[Everyday Life and Mental Health of Elderly with Cognitive Impairment During the Covid-19 Pandemic]. / Lebensalltag und psychosoziale Gesundheit älterer Menschen mit kognitiven Beeinträchtigungen während der COVID-19-Pandemie.

OBJECTIVE: The aim is to analyze pandemic-related effects on everyday life and psychosocial health in the understudied vulnerable group of cognitively impaired elderly people living at home. METHODS: Structured telephone interviews in 2020 (n+=+141) and 2021 (n+=+107) were used to survey over-65s with cognitive impairment (MMSE Ø 23.4). The results from the 2021 survey presented here reflect experiences and attitudes, effects on daily life and health care, and psychosocial burdens and resources. Longitudinal analysis of selected indicators of burden is provided for n+=+66. RESULTS: Even in the face of increasing concerns and moderate impacts on everyday life and health care, overall psychosocial health is proving to be good and largely stable over time. CONCLUSION: Respondents have high levels of personal and social resources, and their coping with limitations is characterized by acceptance and willingness to adapt.

[Work and Employment Situation of People with Mental Illness Receiving Independent Supported Housing: An Analysis of Routine Data from a Community Psychiatry Service]. / Die Arbeits- und Beschäftigungssituation von psychisch erkrankten Menschen mit ambulanter Wohnunterstützung: Eine Auswertung gemeindepsychiatrischer Routinedaten.

OBJECTIVES: Due to insufficient empirical data on the occupational participation of people affected by severe mental illness receiving integration assistance, routine data from a community psychiatry service were evaluated. METHODS: Reference workers filled out a short questionnaire on different occupational and employment aspects of their clients from supported housing/floating outreach. In addition to descriptive and exploratory analyses, overall results from previous survey rounds were also evaluated. RESULTS: N=1418 individuals (M=47.6 years) could be included, of whom approximately 45% had no job, sheltered employment, or daytime service. This percentage has remained almost unchanged over the last decades. CONCLUSION: Overall, there is an urgent need for action to improve occupational participation opportunities for people with mental illness and substance addiction.

Everyday memory in patients with depression: An explorative pilot study using an ecological assessment paradigm.

BACKGROUND: People with major depressive disorder (MDD) often experience significant memory problems in their daily lives, which, however, frequently do not correspond to standardized memory test (SMT) results. The present pilot study aimed to examine the everyday memory performance of people with MDD by means of an ecological assessment paradigm (EAP). METHODS: Participants were unexpectedly called one week after their neuropsychological test assessment and asked about their memories of specific details of the former test situation. Associations of this EAP with SMT, subjective everyday memory problems, and symptom coping were exploratively analyzed. RESULTS: The study involved 22 MDD inpatients (M = 42.5 years, 64% female) and 22 comparable healthy control persons. MDD patients showed a significantly reduced performance in the EAP as well as in the SMT and they reported more memory problems in their daily lives. However, the EAP was not related to SMT results assessed a week before. Moreover, only the EAP was significantly associated with subjective daily memory problems and (distraction) coping style in the MDD group. CONCLUSIONS: The EAP appears to better reflect the everyday memory problems of persons with depression than standardized test procedures. However, the findings need to be validated by further research with larger samples.

[Personalized psychotherapy of posttraumatic stress disorder : Overview on the selection of treatment methods and techniques using statistical procedures]. / Personalisierte Psychotherapie der posttraumatischen Belastungsstörung : Übersicht zur Auswahl von Behandlungsmethoden und -techniken mittels statistischer Verfahren.

BACKGROUND: A relevant heterogeneity of treatment effects in posttraumatic stress disorder (PTSD) is discussed with respect to the debate about the necessity of phase-based treatment and in light of the new diagnosis of complex PTSD and has recently been proven; however, there has been little personalization in the treatment of PTSD. This article presents the current state of research on the personalized selection of specific psychotherapeutic methods for the treatment of PTSD based on patient characteristics using statistical methods. METHODS: A systematic literature search was conducted in the PubMed (including Medline), Embase, Web of Science Core Collection, Google Scholar, PsycINFO and PSYNDEX databases to identify clinical trials and reviews examining personalized treatment for PTSD. RESULTS: A total of 13 relevant publications were identified, of which 5 articles were predictor analyses in samples without control conditions and 7 articles showed analyses of randomized controlled trials (RCT) with a post hoc comparison of treatment effects in optimally and nonoptimally assigned patients. In addition, one article was a systematic review on the treatment of patients with comorbid borderline personality order and PTSD. DISCUSSION: The available manuscripts indicate the importance and benefits of personalized treatment in PTSD. The relevant predictor variables identified for personalization should be used as a suggestion to investigate them in future prospective studies.

The Interplay of Oxytocin and Attachment in Schizophrenic Patients: An fMRI Study.

BACKGROUND: Attachment theory offers an important framework for understanding interpersonal interaction experiences. In the present study, we examined the neural correlates of attachment patterns and oxytocin in schizophrenic patients (SZP) compared to healthy controls (HC) using fMRI. We assumed that male SZP shows a higher proportion of insecure attachment and an altered level of oxytocin compared to HC. On a neural level, we hypothesized that SZP shows increased neural activation in memory and self-related brain regions during the activation of the attachment system compared to HC. METHODS: We used an event-related design for the fMRI study based on stimuli that were derived from the Adult Attachment Projective Picture System to examine attachment representations and their neural and hormonal correlates in 20 male schizophrenic patients compared to 20 male healthy controls. RESULTS: A higher proportion of insecure attachment in schizophrenic patients compared to HC could be confirmed. In line with our hypothesis, Oxytocin (OXT) levels in SZP were significantly lower than in HC. We found increasing brain activations in SZP when confronted with personal relevant sentences before attachment relevant pictures in the precuneus, TPJ, insula, and frontal areas compared to HC. Moreover, we found positive correlations between OXT and bilateral dlPFC, precuneus, and left ACC in SZP only. CONCLUSION: Despite the small sample sizes, the patients' response might be considered as a mode of dysregulation when confronted with this kind of personalized attachment-related material. In the patient group, we found positive correlations between OXT and three brain areas (bilateral dlPFC, precuneus, left ACC) and may conclude that OXT might modulate within this neural network in SZP.

Therapeutic alliance and dropout in patients with borderline pathology receiving residential dialectical behavior therapy.

BACKGROUND: This study focused on the impact of therapeutic alliance on therapy dropout in a naturalistic sample of patients with borderline pathology receiving dialectical behavior therapy (DBT) in a residential setting. We assumed that low therapeutic alliance shortly after admission would be associated with elevated dropout. METHODS: 44 participants with borderline pathology (≥ 3 DSM-5 borderline personality disorder criteria) in a residential DBT program completed a quality assurance questionnaire set assessing demographic information, pretreatment psychopathology and therapeutic alliance during the first seven days of their residential stay. Predictors of dropout were investigated using binary logistic regression analyses. RESULTS: The dropout rate was 34.1% (n = 15). In binary logistic regression analyses with variables covering demographic and clinical characteristics, comorbidities and childhood trauma history, only the therapeutic alliance significantly predicted dropout (z = -2.371, p = .018). CONCLUSIONS: This study supports the importance of therapy process variables, here the therapeutic alliance at the beginning of treatment, as predictors of therapy dropout in borderline pathology. If this finding is replicated, it shows the potential importance of monitoring the therapeutic relationship throughout the therapeutic process. CLINICALTRIALS: gov Identifier: NCT05289583, retrospectively registered on March 11, 2022.

Psychosocial functioning as a mediator between childhood trauma and symptom severity in patients with schizophrenia.

BACKGROUND: There is empirical evidence that childhood trauma is associated with symptom severity and psychosocial functioning in schizophrenia. OBJECTIVE: The present study aimed to further elucidate these associations by examining which subdomains of schizophrenic symptoms and psychosocial functioning are associated with childhood trauma. In addition, it should be tested whether the association between childhood trauma and schizophrenic symptoms is mediated by psychosocial functioning. PARTICIPANTS AND SETTING: Participants of this study were 253 inpatients of five psychiatric hospitals diagnosed with schizophrenia. Clinical interviews were conducted with these patients towards the end of therapy. METHODS: Childhood trauma was assessed with the Childhood Trauma Questionnaire (CTQ), a retrospective self-report scale. Schizophrenic symptoms were measured with the Positive and Negative Syndrome Scale (PANSS) and psychosocial functioning with the Personal and Social Performance Scale (PSP), two measures for ratings by experts. RESULTS: Most participants were affected by childhood trauma, with 91.7 % reporting at least one trauma. Childhood trauma showed small but significant correlations with positive symptoms and general psychopathology, and also with psychosocial functioning in the occupational and social area and in control over aggressive behavior. Psychosocial functioning was shown to mediate the association between childhood trauma and symptom severity, whereby full mediation was found with regard to positive symptoms and partial mediation with regard to general psychopathology. CONCLUSIONS: The findings suggest that good psychosocial functioning mitigates the negative impact of childhood trauma on illness severity in schizophrenic patients. Therapeutic interventions that promote personal and social resources are therefore useful in the treatment of schizophrenia.

Do depressed patients really over-report cognitive impairment?

BACKGROUND: Depressed patients report more severe cognitive impairment than is detectable by neuropsychological tests because they may underestimate their cognitive performance. Alternatively, it is possible that cognitive impairment primarily occurs under everyday life conditions as referred to in most questionnaires. The aim of the present study is to investigate the validity of self-reports in patients with major depression in order to better understand the pronounced impairment in self-reports. METHODS: We investigated 58 patients with major depression and 28 heathy control participants. We administered the "Screen for Cognitive Impairment in Psychiatry" (SCIP) to assess cognitive performance, the "Questionnaire for Cognitive Complaints" (FLei), and the newly developed scale for "Self-Perception of Cognitive Performance in everyday life and test settings" to ask for the self-assessed cognitive performance in everyday life and in a test situation more specifically. RESULTS: Depressed patients showed an inferior test performance and reported much more general everyday life related cognitive problems compared to healthy participants. When asked more specifically for their cognitive performance in the test-situation compared to others and compared to everyday life, they did not report more test-related and everyday life related impairment than healthy participants did. LIMITATIONS: Results might be influenced by comorbidity. CONCLUSIONS: These results have implications for the assessment of subjective cognitive performance of depressed patients and shed light on the negative effects of general versus more specific recall of autobiographical information.

Overestimation of on-road driving performance is associated with reduced driving safety in older drivers.

OBJECTIVES: Older drivers often show less precise self-ratings with a tendency to overestimate themselves. It is unclear, however, how overestimators differ from underestimators or drivers with adequate self-ratings. METHODS: 59 healthy older drivers participated in this on-road study. Besides standardized on-road driving assessment, the study protocol included the collection of neuropsychological and driving-related data as well as different self-ratings. Statistical analyses involved correlations between different subjective and objective ratings as well as statistical comparisons between drivers who overestimated and drivers who adequately rated their on-road driving performance (no drivers underestimated their performance). RESULTS: Despite positive correlations between different self- and expert ratings, our results revealed that 25 % of the participants overestimated their on-road driving skills. Among other things, overestimators showed poorer on-road driving performances, more prospective near and minor at-fault accidents, poorer cognitive performances in specific driving-related domains and reduced annual mileage. DISCUSSION: Our results suggest that older drivers who overestimate their driving skills show poorer performances within a broad range of skills that directly reflect or are closely related to driving safety. Against the background that an adequate self-assessment is required by German traffic regulations, our findings suggest that overestimators represent a risk group among the population of older drivers.

Combined physical activity training versus aerobic activity training in unipolar depressive disorder: a quasi-randomised evaluation study.

OBJECTIVE: The positive effect of sport and exercise interventions on the treatment of unipolar depressive disorder (UDD) is well documented with respect to aerobic exercise. However, few studies have determined the effectiveness of other types of interventions (e.g., weight training, body and mind oriented, qigong or progressive muscle relaxation). Additionally, the effectiveness of specific combined sport and exercise approaches has rarely been investigated. Therefore, recommendations for the use of sport and exercise therapy to treat UDD have been developed. METHODS: This quasi-randomised study used a pretest/posttest design to compare the effectiveness of two different interventions (aerobic activity training vs. combined physical activity training) on psychiatric outcome parameters in a day clinic psychiatric setting. A total of 62 participants were quasi-randomised to one of the two conditions. Affective, cognitive, psychosocial and neuropsychological changes were assessed by a battery of questionnaires before (t1) and after (t2) treatment. Accelerometers were used to assess energy consumption. RESULTS: The results show that both training interventions have similar effects on the treatment of UDD. CONCLUSION: These findings highlight the effectiveness of different physical activities in the treatment of UDD and provide further information for good clinical practice.

The Collaborative Assessment and Management of Suicidality compared to enhanced treatment as usual for inpatients who are suicidal: A randomized controlled trial.

Background: Although use of inpatient crisis hospital intervention for suicide risk is common, the evidence for inpatient treatments that reduce suicidal thoughts and behaviors is remarkably limited. To address this need, this novel feasibility pilot randomized controlled trial compared the use of the Collaborative Assessment and Management of Suicidality (CAMS) to enhanced treatment as usual (E-TAU) within a standard acute inpatient mental health care setting. Objectives: We hypothesized that CAMS would be more effective than E-TAU in reducing suicidal thoughts and behaviors. As secondary outcomes we also investigated depressive symptoms, general symptom burden, reasons for living, and quality of the therapeutic relationship. Methods: All patients were admitted due to acute suicidal thoughts or behaviors. They were randomly assigned to CAMS (n = 43) or E-TAU (n = 45) and assessed at four time points (admission, discharge, 1 month and 5 months after discharge). We used mixed-effects models, effect sizes, and reliable change analyses to compare improvements across and between treatment groups over time. Results: Intent-to-treat analyses of 88 participants [mean age 32.1, SD = 13.5; n = 47 (53%) females] showed that both groups improved over time across all outcome measures with no significant between-group differences in terms of change in suicidal ideation, depression, reasons for living, and distress. However, CAMS showed larger effect sizes across all measures; for treatment completers CAMS patients showed significant improvement in suicidal ideation (p = 0.01) in comparison to control patients. CAMS patients rated the therapeutic relationship significantly better (p = 0.02) than E-TAU patients and were less likely to attempt suicide within 4 weeks after discharge (p = 0.05). Conclusions: CAMS and E-TAU were both effective in reducing suicidal thoughts and symptom distress. Within this feasibility RCT the pattern of results was generally supportive of CAMS suggesting that inpatient use of CAMS is both feasible and promising. However, our preliminary results need further replication within well-powered multi-site randomized controlled trials. Trial registration: DRKS-ID/ICTRP-ID: DRKS00013727. The trial was retrospectively registered in the German Clinical Trials Register, registration code/ DRKS-ID: DRKS00013727 on 12.01.2018 and also in the International Clinical Trials Registry Platform of the World Health Organization (identical registration code).

Give Me a Sign: Concrete Symbols Facilitate Orientation in Alzheimer's Disease Dementia.

OBJECTIVES: Persons with Alzheimer's disease dementia (ADD) often show impaired orientation, particularly in unknown environments. Signs may offer an opportunity to compensate for these deficits and thus improve participation. METHODS: We assessed 30 persons with ADD and 36 healthy controls by using a sign comprehension paradigm (SCP) in a real-life environment. Nonparametric mixed model analyses of variance were used to analyze the effect of different symbols and additional scripture (coding condition) on SCP performance speed and accuracy. RESULTS: Analyses revealed a significant main effect of symbol design on SCP speed as well as an interaction effect of group × symbol, indicating a benefit of concrete, optimized signs for persons with ADD. Furthermore, analyses of SCP error rates revealed the main effects of group and coding condition as well as an interaction effect of group × coding. Persons with ADD made more errors than healthy controls, but SCP error rates decreased significantly in ADD in the double-coding condition. DISCUSSION: Our findings revealed an advantage of concrete double-coded symbols over conventional symbols and therefore strongly suggest the implementation of concrete double-coded signs to support older people living with ADD.

Joint Crisis Plans and Crisis Cards in Inpatient Psychiatric Treatment­a Multicenter Randomized Controlled Trial

BACKGROUND: Joint Crisis Plans (JCP) and crisis cards (CC) are both instruments designed to improve the management of future psychiatric crisis situations, but they differ, for example, in terms of resource use, legal validity, and aims. International research findings for JCP are inconsistent. METHODS: From January 2018 to December 2020, a single-blinded, two-armed multicenter RCT was carried out, with assessments at T0 (baseline) and T1 (18 months later). The patients included had schizophrenia or schizoaffective disorder and were aged between 18 and 62 years. The primary outcome was the cumulative duration of inpatient treatment (voluntary/involuntary), and coercive measures comprised the secondary outcome. Trial registration: DRKS00013985. RESULTS: Of the 266 study participants, 157 completed the study. In the CC group 57.8% and in the JCP group 64.9% were admitted to psychiatric hospitals between the index treatment and T1 (p = 0.367); 8.4% of the CC group and 12.2% of the JPC group were admitted against their will (p = 0.441). The cumulative treatment duration was not significantly shorter (p = 0.631) in the JPC group (mean 42.43 days, SD = 48.60) than in the CC group (50.16 days, SD = 74.16). Thus, JPCs did not achieve the expected improvement with regard to the primary endpoint. There were also no relevant differences regarding the secondary endpoint. Major effects in favor of the JCP were observed, however, in patients' development of conficence in the treatment teams and in their active participation in the treatment procedure. CONCLUSION: Although the study showed no superiority of JCP over CC with regard to the primary and secondary outcomes, JCP should be used more frequently in routine practice as an intervention to support a participative approach to treatment.

Neuropsychological predictors of vocational rehabilitation outcomes in individuals with major depression: A scoping review.

Background: Major depression is one of the leading causes of disability and limited capacity to work. Neuropsychological impairment is a common symptom in acute and remitted major depression and is associated with poor psychosocial functioning. This scoping review aimed to identify research on the role of neuropsychological functioning in outcomes of vocational rehabilitation programs in individuals with depression. Methods: We report on the conduct of this pre-registered (https://osf.io/5yrnf) scoping review in accordance with PRISMA-ScR guidelines. PubMed and PsychInfo were systematically searched for English or German research articles published between 1990 and September 2021 that studied objective neuropsychological tests as predictors of vocational rehabilitation interventions and included participants with depression. Results: The systematic literature search yielded no studies that specifically targeted subjects with major depression. However, eight articles published since 2016 were included in the review, analyzing data from five trials that evaluated the effectiveness of supported employment in North America and Europe in severe mental illnesses. An estimated 31% of the total number of participants included (n = 3,533) had major depression. Using a variety of cognitive tests and covariates, seven articles found that neuropsychological functioning - especially global cognition scores, verbal and visual learning and memory - significantly predicted vocational outcomes of rehabilitation programs. Conclusion: Despite a lack of studies specifically targeting major depressive disorder, the identified literature suggests that higher baseline neuropsychological functioning predicts better vocational outcomes of supported employment programs in individuals with depression. In clinical practice, additional neuropsychological modules during return-to-work interventions might be helpful for vocational outcomes of such programs.

Evaluation of a supported education and employment program for adolescents and young adults with mental health problems: A study protocol of the StAB project.

The majority of mental illnesses begins in childhood, adolescence and young adulthood before the age of 25. The transition from adolescence to adulthood is a particularly vulnerable time for adolescents with mental illness, affecting psychosocial functioning and participation in work life. Therefore, they need-in contrast to classic standard vocational interventions-a long-term, holistic and individually oriented vocational rehabilitation program. With the innovative model project "Start in education and employment (StAB)", adolescents and young adults with mental illnesses are to be supported with regard to their vocational perspectives and participation by a new type of individualized, holistic, long-term job coaching. It follows the Individual Placement and Support (IPS) concept, as a manualized form of the Supported Employment Approach and is based on the "first place-then train" principle. In order to evaluate the effectiveness and feasibility of the StAB program, a double-centre prospective single arm evaluation study in a mixed-methods design will be conducted. The focus is on quantitative research analysing pre-post-effects of the StAB intervention in a two-year observational study. Young people between 15 and 25 years with a psychiatric diagnosis who are currently in receipt of means-tested benefits or are entitled to them will be recruited. The study will take place in two major cities in the north-western part of Germany, Bielefeld and Dortmund. We expect to contribute to gain more empirical data about the implementation of Supported Employment and Education to severely mentally ill adolescents and young adults in German settings. Moreover, these results may also provide the scientific foundation for future measures focusing the improvement of vocational rehabilitation for young people with mental illness. The study was registered in the German Clinical Trials Register (DRKS00027576) on March 10, 2022.

Psychosocial functioning as a personal resource promoting a milder course of schizophrenia.

Schizophrenia has been shown repeatedly to be associated with a low level of psychosocial functioning. It is assumable that psychosocial functioning is related not only to current, but also to future symptom severity. To test this assumption, a follow-up study with two measurement time points with an interval of 18 months was conducted. In total, 154 inpatients from five psychiatric hospitals with a diagnosis of a schizophrenic disorder took part at both visits. Psychosocial functioning was measured with the Personal and Social Performance Scale (PSP scale) at baseline, and schizophrenic symptoms were assessed with the Positive and Negative Syndrome Scale (PANSS) at baseline and at follow-up. Two PSP subscales, i.e. socially useful activities and control over disturbing and aggressive behavior, turned out to be significant predictors of symptom severity 18 months later. The findings reveal that personal resources in the occupational domain and in adequate interpersonal behavior can have a positive impact on the long-term course of schizophrenia.

Participating in Longitudinal Observational Research on Psychiatric Rehabilitation: Quantitative Results From a Patient Perspective Study.

BACKGROUND: Longitudinal observational studies play on an important role for evidence-based research on health services and psychiatric rehabilitation. However, information is missing about the reasons, why patients participate in such studies, and how they evaluate their participation experience. METHODS: Subsequently to their final assessment in a 2-year follow-up study on supported housing for persons with severe mental illness, n = 182 patients answered a short questionnaire on their study participation experience (prior experiences, participation reasons, burden due to study assessments, intention to participate in studies again). Basic respondent characteristics as well as symptom severity (SCL-K9) were also included in the descriptive and analytical statistics. RESULTS: To help other people and curiosity were cited as the main initial reasons for study participation (>85%). Further motives were significantly associated with demographic and/or clinical variables. For instance, "relieve from boredom" was more frequently reported by men and patients with substance use disorders (compared to mood disorders), and participants 'motive" to talk about illness" was associated with higher symptom severity at study entry. Furthermore, only a small proportion of respondents indicated significant burdens by study participation and about 87% would also participate in future studies. CONCLUSIONS: The respondents gave an overall positive evaluation regarding their participation experience in an observational study on psychiatric rehabilitation. The results additionally suggest that health and social care professionals should be responsive to the expectations and needs of patients with mental illness regarding participation in research.