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 - 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 - 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 - 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 - Bauer, M.
A1 - Banaschewski, Tobias
A1 - Heinz, A.
A1 - Kamp-Becker, I.
A1 - Meyer-Lindenberg, A.
A1 - Padberg, F.
A1 - Rapp, Michael A.
A1 - Rupprecht, R.
A1 - Schneider, F.
A1 - Schulze, T. G.
A1 - Wittchen, Hans-Ulrich
T1 - The German Research Network for mental Disorders
JF - Der Nervenarzt : Organ der Deutschen Gesellschaft für Psychiatrie, Psychotherapie und Nervenheilkunde ; Mitteilungsblatt der Deutschen Gesellschaft für Neurologie
N2 - Mental disorders are among the greatest medical and social challenges facing us. They can occur at all stages of life and are among the most important commonly occurring diseases. In Germany 28 % of the population suffer from a mental disorder every year, while the lifetime risk of suffering from a mental disorder is almost 50 %. Mental disorders cause great suffering for those affected and their social network. Quantitatively speaking, they can be considered to be among those diseases creating the greatest burden for society due to reduced productivity, absence from work and premature retirement. The Federal Ministry of Education and Research is funding a new research network from 2015 to 2019 with up to 35 million euros to investigate mental disorders in order to devise and develop better therapeutic measures and strategies for this population by means of basic and translational clinical research. This is the result of a competitive call for research proposals entitled research network for mental diseases. It is a nationwide network of nine consortia with up to ten psychiatric and clinical psychology partner institutions from largely university-based research facilities for adults and/or children and adolescents. Furthermore, three cross-consortia platform projects will seek to identify shared causes of diseases and new diagnostic modalities for anxiety disorders, attention deficit hyperactivity disorders (ADHS), autism, bipolar disorders, depression, schizophrenia and psychotic disorders as well as substance-related and addictive disorders. The spectrum of therapeutic approaches to be examined ranges from innovative pharmacological and psychotherapeutic treatment to novel brain stimulation procedures. In light of the enormous burden such diseases represent for society as a whole, a sustainable improvement in the financial support for those researching mental disorders seems essential. This network aims to become a nucleus for long overdue and sustained support for a German center for mental disorders.
Y1 - 2016
U6 - https://doi.org/10.1007/s00115-016-0169-y
SN - 0028-2804
SN - 1433-0407
VL - 87
SP - 989
EP - 1010
PB - Springer
CY - New York
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 - Bohle, Hannah
A1 - Rimpel, Jérôme
A1 - Schauenburg, Gesche
A1 - Gebel, Arnd
A1 - Stelzel, Christine
A1 - Heinzel, Stephan
A1 - Rapp, Michael A.
A1 - Granacher, Urs
T1 - Behavioral and Neural Correlates of Cognitive-Motor Interference during Multitasking in Young and Old Adults
JF - Neural Plasticity
N2 - The concurrent performance of cognitive and postural tasks is particularly impaired in old adults and associated with an increased risk of falls. Biological aging of the cognitive and postural control system appears to be responsible for increased cognitive-motor interference effects. We examined neural and behavioral markers of motor-cognitive dual-task performance in young and old adults performing spatial one-back working memory single and dual tasks during semitandem stance. On the neural level, we used EEG to test for age-related modulations in the frequency domain related to cognitive-postural task load. Twenty-eight healthy young and 30 old adults participated in this study. The tasks included a postural single task, a cognitive-postural dual task, and a cognitive-postural triple task (cognitive dual-task with postural demands). Postural sway (i.e., total center of pressure displacements) was recorded in semistance position on an unstable surface that was placed on top of a force plate while performing cognitive tasks. Neural activation was recorded using a 64-channel mobile EEG system. EEG frequencies were attenuated by the baseline postural single-task condition and demarcated in nine Regions-of-Interest (ROIs), i.e., anterior, central, posterior, over the cortical midline, and both hemispheres. Our findings revealed impaired cognitive dual-task performance in old compared to young participants in the form of significantly lower cognitive performance in the triple-task condition. Furthermore, old adults compared with young adults showed significantly larger postural sway, especially in cognitive-postural task conditions. With respect to EEG frequencies, young compared to old participants showed significantly lower alpha-band activity in cognitive-cognitive-postural triple-task conditions compared with cognitive-postural dual tasks. In addition, with increasing task difficulty, we observed synchronized theta and delta frequencies, irrespective of age. Taskdependent alterations of the alpha frequency band were most pronounced over frontal and central ROIs, while alterations of the theta and delta frequency bands were found in frontal, central, and posterior ROIs. Theta and delta synchronization exhibited a decrease from anterior to posterior regions. For old adults, task difficulty was reflected by theta synchronization in the posterior ROI. For young adults, it was reflected by alpha desynchronization in bilateral anterior ROIs. In addition, we could not identify any effects of task difficulty and age on the beta frequency band. Our results shed light on age-related cognitive and postural declines and how they interact. Modulated alpha frequencies during high cognitive-postural task demands in young but not old adults might be reflective of a constrained neural adaptive potential in old adults. Future studies are needed to elucidate associations between the identified age-related performance decrements with task difficulty and changes in brain activity.
Y1 - 2019
U6 - https://doi.org/10.1155/2019/9478656
SN - 2090-5904
SN - 1687-5443
PB - Hindawi
CY - New York
ER -
TY - JOUR
A1 - Bohlken, Jens
A1 - Jacob, Louis
A1 - Schaum, Peter
A1 - Rapp, Michael A.
A1 - Kostev, Karel
T1 - Hip fracture risk in patients with dementia in German primary care practices
JF - Dementia
N2 - The aim was to analyze the risk of hip fracture in German primary care patients with dementia. This study included patients aged 65-90 from 1072 primary care practices who were first diagnosed with dementia between 2010 and 2013. Controls were matched (1:1) to cases for age, sex, and type of health insurance. The primary outcome was the diagnosis of hip fracture during the three-year follow-up period. A total of 53,156 dementia patients and 53,156 controls were included. A total of 5.3% of patients and 0.7% of controls displayed hip fracture after three years. Hip fracture occurred more frequently in dementia subjects living in nursing homes than in those living at home (9.2% versus 4.3%). Dementia, residence in nursing homes, and osteoporosis were risk factors for fracture development. Antidementia, antipsychotic, and antidepressant drugs generally had no significant impact on hip fracture risk when prescribed for less than six months. Dementia increased hip fracture risk in German primary care practices.
KW - hip fracture
KW - dementia
KW - nursing homes
KW - osteoporosis
KW - risk factors
Y1 - 2015
U6 - https://doi.org/10.1177/1471301215621854
SN - 1471-3012
SN - 1741-2684
VL - 16
SP - 853
EP - 864
PB - Sage Publ.
CY - London
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 - Bohlken, Jens
A1 - Weber, Simon A.
A1 - Siebert, Anke
A1 - Forstmeier, Simon
A1 - Kohlmann, Thomas
A1 - Rapp, Michael A.
T1 - Reminiscence therapy for depression in dementia
BT - An observational study with matched pairs
JF - GeroPsych - The Journal of gerontopsychology and geriatric psychiatry
N2 - We investigated the efficacy of reminiscence therapy (RT) on symptoms of depression in patients with mild to moderate dementia. Out of 227 patients with mild to moderate dementia from a specialized physician’s office, 27 pairs (N = 54; mean age 79.04 ± 6.16 years) who had either received treatment as usual (TAU) or TAU combined with RT, were matched retrospectively according to age as well as cognitive and depressive symptom scores. After controlling for age and sex, symptoms of depression significantly decreased over time in the RT group compared to TAU (F1,52 = 4.36; p < .05). RT is a promising option for the treatment of depression in mild to moderate dementia. Larger randomized-controlled trials are needed.
KW - reminiscence
KW - life story book
Y1 - 2017
U6 - https://doi.org/10.1024/1662-9647/a000175
SN - 1662-9647
SN - 1662-971X
VL - 30
SP - 145
EP - 151
PB - Hogrefe
CY - Göttingen
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 - 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 - 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 - 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 - Chen, Hao
A1 - Belanger, Matthew J.
A1 - Garbusow, Maria
A1 - Kuitunen-Paul, Soeren
A1 - Huys, Quentin J. M.
A1 - Heinz, Andreas
A1 - Rapp, Michael A.
A1 - Smolka, Michael N.
T1 - Susceptibility to interference between Pavlovian and instrumental control predisposes risky alcohol use developmental trajectory from ages 18 to 24
JF - Addiction biology
N2 - Pavlovian cues can influence ongoing instrumental behaviour via Pavlovian-to-instrumental transfer (PIT) processes. While appetitive Pavlovian cues tend to promote instrumental approach, they are detrimental when avoidance behaviour is required, and vice versa for aversive cues. We recently reported that susceptibility to interference between Pavlovian and instrumental control assessed via a PIT task was associated with risky alcohol use at age 18. We now investigated whether such susceptibility also predicts drinking trajectories until age 24, based on AUDIT (Alcohol Use Disorders Identification Test) consumption and binge drinking (gramme alcohol/drinking occasion) scores. The interference PIT effect, assessed at ages 18 and 21 during fMRI, was characterized by increased error rates (ER) and enhanced neural responses in the ventral striatum (VS), the lateral and dorsomedial prefrontal cortices (dmPFC) during conflict, that is, when an instrumental approach was required in the presence of an aversive Pavlovian cue or vice versa. We found that a stronger VS response during conflict at age 18 was associated with a higher starting point of both drinking trajectories but predicted a decrease in binge drinking. At age 21, high ER and enhanced neural responses in the dmPFC were associated with increasing AUDIT-C scores over the next 3 years until age 24. Overall, susceptibility to interference between Pavlovian and instrumental control might be viewed as a predisposing mechanism towards hazardous alcohol use during young adulthood, and the identified high-risk group may profit from targeted interventions.
KW - interference control
KW - Pavlovian-to-instrumental transfer
KW - risky drinking
Y1 - 2023
U6 - https://doi.org/10.1111/adb.13263
SN - 1355-6215
SN - 1369-1600
VL - 28
IS - 2
PB - Wiley
CY - Hoboken
ER -
TY - JOUR
A1 - Chen, Hao
A1 - Nebe, Stephan
A1 - Mojtahedzadeh, Negin
A1 - Kuitunen-Paul, Soren
A1 - Garbusow, Maria
A1 - Schad, Daniel
A1 - Rapp, Michael A.
A1 - Huys, Quentin J. M.
A1 - Heinz, Andreas
A1 - Smolka, Michael N.
T1 - Susceptibility to interference between Pavlovian and instrumental control is associated with early hazardous alcohol use
JF - Addiction biology
N2 - Pavlovian-to-instrumental transfer (PIT) tasks examine the influence of Pavlovian stimuli on ongoing instrumental behaviour. Previous studies reported associations between a strong PIT effect, high-risk drinking and alcohol use disorder. This study investigated whether susceptibility to interference between Pavlovian and instrumental control is linked to risky alcohol use in a community sample of 18-year-old male adults. Participants (N = 191) were instructed to 'collect good shells' and 'leave bad shells' during the presentation of appetitive (monetary reward), aversive (monetary loss) or neutral Pavlovian stimuli. We compared instrumental error rates (ER) and functional magnetic resonance imaging (fMRI) brain responses between the congruent and incongruent conditions, as well as among high-risk and low-risk drinking groups. On average, individuals showed a substantial PIT effect, that is, increased ER when Pavlovian cues and instrumental stimuli were in conflict compared with congruent trials. Neural PIT correlates were found in the ventral striatum and the dorsomedial and lateral prefrontal cortices (lPFC). Importantly, high-risk drinking was associated with a stronger behavioural PIT effect, a decreased lPFC response and an increased neural response in the ventral striatum on the trend level. Moreover, high-risk drinkers showed weaker connectivity from the ventral striatum to the lPFC during incongruent trials. Our study links interference during PIT to drinking behaviour in healthy, young adults. High-risk drinkers showed higher susceptibility to Pavlovian cues, especially when they conflicted with instrumental behaviour, indicating lower interference control abilities. Increased activity in the ventral striatum (bottom-up), decreased lPFC response (top-down), and their altered interplay may contribute to poor interference control in the high-risk drinkers.
KW - high‐risk drinking
KW - interference control
KW - Pavlovian‐to‐instrumental transfer
Y1 - 2020
U6 - https://doi.org/10.1111/adb.12983
SN - 1355-6215
SN - 1369-1600
VL - 26
IS - 4
SP - 1
EP - 14
PB - Wiley
CY - Hoboken
ER -
TY - JOUR
A1 - Deeken, Friederike
A1 - Häusler, Andreas
A1 - Nordheim, Johanna
A1 - Rapp, Michael A.
A1 - Knoll, Nina
A1 - Rieckmann, Nina
T1 - Psychometric properties of the Perceived Stress Scale in a sample of German dementia patients and their caregivers
JF - International psychogeriatrics
N2 - Background: The aim of the present study was to investigate the psychometric characteristics of the Perceived Stress Scale (PSS) in a sample of dementia patients and their spousal caregivers. Methods: We investigated the reliability and validity of the 14-item PSS in a sample of 80 couples, each including one spouse who had been diagnosed with mild to moderate dementia (mean age 75.55, SD = 5.85, 38.7% female) and one spousal caregiver (mean age 73.06, SD = 6.75, 61.3% female). We also examined the factor structure and sensitivity of the scale with regard to gender differences. Results: Exploratory factor analysis of the PSS revealed a two-factor solution for the scale; the first factor reflected general stress while the second factor consisted of items reflecting the perceived ability to cope with stressors. A confirmatory factor analysis verified that the data were a better fit for the two-factor model than a one-factor model. The two factors of the PSS showed good reliability for patients as well as for caregivers ranging between alpha = 0.73 and alpha = 0.82. Perceived stress was significantly positively correlated with depressive symptomatology in both caregivers and patients. Mean PSS scores did not significantly differ between male and female patients nor did they differ between male and female caregivers. Conclusion: The present data indicate that the PSS provides a reliable and valid measure of perceived stress in dementia patients and their caregivers.
KW - Perceived Stress Scale
KW - psychometric properties
KW - dementia
KW - caregiver
Y1 - 2017
U6 - https://doi.org/10.1017/S1041610217001387
SN - 1041-6102
SN - 1741-203X
VL - 30
IS - 1
SP - 39
EP - 47
PB - Cambridge Univ. Press
CY - New York
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 -