Psychological Effects of Whole-body Electromyostimulation Training: a Controlled Pilot Study in Healthy Volunteers.

BACKGROUND: Whole-body electromyostimulation (WB-EMS) training is used in popular and health sports to improve muscular performance. Little is known about the possible psychological effects of WB-EMS training. The aim of the study is therefore to investigate the possible psychological effects of WB-EMS training on subjective well-being, relaxation, mood, and perceived stress. MATERIALS AND METHODS: Twenty-five healthy subjects underwent conventional WB-EMS training and Sham training (without the application of electrical stimulation) as part of a randomized, controlled pilot study in a crossover design. Subjective well-being and subjective relaxation were assessed using visual analog scales, the current state of mood was assessed with Multidimensional Mood State Questionnaires (MDBF), and the current level of stress was assessed with Recovery-Stress Questionnaires/Erholungs-Belastungs-Fragebögen (RESTQEBF) before and after training. RESULTS: WB-EMS training has a statistically significant positive effect on subjective well-being and subjective relaxation, as well as on the awake subscale of the MDBF. No significant main effect of sequence and no interaction effects were found. Also, compared to a Sham training session, a single WB-EMS training session had no significant effect on mood, nervousness, or the current level of stress. CONCLUSION: Besides physiological effects, WB-EMS might also have a strong psychological impact. WB-EMS could be beneficial for people who, due to their limitations, have problems training on a regular basis and with adequate training intensity. TRIAL REGISTRATION: German Clinical Trials Register, DRKS00012583 , 22 June 2017.

Associations between COVID-19 related media consumption and symptoms of anxiety, depression and COVID-19 related fear in the general population in Germany.

In context of the current COVID-19 pandemic the consumption of pandemic-related media coverage may be an important factor that is associated with anxiety and psychological distress. Aim of the study was to examine those associations in the general population in Germany. 6233 participants took part in an online-survey (March 27th-April 6th, 2020), which included demographic information and media exploitation in terms of duration, frequency and types of media. Symptoms of depression, unspecific anxiety and COVID-19 related anxiety were ascertained with standardized questionnaires. Frequency, duration and diversity of media exposure were positively associated with more symptoms of depression and unspecific and COVID-19 specific anxiety. We obtained the critical threshold of seven times per day and 2.5 h of media exposure to mark the difference between mild and moderate symptoms of (un)specific anxiety and depression. Particularly the usage of social media was associated with more pronounced psychological strain. Participants with pre-existing fears seem to be particularly vulnerable for mental distress related to more immoderate media consumption. Our findings provide some evidence for problematical associations of COVID-19 related media exposure with psychological strain and could serve as an orientation for recommendations-especially with regard to the thresholds of critical media usage.

Development of the COVID-19-Anxiety Questionnaire and first psychometric testing.

The coronavirus disease 2019 (COVID-19) pandemic may cause psychological distress in the general population and has the potential to cause anxiety regarding COVID-19. No validated questionnaires exist for the measurement of specific COVID-19 anxiety. We modified the DSM 5 - Severity Measure for Specific Phobia-Adult scale specifically for anxiety regarding COVID-19, and report the psychometric properties from an online study with 6262 participants from the general population in Germany. We analysed internal consistency as well as concordant validity. The scale showed good internal consistency (α = 0.86) and good concordant validity (rs = 0.60) with the 2-item Generalized Anxiety Disorder measure and rs = 0.61 with self-rating of limitations in daily life caused by COVID-19 anxiety.

Risk, resilience, psychological distress, and anxiety at the beginning of the COVID-19 pandemic in Germany.

BACKGROUND: The current COVID-19 pandemic comes with multiple psychological stressors due to health-related, social, economic, and individual consequences and may cause psychological distress. The aim of this study was to screen the population in Germany for negative impact on mental health in the current COVID-19 pandemic and to analyze possible risk and protective factors. METHODS: A total of 6,509 people took part in an online survey in Germany from 27 March to 6 April. The questionnaire included demographic information and ascertained psychological distress, anxiety and depressive symptoms, and risk and protective factors. RESULTS: In our sample, over 50% expressed suffering from anxiety and psychological distress regarding the COVID-19 pandemic. Participants spent several hours per day thinking about COVID-19 (M = 4.45). Psychological and social determinants showed stronger associations with anxiety regarding COVID-19 than experiences with the disease. CONCLUSIONS: The current COVID-19 pandemic does cause psychological distress, anxiety, and depression for large proportions of the general population. Strategies such as maintaining a healthy lifestyle and social contacts, acceptance of anxiety and negative emotions, fostering self-efficacy, and information on where to get medical treatment if needed, seem of help, while substance abuse and suppression of anxiety and negative emotions seem to be associated with more psychological burden.

Heart rate variability in patients with agoraphobia with or without panic disorder remains stable during CBT but increases following in-vivo exposure.

Patients with anxiety disorders have a lower heart rate variability (HRV) than healthy controls. Low HRV is associated with cardiovascular disease and dysfunction of the autonomic nervous system (ANS). The aim of the present study was to investigate if HRV in patients with agoraphobia with or without panic disorder can be influenced by cognitive behavioral therapy (CBT). 73 patients with agoraphobia with or without panic disorder were included in the study. Heart rate (HR) and HRV were recorded at rest before and after CBT and during in-vivo exposure. No changes in HR and HRV were observed throughout therapy. During in-vivo exposure HRV increased significantly and HR exhibited a tendency to decrease. Despite clinical improvement of anxiety symptoms, ANS activity at rest did not seem to be influenced by CBT. However, during in-vivo exposure, HRV changed significantly, indicating a higher parasympathetic activity at the end of exposure.

The best next drug in the course of generalized anxiety disorders: the "PN-GAD-algorithm".

OBJECTIVE: Today, there are many pharmacotherapeutic options for generalized anxiety disorder (GAD). The question is, which is the best medication for a particular patient at a particular moment? This is especially challenging because GAD is by definition a chronic disorder and new interventions should learn from earlier experiences. An algorithm which can help to use pretreatment information for drug selection is the "Pretreatment - Next Treatment (PN) - Algorithm". This article introduces an PN-algorithm for GAD. METHODS AND RESULTS: For the development of a GAD-specific PN-algorithm, all possible pharmacological options for GAD are reviewed and brought into a rank order on the basis of scientific evidence regarding efficacy, tolerability, or price: (1) pregabalin, (2) venlafaxine XR, (3) selective serotonin reuptake inhibitors, (4) tricyclic antidepressants, (5) buspirone, (6) antipsychotics, (7) benzodiazepines, and (8) hydroxyzine. Based on this hierarchy and patient-specific information, a decision algorithm is derived, which allows to assess and evaluate pretreatment and to select the drug with no contraindications, limited negative or convincing positive effects, or the option which has not been used so far but which is the next compound in the hierarchy. CONCLUSIONS: The "PN-GAD-algorithm" can be easily translated into a checklist to support clinical decision-making. It can also help to increase patient empowerment and cooperation in long-term treatment.

Distinct panicogenic activity of sodium lactate and cholecystokinin tetrapeptide in patients with panic disorder.

BACKGROUND: The validity of experimentally induced panic attacks as a model to study the pathophysiology of panic disorder has been questioned. Unspecific, unpleasant and aversive effects as well as specific patterns of psychovegetative symptoms pointing to different subtypes of panic disorder patients have been observed. These findings raise the question of challenge paradigms as a valuable tool to identify different vulnerabilities in patients with panic disorder. METHODS: We compared the two most widely studied panicogenic drugs sodium lactate and cholecystokinine tetrapeptide (CCK-4) with placebo in 25 patients with panic disorder and matched healthy control subjects. Psychophysiological changes were measured using the Acute Panic Inventory (API) and visual analogue scales for anxiety and arousal. RESULTS: In patients with panic disorder 18 out of 25 experienced a sodium lactate- or a CCK-4 induced panic attack. Lactate or CCK-4 induced symptoms and induced panic attacks were only correlated in healthy controls, but not in patients with panic disorder. CONCLUSION: The mechanisms of lactate and CCK-4 induced panic attacks are distinct in panic disorder patients but not in healthy controls. Different neurobiological vulnerabilities may be uncovered by different challenges.

Frequency and effects of psychosocial interventions additional to olanzapine treatment in routine care of schizophrenic patients.

BACKGROUND: Guidelines for the treatment of schizophrenia recommend the combination of pharmacologic and psychosocial interventions. There is a lack of data on the utilization and effects of psychosocial interventions additional to neuroleptic treatment in routine care of schizophrenic patients. METHOD: In a drug utilization study 495 psychiatrists documented patient and disease characteristics of 1,711 schizophrenic outpatients treated with olanzapine. Data were recorded at five visits during an observation period of 6 months. RESULTS: Psychosocial interventions were reported in 30% of all patients. Compared to patients who were treated with olanzapine alone (nPSI), patients receiving psychosocial interventions (PSI) were more likely to be unmarried and unemployed, and showed significantly higher impairment on relevant psychopathological and psychosocial parameters (e.g. PANSS, GAF, LQLP). After 6 months of treatment with olanzapine patients improved significantly in respect to their schizophrenic symptoms, psychosocial functioning, and quality of life. Patients receiving psychoeducation showed a higher degree of improvement than the other patients. They were more ill at the beginning of the study, but less ill at the end of the study. Patients receiving psychoeducation showed a trend to better medication compliance. CONCLUSIONS: The data suggest that psychosocial interventions are a frequently used mode of treatment especially for severe cases of schizophrenia Psychoeducation appears to be especially effective for this patient group with a positive impact not only on psychosocial but also on psychopathological criteria of outcome.

Do differences in atypical antipsychotics matter in routine practice? Medication switch from olanzapine and risperidone to amisulpride.

Atypical antipsychotics are often addressed as one class of drugs, although there are marked differences in their pharmacological profiles. It is unknown how this is seen by practitioners and to what extent they differentiate between the various atypical compounds. In a drug utilization study, 472 schizophrenic outpatients who were switched for individual reasons from either olanzapine or risperidone to amisulpride were monitored. Data on patients, illness and treatment as well as on reasons to switch were collected. The reasons to switch from olanzapine to amisulpride were preferably 'weight gain' (72.6% of the physicians), or the 'expectancy of less weight gain with amisulpride' (84.1%) and 'patient request' (60.2%). Specific reasons to switch from risperidone were 'extrapyramidal symptoms' (58.5%), or the 'expectancy of few extrapyramidal symptoms with amisulpride' (82.5%). In conclusion, this study confirms that physicians do not consider 'atypical antipsychotics' as one homogeneous class of drugs but make differences that reflect the specific pharmacological profiles of the respective drugs.

Why do physicians switch from one antipsychotic agent to another? The "physician drug stereotype".

There is a lack of research on why physicians select a certain drug in an individual case and not another available alternative, although this drug selection process is important for quality assurance and cost control. Four hundred ninety-five psychiatrists documented in a standardized form patient and illness characteristics of 1711 schizophrenic outpatients who were switched for individual clinical reasons from an ongoing neuroleptic treatment to olanzapine, and of another 1654 schizophrenic outpatients whose present neuroleptic medication was continued. Physicians also filled in the "Reason for Treatment Selection Questionnaire." Patients who were switched to olanzapine were more ill and showed more preexisting extrapyramidal symptoms and less patient compliance. Reasons of psychiatrists to switch to olanzapine were the expectation of better efficacy and tolerability of the present treatment and patient preferences to continue with the present medication. The price of olanzapine is seen as a reason not to select olanzapine but has no effect on the treatment decision. The "physician drug stereotype" of olanzapine corresponds with clinical data on the efficacy and tolerability of olanzapine. The data show that medical decisions about drug selection are multidimensional, integrating knowledge about the clinical properties of the drug, personal experiences and information about the individual case. The Reason for Treatment Selection Questionnaire is an instrument that allows to objectively assess important aspects of medical decision making, to generate psychological drug profile, and to understand why physicians prefer one drug over alternatives.