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. <br /> Methods An online survey was conducted with 987 statutory health insurance approved therapists. The questionnaire focused on various innovations in the guideline. <br /> 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. <br /> 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. <br /> 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. <br /> 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  -