TY - JOUR A1 - Deeken, Friederike A1 - Rezo, Anna A1 - Hinz, Matthias A1 - Discher, Robert A1 - Rapp, Michael A. T1 - Evaluation of technology-based interventions for informal caregivers of patients with dementia BT - a Meta-Analysis of Randomized Controlled Trials JF - The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry N2 - Objective: The aim of this study was to estimate the efficacy of technology-based interventions for informal caregivers of people with dementia (PWD). Methods: PubMed, PsycINFO, and Cochrane Library databases were searched in August 2018, with no restrictions in language or publication date. Two independent reviewers identified 33 eligible randomized controlled trials (RCTs) conducting a technology-based intervention for informal carers of PWD. Meta-analyses for the outcome measures caregiver depression and caregiver burden were conducted with subgroup analyses according to mode of delivery (telephone, computer/web-based, combined interventions). To assess methodologic quality, the Cochrane risk-of-bias assessment was rated. Results: Meta-analyses revealed a small but significant postintervention effect of technology-based interventions for caregiver depression and caregiver burden. Combined interventions showed the strongest effects. Conclusion: Technology-based interventions have the potential to support informal caregivers of PWD. Because of advantages such as high flexibility and availability, technology-based interventions provide a promising alternative compared with "traditional services," e.g., those for people living in rural areas. More high-quality RCTs for specific caregiver groups are needed. KW - Caregiver KW - dementia KW - technology KW - meta-analysis Y1 - 2019 U6 - https://doi.org/10.1016/j.jagp.2018.12.003 SN - 1064-7481 SN - 1545-7214 VL - 27 IS - 4 SP - 426 EP - 445 PB - Elsevier CY - New York ER - TY - JOUR A1 - Zech, Philipp A1 - Perez Chaparro, Camilo Germán Alberto A1 - Schuch, Felipe A1 - Wolfarth, Bernd A1 - Rapp, Michael A. A1 - Heissel, Andreas T1 - Effects of Aerobic and Resistance Exercise on Cardiovascular Parameters for People Living With HIV BT - a Meta-analysis JF - JANAC-Journal of the Association of Nurses in AIDS Care N2 - People living with HIV (PLWH) have limited exercise capacity because of anemia, neuromuscular disorders, and pulmonary limitations. We used a meta-analysis to examine the effect of aerobic and resistance exercise alone and in combination on cardiovascular parameters. Subgroup meta-analyses were conducted and long-term effects of exercise were investigated. A systematic literature search was conducted up to July/August 2017. The Physiotherapy Evidence Database-scale was used to rate quality and assess the risk of bias on the papers. Standardized mean differences (SMDs) were calculated to assess the effect of exercise. Posttreatment comparison between the exercise and control groups revealed moderate and large effect sizes in favor of the intervention group for VO2max (SMD50.66, p < .0001) and the 6-minute walk test (SMD = 1.11, p = .0001). Exercise had a positive effect on cardiovascular parameters in PLWH. Exercise can be a prevention factor for PLWH dealing with multiple comorbidities. KW - aerobic exercise KW - cardiovascular KW - HIV KW - long-term effects KW - physical exercise KW - resistance training Y1 - 2019 U6 - https://doi.org/10.1097/JNC.0000000000000006 SN - 1055-3290 SN - 1552-6917 VL - 30 IS - 2 SP - 186 EP - 205 PB - Lippincott Williams & Wilkins CY - Philadelphia ER - TY - JOUR A1 - Heinzel, Stephan A1 - Lorenz, Robert C. A1 - Pelz, Patricia A1 - Heinz, Andreas A1 - Walter, Henrik A1 - Kathmann, Norbert A1 - Rapp, Michael A. A1 - Stelzel, Christine T1 - Neural correlates of training and transfer effects in working memory in older adults JF - NeuroImage : a journal of brain function N2 - As indicated by previous research, aging is associated with a decline in working memory (WM) functioning, related to alterations in fronto-parietal neural activations. At the same time, previous studies showed that WM training in older adults may improve the performance in the trained task (training effect), and more importantly, also in untrained WM tasks (transfer effects). However, neural correlates of these transfer effects that would improve understanding of its underlying mechanisms, have not been shown in older participants as yet. In this study, we investigated blood-oxygen-level-dependent (BOLD) signal changes during n-back performance and an untrained delayed recognition (Sternberg) task following 12 sessions (45 min each) of adaptive n-back training in older adults. The Sternberg task used in this study allowed to test for neural training effects independent of specific task affordances of the trained task and to separate maintenance from updating processes. Thirty-two healthy older participants (60-75 years) were assigned either to an n-back training or a no-contact control group. Before (t1) and after (t2) training/waiting period, both the n-back task and the Sternberg task were conducted while BOLD signal was measured using functional Magnetic Resonance Imaging (fMRI) in all participants. In addition, neuropsychological tests were performed outside the scanner. WM performance improved with training and behavioral transfer to tests measuring executive functions, processing speed, and fluid intelligence was found. In the training group, BOLD signal in the right lateral middle frontal gyrus/caudal superior frontal sulcus (Brodmann area, BA 6/8) decreased in both the trained n-back and the updating condition of the untrained Sternberg task at t2, compared to the control group. fMRI findings indicate a training-related increase in processing efficiency of WM networks, potentially related to the process of WM updating. Performance gains in untrained tasks suggest that transfer to other cognitive tasks remains possible in aging. (C) 2016 Elsevier Inc. All rights reserved. KW - Aging KW - Working memory KW - Training KW - Transfer KW - Neuroimaging KW - fMRI KW - Updating KW - Executive functions KW - Fluid intelligence Y1 - 2016 U6 - https://doi.org/10.1016/j.neuroimage.2016.03.068 SN - 1053-8119 SN - 1095-9572 VL - 134 SP - 236 EP - 249 PB - Elsevier CY - San Diego ER - TY - JOUR A1 - Drosselmeyer, Julia A1 - Rapp, Michael A. A1 - Kostev, Karel T1 - Prevalence and type of antidepressant therapy used by German general practitioners to treat female patients with osteoporosis JF - International journal of clinical pharmacology and therapeutics N2 - Objective: To estimate the prevalence and type of antidepressant medication prescribed by German primary care physicians for patients with depression and osteoporosis. Methods: This study was a retrospective database analysis conducted in Germany utilizing the Disease Analyzer (R) Database (IMS Health, Germany). The study population included 3,488 female osteoporosis patients aged between 40 and 90 years recruited from 1,179 general practitioner practices and who were initially diagnosed with depression during the index period (January 2004 to December 2013). Follow-up lasted up to 12 months and was completed in August 2015. Also included in this study were 3,488 nonosteoporosis controls who were matched (1 : 1) to osteoporosis cases on the basis of age, health insurance coverage, severity of depression, and physician carrying out the diagnosis. Results: After 12 months of followup, 30.1% of osteoporosis and 29.9% of nonosteoporosis patients with mild depression (p = 0.783), 52.4% of osteoporosis and 48.0% of non-osteoporosis patients with moderate depression (p = 0.003), and 39.4% of osteoporosis and 35.1% of nonosteoporosis patients with severe depression (p = 0.147) were being treated with antidepressants. Osteoporosis patients with moderate depression had a higher chance of being prescribed antidepressant therapy at the initial diagnosis (hazard ratio (HR): 1.12, p = 0.014). No differences were found between osteoporosis and nonosteoporosis patients regarding the proportion of patients receiving selective serotonin reuptake inhibitors (SSRI)/serotonin-noradrenaline reuptake inhibitors (SNRI), tricyclic antidepressant (TCA), or other antidepressants. Osteoporosis patients were more often referred to hospitals or psychiatrists for consultation. Conclusion: Osteoporosis patients are more often treated initially with antidepressants than non-osteoporosis patients, especially within the groups of patients with moderate or severe depression. TCA was the most frequently used antidepressant therapy class on initial diagnosis in both patient groups. Osteo-porosis patients receive referrals to hospitals or psychiatrists more often than patients without osteoporosis. KW - depression therapy KW - osteoporosis KW - hospital referral KW - primary care practices Y1 - 2016 U6 - https://doi.org/10.5414/CP202610 SN - 0946-1965 VL - 54 SP - 743 EP - 749 PB - Dustri-Verlag Dr. Karl Feistle CY - Deisenhofen-München ER - TY - JOUR A1 - Bakanidze, George A1 - Brandl, Eva J. A1 - Hutzler, Christine A1 - Aurass, Friederike A1 - Onken, Silke A1 - Rapp, Michael A. A1 - Puls, Imke T1 - Association of Dystrobrevin-Binding Protein 1 Polymorphisms with Sustained Attention and Set-Shifting in Schizophrenia Patients JF - Neuropsychobiology : international journal of experimental and clinical research in biological psychiatry, pharmacopsychiatry, Biological Psychology/Pharmacopsychology and Pharmacoelectroencephalography N2 - Background: Despite extensive research in the past decades, the influence of genetics on cognitive functions in schizophrenia remains unclear. Dystrobrevin-binding protein 1 (DTNBP1) is one of the most promising candidate genes in schizophrenia. An association of DTNBP1 with cognitive dysfunction, particularly memory impairment, has been reported in a number of studies. However, the results remain inconsistent. The aim of this study was to measure the association between DTNBP1 polymorphisms and cognitive domains in a well-characterized sample. Methods: Ninety-one clinically stable schizophrenia outpatients underwent a battery of cognitive tests. Six single nucleotide polymorphisms (SNPs) of DTNBP1 were genotyped in all participants. Statistical and multivariate analyses were performed. Results: Factor analysis revealed 4 factors corresponding to distinct cognitive domains, namely sustained attention, set-shifting, executive functioning, and memory. We found a significant association of the rs909706 polymorphism with attention (p = 0.030) and a nonsignificant trend for set-shifting (p = 0.060). The other SNPs and haplotypes were not associated with cognitive function. Discussion: Replication of this finding in a larger sample is needed in order to confirm the importance of this particular polymorphism in the genetics of schizophrenia, particularly the distinct cognitive domains. In conclusion, the present study supports the involvement of DTNBP1 in the regulation of cognitive processes and demonstrates association in particular with sustained attention and set-shifting in schizophrenia patients. (C) 2016 S. Karger AG, Basel KW - DTNBP1 KW - Genetics KW - Cognitive dysfunction KW - Factor analysis Y1 - 2016 U6 - https://doi.org/10.1159/000450550 SN - 0302-282X SN - 1423-0224 VL - 74 SP - 41 EP - 47 PB - Karger CY - Basel ER - TY - JOUR A1 - Drosselmeyer, J. A1 - Rapp, Michael A. A1 - Hadji, P. A1 - Kostev, K. T1 - Depression risk in female patients with osteoporosis in primary care practices in Germany JF - Osteoporosis international N2 - The Summary Thirty-five thousand four hundred eighty-three female osteoporosis patients were compared with 35,483 patients without osteoporosis regarding the incidence of depression. The risk of depression is significantly increased for patients with osteoporosis compared with patients without osteoporosis in primary care practices within Germany. Introduction The objectives of the present study were to analyze the incidence of depression in German female patients with osteoporosis and to evaluate the risk factors for depression diagnosis within this patient population. Methods This study was a retrospective database analysis conducted in Germany utilizing the Disease Analyzer (R) Database (IMS Health, Germany). The study population included 70,966 patients between 40 and 80 years of age from 1072 primary care practices. The observation period was between 2004 and 2013. Follow-up duration was 5 years and was completed in April 2015. A total of 35,483 osteoporosis patients were selected after applying exclusion criteria, and 35,483 controls were chosen and then matched (1:1) to osteoporosis patients based on age, sex, health insurance coverage, depression diagnosis in the past, and follow-up duration after index date. The analyses of depression-free survival were carried out using Kaplan-Meier curves and log-rank tests. Cox proportional hazards models (dependent variable: depression) were used to adjust for confounders. Results Depression diagnoses were presented in 33.0% of the osteoporosis group and 22.7% of the control group after the 5-year follow-up (p < 0.001). Dementia, cancer, heart failure, coronary heart disease, and diabetes were associated with a higher risk of developing depression (p < 0.001). Private health insurance was associated with a lower risk of depression. There was no significant effect of fractures on depression risk. Conclusion The risk of depression is significantly increased for patients with osteoporosis in primary care practices within Germany. KW - Comorbidity KW - Depression risk KW - Osteoporosis KW - Primary care practice Y1 - 2016 U6 - https://doi.org/10.1007/s00198-016-3584-9 SN - 0937-941X SN - 1433-2965 VL - 27 SP - 2739 EP - 2744 PB - Springer CY - London ER - TY - JOUR A1 - Konrad, Marcel A1 - Jacob, Louis A1 - Rapp, Michael A. A1 - Kostev, Karel T1 - Depression risk in patients with coronary heart disease in Germany JF - World Journal of Cardiology N2 - AIM To determine the prevalence of depression and its risk factors among patients with coronary heart disease (CHD) treated in German primary care practices. METHODS Longitudinal data from nationwide general practices in Germany (n = 1072) were analyzed. Individuals initially diagnosed with CHD (2009-2013) were identified, and 59992 patients were included and matched (1: 1) to 59992 controls. The primary outcome measure was an initial diagnosis of depression within five years after the index date among patients with and without CHD. Cox proportional hazards models were used to adjust for confounders. RESULTS Mean age was equal to 68.0 years (SD = 11.3). A total of 55.9% of patients were men. After a five-year follow-up, 21.8% of the CHD group and 14.2% of the control group were diagnosed with depression (P < 0.001). In the multivariate regression model, CHD was a strong risk factor for developing depression (HR = 1.54, 95% CI: 1.49-1.59, P < 0.001). Prior depressive episodes, dementia, and eight other chronic conditions were associated with a higher risk of developing depression. Interestingly, older patients and women were also more likely to be diagnosed with depression compared with younger patients and men, respectively. CONCLUSION The risk of depression is significantly increased among patients with CHD compared with patients without CHD treated in primary care practices in Germany. CHD patients should be routinely screened for depression to ensure improved treatment and management. KW - Coronary heart disease KW - Depression KW - Primary care KW - Risk factors KW - Quality of life Y1 - 2016 U6 - https://doi.org/10.4330/wjc.v8.i9.547 SN - 1949-8462 VL - 8 SP - 547 EP - 552 PB - Baishideng Publishing Group CY - Pleasanton ER - TY - JOUR A1 - Booker, Anke A1 - Bohlken, Jens A1 - Rapp, Michael A. A1 - Kostev, Karel T1 - Persistence with antidepressant drugs in patients with dementia: a retrospective database analysis JF - International journal of clinical pharmacology and therapeutics N2 - Background: The aims of the present study are to determine what proportion of patients with dementia receives antidepressants, how long the treatment is administered, and what factors increase the risk of discontinuation. Methods: The study was based on Disease Analyzer database and included 1,203 general practitioners (GP) and 209 neurologists/psychiatrists (NP). 12,281 patients with a diagnosis of dementia and an initial prescription of an antidepressant drug between January 2004 and December 2013 were included. The main outcome measure was antidepressant discontinuation rates within 6 months of the index date. Results: After 6 months of follow-up, 52.7% of dementia patients treated with antidepressants had stopped medication intake. There was a significantly decreased risk for treatment discontinuation for patients using selective serotonin reuptake inhibitors (SSRRIs) or serotonin and norepinephrine reuptake inhibitors (SSNRIs) compared to tricyclic antidepressants. There was a significantly increased risk of treatment discontinuation for older patients and patients treated in NP practice. Comorbidity of diabetes or history of stroke was associated with a decreased risk of treatment discontinuation. Conclusion: The study results show insufficient persistence in antidepressant treatment in dementia patients in a real world setting. The improvement must be achieved to ensure the treatment recommended in the guidelines. KW - depression Y1 - 2016 U6 - https://doi.org/10.5414/CP202572 SN - 0946-1965 VL - 54 SP - 323 EP - 329 PB - Dustri-Verlag Dr. Karl Feistle CY - Deisenhofen-München ER - TY - JOUR A1 - Booker, Anke A1 - Jacob, Louis E. C. A1 - Rapp, Michael A. A1 - Bohlken, Jens A1 - Kostev, Karel T1 - Risk factors for dementia diagnosis in German primary care practices JF - International psychogeriatrics N2 - Background: Dementia is a psychiatric condition the development of which is associated with numerous aspects of life. Our aim was to estimate dementia risk factors in German primary care patients. Methods: The case-control study included primary care patients (70-90 years) with first diagnosis of dementia (all-cause) during the index period (01/2010-12/2014) (Disease Analyzer, Germany), and controls without dementia matched (1:1) to cases on the basis of age, sex, type of health insurance, and physician. Practice visit records were used to verify that there had been 10 years of continuous follow-up prior to the index date. Multivariate logistic regression models were fitted with dementia as a dependent variable and the potential predictors. Conclusions: Risk factors for dementia found in this study are consistent with the literature. Nevertheless, the associations between statin, PPI and antihypertensive drug use, and decreased risk of dementia need further investigations. KW - dementia KW - Alzheimer KW - risk factors KW - statins Y1 - 2016 U6 - https://doi.org/10.1017/S1041610215002082 SN - 1041-6102 SN - 1741-203X VL - 28 SP - 1059 EP - 1065 PB - Cambridge Univ. Press CY - New York ER - TY - GEN A1 - Stroehle, Andreas A1 - Rapp, Michael A. T1 - Prevention of Cognitive Decline: A Physical Exercise Perspective on Brain Health in the Long Run T2 - Journal of the American Medical Directors Association Y1 - 2016 U6 - https://doi.org/10.1016/j.jamda.2016.02.030 SN - 1525-8610 SN - 1538-9375 VL - 17 SP - 461 EP - 462 PB - Elsevier CY - New York ER - TY - JOUR A1 - Nienaber, André A1 - Heinz, Andreas A1 - Rapp, Michael A. A1 - Bermpohl, F. A1 - Schulz, M. A1 - Behrens, J. A1 - Löhr, M. T1 - Einfluss der Personalbesetzung auf Konflikte auf psychiatrischen Stationen T1 - Influence of staffing levels on conflicts in inpatient psychiatric care JF - Der Nervenarzt : Organ der Deutschen Gesellschaft für Psychiatrie, Psychotherapie und Nervenheilkunde ; Mitteilungsblatt der Deutschen Gesellschaft für Neurologie N2 - Psychiatrische Stationen sind ein wichtiges Element in der psychiatrischen Versorgung von Menschen mit akuter Eigen- oder Fremdgefährdung. Leider kommt es in diesem Rahmen immer wieder auch zu Aggression, Gewalt (Konflikten) sowie zur Anwendung von Zwang (Eindämmung). Als entscheidender Faktor für den sachgemäßen Umgang mit diesen Situationen wird sowohl die Quantität als auch die Qualität der Mitarbeitenden angesehen. Vor diesem Hintergrund beschäftigt sich die vorliegende Untersuchung mit der Versorgungssituation auf akutpsychiatrischen Stationen. Die Hypothese lautet, dass sowohl die Größe der akutpsychiatrischen Station als auch die Anzahl der Pflegenden einen Einfluss auf das Vorkommen konflikthafter Situationen haben. Hierfür sind Daten in 6 Kliniken auf insgesamt 12 psychiatrischen Stationen erfasst worden. Als Erfassungsinstrument diente die Patient Staff Conflict Checklist – Shift Report (PCC-SR). Insgesamt konnten 2026 Schichten (Früh‑, Spät- und Nachtschicht) erfasst und ausgewertet werden. Die personelle Besetzung der Stationen mit Pflegepersonal variierte erheblich. Die Ergebnisse zeigen, dass sowohl die Stationsgröße als auch die Anzahl der Pflegepersonen auf akutpsychiatrischen Stationen einen signifikanten Einfluss auf das Vorkommen von Konflikten haben. In den Ergebnissen zeigt sich weiterhin, dass sich die Inzidenz des konflikthaften Verhaltens von Patienten sowohl im Hinblick auf die untersuchten Stationen der beteiligten Krankenhäuser als auch im Hinblick auf die betrachteten Dienstzeittypen unterscheiden. Darüber hinaus zeigt sich, dass das Ausmaß der Schließung einer Akutstation und die Größe einer Station einen negativen Einfluss auf die Inzidenz von Konflikten im stationär akutpsychiatrischen Kontext haben. Das Auftreten konflikthaften Verhaltens kann zur Fremd- oder Selbstgefährdung und zu einer Vielzahl deeskalierender und eindämmender Maßnahmen führen. Hierfür sind entsprechende personelle Ressourcen erforderlich. N2 - Acute psychiatric wards are an important element in the mental healthcare of people at risk for acute harm to others or self-harm. Unfortunately, aggression, violence (conflict) and the use of coercion (containment) are still part of psychiatric care. The decisive factor for the correct handling of these situations is the quantity as well as the quality of the employees. Therefore, the present study dealt with the care situation on acute psychiatric wards. The hypothesis is that both the number of beds on the acute psychiatric ward and the number of caregivers have an impact on the occurrence of conflict and containment. For this purpose, data were collected in 6 clinics on a total of 12 acute psychiatric wards. The Patient Staff Conflict Checklist - Shift Report (PCC-SR) was used as the data entry tool. A total of 2026 shifts (early, late and night shifts) were recorded and evaluated. The staffing of the wards with nursing personnel varied considerably. The results show that both the size of the ward and also the number of caregivers on acute psychiatric wards have a significant impact on the occurrence of conflicts. The results also show that the incidence of conflicting behavior of patients differs both in terms of the wards of the hospitals involved and in the type of service considered. In addition, it can be seen that the extent of closure of an acute ward (i.aEuroe. the closed ward or entrance door) and the size of a ward (i.aEuroe. the number of beds) have a negative impact on the incidence of inpatient acute psychiatric contexts. The occurrence of conflict behavior can lead to alien or self-endangerment and to a variety of de-escalating and containment measures. This requires appropriate human resources. KW - Inpatient psychiatric care KW - Danger to others KW - Coercion KW - Ward size KW - Personnel resources Y1 - 2018 U6 - https://doi.org/10.1007/s00115-018-0521-5 SN - 0028-2804 SN - 1433-0407 VL - 89 IS - 7 SP - 821 EP - 827 PB - Springer CY - New York ER - TY - JOUR A1 - Heißel, Andreas A1 - Bollmann, Julian A1 - Kangas, Maria A1 - Abdulla, K A1 - Rapp, Michael A. A1 - Sánchez Fernàndez, Alba Cristina T1 - Validation of the German version of the work and social adjustment scale in a sample of depressed patients JF - BMC health services research N2 - Background Depression is one of the key factors contributing to difficulties in one’s ability to work, and serves as one of the major reasons why employees apply for psychotherapy and receive insurance subsidization of treatments. Hence, an increasing and growing number of studies rely on workability assessment scales as their primary outcome measure. The Work and Social Assessment Scale (WSAS) has been documented as one of the most psychometrically reliable and valid tools especially developed to assess workability and social functioning in patients with mental health problems. Yet, the application of the WSAS in Germany has been limited due to the paucity of a valid questionnaire in the German language. The objective of the present study was to translate the WSAS, as a brief and easy administrable tool into German and test its psychometric properties in a sample of adults with depression. Methods Two hundred seventy-seven patients (M = 48.3 years, SD = 11.1) with mild to moderately severe depression were recruited. A multistep translation from English into the German language was performed and the factorial validity, criterion validity, convergent validity, discriminant validity, internal consistency, and floor and ceiling effects were examined. Results The confirmatory factor analysis results confirmed the one-factor structure of the WSAS. Significant correlations with the WHODAS 2–0 questionnaire, a measure of functionality, demonstrated good convergent validity. Significant correlations with depression and quality of life demonstrated good criterion validity. The WSAS also demonstrated strong internal consistency (α = .89), and the absence of floor and ceiling effects indicated good sensitivity of the instrument. Conclusions The results of the present study demonstrated that the German version of the WSAS has good psychometric properties comparable to other international versions of this scale. The findings recommend a global assessment of psychosocial functioning with the sum score of the WSAS. KW - Workability KW - Social functioning KW - Depression KW - Psychometric evaluation KW - Translation Y1 - 2021 U6 - https://doi.org/10.1186/s12913-021-06622-x SN - 1472-6963 VL - 21 SP - 1 EP - 11 PB - BioMed Central CY - London ER - TY - JOUR A1 - Pérez Chaparro, Camilo Germán Alberto A1 - Schuch, Felipe Barreto A1 - Zech, Philipp A1 - Kangas, Maria A1 - Rapp, Michael A. A1 - Heißel, Andreas T1 - Recreational exercising and self-reported cardiometabolic diseases in German people living with HIV BT - A cross-sectional study JF - International journal of environmental research and public health : IJERPH / Molecular Diversity Preservation International N2 - Exercise is known for its beneficial effects on preventing cardiometabolic diseases (CMDs) in the general population. People living with the human immunodeficiency virus (PLWH) are prone to sedentarism, thus raising their already elevated risk of developing CMDs in comparison to individuals without HIV. The aim of this cross-sectional study was to determine if exercise is associated with reduced risk of self-reported CMDs in a German HIV-positive sample (n = 446). Participants completed a self-report survey to assess exercise levels, date of HIV diagnosis, CD4 cell count, antiretroviral therapy, and CMDs. Participants were classified into exercising or sedentary conditions. Generalized linear models with Poisson regression were conducted to assess the prevalence ratio (PR) of PLWH reporting a CMD. Exercising PLWH were less likely to report a heart arrhythmia for every increase in exercise duration (PR: 0.20: 95% CI: 0.10–0.62, p < 0.01) and diabetes mellitus for every increase in exercise session per week (PR: 0.40: 95% CI: 0.10–1, p < 0.01). Exercise frequency and duration are associated with a decreased risk of reporting arrhythmia and diabetes mellitus in PLWH. Further studies are needed to elucidate the mechanisms underlying exercise as a protective factor for CMDs in PLWH. KW - HIV KW - exercise KW - cardiovascular diseases KW - metabolic disease KW - sedentary Y1 - 2021 U6 - https://doi.org/10.3390/ijerph182111579 SN - 1660-4601 VL - 18 IS - 21 SP - 1 EP - 10 PB - MDPI CY - Basel, Schweiz ER - TY - JOUR A1 - Gellert, Paul A1 - Häusler, Andreas A1 - Suhr, Ralf A1 - Gholami, Maryam A1 - Rapp, Michael A. A1 - Kuhlmey, Adelheid A1 - Nordheim, Johanna T1 - Testing the stress-buffering hypothesis of social support in couples coping with early-stage dementia JF - PLoS one N2 - Purpose: To test whether the negative relationship between perceived stress and quality of life (Hypothesis 1) can be buffered by perceived social support in patients with dementia as well as in caregivers individually (Hypothesis 2: actor effects) and across partners (Hypothesis 3: partner effects and actor-partner effects). Method: A total of 108 couples (N = 216 individuals) comprised of one individual with early-stage dementia and one caregiving partner were assessed at baseline and one month apart. Moderation effects were investigated by applying linear mixed models and actor-partner interdependence models. Results: Although the stress-quality of life association was more pronounced in caregivers (beta = -.63, p<.001) compared to patients (beta= -.31, p<.001), this association was equally moderated by social support in patients (beta = .14, p<.05) and in the caregivers (beta =.13, p<.05). From one partner to his or her counterpart, the partner buffering and actor-partner-buffering effect were not present. Conclusion: The stress-buffering effect has been replicated in individuals with dementia and caregivers but not across partners. Interventions to improve quality of life through perceived social support should not only focus on caregivers, but should incorporate both partners. Y1 - 2018 U6 - https://doi.org/10.1371/journal.pone.0189849 SN - 1932-6203 VL - 13 IS - 1 PB - PLoS CY - San Fransisco ER - TY - JOUR A1 - Gellert, Paul A1 - Häusler, Andreas A1 - Gholami, Maryam A1 - Rapp, Michael A. A1 - Kuhlmey, Adelheid A1 - Nordheim, Johanna T1 - Own and partners’ dyadic coping and depressive symptoms in individuals with early-stage dementia and their caregiving partners JF - Aging & Mental Health N2 - Objectives: In patients with early-stage dementia and their caregiving partners, reciprocal dyadic coping (DC) is crucial for preventing or reducing depressive symptoms in both partners. This study examines the relationships between ‘own DC’ and ‘perceived partner DC’ with depressive symptoms in couples coping with dementia on individual (actor effects) and cross-person (partner effects) levels. Method: 164 individuals (82 patients with early-stage dementia and their 82 caregiving partners; ND = 82 dyads) participated in this prospective study with measures (DC, depressive symptoms, and dementia severity) taken at baseline and at six months. Each partner evaluated their own and the perceived partner DC. Actor–partner interdependence models were applied to the resulting four independent evaluations. Results: Results differed substantially between patients and caregivers. DC was significantly related to patients’ but not to caregivers’ depressive symptoms, when adjustments were made for individual coping. Perceived partner DC showed a negative association with depressive symptoms in patients, whereas own DC was adversely related for actor as well as for partner effects across individuals. Conclusion: The adverse association between the own DC of the caregiver and the patient on depressive symptoms of the patient might be due to inappropriate efforts or to the loss of autonomy as a care-receiver. DC is important in both patients and caregivers, as shown by the negative association between perceived partner DC and depressive symptoms in the patients, which might inform interventions that target the couple as a whole. KW - Dyadic coping KW - dementia KW - actor-partner interdependence model KW - caregiver KW - quality of life KW - depression Y1 - 2017 U6 - https://doi.org/10.1080/13607863.2017.1334759 SN - 1360-7863 SN - 1364-6915 VL - 22 IS - 8 SP - 1008 EP - 1016 PB - Routledge, Taylor & Francis Group CY - Abingdon ER - TY - JOUR A1 - Heinzel, Stephan A1 - Rapp, Michael A. A1 - Fydrich, Thomas A1 - Ströhle, Andreas A1 - Teran, Christina A1 - Kallies, Gunnar A1 - Schwefel, Melanie A1 - Heissel, Andreas T1 - Neurobiological mechanisms of exercise and psychotherapy in depression BT - the SPeED studyRationale, design, and methodological issues JF - Clinical Trials N2 - Background/Aims: Even though cognitive behavioral therapy has become a relatively effective treatment for major depressive disorder and cognitive behavioral therapy-related changes of dysfunctional neural activations were shown in recent studies, remission rates still remain at an insufficient level. Therefore, the implementation of effective augmentation strategies is needed. In recent meta-analyses, exercise therapy (especially endurance exercise) was reported to be an effective intervention in major depressive disorder. Despite these findings, underlying mechanisms of the antidepressant effect of exercise especially in combination with cognitive behavioral therapy have rarely been studied to date and an investigation of its neural underpinnings is lacking. A better understanding of the psychological and neural mechanisms of exercise and cognitive behavioral therapy would be important for developing optimal treatment strategies in depression. The SPeED study (Sport/Exercise Therapy and Psychotherapyevaluating treatment Effects in Depressive patients) is a randomized controlled trial to investigate underlying physiological, neurobiological, and psychological mechanisms of the augmentation of cognitive behavioral therapy with endurance exercise. It is investigated if a preceding endurance exercise program will enhance the effect of a subsequent cognitive behavioral therapy. Methods: This study will include 105 patients diagnosed with a mild or moderate depressive episode according to the Diagnostic and Statistical Manual of Mental Disorders (4th ed.). The participants are randomized into one of three groups: a high-intensive or a low-intensive endurance exercise group or a waiting list control group. After the exercise program/waiting period, all patients receive an outpatient cognitive behavioral therapy treatment according to a standardized therapy manual. At four measurement points, major depressive disorder symptoms (Beck Depression Inventory, Hamilton Rating Scale for Depression), (neuro)biological measures (neural activations during working memory, monetary incentive delay task, and emotion regulation, as well as cortisol levels and brain-derived neurotrophic factor), neuropsychological test performance, and questionnaires (psychological needs, self-efficacy, and quality of life) are assessed. Results: In this article, we report the design of the SPeED study and refer to important methodological issues such as including both high- and low-intensity endurance exercise groups to allow the investigation of dose-response effects and physiological components of the therapy effects. Conclusion: The main aims of this research project are to study effects of endurance exercise and cognitive behavioral therapy on depressive symptoms and to investigate underlying physiological and neurobiological mechanisms of these effects. Results may provide important implications for the development of effective treatment strategies in major depressive disorder, specifically concerning the augmentation of cognitive behavioral therapy by endurance exercise. KW - Major depressive disorder KW - depression KW - psychotherapy KW - cognitive behavioral therapy KW - endurance exercise KW - training KW - functional magnetic resonance imaging KW - brain-derived neurotrophic factor KW - basic psychological needs KW - cortisol Y1 - 2017 U6 - https://doi.org/10.1177/1740774517729161 SN - 1740-7745 SN - 1740-7753 VL - 15 IS - 1 SP - 53 EP - 64 PB - Sage Publ. CY - London ER - TY - JOUR A1 - Schraplau, Anne A1 - Block, Andrea A1 - Häusler, Andreas A1 - Wippert, Pia-Maria A1 - Rapp, Michael A. A1 - Völler, Heinz A1 - Bonaventura, Klaus A1 - Mayer, Frank T1 - Mobile diagnostics and consultation for the prevention of the metabolic syndrome and its secondary diseases in Brandenburg—study protocol of a regional prospective cohort study BT - the Mobile Brandenburg Cohort JF - Pilot and Feasibility Studies N2 - Background The metabolic syndrome (MetS) is a risk cluster for a number of secondary diseases. The implementation of prevention programs requires early detection of individuals at risk. However, access to health care providers is limited in structurally weak regions. Brandenburg, a rural federal state in Germany, has an especially high MetS prevalence and disease burden. This study aims to validate and test the feasibility of a setup for mobile diagnostics of MetS and its secondary diseases, to evaluate the MetS prevalence and its association with moderating factors in Brandenburg and to identify new ways of early prevention, while establishing a “Mobile Brandenburg Cohort” to reveal new causes and risk factors for MetS. Methods In a pilot study, setups for mobile diagnostics of MetS and secondary diseases will be developed and validated. A van will be equipped as an examination room using point-of-care blood analyzers and by mobilizing standard methods. In study part A, these mobile diagnostic units will be placed at different locations in Brandenburg to locally recruit 5000 participants aged 40-70 years. They will be examined for MetS and advice on nutrition and physical activity will be provided. Questionnaires will be used to evaluate sociodemographics, stress perception, and physical activity. In study part B, participants with MetS, but without known secondary diseases, will receive a detailed mobile medical examination, including MetS diagnostics, medical history, clinical examinations, and instrumental diagnostics for internal, cardiovascular, musculoskeletal, and cognitive disorders. Participants will receive advice on nutrition and an exercise program will be demonstrated on site. People unable to participate in these mobile examinations will be interviewed by telephone. If necessary, participants will be referred to general practitioners for further diagnosis. Discussion The mobile diagnostics approach enables early detection of individuals at risk, and their targeted referral to local health care providers. Evaluation of the MetS prevalence, its relation to risk-increasing factors, and the “Mobile Brandenburg Cohort” create a unique database for further longitudinal studies on the implementation of home-based prevention programs to reduce mortality, especially in rural regions. Trial registration German Clinical Trials Register, DRKS00022764; registered 07 October 2020—retrospectively registered. KW - Metabolic syndrome KW - Mobile diagnostics KW - Prevention KW - Nutrition KW - Physical activity KW - Rural health Y1 - 2021 U6 - https://doi.org/10.1186/s40814-021-00898-w SN - 2055-5784 VL - 7 SP - 1 EP - 11 PB - BioMed Central (Springer Nature) CY - London ER - TY - JOUR A1 - Heissel, Andreas A1 - Pietrek, Anou F. A1 - Schwefel, Melanie A1 - Abula, Kahar A1 - Wilbertz, Gregor A1 - Heinzel, Stephan A1 - Rapp, Michael A. T1 - STEP.De study BT - a multicentre cluster-randomised effectiveness trial of exercise therapy for patients with depressive symptoms in healthcare services : study protocol JF - BMJ open N2 - Introduction Although exercise therapy has widely been shown to be an efficacious treatment modality for depression, evidence for its effectiveness and cost efficiency is lacking. The Sport/Exercise Therapy for Depression study is a multicentre cluster-randomised effectiveness trial that aims to compare the effectiveness and cost efficiency of exercise therapy and psychotherapy as antidepressant treatment.
Methods and analysis 480 patients (aged 18-65) with an International Classification of Diseases diagnosis associated with depressive symptoms are recruited. Up to 30 clusters (psychotherapists) are randomly assigned to allocate patients to either an exercise or a psychotherapy treatment as usual in a 2: 1 ratio. The primary outcome (depressive symptoms) and the secondary outcomes (work and social adjustment, quality of life) will be assessed at six measurement time points (t0: baseline, t1: 8 weeks after treatment initiation, t2: 16 weeks after treatment initiation, t3/ 4/5: 2, 6, 12 months after treatment). Linear regression analyses will be used for the primary endpoint data analysis. For the secondary endpoints, mixed linear and logistic regression models with fixed and random factors will be added. For the cost efficiency analysis, expenditures in the 12 months before and after the intervention and the outcome difference will be compared between groups in a multilevel model. Recruitment start date was 1 July 2018 and the planned recruitment end date is 31 December 2020.
Ethics and dissemination The study protocol was approved by the ethics committee of the University of Potsdam (No. 17/2018) and the Freie Universitat Berlin (No. 206/2018) and registered in the ISRCTN registry. Informed written consent will be obtained from all participants. The study will be reported in accordance with the Consolidated Standards of Reporting Trials and the Recommendations for Interventional Trials statements. The results will be published in peer-reviewed academic journals and disseminated to the public. Y1 - 2020 U6 - https://doi.org/10.1136/bmjopen-2019-036287 SN - 2044-6055 VL - 10 IS - 4 PB - BMJ Publishing Group CY - London ER - TY - JOUR A1 - Lorenz, Robert C. A1 - Gleich, Tobias A1 - Beck, Anne A1 - Poehland, Lydia A1 - Raufelder, Diana A1 - Sommer, Werner A1 - Rapp, Michael A. A1 - Kuehn, Simone A1 - Gallinat, Jürgen T1 - Reward anticipation in the adolescent and aging brain JF - Human brain mapping : a journal devoted to functional neuroanatomy and neuroimaging N2 - Processing of reward is the basis of adaptive behavior of the human being. Neural correlates of reward processing seem to be influenced by developmental changes from adolescence to late adulthood. The aim of this study is to uncover these neural correlates during a slot machine gambling task across the lifespan. Therefore, we used functional magnetic resonance imaging to investigate 102 volunteers in three different age groups: 34 adolescents, 34 younger adults, and 34 older adults. We focused on the core reward areas ventral striatum (VS) and ventromedial prefrontal cortex (VMPFC), the valence processing associated areas, anterior cingulate cortex (ACC) and insula, as well as information integration associated areas, dorsolateral prefrontal cortex (DLPFC), and inferior parietal lobule (IPL). Results showed that VS and VMPFC were characterized by a hyperactivation in adolescents compared with younger adults. Furthermore, the ACC and insula were characterized by a U-shape pattern (hypoactivation in younger adults compared with adolescents and older adults), whereas the DLPFC and IPL were characterized by a J-shaped form (hyperactivation in older adults compared with younger groups). Furthermore, a functional connectivity analysis revealed an elevated negative functional coupling between the inhibition-related area rIFG and VS in younger adults compared with adolescents. Results indicate that lifespan-related changes during reward anticipation are characterized by different trajectories in different reward network modules and support the hypothesis of an imbalance in maturation of striatal and prefrontal cortex in adolescents. Furthermore, these results suggest compensatory age-specific effects in fronto-parietal regions. Hum Brain Mapp 35:5153-5165, 2014. (c) 2014 Wiley Periodicals, Inc. KW - reward anticipation KW - lifespan KW - aging KW - adolescence KW - fMRI KW - connectivity Y1 - 2014 U6 - https://doi.org/10.1002/hbm.22540 SN - 1065-9471 SN - 1097-0193 VL - 35 IS - 10 SP - 5153 EP - 5165 PB - Wiley-Blackwell CY - Hoboken ER - TY - JOUR A1 - Kuschpel, Maxim S. A1 - Liu, Shuyan A1 - Schad, Daniel A1 - Heinzel, Stephan A1 - Heinz, Andreas A1 - Rapp, Michael A. T1 - Differential effects of wakeful rest, music and video game playing on working memory performance in the n-back task JF - Frontiers in psychology N2 - The interruption of learning processes by breaks filled with diverse activities is common in everyday life. We investigated the effects of active computer gaming and passive relaxation (rest and music) breaks on working memory performance. Young adults were exposed to breaks involving (i) eyes-open resting, (ii) listening to music and (iii) playing the video game “Angry Birds” before performing the n-back working memory task. Based on linear mixed-effects modeling, we found that playing the “Angry Birds” video game during a short learning break led to a decline in task performance over the course of the task as compared to eyes-open resting and listening to music, although overall task performance was not impaired. This effect was associated with high levels of daily mind wandering and low self-reported ability to concentrate. These findings indicate that video games can negatively affect working memory performance over time when played in between learning tasks. We suggest further investigation of these effects because of their relevance to everyday activity. KW - break interventions KW - computer games KW - mozart effect KW - working memory KW - attention KW - cognitive resources KW - mind wandering Y1 - 2015 U6 - https://doi.org/10.3389/fpsyg.2015.01683 SN - 1664-1078 IS - 6 PB - Frontiers Research Foundation CY - Lausanne ER - TY - JOUR A1 - Pérez Chaparro, Camilo Germán Alberto A1 - Zech, Philipp A1 - Schuch, Felipe A1 - Wolfarth, Bernd A1 - Rapp, Michael A. A1 - Heiβel, Andreas T1 - Effects of aerobic and resistance exercise alone or combined on strength and hormone outcomes for people living with HIV BT - A meta-analysis JF - PLOS One N2 - Background: Infection with human immunodeficiency virus (HIV) affects muscle mass, altering independent activities of people living with HIV (PLWH). Resistance training alone (RT) or combined with aerobic exercise (AE) is linked to improved muscle mass and strength maintenance in PLWH. These exercise benefits have been the focus of different meta-analyses, although only a limited number of studies have been identified up to the year 2013/4. An up-to-date systematic review and meta-analysis concerning the effect of RT alone or combined with AE on strength parameters and hormones is of high value, since more and recent studies dealing with these types of exercise in PLWH have been published. Methods: Randomized controlled trials evaluating the effects of RT alone, AE alone or the combination of both (AERT) on PLWH was performed through five web-databases up to December 2017. Risk of bias and study quality was attained using the PEDro scale. Weighted mean difference (WMD) from baseline to post-intervention changes was calculated. The I2 statistics for heterogeneity was calculated. Results: Thirteen studies reported strength outcomes. Eight studies presented a low risk of bias. The overall change in upper body strength was 19.3 Kg (95% CI: 9.8±28.8, p< 0.001) after AERT and 17.5 Kg (95% CI: 16±19.1, p< 0.001) for RT. Lower body change was 29.4 Kg (95% CI: 18.1±40.8, p< 0.001) after RT and 10.2 Kg (95% CI: 6.7±13.8, p< 0.001) for AERT. Changes were higher after controlling for the risk of bias in upper and lower body strength and for supervised exercise in lower body strength. A significant change towards lower levels of IL-6 was found (-2.4 ng/dl (95% CI: -2.6, -2.1, p< 0.001). Conclusion: Both resistance training alone and combined with aerobic exercise showed a positive change when studies with low risk of bias and professional supervision were analyzed, improving upper and, more critically, lower body muscle strength. Also, this study found that exercise had a lowering effect on IL-6 levels in PLWH. KW - Human-immunodeficiency-virus KW - Quality-of-life KW - Randomized controlled-trails KW - Infected patients KW - Muscle strength KW - Body-composition KW - Nandrolone decanoate KW - Cardiovascular risk KW - Style modification KW - Metabolic syndrome Y1 - 2018 U6 - https://doi.org/10.1371/journal.pone.0203384 SN - 1932-6203 VL - 13 IS - 9 SP - 1 EP - 12 PB - PLOS CY - San Francisco ER - TY - JOUR A1 - Aichberger, Marion Christina A1 - Montesinos, Amanda Heredia A1 - Bromand, Zohra A1 - Yesil, Rahsan A1 - Temur-Erman, Selver A1 - Rapp, Michael A. A1 - Heinz, Andreas A1 - Schouler-Ocak, Meryam T1 - Suicide attempt rates and intervention effects in women of Turkish origin in Berlin JF - European psychiatry : the journal of the Association of European Psychiatrists N2 - Purpose: Ethnic minority groups show elevated suicide attempt rates across Europe. Evidence suggests a similar trend for women of Turkish origin in Germany, yet data on suicidal behaviour in minorities in Germany is scarce. The objective was to examine rates of suicidal behaviour, underlying motives, and to explore the effectiveness of an intervention program. Methods: From 05/2009-09/2011, data on all suicide attempts among women of Turkish origin who presented at a hospital-based emergency unit in Berlin, Germany, were collected. A multi-modal intervention was conducted in 2010 and the effects of age, generation and the intervention on suicide attempt rates were examined. Results: At the start, the highest rate was found in women aged 18-24 years with 225.4 (95% CI = 208.8-242.0)/100,000. Adjustment disorder was the most prevalent diagnosis with 49.7% (n = 79), being more common in second-generation women (P = .004). Further analyses suggested an effect of the intervention in the youngest age group (trend change of beta = -1.25; P = .017). Conclusion: Our findings suggest a particularly high rate of suicide attempts by 18-24-year-old, second-generation women of Turkish origin in Berlin. Furthermore, our results suggest a trend change in suicide attempts in women aged 18-24 years related to a population-based intervention program. (C) 2015 Elsevier Masson SAS. All rights reserved. KW - Suicide attempt KW - Incidence rates KW - Turkish migrants KW - Intervention study Y1 - 2015 U6 - https://doi.org/10.1016/j.eurpsy.2014.12.003 SN - 0924-9338 SN - 1778-3585 VL - 30 IS - 4 SP - 480 EP - 485 PB - Elsevier CY - Paris ER - TY - JOUR A1 - Konrad, Marcel A1 - Bohlken, Jens A1 - Rapp, Michael A. A1 - Kostev, Karel T1 - Depression risk in patients with heart failure in primary care practices in Germany JF - International psychogeriatrics N2 - Background: The goal of this study was to estimate the prevalence of and risk factors for diagnosed depression in heart failure (HF) patients in German primary care practices. Methods: This study was a retrospective database analysis in Germany utilizing the Disease Analyzer (R) Database (IMS Health, Germany). The study population included 132,994 patients between 40 and 90 years of age from 1,072 primary care practices. The observation period was between 2004 and 2013. Follow-up lasted up to five years and ended in April 2015. A total of 66,497 HF patients were selected after applying exclusion criteria. The same number of 66,497 controls were chosen and were matched (1:1) to HF patients on the basis of age, sex, health insurance, depression diagnosis in the past, and follow-up duration after index date. Results: HF was a strong risk factor for diagnosed depression (p < 0.0001). A total of 10.5% of HF patients and 6.3% of matched controls developed depression after one year of follow-up (p < 0.001). Depression was documented in 28.9% of the HF group and 18.2% of the control group after the five-year follow-up (p < 0.001). Cancer, dementia, osteoporosis, stroke, and osteoarthritis were associated with a higher risk of developing depression. Male gender and private health insurance were associated with lower risk of depression. Conclusions: The risk of diagnosed depression is significantly increased in patients with HF compared to patients without HF in primary care practices in Germany. KW - depression KW - primary care KW - risk factors KW - antidepressants Y1 - 2016 U6 - https://doi.org/10.1017/S1041610216000867 SN - 1041-6102 SN - 1741-203X VL - 28 SP - 1889 EP - 1894 PB - Cambridge Univ. Press CY - New York ER - TY - JOUR A1 - Häusler, Andreas A1 - Sánchez, Alba A1 - Gellert, Paul A1 - Deeken, Friederike A1 - Rapp, Michael A. A1 - Nordheim, Johanna T1 - Perceived stress and quality of life in dementia patients and their caregiving spouses: does dyadic coping matter? JF - International psychogeriatrics N2 - Background: Given the well-established association between perceived stress and quality of life (QoL) in dementia patients and their partners, our goal was to identify whether relationship quality and dyadic coping would operate as mediators between perceived stress and QoL. Results: We found negative correlations between stress and QoL in both partners (QoL-AD: r = -0.62; p < 0.001; WHO-QOL Overall: r = -0.27; p = 0.02). Spousal caregivers had a significantly lower DCI total score than dementia patients (p < 0.001). Dyadic coping was a significant mediator of the relationship between stress and QoL in spousal caregivers (z = 0.28; p = 0.02), but not in dementia patients. Likewise, relationship quality significantly mediated the relationship between stress and QoL in caregivers only (z = -2.41; p = 0.02). Conclusions: This study identified dyadic coping as a mediator on the relationship between stress and QoL in (caregiving) partners of dementia patients. In patients, however, we found a direct negative effect of stress on QoL. The findings suggest the importance of stress reducing and dyadic interventions for dementia patients and their partners, respectively. KW - dementia KW - dyadic coping KW - perceived stress KW - quality of life Y1 - 2016 U6 - https://doi.org/10.1017/S1041610216001046 SN - 1041-6102 SN - 1741-203X VL - 28 SP - 1857 EP - 1866 PB - Cambridge Univ. Press CY - New York ER - TY - JOUR A1 - Bookers, Anke A1 - Jacob, Louis A1 - Bohlken, Jens A1 - Rapp, Michael A. A1 - Kostev, Karel T1 - Persistence with antipsychotics in dementia patients in Germany JF - International journal of clinical pharmacology and therapeutics N2 - Background/Aims: To analyze the duration of treatment with antipsychotics in German dementia patients. Methods: This study included patients aged 60 years and over with dementia who received a first-time antipsychotic prescription by psychiatrists between 2009 and 2013. The main outcome measure was the treatment rate for more than 6 months following the index date. Results: A total of 12,979 patients with dementia (mean age 82 years, 52.1% living in nursing homes) were included. After 2 years of follow-up, 54.8%, 57.2%, 61.1%, and 65.4% of patients aged 60 - 69, 70 - 79, 80 - 89, and 90 - 99 years, respectively, received antipsychotic prescriptions. 63.9% of subjects living in nursing homes and 55.0% of subjects living at home also continued their treatment (p-value < 0.001). Conclusion: The percentage of dementia patients treated with anti psychotics is very high. KW - persistence KW - antipsychotics KW - dementia Y1 - 2016 U6 - https://doi.org/10.5414/CP202631 SN - 0946-1965 VL - 54 SP - 835 EP - 840 PB - Dustri-Verlag Dr. Karl Feistle CY - Deisenhofen-München ER - TY - INPR A1 - Heinz, Andreas A1 - Charlet, Katrin A1 - Rapp, Michael A. T1 - Public mental health: a call to action T2 - World psychiatry Y1 - 2015 U6 - https://doi.org/10.1002/wps.20182 SN - 1723-8617 SN - 2051-5545 VL - 14 IS - 1 SP - 49 EP - 50 PB - Wiley-Blackwell CY - Hoboken ER - TY - JOUR A1 - Schulze, Susanne A1 - Merz, Sibille A1 - Thier, Anne A1 - Tallarek, Marie A1 - König, Franziska A1 - Uhlenbrock, Greta A1 - Nübling, Matthias A1 - Lincke, Hans-Joachim A1 - Rapp, Michael A. A1 - Spallek, Jacob A1 - Holmberg, Christine T1 - Psychosocial burden in nurses working in nursing homes during the Covid-19 pandemic BT - a cross-sectional study with quantitative and qualitative data JF - BMC health services research N2 - Background The Covid-19 pandemic led to increased work-related strain and psychosocial burden in nurses worldwide, resulting in high prevalences of mental health problems. Nurses in long-term care facilities seem to be especially affected by the pandemic. Nevertheless, there are few findings indicating possible positive changes for health care workers. Therefore, we investigated which psychosocial burdens and potential positive aspects nurses working in long-term care facilities experience during the Covid-19 pandemic. Methods We conducted a mixed-methods study among nurses and nursing assistants working in nursing homes in Germany. The survey contained the third German version of the Copenhagen Psychosocial Questionnaire (COPSOQ III). Using Welch's t-tests, we compared the COPSOQ results of our sample against a pre-pandemic reference group of geriatric nurses from Germany. Additionally, we conducted semi-structured interviews with geriatric nurses with a special focus on psychosocial stress, to reach a deeper understanding of their experiences on work-related changes and burdens during the pandemic. Data were analysed using thematic coding (Braun and Clarke). Results Our survey sample (n = 177) differed significantly from the pre-pandemic reference group in 14 out of 31 COPSOQ scales. Almost all of these differences indicated negative changes. Our sample scored significantly worse regarding the scales 'quantitative demands', 'hiding emotions', 'work-privacy conflicts', 'role conflicts', 'quality of leadership', 'support at work', 'recognition', 'physical demands', 'intention to leave profession', 'burnout', 'presenteeism' and 'inability to relax'. The interviews (n = 15) revealed six main themes related to nurses' psychosocial stress: 'overall working conditions', 'concern for residents', 'management of relatives', 'inability to provide terminal care', 'tensions between being infected and infecting others' and 'technicisation of care'. 'Enhanced community cohesion' (interviews), 'meaning of work' and 'quantity of social relations' (COPSOQ III) were identified as positive effects of the pandemic. Conclusions Results clearly illustrate an aggravation of geriatric nurses' situation and psychosocial burden and only few positive changes due to the Covid-19 pandemic. Pre-existing hardships seem to have further deteriorated and new stressors added to nurses' strain. The perceived erosion of care, due to an overemphasis of the technical in relation to the social and emotional dimensions of care, seems to be especially burdensome to geriatric nurses. KW - COPSOQ KW - Nurses KW - Nursing home KW - Psychosocial burden KW - Mixed-methods study KW - Covid-19 Y1 - 2022 U6 - https://doi.org/10.1186/s12913-022-08333-3 SN - 1472-6963 VL - 22 IS - 1 PB - BMC CY - London 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 - Heissel, Andreas A1 - Pietrek, Anou F. A1 - Rapp, Michael A. A1 - Heinzel, Stephan A1 - Williams, Geoffrey T1 - Perceived health care climate of older people attending an exercise program BT - validation of the german short version of the health care climate questionnaire JF - Journal of aging and physical activity : JAPA ; the official journal of the International Society for Aging and Physical Activity N2 - The role of perceived need support from exercise professionals in improving mental health was examined in a sample of older adults, thereby validating the short Health Care Climate Questionnaire. A total of 491 older people (M = 72.68 years; SD = 5.47) attending a health exercise program participated in this study. Cronbach's alpha was found to be high (alpha = .90). Satisfaction with the exercise professional correlated moderately with the short Health Care Climate Questionnaire mean value (r = .38; p < .01). The mediator analyses yielded support for the self-determination theory process model in older adults by showing both basic need satisfaction and frustration as mediating variables between perceived autonomy support and depressive symptoms. The short Health Care Climate Questionnaire is an economical instrument for assessing basic need satisfaction provided by the exercise therapist from the participant's perspective. Furthermore, this cross-sectional study supported the link from coaching style to the satisfaction/frustration of basic psychological needs, which in turn, predicted mental health. Analyses of criterion validity suggest a revision of the construct by integrating need frustration. KW - autonomy support KW - basic psychological need satisfaction and frustration KW - depression KW - need support KW - physical activity Y1 - 2019 U6 - https://doi.org/10.1123/japa.2018-0350 SN - 1063-8652 SN - 1543-267X VL - 28 IS - 2 SP - 276 EP - 286 PB - Human Kinetics Publ. CY - Champaign ER - TY - JOUR A1 - Deeken, Friederike A1 - Rapp, Michael A. T1 - Technology-based interventions as an approach to treating apathy in people with dementia JF - International psychogeriatrics : the official journal of the International Psychogeriatric Association Y1 - 2022 U6 - https://doi.org/10.1017/S1041610222000035 SN - 1741-203X VL - 34 IS - 2 SP - 95 EP - 96 PB - Cambridge Univ. Press CY - Cambridge ER - TY - JOUR A1 - Bohlken, Jens A1 - Schulz, Mandy A1 - Rapp, Michael A. A1 - Baetzing-Feigenbaum, Joerg T1 - Pharmacotherapy of dementia in Germany: Results from a nationwide claims database JF - European neuropsychopharmacology : the journal of the European College of Neuropsychopharmacology N2 - In 2011, about 1.1-1.4 million patients with dementia were living in Germany, a number expected to rise to three million by 2050. Dementia poses a major challenge to the healthcare system and neuropharmacological service provision. The aim of this study was to determine prescription rates for anti-dementia drugs as well as for neuroleptics, sedative-hypnotics and antidepressants in dementia using the complete nationwide outpatient claims data pertaining to the services of statutory health insurance. We controlled for gender, age, dementia diagnosis, physician specialty (general practitioner GP versus neuropsychiatry specialist physician NPSP), and rural and urban living area. In about one million prevalent dementia patients (N=1,014,710) in 2011, the prescription prevalence rate of anti-dementia drugs was 24.6%; it varied with gender, age, and diagnosis (highest in Alzheimer's disease; 42%), and was higher in patients treated by NPSPs (48% vs. 25% in GPs). At the same time, we found an alarmingly high rate of treatment with neuroleptics in dementia patients (35%), with an only slightly decreased risk in patients treated exclusively by NPSPs (OR=0.86). We found marginal differences between rural and urban areas. Our results show that the majority of anti-dementia drug prescriptions appear guideline-oriented, yet prescription rates are overall comparatively low. On the other hand, neuroleptic drugs, which are associated with excess morbidity and mortality in dementia, were prescribed very frequently, suggesting excess use given current guidelines. We therefore suggest that guideline implementation measures and increasing quality control procedures are needed with respect to the pharmacotherapy of this vulnerable population. (C) 2015 Elsevier B.V. and ECNR All rights reserved. KW - Psychotropics KW - Drug prescription KW - Germany Y1 - 2015 U6 - https://doi.org/10.1016/j.euroneuro.2015.09.014 SN - 0924-977X SN - 1873-7862 VL - 25 IS - 12 SP - 2333 EP - 2338 PB - Elsevier CY - Amsterdam ER - TY - JOUR A1 - Heissel, Andreas A1 - Pietrek, Anou F. A1 - Kangas, Maria A1 - Van der Kaap-Deeder, Jolene A1 - Rapp, Michael A. T1 - The Mediating Role of Rumination in the Relation between Basic Psychological Need Frustration and Depressive Symptoms JF - Journal of Clinical Medicine N2 - Research within the framework of Basic Psychological Need Theory (BPNT) finds strong associations between basic need frustration and depressive symptoms. This study examined the role of rumination as an underlying mechanism in the association between basic psychological need frustration and depressive symptoms. A cross-sectional sample of N = 221 adults (55.2% female, mean age = 27.95, range = 18–62, SD = 10.51) completed measures assessing their level of basic psychological need frustration, rumination, and depressive symptoms. Correlational analyses and multiple mediation models were conducted. Brooding partially mediated the relation between need frustration and depressive symptoms. BPNT and Response Styles Theory are compatible and can further advance knowledge about depression vulnerabilities. KW - psychopathology KW - elf-determination theory KW - response styles theory KW - frustration KW - depressive disorder KW - emotional regulation KW - rumination Y1 - 2023 U6 - https://doi.org/10.3390/jcm12020395 SN - 2077-0383 VL - 12 SP - 1 EP - 10 PB - MDPI CY - Basel, Schweiz ET - 2 ER - TY - JOUR A1 - Jaehn, Philipp A1 - Sasko, Benjamin A1 - Holmberg, Christine A1 - Hoffmann, Stephanie A1 - Spallek, Jacob A1 - Kelesidis, Theodoros A1 - Rapp, Michael A. A1 - Westhoff, Timm H. A1 - Ritter, Oliver A1 - Pagonas, Nikolaos T1 - Levels of high-density lipoprotein lipid peroxidation according to spatial socioeconomic deprivation and rurality among patients with coronary artery disease JF - European journal of preventive cardiology Y1 - 2022 U6 - https://doi.org/10.1093/eurjpc/zwac068 SN - 2047-4873 SN - 2047-4881 VL - 29 IS - 15 SP - E343 EP - E346 PB - Oxford University Press CY - Oxford ER - TY - JOUR A1 - Sturm, Heidrun A1 - Wildermuth, Ronja A1 - Stolz, Regina A1 - Bertram, L. A1 - Eschweiler, G. W. A1 - Thomas, C. A1 - Rapp, Michael A. A1 - Joos, S. T1 - Diverging awareness of postoperative delirium and cognitive dysfunction in German Health Care Providers JF - Clinical interventions in agins N2 - Purpose: Postoperative cognitive dysfunction (POCD) appears in up to 30% of patients suffering from postoperative delirium (POD). Both are associated with higher mortality and postoperative complications, prolonged hospital stays, and increased costs. Multi-modal models with pre-admission risk reduction counselling, perioperative monitoring, and training of multidisciplinary patient care providers have been shown to decrease the prevalence of both. The aim of our study is to understand how far those measures are known and implemented in routine care and to detect potential gaps in the current practice regarding risk communication and information flow between involved caregivers for patients at risk for POD/POCD. Patients and Methods: As part of a multicenter study, seven semi-structured focus group (FG) discussions with nurses and physicians from tertiary care hospitals (surgery, anesthesiology, and orthopedics, n=31) and general practitioners (GPs) in private practice (n=7) were performed. Transcribed discussions were analyzed using qualitative content analysis. Results: POD is present above all in the daily work of nurses, whereas physicians do not perceive it as a relevant problem. Physicians report that no regular risk assessment or risk communication was performed prior to elective surgery. Information about POD often gets lost during hand-offs and is not regularly reported in discharge letters. Thus, persisting cognitive dysfunction is often missed. The importance of standardized documentation and continuous education concerning risks, screening, and treatment was emphasized. The often-suggested pre-OP medication adjustment was seen as less important; in contrast, avoiding withdrawal was regarded as far more important. Conclusion: Altogether, it seems that standards and available best practice concepts are rarely implemented. In contrast to physicians, nurses are highly aware of delirium and ask for standardized procedures and more responsibility. Therefore, raising awareness regarding risks, screening tools, and effective preventive measures for POD/POCD seems an urgent goal. Nurses should have a central role in coordination and care of POD to prevent the risk for POCD. KW - cross-sectoral care KW - delirium prevention KW - postoperative cognitive dysfunction KW - POCD KW - dementia KW - clinical pathways KW - risk screening Y1 - 2019 U6 - https://doi.org/10.2147/CIA.S230800 SN - 1178-1998 VL - 14 SP - 2125 EP - 2135 PB - DOVE Medical Press CY - Albany ER - TY - JOUR A1 - Pietrek, Anou F. A1 - Kangas, Maria A1 - Kliegl, Reinhold A1 - Rapp, Michael A. A1 - Heinzel, Stephan A1 - Van der Kaap-Deeder, Jolene A1 - Heissel, Andreas T1 - Basic psychological need satisfaction and frustration in major depressive disorder JF - Frontiers in Psychiatry - Mood Disorders N2 - Basic psychological needs theory postulates that a social environment that satisfies individuals’ three basic psychological needs of autonomy, competence, and relatedness leads to optimal growth and well-being. On the other hand, the frustration of these needs is associated with ill-being and depressive symptoms foremost investigated in non-clinical samples; yet, there is a paucity of research on need frustration in clinical samples. Survey data were compared between adult individuals with major depressive disorder (MDD; n = 115; 48.69% female; 38.46 years, SD = 10.46) with those of a non-depressed comparison sample (n = 201; 53.23% female; 30.16 years, SD = 12.81). Need profiles were examined with a linear mixed model (LMM). Individuals with depression reported higher levels of frustration and lower levels of satisfaction in relation to the three basic psychological needs when compared to non-depressed adults. The difference between depressed and non-depressed groups was significantly larger for frustration than satisfaction regarding the needs for relatedness and competence. LMM correlation parameters confirmed the expected positive correlation between the three needs. This is the first study showing substantial differences in need-based experiences between depressed and non-depressed adults. The results confirm basic assumptions of the self-determination theory and have preliminary implications in tailoring therapy for depression. KW - basic need satisfaction and frustration KW - depressive symptoms KW - clinical sample KW - need profiles KW - social environment Y1 - 2022 U6 - https://doi.org/10.3389/fpsyt.2022.962501 SN - 1664-0640 SP - 1 EP - 10 PB - Frontiers Media S.A. CY - Lausanne, Schweiz ER - TY - CHAP A1 - Haegele, Claudia A1 - Friedel, Eva A1 - Schlagenhauf, Florian A1 - Sterzer, Philipp A1 - Beck, Anne A1 - Bermpohl, Felix A1 - Rapp, Michael A. A1 - Stoy, Meline A1 - Stroehle, Andreas A1 - Dolan, Raymond J. A1 - Heinz, Andreas T1 - Reward expectation and affective responses across psychiatric disorders - A dimensional approach T2 - Biological psychiatry : a journal of psychiatric neuroscience and therapeutics ; a publication of the Society of Biological Psychiatry KW - dimensional KW - transdiagnostic KW - reward system KW - ventral striatum KW - fMRI Y1 - 2014 SN - 0006-3223 SN - 1873-2402 VL - 75 IS - 9 SP - 91S EP - 92S PB - Elsevier CY - New York ER - TY - GEN A1 - Heinz, Andreas A1 - Beck, Anne A1 - Rapp, Michael A. T1 - Alcohol as an Environmental Mortality Hazard T2 - JAMA psychiatry Y1 - 2016 U6 - https://doi.org/10.1001/jamapsychiatry.2016.0399 SN - 2168-622X SN - 2168-6238 VL - 73 SP - 549 EP - 550 PB - American Veterinary Medical Association CY - Chicago ER - TY - JOUR A1 - Drosselmeyer, Julia A1 - Jacob, Louis A1 - Rathmann, Wolfgang A1 - Rapp, Michael A. A1 - Kostev, Karel T1 - Depression risk in patients with late-onset rheumatoid arthritis in Germany JF - Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation N2 - The goal of this study was to determine the prevalence of depression and its risk factors in patients with late-onset rheumatoid arthritis (RA) treated in German primary care practices. Longitudinal data from general practices (n=1072) throughout Germany were analyzed. Individuals initially diagnosed with RA (2009-2013) were identified, and 7301 patients were included and matched (1:1) to 7301 controls. The primary outcome measure was the initial diagnosis of depression within 5 years after the index date in patients with and without RA. Cox proportional hazards models were used to adjust for confounders. The mean age was 72.2 years (SD: 7.6 years). A total of 34.9 % of patients were men. Depression diagnoses were present in 22.0 % of the RA group and 14.3 % of the control group after a 5-year follow-up period (p < 0.001). In the multivariate regression model, RA was a strong risk factor for the development of depression (HR: 1.55, p < 0.001). There was significant interaction of RA and diagnosed inflammatory polyarthropathies (IP) (RA*IP interaction: p < 0.001). Furthermore, dementia, cancer, osteoporosis, hypertension, and diabetes were associated with a higher risk of developing depression (p values < 0.001). The risk of depression is significantly higher in patients with late-onset RA than in patients without RA for subjects treated in primary care practices in Germany. RA patients should be screened routinely for depression in order to ensure improved treatment and management. KW - Late-onset rheumatoid arthritis KW - Depression KW - Primary care KW - Risk factors KW - Germany Y1 - 2016 U6 - https://doi.org/10.1007/s11136-016-1387-2 SN - 0962-9343 SN - 1573-2649 VL - 26 IS - 2 SP - 437 EP - 443 PB - Springer CY - Dordrecht ER - TY - JOUR A1 - Friedel, Eva A1 - Schlagenhauf, Florian A1 - Beck, Anne A1 - Dolan, Raymond J. A1 - Huys, Quentin J. M. A1 - Rapp, Michael A. A1 - Heinz, Andreas T1 - The effects of life stress and neural learning signals on fluid intelligence JF - European archives of psychiatry and clinical neuroscience : official organ of the German Society for Biological Psychiatry N2 - Fluid intelligence (fluid IQ), defined as the capacity for rapid problem solving and behavioral adaptation, is known to be modulated by learning and experience. Both stressful life events (SLES) and neural correlates of learning [specifically, a key mediator of adaptive learning in the brain, namely the ventral striatal representation of prediction errors (PE)] have been shown to be associated with individual differences in fluid IQ. Here, we examine the interaction between adaptive learning signals (using a well-characterized probabilistic reversal learning task in combination with fMRI) and SLES on fluid IQ measures. We find that the correlation between ventral striatal BOLD PE and fluid IQ, which we have previously reported, is quantitatively modulated by the amount of reported SLES. Thus, after experiencing adversity, basic neuronal learning signatures appear to align more closely with a general measure of flexible learning (fluid IQ), a finding complementing studies on the effects of acute stress on learning. The results suggest that an understanding of the neurobiological correlates of trait variables like fluid IQ needs to take socioemotional influences such as chronic stress into account. KW - Reinforcement learning KW - Prediction error signal KW - Ventral striatum KW - Stress KW - Intelligence Y1 - 2015 U6 - https://doi.org/10.1007/s00406-014-0519-3 SN - 0940-1334 SN - 1433-8491 VL - 265 IS - 1 SP - 35 EP - 43 PB - Springer CY - Heidelberg ER - TY - JOUR A1 - Liu, Shuyan A1 - Kuschpel, Maxim S. A1 - Schad, Daniel A1 - Heinz, Andreas A1 - Rapp, Michael A. T1 - Differential Effects of Music and Video Gaming During Breaks on Auditory and Visual Learning JF - Cyberpsychology, behavior and social networking N2 - The interruption of learning processes by breaks filled with diverse activities is common in everyday life. This study investigated the effects of active computer gaming and passive relaxation (rest and music) breaks on auditory versus visual memory performance. Young adults were exposed to breaks involving (a) open eyes resting, (b) listening to music, and (c) playing a video game, immediately after memorizing auditory versus visual stimuli. To assess learning performance, words were recalled directly after the break (an 8:30 minute delay) and were recalled and recognized again after 7 days. Based on linear mixed-effects modeling, it was found that playing the Angry Birds video game during a short learning break impaired long-term retrieval in auditory learning but enhanced long-term retrieval in visual learning compared with the music and rest conditions. These differential effects of video games on visual versus auditory learning suggest specific interference of common break activities on learning. Y1 - 2015 U6 - https://doi.org/10.1089/cyber.2015.0140 SN - 2152-2715 SN - 2152-2723 VL - 18 IS - 11 SP - 647 EP - 653 PB - Liebert CY - New Rochelle ER - TY - JOUR A1 - Stelzel, Christine A1 - Schauenburg, Gesche A1 - Rapp, Michael A. A1 - Heinzel, Stephan A1 - Granacher, Urs T1 - Age-Related Interference between the Selection of Input-Output Modality Mappings and Postural Control-a Pilot Study JF - Frontiers in psychology N2 - Age-related decline in executive functions and postural control due to degenerative processes in the central nervous system have been related to increased fall-risk in old age. Many studies have shown cognitive-postural dual-task interference in old adults, but research on the role of specific executive functions in this context has just begun. In this study, we addressed the question whether postural control is impaired depending on the coordination of concurrent response-selection processes related to the compatibility of input and output modality mappings as compared to impairments related to working-memory load in the comparison of cognitive dual and single tasks. Specifically, we measured total center of pressure (CoP) displacements in healthy female participants aged 19-30 and 66-84 years while they performed different versions of a spatial one-back working memory task during semi-tandem stance on an unstable surface (i.e., balance pad) while standing on a force plate. The specific working-memory tasks comprised: (i) modality compatible single tasks (i.e., visual-manual or auditory-vocal tasks), (ii) modality compatible dual tasks (i.e., visual-manual and auditory-vocal tasks), (iii) modality incompatible single tasks (i.e., visual-vocal or auditory-manual tasks), and (iv) modality incompatible dual tasks (i.e., visual-vocal and auditory-manual tasks). In addition, participants performed the same tasks while sitting. As expected from previous research, old adults showed generally impaired performance under high working-memory load (i.e., dual vs. single one-back task). In addition, modality compatibility affected one-back performance in dual-task but not in single-task conditions with strikingly pronounced impairments in old adults. Notably, the modality incompatible dual task also resulted in a selective increase in total CoP displacements compared to the modality compatible dual task in the old but not in the young participants. These results suggest that in addition to effects of working-memory load, processes related to simultaneously overcoming special linkages between input-and output modalities interfere with postural control in old but not in young female adults. Our preliminary data provide further evidence for the involvement of cognitive control processes in postural tasks. KW - cognitive-postural dual task KW - postural stability KW - working memory KW - modality compatibility KW - aging Y1 - 2017 U6 - https://doi.org/10.3389/fpsyg.2017.00613 SN - 1664-1078 VL - 8 PB - Frontiers Research Foundation CY - Lausanne ER - TY - JOUR A1 - Heinzel, Stephan A1 - Lorenz, Robert C. A1 - Quynh-Lam Duong, A1 - Rapp, Michael A. A1 - Deserno, Lorenz T1 - Prefrontal-parietal effective connectivity during working memory in older adults JF - Neurobiology of Aging N2 - Theoretical models and preceding studies have described age-related alterations in neuronal activation of frontoparietal regions in a working memory (WM)load-dependent manner. However, to date, underlying neuronal mechanisms of these WM load-dependent activation changes in aging remain poorly understood. The aim of this study was to investigate these mechanisms in terms of effective connectivity by application of dynamic causal modeling with Bayesian Model Selection. Eighteen healthy younger (age: 20-32 years) and 32 older (60-75 years) participants performed an n-back task with 3 WM load levels during functional magnetic resonance imaging (fMRI). Behavioral and conventional fMRI results replicated age group by WM load interactions. Importantly, the analysis of effective connectivity derived from dynamic causal modeling, indicated an age-and performance-related reduction in WM load-dependent modulation of connectivity from dorsolateral prefrontal cortex to inferior parietal lobule. This finding provides evidence for the proposal that age-related WM decline manifests as deficient WM load-dependent modulation of neuronal top-down control and can integrate implications from theoretical models and previous studies of functional changes in the aging brain. KW - Aging KW - Dynamic causal modeling (DCM) KW - Effective connectivity KW - Functional magnetic resonance imaging (fMRI) KW - Working memory Y1 - 2017 U6 - https://doi.org/10.1016/j.neurobiolaging.2017.05.005 SN - 0197-4580 SN - 1558-1497 VL - 57 SP - 18 EP - 27 PB - Elsevier CY - New York ER - TY - JOUR A1 - Heinzel, Stephan A1 - Rimpel, Jérôme A1 - Stelzel, Christine A1 - Rapp, Michael A. T1 - Transfer Effects to a Multimodal Dual-Task after Working Memory Training and Associated Neural Correlates in Older Adults BT - A Pilot Study JF - Frontiers in human neuroscience N2 - Working memory (WM) performance declines with age. However, several studies have shown that WM training may lead to performance increases not only in the trained task, but also in untrained cognitive transfer tasks. It has been suggested that transfer effects occur if training task and transfer task share specific processing components that are supposedly processed in the same brain areas. In the current study, we investigated whether single-task WM training and training-related alterations in neural activity might support performance in a dual-task setting, thus assessing transfer effects to higher-order control processes in the context of dual-task coordination. A sample of older adults (age 60–72) was assigned to either a training or control group. The training group participated in 12 sessions of an adaptive n-back training. At pre and post-measurement, a multimodal dual-task was performed in all participants to assess transfer effects. This task consisted of two simultaneous delayed match to sample WM tasks using two different stimulus modalities (visual and auditory) that were performed either in isolation (single-task) or in conjunction (dual-task). A subgroup also participated in functional magnetic resonance imaging (fMRI) during the performance of the n-back task before and after training. While no transfer to single-task performance was found, dual-task costs in both the visual modality (p < 0.05) and the auditory modality (p < 0.05) decreased at post-measurement in the training but not in the control group. In the fMRI subgroup of the training participants, neural activity changes in left dorsolateral prefrontal cortex (DLPFC) during one-back predicted post-training auditory dual-task costs, while neural activity changes in right DLPFC during three-back predicted visual dual-task costs. Results might indicate an improvement in central executive processing that could facilitate both WM and dual-task coordination. KW - working memory KW - cognitive training KW - modality KW - dual-task KW - aging KW - transfer KW - fMRI KW - neuroimaging Y1 - 2017 U6 - https://doi.org/10.3389/fnhum.2017.00085 VL - 11 PB - Frontiers Research Foundation CY - Lausanne ER - TY - JOUR A1 - Jacob, Louis A1 - Rapp, Michael A. A1 - Kostev, Karel T1 - Long-term use of benzodiazepines in older patients in Germany BT - a retrospective analysis JF - Therapeutic Advances in Psychopharmacology N2 - Background: The purpose of this study was to analyze the prevalence of long-term benzodiazepine use in older adults treated in general and neuropsychiatric practices in Germany. Methods: This study included 32,182 patients over the age of 65 years who received benzodiazepine prescriptions for the first time between January 2010 and December 2014 in general and neuropsychiatric practices in Germany. Follow up lasted until July 2016. The main outcome measure was the proportion of patients treated with benzodiazepines for >6 months. Results: The proportion of patients with benzodiazepine therapy for >6 months increased with age (65-70 years: 12.3%; 71-80 years: 15.5%; 81-90 years: 23.7%; >90 years: 31.6%) but did not differ significantly between men (15.5%) and women (17.1%). The proportion of patients who received benzodiazepines for >6 months was higher among those with sleep disorders (21.1%), depression (20.8%) and dementia (32.1%) than among those with anxiety (15.5%). By contrast, this proportion was lower among people diagnosed with adjustment disorders (7.7%) and back pain (3.8%). Conclusion: Overall, long-term use of benzodiazepines is common in older people, particularly in patients over the age of 80 and in those diagnosed with dementia, sleep disorders, or depression. KW - benzodiazepines KW - Germany KW - long-term use KW - older people KW - risk factors Y1 - 2017 U6 - https://doi.org/10.1177/2045125317696454 SN - 2045-1253 SN - 2045-1261 VL - 7 IS - 6/7 SP - 191 EP - 200 PB - Sage Publ. CY - London ER - TY - JOUR A1 - Kallies, Gunnar A1 - Rapp, Michael A. A1 - Fydrich, Thomas A1 - Fehm, Lydia A1 - Tschorn, Mira A1 - Teran, Christina A1 - Schwefel, Melanie A1 - Pietrek, Anou F. A1 - Henze, Romy A1 - Hellweg, Rainer A1 - Ströhle, Andreas A1 - Heinzel, Stephan A1 - Heissel, Andreas T1 - Serum brain-derived neurotrophic factor (BDNF) at rest and after acute aerobic exercise in major depressive disorder JF - Psychoneuroendocrinology N2 - Physiological mechanisms of an anti-depressive effect of physical exercise in major depressive disorder (MDD) seem to involve alterations in brain-derived neurotrophic factor (BDNF) level. However, previous studies which investigated this effect in a single bout of exercise, did not control for confounding peripheral factors that contribute to BDNF-alterations. Therefore, the underlying cause of exercise-induced BDNF-changes remains unclear. The current study aims to investigate serum BDNF (sBDNF)-changes due to a single-bout of graded aerobic exercise in a group of 30 outpatients with MDD, suggesting a more precise analysis method by taking plasma volume shift and number of platelets into account. Results show that exercise-induced increases in sBDNF remain significant (p<.001) when adjusting for plasma volume shift and controlling for number of platelets. The interaction of sBDNF change and number of platelets was also significant (p=.001) indicating larger sBDNF-increase in participants with smaller number of platelets. Thus, findings of this study suggest an involvement of peripheral as well as additional possibly brain-derived mechanisms explaining exercise-related BDNF release in MDD. For future studies in the field of exercise-related BDNF research, the importance of controlling for peripheral parameters is emphasized. KW - Brain-derived neurotrophic factor (BDNF) KW - Platelets KW - Major depressive disorder KW - Physical exercise Y1 - 2018 U6 - https://doi.org/10.1016/j.psyneuen.2018.12.015 SN - 0306-4530 VL - 102 SP - 212 EP - 215 PB - Elsevier CY - Oxford ER - TY - JOUR A1 - Meiberth, Dix Urs A1 - Rapp, Michael A. A1 - Jessen, Frank T1 - Gedächtnisambulanzstrukturen in Deutschland – Ergebnisse einer Klinikbefragung JF - Psychiatrische Praxis N2 - Ziel der Studie Erfassung der Strukturen zur Frühdiagnostik von Demenzen an Krankenhäusern in Deutschland. Methodik Fragebogenerhebung. Ergebnisse 14 % von 1758 kontaktierten Einrichtungen antworteten. 52 % berichteten über ein entsprechendes Angebot, zum großen Teil mit leitlinienorientierten Verfahren, wie Liquordiagnostik. Das Diagnosespektrum umfasste zu 46 % Demenzen und zu 41 % Diagnosen der leichten oder subjektiven kognitiven Störung. Schlussfolgerung Leitlinienbasierte Diagnostik und Früherkennungskonzepte sind in Gedächtnisambulanzen weitgehend etabliert. N2 - Objective To assess the structures for early and differential diagnosis of dementia in hospitals in Germany. Methods Written questionnaire to all German hospitals. Results 14 % of 1.758 hospitals responded. Of those, 52 % reported to offer a special service for early dementia diagnosis, mostly on an outpatient basis. The applied methods were in agreement with the national guideline for diagnosis and treatment of dementias, including technical diagnostics, such as neuroimaging and cerebrospinal fluid examinations. 46 % of the diagnostic spectrum were dementia. 41 % were either diagnosed as mild cognitive impairment (MCI) or as subjective cognitive decline (SCD). Conclusion Despite mostly insufficient reimbursement, a large proportion of the responding hospitals offer a specialized service, which largely adheres to guideline-based diagnostic procedures. The concepts of at-risk and prodromal stages of dementia seem to be largely established. T2 - Memory Clinics in Germany - Results of a Hospital Survey KW - dementia KW - Alzheimer KW - memory clinic KW - early diagnosis KW - Demenz KW - Alzheimer KW - Gedächtnisambulanz KW - Frühdiagnose Y1 - 2019 U6 - https://doi.org/10.1055/a-0825-9049 SN - 0303-4259 SN - 1439-0876 VL - 46 IS - 4 SP - 213 EP - 216 PB - Thieme CY - Stuttgart ER - TY - GEN A1 - Awasthi, Swapnil A1 - Kaminski, Jakob A1 - Rapp, Michael A. A1 - Schlagenhauf, Florian A1 - Walter, Henrik A1 - Ruggeri, Barbara A1 - Ripke, Stephan A1 - Schumann, Gunter A1 - Heinz, Andreas T1 - A neural signature of malleability BT - general intelligence correlates with ventral striatal activation and epigenetic makers of dopamine neurotransmission T2 - European neuropsychopharmacology : the journal of the European College of Neuropsychopharmacology N2 - General intelligence has a substantial genetic background in children, adolescents, and adults, but environmental factors also strongly correlate with cognitive performance as evidenced by a strong (up to one SD) increase in average intelligence test results in the second half of the previous century. This change occurred in a period apparently too short to accommodate radical genetic changes. It is highly suggestive that environmental factors interact with genotype by possible modification of epigenetic factors that regulate gene expression and thus contribute to individual malleability. This modification might as well be reflected in recent observations of an association between dopamine-dependent encoding of reward prediction errors and cognitive capacity, which was modulated by adverse life events. Y1 - 2019 U6 - https://doi.org/10.1016/j.euroneuro.2017.08.139 SN - 0924-977X SN - 1873-7862 VL - 29 SP - S858 EP - S859 PB - Elsevier CY - Amsterdam 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 - Konrad, Marcel A1 - Jacob, Louis A1 - Rapp, Michael A. A1 - Kostev, Karel T1 - Treatment of depression in patients with cardiovascular diseases by German psychiatrists JF - International journal of clinical pharmacology and therapeutics N2 - Objective: To estimate the prevalence and the type of antidepressant medication prescribed by German psychiatrists to patients with depression and cardiovascular diseases (CVD). Methods: This study was a retrospective database analysis in Germany using the Disease Analyzer Database (IMS Health, Germany). The study population included 2,288 CVD patients between 40 and 90 years of age from 175 psychiatric practices. The observation period was between 2004 and 2013. Follow-up lasted up to 12 months and ended in April 2015. Also included were 2,288 non-CVD controls matched (1 : 1) to CVD cases on the basis of age, gender, health insurance coverage, depression severity, and diagnosing physician. Results: Mean age was 68.6 years. 46.2% of patients were men, and 5.9% had private health insurance coverage. Mild, moderate, or severe depression was present in 18.7%, 60.7%, and 20.6% of patients, respectively. Most patients had treatment within a year, many of them immediately after depression diagnosis. Patients with moderate and severe depression were more likely to receive treatment than patients with mild depression. There was no difference between CVD and non-CVD in the proportion of patients treated. Nonetheless, CVD patients received selective serotonin reuptake inhibitors / serotonin-noradrenaline reuptake inhibitors (SSRIs/SNRIs) significantly more frequently. Conversely, patients without CVD were more often treated with TCA. Conclusion: There was no association between CVD and the initiation of depression treatment. Furthermore, CVD patients received SSRIs/SNRIs more frequently. KW - depression KW - cardiovascular diseases KW - antidepressant therapy KW - psychiatric practices Y1 - 2016 U6 - https://doi.org/10.5414/CP202591 SN - 0946-1965 VL - 54 SP - 557 EP - 563 PB - Dustri-Verlag Dr. Karl Feistle CY - Deisenhofen-München ER - TY - CHAP A1 - Rapp, Michael A. T1 - When Local Poverty is More Important Than Your Income: Migrant Mental Health in Inner Cities T2 - European psychiatry : the journal of the Association of European Psychiatrists Y1 - 2015 SN - 0924-9338 SN - 1778-3585 VL - 30 PB - Elsevier CY - Paris ER - TY - JOUR A1 - Stroehle, Andreas A1 - Schmidt, Dietlinde K. A1 - Schultz, Florian A1 - Fricke, Nina A1 - Staden, Theresa A1 - Hellweg, Rainer A1 - Priller, Josef A1 - Rapp, Michael A. A1 - Rieckmann, Nina T1 - Drug and Exercise Treatment of Alzheimer Disease and Mild Cognitive Impairment: A Systematic Review and Meta-Analysis of Effects on Cognition in Randomized Controlled Trials JF - The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry N2 - Objective: Demographic changes are increasing the pressure to improve therapeutic strategies against cognitive decline in Alzheimer disease (AD) and mild cognitive impairment (MCI). Besides drug treatment, physical activity seems to be a promising intervention target as epidemiological and clinical studies suggest beneficial effects of exercise training on cognition. Using comparable inclusion and exclusion criteria, we analyzed the efficacy of drug therapy (cholinesterase inhibitors, memantine, and Ginkgo biloba) and exercise interventions for improving cognition in AD and MCI populations. Methods: We searched The Cochrane Library, EBSCO, OVID, Web of Science, and U.S Food and Drug Administration data from inception through October 30, 2013. Randomized controlled trials in which at least one treatment arm consisted of an exercise or a pharmacological intervention for AD or MCI patients, and which had either a non-exposed control condition or a control condition that received another intervention. Treatment discontinuation rates and Standardized Mean Change score using Raw score standardization (SMCR) of cognitive performance were calculated. Results: Discontinuation rates varied substantially and ranged between 0% and 49% with a median of 18%. Significantly increased discontinuation rates were found for galantamine and rivastigmine as compared to placebo in AD studies. Drug treatments resulted in a small pooled effect on cognition (SMCR: 0.23, 95% CI: 0.20 to 0.25) in AD studies (N = 45, 18,434 patients) and no effect in any of the MCI studies (N = 5, 3,693 patients; SMCR: 0.03, 95% CI: 0.00 to 0.005). Exercise interventions had a moderate to strong pooled effect size (SMCR: 0.83, 95% CI: 0.59 to 1.07) in AD studies (N = 4, 119 patients), and a small effect size (SMCR: 0.20, 95% CI: 0.11 to 0.28) in MCI (N = 6, 443 patients). Conclusions: Drug treatments have a small but significant impact on cognitive functioning in AD and exercise has the potential to improve cognition in AD and MCI. Head-to-head trials with sufficient statistical power are necessary to directly compare efficacy, safety, and acceptability. Combining these two approaches might further increase the efficacy of each individual intervention. Identifier: PROSPERO (2013:CRD42013003910). KW - Alzheimer dementia KW - mild cognitive impairment KW - drug KW - exercise Y1 - 2015 U6 - https://doi.org/10.1016/j.jagp.2015.07.007 SN - 1064-7481 SN - 1545-7214 VL - 23 IS - 12 SP - 1234 EP - 1249 PB - Elsevier CY - New York ER - TY - JOUR A1 - Bohlken, Jens A1 - Weber, Simon A1 - Rapp, Michael A. A1 - Kostev, Karel T1 - Continuous treatment with antidementia drugs in Germany 2003-2013: a retrospective database analysis JF - International psychogeriatrics N2 - Background: Continuous treatment is an important indicator of medication adherence in dementia. However, long-term studies in larger clinical settings are lacking, and little is known about moderating effects of patient and service characteristics. Methods: Data from 12,910 outpatients with dementia (mean age 79.2 years; SD = 7.6 years) treated between January 2003 and December 2013 in Germany were included. Continuous treatment was analysed using Kaplan-Meier curves and log-rank tests. In addition, multivariate Cox regression models were fitted with continuous treatment as dependent variable and the predictors antidementia agent, age, gender, medical comorbidities, physician specialty, and health insurance status. Results: After one year of follow-up, nearly 60% of patients continued drug treatment. Donezepil (HR: 0.88; 95% CI: 0.82-0.95) and memantine (HR: 0.85; 0.79-0.91) patients were less likely to be discontinued treatment as compared to rivastigmine users. Patients were less likely to be discontinued if they were treated by specialist physicians as compared to general practitioners (HR: 0.44; 0.41-0.48). Younger male patients and patients who had private health insurance had a lower discontinuation risk. Regarding comorbidity, patients were more likely to be continuously treated with the index substance if a diagnosis of heart failure or hypertension had been diagnosed at baseline. Conclusions: Our results imply that besides type of antidementia agent, involvement of a specialist in the complex process of prescribing antidementia drugs can provide meaningful benefits to patients, in terms of more disease-specific and continuous treatment. KW - adherence KW - cholinesterase inhibitors KW - memantine Y1 - 2015 U6 - https://doi.org/10.1017/S1041610215000654 SN - 1041-6102 SN - 1741-203X VL - 27 IS - 8 SP - 1335 EP - 1342 PB - Cambridge Univ. Press CY - New York ER - TY - JOUR A1 - Heinzel, Stephan A1 - Riemer, Thomas G. A1 - Schulte, Stefanie A1 - Onken, Johanna A1 - Heinz, Andreas A1 - Rapp, Michael A. T1 - Catechol-O-methyltransferase (COMT) genotype affects age-related changes in plasticity in working memory: a pilot study JF - BioMed research international N2 - Objectives. Recent work suggests that a genetic variation associated with increased dopamine metabolism in the prefrontal cortex (catechol-O-methyltransferase Val158Met; COMT) amplifies age-related changes in working memory performance. Research on younger adults indicates that the influence of dopamine-related genetic polymorphisms on working memory performance increases when testing the cognitive limits through training. To date, this has not been studied in older adults. Method. Here we investigate the effect of COMT genotype on plasticity in working memory in a sample of 14 younger (aged 24-30 years) and 25 older (aged 60-75 years) healthy adults. Participants underwent adaptive training in the n-back working memory task over 12 sessions under increasing difficulty conditions. Results. Both younger and older adults exhibited sizeable behavioral plasticity through training (P < .001), which was larger in younger as compared to older adults (P < .001). Age-related differences were qualified by an interaction with COMT genotype (P < .001), and this interaction was due to decreased behavioral plasticity in older adults carrying the Val/Val genotype, while there was no effect of genotype in younger adults. Discussion. Our findings indicate that age-related changes in plasticity in working memory are critically affected by genetic variation in prefrontal dopamine metabolism. Y1 - 2014 U6 - https://doi.org/10.1155/2014/414351 SN - 2314-6133 SN - 2314-6141 PB - Hindawi Publishing Corp. CY - New York ER - TY - JOUR A1 - Liu, Shuyan A1 - Schad, Daniel A1 - Kuschpel, Maxim S. A1 - Rapp, Michael A. A1 - Heinz, Andreas T1 - Music and Video Gaming during Breaks BT - Influence on Habitual versus Goal-Directed Decision Making JF - PLoS one N2 - Different systems for habitual versus goal-directed control are thought to underlie human decision-making. Working memory is known to shape these decision-making systems and their interplay, and is known to support goal-directed decision making even under stress. Here, we investigated if and how decision systems are differentially influenced by breaks filled with diverse everyday life activities known to modulate working memory performance. We used a within-subject design where young adults listened to music and played a video game during breaks interleaved with trials of a sequential two-step Markov decision task, designed to assess habitual as well as goal-directed decision making. Based on a neurocomputational model of task performance, we observed that for individuals with a rather limited working memory capacity video gaming as compared to music reduced reliance on the goal-directed decision-making system, while a rather large working memory capacity prevented such a decline. Our findings suggest differential effects of everyday activities on key decision-making processes. KW - Decision making KW - Games KW - Working memory KW - Video games KW - Cognition KW - Cognitive impairment KW - Music cognition KW - Learning Y1 - 2016 U6 - https://doi.org/10.1371/JOURNAL.PONE.0150165 SN - 1932-6203 VL - 11 IS - 3 SP - 1 EP - 12 PB - Public Library of Science CY - Lawrence, Kan. ER - TY - JOUR A1 - Zaytseva, Yuliya A1 - Korsakova, Natalya A1 - Gurovich, Isaac Ya A1 - Heinz, Andreas A1 - Rapp, Michael A. T1 - Luria revisited: Complex motor phenomena in first episode schizophrenia and schizophrenia spectrum disorders JF - Psychiatry research : the official publication of the International Society for Neuroimaging in Psychiatry KW - Luria KW - Fist-Edge-Palm test KW - Bimanual probe KW - Error monitoring KW - First psychotic episode KW - Schizophrenia KW - Schizophrenia spectrum disorders Y1 - 2014 U6 - https://doi.org/10.1016/j.psychres.2014.08.009 SN - 0165-1781 VL - 220 IS - 1-2 SP - 145 EP - 151 PB - Elsevier CY - Clare ER - TY - CHAP A1 - Nordheim, J. A1 - Rapp, Michael A. A1 - Krause-Koehler, Kathleen A1 - Niemann-Mirmehdi, M. A1 - Haeusler, Andreas T1 - Support for dementia affected Couples. Results of the DYADEM- study T2 - Zeitschrift für Gerontologie und Geriatrie Y1 - 2014 SN - 0948-6704 SN - 1435-1269 VL - 47 SP - 136 EP - 136 PB - Springer CY - Heidelberg ER - TY - JOUR A1 - Heissel, Andreas A1 - Zech, Philipp A1 - Rapp, Michael A. A1 - Schuch, Felipe B. A1 - Lawrence, Jimmy B. A1 - Kangas, Maria A1 - Heinzel, Stephan T1 - Effects of exercise on depression and anxiety in persons living with HIV: A meta-analysis JF - Journal of psychosomatic research N2 - Objective: The purpose of this systematic review and meta-analysis was to examine the effects of exercise on depression and anxiety in people living with HIV (PLWH), and to evaluate, through subgroup analysis, the effects of exercise type, frequency, supervision by exercise professionals, study quality, and control group conditions on these outcomes. Method: A literature search was conducted through four electronic databases from inception to February 2019. Considered for inclusion were randomized controlled trials (RCTs) investigating exercise interventions and depression or anxiety as outcomes in people living with HIV (>= 18 years of age). Ten studies were included (n = 479 participants, 49.67% females at baseline), and the standardized mean difference (SMD) and heterogeneity were calculated using random-effect models. An additional pre-post meta-analysis was also conducted. Results: A large effect in favor of exercise when compared to controls was found for depression (SMD = -0.84, 95%CI = [-1.57, -0.11], p = 0.02) and anxiety (SMD = -1.23, 95%CI = [-2.42, 0.04], p = -0.04). Subgroup analyses for depression revealed large effects on depression for aerobic exercise only (SMD = -0.96, 95%CI = [-1.63, -0.30], p = 0.004), a frequency of >= 3 exercise sessions per week (SMD = -1.39, 95%CI = [-2.24, -0.54], p < 0.001), professionally supervised exercise (SMD = -1.40, 95%CI = [-2.46, -0.17], p = 0.03]), and high-quality studies (SMD = -1.31, 95%CI = [-2.46, -0.17], p = 0.02). Conclusion: Exercise seems to decrease depressive symptoms and anxiety in PLWH, but other larger and high-quality studies are needed to verify these effects. KW - HIV KW - Exercise KW - Depression KW - Anxiety KW - Meta-analysis KW - Supervision Y1 - 2019 U6 - https://doi.org/10.1016/j.jpsychores.2019.109823 SN - 0022-3999 SN - 1879-1360 VL - 126 PB - Elsevier CY - Oxford ER - TY - JOUR A1 - Mell, Thomas A1 - Jacob, Louis A1 - Fuhr, Ida A1 - Dick, Sandra A1 - Rapp, Michael A. A1 - Kostev, Karel T1 - Patterns of benzodiazepine prescribing by neuropsychiatrists and general practitioners for elderly patients in Germany in 2014 JF - International journal of clinical pharmacology and therapeutics N2 - Background: The patterns of benzodiazepine prescriptions in older adults are of general and scientific interest as they are not yet well understood. The aim of this study was to compare the prescription patterns of benzodiazepines in elderly people in Germany to determine the share or proportion treated by general practitioners (GP) and neuropsychiatrists (NP). Methods: This study included 31,268 and 6,603 patients between the ages of 65 and 100 with at least one benzodiazepine prescription in 2014 from GP and NP, respectively. Demographic data included age, gender, and type of health insurance coverage. The share of elderly people with benzodiazepine prescriptions was estimated in different age and disease groups for both GP and NP patients. The share of the six most commonly prescribed drugs was also calculated for each type of practice. Results: The share of people taking benzodiazepines prescribed by GP increased from 3.2% in patients aged between 65 and 69 years to 8.6% in patients aged between 90 and 100 years, whereas this share increased from 5.4% to 7.1% in those seen by NP. Benzodiazepines were frequently used by patients suffering from sleep disorders (GP: 33.9%; NP: 5.5%), depression (GP: 17.9%; NP: 29.8%), and anxiety disorders (GP: 14.5%; NP: 22.8%). Lorazepam (30.3%), oxazepam (24.7%), and bromazepam (24.3%) were the three most commonly prescribed drugs for GP patients. In contrast, lorazepam (60.4%), diazepam (14.8%), and oxazepam (11.2%) were those more frequently prescribed to NP patients. Conclusion: Prescription patterns of benzodiazepine in the elderly varied widely between GP and NP. KW - benzodiazepines KW - prescription patterns KW - elderly people KW - Germany Y1 - 2017 U6 - https://doi.org/10.5414/CP202904 SN - 0946-1965 VL - 55 SP - 466 EP - 471 PB - Dustri-Verlag Dr. Karl Feistle CY - Deisenhofen-München ER - TY - JOUR A1 - Zech, Philipp A1 - Schuch, Felipe A1 - Pérez Chaparro, Camilo Germán Alberto A1 - Kangas, Maria A1 - Rapp, Michael A. A1 - Heissel, Andreas T1 - Exercise, Comorbidities, and Health-Related Quality of Life in People Living with HIV BT - The HIBES Cohort Study JF - International Journal of Environmental Research and Public Health N2 - (1) Background: People with HIV (PWH) may perform more than one type of exercise cumulatively. The objective of this study is to investigate recreational exercise and its association with health-related quality of life (HRQOL) and comorbidities in relation to potential covariates. (2) Methods: The HIBES study (HIV-Begleiterkrankungen-Sport) is a cross-sectional study for people with HIV. The differences between non-exercisers versus exercisers (cumulated vs. single type of exercises) were investigated using regression models based on 454 participants. (3) Results: Exercisers showed a higher HRQOL score compared to non-exercisers (Wilcox r = 0.2 to 0.239). Psychological disorders were identified as the main covariate. Participants performing exercise cumulatively showed higher scores in duration, frequency, and intensity when compared to participants performing only one type of exercise. The mental health summary score was higher for the cumulated and single type of exercise if a psychological disorder existed. Duration and intensity were associated with an increase of HRQOL, whilst a stronger association between psychological disorders and exercise variables were evident. Exercise duration (minutes) showed a significant effect on QOL (standardized beta = 0.1) and for participants with psychological disorders (standardized beta = 0.3), respectively. (4) Conclusions: Psychological disorders and other covariates have a prominent effect on HRQOL and its association with exercise. For PWH with a psychological disorder, a stronger relationship between HRQOL with exercise duration and intensity emerged. However, differentiation of high-HRQOL individuals warrants further investigation by considering additional factors. KW - HIV KW - exercise intensity KW - quality of life KW - comorbidity Y1 - 2020 U6 - https://doi.org/10.3390/ijerph17145138 SN - 1660-4601 SN - 1661-7827 VL - 17 IS - 14 PB - MDPI AG CY - Basel ER - TY - JOUR A1 - Kluge, Ulrike A1 - Rapp, Michael A. A1 - Mehran, Nassim A1 - Abi Jumaa, Jinan A1 - Aichberger, Marion Christina T1 - Poverty, migration and mental health JF - Der Nervenarzt : Organ der Deutschen Gesellschaft für Psychiatrie, Psychotherapie und Nervenheilkunde ; Mitteilungsblatt der Deutschen Gesellschaft für Neurologie N2 - Poverty and social exclusion are closely related to an increased risk for the deterioration of mental health. In 2018 approximately 19% of the German population were threatened by poverty and the associated social ostracization. Migrant groups in particular often show an increased risk for poverty and are often exposed to multiple socioeconomic stress factors depending on the context of migration, pre-migration and post-migration social factors. Numerous studies have shown that societal exclusion, precarious living conditions and the residential environment negatively affect mental health beyond the effects of pre-migration risk factors. This article provides a review and discussion on the relationship between mental health, poverty and related constructs, such as social cohesion, social capital and social exclusion in general as well as in specific risk groups, such as migrant and refugee populations. KW - Social capital KW - Social cohesion KW - Migration KW - Exclusion KW - Residential environment Y1 - 2019 U6 - https://doi.org/10.1007/s00115-019-00790-2 SN - 0028-2804 SN - 1433-0407 VL - 90 IS - 11 SP - 1103 EP - 1108 PB - Springer CY - New York ER - TY - JOUR A1 - Rapp, Michael A. T1 - Die Versorgung für die nächste Dekade sichern: Gerontopsychiatrie in der Krise? T1 - Covering Care for the Next Decade: A Crisis in Geriatric Psychiatry? JF - Psychatrische Praxis N2 - Der demografische Wandel wird nicht nur mit einer rasanten Zunahme der Hochaltrigen einhergehen [1], was für die gerontopsychiatrische Versorgung aufgrund der altersassoziierten Inzidenzraten in erster Linie eine Zunahme an Demenzerkrankungen und Patienten mit Multimorbidität und Gebrechlichkeit bedeutet [2], sondern auch mit einer Zunahme jüngerer alter Menschen vom 65. bis 75. Lebensjahr, was für die Gerontopsychiatrie eine Zunahme der Patienten mit Abhängigkeitserkrankungen, Erkrankungen aus dem schizophrenen Formenkreis und affektiven Erkrankungen bedeutet. Soziale Faktoren werden hier mehr und mehr eine zentrale Rolle spielen, da neben der Qualität der medizinischen Versorgung insbesondere die individuelle soziale Situation der Patienten mit einer erhöhten Morbidität und Mortalität einhergehen wird [3]. Y1 - 2019 U6 - https://doi.org/10.1055/a-0971-5551 SN - 0303-4259 SN - 1439-0876 VL - 46 IS - 6 SP - 305 EP - 306 PB - Thieme CY - Stuttgart ER - TY - JOUR A1 - Rapp, Michael A. T1 - Alterspsychiatrie ist Teil ganzheitlicher Altersmedizin, kein Teilbereich der Psychiatrie – Kontra T1 - Not a Sub-Speciality of Psychiatry - Contra JF - Psychatrische Praxis N2 - Wenn in der Medizin vom demografischen Wandel gesprochen wird [1], wird zumeist von einer rasanten Zunahme der Hochaltrigen gesprochen, bei denen aufgrund der differenziellen altersassoziierten Inzidenzraten in erster Linie eine Zunahme an Demenzerkrankungen, kardiovaskulären Erkrankungen, Krebserkrankungen und allgemeiner Multimorbidität und Gebrechlichkeit zu erwarten ist [2]. Dies ist unstrittig richtig, aber nur ein Teil der Folgen des demografischen Wandels für die psychiatrische Versorgung. Diese muss weiterhin die gesamte adulte Lebensspanne im Blick haben, da sonst Versorgungsengpässe bei ohnehin vulnerablen Patienten verstärkt werden, mit Folgen für die Morbidität und Mortalität auf Bevölkerungsebene [3]. Y1 - 2019 U6 - https://doi.org/10.1055/a-0958-8403 SN - 0303-4259 SN - 1439-0876 VL - 46 IS - 6 SP - 308 EP - 309 PB - Thieme CY - Stuttgart ER - TY - JOUR A1 - Balta Beylergil, Sinem A1 - Beck, Anne A1 - Deserno, Lorenz A1 - Lorenz, Robert C. A1 - Rapp, Michael A. A1 - Schlagenhauf, Florian A1 - Heinz, Andreas A1 - Obermayer, Klaus T1 - Dorsolateral prefrontal cortex contributes to the impaired behavioral adaptation in alcohol dependence JF - NeuroImage: Clinical : a journal of diseases affecting the nervous system N2 - Substance-dependent individuals often lack the ability to adjust decisions flexibly in response to the changes in reward contingencies. Prediction errors (PEs) are thought to mediate flexible decision-making by updating the reward values associated with available actions. In this study, we explored whether the neurobiological correlates of PEs are altered in alcohol dependence. Behavioral, and functional magnetic resonance imaging (fMRI) data were simultaneously acquired from 34 abstinent alcohol-dependent patients (ADP) and 26 healthy controls (HC) during a probabilistic reward-guided decision-making task with dynamically changing reinforcement contingencies. A hierarchical Bayesian inference method was used to fit and compare learning models with different assumptions about the amount of task-related information subjects may have inferred during the experiment. Here, we observed that the best-fitting model was a modified Rescorla-Wagner type model, the “double-update” model, which assumes that subjects infer the knowledge that reward contingencies are anti-correlated, and integrate both actual and hypothetical outcomes into their decisions. Moreover, comparison of the best-fitting model's parameters showed that ADP were less sensitive to punishments compared to HC. Hence, decisions of ADP after punishments were loosely coupled with the expected reward values assigned to them. A correlation analysis between the model-generated PEs and the fMRI data revealed a reduced association between these PEs and the BOLD activity in the dorsolateral prefrontal cortex (DLPFC) of ADP. A hemispheric asymmetry was observed in the DLPFC when positive and negative PE signals were analyzed separately. The right DLPFC activity in ADP showed a reduced correlation with positive PEs. On the other hand, ADP, particularly the patients with high dependence severity, recruited the left DLPFC to a lesser extent than HC for processing negative PE signals. These results suggest that the DLPFC, which has been linked to adaptive control of action selection, may play an important role in cognitive inflexibility observed in alcohol dependence when reinforcement contingencies change. Particularly, the left DLPFC may contribute to this impaired behavioral adaptation, possibly by impeding the extinction of the actions that no longer lead to a reward. KW - Alcohol dependence KW - Prediction error KW - Reinforcement learning KW - Reversal learning KW - Dorsolateral prefrontal cortex KW - Decision-making Y1 - 2017 U6 - https://doi.org/10.1016/j.nicl.2017.04.010 SN - 2213-1582 VL - 15 SP - 80 EP - 94 PB - Elsevier CY - Oxford ER - TY - JOUR A1 - Bangeow, Petjo A1 - Rapp, Michael A. T1 - Beurteilung und Nutzung der 2016 reformierten Psychotherapierichtlinie T1 - Assessment and use of 2016 reformed psychotherapeutic guideline BT - Teil II : Ost-West- und Stadt-Land-Vergleich BT - part II : comparing Eastern and Western Germany as well as urban and rural areas JF - Psychiatrische Praxis : Sozialpsychiatrie, klinische Psychiatrie, public mental health, Versorgungsforschung N2 - Ziel der Studie Dieser Artikel untersucht, inwiefern sich die 2016 reformierte Richtlinie im Stadt-Land- sowie im Ost-West-Vergleich auf die ambulante psychotherapeutische Arbeit und Versorgung auswirkt. Methodik Eine Onlineumfrage unter vertragsärztlich tätigen TherapeutInnen wurde durchgeführt. Die Fragen bezogen sich auf verschiedene Neuerungen in der Richtlinie. Ergebnisse Unabhängig von der Region schätzten die Befragten ein, dass die Reform zu keiner verbesserten Versorgung führte. Im Westen und in der Stadt tätige TherapeutInnen verwiesen PatientInnen nach der Sprechstunde öfter an andere Psychotherapiepraxen, im Osten und auf dem Land tätige hingegen öfter auf andere Hilfeangebote. Schlussfolgerung Stärkere Anreize für die psychotherapeutische Tätigkeit auf dem Land sind zu schaffen. Abbaumaßnahmen der Ost-West-Ungleichheiten in der Versorgungsdichte scheinen nötig. N2 - Objective This article investigated whether or not the reformed psychotherapeutic guideline had different effects on outpatient psychotherapeutic work and services comparing urban and rural areas as well as eastern and western Germany. Methods An online survey of psychotherapists was conducted. The survey included questions on various innovations within the reformed guideline. Results Regardless of region, therapists stated overall that the reform has not led to improved psychotherapeutic care. Therapists in the West and in urban areas referred more patients to other psychotherapeutic practices after their consultation. Therapists in the East and in rural areas referred more patients to other institutions and services. Conclusions Psychotherapeutic work in rural areas should be better incentivized. Interventions to reduce east-west inequalities in the density of service provision seem to be necessary. KW - Psychotherapierichtlinie KW - Ostdeutschland KW - Westdeutschland KW - Stadt-Land-Vergleich KW - psychotherapy guidelines KW - Eastern-Western Germany KW - urban-rural KW - comparison Y1 - 2020 U6 - https://doi.org/10.1055/a-1045-9820 SN - 0303-4259 SN - 1439-0876 VL - 47 IS - 07 SP - 383 EP - 387 PB - Thieme CY - Stuttgart ER - TY - JOUR A1 - Block, Andrea A1 - Schulze, Susanne A1 - Deeken, Friederike A1 - Häusler, Andreas A1 - Rezo, Anna A1 - Rapp, Michael A. A1 - Wippert, Pia-Maria T1 - Effects of inflammatory markers and biographical stress on treatment response in depression JF - Psychoneuroendocrinology : an international journal ; the official journal of the International Society of Psychoneuroendocrinology N2 - Background Recent research emphasized the role of inflammatory processes in the pathophysiology of depression. Theories hypothesizes that life events (LE) can affect the immune system and trigger depressive symptoms. LE are also considered as one of the best predictors for the onset and course of depressive disorders. Methods Observational study across three treatment settings: n=208 depressive patients (75.5%f, M 46.6 y) were examined on depression (BDI-II), life events (ILE) and inflammatory markers (IL-6, CRP, fibrinogen, ICAM-1, TNF-alpha, E-selectin) at baseline (t0), 5-week(t1) and 5-month(t2) follow-up. Effects and interactions were analyzed with regression models. Results LE were associated with depressive symptoms at t0 (beta=.209; p=.002) and both follow-ups. Except for CRP, which was linked to depression symptoms at t2 (betai=-.190; p=.032), there were no effects of inflammatory markers on depressive symptoms. At t1, an interaction between CRP and LE in total (beta=-.249; p=.041) was found as well as for LE in the past five years (beta=-.122; p=.027). Similar interactions were found between cumulative LE and ICAM-1 (beta=-.197; p=.003) and IL-6 (beta=-.425; p=.001). Conclusion The cumulative burden of LE effects symptoms and treatment outcome in depressive patients. There is some evidence that inflammatory marker may have long-term effects on treatment outcome as they seem to weaken the determining relation between LE and depression. Y1 - 2021 U6 - https://doi.org/10.1016/j.psyneuen.2021.105535 SN - 0306-4530 SN - 1873-3360 VL - 131 IS - Supplement SP - S24 EP - S24 PB - Elsevier CY - Oxford ER - TY - JOUR A1 - Bangeow, Petjo A1 - Rapp, Michael A. T1 - Beurteilung und Nutzung der 2016 reformierten Psychotherapierichtlinie BT - Teil I: Vergleich unter den psychotherapeutischen Richtlinienverfahren BT - Part I: A Comparison of the Psychotherapeutic Methods JF - Psychiatrische Praxis N2 - Objective This article investigates how aspects of 2016 reform of the German psychotherapeutic guideline were evaluated and used differently by therapists from three different psychotherapeutic treatment methods.
Methods An online survey was conducted with 987 statutory health insurance approved therapists. The questionnaire focused on various innovations in the guideline.
Results There were significant differences in the use of the broadened authority and of specific treatment services. There were also differences in the application for short-term and long-term psychotherapies as well as in the application to extend short to long-term psychotherapy.
Conclusions Elements of the guideline should be evaluated in relation to the preferred treatment method. Aspects related to the psychotherapeutic work with patients seem to be especially significant. N2 - Ziel der Studie Dieser Artikel untersucht, inwiefern Aspekte der 2016 reformierten Psychotherapierichtlinie aus Sicht der drei Richtlinienverfahren für die praktische Arbeit unterschiedlich bewertet und genutzt werden.
Methodik Eine Onlineumfrage wurde unter vertragsärztlich tätigen PsychotherapeutInnen (n = 987) durchgeführt. Die Fragen bezogen sich auf die unterschiedlichen Neuerungen in der Psychotherapierichtlinie. Ergebnisse Signifikante Unterschiede wurden u. a. in der Nutzung der erweiterten Befugnisse sowie in der Abrechnung bestimmter Leistungen deutlich. Die Gruppen unterschieden sich auch in der Beantragung von Behandlungskontingenten.
Schlussfolgerung Es scheint sinnvoll, Elemente der Richtlinienreform aus der Sicht des bevorzugten Behandlungsverfahrens zu evaluieren. Jene Aspekte scheinen bedeutsam, die sich auf die unmittelbare Arbeit mit den PatientInnen beziehen. T2 - Assessment and Use of 2016 Reformed Psychotherapeutic Guideline KW - Psychotherapierichtlinie KW - Richtlinienverfahren KW - Unterschiede KW - psychotherapy guideline KW - psychotherapy methods KW - differences Y1 - 2020 U6 - https://doi.org/10.1055/a-1045-9801 SN - 0303-4259 SN - 1439-0876 VL - 47 IS - 3 SP - 135 EP - 141 PB - Thieme CY - Stuttgart ER - TY - JOUR A1 - Brahms, Markus A1 - Heinzel, Stephan A1 - Rapp, Michael A. A1 - Mückstein, Marie A1 - Hortobágyi, Tibor A1 - Stelzel, Christine A1 - Granacher, Urs T1 - The acute effects of mental fatigue on balance performance in healthy young and older adults – A systematic review and meta-analysis JF - Acta Psychologica N2 - Cognitive resources contribute to balance control. There is evidence that mental fatigue reduces cognitive resources and impairs balance performance, particularly in older adults and when balance tasks are complex, for example when trying to walk or stand while concurrently performing a secondary cognitive task. We conducted a systematic literature search in PubMed (MEDLINE), Web of Science and Google Scholar to identify eligible studies and performed a random effects meta-analysis to quantify the effects of experimentally induced mental fatigue on balance performance in healthy adults. Subgroup analyses were computed for age (healthy young vs. healthy older adults) and balance task complexity (balance tasks with high complexity vs. balance tasks with low complexity) to examine the moderating effects of these factors on fatigue-mediated balance performance. We identified 7 eligible studies with 9 study groups and 206 participants. Analysis revealed that performing a prolonged cognitive task had a small but significant effect (SMDwm = −0.38) on subsequent balance performance in healthy young and older adults. However, age- and task-related differences in balance responses to fatigue could not be confirmed statistically. Overall, aggregation of the available literature indicates that mental fatigue generally reduces balance in healthy adults. However, interactions between cognitive resource reduction, aging and balance task complexity remain elusive. KW - Cognitive fatigue KW - Exertion KW - Tiredness KW - Postural control KW - Gait KW - Sway Y1 - 2022 U6 - https://doi.org/10.1016/j.actpsy.2022.103540 SN - 1873-6297 VL - 225 SP - 1 EP - 13 PB - Elsevier CY - Amsterdam ER - TY - JOUR A1 - Gruebner, Oliver A1 - Rapp, Michael A. A1 - Adli, Mazda A1 - Kluge, Ulrike A1 - Galea, Sandro A1 - Heinz, Andreas T1 - Cities and Mental Health JF - Deutsches Ärzteblatt international : a weekly online journal of clinical medicine and public health N2 - Background: More than half of the global population currently lives in cities, with an increasing trend for further urbanization. Living in cities is associated with increased population density, traffic noise and pollution, but also with better access to health care and other commodities. Methods: This review is based on a selective literature search, providing an overview of the risk factors for mental illness in urban centers. Results: Studies have shown that the risk for serious mental illness is generally higher in cities compared to rural areas. Epidemiological studies have associated growing up and living in cities with a considerably higher risk for schizophrenia. However, correlation is not causation and living in poverty can both contribute to and result from impairments associated with poor mental health. Social isolation and discrimination as well as poverty in the neighborhood contribute to the mental health burden while little is known about specific inter actions between such factors and the built environment. Conclusion: Further insights on the interaction between spatial heterogeneity of neighborhood resources and socio-ecological factors is warranted and requires interdisciplinary research. Y1 - 2017 U6 - https://doi.org/10.3238/arztebl.2017.0121 SN - 1866-0452 VL - 114 IS - 8 SP - 121 EP - 127 PB - Dt. Ärzte-Verl. CY - Cologne ER - TY - GEN A1 - Wippert, Pia-Maria A1 - Block, Andrea A1 - Mansuy, Isabelle M. A1 - Peters, Eva M. J. A1 - Rose, Matthias A1 - Rapp, Michael A. A1 - Huppertz, Alexander A1 - Würtz-Kozak, Karin T1 - Alterations in Bone Homeostasis and Microstructure Related to Depression and Allostatic Load T2 - Psychotherapy and Psychosomatics Y1 - 2019 U6 - https://doi.org/10.1159/000503640 SN - 0033-3190 SN - 1423-0348 VL - 88 IS - 6 SP - 383 EP - 385 PB - Karger CY - Basel ER -