TY - THES A1 - Förstner, Bernd Rainer T1 - Transdiagnostic assessment of mental disorders using the Research Domain Criteria (RDoC) approach: relationship to disease severity N2 - Traditionally, mental disorders have been identified based on specific symptoms and standardized diagnostic systems such as the DSM-5 and ICD-10. However, these symptom-based definitions may only partially represent neurobiological and behavioral research findings, which could impede the development of targeted treatments. A transdiagnostic approach to mental health research, such as the Research Domain Criteria (RDoC) approach, maps resilience and broader aspects of mental health to associated components. By investigating mental disorders in a transnosological way, we can better understand disease patterns and their distinguishing and common factors, leading to more precise prevention and treatment options. Therefore, this dissertation focuses on (1) the latent domain structure of the RDoC approach in a transnosological sample including healthy controls, (2) its domain associations to disease severity in patients with anxiety and depressive disorders, and (3) an overview of the scientific results found regarding Positive (PVS) and Negative Valence Systems (NVS) associated with mood and anxiety disorders. The following main results were found: First, the latent RDoC domain structure for PVS and NVS, Cognitive Systems (CS), and Social Processes (SP) could be validated using self-report and behavioral measures in a transnosological sample. Second, we found transdiagnostic and disease-specific associations between those four domains and disease severity in patients with depressive and anxiety disorders. Third, the scoping review showed a sizable amount of RDoC research conducted on PVS and NVS in mood and anxiety disorders, with research gaps for both domains and specific conditions. In conclusion, the research presented in this dissertation highlights the potential of the transnosological RDoC framework approach in improving our understanding of mental disorders. By exploring the latent RDoC structure and associations with disease severity and disease-specific and transnosological associations for anxiety and depressive disorders, this research provides valuable insights into the full spectrum of psychological functioning. Additionally, this dissertation highlights the need for further research in this area, identifying both RDoC indicators and research gaps. Overall, this dissertation represents an important contribution to the ongoing efforts to improve our understanding and the treatment of mental disorders, particularly within the commonly comorbid disease spectrum of mood and anxiety disorders. N2 - Traditionell werden psychische Störungen auf der Grundlage spezifischer Symptome und standardisierter Diagnosesysteme wie DSM-5 und ICD-10 diagnostiziert. Diese symptombasierten Definitionen entsprechen jedoch nur teilweise den Erkenntnissen der neurobiologischen und Verhaltensforschung, was die Entwicklung gezielter Behandlungen behindern kann. Ein transdiagnostischer Ansatz zur Erforschung psychischer Gesundheit, wie z. B. der Research Domain Criteria (RDoC) Ansatz, ordnet umfassendere Aspekte psychischer Gesundheit, wie z. B. Resilienz, den entsprechenden Komponenten zu. Durch die Untersuchung psychischer Störungen aus einer transnosologischen Perspektive können wir Krankheitsbilder und ihre gemeinsamen und unterscheidenden Faktoren besser verstehen, was zu präziseren Präventions- und Behandlungsmöglichkeiten führt. Daher konzentriert sich diese Dissertation auf (1) die latente Domänenstruktur des RDoC-Ansatzes in einer transnosologischen Stichprobe einschließlich gesunder Kontrollen, (2) die domänenspezifischen Assoziationen zur Krankheitsschwere bei Patienten mit Angst- und depressiven Störungen und (3) einen Überblick über die wissenschaftlichen Ergebnisse zu Positiven (PVS) und Negativen Valenzsystemen (NVS), die mit Affektiven Störungen assoziiert sind. Die folgenden Hauptergebnisse wurden gefunden: Erstens konnte die latente RDoC-Domänenstruktur für PVS und NVS, Kognitive Systeme (CS) und Soziale Prozesse (SP) anhand von Selbstberichten und Verhaltensmessungen in einer transnosologischen Stichprobe validiert werden. Zweitens fanden wir transdiagnostische und krankheitsspezifische Assoziationen zwischen diesen vier Domänen und der Krankheitsschwere bei Patienten mit Angst- und depressiven Störungen. Drittens zeigte die durchgeführte Übersichtsarbeit eine beträchtliche Menge an RDoC-Forschung zu PVS und NVS bei affektiven Störungen, mit Forschungslücken für beide Domänen und spezifische Bedingungen. Zusammenfassend lässt sich sagen, dass die in dieser Dissertation vorgestellten Forschungsergebnisse das Potenzial des transnosologischen RDoC-Konzepts zur Verbesserung unseres Verständnisses psychischer Störungen unterstreichen. Durch die Untersuchung der latenten RDoC-Struktur und der Assoziationen mit dem Krankheitsschweregrad sowie der krankheitsspezifischen und transnosologischen Assoziationen für Angst- und depressive Störungen liefert diese Forschungsarbeit wertvolle Einblicke in das gesamte Spektrum psychischer Funktionsweisen. Darüber hinaus zeigt diese Dissertation den Bedarf an weiterer Forschung in diesem Bereich auf, indem sie sowohl RDoC-Indikatoren als auch Forschungslücken identifiziert. Insgesamt stellt diese Dissertation einen wichtigen Beitrag zu den laufenden Bemühungen um ein besseres Verständnis und eine bessere Behandlung psychischer Störungen dar, insbesondere innerhalb des häufig komorbiden Krankheitsspektrums der affektiven Störungen. KW - diagnosis and classification KW - Research Domain Criteria KW - RDoC KW - transdiagnostic KW - positive valence systems KW - negative valence systems KW - disease severity KW - Diagnose und Klassifikation KW - transdiagnostisch KW - positives Valenzsystem KW - negatives Valenzsystem KW - Krankheitsschwere Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:kobv:517-opus4-611150 ER - TY - JOUR A1 - Hoffmann, Stephanie A1 - Tschorn, Mira A1 - Michalski, Niels A1 - Hoebel, Jens A1 - Förstner, Bernd Rainer A1 - Rapp, Michael A. A1 - Spallek, Jacob T1 - Association of regional socioeconomic deprivation and rurality with global developmental delay in early childhood BT - Data from mandatory school entry examinations in Germany JF - Health & place : an international journal ; a social science & medicine publication ; incorporating Geographia medica N2 - Background: From birth to young adulthood, health and development of young people are strongly linked to their living situation, including their family's socioeconomic position (SEP) and living environment. The impact of regional characteristics on development in early childhood beyond family SEP has been rarely investigated. This study aimed to identify regional predictors of global developmental delay at school entry taking family SEP into consideration. Method: We used representative, population-based data from mandatory school entry examinations of the German federal state of Brandenburg in 2018/2019 with n=22,801 preschool children. By applying binary multilevel models, we hierarchically analyzed the effect of regional deprivation defined by the German Index of Socioeconomic Deprivation (GISD) and rurality operationalized as inverted population density of the children's school district on global developmental delay (GDD) while adjusting for family SEP (low, medium and high) Results: Family SEP was significantly and strongly linked to GDD. Children with the highest family SEP showed a lower odds for GDD compared to a medium SEP (female: OR=4.26, male: OR=3.46) and low SEP (female: OR=16.58, male: OR=12.79). Furthermore, we discovered a smaller, but additional and independent effect of regional socioeconomic deprivation on GDD, with a higher odds for children from a more deprived school district (female: OR=1.35, male: OR=1.20). However, rurality did not show a significant link to GDD in preschool children beyond family SEP and regional deprivation. Conclusion: Family SEP and regional deprivation are risk factors for child development and of particular interest to promote health of children in early childhood and over the life course. KW - Health inequalities KW - Spatial analysis KW - Regional deprivation KW - Rurality KW - Developmental delay KW - Children Y1 - 2022 U6 - https://doi.org/10.1016/j.healthplace.2022.102794 SN - 1353-8292 SN - 1873-2054 VL - 75 PB - Elsevier Science CY - Amsterdam [u.a.] ER - TY - JOUR A1 - Förstner, Bernd Rainer A1 - Böttger, Sarah Jane A1 - Moldavski, Alexander A1 - Bajbouj, Malek A1 - Pfennig, Andrea A1 - Manook, Andre A1 - Ising, Marcus A1 - Pittig, Andre A1 - Heinig, Ingmar A1 - Heinz, Andreas A1 - Mathiak, Klaus A1 - Schulze, Thomas G. A1 - Schneider, Frank A1 - Kamp-Becker, Inge A1 - Meyer-Lindenberg, Andreas A1 - Padberg, Frank A1 - Banaschewski, Tobias A1 - Bauer, Michael A1 - Rupprecht, Rainer A1 - Wittchen, Hans-Ulrich A1 - Rapp, Michael A. A1 - Tschorn, Mira T1 - The associations of positive and negative valence systems, cognitive systems and social processes on disease severity in anxiety and depressive disorders JF - Frontiers in psychiatry N2 - Background Anxiety and depressive disorders share common features of mood dysfunctions. This has stimulated interest in transdiagnostic dimensional research as proposed by the Research Domain Criteria (RDoC) approach by the National Institute of Mental Health (NIMH) aiming to improve the understanding of underlying disease mechanisms. The purpose of this study was to investigate the processing of RDoC domains in relation to disease severity in order to identify latent disorder-specific as well as transdiagnostic indicators of disease severity in patients with anxiety and depressive disorders. Methods Within the German research network for mental disorders, 895 participants (n = 476 female, n = 602 anxiety disorder, n = 257 depressive disorder) were recruited for the Phenotypic, Diagnostic and Clinical Domain Assessment Network Germany (PD-CAN) and included in this cross-sectional study. We performed incremental regression models to investigate the association of four RDoC domains on disease severity in patients with affective disorders: Positive (PVS) and Negative Valance System (NVS), Cognitive Systems (CS) and Social Processes (SP). Results The results confirmed a transdiagnostic relationship for all four domains, as we found significant main effects on disease severity within domain-specific models (PVS: & beta; = -0.35; NVS: & beta; = 0.39; CS: & beta; = -0.12; SP: & beta; = -0.32). We also found three significant interaction effects with main diagnosis showing a disease-specific association. Limitations The cross-sectional study design prevents causal conclusions. Further limitations include possible outliers and heteroskedasticity in all regression models which we appropriately controlled for. Conclusion Our key results show that symptom burden in anxiety and depressive disorders is associated with latent RDoC indicators in transdiagnostic and disease-specific ways. KW - Research Domain Criteria KW - depression KW - anxiety disoders KW - disease severity KW - transdiagnostic KW - RDoC Y1 - 2023 U6 - https://doi.org/10.3389/fpsyt.2023.1161097 SN - 1664-0640 VL - 14 PB - Frontiers Research Foundation CY - Lausanne ER - TY - JOUR A1 - Tschorn, Mira A1 - Schulze, Susanne A1 - Förstner, Bernd Rainer A1 - Holmberg, Christine A1 - Spallek, Jacob A1 - Heinz, Andreas A1 - Rapp, Michael A. T1 - Predictors and prevalence of hazardous alcohol use in middle-late to late adulthood in Europe JF - Aging & mental health N2 - Objectives: Even low to moderate levels of alcohol consumption can have detrimental health consequences, especially in older adults (OA). Although many studies report an increase in the proportion of drinkers among OA, there are regional variations. Therefore, we examined alcohol consumption and the prevalence of hazardous alcohol use (HAU) among men and women aged 50+ years in four European regions and investigated predictors of HAU. Methods: We analyzed data of N = 35,042 participants of the European SHARE study. We investigated differences in alcohol consumption (units last week) according to gender, age and EU-region using ANOVAs. Furthermore, logistic regression models were used to examine the effect of income, education, marital status, history of a low-quality parent-child relationship and smoking on HAU, also stratified for gender and EU-region. HAU was operationalized as binge drinking or risky drinking (<12.5 units of 10 ml alcohol/week). Results: Overall, past week alcohol consumption was 5.0 units (+/- 7.8), prevalence of HAU was 25.4% within our sample of European adults aged 50+ years. Male gender, younger age and living in Western Europe were linked to both higher alcohol consumption and higher risks of HAU. Income, education, smoking, a low-quality parent-child relationship, living in Northern and especially Eastern Europe were positively associated with HAU. Stratified analyses revealed differences by region and gender. Conclusions: HAU was highly prevalent within this European sample of OA. Alcohol consumption and determinants of HAU differed between EU-regions, hinting to a necessity of risk-stratified population-level strategies to prevent HAU and subsequent alcohol use disorders. KW - Hazardous alcohol use KW - older adults KW - middle-aged adults KW - Europe KW - alcohol KW - drug and alcohol abuse KW - cross-national KW - international studies KW - environmental factors KW - housing KW - rural-urban factors KW - epidemiology (mental health) Y1 - 2022 U6 - https://doi.org/10.1080/13607863.2022.2076208 SN - 1360-7863 SN - 1364-6915 VL - 27 IS - 5 SP - 1001 EP - 1010 PB - Routledge, Taylor & Francis Group CY - Abingdon ER - TY - JOUR A1 - Förstner, Bernd R. A1 - Tschorn, Mira A1 - Reinoso-Schiller, Nicolas A1 - Maričić, Lea Mascarell A1 - Röcher, Erik A1 - Kalman, Janos L. A1 - Stroth, Sanna A1 - Mayer, Annalina V. A1 - Schwarz, Kristina A1 - Kaiser, Anna A1 - Pfennig, Andrea A1 - Manook, André A1 - Ising, Marcus A1 - Heinig, Ingmar A1 - Pittig, Andre A1 - Heinz, Andreas A1 - Mathiak, Klaus A1 - Schulze, Thomas G. A1 - Schneider, Frank A1 - Kamp-Becker, Inge A1 - Meyer-Lindenberg, Andreas A1 - Padberg, Frank A1 - Banaschewski, Tobias A1 - Bauer, Michael A1 - Rupprecht, Rainer A1 - Wittchen, Hans-Ulrich A1 - Rapp, Michael A. T1 - Mapping research domain criteria using a transdiagnostic mini-RDoC assessment in mental disorders: a confirmatory factor analysis JF - European archives of psychiatry and clinical neuroscience N2 - This study aimed to build on the relationship of well-established self-report and behavioral assessments to the latent constructs positive (PVS) and negative valence systems (NVS), cognitive systems (CS), and social processes (SP) of the Research Domain Criteria (RDoC) framework in a large transnosological population which cuts across DSM/ICD-10 disorder criteria categories. One thousand four hundred and thirty one participants (42.1% suffering from anxiety/fear-related, 18.2% from depressive, 7.9% from schizophrenia spectrum, 7.5% from bipolar, 3.4% from autism spectrum, 2.2% from other disorders, 18.4% healthy controls, and 0.2% with no diagnosis specified) recruited in studies within the German research network for mental disorders for the Phenotypic, Diagnostic and Clinical Domain Assessment Network Germany (PD-CAN) were examined with a Mini-RDoC-Assessment including behavioral and self-report measures. The respective data was analyzed with confirmatory factor analysis (CFA) to delineate the underlying latent RDoC-structure. A revised four-factor model reflecting the core domains positive and negative valence systems as well as cognitive systems and social processes showed a good fit across this sample and showed significantly better fit compared to a one factor solution. The connections between the domains PVS, NVS and SP could be substantiated, indicating a universal latent structure spanning across known nosological entities. This study is the first to give an impression on the latent structure and intercorrelations between four core Research Domain Criteria in a transnosological sample. We emphasize the possibility of using already existing and well validated self-report and behavioral measurements to capture aspects of the latent structure informed by the RDoC matrix. KW - Diagnosis and classification KW - Research Domain Criteria KW - PD-CAN KW - Confirmatory factor analysis CFA KW - RDoC KW - Transdiagnostic Y1 - 2022 U6 - https://doi.org/10.1007/s00406-022-01440-6 SN - 0940-1334 SN - 1433-8491 VL - 273 IS - 3 SP - 527 EP - 539 PB - Springer Nature CY - Heidelberg ER - TY - JOUR A1 - Herrmann, Matthias L. A1 - Boden, Cindy A1 - Maurer, Christoph A1 - Kentischer, Felix A1 - Mennig, Eva A1 - Wagner, Sören A1 - Conzelmann, Lars O. A1 - Förstner, Bernd R. A1 - Rapp, Michael A. A1 - von Arnim, Christine A. F. A1 - Denkinger, Michael A1 - Eschweiler, Gerhard W. A1 - Thomas, Christine T1 - Anticholinergic drug exposure increases the risk of delirium in older patients undergoing elective surgery JF - Frontiers in medicine N2 - IntroductionPostoperative delirium (POD) is a common and serious adverse event of surgery in older people. Because of its great impact on patients' safety and quality of life, identification of modifiable risk factors could be useful. Although preoperative medication intake is assumed to be an important modifiable risk factor, the impact of anticholinergic drugs on the occurrence of POD seems underestimated in elective surgery. The aim of this study was to investigate the association between preoperative anticholinergic burden and POD. We hypothesized that a high preoperative anticholinergic burden is an independent, potentially modifiable predisposing and precipitating factor of POD in older people. MethodsBetween November 2017 and April 2019, 1,470 patients of 70 years and older undergoing elective orthopedic, general, cardiac, or vascular surgery were recruited in the randomized, prospective, multicenter PAWEL trial. Anticholinergic burden of a sub-cohort of 899 patients, who did not receive a multimodal intervention for preventing POD, was assessed by two different tools at hospital admission: The established Anticholinergic Risk Scale (ARS) and the recently developed Anticholinergic Burden Score (ABS). POD was detected by confusion assessment method (CAM) and a validated post discharge medical record review. Logistic regression analyses were performed to evaluate the association between anticholinergic burden and POD. ResultsPOD was observed in 210 of 899 patients (23.4%). Both ARS and ABS were independently associated with POD. The association persisted after adjustment for relevant confounding factors such as age, sex, comorbidities, preoperative cognitive and physical status, number of prescribed drugs, surgery time, type of surgery and anesthesia, usage of heart-lung-machine, and treatment in intensive care unit. If a patient was taking one of the 56 drugs listed in the ABS, risk for POD was 2.7-fold higher (OR = 2.74, 95% CI = 1.55-4.94) and 1.5-fold higher per additional point on the ARS (OR = 1.54, 95% CI = 1.15-2.02). ConclusionPreoperative anticholinergic drug exposure measured by ARS or ABS was independently associated with POD in older patients undergoing elective surgery. Therefore, identification, discontinuation or substitution of anticholinergic medication prior to surgery may be a promising approach to reduce the risk of POD in older patients. KW - delirium KW - acute encephalopathy KW - surgery KW - anticholinergic KW - geriatric KW - postoperative Y1 - 2022 U6 - https://doi.org/10.3389/fmed.2022.871229 SN - 2296-858X VL - 9 PB - Frontiers Media CY - Lausanne ER - TY - CHAP A1 - Förstner, Bernd A1 - Sanchez, Alba T1 - Postoperative cognitive deficits (POCD) in 1-year long-term follow-up after various elective surgeries in the elderly people T2 - Zeitschrift für Gerontologie und Geriatrie Y1 - 2022 U6 - https://doi.org/10.1007/s00391-022-02095-7 SN - 0948-6704 SN - 1435-1269 VL - 55 IS - Suppl 1 SP - S86 EP - S86 PB - Springer CY - Heidelberg ER - TY - JOUR A1 - Desch, Anke A1 - Förstner, Bernd Rainer A1 - Artmann, Jörg A1 - Häusler, Andreas A1 - Hauptmann, Michael A1 - Altin, Sibel Vildan A1 - Rapp, Michael A. A1 - Holmberg, Christine T1 - A theory of change of an innovation for therapeutic care and meaningful living in a German nursing home JF - BMC geriatrics N2 - Background: Demographic changes are leading to growing care needs of older people and creating a challenge for healthcare systems worldwide. Nursing homes (NHs) need to provide care for growing numbers of residents while ensuring a high-quality care. We aimed to examine an innovative NH in Germany and apply a theory of change (ToC) approach to develop a best practice model (BPM) for therapeutic care in NHs. Methods: A multimethod qualitative study conducted from February to July 2021 in Germany involved interviews with 14 staff members of an innovative NH and 10 directors and care managers of other NHs. The interview guidelines included questions on nursing practices, infrastructure, resources, interprofessional collaboration, and working culture. Additional material on the participating NH (website, promotion videos, newsletters, care documentation) were collected. Contextual literature on NH culture and therapeutic care in Germany, ToC methodology, and NH culture change were reviewed. Following a question-focused analysis of all material, we generated a ToC model towards a BPM of therapeutic care and meaningful living in NHs. Results: were verified in interdisciplinary team meetings, with study participants and other stakeholders to establish consensus. Results The participating NH's care concept aims to improve residents' functional abilities and wellbeing as well as staff members' job satisfaction. Central components of their approach include therapeutic elements such as music and movement in all nursing activities, multidisciplinary collaboration, a broad therapy and social activity offer, the continuation of therapy in everyday activities, a focus on individual life history, values, needs, and skills, social integration into the regional community, and the creation of a meaningful living environment for residents and staff. Conclusion: The BPM we developed shows how a meaningful living environment can be created through therapeutic care and integrative activities. The ToC sheds light onto the contextual factors and cultural values which should be considered in the development of NH interventions. Research on not only biomedical aspects, but also psychosocial dynamics and narrative co-constructions in nursing practice should inform NH innovations. The ToC also highlights the importance of developing adequate political frameworks and infrastructures for implementing such innovative practices on a larger scale. KW - positive gerontology KW - de-institutionalization KW - meaning-making KW - therapeutic emplotment KW - integrated narrative nursing KW - nursing home culture change Y1 - 2022 U6 - https://doi.org/10.1186/s12877-022-03462-0 SN - 1471-2318 VL - 22 IS - 1 PB - BioMed Central CY - London ER -