Long-term course of psychogenic nonepileptic seizures: Who gets seizure-free, has better functional level and higher health-related quality of life?

BACKGROUND: The disease course of psychogenic nonepileptic seizures (PNES) over a prolonged period of time remains unclear. The aims of the study were: 1. to describe the course of illness with a median follow-up time of 4 years and a range of 2-15 years; and 2. to identify distinguishing features between participants regarding seizure cessation, functional level and health-related quality of life. METHODS: Formerly, inpatients of an epileptic ward diagnosed with PNES between 2000 and 2013 were contacted via mail. They were asked by questionnaire about illness characteristics, i.e., age at onset, PNES status at onset and in the course, treatments, psychosocial situation, and quality of life status. RESULTS: Two-thirds of the N = 63 formerly inpatients were female, their age at onset was 26.7 years. Seizure frequency decreased significantly over time, 31.7% were currently seizure-free, but still only 37% were regularly employed. Only 48% had a satisfying health-related quality of life. The remitted participants had a shorter duration of illness and higher health-related quality of life. Participants with a good level of functioning were more likely to be male, took fewer medications, and had a higher health-related quality of life. Those participants with higher quality of life were more frequently employed and had fewer seizures. CONCLUSIONS: As participants continue to be severely limited in their functional level and quality of life over the period under review, enhanced treatment approaches that address experiential avoidance seem to be needed.

Friend or fiend? Disentangling upward humor's (De)stabilizing effects on hierarchies.

Humor research in organizations focuses on leaders' humor, but we know far less about followers' humor. Here, we review and synthesize the scattered work on this "upward humor," offering a novel framing of it as a strategy for followers to deal with hierarchies. We propose a continuum of upward humor from stabilizing (i.e., a friend who uses upward humor to reinforce hierarchies, make hierarchies more bearable or stable) to destabilizing (i.e., a fiend who uses upward humor to question or reshape existing hierarchies) depending on perceived intent (i.e., from benevolent to malicious, respectively) and outline key factors that shape these interpretations. We close with novel questions and methods for future research such as power plays, multi-modal data, and human-robot interactions.

[Schema Therapy with Sheep: Animal-assisted Intervention in Schema Therapeutic Psychiatric Addiction Treatment]. / Schematherapie mit Schafen: Tiergestützte Intervention in der schematherapeutischen, psychiatrischen Suchtbehandlung.

AIM OF THE STUDY: Schematherapy is often used in addiction treatment. The question is whether animal-assisted interventions can improve the effects. METHOD: During an inpatient psychiatric stay with a schematherapeutic focus, an animal-assisted intervention with sheep was implemented. A case report is presented. RESULTS: After the intervention, the individual mode model of the presented patient shows significant changes towards a strengthening the healthy adult and happy child mode and a reduction of dysfunctional modes. CONCLUSION: The animal-assisted intervention, embedded in a schematherapeutic context, was experienced in this patient as well implementable and impressively effective with regard to a modification of the mode model.

Beliefs about abstraction: Low-level and high-level construal signal different lay theories.

Construal level theory identifies abstraction as the key process that guides the pursuit of distant goals and expands the scope of regulation beyond the here and now (Liberman & Trope, 2008; Trope et al., 2021). While low-level (concrete) construals are concrete representations that foster a narrow view on the immediate circumstances and allow people to focus on a small subset of concerns, high-level (abstract) construals enable people to consider variability and change by taking more distant targets into account. In the present research, we investigate how people associate construal level with lay theories and, in particular, how this association manifests in the inferences they draw about others. In line with predictions, results across eight experiments (N = 1,110) show that people associate high-level construal with growth theories and low-level construal with fixed theories. Moreover, Studies 4 and 5 demonstrate that construal level can selectively influence a candidate's employability, depending on the hiring company's organizational mindset. Overall, this research points out the importance of investigating people's beliefs about abstraction, as it highlights how low-level and high-level construals can communicate distinct traits, characteristics, or intentions to peers. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

One-year follow-up of functional impairment in inpatients with mood and anxiety disorders - Potentials of the Mini-ICF-APP.

BACKGROUND: The aim of the study was to investigate functional impairment and its relationship to illness severity in a sample of patients with a diagnosis of mood or anxiety disorder during inpatient treatment and 1 year after discharge. METHODS: Two hundred thirty-nine inpatients with primary diagnoses of mood or anxiety disorders were assessed at baseline and at follow-up by a range of validated instruments. Mini-ICF-APP was used for the assessment of functional impairment, BDI-II for the assessment of clinical symptoms and remission. Sample characteristics and measures of impairment at baseline and at follow-up were analysed descriptively. Symptomatically remitted and non-remitted patients were compared with regard to capacity limitations. RESULTS: Initially, the sample showed considerable impairment in many capacities, particularly endurance, spontaneous activities, structuring of tasks, competency and flexibility. After 1 year, all capacities significantly improved. The level of impairment was correlated with employment status and severity of clinical symptoms. About 50% of the patients remitted in clinical symptomatology. Retrospectively, the remitted and the unremitted did not differ in functional impairment at baseline but there were considerable differences at follow-up. CONCLUSIONS: Mini-ICF-APP is a useful instrument to monitor functional status and change in psychiatric samples, complementing the usual focus on symptom reduction.

[An Outpatient Withdrawal Treatment of Kratom in Social Phobia: Psychotherapeutic Surgery Meets Addiction Psychiatric Outpatient Clinic]. / Eine ambulante Entzugsbehandlung von Kratom bei sozialer Phobie: psychotherapeutische Praxis trifft suchtpsychiatrische Institutsambulanz.

BACKGROUND: An increase in the use of kratom is reported worldwide. The substance is not classified as illegal in Germany. The psychoactive effects and withdrawal symptoms are opioid-like. METHOD: A patient visited a psychotherapy practice for treatment of his social phobia. Problematic use of kratom was disclosed, and treatment planning was adjusted accordingly. RESULTS: The physical withdrawal treatment was carried out in cooperation of the psychiatric outpatient clinic and the psychotherapeutic practice. Securing abstinence and treatment of social phobia are now upcoming goals in the psychotherapeutic practice. DISCUSSION: The use of kratom is more widespread than apparently assumed. Detoxification can be performed on an outpatient basis. CONCLUSION: The case underlines the importance of a detailed addiction anamnesis, but especially of the individual case-related cooperation therapists.

[Can you See and Hear How Bad I Feel Right Now? - Self-Injury and Suicidal Communication in Borderline Personality Disorder - A Secondary Analysis]. / Kannst Du sehen und hören, wie schlecht es mir gerade geht?

Non-suicidal self-injurious behavior (NSSV) and suicide attempts are well-known features of borderline personality disorder; communicative behavior is poorly studied. Differences between patients with and without NSSV as well as differences in current suicide attempts regarding suicidal communication and NSSV were investigated.In a secondary analysis, data on current and anamnestic NSSV, suicide attempts, suicidal communication, and clinical symptomatology of 87 inpatients were studied.Patients with and without current NSSV did not differ in anamnestic but did differ in current suicide attempts and suicidal communication. In regard to the current inpatient stay, it was observed that patients with and without suicide attempts differed considerably in the variables NSSV (100 vs. 32.5 %) and suicidal communication (71.4 vs. 7.5 %).Current self-injury and suicidal communication are highly significant for risk assessment of current suicidality.

Individuals' Power Persistence in Teams: A Study Examining the Effects of Individuals' Competence, Uncooperative Behavior and Team Performance in the National Basketball Association.

This paper examined (a) the persistence of individuals' power in teams and (b) the individual- and team-level factors influencing power maintenance and loss in the long-term (i.e., power dynamics). Specifically, and in line with the functional theory of power, we showed that individuals' state of power in the past exerted a significant behavioral impact on their later state of power, hence, confirming the "power persistence" hypothesis. Furthermore, and in accordance with the conflict theory of power, we found that individuals' competence positively influenced power above and beyond its persistence. We also showed that individuals' uncooperative behavior and team performance had a negative and significant effect on individuals' power above and beyond its persistence. Finally, we discussed the importance of individuals' power dynamics for effectively managing power struggles in teams.

[Case Report on the Treatment of Inner Restlessness with Biofeedback and Behavior Therapy]. / Fallvorstellung zur Behandlung innerer Unruhe mit Biofeedback und Verhaltenstherapie.

BACKGROUND: Inner restlessness is a frequently mentioned symptom in psychiatric-psychotherapeutic clinical practice, from which patients with various mental illnesses suffer. METHOD: A patient with major depression was treated with a total of eight biofeedback sessions with the physiological parameter heart rate variability and three behavioral therapy sessions. Questionnaires were used to assess the symptom of inner restlessness and a possible success of the therapy. RESULTS: Inner restlessness, ability to relax, disease burden and self-efficacy improved significantly over the 3-week treatment period. DISCUSSION: Inner restlessness could be treated surprisingly successfully. CONCLUSION: More importance should be given to the treatment of inner restlessness.

The screen for cognitive impairment in psychiatry (SCIP) as a routinely applied screening tool: pathology of acute psychiatric inpatients and cluster analysis.

BACKGROUND: Cognitive dysfunction has been reported in acute psychiatric patients for a long time. The detection of cognitive deficits is crucial both for clinical treatment and for predicting the psychosocial functional level in the further course of the disease. The SCIP is a well-evaluated screening instrument for the examination of cognitive performance in psychiatric patients. We recently integrated the SCIP into our routine admission and discharge assessments on two inpatient wards, and we examined the cognitive profiles of patients with psychotic and affective disorders over the course of their admission. METHODS: Shortly after admission, and prior to discharge, patients were routinely referred for examination with the SCIP. A total of 529 assessments were completed on admission, and 227 returned for SCIP at the time of discharge. After standardization of the test results against a normative sample, we examined the normalized test values in terms of percentages of pathological cognitive performance based on the total SCIP score, and each of the SCIP subscale scores. We conducted cluster analysis to identify cognitive subgroups within the clinical sample. RESULTS: More than 70% of the SCIP results on admission were pathological. At discharge, improvements were observed, especially on tests with attention and speed components. Cluster analysis identified two groups. The cluster with chronic patients showed poorer results at admission, but greater improvement and reached the level of the others at discharge. CONCLUSIONS: The SCIP appears to have value in routine diagnostic assessments, and in the quantification of improvements in cognitive performance during an inpatient stay. The greatest benefit was observed in chronically ill patients with many previous stays. TRIAL REGISTRATION: DRKS00019825 (retrospectively registered on 03.12.2019).

Effects of high and low power on the visual encoding of faces.

The experience of power is typically associated with social disengagement, yet power has also been shown to facilitate configural visual encoding - a process that supports the initial perception of a human face. To investigate this apparent contradiction, we directly tested whether power influences the visual encoding of faces. Two experiments, using neural and psychophysical assessments, revealed that low power impeded both first-order configural processing (the encoding of a stimulus as a face, assessed by the N170 event-related potential) and second-order configural processing (the encoding of feature distances within configuration, assessed using the face inversion paradigm), relative to high-power and control conditions. Power did not significantly affect facial feature encoding. Results reveal an early and automatic effect of low power on face perception, characterized primarily by diminished face processing. These findings suggest a novel interplay between visual and cognitive processes in power's influence on social behavior.

Psychological power alters cognitive efficiency.

Power is known to promote cognitive processing in a goal-directed way. However, it is unknown whether powerful individuals invest more resources when pursuing their goals or whether they invest their resources more efficiently. We examined how experiencing high versus low power affects the efficient investment of cognitive resources using electroencephalography (EEG). Specifically, event-related desynchronization (ERD) in the upper alpha band (10.5-12.75 Hz) was used to quantify the use of cognitive resources during task completion. Results showed that high-power participants used fewer neural resources compared to low-power participants across the whole brain but task performance did not differ between groups. These findings demonstrate that, instead of investing more resources, high-power participants performed the task with greater cognitive efficiency compared to low-power participants. Performing tasks efficiently could help powerholders deal with their demanding jobs and responsibilities.

[Clinical courses of depressive and anxiety disorders over 1 year : Direct comparison of four treatment settings in psychiatry and psychosomatic medicine-results of the PfAD study]. / Erkrankungsverläufe depressiver und Angststörungen über ein Jahr : Direkter Vergleich von vier Behandlungssettings in Psychiatrie und Psychosomatik ­ Ergebnisse der PfAD-Studie.

BACKGROUND: Inpatient care for patients with depressive and anxiety disorders (ICD-10 F3/F4 diagnoses) is provided in Germany in different settings of psychiatry and psychosomatic medicine. OBJECTIVE: Apart from the question of the effectiveness of treatment, it is of interest whether the course of the disease differs between four different settings up to a period of 1 year after discharge. MATERIAL AND METHODS: A total of 320 patients with main clinical diagnoses from the ICD-10 F3/F4 spectrum were recruited and interviewed consecutively in four treatment settings (psychiatric depression unit, psychiatric crisis intervention unit, psychiatric day hospital, psychosomatic acute hospital). The interviews were conducted after admission, before discharge and 6 and 12 months after discharge. RESULTS: Overall, treatment in all four settings was shown to be highly effective. The slight increase in symptoms in the postinpatient phase described in the literature was observed across all settings. In terms of treatment intensity, those treated in the crisis intervention unit received the most services after index treatment; however, this group was also the one with the most pronounced symptom burden at admission. Patients treated in the psychosomatic department had the lowest symptom burden at admission and overall received the least inpatient services over the observation period; however, outpatient follow-up treatment was apparently used most by those patients. CONCLUSION: The treatments proved to be effective in the long-term in both psychiatric and psychosomatic units. The different settings seem to be successful in adapting the treatments to the respective patient groups.

Between Conspiracy Beliefs, Ingroup Bias, and System Justification: How People Use Defense Strategies to Cope With the Threat of COVID-19.

The current situation around coronavirus disease 2019 (COVID-19) portrays a threat to us in several ways: It imposes uncertainty and a lack of control and reminds us of our own mortality. People around the world have reacted to these threats in seemingly unrelated ways: From stockpiling yeast and toilet paper to favoring nationalist ideas or endorsing conspiratorial beliefs. According to the General Process Model of Threat and Defense, the confrontation with a threat - a discrepant experience - makes humans react with both proximal and distal threat responses. While the proximal response manifests in behavioral inhibition that leads to heightened anxious arousal and vigilance, distal responses seek to lower behavioral inhibition and the associated state of anxiety and vigilance through engaging in distal defenses. In the present research, we propose that the reactions to COVID-19 may represent distal defense strategies to the pandemic and, therefore, can be explained and forecasted by the model. Thus, we hypothesized increased perceived COVID-19 threat to lead to a proximal threat response in the form of heightened behavioral inhibition. This, in return, should enhance the use of distal defenses (i.e., several ingroup biases, system justification, and conspiratorial beliefs) overlapping with the reactions observed as a response to COVID-19. This hypothesized mediated effect of increased perceived COVID-19 threat on distal defenses was tested in two preregistered studies: In Study 1 (N = 358), results showed perceived COVID-19 threat to be related to behavioral inhibition and, in turn, to be associated with increased distal defenses (i.e., higher entitativity, control restoration motivation, passive party support). In Study 2 (N = 348), we manipulated COVID-19 threat salience and found results suggesting the distal defenses of ingroup entitativity, system justification, and conspiratorial beliefs to be mediated by the proximal threat response. The results of the present research hint toward a common mechanism through which the seemingly unrelated reactions to COVID-19 can be explained. The results might help to predict future behavior during the COVID-19 pandemic and to design measures to counteract the detrimental effects of the pandemic.

[Open doors of a psychiatric intensive care unit with addiction patients: A 3-year Follow up study]. / Auswirkungen der Teilöffnung einer Suchtaufnahmestation ­ Follow-Up nach 3 Jahren.

OBJECTIVE: A psychiatric addiction admission ward was conceptually modified in 2014 into a therapeutic and an intensive care unit. The effects of this restructuring procedure were now studied in a 3-year follow up. METHODS: Data about times of closed doors, length of stay and coercive measures were evaluated over 3 measurement phases (Prä, Post, Follow-Up), each covering a 5-months period. RESULTS: After restructuring, the door was closed significantly less often. In the follow-up period the results improved once more. CONCLUSIONS: The conceptual restructuring on a therapeutic, organizational and constructional level resulted in a sustained change in terms of custodial measures and length of stay.

[Effects of an animal-assisted intervention on psychiatric in-patient addiction treatment - a pilot study]. / Effekte einer tiergestützten Intervention in der stationären psychiatrischen Suchtbehandlung ­ eine Pilotstudie.

OBJECTIVE: Animal-assisted therapies, especially with therapy dogs, are getting increasingly popular in inpatient psychiatric treatment. In the present pilot study, we examined how chronic and comorbid patients in psychiatric addiction treatment assess this form of therapeutic support. METHODS: Pre-post-evaluation of the intervention variable "therapy dog" in a prospective, naturalistic setting. Without intervention 50 patients, with intervention 52 patients were requested to answer a questionnaire on topics covering social interaction / ward atmosphere, emotional competences and pathological addiction behavior. RESULTS: The two studied groups differed highly significantly in most of the items on the topics social interaction / ward atmosphere, emotionality and addiction pathology, in favor of animal-assisted therapy. Also, the frequency of smoking and dealing with craving were significantly reduced in this group. Effect sizes were medium to high. CONCLUSIONS: Patients consider the presence of a therapy dog on a psychiatric addiction ward very positively. Ward atmosphere is experienced as more pleasant and patients see a possibility of behavioral change with respect to social and emotional competences.

[Smoking Behaviour Among Patients and Staff of a Psychiatric Hospital: Two Independent Surveys in 2007 and 2015]. / Rauchverhalten bei Patienten und Beschäftigten einer psychiatrischen Klinik: zwei unabhängige Stichtagserhebungen im Abstand von 8 Jahren.

OBJECTIVE: In order to evaluate the prevalence and smoking behaviour in a psychiatric hospital two independent surveys in 2007 (t1) and 2015 (t2) were carried out before and after implementing strategies to protect non-smokers and to offer assistance to stop smoking. METHODS: In two cross-sectional surveys all in-patients and staff of the Centre for Psychiatry Ravensburg-Bodensee were interviewed by questionnaire. RESULTS: The prevalence of smoking among patients was very high at both time points with 59 % (t1) and 57 % (t2), respectively. Among staff, the prevalence of smoking was 35 % (t1) and 33 % (t2). In both surveys, patients were more severely nicotine-dependent than staff. 57 % of all smokers wanted to stop smoking. CONCLUSIONS: High prevalence and strong nicotine dependence of patients and staff were observed in both surveys in 2007 and 2015, respectively. More rigorous interventions in psychiatric hospitals and the society as a whole seem to be required to decrease the prevalence of smoking among psychiatric patients and staff.

Frontal cortical effects on feedback processing and reinforcement learning: Relation of EEG asymmetry with the feedback-related negativity and behavior.

Reinforcement learning refers to the acquisition of approach or avoidance action tendencies through repeated reward/nonreward feedback. Although much research on reinforcement learning has focused on the striatum, the prefrontal cortex likely modulates this process. Given prior research demonstrating a consistent pattern of lateralized frontal cortical activity in affective responses and approach/avoidance tendencies in the EEG literature, we aimed to elucidate the role of frontal EEG asymmetry in reinforcement learning. Thirty-two participants completed a probabilistic selection task in which they learned to select some targets and avoid others though correct/incorrect feedback. EEG indices of frontal cortical asymmetry were computed from alpha power recorded at baseline and during task completion. We also examined the feedback-related negativity ERP component to assess feedback processing associated with activity in the dorsal anterior cingulate cortex. Results revealed that greater right-lateralized frontal cortical activity during learning was associated with better avoidance learning, but neither left- nor right-sided asymmetry reliably related to approach learning. Results also suggested that left frontal activity may relate to reinforcement feedback processing, as indicated by the feedback-related negativity (FRN). These findings offer preliminary evidence regarding the role of frontal cortical activity in reinforcement learning while integrating classic and contemporary research on lateralized frontal cortical functions.

Power effects on implicit prejudice and stereotyping: The role of intergroup face processing.

Power is thought to increase discrimination toward subordinate groups, yet its effect on different forms of implicit bias remains unclear. We tested whether power enhances implicit racial stereotyping, in addition to implicit prejudice (i.e., evaluative associations), and examined the effect of power on the automatic processing of faces during implicit tasks. Study 1 showed that manipulated high power increased both forms of implicit bias, relative to low power. Using a neural index of visual face processing (the N170 component of the ERP), Study 2 revealed that power affected the encoding of White ingroup vs. Black outgroup faces. Whereas high power increased the relative processing of outgroup faces during evaluative judgments in the prejudice task, it decreased the relative processing of outgroup faces during stereotype trait judgments. An indirect effect of power on implicit prejudice through enhanced processing of outgroup versus ingroup faces suggested a potential link between face processing and implicit bias. Together, these findings demonstrate that power can affect implicit prejudice and stereotyping as well as early processing of racial ingroup and outgroup faces.