A new approach to cultural scripts of trauma sequelae assessment: The sample case of Switzerland.

BACKGROUND: The novel concept of cultural scripts of trauma sequelae captures culture-specific expressions of posttraumatic distress (e.g., cognitive, emotional, interpersonal, psychosomatic changes) and their temporal associations. Cultural scripts of trauma sequelae complement pan-cultural (etic) diagnoses, such as posttraumatic stress disorder (PTSD) and Complex PTSD, as well as the cultural syndromes concept. OBJECTIVE: This study aimed to develop the cultural scripts of trauma inventory (CSTI) for German-speaking Switzerland and to explore temporal associations of script elements. METHOD: Five semi-structured focus groups were conducted with psychotraumatologists (n = 8) and Swiss trauma survivors (n = 7). The interview schedule included open questions about different domains of potential posttraumatic changes (emotions, cognitions, worldviews, interpersonal relationships, body-related experiences, behavior, and growth). Data were analyzed using qualitative content analysis. RESULTS: The Swiss CSTI includes 57 emic elements that represent salient trauma sequelae (30 conformed with a theoretically derived item pool, 27 were newly phrased). Temporal script associations were visualized in a network, whereby self-deprecation, the urge to function and overcompensate, and the urge to hide and endure suffering had the highest number of connections. CONCLUSION: While many posttraumatic changes identified in the present work seem to mirror pan-cultural phenomena represented in the Complex PTSD concept (e.g., self-deprecation), others (e.g., urge to function and perform, urge to hide and endure suffering) may be prominently related to Swiss culture with its value orientations. Knowledge about cultural scripts of trauma sequelae may provide a culture-specific framework that can help to understand individual experiences of distress and enable mental health practitioners to administer culturally sensitive interventions. Pending further validation, the Swiss CSTI bears the potential to advance culture-sensitive assessment of trauma sequelae.

The worse we feel, the more intensively we need to stick together: a qualitative study of couples' emotional co-regulation of the challenge of multimorbidity.

Introduction: Being faced with multimorbidity (i.e., being diagnosed with at least two chronic conditions), is not only demanding in terms of following complicated medical regimes and changing health behaviors. The changes and threats involved also provoke emotional responses in the patients but also in their romantic partners. This study aims at exploring the ways of emotional co-regulation that couples facing multimorbidity express when interviewed together. Method: N = 15 opposite sex couples with one multimorbid patient after an acute health crisis that led to hospitalization were asked in a semi-structured interview about how they found ways to deal with the health situation, what they would recommend to other couples in a similar situation, and how they regulated their emotional responses. Interviews were analyzed qualitatively following open, axial, and selective coding, as in the grounded theory framework. Results: Emerging categories from the romantic partners' and the patients' utterances revealed three main categories: First, overlapping cognitive appraisals about the situation (from fighting spirit to fatalism) and we-ness (construing the couple self as a unit) emerged as higher order factor from the utterances. Second, relationship-related strategies including strategies aimed at maintaining high relationship quality in spite of the asymmetric situation like strengthening the common ground and balancing autonomy and equity in the couple were often mentioned. Third, some couples mentioned how they benefit from individual strategies that involve fostering individual resources of the partners outside the couple relationship (such as cultivating relationships with grandchildren or going outdoors to nature). Discussion: Results underline the importance of a dyadic perspective not only on coping with disease but also on regulating the emotional responses to this shared challenging situation. The utterances of the couples were in line with earlier conceptualizations of interpersonal emotion regulation and dyadic perspectives on we-disease. They broaden the view by integrating the interplay between individual and interpersonal regulation strategies and underline the importance of balancing individual and relational resources when supporting couples faced with chronic diseases.

Internalizing Mental Health Disorders and Emotion Regulation: A Comparative and Mediational Study of Older Adults With and Without a History of Complex Trauma Exposure.

Individuals with complex trauma exposure (CTE) in early life (i.e., childhood/adolescence) are at heightened risk for developing problems in various domains of functioning. As such, CTE has repeatedly been linked to internalizing mental health disorders, such as depression and anxiety, as well as emotion dysregulation across the lifespan. While these correlates of CTE are comparatively well studied up to middle adulthood, they are insufficiently studied in older adulthood. Therefore, this study aimed to (a) compare Swiss older adults with and without a CTE history regarding current and lifetime internalizing mental health disorders and emotion regulation strategies; and (b) to examine the potential mediating role of emotion regulation in the mental health disparities between these groups. A total of N = 257 participants (age = 49-95 years; 46.3% female) were assessed in a retrospective, cross-sectional study, using two face-to-face interviews. The CTE group (n = 161; M age = 69.66 years, 48.4% female) presented with significantly more current and lifetime internalizing mental health disorders than the non-affected (nCTE) group (n = 96; M age = 72.49 years, 42.7% female). The CTE group showed significantly higher emotion suppression and lower emotion reappraisal compared to the nCTE group. Mediation analysis revealed that the two emotion regulation strategies were significant mediators between CTE history and internalizing mental health disorders. Findings emphasize the relevance of emotion (dys-)regulation in understanding mental health disparities in older age and deciding about treatment strategies. Research and practice should pay more attention to the needs of this high-risk group of older individuals.

Salutary mechanisms in the relationship between stress and health: The mediating and moderating roles of Sense of Coherence-Revised.

While chronic and acute stress are often associated with negative health, the sense of coherence-revised (SOC-R) is proposed to facilitate coping with stress and promote health. However, research is lacking on the specific mechanisms. Therefore, the current study aimed to investigate potential mediating and moderating mechanisms of SOC-R in the relationship between stress and health. Using a cross-sectional design, standardized questionnaires assessed SOC-R, acute (perceived) stress, early-life adversity (ELA; indicator for early-life chronic stress), mental and physical health, and satisfaction with life. Mediation and moderation analyses were conducted with N = 531 Irish adults (mean age: 59.5 years; 58.4% female). Regarding acute (perceived) stress, results showed that SOC-R and its Manageability subscale significantly mediated the association between perceived stress and mental health, and satisfaction with life. SOC-R and its Manageability subscale also significantly moderated the association between perceived stress and mental health. Regarding ELA, the Manageability subscale significantly mediated the association between ELA and mental health, and satisfaction with life; and the Balance subscale significantly mediated the association between ELA and physical health. SOC-R may provide a useful focus for stress-related research, with future longitudinal studies needed to examine SOC-R as a long-term modulating pathway between stress and health.

Prolonged Grief Disorder and Positive Affect Improved by Chinese Brush Painting Group in Bereaved Parents: A Pilot Study.

Traditional Chinese art practices such as brush painting and calligraphy are thought to promote self-development through holistically engaging both physical and mental health. This pilot study investigated the beneficial effects of a community-based self-help group incorporating Chinese art practices as a culturally adapted bereavement intervention. Twenty-six Chinese parents aged over 49 years and who had lost their only child participated in a 20-session Chinese brush painting group over a 6-month period. Ten bereaved parents from the same community who did not participate in the art course but received living support were recruited as a control group. Compared with the control group, the art practice group exhibited a pre-post intervention effect in terms of promoting positive affect and preventing deterioration of prolonged grief symptoms, particularly through the improvement of accessory grief symptoms (e.g., "emotional numbness due to the loss", and "feeling that life is unfulfilling, empty or meaningless after the loss"). No effect was found on negative affect. These findings indicate that a culturally adapted community-based art group may be an effective means of improving grief-related health.

[Clinical Utility and Global Applicability of Prolonged Grief Disorder in the ICD-11 from the Perspective of Chinese and German-Speaking Health Care Professionals].

BACKGROUND: Prolonged grief disorder (PGD) is included in the ICD-11 (11th edition of the International Classification of Diseases). The new PGD criteria reflect the requirements and recommendations of the World Health Organization for improved clinical utility and international applicability. Even though the ICD classification system is globally used, no research has investigated how healthcare professionals (HP) in non-Western countries may adopt this change for their own practice. OBJECTIVE: The present study explored the extent to which the new PGD criteria were accepted and perceived to meet the standards for clinical utility and international applicability among Chinese and German-speaking HP. METHODS: Individual semistructured interviews were conducted in person, by phone, or online (e.g., via Skype), with 24 Chinese (n = 10) and German-speaking (n = 14) HP working with bereaved populations in China and Switzerland, and analyzed using a qualitative framework analysis. Questions included "what items are currently missing from the PGD criteria?". RESULTS: Across all HP, the majority supported the inclusion of PGD and were generally aligned with the current criteria. HP found that the criteria distinguished between normal and abnormal grief and considered the criteria easy to use if their modifications were considered. Merits included, among others, improved clinical decision making, research promotion, and social acknowledgment. Main concerns included misdiagnosis, pathologization, and a lack of specificity of criteria. The importance of international applicability was emphasized across Chinese and German-speaking HP. Different grief-specific symptoms were identified by German-speaking and Chinese HP. CONCLUSIONS: These findings provide evidence for the clinical utility and international applicability of ICD-11 PGD criteria among German-speaking and Chinese HP, as well as cultural similarities and differences in the barriers to implementation of these criteria.

Value Orientations and Mental Health: A Theoretical Review.

Cross-national epidemiological studies show that prevalence rates of common mental disorders (i.e. depression, anxiety disorders, and PTSD) vary considerably between countries, suggesting cultural differences. In order to gather evidence on how culture relates to the aetiology and phenomenology of mental disorders, finding meaningful empirical instruments for capturing the latent (i.e. non-visible) construct of 'culture' is vital. In this review, we suggest using value orientations for this purpose. We focus on Schwartz's value theory, which includes two levels of values: cultural and personal. We identified nine studies on personal values and four studies on cultural values and their relationship with common mental disorders. This relationship was assessed among very heterogeneous cultural groups; however, no consistent correlational pattern occurred. The most compelling evidence suggests that the relationship between personal values and mental disorders is moderated by the cultural context. Hence, assessing mere correlations between personal value orientations and self-reported symptoms of psychopathology, without taking into account the cultural context, does not yield meaningful results. This theoretical review reveals important research gaps: Most studies aimed to explain how values relate to the aetiology of mental disorders, whereas the question of phenomenology was largely neglected. Moreover, all included studies used Western instruments for assessing mental disorders, which may not capture culturally-specific phenomena of mental distress. Finding systematic relationships between values and mental disorders may contribute to making more informed hypotheses about how psychopathology is expressed under different cultural circumstances, and how to culturally adapt psychological interventions.

The Assessment of Grief in Refugees and Post-conflict Survivors: A Narrative Review of Etic and Emic Research.

Background: Prolonged grief disorder (PGD) is a new mental health disorder that will be recognized by the World Health Organization's disorder classification, the ICD-11, in 2018. Current assessment measures of PGD are largely based on North American and European conceptualizations of grief (etic i.e., from the perspective of the observer). However, research is emerging from communities outside of the Global North, in particular, conflict-exposed communities, exploring local models (emic i.e., from within the cultural group), assessment measures and symptoms of grief. Several reviews have found that refugees have higher rates of mental illness, defined by etic standards as depression, post-traumatic stress disorder (PTSD), anxiety disorders and psychotic symptoms. Yet, presently there are no reviews documenting the assessment of PGD in refugees and post conflict survivors. Method: This narrative review will provide an overview of studies that assess grief in refugees to (1) identify current assessment measures of grief in refugees (i.e., type and frequency of questionnaires used, whether Global North-based, etic, or locally developed, emic, and the level of cultural adaptation) and (2) to document the variety and rate of grief symptoms identified with Global North standard measures and/or local measures (i.e., the endorsement of standard symptom items and the identification of culturally specific symptoms of grief). Results: This review revealed 24 studies that assessed disordered grief in refugee or post conflict samples. Studies were heterogeneous in their assessment methods; the majority (n = 17) used an etic approach, four used a combined etic/emic approach, and three used a predominantly emic approach. The rate of disordered grief was high depending on cultural adaptation approach (31-76%) and when standard etic measures were used the disordered grief rate was 32%. Conclusion: These findings will help to guide future studies to provide accurate assessment of grief in refugee and post conflict populations and has implications for improving cultural knowledge in clinical practice.

An empirical assessment of adjustment disorder as proposed for ICD-11 in a general population sample of Israel.

BACKGROUND: A new diagnostic concept of Adjustment Disorder (AjD) was proposed for inclusion in the International Classification of Diseases, 11th version (ICD-11). However, the symptom structure of AjD is poorly understood. The aim of the present study was to investigate the dimensionality of AjD as a stress-response syndrome. METHODS: A general population sample of the Israeli population (N = 1003) completed the Adjustment Disorder - New Module 20 and the WHO-5 Wellbeing Scale. We compared seven alternative models of AjD using confirmatory factor analysis (CFA). A latent profile analysis (LPA) was performed to determine if subtypes of AjD were present. The performance of the unidimensional and multidimensional models of AjD were evaluated using regression analyses. RESULTS: CFA results supported a unidimensional model of AjD. The LPA identified three quantitatively distinct classes (low, medium, and high) with no evidence of any subtypes of AjD. The criterion validity of AjD was superior when treated as unidimensional. AjD was associated with lower levels of psychological wellbeing (ß = -.32, p < .001). CONCLUSIONS: Our results suggest that AjD is better conceptualised as a unidimensional construct. Future work should focus on a reduction of required symptoms in order to improve clinical utility and validity of the diagnosis.

Cultural values and the prevalence of mental disorders in 25 countries: A secondary data analysis.

RATIONALE: The prevalence of common mental disorders (CMDs, i.e., depression and anxiety) worldwide is substantial, and prevalence rates are higher in high-income than in low- and middle-income countries. This difference might reflect both underlying prevalence rates as well as the measurement model used in cross-national epidemiological studies. Schwartz' cultural values provide a meaningful taxonomy to describe 'culture' and to examine how culture affects both the aetiology and phenomenology of CMDs. OBJECTIVE: The present study examines to what extent Schwartz' cultural values correlate with prevalence rates of CMDs at the country-level. METHOD: Twenty-five countries were included in this study. Countries were included if data on cultural values and lifetime prevalence rates, from either the World Mental Health Surveys or the Global Burden of Disease Study, were available for at least one CMD. Spearman rank correlations were calculated between prevalence rates and cultural values, controlling for gross national income (GNI) per capita. RESULTS: Affective disorders correlated with cultural values, after controlling for GNI. For anxiety disorders, correlations were lower but still offered meaningful insights. Correlations followed the circular structure of values, meaning that the strength of relationship decreased and increased again when moving around the circle: the strongest positive correlations were found with egalitarianism, and the strongest negative correlations with hierarchy and mastery. The autonomy-embeddedness dimension correlated weakly with the prevalence of CMDs. CONCLUSIONS: Diverging prevalence rates between high-income countries and low- and middle-income countries are associated with differences in cultural values. Values might not only relate to the aetiology of mental disorders, but most possibly affect the way in which psychological distress is expressed. As an example, in societies with a strong focus on embeddedness, the fear of stigma might be more pronounced. Cultural values offer a middle ground between culturally specific (i.e., emic) and universalist (i.e., etic) research.

Cognitive behavioural treatment for mild Alzheimer's patients and their caregivers (CBTAC): study protocol for a randomized controlled trial.

BACKGROUND: About 90 % of all persons with mild Alzheimer's disease experience neuropsychiatric symptoms, most frequently apathy, depression, anxiety and irritability. These symptoms are associated with greater morbidity, a reduced quality of life for the patient, an increased burden and depression for the caregiver, and higher costs of care and nursing home placement. Psychosocial interventions based on behaviour therapy represent the most efficacious treatment of neuropsychiatric symptoms. However, there is no study, to our knowledge, that has evaluated a multicomponent treatment programme based on comprehensive, cognitive behavioural therapy (CBT). This randomized controlled trial aims to evaluate a CBT-based treatment programme consisting of 8 modules and 25 sessions. METHODS/DESIGN: Fifty patients with mild Alzheimer's disease alone or with mild mixed dementia (Alzheimer's disease and vascular dementia) who have any neuropsychiatric symptom will be included. A caregiver must be available. The patients and their caregivers will be randomized to either the CBT-based intervention group or to the control condition group, which receives treatment as usual. The primary outcome measure is depression in the patient with Alzheimer's disease. The secondary outcome measures for a person with Alzheimer's disease are other neuropsychiatric symptoms, quality of life and coping strategies. The secondary outcome measures for a caregiver are caregiver's burden, depression, anxiety, anger, quality of life and coping strategies. Neuropsychological testing includes tests of cognitive function and activities of daily living and a global clinical assessment of severity. Participants in both groups will be assessed before and after the treatment phase (lasting approximately 9 months). Follow-up assessments will take place 6 and 12 months after treatment. All assessments will be conducted by blinded assessors. DISCUSSION: This trial has the potential to establish an empirically based psychological treatment for non-cognitive symptoms that reduce the quality of life of a person with dementia and a caregiver. This treatment approach focuses not only on the person with dementia, but also on the caregiver and on the dyad. The treatment manual will be published and training workshops will be offered, so that the information can be widely spread among healthcare professionals. TRIAL REGISTRATION: ClinicalTrials.gov NCT01273272.

Personal value orientations as mediated predictors of mental health: A three-culture study of Chinese, Russian, and German university students.

Previous studies of traditional and modern value orientations in individuals found mediated predictive relationships of these values on particular mental disorders. The aim of this study with samples from three countries (Germany, Russia, and China) is to extend findings on mental health (MH) and value orientations to broader MH indicators and two types of mediators, i.e. social support and resilience in accordance to a theory of values and modernization/postmodernization. The multisite study was conducted in the three countries. A path-model with traditional values predicting MH mediated by social support, and modern values predicting MH mediated by resilience was tested in all three countries. As expected, value orientations were for the most part strongest in China, followed by Russia and Germany. Structural equation modeling supported the assumption of mediated prediction of MH by value orientations by and large. The traditional value benevolence predicts social support whereas the modern value self-direction predicts resilience. Value orientations are a sensitive tool to empirically describe cross-cultural differences. The findings indicate that personal value orientations are meaningful predictors of MH. The analysis of personal values shows promise in linking public health, cross-cultural and modernization issues.

Estudios previos sobre orientaciones de valores tradicionales y modernos encontraron relaciones predictivas mediadas con trastornos mentales particulares. El objetivo de este estudio con muestras procedentes de tres países (Alemania, Rusia y China) es ampliar los resultados indicadores más amplios de salud mental (SM) y dos tipos de mediadores (apoyo social y resiliencia), de acuerdo a la teoría de los valores y la modernización/postmodernización. Se probó en los tres países un path-model con valores tradicionales prediciendo la SM mediada por el apoyo social y valores modernos prediciendo la SM mediada por la resiliencia. Como era de esperar, las orientaciones de valores eran en su mayor parte más fuertes en China, seguido por Rusia y Alemania. Modelos de ecuaciones estructurales apoyaron la hipótesis de la predicción de la SM mediada por las orientaciones de valores en general. La benevolencia de valores tradicionales predice el apoyo social, mientras que el valor autodirección moderna predice la resiliencia. Las orientaciones de valores constituyen una herramienta sensible para describir empíricamente las diferencias interculturales. Los resultados indican que las orientaciones de valores personales son predictores significativos de la SM. El análisis de los valores personales se muestra prometedor en la salud pública transcultural y cuestiones de modernización.

[Validity of the suicidality assessment instrument PRISM-S (Pictoral Representation of Illness Self Measure - Suicidality)]. / Validierung des Suizidalitätseinschätzungsinstrumentes PRISM-S (Pictoral Representation of Illness Self Measure - Suicidality).

In routine clinical practice the assessment of suicidality proves to be difficult and complex. The aim of the present study was to examine if PRISM can be used to measure validly the person's subjectively perceived suicidality. The nonverbal visualization technique PRISM (Pictoral Representation of Illness and Self Measure) has been developed by Büchi et al. (2002) to evaluate the perceived burden of suffering due to physical illness. The adapted version of PRISM used in our study is called PRISM-S (Pictoral Representation of Illness and Self Measure - Suicidality). 156 eligible inpatients, admitted voluntarily to the crisis intervention centre Winterthur, participated in the study. We used as gold standards the well established assessment tools the Beck Scale of Suicide Ideation (BSS) and the Depressive Symptome Inventory - Subscale (DSI-SS). The results showed high correlations between PRISM-S and the BSS (r = - 0,73) and the DSI-SS scores (r = - 0,76). Clinicians, general practitioners, psychiatrists and psychologists receive with PRISM-S a valid suicidality assessment tool that is very brief and easy to administer in clinical settings.

Differences in prevalence rates of PTSD in various European countries explained by war exposure, other trauma and cultural value orientation.

BACKGROUND: Guided by previous explorations of historical and cultural influences on the occurrence of PTSD, the aim of the present study was to investigate the contributions of war victimisation (in particular, World War II) and other civil trauma on the prevalence of PTSD, as mediated by cultural value orientation. Secondary data analysis was performed for 12 European countries using data, including PTSD prevalence and number of war victims, crime victims, and natural disaster victims, from different sources. Ten single value orientations, as well as value aggregates for traditional and modern factors, were investigated. RESULTS: Whilst differences in PTSD prevalence were strongly associated with war victim rates, associations, albeit weaker, were also found between crime victims and PTSD. When cultural value orientations, such as stimulation and conformity as representatives of modern and traditional values, were included in the multivariate predictions of PTSD prevalence, an average of approximately 80% of PTSD variance could be explained by the model, independent of the type of trauma exposure. CONCLUSION: The results suggest that the aftermath of war contributes to current PTSD prevalence, which may be explained by the high proportion of the older population who directly or indirectly experienced traumatic war experiences. Additional findings for other types of civil trauma point towards an interaction between value orientation and country-specific trauma rates. Particularly, being personally oriented towards stimulation appears to interact with differences in trauma prevalence. Thus, cultural value orientation might be viewed not only as an individual intrinsic process but also as a compensatory strategy after trauma exposure.

Caregiver rating bias in mild cognitive impairment and mild Alzheimer's disease: impact of caregiver burden and depression on dyadic rating discrepancy across domains.

BACKGROUND: Caregivers of individuals with dementia are biased in their rating of mental health measures of the care receiver. This study examines caregiver burden and depression as predictors of this bias for mild cognitive impairment and mild Alzheimer's disease in different domains. METHODS: The sample consisted of 202 persons: 60 with mild cognitive impairment, 41 with mild Alzheimer's disease, and 101 caregivers. Discrepancy scores were calculated by subtracting the mean caregiver score from the respective mean patient score on the following assessment instruments: the Geriatric Depression Scale, Apathy Evaluation Scale, Bayer-Activities of Daily Living Scale, and Quality of Life-AD scale. Caregiver burden and depression were assessed by the Zarit Burden Interview and the Center for Epidemiologic Studies Depression Scale. RESULTS: Intraclass correlation coefficients were low for apathy (0.38), daily functioning (0.38), and quality of life (0.30) and moderate for depression (0.49). These domains showed negative rating discrepancies, which indicates caregiver rating bias for all four domains. Regression analyses revealed that caregiver burden significantly contributed to explaining these discrepancies in the domains apathy, daily functioning, and quality of life. CONCLUSION: Caregiver rating bias can be attributed to caregiver burden. When caregiver burden is present, data based on caregiver ratings should therefore be interpreted with caution.

[Towards 'complex PTSD': German translation of the Trauma Symptom Inventory (TSI) for the assessment of complex trauma Sequelae]. / In Richtung "Komplexe PTBS": Die deutsche Version des Trauma Symptom Inventory (TSI) zur Erfassung komplexer Traumafolgen.

This study tested the German translation of the Trauma Symptom Inventory (TSI) by Briere [1]. The TSI aims at assessing complex posttraumatic symptoms. TSI was part of a large test battery, among which the Childhood Trauma Questionnaire, Short Screening Scale, Short Form Health Survey, Geriatric Depression Scale and Mini International Neuropsychiatric Interview were part of. A sample of N=116 elderly people (range of age: 59-98 years; 40.5% women) with childhood traumatization were studied. The German version of the TSI presents with adequate internal consistency, mainly good discriminability and facility indices, and good criterion and construct validity. With reference to factorial validity, a European validation model [2] replicated the data more accurate than the original American model. TSI proved to be a reliable, economic and--to some extent--valid instrument for the assessment of complex posttraumatic stress symptoms.

The costs of disorders of the brain in Switzerland: an update from the European Brain Council Study for 2010.

BACKGROUND: In 2005, findings of the first "cost of disorders of the brain in Europe" study of the European Brain Council (EBC) showed that these costs cause a substantial economic burden to the Swiss society. In 2010 an improved update with a broader range of disorders has been analysed. This report shows the new findings for Switzerland and discusses changes. METHODS: Data are derived from the EBC 2010 census study that estimates 12-month prevalence of 12 groups of disorders of the brain and calculates costs (direct health-care costs, direct non-medical costs and indirect costs) by combining top-down and bottom up cost approaches using existing data. RESULTS: The most frequent disorder was headache (2.3 million). Anxiety disorders were found in 1 million persons and sleep disorders in 700,000 persons. Annual costs for all assessed disorders total to 14.5 billion Euro corresponding to about 1,900 EUR per inhabitant per year. Mood, psychotic disorders and dementias (appr. 2 billion EUR each) were most costly. Costs per person were highest for neurological/neurosurgery-relevant disorders, e.g. neuromuscular disorders, brain tumour and multiple sclerosis (38,000 to 24,000 EUR). CONCLUSION: The estimates of the EBC 2010 study for Switzerland provide a basis for health care planning. Increase in size and costs compared to 2005 are mostly due to the inclusion of new disorders (e.g., sleep disorders), or the re-definition of others (e.g., headache) and to an increase in younger cohorts. We suggest coordinated research and preventive measures coordinated between governmental bodies, private health-care and pharmaceutical companies.

Delay of gratification in old age: assessment, age-related effects, and clinical implications.

Delay of gratification (DoG), the ability to reject immediately available smaller rewards in favor of later larger rewards, has been a topic of continuous research interest for almost 60 years. Although numerous studies have explored this construct and its effects on wellbeing, social behavior, cognitive abilities, and academic success in children, DoG studies in adulthood and old age are scarce. Instead, delay discounting (DD), that is, the degree to which individuals devalue delayed rewards, has been used in samples of adults and older individuals, and is of particular interest in clinical studies. Findings from DD research suggest that the preference for delayed rewards increases from childhood to early adulthood, and then decreases from middle age to old age. The main aim of this review is to elucidate the importance of DoG in adulthood and old age. First, the review explores the theoretical status of DoG by specifying the relationships and distinctions between DoG and related constructs. Second, it provides an overview of DoG measurements, from traditional to novel. Third, the effects of DoG on development and wellbeing are explored. Fourth, age-related differences in DoG are summarized. Lastly, the review closes with conclusions, clinical implications, and the outlook for possible further research directions.

Cost of disorders of the brain in Europe 2010.

BACKGROUND: The spectrum of disorders of the brain is large, covering hundreds of disorders that are listed in either the mental or neurological disorder chapters of the established international diagnostic classification systems. These disorders have a high prevalence as well as short- and long-term impairments and disabilities. Therefore they are an emotional, financial and social burden to the patients, their families and their social network. In a 2005 landmark study, we estimated for the first time the annual cost of 12 major groups of disorders of the brain in Europe and gave a conservative estimate of €386 billion for the year 2004. This estimate was limited in scope and conservative due to the lack of sufficiently comprehensive epidemiological and/or economic data on several important diagnostic groups. We are now in a position to substantially improve and revise the 2004 estimates. In the present report we cover 19 major groups of disorders, 7 more than previously, of an increased range of age groups and more cost items. We therefore present much improved cost estimates. Our revised estimates also now include the new EU member states, and hence a population of 514 million people. AIMS: To estimate the number of persons with defined disorders of the brain in Europe in 2010, the total cost per person related to each disease in terms of direct and indirect costs, and an estimate of the total cost per disorder and country. METHODS: The best available estimates of the prevalence and cost per person for 19 groups of disorders of the brain (covering well over 100 specific disorders) were identified via a systematic review of the published literature. Together with the twelve disorders included in 2004, the following range of mental and neurologic groups of disorders is covered: addictive disorders, affective disorders, anxiety disorders, brain tumor, childhood and adolescent disorders (developmental disorders), dementia, eating disorders, epilepsy, mental retardation, migraine, multiple sclerosis, neuromuscular disorders, Parkinson's disease, personality disorders, psychotic disorders, sleep disorders, somatoform disorders, stroke, and traumatic brain injury. Epidemiologic panels were charged to complete the literature review for each disorder in order to estimate the 12-month prevalence, and health economic panels were charged to estimate best cost-estimates. A cost model was developed to combine the epidemiologic and economic data and estimate the total cost of each disorder in each of 30 European countries (EU27+Iceland, Norway and Switzerland). The cost model was populated with national statistics from Eurostat to adjust all costs to 2010 values, converting all local currencies to Euro, imputing costs for countries where no data were available, and aggregating country estimates to purchasing power parity adjusted estimates for the total cost of disorders of the brain in Europe 2010. RESULTS: The total cost of disorders of the brain was estimated at €798 billion in 2010. Direct costs constitute the majority of costs (37% direct healthcare costs and 23% direct non-medical costs) whereas the remaining 40% were indirect costs associated with patients' production losses. On average, the estimated cost per person with a disorder of the brain in Europe ranged between €285 for headache and €30,000 for neuromuscular disorders. The European per capita cost of disorders of the brain was €1550 on average but varied by country. The cost (in billion €PPP 2010) of the disorders of the brain included in this study was as follows: addiction: €65.7; anxiety disorders: €74.4; brain tumor: €5.2; child/adolescent disorders: €21.3; dementia: €105.2; eating disorders: €0.8; epilepsy: €13.8; headache: €43.5; mental retardation: €43.3; mood disorders: €113.4; multiple sclerosis: €14.6; neuromuscular disorders: €7.7; Parkinson's disease: €13.9; personality disorders: €27.3; psychotic disorders: €93.9; sleep disorders: €35.4; somatoform disorder: €21.2; stroke: €64.1; traumatic brain injury: €33.0. It should be noted that the revised estimate of those disorders included in the previous 2004 report constituted €477 billion, by and large confirming our previous study results after considering the inflation and population increase since 2004. Further, our results were consistent with administrative data on the health care expenditure in Europe, and comparable to previous studies on the cost of specific disorders in Europe. Our estimates were lower than comparable estimates from the US. DISCUSSION: This study was based on the best currently available data in Europe and our model enabled extrapolation to countries where no data could be found. Still, the scarcity of data is an important source of uncertainty in our estimates and may imply over- or underestimations in some disorders and countries. Even though this review included many disorders, diagnoses, age groups and cost items that were omitted in 2004, there are still remaining disorders that could not be included due to limitations in the available data. We therefore consider our estimate of the total cost of the disorders of the brain in Europe to be conservative. In terms of the health economic burden outlined in this report, disorders of the brain likely constitute the number one economic challenge for European health care, now and in the future. Data presented in this report should be considered by all stakeholder groups, including policy makers, industry and patient advocacy groups, to reconsider the current science, research and public health agenda and define a coordinated plan of action of various levels to address the associated challenges. RECOMMENDATIONS: Political action is required in light of the present high cost of disorders of the brain. Funding of brain research must be increased; care for patients with brain disorders as well as teaching at medical schools and other health related educations must be quantitatively and qualitatively improved, including psychological treatments. The current move of the pharmaceutical industry away from brain related indications must be halted and reversed. Continued research into the cost of the many disorders not included in the present study is warranted. It is essential that not only the EU but also the national governments forcefully support these initiatives.

[Assessment of overinclusion in schizophrenia by a computer-assisted version of the Concept Overinclusion test]. / Erfassung des veränderten Begriffsumfangs bei Schizophrenie mit Hilfe der computergestützten Version des Begriffsumfangstests (BUT).

OBJECTIVE: A special form of formal thought disorder is the overinclusion in schizophrenia. The Begriffsumfangstest (BUT, Concept Overinclusion test) is a neuropsychological test for the assessment of this phenomenon. The test is available in a paperand- pencil version since the 1990s and now available in a computerized version. The aim of this study was a replication of the paper-and-pencil version with the computerized version of the test and also the detection of putative correlations with ego-psychopathology. METHODS: 40 patients with schizophrenia and 16 healthy controls were assessed with the BUT and with a scale for the assessment of ego-psychopathology (IPP). The tests were performed on five different time points with intervals of approximately two weeks. RESULTS: The BUT-parameters for the group of patients and the control group differed significantly. Several positive correlations were found between he values of the BUT and the IPP. CONCLUSION: The computerized Version of the BUT is also applicable for the detection of overinclusion. The relation between overinclusion as a semantic dysfunction and ego-psychopathology may lead to further psychopathological investigations concerning schizophrenic thought disorders.