The translation from psychiatric core symptoms to brain functions and vice versa is a largely unresolved issue. In particular, the search for disorders of single brain regions explaining classical symptoms has not yielded the expected results. Based on the assumption that the psychopathology of psychosis is related to a functional imbalance of higher-order brain systems, the authors focused on three specific candidate brain circuitries, namely the language, and limbic and motor systems. These domains are of particular interest for understanding the disastrous communication breakdown during psychotic disorders. Core symptoms of psychosis were mapped on these domains by shaping their definitions in order to match the related brain functions. The resulting psychopathological assessment scale was tested for interrater reliability and internal consistency in a group of 168 psychotic patients. The items of the scale were reliable and a principal component analysis (PCA) was best explained by a solution resembling the three candidate systems. Based on the results, the scale was optimized as an instrument to identify patient subgroups characterized by a prevailing dysfunction of one or more of these systems. In conclusion, the scale is apt to distinguish symptom domains related to the activity of defined brain systems. PCA showed a certain degree of independence of the system-specific symptom clusters within the patient group, indicating relative subgroups of psychosis. The scale is understood as a research instrument to investigate psychoses based on a system-oriented approach. Possible immediate advantages in the clinical application of the understanding of psychoses related to system-specific symptom domains are also discussed.

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Exaggerated conditioned fear responses and impaired extinction along with amygdala overactivation have been observed in posttraumatic stress disorder (PTSD). These fear responses might be triggered by cues related to the trauma through higher-order conditioning, where reminders of the trauma may serve as unconditioned stimuli (US) and could maintain the fear response. We compared arousal, valence, and US expectancy ratings and BOLD brain responses using fMRI in 14 traumatized persons with PTSD and 14 without PTSD (NPTSD) and 13 matched healthy controls (HC) in a differential aversive conditioning paradigm. The US were trauma-specific pictures for the PTSD and NPTSD group and equally aversive and arousing for the HC; the conditioned stimuli (CS) were graphic displays. During conditioning, the PTSD patients compared to the NPTSD and HC indicated higher arousal to the conditioned stimulus that was paired with the trauma picture (CS+) compared to the unpaired (CS-), increased dissociation during acquisition and extinction, and failure to extinguish the CS/US-association compared to NPTSD. During early and late acquisition, the PTSD patients showed a significantly lower amygdala activation to CS+ versus CS- and a negative interaction between activation in the amygdala and dorsolateral prefrontal cortex (PFC), while NPTSD and HC displayed a negative interaction between amygdala and medial PFC. These findings suggest maladaptive anticipatory coping with trauma-related stimuli in patients with PTSD, indicated by enhanced conditioning, with related abnormal amygdala reactivity and connectivity, and delayed extinction.

Abstract:Little is known about the influence of particular characteristics of childhood maltreatment, such as developmental stage, relationship to the perpetrator and nature of the trauma, on adult psychopathology. The effects of childhood maltreatment were assessed in adult psychiatric patients (N=287) using self-rating scales and diagnostic checklists. Maltreatment was strongly associated with dissociation. This relationship was observed for all childhood developmental stages and was strongest when the perpetrator was outside the family. Dissociation was more strongly correlated with childhood emotional abuse and sexual harassment, than with sexual or physical abuse. Childhood sexual abuse was found to be associated with symptoms of posttraumatic stress. Findings suggest that dissociation is a relatively specific consequence of childhood maltreatment that is largely independent of the familial relationship to the perpetrator or the child's developmental stage. Keywords: Dissociation, Child Abuse, Posttraumatic Stress Disorder 3The World Health Organization defines child maltreatment as "all forms of physical and/or emotional ill-treatment, sexual abuse, neglect or negligent treatment or commercial or other exploitation, resulting in actual or potential harm to the child's health, survival, development or dignity in the context of a relationship of responsibility, trust or power" (World Health Organization, 1999). Dissociation, mood disorders, anxiety and posttraumatic stress symptoms are believed to constitute potential sequelae of childhood trauma (Fairbank et al, 2007;Heim et al, 2001;Spertus et al, 2003;Van der Hart et al, 2006). However, it is not clear what aspects of childhood maltreatment influence the development and nature of trauma-related symptoms.Dissociation related to trauma may involve disruptions or breakdowns of memory, awareness, identity and/or perception ("psychoform dissociation") as well as losses or distortion of sensory, perceptual, affective or motor functions ("somatoform dissociation") ( Van der Hart et al, 2004). Current theories about the development of severe dissociation emphasize the role of early onset chronic abuse and neglect from primary caregivers in childhood (Liotti, 2006;Van der Hart et al, 2006). There is ample evidence supporting the strong association between childhood maltreatment and dissociative psychopathology (Chu et al, 1999;Draijer et al, 1999;Nijenhuis et al, 1998;Ogawa et al, 1997;. Not all traumatized children develop dissociative symptoms and other factors, such as severity of abuse, numbers of perpetrators, the victim's coping style and affect modulation capacities, may moderate its relationship with maltreatment (Briere, 2006;Lange et al, 1999). This also holds true for the relationship between posttraumatic stress symptoms, depression and childhood maltreatment; victims of child abuse are at increased risk for developing posttraumatic stress disorder and depressive disorder, but childhood victimization alone is not sufficient to cause these disorders (Ch...