Predictors of return to work in people with major depression: Results from a supported employment program in Germany.

BACKGROUND: Depression is a common mental disorder and is associated with work disability. For the implementation of evidence-based interventions, such as Individual Placement and Support (IPS) for people with depression in Germany, the aim of this study was to investigate client variables that predict return to work. METHODS: The sample consisted of 129 participants, initially treated in a psychiatric hospital due to major depression, who participated in IPS as part of a German clinical trial. Baseline demographic (age, sex, education, sickness absence days, employment status), psychiatric (symptom severity, comorbidity, general physical and mental health, disability), and neuropsychological (self-rated deficits, test performance) variables were included. Return to work within one year was predicted using separate and overall binary logistic regression analyses. RESULTS: A total of 70 participants (56 %) returned to work within the one-year follow-up period. >100 days of sick leave in the year prior to study entry (vs. <100 days) and higher self-rated cognitive deficits were significantly associated with reduced odds of return to work within one year of IPS. LIMITATIONS: The sample consisted of participants with a relatively good work history who were assigned to IPS by the treatment team, thus, the generalizability of the results is limited. CONCLUSIONS: People with depression who participate in IPS interventions might benefit from specifically targeting perceived cognitive deficits. Factors associated with prolonged sick leave due to depression and their role in return to work with IPS need further investigation.

Somatic Factors Predict On-Road Driving Skills in Older Drivers and Drivers with Mild Cognitive Impairment.

BACKGROUND: On-road driving skills can be impaired in older drivers and drivers with mild cognitive impairment (MCI) due to different driving-relevant deficits. Among these deficits, somatic factors have received little attention so far. METHODS: In a prospective observational on-road driving study, we examined whether somatic factors can predict on-road driving skills in a mixed sample of healthy older drivers and drivers with MCI (n = 99) and whether the inclusion of age explains additional variance. Somatic factors included the number of prescribed drugs, visual acuity, peripheral visual field integrity, mobility of the cervical spine, and hearing impairment. A hierarchical regression analysis was used to predict on-road driving skills by adding the somatic factors in the first step and age in the second step. RESULTS: Results revealed that the combination of somatic factors significantly predicted on-road driving skills (R2adjusted = 0.439). The inclusion of age led to a significant increase of explained variance (R2adjusted = 0.466). CONCLUSIONS: Our results suggest that somatic factors can accurately predict on-road driving skills in healthy older drivers and drivers with MCI. In addition, our results suggest that there is a significant but rather small effect of age beyond somatic changes.

Cognitive Behavioral Psychotherapy as an Add-on in Comprehensive Outpatient Care of Non-affective Psychoses: A Multicenter Randomized-Controlled Effectiveness Trial in a Naturalistic Setting.

BACKGROUND AND HYPOTHESIS: Non-affective psychoses (NAP) are associated with severe consequences with regard to social functioning, physical health, employment, and suicidality. Treatment guidelines recommend cognitive behavioral therapy for psychosis (CBTp) as an effective additional treatment strategy to psychopharmacology. We hypothesized that outpatient CBTp has an add-on effect in individuals with NAP who already receive comprehensive outpatient care (COC) in Germany. STUDY DESIGN: In a randomized-controlled effectiveness trial, 6 months of COC + CBTp were compared to COC. The primary outcomes were change of symptom severity as assessed by the Positive and Negative Symptom Scale (pre-/post-treatment and 6-month follow-up). Mixed linear models and effect sizes were used to compare changes across treatment groups. Additionally, the number of readmissions was compared. STUDY RESULTS: N = 130 individuals with chronic NAP were recruited (COC + CBTp: n = 64, COC: n = 66). COC + CBTp participants significantly improved more regarding positive symptom severity (estimated mean difference at follow-up: -2.33, 95% CI: -4.04 to -0.61, P = .0083, d = 0.32) and general psychopathology (estimated mean difference at follow-up: -4.55, 95% CI: -7.30 to -1.81, P = .0013, d = 0.44) than the COC group. In both groups, negative symptom severity did not change significantly over time nor did groups differ regarding readmissions. CONCLUSION: The results underline an add-on benefit of CBTp in chronically ill individuals with NAP. Superiority of CBTp was demonstrated in comparison with high-quality comprehensive care and may also be true in different comprehensive care settings. CLINICAL TRIALS REGISTRATION: DRKS00015627.

Two Sides of the Same Coin in Female Borderline Personality Disorder: Self-Reported Guilt and Shame and Their Neurofunctional Correlates.

OBJECTIVE: Patients with borderline personality disorder (BPD) report to be especially prone to social emotions like shame and guilt. At the same time, these emotions seem to play an important role in BPD pathology. The present study aimed to deepen the knowledge about the processes behind shame and guilt in patients with BPD. METHODS: Twenty patients with BPD and twenty healthy controls (HCs) took part in an experiment that induced shame and guilt by imagining scenarios during scanning using functional brain imaging. Participants also filled out self-report questionnaires and took part in diagnostic interviews. RESULTS: BPD patients reported more proneness to guilt but not to shame than the HCs. There was no difference in the self-reported intensity rating of experimentally induced emotions between the groups. Between-group contrast of neural signals in the shame condition revealed a stronger activation of cingulate and fusiform gyrus for the BPD patients compared to the controls, and a more pronounced activation in the lingual gyrus and cuneus for the HCs. In the guilt condition, activation in the caudate nucleus, the fusiform gyrus, and the posterior cingulate cortex was stronger in BPD patients, while HC showed stronger activations in cuneus, lingual gyrus, and fronto-temporal regions. CONCLUSIONS: Differences in the neuro-functional processes between BPD patients and HC were found, even though the two groups did not differ in their self-report of subjective proneness to guilt and emotional intensity of shame and guilt during the experiment. While the HCs may be engaged more by the emotional scenarios themselves, the BPD patients may be more occupied with cognitive regulatory and self-referential processing.

[Everyday Life and Mental Health of Elderly with Cognitive Impairment During the Covid-19 Pandemic]. / Lebensalltag und psychosoziale Gesundheit älterer Menschen mit kognitiven Beeinträchtigungen während der COVID-19-Pandemie.

OBJECTIVE: The aim is to analyze pandemic-related effects on everyday life and psychosocial health in the understudied vulnerable group of cognitively impaired elderly people living at home. METHODS: Structured telephone interviews in 2020 (n+=+141) and 2021 (n+=+107) were used to survey over-65s with cognitive impairment (MMSE Ø 23.4). The results from the 2021 survey presented here reflect experiences and attitudes, effects on daily life and health care, and psychosocial burdens and resources. Longitudinal analysis of selected indicators of burden is provided for n+=+66. RESULTS: Even in the face of increasing concerns and moderate impacts on everyday life and health care, overall psychosocial health is proving to be good and largely stable over time. CONCLUSION: Respondents have high levels of personal and social resources, and their coping with limitations is characterized by acceptance and willingness to adapt.

Two Sides of Theory of Mind: Mental State Attribution to Moving Shapes in Paranoid Schizophrenia Is Independent of the Severity of Positive Symptoms.

BACKGROUND: Theory of Mind (ToM) impairment has repeatedly been found in paranoid schizophrenia. The current study aims at investigating whether this is related to a deficit in ToM (undermentalizing) or an increased ToM ability to hyperattribute others' mental states (overmentalizing). METHODS: Mental state attribution was examined in 24 patients diagnosed with schizophrenia (12 acute paranoid (APS) and 12 post-acute paranoid (PPS)) with regard to positive symptoms as well as matched healthy persons using a moving shapes paradigm. We used 3-T-functional magnetic resonance imaging (fMRI) to provide insights into the neural underpinnings of ToM due to attributional processes in different states of paranoid schizophrenia. RESULTS: In the condition that makes demands on theory of mind skills (ToM condition), in patients with diagnosed schizophrenia less appropriate mental state descriptions have been used, and they attributed mental states less often to the moving shapes than healthy persons. On a neural level, patients suffering from schizophrenia exhibited within the ToM network hypoactivity in the medial prefrontal cortex (MPFC) and hyperactivity in the temporo-parietal junction (TPJ) as compared to the healthy sample. CONCLUSIONS: Our results indicate both undermentalizing and hypoactivity in the MPFC and increased overattribution related to hyperactivity in the TPJ in paranoid schizophrenia, providing new implications for understanding ToM in paranoid schizophrenia.