Limitations in staff resources at memory clinics in Germany can limit their ability to perform diagnostic procedures. Because of demographic changes, an increasing number of people are expected to develop mild cognitive impairment and dementia and thus require effective screening to enable early diagnosis. Telemedicine screening instruments may help identify individuals at risk. We invited N = 30 memory clinic patients to participate in both a telemedicine and an in-person interview. The telephone interview consisted of the German version of a word-retrieval test (Word Finding Test, WoFi 1), the latter a parallel version of the WoFi (WoFi 2), as well as routine diagnostic procedures for assessing neurocognitive impairment. We compared the results of WoFi 1 and 2 with each other and with the results of the neuropsychological cognitive test battery. The analyses included 13 patients diagnosed with Alzheimer's disease and 13 with mild cognitive impairment; we excluded 4 patients with depressive disorder from the analyses. The scores on WoFi 1 and 2 correlated highly with each other (rho = 0.814, p < .001); remote WoFi correlated highly with other verbal word retrieval tests such as semantic (beta = 0.760; p < .001), phonemic fluency (beta = 0.639; p = .002), and a global cognitive status score (beta = 0.591; p = .009). Participants performed better when assessed in person: The mean WoFi score was 87.00 (remotely) and 93.96 (in person). The gold standard for neuropsychological testing is face-to-face interaction between the investigator and the interviewee, but this approach requires significant staff resources and time. The study indicates that a brief, feasible telemedicine screening tool may help identify individuals who could benefit from further cognitive evaluation.

Background Individuals with mental disorders face substantially reduced life expectancy, with cardiovascular disease (CVD) as the leading cause of premature death, likely due to a complex interplay of multiple factors. Prior studies examining whether patients with comorbid mental illness receive guideline-concordant pharmacological secondary prevention of ischemic heart disease (IHD) and cerebrovascular disease (CeVD) at rates comparable to those without psychiatric diagnoses are few and yielded inconsistent findings. Methods We conducted a retrospective cross-sectional analysis of statutory health insurance data for 2019–2022 (n = 238,616 adults with IHD or CeVD). Secondary prevention was defined as concurrent prescription of a lipid-modifying agent and an antiplatelet therapy or anticoagulant. Propensity score matching combined with logistic regression was used to estimate adjusted odds ratios (ORs) across all ICD-10 F-chapters (F0–F9) and for severe mental illness (SMI). Results Patients with any mental disorder had significantly higher odds of receiving secondary prevention for IHD (OR 1.18) and CeVD (OR 1.17) than those without. SMI was associated with even higher odds (IHD: OR 1.36; CeVD: OR 1.32). Diagnosis-specific subgroup analysis yielded no substantial differences between different mental disorders. Conclusion In general, prescription rates of pharmacological secondary prevention were higher in patients with comorbid mental disorders compared to patients without mental comorbidity. Factors other than pharmacological undertreatment – such as lifestyle-related prevention and physical health monitoring – may play a more central role in addressing the excess cardiovascular mortality burden in individuals with mental illness.

Background:Social impairments and low-grade inflammation (LGI) are associated with psychotic disorders (e.g. schizophrenia spectrum disorders). Social impairments are important symptoms of the disease nonetheless a disturbed social interaction and inflammatory processes are further discussed as being part of the underlying pathophysiology, which is also characterized by blood-cerebrospinal fluid barrier (BCSFB) dysfunction. The relationship between social impairments, peripheral LGI (pLGI) and BCSFB permeability in psychotic disorders, however, is poorly understood. Therefore, we hypothesized that social impairment might be linked to pLGI, which, in turn, might affect BCSFB function in schizophrenia. Method:We conducted a retrospective chart review of all psychiatric inpatients who underwent lumbar puncture as part of their diagnostic work-up between January 1, 2021, and June 30, 2023 (n = 53). Thirty-one patients diagnosed with SSD (n = 27) or affective psychosis (n = 4) with a C-reactive protein (CRP) serum level <10 mg/L upon admission, indicating the absence of acute inflammation, were included in the analysis. Results:The cerebrospinal fluid (CSF)/serum albumin ratio - as a measure of BCSFB permeability - was shown to be positively correlated with our measure of pLGI (r = 0.418, p = 0.019) using the pLGI score (previously also named "INFLA-score", "LGI score"), as well as with age (r = 0.415, p = 0.020) . Additionally, a trend toward a negative correlation with global functioning (GAF) was observed (r = -0.349, p = 0.054).A multiple linear regression including pLGI, age, and sex yielded the best-fitting model (p = 0.003, corrected R2 = 0.337), with all predictors showing independent significant effects.Interestingly, regarding single parameters of the pLGI score a significant correlation between platelets and the CSF/serum albumin ratio (r = 0.490, p = 0.005) was found. Positive and Negative Syndrome Scale (PANSS6) and social isolation score did not correlate with the model. Conclusion:These data demonstrate - for the first time - a link between an established peripheral marker of LGI and BCSFB permeability in schizophrenia. Platelets were found to be the main driver of the pLGI score regarding BCSFB permeability. Future research will need to replicate these findings and could explore whether measures of peripheral inflammation could be useful in the diagnostic work-up of patients with psychotic disorders.

Abstract: Limitations in staff resources at memory clinics in Germany can limit their ability to perform diagnostic procedures. Because of demographic changes, an increasing number of people are expected to develop mild cognitive impairment and dementia and thus require effective screening to enable early diagnosis. Telemedicine screening instruments may help identify individuals at risk. We invited N = 30 memory clinic patients to participate in both a telemedicine and an in-person interview. The telephone interview consisted of the German version of a word-retrieval test (Word Finding Test, WoFi 1), the latter a parallel version of the WoFi (WoFi 2), as well as routine diagnostic procedures for assessing neurocognitive impairment. We compared the results of WoFi 1 and 2 with each other and with the results of the neuropsychological cognitive test battery. The analyses included 13 patients diagnosed with Alzheimer’s disease and 13 with mild cognitive impairment; we excluded 4 patients with depressive disorder from the analyses. The scores on WoFi 1 and 2 correlated highly with each other ( ρ = 0.814, p < .001); remote WoFi correlated highly with other verbal word retrieval tests such as semantic (β = 0.760; p < .001), phonemic fluency (β = 0.639; p = .002), and a global cognitive status score (β = 0.591; p = .009). Participants performed better when assessed in person: The mean WoFi score was 87.00 (remotely) and 93.96 (in person). The gold standard for neuropsychological testing is face-to-face interaction between the investigator and the interviewee, but this approach requires significant staff resources and time. The study indicates that a brief, feasible telemedicine screening tool may help identify individuals who could benefit from further cognitive evaluation.

The aim of this study was to investigate the effect of arterial hypertension (AH) and of obstructive sleep apnea (OSA) on cognitive course in the neurocognitive disorder (NCD) cohort RIFADE which enrolled patients with NCD due to Alzheimer’s disease (AD), vascular NCD (vNCD), and mixed NCD (AD + vNCD = mNCD). Multiple risk factors (RF), including AH and OSA, that contribute to the development of various kinds of dementia have been identified in previous studies. Studies that observed AH lacked investigation of long-term effects and did not isolate it from other RF. Studies involving OSA as a risk factor did not include participants with all stages of NCD. 126 subjects were screened for AH and OSA. Repeated cognitive measurements were performed with the DemTect as primary outcome and the clock drawing test as secondary outcome measure. 90 patients had AH (71.4%) and 40 patients had OSA (31.7%). RF-status had a significant effect on cognitive outcome in models with RF as single factors (AH p = 0.027, OSA p < 0.001), a 2-factor analysis with AH × OSA (AH as main factor p = 0.027) as well as a model including the 3 factors AH × OSA × diagnosis (p = 0.038). Similarly, a 3-factor model was significant for the clock-drawing test, whereas single factor-models remained insignificant. AH and OSA appear to be risk factors in common NCD and cognitive decline can be mitigated by treatment of these RF.

Specialized psychotherapeutic treatments like dialectical behavioral therapy (DBT) are recommended as first treatment for borderline personality disorder (BPD). In recent years, studies have emerged that focus on repetitive transcranial magnetic stimulation (rTMS) in BPD. Both have independently demonstrated efficacy in the treatment of BPD. Intermitted theta burst stimulation (iTBS), a modified design of rTMS, is thought to increase the excitability of neurons and could be a supplement to psychotherapy in addition to being a standalone treatment. However, no studies to date have investigated the combination of DBT and rTMS/iTBS. This study protocol describes the methods and design of a randomized, single-blinded, sham-controlled clinical pilot study in which BPD patients will be randomly assigned to either iTBS or sham during four consecutive weeks (20 sessions in total) in addition to standardized DBT treatment. The stimulation will focus on the unilateral stimulation of the left dorsolateral prefrontal cortex (DLPFC), which plays an important role in the control of impulsivity and risk-taking. Primary outcome is the difference in borderline symptomatology, while secondary target criteria are depressive symptoms, general functional level, impulsivity and self-compassion. Statistical analysis of therapy response will be conducted by Mixed Model Repeated Measurement using a 2 × 2-factorial between-subjects design with the between-subject factor stimulation (TMS vs. Sham) and the within-subject factor time (T0 vs. T1). Furthermore, structural magnetic resonance imaging (MRI) will be conducted and analyzed. The study will provide evidence and insight on whether iTBS has an enhancing effect as add-on to DBT in BPD. Trial registration : drks.de (DRKS00020413) registered 13/01/2020.

Background Healthcare for people with somatic and comorbid mental diseases can pose a challenge to the healthcare system. The aim of the SoKo study (the Somatic care of patients with mental Comorbidity) is to assess the current state of care and the facilitators and barriers of somatic care of people with somatic disorders and comorbidity of a mental disorder. Methods The study is conducted as a mixed-methods approach and will include (a) descriptive and inferential analysis of secondary claims data of persons insured by a German statutory health insurance company in North Rhine-Westphalia (Techniker Krankenkasse, TK-NRW), (b) qualitative individual interviews and group discussions, and (c) based on (a) and (b), quantitative surveys of both patients and physicians. We intend to analyse a sample of claims data of about 2.6 million persons insured by TK-NRW (group comparisons between TK-NRW insured persons with a diagnosis of a prevalent somatic disease [ICD-10-GM E01–E07, E11, E66, I10–I15, I20–I25, I60–I64] with and without comorbidity of a mental disorder [F00–F99]), in order to assess the uptake of somatic care by people with mental and somatic comorbidity. In addition, primary data from patients with the aforementioned somatic illnesses and a mental comorbidity as well as primary data from physicians (general practitioners and medical specialists) will be collected. The focus here will be on support factors and barriers in the somatic care of people with mental comorbidity. Discussion Up to now, there have been no published results of a systematic collection of both secondary and primary data on the utilisation of different care services of somatically ill patients with mental comorbidity for Germany. The present mixed-methods study aims to address this gap. Trial registration The trial is registered with the German Clinical Trials Register DRKS: DRKS00030513. The trial was registered on 3rd February 2023.

The year 2020 saw the emergence of a worldwide pandemic caused by the novel coronavirus COVID-19. Measures against further spread of the virus were taken nearly everywhere in the world. Many countries also imposed social distancing rules and lockdowns on their population. This situation has caused a lot of fear and insecurity, along with reactance and even unrest in some countries. In this study, we measured the psychological concepts of resilience, reactance, positive schemas, social solidarity, and anxiety among psychiatric patients and in how far these factors influence their psychopathological anxiety during the pandemic. The aim was to better understand in what ways these factors influence pandemic anxiety to be able to reduce its negative psychological effects. Findings show a significant effect of positive schemas and social solidarity on the level of pandemic anxiety in a sample of psychiatric patients, but no correlation between resilience or reactance and pandemic anxiety. Based on these insights, the inclusion of positive schemas and social solidarity for therapy should be considered. Looking deeper into the relation between positive schemas and pandemic anxiety could provide insight into the different ways that schemas influence people's anxiety and determine whether some of them are particularly important.

Objective Inpatient suicides are rare incidents; however, the impacts of such events on associated families and hospital staff are severe. Therefore, preventive strategies need to focus on risk factors. Clinical management in a hospital setting must integrate the home environment and social life of patients. Nevertheless, home leaves require careful preparation. Methods Suicides were reported systematically from all psychiatric departments of the Landschaftsverband Rheinland (an assembly of municipalities) using a structured form during two periods (1995-2004, 2005-2014). From these reports we extracted data on suicide methods and sociodemographic and clinical variables. Only patients 65 years and older were included. Results From a total of 551 reports on suicides in the period of 1995-2014, 103 patients 65 years and older (60 women, 43 men) died by suicide. In contrast to the general trend in Germany during this period, no decline in overall suicide rates was found. Most patients were treated because of depression (73.8%); schizophrenic psychosis was diagnosed in 11.7%; and dementia was only diagnosed in 1.9%. The most frequent suicide method was hanging (40%). All suicides within the hospital were hangings. The majority of suicides occurred outside the hospital during approved home leaves. Only 7% of suicides occurred when patients left the hospital without permission. Almost half of the patients (n = 44) died by suicide during the first month of treatment. With longer duration of hospitalization, the risk of suicide decreased. There were no significant trends with regard to suicide methods between the two periods. Conclusions In the first weeks of hospitalizations the patients are most endangered to die by suicide. Therefore, home leaves need careful consideration.

The NCD cohort study RIFADE (RIsk FActors of DEmentia) investigates the interaction of risk factors and neurocognitive disorders (NCDs) due to Alzheimer’s disease (NCD-AD) and NCD of vascular type (NCD-vascular). Retrospective recruitment referred to a period from 2007 to 2018 in a single centre. In addition to the baseline visit, follow-up visits took place at 3, 6, 12 months followed by yearly visits. Visit times varied in part depending on adherence. The study also comprises an EEG bank and a bank with cerebral MRI (c-MRI). Inclusion criteria were broad in order to cover a wide range of patterns of NCD. At baseline, patients underwent a large panel of assessments, e.g. including clinical history, diagnostic evaluation for NCD according to DSM-IV and NINDS AIREN criteria, a cognitive test battery including the DemTect, the clock drawing test and the Instrumental-Activities-of-Daily-Living-scale of Lawton and Brodie, EEG and c-MRI. At each follow-up visit, cognitive tests were repeated, in most cases also EEGs and in some cases c-MRIs. Numerous risk factors (RF) including vascular RF, atrial fibrillation, heart failure, sleep apnoea and lifestyle factors such as sedentary lifestyle, low cognitive style and smoking were evaluated for presence and for correction status at each visit, and modulation of uncorrected RF was initiated. Overall, 126 subjects with a clinical diagnosis of NCD were included (52

Objectives: The aim of this study was to describe neuropsychiatric disorders of geriatric inpatients, to investigate associations of psychopathological symptomatology with clinical variables and to determine its impact on treatment outcome. Methods: From January to April 2018, treatment data of geriatric inpatient records were collected retrospectively. Clinical diagnoses of neuropsychiatric disorders, that is, depression, dementia, and delirium, were identified. Clinical correlations were calculated by chi (2)-tests and t-tests. Confounding variables for determined correlations were ascertained by analyses of variance. Functional measurements (Barthel Index, Timed Up and Go, Tinetti Test, and De Morton Immobility Index) were assessed at start and end of geriatric inpatient treatment. Results: The mean age of the included 280 inpatients was 84 years, 71% were female, and the mean duration of treatment was 19.5 days. Twenty-nine percent of cases suffered from dementia, 27% from depression, and 15% from delirium at the time of geriatric treatment onset. Mentally ill inpatients, in addition, presented with a significantly higher number of comorbidities, compared to the group of mentally healthy inpatients. In contrast to the dementia and the delirium group of inpatients, prescription of analgetics was highest among the mentally healthy inpatients and inpatients with depression. Improvement was observed in each of the defined groups, and significant functional differences between all groups were found. Conclusion: Neuropsychiatric disorders occur quite often in a geriatric hospital department, especially depression and dementia. Clinical correlations determined in this study suggest a close relationship of mental and somatic disorders in geriatric inpatients. This study further demonstrates that neuropsychiatric disorders in multimorbid, elderly patients do not prevent functional improvement.

Introduction/Objective. Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive and safe brain stimulation method for the treatment of therapy resistant depression in adulthood. The German S3 guideline for unipolar depression recommends the use of high frequency rTMS of the left dorsolateral prefrontal cortex for depressive patients who did not respond primarily to antidepressant pharmacotherapy. Although a number of meta-analyses demonstrated its antidepressant efficacy on a high evidence level, rTMS is rarely offered to patients with mental disorders in German psychiatric hospitals. Methods. We introduced a questionnaire-based survey examining patients? (n = 122) and medical students? (n = 53) attitude towards rTMS. The questionnaire consisted of 10 questions with a 5-point Likert-scale. When testing for group differences, we conducted ?2 tests. Results. The majority of students and patients are not aware of rTMS as a psychiatric treatment of depression, with more patients than students not being aware (?2(1) = 9.462, p = 0.002; 39.3% vs. 17%). However, participants wish to be informed in more detail about rTMS. In general, positive attitudes cover the assumption of safety, while negative attitudes show concerns regarding the efficacy and a lack of trust in the method, mainly due to the fear of irreversible brain damage. Most participants would rather take psychiatric medication than rTMS. rTMS was assumed to be a helpful [?2(2) = 16.710, p < 0.001 (patients: 32.8% vs. students: 5.7%)] and well-tolerated treatment [?2(1) = 9.110, p = 0.003 (36.1% vs. 15.1%)] significantly more often by patients than by students. Conclusion. Our results show a clear need for more information on rTMS as a psychiatric treatment for patients and medical students to fight present prejudices and negative assumptions so that this treatment method with fewer side effects than medication may be used more often.

ABSTRACTBackground:Impulsive–aggressive behavior is a significant challenge in geriatric psychiatry and requires professional evaluation and management.Methods:SOAS-R scales (Staff Observation Aggression Scale-Revision) completed by medical staff on three secure psychiatric wards were analyzed during a period of 12 months. Patients were subdivided into the following two diagnostic subgroups: dementia and other diagnoses.Results:A total of 146 aggressive incidents involving 66 patients were reported (8.8% of patients treated during this period, n = 752). Fifty-seven percent of the incidents involved patients with dementia. In 20% of the incidents, no precipitating event could be identified; this was more common in patients without dementia (p = 0.005). The medical condition of the patient was considered the trigger in 55% of the cases. Aggression was directed at nurses in 82% of the cases. Visible injury was reported in 12 cases, 3 of which required medical treatment. Male gender, the presence of previous aggressive incidents, and the evening shift (in the case of dementia patients) were identified as risk factors.Conclusions:Aggression in dementia is often reactive and seems to be more predictable than if occurring with other diagnoses. Prevention measures such as de-escalations techniques, warning notes in the patient's file with previous aggressive behavior and stepping up for evening shifts are of crucial importance. As nurses were primarily affected, employer support programs, and mental health interventions are proposed to avoid long-term consequences.

Hallucinations are at the core of the diagnosis of schizophrenia and schizoaffective disorders, and many neuroscience studies focus on hallucinations. However, there is a lack of data on prevalence, subtyping, and clinical correlates of hallucinations as well as on the comparison of hallucinating schizophrenia versus hallucinating schizoaffective patients. Analysis of all psychopathology evaluations is based on the AMDP scale in a German psychiatric university hospital between 2007 and 2013 regarding patients with schizophrenia or schizoaffective disorder (diagnosed according to ICD-10). Hallucinating versus non-hallucinating patients and age- and gender-matched hallucinating schizophrenic versus schizoaffective patients were compared with regard to key psychopathological and demographic characteristics. Relative to patients with schizoaffective disorder, patients with schizophrenia more often hallucinated at admission (36.6 vs. 16.2 %, RR: 2.3, p < 0.001). By subtype, frequency of hallucinations ranked auditory verbal > other auditory > visual > somatic/tactile > olfactory/gustatory. Hallucinating patients of either disorder were more often affected with respect to delusions (83 vs. 62 % and 81 vs. 48 % among patients with schizophrenia and schizoaffective disorder, respectively [both p < 0.0001]) and anxiety. Hallucinating patients with schizoaffective disorder did not differ from hallucinating patients with schizophrenia. This is one of the few studies providing data on hallucinations in a routine clinical care setting. Hallucinations are a sign and likely a cause of greater illness severity. Patients with schizoaffective disorder less often experience hallucinations than patients with schizophrenia, but if they do, they seem to resemble patients with schizophrenia with regard to illness severity.

Genetic and environmental risk factors contribute to the pathogenesis of Alzheimer’s dementia. Besides known genetic risk factors like the apolipoprotein (APO) Eε4 allele, single nuclear polymorphisms (SNPs) of the estrogen receptors ( ESRs ) are candidate genetic risk factors, while air pollution represents an environmental risk factor for dementia. Effects of these risk factors and their interaction were investigated in the SALIA cohort of 834 non-demented elderly women. Cognitive function was assessed by the CERAD-plus test battery. Air pollution was estimated by land use regression (LUR) models. Genotyping was carried out for nine ESR1 and ESR2 SNPs and two ApoE SNPs. Carriers of minor ESR 2 alleles showed significantly reduced cognitive performance in the CERAD total score with most pronounced deficits in semantic memory (rs1256062, rs10144225, and rs2274705) and executive function (rs1256062). The minor allele effects of ESR 2 were stronger in carriers of APOEε4 for the cognitive domain ‘executive function’ ( p value of interaction 0.023 for rs1256062). The investigated ESR1 SNPs were not associated with cognition. Furthermore, we found a significant gene–environment interaction between the ESR2 SNP rs1256062 and air pollution on cognition. Carriers of two major alleles of rs1256062 were more susceptible for an air pollution-induced decrease in performance of ‘figure copying’ than carriers of minor alleles ( p value of interaction, e.g., 0.031 for PM 2.5 ). In conclusion, ESR 2 but not ESR 1 minor alleles were associated with lower cognitive performance in elderly women with an indication of a gene–gene interaction with APOEε4. We also found indications for gene–environment interactions of ESR 2 with traffic-related air pollution exposure on cognitive performance.

Aims: The aim of this randomized, controlled, multisite trial was to evaluate the efficacy of combined treatment with integrative behaviour therapy (IBT) and acamprosate on drinking behaviour in detoxified alcohol-dependent patients.Methods: A total of 371 patients were randomized to one of the three treatment conditions: IBT plus acamprosate, IBT plus placebo, or supportive counselling ('treatment as usual', TAU) plus acamprosate. The main outcome was success rate, i.e., rate of abstinence plus improvement according to the criteria of Feuerlein and Kufner (1989), at the end of the six-month treatment phase and at the subsequent six-month follow-up. Drinking status was validated by blood parameters (CDT, GGT, and MCV). Data were analyzed by an intent-to-treat model and missing data were classified as relapse.Results: The success rates at the end of treatment under both TAU plus acamprosate (37.7%) and IBT plus placebo (48%) almost reached the levels derived from the literature. However, adding acamprosate to IBT did not result in the expected increase in success rate (IBT plus acamprosate: 47.6%), and success rates did not differ significantly between groups. Similarly, there was no significant difference between treatment success rates at follow-up.Conclusion: The results suggest that the combination of acamprosate and IBT is not more effective than treatment with either IBT or acamprosate alone. However, the two acamprosate conditions differed in success rate by about 10%, which might constitute a clinically relevant though statistically non-significant effect. (C) 2011 Elsevier Ireland Ltd. All rights reserved.