Heart rate vARiability and physical activity in inpatient treatMent of burnOut and DepressIon (HARMODI): protocol of a cross-sectional study with up to 8-week follow up.

INTRODUCTION: Chronic stress can cause an imbalance within the autonomic nervous system, thereby affecting cardiovascular and mental health. Physical activity (PA) may have a positive effect on the autonomic nervous system and stress-related disorders, such as depression and burnout. Heart rate variability (HRV) is a non-invasive marker of the autonomic nervous system. However, limited and inconsistent data exist on the exact relationship between HRV, PA and depression and burnout symptoms. The HARMODI study aims to explore whether HRV is a feasible marker of depression and burnout symptoms and aims to evaluate the role of PA in the treatment of stress-related disorders. METHODS AND ANALYSES: This is an observational study with a cross-sectional up to 8 week follow-up study design. A total of 153 patients, undergoing psychiatric inpatient treatment with burnout syndrome (Z73) and depressive episode (F32 or F33) or adjustment disorder (F43.2), will be recruited. Data on depression and burnout symptoms, HRV recordings (24-hour, supine, standing and exercise stress test), cognitive function, cardiorespiratory fitness, cardiovascular health, balance and strength will be collected at baseline (T1) and after up to 8 weeks (T2). Continuous data on PA and Ecological Momentary Assessments of exhaustion, mood and tension will be monitored daily throughout inpatient treatment. Multiple regression models, adjusted for potential confounders, will assess the association between HRV as the primary outcome, PA and depression and burnout severity score. ETHICS AND DISSEMINATION: The protocol has been approved by Swiss Ethics Committee, Cantonal Ethics Committee Zürich. Results of HARMODI will be disseminated through peer-reviewed journals and conference presentations. TRIAL REGISTRATION NUMBER: NCT05874856.

Enriched cereal bars are more effective in increasing plasma quercetin compared with quercetin from powder-filled hard capsules.

The flavonol quercetin, is one of the major flavonoids found in edible plants. The bioavailability of quercetin in humans may be influenced by the food matrix in which it is consumed as well as by its chemical and physical form. The objective of the present study was to investigate the biokinetics of quercetin from quercetin-enriched cereal bars and quercetin powder-filled hard capsules. In a randomised, single-blinded, diet-controlled cross-over study, six healthy women aged 22-28 years took a single oral dose of approximately 130 mg quercetin equivalents from either quercetin-enriched cereal bars (containing 93·3 % quercetin aglycone plus 6·7 % quercetin-4'-glucoside) or quercetin powder-filled hard capsules (100 % quercetin aglycone). Blood samples were drawn before and after quercetin administration over a 24 h period. The concentrations of quercetin and its monomethylated derivatives, isorhamnetin (3'-O-methyl quercetin) and tamarixetin (4'-O-methyl quercetin), were measured by HPLC with fluorescence detection after plasma enzymatic treatment. The systemic availability as determined by comparing the plasma concentration-time curves of quercetin was found to be five times and the cmax values six times higher after ingestion of 130 mg quercetin by quercetin-enriched cereal bars than after ingestion by quercetin capsules. In contrast, tmax did not differ significantly between the two treatments. The cmax values for isorhamnetin and tamarixetin were four and nine times higher after ingestion of quercetin by quercetin-enriched cereal bars than after ingestion by quercetin capsules. In conclusion, quercetin from quercetin-enriched cereal bars is significantly more bioavailable than from quercetin powder-filled hard capsules.

Perception of overweight and obesity from different angles: a qualitative study.

AIMS: Up to this date, the obesity pandemic has yet to be confined, with prevalence rates still rising in most countries. Aside from numerous negative consequences such as comorbid diseases and a reduction in life expectancy due to excessive bodyweight and the economic impact of obesity on healthcare systems, negative outcomes in overweight and obese individuals are also affected by perceived stigmatisation and discrimination. Knowledge of common views and perception overweight and obesity in the general public as well as in specific populations (e.g. healthcare professionals) is crucial in order to develop stigma-reduction interventions. The specific aim of the current study was to develop an appropriate questionnaire to be used in the survey to follow and further to enhance existing instruments. METHODS: This qualitative study reports results from focus groups with normal-weight and overweight individuals as well as healthcare professionals. RESULTS: Contents of the discussion of overweight and obesity did not differ substantially between the three groups. Results show that the definition of obesity in our focus groups is a subjective construct influenced mainly by aesthetics, sympathy, and activity. Within the groups, obesity was mainly seen as a controllable condition; however, external, such as societal, factors were named as well. In line with this and as expected from theoretical background, obese individuals are ascribed mainly negative attributions. CONCLUSIONS: With these results, this study enlightens lived realities of different groups of people. The results can be applied to improve existing instruments for the measurement of attitudes towards obesity.

Do patients think cannabis causes schizophrenia? - A qualitative study on the causal beliefs of cannabis using patients with schizophrenia.

BACKGROUND: There has been a considerable amount of debate among the research community whether cannabis use may cause schizophrenia and whether cannabis use of patients with schizophrenia is associated with earlier and more frequent relapses. Considering that studies exploring patients' view on controversial topics have contributed to our understanding of important clinical issues, it is surprising how little these views have been explored to add to our understanding of the link between cannabis and psychosis. The present study was designed to elucidate whether patients with schizophrenia who use cannabis believe that its use has caused their schizophrenia and to explore these patients other beliefs and perceptions about the effects of the drug. METHODS: We recruited ten consecutive patients fulfilling criteria for paranoid schizophrenia and for a harmful use of/dependence from cannabis (ICD-10 F20.0 + F12.1 or F12.2) from the in- and outpatient clinic of the Psychiatric University Hospital Zurich. They were interviewed using qualitative methodology. Furthermore, information on amount, frequency, and effects of use was obtained. A grounded theory approach to data analysis was taken to evaluate findings. RESULTS: None of the patients described a causal link between the use of cannabis and their schizophrenia. Disease models included upbringing under difficult circumstances (5) or use of substances other than cannabis (e. g. hallucinogens, 3). Two patients gave other reasons. Four patients considered cannabis a therapeutic aid and reported that positive effects (reduction of anxiety and tension) prevailed over its possible disadvantages (exacerbation of positive symptoms). CONCLUSIONS: Patients with schizophrenia did not establish a causal link between schizophrenia and the use of cannabis. We suggest that clinicians consider our findings in their work with patients suffering from these co-occurring disorders. Withholding treatment or excluding patients from certain treatment settings like day-care facilities or in patient care because of their use of cannabis, may cause additional harm to this already heavily burdened patient group.

The stigma of schizophrenia from patients' and relatives' view: A pilot study in an Italian rehabilitation residential care unit.

OBJECTIVE: To identify the constituent elements of the stigma from the perspective of those having first-hand experiences of it. METHODS: Subjective experiences of stigma were explored in six focus groups: three with people suffering from schizophrenia and three with patients' relatives. Focus group sessions were tape-recorded, transcribed and analyzed by means of an inductive method, forming categories from the texts, as a basis for coding. Analysis aimed at establishing a typology of stigmatization experiences from the spoken words of the focus group participants. RESULTS: Four dimensions of stigma were identified: access to social roles; internalization of stigma; quality of mental health services, public image of mental illness. CONCLUSION: The most frequently found topics concerned experiences of marginalization and discrimination that people with schizophrenia experience in their daily life. These results mirror the findings of similar studies obtained in other cultural contexts.

Motivational Incongruence and Well-Being at the Workplace: Person-Job Fit, Job Burnout, and Physical Symptoms.

Person-environment fit has been identified as a key prerequisite for employee well-being. We investigated to what extent a misfit between motivational needs and supplies at the workplace affects two key health outcomes: burnout and physical symptoms. Individual needs (implicit affiliation and power motives) and environment supplies (motive specific job characteristics) were assessed in an online survey of full time employees (n = 97), using a picture story exercise measuring implicit motives and a scale listing affiliation and power related job characteristics. Outcomes were assessed using the Maslach Burnout Inventory and a checklist of physical symptoms. We conducted polynomial regressions with response surface analysis. Results reveal that motivational incongruence with respect to the affiliation motive was related to high job burnout, while motivational incongruence concerning the power motive predicted increased physical symptoms. This was true for both those with a strong affiliation or power motive and low corresponding job characteristics and those with a weak affiliation or power motive and job characteristics demanding the respective motive. Results hint at potential interventions toward preventing or remedying a lack of needs-supply fit and reducing the risk of impairments of well-being.

Proteinase-activated receptors (PARs)--the PAR3 Neo-N-terminal peptide TFRGAP interacts with PAR1.

Thrombin activates proteinase-activated receptor (PAR)1, PAR3 and PAR4 by a unique mechanism that involves cleavage of the receptor and exposure of a new N-terminal domain acting as a tethered ligand. Synthetic peptides based on the proteolytically revealed receptor sequence can selectively activate PAR1 or PAR4 independently of receptor cleavage. However, corresponding peptides for PAR3 have not been identified thus far. Here, we demonstrate that the synthetic peptide TFRGAP representing the 1st six residues of the new amino terminus of PAR3 induced ERK activation in human A-498 carcinoma cells endogeneously expressing PAR1 and PAR3. This effect was completely abolished by single alanine substitution at positions 3, 4 and 6 in the peptide. Since the specific PAR1 antagonist RWJ 56110 completely abolished TFRGAP-induced ERK activation in A-498 cells we speculate that TFRGAP does signal MAPK via interaction with PAR1. This was underlined by experiments on PAR1-/- mouse lung fibroblasts (KOLF cells) that stably overexpress human PAR1 and PAR3, respectively. While TFRGAP was without effect on ERK activation in PAR3+ KOLF cells, it induced MAPK activation in KOLF cells transfected with PAR1. These studies provide evidence that analogues of the PAR3 tethered ligand can mediate cell signaling by interaction with PAR1-type thrombin receptors.

Caregiver burden in mental illness: review of measurement, findings and interventions in 2004-2005.

PURPOSE OF REVIEW: This review summarizes recent evidence on caregiver burden in mental illness. It examines how the field has advanced in terms of measurement, results, and interventions in 2004/2005, and identifies potential for further studies. RECENT FINDINGS: Burden has been studied in a much wider spectrum of diagnostic groups and types of caregivers, some brief and practical assessment tools have become available, cultural aspects of burden are better understood, and a high potential for caregiver appraisal to prevent negative consequences of burden has been identified. Recent findings afford a more comprehensive understanding of the caregiving situation and its outcomes, and may find a practical application in devising effective support strategies for family carers, which still seem to be lacking. SUMMARY: Substantial progress has been made in the measurement of caregiver burden. In terms of publication quantity, the field is growing rapidly, and international interest in the area is increasing. Improvements in methodological quality are also evident. These new research developments may be taken to reflect an increasing recognition of the contribution of families-away from stigma, shame, and blame. This requires accepting relatives as caregiving experts and as genuine partners in both psychiatric practice and research.

What is schizophrenia? Secondary school students' associations with the word and sources of information about the illness.

Young people are generally assumed to be less prejudiced toward people with schizophrenia than are adults. This article presents findings from a survey of 293 secondary school students in Germany, exploring their associations with the word schizophrenia and sources of information. Results indicate that the majority of young people appear either rather well informed or totally lacking information about schizophrenia. Findings are discussed in view of their implications for effective antistigma interventions and mental health education.

PAR1-type thrombin receptor stimulates migration and matrix adhesion of human colon carcinoma cells by a PKCepsilon-dependent mechanism.

The proteinase-activated receptor1 (PAR1) was characterized as a functional receptor for thrombin in cells from different tumor entities. In colon carcinoma, its function has to be defined. In this study we demonstrate that the PAR1-selective agonist peptide TFLLRN induced activation of protein kinase C isoenzymes alpha and epsilon in human HT-29 colon carcinoma cells expressing PAR1 endogeneously. On the cellular level, TFLLRN and thrombin prompted HT-29 cell migration and matrix adhesion by a PKCepsilon-dependent mechanism as concluded because of the inhibition of PAR1-mediated effects by the PKC inhibitor bisindolylmaleimide I and the PKCepsilon translocation inhibitory peptide EAVSLKPT but not by the PKC inhibitor Gö 6976. In addition, blockade of PAR1 by RWJ 56110, a selective PAR1 antagonist, fully abolished the effect of thrombin on HT-29 cell migration and adhesion. Therefore, PAR1 seems to be the responsible receptor for thrombin-induced migration and adhesion of human colon carcinoma cells including PKCepsilon as an essential signal transducer.

Subjective experiences of stigma. A focus group study of schizophrenic patients, their relatives and mental health professionals.

Schizophrenia has been found to be one of the most stigmatising conditions. To the present, most research on stigma related to mental illness has drawn conclusions on the adverse reactions faced by people with schizophrenia from studies on public attitudes or analogue behavioural studies. The views of those exposed to the stigmatising reactions, however, has largely been absent. Aiming to explore stigma from the subjective perspective of people with schizophrenia, a focus group study was carried out at the four centres involved in the WPA Global Programme against Stigma and Discrimination because of Schizophrenia in Germany. In order to get a comprehensive picture of how stigma affects the lives of schizophrenic patients, collateral information was sought from relatives and mental health professionals. The focus groups enquired about concrete stigmatisation experiences of the patients and incidences of stigma witnessed by the other two groups. Focus group sessions were tape-recorded and transcripts were coded using an inductive method. Results reveal four dimensions of stigma: interpersonal interaction, structural discrimination, public images of mental illness and access to social roles. Examples are given for the views of patients, relatives and mental health professionals on each of the four stigma types. The consequences for conceptualisations of stigma and the development of effective strategies to reduce stigma and discrimination because of schizophrenia are discussed.

The film festival "AUSNAHME|ZUSTAND" (State of Emergency)--do feature films and documentaries on mental health reduce stigma and influence help-seeking attitudes?

The study aims at evaluating the impact of the Germany-wide film festival "AUSNAHME|ZUSTAND" on social distance and help-seeking attitudes of the adolescent audience. The festival, on the subject of mental health, was staged for the second time, aiming to give a podium to the topic mental health and to inform and entertain an adolescent audience that has not been in close contact with the subject before. A pre-post test was carried out to look for the effect of feature films and documentaries on social distance of the audience towards people with mental illness and on the change in help-seeking attitudes. A total of 532 young people with a mean age of 15.6 were questioned during the film festival in Leipzig. As the results show, the effect on the viewers׳ social distance and their help-seeking attitudes strongly depend on the content of the feature films and documentaries. Two films improved attitudes ­ one both social distance and help-seeking, one only help-seeking. One film increased social distance, and two films did not affect either outcome. Age, gender, and knowing someone with mental health problems also turned out to be decisive factors influencing the development of social distance and help-seeking attitudes. Feature films or documentaries about mental illness can reduce social distance or influence help-seeking attitudes, but effects strongly depend on the particular film.

Mental health-related stigma in health care and mental health-care settings.

This Review considers the evidence for mental-health-related stigma in health-care and mental-health-care settings. Do mental-health-care and other health-care professionals stigmatise people using their services? If so, what are the effects on quality of mental and physical health care? How can stigma and discrimination in the context of health care be reduced? We show that the contact mental-health-care professionals have with people with mental illness is associated with positive attitudes about civil rights, but does not reduce stigma as does social contact such as with friends or family members with mental illness. Some evidence suggests educational interventions are effective in decreasing stigma especially for general health-care professionals with little or no formal mental health training. Intervention studies are needed to underpin policy; for instance, to decrease disparity in mortality associated with poor access to physical health care for people with mental illness compared with people without mental illness.

[The German version of the Inventory of Stigmatizing Experiences (ISE)--a new tool for assessing the prevalence and impact of "felt stigma"]. / Das Inventar Subjektiver Stigmaerfahrungen (ISE): Ein neues Instrument zur quantitativen Erfassung subjektiven Stigmas.

OBJECTIVES: Stigma research has been criticized for excluding the views of those exposed to stigmatizing reactions. While this changed with the advent of qualitative research into stigma, population-based data on the prevalence, severity and consequences of stigma experiences are lacking. The present study aims at field-testing the German version of the Inventory of Stigmatizing Experiences (ISE) , developed to investigate the epidemiology of "felt stigma". METHODS: The ISE is a semi-structured questionnaire composed of two scales: one measuring the scope of stigma experienced in different life domains (SES; 9 items), the other assessing their psychosocial impact (SIS; 7 items). The instrument was translated into German, using the three-step procedure proposed by WHO (translation, back-translation, feasibility testing). Field-testing of the German version was carried out on 95 service users. RESULTS: The German version of the ISE shows good reliabilities for both the stigma experiences (SES; alpha = 0.74) and stigma impact (SIS; alpha = 0.86) scales. 54.4 % of service users report stigma experiences across the SES; 72 % of these are recent and thus susceptible for interventions. CONCLUSIONS: The German version of the ISE is a compact and reliable tool for measuring the prevalence and impact of felt stigma, with potential uses in both population-based stigma research and clinical practice.

Stigma and mental health professionals: a review of the evidence on an intricate relationship.

In the past decade, mental health professionals have initiated a number of national and international efforts against the stigma of mental illness. While largely successful in beating stigma and discrimination, these programmes have, in part, been criticized to be largely uninformed by the lived realities of people with mental illness and their families. Some critics claimed that anti-stigma efforts led by mental health professionals were in fact a concealed attempt at de-stigmatizing psychiatry itself as a profession. This paper will attempt to throw light on the various ways in which mental health professionals are 'entangled' in anti-stigma activities. It will outline the complex relationships between stigma and the psychiatric profession, presenting evidence on how its members can simultaneously be stigmatizers, stigma recipients and powerful agents of de-stigmatization. In exploring the role of mental health professionals as targets of stigma, new findings will be presented on the role of stigma as a professional stressor in psychiatry. Conclusions will be drawn on how the pursuit of professional self-interest can be a legitimate goal of anti-stigma programmes. Further, ways in which acknowledging psychiatry's own agenda can contribute to both credibility and success of fighting stigma from within psychiatry will be discussed.

Courtesy stigma--a focus group study of relatives of schizophrenia patients.

BACKGROUND: Stigmatization of people with mental illness has been investigated in numerous studies. Little research, however, has been done to explore how relatives of people with schizophrenia perceive and experience stigmatization and how they can fight such stigmatization. METHOD: Aiming to explore stigma from the perspective of relatives of people with schizophrenia, focus group interviews were conducted with 122 members of advocacy groups from different parts of Germany. Focus group sessions were tape- and video-recorded and transcribed. Transcripts were coded using an inductive method, generating categories (domains) from the material. RESULTS: The analysis of focus group data shows that, contrary to previous research findings, discrimination and disadvantages encountered by relatives of schizophrenia patients reach far beyond the spheres of direct social interaction and access to social roles. Our study revealed two additional domains in which relatives encounter stigmatization: structural discrimination and public images of mental illness. Furthermore, psychiatry has been identified as one important source of stigma. Relatives also suggested numerous anti-stigma interventions. These can be grouped into five main categories: communication measures, support for the ill and their relatives, changes in mental health care, education and training, and control and supervision. DISCUSSION: Based on our findings,ways of how relatives of schizophrenia patients and mental health professionals can fight against stigma are discussed.

The vascular endothelin system is not overactive in normotensive hemodialysis patients.

BACKGROUND: The hemodynamic significance of elevated endothelin-1 (ET) plasma levels in hemodialysis (HD) patients is unknown. Therefore, we studied the role of ET in the regulation of vascular tone in normotensive HD patients and matched healthy controls (C). METHODS: The forearm blood flow (FBF) responses to adenosine, norepinephrine, the ET-A receptor antagonist BQ-123 (40 nmol/min), the ET-B receptor antagonist BQ-788 (1 and 50 nmol/min), and ET (5 pmol/min) were measured. Results are percent of baseline change +/- SEM (baseline = 100%). RESULTS: Responses to adenosine and norepinephrine were both unchanged in HD. In HD, BQ-123 increased FBF less than in C (133 +/- 9 vs. 178 +/- 27%; P = 0.02). BQ-788 failed to change FBF in C but decreased FBF to 83 +/- 4% in HD. Compared to BQ-123 alone, BQ-123 plus BQ-788 (50 nmol/min) caused an additional increase of FBF (234 +/- 32%, P < 0.001) in C, but not in HD (139 +/- 14%). This additional increase was absent when BQ-788 was co-infused at 1 nmol/min. ET reduced FBF comparably in both groups. CONCLUSIONS: Resistance vessels of HD patients have unremarkable contractile properties, as shown by responses to adenosine and norepinephrine. In HD, the basal vascular ET-mediated tone is reduced. The main action of the ET-B receptor in C is vasoconstrictive, which also is blunted in HD. The intact response to exogenous ET indicates the normal function of ET receptors in HD. Our results could be explained by a reduced generation or reduced metabolic clearance rate of ET in normotensive HD patients. Controversy remains concerning the role of the ET-B receptor when comparing the present data with previously published literature.

[The German version of the Community-Attitudes-Toward-the-Mentally-Ill (CAMI) inventory]. / Die deutsche Version des Community-Attitudes-toward-the-Mentally-Ill(CAMI)-Inventars.

OBJECTIVE: The German version of the Community Attitudes toward the Mentally Ill (CAMI) inventory developed by Taylor and Dear (1981) is presented. METHOD: The questionnaire was applied in a mail survey which was conducted in 3 small towns in Germany. RESULTS: At the item level surprisingly positive attitudes toward people with mental illness were found. The factor analysis with the 40 Likert-scaled items yielded 4 dimensions (exclusion, integration, benevolence, social control) which account for 46 % of the total variance. As in previous studies, age had a negative effect and the level of education a positive effect on public attitudes, while the gender of the respondents had only a small effect. Familiarity with mental illness did not have an effect as important as in previous studies. CONCLUSION: There is a close correspondence between the German version and the original version of the CAMI-inventory.