OBJECTIVE:Malignant brain tumors place significant physical, cognitive, and emotional strain on patients and caregivers. Psychosocial distress screening is part of standard care for patients, while caregiver screening remains challenging. This study examined the association of patient psychosocial distress at diagnosis with caregiver anxiety and depression over time. METHODS:This secondary analysis used data from a prospective, single-center, observational study of malignant brain tumor dyads. To assess the association of patient psychosocial distress at diagnosis (T0) with caregiver anxiety and depression at T0 and at 3 (T1) and 6 (T2) months post-diagnosis, the Actor-Partner Interdependence Model (APIM) was used. RESULTS:Complete data from 58 dyads were included at T0, 43 at T1, and 41 at T2. Patient distress at T0 predicted caregiver depression at T1 (β = 0.310, p = 0.007) and T2 (β = 0.322, p = 0.005), and caregiver anxiety at T2 (β = 0.303, p = 0.020). Caregiver distress at T0 did not predict patient anxiety and depression at any time point. For both patients and caregivers, distress at T0 predicted their own anxiety and depression at T0 and their anxiety at T1. For caregivers, distress at diagnosis also predicted anxiety at T2. CONCLUSIONS:Psychosocial distress experienced by patients with malignant brain tumors at diagnosis significantly predicts their caregivers' anxiety and depression over time. Caregivers at risk of increased anxiety and depression could therefore be identified by screening for patient distress. These findings also highlight the critical need for early psychosocial support for both patients and caregivers. TRIAL REGISTRATION:Retrospectively registered in the German Clinical Trial Register (10 July 2024; DRKS00034637).

(1) Background: The relationship between sleep bruxism (SB) and psychological distress has been investigated in numerous studies and is heterogeneous. Different diagnostic procedures have been applied to determine SB. The aim of this study was to directly compare the association between psychological distress and SB diagnosed by different accepted methods. (2) Methods: Data of N = 45 subjects were analyzed, including group comparisons and correlation analyses. Following diagnostic methods for the determination of SB were used in one sample: self-report, clinical assessment, polysomnography with audio-video recording and a novel diagnostic sheet with analyzing software. Psychological distress was measured using the global severity index (GSI) of the Symptom Checklist-90-Standard (SCL-90-S). (3) Results: The GSI did not differ significantly between subjects with and without SB, regardless of the underlying diagnostic classification (p > 0.05). In-depth correlation analyses of self-report and clinical data revealed a weak-to-medium correlation with the GSI (r = 0.12-0.44). Due to non-normally distributed data, a test of statistical significance was not possible. Variables of instrumental methods such as the SB index (amount of SB activity per hour) of polysomnography (PSG) showed almost no correlation with psychological distress (r = -0.06-0.05). (4) Conclusions: Despite these limitations, the results provide an indication that the choice of diagnostic procedure may elucidate the variance in the correlation between SB and psychological distress.

Facial mimicry is the automatic imitation of the facial affect expressions of others. It serves as an important component of interpersonal communication and affective co-experience. Facial mimicry has so far been measured by Electromyography (EMG), which requires a complex measuring apparatus. Recently, software for measuring facial expressions have become available, but it is still unclear how well it is suited for measuring facial mimicry. This study investigates the comparability of the automated facial coding software Affdex with EMG for measuring facial mimicry. For this purpose, facial mimicry was induced in 33 subjects by presenting naturalistic affect-expressive video sequences (anger, joy). The response of the subjects is measured simultaneously by facial EMG (corrugator supercilii muscle, zygomaticus major muscle) and by Affdex (action units lip corner puller and brow lowerer and affects joy and anger). Subsequently, the correlations between the measurement results of EMG and Affdex were calculated. After the presentation of the joy stimulus, there was an increase in zygomaticus muscle activity (EMG) about 400 ms after stimulus onset and an increase in joy and lip corner puller activity (Affdex) about 1200 ms after stimulus onset. The joy and the lip corner puller activity detected by Affdex correlate significantly with the EMG activity. After presentation of the anger stimulus, corrugator muscle activity (EMG) also increased approximately 400 ms after stimulus onset, whereas anger and brow lowerer activity (Affdex) showed no response. During the entire measurement interval, anger activity and brow lowerer activity (Affdex) did not correlate with corrugator muscle activity (EMG). Using Affdex, the facial mimicry response to a joy stimulus can be measured, but it is detected approximately 800 ms later compared to the EMG. Thus, electromyography remains the tool of choice for studying subtle mimic processes like facial mimicry.

Aim: Stigmatization by healthcare workers poses a challenge to providing care to the mentally ill. Bedside teaching during undergraduate medical education offers students an opportunity to directly interact with patients with a range of psychiatric disorders and thereby gather reflective experience. The present study investigates if this supervised contact with mentally ill patients during a one-week clinical course on psychosomatic medicine leads to stigma reduction in medical students. The factors influencing stigmatization were also investigated. Method: This was a prospective, non-randomized, controlled interventional study done in the 2019/20 winter semester involving fourth-year medical students who attended a week-long practical block on psychosomatic medicine (intervention group). This group was compared to students who had attended a week-long practical block with a somatic focus during the same time period (control group). Stigmatization was measured before and immediately upon completion of the week using the MICA-4 scale. Data on age, sex, experience with the mentally ill, interest in psychiatry/psychosomatics, and sense of self-worth were also gathered prior to starting the practical block. Analysis of the sample of 143 students with a complete basic data set was carried out using mixed ANOVA, multiple linear regression and moderator analysis. Results: In the context of clinical teaching with psychiatric patients, the stigmatization of the mentally ill among medical students decreased significantly more in the intervention group compared to the students in the control group who received instruction on somatic topics (p=.019, η2p=.04). In addition, being female, having previous experience with the mentally ill and general interest in the subjects of psychiatry or psychosomatics at T0 associated with lower stigma. In contrast, stigmatization was increased at the beginning of the study in males and those with low self-esteem. A moderating effect of the factors on stigma reduction was not seen. Conclusion: Undergraduate clinical instruction that enables direct contact and reflective experiences with the mentally ill leads to a reduction in the stigmatizing attitudes held by medical students toward the mentally ill. This underscores the need to have practical clinical instruction using patients.

INTRODUCTION:Depression is the most frequent psychiatric disorder following stroke, affecting about one-third of stroke survivors. Patients experience poorer recovery, lower quality of life and higher mortality compared with stroke survivors without depression. Despite these well-known malign consequences, poststroke depression (PSD) is regarded underdiagnosed and undertreated. Evidence of beneficial effects of psychotherapy to treat PSD remains scarce and inconclusive and is limited by heterogeneity in design, content and timing of the intervention. This pilot study aims to assess the feasibility of a newly developed integrative-interpersonal dynamic PSD intervention in an outpatient setting and provide a first estimation of the potential effect size as basis for the sample size estimation for a subsequent definite trial.METHOD AND ANALYSIS:Patients will be recruited from two German stroke units. After discharge from inpatient rehabilitation, depressed stroke survivors will be randomised to short-term psychotherapy (12 weeks, ≤16 sessions) or enhanced treatment as usual. The manualised psychotherapy integrates key features of the Unified Psychodynamic and Cognitive-Behavioural Unified Protocol for emotional disorders and was adapted for PSD. Primary endpoints are recruitment feasibility and treatment acceptability, defined as a recruitment rate of ≥20% for eligible patients consenting to randomisation and ≥70% completion-rate of patients participating in the treatment condition. A preliminary estimation of the treatment effect based on the mean difference in Patient Health Questionnaire-9 (PHQ-9) scores between intervention and control group six months poststroke is calculated. Secondary endpoints include changes in depression (PHQ-9/Hamilton Depression Scale) and anxiety (Generalised Anxiety Disorder 7) of all participants across all follow-ups during the first year poststroke.ETHICS AND DISSEMINATION:The INID pilot study received full ethical approval (S-321/2019; 2022-2286_1). Trial results will be published in a peer-reviewed journal in the first half of 2025. One-year follow-ups are planned to be carried out until summer 2025.TRIAL REGISTRATION NUMBER:DRKS00030378.

Sleep disorders reduce the therapeutic success of inpatient psychosomatic treatments for depressive disorders Objective: What influence do difficulties in falling and staying asleep in patients with depressive disorders have on the success of psychosomatic treatment? Method: The Data were collected in a naturalistic, multicenter observational study (STOP-D) at the beginning (T1), the end (T2) and six months later after discharge (T3). The sample consisted of female patients with depressive disorders (N = 487) who were treated for M = 61.7 days (SD = 26.8). An insomnia scale with a total of seven items was created subsequently to T1 from Items of the Beck Depression Inventory (BDI-I), from the Hamilton Depression Scale (HAMD) and from the Global Severe Index (GSI) from the Symptom Checklist 90 (SCL-90-R). Then groups were formed on changes in insomnia symptoms from T1 to T2. These two groups "sleep improver" and "sleep deteriorators" were tested by analysis of variance. Results: The subsequently constructed insomnia scale showed good psychometric characteristics in the performed analyses. Patients who reported an improvement in their sleep disturbances during inpatient psychosomatic treatment had significantly lower depression scores in the self-evaluation inventories (BDI-I und SCL-90-R) than patients without improvements in their sleep patterns. This effect was even more pronounced for the catamnestic period. Discussion: Insomnia symptoms in depressed female patients can be an important indicator of the effect of inpatient psychosomatic treatment and can have negative impact on the sustainability of the therapy success.

The immediate detection and correct processing of affective facial expressions are one of the most important competences in social interaction and thus a main subject in emotion and affect research. Generally, studies in these research domains, use pictures of adults who display affective facial expressions as experimental stimuli. However, for studies investigating developmental psychology and attachment behaviour it is necessary to use age-matched stimuli, where it is children that display affective expressions. PSYCAFE represents a newly developed picture-set of children's faces. It includes reference portraits of girls and boys aged 4 to 6 years averaged digitally from different individual pictures, that were categorized to six basic affects (fear, disgust, happiness, sadness, anger and surprise) plus a neutral facial expression by cluster analysis. This procedure led to deindividualized and affect prototypical portraits. Individual affect expressive portraits of adults from an already validated picture-set (KDEF) were used in a similar way to create affect prototypical images also of adults. The stimulus set has been validated on human observers and entail emotion recognition accuracy rates and scores for intensity, authenticity and likeability ratings of the specific affect displayed. Moreover, the stimuli have also been characterized by the iMotions Facial Expression Analysis Module, providing additional data on probability values representing the likelihood that the stimuli depict the expected affect. Finally, the validation data from human observers and iMotions are compared to data on facial mimicry of healthy adults in response to these portraits, measured by facial EMG (m. zygomaticus major and m. corrugator supercilii).

Facial mimicry is the automatic tendency to imitate facial expressions of emotions. Alexithymia is associated with a reduced facial mimicry ability to affect expressions of adults. There is evidence that the baby schema may influence this process. In this study it was tested experimentally whether facial mimicry of the alexithymic group (AG) is different from the control group (CG) in response to dynamic facial affect expressions of children and adults. A multi-method approach (20-point Toronto Alexithymia Scale and Toronto Structured Interview for Alexithymia) was used for assessing levels of alexithymia. From 3503 initial data sets, two groups of 38 high and low alexithymic individuals without relevant mental or physical diseases were matched regarding age, gender, and education. Facial mimicry was induced by presentation of naturalistic affect-expressive video sequences (fear, sadness, disgust, anger, and joy) taken from validated sets of faces from adults (Averaged Karolinska Directed Emotional Faces) and children (Picture-Set of Young Children’s Affective Facial Expressions). The videos started with a neutral face and reached maximum affect expression within 2 s. The responses of the groups were measured by facial electromyographic activity (fEMG) of corrugator supercilii and zygomaticus major muscles. Differences in fEMG response (4000 ms) were tested in a variance analytical model. There was one significant main effect for the factor emotion and four interaction effects for the factors group × age, muscle × age, muscle × emotion, and for the triple interaction muscle × age × emotion. The participants of AG showed a decreased fEMG activity in response to the presented faces of adults compared to the CG but not for the faces of children. The affect-expressive faces of children induced enhanced zygomatic and reduced corrugator muscle activity in both groups. Despite existing deficits in the facial mimicry of alexithymic persons, affect-expressive faces of children seem to trigger a stronger positive emotional involvement even in the AG.

Background The effectiveness of psychodynamic psychotherapy on clinical outcome variables, such as depressive symptom load is proven; however, there is still a lack of studies documenting the effectiveness of psychodynamic clinical inpatient treatment on psychodynamically relevant outcome measures. Method Within a naturalistic multicenter study "Inpatient psychodynamic oriented psychotherapy of depressive disorders (STOP-D)" the effectiveness of psychodynamic inpatient psychotherapy on the adaptivity of defence organization (inventory of personality organization, IPO) and the personality structural resources to handle conflicts (Heidelberg restructuring scale, HUS) was analyzed. Female inpatients with depressive symptoms from 15 psychosomatic hospital units were included in the study. The mean treatment duration was 61.8 days. Data acquisition was implemented at admission (T1;n & x202f;= 474), discharge (T2;n & x202f;= 432) and a 6-month follow-up after discharge (T3;n & x202f;= 286). Results There are indications of the effectiveness on the psychodynamically relevant outcome variables investigated. In addition to the known clear improvement of clinical symptom load, low-grade to high-grade effect sizes on psychodynamic core variables also became apparent. The alterations remained stable at the catamnesis. Conclusion The effectiveness of psychodynamic inpatient psychotherapy on the typical depressive symptom load seems to be associated with a long-lasting increase of structural resources of personality and might facilitate a more adaptive coping of imminent conflicts and stresses even after discharge.

Postpartum depression (PPD) is the most common mental illness in mothers following the birth of a child. Since the symptoms of PPD are similar to the normal stress of healthy women following childbirth, it is often difficult for the attending gynaecologist or midwife to diagnose this illness in a timely manner and thus initiate adequate treatment and comprehensive support for the patient. Even if there are options for a screening using evaluated questionnaires and subsequent psychotherapy and/or drug therapy in the treatment of PPD which has proven effective, it is seen that, in most treatment approaches, little consideration is given to the affect-controlled interaction and the bonding behaviour between mother and child. This article presents diagnostic measures and current therapeutic approaches as well as their integration in practice in order to achieve awareness of this topic in everyday clinical practice and show the pathways of appropriate treatment. Specific multiprofessional treatment approaches which centre on the mother-child relationship demonstrate successes with regard to depression in the mothers and also on the development of a secure mother-child bond and are thus a protective factor in the development of the affected children. The now well-known effects of PPD on the fathers as well as the negative impacts of paternal depression on child development make it clear that the treatment should not focus solely on maternal depression, but also always on the family bond between the mother, child and father in the treatment.

Objectives: Depression is one of the most common disorders with a rate of recurrence between 60-75%. The effectiveness of psychodynamic therapy is well-proven, but there is still a lack of studies proving the long-term effectiveness of inpatient treatment on depressive symptom load. Methods: After psychodynamic inpatient treatment in a psychodynamically oriented psychosomatic hospital unit, the reduction in general and depressive symptom load (e.g. BDI, HAMD, SCL-90-R) was evaluated by a six-month follow up design. The study was set up as naturalistic multicenter intervention study including a female follow-up sample (N = 291; age 25-45 years). Results: The symptom improvement reached by the inpatient treatment remained stable at the follow-up survey. Patients treated with antidepressant medication showed stronger depressive symptom load at discharge and follow-up survey compared to patients without antidepressant medication. Sociodemographic variables and a comorbid personality disorder were not associated with increased drop-out rates, but depressive symptom load and a premature ending of the treatment. Conclusions: The obtained results demonstrate the long-term effectiveness of inpatient psychodynamic psychotherapy. Further studies about the influence of post-hospital psychotherapy and medical treatment as well as patient satisfaction seem necessary.

Facial mimicry, the unconscious imitation of others' affective facial expressions, serves as an important basis for interpersonal communication. Although there are many studies dealing with this phenomenon regarding the interaction between adults, only few experiments have explored facial mimicry in response to affective facial expressions of children. In the following study affect-prototypical video clips of children's and adults' faces were presented to 44 adults while the activity of corrugator supercilii and zygomaticus muscles was electromyographically measured. A discrete mimic reaction was detected in response to each basic affect (fear, disgust, happiness, sadness, surprise and anger). The activity of corrugator supercilii muscle was significantly lower when affective facial expressions of children were presented in contrast to those of adults. In addition, negative correlations between alexithymia and the averaged facial EMG activity were detected.

OBJECTIVE:To quantify the postoperative quality of life (QOL) of patients after translabyrinthine surgery for vestibular schwannoma (VS) using the German version of the Penn acoustic neuroma quality-of-life questionnaire (PANQOL) in a university hospital.METHODS:The PANQOL questionnaire was administered to 72 patients who were treated in our department with translabyrinthine surgery for VS between January 2007 and January 2017. Descriptive evaluations of results were performed in addition to analyses of the reliability and convergent validity of the results and a subgroup analysis.RESULTS:For the first time, QOL was measured in German-speaking VS patients after translabyrinthine surgery. Cronbach's alpha for internal consistency and Guttman's split half, used as measures of reliability, showed values between 0.39 and 0.92 (raw alpha) and 0.58 and 0.98 (Lambda 4), respectively.DESCRIPTIVE STATISTICS:The mean total PANQOL score of patients after translabyrinthine VS resection was 61.96. The domain "hearing" had the lowest score (50.87), while "facial dysfunction" had the highest score (74.88). Subgroup analysis showed that neither preoperative tumor size nor elapsed time postoperatively significantly influenced QOL outcomes.CONCLUSIONS:Depending on the different domains the German PANQOL questionnaire showed poor to good internal consistency, reliability, and convergent validity. Moreover, some VS patients suffer from reduced QOL for a long time after the translabyrinthine procedure, thus psycho-oncological care should be recommended in these cases.

Background Impending cardiac surgery presents an existential experience that may induce psychological trauma. Moreover, quality of life long after successful coronary artery bypass graft surgery (CABG) can be impaired. Aim The aim of this study was to describe the time course of anxiety and depression in patients undergoing mitral valve surgery and compare it with our earlier results of patients undergoing CABG, a disease that is likely to be related to psychosomatic disorders. We hypothesized that patients undergoing mitral valve surgery can better manage stresses of cardiac surgery than patients undergoing CABG. Patients and Methods Of 117 patients undergoing mitral valve surgery, 100 patients (22 to 87 years; 53 females) completed the study and were interviewed before (pre), 1week after (early), and 6 months after (late) surgery. The Hospital Anxiety and Depression Scale (HADS) was employed. Results The proportion of patients with elevated anxiety scores (AS 8) was higher than normal (19.8%): pre, 33.0%; early, 28.0%; and was normalized late (18.0%). Similarly, depression scores (DS 8) were increased: pre, 15.0%; early, 20.0%; and late 14.0%, respectively (normal: 3.2%). Conclusion Coronary heart disease of CABG patients is presented as a systemic disorder, associated with both higher and postoperatively increased distress levels than in mitral valve patients. Anxiety and depression should be recognized as possible symptoms of psychosomatic disorders necessitating psychotherapeutic intervention to prevent postoperative depression and warrant patient-perceived surgical outcome that is additionally affected by expectations with respect to treatment and individual coping capacities. HADS is recommended to screen for vulnerable patients in the clinical routine, and psychosomatic support should be provided.

The development cycle within health services research is depicted starting from epidemiological risk findings to the intervention by the example of war and separation related fatherlessness. Even after sixty years, wartime children who grew up fatherless suffer more often from psychogenic conditions. Today effects of fatherlessness are mostly related to conflictual paternal divorce. Single mothers are exposed to elevated poverty and health risks, which may affect the development of their children. Thus, the preventive attachment oriented parental training program wir2 was developed, which reduces parental psychological distress and focusses on their emotional sensitivity. The long-term efficacy of wir2 on maternal contentment as well as on problem behavior in children has been proven within a randomized controlled study. Meanwhile, the program was modified as a six-week compact version for psychosomatic rehabilitation. The nationwide roll-out of wir2 into practice could be facilitated by the new law of prevention.

OBJECTIVESWhile the general effectiveness of psychodynamic psychotherapy in both outpatient and inpatient treatment has been proven, few studies document the effectiveness of clinical inpatient treatment of depression through psychodynamic psychotherapy.METHODSThis paper presents first results of a naturalistic multicenter intervention study. Included were female inpatients suffering from depressive symptoms who had been admitted to 15 psychodynamically oriented psychosomatic hospital units (N = 487). The mean duration of treatment was 61.8 days. Data were acquired at admission (T1) and discharge (T2).RESULTSOur findings support previous evidence and show that psychodynamically oriented inpatient psychotherapy of depressive disorders is efficient. High pre-post effect sizes were documented in all psychometric instruments used (BDI, HAM-D, SCL-90-R, BSS, GAF). Initial subgroup comparisons reveal that the benefits for patients with comorbid personality disorder are significantly lower than for depressed patients without comorbid personality disorder.CONCLUSIONPsychodynamic inpatient psychotherapy, as practiced under naturalistic conditions, is an effective treatment of depression. Predictors of therapeutic effects within different therapeutic settings, however, remain unclear. The sustainability of the therapeutic effects found and their impact on psychodynamic relevant constructs have still to be proven.