TY  - THES
A1  - Schneider, Silvia Isabella
T1  - Operationstechniken zur Vermeidung des perioperativen Apoplex
T1  - Surgical techniques to avoid perioperative stroke
N2  - Hintergrund: Der perioperative Schlaganfall gilt als eine der häufigsten Komplikationen bei herzchirurgischen Eingriffen. Durch die Manipulation der Aorta kann es zum Lösen von atherosklerotischer Plaque und zur Entstehung eines perioperativen neurologischen Defizites kommen.
Methodik: 142 Patienten der Universität Würzburg mit perioperativem Schlaganfall wurden untersucht (gesamte Op-Zahl: n = 9074). Abhängig von der Operationsmethode und dem Zeitraum wurden die Patienten in zwei Gruppen unterteilt. Bei 30 Patienten wurde die Herzoperation mittels MAC und ohne EAS durchgeführt, bei 112 Patienten mittels SAC und mit routinemäßigem EAS. Diese beiden Kollektive wurden hinsichtlich des Auftretens von Schlaganfällen miteinander verglichen. 
Ergebnisse: Das Risiko für einen perioperativen Schlaganfall lag mit MAC bei 2,03 % (30/1481) und mit SAC und EAS bei 1,48 % (112/7593; p = 0,148). Im Vergleich zur reinen Bypass- oder Klappenoperation war das Risiko bei einem kombinierten Eingriff signifikant erhöht (p < 0,001).
Zusammenfassung: Neuroprotektive Operationsmethoden wie die SAC und der EAS verringern das Risiko für einen perioperativen Schlaganfall, jedoch ist ein solcher multifaktoriell bedingt und die Operationsmethode kann nicht alleinig als Auslöser verantwortlich gemacht werden. Kombiniert intrakardiale und koronararterielle Eingriffe tragen zudem das höchste Risiko für perioperative Insulte.
N2  - Background: Perioperative stroke is a serious event after cardiac surgery. Aortic manipulation can induce embolus formation, causing perioperative strokes. 
Methods: 142 patients with perioperative stroke undergoing cardiac surgery in Wuerzburg (HTC, University Wuerzburg) were analyzed (total number of operations: n = 9074). Patients were divided into two groups according to the operation method and period of time. 30 patients underwent multi aortic clamp technique (MAC), 112 had single aortic clamp technique (SAC) and epiaortic ultrasonography (EAS). These two groups were compared to each other and tested concerning the impact of aortic manipulation on incedence of cerebrovascular accidents.
Results: The stroke rate was 2,03 % (30/1481) in the multi clamp group and 1,48 % (112/7593; p = 0,148) with single aortic clamp. There was a significant higher risk for patients undergoing combined coronary artery bypass grafting and valve surgery than with isolated surgery (p < 0,001).
Conclusion: Surgical technical maneuvers like SAC and EAS may improve neurobehavioral outcome. However there are several risk factors for cerebrovascular events beside the surgical technic. The combined procedure (CABG and valve surgery) is associated significantly with occurence of a neurological event.
KW  - Schlaganfall
KW  - Epiaortaler Scan
KW  - Single Aortic Clamp
KW  - Multi Aortic Clamp
KW  - perioperativer Apoplex
Y1  - 2019
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-183931
ER  - 
TY  - JOUR
A1  - Pittig, Andre
A1  - Heinig, Ingmar
A1  - Goerigk, Stephan
A1  - Thiel, Freya
A1  - Hummel, Katrin
A1  - Scholl, Lucie
A1  - Deckert, Jürgen
A1  - Pauli, Paul
A1  - Domschke, Katharina
A1  - Lueken, Ulrike
A1  - Fydrich, Thomas
A1  - Fehm, Lydia
A1  - Plag, Jens
A1  - Ströhle, Andreas
A1  - Kircher, Tilo
A1  - Straube, Benjamin
A1  - Rief, Winfried
A1  - Koelkebeck, Katja
A1  - Arolt, Volker
A1  - Dannlowski, Udo
A1  - Margraf, Jürgen
A1  - Totzeck, Christina
A1  - Schneider, Silvia
A1  - Neudeck, Peter
A1  - Craske, Michelle G.
A1  - Hollandt, Maike
A1  - Richter, Jan
A1  - Hamm, Alfons
A1  - Wittchen, Hans-Ulrich
T1  - Efficacy of temporally intensified exposure for anxiety disorders: A multicenter randomized clinical trial
JF  - Depression and Anxiety
N2  - Background

The need to optimize exposure treatments for anxiety disorders may be addressed by temporally intensified exposure sessions. Effects on symptom reduction and public health benefits should be examined across different anxiety disorders with comorbid conditions.

Methods

This multicenter randomized controlled trial compared two variants of prediction error-based exposure therapy (PeEx) in various anxiety disorders (both 12 sessions + 2 booster sessions, 100 min/session): temporally intensified exposure (PeEx-I) with exposure sessions condensed to 2 weeks (n = 358) and standard nonintensified exposure (PeEx-S) with weekly exposure sessions (n = 368). Primary outcomes were anxiety symptoms (pre, post, and 6-months follow-up). Secondary outcomes were global severity (across sessions), quality of life, disability days, and comorbid depression.

Results

Both treatments resulted in substantial improvements at post (PeEx-I: d\(_{within}\) = 1.50, PeEx-S: d\(_{within}\) = 1.78) and follow-up (PeEx-I: d\(_{within}\) = 2.34; PeEx-S: d\(_{within}\) = 2.03). Both groups showed formally equivalent symptom reduction at post and follow-up. However, time until response during treatment was 32% shorter in PeEx-I (median = 68 days) than PeEx-S (108 days; TR\(_{PeEx-I}\)-I = 0.68). Interestingly, drop-out rates were lower during intensified exposure. PeEx-I was also superior in reducing disability days and improving quality of life at follow-up without increasing relapse.

Conclusions

Both treatment variants focusing on the transdiagnostic exposure-based violation of threat beliefs were effective in reducing symptom severity and disability in severe anxiety disorders. Temporally intensified exposure resulted in faster treatment response with substantial public health benefits and lower drop-out during the exposure phase, without higher relapse. Clinicians can expect better or at least comparable outcomes when delivering exposure in a temporally intensified manner.
KW  - randomized controlled trial
KW  - anxiety disorders
KW  - exposure therapy
KW  - intensified treatment
KW  - public health
Y1  - 2021
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-257331
VL  - 38
IS  - 11
ER  - 
TY  - JOUR
A1  - Rayner, Christopher
A1  - Coleman, Jonathan R. I.
A1  - Purves, Kirstin L.
A1  - Hodsoll, John
A1  - Goldsmith, Kimberley
A1  - Alpers, Georg W.
A1  - Andersson, Evelyn
A1  - Arolt, Volker
A1  - Boberg, Julia
A1  - Bögels, Susan
A1  - Creswell, Cathy
A1  - Cooper, Peter
A1  - Curtis, Charles
A1  - Deckert, Jürgen
A1  - Domschke, Katharina
A1  - El Alaoui, Samir
A1  - Fehm, Lydia
A1  - Fydrich, Thomas
A1  - Gerlach, Alexander L.
A1  - Grocholewski, Anja
A1  - Hahlweg, Kurt
A1  - Hamm, Alfons
A1  - Hedman, Erik
A1  - Heiervang, Einar R.
A1  - Hudson, Jennifer L.
A1  - Jöhren, Peter
A1  - Keers, Robert
A1  - Kircher, Tilo
A1  - Lang, Thomas
A1  - Lavebratt, Catharina
A1  - Lee, Sang-hyuck
A1  - Lester, Kathryn J.
A1  - Lindefors, Nils
A1  - Margraf, Jürgen
A1  - Nauta, Maaike
A1  - Pané-Farré, Christiane A.
A1  - Pauli, Paul
A1  - Rapee, Ronald M.
A1  - Reif, Andreas
A1  - Rief, Winfried
A1  - Roberts, Susanna
A1  - Schalling, Martin
A1  - Schneider, Silvia
A1  - Silverman, Wendy K.
A1  - Ströhle, Andreas
A1  - Teismann, Tobias
A1  - Thastum, Mikael
A1  - Wannemüller, Andre
A1  - Weber, Heike
A1  - Wittchen, Hans-Ulrich
A1  - Wolf, Christiane
A1  - Rück, Christian
A1  - Breen, Gerome
A1  - Eley, Thalia C.
T1  - A genome-wide association meta-analysis of prognostic outcomes following cognitive behavioural therapy in individuals with anxiety and depressive disorders
JF  - Translational Psychiatry
N2  - Major depressive disorder and the anxiety disorders are highly prevalent, disabling and moderately heritable. Depression and anxiety are also highly comorbid and have a strong genetic correlation (r(g) approximate to 1). Cognitive behavioural therapy is a leading evidence-based treatment but has variable outcomes. Currently, there are no strong predictors of outcome. Therapygenetics research aims to identify genetic predictors of prognosis following therapy. We performed genome-wide association meta-analyses of symptoms following cognitive behavioural therapy in adults with anxiety disorders (n = 972), adults with major depressive disorder (n = 832) and children with anxiety disorders (n = 920; meta-analysis n = 2724). We (h(SNP)(2)) and polygenic scoring was used to examine genetic associations between therapy outcomes and psychopathology, personality and estimated the variance in therapy outcomes that could be explained by common genetic variants learning. No single nucleotide polymorphisms were strongly associated with treatment outcomes. No significant estimate of h(SNP)(2) could be obtained, suggesting the heritability of therapy outcome is smaller than our analysis was powered to detect. Polygenic scoring failed to detect genetic overlap between therapy outcome and psychopathology, personality or learning. This study is the largest therapygenetics study to date. Results are consistent with previous, similarly powered genome-wide association studies of complex traits.
KW  - Human behaviour
KW  - Personalized medicine
KW  - Prognostic markers
KW  - Psychiatric disorders
Y1  - 2019
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-225048
VL  - 9
IS  - 150
ER  - 
TY  - JOUR
A1  - Biere, Silvia
A1  - Kranz, Thorsten M.
A1  - Matura, Silke
A1  - Petrova, Kristiyana
A1  - Streit, Fabian
A1  - Chiocchetti, Andreas G.
A1  - Grimm, Oliver
A1  - Brum, Murielle
A1  - Brunkhorst-Kanaan, Natalie
A1  - Oertel, Viola
A1  - Malyshau, Aliaksandr
A1  - Pfennig, Andrea
A1  - Bauer, Michael
A1  - Schulze, Thomas G.
A1  - Kittel-Schneider, Sarah
A1  - Reif, Andreas
T1  - Risk Stratification for Bipolar Disorder Using Polygenic Risk Scores Among Young High-Risk Adults
JF  - Frontiers in Psychiatry
N2  - Objective: 
Identifying high-risk groups with an increased genetic liability for bipolar disorder (BD) will provide insights into the etiology of BD and contribute to early detection of BD. We used the BD polygenic risk score (PRS) derived from BD genome-wide association studies (GWAS) to explore how such genetic risk manifests in young, high-risk adults. We postulated that BD-PRS would be associated with risk factors for BD.

Methods: 
A final sample of 185 young, high-risk German adults (aged 18–35 years) were grouped into three risk groups and compared to a healthy control group (n = 1,100). The risk groups comprised 117 cases with attention deficit hyperactivity disorder (ADHD), 45 with major depressive disorder (MDD), and 23 help-seeking adults with early recognition symptoms [ER: positive family history for BD, (sub)threshold affective symptomatology and/or mood swings, sleeping disorder]. BD-PRS was computed for each participant. Logistic regression models (controlling for sex, age, and the first five ancestry principal components) were used to assess associations of BD-PRS and the high-risk phenotypes.

Results: 
We observed an association between BD-PRS and combined risk group status (OR = 1.48, p < 0.001), ADHD diagnosis (OR = 1.32, p = 0.009), MDD diagnosis (OR = 1.96, p < 0.001), and ER group status (OR = 1.7, p = 0.025; not significant after correction for multiple testing) compared to healthy controls.

Conclusions: 
In the present study, increased genetic risk for BD was a significant predictor for MDD and ADHD status, but not for ER. These findings support an underlying shared risk for both MDD and BD as well as ADHD and BD. Improving our understanding of the underlying genetic architecture of these phenotypes may aid in early identification and risk stratification.
KW  - polygenic risk score
KW  - bipolar disorder
KW  - genetic phenotypes
KW  - depression
KW  - ADHD
KW  - early recognition
Y1  - 2020
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-214976
VL  - 11
ER  -