First international consensus statement on sports psychiatry.

Sports psychiatry is a young field of medicine and psychiatry that focuses on mental health among athletes, and sports and exercise within psychiatry and mental disorders. However, the development of sports psychiatry and its fields of activity vary from region to region and are not uniform yet. Sports psychiatry and the role of sports psychiatrists have also already been discussed in the field of sports and exercise medicine, and within medical teams in competitive and elite sports. A uniform definition on sports psychiatry, its fields of activity, sports psychiatrist, and the essential knowledge, skills, and abilities (plus attitudes, eKSA+A) of the sports psychiatrist were developed as part of an International Society for Sports Psychiatry (ISSP) Summit, as well as First International Consensus Statement on Sports Psychiatry. Three fields of activity can be distinguished within sports psychiatry: (i) mental health and disorders in competitive and elite sports, (ii) sports and exercise in prevention of and treatment for mental disorders, and (iii) mental health and sport-specific mental disorders in recreational sports. Each of these fields have its own eKSA+A. The definitions on sports psychiatry and sports psychiatrists, as well as the framework of eKSA+A in the different fields of activity of sports psychiatrists will help to unify and standardize the future development of sports psychiatry, establish a standard of service within sports psychiatry and together with the neighboring disciplines, and should be included into current, and future sports psychiatry education and training.

Athletes are not at greater risk for death by suicide: A review.

INTRODUCTION: Suicide represents a major mental and public health issue. Elite athletes share certain individual and environmental characteristics that may increase their risk for mental illnesses, ultimately leading to suicide. This notion conflicts with the general perception of athletes, being the healthiest representatives of society. METHODS: A comprehensive literature search was carried out through PubMed and Embase databases for relevant publications. RESULTS: Recent calls for investigating suicidality among athletes resulted in a considerable amount of literature providing some evidence regarding lower rates of suicide among professional and high-performance athletes as well as similar incidence and prevalence of mental conditions, which are known as risk factors for suicide. Nevertheless, special attention is required in this population as predisposing and precipitating factors might differ from classical features of suicidality in the general population. Sports physicians, sports psychiatrists, and other mental health professionals in elite sports should be aware of early signs of affective disorders, risk of recreational drug abuse, misuse of performance-enhancing medications, sport-specific environmental stressors, serious physical injuries, and presence of physical or mental illness, all of which may increase suicidality. Traumatic brain injury (TBI) is with suicide with higher severity correlated with increased risk. Compared to active athletes, former athletes may have higher rates of suicide due to common life stressors occurring after sports retirement. CONCLUSIONS: The findings suggest a multidisciplinary approach to suicidality in elite athletes, the main goal of which should be the reduction of suicide-related morbidity and mortality. Further research is required to clarify the existing gaps in the current knowledge of the issue. While having lower rates of suicide, athletes share some similar (affective disorders, drug abuse, mental and physical illness) and unique factors (misuse of performance-enhancing substances, sports-related stressors, sports injuries, TBI) putting them at risk of suicide during active career and retirement.

[Sport as applied therapy in patients with schizophrenic psychoses]. / Sport als angewandte Therapie bei Patienten mit schizophrenen Psychosen.

Sport as applied therapy in patients with schizophrenic psychoses Abstract. Schizophrenic psychoses are serious mental illnesses associated with low life expectancy compared with healthy individuals and other psychiatric disorders. Overweight and associated health problems such as diabetes mellitus, cardiovascular disease and smoking-associated lung disease have been shown to be risk factors related to high mortality. Low physical activity and increased sedentary behavior have been identified as the most important behavioral risk factors for cardiovascular diseases in people with schizophrenia. Numerous research results show a positive influence of sport on mental symptoms as well as on physical health. In the studies, however, different types of guided movement with divergent intensity were used in group or single setting. The Deutsche Gesellschaft für Psychiatrie und Psychotherapie, Psychosomatik und Nervenheilkunde [German Association for Psychiatry, Psychotherapy and Psychosomatics] recommends sports and physical exercise interventions for patients with severe mental illnesses. Still, further large randomized controlled trials are needed to investigate the nature, extent and duration, as well as the effect of the methods used in the various stages of the disease. One goal should be the evidence-based implementation of specific and systematic sport and movement interventions as a complementary module in addition to psychopharmacological and psychotherapeutic treatment in people with schizophrenia.

Exploring the relationship between low energy availability, depression and eating disorders in female athletes: a cross-sectional study.

Objective: This cross-sectional study aimed to investigate the role of low energy availability (LEA) in the interplay between depression and disordered eating/eating disorders (DE/EDs) among female athletes. The International Olympic Committee consensus statement on Relative Energy Deficiency in Sport (REDs) identified depression as both an outcome of LEA and a secondary risk factor for REDs. However, the direct link between LEA and depression has yet to be fully established. Methods: We assessed 57 female athletes participating in weight-sensitive sports at different levels of competition training at least four times a week. Assessment was conducted using laboratory analyses, clinical interviews and the Patient Health Questionnaire-9 questionnaire. Participants were recruited through various channels, including German sports clubs, Olympic training centres, social media platforms and the distribution of flyers at competitions. Indicators of LEA were defined if at least two of the following three physiological indicators were present: menstrual disturbances, suppressed resting metabolic rate and suppressed thyroid hormones. Logistic and linear regression analysis were used to examine the relationship between LEA, depression and DE/ED. Results: The lifetime prevalence of depressive disorders was 29.6%. 19% of the participants were diagnosed with an ED, and an additional 22.6% exhibited DE.LEA was not significantly associated with either lifetime prevalence of depressive disorders or current depressive symptoms. However, a significant association was found between depression and DE/ED in terms of both lifetime prevalence and current depressive symptoms. DE/ED increased the probability of lifetime prevalence of depressive disorders by 34% (19%-49%) compared with normal eating behaviour. Conclusion: We found no evidence that LEA is an independent factor for depression in female athletes. Its association with LEA and REDs appears to occur primarily in the presence of DE/ED.

Mental Health in Elite Coaches.

CONTEXT: Coaches play an important role in promoting mental health in elite sports. However, they themselves are exposed to risks affecting their mental health, and their fears and worries are often overlooked. Moreover, it remains unclear how coaches' mental health affects their athletes' mental health. OBJECTIVE: To create a compilation of the literature on (1) elite coaches' mental health and (2) how coaches' mental health influences elite athletes' mental health. Building on this, recommendations for improving coaches' psychological well-being should be elaborated upon and discussed. DATA SOURCES: A literature search was conducted up to November 30, 2021, using the following databases: PubMed, PsycINFO, Scopus, Web of Science, and SportDiscus. STUDY SELECTION: Studies reporting elite coaches' mental health symptoms and disorders and the influence of elite coaches' mental health on elite athletes' mental health were included. STUDY DESIGN: Scoping review. LEVEL OF EVIDENCE: Level 4. DATA EXTRACTION: Data regarding elite coaches' mental health, as well as their influence on athletes' mental health and performance, were included in a descriptive analysis. The PRISMA guidelines were used to guide this review. RESULTS: Little research has been done on elite coaches' mental health disorders, although studies confirm that they do experience, for example, symptoms of burnout, anxiety, and depression. The influence of coaches' mental health on their athletes is underinvestigated, with research focused mainly on the influence of coaches' stress. CONCLUSION: Knowledge about coaches' mental health is still limited. Coaches' poor mental health diminishes coaching performance and might impair athletes' mental health. Coaches should receive more support, including sports psychiatric care and education on the importance of mental health. This could improve the mental health of both coaches and athletes, and positively affect athlete performance.

Combined symptomatology of psychosis, pica syndrome, and hippocampal sclerosis: a case report.

Pica is the developmentally and culturally inappropriate eating of nonnutritive substances for at least 1 month. Herein, we present the case of a male patient that suddenly showed behavioral changes including aggressiveness, withdrawal, and perceptional disturbances at the age of 12. About 7 years later, pica symptoms emerged additionally. Neither pharmacotherapy nor electroconvulsive therapy led to success. Magnetic resonance imaging showed bilateral sclerosis of the hippocampus. The therapy with carbamazepine, clozapine, diazepam, and zinc finally improved the symptoms including the pica symptoms.

[The Social Perspective of Body Changing Behaviors]. / Die Bedeutung des Körpers aus gesellschaftlicher Perspektive.

The Social Perspective of Body Changing Behaviors Abstract. In clinical practice, patients who are strongly dissatisfied with the condition or appearance of their body are common. Many of them try to shape their body according to their own ideals by means of body practices. However, this is about much more than mere appearance. The body is a central element of one's identity. The relationship we have with our body is socially shaped and reflects questions about who we are and how we want to be perceived. The needs for attachment and control represent central motives here: In the need for attachment, body practice primarily serves social recognition, whether to stand out positively or not negatively. In the case of the need for control, the body serves as a docile object of self-empowerment.

The Three-Level Curriculum Sports Psychiatry and an Evaluation of the First Course "Basic Health Care in Sports Psychiatry".

Due to scientific progress and diversification in medicine and psychiatry, there is a need for specialization in sports psychiatry. Therefore, the SSSPP has been developing a curriculum on sports psychiatry. Different backgrounds and approaches within the above-mentioned areas are presented here since they have influenced the development of the three-level curriculum. The structure of the three-level curriculum, which contains theory, practical experience, and supervision, encompassing 80 hours of additional training, will also be explained. Within this curriculum, basic knowledge in sports medicine, sports psychology, sports science, and applied sports theory will also be taught. Other subjects include sports and exercise on mental disorders, mental disorders in competitive sports, sports as a coping strategy, and other contents. Moreover, different contents and key topics of the curriculum's three levels will be presented.

Sports Psychiatric Diagnostics in Competitive Sports - Establishing a Clinical Standard.

Mental complaints and disorders are common in competitive sports. Despite this, they are not recognized sufficiently in Pre-Participation Examinations (PPE) yet. We present a structured, staged model of sports psychiatric diagnosis containing a Psychiatric Basic Assessment (PBA) within the annual PPE as well as a Sports Psychiatric Evaluation (SPE) in case of conspicuous PBA results. The PBA should be designed as a compact as well as sensitive and specific instrument. An optional three-stage SPE by specialists for both psychiatric disciplines should preferably include a general psychiatric assessment, a clinical interview and a symptom- or disorder-specific diagnosis and examination. Such a staged approach should be time-efficient and well accepted by the athletes. The model proposed here will hopefully contribute as a clinical standard to the early detection of mental disorders requiring treatment.

[Sports Psychiatric Diagnostics in Competitive Sports - Establishing a Clinical Standard]. / Sportpsychiatrische Diagnostik imLeistungssport­ Entwicklung eines klinischenStandards.

Sports Psychiatric Diagnostics in Competitive Sports - Establishing a Clinical Standard Abstract. Mental complaints and disorders are common in competitive sports. Despite this, they are not recognized sufficiently in Pre-Participation Examinations (PPE) yet. We present a structured, staged model of sports psychiatric diagnosis containing a Psychiatric Basic Assessment (PBA) within the annual PPE as well as a Sports Psychiatric Evaluation (SPE) in case of conspicuous PBA results. The PBA should be designed as a compact as well as sensitive and specific instrument. An optional three-stage SPE by specialists for both psychiatric disciplines should preferably include a general psychiatric assessment, a clinical interview and a symptom- or disorder-specific diagnosis and examination. Such a staged approach should be time-efficient and well accepted by the athletes. The model proposed here will hopefully contribute as a clinical standard to the early detection of mental disorders requiring treatment.

The Importance of Physical Activityfor Mental Health.

Due to the worldwide high prevalence of psychiatric disorders and its association with sedentary behavior and comorbid physical diseases, increasing physical activity in psychiatric populations is of high importance. Regular physical activity is associated with increased mental wellbeing and has shown to have preventive effects on depression, anxiety disorders and probably sleep disorders. Additionally, positive effects on comorbid chronic physical diseases have been found. Exercise as treatment for several weeks has shown to have an antidepressant effect. Similar positive effects on symptoms have been found in anxiety disorders and schizophrenia. Therefore, assessing and promoting physical activity is advisable in clinical psychiatric practice. Patients should be coached to reach at least a weekly average of 150 minutes of moderate and/or 75 minutes of vigorous physical activity. Establishing physical activity and exercise groups is of utmost importance for psychiatric outpatients.

[The Importance of Physical Activity for Mental Health]. / Die Bedeutung von körperlicher Aktivität für die psychische Gesundheit.

The Importance of Physical Activity for Mental Health Abstract. Due to the worldwide high prevalence of psychiatric disorders and its association with sedentary behavior and comorbid physical diseases, increasing physical activity in psychiatric populations is of high importance. Regular physical activity is associated with increased mental wellbeing and has shown to have preventive effects on depression, anxiety disorders and probably sleep disorders. Additionally, positive effects on comorbid chronic physical diseases have been found. Exercise as treatment for several weeks has shown to have an antidepressant effect. Similar positive effects on symptoms have been found in anxiety disorders and schizophrenia. Therefore, assessing and promoting physical activity is advisable in clinical psychiatric practice. Patients should be coached to reach at least a weekly average of 150 minutes of moderate and/or 75 minutes of vigorous physical activity. Establishing physical activity and exercise groups is of utmost importance for psychiatric outpatients.

Association between muscle dysmorphia psychopathology and binge eating in a large at-risk cohort of men and women.

BACKGROUND: Current research on muscle dysmorphia (MD) has focused on restrained eating behaviors and has adopted a primarily male perspective. Despite initial evidence, the role of possible binge eating associated with MD has only been scarcely investigated. To extend the transdiagnostic and cross-gender approaches and address the dearth in research related to MD, this study investigated the association between MD psychopathology and binge eating in men and women. METHODS: This study investigated the association between MD psychopathology and binge eating in both men and women. Participants were a sample of 5905 men (n = 422) and women (n = 5483) social media users aged 18-72 years. They completed an online survey that included self-report measures assessing demographics, binge eating, MD psychopathology, and drive for thinness and leanness. Binge eating was assessed using the diagnostic questions of the validated German version of the Eating Disorder Examination-Questionnaire. The Muscle Dysmorphic Disorder Inventory (MDDI) was used to assess MD psychopathology. A total score of > 39 was set as a cutoff to define an "MD at-risk" state for both men and women. Hierarchical logistic regression analysis was used to analyze the association between MD psychopathology and binge eating. RESULTS: MD psychopathology was significantly positively associated with binge eating in both men and women. Among the three MDDI subscales, only appearance intolerance was significantly associated with MD, and drive for size and functional impairment were not associated. MD at-risk status yielded a predicted probability of binge eating of 25% for men and 66.9% for women. The increased probability of binge eating associated with MD at-risk status was mainly accounted for by appearance intolerance in men and drive for thinness in women. CONCLUSION: MD psychopathology is positively associated with binge eating in both men and women. Binge eating episodes should therefore form part of the clinical assessment of MD.

Muscle dysmorphia is a mental disorder in which those affected are constantly preoccupied with being insufficiently muscular. Although there is initial evidence that binge eating may play a role in the clinical presentation of muscle dysmorphia (MD), this has not been investigated. In addition, MD has rarely been studied in women. We conducted a study involving 5905 men (n = 422) and women (n = 5483) using self-report questionnaires to examine the association between binge eating and symptoms of MD. We found that symptoms of MD and binge eating are positively associated. According to our model, two-thirds of women and one-quarter of men at-risk for MD exhibit binge eating. Binge eating episodes should therefore form part of the clinical assessment of MD.

[Interdisciplinary and Psychiatric Treatment of Anabolic Androgenic Steroids Users]. / Interdisziplinäre und psychiatrisch-psychotherapeutische Behandlung bei Gebrauch von anabolen androgenen Steroiden.

Interdisciplinary and Psychiatric Treatment of Anabolic Androgenic Steroids Users Abstract. The prevalence of anabolic androgenic steroid (AAS; anabolic steroids) use in recreational sports is underestimated. Due to the influence of social media, an increase in AAS use in recreational sports and in the general population is to be expected. AAS use is associated with significant physical and mental health consequences, and the psychiatric consequences include the risk of developing addictive behaviour. The widespread stigmatization of AAS use also by professionals often undermines users' trust in physicians and drives them into the arms of so-called "gurus." The tightening of anti-doping practices in sports and an exclusively prohibitive stance have so far failed to convincingly curb the problem in recreational sports. Harm reduction strategies could help patients to get the help they need from primary care providers.

Interdisciplinary and Psychiatric Treatment of Anabolic Androgenic Steroids Users.

The prevalence of anabolic androgenic steroid (AAS; anabolic steroids) use in recreational sports is underestimated. Due to the influence of social media, an increase in AAS use in recreational sports and in the general population is to be expected. AAS use is associated with significant physical and mental health consequences, and the psychiatric consequences include the risk of developing addictive behaviour. The widespread stigmatization of AAS use also by professionals often undermines users' trust in physicians and drives them into the arms of so-called "gurus." The tightening of anti-doping practices in sports and an exclusively prohibitive stance have so far failed to convincingly curb the problem in recreational sports. Harm reduction strategies could help patients to get the help they need from primary care providers.

[Recognizing IPED Use in Clinical Practice]. / Somatische Folgen des IPED-Gebrauchs früh in der Hausarztpraxis erkennen.

Recognizing IPED Use in Clinical Practice Abstract. The non-medical use of image- and performance-enhancing drugs (IPEDs) is widespread in the fitness and bodybuilding scene. The reasons for IPED use are often hedonistic in nature and they are used in so-called "cycles" over several weeks. The most common side effects are: testicular atrophy, acne, hypersexuality, hypertension, gynecomastia, lipid metabolism disorders, mood swings, hair loss, and policythemia. Common consequences following IPED use are: decreased libido, oligo- or azoospermia, and erectile dysfunction. To reduce undesirable side effects and consequences, IPED users often take medications for self-treatment; occasionally IPED users also mention such medications and ask for them in the general medical practice.

[IPED Use in Recreational Sports]. / IPED-Gebrauch im Freizeitsport.

IPED Use in Recreational Sports Abstract. Abtract: IPED consumers seek medical advice when uncertain as to their use. Due to shame or fear of stigmatization IPED consumers are often reluctant to talk about their drug use; they fear prejudice and a lack of experience when caring for this specific patient group. In order to strengthen trust, a non-judgmental, non-stigmatizing and supportive attitude is essential. The interaction should primarily lead to an understanding of why AAS are being used, what the patient's concerns are, and why medical help is being sought, without judgment or condemnation of the behavior. If no motivation to abstain from drug use is found during the consultation, harm reduction should be sought and the consequences of use addressed. Regular talks and active harm reduction can increase the confidence in evidence-based treatment to achieve personal motivation to abstain under medical supervision.

Recognizing IPED Use in Clinical Practice.

The non-medical use of image- and performance-enhancing drugs (IPEDs) is widespread in the fitness and bodybuilding scene. The reasons for IPED use are often hedonistic in nature and they are used in so-called "cycles" over several weeks. The most common side effects are: testicular atrophy, acne, hypersexuality, hypertension, gynecomastia, lipid metabolism disorders, mood swings, hair loss, and policythemia. Common consequences following IPED use are: decreased libido, oligo- or azoospermia, and erectile dysfunction. To reduce undesirable side effects and consequences, IPED users often take medications for self-treatment; occasionally IPED users also mention such medications and ask for them in the general medical practice.

IPED in Recreational Sports.

IPED consumers seek medical advice when uncertain as to their use. Due to shame or fear of stigmatization IPED consumers are often reluctant to talk about their drug use; they fear prejudice and a lack of experience when caring for this specific patient group. In order to strengthen trust, a non-judgmental, non-stigmatizing and supportive attitude is essential. The interaction should primarily lead to an understanding of why AAS are being used, what the patient's concerns are, and why medical help is being sought, without judgment or condemnation of the behavior. If no motivation to abstain from drug use is found during the consultation, harm reduction should be sought and the consequences of use addressed. Regular talks and active harm reduction can increase the confidence in evidence-based treatment to achieve personal motivation to abstain under medical supervision.

Sports Psychiatry in Competitive Sports.

Mental complaints and illnesses are common health problems in competitive sports, and mental health, like physical health and performance, is an integral dimension in competitive sports. The promotion of mental health and safe management of mental complaints and illnesses in competitive sports requires a qualified medical discipline for mental health: sports psychiatry as well as an interdisciplinary and interprofessional understanding of care and cooperation. In the following article, sports psychiatry in competitive sports will be addressed and (i) mental health promotion and prevention, (ii) the tandem concept of interprofessional care and collaboration, (iii) diagnosis, treatment, and aftercare of mental disorders and illnesses, and (iv) education and training in sports psychiatry will be presented and discussed.