Autopilot functionality and self-destructive behavior in patients with complex dissociative disorders-A qualitative study.

OBJECTIVE: Dissociative disorders are common in psychiatric patients and severely impact patients' lives. They are, however, underdiagnosed, thus preventing patients from accessing timely and adequate therapy. Identifying how patients with dissociative disorders relate to themselves could improve diagnostics. However, this question has not been explored in detail. The aim of the study was to gain insights into how people with complex dissociative disorders relate to themselves. METHOD: We conducted semistructured qualitative interviews with ten women diagnosed with complex dissociative disorders who had previously completed trauma-focused therapy. Data were analyzed through reflexive thematic analysis. RESULTS: Participants described their behavior toward themselves before the start of the therapy as "autopilot-functional" and "self-destructive." The "autopilot functionality" was characterized by being outward-oriented and ignoring one's own needs. Hence, participants only appeared to be functional. "Self-destructive behavior" was described as a spectrum of various destructive behaviors (e.g., eating disorders, self-harm, excessive exercise, and substance abuse) that participants perceived as a cohesive complex. The participants illustrated that both behaviors were driven by a lack of self-empathy and connected to suppression and poor perception of bodily stimuli. CONCLUSIONS: "Autopilot functionality" seems to be a hallmark in patients with complex dissociative disorders. With patients hiding their self-destructive behavior, health personnel may misjudge the severity of these patients' mental illness. Neither "autopilot functionality" nor "self-destructive behavior" should be judged (neither negatively nor positively), but one should understand both as a coping mechanism for trauma-related disorders. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

FLASHlab@PITZ: New R&D platform with unique capabilities for electron FLASH and VHEE radiation therapy and radiation biology under preparation at PITZ.

At the Photo Injector Test facility at DESY in Zeuthen (PITZ), an R&D platform for electron FLASH and very high energy electron radiation therapy and radiation biology is being prepared (FLASHlab@PITZ). The beam parameters available at PITZ are worldwide unique. They are based on experiences from 20 + years of developing high brightness beam sources and an ultra-intensive THz light source demonstrator for ps scale electron bunches with up to 5 nC bunch charge at MHz repetition rate in bunch trains of up to 1 ms length, currently 22 MeV (upgrade to 250 MeV planned). Individual bunches can provide peak dose rates up to 1014 Gy/s, and 10 Gy can be delivered within picoseconds. Upon demand, each bunch of the bunch train can be guided to a different transverse location, so that either a "painting" with micro beams (comparable to pencil beam scanning in proton therapy) or a cumulative increase of absorbed dose, using a wide beam distribution, can be realized at the tumor. Full tumor treatment can hence be completed within 1 ms, mitigating organ movement issues. With extremely flexible beam manipulation capabilities, FLASHlab@PITZ will cover the current parameter range of successfully demonstrated FLASH effects and extend the parameter range towards yet unexploited short treatment times and high dose rates. A summary of the plans for FLASHlab@PITZ and the status of its realization will be presented.

Altered frontal electroencephalography as a potential correlate of acute dissociation in dissociative disorders: novel findings from a mirror confrontation study.

People suffering from chronic dissociation often experience stress and detachment during self-perception. We tested 18 people with dissociative disorders not otherwise specified (DDNOS; compared with a matched sample of 18 healthy controls) undergoing a stress-inducing facial mirror confrontation paradigm, and measured acute dissociation and frontal electroencephalography (measured with a four-channel system) per experimental condition (e.g. confrontation with negative cognition). Linear mixed models indicated a significant group×time×condition effect, with DDNOS group depicting less electroencephalography power than healthy controls at the beginning of mirror confrontation combined with negative and positive cognition. This discrepancy - most prominent in the negative condition - diminished in the second minute. Correlational analyses depicted a positive association between initial electroencephalography power and acute dissociation in the DDNOS group. These preliminary findings may indicate altered neural processing in DDNOS, but require further investigation with more precise electroencephalography measures.

The Child Behavior Checklist as a Screening Instrument for PTSD in Refugee Children.

Thousands of refugees who have entered Europe experienced threatening conditions, potentially leading to post traumatic stress disorder (PTSD), which has to be detected and treated early to avoid chronic manifestation, especially in children. We aimed to evaluate and test suitable screening tools to detect PTSD in children. Syrian refugee children aged 4-14 years were examined using the PTSD-semi-structured interview, the Kinder-DIPS, and the Child Behavior Checklist (CBCL). The latter was evaluated as a potential screening tool for PTSD using (i) the CBCL-PTSD subscale and (ii) an alternative subscale consisting of a psychometrically guided selection of items with an appropriate correlation to PTSD and a sufficient prevalence (presence in more than 20% of the cases with PTSD). For both tools we calculated sensitivity, specificity, and a receiver operating characteristic (ROC) curve. Depending on the sum score of the items, the 20-item CBCL-PTSD subscale as used in previous studies yielded a maximal sensitivity of 85% and specificity of 76%. The psychometrically guided item selection resulted in a sensitivity of 85% and a specificity of 83%. The areas under the ROC curves were the same for both tools (0.9). Both subscales may be suitable as screening instrument for PTSD in refugee children, as they reveal a high sensitivity and specificity.

Positive side effects in trauma-focusing PTSD treatment: Reduction of attendant symptoms and enhancement of affective and structural regulation.

OBJECTIVE: Trauma-focusing treatments such as eye movement desensitization and reprocessing (EMDR) are highly effective in reducing the core symptoms of posttraumatic stress disorder (PTSD), for example, intrusive memories and flashbacks, hyperarousal, and avoidance. Additionally, suffering from PTSD is often accompanied by a broader set of mental comorbidities and complaints such as depression, anxiety disorders or somatization, and disturbed self-regulation abilities. According to the Adaptive Information Processing model (Shapiro, 2001), the processing of pathogenic memories can help not only to reduce the PTSD symptoms but also accompanying complaints additionally. METHOD: In an eye movement desensitization and reprocessing treatment study of 116 patients suffering from PTSD, we targeted the course of additional symptoms and structural skills using the Symptom Checklist-90 SCL-90, Beck Depression Inventory, Toronto Alexithymia Scale-20, and Hannover Selbstregulationsinventar in a pre-post design. RESULTS: The results showed that apart from alleviating the PTSD symptoms, exposure-based treatment of pathogenic memories led to a significant decrease in accompanying symptoms such as depression, anxiety, and somatization. Furthermore, patients improved their structural abilities with regard to emotional perception and differentiation, controlling impulses, tolerating frustration, and regulating self-esteem. CONCLUSION: PTSD core symptoms and comorbid complaints are closely interlinked and can be seen as a traumatic-stress cluster, which is accompanied by significant impairments in self- and emotion regulation. Therefore, treatment concepts should explicitly foster emotional processing and structural abilities to target the posttraumatic stress responses entirely. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Evolution of Volatile and Phenolic Compounds during Bottle Storage of Merlot Wines Vinified Using Pulsed Electric Fields-Treated Grapes.

This study aimed to elucidate changes in volatile, phenolic, and oenological profiles of wines vinified from Pulsed Electric Fields (PEF)-treated and untreated Merlot grapes during bottle storage of up to 150, 90, and 56 days at 4 °C, 25 °C, and 45 °C, respectively, through chemometrics technique. Wines produced from untreated grapes and those PEF-treated at four different processing conditions (electric field strength 33.1 and 41.5 kV/cm and energy inputs between 16.5 and 49.4 kJ/kg) were used for the bottle storage study. Results showed that hydroxycinnamic and hydroxybenzoic acids in all stored wines, regardless vinified from untreated and PEF-treated grapes, increased as a function of time and temperature, while anthocyanins and selected esters (e.g., ethyl butanoate) decreased. Extreme storage temperature, at 45 °C particularly, resulted in a higher amount of linalool-3, 7-oxide in all stored wines. After prolonged storage, all wines produced from grapes PEF-treated with four different processing conditions were shown to favor high retention of phenolics after storage but induced faster reduction of anthocyanins when compared to wines produced from untreated grapes. Moreover, some volatiles in wines vinified using PEF-treated grapes, such as citronellol and 2-phenylethyl acetate, were found to be less susceptible towards degradation during prolonged storage. Production of furans was generally lower in most stored wines, particularly those produced from PEF-treated grapes at higher energy inputs (>47 kJ/kg). Overall, PEF pre-treatment on grapes may improve storage and temperature stability of the obtained wines.

Assessment of the Psychological Situation in Adults with Congenital Heart Disease.

BACKGROUND: Due to advances in the diagnosis and treatment of congenital heart disease (CHD), the number of adults who are surviving with congenital heart disease (ACHD) is constantly growing. Until recently, the psychological effects of CHD had been widely neglected. Current research provides evidence for an increased risk of emotional distress in ACHD. The concept of illness identity attempts to explain how patients experience and integrate their CHD into their identities. The present study investigated illness identity in relation to clinical parameters and psychological functioning. Psychometric properties of the German version of the Illness Identity Questionnaire (IIQD) were examined. METHODS: Self-reported measures on illness identity and psychological functioning (HADS-D) were assessed in a representative sample of 229 ACHD (38 ± 12.5 (18-73) years; 45% female) at the German Heart Center Munich. Descriptive analyses and multiple regression models were conducted. Confirmatory factor analysis was performed to validate the IIQD. RESULTS: The IIQD demonstrated good reliability. The originally-postulated four-factor structure could not be replicated. Anatomic disease complexity and functional status significantly influenced illness identity. Illness identity accounted for unique variances in depression and anxiety: Maladaptive illness identity states (i.e., , engulfment and rejection) were associated with higher emotional distress, whereas adaptive illness (i.e., , acceptance and enrichment) identity states were linked to lower emotional distress. CONCLUSIONS: Illness Identity emerged as a predictor of emotional distress in ACHD. Findings raise the possibility that interventions designed to target a patient's illness identity may improve psychological well-being and cardiac outcomes in ACHD.

In silico food allergenic risk evaluation of proteins extracted from macroalgae Ulva sp. with pulsed electric fields.

Extraction of protein from macroalgae, currently defined as "novel food", is challenging and limited information about the health impacts of these proteins is available. Here, we report on a non-thermal, chemical-free green macroalgae Ulva sp. protein extraction by osmotic shock combined with pulsed electric fields (PEF) followed by hydraulic pressure. The extracted proteins were identified and annotated to allergens using sequence similarity. The allergenicity potential of PEF extracted proteins was compared to osmotic shock extracts and complete Ulva sp. proteome, extracted with the thermochemical method. The PEF extracts contained 'superoxide dismutase' (SOD), a known food allergen, osmotic shock extract contained 'troponin C', and thermochemical extract contained two additional potential food allergens 'aldolase A' and 'thioredoxin h'. This study shows an importance and the need for deep investigation of algal proteins and protein extraction technology health impacts prior to large-scale release to the market of "novel food" derived proteins.

Disconnected - Impaired Interoceptive Accuracy and Its Association With Self-Perception and Cardiac Vagal Tone in Patients With Dissociative Disorder.

Patients suffering from dissociative disorders are characterized by an avoidance of aversive stimuli. This includes the avoidance of emotions and, in particular, bodily perceptions. In the present pilot study, we explored the potential interoceptive accuracy deficit of patients suffering from dissociative disorders in a heartbeat detection task. Moreover, we investigated the impact of facial mirror-confrontation on interoceptive accuracy and the potential association between cardiac vagal tone derived from heart rate variability and interoceptive accuracy. Eighteen patients suffering from dissociative disorders and 18 healthy controls were assessed with the Mental Tracking Paradigm by Schandry for heartbeat detection at baseline and after confrontations exposing them to their own faces in a mirror (2 min each, accompanied by a negative or positive cognition). During the experiment, cardiac vagal tone was assessed. We used Pearson correlations to calculate potential associations between cardiac vagal tone and interoceptive accuracy. Patients performed significantly worse than the healthy controls in the heartbeat detection task at baseline. They displayed no significant increase in interoceptive accuracy following facial mirror-confrontation. In the patient group, higher cardiac vagal tone was associated with a more precise heartbeat detection performance. Dissociative disorder patients showed a considerable deficit in interoceptive accuracy. Our results fit with the assumption that highly dissociative patients tend to tune out the perceiving of bodily signals. To the extent that bodily signal perception may play a causal role in these disorders, therapeutic approaches enhancing interoceptive accuracy and cardiac vagal tone may be considered important and practicable steps to improve the therapy outcome of this patient group.

The enemy in the mirror: self-perception-induced stress results in dissociation of psychological and physiological responses in patients with dissociative disorder.

Background: Patients suffering from dissociative disorders (DD) are characterized by an avoidance of aversive stimuli. Clinical experience has shown that DD patients typically avoid the confrontation with their own faces in a mirror (CFM). Objective: To investigate potential CFM-associated self-reported and psychophysiological stress reactions of DD patients, which most likely inform on the still unknown pathophysiology of dysfunctional self-perception in DD. Method: Eighteen DD patients and 18 healthy controls (HCs) underwent CFM. They were assessed for CFM-induced subjective self-reported stress, acute dissociative symptoms and sympathetic and parasympathetic drive using impedance cardiography. Results: DD patients experienced more subjective stress and acute dissociation than HCs upon CFM. Their psychological stress response did not activate the sympathetic and parasympathetic nervous system. Conclusions: In DD patients, CFM constitutes serious self-reported stress and is associated with a blunted autonomic reactivity. Therapeutic approaches promoting self-perception and self-compassion, in particular by using CFM, might serve as goal-oriented diagnostic and therapeutic tools in DD.

Antecedentes: Los pacientes que sufren trastornos disociativos (DD en su sigla en inglés) se caracterizan por evitar los estímulos aversivos. La experiencia clínica ha mostrado que los pacientes con DD típicamente evitan la confrontación con sus propias caras en un espejo (CFM en su sigla en inglés). Objetivo: Investigar las potenciales reacciones de estrés psicofisiológicas y autoinformadas asociadas a CFM de pacientes con DD, las que muy probablemente informan sobre la fisiopatología todavía desconocida de la autopercepción disfuncional en los DD. Método: Dieciocho pacientes con DD y 18 controles sanos (HCs en sus siglas en inglés) se sometieron a CFM. Fueron evaluados en cuanto al estrés subjetivo auto-informado inducido por CFM, síntomas disociativos agudos e impulso simpático y parasimpático, usando cardiografía de impedancia. Resultados: Los pacientes con DD experimentaron más estrés subjetivo y disociación aguda que los HCs en CFM. Su respuesta de estrés psicológico no activó el sistema nervioso simpático y parasimpático. Conclusiones: En pacientes con DD, el CFM constituye un estrés grave auto-informado y se asocia con una reactividad autonómica limitada. Los enfoques terapéuticos que promueven la autopercepción y la autocompasión, en particular mediante el uso de CFM, podrían servir como herramientas diagnósticas y terapéuticas orientadas a objetivos en los DD.

Deashing macroalgae biomass by pulsed electric field treatment.

Among all biomass constituents, the ashes are major hurdles for biomass processing. Ashes currently have low market value and can make a non-negligible fraction of the biomass dry weight significantly impacting its further processing by degrading equipment, lowering process yield, inhibiting reactions and decreasing products qualities. However, most of the current treatments for deashing biomass are of poor efficiency or industrial relevance. This work is the first report on the use of Pulsed Electric Field (PEF) to enhance deashing of biomass from a high ash content green marine macroalga, Ulva sp., using hydraulic pressing. By inducing cell permeabilization of the fresh biomass, PEF was able to enhance the ash extraction from 18.4% (non-treated control) to 37.4% of the total ash content in average, significantly enhancing the extraction of five of the major ash elements (K, Mg, Na, P and S) compared to pressing alone.

[Validation of the Screening for Complex PTSD (SkPTBS) - Revision]. / Validierung des Screenings zur komplexen Posttraumatischen Belastungsstörung (SkPTBS) ­ Revision.

BACKGROUND: The aim was to develop further a screening instrument for complex posttraumatic stress disorder (cPTSD). The screening for cPTSD (SkPTBS) tests a) potential traumatic experiences, b) influential features and risk factors, and c) symptoms of cPTSD. The SkPTBS by Dorr et al. (2016) was revised according to the current ICD-11 criteria set proposal for cPTSD and is explored in its revised edition. METHOD: Impacts of long-lasting interpersonal trauma were tested in inpatients of psychosomatic rehabilitation and in patients consulting a university outpatient center for trauma therapy. Patients filled out the screening at the beginning of their treatment (N=525, among these n=359 rehabilitation patients and n=157 in the outpatient center, mean age 48 years, 68% female). Later diagnosed complex PTSD as well as results of the SCID and the Interview for complex PTSD (IkPTBS) served as primary validation criteria. RESULTS: 88 patients (17%) were diagnosed with complex PTSD. Metric SkPTBS items were selective and the scale had an internal reliability of Cronbachs α=0.91. The one-dimensional factor structure was replicated. SkPTBS correlated moderately with posttraumatic symptoms measured by IES-15, with dissociative symptoms (DES-Taxon), depressive symptoms (in BDI-II, PHQ-9), and global symptom severity (in SCL-90-R). Finally, norms for different groups of age, diagnosis and treatment settings were developed. CONCLUSION: The SkPTBS revision is a feasible and brief instrument to identify patients at risk for complex PTSD. It is provided freely and can be applied for diagnostic and therapeutic purposes.

A Comparison of Dual Attention, Eye Movements, and Exposure Only during Eye Movement Desensitization and Reprocessing for Posttraumatic Stress Disorder: Results from a Randomized Clinical Trial.

BACKGROUND: Currently, there is controversy on the possible benefits of dual-attention tasks during eye movement desensitization and reprocessing (EMDR) for patients with posttraumatic stress disorder (PTSD). METHODS: A total of 139 consecutive patients (including 85 females) suffering from PTSD were allocated randomly among 3 different treatment conditions: exposure with eyes moving while fixating on the therapist's moving hand (EM), exposure with eyes fixating on the therapist's nonmoving hand (EF), and exposure without explicit visual focus of attention as control condition (EC). Except for the variation in stimulation, treatment strictly followed the standard EMDR manual. Symptom changes from pre- to posttreatment were measured with the Clinician-Administered PTSD Scale (CAPS) by an investigator blinded to treatment allocation. RESULTS: In total, 116 patients completed the treatment, with an average of 4.6 sessions applied. Intention-to-treat analysis revealed a significant improvement in PTSD symptoms with a high overall effect size (Cohen's d = 1.96, 95% CI: 1.67-2.24) and a high remission rate of PTSD diagnosis (79.8%). In comparison to the control condition, EM and EF were associated with significantly larger pre-post symptom decrease (ΔCAPS: EM = 35.8, EF = 40.5, EC = 31.0) and significantly larger effect sizes (EM: d = 2.06, 95% CI: 1.55-2.57, EF: d = 2.58, 95% CI: 2.01-3.11, EC: d = 1.44, 95% CI: 0.97-1.91). No significant differences in symptom decrease and effect size were found between EM and EF. CONCLUSIONS: Exposure in combination with an explicit external focus of attention leads to larger PTSD symptom reduction than exposure alone. Eye movements have no advantage compared to visually fixating on a nonmoving hand.

Energy-efficient biomass processing with pulsed electric fields for bioeconomy and sustainable development.

Fossil resources-free sustainable development can be achieved through a transition to bioeconomy, an economy based on sustainable biomass-derived food, feed, chemicals, materials, and fuels. However, the transition to bioeconomy requires development of new energy-efficient technologies and processes to manipulate biomass feed stocks and their conversion into useful products, a collective term for which is biorefinery. One of the technological platforms that will enable various pathways of biomass conversion is based on pulsed electric fields applications (PEF). Energy efficiency of PEF treatment is achieved by specific increase of cell membrane permeability, a phenomenon known as membrane electroporation. Here, we review the opportunities that PEF and electroporation provide for the development of sustainable biorefineries. We describe the use of PEF treatment in biomass engineering, drying, deconstruction, extraction of phytochemicals, improvement of fermentations, and biogas production. These applications show the potential of PEF and consequent membrane electroporation to enable the bioeconomy and sustainable development.

Heart rate variability predicts therapy outcome in pain-predominant multisomatoform disorder.

BACKGROUND: Autonomic imbalance establishes an important model to understand organically unexplained physical complaints. Our study aimed to investigate whether the functioning of the autonomous nervous system corresponds with somatoform symptoms and predicts the outcome of brief psychotherapy in these patients. METHOD: As a part of multicenter study assessing effects of brief psychodynamic interpersonal therapy on multisomatoform disorder (PISO-study), 106 patients participated in a stress experiment investigating autonomic reactivity during application of the Stroop-test. Patients were randomized receiving either enhanced medical care (EMC, N=49) or psychotherapy (N=57). Autonomic baseline functioning as well as stress reactivity of heart rate (HR) and heart rate variability (HRV) were analyzed in their relation to symptom measures and as potential predictors of the primary outcome (Physical Component Score of the SF-36) during 9-month follow-up. RESULTS: After therapy patients markedly and sustainably improved in physical quality of life, and this long-term improvement was predicted by baseline HR and HRV. HRV also predicted change in pain symptoms following psychotherapy. A responder analysis revealed a significant better treatment outcome in patients with high pre-treatment HRV (OR 3.4, CI: 1.2-9.9, p=.0035). No significant associations between HR or HRV and outcome measures were found in the EMC group. CONCLUSION: In our study, the adaptability of the autonomous nervous system as indicated by low pretreatment HR and high HRV was associated with a more pronounced benefit from psychotherapy. This finding can be explained by a possible association between autonomic self-regulation and emotional learning capacities.

Electroporation-based applications in biotechnology.

Electroporation is already an established technique in several areas of medicine, but many of its biotechnological applications have only started to emerge; we review here some of the most promising. We outline electroporation as a phenomenon and then proceed to applications, first outlining the best established - the use of reversible electroporation for heritable genetic modification of microorganisms (electrotransformation), and then explore recent advances in applying electroporation for inactivation of microorganisms, extraction of biomolecules, and fast drying of biomass. Although these applications often aim to upscale to the industrial and/or clinical level, we also outline some important chip-scale applications of electroporation. We conclude our review with a discussion of the main challenges and future perspectives.

On the interaction of self-regulation, interoception and pain perception.

BACKGROUND: Interoceptive processes were found to be associated with better self-regulation capacities in healthy participants. Further empirical research suggests that interoceptive sensitivity is also important for the perception of pain both in healthy participants and in somatoform patients. Nevertheless, little is known about the interaction of interoceptive processes and self-regulation for pain. We therefore conducted a study examining the interaction of interoception and self-regulation in somatoform patients. METHODS: We investigated interoceptive sensitivity and self-regulatory capacities in 30 somatoform patients and 30 healthy controls when experimentally assessing pain threshold and pain tolerance. RESULTS: Interoceptive sensitivity was associated with better self-regulation capacities. Somatoform patients exhibited a significantly reduced interoceptive sensitivity and reduced self-regulatory capacities as assessed by self-report. Additionally, pain tolerance was significantly increased in somatoform patients as compared to controls. CONCLUSIONS: Our findings highlight that interoceptive sensitivity differentially interacts with pain and self-regulation both in healthy participants and somatoform patients. This might provide ideas for novel therapeutic interventions, e.g. a combined training of interoceptive sensitivity with certain aspects of self-regulation.

[Internalization and externalization as features of a shared clinical dimension in traumatized patients]. / Internalisierung und Externalisierung als Ausprägungen einer gemeinsamen Störungs-dimension bei traumatisierten Patienten.

In patients with complex posttraumatic stress disorder (complex PTSD; Herman, 1992) as well as in those with borderline personality disorder (BPD) traumata are often found anamnestically. Besides high comorbidity were found between both disorders. Thus it was examined whether internalizing and externalizing subtypes can be distinguished in chronic traumatized patients (N = 266) accounting for personality accentuations. Item parameters of a 2-class solution of the dichotomous Mixed Rasch Model were consistent with hypothesized patterns. χ²-tests indicated that patients subsumed to the internalizing group showed twice as much the diagnosis of complex PTSD. However an information criterion favored a one-class solution. Given that the analysis did not reveal 2 subtypes, a one-dimensional approach is suggested, that helps to describe internalizing and externalizing symptoms in chronic traumatized patients.