Enduring effects of psychological treatments for anxiety disorders: meta-analysis of follow-up studies.

BACKGROUND: It is a widespread opinion that after treatment with psychotherapy, patients with anxiety disorders maintain their gains beyond the active treatment period, whereas patients treated with medication soon experience a relapse after treatment termination.AimsWe aimed to provide evidence on whether enduring effects of psychotherapy differ from control groups. METHOD: We searched 93 randomised controlled studies with 152 study arms of psychological treatment (cognitive-behavioural therapy or other psychotherapies) for panic disorder, generalised anxiety disorder and social anxiety disorder that included follow-up assessments. In a meta-analysis, pre-post effect sizes for end-point and all follow-up periods were calculated and compared with control groups (medication: n = 16 study arms; pill and psychological placebo groups: n = 17 study arms). RESULTS: Gains with psychotherapy were maintained for up to 24 months. For cognitive-behavioural therapy, we observed a significant improvement over time. However, patients in the medication group remained stable during the treatment-free period, with no significant difference when compared with psychotherapy. Patients in the placebo group did not deteriorate during follow-up, but showed significantly worse outcomes than patients in cognitive-behavioural therapy. CONCLUSIONS: Not only psychotherapy, but also medications and, to a lesser extent, placebo conditions have enduring effects. Long-lasting treatment effects observed in the follow-up period may be superimposed by effects of spontaneous remission or regression to the mean.Declaration of interestIn the past 12 months and in the near future, Dr Bandelow has been/will be on the speakers/advisory board for Hexal, Mundipharma, Lilly, Lundbeck, Pfizer and Servier. Dr Wedekind was on the speakers' board of AstraZeneca, Essex Pharma, Lundbeck and Servier. All other authors have nothing to declare.

Medical school admission test: advantages for students whose parents are medical doctors?

BACKGROUND: Admission candidates especially in medicine do not represent the socio-demographic proportions of the average population: children of parents with an academic background are highly overrepresented, and those with parents who are medical doctors represent quite a large and special group. At Göttingen University Medicine, a new admission procedure was established with the intention to broaden the base of applicants towards including candidates with previous medical training or lower final school grades. With a view to family background, we wished to know whether candidates differ in the test scores in our admission procedure. METHODS: In February 2014 we asked all admission candidates of Göttingen University Medicine by questionnaire (nine closed, four open questions) about the academic background in their families, specifically, the medical background, school exam grades, and previous medical training as well as about how they prepared for the admission test. We also analysed data from admission scores of this group (semi-structured interview and four multiple mini-interviews). In addition to descriptive statistics, we used a Pearson correlation, means comparisons (t-test, analysis of variance), ANOVA, and a Scheffé test. RESULTS: In February 2014 nearly half of the applicants (44%) at Göttingen University Medicine had a medical background, most frequently, their parents were physicians. This rate is much higher than reported in the literature. Other socio-demographic baseline data did not differ from the percentages given in the literature. Of all applicants, 20% had previous medical training. The group of applicants with parents who were medical doctors did not show any advantage in either test-scoring (MMI and interview), their individual preparation for the admission test, or in receiving or accepting a place at medical school. Candidates with parents who were medical doctors had scored slightly lower in school exam grades. CONCLUSION: Our results suggest that there is a self-selection bias as well as a pre-selection for this particular group of applicants. This effect has to be observed during future admission procedures.

Creativity and productivity during the COVID-19 pandemic.

This study explored impacts of the COVID-19 pandemic on creativity and productivity and how personality variables moderated these impacts. Two online self-report surveys were conducted. 863 (spring 2020) and 421 (spring 2021) participants were asked how the corona crisis affected their creativity and productivity. In addition, personality variables, namely the Big Five (openness, conscientiousness, extraversion, agreeableness, neuroticism), as well as interpersonal trust, need for cognition, risk-taking, and life satisfaction, were assessed. As a result of the crisis, the group of participants appeared more creative in 2020, while no significant group effect of the pandemic was found for productivity. In 2021, however, the crisis had a negative impact on creativity and productivity. In 2020, predictors for an improved creativity were openness, conscientiousness, neuroticism, and life satisfaction; predictors for improved productivity were conscientiousness, negative interpersonal trust, and life satisfaction. In 2021, only life satisfaction predicted improved creativity, while improved productivity was predicted by conscientiousness, negative neuroticism, and life satisfaction. At its beginning, the COVID-19 pandemic had, on average, a positive effect on creativity and a neutral one on productivity. Later, the impact turned negative on both creativity and productivity. Here, lower life satisfaction was particularly relevant.

Exploring nomophobia with a German adaption of the nomophobia questionnaire (NMP-Q-D).

Nomophobia is considered a disorder of the modern world and describes the fear of being separated from one's smartphone and being no longer connected and reachable. The aims of this Study were to translate the nomophobia questionnaire (NMP-Q) into German, validate the NMP-Q-D, and use it to shed light on the nomophobia construct. A total of 807 volunteer test subjects were included in the evaluation, 50 of them participated five months later in a retest study. A 4-factor structure of the NMP-Q-D could be confirmed by exploratory as well as by confirmatory factor analyses. The four factors are: (1) "Not being able to communicate", (2) "Losing connectedness", (3) "Not being able to access information", and (4) "Giving up convenience". The Cronbach's alpha coefficient of the NMP-Q-D was .92 and the test-retest-reliability was .80. Significant correlations of frequency of smartphone usage with time spent confirmed criterion validity of NMP-Q-D. Construct validity was given by significant correlations of NMP-Q-D to fear of missing out and smartphone addiction. Neuroticism was positively associated with nomophobia, while consciousness and openness were lightly negatively associated. Anxiety correlated significantly positively with factor 1, and stress with factors 1 and 4. Life satisfaction was positively associated with factor 3 and well-being negatively with factor 4. A multiple regression analysis revealed smartphone usage, gender, and neuroticism as significant predictors of nomophobia. Females scored significantly higher for factors 1 and 4 compared to males. Nomophobia was rather widespread in the sample: Nearly half of the participants (49.4%) had a moderate level of nomophobia and 4.1% a severe nomophobia.

Influences of negative BOLD responses on positive BOLD responses.

Understanding possible interactions between blood oxygenation level-dependent (BOLD) responses is critical for model-based analyses and the interpretation of experiments that deal with stimuli presented close together in time. Such interactions are well documented in the case of successive positive BOLD responses. However, the influence that a stimulus-induced, negative BOLD response exerts on a subsequent positive BOLD response has yet to be investigated and is the focus of the current study. We performed functional magnetic resonance imaging on 10 healthy subjects during bilateral electrical median nerve stimulation using five different time intervals between left- and right-sided stimuli. We found an acute interruption of the ongoing negative BOLD response at the onset of the positive BOLD response. Different parameters characterizing the positive BOLD response were estimated. There was no impact of the preceding negative BOLD response on the parameters describing the subsequent positive BOLD response. These findings indicate that the underlying mechanisms for negative and positive BOLD responses do not engage parallel processes. We hypothesize that the negative BOLD response is caused by a decreased release of the same vasodilatative agents that evoke the positive BOLD response. Additionally, our results demonstrate that there is no need to adjust the model of a positive BOLD response due to a preceding negative BOLD response in the same brain area.

Somatic classification of neonates based on birth weight, length, and head circumference: quantification of the effects of maternal BMI and smoking.

We defined neonates as small, appropriate, or large for gestational age (SGA, AGA, LGA) based on birth weight, length, and head circumference. We analyzed the effects on the somatic classification of maternal body mass index (BMI) (<18.5, 18.5-24.99, 25.0-29.99, ≥ 30) and smoking during pregnancy (0, 1-7, 8-14, ≥ 15 cigarettes daily). Data were from the German Perinatal Survey (1998-2000; 433,669 cases). The following refers to the classification by birth weight. In the normal maternal weight population SGA rates increased with cigarette consumption: 9.8%, 17.8%, 21.6%, and 25.4% for non-smokers, and smokers of 1-7, 8-14, and ≥ 15 cigarettes daily, respectively. In non-smoking underweight women the SGA rate was 17.4%. In underweight smokers of ≥ 15 cigarettes daily the SGA rate was 38.5% [odds ratio 5.77, 95% confidence interval 5.10-6.53, compared with normal weight non-smokers]. In the normal maternal weight population, LGA rates were 9.9%, 5.3%, 4.6%, and 3.5% for non-smokers, and smokers of 1-7, 8-14, and ≥ 15 cigarettes daily, respectively. In the obese, LGA rates were 20.9% (non-smokers) and 11.4% (≥ 15 cigarettes). Similar findings were obtained for the somatic classifications based on birth length and head circumference. Results for the various combinations of maternal BMI and smoking status in the three classification systems are described. Our findings may assist in individualized risk assessment for SGA and LGA births.

Mental Health of Flying Cabin Crews: Depression, Anxiety, and Stress Before and During the COVID-19 Pandemic.

Objectives: Initially, we analyzed relations between the challenging working conditions of flight attendants with symptoms of depression, anxiety and stress. As the COVID-19 pandemic plunged airlines into an unprecedented crisis, its impact on the mental health of flying cabin crews became the focus of a second survey. Methods: Flight attendants were surveyed online with DASS-21 in May 2019 (N = 105; sample 1) and April 2020 (N = 1119; sample 2), complemented with questions about working conditions (in 2019) and existential fears and fear of job loss (in 2020). Results: Sample 1 revealed that symptoms of depression, anxiety and stress highly correlated with the subjective assessment of working conditions, but not with objectifiable parameters. Sample 2 showed significant positive correlations between existential fears and fear of job loss with depression, anxiety and stress. Crew members, grounded in April 2020, showed significantly higher scores in depression and stress, while still flying individuals had more clinically relevant symptoms of anxiety. Mean value comparisons between sample 1 and 2 in DASS-21 revealed a significant increase in symptoms at the time of crisis with effect sizes of d = 0.63 for depression, d = 0.26 for anxiety, and d = 0.52 for stress. The incidence of clinically relevant symptoms among the respondents increased from 8 to 23% (depression), from 6 to 14% (anxiety), and from 8 to 24% (stress). Conclusion: The COVID-19 pandemic and associated work restrictions coincide with severe impairment of mental health of flying cabin crews, consistent with a mental health protecting function of labor.

Efficacy of treatments for anxiety disorders: a meta-analysis.

To our knowledge, no previous meta-analysis has attempted to compare the efficacy of pharmacological, psychological and combined treatments for the three main anxiety disorders (panic disorder, generalized anxiety disorder and social phobia). Pre-post and treated versus control effect sizes (ES) were calculated for all evaluable randomized-controlled studies (n = 234), involving 37,333 patients. Medications were associated with a significantly higher average pre-post ES [Cohen's d = 2.02 (1.90-2.15); 28,051 patients] than psychotherapies [1.22 (1.14-1.30); 6992 patients; P < 0.0001]. ES were 2.25 for serotonin-noradrenaline reuptake inhibitors (n = 23 study arms), 2.15 for benzodiazepines (n = 42), 2.09 for selective serotonin reuptake inhibitors (n = 62) and 1.83 for tricyclic antidepressants (n = 15). ES for psychotherapies were mindfulness therapies, 1.56 (n = 4); relaxation, 1.36 (n = 17); individual cognitive behavioural/exposure therapy (CBT), 1.30 (n = 93); group CBT, 1.22 (n = 18); psychodynamic therapy 1.17 (n = 5); therapies without face-to-face contact (e.g. Internet therapies), 1.11 (n = 34); eye movement desensitization reprocessing, 1.03 (n = 3); and interpersonal therapy 0.78 (n = 4). The ES was 2.12 (n = 16) for CBT/drug combinations. Exercise had an ES of 1.23 (n = 3). For control groups, ES were 1.29 for placebo pills (n = 111), 0.83 for psychological placebos (n = 16) and 0.20 for waitlists (n = 50). In direct comparisons with control groups, all investigated drugs, except for citalopram, opipramol and moclobemide, were significantly more effective than placebo. Individual CBT was more effective than waiting list, psychological placebo and pill placebo. When looking at the average pre-post ES, medications were more effective than psychotherapies. Pre-post ES for psychotherapies did not differ from pill placebos; this finding cannot be explained by heterogeneity, publication bias or allegiance effects. However, the decision on whether to choose psychotherapy, medications or a combination of the two should be left to the patient as drugs may have side effects, interactions and contraindications.

[Medical school admission test at the University of Goettingen - which applicants will benefit?]. / Das neue Göttinger Auswahlverfahren für Medizin - welche Bewerber können profitieren?

Medical schools in Germany may select 60% of the student applicants through their own admission tests. The influence of the school-leaving examination grades (EGs) in each of the procedural steps is controversial. At Goettingen Medical School, we combine a structured interview and a communicative skills assessment. We analysed how many applicants succeeded in our admission test, compared to a model which only takes EGs into account. Admission scores were transferred into SPSS-21. Sociodemographic data were submitted by the Stiftung Hochschulstart. Besides descriptive statistics, we used Pearson-correlation and means comparisons (t-test, analysis of variance). 221 applicants (EGs 1.0-1.9) were invited in the winter semester 2013/14 and 222 applicants (EGs 1.1-1.8) in the summer semester 2014. The proportion of women was 68% (winter) and 74% (summer). Sixteen and 37 applicants had a medical vocational training and performed slightly better. The analysis showed that our test was gender neutral. EGs did not correlate with interviews or skills assessment. Despite a two-fold impact of EGs, 26 (winter) and 44 (summer) of the overall 181 applicants had EGs of 1.4 -1.9, which would have been too low for admission otherwise. If EGs were only considered once, 40 (winter) and 59 (summer) applicants would have succeeded.