[Subjective Financial Resources of Temporary Disability Pensioners: Interrelation with Loneliness and Life Satisfaction]. / Gesundheit und Lebenszufriedenheit bei Erwerbsminderungsrentnern und -rentnerinnen: Die Bedeutung von finanziellen Ressourcen und Einsamkeit.

AIM OF THE STUDY: In Germany, a disability that prevents a person from fully participating in the labor market can partly be compensated for financially with temporary disability pension. Due to fewer financial resources, this group is at a higher risk of poverty, which in conjunction with a worse health status might be related to other limitations such as lower social participation, loneliness and reduced life satisfaction. This study examined the relationships between household income, subjective financial resources, loneliness and life satisfaction. METHODOLOGY: 199 former employees with current reduced earning capacity status were interviewed at 2 points in time (T1; T2=T1+approx. 8 months) by means of structured telephone interviews. RESULTS: Income was not related to loneliness or life satisfaction. However, lower perceived financial resources were associated with higher levels of loneliness, which in turn was related to lower life satisfaction. Loneliness partially mediated this relationship. A lower health status was associated with more loneliness and lower life satisfaction. CONCLUSION: Rehabilitative measures that teach money management skills and aim to overcome loneliness could improve the life satisfaction of people with reduced earning capacity. This is highly relevant, as other studies have shown a connection between life satisfaction and return to work as well as social participation.

Temporary Disability Pension, RTW-Intentions, and RTW-Behavior: Expectations and Experiences of Disability Pensioners over 17 Months.

Purpose: Individuals receiving a temporary disability pension (TDP) should get the opportunity to return to work (RTW). The current study aims to determine the factors contributing to RTW. Methods: 453 individuals on TDP were interviewed at three measurement points (T1, T2 = T1 + approximately 7 months, T3 = T1 + approximately 17 months). Socio-demographics, psychological predictors, and current work status (maintained TDP, permanent disability pension, old-age pension, employed, or receipt of other benefits) were assessed. Results: Throughout the duration of the study, only four of the former temporary disability pensioners returned to work, and an additional seven made themselves available to the labor market. These were individuals who were younger, in TDP for a shorter period of time, and reported a higher RTW-intention. Higher RTW-intention was cross-sectionally associated with younger age, shorter TDP duration, and more positive outcome expectancies. Additionally, study participants who expected that medical rehabilitation would help them RTW were more motivated to RTW. An increase in RTW-intention over 17 months was related to younger age and better health. Conclusion: Personal factors such as self-efficacy and job-related variables appear less important for RTW than age and subjective health status. The observed RTW rates call for early support and tailored medical rehabilitation interventions that help individuals prevent functional limitations, overcome disability, and facilitate RTW.

The stress-buffering effect of acute exercise: Evidence for HPA axis negative feedback.

According to the cross-stressor adaptation hypothesis, physically trained individuals show lower physiological and psychological responses to stressors other than exercise, e.g. psychosocial stress. Reduced stress reactivity may constitute a mechanism of action for the beneficial effects of exercise in maintaining mental health. With regard to neural and psychoneuroendocrine stress responses, the acute stress-buffering effects of exercise have not been investigated yet. A sample of highly trained (HT) and sedentary (SED) young men was randomized to either exercise on a treadmill at moderate intensity (60-70% VO2max; AER) for 30 min, or to perform 30 min of "placebo" exercise (PLAC). 90 min later, an fMRI experiment was conducted using an adapted version of the Montreal Imaging Stress Task (MIST). The subjective and psychoneuroendocrine (cortisol and α-amylase) changes induced by the exercise intervention and the MIST were assessed, as well as neural activations during the MIST. Finally, associations between the different stress responses were analysed. Participants of the AER group showed a significantly reduced cortisol response to the MIST, which was inversely related to the previous exercise-induced α-amylase and cortisol fluctuations. With regard to the sustained BOLD signal, we found higher bilateral hippocampus (Hipp) activity and lower prefrontal cortex (PFC) activity in the AER group. Participants with a higher aerobic fitness showed lower cortisol responses to the MIST. As the Hipp and PFC are brain structures prominently involved in the regulation of the hypothalamus-pituitary-adrenal (HPA) axis, these findings indicate that the acute stress-buffering effect of exercise relies on negative feedback mechanisms. Positive affective changes after exercise appear as important moderators largely accounting for the effects related to physical fitness.

Evidence for a normal HPA axis response to psychosocial stress in patients remitted from depression.

The purpose of this study was to investigate subjective mood and the effect of a psychosocial stress challenge on cortisol response in patients remitted from depression in comparison to healthy controls. Only few studies on small samples have been conducted on the influence of psychosocial stress on HPA system responsivity in this group. Results regarding patients who have achieved clinical remission from depression remain inconclusive so far. In comparison to healthy controls, some studies found blunted cortisol responses to a psychological stressor in patients with remitted depression. However, others found no differences. This discrepancy may be due to use of heterogeneous stress measures or dissimilar sample sizes and characteristics, e.g. including patients with comorbid generalized anxiety or patients with an unknown duration of remission. The present study included 77 healthy controls and 70 unipolar depressed patients who had achieved stable, full remission for at least 6 months (average 31 months) with no further Axis I disorder. Participants underwent the Trier Social Stress Test and salivary cortisol levels and mood were assessed repeatedly during the experimental procedure. For both groups, we observed a marked cortisol response and worsening of mood after the stress challenge. However, no differences between formerly depressed patients and healthy participants were observed. Assuming a disturbed HPA system regulation in acute depression, we interpret these findings as evidence for a restored HPA axis function in fully remitted patients.

Exercise and physical activity in mental disorders: clinical and experimental evidence.

Several epidemiological studies have shown that exercise (EX) and physical activity (PA) can prevent or delay the onset of different mental disorders, and have therapeutic benefits when used as sole or adjunct treatment in mental disorders. This review summarizes studies that used EX interventions in patients with anxiety, affective, eating, and substance use disorders, as well as schizophrenia and dementia/mild cognitive impairment. Despite several decades of clinical evidence with EX interventions, controlled studies are sparse in most disorder groups. Preliminary evidence suggests that PA/EX can induce improvements in physical, subjective and disorder-specific clinical outcomes. Potential mechanisms of action are discussed, as well as implications for psychiatric research and practice.

Acute exercise influences reward processing in highly trained and untrained men.

INTRODUCTION: Physical activity activates brain regions and transmitter systems that represent the reward system (i.e., the ventral striatum [VS] and dopamine). To date, the effect of training status and acute exercise on reward processing has not been investigated systematically in humans. To address this issue, we examined highly trained (HT) physically inactive (PIA) men with a monetary incentive delay (MID) paradigm. METHODS: We used functional magnetic resonance imaging (fMRI) to investigate the neural correlates of monetary incentive processing after acute exercise. HT and PIA subjects were randomized into two groups. Subjects in one group ran on a treadmill (T) for 30 min at 60%-70% of their maximal oxygen uptake (V˙O2max), whereas subjects in the other group performed placebo exercise (P). Approximately 1 h after exercise, the MID task was conducted. Mood was assessed using the Positive and Negative Affect Schedule before and after the exercise intervention. RESULTS: The psychological assessment showed that exercise significantly increased mood in HT and PIA men. During gain anticipation and gain feedback of the MID task, the VS was significantly stronger activated in the placebo group than in the treadmill group. No effect of training status and no interactions between training status and acute exercise were found. CONCLUSIONS: Acute exercise diminishes sensitivity to monetary rewards in humans. This finding is discussed concerning interactions between tonic and phasic dopamine in the VS.

Affective set-shifting deficits in patients with major depression in remission.

While numerous studies have focused on neuropsychological deficits during acute depressive episodes, results have been inconsistent for patients in remission. This case-control study aimed to explore whether remitted patients show deficits in an affective shifting task that has proven sensitive to assess emotional-cognitive deficits in acute depression. 69 fully remitted depressed patients were compared with 76 matched healthy subjects in their performance of a picture-based affective shifting task. Compared to healthy subjects, remitted patients show impaired go/no-go performance during shift, but not during non-shift conditions, reflecting a specific deficit in affective set-shifting. Impaired performance concerns omissions rather than false alarms or response times and is correlated with the duration of illness, but not the number of depressive episodes, time since remission or age. Our findings suggest that affective set-shifting deficits are also present during remission of depressive symptoms. These deficits may particularly concern enhanced inhibitory control and seem to develop over the course of the illness independent of acute episodes.

Exercise and physical activity in the therapy of substance use disorders.

Exercise and physical activity are constantly gaining attention as adjuvant treatment for substance use disorders, supplementing classical pharmacological and psychotherapeutic approaches. The present work reviews studies addressing the therapeutic effects of exercise in alcohol abuse/dependence, nicotine abuse/dependence, and illicit drug abuse/dependence. In the field of smoking cessation, evidence is strong for exercise as an effective adjuvant treatment, whereas no generalizable and methodologically strong studies have been published for alcohol and drug treatment so far, allowing only preliminary conclusions about the effectiveness of exercise in these disorders. A couple of potential mechanisms are discussed, by which exercise may act as an effective treatment, as well as future directions for studies investigating exercise as a treatment strategy for substance use disorders.

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.