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Startseite > Forschung > Publikationen / Publications



Siehl, S., Wicking, M., Pohlack, S., Winkelmann, T., …, Nees, F., & Flor, H. (2023). Altered frontolimbic activity during virtual reality-based contextual fear learning in patients with posttraumatic stress disorder. Psychological medicine, pp. 1–11. PMID:36601857, doi:10.1017/S0033291722003695.

BACKGROUND Deficiency in contextual and enhanced responding in cued fear learning may contribute to the development of posttraumatic stress disorder (PTSD). We examined the responses to aversive Pavlovian conditioning with an unpredictable spatial context as conditioned stimulus compared to a predictable context. We hypothesized that the PTSD group would demonstrate less hippocampal and ventromedial prefrontal cortex (vmPFC) activation during acquisition and extinction of unpredictable contexts and an over-reactive amygdala response in the predictable contexts compared to controls. METHODS A novel combined differential cue-context conditioning paradigm was applied using virtual reality with spatial contexts that required configural and cue processing. We assessed 20 patients with PTSD, 21 healthy trauma-exposed (TC) and 22 non-trauma-exposed (HC) participants using functional magnetic resonance imaging, skin conductance responses, and self-report measures. RESULTS During fear acquisition, patients with PTSD compared to TC showed lower activity in the hippocampi in the unpredictable and higher activity in the amygdalae in the predictable context. During fear extinction, TC compared to patients and HC showed higher brain activity in the vmPFC in the predictable context. There were no significant differences in self-report or skin conductance responses. CONCLUSIONS Our results suggest that patients with PTSD differ in brain activation from controls in regions such as the hippocampus, the amygdala, and the vmPFC in the processing of unpredictable and predictable contexts. Deficient encoding of more complex configurations might lead to a preponderance of cue-based predictions in PTSD. Exposure-based treatments need to focus on improving predictability of contextual processing and reducing enhanced cue reactivity.

Stepanous, J., Munford, L., Qualter, P., Banaschewski, T., Nees, F., …, & IMAGEN Consortium. (2023). Social environment and brain structure in adolescent mental health: A cross-sectional structural equation modelling study using IMAGEN data. PloS one, 18(1), e0280062. PMID:36603003, doi:10.1371/journal.pone.0280062.

Adolescent mental health is impacted by a myriad of factors, including the developing brain, socioeconomic conditions and changing social relationships. Studies to date have neglected investigating those factors simultaneously, despite evidence of their interacting effects and distinct profiles for males and females. The current study addressed that gap by applying structural equation modelling to IMAGEN data from adolescents aged 14 years (n = 1950). A multi-group model split by sex was tested with the variables of socioeconomic stress, family support, peer problems, and brain structure as predictors, and emotional symptoms as the main outcome. Findings indicated that, for both sexes, peer problems were positively associated with emotional symptoms, and socioeconomic stress was negatively associated with family support. Additionally, there were sex-specific findings within the full models: ventromedial prefrontal cortex grey matter volume was negatively associated with emotional symptoms for males when corrected for whole brain volume, and socioeconomic stress was negatively associated with whole brain volume for females. This study underscores the importance of the peer environment for early adolescent emotional symptoms in both boys and girls, but goes further to suggest distinct gender associations with socioeconomic factors and brain structure which provides a multi-level view of risk and resilience. Future research could exploit existing IMAGEN longitudinal data to strengthen causal claims and to determine the potential longstanding impact of social environment and brain development on adolescent mental health.


Antal, A., Luber, B., Brem, A.-K., Bikson, M., …, Moliadze, V., …, & Paulus, W. (2022). Non-invasive brain stimulation and neuroenhancement. Clinical Neurophysiology Practice. doi:10.1016/j.cnp.2022.05.002.

Attempts to enhance human memory and learning ability have a long tradition in science. This topic has recently gained substantial attention because of the increasing percentage of older individuals worldwide and the predicted rise of age-associated cognitive decline in brain functions. Transcranial brain stimulation methods, such as transcranial magnetic (TMS) and transcranial electric (tES) stimulation, have been extensively used in an effort to improve cognitive functions in humans. Here we summarize the available data on low-intensity tES for this purpose, in comparison to repetitive TMS and some pharmacological agents, such as caffeine and nicotine. There is no single area in the brain stimulation field in which only positive outcomes have been reported. For self-directed tES devices, how to restrict variability with regard to efficacy is an essential aspect of device design and function. As with any technique, reproducible outcomes depend on the equipment and how well this is matched to the experience and skill of the operator. For self-administered non-invasive brain stimulation, this requires device designs that rigorously incorporate human operator factors. The wide parameter space of non-invasive brain stimulation, including dose (e.g., duration, intensity (current density), number of repetitions), inclusion/exclusion (e.g., subject's age), and homeostatic effects, administration of tasks before and during stimulation, and, most importantly, placebo or nocebo effects, have to be taken into account. The outcomes of stimulation are expected to depend on these parameters and should be strictly controlled. The consensus among experts is that low-intensity tES is safe as long as tested and accepted protocols (including, for example, dose, inclusion/exclusion) are followed and devices are used which follow established engineering risk-management procedures. Devices and protocols that allow stimulation outside these parameters cannot claim to be “safe” where they are applying stimulation beyond that examined in published studies that also investigated potential side effects. Brain stimulation devices marketed for consumer use are distinct from medical devices because they do not make medical claims and are therefore not necessarily subject to the same level of regulation as medical devices (i.e., by government agencies tasked with regulating medical devices). Manufacturers must follow ethical and best practices in marketing tES stimulators, including not misleading users by referencing effects from human trials using devices and protocols not similar to theirs.

Beier, F., Löffler, M., Nees, F., Hausner, L., …, & Flor, H. (2022). Sensory and motor correlates of frailty: dissociation between frailty phenotype and frailty index. BMC geriatrics, 22(1), 755. PMID:36109693, doi:10.1186/s12877-022-03416-6.

BACKGROUND Frailty has been associated with a decline in sensory and motor function. However, given that different frailty measures were shown to overlap but also differ in their diagnostic properties, sensory and motor correlates of frailty might be different depending on the operationalization of frailty. Our objective was to identify sensory and motor determinants of frailty and compare the results between frailty phenotype (FP) and frailty index (FI). METHODS Data from 44 pre-frail and frail subjects aged 65 and above were used. Frailty was measured using the FP and the FI. Sensory function in the visual, auditory, and tactile domain was assessed using visual acuity, absolute hearing threshold and mechanical detection threshold. Upper extremity motor performance was evaluated by the Purdue Pegboard Test and the Short Physical Performance Battery was used to assess lower extremity motor function. Multiple logistic regression models were employed to determine associations of sensory and motor function with frailty vs. pre-frailty for both frailty measures. RESULTS The frailty measures were moderately correlated (0.497, p ≤ 0.01) and had a Kappa agreement of 0.467 (p = 0.002). Using the FP, frailty was significantly associated with reduced upper extremity motor function only (OR = 0.50, 95% CI 0.29-0.87, p = 0.014). Frailty as assessed by the FI was significantly related to higher hearing thresholds (OR = 1.21, 95% CI 1.02-1.43, p = 0.027) and reduced lower extremity performance (OR = 0.32, 95% CI 0.13-0.77, p = 0.012). CONCLUSION Frailty is related to reduced performance in measures of sensory and motor function. However, traditional measures of frailty might be differentially sensitive to capture sensory and motor decline, possibly contributing to the much-observed discordance between the diagnostic instruments. This should be taken into account by researchers and clinicians when planning and evaluating therapeutic interventions for frailty. TRIAL REGISTRATION NCT03666039 . Registered 11 September 2018 - Retrospectively registered.

Berling-Ernst, A., Yahiaoui-Doktor, M., Kiechle, M., Engel, C., …, Niederberger, U., …, & Halle, M. (2022). Predictors of cardiopulmonary fitness in cancer-affected and -unaffected women with a pathogenic germline variant in the genes BRCA1/2 (LIBRE-1). Scientific Reports, 12(1), 2907. doi:10.1038/s41598-022-06913-1.

Physical activity (PA) helps prevention and aftercare of sporadic breast cancer (BC), cardiopulmonary fitness (CPF) being an age-independent predictor of tumor-specific mortality. Therefore, we wanted to identify predictors of CPF (represented by peak oxygen uptake: VO 2peak ) in BRCA1/2 mutation carriers whose risk of developing BC is high. We used cross-sectional data from 68 BRCA1/2 germline mutation carrying women participating in the randomized, prospective, controlled clinical study LIBRE-1. Assessments included cardiopulmonary exercise testing, medical and lifestyle history plus socioeconomic status. Additionally, the participants completed a psychological questionnaire regarding their attitude, subjective norms, perceived behavior control and intention towards PA. A multivariate logistic regression model was used to identify predictors for participants reaching their age- and sex-adjusted VO 2peak reference values. 22 participants (median age: 40 years, interquartile range (IQR) 33–46) were cancer-unaffected and 46 cancer-affected (median age: 44 years, IQR 35–50). The strongest predictor for reaching the reference VO 2peak value was attitude towards PA (Odds Ratio 3.0; 95% Confidence Interval 1.3–8.4; p = 0.021). None of the other predictors showed a significant association. A positive attitude towards PA seems to be associated with VO 2peak , which should be considered in developing therapeutic and preventive strategies.

Brouwer, R. M., Klein, M., Grasby, K. L., Schnack, H. G., …, IMAGEN Consortium, …, Nees, F., …, & Hulshoff Pol, H. E. (2022). Genetic variants associated with longitudinal changes in brain structure across the lifespan. Nature neuroscience, 25(4), 421–432. PMID:35383335, doi:10.1038/s41593-022-01042-4.

Human brain structure changes throughout the lifespan. Altered brain growth or rates of decline are implicated in a vast range of psychiatric, developmental and neurodegenerative diseases. In this study, we identified common genetic variants that affect rates of brain growth or atrophy in what is, to our knowledge, the first genome-wide association meta-analysis of changes in brain morphology across the lifespan. Longitudinal magnetic resonance imaging data from 15,640 individuals were used to compute rates of change for 15 brain structures. The most robustly identified genes GPR139, DACH1 and APOE are associated with metabolic processes. We demonstrate global genetic overlap with depression, schizophrenia, cognitive functioning, insomnia, height, body mass index and smoking. Gene set findings implicate both early brain development and neurodegenerative processes in the rates of brain changes. Identifying variants involved in structural brain changes may help to determine biological pathways underlying optimal and dysfunctional brain development and aging.

Bucolo, M., Rance, M., Nees, F., Ruttorf, M., …, & Flor, H. (2022). Cortical networks underlying successful control of nociceptive processing using real-time fMRI. Frontiers in pain research (Lausanne, Switzerland), 3, 969867. PMID:36353700, doi:10.3389/fpain.2022.969867.

Real-time fMRI (rt-fMRI) enables self-regulation of neural activity in localized brain regions through neurofeedback. Previous studies showed successful up- and down-regulation of neural activity in the anterior cingulate cortex (ACC) and the insula (Ins) during nociceptive stimulation. Such self-regulation capacity is, however, variable across subjects, possibly related to the ability of cognitive top-down control of pain. Moreover, how specific brain areas interact to enable successful regulation of nociceptive processing and neurofeedback-based brain modulation is not well understood. A connectivity analysis framework in the frequency domain was used to examine the up- or down-regulation in the ACC and Ins and pain intensity and unpleasantness ratings were assessed. We found that successful up- and down-regulation was mediated by the ACC and by its functional connectivity with the Ins and secondary somatosensory cortex. There was no significant relationship between successful up- or downregulation and pain ratings. These findings demonstrate functional interactions between brain areas involved in nociceptive processing during regulation of ACC and Ins activity, and the relevance of the frequency domain connectivity analysis for real-time fMRI. Moreover, despite successful neural regulation, there was no change in pain ratings, suggesting that pain is a complex perception, which may be more difficult to modify than other sensory or emotional processes.

Cao, Z., Cupertino, R. B., Ottino-Gonzalez, J., Murphy, A., …, Nees, F., …, IMAGEN Consortium, & ENIGMA Addiction Working Group. (2022). Cortical profiles of numerous psychiatric disorders and normal development share a common pattern. Molecular psychiatry. PMID:36380235, doi:10.1038/s41380-022-01855-6.

The neurobiological bases of the association between development and psychopathology remain poorly understood. Here, we identify a shared spatial pattern of cortical thickness (CT) in normative development and several psychiatric and neurological disorders. Principal component analysis (PCA) was applied to CT of 68 regions in the Desikan-Killiany atlas derived from three large-scale datasets comprising a total of 41,075 neurotypical participants. PCA produced a spatially broad first principal component (PC1) that was reproducible across datasets. Then PC1 derived from healthy adult participants was compared to the pattern of CT differences associated with psychiatric and neurological disorders comprising a total of 14,886 cases and 20,962 controls from seven ENIGMA disease-related working groups, normative maturation and aging comprising a total of 17,697 scans from the ABCD Study{\textregistered} and the IMAGEN developmental study, and 17,075 participants from the ENIGMA Lifespan working group, as well as gene expression maps from the Allen Human Brain Atlas. Results revealed substantial spatial correspondences between PC1 and widespread lower CT observed in numerous psychiatric disorders. Moreover, the PC1 pattern was also correlated with the spatial pattern of normative maturation and aging. The transcriptional analysis identified a set of genes including KCNA2, KCNS1 and KCNS2 with expression patterns closely related to the spatial pattern of PC1. The gene category enrichment analysis indicated that the transcriptional correlations of PC1 were enriched to multiple gene ontology categories and were specifically over-represented starting at late childhood, coinciding with the onset of significant cortical maturation and emergence of psychopathology during the prepubertal-to-pubertal transition. Collectively, the present study reports a reproducible latent pattern of CT that captures interregional profiles of cortical changes in both normative brain maturation and a spectrum of psychiatric disorders. The pubertal timing of the expression of PC1-related genes implicates disrupted neurodevelopment in the pathogenesis of the spectrum of psychiatric diseases emerging during adolescence.

Chavanne, A. V., Paillère Martinot, M. L., Penttilä, J., Grimmer, Y., …, Nees, F., …, & consortium, I. (2022). Anxiety onset in adolescents: a machine-learning prediction. Molecular psychiatry. PMID:36481929, doi:10.1038/s41380-022-01840-z.

Recent longitudinal studies in youth have reported MRI correlates of prospective anxiety symptoms during adolescence, a vulnerable period for the onset of anxiety disorders. However, their predictive value has not been established. Individual prediction through machine-learning algorithms might help bridge the gap to clinical relevance. A voting classifier with Random Forest, Support Vector Machine and Logistic Regression algorithms was used to evaluate the predictive pertinence of gray matter volumes of interest and psychometric scores in the detection of prospective clinical anxiety. Participants with clinical anxiety at age 18-23 (N = 156) were investigated at age 14 along with healthy controls (N = 424). Shapley values were extracted for in-depth interpretation of feature importance. Prospective prediction of pooled anxiety disorders relied mostly on psychometric features and achieved moderate performance (area under the receiver operating curve = 0.68), while generalized anxiety disorder (GAD) prediction achieved similar performance. MRI regional volumes did not improve the prediction performance of prospective pooled anxiety disorders with respect to psychometric features alone, but they improved the prediction performance of GAD, with the caudate and pallidum volumes being among the most contributing features. To conclude, in non-anxious 14 year old adolescents, future clinical anxiety onset 4-8 years later could be individually predicted. Psychometric features such as neuroticism, hopelessness and emotional symptoms were the main contributors to pooled anxiety disorders prediction. Neuroanatomical data, such as caudate and pallidum volume, proved valuable for GAD and should be included in prospective clinical anxiety prediction in adolescents.

Chen, D., Jia, T., Cheng, W., Cao, M., …, Nees, F., …, & IMAGEN Consortium. (2022). Brain Signatures During Reward Anticipation Predict Persistent Attention-Deficit/Hyperactivity Disorder Symptoms. Journal of the American Academy of Child and Adolescent Psychiatry, 61(8), 1050–1061. PMID:34954028, doi:10.1016/j.jaac.2021.11.030.

OBJECTIVE Children experiencing attention-deficit/hyperactivity disorder (ADHD) symptoms may retain symptoms into adulthood, but little is known about the underlying mechanism. METHOD To identify biomarkers of persistent ADHD symptom development, we carried out whole-brain analyses of neuroimaging data during the anticipation phase of the Monetary-Incentive-Delay (MID) task in 1,368 adolescents recruited by the IMAGEN Consortium at age 14 years, whose behavioral measurements were followed up longitudinally at age 16. In particular, we focused on comparing individuals with persistent high ADHD symptoms at both ages 14 and 16 years to unaffected control individuals, but also exploring which individuals demonstrating symptom remission (with high ADHD symptoms at age 14 but much reduced at age 16). RESULTS We identified reduced activations in the medial frontal cortex and the thalamus during reward anticipation as neuro-biomarkers for persistent ADHD symptoms across time. The genetic relevance of the above findings was further supported by the associations of the polygenic risk scores of ADHD with both the persistent and control status and the activations of both brain regions. Furthermore, in an exploratory analysis, the thalamic activation might also help to distinguish persons with persistent ADHD from those remitted in both an exploratory sample (odds ratio = 9.43, p < .001) and an independent generalization sample (odds ratio = 4.64, p = .003). CONCLUSION Using a well-established and widely applied functional magnetic resonance imaging task, we have identified neural biomarkers that could discriminate ADHD symptoms that persist throughout adolescence from controls and potentially those likely to remit during adolescent development as well.

Dagnino, P. C., Braboszcz, C., Kroupi, E., Splittgerber, M., …, Moliadze, V., & Soria-Frisch, A. (2022). Stratification of responses to tDCS intervention in a healthy paediatric population based on resting-state EEG profiles. bioRxiv. doi:10.1101/2022.08.09.503347.

Transcranial Direct Current Stimulation (tDCS) is a non-invasive neuromodulation technique with a wide variety of applications in both the clinical and cognitive psychology domains. As increasingly acknowledged, its effectiveness is subject dependent, which may lead to timely and costly treatments with ineffective results if this variability is not taken into account. We propose the usage of electroencephalography (EEG) for the analysis and prediction of individual responses to tDCS. In this context the application of machine learning can be of enormous help.We analysed resting-state EEG activity to identify subgroups of participants with an homogeneous electrophysiological profile and their response to different tDCS interventions. The study described herein, which focuses on healthy controls, was conducted within a clinical trial for the development of treatments based on tDCS for age-matched children diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD).We have studied a randomized, double-blind, sham-controlled tDCS intervention in 56 healthy children and adolescents aged 10-17, applied in 2 parallel groups over 2 target regions, namely left Dorsolateral Prefrontal Cortex (lDLPFC) and right Inferior Frontal Gyrus (rIFG). Cognitive behavioural tasks were used to both activate particular brain areas during the stimulation and to assess the impact of the intervention afterwards. We have implemented an unsupervised learning approach to stratify participants based on their resting-state EEG spectral features before the tDCS application. We have then applied a correlational analysis to identify EEG profiles associated with tDCS subject response to the specific stimulation sites and the presence or not of concurrent tasks during the intervention.In the results we found specific digital electrophysiological profiles that can be associated to a positive response, whereas subjects with other profiles respond negatively or do not respond to the intervention. Findings suggest that unsupervised machine learning procedures, when associated with proper visualization features, can be successfully used to interpret and eventually to predict responses of individuals to tDCS treatment.Competing Interest StatementThe authors have declared no competing interest.

Diener, H.-C., Kropp, P., Dresler, T., Evers, S., …, Niederberger, U., …, & Lampl, C. (2022). Management of medication overuse (MO) and medication overuse headache (MOH) S1 guideline. Neurological Research and Practice, 4(1), 37. doi:10.1186/s42466-022-00200-0.

Introduction Chronic headache due to the overuse of medication for the treatment of migraine attacks has a prevalence of 0.5–2.0%. This guideline provides guidance for the management of medication overuse (MO) and medication overuse headache (MOH). Recommendations Treatment of headache due to overuse of analgesics or specific migraine medications involves several stages. Patients with medication overuse (MO) or medication overuse headache (MOH) should be educated about the relationship between frequent use of symptomatic headache medication and the transition from episodic to chronic migraine (chronification), with the aim of reducing and limiting the use of acute medication. In a second step, migraine prophylaxis should be initiated in patients with migraine and overuse of analgesics or specific migraine drugs. Topiramate, onabotulinumtoxinA and the monoclonal antibodies against CGRP or the CGRP-receptor are effective in patients with chronic migraine and medication overuse. In patients with tension-type headache, prophylaxis is performed with amitriptyline. Drug prophylaxis should be supplemented by non-drug interventions. For patients in whom education and prophylactic medication are not effective, pausing acute medication is recommended. This treatment can be performed in an outpatient, day hospital or inpatient setting. Patients with headache due to overuse of opioids should undergo inpatient withdrawal. The success rate of the stepped treatment approach is 50–70% after 6 to 12 months. A high relapse rate is observed in patients with opioid overuse. Tricyclic antidepressants, neuroleptics (antiemetics) and the administration of steroids are recommended for the treatment of withdrawal symptoms or headaches during the medication pause. Consistent patient education and further close monitoring reduce the risk of relapse.

Farcy, C., Moliadze, V., Nees, F., Hartwigsen, G., & Guggisberg, A. G. (2022). Identifying neural targets for enhancing phonological processing with transcranial alternate current stimulation. Brain stimulation. PMID:35561959, doi:10.1016/j.brs.2022.05.009.
Fröhner, J. H., Ripke, S., Jurk, S., Li, Shu‐Chen S.-C., …, Nees, F., …, & IMAGEN Consortium. (2022). Associations of delay discounting and drinking trajectories from ages 14 to 22. Alcoholism, clinical and experimental research. PMID:35257381, doi:10.1111/acer.14799.

BACKGROUND While drinking alcohol, one must choose between the immediate rewarding effects and the delayed reward of a healthier lifestyle. Individuals differ in their devaluation of a delayed reward based on the time required to receive it, i.e., delay discounting (DD). Previous studies have shown that adolescents discount more steeply than adults and that steeper DD is associated with heavier alcohol use in both groups. METHODS In a large-scale longitudinal study, we investigated whether higher rates of DD are an antecedent or a consequence of alcohol use during adolescent development. As part of the IMAGEN project, 2220 adolescents completed the Monetary Choice Questionnaire as a DD measure, the Alcohol Use Disorders Identification Test, and the Timeline Follow Back interview at ages 14, 16, 18, and 22. Bivariate latent growth curve models were applied to investigate the relationship between DD and drinking. To explore the consequences of drinking, we computed the cumulative alcohol consumption and correlated it with the development of discounting. A subsample of 221 participants completed an intertemporal choice task (iTeCh) during functional magnetic resonance imaging at ages 14, 16, and 18. Repeated-measures ANOVA was used to differentiate between high-risk and low-risk drinkers on the development of neural processing during intertemporal choices. RESULTS Overall, high rates of DD at age 14 predicted a greater increase in drinking over 8 years. In contrast, on average, moderate alcohol use did not affect DD from ages 14 to 22. Of note, we found indicators for less brain activity in top-down control areas during intertemporal choices in the participants who drank more. CONCLUSIONS Steep DD was shown to be a predictor rather than a consequence of alcohol use in low-level drinking adolescents. Important considerations for future longitudinal studies are the sampling strategies to be used and the reliability of the assessments.

Gazula, H., Rootes-Murdy, K., Holla, B., Basodi, S., …, Nees, F., …, IMAGEN Consortium, …, & Calhoun, V. D. (2022). Federated Analysis in COINSTAC Reveals Functional Network Connectivity and Spectral Links to Smoking and Alcohol Consumption in Nearly 2,000 Adolescent Brains. Neuroinformatics. PMID:36434478, doi:10.1007/s12021-022-09604-4.

With the growth of decentralized/federated analysis approaches in neuroimaging, the opportunities to study brain disorders using data from multiple sites has grown multi-fold. One such initiative is the Neuromark, a fully automated spatially constrained independent component analysis (ICA) that is used to link brain network abnormalities among different datasets, studies, and disorders while leveraging subject-specific networks. In this study, we implement the neuromark pipeline in COINSTAC, an open-source neuroimaging framework for collaborative/decentralized analysis. Decentralized exploratory analysis of nearly 2000 resting-state functional magnetic resonance imaging datasets collected at different sites across two cohorts and co-located in different countries was performed to study the resting brain functional network connectivity changes in adolescents who smoke and consume alcohol. Results showed hypoconnectivity across the majority of networks including sensory, default mode, and subcortical domains, more for alcohol than smoking, and decreased low frequency power. These findings suggest that global reduced synchronization is associated with both tobacco and alcohol use. This proof-of-concept work demonstrates the utility and incentives associated with large-scale decentralized collaborations spanning multiple sites.

Geremek, A., Ruby, L., Lindner, C., Niederberger, U., …, & Siniatchkin, M. (2022). Child and adolescent psychiatry staff's knowledge on pain management. Clinical child psychology and psychiatry, p. 13591045221125334. PMID:36062462, doi:10.1177/13591045221125334.

OBJECTIVE To assess the level of child and adolescent psychiatric staff's knowledge regarding pain management, to determine group differences between the medically more educated (physicians, nurses) and the less educated (psychologists, educators, special therapists) and to investigate the influence of gender, age, or professional experience as well as staff's own pain experiences. METHODS A total of 193 staff members from different professional backgrounds from three independent child and adolescent psychiatry clinics in Northern Germany were tested using the German version of the Pediatric Nurses' Knowledge and Attitudes Survey Regarding Pain Shriner's revision (PNKAS-Sr). RESULTS In total, the staff scored correctly 66% of the inventory questions. There was no difference between medically more educated and less educated staff members regarding the knowledge of pain management. The main factors influencing PNKAS score were age, profession, and pain education training. CONCLUSIONS Although chronic pain is not one of the main aspects of continuing education in child and adolescent psychiatry, the resulting level of knowledge was comparable to results of similar surveys with paediatric staffs. Nevertheless, further education is needed to enhance knowledge and understanding of children's pain in child psychiatry staff in order to professionally treat patients with chronic somatic and mental illnesses.

Giustiniani, A., Vallesi, A., Oliveri, M., Tarantino, V., …, Moliadze, V., …, & Burgio, F. (2022). A questionnaire to collect unintended effects of transcranial magnetic stimulation: A consensus based approach. Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology, 141, 101–108. PMID:35798667, doi:10.1016/j.clinph.2022.06.008.

Transcranial magnetic stimulation (TMS) has been widely used in both clinical and research practice. However, TMS might induce unintended sensations and undesired effects as well as serious adverse effects. To date, no shared forms are available to report such unintended effects. This study aimed at developing a questionnaire enabling reporting of TMS unintended effects. A Delphi procedure was applied which allowed consensus among TMS experts. A steering committee nominated a number of experts to be involved in the Delphi procedure. Three rounds were conducted before reaching a consensus. Afterwards, the questionnaire was publicized on the International Federation of Clinical Neurophysiology website to collect further suggestions by the wider scientific community. A last Delphi round was then conducted to obtain consensus on the suggestions collected during the publicization and integrate them in the questionnaire. The procedure resulted in a questionnaire, that is the TMSens_Q, applicable in clinical and research settings. Routine use of the structured TMS questionnaire and standard reporting of unintended TMS effects will help to monitor the safety of TMS, particularly when applying new protocols. It will also improve the quality of data collection as well as the interpretation of experimental findings.

Hanewinkel, R., Niederberger, K., Pedersen, A., Unger, J. B., & Galimov, A. (2022). E-cigarettes and nicotine abstinence: a meta-analysis of randomised controlled trials. European respiratory review : an official journal of the European Respiratory Society, 31(163). PMID:35321930, doi:10.1183/16000617.0215-2021.

OBJECTIVES To determine the effects of electronic cigarettes (e-cigarettes) as a therapeutic intervention compared to nicotine replacement therapy (NRT) on nicotine abstinence. METHODS Two authors independently searched the PubMed, Embase, PsycInfo and Cochrane Central Register of Controlled Trials databases for articles published up to and including 10 July 2021. We included randomised controlled trials (RCTs) in which nicotine e-cigarettes were compared to NRT among current cigarette users. The primary outcome was abstaining from all nicotine-delivery devices. Secondary outcomes were 1) allocated product use (e-cigarettes or NRT) among successful cigarette quitters and 2) quitting cigarettes at the end of the trial using fixed-effect Mantel-Haenszel models. RESULTS We included four RCTs representing 1598 adult participants (51.0% females). The mean age of participants in these studies ranged from 41 to 54 years, while average baseline smoking ranged from 14 to 21 cigarettes per day. Compared to NRT, e-cigarette use was associated with lower nicotine abstinence rates at the longest follow-up (risk ratio 0.50 (95% CI 0.32-0.77)). Among successful cigarette quitters, the risk of allocated product use by the end of the observational time was higher for e-cigarette users compared to NRT (risk ratio 8.94 (95% CI 3.98-20.07)). E-cigarette users had higher cigarette smoking cessation rates compared to NRT users (risk ratio 1.58 (95% CI 1.20-2.08)). CONCLUSIONS The use of e-cigarettes as a therapeutic intervention for smoking cessation may lead to permanent nicotine dependence.

Hanewinkel, R., Niederberger, K., Pedersen, A., Unger, J. B., & Galimov, A. (2022). Reply to: “Nicotine or tobacco abstinence?”. European Respiratory Review, 31(166), 220158. doi:10.1183/16000617.0158-2022.

9 years ago, in July 2013, a group of 12 experts, many who had previously expressed support for e-cigarettes, rated the relative harm of 12 nicotine-containing products by using 14 criteria addressing harms to the users and others [1]. The group concluded e-cigarettes were substantially less harmful than combustible cigarettes. The popular media have taken up these results and promoted e-cigarettes as “95% less risky” or “95% less harmful” than combustible cigarettes. However, the authors acknowledged, “a limitation of this study is the lack of hard evidence for the harms of most products on most of the criteria” [1].The true impact of vaping on health will manifest over the coming decades, but the evidence to date on the deleterious effects of e-cigarettes on health justifies the recommendation to abstain from the consumption of inhaled nicotine and other products

Hunold, A., Haueisen, J., Nees, F., & Moliadze, V. (2022). Review of individualized current flow modeling studies for transcranial electrical stimulation. Journal of neuroscience research. PMID:36537991, doi:10.1002/jnr.25154.

There is substantial intersubject variability of behavioral and neurophysiological responses to transcranial electrical stimulation (tES), which represents one of the most important limitations of tES. Many tES protocols utilize a fixed experimental parameter set disregarding individual anatomical and physiological properties. This one-size-fits-all approach might be one reason for the observed interindividual response variability. Simulation of current flow applying head models based on available anatomical data can help to individualize stimulation parameters and contribute to the understanding of the causes of this response variability. Current flow modeling can be used to retrospectively investigate the characteristics of tES effectivity. Previous studies examined, for example, the impact of skull defects and lesions on the modulation of current flow and demonstrated effective stimulation intensities in different age groups. Furthermore, uncertainty analysis of electrical conductivities in current flow modeling indicated the most influential tissue compartments. Current flow modeling, when used in prospective study planning, can potentially guide stimulation configurations resulting in individually effective tES. Specifically, current flow modeling using individual or matched head models can be employed by clinicians and scientists to, for example, plan dosage in tES protocols for individuals or groups of participants. We review studies that show a relationship between the presence of behavioral/neurophysiological responses and features derived from individualized current flow models. We highlight the potential benefits of individualized current flow modeling.

Kumar, A., Lyzhko, E., Hamid, L., Srivastav, A., …, & Japaridze, N. (2022). Neuronal networks underlying ictal and subclinical discharges in childhood absence epilepsy. Journal of Neurology. doi:10.1007/s00415-022-11462-8.

Childhood absence epilepsy (CAE), involves 3 Hz generalized spikes and waves discharges (GSWDs) on the electroencephalogram (EEG), associated with ictal discharges (seizures) with clinical symptoms and impairment of consciousness and subclinical discharges without any objective clinical symptoms or impairment of consciousness. This study aims to comparatively characterize neuronal networks underlying absence seizures and subclinical discharges, using source localization and functional connectivity (FC), to better understand the pathophysiological mechanism of these discharges. Routine EEG data from 12 CAE patients, consisting of 45 ictal and 42 subclinical discharges were selected. Source localization was performed using the exact low-resolution electromagnetic tomography (eLORETA) algorithm, followed by FC based on the imaginary part of coherency. FC based on the thalamus as the seed of interest showed significant differences between ictal and subclinical GSWDs ( p < 0.05). For delta (1–3 Hz) and alpha bands (8–12 Hz), the thalamus displayed stronger connectivity towards other brain regions for ictal GSWDs as compared to subclinical GSWDs. For delta band, the thalamus was strongly connected to the posterior cingulate cortex (PCC), precuneus, angular gyrus, supramarginal gyrus, parietal superior, and occipital mid-region for ictal GSWDs. The strong connections of the thalamus with other brain regions that are important for consciousness, and with components of the default mode network (DMN) suggest the severe impairment of consciousness in ictal GSWDs. However, for subclinical discharges, weaker connectivity between the thalamus and these brain regions may suggest the prevention of impairment of consciousness. This may benefit future therapeutic targets and improve the management of CAE patients.

Lenz, B., Gerhardt, S., Boroumand-Jazi, R., Eichler, A., …, Nees, F., & IMAC-Mind Consortium. (2022). Sex-specific association between prenatal androgenization (second-to-fourth digit length ratio) and frontal brain volumes in adolescents. European archives of psychiatry and clinical neuroscience. PMID:36449103, doi:10.1007/s00406-022-01515-4.

Prenatal androgenization associates sex-dependently with behavior and mental health in adolescence and adulthood, including risk-taking, emotionality, substance use, and depression. However, still little is known on how it affects underlying neural correlates, like frontal brain control regions. Thus, we tested whether prenatal androgen load is sex-dependently related to frontal cortex volumes in a sex-balanced adolescent sample. In a cross-sectional magnetic resonance imaging study, we examined 61 adolescents (28 males, 33 females; aged 14 or 16 years) and analyzed associations of frontal brain region volumes with the second-to-fourth digit length ratio (2D:4D), an established marker for prenatal androgenization, using voxel-based morphometry in a region-of-interest approach. Lower 2D:4D (indicative of higher prenatal androgen load) correlated significantly with smaller volumes of the right anterior cingulate cortex (r-ACC; $\beta$ = 0.45) in male adolescents and with larger volumes of the left inferior frontal gyrus orbital part (l-IFGorb; $\beta$ = - 0.38) in female adolescents. The regression slopes of 2D:4D on the r-ACC also differed significantly between males and females. The study provides novel evidence that prenatal androgenization may influence the development of the frontal brain in a sex- and frontal brain region-specific manner. These effects might contribute to the well-known sex differences in risk-taking, emotionality, substance use, and depression. Future research is needed to elucidate the role of prenatal androgenization within the biopsychosocial model.

Löffler, M., Levine, S. M., Usai, K., Desch, S., …, Nees, F., & Flor, H. (2022). Corticostriatal circuits in the transition to chronic back pain: The predictive role of reward learning. Cell reports. Medicine, p. 100677. PMID:35798001, doi:10.1016/j.xcrm.2022.100677.

Connectivity between the nucleus accumbens (NAc) and ventromedial prefrontal cortex (vmPFC) and reward learning independently predict the transition from acute to chronic back pain (CBP). However, how these predictors are related remains unclear. Using functional magnetic resonance imaging, we investigate NAc- and vmPFC-dependent reward learning in 50 patients with subacute back pain (SABP) and follow them over 6 months. Additionally, we compare 29 patients with CBP and 29 pain-free controls to characterize mechanisms of reward learning in the chronic stage. We find that the learning-related updating of the value of reinforcement (prediction error) in the NAc predicts the transition to chronicity. In CBP, compared with controls, vmPFC responses to this prediction error signal are decreased, but increased during a discriminative stimulus. Distinct processes of reward learning in the vmPFC and NAc characterize the development and maintenance of CBP. These could be targeted for the prevention and treatment of chronic pain.

Maitra, R., Horne, C. M., O'Daly, O., Papanastasiou, E., …, & IMAGEN Consortium. (2022). Psychotic Like Experiences in Healthy Adolescents are Underpinned by Lower Fronto-Temporal Cortical Gyrification: a Study from the IMAGEN Consortium. Schizophrenia bulletin. PMID:36226895, doi:10.1093/schbul/sbac132.

BACKGROUND AND HYPOTHESIS Psychotic Like Experiences (PLEs) are widely prevalent in children and adolescents and increase the risk of developing psychosis. Cortical gyrification characterizes brain development from in utero till about the first 2 years of life and can be measured in later years as static gyrification changes demonstrating neurodevelopment and dynamic gyrification changes reflecting brain maturation during adolescence. We hypothesized that PLEs would be associated with static cortical gyrification changes reflecting a neurodevelopmental abnormality. STUDY DESIGN We studied 1252 adolescents recruited in the IMAGEN consortium. We used a longitudinal study design, with Magnetic Resonance Imaging measurements at age 14 years and age 19 years; measurement of PLEs using the Community Assessment of Psychic Experiences (CAPE) questionnaire at age 19 years; and clinical diagnoses at age 23 years. STUDY RESULTS Our results show static gyrification changes in adolescents with elevated PLEs on 3 items of the CAPE-voice hearing, unusual experiences of receiving messages, and persecutory ideas-with lower cortical gyrification in fronto-temporal regions in the left hemisphere. This group also demonstrated dynamic gyrification changes with higher cortical gyrification in right parietal cortex in late adolescence; a finding that we replicated in an independent sample of patients with first-episode psychosis. Adolescents with high PLEs were also 5.6 times more likely to transition to psychosis in adulthood by age 23 years. CONCLUSIONS This is the largest study in adolescents that demonstrates fronto-temporal abnormality of cortical gyrification as a potential biomarker for vulnerability to PLEs and transition to psychosis.

Nees, F., Ditzen, B., & Flor, H. (2022). When shared pain is not half the pain: enhanced central nervous system processing and verbal reports of pain in the presence of a solicitous spouse. Pain, 163(9), e1006–e1012. PMID:35027517, doi:10.1097/j.pain.0000000000002559.

ABSTRACT The experience of pain and pain behaviors is not only determined by physiological but also psychosocial factors. In this context, the learning history of the individual and specifically operant reinforcement related to spouse responses might play an important role. We investigated the effect of a solicitous and habitually pain-reinforcing spouse for the processing of pain in patients with chronic pain. Using multichannel electroencephalography, pain behaviors, and self-reports of pain, we examined 20 patients with chronic back pain (10 with solicitous and 10 with nonsolicitous spouses) and 10 matched healthy controls. The participants received a series of painful and nonpainful electrical stimuli applied to the site of pain (back) and a control area (finger) in the presence vs absence of the spouse. The global field power of the electroencephalogram with a focus in the frontal region was enhanced in patients with chronic back pain who had a solicitous spouse compared to those with a nonsolicitous spouse and the healthy controls. This was specific for the painful stimulation at the back and occurred only in the presence but not the absence of the spouse. Pain ratings of intensity and unpleasantness were also higher in the patients with solicitous spouses when the spouse was present during painful stimulation. These data suggest that significant other responses indicative of operant reinforcement may have a direct effect on the cerebral processing of pain and related pain perception.

Nees, F., Banaschewski, T., Bokde, A. L. W., Desrivières, S., …, & on behalf of the IMAGEN Consortium. (2022). Global and Regional Structural Differences and Prediction of Autistic Traits during Adolescence. Brain Sciences, 12(9). doi:10.3390/brainsci12091187.

Background: Autistic traits are commonly viewed as dimensional in nature, and as continuously distributed in the general population. In this respect, the identification of predictive values of markers such as subtle autism-related alterations in brain morphology for parameter values of autistic traits could increase our understanding of this dimensional occasion. However, currently, very little is known about how these traits correspond to alterations in brain morphology in typically developing individuals, particularly during a time period where changes due to brain development processes do not provide a bias. Therefore, in the present study, we analyzed brain volume, cortical thickness (CT) and surface area (SA) in a cohort of 14–15-year-old adolescents (N = 285, female: N = 162) and tested their predictive value for autistic traits, assessed with the social responsiveness scale (SRS) two years later at the age of 16–17 years, using a regression-based approach. We found that autistic traits were significantly predicted by volumetric changes in the amygdala (r = 0.181), cerebellum (r = 0.128) and hippocampus (r = −0.181, r = −0.203), both in boys and girls. Moreover, the CT of the superior frontal region was negatively correlated (r = −0.144) with SRS scores. Furthermore, we observed a significant association between the SRS total score and smaller left putamen volume, specifically in boys (r = −0.217), but not in girls. Our findings suggest that neural correlates of autistic traits also seem to lie on a continuum in the general population, are determined by limbic–striatal neuroanatomical brain areas, and are partly dependent on sex. As we imaged adolescents from a large population-based cohort within a small age range, these data may help to increase the understanding of autistic-like occasions in otherwise typically developing individuals.

Ottino-González, J., Garavan, H., ENIGMA-Addiction, & IMAGEN Consortium. (2022). Brain structural covariance network differences in adults with alcohol dependence and heavy-drinking adolescents. Addiction (Abingdon, England), 117(5), 1312–1325. PMID:34907616, doi:10.1111/add.15772.

BACKGROUND AND AIMS Graph theoretic analysis of structural covariance networks (SCN) provides an assessment of brain organization that has not yet been applied to alcohol dependence (AD). We estimated whether SCN differences are present in adults with AD and heavy-drinking adolescents at age 19 and age 14, prior to substantial exposure to alcohol. DESIGN Cross-sectional sample of adults and a cohort of adolescents. Correlation matrices for cortical thicknesses across 68 regions were summarized with graph theoretic metrics. SETTING AND PARTICIPANTS A total of 745 adults with AD and 979 non-dependent controls from 24 sites curated by the Enhancing NeuroImaging Genetics through Meta Analysis (ENIGMA)-Addiction consortium, and 297 hazardous drinking adolescents and 594 controls at ages 19 and 14 from the IMAGEN study, all from Europe. MEASUREMENTS Metrics of network segregation (modularity, clustering coefficient and local efficiency) and integration (average shortest path length and global efficiency). FINDINGS The younger AD adults had lower network segregation and higher integration relative to non-dependent controls. Compared with controls, the hazardous drinkers at age 19 showed lower modularity [area-under-the-curve (AUC) difference = -0.0142, 95% confidence interval (CI) = -0.1333, 0.0092; P-value = 0.017], clustering coefficient (AUC difference = -0.0164, 95% CI = -0.1456, 0.0043; P-value = 0.008) and local efficiency (AUC difference = -0.0141, 95% CI = -0.0097, 0.0034; P-value = 0.010), as well as lower average shortest path length (AUC difference = -0.0405, 95% CI = -0.0392, 0.0096; P-value = 0.021) and higher global efficiency (AUC difference = 0.0044, 95% CI = -0.0011, 0.0043; P-value = 0.023). The same pattern was present at age 14 with lower clustering coefficient (AUC difference = -0.0131, 95% CI = -0.1304, 0.0033; P-value = 0.024), lower average shortest path length (AUC difference = -0.0362, 95% CI = -0.0334, 0.0118; P-value = 0.019) and higher global efficiency (AUC difference = 0.0035, 95% CI = -0.0011, 0.0038; P-value = 0.048). CONCLUSIONS Cross-sectional analyses indicate that a specific structural covariance network profile is an early marker of alcohol dependence in adults. Similar effects in a cohort of heavy-drinking adolescents, observed at age 19 and prior to substantial alcohol exposure at age 14, suggest that this pattern may be a pre-existing risk factor for problematic drinking.

Owens, M. M., Albaugh, M. D., Allgaier, N., Yuan, D., …, Nees, F., …, Nees, F., …, & Schumann, G. (2022). Bayesian causal network modeling suggests adolescent cannabis use accelerates prefrontal cortical thinning. Translational Psychiatry, 12(1), 188. doi:10.1038/s41398-022-01956-4.

While there is substantial evidence that cannabis use is associated with differences in human brain development, most of this evidence is correlational in nature. Bayesian causal network (BCN) modeling attempts to identify probable causal relationships in correlational data using conditional probabilities to estimate directional associations between a set of interrelated variables. In this study, we employed BCN modeling in 637 adolescents from the IMAGEN study who were cannabis na{\"{i}}ve at age 14 to provide evidence that the accelerated prefrontal cortical thinning found previously in adolescent cannabis users by Albaugh et al. [1] is a result of cannabis use causally affecting neurodevelopment. BCNs incorporated data on cannabis use, prefrontal cortical thickness, and other factors related to both brain development and cannabis use, including demographics, psychopathology, childhood adversity, and other substance use. All BCN algorithms strongly suggested a directional relationship from adolescent cannabis use to accelerated cortical thinning. While BCN modeling alone does not prove a causal relationship, these results are consistent with a body of animal and human research suggesting that adolescent cannabis use adversely affects brain development.</p>

Pagano, R., Salamian, A., Zielinski, J., Beroun, A., …, Nees, F., …, & Consortium, I. (2022). Arc controls alcohol cue relapse by a central amygdala mechanism. Molecular Psychiatry. doi:10.1038/s41380-022-01849-4.

Alcohol use disorder (AUD) is a chronic and fatal disease. The main impediment of the AUD therapy is a high probability of relapse to alcohol abuse even after prolonged abstinence. The molecular mechanisms of cue-induced relapse are not well established, despite the fact that they may offer new targets for the treatment of AUD. Using a comprehensive animal model of AUD, virally-mediated and amygdala-targeted genetic manipulations by CRISPR/Cas9 technology and ex vivo electrophysiology, we identify a mechanism that selectively controls cue-induced alcohol relapse and AUD symptom severity. This mechanism is based on activity-regulated cytoskeleton-associated protein (Arc)/ARG3.1-dependent plasticity of the amygdala synapses. In humans, we identified single nucleotide polymorphisms in the ARC gene and their methylation predicting not only amygdala size, but also frequency of alcohol use, even at the onset of regular consumption. Targeting Arc during alcohol cue exposure may thus be a selective new mechanism for relapse prevention.

Perkins, E. R., Joyner, K. J., Foell, J., Drislane, L. E., …, Nees, F., …, & Patrick, C. J. (2022). Assessing general versus specific liability for externalizing problems in adolescence: Concurrent and prospective prediction of symptoms of conduct disorder, ADHD, and substance use. Journal of Psychopathology and Clinical Science, 131, 793–807. doi:10.1037/abn0000743.

This study explored the generality versus specificity of two trait-liability factors for externalizing problems—disinhibition and callousness—in the concurrent and prospective prediction of symptoms of conduct disorder, attention-deficit/hyperactivity disorder (ADHD), and substance use (i.e., alcohol use disorder and history of illicit substance use). Disinhibition involves an impulsive, unrestrained cognitive–behavioral style; callousness entails a dispositional lack of social-emotional sensitivity. Participants were European adolescents from the multisite IMAGEN project who completed questionnaires and clinical interviews at ages 14 (N = 1,504, Mage = 14.41, 51.13% female) and 16 (N = 1,407, Mage = 16.46, 51.88% female). Disinhibition was related concurrently and prospectively to greater symptoms of conduct disorder, ADHD, and alcohol use disorder; higher scores on a general externalizing factor; and greater likelihood of having tried an illicit substance. Callousness was selectively related to greater conduct disorder symptoms. These findings indicate disinhibition confers broad liability for externalizing spectrum disorders, perhaps due to its affiliated deficits in executive function. In contrast, callousness appears to represent more specific liability for antagonistic (aggressive/exploitative) forms of externalizing, as exemplified by antisocial behavior. Results support the utility of developmental-ontogenetic and hierarchical-dimensional models of psychopathology and have important implications for early assessment of risk for externalizing problems. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Pijnenburg, L. J., Kaplun, A., de Haan, L., Janecka, M., …, Nees, F., …, & IMAGEN Consortium. (2022). Autistic traits and alcohol use in adolescents within the general population. European child & adolescent psychiatry. PMID:35318541, doi:10.1007/s00787-022-01970-3.

It has been suggested that autistic traits are associated with less frequent alcohol use in adolescence. Our study seeks to examine the relationship between autistic traits and alcohol use in a large adolescent population. Leveraging data from the IMAGEN cohort, including 2045 14-year-old adolescents that were followed-up to age 18, we selected items on social preference/skills and rigidity from different questionnaires. We used linear regression models to (1) test the effect of the sum scores on the prevalence of alcohol use (AUDIT-C) over time, (2) explore the relationship between autistic traits and alcohol use patterns, and (3) explore the specific effect of each autistic trait on alcohol use. Higher scores on the selected items were associated with trajectories of less alcohol use from the ages between 14 and 18 (b = - 0.030; CI 95% = - 0.042, - 0.017; p < 0.001). Among adolescents who used alcohol, those who reported more autistic traits were also drinking less per occasion than their peers and were less likely to engage in binge drinking. We found significant associations between alcohol use and social preference (p < 0.001), nervousness for new situations (p = 0.001), and detail orientation (p < 0.001). Autistic traits (social impairment, detail orientation, and anxiety) may buffer against alcohol use in adolescence.

Rane, R. P., de Man, E. F., Kim, J., Görgen, K., …, Nees, F., …, & IMAGEN Consortium. (2022). Structural differences in adolescent brains can predict alcohol misuse. eLife, 11. PMID:35616520, doi:10.7554/eLife.77545.

Alcohol misuse during adolescence (AAM) has been associated with disruptive development of adolescent brains. In this longitudinal machine learning (ML) study, we could predict AAM significantly from brain structure (T1-weighted imaging and DTI) with accuracies of 73 - 78% in the IMAGEN dataset (n $\sim$1182). Our results not only show that structural differences in brain can predict AAM, but also suggests that such differences might precede AAM behavior in the data. We predicted ten phenotypes of AAM at age 22 using brain MRI features at ages 14, 19, and 22. Binge drinking was found to be the most predictable phenotype. The most informative brain features were located in the ventricular CSF, and in white matter tracts of the corpus callosum, internal capsule, and brain stem. In the cortex, they were spread across the occipital, frontal, and temporal lobes and in the cingulate cortex. We also experimented with four different ML models and several confound control techniques. Support Vector Machine (SVM) with rbf kernel and Gradient Boosting consistently performed better than the linear models, linear SVM and Logistic Regression. Our study also demonstrates how the choice of the predicted phenotype, ML model, and confound correction technique are all crucial decisions in an explorative ML study analyzing psychiatric disorders with small effect sizes such as AAM.

Siehl, S., Sicorello, M., Herzog, J., Nees, F., …, & Flor, H. (2022). Neurostructural associations with traumatic experiences during child- and adulthood. Translational psychiatry, 12(1), 515. PMID:36517466, doi:10.1038/s41398-022-02262-9.

Adverse experiences can lead to severe mental health problems, such as posttraumatic stress disorder (PTSD), throughout the lifespan. In individuals with PTSD, both global and local brain volume reductions have been reported-especially in the amygdala and hippocampus-while the literature on childhood maltreatment suggests a strong dependency on the timing of adverse events. In the present study, we pooled data from two studies to contrast the effects of reported trauma exposure during neurodevelopmentally sensitive periods in early life with trauma exposure during adulthood. A total of 155 women were allocated into one of six age-matched groups according to the timing of traumatization (childhood vs adulthood) and psychopathology (PTSD vs trauma-exposed healthy vs trauma-na{\"{i}}ve healthy). Volumes of the amygdala and hippocampus were compared between these groups. Six additional exploratory regions of interest (ROI) were included based on a recent meta-analysis. Amygdala volume was strongly dependent on the timing of traumatization: Smaller amygdala volumes were observed in participants with childhood trauma and PTSD compared to the healthy control groups. In contrast, larger amygdala volumes were observed in both groups with trauma exposure during adulthood compared to the trauma-na{\"{i}}ve control group. Hippocampal volume comparisons revealed no statistically significant differences, although the descriptive pattern was similar to that found for the amygdala. The remaining exploratory ROIs showed significant group effects, but no timing effects. The timing might be an important moderator for adversity effects on amygdala volume, potentially reflecting neurodevelopmental factors. Albeit confounded by characteristics like trauma type and multiplicity, these findings pertain to typical childhood and adulthood trauma as often observed in clinical practice and speak against a simple association between traumatic stress and amygdala volume.

Sierawska, A., Splittgerber, M., Moliadze, V., Siniatchkin, M., & Buyx, A. (2022). Transcranial Direct Current Stimulation (tDCS) in Pediatric Populations—– Voices from Typically Developing Children and Adolescents and their Parents. Neuroethics, 16(1), 3. doi:10.1007/s12152-022-09507-w.

Transcranial direct current stimulation (tDCS) is a brain stimulation technique currently being researched as an alternative or complimentary treatment for various neurological disorders. There is little knowledge about experiences of the participants of tDCS clinical research, especially from pediatric studies.

Sun, Y., Jia, T., Barker, E. D., Chen, D., …, Nees, F., …, & Desrivières, S. (2022). Associations of DNA Methylation With Behavioral Problems, Gray Matter Volumes, and Negative Life Events Across Adolescence: Evidence From the Longitudinal IMAGEN Study. Biological psychiatry. PMID:36241462, doi:10.1016/j.biopsych.2022.06.012.

BACKGROUND Negative life events (NLEs) increase the risk for externalizing behaviors (EBs) and internalizing behaviors (IBs) in adolescence and adult psychopathology. DNA methylation associated with behavioral problems may reflect this risk and long-lasting effects of NLEs. METHODS To identify consistent associations between blood DNA methylation and EBs or IBs across adolescence, we conducted longitudinal epigenome-wide association studies (EWASs) using data from the IMAGEN cohort, collected at ages 14 and 19 years (n = 506). Significant findings were validated in a separate subsample (n = 823). Methylation risk scores were generated by 10-fold cross-validation and further tested for their associations with gray matter volumes and NLEs. RESULTS No significant findings were obtained for the IB-EWAS. The EB-EWAS identified a genome-wide significant locus in a gene linked to attention-deficit/hyperactivity disorder (ADHD) (IQSEC1, cg01460382; p = 1.26 × 10-8). Other most significant CpG sites were near ADHD-related genes and enriched for genes regulating tumor necrosis factor and interferon-$\gamma$ signaling, highlighting the relevance of EB-EWAS findings for ADHD. Analyses with the EB methylation risk scores suggested that it partly reflected comorbidity with IBs in late adolescence. Specific to EBs, EB methylation risk scores correlated with smaller gray matter volumes in medial orbitofrontal and anterior/middle cingulate cortices, brain regions known to associate with ADHD and conduct problems. Longitudinal mediation analyses indicated that EB-related DNA methylation were more likely the outcomes of problematic behaviors accentuated by NLEs, and less likely the epigenetic bases of such behaviors. CONCLUSIONS Our findings suggest that novel epigenetic mechanisms through which NLEs exert short and longer-term effects on behavior may contribute to ADHD.

Tesarz, J., & Nees, F. (2022). Pain, the brain, and SARS-CoV-2: evidence for pain-specific alterations in brain-related structure–function properties. Neuroforum, 28(2), 105–116. doi:10.1515/nf-2021-0034.

According to best current estimates, approximately 10% of those infected with SARS-CoV-2-virus experience long-term clinical and nonspecific neurological symptoms that may last for several weeks or months. This is currently referred to as “Long-COVID” or “Post-COVID-Syndrome”. Based on current knowledge, the most common long-term symptoms of COVID-19 disease include fatigue and poor concentration, but particularly also headache and musculoskeletal pain. However, given the novelty of COVID-19, only a few studies have systematically evaluated the central nervous alterations in the pain processing structures of our brain. Those first insights are yet important in order to offer patients adequate therapeutic options. Based on a systematic review of the literature, we will therefore provide an overview of the central nervous alterations in the brain described in the context of SARS-CoV-2 infection, focusing on findings with brain imaging.

Vulser, H., Lemaître, H. S., Guldner, S., Bezivin-Frère, P., …, Nees, F., & IMAGEN Consortium. (2022). Chronotype, Longitudinal Volumetric Brain Variations Throughout Adolescence and Depressive Symptom Development. Journal of the American Academy of Child and Adolescent Psychiatry. PMID:35714839, doi:10.1016/j.jaac.2022.06.003.

OBJECTIVE: Adolescence is a critical period for circadian rhythm, with a strong shift towards eveningness around age 14. Also, eveningness in adolescence has been found to predict later onset of depressive symptomatology. However, no previous study has investigated structural variations associated with chronotype in early adolescence, and how this adds to the development of depressive symptoms. METHOD: We assessed 128 community-based adolescents (51% girls) at age 14 and 19 years. Using whole brain voxel-based morphometry (VBM), we measured baseline (at age 14), follow-up (at age 19) regional gray matter volumes (GMV) and longitudinal changes (between 14 and 19) associated with the morningness/eveningness scale in children (MESC) score and sleep habits at baseline. We then studied the association of GMV with depressive symptoms at 19 years and assessed the role of potential clinical and genetics factors as mediators and moderators. RESULTS Higher eveningness was associated with larger GMV in the right medial prefrontal cortex (mPFC) at ages 14 and 19 in the whole sample. GMV in this region related to depressive symptoms at age 19 in val/val but not in Met COMT carriers. We also observed larger GMV the right fusiform at age 14 that were explained by later wake-up time during weekends. CONCLUSION: In adolescence, eveningness and its related sleep habits correlated with distinct developmental patterns. Eveningness was specifically associated with GMV changes in the mPFC; this could serve as brain vulnerability factor for later self-reported depressive symptoms in COMT val/val carriers.

Werchowski, M., Stenner, T., Splittgerber, M., Siniatchkin, M., Nees, F., …, & Moliadze, V. (2022). No effects of prefrontal multichannel tACS at individual alpha frequency on phonological decisions. Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology, 142, 96–108. PMID:36029581, doi:10.1016/j.clinph.2022.07.494.

OBJECTIVE Alpha oscillations are linked to inhibitory capabilities in higher cognitive processing. Transcranial alternating current stimulation (tACS) at 10 Hz can enhance alpha oscillations and modulate behaviour. One possibility to increase the efficacy of tACS may be stimulating at the individual alpha frequency (IAF). The present work addresses this issue (among others) to increase the current understanding of the functional role of alpha oscillations in higher cognitive tasks. METHODS Twenty-two healthy and 13 dyslexic participants performed two word decision tasks while receiving IAF-tACS over the left prefrontal cortex. Resting EEG was recorded to detect electrophysiological changes. Cortical excitability was assessed with TMS. RESULTS Dyslexic participants performed worse in the phonological task. However, no significant tACS effects were found. Interestingly, higher cortical excitability was correlated with faster responses in healthy controls. In dyslexics this association significantly differed in the phonological task. CONCLUSION The non-significant modulation by tACS might be explained by methodological limitations. Alternatively, it may indicate that alpha oscillations do not play a functional role in phonological decisions. The findings on cortical excitability expands the existing literature and may reflect the specific phonological deficit in dyslexics. SIGNIFICANCE Our critical discussion of these null findings expands the systematic knowledge on alpha-tACS for future studies.

Wiegand, G., Japaridze, N., Gröning, K., Stephani, U., & Kadish, N. E. (2022). EEG-Findings during long-term treatment with Everolimus in TSC-associated and therapy-resistant epilepsies in children. Seizure - European Journal of Epilepsy. doi:10.1016/j.seizure.2022.10.022.
Xu, J., Xia, X., Li, Q., Dou, Y., …, Nees, F., …, Nees, F., …, & Consortia, I. (2022). A causal association of ANKRD37 with human hippocampal volume. Molecular Psychiatry. doi:10.1038/s41380-022-01800-7.

Human hippocampal volume has been separately associated with single nucleotide polymorphisms (SNPs), DNA methylation and gene expression, but their causal relationships remain largely unknown. Here, we aimed at identifying the causal relationships of SNPs, DNA methylation, and gene expression that are associated with hippocampal volume by integrating cross-omics analyses with genome editing, overexpression and causality inference. Based on structural neuroimaging data and blood-derived genome, transcriptome and methylome data, we prioritized a possibly causal association across multiple molecular phenotypes: rs1053218 mutation leads to cg26741686 hypermethylation, thus leads to overactivation of the associated ANKRD37 gene expression in blood, a gene involving hypoxia, which may result in the reduction of human hippocampal volume. The possibly causal relationships from rs1053218 to cg26741686 methylation to ANKRD37 expression obtained from peripheral blood were replicated in human hippocampal tissue. To confirm causality, we performed CRISPR-based genome and epigenome-editing of rs1053218 homologous alleles and cg26741686 methylation in mouse neural stem cell differentiation models, and overexpressed ANKRD37 in mouse hippocampus. These in-vitro and in-vivo experiments confirmed that rs1053218 mutation caused cg26741686 hypermethylation and ANKRD37 overexpression, and cg26741686 hypermethylation favored ANKRD37 overexpression, and ANKRD37 overexpression reduced hippocampal volume. The pairwise relationships of rs1053218 with hippocampal volume, rs1053218 with cg26741686 methylation, cg26741686 methylation with ANKRD37 expression, and ANKRD37 expression with hippocampal volume could be replicated in an independent healthy young (n = 443) dataset and observed in elderly people (n = 194), and were more significant in patients with late-onset Alzheimer's disease (n = 76). This study revealed a novel causal molecular association mechanism of ANKRD37 with human hippocampal volume, which may facilitate the design of prevention and treatment strategies for hippocampal impairment.


Albaugh, M. D., Ottino-Gonzalez, J., Sidwell, A., Lepage, C., …, Nees, F., …, IMAGEN Consortium, & Garavan, H. (2021). Association of Cannabis Use During Adolescence With Neurodevelopment. JAMA Psychiatry. PMID:34132750, doi:10.1001/jamapsychiatry.2021.1258.

Importance Animal studies have shown that the adolescent brain is sensitive to disruptions in endocannabinoid signaling, resulting in altered neurodevelopment and lasting behavioral effects. However, few studies have investigated ties between cannabis use and adolescent brain development in humans. Objective To examine the degree to which magnetic resonance (MR) imaging-assessed cerebral cortical thickness development is associated with cannabis use in a longitudinal sample of adolescents. Design, Setting, and Participants Data were obtained from the community-based IMAGEN cohort study, conducted across 8 European sites. Baseline data used in the present study were acquired from March 1, 2008, to December 31, 2011, and follow-up data were acquired from January 1, 2013, to December 31, 2016. A total of 799 IMAGEN participants were identified who reported being cannabis naive at study baseline and had behavioral and neuroimaging data available at baseline and 5-year follow-up. Statistical analysis was performed from October 1, 2019, to August 31, 2020. Main Outcomes and Measures Cannabis use was assessed at baseline and 5-year follow-up with the European School Survey Project on Alcohol and Other Drugs. Anatomical MR images were acquired with a 3-dimensional T1-weighted magnetization prepared gradient echo sequence. Quality-controlled native MR images were processed through the CIVET pipeline, version 2.1.0. Results The study evaluated 1598 MR images from 799 participants (450 female participants [56.3%]; mean [SD] age, 14.4 [0.4] years at baseline and 19.0 [0.7] years at follow-up). At 5-year follow-up, cannabis use (from 0 to >40 uses) was negatively associated with thickness in left prefrontal (peak: t785 = -4.87, cluster size = 1558 vertices; P = 1.10 × 10-6, random field theory cluster corrected) and right prefrontal (peak: t785 = -4.27, cluster size = 1551 vertices; P = 2.81 × 10-5, random field theory cluster corrected) cortices. There were no significant associations between lifetime cannabis use at 5-year follow-up and baseline cortical thickness, suggesting that the observed neuroanatomical differences did not precede initiation of cannabis use. Longitudinal analysis revealed that age-related cortical thinning was qualified by cannabis use in a dose-dependent fashion such that greater use, from baseline to follow-up, was associated with increased thinning in left prefrontal (peak: t815.27 = -4.24, cluster size = 3643 vertices; P = 2.28 × 10-8, random field theory cluster corrected) and right prefrontal (peak: t813.30 = -4.71, cluster size = 2675 vertices; P = 3.72 × 10-8, random field theory cluster corrected) cortices. The spatial pattern of cannabis-related thinning was associated with age-related thinning in this sample (r = 0.540; P < .001), and a positron emission tomography-assessed cannabinoid 1 receptor-binding map derived from a separate sample of participants (r = -0.189; P < .001). Analysis revealed that thinning in right prefrontal cortices, from baseline to follow-up, was associated with attentional impulsiveness at follow-up. Conclusions and Relevance Results suggest that cannabis use during adolescence is associated with altered neurodevelopment, particularly in cortices rich in cannabinoid 1 receptors and undergoing the greatest age-related thickness change in middle to late adolescence.

Appelhoff, S., & Stenner, T. (2021). In COM we trust: Feasibility of USB-based event marking. Behavior Research Methods. PMID:33852129, doi:10.3758/s13428-021-01571-z.

Modern experimental research often relies on the synchronization of different events prior to data analysis. One way of achieving synchronization involves marking distinct events with electrical pulses (event markers or “TTL pulses”), which are continuously recorded with research hardware, and can later be temporally aligned. Traditionally, this event marking was often performed using the parallel port in standard personal computers. However, the parallel port is disappearing from the landscape of computer hardware, being replaced by a serial (COM) port, namely the USB port. To find an adequate replacement for the parallel port, we evaluated four microcontroller units (MCUs) and the LabJack U3, an often-used USB data acquisition device, in terms of their latency and jitter for sending event markers in a simulated experiment on both Windows and Linux. Our results show that all four MCUs were comparable to the parallel port in terms of both latency and jitter, and consistently achieved latencies under 1 ms. With some caveats, the LabJack U3 can also achieve comparable latencies. In addition to the collected data, we share extensive documentation on how to build and use MCUs for event marking, including code examples. MCUs are a cost-effective, flexible, and performant replacement for the disappearing parallel port, enabling event marking and synchronization of data streams.

Axelrud, L. K., Simioni, A. R., Pine, D. S., Winkler, A. M., …, Nees, F., …, & Salum, G. A. (2021). Neuroimaging Association Scores: reliability and validity of aggregate measures of brain structural features linked to mental disorders in youth. European Child & Adolescent Psychiatry, 30(12), 1895–1906. doi:10.1007/s00787-020-01653-x.
Barker, E. D., Ing, A., Biondo, F., Jia, T., …, Nees, F., …, & Schumann, G. (2021). Do ADHD-impulsivity and BMI have shared polygenic and neural correlates? Mol. Psychiatry, 26(3), 1019–1028. PMID:31227801, doi:10.1038/s41380-019-0444-y.

There is an extensive body of literature linking ADHD to overweight and obesity. Research indicates that impulsivity features of ADHD account for a degree of this overlap. The neural and polygenic correlates of this association have not been thoroughly examined. In participants of the IMAGEN study, we found that impulsivity symptoms and body mass index (BMI) were associated ( r = 0.10, n = 874, p = 0.014 FWE corrected), as were their respective polygenic risk scores (PRS) ( r = 0.17, n = 874, p = 6.5 × 10 −6 FWE corrected). We then examined whether the phenotypes of impulsivity and BMI, and the PRS scores of ADHD and BMI, shared common associations with whole-brain grey matter and the Monetary Incentive Delay fMRI task, which associates with reward-related impulsivity. A sparse partial least squared analysis (sPLS) revealed a shared neural substrate that associated with both the phenotypes and PRS scores. In a last step, we conducted a bias corrected bootstrapped mediation analysis with the neural substrate score from the sPLS as the mediator. The ADHD PRS associated with impulsivity symptoms ( b = 0.006, 90% CIs = 0.001, 0.019) and BMI ( b = 0.009, 90% CIs = 0.001, 0.025) via the neuroimaging substrate. The BMI PRS associated with BMI ( b = 0.014, 95% CIs = 0.003, 0.033) and impulsivity symptoms ( b = 0.009, 90% CIs = 0.001, 0.025) via the neuroimaging substrate. A common neural substrate may (in part) underpin shared genetic liability for ADHD and BMI and the manifestation of their (observable) phenotypic association.

Beier, F., Löffler, M., Nees, F., Hausner, L., …, & Flor, H. (2021). Promoting neuroplasticity and neuropsychological functioning in frailty through an app-based sensorimotor training: study protocol for a randomized trial. BMC Geriatrics, 21(1), 343. doi:10.1186/s12877-021-02293-9.

Background Frailty is characterized by an age-related decline in multiple physiological systems, leading to a high vulnerability to stressors, adverse health outcomes, and low quality of life. Neuroscientific models of pathological aging emphasize the loss of sensorimotor stimulation and reduced neuromodulatory capacities as core processes in age-related cognitive and bodily decline, which may be associated with maladaptive plastic changes in the brain. We plan to increase sensorimotor stimulation in frail persons through a newly developed app-based training program and link the training trials to biological and psychological correlates of age-associated vulnerability and health indices. Methods We will conduct a randomized trial, applying an app-based sensorimotor home training (N = 30) in people suffering from frailty. An app-based relaxation training will serve as an active control condition (N = 30). Both interventions will last for 90 days each. The sensorimotor training includes unimodal and multimodal sensory discrimination tasks in the visual, auditory, and tactile domain, as well as sensorimotor precision tasks. The tasks will be implemented using an adaptive training algorithm and enriched with motivational components embedded in a virtual training environment. We expect a pre-post reduction of frailty status and associated functional decline related to refinement of representational maps within the sensorimotor system and improved sensorimotor function such as extremity function. Secondary analyses will study the influence of BDNF genotype as moderating variable. Additional outcomes will include measures of perceptual and cognitive functioning, quality of life as well as BDNF serum levels. Measurements will take place before training (baseline), after 60 days (assessment 1), and at the end of the training after 90 days (assessment 2). Discussion In our randomized trial, we aim to characterize a multidimensional concept of frailty and to target maladaptive behaviors and neuroplasticity using an app-based sensorimotor training. This type of intervention might provide further knowledge and new possibilities for preventing decline and preserving function in older adults.

Biondo, F., Thunell, C. N., Xu, B., Chu, C., …, Nees, F., …, & Schumann, G. (2021). Sex differences in neural correlates of common psychopathological symptoms in early adolescence. Psychol. Med., pp. 1–11. PMID:33769238, doi:10.1017/S0033291720005140.

BACKGROUND Sex-related differences in psychopathology are known phenomena, with externalizing and internalizing symptoms typically more common in boys and girls, respectively. However, the neural correlates of these sex-by-psychopathology interactions are underinvestigated, particularly in adolescence. METHODS Participants were 14 years of age and part of the IMAGEN study, a large (N = 1526) community-based sample. To test for sex-by-psychopathology interactions in structural grey matter volume (GMV), we used whole-brain, voxel-wise neuroimaging analyses based on robust non-parametric methods. Psychopathological symptom data were derived from the Strengths and Difficulties Questionnaire (SDQ). RESULTS We found a sex-by-hyperactivity/inattention interaction in four brain clusters: right temporoparietal-opercular region (p < 0.01, Cohen's d = -0.24), bilateral anterior and mid-cingulum (p < 0.05, Cohen's d = -0.18), right cerebellum and fusiform (p < 0.05, Cohen's d = -0.20) and left frontal superior and middle gyri (p < 0.05, Cohen's d = -0.26). Higher symptoms of hyperactivity/inattention were associated with lower GMV in all four brain clusters in boys, and with higher GMV in the temporoparietal-opercular and cerebellar-fusiform clusters in girls. CONCLUSIONS Using a large, sex-balanced and community-based sample, our study lends support to the idea that externalizing symptoms of hyperactivity/inattention may be associated with different neural structures in male and female adolescents. The brain regions we report have been associated with a myriad of important cognitive functions, in particular, attention, cognitive and motor control, and timing, that are potentially relevant to understand the behavioural manifestations of hyperactive and inattentive symptoms. This study highlights the importance of considering sex in our efforts to uncover mechanisms underlying psychopathology during adolescence.

Böttinger, B. W., Baumeister, S., Millenet, S. K., Barker, G. J., …, & Nees, F. (2021). Orbitofrontal control of conduct problems? Evidence from healthy adolescents processing negative facial affect. European Child & Adolescent Psychiatry. PMID:33861383, doi:10.1007/s00787-021-01770-1.

Conduct problems (CP) in patients with disruptive behavior disorders have been linked to impaired prefrontal processing of negative facial affect compared to controls. However, it is unknown whether associations with prefrontal activity during affective face processing hold along the CP dimension in a healthy population sample, and how subcortical processing is affected. We measured functional brain responses during negative affective face processing in 1444 healthy adolescents [ M = 14.39 years (SD = 0.40), 51.5% female] from the European IMAGEN multicenter study. To determine the effects of CP, we applied a two-step approach: (a) testing matched subgroups of low versus high CP, extending into the clinical range [ N = 182 per group, M = 14.44 years, (SD = 0.41), 47.3% female] using analysis of variance, and (b) considering (non)linear effects along the CP dimension in the full sample and in the high CP group using multiple regression. We observed no significant cortical or subcortical effect of CP group on brain responses to negative facial affect. In the full sample, regression analyses revealed a significant linear increase of left orbitofrontal cortex (OFC) activity with increasing CP up to the clinical range. In the high CP group, a significant inverted u-shaped effect indicated that left OFC responses decreased again in individuals with high CP. Left OFC activity during negative affective processing which is increasing with CP and decreasing in the highest CP range may reflect on the importance of frontal control mechanisms that counteract the consequences of severe CP by facilitating higher social engagement and better evaluation of social content in adolescents.

Brauer, H., Breitling-Ziegler, C., Moliadze, V., Galling, B., & Prehn-Kristensen, A. (2021). Transcranial direct current stimulation in attention-deficit/hyperactivity disorder: A meta-analysis of clinical efficacy outcomes. In Kadosh, R. C., Zaehle, T., & Krauel, K. (Eds.), Non-invasive Brain Stimulation (NIBS) in Neurodevelopmental Disorders (pp. 91–116). Elsevier. doi:10.1016/bs.pbr.2021.01.013.

Background: Evidence for the application of transcranial direct current stimulation (tDCS) in the clinical care of attention-deficit/hyperactivity disorder (ADHD) is limited. Therefore, we aimed to summarize study results using meta-analyses of measures of the cardinal symptoms of ADHD. Methods: We conducted a systematic literature search (PubMed/pubpsych/PsychInfo/WOS) until 01/05/2020 for randomized controlled trials (RCTs) evaluating tDCS vs. control condition in patients with ADHD. A random effects meta-analysis of symptom-related outcomes was performed separately for data on the immediate effect and follow-up. Subgroup- and metaregression analyses for patient characteristics and tDCS parameters were included. Results: Meta-analyzing 13 studies (n = 308, age = 23.7± 13.3), including 20 study arms, tDCS had an immediate effect on overall symptom severity, inattention, and impulsivity, but not on hyperactivity. Results were significant in children and adolescents (8 studies, n = 133, age = 12.4 ± 3.0). Follow-up data (3 days–4 weeks after stimulation) suggested an ongoing beneficial effect regarding overall symptom severity and a delayed effect on hyperactivity. Discussion: TDCS seems to be a promising method to treat clinical symptoms in ADHD with long-lasting effects. Still, more research considering the individual neuropsychological and anatomical dispositions of the subjects is needed to optimize tDCS protocols and efficacy. Safety issues of tDCS treatment in children and adolescents are addressed.

Cao, Z., Ottino-Gonzalez, J., Cupertino, R. B., Juliano, A., …, Nees, F., …, IMAGEN Consortium, & Garavan, H. (2021). Characterizing reward system neural trajectories from adolescence to young adulthood. Developmental Cognitive Neuroscience, p. 101042. doi:10.1016/j.dcn.2021.101042.

Mixed findings exist in studies comparing brain responses to reward in adolescents and adults. Here we examined the trajectories of brain response, functional connectivity and task-modulated network properties during reward processing with a large-sample longitudinal design. Participants from the IMAGEN study performed a Monetary Incentive Delay task during fMRI at timepoint 1 (T1; n=1,304, mean age=14.44 years old) and timepoint 2 (T2; n=1,241, mean age=19.09 years). The Alcohol Use Disorders Identification Test (AUDIT) was administrated at both T1 and T2 to assess a participant's alcohol use during the past year. Voxel-wise linear mixed effect models were used to compare whole brain response as well as functional connectivity of the ventral striatum (VS) during reward anticipation (large reward vs no-reward cue) between T1 and T2. In addition, task-modulated networks were constructed using generalized psychophysiological interaction analysis and summarized with graph theory metrics. To explore alcohol use in relation to development, participants with no/low alcohol use at T1 but increased alcohol use to hazardous use level at T2 (i.e., participants with AUDIT≤2 at T1 and ≥8 at T2) were compared against those with consistently low scores (i.e., participants with AUDIT≤2 at T1 and ≤7 at T2). Across the whole sample, lower brain response during reward anticipation was observed at T2 compared with T1 in bilateral caudate nucleus, VS, thalamus, midbrain, dorsal anterior cingulate as well as left precentral and postcentral gyrus. Conversely, greater response was observed bilaterally in the inferior and middle frontal gyrus and right precentral and postcentral gyrus at T2 (vs. T1). Increased functional connectivity with VS was found in frontal, temporal, parietal and occipital regions at T2. Graph theory metrics of the task-modulated network showed higher inter-regional connectivity and topological efficiency at T2. Interactive effects between time (T1 vs. T2) and alcohol use group (low vs. high) on the functional connectivity were observed between left middle temporal gyrus and right VS and the characteristic shortest path length of the task-modulated networks. Collectively, these results demonstrate the utility of the MID task as a probe of typical brain response and network properties during development and of differences in these features related to adolescent drinking, a reward-related behaviour associated with heightened risk for future negative health outcomes.

Chen, D., Jia, T., Cheng, W., Cao, M., …, Nees, F., …, Nees, F., …, & Schumann, G. (2021). Brain Signatures During Reward Anticipation Predict Persistent Attention-Deficit/Hyperactivity Disorder Symptoms. Journal of the American Academy of Child & Adolescent Psychiatry. doi:10.1016/j.jaac.2021.11.030.
Daedelow, L. S., Banaschewski, T., Berning, M., Bokde, A. L. W., …, Nees, F., …, IMAGEN Consortium, & Heinz, A. (2021). Are psychotic-like experiences related to a discontinuation of cannabis consumption in young adults? Schizophrenia research, 228, 271–279. PMID:33493775, doi:10.1016/j.schres.2021.01.002.

OBJECTIVE To assess changes in cannabis use in young adults as a function of psychotic-like experiences. METHOD Participants were initially recruited at age 14 in high schools for the longitudinal IMAGEN study. All measures presented here were assessed at follow-ups at age 19 and at age 22, respectively. Perceived stress was only assessed once at age 22. Ever users of cannabis (N = 552) gave qualitative and quantitative information on cannabis use and psychotic-like experiences using the Community Assessment of Psychic Experiences (CAPE). Of those, nearly all n = 549 reported to have experienced at least one psychotic experience of any form at age 19. RESULTS Mean cannabis use increased from age 19 to 22 and age of first use of cannabis was positively associated with a change in cannabis use between the two time points. Change in cannabis use was not significantly associated with psychotic-like experiences at age 19 or 22. In exploratory analysis, we observed a positive association between perceived stress and the experience of psychotic experiences at age 22. CONCLUSION Age of first use of cannabis influenced trajectories of young cannabis users with later onset leading to higher increase, whereas the frequency of psychotic-like experiences was not associated with a change in cannabis use. The observed association between perceived stress and psychotic-like experiences at age 22 emphasizes the importance of stress experiences in developing psychosis independent of cannabis use.

Elkrief, L., Spinney, S., Vosberg, D. E., Banaschewski, T., …, Nees, F., …, IMAGEN Consortium, & Conrod, P. J. (2021). Endocannabinoid Gene × Gene Interaction Association to Alcohol Use Disorder in Two Adolescent Cohorts. Frontiers in Psychiatry, 12, 645746. PMID:33959052, doi:10.3389/fpsyt.2021.645746.

Genetic markers of the endocannabinoid system have been linked to a variety of addiction-related behaviors that extend beyond cannabis use. In the current study we investigate the relationship between endocannabinoid (eCB) genetic markers and alcohol use disorder (AUD) in European adolescents (14-18 years old) followed in the IMAGEN study (n = 2,051) and explore replication in a cohort of North American adolescents from Canadian Saguenay Youth Study (SYS) (n = 772). Case-control status is represented by a score of more than 7 on the Alcohol Use Disorder Identification Test (AUDIT). First a set-based test method was used to examine if a relationship between the eCB system and AUDIT case/control status exists at the gene level. Using only SNPs that are both independent and significantly associated to case-control status, we perform Fisher's exact test to determine SNP level odds ratios in relation to case-control status and then perform logistic regressions as post-hoc analysis, while considering various covariates. Generalized multifactor dimensionality reduction (GMDR) was used to analyze the most robust SNP×SNP interaction of the five eCB genes with positive AUDIT screen. While no gene-sets were significantly associated to AUDIT scores after correction for multiple tests, in the case/control analysis, 7 SNPs were significantly associated with AUDIT scores of > 7 (p < 0.05; OR<1). Two SNPs remain significant after correction by false discovery rate (FDR): rs9343525 in CNR1 (pcorrected =0.042, OR = 0.73) and rs507961 in MGLL (pcorrected = 0.043, OR = 0.78). Logistic regression showed that both rs9353525 (CNR1) and rs507961 (MGLL) remained significantly associated with positive AUDIT screens (p < 0.01; OR < 1) after correction for multiple covariables and interaction of covariable × SNP. This result was not replicated in the SYS cohort. The GMDR model revealed a significant three-SNP interaction (p = 0.006) involving rs484061 (MGLL), rs4963307 (DAGLA), and rs7766029 (CNR1) predicted case-control status, after correcting for multiple covariables in the IMAGEN sample. A binomial logistic regression of the combination of these three SNPs by phenotype in the SYS cohort showed a result in the same direction as seen in the IMAGEN cohort (BETA = 0.501, p = 0.06). While preliminary, the present study suggests that the eCB system may play a role in the development of AUD in adolescents.

Filippi, I., Galinowski, A., Lemaître, H., Massot, C., …, Nees, F., …, & Martinot, J.-L. (2021). Neuroimaging evidence for structural correlates in adolescents resilient to polysubstance use: A five-year follow-up study. Eur. Neuropsychopharmacol., 49, 11–22. PMID:33770525, doi:10.1016/j.euroneuro.2021.03.001.

Early initiation of polysubstance use (PSU) is a strong predictor of subsequent addiction, however scarce individuals present resilience capacity. This neuroimaging study aimed to investigate structural correlates associated with cessation or reduction of PSU and determine the extent to which brain structural features accounted for this resilient outcome. Participants from a European community-based cohort self-reported their alcohol, tobacco and cannabis use frequency at ages 14, 16 and 19 and had neuroimaging sessions at ages 14 and 19. We included three groups in the study: the resilient-to-PSU participants showed PSU at 16 and/or 14 but no more at 19 (n = 18), the enduring polysubstance users at 19 displayed PSU continuation from 14 or 16 (n = 193) and the controls were abstinent or low drinking participants (n = 460). We conducted between-group comparisons of grey matter volumes on whole brain using voxel-based morphometry and regional fractional anisotropy using tract-based spatial statistics. Random-forests machine-learning approach generated individual-level PSU-behavior predictions based on personality and neuroimaging features. Adolescents resilient to PSU showed significant larger grey matter volumes in the bilateral cingulate gyrus compared with enduring polysubstance users and controls at ages 19 and 14 (p<0.05 corrected) but no difference in fractional anisotropy. The larger cingulate volumes and personality trait "openness to experience" were the best precursors of resilience to PSU. Early in adolescence, a larger cingulate gyrus differentiated adolescents resilient to PSU, and this feature was critical in predicting this outcome. This study encourages further research into the neurobiological bases of resilience to addictive behaviors.

Grill, S., Yahiaoui-Doktor, M., Basrai, M., Struck, J., …, Niederberger, U., …, & Kiechle, M. (2021). Precursor fractions of neurotensin and enkephalin might point to molecular mechanisms of cancer risk modulation during a lifestyle-intervention in germline BRCA1/2 gene mutation carriers. Breast cancer research and treatment, 186(3), 741–752. PMID:33543354, doi:10.1007/s10549-020-06070-x.

BACKGROUND Germline BRCA1/2 mutation carriers (gBMC) face increased cancer risks that are modulated via non-genetic lifestyle factors whose underlying molecular mechanisms are unknown. The peptides Neurotensin (NT) and Enkephalin (ENK)-involved in tumorigenesis and obesity-related diseases-are of interest. We wanted to know whether these biomarkers differ between gBMC and women from the general population and what effect a 1-year lifestyle-intervention has in gBMC. METHODS The stable precursor fragments pro-NT and pro-ENK were measured at study entry (SE), after 3 and 12 months for 68 women from LIBRE-1 (a controlled lifestyle-intervention feasibility trial for gBMC involving structured endurance training and the Mediterranean Diet). The SE values were compared with a cohort of the general population including female subjects with and without previous cancer disease, non-suggestive for hereditary breast and ovarian cancer (OMA-reference). For LIBRE-1, we analysed the association between the intervention-related change in the two biomarkers and certain lifestyle factors. RESULTS At SE, gBMC had a higher median pro-NT than OMA-reference (in the subgroups with previous cancer 117 vs. 91 pmol/L, p = 0.002). Non-diseased gBMC had lower median pro-ENK levels when compared to the non-diseased reference group. VO2peak and pro-NT 1-year change in LIBRE-1 were inversely correlated (r = - 0.435; CI - 0.653 to - 0.151; p = 0.004). Pro-ENK correlated positively with VO2peak at SE (r = 0.323; CI 0.061-0.544; p = 0.017). Regression analyses showed an inverse association of 1-year changes for pro-NT and Omega-6/Omega-3 (Estimate: - 37.9, p = 0.097/0.080) in multivariate analysis. CONCLUSION Our results give first indications for lifestyle-related modification particularly of pro-NT in gBMC.

Holz, N. E., Nees, F., Meyer-Lindenberg, A., Tost, H., …, & Banaschewski, T. (2021). Kohortenstudien in der Kinder- und Jugendpsychiatrie. Der Nervenarzt, 92(3), 208–218. doi:10.1007/s00115-020-01018-4.
Hunold, A., Haueisen, J., Freitag, C. M., Siniatchkin, M., & Moliadze, V. (2021). Cortical current density magnitudes during transcranial direct current stimulation correlate with skull thickness in children, adolescent and young adults. In Kadosh, R. C., Zaehle, T., & Krauel, K. (Eds.), Non-invasive Brain Stimulation (NIBS) in Neurodevelopmental Disorders (pp. 41–56). Elsevier. doi:10.1016/bs.pbr.2021.01.010.

Transcranial direct current stimulation protocols are often applied with a fixed parameter set to all subjects participating in an interventional study. This might lead to considerable effect variation in inhomogeneous subject groups or when transferring stimulation protocols to different age groups. The aim of this study was to evaluate magnitude differences of the electric current density distribution on the gray matter surface in children, adolescent and adults in correlation with the individual volume conductor geometry. We generated individual six compartment finite element models from structural magnetic resonance images of four children (age: 10.95 a ± 1.32 a), eight adolescents (age: 15.10 a ± 1.16 a) and eight young adults (age: 21.62 a ± 2.45 a). We determined the skull thickness in the models as Euclidean distance between the surface of the cerebrospinal fluid compartment and outer skull boundary. For tDCS simulations, we modeled 5 × 7 cm patch electrodes impressing 1 mA current intensity as anode and cathode over the left M1 and the right fronto-polar orbit, respectively. The resulting current density was analyzed on the gray matter surface. Our results demonstrate higher cortical current density magnitudes in children compared to adults for a given tDCS current strength. Above the evaluated cortex, the skull thickness increased with age. In conclusion, we underline the importance of age-dependent and individual models in tDCS simulations.

Ivanov, I., Parvaz, M. A., Velthorst, E., Shaik, R. B., …, Nees, F., …, Nees, F., …, Nees, F., …, & Stedman, A. (2021). Substance Use Initiation, Particularly Alcohol, in Drug-Naive Adolescents: Possible Predictors and Consequences From a Large Cohort Naturalistic Study. Journal of the American Academy of Child & Adolescent Psychiatry, 60(5), 623–636. PMID:33011213, doi:10.1016/j.jaac.2020.08.443.

OBJECTIVE It is unclear whether deviations in brain and behavioral development, that may underpin elevated substance use during adolescence, are predispositions for or are consequences of substance use initiation. Here, we examine behavioral and neuroimaging indices at early and mid-adolescence in drug na{\"{i}}ve youth to identify possible predisposing factors for substance use initiation and its possible consequences. METHOD Among 304 drug-na{\"{i}}ve adolescents at baseline (age 14) from the IMAGEN dataset, 83 stayed drug-na{\"{i}}ve, 133 used alcohol on 1-9 occasions, 42 on 10-19 occasions, 27 on 20-39 occasions, and 19 on >40 occasions at follow-up (age 16). Baseline measures included brain activation during the Monetary Incentive Delay task, whereas data at both baseline and follow-up included measures of trait impulsivity and delay discounting. RESULTS From baseline to follow-up, impulsivity decreased in the 0 and 1-9 occasions groups (p<.004), did not change in the 10-19 and 20-29 occasions groups (p>.294), and uncharacteristically increased in the >40 occasions group (p=.046). Further, blunted mOFC activation during reward outcome at baseline significantly predicted higher alcohol use frequency at follow-up, above and beyond behavioral and clinical variables (p=.008). CONCLUSIONS These results suggest that transition from no use to frequent drinking in early to mid-adolescence may disrupt normative developmental changes in behavioral control. Additionally, blunted activity of the mOFC during reward outcome may underscore a predisposition to the development of more severe alcohol use in adolescents. This distinction is clinically important as it informs early intervention efforts in preventing the onset of substance use disorder in adolescents.

Jia, T., Xie, C., Banaschewski, T., Barker, G. J., …, Nees, F., …, & Feng, J. (2021). Neural network involving medial orbitofrontal cortex and dorsal periaqueductal gray regulation in human alcohol abuse. Sci. Adv., 7(6), eabd4074. doi:10.1126/sciadv.abd4074.

Prompted by recent evidence of neural circuitry in rodent models, functional magnetic resonance imaging and functional connectivity analyses were conducted for a large adolescent population at two ages, together with alcohol abuse measures, to characterize a neural network that may underlie the onset of alcoholism. A network centered on the medial orbitofrontal cortex (mOFC), as well as including the dorsal periaqueductal gray (dPAG), central nucleus of the amygdala, and nucleus accumbens, was identified, consistent with the rodent models, with evidence of both inhibitory and excitatory coregulation by the mOFC over the dPAG. Furthermore, significant relationships were detected between raised baseline excitatory coregulation in this network and impulsivity measures, supporting a role for negative urgency in alcohol dependence.

Kandić, M., Moliadze, V., Andoh, J., Flor, H., & Nees, F. (2021). Brain Circuits Involved in the Development of Chronic Musculoskeletal Pain: Evidence From Non-invasive Brain Stimulation. Frontiers in Neurology, 12, 1526. doi:10.3389/fneur.2021.732034.

It has been well-documented that the brain changes in states of chronic pain. Less is known about changes in the brain that predict the transition from acute to chronic pain. Evidence from neuroimaging studies suggests a shift from brain regions involved in nociceptive processing to corticostriatal brain regions that are instrumental in the processing of reward and emotional learning in the transition to the chronic state. In addition, dysfunction in descending pain modulatory circuits encompassing the periaqueductal gray and the rostral anterior cingulate cortex may also be a key risk factor for pain chronicity. Although longitudinal imaging studies have revealed potential predictors of pain chronicity, their causal role has not yet been determined. Here we review evidence from studies that involve non-invasive brain stimulation to elucidate to what extent they may help to elucidate the brain circuits involved in pain chronicity. Especially, we focus on studies using non-invasive brain stimulation techniques [e.g., transcranial magnetic stimulation (TMS), particularly its repetitive form (rTMS), transcranial alternating current stimulation (tACS), and transcranial direct current stimulation (tDCS)] in the context of musculoskeletal pain chronicity. We focus on the role of the motor cortex because of its known contribution to sensory components of pain via thalamic inhibition, and the role of the dorsolateral prefrontal cortex because of its role on cognitive and affective processing of pain. We will also discuss findings from studies using experimentally induced prolonged pain and studies implicating the DLPFC, which may shed light on the earliest transition phase to chronicity. We propose that combined brain stimulation and imaging studies might further advance mechanistic models of the chronicity process and involved brain circuits. Implications and challenges for translating the research on mechanistic models of the development of chronic pain to clinical practice will also be addressed.

Koenig, J., Abler, B., Agartz, I., Åkerstedt, T., …, Nees, F., …, & Quintana, D. S. (2021). Cortical thickness and resting‐state cardiac function across the lifespan: A cross‐sectional pooled mega‐analysis. Psychophysiology, 58(7). doi:10.1111/psyp.13688.
Kropp, P., Niederberger, U., & Dresler, T. (2021). Wirkungsweise und Anwendung des Biofeedbacks am Beispiel von Kopfschmerzen. Psychotherapeut. doi:10.1007/s00278-021-00499-1.

Biofeedback ist ein apparatives Behandlungsverfahren, das aus der Verhaltenstherapie stammt und dazu dienen soll, normalerweise autonome physiologische Prozesse („Bio“) aktiv und willentlich zu regulieren. Diese werden {\"{u}}ber ein Messger{\"{a}}t erfasst und so umgewandelt, dass sie akustisch, visuell oder taktil wahrgenommen werden k{\"{o}}nnen. Sobald eine derartige Wahrnehmung besteht, kann das Signal von der Person selbst willentlich beeinflusst werden. Die R{\"{u}}ckmeldung („Feedback“) bewirkt demnach eine bewusste Wahrnehmung dieser autonomen, oft unbewussten K{\"{o}}rperprozesse. Dadurch lassen diese sich aktiv beeinflussen und gezielt ver{\"{a}}ndern. Dies gilt prinzipiell f{\"{u}}r alle K{\"{o}}rperprozesse, jedoch liegen G{\"{u}}te und Qualit{\"{a}}t der R{\"{u}}ckmeldung insbesondere an der Wahl der Sensoren. Die Methode erfordert daher sowohl technisches Grundverst{\"{a}}ndnis als auch therapeutische Kompetenz. Beides wird im vorliegenden Beitrag vermittelt.

Kropp, P., & Niederberger, U. (2021). Schmerz. In Deinzer, R., & von dem Knesebeck, O. (Eds.), Online Lehrbuch der Medizinischen Psychologie und Medizinischen Soziologie. Berlin: German Medical Science GMS Publishing House. doi:10.5680/olmps000011.

Neben einer kurzen {\"{U}}bersicht {\"{u}}ber geschichtliche Aspekte des Schmerzes und seiner anatomischen und physiologischen Grundlagen sollen die wesentlichen Unterschiede zwischen akutem und chronischem Schmerz zusammengetragen werden. Hier werden vor allem das bio-psycho-soziale Modell (siehe auch Kap. 1.), psychologische Aspekte des Lernens und die emotionale Reagibilit{\"{a}}t betont. Nach einer {\"{U}}bersicht {\"{u}}ber Verfahren der Schmerzdiagnostik folgt die Zusammenstellung wichtiger, evidenzbasierter M{\"{o}}glichkeiten zur Therapie von Schmerzen. Aufgrund der medizin-psychologischen Ausrichtung werden vor allem nicht-medikament{\"{o}}se Verfahren zur Schmerzkontrolle vorgestellt.

Liao, Z., Banaschewski, T., Bokde, A. L. W., Desrivières, S., …, Nees, F., …, & Paus, T. (2021). Similarity and stability of face network across populations and throughout adolescence and adulthood. NeuroImage, 244, 118587. doi:10.1016/j.neuroimage.2021.118587.

The ability to extract cues from faces is fundamental for social animals, including humans. An individual's profile of functional connectivity across a face network can be shaped by common organizing principles, stable individual traits, and time-varying mental states. In the present study, we used data obtained with functional magnetic resonance imaging in two cohorts, IMAGEN (N = 534) and ALSPAC (N = 465), to investigate - both at group and individual levels - the consistency of the regional profile of functional connectivity across populations (IMAGEN, ALSPAC) and time (Visits 1 to 3 in IMAGEN; age 14 to 22 years). At the group level, we found a robust canonical profile of connectivity both across populations and time. At the individual level, connectivity profiles deviated from the canonical profile, and the magnitude of this deviation related to the presence of psychopathology. These findings suggest that the brain processes faces in a highly stereotypical manner, and that the deviations from this normative pattern may be related to the risk of mental illness.

Meng, W., Sjöholm, L. K., Kononenko, O., Tay, N., …, Nees, F., …, & Liu, Y. (2021). Genotype-dependent epigenetic regulation of DLGAP2 in alcohol use and dependence. Molecular Psychiatry, 26(8), 4367–4382. doi:10.1038/s41380-019-0588-9.
Modabbernia, A., Reichenberg, A., Ing, A., Moser, D. A., …, Nees, F., …, Nees, F., …, & Frangou, S. (2021). Linked patterns of biological and environmental covariation with brain structure in adolescence: a population-based longitudinal study. Molecular Psychiatry, 26(9), 4905–4918. PMID:32444868, doi:10.1038/s41380-020-0757-x.

Adolescence is a period of major brain reorganization shaped by biologically timed and by environmental factors. We sought to discover linked patterns of covariation between brain structural development and a wide array of these factors by leveraging data from the IMAGEN study, a longitudinal population-based cohort of adolescents. Brain structural measures and a comprehensive array of non-imaging features (relating to demographic, anthropometric, and psychosocial characteristics) were available on 1476 IMAGEN participants aged 14 years and from a subsample reassessed at age 19 years ( n = 714). We applied sparse canonical correlation analyses (sCCA) to the cross-sectional and longitudinal data to extract modes with maximum covariation between neuroimaging and non-imaging measures. Separate sCCAs for cortical thickness, cortical surface area and subcortical volumes confirmed that each imaging phenotype was correlated with non-imaging features (sCCA r range: 0.30–0.65, all P FDR < 0.001). Total intracranial volume and global measures of cortical thickness and surface area had the highest canonical cross-loadings (| $\rho$ | = 0.31−0.61). Age, physical growth and sex had the highest association with adolescent brain structure (| $\rho$ | = 0.24−0.62); at baseline, further significant positive associations were noted for cognitive measures while negative associations were observed at both time points for prenatal parental smoking, life events, and negative affect and substance use in youth (|$\rho$| = 0.10−0.23). Sex, physical growth and age are the dominant influences on adolescent brain development. We highlight the persistent negative influences of prenatal parental smoking and youth substance use as they are modifiable and of relevance for public health initiatives.

Moliadze, V., Stenner, T., Matern, S., Siniatchkin, M., Nees, F., & Hartwigsen, G. (2021). Online Effects of Beta-tACS Over the Left Prefrontal Cortex on Phonological Decisions. Neuroscience, 463, 264–271. PMID:33722674, doi:10.1016/j.neuroscience.2021.03.002.

The left posterior inferior frontal gyrus in the prefrontal cortex is a key region for phonological aspects of language processing. A previous study has shown that alpha-tACS over the prefrontal cortex applied before task processing facilitated phonological decision-making and increased task-related theta power. However, it is unclear how alpha-tACS affects phonological processing when applied directly during the task. Moreover, the frequency specificity of this effect is also unclear since the majority of neurostimulation studies tested a single frequency only. The present study addressed the question whether and how 10 Hz online tACS affects phonological decisions. To this end, 24 healthy participants received tACS at 10 Hz or 16.18 Hz (control frequency) or sham stimulation over the left prefrontal cortex during task processing in three sessions. As an unexpected finding, 16.18 Hz significantly impaired task accuracy relative to sham stimulation, without affecting response speed. There was no significant difference in phonological task performance between 10 Hz and 16.18 Hz tACS or between 10 Hz and sham stimulation. Our results support the functional relevance of the left prefrontal cortex for phonological decisions and suggest that online beta-tACS may modulate language comprehension.

Nees, F., Deserno, L., Holz, N. E., Romanos, M., & Banaschewski, T. (2021). Prediction Along a Developmental Perspective in Psychiatry: How Far Might We Go? Frontiers in Systems Neuroscience, 15, 63. doi:10.3389/fnsys.2021.670404.

Most mental disorders originate in childhood, and once symptoms present, a variety of psychosocial and cognitive maladjustments may arise. Although early childhood problems are generally associated with later mental health impairments and psychopathology, pluripotent transdiagnostic trajectories may manifest. Possible predictors range from behavioral and neurobiological mechanisms, genetic predispositions, environmental and social factors, and psychopathological comorbidity. They may manifest in altered neurodevelopmental trajectories and need to be validated capitalizing on large-scale multi-modal epidemiological longitudinal cohorts. Moreover, clinical and etiological variability between patients with the same disorders represents a major obstacle to develop effective treatments. Hence, in order to achieve stratification of patient samples opening the avenue of adapting and optimizing treatment for the individual, there is a need to integrate data from multi-dimensionally phenotyped clinical cohorts and cross-validate them with epidemiological cohort data. In the present review, we discuss these aspects in the context of externalizing and internalizing disorders summarizing the current state of knowledge, obstacles, and pitfalls. Although a large number of studies have already increased our understanding on neuropsychobiological mechanisms of mental disorders, it became also clear that this knowledge might only be the tip of the Eisberg and that a large proportion still remains unknown. We discuss prediction strategies and how the integration of different factors and methods may provide useful contributions to research and at the same time may inform prevention and intervention.

Nees, F. (2021). Vorstellung des Instituts für Medizinische Psychologie und Medizinische Soziologie (IMPS) an der Universität Kiel. PPmP - Psychotherapie · Psychosomatik · Medizinische Psychologie, 71(09/10), 427–428. PMID:34624902, doi:10.1055/a-1532-0265.

Das Institut f{\"{u}}r Medizinische Psychologie und Medizinische Soziologie (IMPS) ist seit 1987 dem Universit{\"{a}}tsklinikum Schleswig-Holstein, Campus Kiel, zugeordnet. Seit 1972 bildet das Institut Studierende der Medizin in den F{\"{a}}chern Medizinische Psychologie sowie Medizinische Soziologie aus. Die wissenschaftlichen Schwerpunkte beziehen sich auf grundlagenorientierte Untersuchungen im Bereich der Neuropsychobiologie und Verhaltensmedizin zu Lern- und Ged{\"{a}}chtnisprozessen und Informationsverarbeitung des Gehirns in den Bereichen Schmerz, Sucht, Psychotraumatologie und {\"{u}}ber die Lebensspanne. Ein weiterer Schwerpunkt liegt in der Integration dieser Erkenntnisse in die Entwicklung und empirischen Evaluation von verhaltensmedizinischen Pr{\"{a}}ventions- und Rehabilitationsprogrammen bei verschiedenen psychischen, somatischen sowie neurologischen Erkrankungen. Dem Institut geh{\"{o}}rt auch eine Institutsambulanz an, welche mit der neuropsychologischen Diagnostik und Therapie von Kindern und Jugendlichen sowie Erwachsenen betraut ist sowie in der Erstellung von Fachgutachten. Prof. Dr. rer. nat. Frauke Nees (41) ist seit dem 1. M{\"{a}}rz 2020 Direktorin des IMPS und W3-Professorin f{\"{u}}r Medizinische Psychologie und Verhaltensneurobiologie an der Christian-Albrechts-Universit{\"{a}}t zu Kiel. Zuvor war sie am Institut f{\"{u}}r Neuropsychologie und Klinische Psychologie des Zentralinstituts f{\"{u}}r Seelische Gesundheit (ZI) der Medizinischen Fakult{\"{a}}t Mannheim/Universit{\"{a}}t Heidelberg t{\"{a}}tig. Dort war sie die St{\"{a}}ndige Stellvertreterin der Wissenschaftlichen Direktorin des Instituts f{\"{u}}r Neuropsychologie und Klinische Psychologie (Prof. Dr. Dr. h.c. Dr. h.c. Herta Flor), leitete seit 2013 die Arbeitsgruppe „Psychobiologie emotionaler Lernprozesse“ und hatte seit 2018 ein Heisenberg-Stipendium der Deutschen Forschungsgemeinschaft inne. Frau Prof. Nees war au{\ss}erdem an der Klinik f{\"{u}}r Psychiatrie und Psychotherapie des Kindes- und Jugendalters des ZI t{\"{a}}tig und unter anderem ein Jahr an der Medizinischen Universit{\"{a}}t Wien. In ihrer Forschung mit interdisziplin{\"{a}}rer Ausrichtung untersucht das IMPS die Interaktion von Gehirn und Verhalten {\"{u}}ber emotionale Lern- und Ged{\"{a}}chtnisprozesse, Motivation und Belohnungsverarbeitung sowie den Einfluss von Stress im Kontext von Gesundheit, Krankheit und Lebensspanne. Eine wichtige Fragestellung ist bspw., inwiefern Mechanismen des emotionalen Lernens oder der Belohnungsverarbeitung bestimmte psychische und k{\"{o}}rperliche Symptome wie Sucht und Schmerz ausl{\"{o}}sen. Ihre Studien im Bereich der Medizinischen und Biologischen Psychologie und kognitiven Neurowissenschaften umfassen eine Vielzahl experimenteller Methoden von der verhaltens- und neuropsychologischen bis hin zur genetischen Ebene. Wichtige Erkenntnisse liefern dabei L{\"{a}}ngsstudien im Rahmen des IMAGEN-Consortiums und der DFG-Sonderforschungsbereiche, die Prof. Nees bereits in Mannheim durchgef{\"{u}}hrt hat und in Kiel fortsetzen wird. Die neurowissenschaftliche Forschung hat in den letzten Jahren einen rapiden Wandel durchzogen – nicht nur bez{\"{u}}glich einer sich immer rasanter entwickelnden Methodik (z. B. hinsichtlich neuronaler Korrelate von Risikofaktoren, epigenetisches Profiling, GWAS und Kommunikationstechnologien, sondern auch in Richtung der B{\"{u}}ndelung gro{\ss}er Datens{\"{a}}tze aus longitudinal angelegten Studien (Big Data, Data Mining). Diese Ans{\"{a}}tze sind wichtiger Bestandteil des wissenschaftlichen Fortschritts, da so Risiko- und Resilienzfaktoren f{\"{u}}r die Entwicklung von psychischen St{\"{o}}rungen verl{\"{a}}sslicher identifiziert werden k{\"{o}}nnen. Hierbei kommt der Ber{\"{u}}cksichtigung neuroplastizit{\"{a}}tsrelevanter und psychobiologischer Aspekte in verschiedenen Lebensspannen eine besondere Bedeutung zu. Am IMPS wird somit ein multimodaler Ansatz verfolgt. Dieser beinhaltet experimental-psychologische Ans{\"{a}}tze, neuropsychologische Testungen, peripher-physiologische Erhebungen sowie strukturelle und funktionelle Bildgebung und Stimulationsmethoden wie die transkranielle Gleichstrom- und Magnetstimulation. Au{\ss}erdem setzen wir Anwendungen in virtueller Realit{\"{a}}t ein sowie Neurofeedback-Verfahren und auch alltagsnahe Verfahren wie das sog. Ecological Momentary Assessment (EMA), welche Erfassungen und Interventionen im t{\"{a}}glichen Umfeld von Personen, bspw. {\"{u}}ber Smartphone Apps, erm{\"{o}}glicht. Im Rahmen des Projektes Imaging Genetics (IMAGEN; „Reinforcement-related behaviour in normal brain function and psychopathology“) haben wir europaweit beispielsweise insgesamt ca. 2500 Jugendliche mit neuropsychologischen und klinisch-psychologischen Verfahren im L{\"{a}}ngsschnitt untersucht und es wurden dar{\"{u}}ber hinaus funktionelle und strukturelle magnetresonanztomographische Daten sowie genetische Daten erhoben. In einer Analyse zur Initiierung von sch{\"{a}}dlichem Trinkverhalten bei 14–15 Jahre alten Jugendlichen beispielsweise konnte die Varianz in der Trinkmenge bei einer Aufgabe, bei der unterschiedlich gro{\ss}e Belohnungen antizipiert wurden, durch Gehirnaktivierungen am wenigsten erkl{\"{a}}rt werden, w{\"{a}}hrend Pers{\"{o}}nlichkeitsvariablen und Verhaltensdaten, die mit der Belohnungsverarbeitung in Bezug standen, deutlich st{\"{a}}rker mit der Trinkmenge assoziiert waren (z. B. Nees et al., [1],] Neuropsychopharmacology). F{\"{u}}r die Vorhersage des sch{\"{a}}dlichen Trinkverhaltens war jedoch das Zusammenspiel all dieser Faktoren (Gehirnaktivierungen, Pers{\"{o}}nlichkeitsvariablen und Verhaltensdaten) entscheidend. In einer Folgestudie wurde die Untersuchung dieser Faktoren anhand von longitudinalen Daten weiter ausgebaut (z. B. Whelan et al., [2], Nature). Mit zunehmendem Alter (16–17 Jahren) gewannen au{\ss}erdem (epi)genetische und Gen-Umwelt Interaktionen an Bedeutung (z. B. Heinrich, et al., [3], Biological Psychology). Diese Arbeiten tragen zur Charakterisierung und Identifikation einzelner Risikofaktoren in der Entstehung von psychischen St{\"{o}}rungen, in diesem Fall Alkoholsucht, bei und werden aktuell von Frau Prof. Nees im Rahmen von 2 weiteren Projekten des BMBF-gef{\"{o}}rderten Verbundes IMAC-Mind („Improving Mental Health and Reducing Addiction in Childhood and Adolescence through Mindfulness: Mechanisms, Prevention and Treatment”; mittels fortgeschrittener Data Mining Strategien an acht Kohortenstudien im Kinder- und Jugendbereich sowie der Entwicklung von „Ecological Momentary Assessment“ (EMA)/„Ecological Momentary Intervention“(EMI) Tools erweitert. Es ist das Ziel, wichtige Erkenntnisse {\"{u}}ber Entwicklungsverl{\"{a}}ufe von Gesundheits- und Krankheitsverhalten entscheidend voranzutreiben und zu verbessern und eine Identifikation und Charakterisierung von Hochrisikopopulationen und Patienten mit schweren Verl{\"{a}}ufen zu erzielen. Im Rahmen der Professur wird auch ein Transfer der Erkenntnisse von psychischen zu k{\"{o}}rperlichen und organischen St{\"{o}}rungen angestrebt. Das IMPS m{\"{o}}chte den unmittelbaren Bezug zur Krankenversorgung durch die Entwicklung von Virtual-Reality-/Tablet-Tools st{\"{a}}rken, die unter anderem in der psychotherapeutischen Praxis das Screening und Training von Patientinnen und Patienten unterst{\"{u}}tzen k{\"{o}}nnen. Dabei ist ihr sehr an einer engen Zusammenarbeit mit den Kliniken und Instituten am Campus Kiel im Rahmen eines f{\"{a}}cher{\"{u}}bergreifenden neurowissenschaftlichen und psychobiologischen Netzwerks gelegen. Das Institut verf{\"{u}}gt auch {\"{u}}ber eine verhaltensmedizinische Ambulanz. Hier bieten wir Erwachsenen Diagnostik und Beratung bei vielen psychischen St{\"{o}}rungen an u. a. bei Angst, Depression, Trauma/PTSD, ADHS). Unser aktuelles Leistungsangebot umfasst: Feststellen des aktuellen kognitiven und affektiven Zustandes sowie der Auswirkungen auf das Verhalten hinsichtlich von Bereichen wie Wahrnehmung, Aufmerksamkeit, Ged{\"{a}}chtnis, Sprache, Wissen, Affektivit{\"{a}}t und Pers{\"{o}}nlichkeit; Objektivierung von Funktionsbeeintr{\"{a}}chtigungen (d. h. welchen einschr{\"{a}}nkenden Wert haben diese St{\"{o}}rungen im Alltag der Patienten); Verlaufsuntersuchungen (d. h. wie ver{\"{a}}ndern sich St{\"{o}}rung und deren Auswirkungen in der Zeit); Begutachtung (d. h. Abgabe von gutachterlichen Stellungnahmen).

Neirich, L., Yahiaoui-Doktor, M., Lammert, J., Basrai, M., …, Niederberger, U., …, & Grill, S. (2021). Physical activity and Mediterranean diet as potential modulators of osteoprotegerin and soluble RANKL in gBRCA1/2 mutation carriers: results of the lifestyle intervention pilot study LIBRE-1. Breast Cancer Research and Treatment. doi:10.1007/s10549-021-06400-7.

Purpose Emerging evidence suggests that the progesterone-mediated receptor activator of nuclear factor $\kappa$B (RANK)/soluble RANK ligand (sRANKL)/osteoprotegerin (OPG) pathway plays an important role in mammary carcinogenesis and is hyperactivated in germline (g)BRCA1/2 mutation carriers. We analyzed the effects of a 3-month intensive lifestyle intervention within the LIBRE-1 study on the serum levels of OPG and sRANKL and hypothesized that the intervention program provides a beneficial impact on the biomarkers by increasing OPG and reducing sRANKL serum concentrations. Methods Serum levels of OPG and sRANKL of 49 gBRCA1/2 mutation carriers were quantified using enzyme-linked immunosorbent assays. We used previously collected blood samples from participants of the prospective LIBRE-1 study, who were randomized into an intervention group (IG), increasing physical activity and adherence to the Mediterranean diet (MedD) through supervised sessions from study entry to the first study visit after 3 months and a usual-care control group (CG). Differences in biomarker levels before and after the 3-month intervention were tested within and between study groups. Results The lifestyle intervention resulted in a significant increase in OPG for participants in both the IG (q = 0.022) and CG (q = 0.002). sRANKL decreased significantly in the IG (q = 0.0464) and seemed to decrease in the CG (q = 0.5584). An increase in the intake of Omega-3 polyunsaturated fatty acids was significantly associated with an increase in OPG (r = 0.579, q = 0.045). Baseline serum levels of sRANKL were a strong predictor for the change of sRANKL in the course of the intervention ({\ss}-estimate = − 0.70; q = 0.0018). Baseline physical fitness (assessed as VO2peak) might predict the change of OPG in the course of the intervention program ({\ss}-estimate = 0.133 pg/ml/ml/min/kg; p = 0.0319; q = 0.2871). Conclusion Findings from this pilot study seem to confirm our hypothesis by showing an increase in OPG and decrease in sRANKL over a 3-month lifestyle intervention and suggest that increased physical activity and adherence to the MedD are potent modulators of the biomarkers OPG and potentially sRANKL.

Penninck, L., Ibrahim, E. C., Artiges, E., Gorgievski, V., …, Nees, F., …, & Martinot, J.-L. (2021). Immune-Related Genetic Overlap Between Regional Gray Matter Reductions and Psychiatric Symptoms in Adolescents, and Gene-Set Validation in a Translational Model. Frontiers in Systems Neuroscience, 15. doi:10.3389/fnsys.2021.725413.

Adolescence is a period of vulnerability for the maturation of gray matter (GM) and also for the onset of psychiatric disorders such as major depressive disorder (MDD), bipolar disorder and schizophrenia. Chronic neuroinflammation is considered to play a role in the etiology of these illnesses. However, the involvement of neuroinflammation in the observed link between regional GM volume reductions and psychiatric symptoms is not established yet. Here, we investigated a possible common immune-related genetic link between these two phenomena in european adolescents recruited from the community. Hippocampal and medial prefrontal cortex (mPFC) were defined a priori as regions of interest (ROIs). Their GM volumes were extracted in 1,563 14-year-olds from the IMAGEN database. We found a set of 26 SNPs that correlated with the hippocampal volumes and 29 with the mPFC volumes at age 14. We formed two ROI-Related Immune-gene scores (RRI) with the inflammation SNPs that correlated to hippocampal GM volume and to mPFC GM volume. The predictive ability of both RRIs with regards to the presence of psychiatric symptoms at age 18 was investigated by correlating the RRIs with psychometric questionnaires obtained at age 18. The RRIs (but not control scores constructed with random SNPs) correlated with the presence of depressive symptoms, positive psychotic symptoms, and externalizing symptoms in later adolescence. In addition, the effect of childhood maltreatment, one of the major environmental risk factors for depression and other mental disorders, interacted with the RRI effect. We next sought to validate this finding by investigating our set of inflammatory genes in a translational animal model of early life adversity. Mice were subjected to a protocol of maternal separation at an early post-natal age. We evaluated depressive behaviors in separated and non-separated mice at adolescence and their correlations with the concomitant expression of our genes in whole blood samples. We show that in mice, early life adversity affected the expression of our set of genes in peripheral blood, and that levels of expression correlated with symptoms of negative affect in adolescence. Overall, our translational findings in adolescent mice and humans provide a novel validated gene-set of immune-related genes for further research in the early stages of mood disorders.

Price, M., Albaugh, M. D., Hahn, S., Juliano, A. C., …, Nees, F., …, & Garavan, H. (2021). Examination of the association between exposure to childhood maltreatment and brain structure in young adults: a machine learning analysis. Neuropsychopharmacology. PMID:33637836, doi:10.1038/s41386-021-00987-7.

Exposure to maltreatment during childhood is associated with structural changes throughout the brain. However, the structural differences that are most strongly associated with maltreatment remain unclear given the limited number of whole-brain studies. The present study used machine learning to identify if and how brain structure distinguished young adults with and without a history of maltreatment. Young adults (ages 18-21, n = 384) completed an assessment of childhood trauma exposure and a structural MRI as part of the IMAGEN study. Elastic net regularized regression was used to identify the structural features that identified those with a history of maltreatment. A generalizable model that included 7 cortical thicknesses, 15 surface areas, and 5 subcortical volumes was identified (area under the receiver operating characteristic curve = 0.71, p < 0.001). Those with a maltreatment history had reduced surface areas and cortical thicknesses primarily in fronto-temporal regions. This group also had larger cortical thicknesses in occipital regions and surface areas in frontal regions. The results suggest childhood maltreatment is associated with multiple measures of structure throughout the brain. The use of a large sample without exposure to adulthood trauma provides further evidence for the unique contribution of childhood trauma to brain structure. The identified regions overlapped with regions associated with psychopathology in adults with maltreatment histories, which offers insights as to how these disorders manifest.

Prignitz, M., Guldner, S., & Nees, F. (2021). Jugendliches Alkoholkonsumverhalten während der COVID-19-Pandemie und die Bedeutung von Achtsamkeit. SUCHT, 67(6), 287–297. doi:10.1024/0939-5911/a000734.

Zusammenfassung. Zielsetzung: Kognitive und psychosoziale Faktoren k{\"{o}}nnen zu individuellen Ver{\"{a}}nderungen im Alkoholmissbrauch beitragen und f{\"{u}}hren im Jugendalter zu einer erh{\"{o}}hten Vulnerabilit{\"{a}}t. In diesem Kontext spielt die aktuelle COVID-19 Pandemie eine wichtige Rolle. In der aktuellen Studie wird untersucht, ob ein Anstieg negativer Gedanken in der Pandemie einen Risikofaktor f{\"{u}}r einen erh{\"{o}}hten Alkoholkonsum darstellt und welche Rolle hierbei Achtsamkeit spielt. Methodik: An der Untersuchung nahmen 72 Jugendliche (36 weiblich, Alter 15.13 ± 1.0 Jahre) teil, von denen N = 21 einen Onlinefragebogen vollst{\"{a}}ndig w{\"{a}}hrend der ersten Lockdown-Phase der Pandemie (Fr{\"{u}}hjahr 2020) und dem {\"{U}}bergang in die zweite Welle im Abstand von jeweils 14 Tagen und {\"{u}}ber 6 Wochen zu ihrem Alkoholkonsum, Kognitionen, Emotionserleben und ihrer sozialen Belastung ausf{\"{u}}llten. Ergebnisse: W{\"{a}}hrend sich der Alkoholkonsum der Jugendlichen im Verlauf der Pandemie nicht signifikant ver{\"{a}}nderte, zeigten sich deutlichere Ver{\"{a}}nderungen in den kognitiven und psychosozialen Belastungen der Jugendlichen. Negative Gedanken waren hierbei ein signifikanter Pr{\"{a}}diktor f{\"{u}}r den Alkoholkonsum zu Beginn der zweiten COVID-19-Welle ( b = 1.314, p < .01). Dieser Zusammenhang wurde durch Trait-Achtsamkeit signifikant moderiert ( b = -.283, p < .01). Diskussion: Negative Gedanken scheinen ein wichtiger Faktor f{\"{u}}r das Alkoholkonsumverhalten im ersten Verlauf der COVID-19 Pandemie zu sein und k{\"{o}}nnten somit das Risiko eines Alkoholmissbrauchs im weiteren Verlauf der Pandemie deutlich erh{\"{o}}hen. Achtsamkeit scheint solchen negativen Entwicklungen entgegenwirken zu k{\"{o}}nnen.</p>

Qi, S., Schumann, G., Bustillo, J., Turner, J. A., …, Nees, F., …, & IMAGEN Consortium. (2021). Reward Processing in Novelty Seekers: A Transdiagnostic Psychiatric Imaging Biomarker. Biological psychiatry. PMID:33875230, doi:10.1016/j.biopsych.2021.01.011.

BACKGROUND Dysfunctional reward processing is implicated in multiple mental disorders. Novelty seeking (NS) assesses preference for seeking novel experiences, which is linked to sensitivity to reward environmental cues. METHODS A subset of 14-year-old adolescents (IMAGEN) with the top 20% ranked high-NS scores was used to identify high-NS-associated multimodal components by supervised fusion. These features were then used to longitudinally predict five different risk scales for the same and unseen subjects (an independent dataset of subjects at 19 years of age that was not used in predictive modeling training at 14 years of age) (within IMAGEN, n ≈1100) and even for the corresponding symptom scores of five types of patient cohorts (non-IMAGEN), including drinking (n = 313), smoking (n = 104), attention-deficit/hyperactivity disorder (n = 320), major depressive disorder (n = 81), and schizophrenia (n = 147), as well as to classify different patient groups with diagnostic labels. RESULTS Multimodal biomarkers, including the prefrontal cortex, striatum, amygdala, and hippocampus, associated with high NS in 14-year-old adolescents were identified. The prediction models built on these features are able to longitudinally predict five different risk scales, including alcohol drinking, smoking, hyperactivity, depression, and psychosis for the same and unseen 19-year-old adolescents and even predict the corresponding symptom scores of five types of patient cohorts. Furthermore, the identified reward-related multimodal features can classify among attention-deficit/hyperactivity disorder, major depressive disorder, and schizophrenia with an accuracy of 87.2%. CONCLUSIONS Adolescents with higher NS scores can be used to reveal brain alterations in the reward-related system, implicating potential higher risk for subsequent development of multiple disorders. The identified high-NS-associated multimodal reward-related signatures may serve as a transdiagnostic neuroimaging biomarker to predict disease risks or severity.

Salvador, R., Biagi, M. C., Puonti, O., Splittgerber, M., Moliadze, V., …, & Ruffini, G. (2021). Personalization of Multi-electrode Setups in tCS/tES: Methods and Advantages. In Makarov, S., Noetscher, G., & Nummenmaa, A. (Eds.), Brain Hum. Body Model. 2020 (1st ed., pp. 119–135). Cham: Springer International Publishing. doi:10.1007/978-3-030-45623-8_7.
Siehl, S., Wilhelms, L., & Crombach, A. (2021). Commentary on Raghuraman et al. (2021). On the Long-Term Efficacy and Effectiveness of Narrative Exposure Therapy. Frontiers in Psychology, 12. doi:10.3389/fpsyg.2021.771958.

In the past years, several systematic reviews and meta-analyses have been published assessing the effectiveness of narrative exposure therapy [NET; (Lely et al., 2019; Raghuraman et al., 2021; Siehl et al., 2021; Wei and Chen, 2021)]. The meta-analyses had different aims and came to different conclusions about the effectiveness of NET. Lely et al. (2019) and Wei and Chen (2021) focused on between-treatment effects, post intervention, comparing NET with active and non-active control-treatment-conditions. In addition to comparing between-treatment effects Raghuraman et al. (2021) and Siehl et al. (2021) assessed also the temporal stability of the effects. The latter two studies investigated the reduction of symptom severity of posttraumatic stress disorder (PTSD) and the percentage of PTSD diagnoses over several follow-up periods. Raghuraman et al. (2021) indicated a medium standardized mean difference (SMD) in favor of NET in comparison to active and inactive control groups in the long-term and no benefit regarding PTSD diagnoses. The authors cautioned against using the existing evidence to inform policies and guidelines. In contrast, Siehl et al. (2021) found a large SMD in favor of NET compared to active or inactive control groups in the long-term. They reported an improvement of effectiveness over time when analyzing active control groups and concluded that NET is an effective treatment approach in post-conflict settings and refugee populations, highlighting the high external validity of the trials. Acknowledging the significant efforts of both author groups to select, code, and analyze the existing evidence, we aim to clarify potential underlying reasons for the differences between the two meta-analyses. The purpose of this commentary is two-fold: (a) discuss more generally ways to assess the quality of a treatment, such as NET, that is used in a broad range of contexts and (b) more specific differences between the two meta-analyses in (1) selecting and analyzing strategies, and (2) potential coding errors. A variety of tools and methods are used to ensure the quality of systematic reviews and meta-analyses (Higgins et al., 2011) to evaluate the effectiveness of psychotherapeutic interventions, such as NET, in comparison to control conditions. These include the preregistration on platforms like the international prospective register of systematic reviews (PROSPERO; or Cochrane ( to a priori define the research question, hypotheses, inclusion/exclusion criteria and planned types of analysis, quality control and the use of risk of bias assessments (RoB) like the Cochrane RoB tool (Higgins et al., 2011). Following the guidelines and using these tools limits systematic errors and offers a possibility to evaluate the primary studies qualitatively. Whereas, both meta-analyses (Raghuraman et al., 2021; Siehl et al., 2021) used the Cochrane RoB tool, Raghuraman et al. (2021) did not pre-register their meta-analysis. However, attempting to resolve quality control-related issues with checklists and preregistrations cannot explain the differences between the two meta-analyses. After intense discussions, the most plausible reasons seem differences in the selection and analysis process as well as potential coding errors. One reason for the disparate results might be the different operationalizations of long-term. Raghuraman et al. (2021) defined “long-term” as 12 months and more. Siehl et al. (2021) defined “long-term” as 6 months and more. However, even the mid-term results (6–7 months) from Raghuraman et al. (2021) yield only a moderate effect in favor of NET regarding PTSD symptom severity. Hence, this explanation seems unlikely. Another reason might be the different selection criteria of the included studies. Raghuraman et al. (2021) included 24 studies using the following inclusion criteria: (a) individuals with a history of exposure to trauma and PTSD outcome measure, (b) randomized controlled study (RCT). While the authors set a restriction on type of therapy, not including NET for children (KIDNET), the authors did include studies with underage populations (Hermenau et al., 2013; Al-Hadethe et al., 2015). They further conducted an analysis combining NET for adults and adaptations for perpetrators (Forensic Offender Rehabilitation NET; FORNET). Siehl et al. (2021) separately coded NET, KIDNET, and FORNET studies. We argue in favor of separating these versions of NET when assessing their efficacy (Siehl et al., 2021) noting a potential age effect regarding the efficacy of NET (Lely et al., 2019), the possible impact of differences in brain maturity and in cognitive development on treatment efficacy (Lenroot and Giedd, 2006), particularities regarding beneficial effects for perpetrators, as well as subsequent adaptations of NET (Stenmark et al., 2014; Hecker et al., 2015). Doing so counteracts heterogeneity that arises when pooling data from different populations and forms of treatment. Even though these aspects partially explain the different results, other aspects regarding methodology and coding possibly contribute significantly to the disparate conclusions. Aiming to replicate the analyses of Raghuraman et al. (2021) we recoded the included articles in line with the described procedures and compared the results to those reported in the original paper. It was unclear why the authors excluded most NET studies with children but included FORNET studies. Furthermore, by recoding the included studies we identified considerable outcome differences in 4 out of 6 studies regarding PTSD symptom severity, and in 1 out of 3 studies regarding the percentage of PTSD diagnoses (see Figure 1). Unfortunately, we could not replicate the results as it remained unclear which data was chosen and coded as the control condition. In our replication of the meta-analysis, we came to an overall SMD of 0.87 (Z = 4.05) in comparison to the results by Raghuraman et al. (2021) with an SMD of 0.49 (Z = 3.06). The following reasons may explain some of the differences: (1) Ertl et al. (2011): a coding error might have occurred; specifically, the interchanging of the percentage of participants no longer fulfilling the criteria for PTSD has possibly led to the opposing results regarding the diagnosis of PTSD (Ertl et al., 2011, p. 510); (2) In the cases of Hinsberger et al. (2020), Neuner et al. (2004), and Ertl et al. (2011) it remained unclear which data was chosen and coded as the control condition in the meta-analysis of symptom severity, because the results reported in these studies are incompatible with those in Raghuraman et al. (2021). We attempted to replicate the results of Raghuraman et al. (2021) with the data available in the original studies, we did not contact them for additional information. Furthermore, we would like to highlight that the reduction of symptoms in highly affected populations like survivors of genocide cannot be captured using binary categories of PTSD diagnosis. In conclusion, both meta-analyses support the effectiveness of NET in comparison with other treatments and found a stable effect over time. However, we demonstrated that the results of meta-analyses are significantly affected by design, potential omissions during study inclusions, challenges during coding procedures, and unclear methodological descriptions, both in the source articles and meta-analyses. Safety procedures, including preregistration and double-checking results, must be implemented with great care. However, even though strict criteria, emphasized, for example, by Cochrane, are very important, we stress that meta-analyses often focus on clinical studies at Phase-III with efficacy studies focusing on RCTs. Here, the internal validity is highly important (Buchkremer and Klingberg, 2001). A large amount of NET studies can be considered to be Phase-IV studies, assessing the effectiveness of an intervention under more naturalistic settings, broadening the context (cultural contexts, community settings, types of populations) in which an intervention is applied with a focus on external validity. In the case of NET, a treatment for vulnerable populations, the latter seems particularly important. Hence, many NET studies have been conducted aiming to assess the external validity of NET in multiple cultural contexts, community settings, and across different populations. This strength, however, is rarely reflected in meta-analyses. We argue that there is evidence on the long-term efficacy of NET. Nevertheless, more classic RCT-Phase III and Phase-IV studies are needed in the case of NET, as is arguably the case for most trauma-focused treatments.

Splittgerber, M., & Nees, F. (2021). Gehirnentwicklung im Jugendalter. Jugendhilfe, 59(4).

Das Jugendalter ist der {\"{U}}bergang von der sp{\"{a}}ten Kindheit ins Erwachsenenalter – eine Entwicklung, die von vielen Kindern und Jugendlichen herbeigesehnt wird: endlich Er- wachsen! Doch Erwachsen werden ist auch nicht immer leicht. Die Jugendzeit stellt einen Menschen vor gro{\ss}e Herausforderungen. Von sozialen Ver{\"{a}}nderungen, dem Erleben starker Gef{\"{u}}hle, der Rollen- und Identit{\"{a}}tsfindung oder dem Suchen nach Neuem ist alles dabei. Zu allem {\"{U}}berfluss macht auch das Gehirn vielf{\"{a}}ltige Ver{\"{a}}nderungen durch, die mit dem Aspekt der Jugendzeit als Phase gro{\ss}er Herausforderungen zusammenzu- h{\"{a}}ngen scheinen. Durch strukturelle und funktionelle Umbauarbeiten wird unser Gehirn besser vernetzt und spezialisierter. Das Gehirn ist in dieser Zeit extrem formbar und sucht in besonderer Weise nach neuem Input, vor allem aus sozialen und emotionalen Kontexten. Die besondere Formbarkeit macht das Gehirn allerdings auch anf{\"{a}}lliger f{\"{u}}r negative Einfl{\"{u}}sse, die sich bis in das Erwachsenenalter auswirken k{\"{o}}nnen.

Splittgerber, M., Borzikowsky, C., Salvador, R., Puonti, O., Papadimitriou, K., Merschformann, C., …, Stenner, T., …, Nees, F., …, & Moliadze, V. (2021). Multichannel anodal tDCS over the left dorsolateral prefrontal cortex in a paediatric population. Scientific Reports, 11(1), 21512. PMID:34728684, doi:10.1038/s41598-021-00933-z.

Methodological studies investigating transcranial direct current stimulation (tDCS) over the left dorsolateral prefrontal cortex (lDLPFC) in paediatric populations are limited. Therefore, we investigated in a paediatric population whether stimulation success of multichannel tDCS over the lDLPFC depends on concurrent task performance and individual head anatomy. In a randomised, sham-controlled, double-blind crossover study 22 healthy participants (10–17 years) received 2 mA multichannel anodal tDCS (atDCS) over the lDLPFC with and without a 2-back working memory (WM) task. After stimulation, the 2-back task and a Flanker task were performed. Resting state and task-related EEG were recorded. In 16 participants we calculated the individual electric field (E-field) distribution. Performance and neurophysiological activity in the 2-back task were not affected by atDCS. atDCS reduced reaction times in the Flanker task, independent of whether atDCS had been combined with the 2-back task. Flanker task related beta oscillation increased following stimulation without 2-back task performance. atDCS effects were not correlated with the E-field. We found no effect of multichannel atDCS over the lDLPFC on WM in children/adolescents but a transfer effect on interference control. While this effect on behaviour was independent of concurrent task performance, neurophysiological activity might be more sensitive to cognitive activation during stimulation. However, our results are limited by the small sample size, the lack of an active control group and variations in WM performance.

Toenders, Y. J., Kottaram, A., Dinga, R., Davey, C. G., …, Nees, F., …, & Schmaal, L. (2021). Predicting depression onset in young people based on clinical, cognitive, environmental and neurobiological data. Biological psychiatry. Cognitive neuroscience and neuroimaging. PMID:33753312, doi:10.1016/j.bpsc.2021.03.005.

BACKGROUND Adolescent onset of depression is associated with long-lasting negative consequences. Identifying adolescents at risk for developing depression would enable the monitoring of risk-factors and the development of early intervention strategies. Using machine learning to combine several risk factors from multiple modalities might allow prediction of depression onset at the individual level. METHODS A subsample of a multi-site longitudinal study in adolescents, the IMAGEN study, was used to predict future (subthreshold) major depressive disorder (MDD) onset in healthy adolescents. Based on 2-year and 5-year follow-up data, participants were grouped into: 1) developing an MDD diagnosis or subthreshold MDD and 2) healthy controls. Baseline measurements of 145 variables from different modalities (clinical, cognitive, environmental and structural magnetic resonance imaging [MRI]) at age 14 were used as input to penalized logistic regression (with different levels of penalization) to predict depression onset in a training dataset (N=407). The features contributing highest to the prediction were validated in an independent hold-out sample (3 independent IMAGEN sites; N=137). RESULTS The area under the receiver operating characteristics curve (AUROC) for predicting depression onset ranged between 0.70-0.72 in the training dataset. Baseline severity of depressive symptoms, female sex, neuroticism, stressful life events and surface area of the supramarginal gyrus contributed most to the predictive model and predicted onset of depression with an AUROC between 0.68-0.72 in the independent validation sample. CONCLUSIONS This study showed that depression onset in adolescents can be predicted based on a combination multimodal data of clinical, life events, personality traits, brain structure variables.

Tschorn, M., Lorenz, R. C., O'Reilly, P. F., Reichenberg, A., …, Nees, F., …, & Rapp, M. A. (2021). Differential predictors for alcohol use in adolescents as a function of familial risk. Transl. Psychiatry, 11(1), 157. doi:10.1038/s41398-021-01260-7.

Traditional models of future alcohol use in adolescents have used variable-centered approaches, predicting alcohol use from a set of variables across entire samples or populations. Following the proposition that predictive factors may vary in adolescents as a function of family history, we used a two-pronged approach by first defining clusters of familial risk, followed by prediction analyses within each cluster. Thus, for the first time in adolescents, we tested whether adolescents with a family history of drug abuse exhibit a set of predictors different from adolescents without a family history. We apply this approach to a genetic risk score and individual differences in personality, cognition, behavior (risk-taking and discounting) substance use behavior at age 14, life events, and functional brain imaging, to predict scores on the alcohol use disorders identification test (AUDIT) at age 14 and 16 in a sample of adolescents ( N = 1659 at baseline, N = 1327 at follow-up) from the IMAGEN cohort, a longitudinal community-based cohort of adolescents. In the absence of familial risk ( n = 616), individual differences in baseline drinking, personality measures (extraversion, negative thinking), discounting behaviors, life events, and ventral striatal activation during reward anticipation were significantly associated with future AUDIT scores, while the overall model explained 22% of the variance in future AUDIT. In the presence of familial risk ( n = 711), drinking behavior at age 14, personality measures (extraversion, impulsivity), behavioral risk-taking, and life events were significantly associated with future AUDIT scores, explaining 20.1% of the overall variance. Results suggest that individual differences in personality, cognition, life events, brain function, and drinking behavior contribute differentially to the prediction of future alcohol misuse. This approach may inform more individualized preventive interventions.

Wang, H., Fan, L., Song, M., Liu, B., …, Nees, F., …, & Jiang, T. (2021). Functional Connectivity Predicts Individual Development of Inhibitory Control during Adolescence. Cerebral Cortex, 31(5), 2686–2700. PMID:33386409, doi:10.1093/cercor/bhaa383.

Derailment of inhibitory control (IC) underlies numerous psychiatric and behavioral disorders, many of which emerge during adolescence. Identifying reliable predictive biomarkers that place the adolescents at elevated risk for future IC deficits can help guide early interventions, yet the scarcity of longitudinal research has hindered the progress. Here, using a large-scale longitudinal dataset in which the same subjects performed a stop signal task during functional magnetic resonance imaging at ages 14 and 19, we tracked their IC development individually and tried to find the brain features predicting their development by constructing prediction models using 14-year-olds' functional connections within a network or between a pair of networks. The participants had distinct between-subject trajectories in their IC development. Of the candidate connections used for prediction, ventral attention-subcortical network interconnections could predict the individual development of IC and formed a prediction model that generalized to previously unseen individuals. Furthermore, we found that connectivity between these two networks was related to substance abuse problems, an IC-deficit related problematic behavior, within 5 years. Our study reveals individual differences in IC development from mid- to late-adolescence and highlights the importance of ventral attention-subcortical network interconnections in predicting future IC development and substance abuse in adolescents.

Wesarg, C., Veer, I. M., Oei, N. Y. L., Daedelow, L. S., …, Nees, F., …, IMAGEN Consortium, & Walter, H. (2021). The interaction of child abuse and rs1360780 of the FKBP5 gene is associated with amygdala resting-state functional connectivity in young adults. Hum. Brain Mapp., pp. 1–13. PMID:33818852, doi:10.1002/hbm.25433.

Extensive research has demonstrated that rs1360780, a common single nucleotide polymorphism within the FKBP5 gene, interacts with early-life stress in predicting psychopathology. Previous results suggest that carriers of the TT genotype of rs1360780 who were exposed to child abuse show differences in structure and functional activation of emotion-processing brain areas belonging to the salience network. Extending these findings on intermediate phenotypes of psychopathology, we examined if the interaction between rs1360780 and child abuse predicts resting-state functional connectivity (rsFC) between the amygdala and other areas of the salience network. We analyzed data of young European adults from the general population (N = 774; mean age = 18.76 years) who took part in the IMAGEN study. In the absence of main effects of genotype and abuse, a significant interaction effect was observed for rsFC between the right centromedial amygdala and right posterior insula (p < .025, FWE-corrected), which was driven by stronger rsFC in TT allele carriers with a history of abuse. Our results suggest that the TT genotype of rs1360780 may render individuals with a history of abuse more vulnerable to functional changes in communication between brain areas processing emotions and bodily sensations, which could underlie or increase the risk for psychopathology.

Wiegand, G., May, T. W., Lehmann, I., Stephani, U., & Kadish, N. E. (2021). Long-term treatment with everolimus in TSC-associated therapy-resistant epilepsies. Seizure, 93, 111–119. doi:10.1016/j.seizure.2021.10.011.
Xie, C., Jia, T., Rolls, E. T., Robbins, T. W., …, Nees, F., …, & IMAGEN Consortium. (2021). Reward Versus Nonreward Sensitivity of the Medial Versus Lateral Orbitofrontal Cortex Relates to the Severity of Depressive Symptoms. Biological psychiatry. Cognitive neuroscience and neuroimaging, 6(3), 259–269. PMID:33221327, doi:10.1016/j.bpsc.2020.08.017.

BACKGROUND The orbitofrontal cortex (OFC) is implicated in depression. The hypothesis investigated was whether the OFC sensitivity to reward and nonreward is related to the severity of depressive symptoms. METHODS Activations in the monetary incentive delay task were measured in the IMAGEN cohort at ages 14 years (n = 1877) and 19 years (n = 1140) with a longitudinal design. Clinically relevant subgroups were compared at ages 19 (high-severity group: n = 116; low-severity group: n = 206) and 14. RESULTS The medial OFC exhibited graded activation increases to reward, and the lateral OFC had graded activation increases to nonreward. In this general population, the medial and lateral OFC activations were associated with concurrent depressive symptoms at both ages 14 and 19 years. In a stratified high-severity depressive symptom group versus control group comparison, the lateral OFC showed greater sensitivity for the magnitudes of activations related to nonreward in the high-severity group at age 19 (p = .027), and the medial OFC showed decreased sensitivity to the reward magnitudes in the high-severity group at both ages 14 (p = .002) and 19 (p = .002). In a longitudinal design, there was greater sensitivity to nonreward of the lateral OFC at age 14 for those who exhibited high depressive symptom severity later at age 19 (p = .003). CONCLUSIONS Activations in the lateral OFC relate to sensitivity to not winning, were associated with high depressive symptom scores, and at age 14 predicted the depressive symptoms at ages 16 and 19. Activations in the medial OFC were related to sensitivity to winning, and reduced reward sensitivity was associated with concurrent high depressive symptom scores.

Xu, J., Liu, X., Li, Q., Goldblatt, R., …, Nees, F., …, & Schumann, G. (2021). Global urbanicity is associated with brain and behaviour in young people. Nature Human Behaviour. PMID:34711977, doi:10.1038/s41562-021-01204-7.

Urbanicity is a growing environmental challenge for mental health. Here, we investigate correlations of urbanicity with brain structure and function, neuropsychology and mental illness symptoms in young people from China and Europe (total n = 3,867). We developed a remote-sensing satellite measure (UrbanSat) to quantify population density at any point on Earth. UrbanSat estimates of urbanicity were correlated with brain volume, cortical surface area and brain network connectivity in the medial prefrontal cortex and cerebellum. UrbanSat was also associated with perspective-taking and depression symptoms, and this was mediated by neural variables. Urbanicity effects were greatest when urban exposure occurred in childhood for the cerebellum, and from childhood to adolescence for the prefrontal cortex. As UrbanSat can be generalized to different geographies, it may enable assessments of correlations of urbanicity with mental illness and resilience globally.

Zhang, Y., Luo, Q., Huang, C.-C., Lo, C.-Y. Z., …, Nees, F., …, & Feng, J. (2021). The Human Brain Is Best Described as Being on a Female/Male Continuum: Evidence from a Neuroimaging Connectivity Study. Cereb. Cortex. doi:10.1093/cercor/bhaa408.

Psychological androgyny has long been associated with greater cognitive flexibility, adaptive behavior, and better mental health, but whether a similar concept can be defined using neural features remains unknown. Using the neuroimaging data from 9620 participants, we found that global functional connectivity was stronger in the male brain before middle age but became weaker after that, when compared with the female brain, after systematic testing of potentially confounding effects. We defined a brain gender continuum by estimating the likelihood of an observed functional connectivity matrix to represent a male brain. We found that participants mapped at the center of this continuum had fewer internalizing symptoms compared with those at the 2 extreme ends. These findings suggest a novel hypothesis proposing that there exists a neuroimaging concept of androgyny using the brain gender continuum, which may be associated with better mental health in a similar way to psychological androgyny.


Arnaud, N., Banaschewski, T., Nees, F., Bucholz, V. N., …, & Thomasius, R. (2020). Achtsamkeit in der entwicklungsorientierten Suchtprävention und -therapie: Rational, Design und Ziele des Forschungsverbundes IMAC-Mind. Prax. Kinderpsychol. Kinderpsychiatr., 69(4), 353–374. PMID:32615894, doi:10.13109/prkk.2020.69.4.353.

Mindfulness in Development-oriented Approaches to Substance Use Prevention and Therapy: Rationale, Design and Objectives of the Research Consortium IMAC-Mind Substance use disorders (SUD) are a major contributor to morbidity and mortality. They are typically initiated during adolescence and can have fatal implications for healthy development. Despite substantial scientific advances, there remains a need to prioritize research directed at reducing risks for SUD, particularly in vulnerable periods and populations from a developmental perspective. Research indicates that reward sensitivity, impulsivity, deficient self-regulation, and stress reactivity develop markedly in childhood and adolescence and play an important role in the initiation and maintenance of SUD. A growing number of research results suggest that these factors can be favorably influenced by mindfulness-based interventions and that mindfulness-based exercises can be successfully integrated into established prevention and treatment programs. In this paper we summarize the conceptual relationships between the development and maintenance of addiction disorders and mindfulness, discuss existing empirical findings with regard to childhood and adolescence, and present the aims, study designs and intervention models of the subprojects from the ongoing research network "IMAC-Mind: Improving Mental Health and Reducing Addiction in Childhood and Adolescence through Mindfulness: Mechanisms, Prevention and Treatment".

Arnaud, N., Baldus, C., Laurenz, L. J., Bröning, S., …, & IMAC-Mind Consortium. (2020). Does a mindfulness-augmented version of the German Strengthening Families Program reduce substance use in adolescents? Study protocol for a randomized controlled trial. Trials, 21(1), 114. PMID:31992356, doi:10.1186/s13063-020-4065-1.

BACKGROUND Mindfulness training (MT) for parents of adolescents has been shown to improve mental health and stress-related outcomes in individuals and their families. Studies of MT among young people are mainly delivered in educational or clinical settings, and there is a need for controlled studies on both parent-directed and adolescent-directed approaches. It is unclear whether MT has preventive effects for substance use outcomes. The primary objective of this trial is to evaluate the effectiveness of family-based MT targeting both adolescents and their parents to prevent adolescent substance use and enhance neurobehavioral self-regulation skills that play a major role in addiction development and mental health. METHODS/DESIGN The trial design is a superiority, two-arm, randomized controlled trial in which families will participate either in the full curriculum of the evidence-based Strengthening Families Program 10-14 (SFP 10-14, German adaptation) or in a mindfulness-enhanced version of this program (SFP-Mind). Both seven-session interventions are highly structured and will each be delivered over a period of approximately 7 weeks. The experimental intervention SFP-Mind is a modified version of the SFP 10-14 in which some elements were eliminated or changed to enable the inclusion of additional parent-directed and adolescent-directed mindfulness components. The primary outcome is adolescent self-reported alcohol use based on an alcohol initiation index at 18-month follow-up. Dispositional mindfulness, impulsivity, and emotion regulation will be included as secondary outcomes and potential mechanisms of action. The study will recruit and randomize 216 adolescents, aged 10-14 years, and their parents who will be followed up for 18 months. DISCUSSION This trial aims to evaluate the effectiveness of SFP-Mind for family-based prevention of substance use and promoting mental health in adolescence. TRIAL REGISTRATION German Register of Clinical Studies, DRKS00015678. Registered on 25 February 2019.

Bayard, F., Nymberg Thunell, C., Abé, C., Almeida, R., …, Nees, F., …, & Petrovic, P. (2020). Distinct brain structure and behavior related to ADHD and conduct disorder traits. Mol. Psychiatry, 25(11), 3020–3033. doi:10.1038/s41380-018-0202-6.

Attention-Deficit/Hyperactivity Disorder (ADHD) and conduct disorder (CD) exemplify top-down dysregulation conditions that show a large comorbidity and shared genetics. At the same time, they entail two different types of symptomology involving mainly non-emotional or emotional dysregulation. Few studies have tried to separate the specific biology underlying these two dimensions. It has also been suggested that both types of conditions consist of extreme cases in the general population where the symptoms are widely distributed. Here we test whether brain structure is specifically associated to ADHD or CD symptoms in a general population of adolescents (n = 1093) being part of the IMAGEN project. Both ADHD symptoms and CD symptoms were related to similar and overlapping MRI findings of a smaller structure in prefrontal and anterior cingulate cortex. However, our regions of interest (ROI) approach indicated that gray matter volume (GMV) and surface area (SA) in dorsolateral/dorsomedial prefrontal cortex and caudal anterior cingulate cortex were negatively associated to ADHD symptoms when controlling for CD symptoms while rostral anterior cingulate cortex GMV was negatively associated to CD symptoms when controlling for ADHD symptoms. The structural findings were mirrored in performance of neuropsychological tests dependent on prefrontal and anterior cingulate regions, showing that while performance on the Stop Signal test was specifically related to the ADHD trait, delayed discounting and working memory were related to both ADHD and CD traits. These results point towards a partially domain specific and dimensional capacity in different top-down regulatory systems associated with ADHD and CD symptoms.

Boll, S., Ueltzhoeffer, K., Roth, C., Bertsch, K., …, Nees, F., …, & Herpertz, S. C. (2020). Pain-modulating effects of oxytocin in patients with chronic low back pain. Neuropharmacology, 171, 108105. PMID:32298704, doi:10.1016/j.neuropharm.2020.108105.

The neuropeptide oxytocin (OT) has been shown to play a modulatory role in nociception. However, analgesic effects of OT in chronic pain conditions remain elusive and the neural underpinnings have not yet been investigated in humans. Here, we conducted an exploratory, randomized, placebo-controlled, cross-over study to examine effects of intranasal OT in male patients suffering from chronic low back pain (CBP) versus healthy controls (HC). N = 22 participants with CBP and 22 HCs were scanned using functional magnetic resonance imaging (fMRI) while they continuously rated either spontaneously occurring back pain or acute thermal pain stimuli applied to the lower back. During heat pain processing we found that OT versus PL attenuated pain intensity ratings and increased BOLD responses in the caudate nucleus of the striatum in CBP versus HCs. Spontaneously experienced pain in contrast to heat pain was associated with activation changes in the medial frontal cortex (MFC) and the anterior cingulate cortex (ACC) as reported in previous studies. However, we did not observe OT effects on spontaneously experienced pain in CBP patients. Overall, our preliminary data may suggest that the striatum is a key structure underlying the pain-modulating effects of OT in patients with chronic pain and adds to the growing evidence linking the neuropeptide to pain modulation in humans. Further studies on neuronal OT effects in larger samples of chronic back pain patients are needed to understand probable mechanisms of OT effects in chronic pain.

Bossier, H., Roels, S. P., Seurinck, R., Banaschewski, T., …, Nees, F., …, & Moerkerke, B. (2020). The empirical replicability of task-based fMRI as a function of sample size. Neuroimage, 212, 116601. PMID:32036019, doi:10.1016/j.neuroimage.2020.116601.

Replicating results (i.e. obtaining consistent results using a new independent dataset) is an essential part of good science. As replicability has consequences for theories derived from empirical studies, it is of utmost importance to better understand the underlying mechanisms influencing it. A popular tool for non-invasive neuroimaging studies is functional magnetic resonance imaging (fMRI). While the effect of underpowered studies is well documented, the empirical assessment of the interplay between sample size and replicability of results for task-based fMRI studies remains limited. In this work, we extend existing work on this assessment in two ways. Firstly, we use a large database of 1400 subjects performing four types of tasks from the IMAGEN project to subsample a series of independent samples of increasing size. Secondly, replicability is evaluated using a multi-dimensional framework consisting of 3 different measures: (un)conditional test-retest reliability, coherence and stability. We demonstrate not only a positive effect of sample size, but also a trade-off between spatial resolution and replicability. When replicability is assessed voxelwise or when observing small areas of activation, a larger sample size than typically used in fMRI is required to replicate results. On the other hand, when focussing on clusters of voxels, we observe a higher replicability. In addition, we observe variability in the size of clusters of activation between experimental paradigms or contrasts of parameter estimates within these.

Chaarani, B., Kan, K.-J., Mackey, S., Spechler, P. A., …, Nees, F., …, & Althoff, R. R. (2020). Neural Correlates of Adolescent Irritability and Its Comorbidity With Psychiatric Disorders. J. Am. Acad. Child Adolesc. Psychiatry. doi:10.1016/j.jaac.2019.11.028.

OBJECTIVE: Irritable mood, a common and impairing symptom in psychopathology, has been proposed to underlie the developmental link between oppositional problems in youth and depression in adulthood. Here, we examined the neural correlates of adolescent irritability in IMAGEN, a sample of 2024 14-year-adolescents from five European countries. METHOD: The Development and Well-Being Assessment (DAWBA) was used to assess attention-deficit/hyperactivity disorder (ADHD), major depressive disorder (MDD), oppositional defiant disorder (ODD), and generalized anxiety (GA). Three items from the DAWBA, selected as close matches to the Affective Reactivity Index, were used to assess irritability. Structural MRI was examined using whole brain Voxel Based Morphometry analysis and functional MRI was examined during a stop signal task of inhibitory control. Imaging data were included in structural equation models (SEM) to examine the direct and indirect associations between irritable mood and comorbid DSM diagnoses. RESULTS: Whole brain voxel wise analysis showed that adolescent irritable mood was associated with less grey matter volume and less neural activation underlying inhibitory control in frontal and temporal cortical areas (cluster-correction at p<0.05). SEM models suggested that part of the observed smaller GMV is exclusively driven by irritability separate from direct relationships between GA (or ADHD, MDD, ODD) and grey matter volume. CONCLUSION: This study identifies adolescent irritability as an independent construct and points to a neurobiological correlate to irritability that is an important contributing feature to many psychopathological disorders.

Galinowski, A., Miranda, R., Lemaître, H., Artiges, E., …, Nees, F., …, & Martinot, J.-L. (2020). Heavy drinking in adolescents is associated with change in brainstem microstructure and reward sensitivity. Addict. Biol., 25(3), e12781. PMID:31328396, doi:10.1111/adb.12781.

Heavy drinker adolescents: altered brainstem microstructure.

Galka, A., Moontaha, S., & Siniatchkin, M. (2020). Constrained expectation maximisation algorithm for estimating ARMA models in state space representation. EURASIP J. Adv. Signal Process., 2020(1), 23. doi:10.1186/s13634-020-00678-3.

This paper discusses the fitting of linear state space models to given multivariate time series in the presence of constraints imposed on the four main parameter matrices of these models. Constraints arise partly from the assumption that the models have a block-diagonal structure, with each block corresponding to an ARMA process, that allows the reconstruction of independent source components from linear mixtures, and partly from the need to keep models identifiable. The first stage of parameter fitting is performed by the expectation maximisation (EM) algorithm. Due to the identifiability constraint, a subset of the diagonal elements of the dynamical noise covariance matrix needs to be constrained to fixed values (usually unity). For this kind of constraints, so far, no closed-form update rules were available. We present new update rules for this situation, both for updating the dynamical noise covariance matrix directly and for updating a matrix square-root of this matrix. The practical applicability of the proposed algorithm is demonstrated by a low-dimensional simulation example. The behaviour of the EM algorithm, as observed in this example, illustrates the well-known fact that in practical applications, the EM algorithm should be combined with a different algorithm for numerical optimisation, such as a quasi-Newton algorithm.

Gerber, W.-D., Niederberger, U., & Siniatchkin, M. (2020). Schmerzen. In Petermann, F. (Ed.), Entspannungsverfahren (pp. 253–267). Weinheim: Beltz.
Göbel, C. H., Göbel, A., Niederberger, U., Heinze, A., …, & Göbel, H. (2020). Occipital Nerve Stimulation in Chronic Migraine: The Relationship Between Perceived Sensory Quality, Perceived Sensory Location, and Clinical Efficacy—A Prospective, Observational, Non-Interventional Study. Pain Ther., 9(2), 615–626. PMID:32910427, doi:10.1007/s40122-020-00194-0.

INTRODUCTION: Occipital nerve stimulation (ONS) is used to treat therapy-resistant chronic migraine. Clinical use has resulted in a wide intraindividual and interindividual variation of clinical efficacy. The aim of this study was to analyze a potential relationship between sociodemographic variables, headache parameters, perceived sensory quality, perceived sensory location, as well as clinical efficacy. METHODS: Thirty-two subjects (21.9% male, mean age 45.77 years) suffering from chronic migraine refractory to other treatment and therefore treated with ONS were included in this study. We used a computer-based imaging method for mapping the ONS-induced perceived sensory location, the perceived spatial sensory field size, as well as the perceived sensory quality in a long-term course over 21 months in weekly time intervals. Additionally, the effect of ONS on the migraine headache was documented weekly by the participants using a verbal rating scale. Over the observation period, a total of 808 individual weekly data sets were recorded and a potential relationship between ONS-induced perceptions and headache parameters could be analyzed. RESULTS: We found that 48.9% of stimulation intervals were reported as effective by patients. Women displayed a significantly higher responder rate than men. The reported effectiveness did not differ depending on age, the average number of migraine days per month, the MIDAS score, or the duration of the migraine disorder prior to ONS treatment. Implantation with trial period led to significantly lower responder rates than without the trial period. The most frequently perceived sensory quality of "tingling" was found significantly more frequently in non-responders than in responders. Responders displayed significantly lower pleasantness scores for their reported perceptions than non-responders. Sensations that were spatially perceived above the line connecting the external acoustic meati with the external occipital protuberance (MOP line) led to patients reporting a positive clinical effect significantly more frequently than sensations spatially perceived below the MOP line. Spatially small fields of sensory perception were correlated with a higher responder rate than those covering broader areas. CONCLUSIONS: The ONS-induced sensory location, the size of the spatial sensory field, as well as the sensory quality are significantly correlated with the reported clinical effectiveness. The results suggest that besides surgical technique, the individual and continuous programming of the stimulation parameters is clinically relevant in increasing the therapeutic effectiveness.

Grasby, K. L., Jahanshad, N., Painter, J. N., Colodro-Conde, L., …, IMAGEN Consortium, & Medland, S. E. (2020). The genetic architecture of the human cerebral cortex. Science, 367(6484), eaay6690. doi:10.1126/science.aay6690.

The cerebral cortex underlies our complex cognitive capabilities, yet little is known about the specific genetic loci that influence human cortical structure. To identify genetic variants that affect cortical structure, we conducted a genome-wide association meta-analysis of brain magnetic resonance imaging data from 51,665 individuals. We analyzed the surface area and average thickness of the whole cortex and 34 regions with known functional specializations. We identified 199 significant loci and found significant enrichment for loci influencing total surface area within regulatory elements that are active during prenatal cortical development, supporting the radial unit hypothesis. Loci that affect regional surface area cluster near genes in Wnt signaling pathways, which influence progenitor expansion and areal identity. Variation in cortical structure is genetically correlated with cognitive function, Parkinson's disease, insomnia, depression, neuroticism, and attention deficit hyperactivity disorder.

Guldner, S., Nees, F., & McGettigan, C. (2020). Vocomotor and Social Brain Networks Work Together to Express Social Traits in Voices. Cereb. Cortex. doi:10.1093/cercor/bhaa175.

Voice modulation is important when navigating social interactions—tone of voice in a business negotiation is very different from that used to comfort an upset child. While voluntary vocal behavior relies on a cortical vocomotor network, social voice modulation may require additional social cognitive processing. Using functional magnetic resonance imaging, we investigated the neural basis for social vocal control and whether it involves an interplay of vocal control and social processing networks. Twenty-four healthy adult participants modulated their voice to express social traits along the dimensions of the social trait space (affiliation and competence) or to express body size (control for vocal flexibility). Na{\"{i}}ve listener ratings showed that vocal modulations were effective in evoking social trait ratings along the two primary dimensions of the social trait space. Whereas basic vocal modulation engaged the vocomotor network, social voice modulation specifically engaged social processing regions including the medial prefrontal cortex, superior temporal sulcus, and precuneus. Moreover, these regions showed task-relevant modulations in functional connectivity to the left inferior frontal gyrus, a core vocomotor control network area. These findings highlight the impact of the integration of vocal motor control and social information processing for socially meaningful voice modulation.

Hamid, L., Habboush, N., Stern, P., Japaridze, N., …, Galka, A., & Siniatchkin, M. (2020). Source imaging of deep-brain activity using the regional spatiotemporal Kalman filter. Comput. Methods Programs Biomed., p. 105830. doi:10.1016/j.cmpb.2020.105830.
Jia, T., Ing, A., Quinlan, E. B., Tay, N., …, Nees, F., …, & Schumann, G. (2020). Neurobehavioural characterisation and stratification of reinforcement-related behaviour. Nat. Hum. Behav., 4(5), 544–558. PMID:32313235, doi:10.1038/s41562-020-0846-5.

Reinforcement-related cognitive processes, such as reward processing, inhibitory control and social–emotional regulation are critical components of externalising and internalising behaviours. It is unclear to what extent the deficit in each of these processes contributes to individual behavioural symptoms, how their neural substrates give rise to distinct behavioural outcomes and whether neural activation profiles across different reinforcement-related processes might differentiate individual behaviours. We created a statistical framework that enabled us to directly compare functional brain activation during reward anticipation, motor inhibition and viewing emotional faces in the European IMAGEN cohort of 2,000 14-year-old adolescents. We observe significant correlations and modulation of reward anticipation and motor inhibition networks in hyperactivity, impulsivity, inattentive behaviour and conduct symptoms, and we describe neural signatures across cognitive tasks that differentiate these behaviours. We thus characterise shared and distinct functional brain activation patterns underling different externalising symptoms and identify neural stratification markers, while accounting for clinically observed comorbidity.

Judd, N., Sauce, B., Wiedenhoeft, J., Tromp, J., …, Nees, F., …, & Klingberg, T. (2020). Cognitive and brain development is independently influenced by socioeconomic status and polygenic scores for educational attainment. Proc. Natl. Acad. Sci., 117(22), 12411–12418. PMID:32430323, doi:10.1073/pnas.2001228117.

Genetic factors and socioeconomic status (SES) inequalities play a large role in educational attainment, and both have been associated with variations in brain structure and cognition. However, genetics and SES are correlated, and no prior study has assessed their neural associations independently. Here we used a polygenic score for educational attainment (EduYears-PGS), as well as SES, in a longitudinal study of 551 adolescents to tease apart genetic and environmental associations with brain development and cognition. Subjects received a structural MRI scan at ages 14 and 19. At both time points, they performed three working memory (WM) tasks. SES and EduYears-PGS were correlated ( r = 0.27) and had both common and independent associations with brain structure and cognition. Specifically, lower SES was related to less total cortical surface area and lower WM. EduYears-PGS was also related to total cortical surface area, but in addition had a regional association with surface area in the right parietal lobe, a region related to nonverbal cognitive functions, including mathematics, spatial cognition, and WM. SES, but not EduYears-PGS, was related to a change in total cortical surface area from age 14 to 19. This study demonstrates a regional association of EduYears-PGS and the independent prediction of SES with cognitive function and brain development. It suggests that the SES inequalities, in particular parental education, are related to global aspects of cortical development, and exert a persistent influence on brain development during adolescence.

Kadish, N. E., Riedel, C., Stephani, U., & Wiegand, G. (2020). Developmental outcomes in children/adolescents and one adult with tuberous sclerosis complex (TSC) and refractory epilepsy treated with everolimus. Epilepsy Behav., 111, 107182. PMID:32535369, doi:10.1016/j.yebeh.2020.107182.

This prospective observational study focuses on developmental outcomes in the treatment of tuberous sclerosis complex (TSC) with everolimus (EVO). Fourteen children/adolescents aged 1.7–13.07 and one adult aged 31 years, all with TSC and refractory epilepsy participated. All were treated with EVO for 3–70 months (md: 37). Development/adaptive functioning were evaluated at baseline with follow-up in 11 patients; all patients were assessed during the course of treatment. Our exploratory analyses included factors contributing to developmental impairment and change from baseline to last evaluation. The majority of patients showed severe developmental impairment (86%). Patients with a higher age at inclusion, duration of epilepsy, and number of previous antiepileptic drugs (AEDs) showed lower developmental levels. Earlier onset of epilepsy and a higher number of current AEDs were associated with worse adaptive functioning. At their last examination, four patients were seizure-free (27%), and four experienced a reduction of seizures > 50% (27%). With treatment, (slight) increase was seen in absolute values of developmental age (DA) regarding both development and adaptive functioning. Yet, when accounting for age, decrease was seen in both assessments. While developmental disorders were prominent, we observed an overall progression at a slower pace. Despite a positive effect on seizure occurrence, treatment with EVO did not reverse developmental problems in the observation period of this study.

Koenig, J., Abler, B., Agartz, I., Åkerstedt, T., …, Nees, F., …, & Quintana, D. S. (2020). Cortical thickness and resting-state cardiac function across the lifespan: A cross-sectional pooled mega-analysis. Psychophysiology, p. psyp.13688. PMID:33037836, doi:10.1111/psyp.13688.

Understanding the association between autonomic nervous system [ANS] function and brain morphology across the lifespan provides important insights into neurovisceral mechanisms underlying health and disease. Resting-state ANS activity, indexed by measures of heart rate [HR] and its variability [HRV] has been associated with brain morphology, particularly cortical thickness [CT]. While findings have been mixed regarding the anatomical distribution and direction of the associations, these inconsistencies may be due to sex and age differences in HR/HRV and CT. Previous studies have been limited by small sample sizes, which impede the assessment of sex differences and aging effects on the association between ANS function and CT. To overcome these limitations, 20 groups worldwide contributed data collected under similar protocols of CT assessment and HR/HRV recording to be pooled in a mega-analysis (N = 1,218 (50.5% female), mean age 36.7 years (range: 12-87)). Findings suggest a decline in HRV as well as CT with increasing age. CT, particularly in the orbitofrontal cortex, explained additional variance in HRV, beyond the effects of aging. This pattern of results may suggest that the decline in HRV with increasing age is related to a decline in orbitofrontal CT. These effects were independent of sex and specific to HRV; with no significant association between CT and HR. Greater CT across the adult lifespan may be vital for the maintenance of healthy cardiac regulation via the ANS-or greater cardiac vagal activity as indirectly reflected in HRV may slow brain atrophy. Findings reveal an important association between CT and cardiac parasympathetic activity with implications for healthy aging and longevity that should be studied further in longitudinal research.

Kühn, S., Banaschewski, T., Bokde, A. L. W., Büchel, C., …, Nees, F., …, & Gallinat, J. (2020). Brain structure and habitat: Do the brains of our children tell us where they have been brought up? Neuroimage, 222, 117225. PMID:32800993, doi:10.1016/j.neuroimage.2020.117225.

Recently many lifestyle factors have been shown to be associated with brain structural alterations. At present we are facing increasing population shifts from rural to urban areas, which considerably change the living environments of human beings. To investigate the association between rural vs. urban upbringing and brain structure we selected 106 14-year old adolescents of whom half were exclusively raised in rural areas and the other half who exclusively lived in cities. Voxel-based morphometry revealed a group difference in left hippocampal formation (Rural > City), which was positively associated with cognitive performance in a spatial processing task. Moreover, significant group differences were observed in spatial processing (Rural > City). A mediation analysis revealed that hippocampal formation accounted for more than half of the association between upbringing and spatial processing. The results are compatible with studies reporting earlier and more intense opportunities for spatial exploration in children brought up in rural areas. The results are interesting in the light of urban planning where spaces enabling spatial exploration for children may deserve more attention.

Kühn, S., Lisofsky, N., Banaschewski, T., Barker, G. J., …, Nees, F., …, & Gallinat, J. (2020). Hierarchical associations of alcohol use disorder symptoms in late adolescence with markers during early adolescence. Addict. Behav., 100, 106130. doi:10.1016/j.addbeh.2019.106130.

High adolescent alcohol consumption is predictive for alcohol problems later in life. To tailor interventions, early identification of risk groups for adolescent alcohol consumption is important. The IMAGEN dataset was utilized to investigate predictors for problematic alcohol consumption at age 18–20 years as a function self and parental personality and drug-related measures as well as life-events and cognitive variables all assessed at age 14 years (N = 1404). For this purpose the binary partitioning algorithm ctree was used in an explorative analysis. The algorithm recursively selects significant input variables and splits the outcome variable based on these, yielding a conditional inference tree. Four significant split variables, namely Place of residence, the Disorganization subscale of the Temperament and Character Inventory, Sex, and the Sexuality subscale of the life-events questionnaire were found to distinguish between adolescents scoring high or low on the Alcohol Use Disorders Identification Test about five years later (all p < 0.001). The analyis adds to the literature on predictors of adolescent drinking problems using a large European sample. The identified split variables could easily be collected in community samples. If their validity is proven in independent samples, they could facilitate intervention studies in the field of adolescent alcohol prevention.

Kühn, S., Mascherek, A., Banaschewski, T., Bokde, A. L. W., …, Nees, F., …, & Gallinat, J. (2020). Predicting change trajectories of neuroticism from baseline brain structure using whole brain analyses and latent growth curve models in adolescents. Sci. Rep., 10(1), 1207. PMID:31988389, doi:10.1038/s41598-020-58128-x.

Adolescence is a vulnerable time for personality development. Especially neuroticism with its link to the development of psychopathology is of interest concerning influential factors. The present study exploratorily investigates neuroanatomical signatures for developmental trajectories of neuroticism based on a voxel-wise whole-brain structural equation modelling framework. In 1,814 healthy adolescents of the IMAGEN sample, the NEO-FFI was acquired at three measurement occasions across five years. Based on a partial measurement invariance second-order latent growth curve model we conducted whole-brain analyses on structural MRI data at age 14 years, predicting change in neuroticism over time. We observed that a reduced volume in the pituitary gland was associated with the slope of neuroticism over time. However, no relations with prefrontal areas emerged. Both findings are discussed against the background of possible genetic and social influences that may account for this result.

Lett, T. A., Vogel, B. O., Ripke, S., Wackerhagen, C., …, Nees, F., …, & Walter, H. (2020). Cortical Surfaces Mediate the Relationship Between Polygenic Scores for Intelligence and General Intelligence. Cereb. Cortex, 30(4), 2708–2719. PMID:31828294, doi:10.1093/cercor/bhz270.

Recent large-scale, genome-wide association studies (GWAS) have identified hundreds of genetic loci associated with general intelligence. The cumulative influence of these loci on brain structure is unknown. We examined if cortical morphology mediates the relationship between GWAS-derived polygenic scores for intelligence (PSi) and g-factor. Using the effect sizes from one of the largest GWAS meta-analysis on general intelligence to date, PSi were calculated among 10 P value thresholds. PSi were assessed for the association with g-factor performance, cortical thickness (CT), and surface area (SA) in two large imaging-genetics samples (IMAGEN N = 1651; IntegraMooDS N = 742). PSi explained up to 5.1% of the variance of g-factor in IMAGEN (F1,1640 = 12.2–94.3; P < 0.005), and up to 3.0% in IntegraMooDS (F1,725 = 10.0–21.0; P < 0.005). The association between polygenic scores and g-factor was partially mediated by SA and CT in prefrontal, anterior cingulate, insula, and medial temporal cortices in both samples (PFWER-corrected < 0.005). The variance explained by mediation was up to 0.75% in IMAGEN and 0.77% in IntegraMooDS. Our results provide evidence that cumulative genetic load influences g-factor via cortical structure. The consistency of our results across samples suggests that cortex morphology could be a novel potential biomarker for neurocognitive dysfunction that is among the most intractable psychiatric symptoms.

Li, J., Liu, B., Banaschewski, T., Bokde, A. L. W., …, Nees, F., …, & Jiang, T. (2020). Orbitofrontal cortex volume links polygenic risk for smoking with tobacco use in healthy adolescents. Psychol. Med., pp. 1–8. doi:10.1017/S0033291720002962.

BackgroundTobacco smoking remains one of the leading causes of preventable illness and death and is heritable with complex underpinnings. Converging evidence suggests a contribution of the polygenic risk for smoking to the use of tobacco and other substances. Yet, the underlying brain mechanisms between the genetic risk and tobacco smoking remain poorly understood.MethodsGenomic, neuroimaging, and self-report data were acquired from a large cohort of adolescents from the IMAGEN study (a European multicenter study). Polygenic risk scores (PGRS) for smoking were calculated based on a genome-wide association study meta-Analysis conducted by the Tobacco and Genetics Consortium. We examined the interrelationships among the genetic risk for smoking initiation, brain structure, and the number of occasions of tobacco use.ResultsA higher smoking PGRS was significantly associated with both an increased number of occasions of tobacco use and smaller cortical volume of the right orbitofrontal cortex (OFC). Furthermore, reduced cortical volume within this cluster correlated with greater tobacco use. A subsequent path analysis suggested that the cortical volume within this cluster partially mediated the association between the genetic risk for smoking and the number of occasions of tobacco use.ConclusionsOur data provide the first evidence for the involvement of the OFC in the relationship between smoking PGRS and tobacco use. Future studies of the molecular mechanisms underlying tobacco smoking should consider the mediation effect of the related neural structure.

Luo, Q., Zhang, L., Huang, C.-C., Zheng, Y., …, Nees, F., …, & Robbins, T. W. (2020). Association between childhood trauma and risk for obesity: a putative neurocognitive developmental pathway. BMC Med., 18(1), 278. doi:10.1186/s12916-020-01743-2.
Mascarell Maričić, L., Walter, H., Rosenthal, A., Ripke, S., …, Nees, F., …, & Heinz, A. (2020). The IMAGEN study: a decade of imaging genetics in adolescents. Mol. Psychiatry, 25(11), 2648–2671. doi:10.1038/s41380-020-0822-5.

Imaging genetics offers the possibility of detecting associations between genotype and brain structure as well as function, with effect sizes potentially exceeding correlations between genotype and behavior. However, study results are often limited due to small sample sizes and methodological differences, thus reducing the reliability of findings. The IMAGEN cohort with 2000 young adolescents assessed from the age of 14 onwards tries to eliminate some of these limitations by offering a longitudinal approach and sufficient sample size for analyzing gene-environment interactions on brain structure and function. Here, we give a systematic review of IMAGEN publications since the start of the consortium. We then focus on the specific phenotype ‘drug use' to illustrate the potential of the IMAGEN approach. We describe findings with respect to frontocortical, limbic and striatal brain volume, functional activation elicited by reward anticipation, behavioral inhibition, and affective faces, and their respective associations with drug intake. In addition to describing its strengths, we also discuss limitations of the IMAGEN study. Because of the longitudinal design and related attrition, analyses are underpowered for (epi-) genome-wide approaches due to the limited sample size. Estimating the generalizability of results requires replications in independent samples. However, such densely phenotyped longitudinal studies are still rare and alternative internal cross-validation methods (e.g., leave-one out, split-half) are also warranted. In conclusion, the IMAGEN cohort is a unique, very well characterized longitudinal sample, which helped to elucidate neurobiological mechanisms involved in complex behavior and offers the possibility to further disentangle genotype × phenotype interactions.

Merkt, J., Siniatchkin, M., & Petermann, F. (2020). Neuropsychological Measures in the Diagnosis of ADHD in Preschool: Can Developmental Research Inform Diagnostic Practice? J. Atten. Disord., 24(11), 1588–1604. PMID:27006414, doi:10.1177/1087054716629741.

Objective: The diagnosis of ADHD in preschool is challenging. Behavioral ratings are less reliable, but the value of neuropsychological tests in the diagnosis of ADHD has been debated. Method: This article provides an overview of neuropsychological measures utilized in preschoolers with ADHD (3-5 years). In addition, the manuscript discusses the extent to which these measures have been tested for their diagnostic capacity. Results: The diagnostic utility of computerized continuous performance tests and working memory subtests from IQ-batteries has been demonstrated in a number of studies by assessing their psychometric properties, sensitivity, and specificity. However, findings from developmental and basic research attempting to describe risk factors that explain variance in ADHD show the most consistent associations of ADHD with measures of delay aversion. Conclusion: Results from developmental research could benefit studies that improve ADHD diagnosis at the individual level. It might be helpful to consider testing as a structured situation for behavioral observation by the clinician.

Moliadze, V.*, Brodski-Guerniero, A.*, Schuetz, M., Siemann, J., Lyzhko, E., …, & Siniatchkin, M. (2020). Significance of Beta-Band Oscillations in Autism Spectrum Disorders During Motor Response Inhibition Tasks: A MEG Study. Brain Topogr., 33(3), 355–374. PMID:32303950, doi:10.1007/s10548-020-00765-6.

In Autism Spectrum Disorders (ASD), impaired response inhibition and lack of adaptation are hypothesized to underlie core ASD symptoms, such as social communication and repetitive, stereotyped behavior. Thus, the aim of the present study was to compare neural correlates of inhibition, post-error adaptation, and reaction time variability in ASD and neuro-typical control (NTC) participants by investigating possible differences in error-related changes of oscillatory MEG activity. Twelve male NTC (mean age 20.3 ± 3.7) and fourteen male patients with ASD (mean age 17.8 ± 2.9) were included in the analysis. Subjects with ASD showed increased error-related reaction time variability. MEG analysis revealed decreased beta power in the ASD group in comparison to the NTC group over the centro-parietal channels in both, the pre-stimulus and post-response interval. In the ASD group, mean centro-parietal beta power negatively correlated with dimensional autism symptoms. In both groups, false alarms were followed by an early increase in temporo-frontal theta to alpha power; and by a later decrease in alpha to beta power at central and posterior sensors. Single trial correlations were additionally studied in the ASD group, who showed a positive correlation of pre-stimulus beta power with post-response theta, alpha, and beta power, particularly after hit trials. On a broader scale, the results deliver important insights into top-down control deficits that may relate to core symptoms observed in ASD.

Nees, F., Ruttorf, M., Fuchs, X., Rance, M., & Beyer, N. (2020). Brain-behaviour correlates of habitual motivation in chronic back pain. Sci. Rep., 10(1), 11090. PMID:32632166, doi:10.1038/s41598-020-67386-8.

Chronic pain may sap the motivation for positive events and stimuli. This may lead to a negative behavioural cycle reducing the establishment of appetitive habitual engagement. One potential mechanism for this might be biased learning. In our experiment, chronic back pain patients and healthy controls completed an appetitive Pavlovian-instrumental transfer procedure. We examined participants` behaviour and brain activity and reported pain, depression and anxiety. Patients showed reduced habitual behaviour and increased responses in the hippocampus than controls. This behavioural bias was related to motivational value and reflected in the updating of brain activity in prefrontal–striatal–limbic circuits. Moreover, this was influenced by pain symptom duration, depression and anxiety (explained variance: up to 50.7%). Together, findings identify brain-behaviour pathways for maladaptive habitual learning and motivation in chronic back pain, which helps explaining why chronic pain can be resistant to change, and where clinical characteristics are significant modulators.

Nees, F., Ruttorf, M., Fuchs, X., Rance, M., & Beyer, N. (2020). Volumetric brain correlates of approach-avoidance behavior and their relation to chronic back pain. Brain Imaging Behav., 14(5), 1758–1768. doi:10.1007/s11682-019-00110-x.

Avoiding any harm, such as painful experiences, is an important ability for our physical and mental health. This avoidance behavior might be overactive under chronic pain, and the cortical and subcortical brain volumetry, which also often changes in chronic pain states, might be a significant correlate of this behavior. In the present study, we thus investigated the association between volumetric brain differences using 3 T structural magnetic resonance imaging and pain- versus pleasure-related approach-avoidance behavior using an Approach Avoidance Task in the laboratory in chronic back pain (N = 42; mean age: 51.34 years; 23 female) and healthy individuals (N = 43; mean age: 45.21 years; 15 female). We found significant differences in hippocampal, amygdala and accumbens volumes in patients compared to controls. The patients` hippocampal volume was significantly positively related to pain avoidance, the amygdala volume to positive approach, and the accumbens volume negatively to a bias to pain avoidance over positive approach. These associations were significantly moderated by pain symptom duration. Cortical structure may thus contribute to an overacting pain avoidance system in chronic back pain, and could, together with a reduction in approaching positive stimuli, be related to maladaptive choice and decision-making processes in chronic pain.

Papanastasiou, E., Mouchlianitis, E., Joyce, D. W., McGuire, P., …, Nees, F., …, & Orfanos, D. P. (2020). Examination of the neural basis of psychotic-like experiences in adolescence during processing of emotional faces. Sci. Rep., 10(1), 5164. PMID:32198484, doi:10.1038/s41598-020-62026-7.

Contemporary theories propose that dysregulation of emotional perception is involved in the aetiology of psychosis. 298 healthy adolescents were assessed at age 14- and 19-years using fMRI while performing a facial emotion task. Psychotic-like experiences (PLEs) were assessed with the CAPE-42 questionnaire at age 19. The high PLEs group at age 19 years exhibited an enhanced response in right insular cortex and decreased response in right prefrontal, right parahippocampal and left striatal regions; also, a gradient of decreasing response to emotional faces with age, from 14 to 19 years, in the right parahippocampal region and left insular cortical area. The right insula demonstrated an increasing response to emotional faces with increasing age in the low PLEs group, and a decreasing response over time in the high PLEs group. The change in parahippocampal/amygdala and insula responses during the perception of emotional faces in adolescents with high PLEs between the ages of 14 and 19 suggests a potential ‘aberrant' neurodevelopmental trajectory for critical limbic areas. Our findings emphasize the role of the frontal and limbic areas in the aetiology of psychotic symptoms, in subjects without the illness phenotype and the confounds introduced by antipsychotic medication.

Quinlan, E. B., Banaschewski, T., Barker, G. J., Bokde, A. L. W., …, Nees, F., …, & Schumann, G. (2020). Identifying biological markers for improved precision medicine in psychiatry. Mol. Psychiatry, 25(2), 243–253. PMID:31676814, doi:10.1038/s41380-019-0555-5.

Mental disorders represent an increasing personal and financial burden and yet treatment development has stagnated in recent decades. Current disease classifications do not reflect psychobiological mechanisms of psychopathology, nor the complex interplay of genetic and environmental factors, likely contributing to this stagnation. Ten years ago, the longitudinal IMAGEN study was designed to comprehensively incorporate neuroimaging, genetics, and environmental factors to investigate the neural basis of reinforcement-related behavior in normal adolescent development and psychopathology. In this article, we describe how insights into the psychobiological mechanisms of clinically relevant symptoms obtained by innovative integrative methodologies applied in IMAGEN have informed our current and future research aims. These aims include the identification of symptom groups that are based on shared psychobiological mechanisms and the development of markers that predict disease course and treatment response in clinical groups. These improvements in precision medicine will be achieved, in part, by employing novel methodological tools that refine the biological systems we target. We will also implement our approach in low- and medium-income countries to understand how distinct environmental, socioeconomic, and cultural conditions influence the development of psychopathology. Together, IMAGEN and related initiatives strive to reduce the burden of mental disorders by developing precision medicine approaches globally.

Robert, G. H., Luo, Q., Yu, T., Chu, C., …, Nees, F., …, & Schumann, G. (2020). Association of Gray Matter and Personality Development With Increased Drunkenness Frequency During Adolescence. JAMA Psychiatry, 77(4), 409. PMID:31851304, doi:10.1001/jamapsychiatry.2019.4063.

Importance: Alcohol abuse correlates with gray matter development in adolescents, but the directionality of this association remains unknown. Objective: To investigate the directionality of the association between gray matter development and increase in frequency of drunkenness among adolescents. Design, Setting, and Participants: This cohort study analyzed participants of IMAGEN, a multicenter brain imaging study of healthy adolescents in 8 European sites in Germany (Mannheim, Dresden, Berlin, and Hamburg), the United Kingdom (London and Nottingham), Ireland (Dublin), and France (Paris). Data from the second follow-up used in the present study were acquired from January 1, 2013, to December 31, 2016, and these data were analyzed from January 1, 2016, to March 31, 2018. Analyses were controlled for sex, site, socioeconomic status, family history of alcohol dependency, puberty score, negative life events, personality, cognition, and polygenic risk scores. Personality and frequency of drunkenness were assessed at age 14 years (baseline), 16 years (first follow-up), and 19 years (second follow-up). Structural brain imaging scans were acquired at baseline and second follow-up time points. Main Outcomes and Measures: Increases in drunkenness frequency were measured by latent growth modeling, a voxelwise hierarchical linear model was used to observe gray matter volume, and tensor-based morphometry was used for gray matter development. The hypotheses were formulated before the data analyses. Results: A total of 726 adolescents (mean [SD] age at baseline, 14.4 [0.38] years; 418 [58%] female) were included. The increase in drunkenness frequency was associated with accelerated gray matter atrophy in the left posterior temporal cortex (peak: t1,710 = -5.8; familywise error (FWE)-corrected P = 7.2 × 10-5; cluster: 6297 voxels; P = 2.7 × 10-5), right posterior temporal cortex (cluster: 2070 voxels; FWE-corrected P =.01), and left prefrontal cortex (peak: t1,710 = -5.2; FWE-corrected P = 2 × 10-3; cluster: 10624 voxels; P = 1.9 × 10-7). According to causal bayesian network analyses, 73% of the networks showed directionality from gray matter development to drunkenness increase as confirmed by accelerated gray matter atrophy in late bingers compared with sober controls (n = 20 vs 60; $\beta$ = 1.25; 95% CI, -2.15 to -0.46; t1,70 = 0.3; P =.004), the association of drunkenness increase with gray matter volume at age 14 years ($\beta$ = 0.23; 95% CI, 0.01-0.46; t1,584 = 2; P =.04), the association between gray matter atrophy and alcohol drinking units ($\beta$ = -0.0033; 95% CI, -6 × 10-3 to -5 × 10-4; t1,509 = -2.4; P =.02) and drunkenness frequency at age 23 years ($\beta$ = -0.16; 95% CI, -0.28 to -0.03; t1,533 = -2.5; P =.01), and the linear exposure-response curve stratified by gray matter atrophy and not by increase in frequency of drunkenness. Conclusions and Relevance: This study found that gray matter development and impulsivity were associated with increased frequency of drunkenness by sex. These results suggest that neurotoxicity-related gray matter atrophy should be interpreted with caution.

Robinson, L., Zhang, Z., Jia, T., Bobou, M., …, Nees, F., …, & Desrivières, S. (2020). Association of Genetic and Phenotypic Assessments With Onset of Disordered Eating Behaviors and Comorbid Mental Health Problems Among Adolescents. JAMA Netw. Open, 3(12), e2026874. doi:10.1001/jamanetworkopen.2020.26874.
Rosero Pahi, M., Cavalli, J., Nees, F., Flor, H., & Andoh, J. (2020). Disruption of the Prefrontal Cortex Improves Implicit Contextual Memory-Guided Attention: Combined Behavioral and Electrophysiological Evidence. Cereb. Cortex, 30(1), 20–30. PMID:31062857, doi:10.1093/cercor/bhz067.

Many studies have shown that the dorsolateral prefrontal cortex (DLPFC) plays an important role in top-down cognitive control over intentional and deliberate behavior. However, recent studies have reported that DLPFC-mediated top-down control interferes with implicit forms of learning. Here we used continuous theta-burst stimulation (cTBS) combined with electroencephalography to investigate the causal role of DLPFC in implicit contextual memory-guided attention. We aimed to test whether transient disruption of the DLPFC would interfere with implicit learning performance and related electrical brain activity. We applied neuronavigation-guided cTBS to the DLPFC or to the vertex as a control region prior to the performance of an implicit contextual learning task. We found that cTBS applied over the DLPFC significantly improved performance during implicit contextual learning. We also noted that beta-band (13–19 Hz) oscillatory power was reduced at fronto-central channels about 140 to 370 ms after visual stimulus onset in cTBS DLPFC compared with cTBS vertex. Taken together, our results provide evidence that DLPFC-mediated top-down control interferes with contextual memory-guided attention and beta-band oscillatory activity.

Schneider, I., Schmitgen, M. M., Boll, S., Roth, C., Nees, F., …, & Wolf, R. C. (2020). Oxytocin modulates intrinsic neural activity in patients with chronic low back pain. Eur. J. Pain, 24(5), 945–955. PMID:32061140, doi:10.1002/ejp.1543.

Background: Modulation of pain perception by oxytocin (OXT) has attracted increased scientific and clinical interest. Neural mechanisms underlying these effects are poorly understood. In this study, we aimed to investigate the effects of intranasally applied OXT on intrinsic neural activity in patients with chronic low back pain (cLBP). Methods: Twenty-four male patients with cLBP and 23 healthy males were examined using resting-state functional magnetic resonance imaging. Participants were scanned twice and received either intranasally applied OXT (24 international units) or placebo 40 min before scanning. The fractional amplitude of low-frequency fluctuations (fALFF) was computed to investigate regionally specific effects of OXT on intrinsic neural activity. In addition a multivariate statistical data analysis strategy was employed to explore OXT-effects on functional network strength. Results: Differential effects of OXT were observed in cLBP and healthy controls. FALFF decreased in left nucleus accumbens and right thalamus in cLBP and increased in right thalamus in healthy controls after OXT application compared to placebo. OXT also induced activity changes in bilateral thalamus, left caudate nucleus and right amygdala in cLBP. OXT was associated with increased medial frontal, parietal and occipital functional network strength, though this effect was not group-specific. Regression analyses revealed significant associations between left nucleus accumbens, left caudate nucleus and right amygdala with pain-specific psychometric scores in cLBP. Conclusions: These data suggest OXT-related modulation of regional activity and neural network strength in patients with cLBP and healthy controls. In patients, distinct regions of the pain matrix may be responsive to modulation by OXT. Significance: Our data suggest significant oxytocin-related modulation of intrinsic regional activity and neural network strength in patients with chronic low back pain and healthy controls. In patients, distinct regions of the pain matrix may be responsive to modulation by oxytocin. Therapeutic effects of oxytocin for improved pain treatment need to be further investigated.

Seethaler, B., Basrai, M., Vetter, W., Lehnert, K., …, Siniatchkin, M., …, & Bischoff, S. C. (2020). Fatty acid profiles in erythrocyte membranes following the Mediterranean diet – data from a multicenter lifestyle intervention study in women with hereditary breast cancer (LIBRE). Clin. Nutr., 39(8), 2389–2398. PMID:31735538, doi:10.1016/j.clnu.2019.10.033.

BACKGROUND & AIMS: Evidence-based concepts to prevent breast cancer in women with BRCA1/2 mutations are limited. Adherence to a Mediterranean diet (MedD) has been associated with a lower risk for breast cancer, possibly due to a favorable fatty acid (FA) intake. Here, we studied in an at-risk population the effect of a lifestyle intervention that included the MedD on FA composition in red blood cell membranes (RBCM). METHODS: Data derived from the German multicenter trial LIBRE, from which 68 women were randomized into an intervention group (IG) trained for MedD and increased physical activity for 12 months, and a usual care control group (CG). Adherence to the diet was assessed after 3 and 12 months using the validated Mediterranean Diet Adherence Screener (MEDAS) and a food frequency questionnaire. RBCM FA were analyzed by gas chromatography with mass spectrometry. RESULTS: The MEDAS was increased in both groups after 3 months (IG: P < 0.001; CG: P = 0.004), and remained increased only in the IG after 12 months (P < 0.001). The food frequency questionnaire revealed an increased intake of omega-3 (n-3) FA at month 3 and month 12 in the IG (both P < 0.01), but not in the CG, in which intake of energy, protein and saturated FA decreased. In both groups n-6 FA in the RBCM decreased (P < 0.001), while n-9 FA increased (P < 0.001) and n-3 FA were unchanged. Women with higher consumption of fish had higher amounts of n-3 fatty acids in the RBCM. The MEDAS was inversely correlated with n-6 fatty acids. CONCLUSIONS: The RBCM FA composition was associated with dietetic parameters related to the MedD. Adherence to the MedD resulted in an altered, likely favorable FA composition. Our data suggest selected FA as biomarkers to monitor compliance to a dietetic intervention such as the MedD. CLINICAL TRIAL REGISTRY: The trial is registered at (reference: NCT02087592).

Shen, C., Luo, Q., Jia, T., Zhao, Q., …, Nees, F., …, & Sahakian, B. J. (2020). Neural Correlates of the Dual-Pathway Model for ADHD in Adolescents. Am. J. Psychiatry, 177(9), 844–854. PMID:32375536, doi:10.1176/appi.ajp.2020.19020183.

OBJECTIVE: The dual-pathway model has been proposed to explain the heterogeneity in symptoms of attention deficit hyperactivity disorder (ADHD) by two independent psychological pathways based on distinct brain circuits. The authors sought to test whether the hypothesized cognitive and motivational pathways have separable neural correlates. METHODS: In a longitudinal community-based cohort of 1,963 adolescents, the neuroanatomical correlates of ADHD were identified by a voxel-wise association analysis and then validated using an independent clinical sample (99 never-medicated patients with ADHD, 56 medicated patients with ADHD, and 267 healthy control subjects). The cognitive and motivational pathways were assessed by neuropsychological tests of working memory, intrasubject variability, stop-signal reaction time, and delay discounting. The associations were tested between the identified neuroanatomical correlates and both ADHD symptoms 2 years later and the polygenic risk score for ADHD. RESULTS: Gray matter volumes of both a prefrontal cluster and a posterior occipital cluster were negatively associated with inattention. Compared with healthy control subjects, never-medicated patients, but not medicated patients, had significantly lower gray matter volumes in these two clusters. Working memory and intrasubject variability were associated with the posterior occipital cluster, and delay discounting was independently associated with both clusters. The baseline gray matter volume of the posterior occipital cluster predicted the inattention symptoms in a 2-year follow-up and was associated with the genetic risk for ADHD. CONCLUSIONS: The dual-pathway model has both shared and separable neuroanatomical correlates, and the shared correlate in the occipital cortex has the potential to serve as an imaging trait marker of ADHD, especially the inattention symptom domain.

Siehl, S., Wicking, M., Pohlack, S. T., Winkelmann, T., …, & Nees, F. (2020). Structural white and gray matter differences in a large sample of patients with Posttraumatic Stress Disorder and a healthy and trauma-exposed control group: Diffusion tensor imaging and region-based morphometry. NeuroImage Clin., 28, 102424. doi:10.1016/j.nicl.2020.102424.

Differences in structural white and gray matter in survivors of traumatic experiences have been related to the development and maintenance of Posttraumatic Stress Disorder (PTSD). However, there are very few studies on diffusion tensor imaging and region based morphometry comparing patients with PTSD to two control groups, namely healthy individuals with or without trauma experience. It is also unknown if differences in white and gray matter are associated. In this cross-sectional study, we examined white- and gray matter differences between 44 patients with PTSD, 49 trauma control and 61 healthy control subjects. We compared the groups applying Tract-Based Spatial Statistics (TBSS) for a whole brain white matter analysis as well as region of interest analyses for white and gray matter. First, trauma control subjects in comparison to patients with PTSD and healthy control subjects showed significantly a) higher fractional anisotropy (FA) in the left corticospinal tract and inferior fronto-occipital fasciculus than patients with PTSD, b) higher FA in the left inferior fronto-occipital-, right inferior– and right superior longitudinal fasciculi, c) higher FA in the forceps minor and d) higher volume of the left and right anterior insulae. Second, we show significant correlations between the FA in the forceps minor and the gray matter volume in the left and right anterior insulae. Third, the mean FA value in the forceps minor correlated negatively with symptom severity of PTSD and depression as well as trait anxiety, whereas the gray matter volume in the left anterior insula correlated negatively with symptom severity in PTSD. Our findings underline the importance of brain structures critically involved in emotion regulation and salience mapping. While previous studies associated these processes primarily to functional and task-based differences in brain activity, we argue that morphometrical white and gray matter differences could serve as targets in neuroscientifically-informed prevention and treatment interventions for PTSD.

Siehl, S., Robjant, K., & Crombach, A. (2020). Systematic review and meta-analyses of the long-term efficacy of narrative exposure therapy for adults, children and perpetrators. Psychother. Res., pp. 1–16. PMID:33205713, doi:10.1080/10503307.2020.1847345.

Objective: Narrative Exposure Therapy (NET) is a short-term trauma-focused intervention originally developed for treating survivors of war and torture. The neurobiological theoretical foundations of NET would suggest that the approach should have long term beneficial effects. We tested this assumption and also provided an extensive overview of all NET studies for adults, for children (KIDNET), and for perpetrators (Forensic Offender Rehabilitation NET; FORNET). Method: Following a systematic literature review, we conducted meta-analyses with all studies that had control conditions, and with all Randomized Controlled Trials (RCTs). We assessed between-groups short- (< 6 months) and long-term (≥ 6 months) effect sizes for symptoms of posttraumatic stress disorder (PTSD) and depression. Results: In a total of 56 studies from 30 countries comparing 1370 participants treated with NET to 1055 controls, we found large between group effect sizes regarding the reduction of PTSD symptoms in favor of NET. Analyses of RCTs with active controls yielded small to medium effect sizes in the short-term, and large effect sizes in the long-term. Conclusions: NET, KIDNET, and FORNET yield beneficial and sustainable treatment results for severely traumatized individuals living in adverse circumstances. Studies in highly developed health care systems comparing NET with other evidence-based trauma-focused interventions are needed.

Sierawska, A., Moliadze, V., Splittgerber, M., Rogge, A., Siniatchkin, M., & Buyx, A. (2020). First Epileptic Seizure and Initial Diagnosis of Juvenile Myoclonus Epilepsy (JME) in a Transcranial Direct Current Stimulation (tDCS) Study– Ethical Analysis of a Clinical case. Neuroethics, 13(3), 347–351. doi:10.1007/s12152-020-09444-6.

We discuss an epileptic incident in an undiagnosed 13-year old girl participating in a clinical study investigating the effects of transcranial direct current stimulation (tDCS) in healthy children and adolescents. This incident poses important research ethics questions with regard to study design, especially pertaining to screening and gaining informed consent. Potential benefits and problems of the incident also need to be considered. The ethical analysis of the case presented in this paper has been informed by an in-depth interview conducted after the incident with the child and the accompanying parent. We discuss the ethical implications of the epileptic incident, the need for improving screening procedures for studies with minors and for providing more effective communication. This case also underscores the problem of undetected teenage epilepsy in neuropsychological clinical studies and the necessity of raising more awareness of this issue. Since research in tDCS is an active and expanding field, we conclude with providing some recommendation that could ensure that future research on tDCS, or other therapies and neuro-interventions where there is a risk of triggering an epileptic seizure, take into account the specifics of teenage epilepsy and the need for more thorough provision of information during the process of gaining informed consent.

Spechler, P. A., Chaarani, B., Orr, C. A., Albaugh, M. D., …, Nees, F., …, & Garavan, H. (2020). Longitudinal associations between amygdala reactivity and cannabis use in a large sample of adolescents. Psychopharmacology (Berl)., 237(11), 3447–3458. doi:10.1007/s00213-020-05624-7.

Rationale: The amygdala is a key brain structure to study in relation to cannabis use as reflected by its high-density of cannabinoid receptors and functional reactivity to processes relevant to drug use. Previously, we identified a correlation between cannabis use in early adolescence and amygdala hyper-reactivity to angry faces (Spechler et al. 2015). Objectives: Here, we leveraged the longitudinal aspect of the same dataset (the IMAGEN study) to determine (1) if amygdala hyper-reactivity predicts future cannabis use and (2) if amygdala reactivity is affected by prolonged cannabis exposure during adolescence. Methods: First, linear regressions predicted the level of cannabis use by age 19 using amygdala reactivity to angry faces measured at age 14 prior to cannabis exposure in a sample of 1119 participants. Next, we evaluated the time course of amygdala functional development from age 14 to 19 for angry face processing and how it might be associated with protracted cannabis use throughout this developmental window. We compared the sample from Spechler et al. 2015, the majority of whom escalated their use over the 5-year interval, to a matched sample of non-users. Results: Right amygdala reactivity to angry faces significantly predicted cannabis use 5 years later in a dose-response fashion. Cannabis-na{\"{i}}ve adolescents demonstrated the lowest levels of amygdala reactivity. No such predictive relationship was identified for alcohol or cigarette use. Next, follow-up analyses indicated a significant group-by-time interaction for the right amygdala. Conclusions: (1) Right amygdala hyper-reactivity is predictive of future cannabis use, and (2) protracted cannabis exposure during adolescence may alter the rate of neurotypical functional development.

Splittgerber, M.*, Japaridze, N.*, Sierawska, A., Gimenez, S., …, Siniatchkin, M., & Moliadze, V. (2020). First generalized tonic clonic seizure in the context of pediatric tDCS – A case report. Neurophysiol. Clin., 50(1), 69–72. PMID:31848082, doi:10.1016/j.neucli.2019.11.002.
Splittgerber, M., Suwelack, J. H., Kadish, N. E.*, & Moliadze, V.*. (2020). The Effects of 1 mA tACS and tRNS on Children/Adolescents and Adults: Investigating Age and Sensitivity to Sham Stimulation. Neural Plast., 2020, 1–14. PMID:32855633, doi:10.1155/2020/8896423.

The aim of this study was to investigate the effect of transcranial random noise (tRNS) and transcranial alternating current (tACS) stimulation on motor cortex excitability in healthy children and adolescents. Additionally, based on our recent results on the individual response to sham in adults, we explored this effect in the pediatric population. We included 15 children and adolescents (10–16 years) and 28 adults (20–30 years). Participants were stimulated four times with 20 Hz and 140 Hz tACS, tRNS, and sham stimulation (1 mA) for 10 minutes over the left M1 HAND . Single-pulse MEPs (motor evoked potential), short-interval intracortical inhibition, and facilitation were measured by TMS before and after stimulation (baseline, 0, 30, 60 minutes). We also investigated aspects of tolerability. According to the individual MEPs response immediately after sham stimulation compared to baseline (Wilcoxon signed-rank test), subjects were regarded as responders or nonresponders to sham. We did not find a significant age effect. Regardless of age, 140 Hz tACS led to increased excitability. Incidence and intensity of side effects did not differ between age groups or type of stimulation. Analyses on responders and nonresponders to sham stimulation showed effects of 140 Hz, 20 Hz tACS, and tRNS on single-pulse MEPs only for nonresponders. In this study, children and adolescents responded to 1 mA tRNS and tACS comparably to adults regarding the modulation of motor cortex excitability. This study contributes to the findings that noninvasive brain stimulation is well tolerated in children and adolescents including tACS, which has not been studied before. Finally, our study supports a modulating role of sensitivity to sham stimulation on responsiveness to a broader stimulation and age range.

Splittgerber, M., Salvador, R., Brauer, H., Breitling-Ziegler, C., …, Moliadze, V.*, & Siniatchkin, M.*. (2020). Individual Baseline Performance and Electrode Montage Impact on the Effects of Anodal tDCS Over the Left Dorsolateral Prefrontal Cortex. Front. Hum. Neurosci., 14. doi:10.3389/fnhum.2020.00349.
Wagner, K., Gau, K., Metternich, B., Geiger, M. J., …, Kadish, N. E., …, & Foit, N. A. (2020). Effects of hippocampus-sparing resections in the temporal lobe: Hippocampal atrophy is associated with a decline in memory performance. Epilepsia, 61(4), 725–734. PMID:32162320, doi:10.1111/epi.16473.

Objective: In patients with temporal lobe epilepsy (TLE) with a nonlesional and nonepileptogenic hippocampus (HC), in order to preserve functionally intact brain tissue, the HC is not resected. However, some patients experience postoperative memory decline, possibly due to disruption of the extrahippocampal memory network and secondary hippocampal volume (HV) loss. The purpose of this study was to determine the extent of hippocampal atrophy ipsilateral and contralateral to the side of the surgery and its relation to memory outcomes. Methods: Hippocampal volume and verbal as well as visual memory performance were retrospectively examined in 55 patients (mean age ± standard deviation [SD] 30 ± 15 years, 25 female, 31 left) before and 5 months after surgery within the temporal lobe that spared the entire HC. HV was extracted based on prespecified templates, and resection volumes were also determined. Results: HV loss was found both ipsilateral and contralateral to the side of surgery (P <.001). Postoperative left HV loss was a significant predictor of postoperative verbal memory deterioration after left-sided surgery (P <.01). Together with the preoperative verbal memory performance, postoperative left HV explained almost 60% of the variance (P <.0001). However, right HV was not a clear predictor of visual memory performance. Larger resection volumes were associated with smaller postoperative HV, irrespective of side of surgery (left: P <.05, right: P <.01). Significance: A disruption of the memory network by any resection within the TL, especially within the language-dominant hemisphere, may lead to HC atrophy and memory decline. These findings may further improve the counseling of patients concerning their postoperative memory outcome before TL resections sparing the entire HC.

Wu, Y., Hall, A. S. M., Siehl, S., Grafman, J., & Krueger, F. (2020). Neural Signatures of Gender Differences in Interpersonal Trust. Front. Hum. Neurosci., 14, 225. PMID:32612518, doi:10.3389/fnhum.2020.00225.

Trust plays a critical role in nearly every aspect of social life. Parental investment theory and social role theory predict that women trust less than men due to a higher sensitivity to risk and betrayal, while men trust more than women to maximize resources and to signal their willingness to lose something. However, the underlying neuropsychological underpinnings for this gender difference are still obscure. In this study, we used functional magnetic resonance imaging (fMRI) to investigate the neural signatures of gender differences in trust by simultaneously scanning 11 male and 11 female same-gender, fixed dyads who played a multi-round binary trust game with varying levels of payoff (low/moderate/high) as an indicator of social risk. Our results showed that men trusted more than women and payoff level moderated the effect of gender on trust. While men trusted the same at all payoff levels, women trusted less with higher payoff levels. This pattern was supported by our neuroimaging finding: men showed a higher activation in the left inferior frontal gyrus (ventrolateral prefrontal cortex) and right precuneus than women, indicating that men exert more effort to inhibit the information of payoff levels and to use self-referencing to infer the strategies of partners with the goal of maximizing profit. Furthermore, men showed equivalent activation in the subgenual anterior cingulate cortex across payoff levels, whereas women showed a decreased activation with increasing payoff level - indicating decreased group bonding with higher risk in women. In conclusion, our results imply that women are more sensitive to social risk while trusting, which has implications for financial interactions, interpersonal relationships, and social involvement.

Xie, C., Jia, T., Rolls, E. T., Robbins, T. W., …, Nees, F., …, & Zhang, Y. (2020). Reward Versus Nonreward Sensitivity of the Medial Versus Lateral Orbitofrontal Cortex Relates to the Severity of Depressive Symptoms. Biol. Psychiatry Cogn. Neurosci. Neuroimaging. doi:10.1016/j.bpsc.2020.08.017.
Yu, T., Jia, T., Zhu, L., Desrivières, S., …, Nees, F., …, & Stedman, A. (2020). Cannabis-Associated Psychotic-like Experiences Are Mediated by Developmental Changes in the Parahippocampal Gyrus. J. Am. Acad. Child Adolesc. Psychiatry, 59(5), 642–649. PMID:31326579, doi:10.1016/j.jaac.2019.05.034.

Objective: Cannabis consumption during adolescence has been reported as a risk factor for psychotic-like experiences (PLEs) and schizophrenia. However, brain developmental processes associated with cannabis-related PLEs are still poorly described. Method: A total of 706 adolescents from the general population who were recruited by the IMAGEN consortium had structural magnetic resonance imaging scans at both 14 and 19 years of age. We used deformation-based morphometry to map voxelwise brain changes between the two time points, using the pairwise algorithm in SPM12b. We used an a priori region-of-interest approach focusing on the hippocampus/parahippocampus to perform voxelwise linear regressions. Lifetime cannabis consumption was assessed using the European School Survey Project on Alcohol and other Drugs (ESPAD), and PLEs were assessed with the Comprehensive Assessment Psychotic-like experiences (CAPE) tool. We first tested whether hippocampus/parahippocampus development was associated with PLEs. Then we formulated and tested an a priori simple mediation model in which uncus development mediates the association between lifetime cannabis consumption and PLEs. Results: We found that PLEs were associated with reduced expansion within a specific region of the right hippocampus/parahippocampus formation, the uncus (p = .002 at the cluster level, p = .018 at the peak level). The partial simple mediation model revealed a significant total effect from lifetime cannabis consumption to PLEs (b = 0.069, 95% CI = 0.04−0.1, p =2 × 10−16), as well as a small yet significant, indirect effect of right uncus development (0.004; 95% CI = 0.0004−0.01, p = .026). Conclusion: We show here that the uncus development is involved in the cerebral basis of PLEs in a population-based sample of healthy adolescents.

Zhang, Z., Robinson, L., Jia, T., Quinlan, E. B., …, Nees, F., …, & Desrivières, S. (2020). Development of Disordered Eating Behaviors and Comorbid Depressive Symptoms in Adolescence: Neural and Psychopathological Predictors. Biol. Psychiatry. doi:10.1016/j.biopsych.2020.06.003.

Background: Eating disorders are common in adolescence and are devastating and strongly comorbid with other psychiatric disorders. Yet little is known about their etiology, knowing which would aid in developing effective preventive measures. Methods: Longitudinal assessments of disordered eating behaviors (DEBs)—binge-eating, purging, and dieting—and comorbid psychopathology were measured in 1386 adolescents from the IMAGEN study. Development of DEBs and associated mental health problems was investigated by comparing participants who reported symptoms at ages 16 or 19 years, but not at age 14 years, with asymptomatic control participants. Voxel-based morphometry and psychopathological differences at age 14 were investigated to identify risk factors for the development of DEBs and associated mental health problems. Results: DEBs and depressive symptoms developed together. Emotional and behavioral problems, including symptoms of attention-deficit/hyperactivity disorder and conduct disorder, predated their development. Alterations in frontostriatal brain areas also predated the development of DEBs and depressive symptoms. Specifically, development of binge-eating was predicted by higher gray matter volumes in the right putamen/globus pallidus at age 14. Conversely, development of purging and depressive symptoms was predicted by lower volumes in the medial orbitofrontal, dorsomedial, and dorsolateral prefrontal cortices. Lower gray matter volumes in the orbitofrontal and anterior cingulate cortices mediated the relationship between attention-deficit/hyperactivity disorder and conduct disorder symptoms and future purging and depressive symptoms. Conclusions: These findings suggest that alterations in frontal brain circuits are part of the shared etiology among eating disorders, attention-deficit/hyperactivity disorder, conduct disorder, and depression and highlight the importance of a transdiagnostic approach to treating these conditions.


Albaugh, M. D., Hudziak, J. J., Ing, A., Chaarani, B., …, Nees, F., …, & Potter, A. S. (2019). White matter microstructure is associated with hyperactive/inattentive symptomatology and polygenic risk for attention-deficit/hyperactivity disorder in a population-based sample of adolescents. Neuropsychopharmacology, 44(9), 1597–1603. PMID:30952157, doi:10.1038/s41386-019-0383-y.

Few studies have investigated the link between putative biomarkers of attention-deficit/hyperactivity disorder (ADHD) symptomatology and genetic risk for ADHD. To address this, we investigate the degree to which ADHD symptomatology is associated with white matter microstructure and cerebral cortical thickness in a large population-based sample of adolescents. Critically, we then test the extent to which multimodal correlates of ADHD symptomatology are related to ADHD polygenic risk score (PRS). Neuroimaging, genetic, and behavioral data were obtained from the IMAGEN study. A dimensional ADHD composite score was derived from multi-informant ratings of ADHD symptomatology. Using tract-based spatial statistics, whole brain voxel-wise regressions between fractional anisotropy (FA) and ADHD composite score were calculated. Local cortical thickness was regressed on ADHD composite score. ADHD PRS was based on a very recent genome-wide association study, and calculated using PRSice. ADHD composite score was negatively associated with FA in several white matter pathways, including bilateral superior and inferior longitudinal fasciculi (p < 0.05, corrected). ADHD composite score was negatively associated with orbitofrontal cortical thickness (p < 0.05, corrected). The ADHD composite score was correlated with ADHD PRS (p < 0.001). FA correlates of ADHD symptomatology were significantly associated with ADHD PRS, whereas cortical thickness correlates of ADHD symptomatology were unrelated to ADHD PRS. Variation in hyperactive/inattentive symptomatology was associated with white matter microstructure, which, in turn, was related to ADHD PRS. Results suggest that genetic risk for ADHD symptomatology may be tied to biological processes affecting white matter microstructure.

Albaugh, M. D., Hudziak, J. J., Orr, C. A., Spechler, P. A., …, Nees, F., …, & Garavan, H. (2019). Amygdalar reactivity is associated with prefrontal cortical thickness in a large population-based sample of adolescents. PLoS One, 14(5), e0216152. PMID:31048888, doi:10.1371/journal.pone.0216152.

In structural neuroimaging studies, reduced cerebral cortical thickness in orbital and ventromedial prefrontal regions is frequently interpreted as reflecting an impaired ability to downregulate neuronal activity in the amygdalae. Unfortunately, little research has been conducted in order to test this conjecture. We examine the extent to which amygdalar reactivity is associated with cortical thickness in a population-based sample of adolescents. Data were obtained from the IMAGEN study, which includes 2,223 adolescents. While undergoing functional neuroimaging, participants passively viewed video clips of a face that started from a neutral expression and progressively turned angry, or, instead, turned to a second neutral expression. Left and right amygdala ROIs were used to extract mean BOLD signal change for the angry minus neutral face contrast for all subjects. T1-weighted images were processed through the CIVET pipeline (version 2.1.0). In variable-centered analyses, local cortical thickness was regressed against amygdalar reactivity using first and second-order linear models. In a follow-up person-centered analysis, we defined a “high reactive” group of participants based on mean amygdalar BOLD signal change for the angry minus neutral face contrast. Between-group differences in cortical thickness were examined (“high reactive” versus all other participants). A significant association was revealed between the continuous measure of amygdalar reactivity and bilateral ventromedial prefrontal cortical thickness in a second-order linear model (p < 0.05, corrected). The “high reactive” group, in comparison to all other participants, possessed reduced cortical thickness in bilateral orbital and ventromedial prefrontal cortices, bilateral anterior temporal cortices, left caudal middle temporal gyrus, and the left inferior and middle frontal gyri (p < 0.05, corrected). Results are consistent with non-human primate studies, and provide empirical support for an association between reduced prefrontal cortical thickness and amygdalar reactivity. Future research will likely benefit from investigating the degree to which psychopathology qualifies relations between prefrontal cortical structure and amygdalar reactivity.

Albaugh, M. D., Ivanova, M., Chaarani, B., Orr, C. A., …, Nees, F., …, & Potter, A. S. (2019). Ventromedial Prefrontal Volume in Adolescence Predicts Hyperactive/Inattentive Symptoms in Adulthood. Cereb. Cortex, 29(5), 1866–1874. PMID:29912404, doi:10.1093/cercor/bhy066.

Youths with attention-deficit/hyperactivity disorder symptomatology often exhibit residual inattention and/or hyperactivity in adulthood; however, this is not true for all individuals. We recently reported that dimensional, multi-informant ratings of hyperactive/inattentive symptoms are associated with ventromedial prefrontal cortex (vmPFC) structure. Herein, we investigate the degree to which vmPFC structure during adolescence predicts hyperactive/inattentive symptomatology at 5-year follow-up. Structural equation modeling was used to test the extent to which adolescent vmPFC volume predicts hyperactive/inattentive symptomatology 5 years later in early adulthood. 1104 participants (M = 14.52 years, standard deviation = 0.42; 583 females) possessed hyperactive/inattentive symptom data at 5-year follow-up, as well as quality controlled neuroimaging data and complete psychometric data at baseline. Self-reports of hyperactive/inattentive symptomatology were obtained during adolescence and at 5-year follow-up using the Strengths and Difficulties Questionnaire (SDQ). At baseline and 5-year follow-up, a hyperactive/inattentive latent variable was derived from items on the SDQ. Baseline vmPFC volume predicted adult hyperactive/inattentive symptomatology (standardized coefficient = -0.274, P < 0.001) while controlling for baseline hyperactive/inattentive symptomatology. These results are the first to reveal relations between adolescent brain structure and adult hyperactive/inattentive symptomatology, and suggest that early structural development of the vmPFC may be consequential for the subsequent expression of hyperactive/inattentive symptoms.

Baker, T. E., Castellanos-Ryan, N., Schumann, G., Cattrell, A., …, Nees, F., …, & Conrod, P. J. (2019). Modulation of orbitofrontal-striatal reward activity by dopaminergic functional polymorphisms contributes to a predisposition to alcohol misuse in early adolescence. Psychol. Med., 49(5), 801–810. PMID:29909784, doi:10.1017/S0033291718001459.

Background Abnormalities in reward circuit function are considered a core feature of addiction. Yet, it is still largely unknown whether these abnormalities stem from chronic drug use, a genetic predisposition, or both.Methods In the present study, we investigated this issue using a large sample of adolescent children by applying structural equation modeling to examine the effects of several dopaminergic polymorphisms of the D1 and D2 receptor type on the reward function of the ventral striatum (VS) and orbital frontal cortex (OFC), and whether this relationship predicted the propensity to engage in early alcohol misuse behaviors at 14 years of age and again at 16 years of age.Results The results demonstrated a regional specificity with which the functional polymorphism rs686 of the D1 dopamine receptor (DRD1) gene and Taq1A of the ANKK1 gene influenced medial and lateral OFC activation during reward anticipation, respectively. Importantly, our path model revealed a significant indirect relationship between the rs686 of the DRD1 gene and early onset of alcohol misuse through a medial OFC × VS interaction.Conclusions These findings highlight the role of D1 and D2 in adjusting reward-related activations within the mesocorticolimbic circuitry, as well as in the susceptibility to early onset of alcohol misuse.

Bartholdy, S., O'Daly, O. G., Campbell, I. C., Banaschewski, T., …, Nees, F., …, & Stedman, A. (2019). Neural Correlates of Failed Inhibitory Control as an Early Marker of Disordered Eating in Adolescents. Biol. Psychiatry, 85(11), 956–965. PMID:31122340, doi:10.1016/j.biopsych.2019.01.027.

Background: Binge eating and other forms of disordered eating behavior (DEB)are associated with failed inhibitory control. This study investigated the neural correlates of failed inhibitory control as a potential biomarker for DEB. Methods: The study used prospective longitudinal data from the European IMAGEN study adolescent cohort. Participants completed baseline assessments (questionnaires and a brain scan [functional magnetic resonance imaging])at 14 years of age and a follow-up assessment (questionnaires)at 16 years of age. Self-reported binge eating and/or purging were used to indicate presence of DEB. Neural correlates of failed inhibition were assessed using the stop signal task. Participants were categorized as healthy control subjects (reported no DEB at both time points), maintainers (reported DEB at both time points), recoverers (reported DEB at baseline only), and developers (reported DEB at follow-up only). Forty-three individuals per group with complete scanning data were matched on gender, age, puberty, and intelligence (N = 172). Results: At baseline, despite similar task performance, incorrectly responding to stop signals (failed inhibitory control)was associated with greater recruitment of the medial prefrontal cortex and anterior cingulate cortex in the developers compared with healthy control subjects and recoverers. Conclusions: Greater recruitment of the medial prefrontal and anterior cingulate regions during failed inhibition accords with abnormal evaluation of errors contributing to DEB development. As this precedes symptom onset and is evident despite normal task performance, neural responses during failed inhibition may be a useful biomarker of vulnerability for DEB. This study highlights the potential value of prospective neuroimaging studies for identifying markers of illness before the emergence of behavior changes.

Brislin, S. J., Patrick, C. J., Flor, H., Nees, F., …, & Foell, J. (2019). Extending the Construct Network of Trait Disinhibition to the Neuroimaging Domain: Validation of a Bridging Scale for Use in the European IMAGEN Project. Assessment, 26(4), 567–581. PMID:29557190, doi:10.1177/1073191118759748.

Trait disinhibition, a clinical-liability construct, has well-established correlates in the diagnostic, self-rating, task-behavioral, and brain potential response domains. Recently, studies have begun to test for neuroimaging correlates of this liability factor, but more work of this type using larger data sets is needed to clarify its brain bases. The current study details the development and validation of a scale measure of trait disinhibition composed of questionnaire items available in the IMAGEN project, a large-scale longitudinal study of factors contributing to substance abuse that includes clinical interview, self-report personality, task-behavioral, neuroimaging, and genomic measures. Using a construct-rating and psychometric refinement approach, a scale was developed that evidenced: (a) positive relations with interview-assessed psychopathology in the IMAGEN sample, both concurrently and prospectively and (b) positive associations with scale measures of disinhibition and reported psychopathology, and a robust negative correlation with P3 brain response, in a separate adult sample (M age = 19.5). These findings demonstrate that a common scale measure can index this construct from adolescence through to early adulthood, and set the stage for systematic work directed at identifying neural and genetic biomarkers of this key liability construct using existing and future data from the IMAGEN project.

Cao, Z., Bennett, M., Orr, C. A., Icke, I., …, Nees, F., …, & Whelan, R. (2019). Mapping adolescent reward anticipation, receipt, and prediction error during the monetary incentive delay task. Hum. Brain Mapp., 40(1), 262–283. PMID:30240509, doi:10.1002/hbm.24370.

The functional neuroanatomy and connectivity of reward processing in adults are well documented, with relatively less research on adolescents, a notable gap given this developmental period's association with altered reward sensitivity. Here, a large sample (n = 1,510) of adolescents performed the monetary incentive delay (MID) task during functional magnetic resonance imaging. Probabilistic maps identified brain regions that were reliably responsive to reward anticipation and receipt, and to prediction errors derived from a computational model. Psychophysiological interactions analyses were used to examine functional connections throughout reward processing. Bilateral ventral striatum, pallidum, insula, thalamus, hippocampus, cingulate cortex, midbrain, motor area, and occipital areas were reliably activated during reward anticipation. Bilateral ventromedial prefrontal cortex and bilateral thalamus exhibited positive and negative activation, respectively, during reward receipt. Bilateral ventral striatum was reliably active following prediction errors. Previously, individual differences in the personality trait of sensation seeking were shown to be related to individual differences in sensitivity to reward outcome. Here, we found that sensation seeking scores were negatively correlated with right inferior frontal gyrus activity following reward prediction errors estimated using a computational model. Psychophysiological interactions demonstrated widespread cortical and subcortical connectivity during reward processing, including connectivity between reward-related regions with motor areas and the salience network. Males had more activation in left putamen, right precuneus, and middle temporal gyrus during reward anticipation. In summary, we found that, in adolescents, different reward processing stages during the MID task were robustly associated with distinctive patterns of activation and of connectivity.

Chaarani, B., Kan, K.-J., Mackey, S., Spechler, P. A., …, Nees, F., …, & Tahmasebi, A. M. (2019). Low Smoking Exposure, the Adolescent Brain, and the Modulating Role of CHRNA5 Polymorphisms. Biol. Psychiatry Cogn. Neurosci. Neuroimaging, 4(7), 672–679. PMID:31072760, doi:10.1016/j.bpsc.2019.02.006.

BACKGROUND Studying the neural consequences of tobacco smoking during adolescence, including those associated with early light use, may help expose the mechanisms that underlie the transition from initial use to nicotine dependence in adulthood. However, only a few studies in adolescents exist, and they include small samples. In addition, the neural mechanism, if one exists, that links nicotinic receptor genes to smoking behavior in adolescents is still unknown. METHODS Structural and diffusion tensor magnetic resonance imaging data were acquired from a large sample of 14-year-old adolescents who completed an extensive battery of neuropsychological, clinical, personality, and drug-use assessments. Additional assessments were conducted at 16 years of age. RESULTS Exposure to smoking in adolescents, even at low doses, is linked to volume changes in the ventromedial prefrontal cortex and to altered neuronal connectivity in the corpus callosum. The longitudinal analyses strongly suggest that these effects are not preexisting conditions in those who progress to smoking. There was a genetic contribution wherein the volume reduction effects were magnified in smokers who were carriers of the high-risk genotype of the alpha 5 nicotinic receptor subunit gene, rs16969968. CONCLUSIONS These findings give insight into a mechanism involving genes, brain structure, and connectivity underlying why some adolescents find nicotine especially addictive.

Deco, G., Cruzat, J., Cabral, J., Tagliazucchi, E., …, & Kringelbach, M. L. (2019). Awakening: Predicting external stimulation to force transitions between different brain states. Proc. Natl. Acad. Sci., 116(36), 18088–18097. doi:10.1073/pnas.1905534116.

A fundamental problem in systems neuroscience is how to force a transition from one brain state to another by external driven stimulation in, for example, wakefulness, sleep, coma, or neuropsychiatric diseases. This requires a quantitative and robust definition of a brain state, which has so far proven elusive. Here, we provide such a definition, which, together with whole-brain modeling, permits the systematic study in silico of how simulated brain stimulation can force transitions between different brain states in humans. Specifically, we use a unique neuroimaging dataset of human sleep to systematically investigate where to stimulate the brain to force an awakening of the human sleeping brain and vice versa. We show where this is possible using a definition of a brain state as an ensemble of “metastable substates,” each with a probabilistic stability and occurrence frequency fitted by a generative whole-brain model, fine-tuned on the basis of the effective connectivity. Given the biophysical limitations of direct electrical stimulation (DES) of microcircuits, this opens exciting possibilities for discovering stimulation targets and selecting connectivity patterns that can ensure propagation of DES-induced neural excitation, potentially making it possible to create awakenings from complex cases of brain injury.

El Sayed Hussein Jomaa, M., Van Bogaert, P., Jrad, N., Kadish, N. E., …, Siniatchkin, M., …, & Humeau-Heurtier, A. (2019). Multivariate improved weighted multiscale permutation entropy and its application on EEG data. Biomed. Signal Process. Control, 52, 420–428. doi:10.1016/j.bspc.2018.08.004.

This paper introduces an entropy based method that measures complexity in non-stationary multivariate signals. This method, called Mutivariate Improved Weighted Multiscale Permutation Entropy (mvIWMPE), has two main advantages: (i) it shows lower variance for the results when applied on a wide range of multivariate signals; (ii) it has good accuracy quantifying complexity of different recorded states in signals and hence discriminating them. mvIWMPE is based on two previously introduced permutation entropy algorithms, Improved Multiscale Permutation Entropy (IMPE) and Multivariate Weighted Multiscale Permutation Entropy (mvWMPE). It combines the concept of coarse graining from IMPE and the introduction of the weight of amplitudes of the signals from mvWMPE. mvIWMPE was validated on both synthetic and human electroencephalographic (EEG) signals. Several synthetic signals were simulated: mixtures of white Gaussian noise (WGN) and pink noise, chaotic and convergent Lorenz system signals, stochastic and deterministic signals. As for real signals, resting-state EEG recorded in healthy and epileptic children during eyes closed and eyes open sessions were analyzed. Our method was compared to multivariate multiscale, multivariate weighted multiscale and multivariate improved multiscale permutation entropy methods. Performance on synthetic as well as on EEG signals showed more undeviating results and higher ability for mvIWMPE discriminating different states of signals (chaotic vs convergent, WGN vs pink noise, stochastic vs deterministic simulated signals, and eyes open vs eyes closed EEG signals). We herein proposed an efficient method to measure the complexity of multivariate non-stationary signals. Experimental results showed the accuracy and the robustness (in terms of variance) of the method.

Ernst, M., Benson, B., Artiges, E., Gorka, A. X., …, Nees, F., …, & Martinot, J.-L. (2019). Pubertal maturation and sex effects on the default-mode network connectivity implicated in mood dysregulation. Transl. Psychiatry, 9(1), 103. PMID:30804326, doi:10.1038/s41398-019-0433-6.

This study examines the effects of puberty and sex on the intrinsic functional connectivity (iFC) of brain networks, with a focus on the default-mode network (DMN). Consistently implicated in depressive disorders, the DMN's function may interact with puberty and sex in the development of these disorders, whose onsets peak in adolescence, and which show strong sex disproportionality (females > males). The main question concerns how the DMN evolves with puberty as a function of sex. These effects are expected to involve within- and between-network iFC, particularly, the salience and the central-executive networks, consistent with the Triple-Network Model. Resting-state scans of an adolescent community sample (n = 304, male/female: 157/147; mean/std age: 14.6/0.41 years), from the IMAGEN database, were analyzed using the AFNI software suite and a data reduction strategy for the effects of puberty and sex. Three midline regions (medial prefrontal, pregenual anterior cingulate, and posterior cingulate), within the DMN and consistently implicated in mood disorders, were selected as seeds. Within- and between-network clusters of the DMN iFC changed with pubertal maturation differently in boys and girls (puberty-X-sex). Specifically, pubertal maturation predicted weaker iFC in girls and stronger iFC in boys. Finally, iFC was stronger in boys than girls independently of puberty. Brain–behavior associations indicated that lower connectivity of the anterior cingulate seed predicted higher internalizing symptoms at 2-year follow-up. In conclusion, weaker iFC of the anterior DMN may signal disconnections among circuits supporting mood regulation, conferring risk for internalizing disorders.

Friedrich, R.-M., Zabel, S., Galka, A., Lukat, N., …, Siniatchkin, M., & Faupel, F. (2019). Magnetic particle mapping using magnetoelectric sensors as an imaging modality. Sci. Rep., 9(1), 2086. PMID:30765847, doi:10.1038/s41598-018-38451-0.

Magnetic nanoparticles (MNPs) are a hot topic in the field of medical life sciences, as they are highly relevant in diagnostic applications. In this regard, a large variety of novel imaging methods for MNP in biological systems have been invented. In this proof-of-concept study, a new and novel technique is explored, called Magnetic Particle Mapping (MPM), using resonant magnetoelectric (ME) sensors for the detection of MNPs that could prove to be a cheap and efficient way to localize the magnetic nanoparticles. The simple and straightforward setup and measurement procedure includes the detection of higher harmonic excitations of MNP ensembles. We show the feasibility of this approach by building a measurement setup particularly suited to exploit the inherent sensor properties. We measure the magnetic response from 2D MNP distributions and reconstruct the distribution by solving the inverse problem. Furthermore, biological samples with magnetically labeled cells were measured and reconstruction of the distribution was compared with light microscope images. Measurement results suggest that the approach presented here is promising for MNP localization.

Griebe, M., Ebert, A., Nees, F., Katic, K., …, & Szabo, K. (2019). Enhanced cortisol secretion in acute transient global amnesia. Psychoneuroendocrinology, 99, 72–79. PMID:30193207, doi:10.1016/j.psyneuen.2018.08.033.

Introduction: Stress-related transient inhibition of memory formation in the hippocampus has been hypothesized as one of the underlying pathomechanisms of transient global amnesia (TGA). TGA episodes, during which patients cannot encode and recall new information (anterograde amnesia affecting episodic long-term memory), are frequently preceded by a psychologically or physically stressful event. Methods: We measured salivary cortisol during acute TGA in 14 patients, as well as cortisol day-profiles and the effect of experimental exposure to stress (using the socially evaluated cold pressor test) on cortisol levels during the subacute phase. We assessed psychiatric comorbidity as well as depression, trait anxiety and chronic stress. These findings were compared with data of 20 healthy controls. Findings: Nine patients reported a precipitating stressor and all 14 developed typical hippocampal lesions on follow-up MRI. During TGA, salivary cortisol levels were more than 3-fold higher compared to time-matched day levels. While there was no difference in mean cortisol levels of the diurnal rhythm, we found a significant interaction between groups during experimental stress exposure (p = 0.049) with the TGA group revealing a higher cortisol increase. The TGA group reported higher levels of depressive symptomatology (CES-D) and higher scores of chronic stress (TICS) compared with the control group and there was a significant correlation between cortisol increase during TGA and the results of self-rating according to the CES-D (r = 0.615; p = 0.004), as well as to the STAI (r = 0.702; p = 0.001). Conclusion: Our findings of enhanced secretion of cortisol in acute TGA patients correlating with symptoms of depression and anxiety and a persisting hyperreactivity to experimental stress in the subacute phase support the hypothesis that stress might be significant for the pathogenesis of TGA.

Haaker, J., Maren, S., Andreatta, M., Merz, C. J., …, Nees, F., …, & Lonsdorf, T. B. (2019). Making translation work: Harmonizing cross-species methodology in the behavioural neuroscience of Pavlovian fear conditioning. Neurosci. Biobehav. Rev., 107, 329–345. PMID:31521698, doi:10.1016/j.neubiorev.2019.09.020.

Translational neuroscience bridges insights from specific mechanisms in rodents to complex functions in humans and is key to advance our general understanding of central nervous function. A prime example of translational research is the study of cross-species mechanisms that underlie responding to learned threats, by employing Pavlovian fear conditioning protocols in rodents and humans. Hitherto, evidence for (and critique of) these cross-species comparisons in fear conditioning research was based on theoretical viewpoints. Here, we provide a perspective to substantiate these theoretical concepts with empirical considerations of cross-species methodology. This meta-research perspective is expected to foster cross-species comparability and reproducibility to ultimately facilitate successful transfer of results from basic science into clinical applications.

Haselbeck, C., Niederberger, U., Gubi-Kelm, S., Jahn, F., …, & Siniatchkin, M. (2019). Secure attachment style appears to compensate for the effect of prenatal maternal distress regarding difficult infant temperament development. Z. Kinder. Jugendpsychiatr. Psychother., 47(3), 239–251. PMID:30080118, doi:10.1024/1422-4917/a000606.

Objective: Secure attachment style is a known protective factor regarding psychopathological development. The infant's attachment style, which is developed during the first two years of life, is therefore considered a moderating factor on the association between prenatal maternal distress and child temperament development which has repeatedly been reported in previous studies. Method: In this longitudinal study on a new sample of 51 mother-child-dyads, reported maternal distress and maternal empathy were assessed during pregnancy. Infant temperament and motor development were assessed at 12 months, while additionally controlling for the infant's attachment style as a postnatal factor. Results: Infants with secure attachment style whose mothers had experienced higher prenatal distress showed slightly better gross motor development at the age of 12 months. No association could be found between prenatal maternal distress and infant temperament. Conclusions: The results support the view that secure attachment style in children is a protective factor and softens the effects of prenatal maternal distress on difficult temperament development.

Ing, A., Sämann, P. G., Chu, C., Tay, N., …, Nees, F., …, & Schumann, G. (2019). Identification of neurobehavioural symptom groups based on shared brain mechanisms. Nat. Hum. Behav., 3(12), 1306–1318. PMID:31591521, doi:10.1038/s41562-019-0738-8.

Most psychopathological disorders develop in adolescence. The biological basis for this development is poorly understood. To enhance diagnostic characterization and develop improved targeted interventions, it is critical to identify behavioural symptom groups that share neural substrates. We ran analyses to find relationships between behavioural symptoms and neuroimaging measures of brain structure and function in adolescence. We found two symptom groups, consisting of anxiety/depression and executive dysfunction symptoms, respectively, that correlated with distinct sets of brain regions and inter-regional connections, measured by structural and functional neuroimaging modalities. We found that the neural correlates of these symptom groups were present before behavioural symptoms had developed. These neural correlates showed case–control differences in corresponding psychiatric disorders, depression and attention deficit hyperactivity disorder in independent clinical samples. By characterizing behavioural symptom groups based on shared neural mechanisms, our results provide a framework for developing a classification system for psychiatric illness that is based on quantitative neurobehavioural measures.

Jia, T., Chu, C., Liu, Y., van Dongen, J., …, Nees, F., …, & Desrivières, S. (2019). Epigenome-wide meta-analysis of blood DNA methylation and its association with subcortical volumes: findings from the ENIGMA Epigenetics Working Group. Mol. Psychiatry. PMID:31811260, doi:10.1038/s41380-019-0605-z.

DNA methylation, which is modulated by both genetic factors and environmental exposures, may offer a unique opportunity to discover novel biomarkers of disease-related brain phenotypes, even when measured in other tissues than brain, such as blood. A few studies of small sample sizes have revealed associations between blood DNA methylation and neuropsychopathology, however, large-scale epigenome-wide association studies (EWAS) are needed to investigate the utility of DNA methylation profiling as a peripheral marker for the brain. Here, in an analysis of eleven international cohorts, totalling 3337 individuals, we report epigenome-wide meta-analyses of blood DNA methylation with volumes of the hippocampus, thalamus and nucleus accumbens (NAcc)—three subcortical regions selected for their associations with disease and heritability and volumetric variability. Analyses of individual CpGs revealed genome-wide significant associations with hippocampal volume at two loci. No significant associations were found for analyses of thalamus and nucleus accumbens volumes. Cluster-based analyses revealed additional differentially methylated regions (DMRs) associated with hippocampal volume. DNA methylation at these loci affected expression of proximal genes involved in learning and memory, stem cell maintenance and differentiation, fatty acid metabolism and type-2 diabetes. These DNA methylation marks, their interaction with genetic variants and their impact on gene expression offer new insights into the relationship between epigenetic variation and brain structure and may provide the basis for biomarker discovery in neurodegeneration and neuropsychiatric conditions.

Kadish, N. E., Bast, T., Reuner, G., Wagner, K., …, & Ramantani, G. (2019). Epilepsy Surgery in the First 3 Years of Life: Predictors of Seizure Freedom and Cognitive Development. Neurosurgery, 84(6), E368—-E377. PMID:30137548, doi:10.1093/neuros/nyy376.

BACKGROUND: Although the majority of children undergoing epilepsy surgery are younger than 3 yr at epilepsy manifestation, only few actually receive surgical treatment in early childhood. Past studies have, however, suggested that earlier intervention may correlate with superior developmental outcomes. OBJECTIVE: To identify predictors for long-term seizure freedom and cognitive development following epilepsy surgery in the first 3 yr of life and determine the appropriate timing for surgical treatment in this age group. METHODS: We retrospectively analyzed the data of 48 consecutive children aged 1.1 ± 0.7 yr at surgery. RESULTS: Final surgeries comprised 52% hemispherotomies, 13% multilobar, and 35% intralobar resections. Etiology included cortical malformations in 71%, peri- or postnatal ischemic lesions in 13%, and benign tumor or tuberous sclerosis in 8% each. At last follow-up (median 4.3, range 1-14.3 yr), 60% of children remained seizure-free: 38% had discontinued antiepileptic drugs. Intralobar lesionectomy resulted more often in seizure control than multilobar or hemispheric surgery. Postsurgical seizure freedom was determined by the completeness of resection. Early postsurgical seizures were key markers of seizure recurrence. Presurgical adaptive and cognitive developmental status was impaired in 89% children. Longer epilepsy duration and larger lesion extent were detrimental to presurgical development, which, in turn, determined the postsurgical developmental outcome. CONCLUSION: Our study demonstrates that epilepsy surgery in very young children is safe as well as efficient regarding long-term seizure freedom and antiepileptic drug cessation in selected candidates. Longer epilepsy duration is the only modifiable predictor of impaired adaptive and cognitive development, thus supporting early surgical intervention.

Kortuem, V., Kadish, N. E., Siniatchkin, M., & Moliadze, V. (2019). Efficacy of tRNS and 140 Hz tACS on motor cortex excitability seemingly dependent on sensitivity to sham stimulation. Exp. Brain Res., 237(11), 2885–2895. PMID:31482197, doi:10.1007/s00221-019-05640-w.

This study investigates the effect of corticospinal excitability during sham stimulation on the individual response to transcranial non-invasive brain stimulation (tNIBS). Thirty healthy young adults aged 24.2 ± 2.8 S.D. participated in the study. Sham, as well as 1 mA of tRNS and 140 Hz tACS stimulation were applied for 10 min each at different sessions. The effect of each stimulation type was quantified by recording TMS-induced, motor evoked potentials (MEPs) before (baseline) and at fixed time points after stimulation (T0, T30, T60 min.). According to the individual response to sham stimulation at T0 in comparison to baseline MEPs, subjects were regarded as responder or non-responder to sham. Following, MEPs at T0, T30 and T60 after verum or sham stimulation were assessed with a repeated measures ANOVA with the within-subject factor stimulation (sham, tRNS, 140 Hz tACS) and the between-subjects factor group (responder vs non-responder). We found that individuals who did not show immediately changes in excitability in sham stimulation sessions were the ones who responded to active stimulation conditions. On the other hand, individuals who responded to sham condition, by either increases or decreases in MEPS, did not respond to active verum stimulation. This result suggests that the presence or lack of responses to sham stimulation can provide a marker for how individuals will respond to tRNS/tACS and thus provide an explanation for the variability in interindividual response. The results of this study draw attention to the general reactivity of the brain, which can be taken into account when planning future studies using tNIBS.

Kühn, S., Mascharek, A., Banaschewski, T., Bodke, A., …, Nees, F., …, & Gallinat, J. (2019). Predicting development of adolescent drinking behaviour from whole brain structure at 14 years of age. Elife, 8. PMID:31262402, doi:10.7554/eLife.44056.

Adolescence is a common time for initiation of alcohol use and development of alcohol use disorders. The present study investigates neuroanatomical predictors for trajectories of future alcohol use based on a novel voxel-wise whole-brain structural equation modeling framework. In 1814 healthy adolescents of the IMAGEN sample, the Alcohol Use Disorder Identification Test (AUDIT) was acquired at three measurement occasions across five years. Based on a two-part latent growth curve model, we conducted whole-brain analyses on structural MRI data at age 14, predicting change in alcohol use score over time. Higher grey-matter volumes in the caudate nucleus and the left cerebellum at age 14 years were predictive of stronger increase in alcohol use score over 5 years. The study is the first to demonstrate the feasibility of running separate voxel-wise structural equation models thereby opening new avenues for data analysis in brain imaging.

Löffler, M., Schneider, P., Schuh-Hofer, S., Kamping, S., …, Nees, F.*, & Flor, H.*. (2019). Stress-induced analgesia in patients with chronic musculoskeletal pain and healthy controls. preprint. arXiv:1902.07795.

Introduction: Individuals with chronic musculoskeletal pain show impairments in their pain-modulatory capacity. Stress-induced analgesia (SIA) is a paradigm of endogenous pain inhibition mainly tested in animals. It has not been tested in patients with chronic pain despite the important role of stress in pain modulation and the chronicity process. Methods: SIA was tested in 22 patients with chronic musculoskeletal pain and 18 healthy participants matched for age and gender. Pain thresholds, pain tolerance and suprathreshold pain sensitivity were examined before and after a cognitive stressor. Additionally, chronic stress levels, pain catastrophizing and pain characteristics were assessed as potential modulating factors. Results: Patients with chronic musculoskeletal pain compared to healthy controls showed significantly impaired SIA (F(1,37)=5.63, p=.02) for pain thresholds, but not pain tolerance (F(1,37)=0.05, p=.83) and stress-induced hyperalgesia (SIH) to suprathreshold pain ratings (F(1,37)=7.76, p=.008). Patients (r(22)=-0.50, p=.05) but not controls (r(18)=-0.39, p=.13) with high catastrophizing had low SIA as assessed by pain thresholds. In controls suprathreshold pain ratings were significantly positively correlated with catastrophizing (r(18)=0.57, p=.03) and life-time stress exposure (r(18)=0.54, p=.03). In patients neither catastrophizing (r(22)=0.21, p=.34) nor stress exposure (r(22)=0.34, p=.34) were associated with suprathreshold SIH. Discussion: Our data suggest impairments of SIA and SIH in patients with chronic musculoskeletal pain. Catastrophizing was associated with deficient SIA in the patients and higher pain ratings in controls. High life time stress also increased pain ratings in the controls.

Luo, Q., Chen, Q., Wang, W., Desrivières, S., …, Nees, F., …, & Feng, J. (2019). Association of a Schizophrenia-Risk Nonsynonymous Variant With Putamen Volume in Adolescents. JAMA Psychiatry, 76(4), 435. PMID:30649180, doi:10.1001/jamapsychiatry.2018.4126.

Importance: Deviation from normal adolescent brain development precedes manifestations of many major psychiatric symptoms. Such altered developmental trajectories in adolescents may be linked to genetic risk for psychopathology. Objective: To identify genetic variants associated with adolescent brain structure and explore psychopathologic relevance of such associations. Design, Setting, and Participants: Voxelwise genome-wide association study in a cohort of healthy adolescents aged 14 years and validation of the findings using 4 independent samples across the life span with allele-specific expression analysis of top hits. Group comparison of the identified gene-brain association among patients with schizophrenia, unaffected siblings, and healthy control individuals. This was a population-based, multicenter study combined with a clinical sample that included participants from the IMAGEN cohort, Saguenay Youth Study, Three-City Study, and Lieber Institute for Brain Development sample cohorts and UK biobank who were assessed for both brain imaging and genetic sequencing. Clinical samples included patients with schizophrenia and unaffected siblings of patients from the Lieber Institute for Brain Development study. Data were analyzed between October 2015 and April 2018. Main Outcomes and Measures: Gray matter volume was assessed by neuroimaging and genetic variants were genotyped by Illumina BeadChip. Results: The discovery sample included 1721 adolescents (873 girls [50.7%]), with a mean (SD) age of 14.44 (0.41) years. The replication samples consisted of 8690 healthy adults (4497 women [51.8%]) from 4 independent studies across the life span. A nonsynonymous genetic variant (minor T allele of rs13107325 in SLC39A8, a gene implicated in schizophrenia) was associated with greater gray matter volume of the putamen (variance explained of 4.21% in the left hemisphere; 8.66; 95% CI, 6.59-10.81; P = 5.35 × 10-18; and 4.44% in the right hemisphere; t = 8.90; 95% CI, 6.75-11.19; P = 6.80 × 10-19) and also with a lower gene expression of SLC39A8 specifically in the putamen (t127 = -3.87; P = 1.70 × 10-4). The identified association was validated in samples across the life span but was significantly weakened in both patients with schizophrenia (z = -3.05; P =.002; n = 157) and unaffected siblings (z = -2.08; P =.04; n = 149). Conclusions and Relevance: Our results show that a missense mutation in gene SLC39A8 is associated with larger gray matter volume in the putamen and that this association is significantly weakened in schizophrenia. These results may suggest a role for aberrant ion transport in the etiology of psychosis and provide a target for preemptive developmental interventions aimed at restoring the functional effect of this mutation..

Mégevand, P., Hamid, L., Dümpelmann, M., & Heers, M. (2019). New horizons in clinical electric source imaging. Zeitschrift für Epileptol., 32(3), 187–193. doi:10.1007/s10309-019-0258-6.
Meng, W., Sjöholm, L. K., Kononenko, O., Tay, N., …, IMAGEN Consortium, & Liu, Y. (2019). Genotype-dependent epigenetic regulation of DLGAP2 in alcohol use and dependence. Mol. Psychiatry. doi:10.1038/s41380-019-0588-9.

Alcohol misuse is a major public health problem originating from genetic and environmental risk factors. Alterations in the brain epigenome may orchestrate changes in gene expression that lead to alcohol misuse and dependence. Through epigenome-wide association analysis of DNA methylation from human brain tissues, we identified a differentially methylated region, DMR-DLGAP2, associated with alcohol dependence. Methylation within DMR-DLGAP2 was found to be genotype-dependent, allele-specific and associated with reward processing in brain. Methylation at the DMR-DLGAP2 regulated expression of DLGAP2 in vitro, and Dlgap2-deficient mice showed reduced alcohol consumption compared with wild-type controls. These results suggest that DLGAP2 may be an interface for genetic and epigenetic factors controlling alcohol use and dependence.

Moliadze, V., Sierau, L., Lyzhko, E., Stenner, T., …, Siniatchkin, M., & Hartwigsen, G. (2019). After-effects of 10 Hz tACS over the prefrontal cortex on phonological word decisions. Brain stimulation, 12(6), 1464–1474. PMID:31278060, doi:10.1016/j.brs.2019.06.021.

Introduction: Previous work in the language domain has shown that 10 Hz rTMS of the left or right posterior inferior frontal gyrus (pIFG) in the prefrontal cortex impaired phonological decision-making, arguing for a causal contribution of the bilateral pIFG to phonological processing. However, the neurophysiological correlates of these effects are unclear. The present study addressed the question whether neural activity in the prefrontal cortex could be modulated by 10 Hz tACS and how this would affect phonological decisions. Methods: In three sessions, 24 healthy participants received tACS at 10 Hz or 16.18 Hz (control frequency) or sham stimulation over the bilateral prefrontal cortex before task processing. Resting state EEG was recorded before and after tACS. We also recorded EEG during task processing. Results: Relative to sham stimulation, 10 Hz tACS significantly facilitated phonological response speed. This effect was task-specific as tACS did not affect a simple control task. Moreover, 10 Hz tACS significantly increased theta power during phonological decisions. The individual increase in theta power was positively correlated with the behavioral facilitation after 10 Hz tACS. Conclusion: Our results show a facilitation of phonological decisions after 10 Hz tACS over the bilateral prefrontal cortex. This might indicate that 10 Hz tACS increased task-related activity in the stimulated area to a level that was optimal for phonological performance. The significant correlation with the individual increase in theta power suggests that the behavioral facilitation might be related to increased theta power during language processing.

Moontaha, S., Galka, A., Siniatchkin, M., Scharlach, S., …, & Meurer, T. (2019). SVD Square-root Iterated Extended Kalman Filter for Modeling of Epileptic Seizure Count Time Series with External Inputs. Annu. Int. Conf. IEEE Eng. Med. Biol. Soc. IEEE Eng. Med. Biol. Soc. Annu. Int. Conf., 2019, 616–619. PMID:31945973, doi:10.1109/EMBC.2019.8857159.

In this paper a nonlinear filtering algorithm for count time series is developed that takes the non-negativity of the data into account and preserves positive definiteness of the covariance matrices of the model. For this purpose, a recently proposed variant of Kalman Filtering based on Singular Value Decomposition is incorporated into Iterative Extended Kalman Filtering, in order to estimate the states of a nonlinear state space model. The resulting algorithm is applied to the evaluation and design of therapies for patients suffering from Myoclonic Astatic Epilepsy, employing time series of daily seizure rate. The analysis provides a decision whether for a specific patient a particular anti-epileptic drug is increasing or reducing the seizure rate. Through a simulation study the proposed algorithm is validated. Additionally, for clinical data results obtained by the proposed algorithm are compared with the results from a Cox-Stuart trend test as well as with the visual assessment of experienced pediatric epileptologists.

Müller, C. P., Chu, C., Qin, L., Liu, C., …, Nees, F., …, & Schumann, G. (2019). The Cortical Neuroimmune Regulator TANK Affects Emotional Processing and Enhances Alcohol Drinking: A Translational Study. Cereb. Cortex, 29(4), 1736–1751. PMID:30721969, doi:10.1093/cercor/bhy341.

Alcohol abuse is a major public health problem worldwide. Understanding the molecular mechanisms that control regular drinking may help to reduce hazards of alcohol consumption. While immunological mechanisms have been related to alcohol drinking, most studies reported changes in immune function that are secondary to alcohol use. In this report, we analyse how the gene "TRAF family member-associated NF-$\kappa$B activator" (TANK) affects alcohol drinking behavior. Based on our recent discovery in a large GWAS dataset that suggested an association of TANK, SNP rs197273, with alcohol drinking, we report that SNP rs197273 in TANK is associated both with gene expression (P = 1.16 × 10?19) and regional methylation (P = 5.90 × 10-25). A tank knock out mouse model suggests a role of TANK in alcohol drinking, anxiety-related behavior, as well as alcohol exposure induced activation of insular cortex NF-$\kappa$B. Functional and structural neuroimaging studies among up to 1896 adolescents reveal that TANK is involved in the control of brain activity in areas of aversive interoceptive processing, including the insular cortex, but not in areas related to reinforcement, reward processing or impulsiveness. Our findings suggest that the cortical neuroimmune regulator TANK is associated with enhanced aversive emotional processing that better protects from the establishment of alcohol drinking behavior.

Muthuraman, M.*, Moliadze, V.*, Boecher, L., Siemann, J., …, & Siniatchkin, M. (2019). Multimodal alterations of directed connectivity profiles in patients with attention-deficit/hyperactivity disorders. Sci. Rep. PMID:31882672, doi:10.1038/s41598-019-56398-8.

Functional and effective connectivity measures for tracking brain region interactions that have been investigated using both electroencephalography (EEG) and magnetoencephalography (MEG) bringing up new insights into clinical research. However, the differences between these connectivity methods, especially at the source level, have not yet been systematically studied. The dynamic characterization of coherent sources and temporal partial directed coherence, as measures of functional and effective connectivity, were applied to multimodal resting EEG and MEG data obtained from 11 young patients (mean age 13.2 ± 1.5 years) with attention-deficit/hyperactivity disorder (ADHD) and age-matched healthy subjects. Additionally, machine-learning algorithms were applied to the extracted connectivity features to identify biomarkers differentiating the two groups. An altered thalamo-cortical connectivity profile was attested in patients with ADHD who showed solely information outflow from cortical regions in comparison to healthy controls who exhibited bidirectional interregional connectivity in alpha, beta, and gamma frequency bands. We achieved an accuracy of 98% by combining features from all five studied frequency bands. Our findings suggest that both types of connectivity as extracted from EEG or MEG are sensitive methods to investigate neuronal network features in neuropsychiatric disorders. The connectivity features investigated here can be further tested as biomarkers of ADHD.

Nees, F., Usai, K., Löffler, M., & Flor, H. (2019). The evaluation and brain representation of pleasant touch in chronic and subacute back pain. Neurobiol. Pain, 5(September 2018), 100025. doi:10.1016/j.ynpai.2018.10.002.

If touch is perceived as pleasant, it can counteract the experience of pain. However, its pain-inhibitory function might be disturbed in chronic pain and this could contribute to pain-related interference. We investigated the perception of pleasant touch and its brain correlates in chronic back pain patients (CBP) compared to subacute back pain patients (SABP) and healthy controls (HC) using soft brush strokes. CBP showed less positive evaluations of touch. We found the highest activation in somatosensory and insular cortices in CBP, ventral striatum (VS) in SABP, and the orbitofrontal cortex in HC. Brain responses were significantly positively correlated with pleasantness ratings in HC and SABP, but not CBP. Further, the insula responses in CBP were positively correlated with pain-related interference and the VS activation in SABP correlated negatively with affective distress. Brain and behavioral changes in the processing of touch and its pleasantness may be a marker of pain chronicity and raise questions about the therapeutic value of pleasant touch in pain prevention and treatment.

Nees, F., Löffler, M., Usai, K., & Flor, H. (2019). Hypothalamic-pituitary-adrenal axis feedback sensitivity in different states of back pain. Psychoneuroendocrinology, 101, 60–66. PMID:30414593, doi:10.1016/j.psyneuen.2018.10.026.

Pain normally signals a threat to bodily integrity and causes emotional distress. Acute pain serves a protective function, yet, when pain turns chronic, the protective function is lost. A chain of psychophysiological alterations including changes in the stress regulation system, apparent in dysfunctional activity and responsivity of the hypothalamic-pituitary-adrenal (HPA) axis, might be an important factor in this context. Moreover, maladaptive responses may be complicated by affective comorbid symptoms such as anxiety and depression, and alter nociceptive processing. However, the relationship among pain chronicity, stress regulation, and contributing components of comorbid symptomatology as well as somatosensory profiles has rarely been examined. In the present study, we obtained diurnal cortisol profiles at baseline and feedback regulation (following a dexamethasone suppression test (DST)) in subacute (SABP) and chronic (CBP) back pain patients and healthy control individuals (HC). We also assessed anxiety, depression and chronic stress levels and used quantitative sensory testing (QST) to detect sensory abnormalities. We found a hyper-suppression of cortisol following DST and thus enhanced negative stress feedback sensitivity in SABP compared to both CBP and HC. In SABP, DST-related cortisol levels were negatively associated with pain intensity, mediated by cold pain thresholds and anxiety. These data support a stress model of pain chronicity and suggest that stress responses might be indicators of individual vulnerability in the transition period of subacute pain.

Nees, F., Pohlack, S. T., Grimm, O., Winkelmann, T., Zidda, F.*, & Flor, H.*. (2019). White matter correlates of contextual pavlovian fear extinction and the role of anxiety in healthy humans. Cortex, 121, 179–188. PMID:31629196, doi:10.1016/j.cortex.2019.08.020.

Pavlovian contextual fear extinction is viewed as an important mechanism for behavioral adaptation in everyday life, including challenging situations of stress and anxiety. It has frequently been shown to relate to the function of brain areas like the hippocampus and medial prefrontal cortex (mPFC), while the role of structural properties, like white matter tracts in these regions, has been less studied. We employed diffusion tensor imaging to determine structural white matter connectivity (cingulum and uncinate fasciculus) correlates of contextual pavlovian fear extinction indicators measured through functional magnetic resonance imaging, skin conductance responses (SCRs) and self-reports of valence, arousal and contingency in 93 healthy individuals. Higher fractional anisotropy values in the hippocampal cingulum were significantly related to higher SCRs during extinction of contextual conditioned responses (explained variance: 11.2%) as an indicator of extinction deficits on the level of physiological arousal. However, FA was neither related to any of the other fear extinction measures, nor did we find associations with functional extinction responses in the hippocampus or mPFC. Trait anxiety was a significant moderator of the SCR-hippocampal cingulum association (explained variance: 32.09%). The data add evidence for a critical role of the hippocampal formation in contextual pavlovian extinction, and, together with the strong effect of trait anxiety, may have implications for the development of anxiety disorders where contextual extinction learning deficits are observed.

Orr, C. A., Spechler, P. A., Cao, Z., Albaugh, M. D., …, Nees, F., …, & Garavan, H. (2019). Grey matter volume differences associated with extremely low levels of cannabis use in adolescence. J. Neurosci., 39(10), 1817–1827. PMID:30643026, doi:10.1523/JNEUROSCI.3375-17.2018.

Rates of cannabis use among adolescents are high, and are increasing concurrent with changes in the legal status of marijuana and societal attitudes regarding its use. Recreational cannabis use is understudied, especially in the adolescent period when neural maturation may make users particularly vulnerable to the effects of $\Delta$-9-tetrahydrocannabinol (THC) on brain structure. In the current study, we used voxel-based morphometry to compare gray matter volume (GMV) in forty-six 14-year-old human adolescents (males and females) with just one or two instances of cannabis use and carefully matched THC-naive controls. We identified extensive regions in the bilateral medial temporal lobes as well as the bilateral posterior cingulate, lingual gyri, and cerebellum that showed greater GMV in the cannabis users. Analysis of longitudinal data confirmed that GMV differences were unlikely to precede cannabis use. GMV in the temporal regions was associated with contemporaneous performance on the Perceptual Reasoning Index and with future generalized anxiety symptoms in the cannabis users. The distribution of GMV effects mapped onto biomarkers of the endogenous cannabinoid system providing insight into possible mechanisms for these effects.

Rosero, M. A., Winkelmann, T., Pohlack, S. T., Cavalli, J., Nees, F.*, & Flor, H.*. (2019). Memory-guided attention: bilateral hippocampal volume positively predicts implicit contextual learning. Brain Struct. Funct., 224(6), 1999–2008. PMID:31104120, doi:10.1007/s00429-019-01887-9.

Several studies have begun to demonstrate that contextual memories constitute an important mechanism to guide our attention. Although there is general consensus that the hippocampus is involved in the encoding of contextual memories, it is controversial whether this structure can support implicit forms of contextual memory. Here, we combine automated segmentation of structural MRI with neurobehavioral assessment of implicit contextual memory-guided attention to test the hypothesis that hippocampal volume would predict the magnitude of implicit contextual learning. Forty healthy subjects underwent 3T magnetic resonance imaging brain scanning with subsequent automatic measurement of the total brain and hippocampal (right and left) volumes. Implicit learning of contextual information was measured using the contextual cueing task. We found that both left and right hippocampal volumes positively predicted the magnitude of implicit contextual learning. Larger hippocampal volume was associated with superior implicit contextual memory performance. This study provides compelling evidence that implicit contextual memory-guided attention is hippocampus-dependent.

Ruan, H., Zhou, Y., Luo, Q., Robert, G. H., …, Nees, F., …, & Feng, J. (2019). Adolescent binge drinking disrupts normal trajectories of brain functional organization and personality maturation. NeuroImage Clin., 22, 101804. PMID:30991616, doi:10.1016/j.nicl.2019.101804.

Adolescent binge drinking has been associated with higher risks for the development of many health problems throughout the lifespan. Adolescents undergo multiple changes that involve the co-development processes of brain, personality and behavior; therefore, certain behavior, such as alcohol consumption, can have disruptive effects on both brain development and personality maturation. However, these effects remain unclear due to the scarcity of longitudinal studies. In the current study, we used multivariate approaches to explore discriminative features in brain functional architecture, personality traits, and genetic variants in 19-year-old individuals (n = 212). Taking advantage of a longitudinal design, we selected features that were more drastically altered in drinkers with an earlier onset of binge drinking. With the selected features, we trained a hierarchical model of support vector machines using a training sample (n = 139). Using an independent sample (n = 73), we tested the model and achieved a classification accuracy of 71.2%. We demonstrated longitudinally that after the onset of binge drinking the developmental trajectory of improvement in impulsivity slowed down. This study identified the disrupting effects of adolescent binge drinking on the developmental trajectories of both brain and personality.

Seo, S., Beck, A., Matthis, C., Genauck, A., …, Nees, F., …, & Obermayer, K. (2019). Risk profiles for heavy drinking in adolescence: differential effects of gender. Addict. Biol., 24(4), 787–801. PMID:29847018, doi:10.1111/adb.12636.

Abnormalities across different domains of neuropsychological functioning may constitute a risk factor for heavy drinking during adolescence and for developing alcohol use disorders later in life. However, the exact nature of such multi-domain risk profiles is unclear, and it is further unclear whether these risk profiles differ between genders. We combined longitudinal and cross-sectional analyses on the large IMAGEN sample (N ≈ 1000) to predict heavy drinking at age 19 from gray matter volume as well as from psychosocial data at age 14 and 19—for males and females separately. Heavy drinking was associated with reduced gray matter volume in 19-year-olds' bilateral ACC, MPFC, thalamus, middle, medial and superior OFC as well as left amygdala and anterior insula and right inferior OFC. Notably, this lower gray matter volume associated with heavy drinking was stronger in females than in males. In both genders, we observed that impulsivity and facets of novelty seeking at the age of 14 and 19, as well as hopelessness at the age of 14, are risk factors for heavy drinking at the age of 19. Stressful life events with internal (but not external) locus of control were associated with heavy drinking only at age 19. Personality and stress assessment in adolescents may help to better target counseling and prevention programs. This might reduce heavy drinking in adolescents and hence reduce the risk of early brain atrophy, especially in females. In turn, this could additionally reduce the risk of developing alcohol use disorders later in adulthood.

Sierawska, A., Prehn-Kristensen, A., Moliadze, V., Krauel, K., …, Siniatchkin, M., & Buyx, A. (2019). Unmet Needs in Children With Attention Deficit Hyperactivity Disorder—Can Transcranial Direct Current Stimulation Fill the Gap? Promises and Ethical Challenges. Front. Psychiatry, 10. doi:10.3389/fpsyt.2019.00334.

Attention deficit hyperactivity disorder (ADHD) is a disorder most frequently diagnosed in children and adolescents. Although ADHD can be effectively treated with psychostimulants, a significant proportion of patients discontinue treatment because of adverse events or insufficient improvement of symptoms. In addition, cognitive abilities that are frequently impaired in ADHD are not directly targeted by medication. Therefore, additional treatment options, especially to improve cognitive abilities, are needed. Because of its relatively easy application, well-established safety, and low cost, transcranial direct current stimulation (tDCS) is a promising additional treatment option. Further research is needed to establish efficacy and to integrate this treatment into the clinical routine. In particular, limited evidence regarding the use of tDCS in children, lack of clear translational guidelines, and general challenges in conducting research with vulnerable populations pose a number of practical and ethical challenges to tDCS intervention studies. In this paper, we identify and discuss ethical issues related to research on tDCS and its potential therapeutic use for ADHD in children and adolescents. Relevant ethical issues in the tDCS research for pediatric ADHD center on safety, risk/benefit ratio, information and consent, labeling problems, and nonmedical use. Following an analysis of these issues, we developed a list of recommendations that can guide clinicians and researchers in conducting ethically sound research on tDCS in pediatric ADHD.

Siniatchkin, M., & Van Bogaert, P. (2019). Pathophysiology of encephalopathy related to continuous spike and waves during sleep: the contribution of neuroimaging. Epileptic Disord., 21(S1), 48–53. PMID:31149901, doi:10.1684/epd.2019.1057.

In the last three decades, studies on functional neuroimaging have helped us to understand pathophysiological mechanisms responsible for electro-clinical patterns associated with epileptic encephalopathies with continuous spikes and waves during slow sleep (ECSWS). MEG and EEG source reconstruction have revealed sources of pathological brain activity associated with epileptiform discharges in the perisylvian region pointing to the significance of this brain area for ECSWS. PET studies have revealed areas of focal hypermetabolism in perisylvian, superior temporal and inferior parietal regions as well as central cortices which were related to epileptic activity. The widespread hypometabolism in regions that belong to the default network (prefrontal and posterior cingulate cortices, parahippocampal gyrus and precuneus) was interpreted as remote inhibition following epileptic activity, which could contribute to cognitive deficits in affected individuals. Note that the described metabolic changes were functional and disappeared after successful treatment and recovery of ECSWS and were found in both sleep and wakefulness which may account for cognitive deficits in patients during the day. EEG-fMRI studies have revealed a functional fingerprint of epileptic encephalopathy: significant positive BOLD signal changes were identified in the perisylvian regions, prefrontal cortex and anterior cingulate as well as thalamus and negative BOLD signal changes in the regions of the default mode network. The pattern of activation represents a propagation of epileptic activity specific to encephalopathy, which is independent of etiology and type of seizure associated with ECSWS. In summary, methods of neuroimaging have shed light on pathogenic mechanisms of ECSWS which may account for a number of clinical phenomena associated with this condition.

Spechler, P. A., Chaarani, B., Orr, C. A., Mackey, S., …, Nees, F., …, & Mennigen, E. (2019). Neuroimaging Evidence for Right Orbitofrontal Cortex Differences in Adolescents With Emotional and Behavioral Dysregulation. J. Am. Acad. Child Adolesc. Psychiatry, 58(11), 1092–1103. PMID:31004740, doi:10.1016/j.jaac.2019.01.021.

Objective: To characterize the structural and functional neurobiology of a large group of adolescents exhibiting a behaviorally and emotionally dysregulated phenotype. Method: Adolescents aged 14 years from the IMAGEN study were investigated. Latent class analysis (LCA) on the Strengths and Difficulties Questionnaire (SDQ) was used to identify a class of individuals with elevated behavioral and emotional difficulties (“dysregulated”; n = 233) who were compared to a matched sample from a low symptom class (controls, n = 233). Whole-brain gray matter volume (GMV) images were compared using a general linear model with 10,000 random label permutations. Regional GMV findings were then probed for functional differences from three functional magnetic resonance imaging (fMRI) tasks. Significant brain features then informed mediation path models linking the likelihood of psychiatric disorders (DSM-IV) with dysregulation. Results: Whole-brain differences were found in the right orbitofrontal cortex (R.OFC; p < .05; k = 48), with dysregulated individuals exhibiting lower GMV. The dysregulated group also exhibited higher activity in this region during successful inhibitory control (F1,429 = 7.53, p < .05). Path analyses indicated significant direct effects between the likelihood of psychopathologies and dysregulation. Modeling the R.OFC as a mediator returned modest partial effects, suggesting that the path linking the likelihood of an anxiety or conduct disorder diagnoses to dysregulation is partially explained by this anatomical feature. Conclusion: A large sample of dysregulated adolescents exhibited lower GMV in the R.OFC relative to controls. Dysregulated individuals also exhibited higher regional activations when exercising inhibitory control at performance levels comparable to those of controls. These findings suggest a neurobiological marker of dysregulation and highlight the role of the R.OFC in impaired emotional and behavioral control.

Spechler, P. A., Allgaier, N., Chaarani, B., Whelan, R., …, Nees, F., …, & Tahmasebi, A. M. (2019). The initiation of cannabis use in adolescence is predicted by sex‐specific psychosocial and neurobiological features. Eur. J. Neurosci., 50(3), 2346–2356. PMID:29889330, doi:10.1111/ejn.13989.

Cannabis use initiated during adolescence might precipitate negative consequences in adulthood. Thus, predicting adolescent cannabis use prior to any exposure will inform the aetiology of substance abuse by disentangling predictors from consequences of use. In this prediction study, data were drawn from the IMAGEN sample, a longitudinal study of adolescence. All selected participants (n = 1,581) were cannabis-na{\"{i}}ve at age 14. Those reporting any cannabis use (out of six ordinal use levels) by age 16 were included in the outcome group (N = 365, males n = 207). Cannabis-na{\"{i}}ve participants at age 14 and 16 were included in the comparison group (N = 1,216, males n = 538). Psychosocial, brain and genetic features were measured at age 14 prior to any exposure. Cross-validated regularized logistic regressions for each use level by sex were used to perform feature selection and obtain prediction error statistics on independent observations. Predictors were probed for sex- and drug-specificity using post-hoc logistic regressions. Models reliably predicted use as indicated by satisfactory prediction error statistics, and contained psychosocial features common to both sexes. However, males and females exhibited distinct brain predictors that failed to predict use in the opposite sex or predict binge drinking in independent samples of same-sex participants. Collapsed across sex, genetic variation on catecholamine and opioid receptors marginally predicted use. Using machine learning techniques applied to a large multimodal dataset, we identified a risk profile containing psychosocial and sex-specific brain prognostic markers, which were likely to precede and influence cannabis initiation.

Tay, N., Macare, C., Liu, Y., Ruggeri, B., …, Nees, F., …, & Schumann, G. (2019). Allele-specific methylation of SpDEF: A novel moderator of psychosocial stress and substance abuse. Am. J. Psychiatry, 176(2), 146–155. PMID:30525907, doi:10.1176/appi.ajp.2018.17121360.

Objective: Psychosocial stress is a key risk factor for substance abuse among adolescents. Recently, epigenetic processes such as DNA methylation have emerged as potential mechanisms that could mediate this relationship. The authors conducted a genome-wide methylation analysis to investigate whether differentially methylated regions are associated with psychosocial stress in an adolescent population. Methods: A methylome-wide analysis of differentially methylated regions was used to examine a sample of 1,287 14-year-old adolescents (50.7% of them female) from the European IMAGEN study. The Illumina 450k array was used to assess DNA methylation, pyrosequencing was used for technical replication, and linear regression analyses were used to identify associations with psychosocial stress and substance use (alcohol and tobacco). Findings were replicated by pyrosequencing a test sample of 413 participants from the IMAGEN study. Results: Hypermethylation in the sterile alpha motif/pointed domain containing the ETS transcription factor (SPDEF) gene locus was associated with a greater number of stressful life events in an allele-dependent way. Among individuals with the minor G-allele, SPDEF methylation moderated the association between psychosocial stress and substance abuse. SPDEF methylation interacted with lifetime stress in gray matter volume in the right cuneus, which in turn was associated with the frequency of alcohol and tobacco use. SPDEF was involved in the regulation of trans-genes linked to substance use. Conclusions: Taken together, the study findings describe a novel epigenetic mechanism that helps explain how psychosocial stress exposure influences adolescent substance abuse.

Wahl, A.-S.*, Löffler, M.*, Hausner, L., Ruttorf, M., Nees, F., & Frölich, L. (2019). Case report: a giant arachnoid cyst masking Alzheimer's disease. BMC Psychiatry, 19(1), 274. PMID:31488095, doi:10.1186/s12888-019-2247-8.

BACKGROUND: Intracranial arachnoid cysts are usually benign congenital findings of neuroimaging modalities, sometimes however, leading to focal neurological and psychiatric comorbidities. Whether primarily clinically silent cysts may become causally involved in cognitive decline in old age is neither well examined nor understood. CASE PRESENTATION: A 66-year old caucasian man presenting with a giant left-hemispheric frontotemporal cyst without progression of size, presented with slowly progressive cognitive decline. Neuropsychological assessment revealed an amnestic mild cognitive impairment (MCI) without further neurological or psychiatric symptoms. The patient showed mild medio-temporal lobe atrophy on structural MRI. Diffusion tensor and functional magnetic resonance imaging depicted a rather sustained function of the strongly suppressed left hemisphere. Amyloid-PET imaging was positive for increased amyloid burden and he was homozygous for the APOE$\epsilon$3-gene. A diagnosis of MCI due to Alzheimer's disease was given and a co-morbidity with a silent arachnoid cyst was assumed. To investigate, if a potentially reduced CSF flow due to the giant arachnoid cyst contributed to the early manifestation of AD, we reviewed 15 case series of subjects with frontotemporal arachnoid cysts and cognitive decline. However, no increased manifestation of neurodegenerative disorders was reported. CONCLUSIONS: With this case report, we illustrate the necessity of a systematic work-up for neurodegenerative disorders in patients with arachnoid cysts and emerging cognitive decline. We finally propose a modus operandi for the stratification and management of patients with arachnoid cysts potentially susceptive for cognitive dysfunction.

Zidda, F.*, Griebe, M.*, Ebert, A., Ruttorf, M., …, Nees, F.*, & Szabo, K.*. (2019). Resting-state connectivity alterations during transient global amnesia. NeuroImage Clin., 23(May), 101869. PMID:31153000, doi:10.1016/j.nicl.2019.101869.

While the pathophysiology of transient global amnesia (TGA)is not understood, due to the specific nature of the clinical deficits, transient dysfunction in the medial temporal lobe, especially in the hippocampus, is assumed; however, concomitant disturbances in other brain regions and in executive function have been postulated. In this study, a cohort of 16 patients was prospectively recruited from the emergency department for resting-state functional MRI (fMRI)during the acute stage of TGA, as confirmed by a standardized neuropsychological assessment. Twenty age- and sex-matched controls, as well as twenty patients with a history of TGA, were recruited for comparison. Functional data were processed using independent component analysis (ICA), allowing the complete automatic (data-driven)identification of spontaneous network dynamics. We documented a severe disturbance in anterograde episodic long-term memory in all patients. Group-based ICA of resting-state data in acute TGA patients versus that of controls and patients with a past TGA episode demonstrated reduced FC mainly of structures belonging to the executive network (EN), but also the hippocampus, confirming its pathophysiological involvement in the disorder, as well as areas belonging to the salience network and other subcortical regions. No significant differences were found when comparing connectivity in patients with a history of TGA and controls. Our findings strengthen previous empirical and theoretical accounts of hippocampal and executive dysfunction in TGA. The disruption of frontal, parietal and insular control regions, together with disruption in the hippocampus, provides a new interpretation for the pathophysiology and neuropsychological profile of this neurological disorder on a large-scale network level