[Sports psychiatry and psychotherapy]

[Treatment resistance in anxiety disorders-Definition and treatment options]

Treatment resistance in anxiety disorders represents a clinical challenge, contributes to the chronicity of the diseases as well as sequential comorbidities, and is associated with a significant individual and socioeconomic burden. This narrative review presents the operational definition of treatment resistance in anxiety disorders according to international consensus criteria (< 50% reduction in the Hamilton Anxiety Scale, HAM‑A, score or < 50% reduction in the Beck Anxiety Inventory, BAI, score or a clinical global impression-improvement, CGI‑I, score > 2). At least two unsuccessful guideline-based treatment attempts with pharmacological monotherapy or at least one unsuccessful treatment attempt with adequately delivered cognitive behavioral therapy are required. Pharmacotherapeutically, after excluding pseudo-resistance, switching the medication within one class or to another class and augmentation strategies with other antidepressants (mirtazapine, agomelatine), antipsychotics (quetiapine) or anticonvulsants (valproate) are recommended. Psychotherapeutically, third-wave therapies, psychodynamic therapy, systemic therapy and physical exercise can be considered for therapy resistance. In cases of no response to psychotherapy or pharmacotherapy, the respective other form of therapy or a combination of both should be offered. Compounds targeting the glutamatergic and endocannabinoid systems as well as neuropeptides are being tested as potential innovative pharmaceuticals for treatment-resistant anxiety disorders. There is an urgent need for further research to identify predictive markers and mechanisms as well as to develop innovative pharmacological and psychotherapeutic interventions for treatment-resistant anxiety disorders.

Exercise as Treatment for "Stress-Related" Mental Disorders

The beneficial impact of physical activity on preventing and treating mental disorders has captured growing (research) interest. This article aims to provide a concise overview of essential evidence regarding the effectiveness and underlying mechanisms of physical activity for individuals with mental disorders clustered as "stress-related" conditions. Empirical findings (e.g., longitudinalprospective studies, interventional randomized-controlled-trials, reviews, meta-analyses) regarding the effects of physical activity in the prevention and treatment of stress-related mental disorders are summarized. Furthermore, potential mechanisms underlying these effects are discussed, and recommendations regarding the use of physical activity are outlined. The majority of studies indicate good efficacy of physical activity in prospectively lowering the risk for the incidence of subsequent stress-related mental disorders as well as in the treatment of manifest disorders. Most evidence targets unipolar depressive disorder and, secondly, anxiety disorders. Research regarding posttraumatic stress disorder, obsessive-compulsive disorders, and somatoform disorders is promising but scarce. Physical activity seems to be useful as a stand-alone-treatment as well as in combination with other psychotherapeutic or pharmacological treatments. Multiple intertwined physiological, psychological, and social mechanisms are assumed to mediate the beneficial effects. Recommendations regarding physical activity can orientate on official guidelines but should consider the individual needs and circumstances of each subject. In summary, physical activity seems to be effective in the prevention and treatment of stressrelated mental disorders and, therefore, should be fostered in healthcare-settings. Future studies are needed to clarify partly inconsistent patterns of results and to close research gaps, e.g., concerning somatoform disorders.

Current trends and perspectives in the exploration of anorexia athletica-clinical challenges and therapeutic considerations

Elite athletes are exposed to a considerable amount of physical and psychological stress throughout their entire professional life, but the exploration of the consequences of this stressful regimen on mental health is still in its early stages. Eating disorders (EDs), substance use disorders, and behavioral addictions represent only several domains that are worth more investigation in this vulnerable population, in order to find preventative and therapeutic strategies. The exploration of EDs in athletes is important because this population is very vulnerable to the impact that weight and body shape may have on their professional performances, and epidemiological studies support this concern, i.e., the prevalence of EDs in athletes is significantly higher than in the general population. This article is dedicated to the synthesis of available data regarding a specific pathology reported in elite athletes, i.e., anorexia athletica (AA), based on a narrative reviewing methodology. The information about risk factors, pathophysiology, positive and differential diagnosis, epidemiology, structured evaluation, and treatment of AA have been summarized and future research directions have been highlighted. While tentative diagnostic criteria for AA and a self-administered questionnaire exist, its pathophysiology is still insufficiently explored, and the treatment is not based on good-quality trials. According to the retrieved data, more research targeting the physical and mental health of elite athletes, especially those practicing esthetic sports, is needed, in order to implement adequate screening and early intervention programs. Future studies targeting various sub-populations of elite athletes, i.e., esthetic vs. non-esthetic sports, individuals presenting a history of ED vs. those without such a history, and those practicing individual sports vs. team sports are needed to reach the objective of improving the quality of life in this population.

Aktiv und zufrieden? Körperliche Aktivität und berufsbezogene Lebensqualität bei Psycholog:innen

Hintergrund

Klinisch tätige Psycholog:innen sind in ihrer Arbeit mit Menschen mit psychischen Erkrankungen oft zahlreichen Stressoren ausgesetzt; diese können sich in psychischer Belastung und einer verringerten Lebensqualität niederschlagen. Körperliche Aktivität könnte eine protektive Ressource darstellen, diesbezüglich fehlen jedoch bisher empirische Befunde.

Methoden

Im Rahmen einer querschnittlichen Online-Befragung über SoSci-Survey (Januar bis April 2020) wurden die körperliche Aktivität und die berufsbezogene Lebensqualität (positive Dimension: Mitgefühlszufriedenheit; negative Dimension: Mitgefühlsmüdigkeit) einer Gelegenheitsstichprobe aus 443 klinisch tätigen Psycholog:innen mithilfe etablierter Selbstberichtfragebogen (International Physical Activity Questionnaire – Short Form [IPAQ-SF], Professional Quality of Life Scale [ProQOL]) erfasst.

Ergebnisse

Der Großteil der befragten Psycholog:innen erfüllte das von der Weltgesundheitsorganisation empfohlene Mindestmaß an körperlicher Aktivität. Die Mitgefühlszufriedenheit war im Schnitt relativ hoch, während eher geringe bis moderate Ausprägungen an Burn-out-Symptomatik sowie sekundärem traumatischem Stress (Facetten der Mitgefühlsmüdigkeit) berichtet wurden. Außer vereinzelten kleinen negativen Korrelationen zwischen körperlicher Inaktivität und Mitgefühlszufriedenheit bei Psycholog:innen in Weiterbildung sowie Burn-out-Symptomen und körperlicher Gesamtaktivität bei Psychologischen Psychotherapeut:innen waren keine Zusammenhänge zwischen körperlicher Aktivität und berufsbezogener Lebensqualität ersichtlich.

Schlussfolgerungen

Psycholog:innen scheinen zu großen Teilen eine körperlich aktive und tendenziell zufriedene Berufsgruppe darzustellen. Zusammenhänge zwischen körperlicher Aktivität und Lebensqualität könnten teilweise durch Deckeneffekte verdeckt sein. Des Weiteren könnte eine Analyse der Ursachen für diese adaptiven Ausprägungen in Aktivität und Lebensqualität Anhaltspunkte für Maßnahmen zur Förderung anderer Professionen liefern.