BackgroundPsychosocial interventions for autistic adults remain limited. This study evaluated the implementation feasibility and potential clinical effectiveness of a manualized group psychotherapy program delivered under routine care conditions.MethodsData from 115 autistic adults who completed the program in routine outpatient care were analyzed. Outcomes included pre- to post-intervention changes in social responsiveness as primary outcome, as well as self-worth, depressive symptoms, and quality of life as secondary outcomes.ResultsOverall social responsiveness improved significantly from pre- to post-intervention. Significant post-intervention improvements were further detected for self-worth and depressive symptoms, while quality of life showed no significant change.DiscussionThe findings indicate that the manualized group psychotherapy program seems to be feasible in routine clinical care and was associated with improvements in social functioning, self-worth, and depressive symptoms, suggesting preliminary clinical effectiveness. However, randomized controlled trials are warranted to further establish efficacy.

In somatischen Notaufnahmen ist die Prävalenz psychiatrischer Notfälle mit 5–10

In somatic emergency departments, the prevalence of psychiatric emergencies is high, ranging from 5-10%. The psychiatric consultation and liaison service plays a central role in the interdisciplinary care of emergency patients in somatic emergency departments. It addresses patients primarily with psychiatric disorders, organically caused psychiatric conditions and somatic illnesses with psychiatric comorbidities. While consultation activities involve advising other medical disciplines, consultation and liaison services enable continuous treatment of patients. Depending on the organization as a consultation or combined consultation and liaison service, the aim is to ensure efficient, targeted, safe and cost-effective evaluation of psychiatric symptoms and/or to screen as many patients as possible with psychiatric symptoms, facilitating access to psychiatric treatment. Psychiatric consultation and liaison services can furthermore support decisions regarding necessary somatic evaluations prior to psychiatric treatment. The "SMART medical clearance form" provides a standardized approach to somatic evaluations for patients with psychiatric symptoms in emergency departments. To improve psychiatric assessments of patients in somatic emergency departments, further standardization of the recommended somatic examinations and the evaluation of whether somatic symptoms can be associated with an underlying psychiatric disorder are needed. In addition, guidelines should establish which patients require a psychiatric consultation assessment in emergency departments.

BACKGROUND:Neuroimaging studies in attention-deficit/hyperactivity disorder (ADHD) demonstrated decreased global gray matter volume. In terms of surface parameters, most investigations focused on cortical thickness with a multi-center MEGA-analysis indicating cortical thinning in children, but not in adults with ADHD. In this single-scanner study, for the first time in adult ADHD, we additionally examined metrics beyond cortical thickness and surface area, namely sulcal depth and fractal dimension as measures of cortical alteration and complexity. Unlike most previous studies, ADHD subtypes were considered.METHODS:As part of the Comparison of Methylphenidate and Psychotherapy in Adult ADHD Study (COMPAS), surface parameters were analyzed in 131 adults with ADHD (66 combined, 60 inattentive and 5 hyperactive/impulsive subtype) and 95 healthy controls with the Computational Anatomy Toolbox (CAT12) using Statistical Parametric Mapping Software (SPM).RESULTS:Neither at the vertex- nor at the region of interest-level, the ADHD and control group differed significantly with regard to cortical thickness, gyrification index, sulcal depth or fractal dimension. Contrasting the combined and the inattentive subtype, patients of the combined subtype showed a significant thinning of the left anterior insular cortex. Thinner left pars opercularis cortical thickness was associated with symptoms of hyperactivity/restlessness.CONCLUSIONS:Resembling previous findings of a correlation of the left anterior insular gray matter volume with oppositional symptoms in adolescents with ADHD, we detected left anterior insular cortical thinning in the ADHD combined subtype. Left insular cortical thickness could represent a potential marker to distinguish the predominantly inattentive and the combined ADHD subtype in adulthood.

Ophthalmological methods have increasingly raised the interest of neuropsychiatric specialists. While the integrity of the retinal cell functions can be evaluated with the electroretinogram (ERG), optical coherence tomography (OCT) allows a structural investigation of retinal layer thicknesses. Previous studies indicate possible functional and structural retinal alterations in patients with schizophrenia. Twenty-five patients with paranoid schizophrenia and 25 healthy controls (HC) matched for age, sex, and smoking status participated in this study. Both, ERG and OCT were applied to obtain further insights into functional and structural retinal alterations. A significantly reduced a-wave amplitude and thickness of the corresponding para- and perifoveal outer nuclear layer (ONL) was detected in patients with paranoid schizophrenia with a positive correlation between both measurement parameters. Amplitude and peak time of the photopic negative response (PhNR) and thickness of the parafoveal ganglion cell layer (GCL) were decreased in patients with schizophrenia compared to HC. Our results show both structural and functional retinal differences between patients with paranoid schizophrenia and HC. We therefore recommend the comprehensive assessment of the visual system of patients with schizophrenia, especially to further investigate the effect of antipsychotic medication, the duration of illness, or other factors such as inflammatory or neurodegenerative processes. Moreover, longitudinal studies are required to investigate whether the functional alterations precede the structural changes.

Since the retina shares its embryological origin with the central nervous system, optical coherence tomography (OCT), an imaging technique frequently employed in ophthalmology to analyze the macula and intraretinal layer thicknesses and volumes, has recently become increasingly important in psychiatric research. We examined 34 autistic and 31 neurotypical adults (NT) using OCT. Autistic adults had reduced overall macular and outer nuclear layer (ONL) thickness and volume compared to NT. Both macular and ONL thickness showed significant inverse associations with the severity of autistic symptoms measured with the Social Responsiveness Scale 2 (SRS-2). Longitudinal studies across different age groups are required to clarify whether retinal changes may represent a possible trait marker.

OBJECTIVE Previous diffusion tensor imaging studies reported a reduced fractional anisotropy in the body of the corpus callosum in patients with anorexia nervosa patients, which may indicate impaired white matter integrity in interhemispheric connections. The aim of the current study was to investigate whether structural connectivity is affected in patients with anorexia nervosa. METHOD To this end, we compared the number of streamlines (a model of the white matter fibre tracts) and the total volume filled by these streamlines in different subsections of the corpus callosum in 33 women with and 33 without anorexia nervosa as well as in 20 recovered individuals. RESULTS The volume of streamlines in the anterior and mid-anterior subsection of the corpus callosum was reduced in women with, but not in those who had recovered from anorexia nervosa. No differences in number of streamlines was detected in the corpus callosum between patients with anorexia nervosa, healthy controls and recovered patients. CONCLUSIONS Alterations of the corpus callosum have been repeatedly reported in anorexia nervosa. Since the recovered group did not differ from the healthy control group, the reported alterations in acute patients appear to represent a state and not a trait marker.

The excitatory-inhibitory imbalance hypothesis postulates dysregulation of the gamma-aminobutyric acid (GABA) and glutamate (Glu) neurotransmitter systems as a common underlying deficit in individuals with autism spectrum disorders (ASD). Previous studies suggest an important role of these systems in the pathophysiology of ASD, including a study of our group reporting decreased glutamate concentrations in the pregenual anterior cingulate cortex (ACC) of adults with ASD. The aim of this study was to replicate our previous findings of impaired glutamate metabolism in ASD in a new sample and to additionally quantify GABA in the ACC and dorsolateral prefrontal cortex (dlPFC). Concentrations of GABA and glutamate-glutamine (Glx; combined glutamate and glutamine signal) were quantified in the ACC and dlPFC of 43 adults with ASD and 43 neurotypical controls (NTC) by magnetic resonance spectroscopy (MRS). The ASD group showed increased absolute GABA concentrations and elevated GABA/creatine ratios in the left dlPFC compared to NTC, while no group differences were detected in the pregenual and dorsal ACC. Previous findings of altered Glx concentration in the pregenual ACC of the ASD group could not be replicated. Regarding Glx concentrations and Glx/creatine ratios, there were no significant differences in the dlPFC and ACC either. The study supports the hypothesis of an altered GABA and glutamate equilibrium, indicating an imbalance between excitatory and inhibitory metabolism in ASD patients. However, inconsistent results across studies and brain regions suggest a complex underlying phenomenon. LAY SUMMARY: Adults of the autism spectrum exhibit elevated levels of the inhibitory neurotransmitter GABA in the left dorsolateral prefrontal cortex. This finding supports the hypothesis of an imbalance between excitatory and inhibitory equilibrium in patients with autism spectrum disorders.

The electroretinogram (ERG) allows the investigation of retinal signaling pathways and has increasingly been applied in individuals with mental disorders in search for potential biomarkers of neurodevelopmental disorders. Preceding ERG examinations in individuals with autism spectrum disorders (ASD) showed inconsistent results, which might be due to the small number of participants, heterogeneity of the ASD population, differences in age ranges, and stimulation methods. The aim of this study was to investigate functional retinal responses in adults with ASD by means of the light-adapted (photopic) ERG. Light-adapted ERG measurements were obtained with the RETeval® system applying three different stimulation protocols. In the final analysis, the ERG parameters a-wave, b-wave, the photopic negative response (PhNR), the photopic hill parameters as well as additional amplitude ratios were compared between 32 adults with high-functioning ASD and 31 non-autistic controls. Both groups were matched with regard to sex and age. No significant functional retinal differences in amplitude or peak time of the a- or b-wave, PhNR, the photopic hill parameters or the ERG-amplitude ratios could be detected in individuals with ASD compared to non-autistic participants. The absence of electrophysiological functional retinal alterations in ASD, suggests that changes in visual perception, such as increased attention to detail or visual hypersensitivity in ASD, are not due to impairments at early levels of retinal signal processing.

An altered pattern of information processing has been hypothesized in autism spectrum disorder (ASD), characterized by enhanced local network connectivity and reduced long-distance communication. Previous findings of impaired white matter integrity in the genu and the body of the corpus callosum already indicated reduced long-distance connectivity in patients with ASD. However, it remained unclear how this reduced white matter integrity affects the structural connectivity of the corresponding brain areas. To this end, we analyzed magnetic resonance images (MRI) from 30 participants with high-functioning ASD and 30 typically developed individuals using a global tracking approach to estimate the fiber count and volume of the transcallosal fiber tracts of the five corpus callosum subsections. A reduced fiber count and fiber volume in the anterior subsection of the corpus callosum was detected, supporting the hypothesis of reduced long-distance connectivity in ASD.

Background: The retina has gained increasing attention in non-ophthalmological research in recent years. The pattern electroretinogram (PERG), a method to evaluate retinal ganglion cell function, has been used to identify objective correlates of the essentially subjective state of depression. A reduction in the PERG contrast gain was demonstrated in patients with depression compared to healthy controls with normalization after remission. PERG responses are not only modulated by stimulus contrast, but also by check size and stimulation frequency. Therefore, the rationale was to evaluate potentially more feasible procedures for PERG recordings in daily diagnostics in psychiatry. Methods: Twenty-four participants (12 patients with major depression (MDD) and 12 age- and sex-matched healthy controls) were examined in this pilot study. We investigated PERG amplitudes for two steady-state pattern reversal frequencies (12.5/18.75 rps) and four sizes of a checkerboard stimulus (0.8°, 1.6°, 3.2°, and 16°) to optimize the PERG recordings in MDD patients. Results: Smaller PERG amplitudes in MDD patients were observed for all parameters, whereby the extent of the reduction appeared to be stimulus-specific. The most pronounced decline in the PERG of MDD patients was observed at the higher stimulation frequency and the finest pattern, whilst responses for the largest check size were less affected. Following the PERG ratio protocol for early glaucoma, where similar stimulus dependent modulations have been reported, we calculated PERG ratios (0.8°/16°) for all participants. At the higher frequency (18.75 rps), significantly reduced ratios were observed in MDD patients. Conclusion: The “normalization” of the PERG responses—via building a ratio—appears to be a very promising approach with regard to the development of an objective biomarker of the depressive state, facilitating inter-individual assessments of PERG recordings in patients with psychiatric disorders.

ZusammenfassungIm Rahmen der Arbeit soll der aktuelle Stand der Forschung zur ADHS im Erwachsenenalter vorgestellt werden. Die Ursachen der ADHS sind noch nicht vollständig geklärt, es werden jedoch genetische und andere Einflussfaktoren wie prä-und perinatale Komplikationen angenommen. Daneben weisen ADHS-Patienten hirnorganisch strukturelle, neurochemische und funktionelle Auffälligkeiten auf. Die Diagnostik der ADHS im Erwachsenenalter basiert auf einem klinischen Interview, biografischer und Fremdanamnese sowie psychometrischen Erhebungen. Zudem sollten organische oder andere psychische Erkrankungen, die ADHS-ähnliche Symptome hervorrufen können, differenzialdiagnostisch ausgeschlossen werden. Erfolgt die Diagnosestellung nach DSM-5 müssen die Symptome vor dem 12. Lebensjahr aufgetreten sein. Bei der Behandlung der ADHS im Erwachsenenalter wird eine Kombination aus Pharmako-und Psychotherapie empfohlen. Neuere Behandlungsansätze wie die Supplementation von Vitaminen, Fettsäuren oder Mineralien, Sport oder Neurofeedback bedürfen einer weiteren Evaluation.

Inattention, distractibility, and problems inhibiting irrelevant information impose a large disease burden in atten- tion de ficit hyperactivity disorder (ADHD). Problems with cognitive function are found in many major psychiatric disorders, and our understanding of ADHD might add to our knowledge of other neuropsychiatric disorders. De- spite the high impact of ADHD, the pathophysiology and the mechanism of treatment action remains poorly un- derstood. Increasing evidence suggests that elevated neuronal and retinal background noise plays a prominent role in ADHD. However, the effect of treatment (e.g., methylphenidate) on noise remains unclear. For this study, retinal background noise was assessed with the pattern-electroretinogram (PERG) in 20 drug -na?ve adults with ADHD before and after treatment with methylphenidate and in 21 control subjects. Background noise was identi fied using the Fourier magnitude at frequencies adjacent to the stimulus -response frequency of 12.5 Hz. At baseline, we found an elevated retinal background noise in ADHD patients ( Mdn = 0.079 ?V) compared to con- trols ( Mdn = 0.062 ?V; z = -2.79, p = 0.016, r = -0.44). The noise in the ADHD group decreased signi ficantly at follow-up after treatment with methylphenidate ( Mdn = 0.069 ?V, z = -2.39, p = 0.035, r = -0.39) while there was no change in the control group. PERG-based retinal noise is increased in adult ADHD and normalizes along with clinical symptoms following treatment with methylphenidate. The retinal noise level might be a promising marker of ADHD in clinical and basic research and illustrates the biological match with nonhuman ADHD models.

Background: Therapeutic drug monitoring has become increasingly important in psychiatric therapy. However, it is not yet implemented as a daily routine in clinical settings. To evaluate new, noninvasive procedures, we compared blood and saliva venlafaxine, quetiapine, and citalopram concentrations in samples collected from psychiatric patients. Methods: We collected blood and saliva samples from 75 psychiatric patients (39 venlafaxine, 19 quetiapine, and 17 citalopram). Saliva sampling was achieved by the use of cotton pads. Venlafaxine (and its metabolite O-desmethylvenlafaxine) and quetiapine were analyzed by LC-MS/MS, whereas citalopram was analyzed by HPLC. Results: We observed significant correlations between concentrations of venlafaxine (ratio saliva/serum ± SD: 18.3 ± 9.5, P < 0.01, r = 0.895) and its metabolite O-desmethylvenlafaxine (ratio saliva/serum ± SD: 4.1 ± 3.2, P < 0.05, r = 0.344), quetiapine (ratio saliva/serum ± SD: 0.2 ± 0.2, P < 0.01, r = 0.935), and citalopram (ratio saliva/serum ± SD: 2.6 ± 1.2, P < 0.05, r = 0.54) in serum and in saliva. Furthermore, measured concentrations of venlafaxine (and its metabolite O-desmethylvenlafaxine) and citalopram were higher in saliva than in serum, whereas measured concentrations of quetiapine were higher in serum than in saliva. Conclusions: Using cotton pad saliva sampling, venlafaxine and quetiapine demonstrate high correlations between saliva and serum concentrations, whereas for O-desmethylvenlafaxine and citalopram, other methods of sampling might be preferable. Saliva therapeutic drug monitoring of psychoactive drugs might become a useful approach to achieving individual treatment regimens.

Problems with cognitive function are found in many major psychiatric disorders. In schizophrenia and attention deficit hyperactivity disorder (ADHD), they are among the core symptoms. Based on a growing recognition that there is little diagnostic specificity for any single cognitive impairment, there is an increasing emphasis on investigating impairments across psychiatric disorders. This approach, which is consistent with the NIMH Research Domain Criteria initiative, is expected to lead to a better understanding of the neurobiological mechanisms involved in cognitive deficits. An increase in neuronal background noise has been identified as a neuronal correlate of inattention. Because the dopamine system has been found to play a critical role in modulating neuronal noise, dopamine dysfunction may play a substantial role in generating the excessive noise that has been found to characterize information processing in both schizophrenia and ADHD. This issue can be studied noninvasively via electrophysiological examination of the retina, a distinct neural network. Both basic research and human studies indicate that retinal information processing is under strong dopaminergic modulation (Bubl, Biol. Psychiatry, 2010; Bubl, Br J Psychiatry, 2012). We have previously demonstrated an elevated level of background noise at a very early stage in visual information processing in untreated patients with ADHD (Bubl, Plos One, 2015). Moreover, background noise was associated with inattention measures in these subjects. To further address the hypothesis that elevated retinal noise reflects dopaminergic dysfunction, we report here on a new study that compared retinal background noise in patients with ADHD both before and after therapy, as well as in patients with schizophrenia. Neuronal noise was assessed using pattern electroretinogram (PERG), an objective electrophysiological measure for retinal network function from the photoreceptors to the retinal ganglion cells. A total of 20 patients diagnosed with ADHD were tested both before and after treatment with methylphenidate (MPH). The control group consisted of 21 healthy subjects. The PERGs were recorded in a steady state mode in response to checkerboard stimuli of 12 reversals/s. Data collection with people with schizophrenia is ongoing, and results will be reported at SIRS. Before treatment, the patients with ADHD presented with elevated background noise (higher by 127%) in comparison to the control group. After treatment, noise level did not differ from what was observed in the control group. Retinal background noise was found to be highly correlated with the severity of the ADHD symptoms. The results will be discussed in relationship to our findings in patients with schizophrenia. These data provide further evidence for the hypothesis that elevated background noise is linked to ADHD and cognitive deficits. The findings are of special relevance because ADHD is a disorder with a dedicated treatment option for cognitive symptoms. Interestingly, a similar pathophysiological mechanism for cognitive dysfunction has been proposed for both schizophrenia and ADHD. However, because ADHD medications, such as MPH, typically elevate dopamine levels, potentially leading to exacerbation of psychotic symptoms, different approaches for treating cognitive symptoms in schizophrenia need to be explored. On this basis, current approaches used to target neuronal noise and cognitive symptoms in patients with schizophrenia will be discussed and their relevance for future research will be addressed.

Introduction: Adult attention-deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder. In subgroups of patients with a (para)epileptic pathomechanism, this might be due to intermittent rhythmic delta or theta activity (IRDA/IRTA). Participants and methods: Using a fully data-driven analysis, we compared the IRDA/IRTA rates in the resting electroencephalography (EEG) results of 97 adult patients with ADHD and 30 control subjects. The IRDA/IRTA rates before hyperventilation (HV) and for HV difference (difference between IRDA/IRTA rate after and before HV) were compared between groups using a linear model. Results: We detected significantly increased rates of IRDA/IRTA before HV (F = 4.209, p = 0.042) in patients with ADHD but no significant difference between the groups for HV-difference (F = 2.46, p = 0.119). Discussion: The increased IRDA/IRTA rates before HV in the group with ADHD might lead to (para)epileptic short-term effects (e.g., impulsivity) via local area network inhibition, and to long-term effects (e.g., cognitive deficits) via connectivistic brain restructuring. (C) 2017 Elsevier Inc. All rights reserved.

Background: Autism spectrum disorder (ASD) is a neurodevelopmental disease characterized by difficulties in social communication, unusually restricted, repetitive behavior and interests, and specific abnormalities in language and perception. The precise etiology of ASD is still unknown and probably heterogeneous. In a subgroup of patients, toxic environmental exposure might lead to an imbalance between oxidative stress and anti-oxidant systems. Previous serum and postmortem studies measuring levels of glutathione (GSH), the main cellular free radical scavenger in the brain, have supported the hypothesis that this compound might play a role in the pathophysiology of autism.Methods: Using the method of single-voxel proton magnetic resonance spectroscopy (MRS), we analyzed the GSH signal in the dorsal anterior cingulate cortex (dACC) and the dorsolateral prefrontal cortex (DLPFC) of 24 ASD patients with normal or above average IQs and 18 matched control subjects. We hypothesized that we would find decreased GSH concentrations in both regions.Results: We did not find overall group differences in neurometabolites including GSH, neither in the dorsal ACC (Wilks' lambda test; p = 0.429) nor in the DLPFC (p = 0.288). In the dACC, we found a trend for decreased GSH signals in ASD patients (p = 0.076).Conclusions: We were unable to confirm our working hypothesis regarding decreased GSH concentrations in the ASD group. Further studies combining MRS, serum, and cerebrospinal fluid measurements of GSH metabolism including other regions of interest or even whole brain spectroscopy are needed.

Background: Autism spectrum disorder (ASD) is often associated with epilepsy. Previous studies have also shown increased rates of electroencephalographic (EEG) alteration in ASD patients without epilepsy. The aim of this study was to compare the rate of intermittent rhythmic delta and theta activity (IRDA/IRTA) events between high-functioning adult patients with ASD and matched healthy controls. Materials and Methods: Routine EEG records of 19 ASD patients and 19 matched controls were screened for IRDA/IRTA using a fully data driven analysis with fixed thresholds. IRDA/IRTA rates before and after hyperventilation (HV) as well as the HV-induced difference in IRDA/IRTA rates (HV difference) were analyzed. For inter-group measures, we used the Wilcoxon rank sum test. Results: Significantly increased HV difference was detected in the ASD group (p = 0.0497). However, the groups showed no difference in IRDA/IRTA rates before HV (p = 0.564) and after HV (p = 0.163). Conclusions: The lack of any group differences regarding IRDA/IRTA before HV might be related to the fact that we only studied non-secondary high-functioning autism in a small sample of epilepsy-free adult patients. A significantly increased HV difference might be regarded as a marker of subtle neuronal network instability possibly causing short-term disturbances via local area network inhibition and long-term effects via epileptic encephalopathy.