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Background: Intrusive traumatic re-experiencing domain (ITRED) was recently introduced as a novel perspective on posttraumatic psychopathology, proposing to focus research of posttraumatic stress disorder (PTSD) on the unique symptoms of intrusive and involuntary re-experiencing of the trauma, namely, intrusive memories, nightmares, and flashbacks. The aim of the present study was to explore ITRED from a neural network connectivity perspective. Methods: Data were collected from 9 sites taking part in the ENIGMA (Enhancing Neuro Imaging Genetics through Meta Analysis) PTSD Consortium (n = 584) and included itemized PTSD symptom scores and resting-state functional connectivity (rsFC) data. We assessed the utility of rsFC in classifying PTSD, ITRED-only (no PTSD diagnosis), and trauma-exposed (TE)–only (no PTSD or ITRED) groups using a machine learning approach, examining well-known networks implicated in PTSD. A random forest classification model was built on a training set using cross-validation, and the averaged cross-validation model performance for classification was evaluated using the area under the curve. The model was tested using a fully independent portion of the data (test dataset), and the test area under the curve was evaluated. Results: rsFC signatures differentiated TE-only participants from PTSD and ITRED-only participants at about 60% accuracy. Conversely, rsFC signatures did not differentiate PTSD from ITRED-only individuals (45% accuracy). Common features differentiating TE-only participants from PTSD and ITRED-only participants mainly involved default mode network–related pathways. Some unique features, such as connectivity within the frontoparietal network, differentiated TE-only participants from one group (PTSD or ITRED-only) but to a lesser extent from the other group. Conclusions: Neural network connectivity supports ITRED as a novel neurobiologically based approach to classifying posttrauma psychopathology.

Background: Recent advances in data-driven computational approaches have been helpful in devising tools to objectively diagnose psychiatric disorders. However, current machine learning studies limited to small homogeneous samples, different methodologies, and different imaging collection protocols, limit the ability to directly compare and generalize their results. Here we aimed to classify individuals with PTSD versus controls and assess the generalizability using a large heterogeneous brain datasets from the ENIGMA-PGC PTSD Working group. Methods: We analyzed brain MRI data from 3,477 structural-MRI; 2,495 resting state-fMRI; and 1,952 diffusion-MRI. First, we identified the brain features that best distinguish individuals with PTSD from controls using traditional machine learning methods. Second, we assessed the utility of the denoising variational autoencoder (DVAE) and evaluated its classification performance. Third, we assessed the generalizability and reproducibility of both models using leave-one-site-out cross-validation procedure for each modality. Results: We found lower performance in classifying PTSD vs. controls with data from over 20 sites (60 % test AUC for s-MRI, 59 % for rs-fMRI and 56 % for D-MRI), as compared to other studies run on single-site data. The performance increased when classifying PTSD from HC without trauma history in each modality (75 % AUC). The classification performance remained intact when applying the DVAE framework, which reduced the number of features. Finally, we found that the DVAE framework achieved better generalization to unseen datasets compared with the traditional machine learning frameworks, albeit performance was slightly above chance. Conclusion: These results have the potential to provide a baseline classification performance for PTSD when using large scale neuroimaging datasets. Our findings show that the control group used can heavily affect classification performance. The DVAE framework provided better gener

Posttraumatic stress disorder (PTSD) is a complex psychiatric condition that has generated much attention in the neuroimaging literature. A neurocircuitry model supporting fronto-limbic dysfunction as a major player in facilitating clinical symptoms of PTSD is well-characterized; however, recent literature suggests that network-based approaches may provide additional insight into neural dysfunction in PTSD. Our analysis uses resting-state neuroimaging scans of 1063 adults from the PGC-ENIGMA PTSD Consortium to investigate a network-based model of functional connectivity in PTSD. With a novel, resolution limit-free community detection approach, 16 communities corresponding to functionally meaningful networks were detected with high quality. After group-level community detection, participants were classified into three groups (PTSD, n=418, trauma-exposed controls without PTSD, n=434, and non-trauma exposed healthy controls, n=211). Individual network connectivity metrics were calculated, including whole-brain, default mode network, and central executive network participation coefficient and connectivity strength. Linear mixed effects models revealed group differences in the whole-brain, default mode, and central executive network participation coefficient and connectivity strength such that individuals with PTSD demonstrated overall greater values. We also described sex differences such that males demonstrate greater whole-brain participation coefficient vs. females and females demonstrate greater default mode network connectivity strength vs. males. Our results suggest that PTSD in adults is associated with reduced specialization and enhanced inter-module communication throughout the brain network, which may contribute to inefficient information processing and poor emotional regulation. This study presents a novel use of resolution limit-free community detection in a large PTSD sample, revealing robust differences in resting-state network topology.

Background: In contrast to cisgender persons, transgender persons identify with a different gender than the one assigned at birth. Although research on the underlying neurobiology of transgender persons has been accumulating over the years, neuroimaging studies in this relatively rare population are often based on very small samples resulting in discrepant findings.Aim: To examine the neurobiology of transgender persons in a large sample.Methods: Using a mega-analytic approach, structural MRI data of 803 non-hormonally treated transgender men (TM, n = 214, female assigned at birth with male gender identity), transgender women (TW, n = 172, male assigned at birth with female gender identity), cisgender men (CM, n = 221, male assigned at birth with male gender identity) and cisgender women (CW, n = 196, female assigned at birth with female gender identity) were analyzed.Outcomes: Structural brain measures, including grey matter volume, cortical surface area, and cortical thickness.Results: Transgender persons differed significantly from cisgender persons with respect to (sub)cortical brain volumes and surface area, but not cortical thickness. Contrasting the 4 groups (TM, TW, CM, and CW), we observed a variety of patterns that not only depended on the direction of gender identity (towards male or towards female) but also on the brain measure as well as the brain region examined.Clinical Translation: The outcomes of this large-scale study may provide a normative framework that may become useful in clinical studies.Strengths and Limitations: While this is the largest study of MRI data in transgender persons to date, the analyses conducted were governed (and restricted) by the type of data collected across all participating sites.Conclusion: Rather than being merely shifted towards either end of the male-female spectrum, transgender persons seem to present with their own unique brain phenotype. Copyright (C) 2021, International Society of Sexual Medicine. Published by El

Background: Trauma-focused psychotherapy is a first-line treatment for PTSD but 30–50% of patients do not benefit sufficiently (Bradley et al., 2005). Neuroimaging has been proposed as a potential biomarker predicting treatment-response in PTSD patients (Colvonen et al., 2017; Yuan et al., 2018). Objective: We investigated whether neuroimaging data could distinguish between treatment responders and non-responders on the group and single-subject level. Method: A total of 44 male veterans with PTSD underwent baseline structural and resting-state MRI followed by trauma-focused therapy (EMDR or TFCBT). Grey-matter volumes (GMV) were extracted from the MRI data and resting-state networks (RSN) were estimated using group-ICA of data from 28 matched trauma-exposed healthy controls. GMV and RSNs were used to find differences between responders and non-responders on the group and single-subject level. Treatment response was defined as 30% decrease in total Clinician-Administered PTSD Scale for the DSM-IV (CAPS-IV) score from pre- to post-treatment assessment. Gaussian process classifiers with 10 times repeated 10-fold cross-validation were used for classification. Results: An RSN centred on the pre-SMA could distinguish between responders and non-responders on an individual level with 81.4% accuracy (p < .001), 84.5% sensitivity, 78% specificity and AUC of 0.93, while an RSN centred on the bilateral superior frontal gyrus differed between groups (pFWE < .05). No significant singlesubject classification or group differences were 54 ESTSS 2019 Rotterdam Symposium Abstract Book observed for GMV. Conclusions: Rs-fMRI is capable of providing personalized predictions of treatment response in a sample of veterans with PTSD. It therefore has the potential to be useful as a biomarker of treatment response.

Background: About 5–13% of Dutch veterans experience PTSD after being deployed (Eekhout et al. 2016). Although effective treatments for PTSD are available, response rates are lower amongst veterans (Watts et al., 2013). Learning theories have been postulated to underlie PTSD (Lissek and van Meurs, 2015). Here, we investigate the empirical evidence from veterans with PTSD for these theories. If we reveal which learning mechanisms are specifically altered in veterans with PTSD, feasible lab-models can be studied and future clinical decision making can be directed accordingly. Objective: Creating a systematic overview of empirical (clinical) evidence for learning models for PTSD in veterans. Method: A systematic search was performed in PubMed. Original studies written in English were included investigating veterans with PTSD and a learning theory. Articles were screened by AF and AK independently. Results: In total, 2167 articles were screened and 101 met our inclusion on the following theories: Amygdala Kindling (n = 30), Reduced Fear Inhibition (n = 17), Resistance to Extinction (n = 15), Stress Sensitization (n = 11), Overgeneralization (n = 7), Failure to Habituate (n = 5), Hyper-Conditionability (n = 3), Associative Learning Deficits (n = 3), Incubation (n = 1), TwoStage Learning (n = 1) and Failure to Inhibit Fear in the presence of safety cues (n = 0). Conclusions: Our systematic search shows evidence for Amygdala Kindling, Reduced Fear Inhibition, and Resistance to Extinction for veterans with PTSD. Other theories are less frequently investigated, revealing a research gap. The evidence supports that these mechanisms can be investigated in lab-models to develop interventions.

Background: Anxious personality characteristics form a risk factor for anxiety disorders, but the mechanism remains unclear. Anxious personality could lead to greater vulnerability by increasing fear generalization. Objective: Here, we investigate if high anxious personality correlates to increased fear generalization in a meta-analysis. Methods: Our search (anxious personality & fear generalization) was performed in PubMed, PsychInfo and Embase and via snowballing. Results: N = 4895 studies were screened based on title and abstract. Twenty-three studies with data on 1303 healthy participants were included in the current study, of which 1082 participants were used in the quantitative analysis. The meta-analysis shows that there is a significant, small, positive relationship between anxious personality and fear generalization (r = .20, 95% CI [.137, .263], p < .001). No moderators of the relationship were identified. Conclusions: The meta-analysis identifies the relation between personality and fear generalization in healthy subjects, as an overall small correlation was established. This suggests that people who score high on anxious personality have a somewhat stronger tendency to generalize fear to safe or novel situations, which may explain mechanistically why these individuals are at higher risk for developing anxiety disorders.

Voor het opstellen van een gezamenlijke strategische agenda voor de Utrechtse jeugd is de methode van group concept mapping gebruikt. Dit is een beslissingsondersteunende methode voor planning en evaluatie bij samenwerkingsprojecten rondom een complex onderwerp. De methode van group concept mapping verloopt gestructureerd in zes vaste stappen: 1) bepalen brainstormfocus en deelnemers, 2) genereren opvattingen, 3) structureren opvattingen, 4) grafische representatie, 5) interpretatie, en 6) implementatie. De concept map geeft een overzicht van de thema’s, opgaven en kansen in hun onderlinge samenhang voor de zorg voor jeugd in Utrecht als het gaat om gezond, veilig en kansrijk opgroeien en opvoeden. Daarmee biedt de methode een basis om met elkaar tot een herijking van de huidige strategische agenda van de AWTJ Utrecht te komen.

Objective: One of the learning theories for the development of posttraumatic stress disorder (PTSD) suggests that individuals have difficulty in inhibiting fear under safety conditions. In addition, other factors such as prior exposure to traumatic events have been found to play a major role in the risk for developing the disorder. PTSD is a common disorder among veterans and offering the right treatment is essential. Therefore, the aim of this meta-analysis was to investigate if there is robust evidence for fear inhibition in veterans and to explore if fear inhibition is related to early life trauma, leading to a possible prevention of the disorder in this population and to the design of more effective interventions. Data Sources: The database PubMed was searched for studies referring to learning theories of PTSD in veterans and 2165 articles were screened. Study Selection: Four studies met the eligibility criteria and were included in the analysis with a total number of 1378 participants. Results: Data synthesis revealed no significant results regarding impaired fear inhibition (-.85) and its association with early life trauma (.65). Conclusion: No evidence was found to support the hypotheses that veterans with PTSD exhibit impaired fear inhibition and that this is affected by early life trauma.

The prevalence of personality disorders (PDs) in forensic populations is high. PDs might be predictive for criminal behaviour and therefore it is interesting to study PDs in the context of risk assessment. The current study investigates whether the Dutch language version of the Shedler-Westen Assessment Procedure (SWAP-200-NL), an instrument that assesses personality pathology, has predictive value on criminal data. It is investigated to what extent the number of convictions, the number of days of detention, and the age of first conviction are explained by the SWAP-200-NL scales. To do so, 34 forensic mental health experts completed the SWAP-200-NL for defendants they were assessing. Information about the number of convictions, the number of days of detention, and the age of first conviction was acquired by studying criminal records. Various multiple regression analyses with bootstrapping were carried out to assess the predictive values of the SWAP-200-NL scales. Results suggest that the psychopathy factor scale accounts for 16% of the variability in the number of convictions and a combination of oedipal conflict factor, psychopathy factor, and schizoid orientation factor explain 43% of the variability in the age of first conviction. The scales do not account significantly for variability in the number of days of detention. In conclusion, the SWAP-200-NL may be used to make chary predictions about the age of first conviction. Future research should extend and define the model of the age of first conviction in the context of risk assessment.

Selective-Serotonin Reuptake Inhibitors (SSRIs) are widely prescribed for the pharmacotherapy of mood disorders and gained much attention for their sexual side-effects. Previous research has shown that antidepressant induced sexual dysfunction may persist upon discontinuation of the therapy, which in turn negatively influences Quality of Life (QoL). As no quantitative studies with large samples are available yet, the present study aimed at establishing the prevalence of persisting sexual dysfunction as well as the relationship between sexual functioning and QoL in a sample (N = 76) of healthy adults. Results showed that 52.6% (n = 40) of participants suffered from persisting sexual dysfunction while 26.3% (n = 20) suffered from genital anesthesia and/ or nipple insensitivity. Persisting sexual dysfunction was shown to negatively influence the relationship domain of the QoL measure (p < .001). Participants with vs. without sexual dysfunction significantly differed in their level of relationship QoL (F(1, 74) = 12.18, p = .001, partial 2 = .141). Therefore, clinicians need to be cautious when evaluating sexual dysfunctions and prescribing antidepressants in order to protect patients’ sexual functioning and QoL.

Backround: Major Depressive Disorder (MDD) is considered to be an enormous burden on society, so much that it is considered to be the largest non-fatal disorder. Antidepressants nowadays are considered to be the most popular treatment for this disorder , however there is a substantial number of patients who either respond much later to pharmacotherapy or not at all. In order to predict response to pharmaceutical treatment, emphasis should be given to biomarkers. Electroencephalography (EEG) seems like a promising and accessible neuroimaging technique to optimize treatment by detecting early on which MDD patients will be better responders. This meta analysis presents a synthesis of studies correlating the degree of treatment response with pretreatment EEG frequency. Methods: PubMed, Psycinfo and Embase were searched for relevant studies and longitudinal studies were included in the meta analysis if they used MDD samples, patients underwent a washout period for current medications before receiving new treatment, antidepressants were used as the only way of treatment and EEG measurement was performed before and after the treatment. Results: 16 studies met the inclusion criteria. Three of them were excluded because of missing data. When the data from the remaining 13 studies were combined, a small to medium pooled effect size was observed. Because of the high heterogeneity among studies, a subgroup analysis was performed with EEG rhythm and age used as moderators. Theta rhythm was found to be a significant predictor for better antidepressant response. Conclusion: In accordance with previous findings, this meta-analysis showed that higher pretreatment theta rhythm was a possible predictor of better antidepressant response. Potentially pretreatment activity in the rostral anterior cingulate cortex (ACC) can be a reliable predictor, especially given that this area is the main generator of theta activity. Recommendations for future research include integration of EEG to a v

In the Netherlands, the 12-month prevalence of individuals suffering from Posttraumatic Stress Disorder(PTSD) is estimated at 1.2%. Treatments for this disorder vary in their efficacy and often are subject to high dropout and nonresponse rates. Therefore, more research is needed to provide knowledge about underlying mechanisms and treatment. A line of research which may provide more insight is that on the relationship between Emotion Regulation(ER) and PTSD. A regularly used way of measuring emotion regulation problems is a self-report questionnaire named the Difficulties in Emotion Regulation Scale (DERS). However, research on the psychometric properties of this scale in a clinical sample are rare, and more specifically, nonexistent in a PTSD patient sample. The main goal of the current study was to assess psychometric properties of the DERS in a sample PTSD patients (n=281), existing of Dutch natives, veterans and refugees from a variety of countries. The DERS showed excellent internal consistency and reliability. Only the awareness subscale showed bad internal consistency. Results of exploratory factor analysis(EFA) showed that the number of factors were equal to the original structure found by the inventors, but the robustness of the factor structure was weak: not all items loaded on the same factors. Confirmatory factor analyses showed that the original six-factor structure and a six-factor structure based on the EFA were a good fit to the data. A five-factor model without the awareness subscale showed the best fit to the data. Lastly, results suggested that the DERS was not able to discriminate between present and absent ER problems. These results implied that the DERS measures a robust construct in a PTSD sample. However, it is advised that more research is conducted on the DERS without the awareness subscale before the scale is used for PTSD patients.

Background. Routine based conducting the Montreal Cognitive Assessment (MoCa) can lead to a more efficient use of the healthcare money through more noticed cognitive disorders, shorter treatment duration and less Neuro Psychological Assessment (NPA) at the elderly psychiatric department. Method. The test region conducted a MoCa at intake while in the control region the therapist continued their working method. First, the amount of cognitive disorders is compared between both regions along with the MoCa as predictor for cognitive disorders. Second the difference in NPA’s and the MoCa as predictor for an NPA was tested. Third, the treatment duration was compared using independent sample t-tests. Finally, the progression of the MoCa scores (∆MoCa) as a predictor for an NPA and the treatment duration was tested. Results. No differences were found between the control and test region on treatment duration, cognitive disorders and NPA. However, the MoCa appeared a significant predictor for cognitive disorders. Conducting (multiple) MoCa(‘s) appeared additionally a positive predictor for NPA and a negative predictor the treatment duration. Conclusion Although further research is needed to gain a better understanding of the impact of the MoCa routine wise, conducting the MoCa is effective in predicting cognitive disorders and thereby permits patients and their family to receive shorter specialised care which could be a more effective use of the healthcare money. Furthermore, a MoCa appears a predictor for an NPA for patients with a lower MoCa mean. A higher MoCa mean was however, a negative predictor for conducting an NPA.

Een interdisciplinair onderzoek naar de toename van depressie.

Notorious for degrading diffusion MRI data quality are so-called susceptibility-induced off-resonance fields, which cause non-linear geometric image deformations. While acquiring additional data to correct for these distortions alleviates the adverse effects of this artifact drastically - e.g., by reversing the polarity of the phase-encoding (PE) direction - this strategy is often not an option due to scan time constraints. Especially in a clinical context, where patient comfort and safety are of paramount importance, acquisition specifications are preferred that minimize scan time, typically resulting in data obtained with only one PE direction. In this work, we investigated whether choosing a different polarity of the PE direction would affect the outcome of a specific clinical research study. To address this methodological question, fractional anisotropy (FA) estimates of FreeSurfer brain regions were obtained in civilian and combat controls, remitted posttraumatic stress disorder (PTSD) patients, and persistent PTSD patients before and after trauma-focused therapy and were compared between diffusion MRI data sets acquired with different polarities of the PE direction (posterior-to-anterior, PA and anterior-to-posterior, AP). Our results demonstrate that regional FA estimates differ on average in the order of 5% between AP and PA PE data. In addition, when comparing FA estimates between different subject groups for specific cingulum subdivisions, the conclusions for AP and PA PE data were not in agreement. These findings increase our understanding of how one of the most pronounced data artifacts in diffusion MRI can impact group analyses and should encourage users to be more cautious when interpreting and reporting study outcomes derived from data acquired along a single PE direction.

Although a substantial amount of research on the consequences of adolescent alcohol use is done, little is known about the psychosocial consequences of alcohol intoxication. The current study investigated two questions: a) is there a difference in psychosocial problems between adolescents who have experienced a single episode of alcohol intoxication (AIG) and a control group? And b) is there a difference in the perception of adolescents and parents? For both the effect of gender was explored. Participants were adolescents admitted to Tergooi hospitals with alcohol intoxication between 2011 and 2014, and their parents, and a control group was included. Data consisted of questionnaires measuring psychosocial problems two to three years after the incident. No significant differences in psychosocial problems between the AIG and control group were found. When split by gender, boys in the control group showed significantly more aggressive behavior than AIG boys, while AIG girls showed significantly more problems than girls in the control group on some of the scales. A significant discrepancy between adolescents’ and parents’ perception of psychosocial problems was found, with adolescents scoring higher than their parents. This difference exists more for girls than boys. This study showed the importance of the use of multiple informants, and may be used to provide better guidance for adolescents who experience alcohol intoxication in the future.

Eating disorders (ED) are common mental disorders with heightened morbidity and the highest mortality rates among all mental disorders. Central to EDs are disturbed patterns of eating behaviour. Binge/purge ED subtypes (anorexia nervosa, binge/purge type (ANBP), and bulimia nervosa (BN)) are more impulsive compared to the restrictive ED subtype (anorexia nervosa, restrictive type (ANR)) which is characterized by its rigid eating behaviour. It is unclear, however, what contributes to the impulsive behaviour in ED. This study investigated the relationship between emotion-driven impulsivity and inhibitory capacity in ED subtypes. In 48 ANR patients, 49 ANBP patients and 32 BN patients inhibitory capacity and emotion-driven impulsivity were investigated using the Stop Signal Task (SST) and the UPPS-P questionnaire respectively. ANBP and BN patients rated themselves higher on emotion-driven impulsivity compared to ANR patients, but no significant differences were found regarding inhibitory capacity. Also no correlation was found between emotion-driven impulsivity and inhibitory capacity. Our results indicate that other factors (e.g. the interference of negative emotions) might play a role in the impulsive behaviour in ED patients. Future studies should investigate these factors more profoundly.

Background: The overall goal of this study was to investigate whether routinely conducting the Montreal Cognitive Assessment (MoCA) at the beginning of the treatment has an added value. This was done by exploring MoCA outcome scores, mild cognitive impairment (MCI) diagnosis frequencies, Neuropsychological Assessment (NPA) frequencies and observing the Global Assessment Functioning (GAF) score after MCI diagnosis between patients who conducted the MoCA routinely versus non-routinely. Methods: All patients at the Functional Psychiatry Department (Altrecht) who conducted a MoCA were included. A t-test for MoCA outcome scores was used. Pearson Chi-Square was used for exploring frequencies concerning sex, MCI diagnosis and to observe whether a NPA was conducted. A Repeated Measures ANOVA was used to evaluate the differences in GAF score between the first GAF score and last GAF score. Results: The distribution of sex differed significantly among patients in the routine or non-routine group. MoCA score outcome did not differ significantly between the groups. The frequency of a MCI diagnosis differed significantly between groups. NPA frequencies differed significantly among the groups. The interaction effect between time and group (routine versus non-routine MoCA) was not significant. Conclusions: Distribution of sex was unevenly among the groups. MoCA score outcome and GAF score were found not to be significantly linked to conducting the MoCA routinely or non-routinely. However, less NPAs are conducted and MCI was diagnosed in 63% of the patients whom conducted the MoCA routinely. Thus, it can be stated that conducting the MoCA routinely has an added value in geriatric psychiatry.