[Effectiveness and Cost-Effectiveness of Individual Placement and Support (Ips) in Germany - A Controlled Trials with Individuals with Psychosis]. / Effektivität und Kosteneffizienz von Individual Placement and Support (IPS) in Deutschland ­ eine Vergleichsstudie bei Menschen mit Psychosen.

OBJECTIVE: To establish the effectiveness of Individual Placement and Support (IPS) to integrate people with mental illness into the general labor market, controlled comparisons with usual rehabilitative practice in terms of employment rates and cost-effectiveness are needed. METHODS: 20 IPS participants with psychoses (primarily schizophrenia spectrum disorders) were compared with 20 controls who were offered usual rehabilitative practices in adjacent counties (rehabilitation as usual, RAU) over 18 months. RESULTS: IPS was significantly superior to RAU on all job-related criteria with moderate to high effect sizes, with no differences in absenteeism, hospital days, or dropout rates. IPS was significantly superior to RAU on cost-effectiveness. CONCLUSION: This study provides evidence that IPS is an effective and cost-efficient addition to existing vocational rehabilitation services for people with psychoses.

[The Konstanz model project for refugees with mental disorders : Coordinated psychotherapeutic treatment involving trained peer support (KOBEG)]. / Konstanzer Modellprojekt für psychisch belastete Geflüchtete : Koordinierte psychotherapeutische Behandlung unter Einbezug von Gesundheitspat:innen (KOBEG).

Refugees with mental disorders are confronted with access barriers to the psychiatric and psychotherapeutic care system. In order to counter these barriers, a model project to support the health care and integration of mentally distressed refugees was established in the district of Konstanz (coordinated psychotherapeutic treatment involving trained peer support; KOBEG) and evaluated in an initial 3­year model phase. A coordination center refers the patients to local certified psychotherapists. Language and culturally sensitive trained mentors (peers) support and accompany the refugees during the therapy. The utilization of the refered therapy and the experiences of the participating therapists serve as indicators for the effectiveness of the peer-supported therapy referral. The effectiveness of therapeutic measures and support by trained peers was evaluated on the basis of the psychological symptom burden (symptom checklist 27) and functional impairment (work and social adjustment scale) before and after an average of 10 months of project participation. The study focuses on the refugees (use of services and mental distress) and the psychotherapists (reported experiences). Initial results showed an above-average stress level among the refugees at the time of the initial interview, a high participation rate and a low drop-out rate. The follow-up survey showed significant improvements in terms of psychological symptom burden as well as functional impairments. The (qualitative) survey among psychotherapists underlines the effectiveness of KOBEG, 93% of the therapists intend to continue working with refugees within the framework of the project.

"It is worth hanging in there" - Psychotherapeutic experiences shaping future motivation for outpatient psychotherapy with refugee clients in Germany.

BACKGROUND: A high prevalence of mental disorders in refugees contrasts with a low rate of treatment and limited access to health care services. In addition to pre-, peri- and post-migration stress, language, cultural barriers together with lack of information about cost reimbursement, and access to German (mental) health care institutions are discussed as barriers to use of available services. Such barriers together with insufficient experience of treating traumatized refugee clients may lower therapists' motivation and facilities to accept refugee clients. A model project called "Fearless" trained, and supervised therapists, translators, and peer counsellors to reduce these barriers and increase therapists' motivation and engagement in future treatment of refugees. METHODS: From a total 14 therapists participating in the project N = 13 were available for semi-structured interviews. The interviews were scheduled during or after their outpatient psychotherapy of refugee clients and lasted one hour on average. Based on qualitative assessment strategies, open questions addressed the therapists' experience of challenges, enrichments, and motivation throughout the therapy. Therapists' responses were analyzed using content structuring qualitative content analysis. RESULTS: Three major challenges modulated therapists' future motivation for treating refugee clients: specific bureaucratic efforts (e.g., therapy application), organizational difficulties (e.g., scheduling appointments), and clients' motivation (e.g., adherence, reliability). Still, most interviewed therapists (n = 12) evaluated the therapy as enriching and expressed their motivation to accept refugee clients in the future (n = 10). CONCLUSION: Results recommend the reduction of bureaucratic effort (e.g., regular health insurance cover for all refugees) and implementation of organizational support (e.g., peer counsellors) in support of therapists' motivation for future treatment of refugee clients. Further structural support e.g., with organizing and financing professional translators and referring refugee clients to psychotherapists should be deployed nationwide. We recommend the training in, and supervision of, the treatment of refugee clients as helpful additional modules in psychotherapy training curricula to raise therapists' motivation to work with refugee clients.

The impact of experiencing severe physical abuse in childhood on adolescent refugees' emotional distress and integration during the COVID-19 pandemic.

Background: Accumulating evidence highlights the importance of pre- and post- migration stressors on refugees' mental health and integration. In addition to migration-associated stressors, experiences earlier in life such as physical abuse in childhood as well as current life stress as produced by the COVID-19-pandemic may impair mental health and successful integration - yet evidence on these further risks is still limited. The present study explicitly focused on the impact of severe physical abuse in childhood during the COVID-19 pandemic and evaluated the impact of these additional stressors on emotional distress and integration of refugees in Germany. Methods: The sample included 80 refugees, 88.8% male, mean age 19.7 years. In a semi-structured interview, trained psychologists screened for emotional distress, using the Refugee Health Screener, and integration status, using the Integration Index. The experience of severe physical abuse in childhood was quantified as a yes/no response to the question: "Have you been hit so badly before the age of 15 that you had to go to hospital or needed medical attention?" Multiple hierarchical regression analyses further included gender, age, residence status, months since the start of the COVID-19 pandemic and length of stay in Germany to predict emotional distress and integration. Results: Two regression analyses determined significant predictors of (1) emotional distress (adjusted R 2 = 0.23): duration of being in the pandemic (ß = 0.38, p < 0.001) and severe physical abuse in childhood (ß = 0.31, p = 0.005), and significant predictors of (2) integration (adjusted R 2 = 0.53): length of stay in Germany (ß = 0.62, p < 0.001), severe physical abuse in childhood (ß = 0.21, p = 0.019) and emotional distress (ß = -0.28, p = 0.002). Conclusion: In addition to migration-associated stressors, severe physical abuse in childhood constitutes a pre-migration risk, which crucially affects the well-being, emotional distress and integration of refugees in Germany.

NETfacts: An integrated intervention at the individual and collective level to treat communities affected by organized violence.

War and crises affect mental health, social attitudes, and cultural norms, which can exacerbate the state of long-term insecurity. With decades of armed conflict, the Democratic Republic of Congo is one example, and violence has become normalized in civilian settings. In this study, we tested the effectiveness of the NETfacts health system, an integrated model of evidence-based individual trauma treatment (Narrative Exposure Therapy [NET]) and a trauma-informed community-based intervention (NETfacts). Alongside changes in mental health outcomes (posttraumatic stress disorder, depression, social disapproval, and shame) we also investigated change in attitudes, including rape myth acceptance, stigmatization of survivors of sexual violence, and skepticism about the reintegration of former combatants. To test whether the additional community intervention is superior to individual NET alone, we implemented a randomized controlled design with six villages and interviewed a sample of 1,066 community members. Our results demonstrate that the NETfacts health system in comparison with NET alone more effectively reduced rape myth acceptance and with it ongoing victimization and perpetration. Community members of the NETfacts group also presented with less stigmatizing attitudes against survivors of sexual violence. Skepticism about the reintegration of former combatants declined in both groups. NETfacts appears to have increased motivation to engage in individual treatment. Synergizing the healing effects of individual and collective trauma exposure, the NETfacts health system appears to be an effective and scalable approach to correct degrading or ignominious norms and restore functioning and mental health in postconflict communities.

Oscillatory connectivity as a mechanism of auditory sensory gating and its disruption in schizophrenia.

Although innumerable studies using an auditory sensory gating paradigm have confirmed that individuals with schizophrenia (SZ) show less reduction in brain response to the second in a pair of clicks, this large literature has not yielded consensus on the circuit(s) responsible for gating nor for the gating difference in SZ. Clinically stable adult inpatients (N = 157) and matched community participants (N = 90) participated in a standard auditory sensory gating protocol. Responses to paired clicks were quantified as peak-to-peak amplitude from a response at approximately 50 ms to a response at approximately 100 ms in MEG-derived source waveforms. For bilateral sources in each of four regions near Heschl's gyrus, the gating ratio was computed as the response to the second stimulus divided by the response to the first stimulus. Spectrally resolved Granger causality quantified effective connectivity among regions manifested in alpha-band oscillatory coupling before and during stimulation. Poorer sensory gating localized to A1 in SZ than in controls confirmed previous results, here found in adjacent brain regions as well. Spontaneous, stimulus-independent effective connectivity within the hemisphere from angular gyrus to portions of the superior temporal gyrus was lower in SZ and correlated with gating ratio. Significant involvement of frontal and subcortical brain regions previously proposed as contributing to the auditory gating abnormality was not found. Findings point to endogenous connectivity evident in a sequence of activity from angular gyrus to portions of superior temporal gyrus as a mechanism contributing to normal and abnormal gating in SZ and potentially to sensory and cognitive symptoms.

Feedback-Related Brain Potentials Indicate the Influence of Craving on Decision-Making in Patients with Alcohol Use Disorder: An Experimental Study.

INTRODUCTION: Alcohol craving is a key symptom of alcohol use disorder (AUD) and a significant cause of poor treatment outcome and frequent relapse. Craving is supposed to impair executive functions by modulating reward salience and decision-making. OBJECTIVE: The present study sought to clarify this modulation by scrutinizing reward feedback processing in an experimental decision-making task, which was accomplished by AUD patients in 2 conditions, in the context of induced alcohol craving and in neutral context. METHODS: AUD inpatients (N = 40) accomplished the Balloon Analog Risk Task, while their EEG was monitored; counterbalanced across conditions, the tasks were preceded either by craving induction by means of imagery and olfactory alcohol cues, or by neutral cues. Decision choice and variability, and event-related potentials (ERPs) prior to (stimulus-preceding negativity [SPN]) and following (P2a) reward feedback upon decisions, and the outcome-related feedback-related negativity (FRN) were compared between conditions and between patients, who experienced high craving upon alcohol cues (N = 18) and those who did not (N = 22). RESULTS: Upon craving induction (vs. neutral condition), high-craving AUD patients showed less adjustment of decision choice to preceding reward experience and more variable decisions than low-craving AUD patients, together with accentuated reward-associated ERP (SPN and P2a), while outcome-related FRN was not modified by craving. CONCLUSIONS: Results support orientation to reward in AUD patients, particularly amplified upon experienced craving, which may interfere with (feedback-guided) decision-making even in alcohol-unrelated context. Craving-accentuated ERP indices suggest neuroadaptive changes of cognitive-motivational states upon chronic alcohol abuse. Together with altered reward-related expectancies, this has to be considered in intervention and relapse prevention.

Therapeutic success in relapse prevention in alcohol use disorder: the role of treatment motivation and drinking-related treatment goals.

Background: Changing addictive behavior is a complex process with high demands on motivation. The Transtheoretical Model of Behavior Change provides a theoretical framework for explaining and predicting behavioral change, although its predictive value for addiction is somewhat inconsistent.Objective: The aim of the present study is to extend the Transtheoretical Model of Behavior Change by investigating not only treatment motivation but also the predictive value of the type of drinking-related treatment goal. Additional predictors, such as substance-related and sociodemographic variables, are also included in analyses seeking to predict return to drinking during relapse prevention treatment for alcohol use disorder.Methods: In this observational study, 99 inpatients from a treatment center for alcohol use disorder were recruited. Treatment motivation was assessed in accordance with the Transtheoretical Model of Behavior Change, drinking-related treatment goal through a self-report questionnaire, and substance-related and sociodemographic variables via the clinic information system. Associations between the potential predictors and covariates were explored using stepwise logistic regression.Results: During treatment, 42.6% of participants had at least one relapse. Scoring higher on the action dimension at admission (OR = 0.81, p = .04) and being employed (OR = 0.37, p = .02) were significant predictors of abstinence during treatment.Conclusions: This study confirms that treatment motivation contributes to the prediction of treatment outcome, even when controlling for other variables. In future research, the underlying mechanisms of treatment motivation should be further explored.

A combined therapy for limb apraxia and related anosognosia.

Left hemisphere stroke frequently leads to limb apraxia, a disorder that has been reported to impact independence in daily life and rehabilitation success. Nonetheless, there is a shortcoming in research and availability of applicable trainings. Further, to date, anosognosia for limb apraxia has largely been neglected. Therefore, we developed a Naturalistic Action Therapy that trains object selection and application with an errorless learning approach and which includes supported self-evaluation. The current study presents the results of two stroke patients participating in the training. The procedure entailed two baseline and one post-training sessions including standardized limb apraxia and anosognosia assessments as well as 18 naturalistic action tasks. The training consisted of 15 sessions during which 4-6 of the 18 naturalistic action tasks (e.g., pour water into a glass, make a phone call) were trained. Both patients showed improvement in trained and untrained tasks as well as in standardized apraxia and anosognosia assessments. Training effects appeared strongest for the trained items. The procedure is documented in detail and easy to administer and thus may have the potential to be applied by relatives. The results of this pilot-study are promising and suggest that the approach is suitable for further evaluation.

Decision- and feedback-related brain potentials reveal risk processing mechanisms in patients with alcohol use disorder.

Individuals with alcohol use disorder (AUD) are aware of the risks of alcohol abuse yet continue risky drinking. Research indicates that dysfunctional decision processes and trait variables such as impulsivity contribute to this awareness-behavior discrepancy. The present study focused on decision-related versus feedback-related processes as potential contributors to decision making in AUD by examining the relationship between decision choices and decision- and feedback-related ERP phenomena in the balloon analogue risk task (BART). N = 39 AUD and n = 35 healthy comparison participants (HC) performed the BART modified for EEG assessment. In each of 100 runs, participants made a series of choices about whether to pump up a virtual balloon, which popped pseudorandomly, ending the run. Alternatively, participants ended the run by pressing a "cash-out" button. Each pump not producing a pop provided .05 €; popping resulted in loss of the run's accumulated gain. Groups made similar choices, though AUD responded more slowly. The decision P3 200-400 ms after decision prompt (balloon) was larger in AUD than in HC, and decision P3 enhancement on high-risk trials predicted choices to pump. Feedback-related negativity (FRN) after loss (relative to cash out) feedback was smaller in AUD than in HC, suggesting indifference to negative feedback. In AUD, high impulsivity was associated with risk-modulated decision P3 but not FRN. Results indicate atypical decision- and feedback-related processes that could contribute to difficulties in engaging with daily challenges effectively.

Mismatch negativity and cognitive performance in the course of schizophrenia.

BACKGROUND: Cognitive deficits and abnormal event-related brain potentials (ERP) have been proposed as risk markers for the development of schizophrenia. Evidence is inconclusive whether these markers indicate a risk for the development of psychosis or illness progression. METHODS: The present study aimed at further clarification by comparing symptom expression (Brief Psychiatric Rating Scale, BRPS), the ERP Mismatch Negativity (MMN), and neuropsychological performance on the MATRICS Consensus Cognitive Battery between healthy controls (HC, n = 38) and individuals at different stages of illness: individuals at risk for psychosis (ARP, n = 33), patients at first admission, thus, early stage (ES, n = 35), chronic schizophrenia patients (CS, n = 25). Moreover, symptom expression was reassessed for ARP and ES at a 6 months follow-up. RESULTS: MMN was smaller in individuals with manifest psychosis (ES, CS) than in HC, but did not differ between ARP and HC. In contrast, ARP showed similar cognitive deficits as ES and CS, all three groups differing from HC. Lower cognitive performance predicted higher symptom severity at index assessments and 6 months follow-up in ARP and ES, while MMN did not explain additional variance. CONCLUSION: MMN seems to mark manifest psychosis, independent of early or chronic stage, while cognitive deficits mark early present psychopathology in individuals at risk for and with diagnosed psychosis rather than illness progression.

Oscillatory brain dynamics supporting impaired Stroop task performance in schizophrenia-spectrum disorder.

The Stroop color-word interference task, prompting slower response to color-incongruent than to congruent items, is often used to study neural mechanisms of inhibitory control and dysfunction in schizophrenia-spectrum disorders. Inconsistent findings of an augmented Stroop effect limit identification of relevant dysfunctional mechanism(s) in schizophrenia. The present study sought to advance understanding of normal and impaired neural oscillatory dynamics by distinguishing interference detection and response preparation during the Stroop task in schizophrenia-spectrum disorders via analysis of behavioral performance and 4-7 Hz (theta) and 10-30 Hz (alpha/beta) EEG oscillations in 40 patients (SZ) and 27 healthy comparison participants (HC). SZ responded more slowly and showed less dorsal anterior cingulate (dACC) theta enhancement during INC trials, less enhancement of dACC-sensorimotor cortex connectivity (theta phase synchrony) during INC trials, more alpha/beta suppression though less enhancement of that suppression during INC trials, and slower post-response alpha/beta rebound than did HC. Reaction time distributions showed larger group and Stroop effects during the 25% of trials with the slowest responses. Poorer theta phase coherence in patients indicates impaired communication between regions associated with interference processing (dACC) and response preparation (sensorimotor cortex). Results suggest a failure cascade in which compromised behavioral Stroop effects are driven at least in part by dysfunctional interference processing (less theta power increase) prompting dysfunctional motor response preparation (less alpha/beta power suppression). Inconsistent Stroop effects in past studies of schizophrenia may result from differing task parameters sampling different degrees of Stroop task difficulty.

Environmental adversities and psychotic symptoms: The impact of timing of trauma, abuse, and neglect.

BACKGROUND: Trauma and adverse childhood experiences (ACE) occur more often in mental illness, including psychosis, than in the general population. Individuals with psychosis (cases) report a higher number and severity (dose) of adversities than healthy controls. While a dose-dependent increase of adversities has been related to more severe psychopathology, the role of type and timing is still insufficiently understood on the exacerbation of positive and negative psychotic symptoms. Moreover, dissociative symptoms were examined as potential mediator between adversities and severity of psychotic symptoms. METHODS: Exposure to adversities were assessed by interviews in n=180 cases and n=70 controls. In cases, symptom severities were obtained for psychotic symptoms and dissociation. Conditioned random forest regression determined the importance of type and timing of ACE for positive and negative symptom severity, and mediator analyses evaluated the role of dissociative symptoms in the relationship between adversities and psychotic symptoms. RESULTS: Cases experienced substantially more abuse and neglect than controls. Adversities were related in a dose-dependent manner to psychotic disorder. An array of adversities was associated with more severe positive symptoms, while the conditioned random forest regression depicted neglect at age 10 as the most important predictor. Dissociative symptoms mediated the small relation of trauma load in childhood and positive symptoms. CONCLUSION: The role of trauma and ACE on psychotic symptoms can be specified by neglect during frontocortical development in the exacerbation of positive symptoms. The mediating role of dissociation is restricted to the relation of childhood trauma and positive symptoms.

Cross-frequency interactions between frontal theta and posterior alpha control mechanisms foster working memory.

Neural oscillatory activity in the theta (4-8 Hz) and alpha (8-14 Hz) bands has been associated with the implementation of executive function, with theta in midline frontal cortex and alpha in posterior parietal cortex related to working memory (WM) load. To identify how these spatially and spectrally distinct neural phenomena interact within a large-scale fronto-parietal network organized in service of WM, EEG was recorded while subjects performed an N-back WM task. Frontal theta power increase, paralleled by posterior alpha decrease, tracked participants' successful WM performance. These power fluctuations were inversely related both across and within trials and predicted reaction time, suggesting a functionally important communication channel within the fronto-parietal network. Granger causality analysis revealed directed parietal to frontal communication via alpha and frontal to parietal communication via theta. Results encourage consideration of these bidirectional, power-to-power, cross-frequency control mechanisms as an important feature of cerebral network organization supporting executive function.

Neural network communication facilitates verbal working memory.

Oscillatory brain activity in the theta, alpha, and gamma frequency ranges has been associated with working memory (WM). In addition to alpha and theta activity associated with WM retention, and gamma band activity with item encoding, activity in the alpha band is related to the deployment of attention resources and information. The present study sought to specify distinct roles of neuromagnetic 4-7 Hz theta, 9-13 Hz alpha, and 50-70 Hz gamma power modulation and communication in fronto-parietal networks during cued, hemifield-specific item presentation in a modified Sternberg verbal WM task in 14 student volunteers. Lateralized posterior alpha and gamma power during encoding suggest a preparatory role of alpha oscillations. Bilateral alpha power increases during maintenance reflect information retention for the non-lateralized probe response. Lateralized alpha power increase during encoding was apparently driven by a monotonic increase in fronto-parietal 6 Hz phase, suggesting a mechanism facilitating WM encoding and successful performance.

The impact of cognitive training on spontaneous gamma oscillations in schizophrenia.

Schizophrenia patients exhibit less gamma-frequency EEG/MEG activity (>30 Hz), a finding interpreted as evidence of poor temporal neural organization and functional network communication. Research has shown that neuroplasticity-oriented training can improve task-related oscillatory dynamics, indicating some reorganization capacity in schizophrenia. Demonstrating a generalization of such task training effects to spontaneous oscillations at rest would not only enrich understanding of this neuroplastic potential but inform the interpretation of spontaneous gamma oscillations in the service of normal cognitive function. In the present study, neuromagnetic resting-state oscillatory brain activity and cognitive performance were assessed before and after training in 61 schizophrenia patients, who were randomly assigned to 4 weeks of neuroplasticity-oriented targeted cognitive training or treatment as usual (TAU). Gamma power of 40-90 Hz increased after training, but not after TAU, in a frontoparietal network. Across two types of training, this increase was related to improved cognitive test performance. These results indicate that abnormal oscillatory dynamics in schizophrenia patients manifested in spontaneous gamma activity can be changed with neuroplasticity-oriented training parallel to cognitive performance.

Time Course of Brain Network Reconfiguration Supporting Inhibitory Control.

Hemodynamic research has recently clarified key nodes and links in brain networks implementing inhibitory control. Although fMRI methods are optimized for identifying the structure of brain networks, the relatively slow temporal course of fMRI limits the ability to characterize network operation. The latter is crucial for developing a mechanistic understanding of how brain networks shift dynamically to support inhibitory control. To address this critical gap, we applied spectrally resolved Granger causality (GC) and random forest machine learning tools to human EEG data in two large samples of adults (test sample n = 96, replication sample n = 237, total N = 333, both sexes) who performed a color-word Stroop task. Time-frequency analysis confirmed that recruitment of inhibitory control accompanied by slower behavioral responses was related to changes in theta and alpha/beta power. GC analyses revealed directionally asymmetric exchanges within frontal and between frontal and parietal brain areas: top-down influence of superior frontal gyrus (SFG) over both dorsal ACC (dACC) and inferior frontal gyrus (IFG), dACC control over middle frontal gyrus (MFG), and frontal-parietal exchanges (IFG, precuneus, MFG). Predictive analytics confirmed a combination of behavioral and brain-derived variables as the best set of predictors of inhibitory control demands, with SFG theta bearing higher classification importance than dACC theta and posterior beta tracking the onset of behavioral response. The present results provide mechanistic insight into the biological implementation of a psychological phenomenon: inhibitory control is implemented by dynamic routing processes during which the target response is upregulated via theta-mediated effective connectivity within key PFC nodes and via beta-mediated motor preparation.SIGNIFICANCE STATEMENT Hemodynamic neuroimaging research has recently clarified regional structures in brain networks supporting inhibitory control. However, due to inherent methodological constraints, much of this research has been unable to characterize the temporal dynamics of such networks (e.g., direction of information flow between nodes). Guided by fMRI research identifying the structure of brain networks supporting inhibitory control, results of EEG source analysis in a test sample (n = 96) and replication sample (n = 237) using effective connectivity and predictive analytics strategies advance a model of inhibitory control by characterizing the precise temporal dynamics by which this network operates and exemplify an approach by which mechanistic models can be developed for other key psychological processes.

Verbal working memory-related neural network communication in schizophrenia.

Impaired working memory (WM) in schizophrenia is associated with reduced hemodynamic and electromagnetic activity and altered network connectivity within and between memory-associated neural networks. The present study sought to determine whether schizophrenia involves disruption of a frontal-parietal network normally supporting WM and/or involvement of another brain network. Nineteen schizophrenia patients (SZ) and 19 healthy comparison subjects (HC) participated in a cued visual-verbal Sternberg task while dense-array EEG was recorded. A pair of item arrays each consisting of 2-4 consonants was presented bilaterally for 200 ms with a prior cue signaling the hemifield of the task-relevant WM set. A central probe letter 2,000 ms later prompted a choice reaction time decision about match/mismatch with the target WM set. Group and WM load effects on time domain and time-frequency domain 11-15 Hz alpha power were assessed for the cue-to-probe time window, and posterior 11-15 Hz alpha power and frontal 4-8 Hz theta power were assessed during the retention period. Directional connectivity was estimated via Granger causality, evaluating group differences in communication. SZ showed slower responding, lower accuracy, smaller overall time-domain alpha power increase, and less load-dependent alpha power increase. Midline frontal theta power increases did not vary by group or load. Network communication in SZ was characterized by temporal-to-posterior information flow, in contrast to bidirectional temporal-posterior communication in HC. Results indicate aberrant WM network activity supporting WM in SZ that might facilitate normal load-dependent and only marginally less accurate task performance, despite generally slower responding.

Variation of Functional Neurological Symptoms and Emotion Regulation with Time.

INTRODUCTION: The present study addressed the variation of emotion regulation in the context of functional neurological symptom disorder (FNSD) by examining changes of functional neurological symptoms (FNS), general psychological strain, alexithymia, emotion regulation strategies, and cortical correlates of emotion regulation in the context of a standard inpatient treatment program. METHODS AND MATERIALS: Self-report data on FNS, general psychological strain, alexithymia, emotion regulation strategies, and cortical correlates of an experimentally induced emotion regulation task (participants either passively watched unpleasant and neutral pictures or regulated their emotional response to unpleasant pictures using pre-trained reappraisal, while an electroencephalogram was recorded) were compared between 19 patients with FNSD and 19 healthy comparison participants (HC) before and after a 4-week standard treatment protocol that included a combination of (individual and group) psychotherapies and functional treatments (such as physiotherapy) or a 4-week interval in HC, respectively. RESULTS: General psychological strain did not decrease significantly in FNSD patients. Changes in emotion regulation in FNSD patients were constrained to an increase in self-reported use of cognitive reappraisal strategies. Subjective symptom intensity in FNSD patients varied with alexithymia pretreatment, but did not decrease significantly. Cortical activity in the time and frequency-domain distinguished passive watching of neutral and unpleasant pictures and regulating emotional responses upon unpleasant pictures from passively watching them without difference between groups and/or time. DISCUSSION: Over the investigated time interval, augmented habitual cognitive emotion regulation suggests an alleviation of emotion processing deficits, but no significant symptom decrease. More controlled and prolonged treatment studies would be needed to determine whether and how a specific contribution of treatment-related changes of emotion regulation and FNS might be inferred.