identity confusion in second-generation migrants are conceptualised as risk factors for mental illness. Factors portrayed as protective comprised a stable premigration identity, being safe with a family member or good friend, (romantic) love, therapeutic writing, art, and the concept of time having an element of simultaneousness. This literature challenges the idiocentric model of identity. Analysing fictional texts on migration experiences can be a promising hypothesis-generating approach for further research.

Increased Treatment Complexity for Major Depressive Disorder for Inpatients With Comorbid Personality Disorder.

OBJECTIVE: The study examined inpatient treatment for major depressive disorder (MDD) when it is complicated by comorbid personality disorder. METHODS: In this descriptive analysis of a large data sample from 2013 (German VIPP data set) of 58,913 cases from 75 hospitals, three groups were compared: patients with MDD, patients with MDD and a comorbid personality disorder, and patients with a main diagnosis of personality disorder. RESULTS: Compared with MDD patients, those with comorbid personality disorder had higher rates of recurrent depression and nearly twice as many readmissions within one year, despite longer mean length of stay. Records of patients with comorbidities more often indicated accounting codes for "complex diagnostic procedures," "crisis intervention," and "constant observation." Patients with comorbid disorders differed from patients with a main diagnosis of personality disorder in treatment indicator characteristics and distribution of personality disorder diagnoses. CONCLUSIONS: Personality disorder comorbidity made MDD treatment more complex, and recurrence of MDD episodes and hospital readmission occurred more often than if patients had a sole MDD diagnosis.

Old man-young man: T.S. Eliot's Gerontion and the problem of identity.

BACKGROUND: In his poem Gerontion (1920) Nobel laureate T.S. Eliot uses powerful language to give a fictional, highly condensed, first-person account of medical and psychological conditions that arise with old age: physical frailty, cognitive decline, sensory impairment, depressive symptoms with embitterment, social withdrawal and the psychological strain of having to face old age and make meaning of one's life. Surprisingly, he wrote the poem as a young man. METHODS: In this qualitative study, we used a hermeneutic approach to interpret Gerontion from a psychiatric perspective. We considered how Gerontion could help us to further an empathic understanding of these mental states, why a young man expresses himself through the voice of an old man and how the depressed-aggressive tone of the poem with its contempt and anti-Semitism can be interpreted. CONCLUSIONS: We concluded that Eliot was grappling with his identity as an American in England, as a sexually inhibited husband to a demanding wife, as a banker and poet and as someone who had witnessed the effects of WWI. Readers of the poem can simultaneously experience the suffering of an old man and the identity crisis of a young man. The poem can thus further insight into the development of contempt and promote empathy and professionalism in dealing with states such as late-life depression. Consequently it is well suited for use in medical classes on these issues, particularly because it is much shorter than a novel or film.

Personal suffering and social criticism in T. S. Eliot's The Waste Land and A. Ginsberg's Howl: Implications for social psychiatry.

BACKGROUND: T. S. Eliot's The Waste Land and A. Ginsberg's Howl are two landmark poems of the 20th century which have a unique way of dealing with emotional suffering. AIMS: (a) To explore the interplay between emotional suffering, conflicting relationships and societal perceptions; (b) to show the therapeutic effect of the writing process; (c) to analyse the portrayal of 'madness'; and (d) to discuss, in contemporary psychiatric terms, the 'solutions' offered by the poets. METHOD: Qualitative research with a narrative, hermeneutic approach. RESULTS: Against the background of wartime/genocide and postwar disillusionment, close relationships are projected onto societal perceptions. Concepts of (self-)control, compassion, empowerment and self-efficacy are offered as solutions to overcome feelings of despair. CONCLUSION: In a time of perceived societal and environmental crises, both poems help us understand people's fears and how to counteract them. Besides biological approaches, the narrative approach to the suffering human being has not lost its significance.

Analysis of excitatory microcircuitry in the medial entorhinal cortex reveals cell-type-specific differences.

Medial entorhinal cortex (MEC) plays an important role in physiological processes underlying navigation, learning, and memory. Excitatory cells in the different MEC layers project in a region-specific manner to the hippocampus. However, the intrinsic microcircuitry of the main excitatory cells in the superficial MEC layers is largely unknown. Using scanning photostimulation, we investigated the functional microcircuitry of two such cell types, stellate and pyramidal cells. We found cell-type-specific intralaminar and ascending interlaminar feedback inputs. The ascending interlaminar inputs display distinct organizational principles depending on the cell-type and its position within the superficial lamina: the spatial spread of inputs for stellate cells is narrower than for pyramidal cells, while inputs to pyramidal cells in layer 3, but not in layer 2, exhibit an asymmetric offset to the medial side of the cell's main axis. Differential laminar sources of excitatory inputs might contribute to the functional diversity of stellate and pyramidal cells.