Self-aggression, reactive aggression, and spontaneous aggression: Mediating effects of self-esteem and psychopathology.

This study examined whether the associations between self-aggression and different forms of externalized aggression (reactive and spontaneous aggression) are influenced by self-esteem and current psychopathological symptoms. For this purpose, we asked 681 participants from the general population (GP) and 282 general psychiatric patients (PPs) to answer the German versions of the Short Questionnaire for Assessing Factors of Aggression (K-FAF), the Multidimensional Self-Esteem Scale (MSWS), and the Brief Symptom Inventory 25 Forensic (BSI-25-F). Statistically, we performed descriptive and mediation analyses. Our findings indicated that in both samples the association between self-aggression and reactive aggression was mediated by self-esteem but not by current psychological problems. The association between self-aggression and spontaneous aggression was mediated by self-esteem in the GP sample and by psychopathological symptoms in the PP sample. We conclude that when examining the association between self-aggression and externalized aggression it is important to consider the various subtypes of externalized aggression and differences between populations.

The Therapeutic Relationship in Forensic and General Psychiatric Settings.

INTRODUCTION: Therapeutic relationship in forensic psychiatry is believed to be affected by the coercive setting and the role conflict of the therapists as both treaters and court-appointed experts. The aim of the study was to examine and compare the therapeutic relationship in forensic and general psychiatric settings. MATERIAL AND METHODS: 52 forensic patients and 66 general psychiatric patients filled in the Psychopathy Personality Inventory - Revised (PPI-R), the Inventory of Interpersonal Problems - German Version (IIP-D), the Questionnaire on Motivation for Psychotherapy (Fragebogen zur Erfassung der Psychotherapiemotivation (FPTM)) as well as the Working Alliance Inventory - Short Revised (WAI-SR). We applied descriptive analyses, calculated univariate t-tests as well as multivariate T-tests and performed general linear models. RESULTS: The quality of the therapeutic alliance does not differ significantly between forensic and general psychiatric patients. Moreover, patients of forensic psychiatry consider therapeutic techniques applied by their therapists as more valuable for achieving their therapeutic aims than patients of the general psychiatry. DISCUSSION: The therapeutic relationship in forensic psychiatry is as viable as in general psychiatry. This can be regarded as a result of the long-term therapy in the context of forensic psychiatry which allows more time to be spent on relationship building than in a general psychiatry setting where therapy is limited to a few weeks.

Driving skills in unmedicated first- and recurrent-episode schizophrenic patients.

The present study was designed to examine driving skills according to regulations of the German guidelines for road and traffic safety in unmedicated schizophrenic inpatients. A total of 13 first-episode (FES) and 13 recurrent-episode (RES) schizophrenic inpatients were included in the analysis and compared with a group of 20 healthy controls (HC). Data were collected with the computerised Wiener Testsystem measuring visual perception, reactivity and stress tolerance, concentration and vigilance. Analysis of data indicates that a great proportion (58 %) of schizophrenic patients were impaired in psychomotor functions related to driving skills. FES and RES significantly differed with respect to driving ability with a greater proportion in the FES (38 %) showing severe impairments when compared with RES (25 %). Differences with respect to HC performance were most pronounced in concentration and for the FES additionally in visual perception. Analysis of our data indicates that a great proportion of schizophrenic patients are impaired in psychomotor functions related to driving skills that cannot be attributed to adverse side effects of psychopharmacological treatment. Besides, we cannot confirm a chronical decline of psychomotor functions related to driving skills at least in the early course of schizophrenic illness.

Transcranial direct current stimulation in children and adolescents: a comprehensive review.

Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation method that has shown promising results in various neuropsychiatric disorders in adults. This review addresses the therapeutic use of tDCS in children and adolescents including safety, ethical, and legal considerations. There are several studies addressing the dosage of tDCS in children and adolescents by computational modeling of electric fields in the pediatric brain. Results suggest halving the amperage used in adults to obtain the same peak electric fields, however, there are some studies reporting on the safe application of tDCS with standard adult parameters in children (2 mA; 20-30 min). There are several randomized placebo controlled trials suggesting beneficial effects of tDCS for the treatment of cerebral palsy. For dystonia there are mixed data. Some studies suggest efficacy of tDCS for the treatment of refractory epilepsy, and for the improvement of attention deficit/hyperactivity disorder and autism. Interestingly, there is a lack of data for the treatment of childhood and adolescent psychiatric disorders, i.e., childhood onset schizophrenia and affective disorders. Overall, tDCS seems to be safe in pediatric population. More studies are needed to confirm the preliminary encouraging results; however, ethical deliberation has to be weighed carefully for every single case.

Mobility behaviour and driving status of patients with mental disorders - an exploratory study.

BACKGROUND: Driving is an important activity of daily life and an integral part of mobility. However, impact of mental illness on road mobility is widely unexplored. METHOD: Driving status in 1497 psychiatric inpatients (PPs) and a clinical control group of 313 neurological inpatients (NPs) was investigated using a brief questionnaire. RESULTS: 67% of PPs (89% NPs) reported to have a valid driver's licence and 77% of them (92% NPs) reported to regularly use their cars. Within driver's license holders, patients with organic mental disorder (32%), substance dependence (37%) and psychotic disorder (40%) had the lowest proportion of current drivers. Higher educational qualification (odds ratio [OR] from 2.978 to 17.036) and being married/partnered (OR 3.049) or divorced (OR 4.840) significantly advanced the probability of possession of a driving license. Predictive factors for driving cessation were being female, an older age, drawing a pension and having an organic mental disease or schizophrenic disorder. CONCLUSION: Mental disease has a negative impact on driving status and this is especially true for illnesses frequently being accompanied by distinct cognitive impairments. Factors predicting road mobility elucidate the strong relationship with psychosocial status indicating that recovery of driving competence should be an integral goal of treatment strategies.

Dopaminergic mechanisms of target detection - P300 event related potential and striatal dopamine.

The P300 is a cortically generated event related potential (ERP) widely used in neurophysiological research since it is related to cognitive functions and central information processing. Intracerebral recordings and functional neuroimaging studies have demonstrated that this potential is generated by various brain regions including frontal, temporal and parietal cortices. Regarding the neurochemical background, clinical and genetic investigations suggest that dopaminergic neurons could be involved in the generation of the P300. However, there is no direct evidence in vivo that P300 amplitudes and latencies are related to dopaminergic parameters. The aim of this study was to further elucidate dopaminergic aspects of the P300 ERP by combining neurophysiological and nuclear medicine assessments in vivo. Patients with a major depressive episode underwent both P300 recordings and dynamic [¹²³I] IBZM SPECT for the evaluation of striatal dopamine D2/D3-receptor availability. There were statistically significant positive correlations of the striatal dopamine D2/D3-receptor status with P300 amplitudes and significant negative correlations with P300 latencies. Using this combined approach, the study presents direct evidence in vivo that the central dopaminergic system might play an important role in the generation of the P300 and that central dopaminergic activity could be involved in the modulation of P300 parameters. This association might be of relevance for the interpretation of P300 studies in psychiatric disorders.

The Effects of Transcranial Direct Current Stimulation (tDCS) on Psychomotor and Visual Perception Functions Related to Driving Skills.

Objective: It could be demonstrated that anodal transcranial direct current stimulation (tDCS) of the left dorsolateral prefrontal cortex (DLPFC) enhances accuracy in working memory tasks and reaction time in healthy adults and thus may also have an influence on complex everyday tasks like driving a car. However, no studies have applied tDCS to psychomotor skills related to a standard driving test so far. Methods: 10 female and 5 male healthy adults without any medication and history of psychiatric or neurological illness were randomly assigned to two groups receiving active and sham stimulation in a double blind, cross-over study design. Standardized computerized psychomotor tests according to the German guidelines for road and traffic safety were administered at baseline. Then they performed the same tests during an anodal or sham tDCS of the left DLPFC in two separated sessions. Results: No significant improvements in skills related to driving performance like visual perception, stress tolerance, concentration, and vigilance could be shown after left anodal prefrontal tDCS. Side effects were low and did not differ between active and sham stimulation. Conclusions: The findings of our study indicate that left prefrontal tDCS may not alter driving skills affording more automated action patterns but as shown in previous studies may have an influence on driving behavior requiring executive control processes. This however has to be proved in future studies and within greater samples.

[Who Benefits from Forensic Psychiatric Treatment? Results of a Catamnestic Study in Swabia]. / Wer profitiert von einer Behandlung im Maßregelvollzug? Ergebnisse einer bayernweiten Katamnesestudie für den Bezirk Schwaben.

OBJECTIVE: Evaluation of treatment outcomes of forensic inpatients in the Bavarian district of Swabia (2010 - 2014). METHODS: 130 inpatients were interviewed about their social reintegration, substance use and delinquency immediately after discharge from forensic psychiatry and one year after. RESULTS: One year after discharge 67 % of the patients referred due to substance use disorder according to §â€Š64 of the German Penal Code were employed, 57 % were abstinent and 83 % did not reoffend. Patients who were detained due to severe mental illness according to §â€Š63 of the German Penal Code often received inability pensions (57 %), 14 % were integrated in sheltered workshops and 100 % did not reoffend. CONCLUSION: Forensic-psychiatric treatment contributes to rehabilitation and reduces risk factors of mentally disordered offenders.

Increased Event-Related Potentials and Alpha-, Beta-, and Gamma-Activity Associated with Intentional Actions.

OBJECTIVE: Internally guided actions are defined as being purposeful, self-generated and offering choices between alternatives. Intentional actions are essential to reach individual goals. In previous empirical studies, internally guided actions were predominantly related to functional responses in frontal and parietal areas. The aim of the present study was to distinguish event-related potentials and oscillatory responses of intentional actions and externally guided actions. In addition, we compared neurobiological findings of the decision which action to perform with those referring to the decision whether or not to perform an action. METHODS: Twenty-eight subjects participated in adapted go/nogo paradigms, including a voluntary selection condition allowing participants to (1) freely decide whether to press the response button or (2) to decide whether they wanted to press the response button with the right index finger or the left index finger. RESULTS: The reaction times were increased when participants freely decided whether and how they wanted to respond compared to the go condition. Intentional processes were associated with a fronto-centrally located N2 and P3 potential. N2 and P3 amplitudes were increased during intentional actions compared to instructed responses (go). In addition, increased activity in the alpha-, beta- and gamma-frequency range was shown during voluntary behavior rather than during externally guided responses. CONCLUSION: These results may indicate that an additional cognitive process is needed for intentional actions compared to instructed behavior. However, the neural responses were comparatively independent of the kind of decision that was made (1) decision which action to perform; (2) decision whether or not to perform an action). SIGNIFICANCE: The study demonstrates the importance of fronto-central alpha-, beta-, and gamma oscillations for voluntary behavior.

Loudness dependence of auditory evoked potentials in patients with borderline personality disorder--impact of psychopathology.

Alterations of the central serotonergic system are considered to be involved in the pathophysiology of borderline personality disorder (BPD). The loudness dependence of the N1/P2 component of auditory evoked potentials (LD) has been shown to indirectly reflect central serotonergic activity. The aim of this study was to investigate LD in patients with BPD compared to healthy controls, and to evaluate the association between LD and psychopathology such as anxiety, anger or impulsiveness. Female patients with BPD were included and compared to age- and sex-matched healthy subjects. Self-rating instruments, such as the State-Trait Anxiety Inventory (STAI), State-Trait Anger Expression Inventory (STAXI), and the Barratt Impulsiveness Scale (BIS) were used to assess clinical scores of anxiety, anger, and impulsiveness. Evoked potentials were recorded following the application of acoustic stimuli with increasing intensities; the LD was analysed using dipole source analysis. The mean LD was significantly higher in patients with BPD compared to controls. In the entire sample there were significant positive correlations of LD with state anxiety scores and STAXI subscores. The data contribute to the knowledge of neurophysiological alterations in patients with BPD, supporting the hypothesis of serotonergic dysregulation in the pathophysiology of the disorder. The significant clinical correlations suggest monoaminergic modulations of psychopathology on the symptom level.

Increased γ oscillations during voluntary selection processes in adult patients with attention deficit/hyperactivity disorder.

Executive dysfunctions (regarding behavioural inhibition, decision making, flexibility or voluntary selection) rank among the core symptoms of attention deficit/hyperactivity disorder. Several studies demonstrated functional variations in patients with ADHD especially during response inhibition and flexibility. However, information about functional correlates of other aspects of executive functions such as voluntary selection processes is limited. A group of thirty adult patients with attention deficit/hyperactivity disorder (ADHD) and 30 healthy controls, matched for age and education, participated in the present study. Electrophysiological responses (event-related potentials, gamma oscillations) and behavioural data were acquired during the voluntary selection between various response alternatives. ADHD patients demonstrated increased responses in the gamma frequency band especially in frontal and fronto-central brain areas during voluntary response selection processes compared to healthy subjects. In addition, the error rate was increased in patients. Given that gamma-band responses have been related to GABAergic and glutamatergic responses these results may indicate accordant dysfunction in patients with ADHD.

The diagnosis and treatment of primary hyperaldosteronism in Germany: results on 555 patients from the German Conn Registry.

BACKGROUND: Primary hyperaldosteronism (Conn's syndrome) is being diagnosed increasingly often. As many as 12% of patients with hypertension have the characteristic laboratory constellation of Conn's syndrome. Its diagnosis and treatment have not been standardized. METHODS: The authors retrospectively analyzed data of 555 patients (327 men and 228 women, aged 55 +/- 13 years) who were treated for primary hyperaldosteronism in 5 different centers from 1990 to 2006. The objective was to determine center-specific features of diagnosis and treatment. RESULTS: 353 (63%) of the patients had the hypokalemic variant of primary hyperaldosteronism; 202 never had documented hypokalemia. The centers differed markedly with respect to the patients' clinical presentation, diagnostic testing of endocrine function, and diagnostic imaging techniques, including adrenal venous sampling. The adrenalectomy rate ranged from 15% to 46%. CONCLUSIONS: The registry data reveal an unexpected heterogeneity in the diagnostic evaluation and treatment of primary hyperaldosteronism. National or international guidelines are needed so that these can be standardized.