Background:Despite the well-documented efficacy of exposure therapy for phobic disorders, its real-world implementation remains limited due to barriers in accessibility, acceptability, and generalization. Objective:This proof-of-concept study examined the feasibility and preliminary effects of a novel gamified augmented reality (AR) intervention designed to support in vivo exposure by embedding playful, non-threatening virtual stimuli into real-world anxiety-provoking contexts. Methods:Twenty individuals with various phobic disorders participated in a multiple-baseline design. At a randomly assigned time point, participants used a smartphone-based AR application, or in some cases, a VR headset version, to interact with virtual game elements within individualized fear-relevant environments. The task involved physically navigating individualized fear-relevant environments while collecting color-coded virtual objects presented via augmented reality within the real-world setting. Results:Linear mixed-effects analyses indicated a significant reduction in self-reported situational fear following the intervention, with a large within-subject effect size estimate (Cohen's d = 2.21). Secondary outcomes related to anxiety sensitivity, agoraphobic cognitions, and depressive symptoms also showed pre-post improvements with small to moderate effect sizes. No significant differences were observed across device types or treatment settings. Conclusion:The findings provide preliminary support for a low-threshold, smartphone-based AR approach that may complement exposure-based interventions in naturalistic settings. However, given the small and heterogeneous sample and the absence of a control group, these results should be interpreted cautiously. Future randomized controlled studies with larger and more homogeneous samples, validated behavioral outcome measures, and follow-up assessments are needed to clarify efficacy, mechanisms of change, and long-term effects.

(1) Background: Dementia and mild cognitive impairment (MCI) are still underdiagnosed in the general population. Impaired odor identification has been identified as an early marker of MCI and dementia. We aimed to compare the additional diagnostic value of two odor identification tests to a cognitive screening test in detecting MCI or dementia. (2) Methods: The Sniffin' Sticks odor identification test (SS-OIT), a brief odor identification test (B-OIT) requiring the identification of coffee scent, and the Mini-Mental State Exam (MMSE) were administered to a consecutive series of 174 patients (93 with dementia, 42 with mild cognitive impairment, and 39 without cognitive impairment) referred for neuropsychological testing. (3) Results: Both participants with dementia and with MCI exhibited impairments in odor identification. The SS-OIT and the B-OIT were substantially correlated. Complementing MMSE scores with the SS-OIT or the B-OIT similarly improved the diagnostic accuracy of individuals with dementia and MCI. (4) Conclusions: People with suspected dementia or MCI may already benefit from brief odor identification tests. Although these tests require little additional time, they can notably increase sensitivity for dementia or MCI.

(1) Background: Dementia and mild cognitive impairment (MCI) are still underdiagnosed in the general population. Impaired odor identification has been identified as an early marker of MCI and dementia. We aim to investigate whether short tasks, in which simple forms must be assembled from single building blocks based on a template or while considering specific re-strictions, could increase the diagnostic quality of established cognitive screening tests in detecting MCI or dementia. (2) Methods: A brief assembly test, where participants had to assemble simple animal shapes from Lego® Duplo® building blocks, the Frontal Assessment Battery, and the Mini-Mental State Exam (MMSE) were administered to a consecutive series of 197 patients (89 with mild dementia, 62 with mild cognitive impairment, and 46 without cognitive impairment) referred for neuropsychological testing. (3) Results: Both participants with dementia and with MCI performed badly in the assembly tasks. The assembly tasks and the Frontal Assessment Battery were substantially correlated. Complementing MMSE scores with the assembly tasks improved the diagnostic accuracy of individuals with dementia and MCI. (4) Conclusions: People with suspected dementia or MCI may already benefit from simple assembly tasks. Although these tests require little additional time, they can notably increase sensitivity for dementia or MCI.

Many people with psychiatric disorders experience impairments in cognition. These deficits have a significant impact on daily functioning and sometimes even on the further course of their disease. Cognitive remediation (CR) is used as an umbrella term for behavioral training interventions to ameliorate these deficits. In most but not all studies, CR has proven effective in improving cognition and enhancing everyday functional outcomes. In this paper, after quickly summarizing the empirical evidence, practical advice to optimize the effects of CR interventions is provided. We advocate that CR interventions should be as fun and motivating as possible, and therapists should at least consider using positively toned emotional stimuli instead of neutral stimuli. Participants should be screened for basic processing deficits, which should be trained before CR of higher-order cognitive domains. CR should stimulate metacognition and utilize natural settings to invoke social cognition. Wherever possible, CR tasks should link to tasks that participants face in their everyday life. Therapists should consider that participants might also benefit from positive side effects on symptomatology. Finally, the CR approach might even be utilized in settings where the treatment of cognitive impairments is not a primary target.

It is well established that individuals with cognitive impairment present with disturbed forms of pain processing of still unknown origin. As a neurocognitive factor, executive functions have become favored candidates for explanation. For further insights, we aimed at comparing executive functions and memory in their association with parameters indicating onset and escalation of pain perception. Subjective ratings of experimentally induced pressure pain applied in ascending series were assessed in older individuals with (N = 32) and without mild cognitive impairments (MCI) (N = 32). We investigated whether executive functioning (Trail Making Test-B (TMT-B), semantic fluency) or memory (word list and figure recall) were more closely linked to the onset and the escalation of pain. For the MCI group, a strong linkage between pain responses and the TMT-B could be found, i.e., poor test performance was associated with weak pain onset but strong pain escalation. The contribution of memory functions was less substantial and systematic. The prominent role of executive function for pain processing in individuals with MCI could be replicated by a test of cognitive flexibility. This lack of adaptability let individuals with MCI be less vigilant to pain at the beginning but allows for escalating pain in the further course. Thus, being first not sufficiently prepared and later overwhelmed as regards pain may be an early problem in MCI individuals with reduced executive functioning.

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Background: Extensive research has reported that electroconvulsive therapy (ECT) can be highly effective in approximately 80% of patients suffering from depression. Its clinical use is mainly limited by historical objections and the concern about unwanted adverse effects (AEs), including serious and potentially life-threatening adverse events (pLTAEs), induced either by ECT or by anesthesia. Objective risk estimation is, therefore, a decisive factor in determining an indication for ECT. Methods: This paper presents a retrospective analysis of 3-year safety protocols and patient files of 157 patients who received a total of 3,106 ECT applications in a psychiatric inpatient setting at a psychiatric community hospital. This patient group comprises 5.3% of inpatients admitted with comparable diagnoses. Adverse events were analyzed from standardized safety protocols and patient files with a focus on pLTAEs. Results: Adverse events were reported for 30 (19.1%) of the 157 participants during 39 (6.1%) of 641 hospital stays. Serious pLTAEs occurred during three electroconvulsive stimulations in three patients, who needed action through the administration of medication or mechanical respiration. No patient suffered permanent damage to health, and no patient died. The incidence of these and other AEs was independent of sex, age, and diagnosis of patients, and anesthesia medication. Minor AEs occurred more often with higher stimulus doses and an increasing number of treatments. Conclusion: The low incidence rate of 0.097% of serious pLTAEs that require medical action may allow the conclusion that ECT is a rather safe treatment when performed in a controlled setting. The beneficial risk profile of ECT performed in the standard care of psychiatric hospitals suggests a more generous indication of this treatment method. We recommend that ECT facilities collect individual safety data to allow a reliable judgment of their institutional ECT risk profile.

Recently, non-drug treatment options to reduce cognitive decline in dementia have become increasingly prominent. First results from qualitative studies show that tablet-based applications are perceived as attractive by dementia patients. Attractiveness, validity and usability of a cognitive stimulation app developed for groups of older people were examined using quantitative data. A standardized group session was performed with 20 subjects (10 women, 10 men, 6 controls, 8 patients with mild cognitive impairment and 6 patients with mild dementia), in which four tasks from the tablet-based app as well as four paper and pencil tasks from a validated manual for cognitive activation in patients with mild dementia were administered. Both types of tasks were rated as little exhausting and very attractive, with three of the four tablet tasks being rated better in terms of attractiveness (P=.017, .008 and .096). Although the majority of tasks was solved more quickly by the participants with lower cognitive deficits (.002 <= P <= .038), the exercises were resolved timely and without problems by all participants from the beginning, and the groups did not differ in their learning progress regarding tablet operating speed (.193 <= P <= .739). The findings encourage the use of this low cost and accessible technology. With the BTTB, a ready-to-use application without additional costs or hardware requirements is available, which can be used directly in group sessions with dementia patients.

Cognitive models of depression emphasize the relevance of cognitive biases for development, onset and maintenance of major depressive disorder (MDD). Attentional biases consisting of increased attention to negative, mood congruent stimuli and reduced attention to positive, mood-incongruent stimuli are postulated but have rarely been tested for early attentional processing. Furthermore, the role of concurrent depressive mood as a moderating factor has not been studied to date. Participants comprised 30 patients suffering from MDD and 30 healthy control subjects. All participants performed a dot-probe task with pictorial stimuli displaying affective facial expressions, presented either for 100 ms or for 500 ms. Attentional biases towards faces displaying joy in both MDD patients and control subjects and towards faces displaying pain in MDD subjects were found at presentation times of 100 ms. In the MDD sample, the bias indices at 100 ms were correlated with concurrent depressive mood. In patients with pronounced depressive mood, significant biases towards happy and angry faces were observed that exceed the biases obtained in control subjects and patients with less depressive mood. The results provide first evidence that MDD patients with pronounced depressive mood show an increased early attentional engagement towards emotional salient stimuli, independent from valence.

Schizophrenia is associated with deficits in working memory (WM) and executive functioning (EF) that are present from prodrome to chronic stages of the disease and are related to social and occupational functioning. Recent empirical findings suggest that schizophrenia patients might suffer from a specific speed deficit regarding WM operations that also affects EF. To test this hypothesis, executive functioning (EF) and working memory (WM) performance of 20 schizophrenia (SC) patients, 20 patients suffering from Major Depressive Disorder (MDD) and 40 healthy control (HC) subjects were compared. While schizophrenia patients performed worse in the measure of EF, no difference between the SC and the MDD patients was found regarding WM capacity. However, the SC group was shown to have an impaired speed in encoding, retrieval and manipulation of WM contents compared to the HC group whereas the MDD group showed no such deficit. Furthermore, while in the MDD group only WM capacity was linked to EF performance, in the SC group EF was determined by both WM capacity and WM speed. Hence, increasing the speed of WM operations might be a fruitful target for future therapeutic interventions, and assessing not only the capacity but also the speed of WM might be helpful in identifying candidates for endophenotypic cognitive markers of SC.

Objectives: Although electroconvulsive therapy (ECT) is considered a safe and highly effective treatment option for major depressive disorder, there are still some reservations with regard to possible adverse cognitive adverse effects. This is the case despite a large body of evidence showing that these deficits are transient and that there even seems to be a long-term improvement of cognitive functioning level. However, most data concerning cognitive adverse effects stem from studies using mixed samples of treatment-resistant and non-treatment-resistant as well as ECT-naive and non-ECT-naive subjects. Furthermore, neurocognitive measures might partly be sensitive to practice effects and improvements in depressive symptom level.Methods: We examined neurocognitive performance in a sample of 20 treatment-resistant and ECT-naive subjects using repeatable neurocognitive tests, whereas changes in depressive symptom level were controlled. Cognitive functioning level was assessed before (baseline), 1 week, and 6 months (follow-up 1 and 2) after (12 to) 15 sessions of unilateral ECT treatment.Results: No adverse cognitive effects were observed in any of the cognitive domains examined. Instead, a significant improvement in verbal working memory performance was found from baseline to follow-up 2. When changes in depressive symptom levels were controlled statistically, this improvement was no longer seen.Conclusions: Although findings that ECT does not lead to longer lasting cognitive deficits caused by ECT were confirmed, our study adds evidence that previous results of a beneficial effect of ECT on cognition might be questioned.

Little is known whether tests used for the diagnosis of dementia syndromes are sensitive to time of day effects. In a sample of 145 participants, no such effect (test administration either in the morning from 9.30 to 11.30 a.m. or in the afternoon from 2.30 to 4.30 p.m.) could be found for most subtests of a neurocognitive test battery (CERAD-Plus) used for the detection of dementia syndromes. However, for subjects suffering from mild cognitive impairment, completion time for the Trail-Making Test B, a brief cognitive test for the assessment of cognitive flexibility, was longer in the afternoon compared to the morning.

Objective: Neurocognitive deficits that persist despite antidepressive treatment and affect social and vocational functioning are well documented in major depressive disorder. Cognitive training approaches have proven successful in ameliorating these deficits in other psychiatric groups, but very few studies have been conducted in unipolar depressive patients by now. In contrast to previous studies solely including outpatients, effects of a cognitive remediation intervention on neurocognitive functioning of depressed inpatients were assessed by the present study. Method: A randomized controlled trial was carried out with 46 depressed inpatients of a psychiatric hospital. Patients were randomly assigned to either a control group that received standard drug and non-drug (cognitive behavioural, occupational, sports, relaxation and music therapy) antidepressive treatment or a remediation group that additionally received 12 sessions of cognitive training for a total of 4 weeks (three sessions per week). An intent to treat analysis and a last observation carried forward method was used for data analyses. Results: Patients of the remediation group demonstrated greater improvements in neurocognitive measures of verbal and nonverbal memory, working memory and executive function (Cohen’s d effect sizes between .52 and .98). Conclusions: These results provide preliminary evidence that cognitive remediation interventions can be successfully applied also in psychiatric inpatients experiencing an acute depressive episode.

BACKGROUND:Chronic low back pain (CLBP) is a serious health problem in industrialised countries and the efficacy of current treatment options is unsatisfying.OBJECTIVE:The present study examines the effects of a combined intervention that utilizes visual feedback, motion and sensory discrimination training in CLBP patients.METHODS:Thirty patients of an outpatient orthopaedic rehabilitation unit were randomly assigned to either feedback or control group. In addition to standard treatment, patients of the feedback group received 6 feedback sessions where they watched the image of their back during a brief 2-point discrimination training and, after that, while they were tilting their pelvis up and down on the left and right side using their lumbar musculus multifidus solely. The control group received 6 sessions consisting of 2 units of physiotherapy, relaxation training and movement training (walking) each.RESULTS:A significant effect on self-reported pain and sensory discrimination threshold could be found for the feedback intervention, while, as expected, other pain related variables, like pain anxiety, pain vigilance, depression and cognitive appraisal of pain remained unchanged.CONCLUSIONS:These findings imply that very simple feedback interventions without major technical requirements could be a valuable supplement to standard treatment in CLBP.

Abstract. Due to physical limitations (e. g. difficulties in reading and writing), geriatric inpatients are often not able to complete relevant dementia screening tests. The Bamberg Dementia Screening Test (BDST) is a new dementia screening measure that can be administered in a few minutes as “true bedside” – test. 150 patients suffering from mild cognitive impairment (MCI) and mild or moderate dementia as well as a control sample of 40 cognitively unimpaired participants completed the BDST and the CERAD-Plus test battery. High correlations of BDST-subscores with CERAD subtests of corresponding content and between the total scores of the two tests could be found. Using the BDST, mild dementia and MCI patients could be discriminated from healthy controls with high sensitivity and specificity.

BACKGROUND:Cognitive deficits are stable features of schizophrenia that are linked to functional outcome. Cognitive remediation approaches have been proven successful in ameliorating these deficits, although effect sizes vary considerably. Whether cognitive deficits are serious predictors of clinical outcome is less clear.METHODS:Sixty patients suffering from schizophrenia were included in our sample, thirty of them received computer-assisted cognitive training, and thirty received occupational therapy. For a subsample of 55 patients, who could be traced over a period of five years after the end of the cognitive remediation intervention, time until first relapse and time in psychosis were determined retrospectively from their medical records.RESULTS:Cognitive remediation significantly improved problem solving, memory and attention with high effect sizes. Employment status, a post test verbal memory performance measure and a measure of executive functioning outperformed all other measures in the prediction of time to relapse, while allocation to treatment group outperformed all other variables in the prediction of both cognitive measures.CONCLUSIONS:Cognitive remediation of neurocognitive deficits thus makes sense in a twofold fashion: It enhances cognition directly and positively acts on clinical course indirectly via improved neurocognition.TRIAL REGISTRATION:German Clinical Trials Register: DRKS00004880.

The 16th Biennial Winter Workshop in Psychoses, 30 January to 2 February 2011 Innsbruck, Austria: POSTER ABSTRACTS

Schizophrene Patienten haben ein erhohtes Sterblichkeitsrisiko und eine kurzere Lebenserwartung. Im historischen Verlauf ist zwar das absolute Sterblichkeitsrisiko gesunken, relativ hat die Sterblichkeit aber zugenommen. Neuroleptika stehen im Verdacht, zu dieser Zunahme beigetragen zu haben, da diese mittelbar uber eine Verstarkung des metabolischen Syndroms und negative Beeinflussung des Gesundheitsverhaltens wirken konnten. Untersuchungen an Patienten aus der Vor-Neuroleptika-A;ra und Vergleiche von neuroleptikabehandelten mit nicht medikamentos behandelten Patienten lassen aber den Schluss zu, dass die Behandlung mit Neuroleptika eher einen Schutzfaktor gegen eine erhohte Sterblichkeit darstellt.