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Baessler F, Zafar A, Ciprianidis A, Wagner FL, Klein SB, Schweizer S, Bartolovic M, Roesch-Ely D, Ditzen B, Nikendei C, Schultz JH. Analysis of risk communication teaching in psychosocial and other medical departments. Med Educ Online 2020; 25:1746014. [PMID: 32249706 PMCID: PMC7170276 DOI: 10.1080/10872981.2020.1746014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Aims: Teaching students about risk communication is an important aspect at medical schools given the growing importance of informed consent in healthcare. This observational study analyzes the quality of teaching content on risk communication and biostatistics at a medical school.Methods: Based on the concept of curriculum mapping, purpose-designed questionnaires were used via participant observers to record the frequency, characteristics and context of risk communication employed by lecturers during teaching sessions for one semester. The data was analyzed quantitatively and descriptively.Results: Teaching about risk communication was observed in 24.4% (n = 95 of 390) sessions. Prevalence varied significantly among different departments with dermatology having the highest rate (67.9%) but lesser in-depth teaching than medical psychology where risk communication concepts were discussed on a higher scale in 61.4% sessions. Relevant statistical values were not mentioned at all in 69% of these 95 sessions and clinical contexts were used rarely (55.8%). Supplementary teaching material was provided in 50.5% sessions while students asked questions in 18.9% sessions.Conclusions: Students are infrequently taught about communicating risks. When they are, the teaching does not include the mention of core biostatistics values nor does the teaching involve methods for demonstrating risk communication.
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Affiliation(s)
- Franziska Baessler
- Department of General Internal and Psychosomatic Medicine, Heidelberg University Hospital, Heidelberg, Germany
- CONTACT Franziska Baessler Department for General Internal and Psychosomatic Medicine, Centre for Psychosocial Medicine, Heidelberg University Hospital,Im Neuenheimer Feld 410, Heidelberg 69120, Germany
| | - Ali Zafar
- Department of General Internal and Psychosomatic Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Anja Ciprianidis
- Department of General Internal and Psychosomatic Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Fabienne Louise Wagner
- Department of General Internal and Psychosomatic Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Sonja Bettina Klein
- Department of General Internal and Psychosomatic Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Sophie Schweizer
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Heidelberg, Germany
| | - Marina Bartolovic
- Department of General Adult Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Daniela Roesch-Ely
- Department of General Adult Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Beate Ditzen
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Heidelberg, Germany
| | - Christoph Nikendei
- Department of General Internal and Psychosomatic Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Jobst-Hendrik Schultz
- Department of General Internal and Psychosomatic Medicine, Heidelberg University Hospital, Heidelberg, Germany
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Listunova L, Kienzle J, Bartolovic M, Jaehn A, Grützner TM, Wolf RC, Aschenbrenner S, Weisbrod M, Roesch-Ely D. Cognitive remediation therapy for partially remitted unipolar depression: A single-blind randomized controlled trial. J Affect Disord 2020; 276:316-326. [PMID: 32871662 DOI: 10.1016/j.jad.2020.07.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 06/16/2020] [Accepted: 07/04/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND There is an urgent need for the development and evaluation of targeted interventions for cognitive impairment (CI) in patients with (partially) remitted major depressive disorder (MDD). The aim of our study was therefore to evaluate the effect of cognitive remediation therapy (CRT) on cognitive and psychosocial functioning in a sample of patients with MDD, taking into account comorbidity, psychopathology, remission status and CI profile. Furthermore, we compared a generalized training (GT) with an individualized training (IT) approach regarding their effects on cognition. METHODS Sixty-two MDD patients in partial remission with CI were randomly assigned to a control group (CG), IT or GT. Participants of GT trained six cognitive subdomains (divided attention, selective attention, alertness, working memory, planning and response inhibition), whereas participants of IT trained their three most deficient cognitive subdomains as identified at baseline. Participants of both intervention groups trained three times per week over a five-week period. Both training groups received additional 30-minute compensatory-transfer sessions once per week. RESULTS Attention appeared to be the most frequently impaired cognitive domain as well as the domain which was significantly improved by CRT, with medium to large effect sizes. No difference in improvement was found between IT and GT. The analyses also revealed greater improvement in self-assessed psychosocial functioning in training participants (GT and IT combined) compared to the CG. LIMITATIONS Due to the small sample size, the present results are preliminary in nature. CONCLUSION CRT was well accepted, and patients transferred the attentional improvement to real life, as measured by self-assessed psychosocial functioning. IT yielded no additional advantages over GT. We propose CRT as an integral part of the treatment plan for patients with depression suffering from CI.
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Affiliation(s)
- Lena Listunova
- Centre for Psychosocial Medicine, Department of General Psychiatry, Division Neurocognition, Heidelberg University Hospital, Voßstraße 4, 69115 Heidelberg, Germany.
| | - Johanna Kienzle
- Centre for Psychosocial Medicine, Department of General Psychiatry, Division Neurocognition, Heidelberg University Hospital, Voßstraße 4, 69115 Heidelberg, Germany
| | - Marina Bartolovic
- Centre for Psychosocial Medicine, Department of General Psychiatry, Division Neurocognition, Heidelberg University Hospital, Voßstraße 4, 69115 Heidelberg, Germany
| | - Anna Jaehn
- Centre for Psychosocial Medicine, Department of General Psychiatry, Division Neurocognition, Heidelberg University Hospital, Voßstraße 4, 69115 Heidelberg, Germany
| | - Thea Marianne Grützner
- Centre for Psychosocial Medicine, Department of General Psychiatry, Division Neurocognition, Heidelberg University Hospital, Voßstraße 4, 69115 Heidelberg, Germany
| | - Robert Christian Wolf
- Centre for Psychosocial Medicine, Department of General Psychiatry, Cognitive Neuropsychiatry Section, Heidelberg University Hospital, Voßstraße 4, 69115 Heidelberg, Germany
| | | | - Matthias Weisbrod
- Centre for Psychosocial Medicine, Department of General Psychiatry, Division Neurocognition, Heidelberg University Hospital, Voßstraße 4, 69115 Heidelberg, Germany; Department of Adult Psychiatry, SRH-Klinik, Karlsbad-Langensteinbach, Germany
| | - Daniela Roesch-Ely
- Centre for Psychosocial Medicine, Department of General Psychiatry, Division Neurocognition, Heidelberg University Hospital, Voßstraße 4, 69115 Heidelberg, Germany
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Baessler F, Weidlich J, Schweizer S, Ciprianidis A, Bartolovic M, Zafar A, Wolf M, Wagner FL, Baumann TC, Mihaljevic AL, Ditzen B, Roesch-Ely D, Nikendei C, Schultz JH. What and how are students taught about communicating risks to patients? Analysis of a medical curriculum. PLoS One 2020; 15:e0233682. [PMID: 32470064 PMCID: PMC7259606 DOI: 10.1371/journal.pone.0233682] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 05/11/2020] [Indexed: 11/18/2022] Open
Abstract
Background Communication is a core competence in medical care. Failure of physicians to properly communicate inherent risks of medical interventions has been linked with inadequate training at school. This study analyses a medical curriculum for assessing the content and quality of teaching risk communication to students. Methods A checklist based on the national guidelines of core competencies on risk communication required of physicians was developed. Participant observers surveyed all teaching sessions at a medical school during a semester to record the frequency, characteristics and clinical context used by lectures during classes. Data were analyzed using statistical and descriptive methods to determine the prevalence and quality of teaching content. Results 231 teaching sessions were surveyed. The inter-rater reliability was 81%. Lecturers mentioned topics of risk communication in 61.5% of teaching sessions (83.7% in surgery, 43.3% in internal medicine) but core biostatistics concepts were not discussed in more than 80% of these sessions. Important topics such as patient safety and preventable diseases were underrepresented. Risk communication was mainly taught in large-group, theoretical sessions and rarely with supplementary teaching material (7.4%). Students asked questions in 15.2% of courses, more often in surgery classes than in internal medicine. Conclusion Statistical and clinical topics relevant for teaching risk communication to medical students are not only underrepresented but also minimally explained by lecturers. Supplementary material on risk communication is rarely provided to students during classes. High-resource demanding, small-group teaching formats are not necessarily interactive as students ask few questions.
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Affiliation(s)
- Franziska Baessler
- Department of General, Internal and Psychosomatic Medicine, Center for Psychosocial Medicine, Heidelberg University Hospital, Heidelberg, Germany
- * E-mail:
| | - Joshua Weidlich
- Department of General, Internal and Psychosomatic Medicine, Center for Psychosocial Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Sophie Schweizer
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Heidelberg, Germany
| | - Anja Ciprianidis
- Department of General, Internal and Psychosomatic Medicine, Center for Psychosocial Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Marina Bartolovic
- Department of General Psychiatry, Center for Psychosocial Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Ali Zafar
- Department of General, Internal and Psychosomatic Medicine, Center for Psychosocial Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Michael Wolf
- Department of General, Internal and Psychosomatic Medicine, Center for Psychosocial Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Fabienne Louise Wagner
- Department of General, Internal and Psychosomatic Medicine, Center for Psychosocial Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Tabea Chiara Baumann
- Department of General, Internal and Psychosomatic Medicine, Center for Psychosocial Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - André L. Mihaljevic
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Beate Ditzen
- Institute of Medical Psychology, Heidelberg University Hospital, Heidelberg, Germany
| | - Daniela Roesch-Ely
- Department of General Psychiatry, Center for Psychosocial Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Christoph Nikendei
- Department of General, Internal and Psychosomatic Medicine, Center for Psychosocial Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Jobst-Hendrik Schultz
- Department of General, Internal and Psychosomatic Medicine, Center for Psychosocial Medicine, Heidelberg University Hospital, Heidelberg, Germany
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Listunova L, Bartolovic M, Kienzle J, Jaehn A, Grützner TM, Wolf RC, Weisbrod M, Roesch-Ely D. Predictors of cognitive remediation therapy improvement in (partially) remitted unipolar depression. J Affect Disord 2020; 264:40-49. [PMID: 31846901 DOI: 10.1016/j.jad.2019.12.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 11/26/2019] [Accepted: 12/04/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND There is urgent need for development and evaluation of targeted interventions for cognitive deficits in (partially) remitted major depression. Until now the analyses of the moderators of treatment efficacy were only examined in mixed samples of patients with schizophrenia, affective spectrum and schizoaffective disorders. Thus, the aim of our study was to evaluate the predictors of cognitive remediation therapy (CRT) improvement in a sample of (partially) remitted major depressive disorder patients. METHODS Reliable Change Index with corrections for practice effects was calculated for each participant as an indicator for training improvement. Thirty eight patients, who were randomized within our previously conducted CRT clinical trial, were divided into "Improvers" and "Nonimprovers" in the attention domain, to compare them on sociodemographic, psychopathological, neurocognitive, psychosocial and training factors. RESULTS We detected 13 training participants who improved reliably in the attention domain. Illness duration was the only factor which significantly differentiated between Improvers and Nonimprovers. No significant differences between Improvers and Nonimprovers in terms of other clinical variables, sociodemographic and neuropsychological factors were found. LIMITATIONS Exploratory research results should be taken with caution. Focus on the attention domain could have led to a limited point of view. CONCLUSION Our findings represent a first analysis of the predictors of cognitive remediation training improvement in (partially) remitted unipolar depression. Much more work should be done to refine cognitive treatment approaches. An initiation of cognitive training in early stages of the disease could be beneficial for the affected patients.
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Affiliation(s)
- Lena Listunova
- Centre for Psychosocial Medicine, Department of General Psychiatry, Division Neurocognition, Heidelberg University, Voßstraße 4, 69115 Heidelberg, Germany.
| | - Marina Bartolovic
- Centre for Psychosocial Medicine, Department of General Psychiatry, Division Neurocognition, Heidelberg University, Voßstraße 4, 69115 Heidelberg, Germany
| | - Johanna Kienzle
- Centre for Psychosocial Medicine, Department of General Psychiatry, Division Neurocognition, Heidelberg University, Voßstraße 4, 69115 Heidelberg, Germany
| | - Anna Jaehn
- Centre for Psychosocial Medicine, Department of General Psychiatry, Division Neurocognition, Heidelberg University, Voßstraße 4, 69115 Heidelberg, Germany
| | - Thea Marianne Grützner
- Centre for Psychosocial Medicine, Department of General Psychiatry, Division Neurocognition, Heidelberg University, Voßstraße 4, 69115 Heidelberg, Germany
| | - Robert Christian Wolf
- Centre for Psychosocial Medicine, Department of General Psychiatry, Cognitive Neuropsychiatry Section, Heidelberg University, Voßstraße 4, 69115 Heidelberg, Germany
| | - Matthias Weisbrod
- Centre for Psychosocial Medicine, Department of General Psychiatry, Division Neurocognition, Heidelberg University, Voßstraße 4, 69115 Heidelberg, Germany; Department of Adult Psychiatry, SRH-Klinik, Karlsbad-Langensteinbach, Germany
| | - Daniela Roesch-Ely
- Centre for Psychosocial Medicine, Department of General Psychiatry, Division Neurocognition, Heidelberg University, Voßstraße 4, 69115 Heidelberg, Germany
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Baessler F, Zafar A, Schweizer S, Ciprianidis A, Sander A, Preussler S, Honecker H, Wolf M, Bartolovic M, Wagner FL, Klein SB, Weidlich J, Ditzen B, Roesch-Ely D, Nikendei C, Schultz JH. Are we preparing future doctors to deal with emotionally challenging situations? Analysis of a medical curriculum. Patient Educ Couns 2019; 102:1304-1312. [PMID: 30852116 DOI: 10.1016/j.pec.2019.02.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 02/21/2019] [Accepted: 02/23/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Skilful communication by doctors is necessary for healthcare delivery during emotionally challenging situations. This study analyses a medical curriculum for the frequency and intensity of teaching content on communication in emotionally challenging situations. METHODS A questionnaire with 31 questions ("EmotCog31") was used to evaluate teaching sessions at 17 departments of a medical school for one semester. RESULTS Teaching content on communication in emotionally challenging situations was observed in 62 of 724 (∼nine percent) teaching sessions. Fifty-six percent of these sessions were within psychosocial specialisations. Lecturers used mental diseases as teaching topics four times more than somatic diseases. Forty-two percent of the 62 sessions were large-group while fifty-eight percent were small-group, interactive sessions. Clinical examples were used in sixty-nine percent of these sessions. Eighty-one percent of the handouts provided and sixty-six percent of simulated patient scenarios used were rated as helpful. Two-thirds of teaching sessions were rated positively when they included practical context. CONCLUSION There was a considerable lack of teaching on communication skills in an emotional context. Teaching was limited to psychosocial specialties, reducing the impact of available knowledge for other medical specialties. PRACTICE IMPLICATIONS More interactive, practically oriented teaching methods are useful for teaching emotional communication skills.
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Affiliation(s)
- Franziska Baessler
- Department of General Internal and Psychosomatic Medicine, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany.
| | - Ali Zafar
- Department of General Internal and Psychosomatic Medicine, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany.
| | - Sophie Schweizer
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Germany.
| | - Anja Ciprianidis
- Department of General Internal and Psychosomatic Medicine, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany.
| | - Anja Sander
- Institute of Medical Biometry and Informatics, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany.
| | - Stella Preussler
- Institute of Medical Biometry and Informatics, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany.
| | - Hannah Honecker
- Institute of Medical Biometry and Informatics, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany.
| | - Michael Wolf
- Department of General Internal and Psychosomatic Medicine, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany.
| | - Marina Bartolovic
- Department of General Adult Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Germany.
| | - Fabienne Louise Wagner
- Department of General Internal and Psychosomatic Medicine, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany.
| | - Sonja Bettina Klein
- Department of General Internal and Psychosomatic Medicine, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany.
| | - Joshua Weidlich
- Department of General Internal and Psychosomatic Medicine, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany.
| | - Beate Ditzen
- Institute of Medical Psychology, Heidelberg University Hospital, Bergfheimer Str. 20, 69115 Heidelberg, Germany.
| | - Daniela Roesch-Ely
- Department of General Adult Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Germany.
| | - Christoph Nikendei
- Department of General Internal and Psychosomatic Medicine, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany.
| | - Jobst-Hendrik Schultz
- Department of General Internal and Psychosomatic Medicine, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany.
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Grützner TM, Sharma A, Listunova L, Bartolovic M, Weisbrod M, Roesch-Ely D. Neurocognitive performance in patients with depression compared to healthy controls: Association of clinical variables and remission state. Psychiatry Res 2019; 271:343-350. [PMID: 30529317 DOI: 10.1016/j.psychres.2018.11.047] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Revised: 11/19/2018] [Accepted: 11/20/2018] [Indexed: 11/27/2022]
Abstract
Cognitive impairment in Major Depressive Disorder (MDD) has been postulated to persist into remission. However, inconsistent definitions of clinical remission, patterns and influencing factors, isolated cognitive tasks, and the lack of appropriately matched controls (HCs) present significant limitations of previous studies. Furthermore, studies investigating cognition in partially remitted patients are particularly scarce. This study compares the cognition of MDD patients (N = 65) and HCs (N = 65), matched by one-to-one recruitment strategy for age, sex, and education (ages 19-60). The neuropsychological (NPS) performance was measured via an extensive NPS-test battery and analysed retrospectively, accounting for demographic and clinical variables. Full remission was defined as HAMD cut off ≤7, partial remission as HAMD 8-18. The findings show entire MDD group and partially remitted MDD with significantly poorer NPS performance compared to HCs, while remitted MDD patients did not differ significantly from HCs. This underscores how critical a clear definition of remission is to compare studies on MDD. The clinical variable 'number of hospitalizations' had a significant effect on cognition, whereas current symptom severity did not correlate with performance on any cognitive domain. Higher number of hospitalizations may be associated with higher burden of illness and greater neurobiological "scar effects".
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Affiliation(s)
- Thea Marianne Grützner
- Research Group Neurocognition, Department of General Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Voßstraße 4, 69115, Heidelberg, Baden-Württemberg, Germany.
| | - Anuradha Sharma
- Research Group Neurocognition, Department of General Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Voßstraße 4, 69115, Heidelberg, Baden-Württemberg, Germany
| | - Lena Listunova
- Research Group Neurocognition, Department of General Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Voßstraße 4, 69115, Heidelberg, Baden-Württemberg, Germany
| | - Marina Bartolovic
- Research Group Neurocognition, Department of General Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Voßstraße 4, 69115, Heidelberg, Baden-Württemberg, Germany
| | - Matthias Weisbrod
- Research Group Neurocognition, Department of General Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Voßstraße 4, 69115, Heidelberg, Baden-Württemberg, Germany; Department of Psychiatry and Psychotherapy, SRH Hospital Karlsbad-Langensteinbach, Guttmannstraße 1, 76307, Karlsbad, Germany
| | - Daniela Roesch-Ely
- Research Group Neurocognition, Department of General Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Voßstraße 4, 69115, Heidelberg, Baden-Württemberg, Germany
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Listunova L, Roth C, Bartolovic M, Kienzle J, Bach C, Weisbrod M, Roesch-Ely D. Cognitive Impairment Along the Course of Depression: Non-Pharmacological Treatment Options. Psychopathology 2018; 51:295-305. [PMID: 30184551 DOI: 10.1159/000492620] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 08/02/2018] [Indexed: 11/19/2022]
Abstract
Major Depressive Disorder (MDD) is one of the most common psychiatric disorders, with a large global impact on both the individual and the society. In this narrative review, we summarize neurocognitive deficits during acute and (partially) remitted states of depression. Furthermore, we outline the potential negative effect of cognitive impairment (CI) on functional recovery, and discuss the role of several variables in the development of CI for MDD patients. Though there is cumulating evidence regarding persistent CI in unipolar depression, research on treatment options specific for this patient group is still scarce. Hence the central aim of our review is to present non-pharmacological interventions, which are thought to reduce CI in affected MDD patients. We discuss cognitive remediation therapy (CRT), physical exercise, yoga, mindfulness-based therapy, and modern neuromodulation approaches like neurostimulation and neurofeedback training. In conclusion, we propose future directions for research on CI in depression. Looking further ahead, we suggest creative interventional designs that include a direct comparison of different non-pharmacological treatment approaches on neurocognition and functional outcome of MDD. Furthermore, additive and synergistic effects of CRT with other treatment approaches should be examined and compared to create multimodal and even personalized intervention programs.
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Affiliation(s)
- Lena Listunova
- Department of General Adult Psychiatry, Center for Psychosocial Medicine, Division Neurocognition, University of Heidelberg, Heidelberg,
| | - Corinna Roth
- Department of General Adult Psychiatry, Center for Psychosocial Medicine, Division Neurocognition, University of Heidelberg, Heidelberg, Germany
| | - Marina Bartolovic
- Department of General Adult Psychiatry, Center for Psychosocial Medicine, Division Neurocognition, University of Heidelberg, Heidelberg, Germany
| | - Johanna Kienzle
- Department of General Adult Psychiatry, Center for Psychosocial Medicine, Division Neurocognition, University of Heidelberg, Heidelberg, Germany
| | - Claudia Bach
- Department of General Adult Psychiatry, Center for Psychosocial Medicine, Division Neurocognition, University of Heidelberg, Heidelberg, Germany
| | - Matthias Weisbrod
- Department of General Adult Psychiatry, Center for Psychosocial Medicine, Division Neurocognition, University of Heidelberg, Heidelberg, Germany.,Department of Adult Psychiatry, SRH-Klinik, Karlsbad-Langensteinbach, Germany
| | - Daniela Roesch-Ely
- Department of General Adult Psychiatry, Center for Psychosocial Medicine, Division Neurocognition, University of Heidelberg, Heidelberg, Germany
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Sharma A, Schray A, Bartolovic M, Roesch-Ely D, Aschenbrenner S, Weisbrod M. Relationship between serum calcium and neuropsychological performance might indicate etiological heterogeneity underlying cognitive deficits in schizophrenia and depression. Psychiatry Res 2017; 252:80-86. [PMID: 28259035 DOI: 10.1016/j.psychres.2017.01.101] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 01/06/2017] [Accepted: 01/11/2017] [Indexed: 10/20/2022]
Abstract
Cognitive dysfunction is a core feature of schizophrenia spectrum and depressive disorders. Influx of extracellular calcium is essential for neuronal processes such as pre-synaptic neurotransmitter release and NMDA receptor mediated neuroplasticity. Since serum and brain interstitial fluids maintain equilibrium for ion concentrations via passive diffusion, the amount of peripheral calcium could affect neuronal and hence cognitive function. Within the physiological norm-levels, we hypothesized higher serum-calcium would be associated with better neuropsychological performance in patients diagnosed with schizophrenia or depression. One-tailed Pearson's correlations were calculated between total serum-calcium levels and performance on an extensive computer-based neuropsychological test battery. Influence of covariates was assessed using linear regression. Serum calcium was significantly and positively correlated with neuropsychological composite, information processing speed, executive function and global assessment of functioning (GAF) in depression patients but not in schizophrenia patients. Amongst covariates, age associated significantly with serum calcium and neuropsychological functioning in depression but only with serum calcium in schizophrenia group. The study provides first evidence for a positive relationship between serum calcium and neuropsychological/daily-life function in depression. Absence of this correlation in schizophrenia could point to etiological heterogeneity concerning calcium-related processes underlying cognitive deficits in these disorders.
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Affiliation(s)
- Anuradha Sharma
- Research Group Neurocognition, Department of General Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Germany.
| | - Angela Schray
- Department of Visceral Surgery, University Hospital Heidelberg, Germany
| | - Marina Bartolovic
- Heidelberg Institute for Psychotherapy, University Hospital Heidelberg, Germany
| | - Daniela Roesch-Ely
- Research Group Neurocognition, Department of General Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Germany
| | - Steffen Aschenbrenner
- Department of Psychiatry and Psychotherapy, SRH Hospital, Karlsbad-Langensteinbach, Germany
| | - Matthias Weisbrod
- Research Group Neurocognition, Department of General Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Germany; Department of Psychiatry and Psychotherapy, SRH Hospital, Karlsbad-Langensteinbach, Germany
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Rodewald K, Bartolovic M, Debelak R, Aschenbrenner S, Weisbrod M, Roesch-Ely D. Eine Normierungsstudie eines modifizierten Trail Making Tests im deutschsprachigen Raum. Zeitschrift für Neuropsychologie 2012. [DOI: 10.1024/1016-264x/a000060] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Der Trail Making Test (TMT) ist ein international weit verbreitetes Verfahren, das z. B. zur Untersuchung von Patienten mit erworbenen Hirnschädigungen eingesetzt wird. Die Performanz im TMT wird mit unterschiedlichen neuropsychologischen Domänen, wie z. B. Aufmerksamkeit und Exekutivfunktionen, in Verbindung gebracht. Trotz der häufigen Anwendung im klinischen Alltag liegen bisher keine deutschsprachigen Normen für einen umfassenden Altersrange vor. Die vorliegende Untersuchung hat daher den Einfluss von Alter und Bildung auf die Bearbeitungszeit im TMT bei deutschsprachigen Erwachsenen im Alter zwischen 18 und 85 Jahren erfasst und analysiert. Ausschlusskriterien bildeten neurologische oder psychiatrische Erkrankungen, die Beeinträchtigung des Blickfeldes bzw. der Sehfähigkeit, die motorische Beeinträchtigung der Arme und Hände sowie Drogen- oder Alkoholmissbrauch. Die Stichprobe ist in vier Altersgruppen aufgeteilt: 18 – 34 Jahre (n = 148), 35 – 49 Jahre (n = 111), 50 – 64 Jahre (n = 93) und 65 – 84 Jahre (n = 53). Hinsichtlich der Bildung wurden zwei Gruppen gebildet: niedriges bis mittleres Bildungsniveau ( ≤ 12 Jahre formale Bildung) und höheres Bildungsniveau ( ≥ 12 Jahre formale Bildung). Signifikante Korrelationen zwischen den demografischen Variablen und den Bearbeitungszeiten im TMT-A bzw. TMT-B zeigen, dass sowohl Alter als auch Bildung mit der Leistung im TMT korrelieren (p < .01). Post hoc Analysen machen deutlich, dass sich dabei alle Altersgruppen voneinander unterscheiden. Die Ergebnisse für die Bearbeitungszeit stehen in Einklang mit früheren Normierungsstudien, die ebenfalls Alter und Bildung als die bedeutsamsten Moderatoren für die Leistung im TMT identifiziert hatten.
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Affiliation(s)
- Katlehn Rodewald
- Sektion für Experimentelle Psychopathologie und Neurophysiologie, Psychiatrische Abteilung, Zentrum für Psychosoziale Medizin, Universitätsklinikum Heidelberg
- Berufliches Bildungs- und Rehazentrum (BBRZ) Karlsbad-Langensteinbach
| | - Marina Bartolovic
- Sektion für Experimentelle Psychopathologie und Neurophysiologie, Psychiatrische Abteilung, Zentrum für Psychosoziale Medizin, Universitätsklinikum Heidelberg
| | | | | | - Matthias Weisbrod
- Sektion für Experimentelle Psychopathologie und Neurophysiologie, Psychiatrische Abteilung, Zentrum für Psychosoziale Medizin, Universitätsklinikum Heidelberg
- Abteilung für Psychiatrie und Psychotherapie, SRH Klinikum Karlsbad-Langensteinbach
| | - Daniela Roesch-Ely
- Sektion für Experimentelle Psychopathologie und Neurophysiologie, Psychiatrische Abteilung, Zentrum für Psychosoziale Medizin, Universitätsklinikum Heidelberg
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Abstract
The major objective of this study was to explore and examine common stressors and coping strategies of rural adolescents. Coping was defined as a cognitive and transactional process between a person and the person's environment. A survey of 222 normal adolescents attending a rural southwestern Pennsylvania high school reported experiencing stressful events related to school, family, friendship, health, and transportation. The coping strategy reported as being the most commonly used was optimistic. However, the coping strategy reported to be most effective in dealing with stressful events was supportant. The results of this study contribute to the limited information on adolescent coping in rural areas. This study should help health care providers further their understanding of this vulnerable population. Clinicians can enhance the effective coping and overall health of the rural adolescent by screening for and discussing coping strategies.
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Affiliation(s)
- K R Puskar
- University of Pittsburgh School of Nursing, Pennsylvania
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