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Zusammenfassung. Eines der ersten validierten Instrumente zur wissenschaftlichen Untersuchung von Emotionsregulationsprozessen, stellt der englischsprachige Emotion Regulation Questionnaire (ERQ) von Gross und John (2003) dar. Dieser erlaubt es, Präferenzen für zwei häufig angewandte Strategien zur Emotionsregulation, nämlich Unterdrückung (suppression) und Neubewertung (reappraisal) zu erfassen. Die deutsche Version wurde in drei Übersetzungsschritten an jeweils einer Gruppe von Studenten (n = 113/167/174) erprobt. Dabei stand eine möglichst enge Orientierung am englischen Original sowie die Optimierung der Faktoren-Ladungen auf die zwei Komponenten im Vordergrund. Eine Faktorenanalyse mit iterativer Kommunalitätenschätzung und Varimax-Rotation wurde verwendet. Entsprechend unserem Ziel erreichten die Alpha-Werte (innere Konsistenz) als Reliabilitätsmaß für Unterdrückung und Neubewertung die Durchschnittswerte des amerikanischen Originalfragebogens. Wir entwickelten ein Instrument, das einfach und in kurzer Zeit (5–10 min) zu beantworten ist und differenziert die beiden Emotionsregulationsstile Neubewertung und Suppression erfasst. Mögliche Anwendungsbereiche sind die Untersuchung von Depressionen und Angsterkrankungen und die Bewertung psychotherapeutischer Verfahren.

Transmission of reward signals is a function of dopamine, a neurotransmitter known to be involved in the mechanism of psychosis. Using functional magnetic resonance imaging (fMRI), we investigated how expectation and receipt of monetary rewards modulate brain activation in patients with bipolar mania and schizophrenia. We studied 12 acutely manic patients with a history of bipolar disorder, 12 patients with a current episode of schizoaffective disorder or schizophrenia and 12 healthy subjects. All patients were treated with dopamine antagonists at the time of the study. Subjects performed a delayed incentive paradigm with monetary reward in the scanner that allowed for investigating effects of expectation, receipt, and omission of rewards. Patients with schizophrenia and healthy control subjects showed the expected activation of dopaminergic brain areas, that is, ventral tegmentum activation upon expectation of monetary rewards and nucleus accumbens activation during receipt vs omission of rewards. In manic patients, however, we did not find a similar pattern of brain activation and the differential signal in the nucleus accumbens upon receipt vs omission of rewards was significantly lower compared to the healthy control subjects. Our findings provide evidence for abnormal function of the dopamine system during receipt or omission of expected rewards in bipolar disorder. These deficits in prediction error processing in acute mania may help to explain symptoms of disinhibition and abnormal goal pursuit regulation.

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Psychological considerations suggest that the omission of rewards in humans comprises two effects: first, an allocentric effect triggering learning and behavioural changes potentially processed by dopaminergic neurons according to the prediction error theory; second, an egocentric effect representing the individual's emotional reaction, commonly called frustration. We investigated this second effect in the context of omission of monetary reward with functional magnetic resonance imaging. As expected, the contrast omission relative to receipt of reward led to a decrease in ventral striatal activation consistent with prediction error theory. Increased activation for this contrast was found in areas previously related to emotional pain: the right anterior insula and the right ventral prefrontal cortex. We interpreted this as a neural correlate of the egocentric effect.

Our findings partially support the current concept of dopaminergic dysfunction in schizophrenia, suggesting a rather hyperactive mesolimbic dopamine system and reduced prefrontal activation, at least in partially remitted patients treated with atypical antipsychotics.

The data do not support previous reports from smaller samples indicating an augmenting or accelerating antidepressant effect of rTMS. Further exploration of the possible efficacy of other stimulation protocols or within selected sub-populations of patients is necessary.

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