Bi-directional associations of core affect and physical activity in adults with higher body weight: An ecological momentary assessment study.

Affect is known to be predictive of and enhanced by higher physical activity (PA) levels in the general population. This secondary analysis aimed to increase the understanding of the bi-directional relationship between PA and core affect (i.e. valence, energetic arousal, and calmness) among adults with higher body weight. Affect and PA were assessed in naturalistic settings via ecological momentary assessment using a mixed sampling scheme from 157 participants (body mass index: 32.99 ± 3.78 kg/m2). Multilevel models revealed that being more physically active in the 15 minutes prior to the assessment predicted an increase in energetic arousal and a decrease in calmness. Subsequently, feeling more energetic and agitated was associated with increased PA within the following 15 minutes. Valence (i.e. pleasure-displeasure) was not associated with PA nor predictive of subsequent PA. Digital PA interventions may target the enhancement of feelings of energy and present psychoeducation about these distinct psychological benefits.

I-PREGNO - prevention of unhealthy weight gain and psychosocial stress in families during pregnancy and postpartum using an mHealth enhanced intervention: a study protocol of two cluster randomized controlled trials.

BACKGROUND: The transition to parenthood represents a critical life period with psychosocial, and behavioral changes and challenges for parents. This often increases stress and leads to unhealthy weight gain in families, especially in psychosocially burdened families. Although universal and selective prevention programs are offered to families, specific support often fails to reach psychosocially burdened families. Digital technologies are a chance to overcome this problem by enabling a low-threshold access for parents in need. However, there is currently a lack of smartphone-based interventions that are tailored to the needs of psychosocially burdened families. AIMS: The research project I-PREGNO aims to develop and evaluate a self-guided, smartphone-based intervention in combination with face-to-face counseling delivered by healthcare professionals for the prevention of unhealthy weight gain and psychosocial problems. The intervention is specifically tailored to the needs of psychosocially burdened families during the pregnancy and postpartum period. METHODS: In two cluster randomized controlled trials in Germany and Austria (N = 400) psychosocially burdened families will be recruited and randomized to i) treatment as usual (TAU), or ii) I-PREGNO intervention (self-guided I-PREGNO app with counseling sessions) and TAU. We expect higher acceptance and better outcomes on parental weight gain and psychosocial stress in the intervention group. DISCUSSION: The intervention offers a low cost and low-threshold intervention and considers the life situation of psychosocially burdened families who are a neglected group in traditional prevention programs. After positive evaluation, the intervention may easily be implemented in existing perinatal care structures in European countries such as Germany and Austria. TRIAL REGISTRATION: Both trials were registered prospectively at the German Clinical Trials Register (Germany: DRKS00029673; Austria: DRKS00029934) in July and August 2022.

[First Aid Training for Drug Overdose in Opioid Addicts and Provision of Take-Home Naloxone on Release from Prison: Feasibility Study from the Bavarian Model Project]. / Drogennotfallschulung Opioidabhängiger in Haft und Versorgung mit Take-Home Naloxon bei Haftentlassung: Machbarkeitsstudie aus dem bayerischen Modellprojekt.

INTRODUCTION: Between 22 and 30% of prisoners in Germany are reported to be intravenous drug users. There is a 12-fold increase in mortality, mostly as a result of opioid overdose in the first weeks after release from prison. We evaluated the feasibility of first aid training for drug overdose, including take-home naloxone in incarcerated opioid addicts. METHODOLOGY: Within the Bavarian Take-Home Naloxone Model Project (BayTHN), a subsample of imprisoned opioid addicts was recruited in 5 Bavarian correctional facilities. Manualized first aid training for drug overdose, including take-home naloxone was provided. All surveys were conducted with standardized questionnaires or semi-structured interviews. RESULTS: Sixty-two long-term opioid addicts were included (age: 36 years (22-53 years); 53.2% women; age at first opioid use: 19.2 years (10-31 years). On average, 3.9 (1-10) opioid addicts participated per training session. At the time of training, the opioid addicts had been in prison on average for 42 (1-228) weeks and expected their release from prison in about 10 (1-64) weeks. 68% of participants reported having experienced a drug overdose by themselves. 84% had already experienced at least one drug emergency with another person, 36% more than once. Nearly one-third had not offered helped in the last emergency they had experienced, mostly out of fear of doing something wrong. Only 50% of participants had called emergency services. 25% tried to help, however, by not very effective means. 75% often consumed in the presence of other persons, such as partners and/or friends. The incarcerated opioid addicts were well motivated to participate and showed a significant increase in knowledge and skills for effective first aid in an opioid overdose situation. CONCLUSION: The feasibility study carried out among imprisoned opioid addicts shows that manualized first aid training in handling opioid overdose, including take-home naloxone can be successfully implemented. A best-practice model for reducing initial caveats, organization, and prescribing take-home naloxone at release from prison was established. The high rate of drug overdoses and drug use in the presence of others (potential first responders) proves that the target group for successful use of first aid training along with take-home naloxone could be reached. However, a broad roll-out is needed to achieve a relevant reduction in mortality in opioid addicts after release from prison.

Recommendations for the Development of Family-Based Interventions Aiming to Prevent Unhealthy Changes in Energy Balance-Related Behavior during the Transition to Parenthood: A Focus Group Study.

Feasible interventions addressing unhealthy changes in energy balance-related behavior (EBRB) during pregnancy and early postpartum are needed. This study identified the needs and wishes of expecting and first-time parents concerning EBRB interventions during the transition to parenthood. Thirteen focus group discussions (n = 74) were conducted. Couples provided information about whether an intervention targeting unhealthy EBRB changes during pregnancy and postpartum would be acceptable, how such an intervention should look like, and in which way and during which period they needed support. Guided by the TiDIER checklist, all quotes were divided into five main categories (i.e., 'what', 'how', 'when and how much', 'where', 'for and from whom'). Interventions should aim for changes at the individual, social, environmental and policy levels. The accessibility and approach (indirect or face-to-face) together with communicational aspects should be taken into account. A focus should go to delivering reliable and personalized information and improving self-regulation skills. Interventions should be couple- or family-based. Authorities, healthcare professionals, the partner and peers are important sources for intervention delivery and support. In the prevention of unhealthy EBRB changes around childbirth, the involvement of both parents is needed, while health care professionals play an important role in providing personalized advice.

Psychological flexibility as a potential change factor in cognitive behavioural therapy of OCD.

BACKGROUND: To gain a better understanding about which aspects of the treatment work for obsessive-compulsive disorders (OCD), the investigation of possible change factors is essential. Psychological flexibility (PsyF) has been of interest in research on successful OCD therapy for some time. Exposure interventions and cognitive strategies in cognitive behavioural therapy (CBT) for OCD may enhance PsyF. To date, however, no process studies have been published that clarify the role of PsyF as a possible change factor for the reduction of OCD symptoms. AIMS: This study investigates whether PsyF works as a mediator in successful CBT treatment of OCD. METHOD: The study recruited 112 adults diagnosed with OCD in a multi-modal in-patient treatment with specific CBT including exposure and response prevention (ERP). The Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) was used to measure OCD symptoms and three self-constructed items to assess PsyF. PsyF was conceptualised as the capability of patients to accept stressful feelings and thoughts. Data were collected weekly. For statistical analysis at the process level, longitudinal multi-level models (MLMs) with random intercepts and linear growth curves were estimated to test for mediation of PsyF on Y-BOCS. RESULTS: OCD symptoms decreased significantly and PsyF increased in patients throughout the course of therapy. MLM revealed that higher average values in PsyF were associated with lower Y-BOCS sum values, but only values between subjects significantly predicted the degree of obsessions and compulsions. CONCLUSIONS: Although research shows that PsyF is enhanced by CBT and also shows a connection with Y-BOCS values, its role as a mediator could not be confirmed.

Food Addiction and Its Relationship to Weight- and Addiction-Related Psychological Parameters in Individuals With Overweight and Obesity.

Background and Aims: It is assumed that a relevant subgroup of individuals experiences an addiction-like eating behaviour (Food Addiction), characterized by an impaired control over eating behaviour, emotional eating and food craving. Individuals experiencing Food Addiction partially share common symptomatology with Binge-Eating-Disorder and Bulimia Nervosa. The aim of this study was to investigate the prevalence of Food Addiction, general psychopathology, and associations with weight- and addiction-related constructs in individuals with overweight and obesity, who did not suffer from Binge-Eating-Disorder or Bulimia Nervosa. Methods: N=213 (67.1% female; MBMI=33.35kg/m2, SDBMI=3.79kg/m2) participants who were included in a weight loss program (I-GENDO project) reported BMI and completed questionnaires before the start of the treatment. Food Addiction severity, depressive symptoms, alcohol use disorder, internet use disorder, psychological distress, impulsivity personality trait, impulsive and emotional eating behaviour, food related inhibitory control, weight bias internalization, and self-efficacy were assessed. Results: The prevalence of Food Addiction was 15% with higher, although not statistically significant, prevalence in female (18.2%) compared to male (8.6%) participants. Food Addiction was associated with higher BMI at baseline assessment, low self-esteem, impulsive and emotional eating behaviour, weight bias internalization, and deficits in food-related inhibitory control. In addition, correlations were found between Food Addiction and severity of depressive symptoms, internet use disorder, and psychological distress. Conclusion: A relevant subgroup of participants experiences Food Addiction even when controlling for Binge-Eating-Disorder and Bulimia Nervosa. Future studies are warranted that investigate whether Food Addiction affects treatment success.

Does Weight-Cycling Influence Illness Beliefs in Obesity? A Gender-Sensitive Approach.

Obesity is classified as a chronic disease. Women and men seem to face different obstacles in their attempts to overcome one of the most challenging tasks in the treatment of this disease, namely, weight reduction maintenance. The Common-Sense-Model (CSM) is mainly used to improve the understanding of self-regulation and health behaviour in chronic diseases but has yet to be explored for obesity. This paper applies the CSM to obesity, focussing on the construct of illness representations, which is the basis of health behaviour according to the CSM. A sample of n = 356 women and n = 77 men with obesity was investigated to assess the extent that illness representations in obesity are shaped by experiences of weight-cycling and the extent that gender influences their quality. Our results show that the representations of timeline and consequences as well as the emotional representation are particularly influenced by weight-cycling, especially in men. On average, women showed more maladaptive illness representations than men. These findings not only contribute to a better applicability of the CSM in obesity, but also emphasize the importance of gender in obesity research and interventions.

Effects of oral alcohol administration on heat pain threshold and ratings of supra-threshold stimuli.

Background and aims Evidence for analgesic effects of oral alcohol consumption on heat pain has recently been documented in a placebo-controlled, randomized and double-blind design. We aimed at further investigating these effects and now set the focus on pain threshold and the ratings of supra-threshold pain to cover most of the pain range. Moreover, we now firstly evaluated sex differences in these effects. Methods We investigated 41 healthy participants (22 females) in a randomized, double-blind and placebo-controlled design and targeted two different moderate breath-alcohol levels of 0.06% and 0.08%. Before and after an alcoholic or placebo drink, contact heat was applied at the forearm. Subjects evaluated pain threshold (method of adjustment) and rated pain intensity and pain unpleasantness of supra-threshold stimuli (intensity: threshold +3 °C; duration: 5 s). Results Analgesic effects taking the form of increased pain thresholds were found after both alcohol doses, surprisingly with more pronounced effects for the lower dose. While the high alcohol dose exerted small analgesic effects on pain intensity ratings (i.e. decrease), slightly increased ratings of pain intensity and pain unpleasantness after the low alcohol dose rather suggest pain enhancement. Alcohol did not affect intensity vs. unpleasantness ratings differentially. We found no evidence for sex differences in any of these effects. Conclusions Overall, acute alcohol effects on pain were subtle. Our findings suggest that while low alcohol doses already exert analgesic effects on pain threshold, stronger doses are required for pain reduction on supra-threshold pain levels. Furthermore, sex differences could not be detected within our experimental paradigm but should be further explored in future research. Implications Analgesic effects of sub-toxic alcohol doses - as normally occurring during social drinking - might be weak; however, susceptibility to pain relieving effects of alcohol might be a risk factor for the use of alcohol as self-medication in acute pain states.

Use Motives of Patients with Amphetamine-Type Stimulants Use Disorder and Attention-Deficit/Hyperactivity Disorder.

INTRODUCTION: There is a frequent comorbidity of amphetamine-type stimulants (ATS) use disorders and attention-deficit/hyperactivity disorder (ADHD). The assumption that this patient group "self-medicate" suggests that there are different use motives for ATS addicted patients with and without ADHD. OBJECTIVE: Our study investigates these potential differences in use motives. METHODS: Within a mixed-method approach, we examined the use motives of adults with ATS use disorder with and without ADHD in the first and latest month of their use. For this purpose, we used the 12-item Amphetamine-Type Stimulants Motive Questionnaire (AMQ) and a mind mapping technique after verifying that these tools are applicable to adults with ADHD. RESULTS: The mixed-method approach showed that enhancement motives were the most important motives in the first month of use (e.g., fun/kick/rush/desire, and curiosity/interest in the drug/appeal), and over time, the incidence of coping motives increased (e.g., repression and freeing the mind/not having to think/switching off). There were no differences between adults with and without ADHD in the AMQ data, while the qualitative data showed that adults with ADHD used ATS less often out of social motives. In particular, the results showed no differences in the coping dimension and, thus, did not suggest that self-medication is an important factor for patients with ADHD. CONCLUSIONS: Patients with and without ADHD show very similar motive patterns for ATS use. This indicates that ATS treatment programs addressing use motives do not necessarily have to be different for patients with and without ADHD.

Acute alcohol effects on conditioned pain modulation, but not temporal summation of pain.

Although pain reduction after alcohol administration has repeatedly been demonstrated, alcohol effects on advanced and clinically relevant dynamic pain paradigms are still unknown. As such, temporal summation of pain (TSP) and conditioned pain modulation (CPM) indicate mechanisms of endogenous pain modulation and involve certain neurotransmitter systems crucially influenced by alcohol. Our study is the first to investigate acute alcohol effects on TSP and CPM. We investigated 39 healthy subjects in a placebo-controlled within-subject design and targeted alcohol levels of 0.06% (dose 1) and 0.08% (dose 2). Pain threshold, TSP, and CPM were evaluated before and after an alcoholic or placebo drink. Temporal summation of pain was assessed as enhanced pain response to 5 repetitive contact heat stimuli (threshold +3°C). Conditioned pain modulation was tested as pain inhibition when a conditioning stimulus (46°C hot water) was applied concurrently to a test stimulus (contact heat; threshold + 3°C). Both alcohol doses boosted CPM, with a greater effect size for the higher dose. Conditioning stimulus ratings increased after alcohol intake but were not correlated with CPM, suggesting independence of these effects. Temporal summation of pain was not affected by alcohol, and alcohol effects on pain threshold were small and limited to the higher dose. Our findings suggest that analgesic alcohol effects might be mainly driven by an enhancement of endogenous pain inhibition. The frequent use of alcohol as self-medication in chronic pain might be motivated by alcohol temporarily restoring deficient CPM, thus leading to pain relief in the short run and alcohol-related problems in the long run.

Development and Validation of the Amphetamine-Type Stimulants Motive Questionnaire in a Clinical Population.

Approximately 35.7 million people world-wide use amphetamine-type stimulants (ATS) leading to a high demand for effective treatment. Understanding the motives behind ATS use is a necessary basis for preventive and therapeutic treatment. The objective of this study is to develop the Amphetamine-Type stimulants Motive Questionnaire (AMQ) and to confirm its construct and concurrent validity in respect to the first and the latest month of ATS use based on answers of 233 patients with ATS disorders (74.2% male; mean age: 31.1 years). Confirmatory factor analyses were employed to test for the construct validity of the AMQ. Nested models of confirmatory factor analyses with increasing constraints for gender and age were estimated to test the equivalence of the factor structure in different subgroups. Independent sample t-tests were conducted to test for mean differences in the motive dimensions. A structural equation model was estimated to confirm the concurrent validity using the latent four motive factors (i.e., enhancement, coping, social, and conformity motives) as independent variables and frequency of ATS use in the first and the latest month of use as a dependent variable. The results confirmed the AMQ's four-dimensional factor structure in general, and across gender and age groups for both periods of time. Men (first month: M = 4.21, SD = 0.75; latest month: M = 3.86, SD = 0.93) use ATS more frequently due to enhancement motives than women (first month: M = 3.85, SD = 1.12; latest month: M = 3.46, SD = 1.29) at both periods of time [first month: t(77) = -2.33, p = 0.022; latest month: t(80) = -2.19, p = 0.031]. Structural equation modeling confirmed an association between coping motives and use frequency, for both periods of time (first and latest month: ß = 0.32, p < 0.001), as well as between social motives and frequency of use for the latest month of use (ß = 0.30, p < 0.01). To conclude, the AMQ is a valid and reliable instrument for assessing motives of ATS use in a clinical population. It can provide important insights into the motivational structure of the first and latest months of ATS use which are useful for preventive and therapeutic treatments as well as the development of abstinence skills.

[Psychometric Evaluation of the German Version of the Short Questionnaire for Family Members-Affected by Addiction SQFM-AA (Gambling)]. / Psychometrische Evaluation des deutschen Kurzfragebogens für suchtbelastete Familienmitglieder SQFM-AA (Version Glücksspiel).

INTRODUCTION: Affected others of disordered gamblers are often heavily impacted because of the illness. Up till now, there is no standardized German instrument to assess this impact. Internationally, the Short Questionnaire for Family Members-affected by addiction (SQFM-AA) is often used which is based on the Stress-Strain-Coping-Support-Modell. That is why we translated this questionnaire into the German Kurzfragebogen für suchtbelastete Familienmitglieder SQFM-AA (Version Glücksspiel) to be able to assess the impact on affected others and to compare our results internationally. METHODS: The SQFM-AA was translated and retranslated and tested in an online convenience sample of affected others. Essential psychometric properties, discriminatory power, and internal consistency were calculated. Factor structure was analysed using an exploratory factor analysis (principal axis analysis, varimax rotation). RESULTS: Data collected from 122 affected others (87% female; 67% partners; 61% joint household) were analysed. Discriminatory power ranges between 0.30-0.94, Cronbach's alpha between 0.61-0.95. Factor analysis shows that 69% of variance can be explained in a solution with 9 factors. DISCUSSION: Due to the methods used when translating and back-translating the SQFM-AA, it can be assumed that both versions are comparable. Internal consistency of all scales is in an acceptable to good range. In our sample, the postulated 11 sub-scales cannot be reproduced. The 9 factors found here can be derived based on theoretical preliminary considerations. 4 of the scales are reflected well in the analysis, 3 more factors show a relevant load on other scales. Furthermore, one item each does not load on the proposed factor for the 2 remaining scales. All in all, the factors can be interpreted well regarding their content. A modification of the questionnaire would improve some of the statistical values, but the international comparability would no longer be possible. CONCLUSION: With the adaptation presented here, impact on affected others of disordered gamblers can be assessed and relevant areas for therapy and counselling can be identified.

Effectiveness of a drinking-motive-tailored emergency-room intervention among adolescents admitted to hospital due to acute alcohol intoxication - A randomized controlled trial.

The aim of this study is to develop and test the effectiveness of a drinking-motive-tailored intervention for adolescents hospitalized due to alcohol intoxication in eight cities in Germany between December 2011 and May 2012 against a similar, non-motive-tailored intervention. In a randomized controlled trial, 254 adolescents received a psychosocial intervention plus motive-tailored (intervention group; IG) or general exercises (control group; CG). Adolescents in the IG received exercises in accordance with their drinking motives as indicated at baseline (e.g. alternative ways of spending leisure time or dealing with stress). Exercises for the CG contained alcohol-related information in general (e.g. legal issues). The data of 81 adolescents (age: M = 15.6, SD = 1.0; 42.0% female) who participated in both the baseline and the follow-up were compared using ANOVA with repeated measurements and effect sizes (available case analyses). Adolescents reported lower alcohol use at the four-week follow-up independently of the kind of intervention. Significant interaction effects between time and IG were found for girls in terms of drinking frequency (F = 7.770, p < 0.01) and binge drinking (F = 7.0005, p < 0.05) but not for boys. For the former, the proportional reductions and corresponding effect sizes of drinking frequency (d = - 1.18), binge drinking (d = - 1.61) and drunkenness (d = - 2.87) were much higher than the .8 threshold for large effects. Conducting psychosocial interventions in a motive-tailored way appears more effective for girls admitted to hospital due to alcohol intoxication than without motive-tailoring. Further research is required to address the specific needs of boys in such interventions. (German Clinical Trials Register, DRKS ID: DRKS00005588).

The effect of nonrecurring alcohol administration on pain perception in humans: a systematic review.

PURPOSE: Alcohol is believed to have pain-dampening effects and is often used as self-medication by persons with pain problems; however, experimental evidence confirming this effect is scarce. We conducted a systematic review of experimental studies on the effects of nonrecurring alcohol administration on pain perception in healthy human subjects and the underlying mechanisms. METHOD: Three databases (PubMed, PsycINFO, and Web of Science) were searched for relevant studies using a predefined algorithm. In a next step, irrelevant articles were excluded by screening titles and abstracts. Finally, articles were checked regarding a set of methodological criteria; only publications meeting these criteria were selected for this review. A total of 14 experimental studies were identified. RESULTS: Overall, most of the studies were able to show a pain-dampening effect of alcohol. However, many of them had methodological shortcomings (eg, lack of placebo control, insufficient blinding, or very small sample sizes). In addition, comparability is limited due to considerable variations in alcohol administration and pain measurement. More importantly, potential mechanisms of action and moderating variables have scarcely been investigated. CONCLUSION: Despite the frequent use of alcohol as self-medication by persons with pain problems, there are to date only a few experimental investigations of alcohol effects on pain perceptions. The results of these studies suggest that alcohol does in fact have pain-dampening effects. However, the mechanisms implicated in these effects are still unknown, and experimental research has been limited to pain-free subjects. Future research should provide more knowledge about alcohol effects on pain, especially in chronic pain patients.

Inpatient treatment for pathological gamblers in Germany: setting, utilization, and structure.

In Germany, there are two different approaches to inpatient treatment of pathological gambling (PG): Facilities focusing on addiction or on psychosomatic illness. However, little is known about how these differences influence utilization and structure of treatment. Therefore, in our study, we analyzed all known German gambling inpatient treatment centers concerning patients' sex, age and number of comorbid disorders and evaluated an expert assessment of the treatment system, access to treatment, and structure characteristics of inpatient treatment facilities. In 2011, 2,229 pathological gamblers were treated. This amounts to 1 % of all past-year pathological gamblers. 90 % of the patients were men, 93 % had at least one comorbid disorder. Access to treatment was mostly gained via psychosocial counseling centers, but was not readily available. Facilities with addiction departments treated less pathological gamblers per year (29.3 gamblers) than facilities with psychosomatic departments (53.3 gamblers) or with both departments (76.4 gamblers). Treatment duration was significantly longer in addiction departments treating PG as secondary diagnosis only, with a low rate of gamblers on all patients, or treating few gamblers. Some facilities specialized on PG and treated more gamblers, had a higher rate of gamblers on all patients, and offered specific treatment programs. The impact of this specialization on treatment outcome is still unclear. Although treatment numbers have risen steadily for the past years, only a small fraction of affected gamblers seek inpatient treatment. Therefore, awareness to the disease and access to treatment needs to be improved.

Identifying problematic Internet users: development and validation of the Internet Motive Questionnaire for Adolescents (IMQ-A).

BACKGROUND: Internationally, up to 15.1% of intensive Internet use among adolescents is dysfunctional. To provide a basis for early intervention and preventive measures, understanding the motives behind intensive Internet use is important. OBJECTIVE: This study aims to develop a questionnaire, the Internet Motive Questionnaire for Adolescents (IMQ-A), as a theory-based measurement for identifying the underlying motives for high-risk Internet use. More precisely, the aim was to confirm the 4-factor structure (ie, social, enhancement, coping, and conformity motives) as well as its construct and concurrent validity. Another aim was to identify the motivational differences between high-risk and low-risk Internet users. METHODS: A sample of 101 German adolescents (female: 52.5%, 53/101; age: mean 15.9, SD 1.3 years) was recruited. High-risk users (n=47) and low-risk users (n=54) were identified based on a screening measure for online addiction behavior in children and adolescents (Online-Suchtverhalten-Skala, OSVK-S). Here, "high-risk" Internet use means use that exceeds the level of intensive Internet use (OSVK-S sum score ≥7). RESULTS: The confirmatory factor analysis confirmed the IMQ-A's 4-factor structure. A reliability analysis revealed good internal consistencies of the subscales (.71 up to .86). Moreover, regression analyses confirmed that the enhancement and coping motive groups significantly predicted high-risk Internet consumption and the OSVK-S sum score. A mixed-model ANOVA confirmed that adolescents mainly access the Internet for social motives, followed by enhancement and coping motives, and that high-risk users access the Internet more frequently for coping and enhancement motives than low-risk users. Low-risk users were primarily motivated socially. CONCLUSIONS: The IMQ-A enables the assessment of motives related to adolescent Internet use and thus the identification of populations at risk. The questionnaire enables the development of preventive measures or early intervention programs, especially dealing with internal motives of Internet consumption.

Hazardous alcohol levels in adolescents are underestimated by barkeepers and security personnel.

UNLABELLED: Drunkenness among adolescents represents a significant problem and is associated with adverse consequences. A Licensing Act, which prohibits the dispensing of alcoholic beverages to visibly intoxicated individuals, was introduced in Germany to curb excessive drinking. The objective of the study was to explore whether it is possible for barkeepers and security personnel to correctly estimate the alcohol level (AL) of adolescents merely based on their outer appearance and self-report. In a commercial dance club, 89 adolescents reported their past and current alcohol consumption and estimated their own AL. Their breath alcohol level was measured with a breathalyzer. The sample was divided into "moderate drinkers" and "binge drinkers." Barkeepers and security personnel spoke to and examined the adolescents in order to estimate the adolescents' AL. Professional staff underestimated the ALs of adolescents in 60.7 % of all cases. Estimates of the personnel showed greater deviations from the measured AL of the adolescents as compared to estimates of the adolescents themselves, especially in the group of binge drinkers (t = 2.764; p = 0.009). CONCLUSION: It seems that adolescents suffer less from observable effects of alcohol, such as sedation or impairment of motor function. Consequently, we do not recommend the application of the Licensing Act to adolescents, but suggest its replacement by other restrictions and prevention measures.

Influence of atypical neuroleptics on executive functioning in patients with schizophrenia: a randomized, double-blind comparison of olanzapine vs. clozapine.

Accepted clinical evidence suggests superior efficacy of novel antipsychotics in the treatment of cognitive symptoms in schizophrenia. Whether this constitutes a primary drug effect or a secondary effect due to easing extrapyramidal side-effects or improving positive symptoms when converting from a first- to a second-generation neuroleptic is still open to debate. Long-term efficacy as well as differential drug effects on cognitive performance are also poorly documented. We therefore compared cognitive performance of olanzapine vs. clozapine treatment in a controlled, randomized, double-blind trial. Fifty-four patients were assessed following a 2- to 9-day washout and again after 4 and 26 wk of neuroleptic treatment. Patients were rated on the PANSS for psychopathological changes, extrapyramidal side-effects were assessed on the Simpson-Angus Scale, and cognitive performance was assessed with the Stroop, Wisconsin Card Sorting and the Tower of London tests. Schizophrenia symptoms, extrapyramidal side-effects and cognitive performance improved significantly in the course of either drug treatment. Stroop test performance and Tower of London planning time improved significantly over 26 wk compared to baseline and 4-wk follow-up assessment while Wisconsin Card Sorting and Tower of London execution time improved significantly after 4 wk with no further improvement after 26 wk. Improved executive function was not related to improving positive symptoms and easing extrapyramidal side-effects, thus indicative of a primary treatment effect of either antipsychotic. However, Stroop reaction time improved with olanzapine while clozapine had a stronger effect on improving negative symptoms, thus suggestive of a differential drug effect.

Safety and efficacy of combined clozapine-lithium pharmacotherapy.

Several case reports described neurotoxic side-effects in the course of a combined clozapine-lithium treatment. Here we report on the safety and efficacy of this combination in a sample of 44 hospital patients. Medical records were retrospectively audited and a subsample of 23 patients was re-assessed. Mean total duration of combined treatment was 23.5 months. The combination (indications: prophylaxis; treatment of affective symptoms or aggression/excitement; augmentation of neuroleptic efficacy) was rated effective in 84% and adverse events were reported in 64% of the patients. Notably, most of the adverse events were benign and transient. However, 8 patients (18%) developed transient neurological adverse events that were genuinely novel in only 3 patients (7%) and coincided with high dosage of medication or high plasma levels or serotonergic (antidepressant) co-medication. Our data suggest that combined clozapine-lithium treatment may appear to be safe and effective when administered within a moderate therapeutic dose range and without serotonergic co-medication or other substances interfering with clozapine metabolism.