[Symptom Monitoring and Detection of Early Warning Signs in Bipolar Episodes Via App - Views of Patients and Relatives on e-Health Need]. / Notwendigkeit für Symptom-Monitoring und Frühwarnzeichenerkennung bipolarer Episoden durch eine App? ­ Ansichten von PatientInnen und Angehörigen zu e-health Bedarf.

BACKGROUND: The onset and early warning signs of episodes of bipolar disorder are often realized late by those affected. The earlier an incipient episode is treated, the more prognostically favorable the course will be. Symptom monitoring via smartphone application (app) could be an innovative way to recognize and react to early warning signs more swiftly. The aim of this study was to find out whether patients and their relatives consider technical support through an app to be useful and practical in the early warning sign detection and treatment. METHODS: In the present study, 51 patients with bipolar disorder and 28 relatives were interviewed. We gathered information on whether participants were able to perceive early warning signs in form of behavioral changes sufficiently and in a timely fashion and also whether they would use an app as treatment support tool. RESULTS: Although 94.1% of the surveyed patients and 78.6% of their relatives felt that they were well informed about the disease, 13.7% and 35.7%, respectively were not fully satisfied with the current treatment options. Early warning signs of every depressive development were noticed by 25.5% of the patients (relatives 10.7%). Every (hypo)manic development was only noticed by 11.8% of the patients (relatives 7.1%); 88.2% of the patients and 85.7% of the relatives noticed the same symptoms recurrently at the beginning of a depression and 70.6% and 67.9%, respectively, at the beginning of a (hypo)manic episode (in particular changes in physical activity, communication behavior and the sleep-wake rhythm). 84.3% of the patients and 89.3% of the relatives stated that they considered technical support that draws attention to mood and activity changes as useful and that they would use such an app for the treatment. DISCUSSION: The current options for perceiving early warning signs of a depressive or (hypo)manic episode in bipolar disorder are clinically inadequate. Those affected and their relatives desire innovative, technical support. Early detection of symptoms, which often manifest themselves in changes in behavior or activity patterns, is essentiell for managing the course of bipolar disorder. In the future, smartphone apps could be used for clinical treatment and research through objective, continuous and.

[Comorbidity of posttraumatic stress disorder and addiction from a biopsychosocial perspective]. / Zur Komorbidität von Posttraumatischer Belastungsstörung und Sucht in biopsychosozialer Perspektive.

Posttraumatic stress disorder and substance use disorder often co-occur within the health care system. Their comorbidity is associated with more serious acute clinical symptomatology, more frequent hospital admissions in state of emergency and significantly lower chances of improvement by psychological and pharmacological treatment. Their comorbidity contributes to dramatically unfavourable courses of illness as regards all biopsychosocial levels. The survey presented will discuss empirical findings from various perspectives: general epidemiology, substance use disorder as risk factor of trauma and PTSD, trauma and PTSD as risk factor of SUD, neurobiological effects of SUD converging towards neurobiology of PTSD, shared common factors of genetics/epigenetics, personality traits, and early developmental stress and trauma. The main focus of analysis will be put on processes that are intrinsically linked to the development and course of both disorders.

Body Mass Index Predicts Decline in Executive Function in Bipolar Disorder: Preliminary Data of a 12-Month Follow-up Study.

INTRODUCTION: Obesity and associated risk factors have been linked to cognitive decline before. OBJECTIVES: In the present study, we evaluated potential cumulative negative effects of overweight and obesity on cognitive performance in euthymic patients with bipolar disorder (BD) in a longitudinal design. METHODS: Neurocognitive measures (California Verbal Learning Test, Trail Making Test [TMT] A/B, Digit-Symbol-Test, Digit-Span, d2 Test), anthropometrics (e.g., body mass index [BMI]), and clinical ratings (Hamilton Depression Scale, Young Mania Rating Scale) were collected over a 12-month observation period. Follow-up data of 38 patients with BD (mean age 40 years; 15 males, 23 females) were available. RESULTS: High baseline BMI predicted a decrease in the patient's performance in the Digit-Span backwards task measuring working memory performance. In contrast, cognitive performance was not predicted by increases in BMI at follow-up. Normal weight bipolar patients (n = 19) improved their performance on the TMT B, measuring cognitive flexibility and executive functioning, within 1 year, while overweight bipolar patients (n = 19) showed no change in this task. CONCLUSIONS: The results suggest that overweight can predict cognitive performance changes over 12 months.

Fundamentally altered global- and microstate EEG characteristics in Huntington's disease.

OBJECTIVE: Huntington's disease (HD) is characterized by psychiatric, cognitive, and motor disturbances. The study aimed to determine electroencephalography (EEG) global state and microstate changes in HD and their relationship with cognitive and behavioral impairments. METHODS: EEGs from 20 unmedicated HD patients and 20 controls were compared using global state properties (connectivity and dimensionality) and microstate properties (EEG microstate analysis). For four microstate classes (A, B, C, D), three parameters were computed: duration, occurrence, coverage. Global- and microstate properties were compared between groups and correlated with cognitive test scores for patients. RESULTS: Global state analysis showed reduced connectivity in HD and an increasing dimensionality with increasing HD severity. Microstate analysis revealed parameter increases for classes A and B (coverage), decreases for C (occurrence) and D (coverage and occurrence). Disease severity and poorer test performances correlated with parameter increases for class A (coverage and occurrence), decreases for C (coverage and duration) and a dimensionality increase. CONCLUSIONS: Global state changes may reflect higher functional dissociation between brain areas and the complex microstate changes possibly the widespread neuronal death and corresponding functional deficits in brain regions associated with HD symptomatology. SIGNIFICANCE: Combining global- and microstate analyses can be useful for a better understanding of progressive brain deterioration in HD.

Do increases in deep grey matter volumes after electroconvulsive therapy persist in patients with major depression? A longitudinal MRI-study.

BACKGROUND: Previous MRI studies reported deep grey matter volume increases after electroconvulsive therapy (ECT) in patients with major depressive disorder (MDD). However, the clinical correlates of these changes are still unclear. It remains debated whether such volume changes are transient, and if they correlate with affective changes over time. We here investigated if ECT induces deep grey matter volume increases in MDD-patients; and, if so, whether volume changes persist over more than 9 months and whether they are related to the clinical outcome. METHODS: We examined 16 MDD-patients with 3Tesla MRI before (baseline) and after an ECT-series and followed 12 of them up for 10-36 months. Patients' data were compared to 16 healthy controls. Affective scales were used to investigate the relationship between therapy-outcome and MRI changes. RESULTS: At baseline, MDD-patients had lower values in global brain volume, white matter and peripheral grey matter compared to healthy controls, but we observed no significant differences in deep grey matter volumes. After ECT, the differences in peripheral grey matter disappeared, and patients demonstrated significant volume increases in the right hippocampus and both thalami, followed by subsequent decreases after 10-36 months, especially in ECT-responders. Controls did not show significant changes over time. LIMITATIONS: Beside the relatively small, yet carefully characterized cohort, we address the variability in time between the third scanning session and the baseline. CONCLUSIONS: ECT-induced deep grey matter volume increases are transient. Our results suggest that the thalamus might be a key region for the understanding of the mechanisms of ECT action.

The Influence of an Attachment-Related Stimulus on Oxytocin Reactivity in Poly-Drug Users Undergoing Maintenance Therapy Compared to Healthy Controls.

BACKGROUND: Substance use disorders (SUDs) have been described as a dysfunctional way to compensate for deficiencies in that person's underlying attachment system. Furthermore, the neuropeptide oxytocin (OT), which is a critical component of the neurobiology of the attachment system, has been shown to effectively reduce addictive behavior and therefore has been discussed as a potential medication in SUD treatment. This study investigates variation in peripheral OT plasma levels as a function of exposure to an attachment-related stimulus in SUD patients compared to healthy controls (HCs). METHODS: A total sample of 48 men, 24 inpatients in maintenance treatment who were diagnosed with poly-drug use disorder (PUD) and 24 HC, was investigated. A 15-min exposure to the Adult Attachment Projective Picture System (AAP) was used as an attachment-related stimulus and coded for attachment status. Blood samples before and after the AAP-assessment were taken and assayed for OT levels. Variation in baselines level of OT was examined in relation to the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), the Adult Attachment-Scale (AAS), and the Brief Symptom Inventory (BSI). RESULTS: Following the AAP stimulus controls showed no significant difference in OT levels elevation from baseline compared to the PUD group's OT levels. Furthermore, in the PUD group only OT-baseline-levels may be negatively associated with the AAS subscale "Comfort with Closeness" and "Anxiety" and lifetime substance use. DISCUSSION: Our results suggest that peripheral OT levels in poly-drug users undergoing maintenance treatment are not significantly different in responsiveness to an attachment related stimulus compared to HC. With regard to non-significant tendencies observed in this study which hint toward decreased OT-reactivity in the PUD group, further research is needed to explore this hypothesis with increased statistical power.

Interleukin-6 Gene Expression Changes after a 4-Week Intake of a Multispecies Probiotic in Major Depressive Disorder-Preliminary Results of the PROVIT Study.

Major depressive disorder (MDD) is a prevalent disease, in which one third of sufferers do not respond to antidepressants. Probiotics have the potential to be well-tolerated and cost-efficient treatment options. However, the molecular pathways of their effects are not fully elucidated yet. Based on previous literature, we assume that probiotics can positively influence inflammatory mechanisms. We aimed at analyzing the effects of probiotics on gene expression of inflammation genes as part of the randomized, placebo-controlled, multispecies probiotics PROVIT study in Graz, Austria. Fasting blood of 61 inpatients with MDD was collected before and after four weeks of probiotic intake or placebo. We analyzed the effects on gene expression of tumor necrosis factor (TNF), nuclear factor kappa B subunit 1 (NFKB1) and interleukin-6 (IL-6). In IL-6 we found no significant main effects for group (F(1,44) = 1.33, p = ns) nor time (F(1,44) = 0.00, p = ns), but interaction was significant (F(1,44) = 5.67, p < 0.05). The intervention group showed decreasing IL-6 gene expression levels while the placebo group showed increasing gene expression levels of IL-6. Probiotics could be a useful additional treatment in MDD, due to their anti-inflammatory effects. Results of the current study are promising, but further studies are required to investigate the beneficial effects of probiotic interventions in depressed individuals.

Personality Structure and Attachment in Bipolar Disorder.

BACKGROUND: An impairment of self and interpersonal functioning has an impact on coping strategies, regulation of affect and stress. Little is known so far about the impairment of personality functioning in patients with bipolar disorder (BD). The aim of this study is to assess the effects of personality structure and attachment in BD patients on the symptom burden. METHODS: Forty-six patients with the diagnosis of BD were assessed by the 12-item Operationalized Psychodynamic Diagnosis Structure Questionnaire (OPD-SQS), the short version of Experience in Close Relationship-revised (ECR-R-D), and the Brief Symptom Inventory-18 (BSI 18) to determine the level of personality functioning, attachment patterns, and symptom load. RESULTS: We observed positive correlations between personality difficulties, insecure attachment, and symptom load in patients with BD. A low level of structural integration and an insecure attachment style in patients with BD were accompanied by a significantly higher symptom load (r = 0.66, p ≤ 0.01). Interestingly, there were no significant differences in the structural integration (T(1.44) = -0.93, p = 0.357) and in the attachment style attachment related avoidance: (T(1,44) = 1.50, p = 0.140); attachment related anxiety (T(1,44) = -0.781, p = 0.439) of study participants with BD when compared to the normative value of the general population. LIMITATIONS: Our limitations are the small sample size of our group and the lack of a control group. CONCLUSION: In general, our results suggest that there is a link between personality structure and affective dynamics including depressive, anxiety, and somatization symptoms in BD. These findings underline the increasing importance of assessing personality structure and attachment for diagnosis and treatment planning of BD.

The Relationship Between Food Craving, Appetite-Related Hormones and Clinical Parameters in Bipolar Disorder.

Obesity and weight gain in bipolar disorder (BD) have multifactorial underlying causes such as medication side effects, atypical depressive symptomatology, genetic variants, and disturbances in the neuro-endocrinal system. Therefore, we aim to explore the associations between food craving (FC), clinical parameters, psychotropic medication, and appetite-related hormones. In this cross-sectional investigation, 139 individuals with BD and 93 healthy controls (HC) completed the food craving inventory (FCI). In addition, blood samples (including leptin and acylated ghrelin) were analyzed and sociodemographic and anthropometric data were collected. Individuals with BD reported higher frequencies of total FC as well as craving for fat and fast food than HC. Additionally, we found a significant negative correlation between FC and ghrelin levels in BD. Smokers with BD reported significantly more craving for high fat foods than non-smokers. Age was significantly associated with FC independent of group. Individuals with BD taking olanzapine and quetiapine reported higher frequencies of craving for sweet food, while patients currently taking lithium reported less total FC compared to those without lithium therapy. Likewise, patients currently taking valproate reported less total FC and less craving for sweets than those not taking valproate. FC appears to be of clinical relevance in individuals with BD. Contrary to previous data, this does not seem to be a female phenomenon only and might encompass more than the specific craving for carbohydrates. Although due to the cross sectional design, causality cannot be determined, the association between depressive symptomatology and fast food craving warrants further research.

Total gray matter volume is reduced in individuals with bipolar disorder currently treated with atypical antipsychotics.

BACKGROUND/AIMS: Recent evidence indicates that the intake of atypical antipsychotics (AAP) is associated with gray matter abnormalities in patients with psychiatric disorders. We explored if patients with bipolar disorder (BD) who are medicated with AAP exhibit total gray matter volume (TGV) reduction compared to BD individuals not medicated with AAP and healthy controls (HC). METHODS: In a cross-sectional design, 124 individuals with BD and 86 HC underwent 3T-MRI of the brain and clinical assessment as part of our BIPFAT-study. The TGV was estimated using Freesurfer. We used univariate covariance analysis (ANCOVA) to test for normalized TGV differences and controlled for covariates. RESULTS: ANCOVA results indicated that 75 BD individuals taking AAP had significantly reduced normalized TGV as compared to 49 BD not taking AAP (F = 9.995, p = .002., Eta = 0.084) and 86 HC (F = 7.577, p = .007, Eta = 0.046). LIMITATIONS: Our cross-sectional results are not suited to draw conclusions about causality. We have no clear information on treatment time and baseline volumes before drug treatment in the studied subjects. We cannot exclude that patients received different psychopharmacologic medications prior to the study point. We did not included dosages into the calculation. Many BD individuals received combinations of psychopharmacotherapy across drug classes. We did not have records displaying quantitative alcohol consumption and drug abuse in our sample. CONCLUSIONS: Our data provide further evidence for the impact of AAP on brain structure in BD. Longitudinal studies are needed to investigate the causal directions of the proposed relationships.

Influence of Spiritual Dimensions on Suicide Risk: The Role of Regional Differences.

The field of suicide prevention has been enriched by research on the association between spirituality and suicide. Many authors have suggested focusing on the various dimensions of religiosity in order to better understand the association between religion and suicidal risk, but it is unclear whether the relationship between spirituality and suicidality differs between countries with different cultures, life values, and sociohistorical experiences. To explore this, the aim of this multicenter study was to investigate the possible relationship between suicide and spirituality in Italy and Austria. In the two countries, two different groups of subjects participated: psychiatric patients and university students. The patients were evaluated with the Mini International Neuropsychiatric Interview. In addition, the following measures were used: a sociodemographic questionnaire, the Columbia-Suicide Severity Rating Scale-B, the Symptom-Checklist-90-Standard, and the Multidimensional Inventory for Religious/Spiritual Well-Being. Our results confirmed the multifactorial nature of the relation between suicide risk and the various religious/spiritual dimensions, including religious/spiritual well-being and hope immanent. However, regional differences moderated this relationship in both the clinical and nonclinical samples.

Suicide and Personality Traits: A Multicenter Study of Austrian and Italian Psychiatric Patients and Students.

OBJECTIVE: The aim of this multicenter study was to investigate the differences in personality traits, particularly Neuroticism, in three clinical samples and three student samples in Austria and Italy and their impact on suicide. METHODS: In total, 1,043 people (410 psychiatric inpatients and 633 university students) were tested in three regions of Europe: central Italy, northeast Italy, and eastern Austria. Psychiatric diagnoses were evaluated using the Mini-International Neuropsychiatric Interview, and the following instruments were used: Sociodemographic Questionnaire, Columbia-Suicide Severity Rating Scale-B, Symptom-Checklist-90-Standard, and Big Five Inventory. RESULTS: The study found that the intensity of Suicidal Ideation was associated with the personality traits of Neuroticism, Anxiety, and Extraversion but also with Depression. CONCLUSIONS: In conclusion, without the presence of Depression symptoms, neuroticism was a protective factor against Suicidal Ideation, whereas neuroticism when comorbid with Depression symptoms increased suicide risk in psychiatric patients. In all three regions, the clinical samples had higher scores for Neuroticism and for Depression symptoms than the student sample and consequently higher scores for Suicide. Furthermore, we demonstrated an interaction between gender and culture on personality traits, supporting the hypothesis that the distribution of self-reported personality traits is organized geographically.

Reduced Brain Electric Activity and Functional Connectivity in Bipolar Euthymia: An sLORETA Source Localization Study.

Bipolar disorder (BD) is a chronic illness with a relapsing and remitting time course. Relapses are manic or depressive in nature and intermitted by euthymic states. During euthymic states, patients lack the criteria for a manic or depressive diagnosis, but still suffer from impaired cognitive functioning as indicated by difficulties in executive and language-related processing. The present study investigated whether these deficits are reflected by altered intracortical activity in or functional connectivity between brain regions involved in these processes such as the prefrontal and the temporal cortices. Vigilance-controlled resting state EEG of 13 euthymic BD patients and 13 healthy age- and sex-matched controls was analyzed. Head-surface EEG was recomputed into intracortical current density values in 8 frequency bands using standardized low-resolution electromagnetic tomography. Intracortical current densities were averaged in 19 evenly distributed regions of interest (ROIs). Lagged coherences were computed between each pair of ROIs. Source activity and coherence measures between patients and controls were compared (paired t tests). Reductions in temporal cortex activity and in large-scale functional connectivity in patients compared to controls were observed. Activity reductions affected all 8 EEG frequency bands. Functional connectivity reductions affected the delta, theta, alpha-2, beta-2, and gamma band and involved but were not limited to prefrontal and temporal ROIs. The findings show reduced activation of the temporal cortex and reduced coordination between many brain regions in BD euthymia. These activation and connectivity changes may disturb the continuous frontotemporal information flow required for executive and language-related processing, which is impaired in euthymic BD patients.

Do Primary Emotions Predict Psychopathological Symptoms? A Multigroup Path Analysis.

Background: Research involving animal models has repeatedly proposed dysregulations in subcortically rooted affective systems as a crucial etiological factor in the development of a variety of psychiatric disorders. However, empirical studies with human participants testing these hypotheses have been sparse. Associations between primary emotions systems and different psychiatric symptoms were investigated in order to gain insights into the influence of evolutionary-rooted primary emotions on psychopathology. Material and Methods: The community sample included 616 adults (61.9% female). 243 reported a psychiatric lifetime diagnosis. By applying path analysis, we estimated paths between SEEKING, ANGER, FEAR, SADNESS, CARE, and PLAY (Affective Neuroscience Personality Scales; ANPS) and symptoms of substance abuse (Alcohol, Smoking, and Substance Involvement Screening Test; ASSIST) as well as depression, anxiety, and somatization (Brief Symptom Inventory; BSI-18). To examine the moderator effects of gender and psychiatric lifetime diagnosis, multigroup analysis was applied. Results: Substance abuse was associated with male sex (ß = -.25), SADNESS (ß = .25), and ANGER (ß = .10). Depression was associated with SADNESS (ß = .53), FEAR (ß = .10), SEEKING (ß = -.10), and PLAY (ß = -.15). Anxiety was linked to SADNESS (ß = .33), FEAR (ß = .21) and PLAY (ß = -.10). Somatization was associated with SADNESS (ß = .26) and PLAY (ß = -.12; all p < .001). Multigroup analysis revealed no differences in paths between tested groups (all p > .01). The model explained 14% of the variance of substance abuse, 52% of depression, 32% of anxiety, and 14% of somatization. Conclusions: The results further our understanding of the differential role of primary emotions in the development of psychopathology. In this, the general assumption that primary emotion functioning might be a valuable target in mental health care is underlined.

The Influence of Attachment Styles and Personality Organization on Emotional Functioning After Childhood Trauma.

Background: Current literature suggests a tenuous link among childhood trauma, personality organization, adult attachment, and emotional functioning in various psychiatric disorders. However, empirical research focusing on the interaction of these concepts is sparse. Therefore, this study intends to investigate the influence of personality organization and attachment dimensions on the relationship between childhood maltreatment and emotional functioning in adult life. To assess emotional functioning, we adopted the Affective Neuroscience model of primary emotions, comprising SEEKING, FEAR, ANGER, SADNESS, CARE, and PLAY. Methods: The total sample consisted of 616 nonclinical adults (Age: M = 30; SD = 9.53; 61.9% female). Path analysis was applied to investigate interactions among childhood trauma, personality organization, adult attachment, and primary emotion dispositions. Results: The findings suggest that childhood trauma significantly predicted deficits in personality organization and insecure attachment (all p < 0.001). Furthermore, a reduced level of personality organization was significantly associated with increased ANGER (p < 0.001), whereas adult attachment substantially predicted primary emotion dispositions in general. Moreover, the results indicate significant mediational effects of personality organization and attachment dimensions on the relationship between childhood trauma and primary emotions (p < 0.01). The final model was able to explain 48% of the variance in SADNESS, 38% in PLAY, 35% in FEAR, 28% in CARE, 14% in ANGER, and 13% in SEEKING. Discussion: The findings contribute to the understanding of the relationship between childhood maltreatment and impaired emotional functioning in adult life. Furthermore, the importance of personality organization and attachment dimensions for emotion regulation is underlined. Consequently, the treatment of patients with childhood trauma should focus on facilitating the development of more secure attachment patterns and increased personality functioning to improve overall emotional functioning.

Posttraumatic stress reactions of underground drivers after suicides by jumping to arriving trains; feasibility of an early stepped care outpatient intervention.

Objective: Underground drivers face a considerable risk of running over suicide jumpers on the tracks during their career. These traumatic exposures may lead to major psychological sequelae. Methods: Within an outpatient setting, 50 drivers were consecutively enrolled in a prospective non-controlled trial. A low-intensity, stepped-care approach included: emergency care immediately after the critical accident, comprehensive assessment with a structured clinical interview using the following scales within three days: Composite International Diagnostic Interview (CIDI), Impact of Event Scale (IES), Screening for Somatoform Disorders (SOMS), and Cologne Trauma Inventory (KTI). Results: During a 2-year period, 50 subway drivers were exposed to 66 serious critical accidents (deaths: 39, severe injuries: 27). Rate of acute stress reactions was 48%; rate of acute stress disorders was 30%. Scores of IES and SOMS were significantly increased correspondingly. At 1-month follow-up, PTSD was diagnosed in 24 (ICD-10) and in 9 drivers (DSM-IV), respectively. Major depression (n = 15) and somatoform disorder (n = 10) were diagnosed as coexistent to PTSD. Acute stress reaction/acute stress disorder, IES- and SOMS-scores, and previous traumatic exposures during adulthood, but not during childhood, were significantly associated with the risk of PTSD. A majority of drivers (n = 43) succeeded in reaching complete symptomatic remission and returning to work again within a 6-month period. Seven drivers suffered from long-lasting posttraumatic symptoms causing severe social impairment. Conclusions: A low-intensity, outpatient stepped-care approach may provide support to traumatized underground drivers in their process of posttraumatic remission and recovery.

Sense of coherence is linked to post-traumatic growth after critical incidents in Austrian ambulance personnel.

BACKGROUND: Ambulance personnel, as well as other emergency services like fire-fighters or the police force, are regularly confronted with experiences of extreme psychological distress and potentially traumatizing events in the line of their daily duties. As a consequence, this occupational group is exposed to an elevated risk of developing symptoms of Post-Traumatic Stress (PTSS). Subsequently, symptoms of Post-Traumatic Stress have been observed as potentially co-occurring with Post-Traumatic Growth (PTG) in ambulance personnel as well. Therefore, in this study we hypothesized that Sense of Coherence (SOC) might play an important role as an underlying feature in enabling growth after stressful experiences in Austrian ambulance personnel. METHODS: In this study, voluntary and full-time ambulance personnel (n = 266) of the Austrian Red Cross ambulance service completed an online survey including the Sense of Coherence Scale (SOC-29), the Post-Traumatic Growth Inventory (PTGI) and the Impact of Event Scale Revised (IES-R) for the assessment of PTSS. In line with theoretical considerations, a two-step cluster analysis limited to four clusters and further ANOVAs were conducted. RESULTS: Four clusters were confirmed and labelled PTSS-low/PTG-low, PTSS-low/PTG-high, PTSS-high/PTG-high and PTSS-high/PTG-low. Further ANOVAs revealed substantial cluster differences in SOC, with higher SOC-levels in PTSS-high/PTG-high than in PTSS-high/PTG-low (p < .01), in PTSS-low/PTG-high than in PTSS-low/PTG-low (p < .01) and in PTSS-low/PTG-high than in PTSS-high/PTG-low (p < .01). CONCLUSIONS: Our findings point to a significant association between SOC and the development of PTG in ambulance personnel. Furthermore, the results suggest that growth and stress after critical incidents are independent from each other and can co-exist. Therefore, promoting SOC (e.g., meaningfulness) in ambulance personnel - e.g., through psychological interventions - might preserve and enhance psychological health after critical incidents.

Body modification in Germany: prevalence, gender differences and attitude towards cosmetic surgery.

BACKGROUND: The most popular body modifications are tattoos and piercings and their prevalence has increased in recent years. The current study gathered statistics regarding tattoing, piercing and body-hair removal, differentiated by gender and attitude towards cosmetic surgery. METHODS: The study was based on 2512 individuals and was performed as a population-based survey with the assistance of a demographic consulting company. In addition to sociodemographic questions, specific issues concerning body modification were asked. RESULTS: Men get tattoos more frequently while women more often choose piercings and body hair removal. Women are catching up in the tattoo department and one can no longer observe age differentiations among the younger age groups. Instead there is a decrease in piercings among men. Body hair removal is widespread above all women. People with body modifications tend to be more open-minded about cosmetic surgery. CONCLUSIONS: Tattoos and piercings continue to be the most popular body modification among young adults. The number engaged in tattooing is rising while piercings are still popular among women. Individuals being engaged in body modification are prone to consider cosmetic surgery procedures.

Adiponectin is decreased in bipolar depression.

Objectives: Bipolar disorder (BD) is often accompanied by medical comorbidities, which affect illness course and prognosis. Adipokines may not only be involved in the aetiopathogenetic mechanisms of these comorbidities; there might be an association between adipokines and the neuropsychiatric core features of BD such as mood disturbances and cognitive deficits.Methods: In this investigation, fasting blood samples from 120 individuals with BD (75 euthymic and 45 with mild depressive symptoms) and 68 control subjects were taken and adiponectin and leptin concentrations were analysed.Results: We found that, in female participants, adiponectin levels differed significantly between patients and controls indicating lower levels in individuals with BD, even after controlling for BMI (F(1,92) = 4.65, P = 0.034, partial η2 = 0.05). After stratification by mood status we found a significant difference in adiponectin between controls, euthymic and depressive patients (F(2, 180) = 4.90, P = 0.008, partial η2 = 0.05).Conclusions: This investigation confirms previous findings of an association between low adiponectin levels and depressive state in individuals with BD. Beyond its immediate effect on central nervous system function, adiponectin might interfere with pathophysiological mechanisms of BD and its somatic comorbidities via involvement in metabolic and inflammatory processes.