[A review of the update of the German S3-guideline on diagnostics and therapy of bipolar disorders 2019]. / Überblick über Neuerungen der überarbeiteten und aktualisierten Leitlinie zur Diagnostik und Therapie bipolarer Störungen 2019.

Since the first publication of the guideline in 2012, which included critically reviewed evidence up to 2010, several hundred articles with new evidence were published and some topics of the clinical consensus needed to be reconsidered. Therefore, it was urgently necessary to revise the guideline to bring them up to date. In this article important revisions and updates are presented and the chances and limitations of the development of the guidelines and their implementation are discussed.

[Psychotherapy of depressive disorders: Evidence in chronic depression and comorbidities]. / Psychotherapie depressiver Störungen: Evidenz bei chronischer Depression und bei Komorbidität.

BACKGROUND: Psychotherapy has been shown to be an effective treatment option for depressive disorders; however, its effectiveness varies depending on patient and therapist characteristics and the individual form of the depressive disorder. OBJECTIVES: The aim of this article is to present the current evidence for psychotherapeutic antidepressive treatments for patients with chronic and treatment-resistant depression as well as for patients with mental and somatic comorbidities. MATERIAL AND METHODS: During the revision of the currently valid German S3- and National Disease Management Guideline (NDMG) on unipolar depression published in 2015, a comprehensive and systematic evidence search including psychotherapy for specific patient groups was conducted. The results of this search along with a systematic update are summarized. RESULTS: Psychotherapy has been shown to be effective in reducing depressive symptoms in patients suffering from chronic and treatment-resistant depression and in patients with mental and somatic comorbidities. The evidence is insufficient particularly for patients with mental comorbidities. CONCLUSION: Based on the current evidence and clinical expertise the NDMG recommends psychotherapy alone or in combination with pharmacotherapy to treat most of these depressive patient groups. Evidence gaps were identified, which highlight the need for further research.

[Psychotherapy of depressive disorders : Procedures, evidence and perspectives]. / Psychotherapie depressiver Störungen : Verfahren, Evidenz und Perspektiven.

BACKGROUND: Depressive disorders are associated with a high burden of suffering and significantly reduce the well-being and the self-esteem of affected patients. Psychotherapy is one of the main treatment options for depressive disorders. OBJECTIVE: The aim of this article is to present the current evidence for antidepressive psychotherapeutic treatments. MATERIAL AND METHODS: During the revision of the German S3- and National Disease Management Guideline (NDMG) on unipolar depression in 2015, a comprehensive and systematic evidence search was conducted. The results of this search along with a systematic update are summarized. RESULTS: The most intensively investigated psychotherapeutic method is cognitive behavioral therapy (CBT), which proved to be effective in many trials. Evidence also exists for psychodynamic psychotherapy and interpersonal therapy (IPT), followed by systemic therapy and client-centered psychotherapy; however, the evidence is less robust. CONCLUSION: Psychotherapy alone or in combination with pharmacotherapy was shown to be an effective treatment option. Psychotherapy represents a key element in the treatment of depressive disorders.

[Caregiver intervention studies : Recommendations on endpoints and outcome measures for cognitively impaired care recipients]. / Interventionsstudien zur Unterstützung häuslicher Pflege : Empfehlungen zu Endpunkten und Assessment-Instrumenten bei kognitiv eingeschränkten Pflegebedürftigen.

BACKGROUND: Even though the intervention effects on cognitively impaired care recipients are of interest, the evaluation in dementia caregiver studies on caregiver outcomes is often limited. Furthermore, the comparison of studies and interventions is difficult because of the large variance of endpoints and assessments used in this field. OBJECTIVE: The aim of this study was to give an overview on the most prevalent outcomes for cognitively impaired care recipients and expert based recommendations for assessment. MATERIAL AND METHODS: A written Delphi survey was carried out on 16 assessments from 5 dimensions with 14 experts working in different disciplines in German healthcare and research institutes. RESULTS: The most important outcomes and best rated assessments were 1) for problem behavior: revised memory and behavior problem checklist and neuropsychiatric inventory Q, 2) for depressive symptoms: geriatric depression scale, 3) for quality of life: quality of life in Alzheimer's disease, 4) for cognition: mini mental state examination and 5) for ADL/IADL: Katz activities of daily living and Lawton instrumental activities of daily living. CONCLUSION: Due to the varying experiences of the experts with particular assessments, the ratings were in some cases relatively heterogeneous. Overall previous international recommendations could be confirmed. There is particular need of German validation studies on internationally used instruments within the dimensions of problem behavior and quality of life.

[Psychotherapeutic approaches for treatment of the elderly]. / Psychotherapeutische Ansätze bei der Behandlung älterer Menschen.

BACKGROUND: This article focusses on the possibilities, varieties, indications, and benefits of psychotherapy with elderly patients. OBJECTIVE: Which basic principles can be differentiated, what theoretical rationales are helpful for psychotherapy with the elderly and what kind and forms of psychotherapy are available? MATERIAL AND METHODS: Based on relevant references and research, clinically relevant and evidence-based psychotherapies are described, to understand the theoretical rationale, the goals, the procedure and main strategies. RESULTS: Cognitive behavior therapy, problem solving therapy, life review therapy, interpersonal psychotherapy, and psychodynamic psychotherapy are available to treat various psychological and somatic problems in elderly patients. In particular, cognitive behavior therapy, problem solving therapy, and life review therapy are evidence-based and empirically validated. Evidence for interpersonal psychotherapy is mixed and for psychodynamic psychotherapy is missing. CONCLUSION: Psychotherapy with old and very old patients is possible, well received, and successful. Age per se is no longer considered to be a relevant variable for indications of psychotherapy.

[Rank of outcome parameters in the treatment of depression : Results of a Delphi panel survey]. / Präferenz von Zielparametern bei der Behandlung der Depression : Ergebnisse einer Delphi-Panel-Erhebung.

BACKGROUND: In the context of new drug benefit assessments a list of outcome parameter are evaluated. Currently it is unclear, how different outcome parameters are weighed in the overall assessment. OBJECTIVES: The objective of the survey is to rank relevant outcome parameters in the treatment of depression, which may be considered in benefit the assessment of new antidepressants. MATERIALS AND METHODS: In 2015 a Delphi panel survey with 30 general practitioners and specialists in Germany was performed regarding the benefit assessment of antidepressants. On the basis of two fictive casuistics (patients with depressive disorders) the physicians weighed a range of relevant outcome parameters regarding efficacy, quality of life, safety and tolerability according to their relevance to clinical practice. RESULTS: Regarding efficacy, response, remission and recovery were rated as the most important outcomes. Regarding quality of life, handling of the daily household activities and mental performance were rated as most important. Suicidality was rated as the most important outcome regarding safety and tolerability. CONCLUSIONS: Individual outcome parameters were rated differently by the physicians regarding their relevance to clinical practice. The results indicate that outcome parameters should be weighed differently when assessing the overall benefit of new antidepressants.

[Guideline-adherent psychiatric psychotherapeutic treatment of bipolar disorders : Which resources are needed?] / Leitliniengerechte psychiatrisch-psychotherapeutische Behandlung bei bipolaren Störungen : Welche Ressourcen werden dafür benötigt?

In this article the guideline-adherent psychiatric psychotherapeutic treatment of patients with bipolar disorders is outlined and the required resources are estimated. Based on the core recommendations of the S3 guidelines for diagnostics and treatment of bipolar disorders published in 2012, inpatient treatment needs in hours per week and per patient are determined for both manic and bipolar depressive episodes. The resulting staffing requirements are estimated on this basis. In summary, for guideline-adherent inpatient psychiatric psychotherapeutic treatment the additional needs regarding the physician/psychotherapeutic domain add up to 44 min per patient and week during a manic episode and 88 min for patients with bipolar depression when compared to current psychiatry staffing regulations.

[Psychiatric care of refugees in Africa and the Middle East : Challenges and solutions]. / Psychiatrische Versorgung von Flüchtlingen in Afrika und dem Nahen Osten : Herausforderungen und Lösungsansätze.

Violence, flight, famine, and natural disasters as well as the absence of a psychosocial healthcare system are major psychological burdens for refugees. The level of provision of mental healthcare is particularly low in developing countries. Internally displaced people and refugees place high demands on the healthcare system because they often suffer from psychiatric disorders, such as depression, posttraumatic stress disorder, and substance use disorders. We present first initiatives to improve psychiatric care in refugee camps in Ethiopia, Kenya, and Sudan. Moreover, we provide first insights into a project based in Northern Iraq and Germany aimed at the treatment of people who were severely traumatized by the terror regime of the so-called Islamic State (IS).

Unemotional traits predict early processing deficit for fearful expressions in young violent offenders: an investigation using continuous flash suppression.

BACKGROUND: Research evidence suggests that cognitive and neural mechanisms involved in social information processing may underlie the key aspects associated with the emergence of aggression and psychopathy. Despite extensive research in this field, it is unclear whether this deficit relates to general attentional problems or affects early stages of information processing. Therefore, the aim was to explore the link between aggression, psychopathic traits, and the early processing deficits in young antisocial violent offenders (YAVOs) and healthy controls (CTLs). METHOD: Participants were presented with rapidly changing Mondrian-like images in one eye, while a neutral or emotional (happy, angry, fearful, disgusted, surprised, sad) face was slowly introduced to the other eye. Participants indicated the location in which the face had appeared on the screen, reflecting the time when they became aware of the stimulus. The relative processing advantage was obtained by subtracting mean reaction times for emotional from neutral faces. RESULTS: The results indicated that individuals with higher levels of unemotional traits tended to exhibit an extensive early processing disadvantage for fearful facial expressions; this relationship was only evident in the YAVO as opposed to the CTL sample. CONCLUSIONS: These findings indicate that an emotion processing deficit in antisocial individuals is present even at the most basic levels of processing and closely related to certain psychopathic traits. Furthermore, this early processing deficit appears to be highly specific to fearful expressions, which is consistent with predictions made by influential models of psychopathy. The clinical significance and potential implications of the results are discussed.

[School Based, Universal Primary Prevention of Depressive Symptoms (Disorders) in Adolescents]. / Schulbasierte, universelle Primärprävention depressiver Störungen bei Jugendlichen.

The universal prevention programme "Lifeskills with LARS&LISA" includes 10 sessions held in a regular school setting. We expected the programme to empower young people to improve their life skills, to foster their realistic thinking, to influence school behaviour and thus to prevent the development of depressive symptoms. The "Lifeskills with LARS&LISA" programme can be successfully delivered to a school-based population (grades 7-8) and integrated into the classroom curriculum. Our results demonstrate a prevention (less depressive symptoms) but also an intervention effect on social skills, school behaviour (more social, less aggressive).

Addressing perceptual insensitivity to facial affect in violent offenders: first evidence for the efficacy of a novel implicit training approach.

BACKGROUND: Although impaired recognition of affective facial expressions has been conclusively linked to antisocial behavior, little is known about the modifiability of this deficit. This study investigated whether and under which circumstances the proposed perceptual insensitivity can be addressed with a brief implicit training approach. METHOD: Facial affect recognition was assessed with an animated morph task, in which the participants (44 male incarcerated violent offenders and 43 matched controls) identified the onset of emotional expressions in animated morph clips that gradually changed from neutral to one of the six basic emotions. Half of the offenders were then implicitly trained to direct attention to salient face regions (attention training, AT) using a modified dot-probe task. The other half underwent the same protocol but the intensity level of the presented expressions was additionally manipulated over the course of training sessions (sensitivity to emotional expressions training, SEE training). Subsequently, participants were reassessed with the animated morph task. RESULTS: Facial affect recognition was significantly impaired in violent offenders as compared with controls. Further, our results indicate that only the SEE training group exhibited a pronounced improvement in emotion recognition. CONCLUSIONS: We demonstrated for the first time that perceptual insensitivity to facial affect can be addressed by an implicit training that directs attention to salient regions of a face and gradually decreases the intensity of the emotional expression. Future studies should focus on the potential of this intervention to effectively increase empathy and inhibit violent behavior in antisocial individuals.

Similar autobiographical memory impairment in long-term secondary progressive multiple sclerosis and Alzheimer's disease.

BACKGROUND: Memory disturbance is a common symptom of multiple sclerosis (MS), but little is known about autobiographical memory deficits in the long-term course of different MS subtypes. Inflammatory activity and demyelination is pronounced in relapsing-remitting multiple sclerosis (RRMS) whereas, similar to Alzheimer's disease, neurodegeneration affecting autobiographical memory-associated areas is seen in secondary progressive multiple sclerosis (SPMS). OBJECTIVE: In light of distinct disease mechanisms, we evaluated autobiographical memory in different MS subtypes and hypothesized similarities between elderly patients with SPMS and Alzheimer's disease. METHODS: We used the Autobiographical Memory Interview to assess episodic and semantic autobiographical memory in 112 education- and gender-matched participants, including healthy controls and patients with RRMS, SPMS, amnesic mild cognitive impairment (aMCI) and early Alzheimer's dementia (AD). RESULTS: Patients with SPMS, AD, and aMCI, but not with RRMS, exhibited a pattern of episodic autobiographical memory impairment that followed Ribot's Law; older memories were better preserved than more recent memories. In contrast to aMCI and AD, neither SPMS nor RRMS was associated with semantic autobiographical memory impairment. CONCLUSION: Our neuropsychological findings suggest that episodic autobiographical memory is affected in long-term patients with SPMS, possibly due to neurodegenerative processes in functional relevant brain regions.

Cognitive behaviour therapy and supportive therapy for bipolar disorders: relapse rates for treatment period and 2-year follow-up.

BACKGROUND: The efficacy of adjunctive psychosocial interventions such as cognitive behaviour therapy (CBT) for bipolar disorder (BD) has been demonstrated in several uncontrolled and controlled studies. However, these studies compared CBT to either a waiting list control group, brief psycho-education or treatment as usual (TAU). Our primary aim was to determine whether CBT is superior to supportive therapy (ST) of equal intensity and frequency in preventing relapse and improving outcome at post-treatment. A secondary aim was to look at predictors of survival time. METHOD: We conducted a randomized controlled trial (RCT) at the Department of Psychology, University of Tübingen, Germany (n=76 patients with BD). Both CBT and ST consisted of 20 sessions over 9 months. Patients were followed up for a further 24 months. RESULTS: Although changes over time were observed in some variables, they were not differentially associated with CBT or ST. CBT showed a non-significant trend for preventing any affective, specifically depressive episode during the time of therapy. Kaplan-Meier survival analyses revealed that 64.5% of patients experienced a relapse during the 33 months. The number of prior episodes, the number of therapy sessions and the type of BD predicted survival time. CONCLUSIONS: No differences in relapse rates between treatment conditions were observed, suggesting that certain shared characteristics (e.g. information, systematic mood monitoring) might explain the effects of psychosocial treatment for BD. Our results also suggest that a higher number of prior episodes, a lower number of therapy sessions and a diagnosis of bipolar II disorder are associated with a shorter time before relapse.

[Therapy of functional abdominal pain in childhood. Concept, acceptance and preliminary results of a short hypnotherapeutic-behavioural intervention]. / Therapie funktioneller Bauchschmerzen bei Kindern. Konzept, Akzeptanz und erste Pilotergebnisse einer hypnotherapeutisch-behavioralen Kurzintervention.

OBJECTIVE: Recurrent abdominal pain is one of the most frequent pain syndromes in childhood and is accompanied by notable functional impairment and unfavourable long-term outcome. Psychotherapeutic approaches are promising, but not widely used in Germany. The concept of a multimodal short-term intervention and its acceptance are described and preliminary results are reported. METHOD: A total of 21 children aged 6-12 years and their parents participated in a hypnotherapeutic-behavioural short intervention program. Preliminary results on efficacy up to 3 months are reported. RESULTS: Participating children showed a decrease in pain frequency and daily impairment. Health-related quality of life also increased and associated mental problems could be reduced. Content and conditions of the intervention were rated as helpful by children and parents. CONCLUSION: Preliminary results indicate that even short psychotherapeutic interventions might help affected children effectively and lower the burden felt by parents. Further investigations using a randomized controlled trial design and focussing on children suffering more severely should follow to allow major conclusions.

Addressing barriers to mental health services: evaluation of a psychoeducational short film for forcibly displaced people.

Background: Despite the high prevalence of mental illness in forcibly displaced people, their utilization of mental health services is low. Major barriers to seeking mental health services include mental health self-stigma. To address this issue, the psychoeducational short film 'Coping with Flight and Trauma' was developed as a brief online intervention. Objective: The present study aims to evaluate the feasibility and acceptance of the newly developed 10 min film, and to assess changes in self-stigma and help seeking. Method: The evaluation of the film was conducted using a mixed-methods design with an online survey including the Self-Stigma of Mental Illness Scale, help seeking, and mental health variables at baseline, postintervention, and 3 month follow-up, in addition to telephone interviews postintervention with a randomly selected volunteer subsample. Results: A total of 134 participants with a forced displacement history within the past 8 years took part in the study, of whom 66% scored as having probable post-traumatic stress disorder (PTSD), depression, and/or anxiety. The results revealed emotional, cognitive, and behavioural changes postintervention. Directly after watching the film, participants reported reduced self-stigma and increased openness towards accessing mental health services. At follow-up, precisely 3.8 months later, these changes were no longer significant, yet 11% of participants reported having started psychotherapy since watching the film. Probable PTSD was associated with higher self-stigma at all three time-points. The majority (90%) would recommend watching the film to other forcibly displaced people. Conclusions: Self-stigma was shown to be a robust and persistent issue, which tends to be underestimated by individuals not affected by mental illness. Low-threshold psychoeducational online interventions may be a promising tool to reduce barriers to accessing mental health services for forcibly displaced people, e.g. by being implemented in stepped-care models. HIGHLIGHTS: Mental health self-stigma was shown to be a persistent and underestimated burden in forcibly displaced people.Psychoeducational online interventions are promising for addressing the burden of self-stigma and reducing barriers to seeking mental health services.

Antecedentes: A pesar de la alta prevalencia de enfermedades mentales en las personas desplazadas por la fuerza, la utilización que hacen de los servicios de salud mental es baja. Las principales barreras en la búsqueda de servicios de salud mental incluyen el autoestigma en salud mental. Para abordar este tema, se desarrolló el cortometraje psicoeducativo 'Afrontando la huida y el trauma' como una breve intervención en línea.Objetivo: El presente estudio pretende evaluar la viabilidad y la aceptación del nuevo cortometraje de 10 minutos con personas desplazadas por la fuerza y evaluar los cambios en el autoestigma y la búsqueda de ayuda.Método: La evaluación de la película se llevó a cabo mediante un diseño de métodos mixtos con una encuesta en línea que incluía la Escala de Autoestigma sobre la Enfermedad Mental, la búsqueda de ayuda y las variables de salud mental al inicio, después de la intervención y a los 3 meses de seguimiento, además de entrevistas telefónicas individuales cualitativas después de la intervención con una submuestra de voluntarios seleccionados al azar.Resultados: N = 134 participantes con una historia de desplazamiento forzado en los últimos ocho años tomaron parte en el estudio, de los cuales el 66% puntuó como probable trastorno de estrés postraumático (TEPT), depresión y/o ansiedad. Los resultados revelaron cambios emocionales, cognitivos y conductuales tras la intervención. Inmediatamente después de ver la película, los participantes informaron de una reducción del autoestigma y una mayor apertura para acceder a los servicios de salud mental. En el seguimiento, precisamente 3,8 meses después, estos cambios ya no eran significativos, pero el 11% de los participantes declararon haber iniciado una psicoterapia desde que vieron la película. El probable TEPT se asoció con un mayor autoestigma en las tres mediciones. La mayoría (90%) recomendaría ver la película a otras personas desplazadas por la fuerza.Conclusiones: El autoestigma demostró ser un fuerte problema y persistente que tiende a ser subestimado por los individuos no afectados por la enfermedad mental. Las intervenciones psicoeducativas en línea de bajo umbral podrían ser una herramienta prometedora para reducir las barreras de acceso a los servicios de salud mental para las personas desplazadas por la fuerza, por ejemplo, mediante su aplicación en modelos de atención escalonada.

[Evidence-based therapy of depression: S3 guidelines on unipolar depression]. / Evidenzbasierte Therapie der Depression: Die S3-Leitlinie unipolare Depression.

Unipolar depressive disorders are among the most frequent reasons for utilizing the health care system. Although efficacious treatments are available and further advances have recently been made there is still a need for improving diagnostic and therapeutic procedures. Alignment of treatment on evidence-based treatment guidelines establishes an essential mainstay. The new S3 and National Health Care guidelines on unipolar depression, the compilation of which was coordinated by the German Society of Psychiatry, Psychotherapy and Neurology (DGPPN) and which were approved by 29 scientific and professional associations, is the ambitious effort to present state of the art evidence and clinical consensus for the treatment of depression. For pharmacotherapy of depression differentiated recommendations can be given, also separate from and in addition to psychotherapy.

Satisfaction and use of personal emergency response systems.

BACKGROUND: Despite a wide distribution, little is known about the relationship between subscriber satisfaction and the extent of use or non-use of personal emergency response systems (PERS). OBJECTIVES: To examine the degree of satisfaction with PERS, the wearing time and its use in case of a fall. STUDY DESIGN AND SETTING: Telephone and face-to-face interviews were conducted with 52 elderly community-dwelling PERS users. RESULTS: PERS subscribers were very satisfied with their device; however, 24% of the participants reported that they never wear the alarm button, and only 14% wear it 24 hours each day. After falls PERS was not activated by 83% (n=11) of the subscribers who fell alone and lay on the floor longer than 5 minutes. None of the five different satisfaction measures and only the subscriber's estimation of relevance of the PERS showed to be a significant predictor of PERS use in daily life. CONCLUSIONS: High rates of non-use of PERS in everyday life and after falls can be found. Subscribers' estimation of relevance but not satisfaction predicts the usage of PERS in everyday life. Further research is needed to better understand the reasons not using a PERS.