Background: Adult Attention Deficit Hyperactivity Disorder (aADHD) is characterised by inattention, hyperactivity, impulsivity, and emotional instability, all of which were linked to altered modulation of the autonomic nervous system. This and the clinical effectiveness of sympathomimetic medication raised the question if autonomic modulation is altered in aADHD patients.Methods: We systematically searched PubMed, Cochrane Library, and Web Of Science for publications investigating autonomic modulation in aADHD and controls during resting-state and/or under task conditions.Results: We reviewed 15 studies involving 846 participants (424 aADHD and 422 controls), including 4 studies on sympathetic tone at rest, 13 studies on sympathetic modulation during tasks, 3 studies on resting state parasympathetic modulation and 3 papers on task-related parasympathetic modulation. Studies comprised measurements of electrodermal activity, heart rate variability, blood pressure variability, blood volume pulse, pre-ejection period, and baroreflex sensitivity. 2 studies reported reduced sympathetic tone in aADHD; 7 papers described lower sympathetic reactivity to task demands in this cohort. One study linked aADHD to impaired vagal tone, while no indications of altered tasks-related parasympathetic reactivity in aADHD patients were reported.Conclusion: The reviewed data revealed impaired cardiovascular autonomic modulation in aADHD patients, predominantly in sympathetic modulation and during stress exposure.
Attention Deficit Disorder with Hyperactivity , Humans , Adult , Autonomic Nervous System , Heart Rate/physiology
Objective: The present study examined the follow-up of a multimodal day clinic group-based therapy program for patients with trauma-related disorders and investigated potential differences for patients with classic PTSD versus cPTSD. Method: Sixty-six patients were contacted 6 and 12 months after discharge of our 8-week program and completed various questionnaires (Essen Trauma Inventory (ETI), Beck Depression Inventory-Revised (BDI-II), Screening scale of complex PTSD (SkPTBS), Patient Health Questionnaire (PHQ)-Somatization, as well as single items to therapy utilization and life events in the interim period). Due to organizational reasons a control group could not be included. Statistical analyses included repeated-measures ANOVA with cPTSD as between-subject factor. Results: The reduction of depressive symptoms at discharge was persistent at 6 and 12 months follow-up. Somatization symptoms were increased at discharge, but were leveled out at 6 months follow-up. The same effect was found for cPTSD symptoms in those patients with non-complex trauma-related disorders: Their increase of cPTSD symptoms was flattened at 6 months follow-up. Patients with a very high risk for cPTSD showed a strong linear reduction of cPTSD symptoms from admission to discharge and 6 months follow-up. cPTSD patients had a higher symptom load compared to patients without cPTSD on all time points and scales. Conclusion: Multimodal, day clinic trauma-focused treatment is associated with positive changes even after 6 and 12 months. Positive therapy outcomes (reduced depression, reduced cPTSD symptoms for patients with a very high risk for cPTSD) could be maintained. However, PTSD symptomatology was not significantly reduced. Increases in somatoform symptoms were leveled out and can therefore be regarded as side effects of treatment, which may be connected with actualization of trauma in the intensive psychotherapeutic treatment. Further analyses should be applied in larger samples and a control group.
Background: In the German healthcare system benefits include inpatient and day clinic psychotherapy of trauma-related disorders, which are often provided in gender specific groups. Despite this widespread practice, the actual impact and potential outcome have been studied relatively scarcely and are still open to debate. The present study therefore examines whether the therapeutic relationships in the group vary depending on the group composition and whether this has an effect on therapy outcome. Methods: 66 patients (N = 55 women) were treated in our multimodal, day clinic groupbased treatment program and filled out symptom questionnaires (ETI, BDI-II, PHQ-15, Questionnaire on social support) at admission and discharge and the Group Questionnaire (GQ; including subscales positive bonding, positive working and negative relationships) at the end of each of the eight weeks of treatment. Patients took part in five women-only and six mixed-gender groups and underwent therapy in a closed group format, so that they began and ended therapy within the same group. All patients were diagnosed with trauma-related disorders, which included PTSD, cPTSD, depression, somatoform disorders and further mental diseases. Outcome data were examined using functional regression analysis and linear mixed models. Results: In women-only groups, positive bonding and positive working relationship were significantly higher than in mixed-gender groups. Negative relationship ratings were significantly lower in women-only groups, especially in the middle phase of treatment. However, no effect of an exclusively female group composition on treatment outcome was found, except for the higher increase of perceived social support for patients treated in women-only groups. Conclusions: Group relationships were considered more pleasant in women-only groups than in mixed-gender groups, but this had no effect on the symptom-based therapy outcome. To enhance feelings of safety and comfort, traumatized women should have the possibility to choose whether to be treated in a women-only or a mixed-gender group.
Stress Disorders, Post-Traumatic , Female , Humans , Stress Disorders, Post-Traumatic/diagnosis , Stress Disorders, Post-Traumatic/therapy , Psychotherapy , Somatoform Disorders/diagnosis , Somatoform Disorders/therapy , Treatment Outcome , Combined Modality Therapy
BACKGROUND: Alcohol use disorder, a prevalent and disabling mental health problem, is often characterized by a chronic disease course. While effective inpatient and aftercare treatment options exist, the transferal of treatment success into everyday life is challenging and many patients remain without further assistance. App-based interventions with human guidance have great potential to support individuals after inpatient treatment, yet evidence on their efficacy remains scarce. OBJECTIVES: To develop an app-based intervention with human guidance and evaluate its usability, efficacy, and cost-effectiveness. METHODS: Individuals with alcohol use disorder (DSM-5), aged 18 or higher, without history of schizophrenia, undergoing inpatient alcohol use disorder treatment (N = 356) were recruited in eight medical centres in Bavaria, Germany, between December 2019 and August 2021. Participants were randomized in a 1:1 ratio to either receive access to treatment as usual plus an app-based intervention with human guidance (intervention group) or access to treatment as usual plus app-based intervention after the active study phase (waitlist control/TAU group). Telephone-based assessments are conducted by diagnostic interviewers three and six weeks as well as three and six months after randomization. The primary outcome is the relapse risk during the six months after randomization assessed via the Timeline Follow-Back Interview. Secondary outcomes include intervention usage, uptake of aftercare treatments, AUD-related psychopathology, general psychopathology, and quality of life. DISCUSSION: This study will provide further insights into the use of app-based interventions with human guidance as maintenance treatment in individuals with AUD. If shown to be efficacious, the intervention may improve AUD treatment by assisting individuals in maintaining inpatient treatment success after returning into their home setting. Due to the ubiquitous use of smartphones, the intervention has the potential to become part of routine AUD care in Germany and countries with similar healthcare systems.
Flow experience, a feeling of being absorbed in an activity without reflection and with maximum depth, has positive effects on psychological and physical well-being, performance, and life satisfaction. Little research has been done on flow experience in old age, and there are no studies on geriatric patients. In the present study, elderly patients (mean age:81.2, SD=5.9) of a day hospital were examined with regard to their flow experience using the flow short scale. In addition to age and gender effects, flow was assessed during two different activities ( physical activity vs. memory training). Furthermore, the role of individual activity and group dynamics as well as correlations between flow and therapy success were examined in detail. The results show that flow experience is possible even in old age. Depressed patients experienced as much flow as non-depressed patients; cognitively impaired patients, on the other hand, experienced less flow than patients without cognitive deficits, and chronic pain patients even reported more flow experiences during exercise programs than patients without pain. A high level of self-activity had an overall positive effect on the flow experience. The therapy outcome could not be influenced by flow. Flow experience in old age should be given more attention, especially in physical activity therapy for pain patients; further correlations, especially with regard to depression, remain to be investigated.
Chronic Pain , Quality of Life , Aged , Aged, 80 and over , Depression/psychology , Depression/therapy , Exercise , Exercise Therapy , Humans
OBJECTIVE: Since 1996, older patients have been treated in the Nuremberg Geriatric Day Hospital. The geriatric depression scale (GDS) is an obligatory part of the geriatric assessment at admission but its use in the clinical setting has revealed some problems. The aim of the study was to compare the GDS with the depression in old age scale (DIA-S) in terms of applicability and psychometric characteristics. METHODS: As gold standard a semi-structured interview was used to record the depression criteria according to Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Using a sample of 375 patients, sensitivity and specificity as well as positive and negative predictive values were calculated for both screening tests. RESULTS: No clear superiority of any screening method could be proven. The sensitivity of the DIAS in the overall sample was higher than that of the GDS, but the specificity was much lower. In terms of predictive values, there were slight advantages for the GDS. In the sub-samples, poorer values were found in both scales for cognitively impaired or dementia patients with slightly better values for GDS. CONCLUSION: The DIAS can be used very easily in everyday clinical practice, but no advantages of this method compared to GDS could be demonstrated.
Depression , Geriatric Assessment , Aged , Depression/diagnosis , Depression/epidemiology , Humans , Mass Screening , Psychiatric Status Rating Scales , Reproducibility of Results , Sensitivity and Specificity
BACKGROUND: The present study examines the treatment practice and attitudes of medical staff towards opioid-dependent inmates in Bavarian prisons. METHOD: We interviewed medical staff (n=20) from 18 Bavarian prisons about substitution practice and attitudes by semi-structured interviews. RESULTS: With regard to the treatment routines and the attitudes of the medical staff, we found mixed results. From the perspective of the medical staff, the treatment decision depends on the patients' wishes, the severity and duration of the dependence, the length of sentence and organizational factors. Problems were discussed in particular with regard to the care situation inside and outside the prisons and difficulties in transition management. CONCLUSIONS: Substitution therapy is considered a standard treatment method in prisons today. However, our respondents highlighted some disadvantages (e. g. passing on the substitution drug). Although the treatment goal of complete abstinence was generally viewed positively by a part of the medical staff, it was not considered very realistic. From the point of view of the respondents, special attention should be paid to the continuity of the chosen treatment strategy in the context of discharge management.
Analgesics, Opioid , Medical Staff , Humans , Germany
BACKGROUND: Family violence, especially child maltreatment and intimate partner violence, in early childhood has a strong impact on negative developmental outcomes. There is evidence of child, parental, and family risk factors. Less is known about paternal than maternal risk factors. OBJECTIVE: To identify maternal and paternal predictors of family violence and predictive constellations of risk factors. PARTICIPANTS AND SETTING: According to psychosocial adversity in a larger study, families were stratified into low-, medium- and high-risk groups. Both, mothers and fathers (n = 197/191), were investigated longitudinally across seven months using self-report questionnaires and ratings of the IFEEL Pictures. METHODS: χ2-tests, logistic regression models, and prediction configural frequency analysis (P-CFA) were employed. RESULTS: Univariate predictors (p < .05) were anxiety and stress in mothers, and insensitivity in recognizing negative child emotions in fathers. Within high-risk levels, paternal adverse childhood experiences (ACE) were a predictor (z = 2.92, p > .01), proven by P-CFA. Logistic regression models including family violence at baseline, sociodemographic variables, univariate predictors, and ACE of both parents revealed maternal anxiety (OR = 1.22, p < .05) and low paternal recognition of negative IFEEL Pictures (OR = 6.00, p < .05) as predictors. P-CFA identified socioemotional problems in children and low paternal recognition of negative child emotions as a predictive risk constellation (z = 2.58, p > .01). CONCLUSION: Analysis of both caregivers in small population samples with oversampled at-risk families leads to a systemic perspective of family violence. The identified risk constellation is highly relevant for early childhood intervention.
Child Abuse , Domestic Violence , Intimate Partner Violence , Child , Child Abuse/psychology , Child, Preschool , Fathers/psychology , Female , Humans , Intimate Partner Violence/psychology , Male , Mothers/psychology , Risk Factors
(1) Background: The SKT (Syndrom Kurztest) is a short cognitive performance test that consists of nine subtests and assesses deficits of memory and attention. This study was aimed at exploring the SKT target population in China and evaluating the reliability and validity of the Chinese version of the SKT; (2) Methods: A total of 1624 patients aged over 60 years old were recruited in the Sixth People's Hospital in Shanghai. The SKT raw scores were recorded. Cronbach's alpha coefficient was determined to assess the internal consistency reliability of the SKT. Principal factor analysis was performed to evaluate the factor structure of the SKT subtests. Correlation analyses were carried out to confirm the relationship between the modified SKT and standardized neuropsychological tests. The influence of age and educational years on SKT raw scores were detected using multiple regression analyses. Validations of the SKT subtests for detecting Mild Cognitive Impairment (MCI) from Negative Control(NC)(were determined by Receiver operating characteristic (ROC) curves; (3) Results: The internal consistency among the subtests' scores was high: Cronbach's α = 0.827. The SKT memory test provided a high predictive validity in detecting aMCI with a sensitivity of 90.1% and specificity of 79.3%. (4) Conclusions: Based on our experience with 1624 elderly patients in Shanghai, the Chinese version of SKT has good stability and may be a reliable and valid screening tool for detecting MCI.
BACKGROUND: Many shift workers suffer from sleep issues, which negatively affect quality of life and performance. Scientifically evaluated, structured programs for prevention and treatment are scarce. We developed an anonymous online cognitive behavioral therapy for insomnia (CBT-I) program. After successful completion of a feasibility study, we now start this prospective, randomized, controlled superiority trial to compare outcomes of two parallel groups, namely an intervention group and a waiting-list control-group. Additionally, we will compare these outcomes to those of a face-to-face CBT-I outpatient sample. METHODS: Collaborating companies will offer our anonymous online intervention to their shift-working employees. Company physicians and counseling services will screen those interested for inclusion and exclusion criteria. Participants will receive access to our online service, where they will complete psychometric assessment and receive random assignment to either the intervention group or the waiting-list control group. Participants and providers will be aware of the group assignment. We aim to allocate at least N = 60 participants to the trial. The intervention consists of psychoeducation, sleep restriction, stimulus control, relaxation techniques, and individual feedback delivered via four e-mail contacts. During the intervention, as well as during the waiting period, participants will fill out weekly sleep diaries. Immediately after completion of the program, the post-intervention assessment takes place. Participants in the control group will be able to participate in the program after all study assessments. To recruit an additional sample, collaborating outpatient sleep clinics will provide six sessions of standard face-to-face CBT-I to an ad hoc sample of shift working patients. We expect both the online and the face-to-face CBT-I interventions to have beneficial effects compared to the control group on the following primary outcomes: self-reported symptoms of depression and insomnia, sleep quality, and daytime sleepiness. CONCLUSIONS: The online intervention allows shift workers to follow a CBT-I program independently of their working schedule and location. Forthcoming results might contribute to further improvement of prevention and therapy of sleep issues in shift workers. TRIAL REGISTRATION: German Clinical Trials Register DRKS DRKS00017777 . Registered on 14 January 2020-retrospectively registered.
Cognitive Behavioral Therapy , Sleep Initiation and Maintenance Disorders , Sleep Wake Disorders , Humans , Prospective Studies , Quality of Life , Randomized Controlled Trials as Topic , Sleep Initiation and Maintenance Disorders/diagnosis , Sleep Initiation and Maintenance Disorders/therapy , Treatment Outcome
BACKGROUND: Drinking alcohol during pregnancy is considered a risk factor for child development; however, child biomarkers of prenatal alcohol exposure have been rarely studied. We examined whether a meconium alcohol metabolite (ethyl glucuronide, EtG) was associated with child cortisol concentrations at primary school age. METHODS: For 137 children, prenatal alcohol exposure was operationalized by the meconium biomarker EtG and by maternal self-reports during pregnancy. Two EtG cut-offs (EtG ≥10 ng/g and EtG ≥112 ng/g) were applied. Cortisol concentrations were measured in saliva and hair samples. RESULTS: Children with EtG ≥10 ng/g showed significantly reduced hair cortisol concentrations (HCCs) (p = .050, ηp2 = 0.042). For children with EtG ≥112 ng/g, the cortisol awakening response (CAR) was significantly decreased (p = .025, ηp2 = 0.070). These effects were also present in correlational analyses with continuous EtG data, speaking for partly dose-dependent effects. Especially, within the EtG ≥112 ng/g group, the basal (CAR: rp = -.642, p = .120) and cumulative (HCC: rp = -.660, p = .107) cortisol parameters were associated with child emotional symptoms at medium effect size. CONCLUSIONS: The present study showed both the biological association of intrauterine alcohol exposure with the cortisol stress system, partly dose-dependent, and the functional association with emotional and behavioral symptoms.
Alcohol Drinking , Prenatal Exposure Delayed Effects , Biomarkers/metabolism , Child, Preschool , Ethanol , Female , Hair/chemistry , Humans , Infant, Newborn , Meconium , Pregnancy , Prenatal Exposure Delayed Effects/metabolism
Are suicidal young people reached by online-counselling? Evaluation of the target group outreach of [U25] online suicide prevention Abstract. Objective: "[U25] Germany" is an online-counselling platform designed to help adolescents and young adults suffering from suicidal ideation or emotional crisis. The online approach and anonymous counselling by peers (young voluntary workers) instead of professionals were initiated to lower the threshold for those seeking help. This study examines characteristics of people seeking help from [U25] and estimates the outreach of the program. Method: Data from n = 1062 counselling protocols dating from 2017 were obtained. In addition, we conducted n = 13 problem-focused interviews with peer counsellors. Results: Our data indicate a good target group outreach concerning age, suicidality, and psychological burden of the clients. However, young men seek counselling by [U25] less frequently than young women. Additionally, preliminary data indicate that young people with lower educational background consult [U25] less often. Conclusions: [U25] offers a promising approach to helping young people suffering from suicidal ideation or a personal crisis. New approaches should be developed and evaluated to better reach young men and persons with a lower education background.
Counseling , Internet , Peer Group , Suicide Prevention , Suicide/psychology , Adolescent , Female , Germany , Humans , Male , Suicidal Ideation , Young Adult
Background: The effectiveness of the psychotherapeutic treatment of posttraumatic stress disorder is evidence-based and generally considered proven. However, the effectiveness of multimodal, group-based day clinic treatment programs has rarely been investigated. Moreover, there is no consensus in the literature concerning the question whether psychotherapeutic approaches for trauma-related disorders are also applicable for patients with complex PTSD (cPTSD). The aim of the study was to evaluate our multimodal group-based treatment program regarding a change of psychiatric burden, a change of protective factors, and possible differences in therapy outcome for patients with or without cPTSD. Methods: The group-based treatment for patients with trauma-related disorders was examined in 66 patients who filled out the following questionnaires in the first and in the last week of treatment: Essen Trauma Inventory (ETI), Screening for complex PTSD (SkPTBS), Patient Health Questionnaire-somatization module (PHQ-15), Beck Depression Inventory-Revised (BDI-II), Posttraumatic Growth Inventory (PTGI), and Questionnaire on social support (F-SozU). Results: The treatment was shown to significantly reduce depressive symptoms (p < 0.001, d = -0.536) and increase posttraumatic growth (New Possibilities: p = 0.004, d = 0.405; Personal Strength: p = 0.005, d = 0.414). For patients with cPTSD, depressive (p = 0.010, d = -0.63) as well as cPTSD symptoms (p = 0.020, d = -0.796) were significantly reduced; perceived social support was increased after day clinic treatment (p = 0.003, d = 0.61). Contrary to our expectations, somatoform symptoms were increased after therapy. Conclusions: The present work expands previous research by demonstrating that multimodal group-based, day clinic treatment is effective in the treatment of trauma-related disorders, also in their complex form.
The SKT (Syndrom-Kurztest) is a short cognitive performance test assessing deficits of memory and attention in the sense of speed of information processing. The new standardization of the SKT (2015) aimed at improving its sensitivity for early cognitive decline due to dementia in subjects aged 60 or older. The goal of this article is to demonstrate how the neuropsychological test profile of the SKT can be used to provide valuable information for a differential diagnosis between MCI (mild cognitive impairment), dementia and depression. n = 549 patients attending a memory clinic (Nuremberg, Germany) were diagnosed according to ICD-10 and tested with the SKT. The SKT consists of nine subtests, three for the assessment of memory and six for measuring attention in the sense of speed of information processing. The result of the SKT test procedure is a total score, which indicates the severity of overall cognitive impairment. Besides the summary score, two subscores for memory and attention can be interpreted. Using the level of depression as a covariate, statistical comparisons of SKT test profiles between the three patient groups revealed that depressed patients showed more pronounced deficits than MCI patients in all six attention subtests. On the other hand, MCI patients displayed significantly greater mnestic impairment than the depressed group, which was indicated by significant differences in the memory subscore. MCI and dementia patients showed similar deficit patterns dominated by impairment of memory (delayed recall) with MCI patients demonstrating less overall impairment. In sum, the SKT neuropsychological test profiles provided indicators for a differential diagnosis between MCI and beginning dementia vs. depression.
OBJECTIVE: The aim of this article was to determine the criterion-related validity of the newly normed SKT (Syndrom-Kurztest) Short Cognitive Performance Test with the onset of dementia as the predicted criterion. METHODS: The cognitive ability was tested with the SKT in a sample of 546 cognitively healthy adults aged 65-85 years. New cases of mild cognitive impairment (MCI) or dementia were determined in 3 follow-up investigations at 1-year intervals. Each participant's cognitive status was rated on the Clinical Dementia Rating Scale. The cognitive status according to the SKT is presented in terms of a traffic light system. RESULTS: Based on Kaplan-Meier estimators, the trajectories of the different SKT traffic light labels were investigated over 3 years. The trajectories were significantly different, representing differential risks for dementia onset. In comparison to the green group, the hazard ratio (HR) for the development of dementia and MCI amounted to HR 6.63 (95% CI 2.75-15.96) and HR 2.34 (95% CI 1.37-3.99), respectively, in the yellow group, and to HR 25.40 (95% CI 10.73-60.14) and HR 3.83 (95% CI 1.86-7.86), respectively, in the red group. CONCLUSIONS: The newly normed SKT showed a high predictive validity for the onset of dementia.
Violent extremism research is still lacking a sound empirical basis for the validation of assessment instruments. Yet there is a growing need for these instruments to assess the dangerousness of individuals, but also the success of interventions. By analysing prisoner files of one female and 39 male inmates (average age 28.83 years, SD = 7.58) with administratively assigned Islamism-related security labels in Bavarian prisons, we tried to clarify two questions: Firstly, is it possible to collect relevant data from prisoner files drawing on risk assessment procedures? Secondly, how do inmates associated with the Salafist scene (security label "Salafist scene") differ from those who are apparently involved with terror networks (security label "terror"), and do these differences predict the risk they pose? Our results suggest that files are a valuable, though not perfect data source for individual assessment and research. The two groups defined by the labels differ significantly in their biographies, mental health, and behaviour. Conclusions pertaining to biographical background factors, risk assessment, and management are discussed.
BACKGROUND: The ability to perform activities of daily living (ADLs) is a central marker in the diagnosis and progression of the dementia syndrome. ADLs can be identified as basic ADLs (BADLs), which are fairly easy to perform, or instrumental ADLs (IADLs), which involve more complex activities. Presently, the only performance-based assessment of IADL capabilities in persons with cognitive impairment is the Erlangen Test of Activities of Daily Living in Persons with Mild Dementia or Mild Cognitive Impairment (ETAM). The aim of the present study was to revalidate the ETAM in persons with mild cognitive impairment (MCI) or mild dementia and to analyze its application to persons with moderate dementia. METHODS: We used baseline data from a cluster randomized controlled trial involving a sample of 443 users of 34 day-care centers in Germany. We analyzed groups of persons with MCI, mild dementia, and moderate dementia, categorized on the basis of the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA). An item analysis was performed, and new discriminant validities were calculated. We computed a confirmatory factor analysis (CFA) to examine the postulated theoretical model of the ETAM with all six items loading on a single IADL factor. This was the first time that the ETAM's sensitivity to change was analyzed after a time period of 6 months. RESULTS: The overall sample scored on average 17.3 points (SD = 7.2) on the ETAM (range: 0-30 points). Persons with MCI scored on average 23.2 points, persons with mild dementia scored 18.4 points, and persons with moderate dementia scored 12.9 points, p < .001 (ANOVA). The item analysis yielded good difficulty indices and discrimination powers. The CFA indicated a good fit between the model and the observed data. After 6 months, both the ETAM score at baseline and the change in MMSE score (t0-t1) were significant predictors of the ETAM score at t1. CONCLUSIONS: The ETAM is a valid and reliable instrument for assessing IADL capabilities in persons with MCI or mild dementia. It is sensitive to changes in cognitive abilities. The test parameters confirm its application to persons with moderate dementia. TRIAL REGISTRATION: Identifier: ISRCTN16412551 (Registration date: 30 July 2014, registered retrospectively).
Activities of Daily Living , Cognitive Dysfunction/diagnosis , Dementia/diagnosis , Health Status Indicators , Aged , Aged, 80 and over , Cognitive Dysfunction/physiopathology , Cognitive Dysfunction/psychology , Cross-Sectional Studies , Dementia/physiopathology , Dementia/psychology , Disease Progression , Factor Analysis, Statistical , Female , Follow-Up Studies , Humans , Male , Mental Status and Dementia Tests , Reproducibility of Results , Retrospective Studies
BACKGROUND: Which deficits in cognitive performance indicate the onset of a pathological deterioration process in older persons? AIM AND OBJECTIVES: Based on an established dementia screening test in elderly adults, a differentiation can be made between healthy cognitive performance and the onset of pathological deficits in performance (in the sense of mild cognitive impairment). The aim of the study was to investigate whether cognitive decline assessed with a dementia screening instrument is reflected in an intelligence test for adults. The dementia screening measured disorders in memory and attention, the intelligence testing battery measured information processing, working memory, perceptual reasoning, logical thinking and verbal comprehension. MATERIAL AND METHODS: A total of 253 cognitively healthy, self-dependent and non-dementia persons (129 women and 124 men), aged between 60 and 91 years (M = 71.98 years; SD = ±7.13) were tested with the complete Wechsler adult intelligence scale (WAIS-IV) and the short performance test (SKT), based on the new normalization from 2015. The SKT enables an assessment of the degree of cognitive deterioration based on coloring codes of traffic lights. Green indicates normal aging, yellow mild cognitive impairment and red stands for abnormal cognitive aging. RESULTS AND CONCLUSION: There were significant correlations between the total SKT score as a measure of total cognitive impairment and the indices of the WAIS-IV, such as information processing, working memory and perceptual reasoning. No significant covariation was found for verbal comprehension. The results suggest that in old age cognitive deterioration starts with reduced speed of information processing and impairment in the working memory log before deficits in memory are present. This finding was reflected in significant mean differences between the subjects in the category green versus yellow in the indices information processing and working memory. Under these aspects there were medium effect strengths (d = 0.60) and the second largest (insignificant) differences were shown in working memory (d = 0.39).
Alzheimer Disease/diagnosis , Cognitive Dysfunction/diagnosis , Mental Status and Dementia Tests/statistics & numerical data , Psychometrics/statistics & numerical data , Wechsler Scales/statistics & numerical data , Aged , Aged, 80 and over , Correlation of Data , Disease Progression , Female , Humans , Male , Middle Aged , Reference Values , Reproducibility of Results , Risk Assessment
Objective: Information from parents is regularly used in the diagnostic process of children and adolescents with psychiatric symptoms. But the reliability of this information is debatable, because the parents' own stress can distort their perceptions of the child's symptoms. Method: For each of N = 68 children and adolescents (1118 years) who were using mental health services for the first time, we evaluated the ratings of a parent and a professional clinician (internalizing, externalizing symptoms, total-problem score). In addition, parenting stress was scored on the Eltern-Belastungs-Inventars (EBI, Tröster, 2011), which measures both child-related stress and parent-related stress as well as total stress. Results: Highly stressed parent ratings differed more from the clinicians' ratings than the ratings of less stressed parents. Additionally, correlations showed that higher parenting stress resulted in larger differences between the parent's and the clinician's assessments. Multiple regressions proved the predictive value of child-caused parenting stress for these differences. These results apply for internalizing symptoms, externalizing symptoms, and total-problem score. Conclusions: Parenting stress should be evaluated systematically in order to carefully assess the value of the information from parents and to determine how it should be included in diagnostic and therapeutical decisions.
Child Behavior Disorders/diagnosis , Child Behavior Disorders/psychology , Cost of Illness , Mental Disorders/diagnosis , Mental Disorders/psychology , Parents/psychology , Psychometrics/statistics & numerical data , Surveys and Questionnaires , Adolescent , Child , Community Mental Health Services , Female , Germany , Humans , Internal-External Control , Male , Observer Variation , Parenting/psychology , Reproducibility of Results
The primary aim of family-based prevention programs is to promote children's health. Unfortunately, it is difficult to reach families with such evidence-based prevention programs (EBP). Therefore, implementing EBP on a population level could be a promising approach to reach more families, including those faced with socioeconomic challenges who are usually less likely to participate in randomized controlled trials (RCT). Is a population rollout appropriate to reach more and different families than those participating in RCT, especially those representative of the target population? We implemented three EBP in a city in an uncontrolled trial. The effects of this population rollout were tracked on the level of the participating families and on the level of all families living in the city. More than 3480 families (30 % of the population) with children up to 12 years of age participated based on practitioner report. Analyses indicate that a greater percentage of low socioeconomic-status families attended a program compared with a randomly surveyed sample from the city's general population. The sizes of the within-subject effect for parental strategies, child behavior problems, and children's quality of life for a subsample of n = 411 families were similar to those of other uncontrolled EBP studies. The study contributes to highly needed type 2 translation research. The population-based dissemination of EBP could be a promising approach to reach families at risk. However, there are considerable barriers to the implementation process, which currently limit the effectiveness of this rollout in a community.
Child Health Services/organization & administration , Evidence-Based Practice , Child , Child Behavior , Child, Preschool , Female , Health Promotion , Humans , Male , Randomized Controlled Trials as Topic
