BackgroundPrevious research has indicated cognitive impairments in patients with post-traumatic stress disorder (PTSD), specifically in attention, memory, and executive functioning. However, there is limited knowledge about the cognitive profile of individuals with complex PTSD (cPTSD), a new diagnosis in ICD-11. Moreover, predictors of cognitive impairment remain unclear. The present study aims to enhance understanding of cognitive functioning and its predictors in cPTSD compared with non-complex PTSD (ncPTSD).MethodsN = 64 participants (n = 34 cPTSD, n = 30 ncPTSD) completed psychometric questionnaires and the neuropsychological test set Cognitive Basic Assessment (COGBAT) assessing a general cognitive index, attention, visual memory, and executive functioning. First, the test results of both groups were compared to the COGBAT norm sample. Secondly, group differences in cognitive domains were analyzed using student t-tests with independent samples (cPTSD vs. ncPTSD). Thirdly, bivariate and multivariate regressions examined influencing factors of cognitive impairment.ResultsBoth groups showed cognitive impairments in comparison to the COGBAT norm group. Significant differences between cPTSD and ncPTSD were found in visual memory (p = .003) and selective attention (p = .004). In multivariate regression, type of PTSD and age were found to significantly impact visual memory, while type of PTSD, age, and psychotropic medication showed significant effects on selective attention.ConclusionsGiven higher symptom severity and cognitive deficits in cPTSD, more intensive and diverse interventions should be considered in comprehensive treatment plans, for instance, cognitive training.

Educational escape rooms are an innovative pedagogical approach to encourage proactive learning among students. This study assessed the learning outcomes and student satisfaction with escape room-based teaching at a medical school in Germany. An interdisciplinary escape room was created based on learning goals from the fields of psychiatry, infectious diseases, and communication skills. The gameplay was repeated eight times and pre-post intervention questionnaires were used to assess knowledge gain of participants. Pre- and post-test scores were analyzed using t-tests and correlation analyses to examine their relationships with gender, age, and semester. Evaluation feedback was summarized with descriptive statistics (mean, SD). Three open-text questions recorded qualitative comments, which were analyzed thematically. Overall, 45 students (female = 82.2

Objectives: Physicians and psychologists at psychiatric university hospitals are assigned teaching tasks from the first day of work without necessarily having the prerequisite training in teaching methods. This exploratory survey provides a needs-based analysis for the prospective didactic training of physicians and psychologists at psychiatric hospitals in Germany, Austria and Switzerland.Methods: An online questionnaire was distributed at medical schools via email in German-speaking countries in Europe. All physicians involved in teaching medical students at psychiatry faculties were eligible to participate in the survey. Participants were further requested to recruit eligible participants (snowball sampling). Responses were analyzed descriptively, and differences between groups were calculated using nonparametric Mann-Whitney U tests (p<.05).Results: Overall, 97 respondents (male=55, female=42; mean age= 40.6) from 19 medical schools completed the survey. The respondents consisted of 43 residents, 39 specialists, 6 chief physicians and 9 psychologists. Of the respondents, 97.6% rated didactic competence as either highly relevant or rather relevant for teaching medical students. The highest overall interest was shown for bedside teaching (mode=4; IQR: 2-4) and error culture (mode=3; IQR: 2-4). Respondents expressed the highest training needs for topics regarding presentation and communication (mode=3; IQR: 2-3). Resident physicians were significantly more interested in bedside teaching (U=362.0, p=0.004) and roleplay (U=425.0; p=0.036) than specialist physicians, who were more interested in examination didactics (U=415.0; p=0.022). Chief physicians displayed significantly deeper interest in group dynamics (U=51; p=0.023) than specialist physicians. In-person training was preferred by a majority of respondents, and 27.4% preferred online/web-based training.Conclusions: The majority of physicians and psychologists at psychiatric university hospitals considered professional development for faculty to be helpful for teaching medical students. Bedside teaching and error culture management were the most desired teaching topics for training medical teachers. Tailored educational interventions are recommended, with target-oriented priorities for different hierarchical levels.

Brain-derived neurotrophic factor (BDNF) is a pleiotropic cytokine implicated in the pathogenesis of major depressive disorder (MDD). In MDD, serum BDNF levels are attenuated. Healthy adults show BDNF elevation after exercise. To investigate activity-dependent BDNF elevation in MDD, thirty-seven participants with partially remitted MDD were allocated to either a bout of strenuous or light activity. Serum was collected before and after the intervention. BDNF was measured using a highly sensitive and specific enzyme-linked immunosorbent assay. Significant BDNF elevation in the strenuous activity group emerged. This study confirms exercise-dependent serum BDNF elevation in MDD. Preregistration: German Clinical Trials Register (DRKS0001515).

Deficits in verbal declarative memory for psychotic disorders may constitute a defining transdiagnostic feature, whereas the differences in the extent of these deficits found in previous studies may have been caused by methodological effects. The present study compared patients with different psychotic disorders (n=145) using a test (California Verbal Learning Test, CVLT) and used discriminant analysis with deficits in verbal declarative memory as a criterion to differentiate between patients with psychotic disorders and a sample of patients with depressive disorders (n=89). The results demonstrate evidence for the transdiagnostic comparability of deficits in verbal declarative memory, though only 63% of the patients were classified correctly by discriminant analysis.This can be explained largely by the unexpected severity of the deficits for patients with depressive disorders.

Zusammenfassung. Defizite im verbalen Gedächtnis bei psychotischen Störungen könnten ein definierendes transdiagnostisches Merkmal sein, und in Vorstudien gefundene Unterschiede im Ausmaß dieser könnten auf methodische Effekte zurückgehen. Um dies zu untersuchen, wurden in der vorliegenden Studie Patient*innen mit verschiedenen psychotischen Störungen ( n=145) in einem Verfahren (California Verbal Learning Test, CVLT) verglichen und in einer Diskriminanzanalyse mit Defiziten im verbalen Gedächtnis als Kriterium von einer Vergleichsstichprobe von Patient*innen mit depressiver Störung ( n=89) unterschieden. Es ergibt sich Evidenz für die transdiagnostische Vergleichbarkeit der Defizite im verbalen Gedächtnis, jedoch werden anhand dieser in der Diskriminanzanalyse nur 63 % der Patient*innen korrekt klassifiziert. Dies liegt vor allem daran, dass die Patient*innen mit depressiver Störung ebenfalls unerwartet starke Einbußen zeigen.

Computer-assisted cognitive remediation (CACR) is an economical, adjustable, and effective treatment for individuals with schizophrenia. The current randomized controlled study examined whether an individualized or generic exercise plan in CACR is superior in patients with multiple cognitive deficits compared to treatment-as-usual (TAU). Fifty-nine inpatients diagnosed with schizophrenia were randomly assigned to 1) TAU, 2) TAU plus an individualized exercise plan in CACR, or 3) TAU plus a generic exercise plan in CACR. Neuropsychological performance, psychopathology, and functional outcome were assessed at baseline and post-treatment. The results show a medium to large training effect for all neuropsychological performance measures. Contrary to our expectations the neuropsychological improvement over time did not differ between groups. Self-reported depression, global level of functioning, and activity and participation functioning showed a significant improvement from baseline to post-treatment. However no further group, time, or interaction effects for other psychopathology and functional outcome could be demonstrated. Possible implications for clinical use of CACR and future studies are discussed.

Background: There is an urgent need for the development and evaluation of targeted interventions for cognitive impairment (CI) in patients with (partially) remitted major depressive disorder (MDD). The aim of our study was therefore to evaluate the effect of cognitive remediation therapy (CRT) on cognitive and psychosocial functioning in a sample of patients with MDD, taking into account comorbidity, psychopathology, remission status and CI profile. Furthermore, we compared a generalized training (GT) with an individualized training (IT) approach regarding their effects on cognition. Methods: Sixty-two MDD patients in partial remission with CI were randomly assigned to a control group (CG), IT or GT. Participants of GT trained six cognitive subdomains (divided attention, selective attention, alertness, working memory, planning and response inhibition), whereas participants of IT trained their three most deficient cognitive subdomains as identified at baseline. Participants of both intervention groups trained three times per week over a five-week period. Both training groups received additional 30-minute compensatory-transfer sessions once per week. Results: Attention appeared to be the most frequently impaired cognitive domain as well as the domain which was significantly improved by CRT, with medium to large effect sizes. No difference in improvement was found between IT and GT. The analyses also revealed greater improvement in self-assessed psychosocial functioning in training participants (GT and IT combined) compared to the CG. Limitations: Due to the small sample size, the present results are preliminary in nature. Conclusion: CRT was well accepted, and patients transferred the attentional improvement to real life, as measured by self-assessed psychosocial functioning. IT yielded no additional advantages over GT. We propose CRT as an integral part of the treatment plan for patients with depression suffering from CI.

Background Communication is a core competence in medical care. Failure of physicians to properly communicate inherent risks of medical interventions has been linked with inadequate training at school. This study analyses a medical curriculum for assessing the content and quality of teaching risk communication to students. Methods A checklist based on the national guidelines of core competencies on risk communication required of physicians was developed. Participant observers surveyed all teaching sessions at a medical school during a semester to record the frequency, characteristics and clinical context used by lectures during classes. Data were analyzed using statistical and descriptive methods to determine the prevalence and quality of teaching content. Results 231 teaching sessions were surveyed. The inter-rater reliability was 81%. Lecturers mentioned topics of risk communication in 61.5% of teaching sessions (83.7% in surgery, 43.3% in internal medicine) but core biostatistics concepts were not discussed in more than 80% of these sessions. Important topics such as patient safety and preventable diseases were underrepresented. Risk communication was mainly taught in large-group, theoretical sessions and rarely with supplementary teaching material (7.4%). Students asked questions in 15.2% of courses, more often in surgery classes than in internal medicine. Conclusion Statistical and clinical topics relevant for teaching risk communication to medical students are not only underrepresented but also minimally explained by lecturers. Supplementary material on risk communication is rarely provided to students during classes. High-resource demanding, small-group teaching formats are not necessarily interactive as students ask few questions.

Cerebellar involvement in major depressive disorder (MDD) has been demonstrated by a growing number of studies, but it is unknown whether cognitive functioning in depressed individuals is related to cerebellar gray matter volume (GMV) abnormalities. Impaired attention and executive dysfunction are characteristic cognitive deficits in MDD, and critically, they often persist despite remission of mood symptoms. In this study, we investigated cerebellar GMV in patients with remitted MDD (rMDD) that showed persistent cognitive impairment. We applied cerebellum-optimized voxel-based morphometry in 37 patients with rMDD and with cognitive deficits, in 12 patients with rMDD and without cognitive deficits, and in 36 healthy controls (HC). Compared with HC, rMDD patients with cognitive deficits had lower GMV in left area VIIA, crus II, and in vermal area VIIB. In patients with rMDD, regression analyses demonstrated significant associations between GMV reductions in both regions and impaired attention and executive dysfunction. Compared with HC, patients without cognitive deficits showed increased GMV in bilateral area VIIIB. This study supports cerebellar contributions to the cognitive dimension of MDD. The data also point towards cerebellar area VII as a potential target for non-invasive brain stimulation to treat cognitive deficits related to MDD.

Aims: Teaching students about risk communication is an important aspect at medical schools given the growing importance of informed consent in healthcare. This observational study analyzes the quality of teaching content on risk communication and biostatistics at a medical school.Methods: Based on the concept of curriculum mapping, purpose-designed questionnaires were used via participant observers to record the frequency, characteristics and context of risk communication employed by lecturers during teaching sessions for one semester. The data was analyzed quantitatively and descriptively.Results: Teaching about risk communication was observed in 24.4% (n = 95 of 390) sessions. Prevalence varied significantly among different departments with dermatology having the highest rate (67.9%) but lesser in-depth teaching than medical psychology where risk communication concepts were discussed on a higher scale in 61.4% sessions. Relevant statistical values were not mentioned at all in 69% of these 95 sessions and clinical contexts were used rarely (55.8%). Supplementary teaching material was provided in 50.5% sessions while students asked questions in 18.9% sessions.Conclusions: Students are infrequently taught about communicating risks. When they are, the teaching does not include the mention of core biostatistics values nor does the teaching involve methods for demonstrating risk communication.

BACKGROUND:There is urgent need for development and evaluation of targeted interventions for cognitive deficits in (partially) remitted major depression. Until now the analyses of the moderators of treatment efficacy were only examined in mixed samples of patients with schizophrenia, affective spectrum and schizoaffective disorders. Thus, the aim of our study was to evaluate the predictors of cognitive remediation therapy (CRT) improvement in a sample of (partially) remitted major depressive disorder patients.METHODS:Reliable Change Index with corrections for practice effects was calculated for each participant as an indicator for training improvement. Thirty eight patients, who were randomized within our previously conducted CRT clinical trial, were divided into "Improvers" and "Nonimprovers" in the attention domain, to compare them on sociodemographic, psychopathological, neurocognitive, psychosocial and training factors.RESULTS:We detected 13 training participants who improved reliably in the attention domain. Illness duration was the only factor which significantly differentiated between Improvers and Nonimprovers. No significant differences between Improvers and Nonimprovers in terms of other clinical variables, sociodemographic and neuropsychological factors were found.LIMITATIONS:Exploratory research results should be taken with caution. Focus on the attention domain could have led to a limited point of view.CONCLUSION:Our findings represent a first analysis of the predictors of cognitive remediation training improvement in (partially) remitted unipolar depression. Much more work should be done to refine cognitive treatment approaches. An initiation of cognitive training in early stages of the disease could be beneficial for the affected patients.

In der neuropsychologischen Praxis finden klassischerweise computergestützte oder papierbasierte Trainings Anwendung. In den vergangenen Jahren ist zunehmend auch die Nutzung von Smartphone oder Tablet verbreitet. Dies eignet sich vor allem für den Privatgebrauch. Das älteste computerbasierte Programm ist CogPack®, welches eine Vielzahl von Test- und Übungsprogrammen beinhaltet und wissenschaftlich evaluiert ist. Neuere Programme wie beispielsweise Fresh Minder®, RehaCom® oder CogniPlus® werden gern und häufig genutzt, jedoch gibt es in Bezug auf die Wirksamkeit bei psychiatrischen Patienten bisher kaum Evaluationsstudien. Ähnliches gilt für die verschiedenen Apps, die häufig unter dem Begriff „Gehirnjogging“ zu finden sind. In unserer Praxis werden die computerbasierten Trainingsinhalte gern durch papierbasierte Aufgaben ergänzt. Kritisch ist jedoch auch hier, dass es nach unserem aktuellen Kenntnisstand bisher nur wenige umfassende deutsche Manuale gibt und diese zudem nicht evaluiert sind.

Die Bedeutsamkeit eines Transfers wurde in den letzten Jahren in verschiedenen Publikationen mehrfach besprochen. Für einen langfristigen Trainingserfolg ist es demzufolge wichtig, dass die spezifischen Erfolge in den eigentlichen Trainingsaufgaben (z. B. erreichte Level am Ende eines kognitiven Trainings) darüber hinaus im Alltag ankommen und sich auch im subjektiven Empfinden der Patienten abbilden lassen. – Trotz der nachgewiesenen Bedeutsamkeit gibt es bisher keine systematischen Untersuchungen zur optimalen Gestaltung des Transfers. Angelehnt an ein englischsprachiges Manual empfehlen wir ein Gruppensetting, da sich Patienten so austauschen und voneinander lernen können. Die jeweilige Sitzung findet regelmäßig statt: Entweder wird eine länger dauernde reine Transfersitzung von etwa 50 min implementiert, oder es findet direkt im Anschluss jeder Trainingssitzung eine kürzere Einheit statt (maximal 30 min). Darüber hinaus sind begleitende Arbeitsmaterialien (z. B. kognitives Tagebuch) für den privaten Gebrauch zu empfehlen, die den Transfer unterstützen. Zu Beginn der jeweiligen Sitzung werden Hausaufgaben und Übungen der vergangenen Woche besprochen. Anschließend wird ein neuer kognitiver Bereich psychoedukativ eingeführt. Wichtig sind hierbei aber auch eine lebendige Diskussion mit möglichst hoher Aktivität unter den Gruppenteilnehmern und entsprechend eine Flexibilität und Anpassungsfähigkeit der Trainingsleiter bezüglich der Themen.

Vor Beginn eines Trainings ist es sinnvoll, dem Patienten im Rahmen eines Vorgesprächs die Ergebnisse der neuropsychologischen Untersuchung zurückzumelden. Gleichzeitig ist zu prüfen, ob diese mit der Einschätzung des Patienten übereinstimmen, um daran orientierend die individuellen Ziele unter Berücksichtigung der Probleme im Alltag einerseits und der Ressourcen andererseits festzulegen. In den Sitzungen wird das jeweilige aktuelle Thema dann gemeinsam erörtert, um anschließend daran zu arbeiten. Ab der zweiten Sitzung werden zudem die Hausaufgaben der letzten Stunde besprochen. Nach der Übungsphase, welche PC- oder Papier-Stift-basiert stattfindet, wird die Stunde zusammengefasst, ggf. werden erneut Hausaufgaben mitgegeben. Nach jeder Sitzung sollte die jeweilige Motivation des Patienten mittels einer visuellen Analogskala erfasst und der Trainingsverlauf dokumentiert werden. Nach Ende eines kognitiven Trainings ist eine erneute neuropsychologische Untersuchung zur Objektivierung von Veränderungen wünschenswert. Die jeweiligen Ergebnisse sollten wiederum mit dem Patienten besprochen werden, ebenso wie subjektiv empfundene Veränderungen.

Auch im Rahmen bipolarer affektiver Störungen ist seit einiger Zeit die Bedeutsamkeit kognitiver Einschränkungen für den jeweiligen Krankheitsverlauf und das psychosoziale Funktionsniveau belegt. Ähnlich wie bei den Erkrankungen aus dem schizophrenen Formenkreis lassen sich kognitive Einbußen, welche in allen Domänen auftreten können und zumindest eine Subgruppe Erkrankter betreffen, sowohl in der akuten als auch in der remittierten Phase objektivieren. In Abhängigkeit von der jeweiligen Domäne wurden bisher mittlere bis große Effektstärken im Vergleich zu Gesunden ermittelt. Bis auf weiteres wird hier – ebenso wie im Fall der Schizophrenie – bei Betroffenen eher von einer überdauernden generalisierten kognitiven Störung ausgegangen, die jedoch weniger stark ausgeprägt scheint als bei an Schizophrenie Erkrankten. Darüber hinaus zeigen sich auch bei bipolaren affektiven Störungen Defizite in der sozialen Kognition, welche als Mediatorvariable zwischen den basalen kognitiven Leistungen und dem sozialen Funktionsniveau diskutiert werden.

BACKGROUND:Cognitive impairment is a core feature of major depressive disorder (MDD). Cognitive remediation may improve cognition in MDD, yet so far, the underlying neural mechanisms are unclear. This study investigated changes in intrinsic neural activity in MDD after a cognitive remediation trial. METHODS:In a longitudinal design, 20 patients with MDD and pronounced cognitive deficits and 18 healthy controls (HC) were examined using resting-state functional magnetic resonance imaging. MDD patients received structured cognitive remediation therapy (CRT) over 5 weeks. The whole-brain fractional amplitude of low-frequency fluctuations was computed before the first and after the last training session. Univariate methods were used to address regionally-specific effects, and a multivariate data analysis strategy was employed to investigate functional network strength (FNS). RESULTS:MDD patients significantly improved in cognitive function after CRT. Baseline comparisons revealed increased right caudate activity and reduced activity in the left frontal cortex, parietal lobule, insula, and precuneus in MDD compared to HC. In patients, reduced FNS was found in a bilateral prefrontal system at baseline (p < 0.05, uncorrected). In MDD, intrinsic neural activity increased in right inferior frontal gyrus after CRT (p < 0.05, small volume corrected). Left inferior parietal lobule, left insula, left precuneus, and right caudate activity showed associations with cognitive improvement (p < 0.05, uncorrected). Prefrontal network strength increased in patients after CRT, but this increase was not associated with improved cognitive performance. CONCLUSIONS:Our findings support the role of intrinsic neural activity of the prefrontal cortex as a possible mediator of cognitive improvement following CRT in MDD.