TY - JOUR
A1 - Förstner, Bernd R.
A1 - Tschorn, Mira
A1 - Reinoso-Schiller, Nicolas
A1 - Maričić, Lea Mascarell
A1 - Röcher, Erik
A1 - Kalman, Janos L.
A1 - Stroth, Sanna
A1 - Mayer, Annalina V.
A1 - Schwarz, Kristina
A1 - Kaiser, Anna
A1 - Pfennig, Andrea
A1 - Manook, André
A1 - Ising, Marcus
A1 - Heinig, Ingmar
A1 - Pittig, Andre
A1 - Heinz, Andreas
A1 - Mathiak, Klaus
A1 - Schulze, Thomas G.
A1 - Schneider, Frank
A1 - Kamp-Becker, Inge
A1 - Meyer-Lindenberg, Andreas
A1 - Padberg, Frank
A1 - Banaschewski, Tobias
A1 - Bauer, Michael
A1 - Rupprecht, Rainer
A1 - Wittchen, Hans-Ulrich
A1 - Rapp, Michael A.
T1 - Mapping research domain criteria using a transdiagnostic mini-RDoC assessment in mental disorders: a confirmatory factor analysis
JF - European archives of psychiatry and clinical neuroscience
N2 - This study aimed to build on the relationship of well-established self-report and behavioral assessments to the latent constructs positive (PVS) and negative valence systems (NVS), cognitive systems (CS), and social processes (SP) of the Research Domain Criteria (RDoC) framework in a large transnosological population which cuts across DSM/ICD-10 disorder criteria categories. One thousand four hundred and thirty one participants (42.1% suffering from anxiety/fear-related, 18.2% from depressive, 7.9% from schizophrenia spectrum, 7.5% from bipolar, 3.4% from autism spectrum, 2.2% from other disorders, 18.4% healthy controls, and 0.2% with no diagnosis specified) recruited in studies within the German research network for mental disorders for the Phenotypic, Diagnostic and Clinical Domain Assessment Network Germany (PD-CAN) were examined with a Mini-RDoC-Assessment including behavioral and self-report measures. The respective data was analyzed with confirmatory factor analysis (CFA) to delineate the underlying latent RDoC-structure. A revised four-factor model reflecting the core domains positive and negative valence systems as well as cognitive systems and social processes showed a good fit across this sample and showed significantly better fit compared to a one factor solution. The connections between the domains PVS, NVS and SP could be substantiated, indicating a universal latent structure spanning across known nosological entities. This study is the first to give an impression on the latent structure and intercorrelations between four core Research Domain Criteria in a transnosological sample. We emphasize the possibility of using already existing and well validated self-report and behavioral measurements to capture aspects of the latent structure informed by the RDoC matrix.
KW - Diagnosis and classification
KW - Research Domain Criteria
KW - PD-CAN
KW - Confirmatory factor analysis CFA
KW - RDoC
KW - Transdiagnostic
Y1 - 2022
U6 - https://doi.org/10.1007/s00406-022-01440-6
SN - 0940-1334
SN - 1433-8491
VL - 273
IS - 3
SP - 527
EP - 539
PB - Springer Nature
CY - Heidelberg
ER -
TY - JOUR
A1 - Zech, Hilmar G.
A1 - Reichert, Markus
A1 - Ebner-Priemer, Ulrich W.
A1 - Tost, Heike
A1 - Rapp, Michael A.
A1 - Heinz, Andreas
A1 - Dolan, Raymond J.
A1 - Smolka, Michael N.
A1 - Deserno, Lorenz
T1 - Mobile data collection of cognitive-behavioral tasks in substance use disorders: Where are we now?
JF - Neuropsychobiology
N2 - Introduction: Over the last decades, our understanding of the cognitive, motivational, and neural processes involved in addictive behavior has increased enormously. A plethora of laboratory-based and cross-sectional studies has linked cognitive-behavioral measures to between-subject differences in drinking behavior. However, such laboratory-based studies inevitably suffer from small sample sizes and the inability to link temporal fluctuations in task measures to fluctuations in real-life substance use. To overcome these problems, several existing behavioral tasks have been transferred to smartphones to allow studying cognition in the field. Method: In this narrative review, we first summarize studies that used existing behavioral tasks in the laboratory and self-reports of substance use with ecological momentary assessment (EMA) in the field. Next, we review studies on psychometric properties of smartphone-based behavioral tasks. Finally, we review studies that used both smartphone-based tasks and self-reports with EMA in the field. Results: Overall, studies were scarce and heterogenous both in tasks and in study outcomes. Nevertheless, existing findings are promising and point toward several methodological recommendations: concerning psychometrics, studies show that - although more systematic studies are necessary - task validity and reliability can be improved, for example, by analyzing several measurement sessions at once rather than analyzing sessions separately. Studies that use tasks in the field, moreover, show that power can be improved by choosing sampling schemes that combine time-based with event-based sampling, rather than relying on time-based sampling alone. Increasing sampling frequency can further increase power. However, as this also increases the burden to participants, more research is necessary to determine the ideal sampling frequency for each task. Conclusion: Although more research is necessary to systematically study both the psychometrics of smartphone-based tasks and the frequency at which task measures fluctuate, existing studies are promising and reveal important methodological recommendations useful for researchers interested in implementing behavioral tasks in EMA studies.
KW - Ecological momentary assessment
KW - Behavioral tasks
KW - Smartphone
KW - Substance use
KW - Addiction
Y1 - 2022
U6 - https://doi.org/10.1159/000523697
SN - 0302-282X
SN - 1423-0224
VL - 81
IS - 5
SP - 438
EP - 450
PB - Karger
CY - Basel
ER -
TY - JOUR
A1 - Herrmann, Matthias L.
A1 - Boden, Cindy
A1 - Maurer, Christoph
A1 - Kentischer, Felix
A1 - Mennig, Eva
A1 - Wagner, Sören
A1 - Conzelmann, Lars O.
A1 - Förstner, Bernd R.
A1 - Rapp, Michael A.
A1 - von Arnim, Christine A. F.
A1 - Denkinger, Michael
A1 - Eschweiler, Gerhard W.
A1 - Thomas, Christine
T1 - Anticholinergic drug exposure increases the risk of delirium in older patients undergoing elective surgery
JF - Frontiers in medicine
N2 - IntroductionPostoperative delirium (POD) is a common and serious adverse event of surgery in older people. Because of its great impact on patients' safety and quality of life, identification of modifiable risk factors could be useful. Although preoperative medication intake is assumed to be an important modifiable risk factor, the impact of anticholinergic drugs on the occurrence of POD seems underestimated in elective surgery. The aim of this study was to investigate the association between preoperative anticholinergic burden and POD. We hypothesized that a high preoperative anticholinergic burden is an independent, potentially modifiable predisposing and precipitating factor of POD in older people. MethodsBetween November 2017 and April 2019, 1,470 patients of 70 years and older undergoing elective orthopedic, general, cardiac, or vascular surgery were recruited in the randomized, prospective, multicenter PAWEL trial. Anticholinergic burden of a sub-cohort of 899 patients, who did not receive a multimodal intervention for preventing POD, was assessed by two different tools at hospital admission: The established Anticholinergic Risk Scale (ARS) and the recently developed Anticholinergic Burden Score (ABS). POD was detected by confusion assessment method (CAM) and a validated post discharge medical record review. Logistic regression analyses were performed to evaluate the association between anticholinergic burden and POD. ResultsPOD was observed in 210 of 899 patients (23.4%). Both ARS and ABS were independently associated with POD. The association persisted after adjustment for relevant confounding factors such as age, sex, comorbidities, preoperative cognitive and physical status, number of prescribed drugs, surgery time, type of surgery and anesthesia, usage of heart-lung-machine, and treatment in intensive care unit. If a patient was taking one of the 56 drugs listed in the ABS, risk for POD was 2.7-fold higher (OR = 2.74, 95% CI = 1.55-4.94) and 1.5-fold higher per additional point on the ARS (OR = 1.54, 95% CI = 1.15-2.02). ConclusionPreoperative anticholinergic drug exposure measured by ARS or ABS was independently associated with POD in older patients undergoing elective surgery. Therefore, identification, discontinuation or substitution of anticholinergic medication prior to surgery may be a promising approach to reduce the risk of POD in older patients.
KW - delirium
KW - acute encephalopathy
KW - surgery
KW - anticholinergic
KW - geriatric
KW - postoperative
Y1 - 2022
U6 - https://doi.org/10.3389/fmed.2022.871229
SN - 2296-858X
VL - 9
PB - Frontiers Media
CY - Lausanne
ER -
TY - JOUR
A1 - Sebold, Miriam
A1 - Nebe, Stephan
A1 - Garbusow, Maria
A1 - Guggenmos, Matthias
A1 - Schad, Daniel
A1 - Beck, Anne
A1 - Kuitunen-Paul, Sören
A1 - Sommer, Christian
A1 - Frank, Robin
A1 - Neu, Peter
A1 - Zimmermann, Ulrich S.
A1 - Rapp, Michael A.
A1 - Smolka, Michael N.
A1 - Huys, Quentin J. M.
A1 - Schlagenhauf, Florian
A1 - Heinz, Andreas
T1 - When Habits Are Dangerous: Alcohol Expectancies and Habitual Decision Making Predict Relapse in Alcohol Dependence
JF - Biological psychiatry : a journal of psychiatric neuroscience and therapeutics ; a publication of the Society of Biological Psychiatry
N2 - BACKGROUND: Addiction is supposedly characterized by a shift from goal-directed to habitual decision making, thus facilitating automatic drug intake. The two-step task allows distinguishing between these mechanisms by computationally modeling goal-directed and habitual behavior as model-based and model-free control. In addicted patients, decision making may also strongly depend upon drug-associated expectations. Therefore, we investigated model-based versus model-free decision making and its neural correlates as well as alcohol expectancies in alcohol-dependent patients and healthy controls and assessed treatment outcome in patients. METHODS: Ninety detoxified, medication-free, alcohol-dependent patients and 96 age-and gender-matched control subjects underwent functional magnetic resonance imaging during the two-step task. Alcohol expectancies were measured with the Alcohol Expectancy Questionnaire. Over a follow-up period of 48 weeks, 37 patients remained abstinent and 53 patients relapsed as indicated by the Alcohol Timeline Followback method. RESULTS: Patients who relapsed displayed reduced medial prefrontal cortex activation during model-based decision making. Furthermore, high alcohol expectancies were associated with low model-based control in relapsers, while the opposite was observed in abstainers and healthy control subjects. However, reduced model-based control per se was not associated with subsequent relapse. CONCLUSIONS: These findings suggest that poor treatment outcome in alcohol dependence does not simply result from a shift from model-based to model-free control but is instead dependent on the interaction between high drug expectancies and low model-based decision making. Reduced model-based medial prefrontal cortex signatures in those who relapse point to a neural correlate of relapse risk. These observations suggest that therapeutic interventions should target subjective alcohol expectancies.
KW - Alcohol dependence
KW - Alcohol expectancy
KW - Goal-directed control
KW - Medial prefrontal cortex
KW - Reinforcement learning
KW - Treatment outcome
Y1 - 2017
U6 - https://doi.org/10.1016/j.biopsych.2017.04.019
SN - 0006-3223
SN - 1873-2402
VL - 82
SP - 847
EP - 856
PB - Elsevier
CY - New York
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 - GEN
A1 - Zech, Philipp A.
A1 - Rapp, Michael A.
A1 - Heinzel, Stephan
A1 - Wolfarth, Bernd
A1 - Lawrence, Jimmy B.
A1 - Heissel, Andreas
T1 - Does Exercise Help People Living with HIV Improve Their Quality of Life? A meta-analysis.
T2 - Medicine and science in sports and exercise : official journal of the American College of Sports Medicine
Y1 - 2017
U6 - https://doi.org/10.1249/01.mss.0000518177.22369.2f
SN - 0195-9131
SN - 1530-0315
VL - 49
SP - 470
EP - 470
PB - Lippincott Williams & Wilkins
CY - Philadelphia
ER -
TY - CHAP
A1 - Schad, Daniel
A1 - Juenger, Elisabeth
A1 - Sebold, Miriam
A1 - Garbusow, Maria
A1 - Bernhart, Nadine
A1 - Javadi, Amir Homayoun
A1 - Zimmermann, Ulrich S.
A1 - Smolka, Michael N.
A1 - Heinz, Andreas
A1 - Rapp, Michael A.
A1 - Huys, Quentin J. M.
T1 - Smart goals, slow habits? Individual differences in processing speed and working memory capacity moderate the balance between habitual and goal-directed choice behavior
T2 - Cognitive processing : international quarterly of cognitive science
Y1 - 2014
SN - 1612-4782
SN - 1612-4790
VL - 15
IS - 1
SP - S62
EP - S62
PB - Springer
CY - Heidelberg
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 - CHAP
A1 - Heinz, A.
A1 - Kluge, U.
A1 - Schouler-Ocak, M.
A1 - Rapp, Michael A.
T1 - Biological Effects of Social Exclusion
T2 - European psychiatry : the journal of the Association of European Psychiatrists
N2 - Timing and magnitude of surface uplift are key to understanding the impact of crustal deformation and topographic growth on atmospheric circulation, environmental conditions, and surface processes. Uplift of the East African Plateau is linked to mantle processes, but paleoaltimetry data are too scarce to constrain plateau evolution and subsequent vertical motions associated with rifting. Here, we assess the paleotopographic implications of a beaked whale fossil (Ziphiidae) from the Turkana region of Kenya found 740 km inland from the present-day coastline of the Indian Ocean at an elevation of 620 m. The specimen is similar to 17 My old and represents the oldest derived beaked whale known, consistent with molecular estimates of the emergence of modern straptoothed whales (Mesoplodon). The whale traveled from the Indian Ocean inland along an eastward-directed drainage system controlled by the Cretaceous Anza Graben and was stranded slightly above sea level. Surface uplift from near sea level coincides with paleoclimatic change from a humid environment to highly variable and much drier conditions, which altered biotic communities and drove evolution in east Africa, including that of primates.
Y1 - 2015
SN - 0924-9338
SN - 1778-3585
VL - 30
PB - Elsevier
CY - Paris
ER -
TY - JOUR
A1 - Garbusow, Maria
A1 - Schad, Daniel
A1 - Sebold, Miriam
A1 - Friedel, Eva
A1 - Bernhardt, Nadine
A1 - Koch, Stefan P.
A1 - Steinacher, Bruno
A1 - Kathmann, Norbert
A1 - Geurts, Dirk E. M.
A1 - Sommer, Christian
A1 - Mueller, Dirk K.
A1 - Nebe, Stephan
A1 - Paul, Soeren
A1 - Wittchen, Hans-Ulrich
A1 - Zimmermann, Ulrich S.
A1 - Walter, Henrik
A1 - Smolka, Michael N.
A1 - Sterzer, Philipp
A1 - Rapp, Michael A.
A1 - Huys, Quentin J. M.
A1 - Schlagenhauf, Florian
A1 - Heinz, Andreas
T1 - Pavlovian-to-instrumental transfer effects in the nucleus accumbens relate to relapse in alcohol dependence
JF - Addiction biology
N2 - In detoxified alcohol-dependent patients, alcohol-related stimuli can promote relapse. However, to date, the mechanisms by which contextual stimuli promote relapse have not been elucidated in detail. One hypothesis is that such contextual stimuli directly stimulate the motivation to drink via associated brain regions like the ventral striatum and thus promote alcohol seeking, intake and relapse. Pavlovian-to-Instrumental-Transfer (PIT) may be one of those behavioral phenomena contributing to relapse, capturing how Pavlovian conditioned (contextual) cues determine instrumental behavior (e.g. alcohol seeking and intake). We used a PIT paradigm during functional magnetic resonance imaging to examine the effects of classically conditioned Pavlovian stimuli on instrumental choices in n=31 detoxified patients diagnosed with alcohol dependence and n=24 healthy controls matched for age and gender. Patients were followed up over a period of 3 months. We observed that (1) there was a significant behavioral PIT effect for all participants, which was significantly more pronounced in alcohol-dependent patients; (2) PIT was significantly associated with blood oxygen level-dependent (BOLD) signals in the nucleus accumbens (NAcc) in subsequent relapsers only; and (3) PIT-related NAcc activation was associated with, and predictive of, critical outcomes (amount of alcohol intake and relapse during a 3 months follow-up period) in alcohol-dependent patients. These observations show for the first time that PIT-related BOLD signals, as a measure of the influence of Pavlovian cues on instrumental behavior, predict alcohol intake and relapse in alcohol dependence.
KW - human Pavlovian-to-instrumental transfer
KW - nucleus accumbens
KW - relapse in alcohol use disorder
Y1 - 2016
U6 - https://doi.org/10.1111/adb.12243
SN - 1355-6215
SN - 1369-1600
VL - 21
SP - 719
EP - 731
PB - Wiley-Blackwell
CY - Hoboken
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 - Deeken, Friederike
A1 - Reichert, Markus
A1 - Zech, Hilmar
A1 - Wenzel, Julia
A1 - Wedemeyer, Friederike
A1 - Aguilera, Alvaro
A1 - Aslan, Acelya
A1 - Bach, Patrick
A1 - Bahr, Nadja Samia
A1 - Ebrahimi, Claudia
A1 - Fischbach, Pascale Christine
A1 - Ganz, Marvin
A1 - Garbusow, Maria
A1 - Großkopf, Charlotte M.
A1 - Heigert, Marie
A1 - Hentschel, Angela
A1 - Karl, Damian
A1 - Pelz, Patricia
A1 - Pinger, Mathieu
A1 - Riemerschmid, Carlotta
A1 - Rosenthal, Annika
A1 - Steffen, Johannes
A1 - Strehle, Jens
A1 - Weiss,, Franziska
A1 - Wieder, Gesine
A1 - Wieland, Alfred
A1 - Zaiser, Judith
A1 - Zimmermann, Sina
A1 - Walter, Henrik
A1 - Lenz, Bernd
A1 - Deserno, Lorenz
A1 - Smolka, Michael N.
A1 - Liu, Shuyan
A1 - Ebner-Priemer, Ulrich Walter
A1 - Heinz, Andreas
A1 - Rapp, Michael A.
T1 - Patterns of Alcohol Consumption Among Individuals With Alcohol Use Disorder During the COVID-19 Pandemic and Lockdowns in Germany
JF - JAMA Network Open
N2 - Importance Alcohol consumption (AC) leads to death and disability worldwide. Ongoing discussions on potential negative effects of the COVID-19 pandemic on AC need to be informed by real-world evidence.
Objective To examine whether lockdown measures are associated with AC and consumption-related temporal and psychological within-person mechanisms.
Design, Setting, and Participants This quantitative, intensive, longitudinal cohort study recruited 1743 participants from 3 sites from February 20, 2020, to February 28, 2021. Data were provided before and within the second lockdown of the COVID-19 pandemic in Germany: before lockdown (October 2 to November 1, 2020); light lockdown (November 2 to December 15, 2020); and hard lockdown (December 16, 2020, to February 28, 2021).
Main Outcomes and Measures Daily ratings of AC (main outcome) captured during 3 lockdown phases (main variable) and temporal (weekends and holidays) and psychological (social isolation and drinking intention) correlates.
Results Of the 1743 screened participants, 189 (119 [63.0%] male; median [IQR] age, 37 [27.5-52.0] years) with at least 2 alcohol use disorder (AUD) criteria according to the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) yet without the need for medically supervised alcohol withdrawal were included. These individuals provided 14 694 smartphone ratings from October 2020 through February 2021. Multilevel modeling revealed significantly higher AC (grams of alcohol per day) on weekend days vs weekdays (β = 11.39; 95% CI, 10.00-12.77; P < .001). Alcohol consumption was above the overall average on Christmas (β = 26.82; 95% CI, 21.87-31.77; P < .001) and New Year’s Eve (β = 66.88; 95% CI, 59.22-74.54; P < .001). During the hard lockdown, perceived social isolation was significantly higher (β = 0.12; 95% CI, 0.06-0.15; P < .001), but AC was significantly lower (β = −5.45; 95% CI, −8.00 to −2.90; P = .001). Independent of lockdown, intention to drink less alcohol was associated with lower AC (β = −11.10; 95% CI, −13.63 to −8.58; P < .001). Notably, differences in AC between weekend and weekdays decreased both during the hard lockdown (β = −6.14; 95% CI, −9.96 to −2.31; P = .002) and in participants with severe AUD (β = −6.26; 95% CI, −10.18 to −2.34; P = .002).
Conclusions and Relevance This 5-month cohort study found no immediate negative associations of lockdown measures with overall AC. Rather, weekend-weekday and holiday AC patterns exceeded lockdown effects. Differences in AC between weekend days and weekdays evinced that weekend drinking cycles decreased as a function of AUD severity and lockdown measures, indicating a potential mechanism of losing and regaining control. This finding suggests that temporal patterns and drinking intention constitute promising targets for prevention and intervention, even in high-risk individuals.
Y1 - 2022
U6 - https://doi.org/10.1001/jamanetworkopen.2022.24641
SN - 2574-3805
VL - 5
SP - 1
EP - 11
PB - JAMA Network / American Medical Association
CY - Chicago, Illinois, USA
ET - 8
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 - 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 - 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 - JOUR
A1 - Desch, Anke
A1 - Förstner, Bernd Rainer
A1 - Artmann, Jörg
A1 - Häusler, Andreas
A1 - Hauptmann, Michael
A1 - Altin, Sibel Vildan
A1 - Rapp, Michael A.
A1 - Holmberg, Christine
T1 - A theory of change of an innovation for therapeutic care and meaningful living in a German nursing home
JF - BMC geriatrics
N2 - Background: Demographic changes are leading to growing care needs of older people and creating a challenge for healthcare systems worldwide. Nursing homes (NHs) need to provide care for growing numbers of residents while ensuring a high-quality care. We aimed to examine an innovative NH in Germany and apply a theory of change (ToC) approach to develop a best practice model (BPM) for therapeutic care in NHs.
Methods: A multimethod qualitative study conducted from February to July 2021 in Germany involved interviews with 14 staff members of an innovative NH and 10 directors and care managers of other NHs. The interview guidelines included questions on nursing practices, infrastructure, resources, interprofessional collaboration, and working culture. Additional material on the participating NH (website, promotion videos, newsletters, care documentation) were collected. Contextual literature on NH culture and therapeutic care in Germany, ToC methodology, and NH culture change were reviewed. Following a question-focused analysis of all material, we generated a ToC model towards a BPM of therapeutic care and meaningful living in NHs.
Results: were verified in interdisciplinary team meetings, with study participants and other stakeholders to establish consensus. Results The participating NH's care concept aims to improve residents' functional abilities and wellbeing as well as staff members' job satisfaction. Central components of their approach include therapeutic elements such as music and movement in all nursing activities, multidisciplinary collaboration, a broad therapy and social activity offer, the continuation of therapy in everyday activities, a focus on individual life history, values, needs, and skills, social integration into the regional community, and the creation of a meaningful living environment for residents and staff.
Conclusion: The BPM we developed shows how a meaningful living environment can be created through therapeutic care and integrative activities. The ToC sheds light onto the contextual factors and cultural values which should be considered in the development of NH interventions. Research on not only biomedical aspects, but also psychosocial dynamics and narrative co-constructions in nursing practice should inform NH innovations. The ToC also highlights the importance of developing adequate political frameworks and infrastructures for implementing such innovative practices on a larger scale.
KW - positive gerontology
KW - de-institutionalization
KW - meaning-making
KW - therapeutic emplotment
KW - integrated narrative nursing
KW - nursing home culture change
Y1 - 2022
U6 - https://doi.org/10.1186/s12877-022-03462-0
SN - 1471-2318
VL - 22
IS - 1
PB - BioMed Central
CY - London
ER -