Increase in presentations with new-onset psychiatric disorders in a psychiatric emergency department in Berlin, Germany during the second wave of the COVID-19 pandemic - a retrospective cross-sectional study.

Introduction: While numerous studies have identified an increase in symptoms of depression as well as anxiety and distress due to the COVID-19 pandemic, relatively few studies have investigated the new-onset of psychiatric diseases during the pandemic. Methods: This study focuses on the number of psychiatric new-onset diagnoses in a psychiatric emergency department (pED) in Berlin, Germany during the second wave of the pandemic (i.e. from 09/15/2020 to 03/01/2021 = COVID-19-period) compared to pre-pandemic times (09/15/2019 to 03/01/2020 = control period). We focused on diagnostic subgroups and performed logistic regression analysis to investigate potential risk groups based on covariables such as age, gender, homelessness, attending in police custody and familial relationship. Results: Overall, there was a 59.7% increase in new-onset psychiatric diagnoses during the COVID-19-period. Increases in the following diagnoses were observed: new-onset of substance-related and addictive disorders (+192.5%), depressive disorders (+115.8%), schizophrenia spectrum and psychotic disorders (+113.3%) and anxiety disorders (+63.6%). These diagnostic subgroups, together with attending in police custody, were found to predict pED presentations with new-onset during the COVID-19-period. Interestingly, in the group of new-onset psychiatric diseases in the COVID-19-period, higher amounts of job loss and living alone as well as a relative decrease in familial relationships were observed. Discussion: COVID-19 infections and post-COVID-19 syndrome are unlikely to have played a substantial role in the increase of new-onset diseases in this study. Conclusion: Our findings underline the role of indirect factors in new-onset of psychiatric diseases during the pandemic and should be a caveat for future pandemic control policies.

The dynamics of discrimination, resilience, and social support in the mental health of migrants with and without citizenship.

Perceived discrimination has a significant negative impact on indices of mental health. One potential buffering factor in this is psychological resilience, which encompasses the ability to recover from or adapt successfully to adversity and use coping strategies, such as positive reappraisal of adverse events. This study examines the role of resilience as well as social support in buffering these effects in groups of migrants both with and without local residence permits. We conducted a non-experimental observational study with a cross-sectional design, collecting a variety of health variables in migrant groups in a naturalistic setting, during the COVID-19 period. The total sample consisted of 201 subjects, 88 of whom had a German residence title and 113 did not. These two groups were compared on the following variables of interest: social support, resilience, discrimination, and general mental health. There was no evidence for a difference in mental health between migrants with and without citizenship. However, our results suggested that migrants without citizenship reported less social support, less resilience, and more discrimination, which continued to have a distinct effect on mental health beyond resilience and social support. Psychological resilience mediated the link between social support and mental health, as well as being related to the perception of discrimination in the migrant group without citizenship. In conclusion, our models of migrants with and without citizenship showed that resilience specifically directly affected perceived discrimination in those without citizenship. The high levels of discrimination and lack of social support, particularly in the migrant group without citizenship, are concerning and suggest a focus for future interventions.

Sexual preference for prepubescent children is associated with enhanced processing of child faces in juveniles.

Child sexual abuse offences (CSOs) represent a severe ethical and socioeconomic burden for society. Juveniles with a sexual preference for prepubescent children (PP) commit a large percentage of CSOs, but have been widely neglected in neuroscience research. Aberrant neural responses to face stimuli have been observed in men with pedophilic interest. Thus far, it is unknown whether such aberrations exist already in PP. A passive face-viewing paradigm, including the presentation of child and adult faces, was deployed and high-density electroencephalography data were recorded. The study group comprised 25 PP and the control group involved 22 juveniles with age-adequate sexual preference. Attractiveness ratings and evoked brain responses were obtained for the face stimuli. An aberrant pattern of attractiveness ratings for child vs. adult faces was found in the PP group. Moreover, elevated occipital P1 amplitudes were observed for adult vs. child faces in both groups. At longer latency (340-426 ms), a stronger negative deflection to child vs. adult faces, which was source localized in higher visual, parietal and frontal regions, was specifically observed in the PP group. Our study provides evidence for enhanced neural processing of child face stimuli in PP, which might reflect elevated attention capture of face stimuli depicting members from the sexually preferred age group. This study expands our understanding of the neural foundations underlying sexual interest in prepubescent children and provides a promising path for the uncovering of objective biomarkers of sexual responsiveness to childlike body schemes in juveniles.

Early evoked brain activity underlies auditory and audiovisual speech recognition deficits in schizophrenia.

OBJECTIVES: People with Schizophrenia (SZ) show deficits in auditory and audiovisual speech recognition. It is possible that these deficits are related to aberrant early sensory processing, combined with an impaired ability to utilize visual cues to improve speech recognition. In this electroencephalography study we tested this by having SZ and healthy controls (HC) identify different unisensory auditory and bisensory audiovisual syllables at different auditory noise levels. METHODS: SZ (N = 24) and HC (N = 21) identified one of three different syllables (/da/, /ga/, /ta/) at three different noise levels (no, low, high). Half the trials were unisensory auditory and the other half provided additional visual input of moving lips. Task-evoked mediofrontal N1 and P2 brain potentials triggered to the onset of the auditory syllables were derived and related to behavioral performance. RESULTS: In comparison to HC, SZ showed speech recognition deficits for unisensory and bisensory stimuli. These deficits were primarily found in the no noise condition. Paralleling these observations, reduced N1 amplitudes to unisensory and bisensory stimuli in SZ were found in the no noise condition. In HC the N1 amplitudes were positively related to the speech recognition performance, whereas no such relationships were found in SZ. Moreover, no group differences in multisensory speech recognition benefits and N1 suppression effects for bisensory stimuli were observed. CONCLUSION: Our study suggests that reduced N1 amplitudes reflect early auditory and audiovisual speech processing deficits in SZ. The findings that the amplitude effects were confined to salient speech stimuli and the attenuated relationship with behavioral performance in patients compared to HC, indicates a diminished decoding of the auditory speech signals in SZs. Our study also revealed relatively intact multisensory benefits in SZs, which implies that the observed auditory and audiovisual speech recognition deficits were primarily related to aberrant processing of the auditory syllables.

Early and late evoked brain responses differentially reflect feature encoding and perception in the flash-lag illusion.

In the flash-lag illusion (FLI), the position of a flash presented ahead of a moving bar is mislocalized, so the flash appears to lag the bar. Currently, it is not clear whether this effect is due to early perceptual-related neural processes such as motion extrapolation or reentrant processing, or due to later feedback processing relating to postdiction, i.e., retroactively altered perception. We presented 17 participants with the FLI paradigm while recording EEG. A central flash occurred either 51 ms ("early") or 16 ms ("late") before the bar moving from left to right reached the screen center. Participants judged whether the flash appeared to the right ("no flash lag illusion") or to the left ("flash-lag illusion") of the bar. Using single-trial linear modeling, we examined the influence of timing ("early" vs. "late") and perception ("illusion" vs. "no illusion") on flash-evoked brain responses and estimated the cortical sources underlying the FLI. An earlier frontal and occipital component (200-276 ms) differentiated time-locked early vs. late stimulus presentation, indicating that early evoked brain responses reflect feature encoding in the FLI. Perception of the FLI was associated with a late window (368-452 ms) in the ERP, with larger deflections for illusion than no illusion trials, localized to the left inferior occipital gyrus. This suggests a postdiction-related reconstruction of ambiguous sensory stimulation involving late processes in the occipito-temporal cortex, previously associated with temporal integration phenomena. Our findings indicate that perception of the FLI relies on an interplay between ongoing stimulus encoding of the moving bar and feedback processing of the flash, which takes place at later integration stages.

Multisensory Processing Can Compensate for Top-Down Attention Deficits in Schizophrenia.

Studies on schizophrenia (SCZ) and aberrant multisensory integration (MSI) show conflicting results, which are potentially confounded by attention deficits in SCZ. To test this, we examined the interplay between MSI and intersensory attention (IA) in healthy controls (HCs) (N = 27) and in SCZ (N = 27). Evoked brain potentials to unisensory-visual (V), unisensory-tactile (T), or spatiotemporally aligned bisensory VT stimuli were measured with high-density electroencephalography, while participants attended blockwise to either visual or tactile inputs. Behaviorally, IA effects in SCZ, relative to HC, were diminished for unisensory stimuli, but not for bisensory stimuli. At the neural level, we observed reduced IA effects for bisensory stimuli over mediofrontal scalp regions (230-320 ms) in SCZ. The analysis of MSI, using the additive approach, revealed multiple phases of integration over occipital and frontal scalp regions (240-364 ms), which did not differ between HC and SCZ. Furthermore, IA and MSI effects were both positively related to the behavioral performance in SCZ, indicating that IA and MSI mutually facilitate bisensory stimulus processing. Multisensory processing could facilitate stimulus processing and compensate for top-down attention deficits in SCZ. Differences in attentional demands, which may be differentially compensated by multisensory processing, could account for previous conflicting findings on MSI in SCZ.

Housing Satisfaction of Psychiatric Patients in Different Forms of Housing-A Cross-Sectional Study in Berlin, Germany.

The growing social problem of homelessness and precarious housing situations has negative effects on psychological outcomes and quality of life (QoL) for mentally ill people. Despite a large body of research on QoL among homeless mentally ill people, research on housing satisfaction as a specific QoL domain and important outcome variable for treatment interventions is scarce. The purpose of this cross-sectional study is to investigate housing satisfaction among psychiatric patients in various housing situations. Out of 1,251 patients that were treated in the targeted facilities during the admission period, 540 agreed to participate (43.2%). 123 participants were excluded from the analysis due to missing data, resulting in a sample of N = 417. Housing satisfaction data was assessed in a subjective screening and differences in satisfaction levels between housing status groups were analyzed. As hypothesized, more normative housing situations reported higher housing satisfaction. Homeless participants and those living in socio-therapeutic facilities were associated with more psychological and physical distress resulting from their housing situation than domiciled and flat-sharing participants. Problems of reducing homelessness and improving housing support are highlighted, as well as opportunities for improving support, particularly in therapeutic facilities.

The Differential Impact of Lockdown Measures Upon Migrant and Female Psychiatric Patients - A Cross-Sectional Survey in a Psychiatric Hospital in Berlin, Germany.

The COVID-19 pandemic could have major effects on already vulnerable individuals with psychiatric disorders. It is important to assess how different patient groups respond to stress related to the pandemic, and what additional factors influence it, including family-related stress, migration background, and sex. We conducted a survey in a sample of 294 psychiatric patients in a large outpatient clinic in Berlin, measuring level of distress in relation to COVID-19 lockdown as well as family-related distress. We also measured potential influencing factors such as media consumption and medical support. In the migration background group, we found that women had more lockdown related psychological distress than men. This was not apparent in those patients with a German background. We found that females were more strongly affected by family-related distress, particularly those with a migration background. People with PTSD were most strongly affected by family-related distress, whereas people with psychotic disorders and addiction reported the least distress. There were no effects of media consumption. There were no differences in ability to abide by the lockdown related restrictions across diagnoses. Our results support earlier findings on differential vulnerability of diagnostic groups to these stressors. Thus, clinicians can optimize treatment by taking family-related stressors into account particularly for females and people with a migrant background.

Long-Range Temporal Correlations in Resting State Beta Oscillations are Reduced in Schizophrenia.

Symptoms of schizophrenia (SCZ) are likely to be generated by genetically mediated synaptic dysfunction, which contribute to large-scale functional neural dysconnectivity. Recent electrophysiological studies suggest that this dysconnectivity is present not only at a spatial level but also at a temporal level, operationalized as long-range temporal correlations (LRTCs). Previous research suggests that alpha and beta frequency bands have weaker temporal stability in people with SCZ. This study sought to replicate these findings with high-density electroencephalography (EEG), enabling a spatially more accurate analysis of LRTC differences, and to test associations with characteristic SCZ symptoms and cognitive deficits. A 128-channel EEG was used to record eyes-open resting state brain activity of 23 people with SCZ and 24 matched healthy controls (HCs). LRTCs were derived for alpha (8-12 Hz) and beta (13-25 Hz) frequency bands. As an exploratory analysis, LRTC was source projected using sLoreta. People with SCZ showed an area of significantly reduced beta-band LRTC compared with HCs over bilateral posterior regions. There were no between-group differences in alpha-band activity. Individual symptoms of SCZ were not related to LRTC values nor were cognitive deficits. The study confirms that people with SCZ have reduced temporal stability in the beta frequency band. The absence of group differences in the alpha band may be attributed to the fact that people had, in contrast to previous studies, their eyes open in the current study. Taken together, our study confirms the utility of LRTC as a marker of network instability in people with SCZ and provides a novel empirical perspective for future examinations of network dysfunction salience in SCZ research.

The efficacy of narrative exposure therapy in a sample of Iranian women exposed to ongoing intimate partner violence-A randomized controlled trial.

OBJECTIVE: The mental health needs of women affected by intimate partner violence (IPV) and living under continuous domestic violence are currently not well understood. The present study investigates the feasibility and efficacy of narrative exposure therapy (NET), compared with commonly used counselling (treatment-as-usual, TAU), in a group of currently IPV-affected women in Tehran, Iran. METHOD: Forty-five IPV-affected women with a diagnosis of post-traumatic stress disorder (PTSD) were randomized to 10 to 12 sessions of either NET (n = 24) or TAU (n = 21). Primary outcome measures, including PTSD, depression, and perceived stress symptoms, were examined at pretreatment and 3- and 6-month follow-ups. IPV experiences, general lifetime traumatic events, childhood adversities, borderline symptoms, and daily functioning impairment were also inspected. RESULTS: NET participants showed a significantly greater symptom reduction in comparison with the TAU group in PTSD, depression, and perceived stress at both follow-ups. Improvement in daily functioning and reduction of IPV experiences and borderline symptoms at 3- and 6-month follow-ups were pronounced but not significantly different between the two treatment groups. CONCLUSION: IPV-affected women living under continuous threat and violence would benefit from trauma-focused interventions such as NET.

Two pedals drive the bi-cycle of violence: reactive and appetitive aggression.

The Good: when you fight to counter threat, your aggression is a reactive defense, and often morally justifiable. The Bad: when you loot and rob, hurt and kill, to obtain social status or material goods, that is an extrinsic reward. This is instrumental aggression. And The Ugly: The intrinsic enjoyment of violence. This 'appetitive aggression' describes a lust for violence, underlying first-person shooter gamers, hunting, and extreme acts of violence, such as murder and massacres. Although violence often results from a combination of these forms of aggression, the differentiation is necessary to understand their interplay, as they drive two interconnected cycles of violence: the reactive cycle, fueled by the motivation to overcome negative feelings, and the hedonically driven appetitive cycle.

The individual contribution of DSM 5 symptom clusters of PTSD, life events, and childhood adversity to frontal oscillatory brain asymmetry in a large sample of active combatants.

Post-Traumatic Stress Disorder (PTSD) has been linked to deviations in lateralized frontal functional oscillatory activity. This is possibly because left and right DLPFC have differential roles in regulating both memory and stress response, which are both dysfunctional in PTSD. However, previous results are heterogeneous, and could be attributable to individual symptom clusters, traumatic or aggressive life events, early life stress, or the interaction of these factors. In a large sample of active combatants (N=401), we regressed these factors on frontal electroencephalography (EEG) asymmetry across 5 frequency bands (delta: 2-4Hz; theta: 4-8Hz; alpha: 8-12Hz; beta: 12-24Hz; gamma: 24-48Hz). Negative cognition and mood was associated with stronger relative left delta and theta band power. Traumatic life events showed stronger right alpha and beta band power. Traumatic life events in interaction with hyperarousal predicted stronger relative right left-right imbalance (theta, alpha, and beta bands), whereas childhood adversity, in interaction with negative cognition and mood, predicted stronger relative left left-right imbalance (delta, theta, alpha and beta bands). The contribution of lateralized DLPFC dysfunction to PTSD is thus dependent on the individual complexities of subsymptom clusters and life history, and future studies need to take these factors into account.

The role of intrinsic and extrinsic rewards in committing violence during combat: A cross-sectional study with former combatants in the DR Congo.

It has been postulated that the violent behavior that characterizes armed conflict is reinforced by the possibility of receiving rewards. The present study examined the potential influence of two types of rewards in an ongoing setting of conflict: extrinsic and intrinsic rewards. Former combatants active in the Democratic Republic of the Congo (N = 198) were interviewed and questioned about the way they were recruited, the offenses they committed during combat, their level of perceived intrinsic rewards (i.e., appetitive perception of violence), and the number of received extrinsic rewards during their time in the armed group (e.g., money, extra food, alcohol, or drugs). A moderated multiple regression analysis showed that the number of received extrinsic rewards and the level of intrinsic rewards were significantly positively related to the number of different types of offenses committed. In contrast to our expectations and previous findings, the recruitment type (forced conscription vs. voluntary enlistment) did not moderate this relation. Our findings suggest that both types of rewards play a role in committing violence during combat. We suggest, therefore, that reintegration programs should not only consider the influence of extrinsic rewards, but also need to address the influence of intrinsic rewards to counter violent behavior among former combatants. Aggr. Behav. 43:241-250, 2017. © 2016 Wiley Periodicals, Inc.

The Scent of Blood: A Driver of Human Behavior?

The scent of blood is potentially one of the most fundamental and survival-relevant olfactory cues in humans. This experiment tests the first human parameters of perceptual threshold and emotional ratings in men and women of an artificially simulated smell of fresh blood in contact with the skin. We hypothesize that this scent of blood, with its association with injury, danger, death, and nutrition will be a critical cue activating fundamental motivational systems relating to either predatory approach behavior or prey-like withdrawal behavior, or both. The results show that perceptual thresholds are unimodally distributed for both sexes, with women being more sensitive. Furthermore, both women and men's emotional responses to simulated blood scent divide strongly into positive and negative valence ratings, with negative ratings in women having a strong arousal component. For women, this split is related to the phase of their menstrual cycle and oral contraception (OC). Future research will investigate whether this split in both genders is context-dependent or trait-like.

Differences in brain circuitry for appetitive and reactive aggression as revealed by realistic auditory scripts.

Aggressive behavior is thought to divide into two motivational elements: The first being a self-defensively motivated aggression against threat and a second, hedonically motivated "appetitive" aggression. Appetitive aggression is the less understood of the two, often only researched within abnormal psychology. Our approach is to understand it as a universal and adaptive response, and examine the functional neural activity of ordinary men (N = 50) presented with an imaginative listening task involving a murderer describing a kill. We manipulated motivational context in a between-subjects design to evoke appetitive or reactive aggression, against a neutral control, measuring activity with Magnetoencephalography (MEG). Results show differences in left frontal regions in delta (2-5 Hz) and alpha band (8-12 Hz) for aggressive conditions and right parietal delta activity differentiating appetitive and reactive aggression. These results validate the distinction of reward-driven appetitive aggression from reactive aggression in ordinary populations at the level of functional neural brain circuitry.