Psychiatric presentations and admissions during the first wave of Covid-19 compared to 2019 in a psychiatric emergency department in Berlin, Germany: a retrospective chart review.

BACKGROUND: Most studies agree that the Covid-19 pandemic and the subsequent lockdown had a negative impact on mental health. On the other hand, international studies have shown that psychiatric emergency departments (pED) experienced a decrease in presentations and admissions. METHODS: Retrospective chart review of all pED presentations and admissions during the first wave of Covid-19 pandemic in Germany (Covid-19 period: 3/2/20 to 05/24/20) in a psychiatric hospital in Berlin compared to 1 year earlier (pre-Covid-19 period). Descriptive statistics and logistic regression were performed. RESULTS: We observed no statistical significant changes in overall pED presentations and overall hospital admissions during the Covid-19 period compared to the pre-Covid-19 period (813 vs. 894, - 9.1%, p = 0.064 and (363 vs. 437, - 16.9%, p = 0.080 respectively). In the subgroup analysis, less patients with depressive disorders (p = 0.035) and with personality disorders (p = 0.002) presented to the pED, a larger number of presentations with schizophrenia was observed (p = 0.020). In the Covid-19 period, less patients with substance use disorder and paranoid schizophrenia were admitted to the hospital via the pED than in the pre-Covid-19 period (p = 0.035 and p = 0.006, respectively). Bed capacity was reduced in the Covid-19 period by - 32.8% (p <  0.001). Presentations in police custody were 13.7% (p = 0.029) higher during the Covid-19 compared to pre-Covid-19 period, with higher rates in female presentations (p = 0.008) and suicide attempts (p = 0.012) and less hospital admissions (p = 0.048). Logistic regression analyses revealed that positive predictors for pED presentation during Covid-19 period were police custody (p <  0.001), being redirected from another hospital (p <  0.001), suicide attempt (p = 0.038), suicidal thoughts (p = 0.004), presentation with paranoid schizophrenia (p = 0.001) and bipolar and manic disorders (p = 0.004), negative predictors were hospital admission (p <  0.001), depressive disorders (p = 0.021) and personality disorders (p <  0.001). CONCLUSIONS: A larger number of presentations in police custody during the Covid-19 period may represent untreated medical needs. This was seen predominantly in female patients, suggesting this subgroup might have suffered particularly under lockdown measures. Patients with paranoid schizophrenia were the only subgroup, which increased in absolute numbers, also suggesting a particular lockdown effect. Reduced bed capacity due to infection curbing measures is suggestive to have played an important role in augmenting the threshold for hospital admissions.

[The application of virtual reality in the treatment of mental disorders]. / Die Anwendung der Virtuellen Realität in der Behandlung psychischer Störungen.

BACKGROUND: Virtual reality (VR) enables immersion in an interactive digital world with realistic experiences, that can be applied for controlled and personalized interventions. This review summarizes the current research on VR in the treatment of mental disorders. METHODS: Selective literature search in PubMed and Google Scholar. RESULTS: An increasing number of publications report the therapeutic application of VR for the treatment of mental disorders. Most VR applications are based on established therapy approaches, such as exposure therapy. According to meta-analytic data, virtual exposure therapy (VRET) for specific phobia and agoraphobia with panic disorder is as effective as traditional in vivo exposure therapy. VRET for the treatment of social phobia is significantly more effective than waitlist and placebo control groups with, however, currently inconsistent metanalytic results when compared to in vivo exposure therapy. VRET for the treatment of posttraumatic stress disorder (PTSD) is similar in effectiveness compared to active psychotherapy. For psychosis, positive results have been reported for the VR-based treatment of auditory verbal hallucinations. For patients with a substance use disorder, VR can induce craving, with still unverified diagnostic and therapeutic relevance. CONCLUSIONS: VRET can broaden the psychotherapy options for anxiety disorders. Encouraging results of VR-based treatments for psychosis and PTSD indicate the need for further research concerning its effectiveness and safety. In the field of substance use disorders, evaluation of clinical-orientated VR applications is needed.

The effect of type 2 diabetes mellitus on changes in the fractal dimension of periapical lesion in teeth after root canal treatment: a fractal analysis study.

AIM: This single-centre retrospective case-control study evaluated fractal dimension (FD) changes in radiographs of periapical lesions using a fractal analysis in healthy individuals and type 2 diabetes mellitus (DM) patients following root canal treatment. METHODOLOGY: The study data consisted of two groups: the DM group which contained a total of 46 mandibular molar teeth in 37 patients with no systemic disease other than type 2 DM, and the control group which contained a total of 52 mandibular molar teeth in 41 patients without systemic disease. Periapical radiographs were obtained prior to root canal treatment and 1 year post-treatment. Fractal analysis was performed by selecting a region of interest on the periapical radiographs. For both groups, the FD changes in lesion area were calculated and compared. In addition, periapical status was evaluated using the periapical index (PAI) scores on periapical radiographs for both groups. Data were analysed using dependent-sample t-test, independent-sample t-test, Wilcoxon signed-rank test and Mann-Whitney U-test. RESULTS: In both groups, FD values were increased significantly 1 year post-treatment as compared with those prior to treatment (P < 0.05). The time-dependent increase in FD was significantly greater in the control group (P < 0.05). Time-dependent increases in FD did not differ between genders (P > 0.05). There was a significant decrease in PAI scores in both type 2 DM and control groups depending on time (P < 0.05). No significant difference was found between the groups in terms of time-related decreases in PAI scores (P > 0.05). CONCLUSION: An increase in the FD of the periapical lesion area was observed 1 year after root canal treatment. DM had a negative effect on FD increase.

Micro-Computed Tomography Analysis of Fit of Ceramic Inlays Produced with Different CAD Software Programs.

PURPOSE: The aim of this study was to evaluate marginal and internal fit of ceramic inlays designed with different computer-aided design software programs. MATERIALS AND METHODS: 11 typodont mandibular first molars were prepared as a ceramic class II mesioocclusal inlay cavity. Teeth were scanned using 3Shape TRIOS Intraoral Dental Scanner. The scan data, which was obtained in the form of a STL file, was designed in three different CAD systems (CEREC, KaVo, and Planmeca). The obtained STL scan data was exported to design inlay using three different CAD systems (CEREC, KaVo, and Planmeca). An independent 5-axis milling unit was used to manufacture the feldspatic inlay restorations. 11 measurements for each teeth were made by using micro-ct to evaluate the marginal and internal fit. One-way ANOVA was used to determine the statistical difference between groups, and Tukey posthoc test was used to determine intra-group differences. RESULTS: According to repeated ANOVA test results, a statistically significant difference was found between the groups for the variables A, D, and F. There was no statistically significant difference between the groups in linear measurements for other measurement points and volumetric measurements (p⟩0.05). CONCLUSION: Software programs of different systems affects the marginal and internal fit of inlay restorations.

Omalizumab treatment in adolescents with chronic spontaneous urticaria: Efficacy and safety.

BACKGROUND: Omalizumab is useful as an add-on treatment in patients unresponsive to high doses of second-generation antihistamines. This study aimed to evaluate the efficacy and safety of omalizumab treatment in adolescents with refractory chronic spontaneous urticaria (CSU). METHODS: CSU patients aged 12-18 years old with the diagnosis of symptomatic CSU and unresponsive to classical treatment were included in the study. All patients had an urticaria-activity-score (UAS7) of ≥16 or and were treated with 300mg omalizumab every four weeks. The degree of response was classified into complete, partial and non-responders due to UAS7. RESULTS: A total of 29 patients were evaluated. The median age and symptom onset age of the patients was 15.2 (IQR, 12.8-16.5) years and 14.0 (IQR, 11.8-15.9) years, respectively. The median duration of urticaria was eight (IQR, 4-24) months at admission. Eleven (37.9%) patients had angioedema and ten (34.5%) patients had concomitant allergic diseases. The median age at the beginning of treatment with omalizumab was 15.4 (IQR, 12.9-16.9) years. The median symptom duration was 12 (IQR, 6.5-27.5) months before the omalizumab treatment. Twenty-eight (96.5%) of the patients (89.6% complete, 6.9% partial) achieved response; however, one patient was a non-responder (3.5%). The adverse effect was observed in one (3.4%) patient as angioedema after the third dose. Twenty-three patients were followed up for a median of 18 (IQR, 13-27) months. Relapse was observed in three (13%) patients. CONCLUSIONS: Omalizumab is considered as an effective and safe treatment for CSU in adolescents. Relapses mostly occur within the first year after the cessation of treatment.

Physicians prescribe adrenaline autoinjectors, do parents use them when needed?

BACKGROUND: Anaphylaxis is a sudden, severe, and potentially life-threatening allergic reaction, affecting a portion of allergic patients. Adrenaline is the first-line medication for anaphylaxis and available in many parts of the world as adrenaline autoinjectors (AAIs). OBJECTIVE: Aim of this study was to determine attitudes and knowledge levels of patients/parents regarding the use of AAIs, frequency, and rate of appropriate AAI use and to give a standardized and better education by improving on mistakes during administration. METHOD: 190 patients aged 1-18 years who were prescribed AAIs for any reason between 2012 and 2017 in Hacettepe University Pediatric Allergy Unit. Demographic data were collected during face-to-face interview or by telephone. Parents completed a mini-survey regarding use, carriage, and storage of AAI. RESULTS: Some 190 patients (64.7% male) aged 7.83 (4.99-12.08) years, median (inter-quartile), were included in the study. The indications for AAI prescription were food allergy (78.9%); venom allergy (14.2%); idiopathic anaphylaxis (3.7%); mastocytosis (2.1%); and drug allergy (1.0%). One-fourth of AAI-prescribed patients experienced anaphylaxis requiring the use of AAI within the past five years. However, only 30% of the patients dared to use AAI; only three-quarters of whom had managed to use it correctly. CONCLUSION: After prescription of AAI and initial training, patients and parents' concerns and fears should be taken into consideration and necessary support should be provided. At every opportunity and each clinical visit, not only should training sessions be repeated but also the patients and parents should be psychologically supported.

Efficacy of cabergoline in a double-blind randomized clinical trial on milk leakage reduction at drying-off and new intramammary infections across the dry period and postcalving.

The abrupt cessation of milking at dry-off may induce milk leakage, which may increase the risk of new intramammary infections (IMI). This study assessed the efficacy of 1 i.m. injection of 5.6 mg of cabergoline (Velactis, Ceva Santé Animale, Libourne, France) at drying-off on milk leakage after dry-off and new IMI across the dry period and postcalving compared with a placebo (negative control) and an intramammary antibiotic treatment (positive control) under field conditions. The study was a double-blind, randomized, 3-arm, multicenter, clinical trial performed under Good Clinical Practice conditions. Data from 900 dairy cows of various breeds from 63 farms in France, Germany, and Hungary were analyzed. Only quarters with no bacterial growth at drying-off and a cow somatic cell count ≤200,000 cells/mL were included. Quarters infected with major or minor pathogens or cows with high somatic cell count at time of inclusion were excluded. Cows that qualified for the study were visited 7 times in total before and after drying-off and after calving. Presence (yes/no) of milk leakage was recorded on the day after dry-off. A new infected quarter (new IMI) was defined as one with a major pathogen present in any one of the 2 postcalving samples. Two mixed logistic regression models were fitted to the data to evaluate the efficacy of cabergoline in the reduction of milk leakage and new IMI. One i.m. injection of cabergoline at drying-off significantly reduced the incidence of milk leakage the day after dry-off compared with both placebo and antibiotic treatment. Cabergoline-treated cows significantly reduced the risk of new IMI by major pathogens across the dry period and postcalving by 21% when compared with placebo cows (20.5 vs. 26.0%, respectively). However, when milk leakage was added to the model, the significance of cabergoline was reduced. We interpreted this to show that milk leakage is an intervening variable between treatment with cabergoline and lower risk of new IMI. The antibiotic treatment significantly decreased the odds of new IMI compared with both cabergoline and placebo. However, because several countries are currently disallowing the preventive use of antibiotics at dry-off in noninfected quarters, the dry-off facilitator cabergoline may therefore be of particular value to reduce the risk of new IMI across the dry period.

Micro-CT evaluation of the removal of root fillings using the ProTaper Universal Retreatment system supplemented by the XP-Endo Finisher file.

AIM: To compare the removal of root fillings in extracted teeth using the ProTaper Universal Retreatment system (PTUR) followed by a supplementary preparation with the XP-Endo Finisher file. METHODOLOGY: The mesiobuccal root canals of 30 extracted mandibular first molars were instrumented with ProTaper Universal NiTi files up to F2 and filled with one of the following sealers using a single-cone technique (n = 10): AH Plus, NeoMTA Plus and EndoSequence BC. The root fillings were removed using the PTUR system with additional apical preparation using ProTaper F2 and F3 files. Then, an additional preparation with an XP-Endo Finisher file was performed. The samples were scanned using micro-CT before and after retreatment and again after the use of the XP-Endo Finisher to assess the volume of remaining filling material. Data were analysed by Kruskal-Wallis and Friedman's two-way analysis of variance tests with Bonferroni correction. RESULTS: No significant difference in the initial filling volume was observed amongst the groups (P > 0.05). The amount of filling materials in each group decreased significantly after retreatment with rotary files (P < 0.05). After initial retreatment, the volume of the remaining filling amongst the groups was similar (P > 0.05). Additional preparation with the XP-Endo Finisher improved the removal of filling materials regardless of the sealer type (P < 0.05). CONCLUSIONS: In the mesiobuccal root canals of extracted mandibular first molars, additional preparation using an XP-Endo Finisher file, after using the PTUR system and F3 ProTaper instruments, enhanced the removal of filling materials from root canals.

[Depressive and somatoform disorders in persons with a Turkish migration background in Germany]. / Depressive und somatoforme Störungen bei türkeistämmigen Personen in Deutschland.

BACKGROUND: Migration is a risk factor for the onset of mental disorders. Epidemiologic studies indicate that there is an increased prevalence of depressive and somatoform disorders in individuals with a Turkish migration background in Germany. OBJECTIVES: The aim of this review article is to determine the impact of sociocultural factors on depressive and somatoform disorders in individuals with a Turkish migration background in Germany. MATERIALS AND METHODS: The systematic review is based on 23 studies identified in PubMed and PsycINFO. RESULTS: Acculturation, perceived discrimination and the socioeconomic status affect the severity of mental disorders, and impair the access to the health care system as well as to psychotherapy. Women with a Turkish migration background represent a particularly vulnerable group in this context. CONCLUSION: Multiple factors influence the increased prevalence of depressive and somatoform disorders in individuals with a Turkish migration background in Germany. Most of the identified studies suffer from significant methodological restrictions and as such do not allow generalization to the whole population of individuals with a Turkish migration background in Germany. There is a lack of national surveys and a need for longitudinal studies in representative population samples.

Accuracy of CBCT images in the volumetric assessment of residual root canal filling material: Effect of voxel size.

AIMS: Our aim was to compare three different voxel sizes of CBCT images for the determination of residual filling material volume in root canals when compared with micro CT. MATERIAL AND METHODS: Forty-two root canals of 14 extracted human maxillary molar teeth were retreated by using ProFile® instruments. Images were obtained after retreatment by using ProMax 3D Max CBCT at 3 different voxel sizes (1) High resolution (0.1 mm); (2) High definition (0.15 mm); and (3) Normal resolution (0.2 mm). Two observers measured volumes of residual filling materials in exported CBCT images by means of 3D Doctor Software. Micro CT measurements were served as gold standard. Mann-Whitney U test and Wilcoxon Test were used for the comparison of CBCT and micro CT measurements. Statistical significance was set at P < 0.05. RESULTS: No statistically differences were found between the two observers for all measurements (P > 0.05). There were no significant differences among different CBCT voxel sizes used (0.1 mm, 0.15 mm, and 0.2 mm) (P > 0.05). The Spearman correlation coefficients between CBCT at different voxel sizes significantly highly correlated with micro CT measurements for each observer (P < 0.05). Furthermore, no significant differences were found between the measurements obtained by the two observers in consideration to root canal location (P > 0.05). CONCLUSION: CBCT images may provide useful information in the volumetric assessment of the amount of residual filling material in root canals for retreatment procedures.

[Suicidal tendencies in adolescence : Dysfunctional familiar communication as risk factor]. / Suizidalität in der Adoleszenz : Dysfunktionale familiäre Kommunikation als Risikofaktor.

BACKGROUND: Suicide is one of the four most common causes of death in adolescence worldwide. Although it is well known that suicidal people often have insufficient communication strategies, the importance of family communication for adolescent suicidality has not yet been sufficiently explored. OBJECTIVE: The aim of this study was to provide a systematic review of family communication as a risk factor for adolescent suicidal tendencies and to develop treatment recommendations. METHODS: In this study a systematic literature search was conducted in PubMed, Embase, CENTRAL and PsychINFO. The methodological quality of the studies was evaluated and a summary prepared. RESULT: A total of 195 studies were extracted and screened for their suitability. Of these studies, 7 which examined a total of 13,107 adolescents aged 11-22 years were included in this review and critically evaluated. Of the studies evaluated six found a correlative relationship between dysfunctional parent-child communication and adolescent suicidality. Communication with the mother appears to be more essential. CONCLUSION: The results of this literature search indicate that functional communication with parents seems to be protective for suicidal adolescents. From this, recommendations can be derived for preventive measures in families with adolescents who are otherwise at increased risk of suicide. Longitudinal study designs are needed to conclusively answer the research question.

[Maintenance treatment in opioid-dependent patients with migration background]. / Opioidsubstitution bei heroinabhängigen Patienten mit Migrationshintergrund.

BACKGROUND: No regional analyses regarding opioid-dependent patients in maintenance treatment with a migration background have so far been performed in German-speaking countries. OBJECTIVES: This study examined patients with and without a migration background regarding socioeconomic parameters, characteristics of dependency and attitude towards opiate maintenance treatment (OMT). MATERIAL AND METHODS: From May to October 2011 patients in OMT from all of the 20 psychiatry clinics and 110 physician practices in Berlin with a licence to provide OMT were included in this analysis. RESULTS: Out of the 986 participating patients, 956 gave information on migration background and of these, 204 (21.3 %) originated from a country other than Germany. Compared to patients without a migration background, their participation in a maintenance program was significantly shorter and they more often expressed a desire to end OMT and wanted a limited duration of OMT. CONCLUSION: The differences regarding duration of OMT and the wish to end OMT can reflect a stronger desire for abstinence and a different attitude towards maintenance treatment of patients with a migration background.

[Obsessive-Compulsive Symptoms in a Sample of Patients with Chronic Schizophrenia Under Clozapine Treatment]. / Zwangssymptome bei chronisch erkrankten Patienten mit einer Schizophrenie unter Clozapintherapie.

Background: There is a high prevalence of obsessive-compulsive symptoms (OCS) in patients with schizophrenia. Antipsychotic treatment, especially duration and type of substance, is suspected to increase or even cause OCS. Methods: We examined in a naturalistic cross-sectional study the severity of OCS (Obsessive-Compulsive Inventory - Revised) and the incidence of obsessive-compulsive disorder (OCD) according to ICD-10 criteria in 70 patients with schizophrenia. 26 patients were treated with clozapine and 44 patients were treated with another second-generation antipsychotic (SGA). After group matching, the two groups did not differ significantly in age, gender, duration of illness, treatment duration with the current antipsychotic substance and chlorpromazine-equivalent dosage. Results: Patients treated with Clozapine showed a significantly higher rate of OCD (χ2 = 7.304, p = 0.007) and a significantly higher severity of OCS (t = 2.216, p = 0.037) compared to patients treated with another SGA. For the whole sample, duration of treatment with the current antipsychotic medication correlated significantly (p = 0.033, r = 0.323) with the severity of OCS, controlled for duration of illness. However, there was no significant correlation between severity of OCS and duration of illness, controlled for duration of treatment with the current antipsychotic substance. Discussion: Our data suggest an interrelation between the development of OCS or OCD and antipsychotic treatment, especially clozapine. Thereby, duration of treatment is correlated with the severity of OCS, irrespective of the duration of illness.

[Suicide Rates and Suicide Prevention in Women of Turkish Origin in Berlin]. / Suizidraten und Suizidprävention bei Berliner Frauen mit türkischem Migrationshintergrund.

Suicidality in female Turkish immigrants is higher as compared to that of native-born women of the same age. The analysis of the national mortality registry in Germany reported a 2-fold suicide risk in the target group compared to German women of the same age. A population-based multi-modal intervention project was conducted. Suicidal crisis were analysed in focus groups and guided the development of the intervention module. The intervention consisted of a public awareness campaign, a telephone hotline, and the training of key persons. All parts of the intervention were subsequently evaluated. Suicide attempts of the target group that were presented at all emergency units in Berlin were registered. In a population-based interview survey the aim was to elicit central sociodemographic and psychosocial variables that may influence distress and help-seeking behaviour in women of Turkish origin.

[Mental health care for immigrants in Germany]. / Psychiatrische Versorgung von Menschen mit Migrationshintergrund in Deutschland.

Immigrants represent a very heterogeneous population, with various stress factors for mental disorders. These individuals are confronted with numerous access barriers within the health care system, which are reflected in limited utilization of the mental health system and psychotherapy services. A particularly large gap in health service provision exists among refugees and asylum-seekers. There is an urgent need for action in terms of opening up of the mental health system, improving and simplifying routes of access, and facilitating treatment options.

FGF-21: a novel biomarker predicting no-reflow in ST-segment elevation myocardial infarction.

OBJECTIVE: Primary percutaneous coronary intervention (pPCI) is the most effective reperfusion therapy in the treatment of ST-elevation myocardial infarction (STEMI). Although the infarct-related artery of STEMI patients is effectively revascularized during pPCI, effective reperfusion in the myocardial tissue may not be achieved. This condition is called the no-reflow (NR) phenomenon. FGF-21 is a circulating hormone-like molecule primarily secreted by the liver and has been proven to be the main metabolic regulator of glucolipid metabolism and insulin sensitivity. The aim of this study was to investigate the predictive effect of FGF-21 on the development of the NR phenomenon in STEMI patients undergoing pPCI. PATIENTS AND METHODS: This study included 91 patients with acute STEMI who underwent pPCI and 45 healthy participants. Patients with acute STEMI were split into two groups: 46 patients in the NR phenomenon group and 45 patients in the non-NR phenomenon group. Serum levels of FGF-21 were measured in all study groups. RESULTS: Serum FGF-21, white blood cell count, and high-sensitivity C-reactive protein (hs-CRP) values were considerably different amongst the groups (p = 0.001, p = 0.001, and p = 0.003, respectively). In comparison to patients without NR and the control group, STEMI patients with NR had considerably higher FGF-21 levels. In addition, the FGF-21 level of STEMI patients without NR was significantly higher than that of the control group. In multivariate logistic regression analysis, hs-CRP [odds ratio (OR) 2.106% 95% confidence interval (CI) (0.002-0.069) p = 0.038], age [OR 2.147; 95% (CI) (0.001-0.015); p = 0.0035], and serum FGF-21 levels [OR 4.644; 95% CI (0.003-0.006); p < 0.001] were independent predictors of NR formation. For FGF-21 ≥ 92.2 pg/Ml, 87% sensitivity and 88% specificity were found in predicting NR formation (area under the curve: 0.897, 95% CI: 0.841-0.954; p < 0.001). CONCLUSIONS: Our study demonstrates a strong association between the NR phenomenon, a key indicator of poor prognosis in acute STEMI patients, and an elevated FGF-21 level. These findings indicate FGF-21 as a novel and potent predictor of NR development in STEMI patients.

A novel marker to predict cardiac arrhythmia in epilepsy patients: frontal QRS-T angle.

OBJECTIVE: The most important complication of epilepsy, which is a chronic disorder of the central nervous system, is sudden unexplained death in epilepsy (SUDEP). The causes of SUDEP are complex and multifactorial. Epilepsy patients are at increased risk of cardiovascular events, SUDEP, and ventricular arrhythmias, due to both the disease itself and the effect of antiseizure medications. Previous studies have commonly focused on cardiac repolarization markers in epilepsy patients. This study aimed to investigate frontal QRS-T angle (FTQ angle), a relatively new repolarization parameter, in epilepsy patients. PATIENTS AND METHODS: One hundred two epilepsy patients and 86 healthy volunteers as a control group were included in the study. The clinical data of all patients were prospectively recorded during patient visits. All participants underwent 12-lead surface electrocardiography (ECG). SPSS 22 was used to evaluate all data. p<0.05 was considered statistically significant. RESULTS: When the epilepsy patient group and the control group were compared in terms of QRS (89.59±43.63 vs. 80.00±9.82, p=0.050), QT (364.30±36.16 vs. 335.95±35.64, p<0.001), QTc (418.85±27.06 vs. 409.37±26.66, p=0.018) durations, and FTQ angle (46.55±22.06 vs. 20.84±12.70, p<0.001), statistically significant differences were found between the groups. We observed that FTQ angle was significantly higher in individuals exposed to the disease for more than 10 years (39.2±19.0 vs. 54.7±22.5, p<0.001). In addition, according to the multivariate logistic regression analysis, disease duration was an independent predictor of FTQ angle (ß=0.263, p=0.009). CONCLUSIONS: FTQ angle, a relatively new repolarization parameter, can be used as an inexpensive, easy, reproducible, and reliable ECG marker to predict the risk of adverse cardiac events in epilepsy patients.

Enhancing educational and vocational recovery in adolescents and young adults with early psychosis through Supported Employment and Education (SEEearly): study protocol for a multicenter randomized controlled trial.

BACKGROUND: Psychotic disorders often develop a chronic course with devastating consequences for individuals, families, and societies. Early intervention programs for people in the first 5 years after the initial psychotic episode (early psychosis) can significantly improve the outcome and are therefore strongly recommended in national and international guidelines. However, most early intervention programs still focus on improving symptoms and relapse prevention, rather than targeting educational and vocational recovery. The aim of the present study is to explore the effects of Supported Employment and Education (SEE) following the Individual Placement and Support (IPS) model in people with early psychosis. METHODS: The SEEearly trial compares treatment as usual (TAU) plus SEE to TAU alone in outpatient psychiatric settings. The study is a six-site, two-arm, single-blinded, superiority randomized controlled trial (RCT). Participants are randomly assigned (1:1) to the intervention or control group. Aiming to recruit 184 participants, with an assumed drop-out rate of 22%, we will be able to detect a 24% difference in the main outcome of employment/education with 90% power. We make assessments at baseline and at 6- and 12-month follow-ups. Outcome data on employment/education, medication, and current psychiatric treatment is obtained monthly through phone based short assessments. The primary outcome is steady participation for at least 50% of the 12-month follow-up in competitive employment and/or mainstream education. Secondary employment outcomes capture length of employment/education, time to first employment/education, monthly wages/educational attainment, and social return on investment (SROI). Secondary non-employment outcomes include subjective quality of life, psychopathology, substance use, relapse, hospitalization, and functional impairment. To be eligible, participants must be between 16 and 35 years, fulfill diagnostic criteria for early psychosis, and be interested in competitive employment and/or mainstream education. DISCUSSION: In SEEearly, we hypothesize that participants with psychosis, who receive TAU plus SEE, present with better primary and secondary outcomes than participants, who receive TAU alone. Positive results of this study will justify SEE as an evidence-based strategy for clinical routine treatment in people with early psychosis. TRIAL REGISTRATION: SEEearly was registered nationally and internationally in the German Clinical Trials Register (DRKS; identifier: DRKS00029660) on October 14, 2022.

[Cross-cultural aspects of interaction and communication in mental health care. Barriers and recommendations for action]. / Interkulturelle Aspekte der Interaktion und Kommunikation im psychiatrisch/psychotherapeutischen Behandlungssetting. Mögliche Barrieren und Handlungsempfehlungen.

Mental health care for migrants is often impaired by a lack of policies and provisions in the respective institutions. This article focuses on "communication barriers" in psychosocial and psychotherapeutic settings, where personal communication is of great importance. Barriers that prevent migrants from using health care institutions include translation problems but also more complex misunderstandings based on divergent explanations regarding the causes, course, and adequate treatment of different disorders. The widely recommended intercultural opening of medical and psychosocial institutions involves using interpreters as cultural experts, reflecting on and mediating between divergent explanatory models, and avoiding cultural and ethnic stereotyping as well as encouraging an open, curious, and reflective professional attitude. With respect to institutional settings, rules for the financing of interpreters are as important as tackling barriers that limit migrants' access to medical and psychosocial institutions.