Heinz  Böker, MD

Heinz Böker, MD, Prof.

Professor for Psychiatry (em.) University of Zurich

Affiliated Professor Department of Psychiatry Psychotherapy and Psychosomatics University of Zurich

Guest Professor International Psychoanalytic University (IPU) Berlin

Praxis for Psychiatry Psychotherapy and Psychoanalysis Weinbergstrasse 147 8006 Zürich

heinz.boeker@bli.uzh.ch

Website

Research

Prof. Heinz Boeker, MD is Head of the research group „Therapy and Process Research“ at the Department of Psychiatry, Psychotherapy, and Psychosomatics, University of Zurich.

The research activities focus on the investigation of  the emotional-cognitive interaction in depression. For this, three different methodological approaches were taken:

  1. Single-case studies (ideographic approach using the Repertory Grid Technique and Operationalized Psychodynamic Diagnostics) to analyse the subjective dimension of depression.
  2. Combined neuropsychological and imaging studies focussing on neuropsychological symptoms and neuronal activity in the prefrontal cortex in patients with major depression.
  3. Evaluation of the course of out-patient, day clinic and in-patient treatment of depression. 
     
    Single-case studies (ideographic approach): 
    It has been demonstrated that single-case oriented diagnostics (using the Repertory Grid Technique and OPD) enable empirical research into important personality dimensions on the basis of ideographic findings (Boeker 1999, Boeker et al. 2000a-c).
     
    Combined  neuropsychological and imaging studies in depressed patients
     
    Investigations have been carried out into emotional-cognitive interaction in depressed patients during depression and after improvement/remission of symptoms.
     
    The results point to a disturbance in the reciprocal modulation of the ventromedial prefrontal cortex (VMPFC) and the dorsolateral prefrontal cortex (DLPFC) in depressed patients: greater activity in the VMPFC is correlated with negative, depressed emotions, and reduced activity in the DLPFC is correlated with negative judgement (Grimm et al. 2009)..
     

Furthermore, a connection was found between disturbed activation patterns in the pregenual anterior cingulate cortex (pgACC) and deficits in the glutamatergic metabolism in anhedonic depression (Walter et a. 2009).

The neural and metabolic correlates of emotional processing in major depression was also investigated in a multimodal imaging study using treatment with ketamine (Scheidegger et al. 2012).

Furthermore, It could be shown that interoceptive awareness enhances neural activity during empathy and furthermore that interoceptive awareness and alexithymia are associated with neurotransmitter concentrations in insula and anterior cingulate.(Ernst et al. 2012,2014).

In another neuroimaging study the modulation of fear and empathy by oxytocin was corroborated. It was found that the beneficial effect of oxytocin on avoidance-related facial emotion depends on early life stress experience (Feeser et al 2014).
 

Therapy and Process Research

Neuropsychological deficits were seen in a sample of in-patients with major depression even after remission (attention, memory, strategic aspects of working memory and executive functions, Boeker et al. 2012). These neuropsychological symptoms were observed simultaneously with disturbances in neural activity patterns in the prefrontal cortex; they may be interpreted as trait markers for depression and underline the dissociation of psychopathological and neuropsychological symptoms in the course of depression.

A further focus is on neural and metabolic markers in the course of ECT treatment in patients with chronic depression. Here, the aim is to generate new multimodal information on the neurobiological changes during treatment with ECT. To this end, the consecutive neurodynamic effects of ECT on metabolite concentrations (GABA/glutamate/glutamine), functional brain activity and blood flow to the brain are measured and correlated with effects resulting from antidepressant treatment. These investigations are carried out using various imaging procedures (ASL, fMRI, MRS).

The modulation of mental activity, the neural correlates of control of aversion and the change of mental structure due to Psychodynamic Psychotherapy is investigated using fMRI as well as Operationalized Psychodynamic Diagnostics by applying an individualized neuroimaging paradigm (Zurich Depression-Study;  Fuchs et al. 2017, Wade-Bohleber et al. 2019).

An actual study focusses on "Biopsychosocial variables associated with burnout and alterations induced by a holistic intervention program in inpatients"  (together with  Roberto La Marca). In the present study, we aim at examining biological, social and psychological variables (social status, power, achievement and affiliation motive, narcissism, dominance, attachment, early life adversity, self-worth etc.). Measures were assessed at the beginning and the termination of the holistic treatment program, and further at six-month follow-up.

In conclusion, the “Therapy and Process Research” group, headed by Prof. Heinz Boeker, MD, has developed various methodological approaches (ideographic approach, combined neuropsychological and imaging studies incl. fMRI and MRS, therapy and process research). This group has been cooperating with the “Molecular Genetic Research Group” at the University Hospital of Psychiatry, Zurich (Former Head: Prof. Hans Stassen, PD, PhD), the Department for Biomedical Engineering at the ETH and University of Zurich (Former Head: Prof. Peter Boesiger, PD, PhD), The Royal Ottawa Healthcare Group, University of Ottawa/Canada , Institute of Mental Health Research (Head: Prof. Dr. Dr. phil. habil. Georg Northoff, MD, PhD), Psychiatric Hospital, Charité, Humboldt-University Berlin/Germany (Priv. Doz. Dr. rer. nat. Simone Grimm, PhD) and other national and international research centres.

Selected Publications

Boeker H. (1992) Concepts of Mental Illness: An Ethnopsychiatric Study of the Mental Hospi­tal’s in- and out-patients of the Kathmandu Valley. Contributions to Nepalese Studies 19: 27-50

Boeker H., Hell D., Budischewski K., Eppel A., Härtling F., Rinnert H., von Schmeling C., Will H., Schoeneich F., Northoff G. (2000) Personality and object relations in patients with affective disorders: Idiographic research by means of the repertory grid-technique. J. Affect. Disord. 60: 53-60

Böker H., Northoff G., Lenz C., von Schmeling C., Eppel A., Härtling F., Will H., Lempa G., Meier M., Hell D. (2000) Die Rekonstruktion der Sprachlosigkeit: Untersuchungen des subjektiven Erlebens ehemals katatoner PatientInnen mittels modifizierter Landfield-Kategorien. Psychiat. Prax. 27: 389-396

Northoff G., Richter A., Bermpohl F., Grimm S., Martin E., Marcar V.L., Wahl C., Hell D., Boeker H. (2005) NMDA Hypofunction in the Posterior Cingulate as a Model for Schizophrenia: An Exploratory Ketamine Administration Study in fMRI. Schizophrenia Research 72 (2-3): 235-248

Boeker H., Kleiser M., Lehman D., Jaenke L., Bogerts B., Northoff G.  (2006) Executive dysfunction, Self and Ego Pathology in Schizophrenia: An Exploratory Study of Neuropsychology and Personality. Compr. Psychiatry 47 (1): 7-19

Walter, M., Henning, A., Grimm, S., Schulte, R.F., Beck, J., Dydak, U., Schnepf, B., Boeker, H., Boesiger, P., Northoff, G. (2009) The relationship between aberrant neuronal activation in the pregenual anterior cingulate, altered glutamatergic metabolism and anhedonia in major depression. Archives of General Psychiatry 66 (5): 478 - 486

Boeker H., Schulze J., Richter A., Nikisch G., Schuepbach D., Grimm S. (2012) Sustained cognitive impairments after clinical recovery of severe depression.     Journal of Nervous and Mental Disease 200 (9): 773-776

Boeker H., Richter A., Himmighoffen H., Ernst J., Bohleber L., Hofmann E., Vetter J., Northoff G. (2013) Essentials of psychoanalytic process and change: how can we investigate the neural effects of psychodynamic psychotherapy in individualised neuro-imaging? Frontiers in Human Neuroscience. Volume 7, Article 355

Boeker H., Perniola L., Risch M., Himmighoffen H., Roemer B., Seifritz E., Borgeat A. (2013) Postictal ventricular tachycardia after ECT-treatment associated with a lithium-duloxetine combination. The Journal of ECT September 2013, Volume 29, Issue 3 (Online Article). DOI: 10.1097/YCT.0b013e31828b34c6

Boeker H., Kraehenmann R. (2018) Neuropsychodynamic Approach to depression: Integrating Resting State Dysfunctions of the Brain and Disturbed Self-Related Processes. Front Hum Neurosci. 2018 Jun 27;12:247. doi: 10.3389/fnhum.2018.00247. eCollection 2018. PMID: 29997487