Evolution of psychosocial burden and psychiatric symptoms in patients with psychiatric disorders during the Covid-19 pandemic.

The Covid-19 pandemic highly impacts mental health worldwide. Patients with psychiatric disorders are a vulnerable risk population for worsening of their condition and relapse of symptoms. This study investigates the pandemic-related course of psychosocial burden in patients with pre-existing mental disorders. With the newly developed Goettingen psychosocial Burden and Symptom Inventory (Goe-BSI) psychosocial burden has been traced retrospectively (1) before the pandemic (beginning of 2020), (2) at its beginning under maximum lockdown conditions (March 2020), and (3) for the current state after maximum lockdown conditions (April/May 2020). The Goe-BSI also integrates the Adjustment Disorder New Module (ADNM-20), assesses general psychiatric symptoms, and resilience. A total of 213 patients covering all major psychiatric disorders (ICD-10 F0-F9) were interviewed once in the time range from April, 24th until May 11th, 2020. Across all diagnoses patients exhibited a distinct pattern with an initial rise followed by a decline of psychosocial burden (p < 0.001, partial η2 = 0.09; Bonferroni-corrected pairwise comparisons between all three time-points: p < 0.05 to 0.001). Female gender and high ADNM-20 scores were identified as risk factors for higher levels and an unfavorable course of psychosocial burden over time. Most psychiatric symptoms remained unchanged. Trajectories of psychosocial burden vary in parallel to local lockdown restrictions and seem to reflect an adaptive stress response. For female patients with pre-existing mental disorders and patients with high-stress responses, timely and specific treatment should be scheduled. With the continuation of the pandemic, monitoring of long-term effects is of major importance, especially when long incubation times for the development of mental health issues are considered.

Medium-term and peri-lockdown course of psychosocial burden during the ongoing COVID-19 pandemic: a longitudinal study on patients with pre-existing mental disorders.

While the COVID-19 pandemic continues, patients with pre-existing mental disorders are increasingly recognized as a risk group for adverse outcomes. However, data are conflicting and cover only short time spans so far. Here, we investigate the medium-term and peri-lockdown-related changes of mental health outcomes in such patients in a longitudinal study. A cohort of 159 patients comprising all major mental disorders (ICD-10 F0-F9) were interviewed twice with the Goettingen psychosocial Burden and Symptom Inventory (Goe-BSI) to evaluate psychosocial burden, psychiatric symptoms and resilience at the end of the first (April/May 2020) and the second lockdown in Germany (November/December 2020). For the primary outcome "psychosocial burden" ratings also comprised retrospective pre-pandemic (early 2020) and very early states during the pandemic (March 2020). For all diagnostic groups, psychosocial burden varied significantly over time (p < 0.001) with an increase from the pre-pandemic to the initial phase (p < 0.001), followed by a steady decrease across both lockdowns, normalizing in November/December 2020. Female gender, high adjustment disorder symptom load at baseline and psychiatric comorbidities were risk factors for higher levels and an unfavorable course of psychosocial burden. Most psychiatric symptoms changed minimally, while resilience decreased over time (p = 0.044 and p = 0.037). The longitudinal course of psychosocial burden indicates an initial stress response, followed by a return to pre-pandemic levels even under recurrent lockdown conditions, mimicking symptoms of an adjustment disorder. Strategies for proactive, specific and continuous treatment have to address resilience capacities before their depletion in the pandemic aftermath, especially for patients with additional risk factors.

[Implementation of digital teaching in psychiatry as consequence of COVID-19: a comparative evaluation with classroom teaching]. / Einführung digitaler Lehre im Fach Psychiatrie als Reaktion auf COVID-19: eine vergleichende Evaluation zur Präsenzlehre.

BACKGROUND: In response to the coronavirus pandemic, most universities implemented digital teaching at short notice for the summer semester 2020 (SS20), whereas they simultaneously shut down classroom teaching. In the psychiatric clinic of the University Medical Center Göttingen, students' ratings concerning the learning effect and their substantive assessment for both forms of teaching were comparatively evaluated to determine the quality of this process. MATERIAL AND METHODS: Overall, 350 students who had visited classroom teaching (winter semester, WS18/19 to WS19/20) vs. digital teaching (SS20) assessed their form of teaching post hoc, within a standardized survey. They rated the individual learning effect in seven psychiatric subjects and did a substantive assessment on eight dimensions. In addition, they rated their expenditure of time. RESULTS: For digital teaching, the individual learning effect was rated as either being equivalent or superior (subjects: psychotherapy, schizophrenia). Despite a significantly heightened expenditure of time, digital teaching was substantively assessed as being equivalent to classroom teaching or superior (dimensions: independent processing of learning goals, overall format of lecture). Concerning their anticipated preparation for the professional practice, students rated digital teaching as being inferior to classroom teaching. CONCLUSION: A pandemic-driven conversion from classroom to digital teaching did not result in a loss of quality on the dimensions measured in this comparative evaluation. With a view to professional practice, digital teaching should complement classroom teaching and be part of future curricula.

[Knowledge levels and attitudes of nursing trainees regarding sexuality in old age - An explorative quantitative survey]. / Wissensstände und Einstellungen von Altenpflegeauszubildenden zum Thema Alterssexualität.

Knowledge levels and attitudes of nursing trainees regarding sexuality in old age - An explorative quantitative survey Abstract. Background: In professional geriatric nursing, sexuality in old age is often tabooed - in spite of this demographic group having the desire to live their sexuality. Generally, the possibility to experience sexuality - for example in nursing homes - is limited. Aim: The main objective of this study is to portray the knowledge and attitudes of geriatric nursing trainees towards sexuality in old age in cross section, and to analyze possible differences between training years. Methods: A cross-sectional study was conducted with written standardized surveys of 420 trainees on three research questions: (1) sexuality in old age and its role during class, (2) subjective vs. objective sex education, and (3) sexual assistance and attitudes towards it. Differences between years of education and subgroups were analyzed statistically (Kruskal-Wallis- and chi-square tests). Results: Results showed that addressing sexuality in old age during lessons was perceived to increase with a higher training year. However, 15.1 % experienced it as being exclusively negative. Concerning objective sex education, 15.7 % misjudged frequent masturbation as being psychologically harmful or did not know better. Furthermore, 9.3 % believed homosexuality to be a disease. Differences between years of training could not be found in these variables. The knowledge about sexual assistance increased with higher training years. Conclusions: Regarding these results, we suggest that the subject of sexuality in old age should be intensified as part of the curriculum for geriatric nursing from an early stage on. The aim should be to reduce tabooing and to increase the level of knowledge.

[Video presentations for examination questions in psychiatry : A pilot study]. / Videodarstellungen in psychiatrischen Prüfungsfragen : Eine Pilotstudie.

BACKGROUND: The master plan for medical studies 2020 (MM2020) aims at a restructuring of medical education. The examinations should represent the key element of the evaluation and electronically supported examination methods will be expanded. OBJECTIVE: Videos of actors displaying psychopathological phenomena were implemented into examination questions for the first time through the use of an electronically supported examination (e-examination) and therefore in accordance with the aims of MM2020. METHODS: A total of four multiple choice (MC) questions referencing short video representations of different psychopathological phenomena were formulated and shown to medical students within an e­examination. The MC questions were evaluated with respect to scientific quality criteria and the medical students were asked to fill in a questionnaire regarding their evaluation of the content and format of the MC questions after participating in the examination. RESULTS: The MC video questions were presented to the students directly following the regular e­examination of the teaching module in psychiatry. Out of 69 students 60 participated in the study. The MC video questions had a high level of acceptance and positive evaluation by the students. With respect to the scientific quality criteria, the MC questions showed heterogeneous results. CONCLUSION: Due to the versatile applicability and high efficiency, MC questions will continue to play an important role in medical examinations. In accordance with the aims of MM2020, it could be shown that psychiatric knowledge can be examined in a competence-oriented manner and with a practical orientation by means of video presentations in an e­examination. A broader application of video presentations could complement electronically supported examinations in the discipline of psychiatry.

What do the teachers want? A targeted needs assessment survey for prospective didactic training of psychiatry medical educators.

Objectives: Physicians and psychologists at psychiatric university hospitals are assigned teaching tasks from the first day of work without necessarily having the prerequisite training in teaching methods. This exploratory survey provides a needs-based analysis for the prospective didactic training of physicians and psychologists at psychiatric hospitals in Germany, Austria and Switzerland. Methods: An online questionnaire was distributed at medical schools via email in German-speaking countries in Europe. All physicians involved in teaching medical students at psychiatry faculties were eligible to participate in the survey. Participants were further requested to recruit eligible participants (snowball sampling). Responses were analyzed descriptively, and differences between groups were calculated using nonparametric Mann-Whitney U tests (p<.05). Results: Overall, 97 respondents (male=55, female=42; mean age= 40.6) from 19 medical schools completed the survey. The respondents consisted of 43 residents, 39 specialists, 6 chief physicians and 9 psychologists. Of the respondents, 97.6% rated didactic competence as either highly relevant or rather relevant for teaching medical students. The highest overall interest was shown for bedside teaching (mode=4; IQR: 2-4) and error culture (mode=3; IQR: 2-4). Respondents expressed the highest training needs for topics regarding presentation and communication (mode=3; IQR: 2-3). Resident physicians were significantly more interested in bedside teaching (U=362.0, p=0.004) and roleplay (U=425.0; p=0.036) than specialist physicians, who were more interested in examination didactics (U=415.0; p=0.022). Chief physicians displayed significantly deeper interest in group dynamics (U=51; p=0.023) than specialist physicians. In-person training was preferred by a majority of respondents, and 27.4% preferred online/web-based training. Conclusions: The majority of physicians and psychologists at psychiatric university hospitals considered professional development for faculty to be helpful for teaching medical students. Bedside teaching and error culture management were the most desired teaching topics for training medical teachers. Tailored educational interventions are recommended, with target-oriented priorities for different hierarchical levels.

Community-supported teaching on the topic of transgender identity in undergraduate medical education - a pilot project.

Introduction and objectives: Future physicians are insufficiently prepared for the topic of transgender identity during their studies. Relevant courses during undergraduate medical education are heterogeneous and not widely established within the curricula. At our university, we investigated if students' knowledge of transgender identity could be increased through medical specialist teaching and teaching delivered by representatives of the trans* community (community-supported teaching). Methods: During summer semester 2021 (SS21), the knowledge level on transgender identity of 134 medical students in their fifth clinical semester was evaluated (phase 1). In addition, knowledge gain on gender incongruence through the module "psychiatry" was retrospectively surveyed across two dimensions: 1. diagnostic criteria, 2. treatment/care. During winter semester 2021/22 (WS 21/22), a 90-minute seminar on transgender identity was held either community-supported or by medical specialists (phase 2). Following the psychiatry exam, a re-evaluation was carried out by 115 students (phase 3). Results: The students in SS21 did not feel sufficiently educated in the topic of transgender identity through their studies, but rated the relevance of the topic for their later profession as high. Learning gain improved after the introduction of the seminar in WS21/22 compared to the previous semester (both dimensions p<.001). Community-supported and specialist teaching achieved equivalent results. Conclusion: One 90-minutes seminar led to a significant learning gain regarding the topic of transgender identity. Community-supported teaching is a promising way to impart knowledge in a qualified manner: Medical faculties should use this form of teaching to convey established knowledge to students in future curricula.

One year of digital teaching in psychiatry as a response to the COVID-19 pandemic: Knowledge gain and content evaluation of medical students for two summer semesters in 2020 and 2021.

After the beginning of the COVID-19 pandemic in 2020, digital teaching had to be implemented by most universities at short notice and widely replaced classroom teaching. As a consequence, digital teaching further reduced direct social interaction for students. One year after the introduction of digital teaching formats at our university medical center (department of psychiatry and psychotherapy), teaching evaluation of students from summer semesters 2020 and 2021 (SS20, SS21) were compared. The main objective of this study was to objectify whether students evaluate digital teaching less favorably after one year of its implementation. Ratings of 311 medical students on (1) knowledge gain, (2) teaching contents and (3) subjective advantages of digital teaching were analyzed for the two separate cohorts SS20 (n = 175) and SS21 (n = 136). Students also rated their pandemic-related stress level, and if learning progress had been reduced by the pandemic in general. Significant knowledge gain was achieved for all included domains in psychiatry (all p < .001), and did not differ between SS20/SS21. Teaching contents in SS21 were rated worse in six out of eight domains compared to SS20 (p < .001 to .05). Also, subjective advantages of digital teaching vanished in most domains comparing the cohorts of SS21 and SS20 (p < .001 to .05). No differences were found for pandemic-related stress level and subjective learning progress. Limitations include the post-hoc design, possible bias from individual exam grades, and sampling bias. The present study showed that knowledge gain can be considered to be stable one year after the pandemic-related implementation of digital teaching. However, sustainability of this teaching format should be monitored critically: The subject of psychiatry and psychotherapy thrives on direct communication, which can be compromised when using digital formats only. In this light, implementation of more interactive formats in digital teaching is discussed.

Internal Locus of Control and Sense of Coherence Decrease During the COVID-19 Pandemic: A Survey of Students and Professionals in Social Work.

Mental health is severely challenged by the COVID-19 pandemic due to a variety of restrictions in public and private life. Students in particular may face additional and unique stressors: face-to-face classes have been largely replaced by digital formats, leading to further reduced social contacts, thus facilitating the development of psychological symptoms. In this study, we aimed to assess the impact of the current peri-pandemic situation on students' 1) locus of control and 2) sense of coherence, both of which have been linked to mental health in previous work. A total of 403 social work students from Germany participated, providing both retrospective (pre-pandemic) and current (February/March 2021) ratings. Furthermore, 324 social work professionals were included to analyze differences between both groups. Locus of control shifted significantly from internal to external during the pandemic for students and professionals. Furthermore, high mental burden correlated with increased external and decreased internal locus of control. Sense of coherence decreased during the pandemic for the entire sample and correlated with high mental burden. Overall, students showed a stronger drop compared to professionals, primarily due to a more pronounced decrease in perceived meaningfulness (all p < 0.001). In summary, students and professionals responded with increased feelings of powerlessness in the absence of sufficient coping strategies-this could lead to further deterioration of mental health as the pandemic continues. In this context, students appear to be particularly vulnerable to a reduction in sense of coherence. We conclude that interventions to improve coping strategies are urgently needed.