Between Temperament and Psychopathology: Examples from Neuropharmacological Challenge Tests in Healthy Humans.

BACKGROUND: This paper tries to demonstrate that the questionnaire-based continuum between temperament traits and psychopathology can also be shown on the biochemical level. A common feature is the incapacity to adapt to external demands, as demonstrated by examples of disturbed hormone cycles as well as neurotransmitter (TM) responses related to affective and impulse control disorders. METHODS: Pharmacological challenge tests performed in placebo-controlled balanced crossover experiments with consecutive challenges by serotonin (5-HT), noradrenaline (NA), and dopamine (DA) agonistic drugs were applied to healthy subjects, and individual responsivities of each TM system assessed by respective cortisol and prolactin responses were related to questionnaire-based facets of depressiveness and impulsivity, respectively. RESULTS: The depression-related traits "Fatigue" and "Physical Anhedonia" were characterized by low and late responses to DA stimulation as opposed to "Social Anhedonia," which rather mirrored the pattern of schizophrenia. Reward-related and premature responding-related impulsivity represented by high scores on "Disinhibition" and "Motor Impulsivity," respectively, as well as the questionnaire-based components of attention deficit hyperactivity disorder, "Cognitive" and "Motor Impulsivity," could be discriminated by their patterns of DA/NA responses. 5-HT responses suggested that instead of the expected low availability of 5-HT claimed to be associated with impulse control disorders, low NA responses indicated lack of inhibition in impulsivity and high NA responses in depression-related "Anhedonia" indicated suppression of approach motivation. CONCLUSIONS: In spite of the flaws of pharmacological challenge tests, they may be suitable for demonstrating similarities in TM affinities between psychopathological disturbances and respective temperament traits and for separating sub-entities of larger disease spectra.

NK cell detachment from target cells is regulated by successful cytotoxicity and influences cytokine production.

Natural killer (NK) cells participate in early immune defenses against pathogens and tumors and play a major role as immune effector and regulatory cells. The NK cell-mediated elimination of an infected or cancerous cell is a highly regulated process that requires the formation of a cell contact, the establishment of an immunological synapse and the polarization and release of lytic granules. Additionally, the detachment of NK cells from target cells is important for NK cells to bind and kill other cells in a process called serial killing. However, very little is known about this detachment process. Here, we show that NK detachment is directly connected to the successful killing of a target cell. The inhibition of killing due to reduced NK cell cytotoxicity or increased target cell resistance results in defective detachment and prolonged contact times. This effect leads to sustained Ca2+ flux in NK cells and the hypersecretion of proinflammatory cytokines. Linking defective cytotoxicity with enhanced cytokine secretion via reduced detachment may explain inflammatory pathologies in several diseases.

A novel disorder involving dyshematopoiesis, inflammation, and HLH due to aberrant CDC42 function.

Hemophagocytic lymphohistiocytosis (HLH) is characterized by immune dysregulation due to inadequate restraint of overactivated immune cells and is associated with a variable clinical spectrum having overlap with more common pathophysiologies. HLH is difficult to diagnose and can be part of inflammatory syndromes. Here, we identify a novel hematological/autoinflammatory condition (NOCARH syndrome) in four unrelated patients with superimposable features, including neonatal-onset cytopenia with dyshematopoiesis, autoinflammation, rash, and HLH. Patients shared the same de novo CDC42 mutation (Chr1:22417990C>T, p.R186C) and altered hematopoietic compartment, immune dysregulation, and inflammation. CDC42 mutations had been associated with syndromic neurodevelopmental disorders. In vitro and in vivo assays documented unique effects of p.R186C on CDC42 localization and function, correlating with the distinctiveness of the trait. Emapalumab was critical to the survival of one patient, who underwent successful bone marrow transplantation. Early recognition of the disorder and establishment of treatment followed by bone marrow transplant are important to survival.

Benefits and limitations of drug studies in temperament research: biochemical responses as indicators of temperament.

This paper presents a discussion of principles and problems of neurotransmitter challenge tests using examples of experiments, most of which were performed in the author's laboratory. Drugs targeting synthesis, release, receptors or reuptake of dopamine, serotonin and noradrenergic transmitter (TM) systems were used for characterizing or discriminating certain temperament or personality traits and their sub-factors. Any personality or temperament trait is characterized by multiple TM responses, thus constellations of hormone responses to drugs acting on different TM systems or on different sources of TM activity were investigated within individuals in crossover designs. The major conclusions are: (i) intra-individual patterns of hormone responses to different TM-related drugs, or to agonists and antagonists, can help to discriminate subtypes of temperament dimensions, and (ii) the latency and shape of response curves may help specify processes of biological responses related to psychological dimensions and reveal common TM sensitivities in clusters of traits. TM sensitivity, defined by hormone responses, does not always correspond to accompanying behavioural indicators, but may provide more specific information on underlying mechanisms. Additional consideration of drug doses and experimental induction of stressors may serve to identify temperament-related susceptibilities to certain drugs. Limitations of the challenge approach and recommendations for future research are discussed.This article is part of the theme issue 'Diverse perspectives on diversity: multi-disciplinary approaches to taxonomies of individual differences'.

Diversity in action: exchange of perspectives and reflections on taxonomies of individual differences.

Throughout the last 2500 years, the classification of individual differences in healthy people and their extreme expressions in mental disorders has remained one of the most difficult challenges in science that affects our ability to explore individuals' functioning, underlying psychobiological processes and pathways of development. To facilitate analyses of the principles required for studying individual differences, this theme issue brought together prominent scholars from diverse backgrounds of which many bring unique combinations of cross-disciplinary experiences and perspectives that help establish connections and promote exchange across disciplines. This final paper presents brief commentaries of some of our authors and further scholars exchanging perspectives and reflecting on the contributions of this theme issue.This article is part of the theme issue 'Diverse perspectives on diversity: multi-disciplinary approaches to taxonomies of individual differences'.

Termination of the Activating NK Cell Immunological Synapse Is an Active and Regulated Process.

Cellular cytotoxicity is essential for the elimination of virus-infected and cancerous cells by NK cells. It requires a direct cellular contact through the establishment of an immunological synapse (IS) between the NK cell and the target cell. In this article, we show that not only the establishment of the IS, but also its maintenance is a highly regulated process. Ongoing receptor-proximal signaling events from activating NK cell receptors and actin dynamics were necessary to maintain a stable contact in an energy-dependent fashion, even after the IS was formed successfully. More importantly, the initiation of a contact to a new susceptible target cell resulted in accelerated detachment from an old target cell. We propose that the maintenance of an existing IS is a dynamic and regulated process to allow for effective serial killing of NK cells.

Breast cancer survivors` recollection of their quality of life: Identifying determinants of recall bias in a longitudinal population-based trial.

BACKGROUND: The recollections of survivors of breast cancer are an important source of information about the disease for their family, friends, and newly diagnosed patients. So far, little is known about these memories. This study investigated how accurately survivors of breast cancer remember their past quality of life (QoL) during the disease and if this memory is modified by women`s present QoL and negative affect. MATERIAL AND METHODS: The longitudinal population-based study included 133 survivors of breast cancer (response rate 80%). Participants were asked for their present QoL and to recall their baseline QoL (EORTC QLQ-C30, QLQ-BR23) that had been assessed about seven years ago before discharge from hospital. The dependent variable was recall bias in ten QoL dimensions. Present QoL and negative affect (PANAS) were investigated as predictor variables. RESULTS: Overall, baseline QoL was retrospectively underrated on seven out of ten scales whereas no significant overestimation was found. In multiple linear regression analyses, controlling for confounders, a stronger underrating of QoL was significantly predicted by a lower present QoL on nine out of ten scales and by higher negative affect on six scales. CONCLUSIONS: Survivors of breast cancer tend to underestimate their past QoL during the disease when asked about seven years later. Lower present QoL and higher negative affect contribute to this recall bias. This needs to be considered when interpreting retrospectively reported QoL data. Results are discussed in relation to theory of change or stability and mood congruency theory.

Relapse (number of detoxifications) in abstinent male alcohol-dependent patients as related to personality traits and types of tolerance to frustration.

BACKGROUND: Personality traits like depression on the one hand and aggression and impulsivity on the other are assumed to be predisposing factors for different types of alcohol dependence. Both types are associated with sensitivity to frustration, but this may be different for the two types of personality according to whether they are confronted with frustrations caused by withdrawal from positive or infliction of negative events. It has not been shown so far if both types of personality factors and the two different sources of frustration are differently relevant for the propensity of relapse. This was investigated here in a study on 60 abstinent male alcohol-dependent patients. METHODS: Correlations between the number of previous detoxifications reflecting liability to relapse and questionnaire scores on personality factors and on reactions to frustration were computed. RESULTS: Bonferroni-corrected correlations yielded significant relationships between the number of detoxifications and the personality factor of aggression as well as pronounced depressive reactions to frustrating conditions of non-reward caused by humans. Controlling for impulsivity, aggression and depression revealed that depressive reactions to frustration are genuine predictors for probability of relapse independent of underlying personality factors. Persons particularly sensitive to frustrations from human denial of positive reinforcers are liable to relapse which fits the theory of sensitivity to reward in drug-addicted individuals. CONCLUSION: Results demonstrate that relapse is clearly more related to aggression than to impulsivity, depression and anxiety and may be facilitated if persons are sensitive to frustrating conditions of non-reward caused by social partners.

The impact of coping style on gaze duration.

The understanding of individual differences in response to threat (e.g., attentional bias) is important to better understand the development of anxiety disorders. Previous studies revealed only a small attentional bias in high-anxious (HA) subjects. One explanation for this finding may be the assumption that all HA-subjects show a constant attentional bias. Current models distinguish HA-subjects depending on their level of tolerance for uncertainty and for arousal. These models assume that only HA-subjects with intolerance for uncertainty but tolerance for arousal ("sensitizers") show an attentional bias, compared to HA-subjects with intolerance for uncertainty and intolerance for arousal ("fluctuating subjects"). Further, it is assumed that repressors (defined as intolerance for arousal but tolerance for uncertainty) would react with avoidance behavior when confronted with threatening stimuli. The present study investigated the influence of coping styles on attentional bias. After an extensive recruiting phase, 36 subjects were classified into three groups (sensitizers, fluctuating, and repressors). All subjects were exposed to presentations of happy and threatening faces, while recording gaze durations with an eye-tracker. The results showed that only sensitizer showed an attentional bias: they gazed longer at the threatening face rather than at the happy face during the first 500 ms. The results support the findings of the relationship between anxiety and attention and extend these by showing variations according to coping styles. The differentiation of subjects according to a multifaceted coping style allows a better prediction of the attentional bias and contributes to an insight into the complex interplay of personality, coping, and behavior.

A defined serum-free medium useful for monitoring anti-melanoma responses induced by dendritic cell immunotherapy.

Animal sera provide a non-defined source of nutrients and growth factors for mammalian cell culture. Animal serum supplementation may also introduce experimental artefacts, including immune responses against foreign serum proteins. This artefact is particularly apparent in tumour immunotherapy experiments using dendritic cells (DC) and melanoma cells cultured in fetal calf serum (FCS)-replete media. FCS culture of both DC and melanoma cells significantly enhanced anti-tumour responses in mice immunized with DC that had not been pulsed with tumour antigen. Although serum-free media (SFM) may be used for short term culture of cells, most SFM do not support long term culture of tumour cell lines. In addition, in vivo propagation and re-isolation of tumour cells from rodents is expensive, time consuming and only low numbers of viable tumour cells can be recovered from solid tumours. We show that a defined SFM medium is ideal for routine culture of B16 for use in prophylactic DC immunizations, negating the need for in vivo propagation of tumours to avoid FCS effects in tumour implantation experiments.

Aggression--interactions of serotonin and testosterone in healthy men and women.

Serotonin (5-HT) and testosterone (T) have both been implicated in the regulation of aggression. Findings in humans however are very inconclusive, with respect to main effects of either system. Animal models implicate T to modulate 5-HT system activity, and furthermore have shown behaviorally relevant interactions of T and 5-HT with respect to aggression. We tested for associations between habitual T-level and 5-HT system activity, as well as behaviorally relevant interactions of T and 5-HT with respect to trait aggression in 48 healthy male and female subjects. 5-HT activity was measured by means of neuroendocrine challenge paradigm with S-citalopram. T-levels were measured in saliva samples. Trait aggression was assessed by self-report measures. T-levels were not associated with indices of central 5-HT activity. Results showed significant interaction effects between 5-HT and T for trait aggression in men only (p<0.05). Trait aggression was significantly higher in the combinations "high T+high cortisol responses" (indicating decreased 5-HT availability), and "low T+low cortisol responses" (indicating increased 5-HT availability), after S-citalopram. Results support the notion of behaviorally relevant interactions between T and 5-HT, with respect to aggression in humans, but also indicate the need for further studies.

Do smoking intensity-related differences in vigilance indicate altered glucocorticoid receptor sensitivity?

The relationship of critical flicker fusion frequency (CFF) and a pharmacologically induced cortisol suppression by means of dexamethasone (DEX) and metyrapone (MET) was investigated during nicotine deprivation in a between-subjects design in 60 male smokers divided into light, medium and heavy smokers. DEX reduced vigilance in medium smokers and improved it in heavy smokers compared to placebo, whereas MET was more detrimental in heavy smokers. The hypothesis was put forward that the intensity of nicotine consumption is related to differences in glucocorticoid and mineralocorticoid receptor sensitivity.

Using Latent Mixed Markov Models for the choice of the best pharmacological treatment.

The choice of the best pharmacological treatment for an individual patient is crucial to optimize convalescence. Due to their effects on pharmacokinetics variables like gender and age are important factors when the pharmacological regimen is planned. By means of an example from anaesthesiology the usefulness of Latent Mixed Markov Models for choosing the optimal anaesthetic considering patient characteristics is demonstrated. Latent Mixed Markov models allow to predict and compare the quality of recovery from anaesthesia for different patient groups (defined by age and gender and treated with different anaesthetic regimens) in a multivariate non-parametric approach. On the basis of observed symptoms immediately after surgery and a few days later the probabilities for the respective dynamic latent status (like health or illness) and the probabilities for transition from one status to another are estimated depending on latent class membership (patient group).

Dopamine agonist and antagonist responders as related to types of nicotine craving and facets of extraversion.

The role of dopamine (DA) in drug seeking behavior has been a matter of debate in the literature: One theory claims that DA triggers incentive motivational behavior, the other one favors the idea that DA itself is the rewarding property induced by the positive stimuli. The present experiment tries to contribute to a solution of the controversy by the approach of relating DA-associated motivational behavior to constellations of hormone response to a DA agonistic and DA antagonistic challenge performed in the same subjects and by relating their responses to different aspects of personality and smoking motivation. DA agonist (lisuride = LIS), DA antagonist (fluphenazine = FLU), and placebo (P) were applied to 36 male smokers who were deprived from smoking for 3.5 h in a balanced crossover design. Cigarette craving and prolactin (PRL) responses to the drugs were compared under the three pharmacological conditions and related to personality and smoking motivation. Results showed that PRL responder types to LIS and FLU, defined as differences from respective placebo values, emerged as pure agonist or antagonist responders in two-thirds of the cases and as mixed types in one-third. PRL-LIS responders developed more craving in the LIS condition and PRL-FLU responders when exposed to FLU. Furthermore, the first group scored high on the sensation seeking scale (SSS), which related to the concept of incentive motivation and the FLU responders high on extraversion and smoking motivation for stimulating purposes suggesting the endeavor to replace DA. Thus, evidence for the validity of both theories is proven.

Blunted ACTH and cortisol responses to systemic injection of corticotropin-releasing hormone (CRH) in fibromyalgia: role of somatostatin and CRH-binding protein.

Thirteen female patients suffering from fibromyalgia (FM) and thirteen female age-matched controls were intravenously injected with a bolus dose of 100 microg corticotropin-releasing hormone (CRH), and the evoked secretion pattern of ACTH, cortisol, somatostatin, and growth hormone (GH) was followed up for two hours, together with the plasma levels of CRH. The increases of ACTH and cortisol following CRH were not significantly different between controls and FM patients. The increase of plasma CRH following its injection was significantly higher in FM patients and lasted about 45 min, paralleled by an increase of somatostatin with a similar time course. Basal GH levels were significantly lower in FM patients. GH increased in FM patients 90 min after injection of CRH, coincident with decreasing CRH and somatostatin levels, while GH levels in controls rather decreased with the lowest values occurring 90 min after CRH. The results support the concept that the hormonal secretion pattern frequently observed in FM patients is primarily caused by CRH, possibly as a response to chronic pain and stress. The elevated levels of CRH in the circulation of FM patients suggest elevated levels of CRH-binding protein, which could explain why the levels of ACTH and cortisol between controls and FM following CRH do not differ.

Prenatal stress diminishes the cytokine response of leukocytes to endotoxin stimulation in juvenile rhesus monkeys.

This study investigated whether exposing the fetal primate to repeated episodes of maternal stress would have long-lasting effects on the endotoxin-induced cytokine response and corticosteroid sensitivity of peripheral blood cells in juvenile animals. Pregnant rhesus monkeys were acutely aroused on a daily basis for 6 wk using an acoustical startle protocol, either early or late in the 24-wk pregnancy. To quantify cytokine responses and corticosteroid sensitivity in their offspring at 2 yr of age, whole blood cultures were stimulated with lipopolysaccharide and incubated with dexamethasone (DEX). TNFalpha and IL-6 levels were determined in the culture supernatants. The blood samples were collected from undisturbed monkeys under baseline conditions, as well as in an aroused state induced by a 2 h social separation. Juvenile monkeys from stressed pregnancies had significantly lower cellular cytokine responses compared with the undisturbed controls. When DEX was added to the cell cultures, it systematically inhibited TNFalpha and IL-6 production, bringing the values for control animals down into the range of the prenatally stressed animals. Lipopolysaccharide-induced cytokine production was also markedly suppressed by the experience of acute stress, reducing cytokine responses of controls to the levels found for prenatally disturbed monkeys under baseline conditions. Therefore, this study has demonstrated that prenatal disturbance can induce a lasting change in cytokine biology, which persists well beyond the fetal and infant stage. Further, these effects may be due to elevated hypothalamic-pituitary-adrenal activity in the prenatally stressed animals, because both DEX and acute arousal made the cells from control monkeys appear more similar to those from disturbed pregnancies.