Editorial

Dear colleagues,

I am delighted to introduce to you our sixth issue of 2014 featuring current research on biological, cognitive and treatment characteristics of psychiatric and medical diseases accompanied by elevated anxiety or reduced impulse control.

At the outset of this issue, Diemer and colleagues review evidence for the potential of virtual reality exposure to evoke and modulate psychophysiological fear reactions in anxiety disorders. Virtual reality exposure was found to provoke psychophysiological symptoms, especially in terms of electrodermal activity in both patients and healthy participants. As psychophysiological arousal is considered a prerequisite for effective exposure treatment, the findings provide evidence for this approach to be a promising treatment for anxiety disorders.

In a longitudinal voxel-based morphometry study, Huyser and co-workers set out to identify neurodevelopmental differences in regional brain volume between medication-free paediatric obsessive-compulsive disorder (OCD) patients and controls at a 2-year follow-up after cognitive behavioural therapy. VBM was used to test whole brain voxel-wise for the effects of diagnosis and time on regional grey and white matter volumes. The authors found an increase of grey matter volume of the orbitofrontal cortex over the whole time period in OCD patients and a decrease in controls.

In order to further characterize the aetiological role of infections resulting in immune activation in patients with Tourette syndrome (TS), Weidinger and colleagues analyzed the toll-like receptor (TLR) 4 on CD14+ monocytes and soluble CD14 (sCD14) levels in the serum of Tourette patients and healthy controls and stimulated blood samples with lipopolysaccharide (LPS) mimicking a bacterial infection. Results revealed higher levels of sCD14, lower TLR4 expressions after LPS stimulation and a diminished up-regulation of TLR4 expression after LPS stimulation in patients. This pattern might represent an impaired activation of the innate immune response in TS and a higher susceptibility for infections that could trigger and maintain symptoms of TS.

Georgiou-Karistianis and co-workers examined longitudinal changes in movement sequencing in prodromal Huntington's disease (HD). Prodromal HD patients were stratified according to the CAG-Age Product (CAP) score that indicates the likelihood of increasing proximity to diagnosis and performed a cued movement sequence task. The high CAP group had the highest mean for baseline testing of both movement time and initiation time, but also demonstrated an increase of movement time and a decrease of initiation time across the study. The authors conclude with the presumption that with progress to diagnosis, participants may increasingly use compensatory strategies, but show a decline in effectively accessing 
control processes required to translate movement into effective execution.

By conducting a survey among clinicians from German forensic–psychiatric institutions, Turner and colleagues investigated which factors influence the appropriateness of testosterone-lowering medications (TLM) for sex offenders. The clinical directors of twenty-nine institutions were asked to rate the importance of each item of a standardized questionnaire, the depo-Provera scale (DPS). The most important reason selected for the prescription of TLM for sex offender treatment was “history of sexual offender treatment failure”, whereas the least important item was “deviant sexual interest, by plethysmograph or Abel Screen”. Clinicians’ attitudes towards the DPS correspond to the suggestions made in the WFSBP guidelines for the pharmacological treatment of sex offenders (Thibaut et al. 2010).

Mier and colleagues set out to identify the neurobiological correlates of social-cognitive related alterations in psychopathy. Imprisoned psychopaths and healthy controls underwent functional magnetic resonance imaging (fMRI) to measure brain activation during a paradigm that assessed face recognition, emotion processing and affective Theory of Mind. While no behavioural deficits were found, psychopaths had reduced fusiform activation related to face processing. Furthermore, they showed hypoactivation in amygdala, inferior prefrontal gyrus and superior temporal sulcus and lacked connectivity between superior temporal sulcus and amygdala during affective Theory of Mind. Results might represent the neural substrate of reduced feeling with others during social cognition.

In order to evaluate the safety and efficacy of osmotic-controlled release oral delivery system (OROS) methylphenidate (MPH) in adults with attention deficit/hyperactivity disorder (ADHD), Takahashi and co-workers conducted a randomized, double-blind, placebo-controlled, parallel-group study. The authors found that the mean change in ADHD symptom scores of a standardized questionnaire was significantly larger with OROS MPH compared with placebo. Although treatment-emergent adverse events were reported more frequently in the OROS MPH group than in the placebo group, the authors conclude that OROS MPH showed a well-tolerated safety profile overall.

Finally, Balestrieri and colleagues aimed to explore the expression levels of three human endogenous retrovirus (HERV) families (HERV-H, K and W) in patients with ADHD. The authors found expression levels of HERV-H to be significantly higher in patients with ADHD compared to healthy controls, whereas no differences emerged for HERV-K and W. Subsequently, the significance of HERVs as a link among environmental, biological and genetic factors in the aetiology of ADHD and neurodevelopmental diseases is discussed.

Yours sincerely,

Siegfried Kasper, MD

Chief Editor