How do the guideline recommendations work for you? Patients' perceived effectiveness of therapeutic approaches in arterial hypertension.

Blood pressure remains in the hypertensive range in nearly half of those affected by arterial hypertension despite it being an extremely modifiable risk factor, whereby morbidity decreases significantly upon implementation of lifestyle-based therapeutic approaches. There are significant discrepancies between the S3 guideline's recommendations and its implementation. In this cross-sectional study sampling 160 inpatients with arterial hypertension, we assessed patients' perceptions of secondary prevention therapeutic approaches recommended to them within treatment guidelines. Additionally, we used psychometric questionnaires to assess prevention factors. We conducted a latent class analysis to identify patterns in patients' views, and tested for group differences regarding gender, age, education years, body mass index, psychopathology, and blood pressure. Two latent classes could be identified: Class 1 tended to perceive all recommended therapeutic approaches as helpful and reflected individuals with high-normal blood pressure. Class 2 tended to view recommendations regarding weight reduction, and cessation of nicotine and alcohol use, as less effective and included those with mild hypertension. There were no statistically significant class differences regarding the socio-demographic parameters. We further examined the evaluation of therapeutic approaches independent of classes, with social support reported to be the most effective approach. In conclusion, persistently-elevated blood pressure may be linked to poorer perceptions of therapeutic approaches which are then not implemented. Furthermore, patient-centered treatment planning and concepts such as shared decision-making appear to be central in treating this population regarding secondary prevention.

Co-occurrence, stability and manifestation of child and adolescent mental health problems: a latent transition analysis.

BACKGROUND: Complex constellations of socio-emotional and behavioural problems (i.e., mental health problems) in childhood and adolescence are common and heighten the risk for subsequent personality, anxiety and mood disorders in adulthood. Aims of this study included the examination of patterns of mental health problems (e.g., externalizing-internalizing co-occurrence) and their transitions to reported mental disorders by using a longitudinal person-centered approach (latent class and latent transition analysis). METHODS: The sample consisted of 1255 children and adolescents (51.7% female, mean age = 12.3 years, age range 8-26 years) from three time points of the comprehensive mental health and wellbeing BELLA study. Children and their parents completed the German SDQ (Strength and Difficulties Questionnaire, Goodman, 1997) and reported on diagnoses of ADHD, depression, and anxiety. RESULTS: Latent class analysis identified a normative class, an emotional problem class, and a multiple problem class. According to latent transition analysis, the majority of the sample (91.6%) did not change latent class membership over time; 14.7% of individuals showed a persistent pattern of mental health problems. Diagnoses of mental disorders were more likely to be reported by individuals in the emotional problem or multiple problem class. CONCLUSIONS: Results highlight the need for early prevention of mental health problems to avoid accumulation and manifestation in the transition to adolescence and young adulthood.

The big five model in bipolar disorder: a latent profile analysis and its impact on longterm illness severity.

BACKGROUND: Using a personality typing approach, we investigated the relationship between personality profiles and the prediction of longterm illness severity in patients with bipolar disorder (BD). While previous research suggests associations between BD and traits from the NEO-FFI profiles, the current study firstly aimed to identify latent classes of NEO-FFI profiles, and, secondly, to examine their impact on the longterm prognosis of BD. METHODS: Based on the NEO-FFI profiles of 134 euthymic patients diagnosed with BD (64.2% female, mean age = 44.3 years), successive latent profile analyses were conducted. Subsequently, a subsample (n = 80) was examined prospectively by performing multiple regression analysis of the latent classes to evaluate the longitudinal course of the disease (mean: 54.7 weeks) measured using a modified Morbidity Index. RESULTS: The latent profile analyses suggested a 3-class model typifying in a resilient (n = 68, 51%), vulnerable (n = 55, 41%) and highly vulnerable (n = 11, 8%) class. In the regression analysis, higher vulnerability predicted a higher longterm Morbidity Index (R2 = 0.28). CONCLUSIONS: Subgroups of patients with BD share a number of discrete personality features and their illness is characterized by a similar clinical course. This knowledge is valuable in a variety of clinical contexts including early detection, intervention planning and treatment process.