Relevance of spirituality and perceived social support to mental health of people with pre-existing mental health disorders during the COVID-19 pandemic: a longitudinal investigation.

BACKGROUND: The COVID-19 pandemic and related measures have negatively impacted mental health worldwide. The main objective of the present longitudinal study was to investigate mental health in people living in Tyrol (Austria) and South Tyrol (Italy) during the COVID-19 pandemic and to report the prevalence of psychological distress among individuals with versus those without pre-existing mental health disorders (MHD) in the long-term (summer 2020-winter 2022). Here, we specifically focus on the relevance of spirituality and perceived social support in this regard. METHODS: 161 individuals who had been diagnosed with MHD and 446 reference subjects participated in this online survey. Electronic data capture was conducted using the Computer-based Health Evaluation System and included both sociodemographic and clinical aspects as well as standardized questionnaires on psychological distress, spirituality, and the perception of social support. RESULTS: The prevalence of psychological distress was significantly higher in individuals with MHD (36.6% vs. 12.3%) and remained unchanged among both groups over time. At baseline, the perception of social support was significantly higher in healthy control subjects, whereas the two groups were comparable in regards of the subjective relevance of faith. Reference subjects indicated significantly higher spiritual well-being in terms of the sense of meaning in life and peacefulness, which mediated in large part the between-group difference of psychological distress at follow-up. Notably, both faith and the perception of social support did not prove to be relevant in this context. CONCLUSIONS: These findings point to a consistently high prevalence of psychological distress among people suffering from MHD and underscore the prominent role of meaning in life and peacefulness as a protective factor in times of crisis. Therapeutic strategies that specifically target spirituality may have a beneficial impact on mental health.

Influence of Spiritual Dimensions on Suicide Risk: The Role of Regional Differences.

The field of suicide prevention has been enriched by research on the association between spirituality and suicide. Many authors have suggested focusing on the various dimensions of religiosity in order to better understand the association between religion and suicidal risk, but it is unclear whether the relationship between spirituality and suicidality differs between countries with different cultures, life values, and sociohistorical experiences. To explore this, the aim of this multicenter study was to investigate the possible relationship between suicide and spirituality in Italy and Austria. In the two countries, two different groups of subjects participated: psychiatric patients and university students. The patients were evaluated with the Mini International Neuropsychiatric Interview. In addition, the following measures were used: a sociodemographic questionnaire, the Columbia-Suicide Severity Rating Scale-B, the Symptom-Checklist-90-Standard, and the Multidimensional Inventory for Religious/Spiritual Well-Being. Our results confirmed the multifactorial nature of the relation between suicide risk and the various religious/spiritual dimensions, including religious/spiritual well-being and hope immanent. However, regional differences moderated this relationship in both the clinical and nonclinical samples.

[The interaction of Rhodiola rosea and antidepressants. A case report]. / Das Zusammenwirken von Rhodiola rosea (Eisenwurz) und Antidepressiva.

OBJECTIVE: Rhodiola rosea (Russian Rhodiola/Golden Root) is a high mountain plant from the arctic regions of Europe and Asia which has the active substance phenylpropanoide. It has sedative, anti-depressive, drive-enhancing and stress-modulated properties stimulating the distribution of dopamine and serotonin; in combination with other drugs, an increase of side effects and risk profile has to be expected. METHODS: A case report is presented in order to illustrate the interaction between Rhodiola rosea and antidepressants. RESULTS: We report the case of a 68-year-old female patient with recurrent moderate depressive disorder with somatic syndrome (ICD-10 F33.11) who developed vegetative syndrome, restlessness feeling and trembling since she began to ingest Rhodiola rosea in addition to paroxetine. CONCLUSIONS: Prescribing Rhodiola rosea with paroxetine, pharmacokinetic and -dynamic interactions have to be assumed. The symptoms of the patient can be interpreted as a serotonergic syndrome. Because of its different effects, the plant is widely used. An increase of clinical relevant risks should be considered in the add-on treatments.

Frequency of and rationales for the combined use of electroconvulsive therapy and antiepileptic drugs in Austria and the literature.

Our aim was to observe the frequency of combination therapy using antiepileptic drugs (AEDs) and electroconvulsive therapy (ECT) in Austria and the literature, and to provide rationales and recommendations based on clinical and molecular properties. The responsible ECT leaders of eight Austrian departments were contacted for information about combination therapy. A computerized PubMed database search was performed and supplemented by cross-referencing from papers, review articles and psychiatric manuals. The frequency of combination therapy in Austrian departments ranges between 0 and 85.7%. In 17 studies enrolling a total of 189 patients, 87 (46.0%) patients received combination therapy. Of these 87 patients, nine (10.3%) reported adverse effects. ECT and AEDs show overlapping clinical and molecular properties. Combination therapy is an observed reality and, according to the currently available literature, feasible. A comparison of clinical and molecular properties indicates possible augmentative effects, making combination therapy a promising alternative in treatment-resistant cases. But there is still a clear need for prospective case controlled data concerning side effects, safety profiles and effectiveness until it can be recommended.

[Psychiatric care in South Tyrol -- an example of coordination]. / Psychiatrische Versorgung aus einer Hand: Das Beispiel Südtirol.

The Tyrol's division after the two World Wars cut the South Tyrol off from every relevant aspect of psychiatric care. First attempts towards a community psychiatric system weren't sufficiently sustained by politicians. Only in the 90 ty's was the association of relatives of mentally ill people able to sensitize public and politicians to the need for an adequate psychiatric care system. Since 1996 an excellent psychiatric plan has been in existence, 80 % of which has to date been able to be put into practice. Since 1997 mentally ill people have founded their own self-help-organization and influenced the planning process.

No deterioration of cognitive performance in an aggressive unilateral and bilateral antidepressant rTMS add-on trial.

BACKGROUND: Cognitive functions were assessed before and following a course of repetitive transcranial magnetic stimulation (rTMS) in patients with depression participating in a sham-controlled, randomized trial of rTMS as adjunct to antidepressant treatment. METHOD: Forty-one medicated inpatients with a DSM-IV diagnosis of a depressive episode were consecutively randomly assigned to 1 of 3 groups comparing 2 active rTMS conditions with sham stimulation. The rTMS was applied either at high frequency over the left dorsolateral-prefrontal cortex (DLPFC) (10 sessions x 10 trains x 10 seconds 20 Hz at 100% motor threshold [MT], 90-second intertrain interval) or in a combined high- and low-frequency manner to the left and right DLPFC, respectively (10 sessions x 1 train x 10 minutes at 120% MT). Thirty-eight patients completed a neuropsychological test battery at baseline and following day 14. The cognitive assessment focused on motor skills, attention, executive functions, learning, and memory. Data were collected from November 1999 to August 2002. RESULTS: Active treatment groups did not differ with respect to assessed cognitive measures and thus were pooled. A comparison of short-term changes (baseline-day 14) in neuropsychological performance revealed a more favorable time course of the actively treated patients for encoding in the verbal memory test compared with the sham-stimulated patients. CONCLUSIONS: Unilateral rTMS as well as bilateral combined rTMS revealed no detrimental effects on cognition, as compared with the sham group. Moreover, neither the add-on design nor the used aggressive parameters had a negative impact on cognitive measures in comparison with sham. Repetitive transcranial magnetic stimulation might have mild beneficial cognitive effects partly independent of its antidepressant efficacy.

Effect of chronic repetitive transcranial magnetic stimulation on regional cerebral blood flow and regional cerebral glucose uptake in drug treatment-resistant depressives. A brief report.

Brain imaging studies have shown that repetitive transcranial magnetic stimulation (rTMS) is biologically active. The aim of the present study was to investigate the patterns of the regional cerebral glucose uptake rate (rCMRGlu) and regional (99m)Tc HMPAO uptake rate (regional cerebral blood flow; rCBF) during a series of therapeutic rTMS sessions at low frequency. Four drug-resistant depressed patients underwent 10 rTMS sessions as an add-on measure over 14 days. One day before and 1 day after the TMS series, 511-keV SPECT with simultaneous (18)F-fluorodeoxyglucose and (99m)Tc HMPAO measurements were carried out. All patients showed a good clinical outcome. Statistically significant common changes in rCBF and rCMRGlu patterns were found in the upper frontal regions bilaterally in terms of increased uptake rates and in the left orbitofrontal cortex in terms of decreased uptake rates of both isotopes compared to controls. However, the lateralization patterns of rCBF and rCMRGlu after rTMS treatment revealed marked differences. Thus, although no relevant changes in lateralization of the glucose uptake were observed, a clear right-sided preponderance of rCBF also in areas remote from the stimulation site was described. Therapeutic rTMS seems to influence distinct cortical regions, affecting rCBF and rCMRGlu in a homogeneous manner as well as in different ways, which are probably region dependent and illness related. The role of the stimulation coil placement site should be taken into account.