Introduction: The COVID-19 pandemic significantly impacted the mental health of the Swiss population. Methods: This study analyzed data from the Collaborative Outcome study on Health and Functioning during Infection Times (COH-FIT) across three pandemic waves: T1 (April-June 2020), T2 (July-December 2020) or T3 (January-June 2021). Each participant participated only once, during one of these three waves. Participants reported their subjective well-being and mental health status for the two weeks prior to the pandemic (pre-pandemic baseline) and during their respective pandemic wave. Subjective well-being was assessed using the World Health Organization Well-Being Index (WHO-5) from 4,037 participants, while mental health was measured via the P-score, completed by 3,375 participants. The WHO-5 ranges from 0 to 100, with higher scores indicating better well-being, while the P-score also ranges from 0 to 100 whereas higher scores represent greater levels of perceived burden across five domains of mental health. Pre- and intra-pandemic differences were analyzed using Wilcoxon tests and ANOVA, with subgroup analyses across seven Swiss regions utilizing the Kruskal-Wallis test. Results: Participants had a mean age of 45.6 years (61.9% female). Results showed a substantial decline in well-being during the pandemic, with average WHO-5 scores decreasing from 75.3 pre-pandemic, to 66.5 during the first wave, 69.1 during the second, and 65.1 during the third, representing relative reductions of 11.7%, 8.2%, and 13.5%. The percentage of participants at risk for depression (WHO-5 <50) peaked during the third wave at 19.8%, up from 10.0% pre-pandemic. Mental health burden, as measured by the P-score, increased significantly during the first wave (from 20.6 to 27.3, +32.5%), and remained elevated across the two subsequent waves, with no significant recovery observed. Wilcoxon tests indicated significant differences between pre-pandemic and intra-pandemic WHO-5 and P-scores, with the largest effect sizes during the third wave (r = 0.652 for WHO-5; r = 0.487 for P-score). ANOVA showed significant intra-pandemic differences in WHO-5 across waves (p < 0.001), with improvements noted in the second wave. However, no intra-pandemic differences in P-scores were found (p = 0.298). Regional analyses revealed that Ticino, the Lake Geneva region, and Northwestern Switzerland experienced the most pronounced declines in well-being and increases in mental health burden. In contrast, Espace Mittelland and Eastern Switzerland experienced a less severe impact. Discussion: Overall, these findings highlight the considerable and lasting impact of COVID-19 on mental health in Switzerland, emphasizing the need for targeted interventions, particularly in the most affected regions.

In Basel, only a few hundred meters from where LSD was first synthesized, we tested LSD-assisted therapy for major depression in a randomized trial comparing two high doses with two low doses, each paired with supportive psychotherapy. This Backstory reflects on treating patients, long dosing days, and what remains uncertain.

Background The physical environment of psychiatric in-patient facilities plays a significant role in patient well-being, treatment satisfaction and recovery. Despite growing evidence that architectural design influences clinical outcomes, systematic data on patient preferences regarding hospital structure remain scarce. Aims To identify structural and architectural requirements for psychiatric hospital design, from the patient perspective. Method A cross-sectional, hybrid questionnaire survey incorporating closed- and open-ended questions was administered to former psychiatric in-patients from all wards of a tertiary care centre (University Psychiatric Clinics Basel, Switzerland) who had been treated before September 2023. The survey assessed patient-reported disturbances related to room conditions, preferences for structural and environmental design elements, importance ratings of specific architectural features (measured using Likert scales) and preferred treatment settings. Results A total of 604 participants completed the survey (response rate 19.1%). Room-related disturbances were reported by 49% of respondents (n = 282), with key concerns including insufficient privacy, limited withdrawal opportunities and impaired sleep quality. Single-occupancy rooms were rated as very important (10/10) by 64% of respondents. Access to a surrounding park environment (74%) and direct outdoor access (75%) were among the most highly valued features. In-patient treatment was the preferred modality for 54.1% of respondents, followed by out-patient care (17.8%) and day clinics (15.9%). Conclusions Psychiatric patients strongly prioritise in-patient settings offering single-occupancy rooms, privacy and access to green spaces and outdoor areas. These findings underscore the importance of systematically incorporating patient perspectives into the architectural and structural planning of psychiatric facilities.

The Crisis Intervention Ward relocated from a general hospital to a psychiatric hospital in Basel, Switzerland, on May 26, 2023. We hypothesize that this relocation influenced patient demographics, frequencies of main diagnoses, involuntary admissions, transfer rates, clinical outcomes, patient satisfaction, and clinician perceptions of the treatment setting. We compared two patient cohorts: one from a 12 month period pre-relocation and the other from a 12 month period post-relocation. Two outpatient clinician surveys-one conducted pre- and one post-relocation-assessed location ratings, treatment satisfaction, and the perceived benefits and disadvantages of each location. Prior to relocation, 625 cases were treated; after relocation, 686 cases. Patient's age and gender showed no differences. The frequency of affective disorders (F3) was lower (Φ = - 0.124) at the psychiatric hospital. Clinical outcomes, involuntary patient admissions, and transfer rates to other psychiatric wards were comparable. Patient-reported satisfaction was lower at the psychiatric hospital (mean 4.6 vs. mean 5.2, r = 0.23). Outpatient clinicians favored the general hospital setting strongly (r = 0.78-0.81). Clinical outcomes remained stable, but patient satisfaction was lower after relocation, and clinicians perceived barriers related to accessibility and stigma at the psychiatric hospital.

Psychosis-specific psychotherapy is an evidence-based treatment approach that should be offered to patients during all phases of psychosis. However, to offer psychosis-specific psychotherapy, therapists need to engage in specialized training, which might not be part of their mandatory psychotherapy training. Hence, they may choose to attend the available individual psychosis-specific workshops, potentially resulting in a fragmented training landscape. Therefore, this study aimed to characterize the current training landscape in psychosis-specific psychotherapy. We conducted a large-scale survey among therapists (psychiatrists and clinical psychologists) in Switzerland. We retrospectively assessed self-reported attendance using a predefined list of psychosis-specific psychotherapy workshop types (k = 15), along with demographic variables. To visualize the current training landscape, we used descriptive and social network analyses. Of the participating therapists (n = 1382), 47% self-reported that they had attended at least one psychosis-specific psychotherapy workshop. The training landscape networks appeared fragmented (modularity scores ranging between 0.02 and 0.00). The three workshops with the highest self-reported attendance were cognitive behavioral therapy for psychosis (20%), psychotherapy for psychosis (17%), and psychosis-specific psychoeducation (16%). For combined attendance, no workshop combination exceeded a co-attendance rate of 10%. Furthermore, co-attendance patterns significantly differed across occupations and therapeutic orientations. This study identified gaps in the psychosis-specific psychotherapy training landscape, such as the diversity and fragmentation in training and low co-attendance rates. These findings offer a foundation for addressing potential gaps and providing evidence-informed measures to promote clearly defined, guideline-aligned specialization pathways.

Open-door policies in psychiatric wards are increasingly recommended as a means to reduce coercion and enhance patient autonomy. However, evidence that integrates patient perspectives on ward openness and related safety measures remains limited. Traditional qualitative approaches often lack the breadth to fully capture the complexity of these views. We hypothesized that patients would prefer open-door treatment and hold a critical view of locked-ward environments, emphasizing autonomy and dignity in care. This study aims to systematically explore psychiatric patients' perspectives on open-door versus locked-ward treatment, identifying key themes and quantifying preferences within a large clinical sample. A hybrid questionnaire survey was conducted in September 2023 at the University Psychiatric Clinics (UPK) Basel. The survey examined psychiatric service usage and integrated key factors from a meta-review, including ward relationships, environment, autonomy, legal status, coercion, care entitlement, and expectations at admission and discharge. The final sample comprised 604 patients (response rate 19.1%) drawn from an initial pool of 3212 former inpatients. A text mining approach using latent Dirichlet allocation, a Bayesian topic modeling technique, was applied to analyze open-ended responses and identify latent thematic structures. The majority of respondents (347/544, 63.8%) rated open-door treatment as "very important" (10 out of 10 on a Likert scale). In contrast, only 21.0% (127/552) of participants were willing to accept voluntary treatment in locked wards, with 70.4% (425/552) explicitly rejecting this option. Logistic regression indicated that younger patients were significantly more likely to accept locked ward treatment (β=-.18, P=.04), while patients diagnosed with mood disorders (ICD-10 [International Statistical Classification of Diseases and Related Health Problems, Tenth Revision] F3) showed a trend toward lower acceptance (β=-.42, P=.08). Gender and other diagnoses were not significant predictors. Latent Dirichlet allocation identified 5 key topics within patient narratives, which hierarchical clustering grouped into 2 overarching themes: Restriction and Institutionalization, characterized by terms indicating confinement, loss of control, and social isolation; and Autonomy and Self-Determination, which emphasizes patients' desire for freedom, control over daily life, and access to nature and outdoor spaces. This study provides robust evidence that psychiatric patients overwhelmingly prioritize open-door policies, linking them to enhanced autonomy, trust, and therapeutic engagement. The thematic analysis highlights the psychological and social costs of locked wards and the critical need for flexible, patient-centered care models. Younger age and diagnostic category influence willingness to accept locked settings, suggesting the need for tailored approaches. Institutions aiming to implement open-door policies should consider these preferences alongside adequate staffing, therapeutic programming, and environmental modifications to foster autonomy while maintaining safety. Integrating patient perspectives in policy design may enhance treatment satisfaction and clinical outcomes.

INTRODUCTION:Heroin-assisted treatment (HAT) involves the supervised administration of pharmaceutical heroin (diacetylmorphine; DAM), either injectable or oral, for individuals with severe opioid use disorder who have not achieved stabilisation with conventional opioid agonist treatment. Despite its growing adoption, there is limited literature on the phenomenon of diversion in HAT. Diversion refers to the redirecting of legal prescription medications from their intended medical use to illegal or unauthorised use. This study aimed to investigate the reasons for, experiences with, and consequences of DAM diversion, as reported by both patients and treatment providers. METHODS:In this qualitative study, two separate focus groups were conducted with patients and treatment providers (nurses, psychiatrists, social workers, and psychologists), respectively. Discussions were audio-recorded, transcribed, and analysed. Mayring's qualitative content analysis was used to evaluate the findings. RESULTS:Five themes with fourteen categories emerged. Providers and patients both described procedures and motives of diversion, discussed the positive and negative consequences, and suggested solutions for reduced future diversion of DAM. An important motif for diversion stemmed from patients' urge for more autonomy over route, timing, and fractioning of administration, while also being used to finance concurrent cocaine use. Treatment providers and patients both noted that diversion may lead to increased overdose risk for individuals in and out of treatment. Nurses noted a substantial negative impact of diversion on the therapeutic relationship. Suggestions for reducing diversion included allowing for more take-home dosing, allowing for more flexibility in routes of administration, adapting HAT clinic opening hours, and providing effective treatment for cocaine use disorder. CONCLUSION:The main drivers of diversion in HAT included a desire for more autonomy, unaddressed concurrent substance use, and significant barriers to the existing treatment options. Addressing patients' preferred opioid effect profile, accommodating their social needs, and managing concurrent cocaine use disorders may reduce diversion in the future.

Refugees and asylum seekers face specific barriers when accessing the mental health system. To support long-term optimization of healthcare for this vulnerable patient group, precise knowledge of this patient population is essential. Thus, the aim of the current study is to characterize and compare sociodemographic and clinical characteristics and treatment utilization of inpatients with or without refugee/asylum status. The study deploys an observational design in which a naturalistic sample of 9095 inpatients from a large psychiatric university hospital in Switzerland who received treatment between 2015 and 2021 was assessed. The reliable identification of patients with refugee/asylum status was ensured using a second database from the social welfare institution. To compare refugees with nonrefugees, we used two different variants of propensity score analysis: nearest neighbor matching with matching ratios 1:1 or 1:5 and inverse probability weighting (IPW) with overlap weighting. Among refugees, patients from Western Asia, Southern Asia, sub-Saharan Africa, and Southern Europe were predominantly represented. Refugees in psychiatric inpatient care were more often young men, unemployed, unmarried, with no or only compulsory education, and little or no knowledge of German. Neurotic, mood disorders, stress-related, and somatoform disorders were the most common diagnoses. Also, fewer psychiatric treatment days and lower psychiatric treatment costs were observed among refugees compared to nonrefugees. Our findings suggest that access to inpatient treatment might be more difficult for refugees. To foster culturally sensitive psychiatry, specific characteristics of patients with and without refugee/asylum status should be taken into account and included in further investigations.

Background: High-cost patients (HCP) in psychiatry show an above-average use of healthcare resources. Therefore precise identification is important to enable effective treatment of this vulnerable patient group. This study aims to provide evidence-based definitions of HCP. Methods: Eight hundred ninety-eight inpatients from a large psychiatric university hospital in Switzerland were defined as causing costs at/above or under the 90th percentile in a 12-month observation period after index hospitalization. We used receiver-operator characteristic curve (ROC) analyses to estimate optimal cut-off points for previous admissions and length of stay within a retrospective observation period of either 18 or 30 months before index hospitalization. Results: Previous treatment utilization are predictors for HCP status (AUC 0.70-0.74, p < 0.05). Using optimal cut-off values, the models correctly identified 97.2 %-99.4 % of all non-HCP. However, models assessing the previous number of admissions within a 18- or 30-month observation period could only correctly identify 3.4 % of HCP for each predictor. ROC analyses clearly favored models using cumulative number of inpatient treatment days with a positive predictive value of 51.7 %-53.9 %. Our results suggest that >45.5 inpatient treatment days 18 months before index hospitalization or >46.5 days 30 months before index hospitalization should be used as cut-off for HCP. Still, with these models only a little over half of the HCP are correctly identified. Conclusions: Our results suggests that further predictors contribute to HCP status which should be explored in the future and included as characteristics used to define HCP.

Background:The hippocampus plays a critical role in psychosis, with reduced volume observed across the psychosis continuum. These structural changes are associated with cognitive deficits, symptom severity, and increased risk of psychosis progression. Elevated hippocampal perfusion and glutamate/GABA (gamma-aminobutyric acid) imbalance further suggest metabolic dysregulation as a key mechanism. Gut microbiota composition can influence hippocampal metabolism, but their interplay remains to be explored. Methods:In this cross-sectional study, we recruited 142 healthy participants from the general population, yielding 69 individuals with high schizotypy (HS) and 72 individuals with low schizotypy. All underwent clinical and cognitive testing, multimodal neuroimaging, and gut microbiota analysis via 16S ribosomal RNA gene sequencing. Hippocampal subfield volumes (structural magnetic resonance imaging), perfusion (arterial spin labeling) and glutamate/GABA levels (proton magnetic resonance spectroscopy), and microbial taxa (abundance, diversity, enterotypes) were assessed. Results:Group comparisons of cognition, multimodal neuroimaging, and gut microbiome composition did not reveal significant differences after correction for multiple comparisons. Within the HS group, glutamate (r = 0.38, p = .003) and GABA (r = -0.36, p = .003) ratios were linked to social withdrawal. Across the entire sample, left hippocampal subfield volumes and glutamate/GABA levels differed significantly between predominant gut microbial enterotypes. Conclusions:Our results suggest a potential relationship between aberrant gut microbial composition and hippocampal alterations in people with positive schizotypy from the general population. Our findings inform future large-scale research that further explores specific mechanisms of gut microbiome-hippocampus interactions in psychosis and the potential of tailored microbial interventions targeting hippocampal-mediated symptoms.

Often, after an inpatient stay, early readmission occurs, which is detrimental to the patient. University Psychiatric Clinics Basel developed a 3-month transitional intervention program to bridge inpatient and community treatment by supporting people after their discharge from the psychiatric hospital. In line with international guidelines, this transitional intervention was delivered as assertive community treatment in the homes of people who wished to participate. Data from the 3-year pilot project starting in 2019 have been collected to analyze the success of its implementation and treatment effectiveness in reducing follow-up inpatient treatment days when comparing people choosing to participate in the transitional program and receiving treatment (ncases = 456) versus people declining participation (ncases = 104). Results indicate that within 3 years, a multidisciplinary team could be assembled that was able to work with a caseload of up to 66 persons per month. Receipt of treatment was descriptively associated with lower numbers of inpatient treatment days, stays, and involuntary admissions 6 months after discharge; however, this difference did not reach statistical significance. Program participants further reported very high levels of satisfaction. These findings provide an outlook on the program’s feasibility and potential benefits.

BackgroundLimited data exists regarding gender-specific microbial alterations during gender-affirming hormonal therapy (GAHT) in transgender individuals. This study aimed to investigate the nuanced impact of sex steroids on gut microbiota taxonomy and function, addressing this gap. We prospectively analyzed gut metagenome changes associated with 12 weeks of GAHT in trans women and trans men, examining both taxonomic and functional shifts.MethodsThirty-six transgender individuals (17 trans women, 19 trans men) provided pre- and post-GAHT stool samples. Shotgun metagenomic sequencing was used to assess the changes in gut microbiota structure and potential function following GAHT.ResultsWhile alpha and beta diversity remained unchanged during transition, specific species, including Parabacteroides goldsteinii and Escherichia coli, exhibited significant abundance shifts aligned with affirmed gender. Overall functional metagenome analysis showed a statistically significant effect of gender and transition (R2 = 4.1%, P = 0.0115), emphasizing transitions aligned with affirmed gender, particularly in fatty acid-related metabolism.ConclusionsThis study provides compelling evidence of distinct taxonomic and functional profiles in the gut microbiota between trans men and women. GAHT induces androgenization in trans men and feminization in trans women, potentially impacting physiological and health-related outcomes.Trial registrationClinicaltrials.gov NCT02185274.

International guidelines recommend the provision of community based treatment as an alternative to predominant inpatient stays in psychiatric hospitals for people with severe mental illnesses. Assertive community treatments have been introduced across the globe; however, the development and implementation of such treatment options are still limited in Switzerland in general and were, until recently, not available in Basel-Stadt. We here describe the development and implementation of an assertive community treatment program created specifically for people with previous heavy use of psychiatric inpatient services in the canton of Basel-Stadt. The program offers this patient group a need-centered and recovery-oriented treatment option following an inpatient stay. Primary objectives are a reduction in the likelihood of further inpatient stays and the potential experience of involuntary admissions as well as high participant satisfaction. Results from the three-year pilot study (2019–2022) are reported here on a case-level. We compare objective outcome measures for people participating in the program after an inpatient stay and receiving minimal treatment (ncases = 110) versus people not participating (ncases = 292). Overall, we show that program participation is associated with a lower number of inpatient treatment days, inpatient stays and number of involuntary admissions. Feedback on subjective outcome measures indicates high treatment satisfaction. These findings speak to the feasibility of the program’s implementation and provide a first outlook for a new recovery-oriented treatment option for people with a history of frequent hospitalizations.

Background Several studies have examined 3,4-Methylenedioxymethamphetamine (MDMA) as a therapeutic adjunct in the treatment of post-traumatic stress disorders (PTSD). Alcohol use disorder (AUD) is common in patients with PTSD and can lead to alcohol-induced liver cirrhosis. There is a concern that MDMA, which is associated with liver toxicity in some cases, may not be tolerated by PTSD-patients with pre-existing, alcohol-induced liver cirrhosis. There is currently no data available to asses this risk. Case presentation We present the case of a 32-year old female patient with post-traumatic stress disorder and advanced alcohol-induced liver cirrhosis who received MDMA-assisted therapy. MDMA was administered twice (50 mg, 100 mg) over the course of two weeks. Apart from one episode of vomiting and the subjective sensation of numb and swollen fingers (without clinical findings) under the influence of MDMA, there were no adverse effects. Laboratory values did not show any signs of acute MDMA-induced liver injury. Conclusions There were no signs of acute MDMA-induced liver injury in our patient, despite advanced, pre-existing liver cirrhosis due to alcohol use. This finding is on a case level and cannot be generalized, but is encouraging for future research in patients with liver disorders. Further research is necessary to confirm the safety of MDMA-assisted therapy in patients with pre-existing, alcohol-induced liver cirrhosis.

BACKGROUND:Return of fear after successful exposure therapy for a phobia is a common clinical challenge. A previous study on mice demonstrated that the persistent attenuation of remote fear memories can be achieved by combining histone deacetylase inhibitors (HDACis) with fear-memory retrieval prior to extinction training. METHODS:To evaluate the translational potential of this approach, we conducted a randomized, double-blind, placebo-controlled trial. Forty-eight individuals with DSM-IV spider phobia received either HDACi valproic acid (VPA, 500 mg) or a placebo prior to the retrieval of fear memory, followed by exposure therapy in virtual reality. RESULTS:No significant group difference was found in terms of behavioral change on the behavioral approach test at 3 months follow-up and baseline (primary outcome). However, the VPA group displayed significantly reduced fear in two self-report questionnaires related to spider phobia (Fear of Spiders Questionnaire; Spider Phobia Beliefs Questionnaire) as compared to the placebo group. No group differences were observed for psychophysiological indicators of fear. CONCLUSIONS:The favorable impact of a single administration of VPA in combination with fear-memory retrieval prior to exposure therapy suggests that it might be an effective way to enhance symptom improvement at the subjective level in the treatment of phobias. Further studies need to investigate the conditions under which an improvement on the psychophysiological and behavioral levels can be achieved as well.

Die längerfristige Behandlung (Re-ACT) und Übergangsbehandlung (ACTTIV) sind zwei neu implementierte, aufsuchende Pilotprojekte der Universitären Psychiatrischen Kliniken Basel (UPK). Im Rahmen der Implementierung erfolgt eine Begleitevaluation, aus der erste Ergebnisse in Bezug auf den Zuweisungsprozess aus dem stationären Setting vorgestellt werden. Um die Pilotprojekte erfolgreich zu etablieren wurden die Erfahrungen und Sichtweisen der zuweisenden Ärzt:innen in die aufsuchende Behandlung exploriert. Drei halbstrukturierte Fokusgruppeninterviews wurden durchgeführt. In der Inhaltsanalyse nach Mayring wurden als relevante Themen (1) das Anmeldeprozedere, (2) die Abgrenzung zu bestehenden Versorgungsangeboten in der Region, (3) die Patient:innenerfahrungen mit den Angeboten, (4) die Indikationsstellung und (5) die Erwartungen der Zuweisenden an das aufsuchende Angebot aufgenommen. Die Zuweisenden bewerteten die aufsuchenden Behandlungsangebote als hilfreich und wirksam. Sobald Patient:innen in Kontakt mit der aufsuchenden Behandlung gekommen sind, berichten sie gegenüber den Zuweisenden von positiven Erfahrungen. Gewünscht wurde eine zeitliche Flexibilisierung des Anmeldeprozederes, sodass eine Anmeldung auch nach Entlassung aus dem stationären Setting möglich ist. Weiterhin könnten mehr Informationen für eine systematisierte Indikationsstellung und Abgrenzung zu bestehenden Angeboten hilfreich sein. Die neu implementierten aufsuchenden Versorgungsangebote der UPK Basel werden auch von Seiten der Zuweisenden positiv bewertet. Diese Angebote können eine Behandlungslücke zwischen stationärer und ambulanter Versorgung schliessen und dabei auf die individuellen Bedürfnisse der Patient:innen eingehen. Während die Zuweisenden von positiven Erfahrungen berichten, ist weitere Forschung nötig, um besonders die Perspektive der Patient:innen systematisch zu verstehen.

IntroductionAssociative memory (AM) is the most basic and common memory form. It constitutes the foundation of the declarative memory system, including all semantic and episodic memory processes. However, despite numerous studies, recent and remote memory retrieval processes in AM still need further elucidation.MethodsHere, we investigated the neurofunctional correlates of recent and remote-related AM retrieval using associative face-name pairs of famous and non-famous individuals in a population of young, healthy adults (N = 23; mean age = 23.39 years). Particular interest was placed on the prominent anterior temporal lobe (ATL) found during recent and remote memory, including the right anterior insular (aIC) cortex and posterior midline region (PMR) previously observed during associative memory retrieval.ResultsThe results of the present study revealed significant bilateral activation in the anterior parts of the STG as subdivision of the ATL during recent and remote memory retrieval. In addition, bilateral aIC activation was observed exclusively during recent memory retrieval, while PMR and ventromedial prefrontal cortex (vmPFC) activity was found only during remote memory retrieval.DiscussionThus, the present results corroborate the ATL's role as a common hub not only for AM retrieval but also for recent and remote memory processes. In addition, the recent and remote memory retrieval systems also appear to engage distinct neurofunctional networks to enable successful retrieval of contingent face-name pairs.

IntroductionIndividuals with exercise addiction (EA) report being unable to stop exercising despite its negative psychological, physical, or social impact. Due to a lack of evidence, EA has so far not been officially recognized as a behavioral addiction. Only one study exists, that investigated mental disorders in individuals with EA by utilizing the Structured Clinical Interview for DSM-5 Disorders (SCID-5). The present study followed up on this sample, providing the first longitudinal data on EA.MethodsAll participants of the baseline study were invited to complete validated psychometric instruments assessing symptoms of depression, attention deficit hyperactivity disorder, trauma, and EA. Furthermore, an exhaustive diagnostic assessment with the SCID-5-CV, the SCID-5-PD (following a SAPAS screening), and a self-designed clinical interview to assess EA criteria were conducted.ResultsThe response rate was 59.4% (n=19) and the mean duration of follow-up was 634.5 (SD=155.8) days. Number of fulfilled EA criteria in the sample remained largely stable over time with no change in seven (36.8%), a reduction in nine (47.4%), and an increase in three (15.8%). Eighteen out of 19 participants fulfilled the criteria for at least one mental disorder. The most prevalent disorders were major depressive disorder (lifetime prevalence 73.7%; n=14) and obsessive-compulsive personality disorder (52.6%; n=10).DiscussionThis data suggests that EA is a temporary stable and distinct disorder with affected individuals suffering from severe psychological distress. Further studies are necessary to investigate potential cause-effect relationships between co-occurring mental disorders and EA.