How do you make me feel better? Social cognitive emotion regulation and the default mode network.

Socially-induced cognitive emotion regulation (Social-Reg) is crucial for emotional well-being and social functioning; however, its brain mechanisms remain poorly understood. Given that both social cognition and cognitive emotion regulation engage key regions of the default-mode network (DMN), we hypothesized that Social-Reg would rely on the DMN, and that its effectiveness would be associated with social functioning. During functional MRI, negative emotions were elicited by pictures, and - via short instructions - a psychotherapist either down-regulated participants' emotions by employing reappraisal (Reg), or asked them to simply look at the pictures (Look). Adult Attachment Scale was used to measure social functioning. Contrasting Reg versus Look, aversive emotions were successfully reduced during Social-Reg, with increased activations in the prefrontal and parietal cortices, precuneus and the left temporo-parietal junction. These activations covered key nodes of the DMN and were associated with Social-Reg success. Furthermore, participants' attachment security was positively correlated with both Social-Reg success and orbitofrontal cortex involvement during Social-Reg. In addition, specificity of the neural correlates of Social-Reg was confirmed by comparisons with participants' DMN activity at rest and their brain activations during a typical emotional self-regulation task based on the same experimental paradigm without a psychotherapist. Our results provide first evidence for the specific involvement of the DMN in Social-Reg, and the association of Social-Reg with individual differences in attachment security. The findings suggest that DMN dysfunction, found in many neuropsychiatric disorders, may impair the ability to benefit from Social-Reg.

Cognitive emotion regulation enhances aversive prediction error activity while reducing emotional responses.

Cognitive emotion regulation is a powerful way of modulating emotional responses. However, despite the vital role of emotions in learning, it is unknown whether the effect of cognitive emotion regulation also extends to the modulation of learning. Computational models indicate prediction error activity, typically observed in the striatum and ventral tegmental area, as a critical neural mechanism involved in associative learning. We used model-based fMRI during aversive conditioning with and without cognitive emotion regulation to test the hypothesis that emotion regulation would affect prediction error-related neural activity in the striatum and ventral tegmental area, reflecting an emotion regulation-related modulation of learning. Our results show that cognitive emotion regulation reduced emotion-related brain activity, but increased prediction error-related activity in a network involving ventral tegmental area, hippocampus, insula and ventral striatum. While the reduction of response activity was related to behavioral measures of emotion regulation success, the enhancement of prediction error-related neural activity was related to learning performance. Furthermore, functional connectivity between the ventral tegmental area and ventrolateral prefrontal cortex, an area involved in regulation, was specifically increased during emotion regulation and likewise related to learning performance. Our data, therefore, provide first-time evidence that beyond reducing emotional responses, cognitive emotion regulation affects learning by enhancing prediction error-related activity, potentially via tegmental dopaminergic pathways.

Psychiatric comorbidity and psychosocial impairment among patients with vertigo and dizziness.

BACKGROUND: Vertigo and dizziness are often not fully explained by an organic illness, but instead are related to psychiatric disorders. This study aimed to evaluate psychiatric comorbidity and assess psychosocial impairment in a large sample of patients with a wide range of unselected organic and non-organic (ie, medically unexplained) vertigo/dizziness syndromes. METHODS: This cross-sectional study involved a sample of 547 patients recruited from a specialised interdisciplinary treatment centre for vertigo/dizziness. Diagnostic evaluation included standardised neurological examinations, structured clinical interview for major mental disorders (SCID-I) and self-report questionnaires regarding dizziness, depression, anxiety, somatisation and quality of life. RESULTS: Neurological diagnostic workup revealed organic and non-organic vertigo/dizziness in 80.8% and 19.2% of patients, respectively. In 48.8% of patients, SCID-I led to the diagnosis of a current psychiatric disorder, most frequently anxiety/phobic, somatoform and affective disorders. In the organic vertigo/dizziness group, 42.5% of patients, particularly those with vestibular paroxysmia or vestibular migraine, had a current psychiatric comorbidity. Patients with psychiatric comorbidity reported more vertigo-related handicaps, more depressive, anxiety and somatisation symptoms, and lower psychological quality of life compared with patients without psychiatric comorbidity. CONCLUSIONS: Almost half of patients with vertigo/dizziness suffer from a psychiatric comorbidity. These patients show more severe psychosocial impairment compared with patients without psychiatric disorders. The worst combination, in terms of vertigo-related handicaps, is having non-organic vertigo/dizziness and psychiatric comorbidity. This phenomenon should be considered when diagnosing and treating vertigo/dizziness in the early stages of the disease.

Assessment of psychological aspects of somatoform disorders: a study on the German version of the Health Attitude Survey (HAS).

OBJECTIVE: Given the prevalence and costs of somatoform disorders, it is important to identify and adequately treat these patients as early as possible. Instruments assessing experiences, perceptions, and behaviors of somatoform disorders are rare. In this study we evaluated the structure and validity of the German version of the Health Attitude Survey (HAS), a multidimensional self-report questionnaire for somatoform disorders. METHODS: This cross-sectional study involved 1452 participants. The sample was randomly split for independent exploratory (EFA) and confirmatory factor analyses (CFA). Each of the two samples (n1=726; n2=726) included patients with organic vertigo and current mental disorders (somatoform and other mental disorders). Somatic symptom burden was assessed using the Patient Health Questionnaire (PHQ-15). RESULTS: The CFA did not confirm the original HAS factor structure. The EFA revealed six factors. To enhance the fit of the model, we deleted two factors with the poorest reliability and items with low factor loadings. A modified and shortened version achieved good fit indices (CFI=0.92; RMSEA=0.068). It consists of 14 instead of 27 items and four scales ("dissatisfaction with care," "frustration with ill health," "high utilization of care," "excessive health worry"). HAS subscales discriminated among somatoform patients and physically ill and/or patients with a mental but not somatoform disorder, controlled for age, sex and number of (comorbid) mental diagnoses, confirming its construct validity. CONCLUSION: A modified shortened version of the HAS appears to be a reliable, valid, and economical instrument for assessing facets of somatoform disorders or of the recently published DSM-5 Somatic Symptom Disorder.

Restless legs syndrome as a possible predictor for psychiatric disorders in parents of children with ADHD.

Attention-deficit hyperactivity disorder (ADHD) is a common disorder with estimated prevalence of 5% in children and 3.4% in adults. Psychiatric disorders are a frequent concomitant feature. Restless legs syndrome (RLS) may mimic the symptoms of ADHD. The aim of the study is to evaluate whether the presence of RLS predicts occurrence of psychiatric disorders in parents of children with ADHD. Thirty-seven parents of 26 children with ADHD were examined for RLS and for lifetime prevalence rates of psychiatric disorders and personality disorders based on the Structured Clinical Interview for DSM-IV Diagnoses (SCID). Prevalence rates in parents were 29.7% for RLS, 67.6% for Axis I and 40.5% for Axis II disorders. Mothers revealed higher rates for depression, anxiety disorders and ADHD than fathers, whereas personality disorders occurred at higher rates in fathers. The presence of RLS predicted a diagnosis of ADHD (odds ratio (OR) 21.9), agoraphobia (OR = 20.4) and any anxiety disorder (OR = 8.5). Although limited by the small sample size, we found evidence for increased rates of cluster B personality disorders (OR = 59.3) in parents with RLS. All parents of the latter group (100%) reported a positive family history of psychiatric disorders which was not the case in parents without RLS (69.2%) excluding the index children with ADHD. RLS seems to indicate increased vulnerability for psychiatric disorders, i.e., ADHD and anxiety disorders, in a subgroup of parents from ADHD children. Synaptic dysfunction affecting dopaminergic transmission among other transmitter systems may be a common final pathway related to the phenotypic spectrum of ADHD.

Audiovisual matching in speech and nonspeech sounds: a neurodynamical model.

Audiovisual speech perception provides an opportunity to investigate the mechanisms underlying multimodal processing. By using nonspeech stimuli, it is possible to investigate the degree to which audiovisual processing is specific to the speech domain. It has been shown in a match-to-sample design that matching across modalities is more difficult in the nonspeech domain as compared to the speech domain. We constructed a biophysically realistic neural network model simulating this experimental evidence. We propose that a stronger connection between modalities in speech underlies the behavioral difference between the speech and the nonspeech domain. This could be the result of more extensive experience with speech stimuli. Because the match-to-sample paradigm does not allow us to draw conclusions concerning the integration of auditory and visual information, we also simulated two further conditions based on the same paradigm, which tested the integration of auditory and visual information within a single stimulus. New experimental data for these two conditions support the simulation results and suggest that audiovisual integration of discordant stimuli is stronger in speech than in nonspeech stimuli. According to the simulations, the connection strength between auditory and visual information, on the one hand, determines how well auditory information can be assigned to visual information, and on the other hand, it influences the magnitude of multimodal integration.

An Appraisal of the Influence of the Metabotropic Glutamate 5 (mGlu5) Receptor on Sociability and Anxiety.

Amongst the many neurotransmitter systems causally linked to the expression of social behavior, glutamate appears to play a pivotal role. In particular, metabotropic glutamate 5 (mGlu5) receptors have received much attention as its altered function has been reported in several mouse models of autism spectrum disorders and mental retardation. Inhibition of the activity of mGlu5 receptors by means of genetic or pharmacological manipulations improved social deficits in some of these animal models. However, in normal wild-type (WT) mice, pharmacological blockade of mGlu5 receptors yielded inconsistent results. The aim of our study was to investigate the actual contribution of decreased or absent mGlu5 receptor function in sociability and anxiety-like behavior as well as to explore the impact of mGlu5 receptor ablation on the pattern of brain activation upon social exposure. Here we show that Grm5-/- mice display higher social preference indexes compared to age-matched WT mice in the three-chambered social task. However, this effect was accompanied by a decreased exploratory activity during the test and increased anxiety-like behavior. Contrary to mGlu5 receptor ablation, the mGlu5 receptor negative allosteric modulator 3-((2-methyl-1,4-thiazolyl)ethynyl)pyridine (MTEP) induced anxiolytic effects without affecting social preference in WT mice. By mapping c-Fos expression in 21 different brain regions known to be involved in social interaction, we detected a specific activation of the prefrontal cortex and dorsolateral septum in Grm5-/- mice following social interaction. C-Fos expression correlation-based network and graph theoretical analyses further suggested dysfunctional connectivity and disruption of the functional brain network generated during social interaction in Grm5-/- mice. The lack of mGlu5 receptors resulted in profound rearrangements of the functional impact of prefrontal and hippocampal regions in the social interaction network. In conclusion, this work reveals a complex contribution of mGlu5 receptors in sociability and anxiety and points to the importance of these receptors in regulating brain functional connectivity during social interaction.

Contribution to the construct validity of the Perceived Stress Questionnaire from a population-based survey.

OBJECTIVE: Detailed evidence for the construct validity of stress questionnaires has been repeatedly demanded. This study aimed to investigate the construct validity of the Perceived Stress Questionnaire (PSQ) in the context of a transactional view of stress. METHODS: The examination was based on the PSQ and on standardized quality of life and personality questionnaires. The analyses focused on structural equation modeling. A total of 2552 subjects from a population-based survey were studied. RESULTS: A transactional model fitted the data. Personality aspects and resources contribute to the total perceived stress. Yet the physical aspects of quality of life receive a comparatively low weighting. The prevalence of perceived stress at a moderate level was estimated to be 14.5%, lowest in the age group>75 years and highest in the 35- to 54-year age group. The prevalence of high stress was 3.1%. The total PSQ-30 score of the general population was 0.30 (S.D.=0.15), slightly higher in women than in men. CONCLUSION: We consider the PSQ as a valid instrument for recording subjective perceived stress in the context of a transactional view of stress. The present broad and international database suggests that it needs further investigation in terms of transcultural studies.

Audio-visual matching of speech and non-speech oral gestures in patients with aphasia and apraxia of speech.

BACKGROUND: Audio-visual speech perception mechanisms provide evidence for a supra-modal nature of phonological representations, and a link of these mechanisms to motor representations of speech has been postulated. This leads to the question if aphasic patients and patients with apraxia of speech are able to exploit the visual signal in speech perception and if implicit knowledge of audio-visual relationships is preserved in these patients. Moreover, it is unknown if the audio-visual processing of mouth movements has a specific organisation in the speech as compared to the non-speech domain. METHODS: A discrimination task with speech and non-speech stimuli was applied in four presentation modes: auditory, visual, bimodal and cross-modal. We investigated 14 healthy persons and 14 patients with aphasia and/or apraxia of speech. RESULTS: Patients made substantially more errors than normal subjects on both the speech and the non-speech stimuli, in all presentation modalities. Normal controls made only few errors on the speech stimuli, regardless of the presentation mode, but had a high between-subject variability in the cross-modal matching of non-speech stimuli. The patients' cross-modal processing of non-speech stimuli was mainly predicted by lower face apraxia scores, while their audio-visual matching of syllables was predicted by word repetition abilities and the presence of apraxia of speech. CONCLUSIONS: (1) Impaired speech perception in aphasia is located at a supra-modal representational level. (2) Audio-visual processing is different for speech and non-speech oral gestures. (3) Audio-visual matching abilities in patients with left-hemisphere lesions depend on their speech and non-speech motor abilities.

[Evaluation of the effectiveness of psychosomatic in-patient treatment on the basis of subjective and objective criteria]. / Evaluation stationärer psychosomatischer Behandlung anhand subjektiver und objektiver Kriterien.

OBJECTIVES: The effectiveness of psychosomatic in-patient treatment was evaluated using patients' subjective health ratings and objective data provided by health insurance companies. Associations between subjective and objective criteria were investigated. METHODS: 318 patients participated in the study. They completed questionnaires on physical complaints, moods and everyday functioning upon hospital admission, at discharge and at one-year follow-up. Insurance companies provided data for 140 of these patients (44 %). Sick leave and the utilization of in-patient treatment were assessed for a period of two years before and two years after psychosomatic treatment. RESULTS: As expected, subjective health status improved. The utilization of in-patient treatment decreased in both years after treatment compared to the year before. Sick leave increased in the first year after treatment but decreased significantly below the base level in the second year after treatment. Self-efficacy expectations and being employed were found to be predictors for long-term reduction in the length of in-patient treatment. Subjective and objective criteria were only slightly correlated. CONCLUSIONS: Sick leave and utilization of in-patient treatment were found to increase considerably in the year before psychosomatic treatment. Therefore, pre-post differences over the entire period were only marginal. The change in subjective criteria was more immediate, while changes in some objective parameters were delayed. Both subjective and objective criteria should be included in outcome studies.

Psychological traumatization and adverse life events in patients with organic and functional vestibular symptoms.

OBJECTIVE: . A relationship has frequently been found between a history of traumatization and the existence of somatoform symptoms. The objective of this study was to examine whether this relationship is also observed for functional, i.e. medically not sufficiently explained, vestibular symptoms (FVS). We tested whether patients with FVS and organically explained vestibular symptoms (OVS) differ with regard to frequencies of previous traumatic experiences and posttraumatic stress symptoms. We also explored whether the impact of previous trauma was associated with characteristics of vestibular symptoms and handicap. METHODS: . Patients with a diagnosis of OVS (N=185) or FVS (N=158) completed questionnaires about potentially traumatizing experiences (e.g., Childhood Trauma Questionnaire, Impact of Events Scale) and vertigo-related symptoms and handicap (Vertigo Symptom Scale, Vertigo Handicap Questionnaire). RESULTS: . We found no differences between the two patient groups with regard to number or impact of traumatic life events. However, regression analyses across groups revealed that, regardless of their diagnosis, prior traumatic experiences and the presence of posttraumatic stress symptoms including avoidance and intrusion predicted to some extent higher overall balance symptoms and autonomic symptoms of vertigo-related anxiety. CONCLUSION: . Exposure to trauma and symptoms of posttraumatic stress can contribute to symptom severity and handicap experienced by patients with vestibular symptoms irrespective of their original cause, most likely serving as predisposing, modulating or perpetuating factors.

Preschool regulatory problems and attention-deficit/hyperactivity and cognitive deficits at school age in children born at risk: different phenotypes of dysregulation?

BACKGROUND: Early regulatory problems (RP), i.e., excessive crying, feeding, and sleeping difficulties, have been reported to be predictors of cognitive and attention-deficit/hyperactivity problems. However, previous studies had limitations such as small sample size or retrospective design. AIM: To investigate whether persistent RP from infancy until preschool age are precursors of ADHD problems and cognitive deficits at school age. STUDY DESIGN: A prospective study from birth to 8.5years of age. SUBJECTS: 1120 infants born at risk. MEASURES: RP were assessed at 5months (i.e., excessive crying, feeding, and sleeping problems), 20, and 56months (i.e., eating and sleeping problems) via parent interviews and neurological examination. At 8.5years of age, IQ was assessed by a standard test (K-ABC), and ADHD problems by direct observations in the test situation and by the Mannheimer Parent Interview (MPI, DSM-IV diagnosis of ADHD). RESULTS: 23.8% of the sample born at risk had RP at least at two measurement points until preschool age. Persistent RP predicted lower IQ (ß=-.17; 95% CI (-.21; -.10)), behaviour problems (ß=-.10; 95% CI (-.15; -.03)), attention (OR 2.43; 95% CI (1.16; 5.09)) and hyperactivity problems (OR 3.10; 95% CI (1.29; 7.48)), and an ADHD diagnosis (OR 3.32; 95% CI (1.23; 8.98)) at school age, even when controlled for psychosocial and neurological confounders. CONCLUSIONS: Early persistent RP increased the odds of ADHD and associated problems at school age, indicating a cascade model of development, i.e., infant behaviour problems provide the starting point of a trajectory of dysregulation through time.

Performance benefits of depression: sequential decision making in a healthy sample and a clinically depressed sample.

Previous research reported conflicting results concerning the influence of depression on cognitive task performance. Whereas some studies reported that depression enhances performance, other studies reported negative or null effects. These discrepant findings appear to result from task variation, as well as the severity and treatment status of participant depression. To better understand these moderating factors, we study the performance of individuals-in a complex sequential decision task similar to the secretary problem-who are nondepressed, depressed, and recovering from a major depressive episode. We find that depressed individuals perform better than do nondepressed individuals. Formal modeling of participants' decision strategies suggested that acutely depressed participants had higher thresholds for accepting options and made better choices than either healthy participants or those recovering from depression.

The influence of visual and auditory information on the perception of speech and non-speech oral movements in patients with left hemisphere lesions.

Patients with lesions of the left hemisphere often suffer from oral-facial apraxia, apraxia of speech, and aphasia. In these patients, visual features often play a critical role in speech and language therapy, when pictured lip shapes or the therapist's visible mouth movements are used to facilitate speech production and articulation. This demands audiovisual processing both in speech and language treatment and in the diagnosis of oral-facial apraxia. The purpose of this study was to investigate differences in audiovisual perception of speech as compared to non-speech oral gestures. Bimodal and unimodal speech and non-speech items were used and additionally discordant stimuli constructed, which were presented for imitation. This study examined a group of healthy volunteers and a group of patients with lesions of the left hemisphere. Patients made substantially more errors than controls, but the factors influencing imitation accuracy were more or less the same in both groups. Error analyses in both groups suggested different types of representations for speech as compared to the non-speech domain, with speech having a stronger weight on the auditory modality and non-speech processing on the visual modality. Additionally, this study was able to show that the McGurk effect is not limited to speech.

Crying and feeding problems in infancy and cognitive outcome in preschool children born at risk: a prospective population study.

OBJECTIVE: To investigate whether regulatory problems, i.e., crying and feeding problems in infants older than 3 months of age, predict cognitive outcome in preschool children born at risk even when controlled for confounding factors. METHODS: A prospective longitudinal study of children born in a geographically defined area in Germany. N = 4427 children of 6705 eligible survivors (66%) participated at all 4 assessment points (neonatal, 5, 20, and 56 months of age). Excessive crying and feeding problems were assessed at 5 months. Mental development was measured with the Griffiths Scale at 20 months, and cognitive assessments were conducted at 56 months. Neonatal complications, neurological, and psychosocial factors were controlled as confounders in structural equation modeling and analyses of variance. RESULTS: One in 5 infants suffered from single crying or feeding problems, and 2% had multiple regulatory problems, i.e., combined crying and feeding problems at 5 months. In girls, regulatory problems were directly predictive of lower cognition at 56 months, even when controlled for confounders, whereas in boys, the influence on cognition at 56 months was mediated by delayed mental development at 20 months. Both in boys and girls, shortened gestational age, neonatal neurological complications, and poor parent-infant relationship were predictive of regulatory problems at 5 months and lower cognition at 56 months. CONCLUSION: Excessive crying and feeding problems in infancy have a small but significant adverse effect on cognitive development.

Antonovsky's Sense of Coherence in psychosomatic patients - a contribution to construct validation.

OBJECTIVE: The objective of the present study is to contribute towards the validation of the SOC (Sense of Coherence) construct on the basis of data from psychosomatic patients. METHOD: The study included a total of 1403 patients treated as out-patients or in consultations in the Clinic for Psychosomatic Medicine at the Charité University of Medicine, Berlin, between July 2002 and October 2005. Correlations were tested between the sense of coherence (SOC-L9), sociodemographic variables and the following psychometric instruments: Patient Health Questionnaire (PHQ), Brief COPE, Questionnaire on Self-Efficacy, Optimism and Pessimism (SWOP-K9) and Perceived Stress Questionnaire (PSQ-20). RESULTS: Associations were found between sense of coherence and age, but not with gender. In addition, high sense of coherence was correlated with high self-efficacy, optimism, subjective physical well-being and favourable coping strategies as well as with low perceived stress. CONCLUSION: The results contribute to the validation of the SOC construct. Future investigations should include longitudinal studies of the precise association between sense of coherence and other psychological variables.