Psychosocial distress and psychosocial resources in couples facing non-melanoma skin cancers and malignant melanoma.

BACKGROUND: Skin cancer is the most common cancer worldwide and comprises various non-melanoma skin cancer (NMCS) diagnoses and malignant melanoma (MM). It places a psychological burden on patients and their spouses. The present study aims to investigate psychological distress, temporal changes of psychosocial resources (PR), as well as dyadic dynamics of psychological distress and PR in patients with NMSC or MM and their spouses. METHODS: Fifty-four heterosexual couples with different skin cancers, diagnosed within the previous 12 months, participated in this quantitative cross-sectional study. Patients and spouses provided information about depression and anxiety (Hospital Anxiety and Depression Scale), PR within the last four weeks and last three years (Essen Resource Inventory), and partnership quality (Partnership Questionnaire, short version). Dyadic dynamics were analyzed with multiple regression analyses. RESULTS: We found similar distress levels in patients and spouses, as well as in patients with different skin cancers. Spouses from patients with MM reported significant higher distress levels than spouses from patient with NMSC. Patients' depression predicted spouses' depression, and spouses' anxiety predicted patients' anxiety. In patients, we found associations between personal resources (within the last four weeks and three years) and depression, and an association between patients' social resources (within the last three years) and spouses' depression. CONCLUSIONS: The psychological interdependencies between patients' and spouses' depression and anxiety highlight the importance of considering psychological distress in patients with different skin cancers from a dyadic perspective in clinical contexts. Further, personal resources were indicated as a "distress buffer" for patients' mental health. Our results underline the importance of couple interventions that activate PR in patients with cancer and their spouses.

Responding to human trafficking among refugees: prevalence and test accuracy of a modified version of the adult human trafficking screening tool.

BACKGROUND: Human trafficking is a human rights violation and urgent public health challenge. It involves the exploitation of a person by means of force, intimidation or deceit and causes severe health risks. Though it occurs all over the world, its true extent is still unknown. Refugees are especially vulnerable to human trafficking due to language barriers and difficult living conditions. Therefore, the purpose of this study was to estimate the prevalence and design a screening tool to identify survivors of all forms of human trafficking among refugees in a German state registration and reception centre. METHODS: In cooperation with the local authorities and the Ministry of Justice and for Migration Baden-Württemberg, we interviewed newly arrived refugees at an initial reception centre in Southern Germany to assess the prevalence of human trafficking. We used both a combination of the Adult Human Trafficking Screening Tool and a publication by Mumma et al. to assess all forms of human trafficking. RESULTS: In total, 13 of the 176 refugees had experienced trafficking, which corresponded to a prevalence of 7.3% (95%-CI = [3.5%, 11.3%]). Across all languages the questionnaire had a sensitivity of 76.9% and a specificity of 84.0% at a recommended cut-off of six positive responses. The recommended cut-off differed slightly for the Arabic, Farsi, Turkish, and English version. In an exploratory descriptive analysis on subregions, refugees from West Africa had a substantially higher prevalence (33.3%, 8 out of 24) for human trafficking within our sample, especially women. However, when we excluded this region from our analysis, we found no significant gender difference for the rest of the sample. CONCLUSIONS: The high prevalence of trafficking in most regions, regardless of gender, suggests that more effort is needed to identify and protect all trafficked persons. The designed screening tool seems to be a promising tool to detect an especially vulnerable group of refugees and provides assistance in identifying survivors of human trafficking.

Gender-specific factors associated with case complexity in middle-aged and older adults-Evidence from a large population-based study.

OBJECTIVES: To investigate gender-specific factors associated with case complexity in a population-based sample of middle-aged and older adults using a holistic approach to complexity. METHODS: Data were derived from the 8-year follow-up home visits of the ESTHER study-a German population-based study in middle-aged and older adults. Cross-sectional analyses were conducted for 2932 persons (aged 57-84). Complexity was assessed by the well-established INTERMED for the elderly interview, which uses a holistic approach to the definition of case complexity. The association between various bio-psycho-social variables and case complexity was analyzed using gender-specific logistic regression models, adjusted for sociodemographic factors (age, marital status, education). RESULTS: Prevalence of complexity was 8.3% with significantly higher prevalence in female (10.6%) compared to male (5.8%) participants (p < 0.001). Variables associated with increased odds for complexity in both, women and men were: being divorced (odds ratio [OR] women: 1.86, 95% CI 1.05-3.30; OR men: 3.19, 1.25-8.12), higher total somatic morbidity (women: 1.08, 1.04-1.12; men: 1.06, 1.02-1.11), higher depression severity (women: 1.34, 1.28-1.40; men: 1.35, 1.27-1.44), and higher loneliness scores (women: 1.19, 1.05-1.36; men: 1.23, 1.03-1.47). Women (but not men) with obesity (Body mass index [BMI] ≥30) had higher odds (1.79, 1.11-2.89) for being complex compared to those with a BMI <25. High oxidative stress measured by derivatives of reactive oxygen metabolites in serum was associated with 2.02 (1.09-3.74) higher odds for complexity only in men. CONCLUSIONS: This study provides epidemiological evidence on gender differences in prevalence and factors associated with case complexity in middle-aged and older adults. Moreover, this study adds to the holistic understanding of complexity by identifying novel variables linked to complexity among middle-aged and older individuals. These factors include loneliness for both genders, and high oxidative stress for men. These findings should be confirmed in future longitudinal studies.

Do the elderly and those with comorbid chronic physical conditions have improved access to outpatient psychotherapy post structural reforms in Germany? Results of the ES-RiP study.

Background: In 2017, a reform of the German outpatient psychotherapy guideline was carried out, aiming to reduce waiting times and facilitate low-threshold access. This study analyzes the extent to which the implementation of the two new service elements 'psychotherapeutic consultation times' and 'acute short-term psychotherapeutic interventions' improved psychotherapeutic care for patients with mental disorders and chronic physical conditions (cMPs), for patients with mental disorders without chronic physical conditions (MnoP), and elderly patients. Methods: In a quantitative secondary analysis, we analyzed health insurance data of patients with psychotherapy billing codes obtained from the National Association of Statutory Health Insurance Physicians (KBV) for the years 2015-2019, evaluating descriptive statistical parameters for specific patient groups and care services. Results: Between 2015 and 2019, the number of mentally ill receiving psychotherapy at least once in the corresponding year increased by 30.7%. Among these, the proportion of cMPs-patients increased from 26.8% to 28.2% (+1.4%), while that of MnoP-patients decreased from 68.3% to 66.4% (-1.9%). The number of elderly people receiving treatment also increased. Conclusion: Since increases and decreases in the percentage shares occur evenly over the years investigated, it is questionable whether the reform in 2017 has had a direct influence on these changes. Study registration: ID DRKS00020344, URL: https://www.bfarm.de/DE/Das-BfArM/Aufgaben/Deutsches-Register-Klinischer-Studien/_node.html.

Examining childhood experiences and personality functioning as potential predictors for the speed of recovery during psychotherapy of patients with anxiety disorders.

Background: Adverse childhood experiences were previously identified as relevant risk factors for the development of anxiety disorders. Furthermore, anxiety disorders were shown to be associated with impairments of personality functioning. The objective of this study was to investigate adverse and protective childhood experiences as well as personality functioning, as defined by the Operationalized Psychodynamic Diagnosis system, as potential predictors for the speed of recovery during psychotherapy for patients with anxiety disorders. Methods: The sample consisted of n = 312 completed psychotherapies. The speed of recovery, defined as symptom abatement over time, was calculated using a two-stage hierarchical linear model. The effects of adverse and protective childhood experiences as well as personality functioning on the speed of recovery during psychotherapy were then examined using a structural equation model. Results: The presence of adverse childhood experiences predicted a lower speed of recovery during psychotherapy. In addition, a higher number of adverse childhood experiences was associated with greater impairments in the abilities of perception and regulation as dimensions of personality functioning. A higher number of protective childhood experiences was associated with fewer impairments in the communication and attachment dimensions. Impairments in personality functioning in patients with anxiety disorders did not predict the speed of recovery during psychotherapy. Conclusions: Among patients with anxiety disorders, adverse childhood experiences lead to a lower speed of recovery during psychotherapy. Therefore, childhood adversity should be routinely assessed before and thoroughly addressed during psychotherapy in patients with anxiety disorders.

An integrated mental health video consultations model for patients with somatic symptom disorder in primary care: The randomized VISION pilot trial.

OBJECTIVE: Symptoms of somatic symptom disorder (SSD) are one of the most common reasons for consultations in primary care. However, specialized psychological services are mostly unavailable. This pilot trial aimed to determine the feasibility, acceptability, and safety of the integrated mental health video consultations VISION model for patients with SSD in primary care. METHODS: We conducted a parallel group, randomized controlled pilot trial involving fifty-one patients with SSD from ten primary care practices in Germany, who we randomized to the VISION model or enhanced treatment-as-usual (eTAU). The VISION model comprised five video consultations which featured diagnostic clarification, psychoeducation (acknowledging and legitimizing of symptoms), and brief psychological therapy. eTAU included training primary care practice teams on the DSM-5 concept of SSD and on current guideline recommendations for its treatment in primary care. We assessed feasibility as the primary outcome at 6-months, measuring efficiency of recruitment, intervention acceptability, and safety. RESULTS: Recruitment was efficient reflected in an overall recruitment yield (number randomized per number screened) of 55% (51/92) and a consent rate (number randomized per number eligible) of 94% (51/54). Acceptability of the intervention was high with 98% (123/125) of the video consultations conducted as planned. No serious adverse events were reported in either group. CONCLUSION: An integrated mental health video consultations VISION model for patients with SSD presenting to primary care is feasible, acceptable, and safe. Potential clinical effectiveness of the model should be evaluated in confirmatory trial implementing the multifaceted approach tailored to the individual patient with SSD directly into primary care practice. TRIAL REGISTRATION: The trial protocol was registered at German Clinical Trials Register (number: DRKS00026075, https://www.drks.de).

Autobiographical memory following weight gain in adult patients with Anorexia Nervosa: A longitudinal study.

BACKGROUND: Patients with anorexia nervosa (AN) show overgeneralization of memory (OGM) when generating autobiographical episodes related to food and body shape. These memories are central for the construction of a coherent self-concept, interpersonal relationships, and problem-solving abilities. The current study aims to investigate changes in autobiographical memory following weight gain. METHODS: OGM was assessed with an adapted version of the Autobiographical Memory Test including food-, body-, depression-related, and neutral cues. N = 41 female patients with AN (28 restricting-, 13 binge-eating/purging-subtype; mean disease duration: 4.5 years; mean BMI: 14.5 kg/m2) and N = 27 healthy controls (HC) were included at baseline. After inpatient treatment (mean duration: 11 weeks), 24 patients with AN and 24 age-matched HC were reassessed. Group differences were assessed using independent samples t-tests for cross-sectional comparisons and repeated measures ANOVAs for longitudinal data. RESULTS: At baseline, patients with AN generated significantly fewer specific memories than HC, independent of word category (F(1.66) = 27.167, p < 0.001). During inpatient stay, the average weight gain of patients with AN was 3.1 body mass index points. At follow-up, patients with AN showed a significant improvement in the number of specific memories for both depression-related and neutral cues, but not for food- and body-related cues. CONCLUSIONS: Generalised OGM (i.e., independent of word category) in patients with AN before weight restoration may be a general incapacity to recall autobiographical memory. After weight gain, the previously well-studied pattern of eating disorder-related OGM emerges. The clinical relevance of the continuing disorder-related OGM in patients with AN after weight gain is discussed.

Electronic health intervention to manage symptoms of immunotherapy in patients with cancer (SOFIA): Results from a randomized controlled pilot trial.

BACKGROUND: For patients receiving immune checkpoint inhibitors, early detection of immune-related adverse events (irAEs) is critical for one's safety. To this end, a smartphone app (SOFIA) was developed that featured the assessment of electronic patient-reported outcomes (ePROs) focusing on irAEs as well as a set of comprehensive supportive information. Its feasibility and preliminary efficacy were evaluated in a randomized controlled trial (RCT). METHODS: Patients who received immune checkpoint inhibition therapy were randomly assigned to an intervention group (IG) or a control group (CG; care as usual). During the 12-week intervention period, IG patients used SOFIA to report twice weekly ePROs and receive cancer- and immunotherapy-relevant contents. Before a patient's next clinical visit, the physician in charge was given the ePRO reports. The primary objective was to test the feasibility of SOFIA. Furthermore, the preliminary efficacy of SOFIA for health-related quality of life (HRQOL), psychosocial outcomes, and medical data was examined. Clinical outcomes were assessed at baseline (T0), post-intervention (T1), and a 3-month follow-up (T2). RESULTS: Seventy-one patients were randomized to the IG (n = 34) or the CG (n = 37). SOFIA showed high feasibility and acceptance. At T1, patients in the IG reported significantly better HRQOL and role functioning and less depression, distress, and appetite loss. No significant differences were revealed regarding medical data, the utilization of supportive care services, or survival. CONCLUSIONS: SOFIA showed high feasibility and acceptance and improved HRQOL and psychosocial outcomes. These results suggest further evaluation of efficacy in a large-scale confirmatory multicenter RCT.

Efficacy of supervised immersive virtual reality-based training for the treatment of chronic fatigue in post-COVID syndrome: study protocol for a double-blind randomized controlled trial (IFATICO Trial).

BACKGROUND: The treatment of persistent fatigue after COVID-19 infection is complex. On the one hand, it involves maintaining a sufficient level of physical and mental activity to counteract possible degenerative processes of the body and nervous system. On the other hand, physical and mental activities can also lead to worsening of symptoms. Therefore, the challenge in treating Post-COVID fatigue is to stimulate the body and central nervous system in a way that stimulates growth and improvement, but does not overtax individual physical and mental limits. Special training programs try to take these characteristics into account, but often reach their limits. A promising approach is offered by new fitness technologies based on immersive virtual realities that stimulate both body and brain while minimizing physical and psychological stress. The aim of this study is to investigate the efficacy of supervised immersive Virtual Reality (VR)-based activity training compared to conventional activity training for patients with Post-COVID-associated fatigue. METHODS: In a single centre, individually randomised, prospective, double-blind two-arm exploratory superiority trial with parallel group design, N = 100 patients with persistent fatigue after COVID-19 infection will be recruited. The intervention includes a supervised immersive neuromuscular training (12 sessions of 30 min over 6 weeks) based on a novel VR-exercise device. We will systematically compare the effects of this intervention on Post-COVID-associated fatigue with a supervised conventional activation program of comparable scope without an immersive environment. The primary outcome is the difference between groups in absolute change in the mean fatigue symptom severity measured on the Fatigue Severity Scale (FSS) from baseline to posttreatment assessment. Posttreatment assessment in both groups will be conducted by blinded outcome assessors. At three and six months afterwards, patients are sent self-report questionnaires for follow up. The main analysis will be based on the intention-to-treat principle. DISCUSSION: To the best of our knowledge, this is the first exploratory study on a supervised immersive neuromuscular training for the treatment of persistent fatigue after COVID-19 infection. TRIAL REGISTRATION: German register for clinical studies (ID: DRKS00032059) Prospectively registered on June 16th 2023. URL of trial registration.

Somatic symptom profile in patients with chronic heart failure with and without depressive comorbidity.

Background: Patients with chronic heart failure (CHF) frequently suffer from depressive comorbidity. CHF and depressive comorbidity can cause somatic symptoms. The correct attribution of somatic symptoms is important. Thus, we aimed to assess potential differences in somatic symptom severity between CHF patients with and without depressive comorbidity. Methods: We evaluated depressive comorbidity using the Patient Health Questionnaire-9 (PHQ-9), somatic symptom severity with the Patient Health Questionnaire-15 (PHQ-15), and sociodemographic and medical variables in 308 CHF outpatients. To compare somatic symptom severity between CHF patients with and without depressive comorbidity, we conducted item-level analyses of covariance. Results: Of the 308 participating patients, 93 (30.3%) met the PHQ-9 criteria for depressive comorbidity. These patients did not differ from those without depressive comorbidity with regard to age, sex, left ventricular function, and multimorbidity. Patients with depressive comorbidity scored significantly higher on ten out of thirteen PHQ-15 items than patients without depressive comorbidity. The largest effect sizes (0.71-0.80) were shown for symptoms of headache, chest pain, shortness of breath, and palpitations, and the latter three were potentially attributable to heart failure. Conclusions: Among patients with CHF, somatic symptoms are more pronounced in those with depressive comorbidity than those without depressive comorbidity. This finding is especially true for cardiac symptoms independent of CHF severity. The potential interpretation of somatic symptoms as correlates of depressive comorbidity must be recognized in clinical practice.

Group eye movement desensitization and reprocessing (EMDR) in chronic pain patients.

The prevalence of chronic pain is increasing, and conventional pain therapies often have limited efficacy in individuals with high levels of psychological distress and a history of trauma. In this context, the use of Eye Movement Desensitization and Reprocessing (EMDR), an evidence-based psychotherapy approach for the treatment of posttraumatic stress disorder, is becoming increasingly important. EMDR shows promising results, particularly for patients with pain and high levels of emotional distress. Although group therapy is becoming increasingly popular in pain management, EMDR has mainly been studied as an individual treatment. However, a systematic review suggests that group therapy can be an effective tool for improving mental health outcomes, especially when trauma is addressed together. Based on these findings, an outpatient EMDR group program was developed for patients with chronic pain. The program consists of a total of four treatment days with 5-5.5 h therapy sessions each day and provides patients with a supportive environment in which they can learn effective pain management strategies and interact with other patients with similar experiences. Initial pilot evaluations indicate high efficacy and adequate safety for patients with chronic pain.

Outpatient Psychotherapy in Germany.

BACKGROUND: A structural reform of the German psychotherapy guideline in 2017 was intended to facilitate access to outpatient guideline psychotherapy. In the present study, we evaluate the effects of this reform in particular for patients with a comorbidity of mental disorders and chronic physical conditions (cMP). METHODS: Pre-post analyses of the two primary endpoints "percentage of mentally ill persons who have made an initial contact with a psychotherapist" and "waiting time for guideline psychotherapy" were carried out employing population-based and weighted routine statutory health insurance data from the German BARMER. The secondary endpoints included evaluations from the patients' perspective, based on a representative survey of patients in psychotherapy, and an overview of the health care situation based on data from the National Association of Statutory Health Insurance Physicians (Kassenärztliche Bundesvereinigung, KBV) (study registration number: DRKS00020344). RESULTS: From 2015 to 2018, the percentage of mentally ill persons who had made an initial contact with a psychotherapist rose moderately, from 3.7% (95% confidence interval, [3.6; 3.7]) to 3.9% [3.8; 3.9] among persons with cMP and from 7.3% [7.2; 7.4] to 7.6% [7.5; 7.7] among those with mental disorders but without any chronic physical condition (MnoP). The new structural elements were integrated into patient care. The interval of time between the initial contact and the beginning of guideline psychotherapy became longer in both groups, from a mean of 80.6 [79.4; 81.8] to 114.8 [113.4; 116.2] days among persons with complex disease and from 80.2 [79.2; 81.3] to 109.6 [108.4; 111.0] days among persons with non-complex disease; most patients considered the waiting time. Approximately 8% of the patients who sought psychotherapy reported that they had not obtained access to a psychotherapist. CONCLUSION: Neither in general nor for patients with cMP did the introduction of the structural reform appreciably lower the access barriers to psychotherapy. Further steps are needed so that outpatient care can meet the needs of all patients and particularly those with cMP.

Thrown in at the deep end: a qualitative study with physicians on the purpose and challenges of discharge interviews.

OBJECTIVES: Against the backdrop of poor discharge communication in hospitals, this study explores the purpose of discharge interviews from the physicians' perspective and the challenges they are confronted with. Discharge interviews are legally required in Germany as part of the discharge management. Led by the ward physician, the discharge interview should summarize relevant information about the hospital stay, medication, lifestyle interventions and follow-up treatment. METHODS: Semi-structured interviews with n = 12 physicians were conducted at Heidelberg University Hospital between February and April 2020. Qualitative content analysis was carried out using MAXQDA. RESULTS: Physicians reported gaining information, providing information, and answering open-ended questions as the purpose of the discharge interview. Challenges in conducting discharge interviews were related to finding a common language, patient-related challenges, conditions of everyday ward life, and lack of training. Physicians reported receiving no explicit training on discharge interviews. While professional experience seems to mitigate the lack of training, some physicians expressed a prevailing sense of insecurity. CONCLUSION: The lack of preparation for discharge interviews in medical school makes it particularly challenging for physicians to translate their theoretical knowledge into patient-centered discharge communication. Medical training on discharge interviews should be expanded in terms of theoretical input on the ideal content, its purpose and potential (e.g. in reducing readmissions), as well as practical exercises.

Views of German mental health professionals on the use of digital mental health interventions for eating disorders: a qualitative interview study.

INTRODUCTION: Digital mental health interventions (DMHIs) are getting increasingly important for mental health care. In the case of eating disorders (EDs), DMHIs are still in early stages. Few studies so far investigated the views of mental health professionals for EDs on the integration of DMHIs in routine care. OBJECTIVE: To gain insights into the experiences, perspectives, and expectations of mental health professionals for EDs regarding DMHIs and to identify requirements for the future integration of DMHIs into routine care. METHODS: Semi-structured qualitative telephone interviews with 24 German mental health professionals treating patients with EDs were conducted. A content analysis following a deductive-inductive approach asked for experiences, advantages and chances, disadvantages and boundaries, desired functions and properties, target groups, and general conditions and requirements for DMHIs for patients with EDs. RESULTS: Only few professionals reported experiences with DMHIs besides video-based psychotherapy during the pandemic. From the therapists' point of view, DMHIs have the potential to deliver low-threshold access for patients with EDs. Useful functionalities were seen in digital meal records, skills training, and psychoeducation. However, a stable therapeutic alliance was reported as an important prerequisite for the successful integration into care. Therapists expressed concerns in case of severe anorexia nervosa or suicidality. The participants felt to be informed inadequately on recent developments and on the evidence base of DMHIs. CONCLUSIONS: Mental health professionals for EDs show positive attitudes towards DMHIs, however many barriers to the integration in routine care were observed. The highest potential was seen for the use of DMHIs in addition to outpatient care and in aftercare. Specific requirements for DMHIs are related to different areas of the healthcare spectrum and for the different symptom profiles in anorexia nervosa, bulimia nervosa and binge eating disorder. Targeted DMHIs are needed and appropriate especially for concepts of blended care.

Digital mental health interventions are therapeutic services for people with a mental disorder that can be delivered on electronic devices. They are getting increasingly important, as many patients have to wait long for a therapy. In eating disorders these interventions are still in early stages. Twenty-four telephone interviews were held with German professionals treating adolescent and adult patients with eating disorders. The aim was to understand their experiences, perspectives, and expectations regarding digital mental health interventions and to find out what is needed to integrate them into care in the future. In general, the interview partners showed positive attitudes towards these interventions. However, only few reported experiences and many obstacles were observed. The highest potential was seen for the use in addition to care outside the hospital setting and after treatment has ended. However, in case of a severe eating disorder, such as anorexia, or self-harm and suicidality, they were against the use of digital interventions. A stable personal relationship to their patients was seen as particularly important before recommending a digital intervention. Finally, the interview partners felt not informed in a sufficient way on the scientific basis and regulations regarding digital mental health interventions.

Hypothalamic subregion alterations in anorexia nervosa and obesity: Association with appetite-regulating hormone levels.

OBJECTIVE: Anorexia nervosa (AN) and obesity are weight-related disorders with imbalances in energy homeostasis that may be due to hormonal dysregulation. Given the importance of the hypothalamus in hormonal regulation, we aimed to identify morphometric alterations to hypothalamic subregions linked to these conditions and their connection to appetite-regulating hormones. METHODS: Structural magnetic resonance imaging (MRI) was obtained from 78 patients with AN, 27 individuals with obesity and 100 normal-weight healthy controls. Leptin, ghrelin, and insulin blood levels were measured in a subsample of each group. An automated segmentation method was used to segment the hypothalamus and its subregions. Volumes of the hypothalamus and its subregions were compared between groups, and correlational analysis was employed to assess the relationship between morphometric measurements and appetite-regulating hormone levels. RESULTS: While accounting for total brain volume, patients with AN displayed a smaller volume in the inferior-tubular subregion (ITS). Conversely, obesity was associated with a larger volume in the anterior-superior, ITS, posterior subregions (PS), and entire hypothalamus. There were no significant volumetric differences between AN subtypes. Leptin correlated positively with PS volume, whereas ghrelin correlated negatively with the whole hypothalamus volume in the entire cohort. However, appetite-regulating hormone levels did not mediate the effects of body mass index on volumetric measures. CONCLUSION: Our results indicate the importance of regional structural hypothalamic alterations in AN and obesity, extending beyond global changes to brain volume. Furthermore, these alterations may be linked to changes in hormonal appetite regulation. However, given the small sample size in our correlation analysis, further analyses in a larger sample size are warranted. PUBLIC SIGNIFICANCE: Using an automated segmentation method to investigate morphometric alterations of hypothalamic subregions in AN and obesity, this study provides valuable insights into the complex interplay between hypothalamic alterations, hormonal appetite regulation, and body weight, highlighting the need for further research to uncover underlying mechanisms.

Effects of virtual reality on psychophysical measures of pain: superiority to imagination and nonimmersive conditions.

ABSTRACT: Virtual reality (VR) has been shown to be effective in pain management. However, to date, little is known about the mechanisms by which immersive experiences influence pain processing. The aim of this study was to investigate the direct effects of an immersive VR environment on the perception of experimental pain in individuals with chronic pain and pain-free controls. The immersion in a VR landscape was compared with mental imagery and a nonimmersive control condition. Using a randomized within-crossover design, pressure pain detection and tolerance thresholds, spatial and temporal summation (SSP, TSP), and conditioned pain modulation (CPM) were measured in 28 individuals with chronic pain and 31 pain-free controls using phasic cuff pressure on the legs. Direct comparison between the groups showed that although individuals with pain had significantly lower pain thresholds, reduced CPM effects, and increased TSP, the VR condition had the same pain-inhibitory effect on pain thresholds as in pain-free controls. Conditioned pain modulation effects were reduced by all conditions compared with baseline. There were no significant differences between conditions and baseline for TSP and SSP. Overall, pain modulatory effects were largest for VR and smallest for imagery. These results demonstrate that immersion in a VR environment has an increasing effect on pain thresholds, reduces pain inhibition in a CPM paradigm, and has no effects on TSP. This applies for participants with chronic pain and pain-free controls. These VR effects exceeded the effects of mental imagery on the nonimmersive control condition. This indicates that VR effectively modulates pain perception in both patients and controls irrespective of differences in pain perception.

An untapped potential: Curiosity in medical school.

BACKGROUND: There seems to be a common perception among medical educators that curiosity is untapped or even subjugated in medical education. This review aims to summarize research on curiosity across the fields of psychology, neuroscience, and education and report its potential to advance medical education. METHODS: For this narrative review multiple online libraries were searched using variations of the terms curiosity and school/education/learning. Additional studies were reviewed using the reference lists of included studies, and all studies were assessed for quality and relevance. RESULTS: This review of previous research on curiosity shows that curiosity can significantly impact characteristics relevant to medical education, particularly mental health and learning. In addition, the authors outline how curiosity is linked to other epistemic emotions such as anxiety, novelty, surprise, and uncertainty. Finally, an epistemic-emotion-framework (EEF) is proposed to help educators encourage curiosity in medical students. CONCLUSION: By drawing from other research fields, medical educators can learn valuable lessons about the importance of curiosity and how to influence it. This review provides an overview of current research and a framework for how the potential of curiosity can be harnessed to play an important role in students' medical education.

The relationship of climate change awareness and psychopathology in persons with pre-existing mental health diagnoses.

Introduction: Persons with pre-existing mental health diagnoses are known to be more vulnerable to the consequences of climate change, such as extreme weather events and rising temperatures. However, it remains unclear if this holds true for adverse effects of climate change awareness, too. Methods: N = 89 patients of a psychosomatic outpatient clinic were assessed with well-established mental health questionnaires (PHQ-9 for depressive, GAD-7 for anxious, and PTSS-10 for post-traumatic symptoms) in their original form and in a modified version (PHQ-9-C, GAD-7-C, PTSS-10-C) specifically asking for patients' symptom load regarding climate change awareness, and instruments evaluating personality factors (OPD-SF, SOC, RQ). Results: 21% of the sample reported at least mild symptoms of anxiety regarding climate change awareness, and 11% mild symptoms of depression due to climate change awareness. General anxiety (GAD-7) scores significantly predicted if people reported any psychological symptoms due to climate change awareness. In multiple regression analyses, higher scores of clinical symptoms of depression, anxiety or post-traumatic stress predicted higher scores of depressive, anxious or post-traumatic symptoms regarding climate change awareness, and higher scores of psychological symptoms regarding climate change awareness predicted each other. Younger participants reported significantly more traumatic symptoms regarding climate change awareness. Discussion: The reported mental health impairments regarding climate change awareness in persons with pre-existing mental health diagnoses indicate an increased vulnerability. Hereby, depressive mental health burden seems to induce a predominantly depressive processing of climate change resulting in climate chance related depression. This holds also true for anxious and traumatic symptoms, and points toward biased attentional and memory processes and mood congruent processing.