Differential methylation of OPRK1 in borderline personality disorder is associated with childhood trauma.

According to a growing body of neurobiological evidence, the core symptoms of borderline personality disorder (BPD) may be linked to an opioidergic imbalance between the hedonic and stimulatory activity of mu opioid receptors (MOR) and the reward system inhibiting effects of kappa opioid receptors (KOR). Childhood trauma (CT), which is etiologically relevant to BPD, is also likely to lead to epigenetic and neurobiological adaptations by extensive activation of the stress and endogenous opioid systems. In this study, we investigated the methylation differences in the promoter of the KOR gene (OPRK1) in subjects with BPD (N = 47) and healthy controls (N = 48). Comparing the average methylation rates of regulatorily relevant subregions (specified regions CGI-1, CGI-2, EH1), we found no differences between BPD and HC. Analyzing individual CG nucleotides (N = 175), we found eight differentially methylated CG sites, all of which were less methylated in BPD, with five showing highly interrelated methylation rates. This differentially methylated region (DMR) was found on the falling slope (5') of the promoter methylation gap, whose effect is enhanced by the DMR hypomethylation in BPD. A dimensional assessment of the correlation between disease severity and DMR methylation rate revealed DMR hypomethylation to be negatively associated with BPD symptom severity (measured by BSL-23). Finally, analyzing the influence of CT on DMR methylation, we found DMR hypomethylation to correlate with physical and emotional neglect in childhood (quantified by CTQ). Thus, the newly identified DMR may be a biomarker of the risks caused by CT, which likely epigenetically contribute to the development of BPD.

Smaller total and subregional cerebellar volumes in posttraumatic stress disorder: a mega-analysis by the ENIGMA-PGC PTSD workgroup.

Although the cerebellum contributes to higher-order cognitive and emotional functions relevant to posttraumatic stress disorder (PTSD), prior research on cerebellar volume in PTSD is scant, particularly when considering subregions that differentially map on to motor, cognitive, and affective functions. In a sample of 4215 adults (PTSD n = 1642; Control n = 2573) across 40 sites from the ENIGMA-PGC PTSD working group, we employed a new state-of-the-art deep-learning based approach for automatic cerebellar parcellation to obtain volumetric estimates for the total cerebellum and 28 subregions. Linear mixed effects models controlling for age, gender, intracranial volume, and site were used to compare cerebellum volumes in PTSD compared to healthy controls (88% trauma-exposed). PTSD was associated with significant grey and white matter reductions of the cerebellum. Compared to controls, people with PTSD demonstrated smaller total cerebellum volume, as well as reduced volume in subregions primarily within the posterior lobe (lobule VIIB, crus II), vermis (VI, VIII), flocculonodular lobe (lobule X), and corpus medullare (all p-FDR < 0.05). Effects of PTSD on volume were consistent, and generally more robust, when examining symptom severity rather than diagnostic status. These findings implicate regionally specific cerebellar volumetric differences in the pathophysiology of PTSD. The cerebellum appears to play an important role in higher-order cognitive and emotional processes, far beyond its historical association with vestibulomotor function. Further examination of the cerebellum in trauma-related psychopathology will help to clarify how cerebellar structure and function may disrupt cognitive and affective processes at the center of translational models for PTSD.

Amygdala-related electrical fingerprint is modulated with neurofeedback training and correlates with deep-brain activation: proof-of-concept in borderline personality disorder.

BACKGROUND: The modulation of brain circuits of emotion is a promising pathway to treat borderline personality disorder (BPD). Precise and scalable approaches have yet to be established. Two studies investigating the amygdala-related electrical fingerprint (Amyg-EFP) in BPD are presented: one study addressing the deep-brain correlates of Amyg-EFP, and a second study investigating neurofeedback (NF) as a means to improve brain self-regulation. METHODS: Study 1 combined electroencephalography (EEG) and simultaneous functional magnetic resonance imaging to investigate the replicability of Amyg-EFP-related brain activation found in the reference dataset (N = 24 healthy subjects, 8 female; re-analysis of published data) in the replication dataset (N = 16 female individuals with BPD). In the replication dataset, we additionally explored how the Amyg-EFP would map to neural circuits defined by the research domain criteria. Study 2 investigated a 10-session Amyg-EFP NF training in parallel to a 12-weeks residential dialectical behavior therapy (DBT) program. Fifteen patients with BPD completed the training, N = 15 matched patients served as DBT-only controls. RESULTS: Study 1 replicated previous findings and showed significant amygdala blood oxygenation level dependent activation in a whole-brain regression analysis with the Amyg-EFP. Neurocircuitry activation (negative affect, salience, and cognitive control) was correlated with the Amyg-EFP signal. Study 2 showed Amyg-EFP modulation with NF training, but patients received reversed feedback for technical reasons, which limited interpretation of results. CONCLUSIONS: Recorded via scalp EEG, the Amyg-EFP picks up brain activation of high relevance for emotion. Administering Amyg-EFP NF in addition to standardized BPD treatment was shown to be feasible. Clinical utility remains to be investigated.

[Diagnosis and admission center : Establishment and evaluation of an integrated translational infrastructure for clinical psychiatric research]. / Diagnose- und Aufnahmezentrum : Etablierung und Evaluation einer integrierten translationalen Infrastruktur für die klinisch-psychiatrische Forschung.

The routine in-depth characterization of patients with methods of clinical and scale-based examination, neuropsychology, based on biomaterials, and sensor-based information opens up transformative possibilities on the way to personalized diagnostics, treatment and prevention in psychiatry, psychotherapy, and psychosomatics. Effective integration of the additional temporal and logistical effort into everyday care as well as the acceptance by patients are critical to the success of such an approach but there is little evidence on this to date. We report here on the establishment of the Diagnosis and Admission Center (DAZ) at the Central Institute of Mental Health (ZI) in Mannheim. The DAZ is an outpatient unit upstream of other care structures for clinical and scientific phenotyping across diagnoses as a starting point for data-driven, individualized pathways to further treatment, diagnostics or research. We describe the functions, goals, and implementation of the newly created clinical scientific translational structure, provide an overview of the patient populations it has reached, and provide data on its acceptance. In this context, the close integration with downstream clinical processes enables a better coordinated and demand-oriented allocation. In addition, DAZ enables a faster start of disorder-specific diagnostics and treatment. Since its launch in April 2021 up to the end of 2022, 1021 patients underwent psychiatric evaluation at DAZ during a pilot phase. The patient sample corresponded to a representative sample from standard care and the newly established processes were regarded as helpful by patients. In summary, the DAZ uniquely combines the interests and needs of patient with the collection of scientifically relevant data.

Incidental learning of faces during threat: No evidence for enhanced physiological responses to former threat identities.

Remembering an unfamiliar person and the contextual conditions of that encounter is important for adaptive future behavior, especially in a potentially dangerous situation. Initiating defensive behavior in the presence of former dangerous circumstances can be crucial. Recent studies showed selective electrocortical processing of faces that were previously seen in a threat context compared to a safety context, however, this was not reflected in conscious recognition performance. Here, we investigated whether previously seen threat-faces, that could not be remembered, were capable to activate defensive psychophysiological response systems. During an encoding phase, 50 participants with low to moderate levels of anxiety viewed 40 face pictures with neutral expressions (6 s each), without an explicit learning instruction (incidental learning task). Each half of the faces were presented with contextual background colors that signaled either threat-of-shock or safety. In the recognition phase, all old and additional new faces (total of 60) were presented intermixed without context information. Participants had to decide whether a face was new or had been presented previously in a threatening or a safe context. Results show moderate face recognition independent of context conditions. Startle reflex and skin conductance responses (SCR) were more pronounced for threat compared to safety during encoding. For SCR, this differentiation was enhanced with higher levels of depression and anxiety. There were no differential startle reflex or SCR effects during recognition. From a clinical perspective, these findings do not support the notion that perceptual biases and physiological arousal directly relate to threat-associated identity recognition deficits in healthy and clinical participants with anxiety and trauma-related disorders.

Treating nightmares in posttraumatic stress disorder with dronabinol: study protocol of a multicenter randomized controlled study (THC PTSD-trial).

BACKGROUND: Distressing nightmares are a core symptom of posttraumatic stress disorder (PTSD) and contribute to psychiatric comorbidity, impaired physical health and decreased social functioning. No specific pharmacological treatment for PTSD-related nightmares is yet approved. Preliminary clinical data indicate that cannabinoid agonists can improve nightmares and overall PTSD symptoms in patients with PTSD. The primary objective of the study is to examine the efficacy of oral dronabinol (BX-1) versus placebo in reducing nightmares in patients with PTSD. The secondary objectives of the study are to examine the efficacy of oral BX-1 in reducing other PTSD symptoms. METHODS: The study is designed as a multi-centric, double-blind, randomized (1:1), placebo-controlled, parallel group interventional trial. Eligible patients will be randomized to BX-1 or placebo, receiving a once-daily oral dose before bedtime for 10 weeks. Primary efficacy endpoint is the Clinician-Administered PTSD Scale (CAPS-IV) B2 score for the last week, measuring frequency and intensity of nightmares. Secondary efficacy endpoints are other disorder-specific symptoms in patients with PTSD. Further, tolerability and safety of dronabinol will be assessed. DISCUSSION: This randomized controlled trial will provide evidence whether treating patients with PTSD and nightmares with dronabinol is safe and efficacious. TRIAL REGISTRATION: NCT04448808, EudraCT 2019-002211-25.

Does the Augmentation of Trauma Informed Hatha Yoga Increase the Effect of Dialectical Behavior Therapy for Substance Use Disorders on Psychopathological Strain of Patients with Borderline Personality Disorder and Comorbid Substance Use Disorder? Results of a Quasi-Experimental Study.

BACKGROUND: Borderline personality disorder (BPD) is one of the most common personality disorders among persons with substance use disorders (SUDs) and is characterized by severe clinical symptoms. The aim of this study was to investigate if the effect of dialectical behavior therapy for substance use disorders (DBT-S) inpatient treatment on psychopathological symptom load in patients suffering from both BPD and SUD can be augmented by weekly 60-min "Trauma Informed Hatha Yoga" sessions. MATERIALS AND METHODS: Thirty-nine patients suffering from comorbid BPD and SUD were consecutively in time included in this quasi-experimental pilot study (first intervention then control group). In the intervention group, weekly Trauma Informed Hatha Yoga sessions were added to standard DBT-S for 8 weeks. The participants of the control group received standard DBT-S. All participants completed several self-report questionnaires to assess symptoms of depression, anxiety, symptoms of BPD, and their subjective stress perception at three points in time during the study course. RESULTS: A repeated measures analysis of variance with patients' psychopharmacological medication as covariate revealed a significant main effect of time for each of the psychometric scales (State and Trait Anxiety Inventory subscale for state anxiety [STAI-S] p = 0.001, Beck Depression Inventory [BDI] p < 0.001; Borderline Symptom List 23 [BSL] p = 0.036) indicating that the psychopathological symptom load of the patients was significantly lower at the end of the DBT-S therapy compared to the beginning in both study groups. Moreover, there was a significant interaction effect of group*time on the psychometric scales STAI-T (subscale for trait anxiety) sum score (p = 0.010) and the sum score of the Perceived Stress Scale (PSS) (p = 0.043). This was expressed by the fact that the participants of the intervention group showed a significant reduction of the STAI-T sum score as well as the sum score of the Perceived Stress Scale (PSS), while the control group did not. Due to the exploratory nature of this study, correction for multiple testing was omitted. CONCLUSION: Although they are very preliminary, our results suggest that practicing Trauma Informed Hatha Yoga on a regular basis in addition to DBT-S inpatient treatment seems to reduce the level of trait anxiety and perceived stress significantly more than DBT-S inpatient treatment alone. Nevertheless, the effectiveness of Trauma Informed Hatha Yoga in reducing trait anxiety and perceived stress in patients suffering from SUD und BPD must be tested in large randomized controlled trials.

[Evidence-based inpatient psychotherapy in borderline personality disorder]. / Evidenzbasierte stationäre Psychotherapie der Borderline-Persönlichkeitsstörung.

BACKGROUND: Borderline personality disorder (BPD) is frequent (prevalence in Germany between 0.7% and 4.5%) [11] and is associated with a high level of psychological stress and frequent emergency inpatient admissions. The provision of disorder-specific outpatient psychotherapy is still insufficient also in Germany. OBJECTIVE: This article provides an overview of the available data on the effectiveness of inpatient psychotherapy for BPD. MATERIAL AND METHODS: A qualitative review on the effectiveness and therapy outcome predictors was conducted based on a literature search in PubMed. RESULTS: Overall, very few randomized controlled trials are available; in contrast uncontrolled studies are predominant. Most evidence is available for dialectical behavior therapy (DBT) but other approaches, including psychodynamic procedures, have also been studied. DISCUSSION: The currently available data suggest an efficacy of inpatient psychotherapy for BPD; however, randomized trials with larger samples and sufficient representation including male patients are largely lacking. There is also no substantial direct evidence for the superiority of inpatient compared to outpatient psychotherapy.

Survey on Open Science Practices in Functional Neuroimaging.

Replicability and reproducibility of scientific findings is paramount for sustainable progress in neuroscience. Preregistration of the hypotheses and methods of an empirical study before analysis, the sharing of primary research data, and compliance with data standards such as the Brain Imaging Data Structure (BIDS), are considered effective practices to secure progress and to substantiate quality of research. We investigated the current level of adoption of open science practices in neuroimaging and the difficulties that prevent researchers from using them. Email invitations to participate in the survey were sent to addresses received through a PubMed search of human functional magnetic resonance imaging studies that were published between 2010 and 2020. 283 persons completed the questionnaire. Although half of the participants were experienced with preregistration, the willingness to preregister studies in the future was modest. The majority of participants had experience with the sharing of primary neuroimaging data. Most of the participants were interested in implementing a standardized data structure such as BIDS in their labs. Based on demographic variables, we compared participants on seven subscales, which had been generated through factor analysis. Exploratory analyses found that experienced researchers at lower career level had higher fear of being transparent and researchers with residence in the EU had a higher need for data governance. Additionally, researchers at medical faculties as compared to other university faculties reported a more unsupportive supervisor with regards to open science practices and a higher need for data governance. The results suggest growing adoption of open science practices but also highlight a number of important impediments.

Borderline personality disorder.

Borderline personality disorder (BPD) is a mental disorder with a high burden on patients, family members, and health-care systems. The condition was previously regarded as untreatable, but progress in understanding and management has resulted in earlier diagnosis and better treatment outcomes. A coherent syndrome of BPD typically onsets during adolescence (after age 12 years). BPD is often preceded by or co-develops with symptoms of internalising disorders (depression and anxiety), externalising disorders (conduct problems, hyperactivity, and substance use), or both. BPD is associated with various poor outcomes, including low occupational and educational attainment, lack of long-term relationships, increased partner conflict, sexual risk-taking, low levels of social support, low life satisfaction, and increased service use. Psychotherapy is the main treatment for BPD; drug treatment is only indicated for comorbid conditions that require medication, or during a crisis if psychosocial interventions are insufficient. Awareness of BPD by non-specialists, as well as specialists, is key to appropriate early intervention.

Behavioral and neurophysiological correlates of emotional face processing in borderline personality disorder: are there differences between men and women?

Emotional dysregulation is a core feature of borderline personality disorder (BPD); it is, for example, known to influence one's ability to read other people's facial expressions. We investigated behavioral and neurophysiological foundations of emotional face processing in individuals with BPD and in healthy controls, taking participants' sex into account. 62 individuals with BPD (25 men, 37 women) and 49 healthy controls (20 men, 29 women) completed an emotion classification task with faces depicting blends of angry and happy expressions while the electroencephalogram was recorded. The cortical activity (late positive potential, P3/LPP) was evaluated using source modeling. Compared to healthy controls, individuals with BPD responded slower to happy but not to angry faces; further, they showed more anger ratings in happy but not in angry faces, especially in those with high ambiguity. Men had lower anger ratings than women and responded slower to angry but not happy faces. The P3/LPP was larger in healthy controls than in individuals with BPD, and larger in women than in men; moreover, women but not men produced enlarged P3/LPP responses to angry vs. happy faces. Sex did not interact with behavioral or P3/LPP-related differences between healthy controls and individuals with BPD. Together, BPD-related alterations in behavioral and P3/LPP correlates of emotional face processing exist in both men and women, supposedly without sex-related interactions. Results point to a general 'negativity bias' in women. Source modeling is well suited to investigate effects of participant and stimulus characteristics on the P3/LPP generators.

An Investigation of Awareness and Metacognition in Neurofeedback with the Amygdala Electrical Fingerprint.

Awareness theory posits that individuals connected to a brain-computer interface can learn to estimate and discriminate their brain states. We used the amygdala Electrical Fingerprint (amyg-EFP) - a functional Magnetic Resonance Imaging-inspired Electroencephalogram surrogate of deep brain activation - to investigate whether participants could accurately estimate their own brain activation. Ten participants completed up to 20 neurofeedback runs and estimated their amygdala-EFP activation (depicted as a thermometer) and confidence in this rating during each trial. We analysed data using multilevel models, predicting the real thermometer position with participant rated position and adjusted for activation during the previous trial. Hypotheses on learning regulation and improvement of estimation were not confirmed. However, participant ratings were significantly associated with the amyg-EFP signal. Higher rating accuracy also predicted higher subjective confidence in the rating. This proof-of-concept study introduces an approach to study awareness with fMRI-informed neurofeedback and provides initial evidence for metacognition in neurofeedback.

Efficacy of dialectical behavior therapy for adolescent self-harm and suicidal ideation: a systematic review and meta-analysis.

BACKGROUND: Given the widespread nature and clinical consequences of self-harm and suicidal ideation among adolescents, establishing the efficacy of developmentally appropriate treatments that reduce both self-harm and suicidal ideation in the context of broader adolescent psychopathology is critical. METHODS: We conducted a systematic review and meta-analysis of the Dialectical Behaviour Therapy for Adolescents (DBT-A) literature on treating self-injury in adolescents (12-19 years). We searched for eligible trials and treatment evaluations published prior to July 2020 in MEDLINE/PubMed, Scopus, Google Scholar, EMBASE, and the Cochrane Library databases for clinical trials. Twenty-one studies were identified [five randomized-controlled trials (RCTs), three controlled clinical trials (CCTs), and 13 pre-post evaluations]. We extracted data for predefined primary (self-harm, suicidal ideation) and secondary outcomes (borderline personality symptoms; BPD) and calculated treatment effects for RCTs/CCTs and pre-post evaluations. This meta-analysis was pre-registered with OSF: osf.io/v83e7. RESULTS: Overall, the studies comprised 1673 adolescents. Compared to control groups, DBT-A showed small to moderate effects for reducing self-harm (g = -0.44; 95% CI -0.81 to -0.07) and suicidal ideation (g = -0.31, 95% CI -0.52 to -0.09). Pre-post evaluations suggested large effects for all outcomes (self-harm: g = -0.98, 95% CI -1.15 to -0.81; suicidal ideation: g = -1.16, 95% CI -1.51 to -0.80; BPD symptoms: g = -0.97, 95% CI -1.31 to -0.63). CONCLUSIONS: DBT-A appears to be a valuable treatment in reducing both adolescent self-harm and suicidal ideation. However, evidence that DBT-A reduces BPD symptoms was only found in pre-post evaluations.

Dissociation in Borderline Personality Disorder: Recent Experimental, Neurobiological Studies, and Implications for Future Research and Treatment.

PURPOSE OF REVIEW: The aim of this review article is to give an overview over recent experimental neurobiological research on dissociation in borderline personality disorder (BPD), in order to inform clinicians and to stimulate further research. First, we introduce basic definitions and models that conceptualize dissociation from a transdiagnostic perspective. Then, we discuss recent findings in BPD. RECENT FINDINGS: Stress-related dissociation is a key symptom of BPD, closely linked to other core domains of the disorder (emotion dysregulation, identity disturbances, and interpersonal disturbances). The understanding of neurobiological correlates of dissociation across different psychiatric disorders (e.g., dissociative disorders, post-traumatic stress disorder) is steadily increasing. At the same time, studies explicitly focusing on dissociation in BPD are still scarce. There is evidence for adverse effects of dissociation on affective-cognitive functioning (e.g., interference inhibition), body perception, and psychotherapeutic treatment response in BPD. On the neural level, increased activity in frontal regions (e.g., inferior frontal gyrus) and temporal areas (e.g., inferior and superior temporal gyrus) during symptom provocation tasks and during resting state was observed, although findings are still diverse and need to be replicated. Conceptual differences and methodological differences in study designs and sample characteristics (e.g., comorbidities, trauma history) hinder a straightforward interpretation and comparison of studies. Given the potentially detrimental impact of dissociation in BPD, more research on the topic is strongly needed to deepen the understanding of this complex clinical condition.

[DBT-PTSD-EA: treatment of posttraumatic stress disorder after interpersonal traumatization in childhood in adolescents with borderline personality disorders : A pilot study]. / DBT-PTSD-EA: Behandlung der posttraumatischen Belastungsstörung nach interpersoneller Traumatisierung in der Kindheit bei Adoleszenten mit Borderline-Symptomatik : Eine Pilotstudie.

BACKGROUND: Recent meta-analyses have shown that posttraumatic stress disorder (PTSD) in adolescents and young adults can be effectively treated; however, there is a lack of studies that investigated the efficacy of psychotherapy in the clinically important group of adolescents with PTSD related to childhood sexual and/or physical abuse and co-occurring symptoms of borderline personality disorder (BPD). OBJECTIVE: The aim of this study was a first evaluation of the efficacy of a specifically developed trauma-focused treatment (DBT-PTSD-EA) for adolescent patients with PTSD and BPD symptoms after interpersonal violence in childhood and adolescence. METHODS: Validated questionnaires including the Davidson trauma scale (DTS), the borderline symptom list (BSL-23) and the Beck depression inventory (BDI-II) were used to assess treatment-related changes in psychopathology in 39 treatment-seeking adolescents with a diagnosis of PTSD and symptoms of BPD after childhood sexual and/or physical abuse. The diagnoses were established from standardized clinical interviews. The analyses were primarily based on pre-to-post comparisons of all patients who were included (intent to treat analyses, ITT). RESULTS AND DISCUSSION: Significant improvements were observed in all questionnaires including PTSD severity, intrusive re-experiencing, hyperarousal, PTSD-related avoidance, severity of BPD and depressive symptoms. The pre-post effect sizes were large for the DTS total score (Cohen's d = 1.24) and medium to large for both the BSL-23 (d = 0.69) and the BDI-II (d = 0.72). While these results are very promising, the validity is limited by the lack of a control group.

[Treatment of disorders of emotion regulation in the Adolescents Center at the Central Intitute of Mental Health]. / Behandlung von Störungen der Emotionsregulation im Adoleszentenzentrum am Zentralinstitut für Seelische Gesundheit.

Severe disorders of emotion regulation, e.g. in the context of mental illnesses, such as borderline disorders, attention deficit hyperactivity disorder (ADHD) and complex posttraumatic stress disorder (PTSD), often begin in childhood and adolescence and influence the psychosocial development of those affected, often into adulthood. Professional treatment therefore often requires longer term planning, if possible from a single source. The sectorized structure of the current psychiatric healthcare system, however, makes this process more difficult or is even a hindrance and promotes high hospitalization rates and chronification. The concept of the Adolescents Center for Disorders of Emotion Regulation at the Central Institute of Mental Health functions as a model concept for long-term, cross-sectoral treatment structures. A constant treatment team from child, adolescent and adult psychiatry and psychotherapy provides evidence-based psychotherapy according to the guidelines of dialectical behavior therapy (DBT) for those affected between the ages of 16 and 24 years. Conceptually, inpatient, day care and staged outpatient treatment modules complement each other in order to not only provide psychotherapy to the young patients in this important phase of life but also to accompany and support them in completing school and training, in partnership and independent living.

Contextual source information modulates neural face processing in the absence of conscious recognition: A threat-of-shock study.

Often the source of information is as important as the information itself. The present study examined the impact of contextual threat and safety signals (source information) on memory encoding and recognition of faces (item information). In two experimental sessions, 30 participants viewed neutral face pictures. In the encoding session, 60 faces were presented with contextual background colors (blue or green, 30 pictures each) which were verbally instructed to signal either threat-of-shock or safety. In the recognition session, the 60 old faces intermixed with 30 new faces were shown while a combined old/new recognition and source memory task was performed. During the encoding session, face processing varied as a function of contextual source information. Confirming successful threat-of-shock manipulation, threatening compared to safe face-context compounds revealed differential neural processing (early parieto-occipital and late fronto-central negativity) as well as pronounced threat ratings. During the recognition session, participants had serious problems identifying old from new faces with poor source memory. Intriguingly, however, brain activity differentiated previously seen faces from newly presented pictures (old/new ERP effect). Moreover, old faces presented within a threat context were associated with distributed late negativities compared to old safe faces. Thus, threat effects not only emerged during face encoding (incidental learning) but also during face recognition, although no valid judgements could be made regarding the threatening or safe sources. These findings support the notion that contextual source information critically modulates person perception and recognition as a form of an expectation based remembering in the absence of conscious recognition.

[Borderline Personality Disorders]. / Borderline-Persönlichkeitsstörungen.

Borderline Personality Disorders Abstract. Within the framework of the German task force "Transitional Psychiatry" (DGKJP and DGPPN), a group of experts discussed the significance of adolescence for the mental healthcare of Borderline Personality Disorder (BPD) in Germany. They identified particular gaps and problems within the following areas: early detection, access to specific outpatient psychotherapy, prolonged inpatient treatment, and polypharmacy. The authors then describe various recommendations and demands regarding the generation and dissemination of knowledge about BPD as well as potential adaptations within the German healthcare system.

[Development of an Online Intervention for Adolescents and Young Adults Engaging in Nonsuicidal Self-injury]. / Entwicklung einer Online-Intervention für die Versorgung von sich selbstverletzenden Jugendlichen und jungen Erwachsenen.

Development of an Online Intervention for Adolescents and Young Adults Engaging in Nonsuicidal Self-injury Nonsuicidal self-injury (NSSI) is a prevalent phenomenon in adolescence. Despite the existence of effective psychotherapeutic interventions, the majority of affected adolescents and young adults do not receive any treatment. Structural (e. g., no specific interventions, limited resources, limited accessibility) as well as individual factors (e. g., low help-seeking behavior) impede access to adequate clinical care for adolescent NSSI. Online interventions offer the possibility to provide specific interventions independent of one's location or local healthcare structures. Because of its high confidentiality and accessibility, the Internet also reaches adolescents with low help-seeking behavior. There is already evidence for online interventions concerning different mental health issues, like depression and anxiety. However, regarding NSSI, there are no effective, online interventions. Thus, we developed an online intervention based on an already evaluated short term program specific for adolescents and young adults with NSSI within the German STAR consortium (STAR: Self-Injury - Treatment, Assessment, Recovery). Within a randomised controlled trial, the intervention will be evaluated regarding its efficacy.

fMRI neurofeedback in emotion regulation: A literature review.

OBJECTIVES: Emotion regulation is one of the most prevalent objectives for real-time fMRI neurofeedback (rt-fMRI-NF) studies. The existing studies differ in a number of methodological parameters. This study provides a literature review of the main parameters and results of studies using rt-fMRI-NF for emotion regulation enhancement. METHOD: A search of the Web of Science database up through November 8, 2018, identified 144 articles written in English, 89 of which were excluded as irrelevant for this study. The remaining 51 original studies and four secondary analyses of previously published original studies were included in the literature review. The selection of target brain areas, target populations, emotion regulation protocols, NF presentation, control group types, and emotion regulation instructions were examined in relation to achieved brain regulation and changes in cognitive or clinical outcomes. Study results were evaluated in terms of their statistical robustness. RESULTS: The results show that healthy people are able to regulate their brain activity in the presence of rt-fMRI-NF from various brain regions related to emotion regulation, including the amygdala, anterior insula, and anterior cingulate cortex. The regulation of brain activity using rt-fMRI-NF from prefrontal-limbic connectivity or from individually navigated brain areas is feasible as well. Most studies that used a control group show that rt-fMRI-NF actually induces some effects on brain regulation, cognitive variables, and clinical variables. Generally, the success of ROI regulation during NF training is related to the combination of target brain region, the type of emotion regulation task, and the population undergoing the training. In terms of patient groups, the strongest support for the beneficial effects of rt-fMRI-NF has been shown in increased positive emotion experiencing in patients with depression and in decreased anxiety in patients with anxiety disorders. Symptom reduction following NF training has been also reported in patients with PTSD, BPD, and schizophrenia, but direct comparisons with control groups in these studies makes it impossible to evaluate the added value of NF. Studies often do not report all the relevant analyses for evaluating NF success and many studies lack statistical robustness. CONCLUSIONS: Overall, rt-fMRI-NF seems a promising tool for emotion regulation enhancement with the potential to induce long-term symptom reduction in patients with various mental disorders. Preplanning of statistical analyses, careful interpretations of the results, and evaluations of the NF effect on symptom reduction in patient groups is recommended.