[VR-supported therapy for anxiety and posttraumatic stress disorder: current possibilities and limitations]. / VR-gestützte Therapie bei Angst und posttraumatischer Belastungsstörung: aktuelle Möglichkeiten und Grenzen.

BACKGROUND: Virtual reality (VR) is increasingly used in psychotherapy, and the speed of development of therapeutic VR tools is continuously increasing. OBJECTIVE: This narrative review provides an overview of the state of the art regarding VR applications for psychotherapy. MATERIAL AND METHODS: The current state of VR therapy research for anxiety disorders and posttraumatic stress disorder (PTSD) is summarized. The focus lies on VR exposure therapy. Current developments in the field are outlined. RESULTS: For anxiety disorders, especially phobic disorders, there are already positive recommendations in the current German S3 guidelines. For PTSD, the development of VR therapy tools is still in a relatively early stage. CONCLUSION: The development of mobile cost-effective VR solutions in recent years has enabled entirely new applications for VR. The empirical challenges of these new developments are considerable. Nevertheless, the chances for an improvement of psychotherapeutic routine care are good.

Human cytomegalovirus seropositivity is associated with reduced patient survival during sepsis.

BACKGROUND: Sepsis is one of the leading causes of death. Treatment attempts targeting the immune response regularly fail in clinical trials. As HCMV latency can modulate the immune response and changes the immune cell composition, we hypothesized that HCMV serostatus affects mortality in sepsis patients. METHODS: We determined the HCMV serostatus (i.e., latency) of 410 prospectively enrolled patients of the multicenter SepsisDataNet.NRW study. Patients were recruited according to the SEPSIS-3 criteria and clinical data were recorded in an observational approach. We quantified 13 cytokines at Days 1, 4, and 8 after enrollment. Proteomics data were analyzed from the plasma samples of 171 patients. RESULTS: The 30-day mortality was higher in HCMV-seropositive patients than in seronegative sepsis patients (38% vs. 25%, respectively; p = 0.008; HR, 1.656; 95% CI 1.135-2.417). This effect was observed independent of age (p = 0.010; HR, 1.673; 95% CI 1.131-2.477). The predictive value on the outcome of the increased concentrations of IL-6 was present only in the seropositive cohort (30-day mortality, 63% vs. 24%; HR 3.250; 95% CI 2.075-5.090; p < 0.001) with no significant differences in serum concentrations of IL-6 between the two groups. Procalcitonin and IL-10 exhibited the same behavior and were predictive of the outcome only in HCMV-seropositive patients. CONCLUSION: We suggest that the predictive value of inflammation-associated biomarkers should be re-evaluated with regard to the HCMV serostatus. Targeting HCMV latency might open a new approach to selecting suitable patients for individualized treatment in sepsis.

Did the mental health and well-being of young people increase after the COVID-19 vaccination campaign period? A cross-sectional multicentre study in Austria and Turkey.

In 2019, the global Coronavirus (COVID-19) pandemic and associated prevention measures affected the mental health and psychological well-being of young people with and without a migratory background. The present study aimed to compare the mental health and psychological well-being of migrant and non-migrant young people before and after the COVID-19 vaccination campaign period in two countries which had different policies to deal with the pandemic. The "Psychological General Well-being" of young people and their experiences during the pandemic were investigated using an anonymous online survey during two pandemic waves before the vaccination campaign and 6 months after its start. A majority of the 6154 participants (aged between 15 and 25 years in all study groups) reported a decrease of mental health from the time period before the vaccination (BV) to after the vaccination (AV) campaign (b = 0.27, p < .001). This association was higher in females (b = 0.04, p = 0.008) and in youth with financial problems (b = 0.13, p < .001). Furthermore, this decrease was more pronounced in people ≤17 years old (40% to 62%) than in those >17 years (59% to 67%). Contrary to expectation, vulnerable groups such as the economically disadvantaged, younger, and female participants did not experience a significant easing of the pandemic's psychological burden AV. Vaccination campaigns should continue emphasizing the beneficial effects of COVID-19 vaccination on general well-being, but with an acknowledgement that the road to recovery is still a long one. Concurrently, free access to psychological treatment and financial support should be offered, especially for vulnerable groups. Supplementary Information: The online version contains supplementary material available at 10.1007/s12144-023-04366-x.

'The world somehow stopped moving': impact of the COVID-19 pandemic on adolescent psychiatric outpatients and the implementation of teletherapy.

BACKGROUND: The COVID-19 pandemic results in disproportional consequences for psychiatric patients. Due to restraints in physical contacts, providers switched from face-to-face contacts to teletherapy, but prior experiences were mostly limited. The study aimed at assessing symptom dynamics, potentially increased adversities and factors influencing a successful transition into teletherapy in adolescent psychiatric outpatients during the COVID-19 pandemic. METHOD: Thirty adolescent psychiatric outpatients participated in an interview-based study. The differential impact of the COVID-19 pandemic was measured by integrating patients' and psychiatrists' judgements. RESULTS: Patients who reported deteriorated symptoms and patients who showed (partial) improvement of symptomatology could be separated by feelings of isolation (specific to deterioration) and perceived reduction in school-associated stress (unique to improvement). Patients with worsening symptomatology showed a significantly higher degree of psychosocial disability before lockdown and at the first interview. Patients who deteriorated in their level of psychosocial functioning also reported negatively on teletherapy. These patients were verbally less differentiated concerning emotions and affect, reported introspection and rumination, and stated distinctly lower levels of perceived social support. Concerning adversities, no clear trend could be identified, but some patients reported increased domestic violence and neglect. CONCLUSIONS: Patients with a higher degree of psychosocial disability suffer disproportionally from the crisis, so that an assessment of functioning should serve as a triage tool. Also, a screening of the perceived level of social support should be established before offering teletherapy. Additionally, the provision of strategies to enhance verbalisation and differentiation of emotions and affect might be beneficial.

Coping styles mediating the relationship between perceived chronic stress and conspiracy beliefs about COVID-19.

As a global health crisis, COVID-19 has led to a rise in overall stress levels. Concurrently, conspiracy beliefs regarding the origin and spread of the disease have become widespread. Engaging in such beliefs can be explained as a form of coping in order to deal with elevated levels of stress. The present study investigated the indirect effects of coping strategies in the association between perceived chronic stress and COVID-related conspiracy beliefs. We report data from an online survey (N = 1,354 individuals: 807 female; 508 male; 8 diverse; 6 not specified; mean age 39.14 years) in German-speaking countries collected between January and March 2021. Our results indicate that people who felt more stressed were more prone to conspiracy beliefs. Coping via acceptance and self-blame was associated with decreased tendencies towards COVID-related conspiracy beliefs, while people who used denial as a strategy were more prone to these beliefs. These findings emphasize the need for stress management interventions and effective coping strategies during times of crisis in order to reduce chronic perceived stress, promote adaptive coping, and ultimately reduce conspiracy beliefs.

Efficacy of dialectical behavior therapy for adolescent self-harm and suicidal ideation: a systematic review and meta-analysis.

BACKGROUND: Given the widespread nature and clinical consequences of self-harm and suicidal ideation among adolescents, establishing the efficacy of developmentally appropriate treatments that reduce both self-harm and suicidal ideation in the context of broader adolescent psychopathology is critical. METHODS: We conducted a systematic review and meta-analysis of the Dialectical Behaviour Therapy for Adolescents (DBT-A) literature on treating self-injury in adolescents (12-19 years). We searched for eligible trials and treatment evaluations published prior to July 2020 in MEDLINE/PubMed, Scopus, Google Scholar, EMBASE, and the Cochrane Library databases for clinical trials. Twenty-one studies were identified [five randomized-controlled trials (RCTs), three controlled clinical trials (CCTs), and 13 pre-post evaluations]. We extracted data for predefined primary (self-harm, suicidal ideation) and secondary outcomes (borderline personality symptoms; BPD) and calculated treatment effects for RCTs/CCTs and pre-post evaluations. This meta-analysis was pre-registered with OSF: osf.io/v83e7. RESULTS: Overall, the studies comprised 1673 adolescents. Compared to control groups, DBT-A showed small to moderate effects for reducing self-harm (g = -0.44; 95% CI -0.81 to -0.07) and suicidal ideation (g = -0.31, 95% CI -0.52 to -0.09). Pre-post evaluations suggested large effects for all outcomes (self-harm: g = -0.98, 95% CI -1.15 to -0.81; suicidal ideation: g = -1.16, 95% CI -1.51 to -0.80; BPD symptoms: g = -0.97, 95% CI -1.31 to -0.63). CONCLUSIONS: DBT-A appears to be a valuable treatment in reducing both adolescent self-harm and suicidal ideation. However, evidence that DBT-A reduces BPD symptoms was only found in pre-post evaluations.

The impact of problematic smartphone use on children's and adolescents' quality of life: A systematic review.

AIM: To provide a systematic review on studies examining problematic smartphone (PSU) use in children and adolescents, and its impact on quality of life, life satisfaction, and well-being. METHODS: An extensive literature search was conducted in Google Scholar, Scopus and Pubmed. RESULTS: The search yielded k = 9 articles for which inclusion criteria were met. Five studies examined health-related or overall quality of life, two assessed life satisfaction, and two evaluated well-being in relation to PSU. Negative associations between PSU and the outcome variables were reported almost consistently, with one study yielding only a trend for a negative correlation of PSU with life satisfaction, and one study finding no significant correlation regarding quality of life. Comparability between studies was impeded by the scarcity of studies which met inclusion criteria and by the use of different measures. CONCLUSION: More research is needed regarding PSU and the outcome variables in children and adolescents. Also, a distinct and consistent theoretical conceptualisation of PSU is required to replicate findings, and to enhance comparability between studies. Based on the trend reported here, the development of customised, early on interventions for children and adolescents at risk of PSU is warranted.

Mothers' and Fathers' Perspectives on the Causes of Their Child's Disorder.

BACKGROUND: Parental beliefs about the cause of their child's illness are thought to affect parents' help-seeking behaviors, treatment decisions, and the child's health outcomes. Yet, research on parental beliefs about disease causation is still scarce. While a small number of studies assesses parental cause attributions for singular disorders (e.g., neurodevelopmental disorders), no study has compared disorders with differing physical versus mental conditions or with mixed comorbidities in children and adolescents or their caregivers. Furthermore, most pediatric research suffers from a lack of data on fathers. OBJECTIVE: Hence, the objective of the current study was to test for possible differences in mothers' and fathers' perceptions about the etiology of their child's illness. METHODS: Forty-two parent couples (overall N = 84) whose child had been diagnosed either with Attention Deficit Hyperactivity-Disorder (ADHD) or Autism Spectrum Disorder (ASD) (category "neurodevelopmental disorder") or with a primary physical illness and a comorbid mental disorder, e.g. depression (category "psychosomatic disorder") were asked to rate possible causes of their child's illness using a modified version of the revised Illness Perception Questionnaire (IPQ) Cause scale. RESULTS: A two-way ANOVA showed that psychosomatic disorders were significantly more strongly attributed to be caused by medical and environmental stressors than neurodevelopmental disorders. A significant parent × illness category interaction revealed that this effect was more pronounced in fathers. CONCLUSIONS: By providing first insights into parental beliefs about the etiology of their children's neurodevelopmental versus psychosomatic disorders, this study paves ground for future research and tailored counseling of affected families.

Triggers for attempted suicide in Istanbul youth, with special reference to their socio-demographic background.

OBJECTIVE: Suicidal behavior of young people is a topic of utmost importance because suicide is irreversible, and should be prevented. Knowing about the psychosocial background and the triggering events could help in preventing suicidal behavior. We therefore aimed at identifying psychosocial factors that may trigger suicidal behavior in youth. METHODS: We analyzed retrospectively the standardized records of 2232 youths aged ≤25 years, who were treated after a suicide attempt at emergency units of public hospitals in Istanbul, Turkey during a period of 1 year. We describe this population according to sex and socio-economic conditions, like educational, occupational, relationship status and link them with their reported reasons for suicide attempts. RESULTS: The majority of patients were female (81.6%, N = 1822 females, 18.4%, N = 410 males). Independent of their educational and occupational background, patients indicated most frequently intra-familial problems (females 45.8%, males 30.5%), intrapersonal problems (females 19.9%, males 18.5%), and relationship problems (females 11.3%, males 23.9%) as triggering reasons. CONCLUSIONS: Because intra-familial problems were the most frequently reported triggers of suicide attempts, preventive measures should focus on handling intra-familial conflicts. As sex differences were observed for the second-most common trigger-reasons, prevention should also focus on differentially handling intrapersonal and relationship conflicts better.

Erratum to: Frailty has a stronger association with inflammation than age in older veterans.

[This corrects the article DOI: 10.1186/s12979-016-0082-z.].

Frailty has a stronger association with inflammation than age in older veterans.

BACKGROUND: Upregulation of pro-inflammatory cytokines has not only been associated with increased morbidity and mortality in older adults but also has been linked to frailty. In the current study we aimed to compare the relative relationship of age and frailty on inflammation and thrombosis in older veterans. RESULTS: We analyzed 117 subjects (age range 62-95 years; median 81) divided into 3 cohorts: non-frail, pre-frail and frail based on the Fried phenotype of frailty. Serum inflammatory markers were determined using commercially available ELISA kits. Frail and pre-frail (PF) subjects had higher levels than non-frail (NF) subjects of IL-6 (NF vs. PF: p = 0.002; NF vs. F: p < 0.001), TNFR1 (NF vs. F: p = 0.012), TNFRII (NF vs. F: 0.002; NF vs. PF: p = 0.005) and inflammatory index: = 0.333*log(IL-6) + 0.666*log(sTNFR1) (NF vs. F: p = 0.009; NF vs. PF: p < 0.001). Frailty status explained a greater percent of variability in markers of inflammation than age: IL-6 (12 % vs. 0.3 %), TNFR1 (5 % vs. 4 %), TNFR2 (11 % vs. 6 %), inflammatory index (16 % vs. 8 %). Aging was significantly associated with higher fibrinogen (p = 0.04) and D-dimer levels (p = 0.01) but only among NF subjects. CONCLUSION: In conclusion, these data suggest that among older veterans, frailty status has a stronger association with inflammation and the inflammatory index than age does. Larger studies, in more diverse populations are needed to confirm these findings.

How to Prevent Depression? Current Directions and Future Challenges in Children with Chronic Medical Conditions.

With its high rates of chronicity and concomitant economic costs to society, depression ranges among the most prevalent mental disorders. Several trials have succeeded in demonstrating the beneficial effects of early depression prevention programs for otherwise healthy children and adolescents. However, comparable programs for children and adolescents with a medical condition are still scarce. This paper discusses the situation of chronically ill children and adolescents who are at risk of developing comorbid depressive symptoms using the example of three conditions frequently encountered in pediatric psychosomatic medicine: diabetes, epilepsy and inflammatory bowel disease (IBD). Each patient group is introduced with regards to specific risk factors and correlates of depression. Also, existing customized depression prevention programs and according research trials are presented. Reviewing the body of literature, it becomes apparent that risk factor research and depression prevention are still in their infancy for these three patient groups. While new risk factor models and biomarker approaches emerge as a promising rationale for depression prevention, research is called upon to include randomized control trials as well as longitudinal designs in order to achieve more optimally tailored preventive interventions for children and adolescents with chronic medical conditions.

Preclinical safety and tolerability of a repeatedly administered human leishmaniasis DNA vaccine.

The leishmaniases are a complex of vector-borne diseases caused by protozoan parasites of the genus Leishmania. LEISHDNAVAX is a multi-antigen, T-cell epitope-enriched DNA vaccine candidate against human leishmaniasis. The vaccine candidate has been proven immunogenic and showed prophylactic efficacy in preclinical studies. Here, we describe the safety testing of LEISHDNAVAX in naive mice and rats, complemented by the demonstration of tolerability in Leishmania-infected mice. Biodistribution and persistence were examined following single and repeated intradermal (i.d.) administration to rats. DNA vectors were distributed systemically but did not accumulate upon repeated injections. Although vector DNA was cleared from most other tissues within 60 days after the last injection, it persisted in skin at the site of injection and in draining lymph nodes. Evaluation of single-dose and repeated-dose toxicity of the vaccine candidate after i.d. administration to naive, non-infected mice did not reveal any safety concerns. LEISHDNAVAX was also well tolerated in Leishmania-infected mice. Taken together, our results substantiate a favorable safety profile of LEISHDNAVAX in both naive and infected animals and thus, support the initiation of clinical trials for both preventive and therapeutic applications of the vaccine.

Immune response of healthy horses to DNA constructs formulated with a cationic lipid transfection reagent.

BACKGROUND: Deoxyribonucleic acid (DNA) vaccines are used for experimental immunotherapy of equine melanoma. The injection of complexed linear DNA encoding interleukin (IL)-12/IL-18 induced partial tumour remission in a clinical study including 27 grey horses. To date, the detailed mechanism of the anti-tumour effect of this treatment is unknown. RESULTS: In the present study, the clinical and cellular responses of 24 healthy horses were monitored over 72 h after simultaneous intradermal and intramuscular application of equine IL-12/IL-18 DNA (complexed with a transfection reagent) or comparative substances (transfection reagent only, nonsense DNA, nonsense DNA depleted of CG). Although the strongest effect was observed in horses treated with expressing DNA, horses in all groups treated with DNA showed systemic responses. In these horses treated with DNA, rectal temperatures were elevated after treatment and serum amyloid A increased. Total leukocyte and neutrophil counts increased, while lymphocyte numbers decreased. The secretion of tumour necrosis factor alpha (TNFα) and interferon gamma (IFNγ) from peripheral mononuclear blood cells ex vivo increased after treatments with DNA, while IL-10 secretion decreased. Horses treated with DNA had significantly higher myeloid cell numbers and chemokine (C-X-C motif) ligand (CXCL)-10 expression in skin samples at the intradermal injection sites compared to horses treated with transfection reagent only, suggesting an inflammatory response to DNA treatment. In horses treated with expressing DNA, however, local CXCL-10 expression was highest and immunohistochemistry revealed more intradermal IL-12-positive cells when compared to the other treatment groups. In contrast to non-grey horses, grey horses showed fewer effects of DNA treatments on blood lymphocyte counts, TNFα secretion and myeloid cell infiltration in the dermis. CONCLUSION: Treatment with complexed linear DNA constructs induced an inflammatory response independent of the coding sequence and of CG motif content. Expressing IL-12/IL-18 DNA locally induces expression of the downstream mediator CXCL-10. The grey horses included appeared to display an attenuated immune response to DNA treatment, although grey horses bearing melanoma responded to this treatment with moderate tumour remission in a preceding study. Whether the different immunological reactivity compared to other horses may contributes to the melanoma susceptibility of grey horses remains to be elucidated.

Efficacy of mentalization-based therapy in treating self-harm: A systematic review and meta-analysis.

INTRODUCTION: Mentalization-based therapy (MBT) and its adapted version for adolescents (MBT-A) are repeatedly highlighted as promising treatments for reducing self-harm, particularly in borderline personality disorder (BPD). Despite the availability of publications providing evidence of their efficacy in reducing self-harm, recent meta-analyses have yielded mixed results. To inform best-practice clinical decision-making, we conducted a systematic review and meta-analysis. We aimed to disentangle findings for both adolescents and adults on the efficacy of MBT(-A) in reducing self-harm (primary outcome) and symptoms of BPD and depression (secondary outcomes). METHODS: Web of Science, Scopus, Embase, PubMed/Medline, and Cochrane Review Database were searched for eligible studies published until September 2022. In total, 14 studies were identified, comprising 612 participants from nine MBT studies (six pre-post, three RCTs) and five MBT-A studies (two pre-post, three RCTs). Aggregated effect sizes were estimated using random-effects models. Meta-regressions were conducted to assess the effect of moderator variables (treatment duration, drop-out rates, and age) on effect sizes. RESULTS: Overall, both MBT and MBT-A demonstrated promising effects in reducing self-harm (g = -0.82, 95% CI -1.15 to -0.50), borderline personality disorder (g = -1.08, 95% CI -1.38 to -0.77), and depression (g = -1.1, 95% CI -1.52 to -0.68) symptoms. However, when compared to control interventions (TAU, SCM), MBT(-A) did not prove to be more efficacious, with the exception of MBT showing superior effects on BPD symptoms in adults (g = -0.56, 95% CI -0.88 to -0.24). CONCLUSION: Although the pre-post evaluations seem promising, this analysis, including RCTs, showed no superiority of MBT(-A) to control conditions, so that prioritizing the application of MBT (-A) for the treatment of self-harm is not supported. Possible explanations and further implications are discussed.

Exploring the relationship between media use and depressive symptoms among gender diverse youth: findings of the Mental Health Days Study.

BACKGROUND: Over the past decades, media use has become a key aspect of young people's daily lives, significantly shaping their social interactions, learning processes, and recreational pursuits. At the same time, healthcare professionals and researchers are increasingly concerned about the impact of media use on young people's mental health. This concern is particularly relevant for gender diverse youth who may have distinct experiences with media that could impact their mental health uniquely compared to their peers, such as increased exposure to cyberbullying and negative content regarding their gender identity. This study aims to explore the associations between media use and depressive symptoms among youth and examine if gender moderates this association. METHODS: This study utilized a cross-sectional design involving a school-based sample of 8158 participants (Mage = 14.05 years, SD = 2.45, Ndiverse = 144) from Austria. Participants completed a survey assessing their media use and depressive symptoms using the Patient Health Questionnaire-9 (PHQ-9). Media use was measured by asking participants to report their daily usage in hours and minutes across various categories, including smartphone use, streaming services, social networks, and other media types. Multiple regression analyses were conducted to examine relationships between different forms of media use and depressive symptoms. Moderation analyses were performed using the PROCESS macro for SPSS to explore the role of gender. RESULTS: For gender diverse youth, multiple regression analysis identified streaming services (ß = 0.265, p = .005) and social networks (ß = 0.189, p = .037) as significant predictors of depressive symptoms in gender diverse youth. Moderation analyses conducted with the entire sample showed that gender moderates the relationship between depressive symptoms and smartphone use (B = - 0.008, p = .014), with the effect being the most negative for gender diverse individuals. CONCLUSION: The findings underscore the complex relationship between media use and depressive symptoms among gender diverse youth, emphasizing the moderating role of gender. These results underline the need for gender-sensitive approaches in media literacy and mental health interventions. Stakeholders should be aware of risks and benefits of different media types to foster healthy media engagement.

Attentional Biases and Nonsuicidal Self-Injury Urges in Adolescents.

Importance: Nonsuicidal self-injury (NSSI) is a significant clinical concern among adolescents. Exposure to NSSI-related content on social media platforms has been suspected to potentially act as a trigger for NSSI. Objective: To use free-viewing eye-tracking and dot-probe paradigms to examine attentional bias and psychophysiological responses to NSSI-related pictorial and textual stimuli in adolescents with and without a history of NSSI. Design, Setting, and Participants: From June 2022 to April 2023, adolescent participants in Vienna, Austria with and without a history of NSSI were exposed to NSSI-related stimuli in this nonrandomized controlled trial. Data were analyzed from December 2023 to January 2024. Exposure: Exposure to NSSI-related stimuli. Main Outcomes and Measures: During both tasks, subjective arousal, NSSI urges, and autonomic nervous system activity were assessed. Results: A total of 50 adolescents in 2 groups, 25 who engaged in NSSI (mean [SD] age 15.86 [1.14] years; 19 female participants [76%]) and 25 who did not (mean [SD] age 16.40 [1.71] years; 19 female participants [76%]) were included. Adolescents with a history of NSSI-but not those without a history of NSSI-showed a clear attentional bias toward NSSI-related images during eye-tracking, as indicated by increased initial fixations (500 ms stimulus presentation mean difference, 28.64%; 95% CI, 18.31%-38.98%; P < .001; 1000 ms stimulus presentation mean difference, 18.50%; 95% CI, 9.05%-27.95%; P < .001) and longer fixation durations (500 ms mean difference, 29.51 ms; 95% CI, 4.3-54.72 ms; P < .001; 1000 ms mean difference, 39.83 ms; 95% CI, 6.90-72.76 ms; P < .001), regardless of stimulus duration. This bias was associated with a heightened urge to engage in NSSI (d = 1.22; 95% CI, 0.69-1.73; P < .001), a trend not seen in adolescents without a history of NSSI. Similarly, in the dot-probe task, only the NSSI group showed an attentional bias toward NSSI images but not toward trauma images, emphasizing the specificity of their attentional bias. Physiological measures revealed no significant differences, suggesting that viewing NSSI images is not associated with increased autonomic arousal. Textual NSSI content did not provoke an attentional bias or heighten NSSI urges in either group. Conclusions and Relevance: In this nonrandomized controlled trial of 50 adolescents, results highlighted a specific attentional bias toward NSSI-related pictorial stimuli in adolescents with a history of NSSI, particularly a difficulty in disengaging from NSSI images. These findings contribute to understanding maladaptive information processing in NSSI and suggest implications for clinical management and cognitive models addressing NSSI triggers. Trial Registration: German Clinical Trials Register identifier: DRKS00025905.

On the rise or a return to pre-pandemic levels? A cross-sectional online survey on nicotine, alcohol, and illicit drug use among youth.

OBJECTIVES: The COVID-19 pandemic has had unprecedented and deteriorating effects on the mental health of adolescents and young adults. Various studies have described changes regarding substance abuse, but findings are conflicting. STUDY DESIGN: We conducted a cross-sectional online survey on nicotine, alcohol, and illicit drug use. METHODS: From March to May 2023, 502 participants aged 14-24 from a community-based sample completed the questionnaire. RESULTS: We found a general trend of declining or stable substance use during the first 2 years of the pandemic; however, in the third year (i.e., 2022), substance use returned to pre-pandemic levels or exceeded it. Compared with young adults (age 19-24), adolescents' (age 14-18) use increased more clearly. Participants who scored above the cut-off on screening measures for problematic substance use showed a more pronounced increase in the use of cigarettes and illicit drugs but not of alcohol. Higher alcohol consumption during lockdowns was associated with increased likelihood of current problematic alcohol (odds ratio [OR]: 3.03) and cannabis use (OR: 2.60). Furthermore, individuals who reported increased usage of one psychotropic substance during lockdowns were more likely to have increased their use of other substances as well (OR: 2.66-4.87). CONCLUSIONS: Although not optimally generalizable due to the retrospective online format and convenience sampling, our results support the notion that special attention ought to be paid to certain subgroups such as younger people and those who already exhibit problematic substance use during the pandemic. Following up on post-pandemic trends in substance use is crucial for developing prevention measures and targeted interventions.

Burdens and resources of Austrian clinical psychologists: results of a qualitative study two years into the COVID-19 pandemic.

BACKGROUND: The COVID-19 pandemic increased the mental health burden in the general population, enhancing the demands placed on mental healthcare professionals. METHODS: This study aimed to assess the burdens and resources of clinical psychologists that emerged since the beginning of the pandemic. N = 172 Austrian clinical psychologists participated in a cross-sectional online survey between April and May 2022. The burdens and the sources of support that emerged during the pandemic were analyzed using qualitative content analysis. RESULTS: Mental health-related issues were identified as the greatest burden, followed by work-related themes and restrictions imposed by the government to combat the spreading of the virus. The most important resources mentioned by the clinical psychologists were social contacts and recreational activities. Practising mindfulness and focusing on inner processes and work-related aspects were further important resources mentioned. CONCLUSION: Overall, it seems that clinical psychologists have a high awareness of mental health-related problems related to the pandemic and use adaptive coping strategies to deal with them.

[Urinary diversion in old patients (80+ years)]. / Harnableitung beim alten Patienten (80+).

With increasing life expectancy there is also an increased need for the management of older (≥ 80 years) patients with the diagnosis of muscle-invasive bladder cancer. Radical cystectomy with urinary diversion is the state of the art treatment (with neoadjuvant chemotherapy, as long as the patient is fit enough). Choosing the best urinary diversion with respect to morbidity compared to functionality and quality of life remains a challenge in these patients. Physical age alone is not decisive for making a decision. A thorough preoperative assessment of medical features, physical and cognitive impairments is more important. Older patients are generally provided with an ileal conduit as an incontinent urinary diversion, as the intervention involves reduced operating times and complexity compared to continent urinary diversions; however, in the case of good health status with an adequate life expectancy and sufficient compliance, continent diversions may be considered even in aged candidates. In the case of multimorbid patients with a high perioperative risk, ureterostomy with permanent ureteric stents is an important alternative. Most importantly, a thorough preoperative counselling enables patients to reach an informed decision.