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Effects of chess-based cognitive remediation training as therapy add-on in alcohol and tobacco use disorders: protocol of a randomised, controlled clinical fMRI trial

Erscheinung: 16.8.2022 / BMJ Open

Background

Alcohol and tobacco use disorders (AUD, TUD) are frequent, both worldwide and in the German population, and cognitive impairments are known to facilitate instances of relapse. Cognitive training has been proposed for enhancing cognitive functioning and possibly improving treatment outcome in mental disorders. However, these effects and underlying neurobiological mechanisms are not yet fully understood regarding AUD and TUD. Examining the effect of chess-based cognitive remediation training (CB-CRT) on neurobiological, neuropsychological and psychosocial aspects as well as treatment outcomes will provide insights into mechanisms underlying relapse and abstinence and might help to improve health behaviour in affected individuals if used as therapy add-on.

Methods and analysis

N=96 individuals with either AUD (N=48) or TUD (N=48) between 18 and 65 years of age will participate in a randomised, controlled clinical functional MRI (fMRI) trial. Two control groups will receive treatment as usual, that is, AUD treatment in a clinic, TUD outpatient treatment. Two therapy add-on groups will receive a 6-week CB-CRT as a therapy add-on. FMRI tasks, neurocognitive tests will be administered before and afterwards. All individuals will be followed up on monthly for 3months. Endpoints include alterations in neural activation and neuropsychological task performance, psychosocial functioning, and relapse or substance intake. Regarding fMRI analyses, a general linear model will be applied, and t-tests, full factorial models and regression analyses will be conducted on the second level. Behavioural and psychometric data will be analysed using t-tests, regression analyses, repeated measures and one-way analyses of variance.

Ethics and dissemination

This study has been approved by the ethics committee of the medical faculty Mannheim of the University of Heidelberg (2017-647N-MA). The findings of this study will be presented at conferences and published in peer-reviewed journals.

Trial registration

The study was registered in the Clinical Trials Register (trial identifier: NCT04057534 at clinicaltrials.gov).

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Long Covid - Die neue Volkskrankheit

Erscheinung: 17.3.2022 / C.H.Beck

Dr. Jördis Frommhold, Chefärztin der Abteilung für Atemwegserkrankungen und Allergien der MEDIAN Klinik Heiligendamm, hat ein Buch herausgebracht, das ab dem 17.03.2022 erhältlich ist. Unter dem Titel „Long Covid – die neue Volkskrankheit: Wie man sie erkennt, warum sie so viele betrifft und was wirklich hilft“ beschreibt Dr. Frommhold auch für Laien verständlich wie Krankheitsbilder, –verläufe, gesellschaftliche sowie volkswirtschaftliche Folgen aussehen, welche Therapieansätze es gibt und wo Betroffene Hilfe finden können.

Hier lesen Sie einen Auszug aus dem Klappentext:
„Allein in Deutschland, Österreich und der Schweiz bewegt sich die Zahl derer, die langfristig an einer Beeinträchtigung leiden, auf eine halbe Million zu. Die Symptome von Long Covid sind vielfältig. So fühlen sich die Betroffenen beispielsweise krankhaft erschöpft (Fatigue), leiden an einer Verschlechterung ihres Zustands nach Belastung, an Lärm- und Lichtempfindlichkeit, haben Schmerzen, Schlafstörungen, Konzentrations- oder Gedächtnisprobleme, Kreislaufprobleme und grippeähnliche Symptome.“

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Entwöhnungsbehandlung (Sucht-Rehabilitation) der Alkoholabhängigkeit

Erscheinung: 16.3.2022 / PSYCH up2date

Die ambulante, tagesklinische und stationäre Alkoholentwöhnungsbehandlung (AEB) ermöglicht eine effektive Behandlung der Alkoholabhängigkeit mit hohen Abstinenzquoten. Nach bewilligtem Reha-Antrag können abstinente Rehabilitanden mit einem multimodalen, interdisziplinären, primär psychotherapeutischen Behandlungskonzept an den zugrunde liegenden Ursachen ihrer Abhängigkeitsentwicklung, ihrer Abstinenzmotivation und Rückfallprophylaxe arbeiten.

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Long-COVID-Syndrom Neue Ansätze in Therapie und Reha

Erscheinung: 2022 / doctors|today

Bleibende oder neue chronische Beschwerden und Beeinträchtigungen nach COVID-19-Erkrankung führen bei den Betroffenen zu einer gravierenden Beeinträchtigung von Leistungsfähigkeit und Lebensqualität. Die Symptome des Long-COVID-Syndroms betreffen zahlreiche Funktionsebenen und Organsysteme. Pathophysiologie und Ursache sind bis jetzt noch nicht vollständig verstanden. Viele Therapieansätze bewegen sich noch im experimentellen Bereich. Maßnahmen der auf Long-COVID abgestimmten Rehabilitation sind etabliert und wirksam.

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Obesity – An Update on the Basic Pathophysiology and Review of Recent Therapeutic Advances

Erscheinung: 29.9.2021 / Biomolecules

Obesity represents a major public health problem with a prevalence increasing at an alarming rate worldwide. Continuous intensive efforts to elucidate the complex pathophysiology and improve clinical management have led to a better understanding of biomolecules like gut hormones, antagonists of orexigenic signals, stimulants of fat utilization, and/or inhibitors of fat absorption. In this article, we will review the pathophysiology and pharmacotherapy of obesity including intersection points to the new generation of antidiabetic drugs. We provide insight into the effectiveness of currently approved anti-obesity drugs and other therapeutic avenues that can be explored. 

Keywords: obesity; diabetes mellitus; anti-obesity drugs; obesity metabolism; energy balance

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Repeated application of the covert shift of attention task improves endogenous but not exogenous attention in patients with unilateral visuospatial inattention

Erscheinung: 2021 / Brain and Cognition

Background: Most neglect treatment studies focus on automatic re-orientation procedures, assuming a deficit in automatic processes. We compare an automatic- and a controlled procedure, using the endogenous and exogenous variants of Posner’s covert shift of attention task. Method: In two experiments, neglect patients and patients with a right hemispherical stroke without neglect performed three blocks of Posner’s covert shift of attention task (Posner Task) on two days. In Study 1 we used endogenous cues, in Study 2, exogenous cues. Results: In the endogenous task, neglect patients improved significantly with valid left-sided cues between block 1 and 2 on Day 1, subsequently showing a plateauing. They also showed a gradual improvement on invalid trials on both days. In the exogenous condition, all participants responded only increasingly faster on trials with a long stimulus onset asynchrony. Practicing on both tasks led to fewer omissions for left-sided targets, minimally in the exogenous and clearly in the endogenous condition. Conclusion: In line with prior neuroanatomical studies, our study shows that practicing an endogenous, but not an exogenous, visuospatial attention task leads to significant improvements in neglect patients, especially for invalid trials, suggesting that neglect treatments based on top-down strategies should be given more attention.

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Post-COVID und die Lunge

Erscheinung: 2021 / Respiratory Physiology & Neurobiology

Most people recover completely after an acute infection with the novel corona virus SARS-CoV2. But some people continue to experience symptoms after their recovery. This phenomenon is called post-acute or long-COVID (from week 4 after the infection up to week 12) and persistent post-COVID (symptoms for effects that persist 12 or more weeks after onset). The exact processes that cause long COVID remain unknown. Most of those patients suffer from long-term symptoms of lung damage, including breathlessness, coughing, fatigue and limited ability to exercise. Today, 18 months after the first infections in Europe we have access to the first practical guidelines for the long-/post-COVID syndrome. Further on first prospective studies analysing the incidence of post-COVID are now available. In this review we will discuss some questions about treatment and follow up of patients suffering from pulmonary sequelae after their COVID-19 infection, based on the actual literature.

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Increased network centrality of the anterior insula in early abstinence from alcohol

Erscheinung: 2021 / Addiction Biology

Abnormal resting-state functional connectivity, as measured by functional magnetic resonance imaging (MRI), has been reported in alcohol use disorders (AUD), but findings are so far inconsistent. Here, we exploited recent developments in graph-theoretical analyses, enabling improved resolution and fine-grained representation of brain networks, to investigate functional connectivity in 35 recently detoxified alcohol dependent patients versus 34 healthy controls. Specifically, we focused on the modular organization, that is, the presence of tightly connected substructures within a network, and on the identification of brain regions responsible for network integration using an unbiased approach based on a large-scale network composed of more than 600 a priori defined nodes. We found significant reductions in global connectivity and region-specific disruption in the network topology in patients compared with controls. Specifically, the basal brain and the insular–supramarginal cortices, which form tightly coupled modules in healthy subjects, were fragmented in patients. Further, patients showed a strong increase in the centrality of the anterior insula, which exhibited stronger connectivity to distal cortical regions and weaker connectivity to the posterior insula. Anterior insula centrality, a measure of the integrative role of a region, was significantly associated with increased risk of relapse. Exploratory analysis suggests partial recovery of modular structure and insular connectivity in patients after 2 weeks. These findings support the hypothesis that, at least during the early stages of abstinence, the anterior insula may drive exaggerated integration of interoceptive states in AUD patients with possible consequences for decision making and emotional states and that functional connectivity is dynamically changing during treatment.

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FMRI-based prediction of naltrexone response in alcohol use disorder: a replication study

Erscheinung: 2021 / European Archives of Psychiatry and Clinical Neuroscience

Pharmacological treatment in alcohol use disorder suffers from modest effect sizes. Efforts have been undertaken to identify patient characteristics that help to select individuals that benefit from pharmacological treatment. Previous studies indicated that neural alcohol cue-reactivity (CR) might provide a marker that identifies patients, which benefit from naltrexone treatment. We investigated the reproducibility of the association between ventral striatum (VS) activation and naltrexone (NTX) treatment response by analyzing data from a recent longitudinal clinical trial in N = 44 abstinent treatment-seeking alcohol-dependent patients. A follow-up was conducted over 3 months. We computed the percentage of significant voxels in VS and tested main effects and interactions with NTX treatment on relapse risk using Cox Regression models. We found a significant interaction effect between pre-treatment cue reactivity in the VS and NTX treatment on time to first heavy relapse (Hazard Ratio = 7.406, 95% CI 1.17–46.56, p = 0.033), such that the patient group with high VS activation (defined by a mean split) showed a significant medication effect (Hazard Ratio = 0.140, 95% CI 0.02–0.75, p = 0.022) with a number needed to treat of 3.4 [95% CI 2.413.5], while there was no significant effect in the group with low VS activation (Hazard Ratio = 0.726, p = 0.454). Thus, using an independent sample we replicated the previously described positive association between VS activation and NTX efficacy. Although our results should be considered cautiously in light of the small sample size, our results support the potential of neural alcohol CR as a tool for precision medicine approaches in alcohol dependence.

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Phenotype-tissue expression and exploration (PTEE) resource facilitates the choice of tissue for RNA-seq-based clinical genetics studies

Erscheinung: 2021 / BMC Genomics

Background: RNA-seq emerges as a valuable method for clinical genetics. The transcriptome is “dynamic” and tissue-specific, but typically the probed tissues to analyze (TA) are different from the tissue of interest (TI) based on pathophysiology.

Results: We developed Phenotype-Tissue Expression and Exploration (PTEE), a tool to facilitate the decision about the most suitable TA for RNA-seq. We integrated phenotype-annotated genes, used 54 tissues from GTEx to perform correlation analyses and identify expressed genes and transcripts between TAs and TIs. We identified skeletal muscle as the most appropriate TA to inquire for cardiac arrhythmia genes and skin as a good proxy to study neurodevelopmental disorders. We also explored RNA-seq limitations and show that on-off switching of gene expression during ontogenesis or circadian rhythm can cause blind spots for RNA-seq-based analyses.

Conclusions: PTEE aids the identification of tissues suitable for RNA-seq for a given pathology to increase the success rate of diagnosis and gene discovery. PTEE is freely available at bioinf.eva.mpg.de/PTEE

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