The neurotrophic hypothesis has become the favorite model to explain the antidepressant properties of electroconvulsive therapy (ECT). It is based on the assumption that a restoration of previously defective neural networks drives therapeutic effects. Recent data in rather young patients suggest that neurotrophic effects of ECT might be detectable by diffusion tensor imaging. We here aimed to investigate whether the therapeutic response to ECT necessarily goes along with mesoscopic effects in gray matter (GM) or white matter (WM) in our patients in advanced age. Patients (n = 21, 15 males and 7 females) suffering from major depressive disorder were treated with ECT. Before the start of treatment and after the completion of the index series, they underwent magnetic resonance imaging, including a diffusion-weighed sequence. We used voxel-based morphometry to assess GM changes and tract-based spatial statistics and an SPM-based whole-brain analysis to detect WM changes in the course of treatment. Patients significantly improved clinically during the course of ECT. This was, however, not accompanied by GM or WM changes. This result challenges the notion that mesoscopic brain structure changes are an obligatory prerequisite for the antidepressant effects of ECT.

Although alcohol dependency is a burden to society, data on cognitive performance in therapy-resistant patients after multiple withdrawals are poor. In this study, 22 patients without reported cognitive deficits and 20 control subjects performed extensive cognitive testing and a motor task assessing short-term memory. Patients displayed subtle deficits (mainly in executive function), while memory functions were relatively unimpaired. Our results suggest that subtle frontal-executive deficits may contribute to a poor prognosis, but could be missed by routine clinical tests.

Approximately 73% of patients suffering from Borderline personality disorder (BPD) exhibit aggressive behaviour, which severely hinders therapeutic work and clinical improvement. Because the underlying mechanisms of aggression in BPD are not yet completely understood, additional research in this domain has a high clinical and scientific relevance. We employed a modified version of the Taylor Aggression Paradigm (mTAP), in order to examine for the first time whether this task can be used to differentiate between BPD patients and healthy controls with regard to reactive aggression. In the mTAP, the amount of money subtracted by a virtual opponent was categorized into ‘low’ (10–20 cents) and ‘high’ (80–100 cents) provocations, enabling us to compare how much money BPD patients and healthy controls subtracted (i.e., how aggressively participants responded) following high and low provocation trials. Our results showed that, compared to healthy controls, BPD patients showed higher overall aggression, higher aggression after high provocation trials, as well as a larger difference between high and low provocation trials. This finding was corroborated by a neuropsychological assessment, demonstrating higher levels of aggression and impulsivity in BPD patients. Interestingly, reactive aggression in the mTAP was positively correlated with symptom severity and impulsivity in BPD patients. We suggest that the mTAP provides a valuable tool allowing psychiatrists to quantify reactive aggression in BPD. Therefore, clinicians and researchers might consider this task, as a short experimental measure of reactive aggression, either in future studies or to aid diagnostic assessment during clinical practice.

IntroductionAutism spectrum disorders (ASD) are characterised by repetitive behaviour/interests, an impairment in reciprocal social interaction and communication. This implies the inadequate appreciation of socio-emotional cues and leads to a default in the responses to other people's emotions.ObjectivesDeficits in empathy have been described for individuals with autism spectrum disorders (ASD).AimsWe aim to investigate the described deficits in empathy in a group of people with ASD on a behavioural and a neuronal level.MethodsWe assessed neuronal activity using functional magnetic resonance imaging (fMRI) during three different empathy tasks (“emotion-recognition”, “perspective-taking” and “affective-responsiveness”) of 12 adults with ASD and a matched group of healthy controls.ResultsSubjects with ASD did not have differences in affective responsiveness compared to healthy controls, but in emotion recognition and perspective taking. The reaction time was significantly longer in patients with ASD in all tasks. People with ASD showed a different pattern of brain activation in cortico-limbic areas during the empathy tasks compared to controlsConclusionOur findings of individuals with ASD having problems in emotions-recognition and in perspective taking are supported by previous results. These impairments are reflected by a different pattern of neuronal activation in several brain areas of individuals with ASD compared to controls. Although there are no differences in affective responsiveness in the ASD group a marked difference can be seen in the brain activation during this task. These findings might open up new avenues of intervention for individuals with ASD and their often described problems with empathy.

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