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Kuzin M, Gardin F, Götschi M, Xepapadakos F, Kawohl W, Seifritz E, Trauzeddel A, Paulzen M, Schoretsanitis G. Changes in Psychotropic Drug Blood Levels After SARS-CoV-2 Vaccination: A Two-Center Cohort Study. Ther Drug Monit 2023; 45:792-796. [PMID: 37296505 DOI: 10.1097/ftd.0000000000001118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 03/27/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Limited evidence from case reports suggests that coronavirus disease 2019 (COVID-19) vaccination may interact with the treatment outcomes of psychiatric medications. Apart from clozapine, reports on the effect of COVID-19 vaccination on other psychotropic agents are scarce. This study aimed to investigate the impact of COVID-19 vaccination on the plasma levels of different psychotropic drugs using therapeutic drug monitoring. METHODS Plasma levels of psychotropic agents, including agomelatine, amisulpride, amitriptyline, escitalopram, fluoxetine, lamotrigine, mirtazapine, olanzapine, quetiapine, sertraline, trazodone, and venlafaxine, from inpatients with a broad spectrum of psychiatric diseases receiving COVID-19 vaccinations were collected at 2 medical centers between 08/2021 and 02/2022 under steady-state conditions before and after vaccination. Postvaccination changes were estimated as a percentage of baseline. RESULTS Data from 16 patients who received COVID-19 vaccination were included. The largest changes in plasma levels were reported for quetiapine (+101.2%) and trazodone (-38.5%) in 1 and 3 patients, respectively, 1 day postvaccination compared with baseline levels. One week postvaccination, the plasma levels of fluoxetine (active moiety) and escitalopram increased by 31% and 24.9%, respectively. CONCLUSIONS This study provides the first evidence of major changes in the plasma levels of escitalopram, fluoxetine, trazodone, and quetiapine after COVID-19 vaccination. When planning COVID-19 vaccination for patients treated with these medications, clinicians should monitor rapid changes in bioavailability and consider short-term dose adjustments to ensure safety.
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Affiliation(s)
- Maxim Kuzin
- Clienia Schloessli, Private Psychiatric Hospital and Academic Teaching Hospital of the University of Zurich, Oetwil am See, Zurich, Switzerland
- Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie (AGNP)-Work Group "Therapeutic Drug Monitoring", Nürnberg, Germany
- University of Nicosia Medical School, Nicosia, Cyprus
| | - Fabian Gardin
- Clienia Schloessli, Private Psychiatric Hospital and Academic Teaching Hospital of the University of Zurich, Oetwil am See, Zurich, Switzerland
| | - Markus Götschi
- Clienia Schloessli, Private Psychiatric Hospital and Academic Teaching Hospital of the University of Zurich, Oetwil am See, Zurich, Switzerland
| | - Franziskos Xepapadakos
- Clienia Schloessli, Private Psychiatric Hospital and Academic Teaching Hospital of the University of Zurich, Oetwil am See, Zurich, Switzerland
- University of Nicosia Medical School, Nicosia, Cyprus
| | - Wolfram Kawohl
- Clienia Schloessli, Private Psychiatric Hospital and Academic Teaching Hospital of the University of Zurich, Oetwil am See, Zurich, Switzerland
- University of Nicosia Medical School, Nicosia, Cyprus
- Department of Psychiatry, Psychotherapy and Psychosomatics, Hospital of Psychiatry, University of Zurich, Zurich, Switzerland
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy and Psychosomatics, Hospital of Psychiatry, University of Zurich, Zurich, Switzerland
| | | | - Michael Paulzen
- Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie (AGNP)-Work Group "Therapeutic Drug Monitoring", Nürnberg, Germany
- Alexianer Hospital Aachen, Aachen, Germany
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, and JARA-Translational Brain Medicine, Aachen, Germany
| | - Georgios Schoretsanitis
- Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie (AGNP)-Work Group "Therapeutic Drug Monitoring", Nürnberg, Germany
- Department of Psychiatry, Psychotherapy and Psychosomatics, Hospital of Psychiatry, University of Zurich, Zurich, Switzerland
- Department of Psychiatry, Northwell Health, The Zucker Hillside Hospital, New York, New York; and
- Department of Psychiatry, Zucker School of Medicine at Northwell/Hofstra, Hempstead, New York
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Kuzin M, Boeglin C, Schoretsanitis G, Pannu M, Kawohl W, Xepapadakos F. Letter to the editor: Clozapine plasma levels under co-medication with fluvoxamine during COVID-19 infection: A case report. Schizophr Res 2023; 261:110-112. [PMID: 37717507 DOI: 10.1016/j.schres.2023.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 08/23/2023] [Accepted: 09/04/2023] [Indexed: 09/19/2023]
Affiliation(s)
- Maxim Kuzin
- Clienia Schloessli, Private Psychiatric Hospital and Academic Teaching Hospital of the University of Zurich, Oetwil am See, Zurich, Switzerland; Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie (AGNP)-Work Group "Therapeutic Drug Monitoring", Nürnberg, Germany; University of Nicosia Medical School, Nicosia, Cyprus.
| | - Carla Boeglin
- Clienia Schloessli, Private Psychiatric Hospital and Academic Teaching Hospital of the University of Zurich, Oetwil am See, Zurich, Switzerland
| | - Georgios Schoretsanitis
- Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie (AGNP)-Work Group "Therapeutic Drug Monitoring", Nürnberg, Germany; Department of Psychiatry, Psychotherapy and Psychosomatics, Hospital of Psychiatry, University of Zurich, Zurich, Switzerland; The Zucker Hillside Hospital, Department of Psychiatry Research, Northwell Health, Glen Oaks, NY, USA; Department of Psychiatry, Zucker School of Medicine at Northwell/Hofstra, Hempstead, NY, USA
| | | | - Wolfram Kawohl
- Clienia Schloessli, Private Psychiatric Hospital and Academic Teaching Hospital of the University of Zurich, Oetwil am See, Zurich, Switzerland; University of Nicosia Medical School, Nicosia, Cyprus; Department of Psychiatry, Psychotherapy and Psychosomatics, Hospital of Psychiatry, University of Zurich, Zurich, Switzerland
| | - Franziskos Xepapadakos
- Clienia Schloessli, Private Psychiatric Hospital and Academic Teaching Hospital of the University of Zurich, Oetwil am See, Zurich, Switzerland; University of Nicosia Medical School, Nicosia, Cyprus
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Aeberli T, Müller M, Theodoridou A, Hagenmuller F, Seifritz E, Walitza S, Rössler W, Kawohl W, Heekeren K. Mismatch negativity generation in subjects at risk for psychosis: source analysis is more sensitive than surface electrodes in risk prediction. Front Psychiatry 2023; 14:1130809. [PMID: 37539328 PMCID: PMC10394234 DOI: 10.3389/fpsyt.2023.1130809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 06/30/2023] [Indexed: 08/05/2023] Open
Abstract
Background Deficits of mismatch negativity (MMN) in patients with schizophrenia have been demonstrated many times and there is growing evidence that alterations of MMN already exist in individuals at risk for psychosis. The present study examines differences in MMN between subjects fulfilling ultra-high risk (UHR) or only basic symptoms criteria and it addresses the question, if MMN source analysis can improve prediction of transition to psychosis. Methods The MMN to duration, frequency, and intensity deviants was recorded in 50 healthy controls and 161 individuals at risk for psychosis classified into three subgroups: only basic symptoms (n = 74), only ultra-high risk (n = 13) and persons who fulfill both risk criteria (n = 74). Based on a three-source model of MMN generation, we conducted an MMN source analysis and compared the amplitudes of surface electrodes and sources among the three groups. Results Significant differences in MMN generation among the four groups were revealed at surface electrodes Cz and C4 (p < 0.05) and at the frontal source (p < 0.001) for duration deviant stimuli. The 15 subjects from the risk groups who subsequently developed a manifest psychosis had a significantly lower MMN amplitude at frontal source (p = 0.019) without showing significant differences at surface electrodes. Low activity at frontal MMN source increased the risk of transition to manifest disease by the factor 3.12 in UHR subjects. Conclusion MMN activity differed significantly between subjects presenting only basic symptoms and subjects which additionally meet UHR criteria. The largest differences between groups as well as between individuals with and without transition were observed at the frontal source. The present results suggest that source analysis is more sensitive than surface electrodes in psychosis risk prediction by MMN.
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Affiliation(s)
- Tina Aeberli
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), University of Zurich, Zurich, Switzerland
| | - Mario Müller
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), University of Zurich, Zurich, Switzerland
| | - Anastasia Theodoridou
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), University of Zurich, Zurich, Switzerland
| | - Florence Hagenmuller
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), University of Zurich, Zurich, Switzerland
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland
| | - Susanne Walitza
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), University of Zurich, Zurich, Switzerland
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Zurich, Zurich, Switzerland
| | - Wulf Rössler
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), University of Zurich, Zurich, Switzerland
- Department of Psychiatry and Psychotherapy, Charité University Medicine, Berlin, Germany
| | - Wolfram Kawohl
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), University of Zurich, Zurich, Switzerland
- Clienia Schlössli AG, Oetwil am See, Zurich, Switzerland
- University of Nicosia Medical School, Nicosia, Cyprus
| | - Karsten Heekeren
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), University of Zurich, Zurich, Switzerland
- Department of Psychiatry and Psychotherapy I, LVR-Hospital Cologne, Cologne, Germany
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Ziogas A, Mokros A, Kawohl W, de Bardeci M, Olbrich I, Habermeyer B, Habermeyer E, Olbrich S. Deep Learning in the Identification of Electroencephalogram Sources Associated with Sexual Orientation. Neuropsychobiology 2023; 82:234-245. [PMID: 37369190 DOI: 10.1159/000530931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 04/21/2023] [Indexed: 06/29/2023]
Abstract
INTRODUCTION It is unclear if sexual orientation is a biological trait that has neurofunctional footprints. With deep learning, the power to classify biological datasets without an a priori selection of features has increased by magnitudes. The aim of this study was to correctly classify resting-state electroencephalogram (EEG) data from males with different sexual orientation using deep learning and to explore techniques to identify the learned distinguishing features. METHODS Three cohorts (homosexual men, heterosexual men, and a mixed sex cohort), one pretrained network on sex classification, and one newly trained network for sexual orientation classification were used to classify sex. Further, Grad-CAM methodology and source localization were used to identify the spatiotemporal patterns that were used for differentiation by the networks. RESULTS Using a pretrained network for classification of males and females, no differences existed between classification of homosexual and heterosexual males. The newly trained network was able, however, to correctly classify the cohorts with a total accuracy of 83%. The retrograde activation using Grad-CAM technology yielded distinctive functional EEG patterns in the Brodmann area 40 and 1 when combined with Fourier analysis and a source localization. DISCUSSION This study shows that electrophysiological trait markers of male sexual orientation can be identified using deep learning. These patterns are different from the differentiating signatures of males and females in a resting-state EEG.
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Affiliation(s)
- Anastasios Ziogas
- Department of Forensic Psychiatry, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | | | - Wolfram Kawohl
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
- Clienia Schlössli AG, Oetwil am See, Switzerland
| | - Mateo de Bardeci
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | | | | | - Elmar Habermeyer
- Department of Forensic Psychiatry, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Sebastian Olbrich
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
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Baumann-Vogel H, Ineichen C, Stieglitz L, Kawohl W. [The Value of Deep Brain Stimulation in Difficult-To-Treat and Treatment-Refractory Depression]. Praxis (Bern 1994) 2023; 112:413-418. [PMID: 37282518 DOI: 10.1024/1661-8157/a004047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The Value of Deep Brain Stimulation in Difficult-To-Treat and Treatment-Refractory Depression Abstract: Deep Brain Stimulation ("DBS") is a minimally invasive, neurosurgical and hypothesis-driven therapeutic procedure for permanent local regulation of pathological circuits. While depression represents a heterogeneous syndrome with multifactorial etiopathogenesis, neuroscience research is advancing evidence to identify network-level mechanisms that play an important role in the pathophysiology of depression. In the following article, we will review the role of DBS in treatment-resistant or difficult-to-treat depression. The aim is to increase the awareness of DBS and to discuss the challenges of its therapy and implementation.
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Affiliation(s)
- Heide Baumann-Vogel
- Klinik für Psychiatrie und Psychotherapie, Clienia Schlössli AG, Oetwil am See, Schweiz
- Klinik für Neurologie, Universitätsspital Zürich, Universität Zürich, Zürich, Schweiz
| | - Christian Ineichen
- Klinik für Neurologie, Universitätsspital Zürich, Universität Zürich, Zürich, Schweiz
| | - Lennart Stieglitz
- Klinik für Neurochirurgie, Universitätsspital Zürich, Universität Zürich, Zürich, Schweiz
| | - Wolfram Kawohl
- Klinik für Psychiatrie und Psychotherapie, Clienia Schlössli AG, Oetwil am See, Schweiz
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Psychiatrische Universitätsklinik Zürich, Zürich, Schweiz
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Kuzin M, Schoretsanitis G, Gardin F, Markus G, Kawohl W, Xepapadakos F. Switching From Aripiprazole Tablets to Oral Suspension in a Patient With Roux-en-Y Gastric Bypass: A Case Report. J Clin Psychopharmacol 2023; 43:300-302. [PMID: 37068029 DOI: 10.1097/jcp.0000000000001685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
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Pichler EM, Ploederl M, Rainer L, Gilhofer TS, Michel J, van der Stouwe JG, Luescher TF, Schmied CM, Kawohl W, Kronschnabel J, Niederseer D. Alive and kicking: suicide rates and major soccer events in Austria, Germany and Switzerland. Eur J Public Health 2023:7081288. [PMID: 36940682 DOI: 10.1093/eurpub/ckad042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2023] Open
Abstract
BACKGROUND Major sporting events are postulated to reduce suicide rates by increased social connectedness, by identifying with winning teams, or, conversely, to increase suicide rates by the 'broken promise effect'. METHODS In our observational epidemiological study, we investigated changes in suicide rates between 1970 and 2017 in Austria, Germany and Switzerland during the European and World Soccer Championships in general, and on days that the home team played, won or lost. RESULTS Combining all three studied nations no statistically significant change in the incidence of daily suicides during soccer championships compared to a control period was noted (38.29 ± 9.02 vs. 37.33 ± 10.58; incidence risk ratio = 1.03; 95% confidence interval: 1.01-1.05, P = 0.05). Essentially, no differences in the expected directions were found, and none remained statistically significant after correcting for multiple comparisons in subgroups for country, age and gender in all three studied countries. Compared to a control period, neither a significant difference in the respective national suicide rate was found after Germany's four championship victories nor after Austria's emotional only win over Germany. CONCLUSION Our results do not support the assumption of increased social connectedness and, thus, lowered suicide risk during major sporting events or changes in suicide risk depending on the outcome of important games as predicted by the broken promise effect or changes in self-efficacy by identification with winning teams.
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Affiliation(s)
- Eva-Maria Pichler
- Department of Psychiatry and Psychotherapy, Psychiatric Services Aargau AG, Brugg-Windisch, Switzerland
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich Switzerland
| | - Martin Ploederl
- Department of Inpatient Psychotherapy and Crisis Intervention, University Clinic for Psychiatry, Psychotherapy, and Psychosomatics, Christian Doppler Clinic, Paracelsus Medical University, Salzburg, Austria
- Department of Clinical Psychology, Christian Doppler Clinic, University Clinic for Psychiatry, Psychotherapy, and Psychosomatics, Paracelsus Medical University, Salzburg, Austria
| | - Lucas Rainer
- Department of Inpatient Psychotherapy and Crisis Intervention, University Clinic for Psychiatry, Psychotherapy, and Psychosomatics, Christian Doppler Clinic, Paracelsus Medical University, Salzburg, Austria
- Department of Clinical Psychology, Christian Doppler Clinic, University Clinic for Psychiatry, Psychotherapy, and Psychosomatics, Paracelsus Medical University, Salzburg, Austria
- Department of Neurology, Christian-Doppler Medical Centre, Paracelsus Medical University, Centre for Cognitive Neuroscience Salzburg, EpiCARE, Salzburg, Austria
| | - Thomas S Gilhofer
- Department of Cardiology, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Jonathan Michel
- Department of Cardiology, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Jan Gerrit van der Stouwe
- Department of Cardiology, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Thomas F Luescher
- Center for Molecular Cardiology Schlieren Campus, University of Zurich, Schlieren, Switzerland
- Royal Brompton & Harefield Hospitals, Imperial College and Kings College, London, UK
| | - Christian M Schmied
- Department of Cardiology, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Wolfram Kawohl
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich Switzerland
- Clienia Schlössli AG, Oetwil am See, Switzerland
| | - Jens Kronschnabel
- Department of Psychiatry and Psychotherapy, Psychiatric Services Aargau AG, Brugg-Windisch, Switzerland
| | - David Niederseer
- Department of Cardiology, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Pichler EM, Ewers S, Ajdacic-Gross V, Deutschmann M, Exner J, Kawohl W, Seifritz E, Claussen MC. Athletes are not at greater risk for death by suicide: A review. Scand J Med Sci Sports 2023; 33:569-585. [PMID: 36648386 DOI: 10.1111/sms.14316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 11/21/2022] [Accepted: 01/05/2023] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Suicide represents a major mental and public health issue. Elite athletes share certain individual and environmental characteristics that may increase their risk for mental illnesses, ultimately leading to suicide. This notion conflicts with the general perception of athletes, being the healthiest representatives of society. METHODS A comprehensive literature search was carried out through PubMed and Embase databases for relevant publications. RESULTS Recent calls for investigating suicidality among athletes resulted in a considerable amount of literature providing some evidence regarding lower rates of suicide among professional and high-performance athletes as well as similar incidence and prevalence of mental conditions, which are known as risk factors for suicide. Nevertheless, special attention is required in this population as predisposing and precipitating factors might differ from classical features of suicidality in the general population. Sports physicians, sports psychiatrists, and other mental health professionals in elite sports should be aware of early signs of affective disorders, risk of recreational drug abuse, misuse of performance-enhancing medications, sport-specific environmental stressors, serious physical injuries, and presence of physical or mental illness, all of which may increase suicidality. Traumatic brain injury (TBI) is with suicide with higher severity correlated with increased risk. Compared to active athletes, former athletes may have higher rates of suicide due to common life stressors occurring after sports retirement. CONCLUSIONS The findings suggest a multidisciplinary approach to suicidality in elite athletes, the main goal of which should be the reduction of suicide-related morbidity and mortality. Further research is required to clarify the existing gaps in the current knowledge of the issue. While having lower rates of suicide, athletes share some similar (affective disorders, drug abuse, mental and physical illness) and unique factors (misuse of performance-enhancing substances, sports-related stressors, sports injuries, TBI) putting them at risk of suicide during active career and retirement.
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Affiliation(s)
- Eva-Maria Pichler
- Department of Psychiatry and Psychotherapy, Psychiatric Services Aargau, Windisch, Switzerland
| | - Simon Ewers
- Klinikum Fünfseenland, Fachklinik für Psychiatrie und Psychotherapie, Wallerfangen, Germany
| | - Vladeta Ajdacic-Gross
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland
| | - Markus Deutschmann
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland
| | - Jan Exner
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland
| | - Wolfram Kawohl
- Department of Psychiatry and Psychotherapy, Psychiatric Services Aargau, Windisch, Switzerland.,Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland.,Clienia Schlössli AG, Oetwil am See, Switzerland
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland
| | - Malte Christian Claussen
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland.,Private Clinic Wyss AG, Münchenbuchsee, Switzerland.,Psychiatric Services Grisons, Chur, Switzerland
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Kuzin M, Schoretsanitis G, Götschi M, Gardin F, Kawohl W, Xepapadakos F. Bariatric surgery: impact on oral aripiprazole and fluoxetine
bioavailability – A clinical case. Pharmacopsychiatry 2022. [DOI: 10.1055/s-0042-1757673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Maxim Kuzin
- Private Psychiatric Hospital and Academic Teaching Hospital of the
University of Zurich, Oetwil am See, Switzerland
| | - Georgios Schoretsanitis
- Department of Psychiatry, Psychotherapy and Psychosomatics, University
Clinic Zurich, Switzerland
| | - Markus Götschi
- Private Psychiatric Hospital and Academic Teaching Hospital of the
University of Zurich, Oetwil am See, Switzerland
| | - Fabian Gardin
- Private Psychiatric Hospital and Academic Teaching Hospital of the
University of Zurich, Oetwil am See, Switzerland
| | - Wolfram Kawohl
- Private Psychiatric Hospital and Academic Teaching Hospital of the
University of Zurich, Oetwil am See, Switzerland
| | - Franziskos Xepapadakos
- Private Psychiatric Hospital and Academic Teaching Hospital of the
University of Zurich, Oetwil am See, Switzerland
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Abstract
A promising line of research on forensic assessment of paraphilic sexual interest focuses on behavioral measures of visual attention using sexual stimuli as distractors. The present study combined event-related potentials (ERPs) with behavioral measures to investigate whether detection of a hidden sexual preference can be improved with ERPs. Normal variants of sexual orientation were used for a proof-of-concept investigation. Accordingly, 40 heterosexual and 40 gay men participated in the study. Within each group, half of the participants were instructed to hide their sexual orientation. The results showed that a match between sexual orientation and stimulus delays responses and influences ERP before motor responses. Late ERP components showed higher potential in differentiating hidden sexual preferences than motor responses, thereby showing how ERPs can be used in combination with reaction time measures to potentially facilitate the detection of hidden sexual preferences.
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Affiliation(s)
| | - Benedikt Habermeyer
- Department of Psychiatry and Psychotherapy,
Psychiatric Services Aargau, Brugg, Switzerland
| | - Wolfram Kawohl
- Department of Psychiatry and Psychotherapy,
Psychiatric Services Aargau, Brugg, Switzerland
- Department of Psychiatry, Psychotherapy and
Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | | | - Andreas Mokros
- University Hospital of Psychiatry Zurich,
Switzerland
- FernUniversität in Hagen, Germany
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Soldini E, Alippi M, Zufferey MC, Lisi A, Lucchini M, Albanese E, Colombo RA, Rossa S, Bolla E, Mellacqua ZB, Larghi G, Cordasco S, Kawohl W, Crivelli L, Traber R. Effectiveness of crisis resolution home treatment for the management of acute psychiatric crises in Southern Switzerland: a natural experiment based on geography. BMC Psychiatry 2022; 22:405. [PMID: 35715789 PMCID: PMC9204869 DOI: 10.1186/s12888-022-04020-z] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 05/25/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Crisis Resolution Home Treatment (CRHT) is an alternative to inpatient treatment for acute psychiatric crises management. However, evidence on CRHT effectiveness is still limited. In the Canton of Ticino (Southern Switzerland), in 2016 the regional public psychiatric hospital replaced one acute ward with a CRHT. The current study was designed within this evaluation setting to assess the effectiveness of CRHT compared to standard inpatient treatment. METHODS CRHT was offered to patients aged 18 to 65 with an acute psychiatric crisis that would have required hospitalization. We used a natural experiment based on geography, where intervention and control groups were formed according to the place of residence. Primary endpoints were reduction of psychiatric symptoms at discharge measured using the Health of the Nation Outcome Scales, treatment duration in days, and rate and length of readmissions during a two-year follow-up period after discharge. Safety during the treatment period was measured with the number of serious adverse events (suicide/suicide attempts, major self-harm episodes, acute alcohol/drug intoxications, aggressions to caregivers or family members). We used linear, log-linear and logistic regression models with propensity scores for the main analysis. RESULTS We enrolled 321 patients; 67 were excluded because the treatment period was too short and 17 because they were transferred before the end of the treatment. Two hundred thirty-seven patients were available for data analysis, 93 in the intervention group and 144 in the control group. No serious adverse event was observed during the treatment period in both groups. Reduction of psychiatric symptoms at discharge (p-value = 0.359), readmission rates (p-value = 0.563) and length of readmissions (p-value = 0.770) during the two-year follow-up period did not differ significantly between the two groups. Treatment duration was significantly higher in the treatment group (+ 29.6% on average, p-value = 0.002). CONCLUSIONS CRHT was comparable to standard hospitalization in terms of psychiatric symptoms reduction, readmission rates and length of readmissions, but it was also characterized by a longer first treatment period. However, observational evidence following the study indicated that CRHT duration constantly lowered over time since its introduction in 2016 and became comparable to hospitalization, showing therefore to be an effective alternative also in terms of treatment length. TRIAL REGISTRATION ISRCTN38472626 (17/11/2020, retrospectively registered).
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Affiliation(s)
- Emiliano Soldini
- Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Palazzo E, Via Cantonale 16e, CH-6928, Manno, Switzerland.
| | - Maddalena Alippi
- grid.482997.90000 0001 1091 9932Cantonal Psychiatric Clinic, Organizzazione Sociopsichiatrica Cantonale, Via Agostino Maspoli 6, CH-6850 Mendrisio, Switzerland
| | - Maria Caiata Zufferey
- grid.16058.3a0000000123252233Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Palazzo E, Via Cantonale 16e, CH-6928 Manno, Switzerland
| | - Angela Lisi
- grid.16058.3a0000000123252233Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Palazzo E, Via Cantonale 16e, CH-6928 Manno, Switzerland
| | - Mario Lucchini
- grid.7563.70000 0001 2174 1754Department of Sociology and Social Research, Università Degli Studi Di Milano Bicocca, piazza dell’Ateneo nuovo 1, 20126 Milan, Italy
| | - Emiliano Albanese
- grid.29078.340000 0001 2203 2861Institute of Public Health (IPH), Faculty of Biomedical Sciences, Università Della Svizzera Italiana, Via Giuseppe Buffi 13, CH-6900 Lugano, Switzerland
| | - Raffaella Ada Colombo
- grid.482997.90000 0001 1091 9932Cantonal Psychiatric Clinic, Organizzazione Sociopsichiatrica Cantonale, Via Agostino Maspoli 6, CH-6850 Mendrisio, Switzerland
| | - Simona Rossa
- grid.482997.90000 0001 1091 9932Cantonal Psychiatric Clinic, Organizzazione Sociopsichiatrica Cantonale, Via Agostino Maspoli 6, CH-6850 Mendrisio, Switzerland
| | - Emilio Bolla
- grid.482997.90000 0001 1091 9932Cantonal Psychiatric Clinic, Organizzazione Sociopsichiatrica Cantonale, Via Agostino Maspoli 6, CH-6850 Mendrisio, Switzerland
| | - Zefiro Benedetto Mellacqua
- grid.482997.90000 0001 1091 9932Cantonal Psychiatric Clinic, Organizzazione Sociopsichiatrica Cantonale, Via Agostino Maspoli 6, CH-6850 Mendrisio, Switzerland
| | - Giuseppina Larghi
- grid.482997.90000 0001 1091 9932Cantonal Psychiatric Clinic, Organizzazione Sociopsichiatrica Cantonale, Via Agostino Maspoli 6, CH-6850 Mendrisio, Switzerland
| | - Severino Cordasco
- grid.482997.90000 0001 1091 9932Cantonal Psychiatric Clinic, Organizzazione Sociopsichiatrica Cantonale, Via Agostino Maspoli 6, CH-6850 Mendrisio, Switzerland
| | - Wolfram Kawohl
- Clienia Schlössli, Psychiatric Hospital, Schlösslistrasse 8, 8618 Oetwil Am See, Switzerland
| | - Luca Crivelli
- grid.16058.3a0000000123252233Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Palazzo E, Via Cantonale 16e, CH-6928 Manno, Switzerland
| | - Rafael Traber
- grid.482997.90000 0001 1091 9932Cantonal Psychiatric Clinic, Organizzazione Sociopsichiatrica Cantonale, Via Agostino Maspoli 6, CH-6850 Mendrisio, Switzerland
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12
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Zavorotnyy M, Seifritz E, Brhl A, Kawohl W. Behandlungsoptionen bei schwer behandelbarer Depression und Therapieresistenz. Swiss Arch Neurol Psychiatr Psychother 2022. [DOI: 10.4414/sanp.2022.03315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
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Levati S, Mellacqua Z, Caiata-Zufferey M, Soldini E, Albanese E, Alippi M, Bolla E, Colombo RA, Cordasco S, Kawohl W, Larghi G, Lisi A, Lucchini M, Rossa S, Traber R, Crivelli L. Home Treatment for Acute Mental Health Care: Protocol for the Financial Outputs, Risks, Efficacy, Satisfaction Index and Gatekeeping of Home Treatment (FORESIGHT) Study. JMIR Res Protoc 2021; 10:e28191. [PMID: 34751660 PMCID: PMC8663595 DOI: 10.2196/28191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 07/08/2021] [Accepted: 07/08/2021] [Indexed: 11/13/2022] Open
Abstract
Background Crisis Resolution and Home Treatment (CRHT) teams represent a community-based mental health service offering a valid alternative to hospitalization. CRHT teams have been widely implemented in various mental health systems worldwide, and their goal is to provide care for people with severe acute mental disorders who would be considered for admission to acute psychiatric wards. The evaluation of several home-treatment experiences shows promising results; however, it remains unclear which specific elements and characteristics of CRHT are more effective and acceptable. Objective This study aims to assess the acceptability, effectiveness, and cost-effectiveness of a new CRHT intervention in Ticino, Southern Switzerland. Methods This study includes an interventional, nonrandomized, quasi-experimental study combined with a qualitative study and an economic evaluation to be conducted over a 48-month period. The quasi-experimental evaluation involves two groups: patients in the northern area of the region who were offered the CRHT service (ie, intervention group) and patients in the southern area of the region who received care as usual (ie, control group). Individual interviews will be conducted with patients receiving the home treatment intervention and their family members. CRHT members will also be asked to participate in a focus group. The economic evaluation will include a cost-effectiveness analysis. Results The project is funded by the Swiss National Science Foundation as part of the National Research Program NRP74 for a period of 48 months starting from January 2017. As of October 2021, data for the nonrandomized, quasi-experimental study and the qualitative study have been collected, and the results are expected to be published by the end of the year. Data are currently being collected for the economic evaluation. Conclusions Compared to other Swiss CRHT experiences, the CRHT intervention in Ticino represents a unique case, as the introduction of the service is backed by the closing of one of its acute wards. The proposed study will address several areas where there are evidence gaps or contradictory findings relating to the home treatment of acute mental crisis. Findings from this study will allow local services to improve their effectiveness in a challenging domain of public health and contribute to improving access to more effective care for people with severe mental disorders. Trial Registration ISRCTN registry ISRCTN38472626; https://www.isrctn.com/ISRCTN38472626 International Registered Report Identifier (IRRID) DERR1-10.2196/28191
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Affiliation(s)
- Sara Levati
- Competence Centre for Healthcare Practices and Policies, Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno, Switzerland
| | - Zefiro Mellacqua
- Organizzazione sociopsichiatrica cantonale, Mendrisio, Switzerland
| | - Maria Caiata-Zufferey
- Competence Centre for Healthcare Practices and Policies, Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno, Switzerland
| | - Emiliano Soldini
- Research Methodology Competence Centre, Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno, Switzerland
| | - Emiliano Albanese
- Institute of Public Health, Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Maddalena Alippi
- Organizzazione sociopsichiatrica cantonale, Mendrisio, Switzerland
| | - Emilio Bolla
- Organizzazione sociopsichiatrica cantonale, Mendrisio, Switzerland
| | | | | | | | | | - Angela Lisi
- Research Methodology Competence Centre, Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno, Switzerland
| | - Mario Lucchini
- Department of Sociology and Social Research, University of Milan Bicocca, Milan, Italy
| | - Simona Rossa
- Organizzazione sociopsichiatrica cantonale, Mendrisio, Switzerland
| | - Rafael Traber
- Organizzazione sociopsichiatrica cantonale, Mendrisio, Switzerland
| | - Luca Crivelli
- Competence Centre for Healthcare Practices and Policies, Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno, Switzerland
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Richter D, Bonsack C, Burr C, Gekle W, Hepp U, Kawohl W, Schneeberger AR, Theodoridou A, Traber R, Jger M. Therapeutic alliance, social inclusion and infection control – towards pandemic-adapted mental healthcare services in Switzerland. Swiss Arch Neurol Psychiatr Psychother 2021. [DOI: 10.4414/sanp.2021.03158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Dirk Richter
- Head of Research and Development
- Zentrum Psychiatrische Rehabilitation
- Murtenstrasse 46
- Bern
- 3008
- SWITZERLAND
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15
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Pichler EM, Stulz N, Wyder L, Heim S, Watzke B, Kawohl W. Long-Term Effects of the Individual Placement and Support Intervention on Employment Status: 6-Year Follow-Up of a Randomized Controlled Trial. Front Psychiatry 2021; 12:709732. [PMID: 34712153 PMCID: PMC8546221 DOI: 10.3389/fpsyt.2021.709732] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 09/10/2021] [Indexed: 11/13/2022] Open
Abstract
People with mental illness often experience difficulties with reintegration into the workplace, although employment is known to assist these individuals in their recovery process. Traditional approaches of "first train, then place" have been recently replaced by supported employment (SE) methods that carry strategy of "first place, then train." Individual placement and support (IPS) is one of the best-studied methods of SE, which core principles are individualized assistance in rapid job search with consequent placement in a paid employment position. A considerable amount of high-quality evidence supported the superiority of IPS over conventional methods in providing improved employment rates, longer job tenure, as well as higher salaries in competitive job markets. Nonetheless, our knowledge about the IPS-mediated long-term effects is limited. This non-interventional follow-up study of a previously published randomized controlled trial (RCT) called ZhEPP aimed to understand the long-term impact of IPS after 6 years since the initial intervention. Participants from the ZhEPP trial, where 250 disability pensioners with mental illnesses were randomized into either IPS intervention group or treatment as usual group (TAU), were invited to face-to-face interviews, during which employment status, job tenure, workload, and salaries were assessed. One hundred and fourteen individuals agreed to participate in this follow-up study. Although during the first 2 years post-intervention, the IPS group had higher employment rates (40% (IPS) vs. 28% (TAU), p < 0.05 at 24 months), these differences disappeared by the time of follow-up assessments (72 months). The results indicated no substantial differences in primary outcome measures between IPS and TAU groups: employment rate (36 vs. 33%), workload (10.57 vs. 10.07 h per week), job tenure (29 vs. 28 months), and salary (20.21CHF vs. 25.02 CHF). These findings provide important insights regarding the long-term effects of IPS among individuals with mental health illnesses. Further research is required to advance the current knowledge about IPS intervention and its years-long impact.
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Affiliation(s)
- Eva-Maria Pichler
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland.,Psychiatric Services Aargau, Windisch, Switzerland
| | - Niklaus Stulz
- Psychiatric Services Aargau, Windisch, Switzerland.,Integrated Psychiatric Services Winterthur-Zurcher Unterland (IPW), Winterthur, Switzerland
| | - Lea Wyder
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland.,Psychiatric Services Aargau, Windisch, Switzerland
| | - Simone Heim
- Psychiatric Services Aargau, Windisch, Switzerland.,Praxis Dr. Pramstaller, Uetikon am See, Switzerland
| | - Birgit Watzke
- Clinical Psychology and Psychotherapy, Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Wolfram Kawohl
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland.,Psychiatric Services Aargau, Windisch, Switzerland.,Clienia Schlössli AG, Oetwil am See, Switzerland
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16
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Abstract
Background In line with previous findings, in a recent randomized controlled trial (RCT), we found that home treatment (HT) for acute mental health care can reduce (substitute) hospital use among severely ill patients in crises. This study examined whether the findings of the RCT generalize to HT services provided under routine care conditions. Methods We compared patients who received HT during the RCT study phase with patients who received the same HT service after it had become part of routine mental health services in the same catchment area. Sociodemographic and clinical characteristics as well as service use (HT and hospital bed days) were compared between the RCT and the subsequent routine care study period. Results Compared to patients who received HT during the RCT, routine care HT patients were more often living with others, less often admitted compulsorily, more often diagnosed with anxiety and stress-related disorders (ICD-10 F4) and less often diagnosed with schizophrenia spectrum disorders (F2). When compared to patients who were exclusively treated on hospital wards, involvement of the HT team in patients’ care was associated with a clear-cut reduction of hospital bed days both during the RCT and under routine care conditions. However, unlike during the RCT study period, involvement of HT was associated with longer overall treatment episodes (inpatient + HT days) under routine care conditions. Conclusions HT seems to reduce the use of hospital bed days even under routine care conditions but is at risk of producing longer overall acute treatment episodes.
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Affiliation(s)
- N Stulz
- Integrated Psychiatric Services Winterthur-Zurcher Unterland, P.O. Box 144, CH-8408Winterthur, Switzerland
| | - W Kawohl
- Psychiatric Services Aargau, P.O. Box 432, CH-5201Brugg, Switzerland.,KPPP, University Hospital of Psychiatry Zurich, Lenggstrasse 31, CH-8008Zurich, Switzerland
| | - M Jäger
- KPPP, University Hospital of Psychiatry Zurich, Lenggstrasse 31, CH-8008Zurich, Switzerland.,Psychiatrie Baselland, Bienentalstrasse 7, CH-4410Liestal, Switzerland
| | - S Mötteli
- KPPP, University Hospital of Psychiatry Zurich, Lenggstrasse 31, CH-8008Zurich, Switzerland
| | - U Schnyder
- University of Zurich, CH-8001Zurich, Switzerland
| | - U Hepp
- Integrated Psychiatric Services Winterthur-Zurcher Unterland, P.O. Box 144, CH-8408Winterthur, Switzerland
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17
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Stulz N, Wyder L, Maeck L, Hilpert M, Lerzer H, Zander E, Kawohl W, Grosse Holtforth M, Schnyder U, Hepp U. Home treatment for acute mental healthcare: randomised controlled trial. Br J Psychiatry 2020; 216:323-330. [PMID: 30864532 DOI: 10.1192/bjp.2019.31] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [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] [Indexed: 11/23/2022]
Abstract
BACKGROUND Home treatment has been proposed as an alternative to acute in-patient care for mentally ill patients. However, there is only moderate evidence in support of home treatment. AIMS To test whether and to what degree home treatment services would enable a reduction (substitution) of hospital use. METHOD A total of 707 consecutively admitted adult patients with a broad spectrum of mental disorders (ICD-10: F2-F6, F8-F9, Z) experiencing crises that necessitated immediate admission to hospital, were randomly allocated to either a service model including a home treatment alternative to hospital care (experimental group) or a conventional service model that lacked a home treatment alternative to in-patient care (control group) (trial registration at ClinicalTrials.gov: NCT02322437). RESULTS The mean number of hospital days per patient within 24 months after the index crisis necessitating hospital admission (primary outcome) was reduced by 30.4% (mean 41.3 v. 59.3, P<0.001) when a home treatment team was available (intention-to-treat analysis). Regarding secondary outcomes, average overall treatment duration (hospital days + home treatment days) per patient (mean 50.4 v. 59.3, P = 0.969) and mean number of hospital admissions per patient (mean 1.86 v. 1.93, P = 0.885) did not differ statistically significantly between the experimental and control groups within 24 months after the index crisis. There were no significant between-group differences regarding clinical and social outcomes (Health of the Nation Outcome Scales: mean 9.9 v. 9.7, P = 0.652) or patient satisfaction with care (Perception of Care questionnaire: mean 0.78 v. 0.80, P = 0.242). CONCLUSIONS Home treatment services can reduce hospital use among severely ill patients in acute crises and seem to result in comparable clinical/social outcomes and patient satisfaction as standard in-patient care.
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Affiliation(s)
- Niklaus Stulz
- Head of Research, Integrated Psychiatric Services Winterthur - Zurcher Unterland; Senior Researcher (Former Head of Research), Psychiatric Services Aargau; and Research Associate, Department of Psychology, University of Berne, Switzerland
| | - Lea Wyder
- Research Associate, Psychiatric Services Aargau; and Former PhD Student, Department of Psychology, University of Berne, Switzerland
| | - Lienhard Maeck
- Senior Physician, Psychiatric Services Aargau, Switzerland
| | - Matthias Hilpert
- Deputy Head of Department, Psychiatric Services Aargau, Switzerland
| | - Helmut Lerzer
- Deputy Head of Nursing Services, Psychiatric Services Aargau, Switzerland
| | - Eduard Zander
- Senior Physician, Psychiatric Services Aargau, Switzerland
| | - Wolfram Kawohl
- Head of Department, Psychiatric Services Aargau, Switzerland
| | - Martin Grosse Holtforth
- Associate Professor, Department of Psychology, University of Berne; and Head Researcher, Division of Psychosomatic Medicine, Department of Neurology, Inselspital, University Hospital Berne, Switzerland
| | | | - Urs Hepp
- Medical Director, Integrated Psychiatric Services Winterthur - Zurcher Unterland, Switzerland
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18
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Rössler W, Kawohl W, Nordt C, Haker H, Rüsch N, Hengartner MP. 'Placement budgets' for supported employment: impact on employment rates in a multicentre randomised controlled trial. Br J Psychiatry 2020; 216:308-313. [PMID: 31256765 DOI: 10.1192/bjp.2019.154] [Citation(s) in RCA: 4] [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] [Indexed: 11/23/2022]
Abstract
BACKGROUND The most effective rehabilitation model for job (re-)entry of people with mental illness is supported employment. A barrier to introducing supported employment into standard care is its temporally unlimited provision, which conflicts with health and social legislation in many European countries. AIMS To test the impact of different 'placement budgets', i.e. a predefined maximum time budget for job seeking until take-up of competitive employment. METHOD Participants (116) were randomly assigned to 25 h, 40 h or 55 h placement budgets in an intent-to-treat analysis. We applied the individual placement and support model over 24 months, following participants for 36 months. Primary outcome was employment in the labour market for at least 3 months. RESULTS The proportion of participants obtaining competitive employment was 55.1% in the 25 h group, 37.8% in the 40 h group and 35.8% in the 55 h group. In a Cox regression analysis, time to employment was slightly lower in the 25 h group relative to the 40 h (hazard ratio 1.78, 95% CI 0.88-3.57, P = 0.107) and 55 h groups (hazard ratio 1.74, 95% CI 0.86-3.49, P = 0.122), but this was not statistically significant. The vast majority of all participants who found a job did so within the first 12 months (80.4%). CONCLUSION A restricted time budget for job finding and placement does not affect the rate of successful employment. In accordance with legislation, a restriction of care provision seems justified and enhances the chances of supported employment being introduced in statutory services.
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Affiliation(s)
- Wulf Rössler
- Professor, Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Switzerland; Institute of Psychiatry, Laboratory of Neuroscience (LIM 27), University of Sao Paulo, Brazil; and Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Germany
| | - Wolfram Kawohl
- Senior Consultant, Psychiatrische Dienste Aargau AG, Klinik für Psychiatrie und Psychotherapie, Switzerland
| | - Carlos Nordt
- Senior Researcher, Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Switzerland
| | - Helene Haker
- Senior Researcher, Translational Neuromodeling Unit, Institute for Biomedical Engineering, University of Zurich and ETH Zurich, Switzerland
| | - Nicolas Rüsch
- Professor, Section of Public Mental Health, University of Ulm, Germany
| | - Michael P Hengartner
- Senior Lecturer, Department of Applied Psychology, Zurich University of Applied Sciences, Switzerland
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Affiliation(s)
- Wolfram Kawohl
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich 8032, Switzerland; Psychiatric Services of Argovia, Brugg, Switzerland.
| | - Carlos Nordt
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich 8032, Switzerland
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Régio Brambilla C, Veselinović T, Rajkumar R, Mauler J, Orth L, Ruch A, Ramkiran S, Heekeren K, Kawohl W, Wyss C, Kops ER, Scheins J, Tellmann L, Boers F, Neumaier B, Ermert J, Herzog H, Langen K, Jon Shah N, Lerche C, Neuner I. mGluR5 receptor availability is associated with lower levels of negative symptoms and better cognition in male patients with chronic schizophrenia. Hum Brain Mapp 2020; 41:2762-2781. [PMID: 32150317 PMCID: PMC7294054 DOI: 10.1002/hbm.24976] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 02/25/2020] [Accepted: 02/25/2020] [Indexed: 12/29/2022] Open
Abstract
Consistent findings postulate disturbed glutamatergic function (more specifically a hypofunction of the ionotropic NMDA receptors) as an important pathophysiologic mechanism in schizophrenia. However, the role of the metabotropic glutamatergic receptors type 5 (mGluR5) in this disease remains unclear. In this study, we investigated their significance (using [11C]ABP688) for psychopathology and cognition in male patients with chronic schizophrenia and healthy controls. In the patient group, lower mGluR5 binding potential (BPND) values in the left temporal cortex and caudate were associated with higher general symptom levels (negative and depressive symptoms), lower levels of global functioning and worse cognitive performance. At the same time, in both groups, mGluR5 BPND were significantly lower in smokers (F[27,1] = 15.500; p = .001), but without significant differences between the groups. Our findings provide support for the concept that the impaired function of mGluR5 underlies the symptoms of schizophrenia. They further supply a new perspective on the complex relationship between tobacco addiction and schizophrenia by identifying glutamatergic neurotransmission—in particularly mGluR5—as a possible connection to a shared vulnerability.
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Affiliation(s)
- Cláudia Régio Brambilla
- INM‐4, Forschungszentrum Jülich GmbH, Wilhelm‐Johnen‐StraßeInstitute of Neuroscience and MedicineJülichGermany
- Department of Psychiatry, Psychotherapy and PsychosomaticsRWTH Aachen UniversityAachenGermany
| | - Tanja Veselinović
- Department of Psychiatry, Psychotherapy and PsychosomaticsRWTH Aachen UniversityAachenGermany
| | - Ravichandran Rajkumar
- INM‐4, Forschungszentrum Jülich GmbH, Wilhelm‐Johnen‐StraßeInstitute of Neuroscience and MedicineJülichGermany
- Department of Psychiatry, Psychotherapy and PsychosomaticsRWTH Aachen UniversityAachenGermany
- JARA – BRAIN – Translational MedicineAachenGermany
| | - Jörg Mauler
- INM‐4, Forschungszentrum Jülich GmbH, Wilhelm‐Johnen‐StraßeInstitute of Neuroscience and MedicineJülichGermany
| | - Linda Orth
- INM‐4, Forschungszentrum Jülich GmbH, Wilhelm‐Johnen‐StraßeInstitute of Neuroscience and MedicineJülichGermany
- Department of Psychiatry, Psychotherapy and PsychosomaticsRWTH Aachen UniversityAachenGermany
| | - Andrej Ruch
- Department of Psychiatry, Psychotherapy and PsychosomaticsRWTH Aachen UniversityAachenGermany
| | - Shukti Ramkiran
- INM‐4, Forschungszentrum Jülich GmbH, Wilhelm‐Johnen‐StraßeInstitute of Neuroscience and MedicineJülichGermany
- Department of Psychiatry, Psychotherapy and PsychosomaticsRWTH Aachen UniversityAachenGermany
| | - Karsten Heekeren
- Department of Psychiatry, Psychotherapy and PsychosomaticsUniversity Hospital of PsychiatryZürichSwitzerland
| | - Wolfram Kawohl
- Department of Psychiatry, Psychotherapy and PsychosomaticsUniversity Hospital of PsychiatryZürichSwitzerland
| | - Christine Wyss
- Department of Psychiatry, Psychotherapy and PsychosomaticsUniversity Hospital of PsychiatryZürichSwitzerland
| | - Elena Rota Kops
- INM‐4, Forschungszentrum Jülich GmbH, Wilhelm‐Johnen‐StraßeInstitute of Neuroscience and MedicineJülichGermany
| | - Jürgen Scheins
- INM‐4, Forschungszentrum Jülich GmbH, Wilhelm‐Johnen‐StraßeInstitute of Neuroscience and MedicineJülichGermany
| | - Lutz Tellmann
- INM‐4, Forschungszentrum Jülich GmbH, Wilhelm‐Johnen‐StraßeInstitute of Neuroscience and MedicineJülichGermany
| | - Frank Boers
- INM‐4, Forschungszentrum Jülich GmbH, Wilhelm‐Johnen‐StraßeInstitute of Neuroscience and MedicineJülichGermany
| | - Bernd Neumaier
- INM‐5, Forschungszentrum Jülich GmbH, Wilhelm‐Johnen‐StraßeInstitute of Neuroscience and MedicineJülichGermany
| | - Johannes Ermert
- INM‐5, Forschungszentrum Jülich GmbH, Wilhelm‐Johnen‐StraßeInstitute of Neuroscience and MedicineJülichGermany
| | - Hans Herzog
- INM‐4, Forschungszentrum Jülich GmbH, Wilhelm‐Johnen‐StraßeInstitute of Neuroscience and MedicineJülichGermany
| | - Karl‐Josef Langen
- INM‐4, Forschungszentrum Jülich GmbH, Wilhelm‐Johnen‐StraßeInstitute of Neuroscience and MedicineJülichGermany
- JARA – BRAIN – Translational MedicineAachenGermany
- Department of Nuclear MedicineRWTH Aachen UniversityAachenGermany
| | - N. Jon Shah
- INM‐4, Forschungszentrum Jülich GmbH, Wilhelm‐Johnen‐StraßeInstitute of Neuroscience and MedicineJülichGermany
- JARA – BRAIN – Translational MedicineAachenGermany
- INM‐11, Forschungszentrum Jülich GmbH, Wilhelm‐Johnen‐StraßeInstitute of Neuroscience and MedicineJülichGermany
- Department of NeurologyRWTH Aachen UniversityAachenGermany
| | - Christoph Lerche
- INM‐4, Forschungszentrum Jülich GmbH, Wilhelm‐Johnen‐StraßeInstitute of Neuroscience and MedicineJülichGermany
| | - Irene Neuner
- INM‐4, Forschungszentrum Jülich GmbH, Wilhelm‐Johnen‐StraßeInstitute of Neuroscience and MedicineJülichGermany
- Department of Psychiatry, Psychotherapy and PsychosomaticsRWTH Aachen UniversityAachenGermany
- JARA – BRAIN – Translational MedicineAachenGermany
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21
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Aleksandrowicz A, Hagenmuller F, Haker H, Heekeren K, Theodoridou A, Walitza S, Ehlis AC, Fallgatter A, Rössler W, Kawohl W. Frontal brain activity in individuals at risk for schizophrenic psychosis and bipolar disorder during the emotional Stroop task - an fNIRS study. Neuroimage Clin 2020; 26:102232. [PMID: 32272372 PMCID: PMC7139160 DOI: 10.1016/j.nicl.2020.102232] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 02/28/2020] [Accepted: 02/29/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVES The emotional Stroop effect is defined as increased reaction times to emotional stimuli compared to neutral ones. It has been often reported in the literature, on both behavioral and neurophysiological level. The goal of this study was to investigate the frontal brain activation in individuals at risk for schizophrenic psychosis and bipolar disorder during an emotional Stroop task. We expected to observe decreased activation in the at-risk individuals compared to the healthy controls. METHODS Individuals at high risk for psychosis (HR), at ultra-high risk for psychosis (UHR), at risk for bipolar disorder (BIP) and healthy controls (HC) performed an emotional Stroop task, which included positively, negatively and neutrally valenced words. Functional near-infrared spectroscopy (fNIRS) was used to measure levels of oxygenated hemoglobin (O2Hb) representing brain activity in the dorsolateral prefrontal and frontotemporal cortex. RESULTS Results showed significantly decreased levels of O2Hb in the right dorsolateral prefrontal cortex (DLPFC) in the HR and UHR groups compared to the HC, indicating lower activity. Even though the decrease was independent from the valence of the words, it was the most visible for the negative ones. Moreover, significantly lower O2Hb levels in the frontotemporal cortex (FTC) were observed in all at risk groups compared to the HC. CONCLUSIONS Lower activity in the FTC in groups at risk for psychosis and bipolar disorder reflects unspecific dysfunctions. Decreased activity in the DLPFC in the HR and UHR groups indicates that hypofrontality can be found already in individuals at risk for schizophrenic psychosis.
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Affiliation(s)
- Aleksandra Aleksandrowicz
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), University Hospital of Psychiatry Zurich, Zurich, Switzerland; Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Florence Hagenmuller
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), University Hospital of Psychiatry Zurich, Zurich, Switzerland; Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Helene Haker
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), University Hospital of Psychiatry Zurich, Zurich, Switzerland; Translational Neuromodeling Unit, Institute for Biomedical Engineering, University of Zurich and ETH Zurich, Zurich, Switzerland
| | - Karsten Heekeren
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), University Hospital of Psychiatry Zurich, Zurich, Switzerland; Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Anastasia Theodoridou
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), University Hospital of Psychiatry Zurich, Zurich, Switzerland; Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Susanne Walitza
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), University Hospital of Psychiatry Zurich, Zurich, Switzerland; Department of Child and Adolescent Psychiatry, University of Zurich, Zurich, Switzerland
| | - Ann-Christine Ehlis
- Department of Psychiatry and Psychotherapy, University Clinic Tuebingen, Tuebingen, Germany
| | - Andreas Fallgatter
- Department of Psychiatry and Psychotherapy, University Clinic Tuebingen, Tuebingen, Germany
| | - Wulf Rössler
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), University Hospital of Psychiatry Zurich, Zurich, Switzerland; Institute of Psychiatry, Laboratory of Neuroscience (LIM 27), University of Sao Paulo, Brazil
| | - Wolfram Kawohl
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), University Hospital of Psychiatry Zurich, Zurich, Switzerland; Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland; Department of Psychiatryand Psychotherapy, PDAG, Windisch, Switzerland.
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22
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Heekeren K, Antoniadis S, Habermeyer B, Obermann C, Kirschner M, Seifritz E, Rössler W, Kawohl W. Psychiatric Acute Day Hospital as an Alternative to Inpatient Treatment. Front Psychiatry 2020; 11:471. [PMID: 32523556 PMCID: PMC7261862 DOI: 10.3389/fpsyt.2020.00471] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 05/07/2020] [Indexed: 11/13/2022] Open
Abstract
For the first time in the Swiss health care system, this evaluation study examined whether patients with acute psychiatric illness who were admitted for inpatient treatment could be treated in an acute day hospital instead. The acute day hospital is characterized by the possibility of direct admission of patients without preliminary consultation or waiting time and is open every day of the week. In addition, it was examined whether and to what extent there are cost advantages for day hospital treatment. Patients who were admitted to the hospital with a referral to an inpatient admission were treated randomly either fully inpatient or in the acute day hospital. As a pilot study, 44 patients were admitted to the study. Evidence of efficacy could be provided for both treatment settings based on significant reduction in psychopathological symptoms and improvement in functional level in the course of treatment. There were no significant differences between the two settings in terms of external assessment of symptoms, subjective symptom burden, functional level, quality of life, treatment satisfaction, and number of treatment days. Treatment in the day hospital was about 45% cheaper compared to inpatient treatment. The results show that acutely ill psychiatric patients of different symptom severity can be treated just as well in an acute day hospital instead of being admitted to the hospital. In addition, when direct treatment costs are considered, there are clear cost advantages for day hospital treatment.
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Affiliation(s)
- Karsten Heekeren
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland.,Department of Psychiatry and Psychotherapy I, LVR-Hospital Cologne, Cologne, Germany
| | - Sofia Antoniadis
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland.,Department of Psychiatry and Psychotherapy, Psychiatric Services Aargau, Brugg, Switzerland
| | - Benedikt Habermeyer
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland.,Department of Psychiatry and Psychotherapy, Psychiatric Services Aargau, Brugg, Switzerland
| | - Caitriona Obermann
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland
| | - Matthias Kirschner
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland.,McConnell Brain Imaging Centre, Montréal Neurological Institute, McGill University, Montreal, QC, Canada
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland
| | - Wulf Rössler
- Department of Psychiatry and Psychotherapy, Charité University Medicine, Berlin, Germany
| | - Wolfram Kawohl
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland.,Department of Psychiatry and Psychotherapy, Psychiatric Services Aargau, Brugg, Switzerland
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23
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Frizi R, Lay B, Seifritz E, Kawohl W, Habermeyer B, Roser P. Sociodemographic and Clinical Predictors of the Length of Psychiatric Inpatient Stay of Immigrants in Switzerland. Front Psychiatry 2020; 11:585798. [PMID: 33362603 PMCID: PMC7755930 DOI: 10.3389/fpsyt.2020.585798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 11/13/2020] [Indexed: 11/13/2022] Open
Abstract
Immigrants with mental disorders have consistently been reported to spend shorter time in the psychiatric hospital compared to native patients. The aim of this study was to identify sociodemographic, clinical and migration-related predictors of a shorter length of psychiatric inpatient stay among immigrants in Switzerland. All patients of a foreign nationality admitted for inpatient treatment in the year 2016 (N = 279) were included in this study. The sample characteristics were drawn from the register of the psychiatric hospital. Within this sample, self-harm and substance use predicted a shorter inpatient treatment episode whereas disturbances of general psychosocial functioning were a predictor of a longer length of stay. As similar results were also reported for non-immigrant patients, the impact of these specific behavioral and social problems on the length of inpatient stay does not appear to be migrant-specific. Moreover, a country of origin outside Europe was a strong predictor of shorter length of stay pointing to inequalities of inpatient psychiatric treatment within the group of immigrants. Therefore, the cultural background and migrant history of immigrants in psychiatry need stronger consideration in order to eliminate disadvantages in mental health care.
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Affiliation(s)
- Renée Frizi
- Department of Psychiatry and Psychotherapy, Psychiatric Services Aargau, Academic Teaching Hospital of the University of Zurich, Windisch, Switzerland
| | - Barbara Lay
- Department of Psychiatry and Psychotherapy, Psychiatric Services Aargau, Academic Teaching Hospital of the University of Zurich, Windisch, Switzerland
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital, University of Zurich, Zurich, Switzerland
| | - Wolfram Kawohl
- Department of Psychiatry and Psychotherapy, Psychiatric Services Aargau, Academic Teaching Hospital of the University of Zurich, Windisch, Switzerland
| | - Benedikt Habermeyer
- Department of Psychiatry and Psychotherapy, Psychiatric Services Aargau, Academic Teaching Hospital of the University of Zurich, Windisch, Switzerland
| | - Patrik Roser
- Department of Psychiatry and Psychotherapy, Psychiatric Services Aargau, Academic Teaching Hospital of the University of Zurich, Windisch, Switzerland
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24
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Mucci A, Kawohl W, Maria C, Wooller A. Treating Schizophrenia: Open Conversations and Stronger Relationships Through Psychoeducation and Shared Decision-Making. Front Psychiatry 2020; 11:761. [PMID: 32903708 PMCID: PMC7438851 DOI: 10.3389/fpsyt.2020.00761] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 07/17/2020] [Indexed: 11/13/2022] Open
Abstract
Integrated pharmacological and psychosocial treatments, such as psychoeducation (PE) and shared decision-making (SDM), have been shown to significantly improve outcomes for people living with schizophrenia (PLWS). Underpinning the success of these interventions is a strong therapeutic relationship between PLWS, their carers, and their healthcare team. While many recognize the value of this relationship, implementation of the interventions necessary to facilitate its construction remain low. In this article, we identify the barriers to developing productive therapeutic relationships and explain how PE and SDM, taking into account cultural difference, can improve adherence to treatment, strengthen therapeutic relationships, and ultimately equip patients to achieve better functional outcomes.
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Affiliation(s)
- Armida Mucci
- Department of Psychiatry, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Wolfram Kawohl
- Department of Psychiatry and Psychotherapy, PDAG, Brugg, University of Zurich, Zurich, Switzerland
| | - Cristiana Maria
- Communications EMEA, Janssen Pharmaceutica NV, Beerse, Belgium
| | - Annette Wooller
- Medical Affairs EMEA, Janssen Pharmaceuticals, High Wycombe, United Kingdom
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25
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Neuner I, Rajkumar R, Brambilla CR, Ramkiran S, Ruch A, Orth L, Farrher E, Mauler J, Wyss C, Kops ER, Scheins J, Tellmann L, Lang M, Ermert J, Dammers J, Neumaier B, Lerche C, Heekeren K, Kawohl W, Langen KJ, Herzog H, Shah NJ. Simultaneous PET-MR-EEG: Technology, Challenges and Application in Clinical Neuroscience. IEEE Trans Radiat Plasma Med Sci 2019. [DOI: 10.1109/trpms.2018.2886525] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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26
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Pichler EM, Kawohl W, Seifritz E, Roser P. Pure delta-9-tetrahydrocannabinol and its combination with cannabidiol in treatment-resistant Tourette syndrome: A case report. Int J Psychiatry Med 2019; 54:150-156. [PMID: 30058466 DOI: 10.1177/0091217418791455] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Anecdotal reports and preliminary studies suggest a therapeutic potential of cannabis in Tourette syndrome. We report the case of a female patient suffering from treatment-resistant Tourette syndrome. METHODS Guideline-directed antipsychotic treatment with risperidone and aripiprazole as well as pure delta-9-tetrahydrocannabinol had no significant effect on Tourette syndrome symptomatology. RESULTS Following administration of a daily dosage of 10 mg delta-9-tetrahydrocannabinol combined with 20 mg cannabidiol (CBD), the patient showed a rapid and highly significant improvement in the Yale Global Tic Severity Scale. CONCLUSIONS It can be speculated whether the beneficial effects may rely on the pharmacological properties of cannabidiol.
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Affiliation(s)
- Eva-Maria Pichler
- 1 Department of Psychiatry and Psychotherapy, Psychiatric Services Aargau AG, Brugg, Switzerland.,2 Department for Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland
| | - Wolfram Kawohl
- 1 Department of Psychiatry and Psychotherapy, Psychiatric Services Aargau AG, Brugg, Switzerland.,2 Department for Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland
| | - Erich Seifritz
- 2 Department for Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland
| | - Patrik Roser
- 1 Department of Psychiatry and Psychotherapy, Psychiatric Services Aargau AG, Brugg, Switzerland
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27
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Hagenmuller F, Heekeren K, Roser P, Haker H, Theodoridou A, Walitza S, Rössler W, Kawohl W. Early Somatosensory Processing Over Time in Individuals at Risk to Develop Psychosis. Front Psychiatry 2019; 10:47. [PMID: 30890966 PMCID: PMC6413704 DOI: 10.3389/fpsyt.2019.00047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 01/23/2019] [Indexed: 12/16/2022] Open
Abstract
Objective: Somatosensory evoked potentials (SEPs) enable the investigation of thalamocortical and early cortical processing. Previous studies reported alterations of SEPs in patients with schizophrenia as well as in individuals in the prodromal stage. Moreover, cannabis use as an environmental risk factor for the development of schizophrenia has been demonstrated to influence SEP parameters in individuals at risk to develop psychosis. The aim of this study was to explore the course of SEP changes and the impact of concomitant cannabis use in individuals at risk to develop psychosis who sought medical help. Methods: Median nerve SEPs including high-frequency oscillations (HFOs) superimposed on the primary cortical response (N20) were investigated using multichannel EEG in individuals (n = 54 at baseline) remaining at risk to develop psychosis at follow-up after 1 year (high-risk: n = 19; ultra-high-risk: n = 27) vs. subjects with conversion to psychosis (n = 8) and a healthy control group (n = 35). Longitudinal and cross-sectional analyses of SEP components as estimated by dipole source analysis were performed. Results: The longitudinal development of the N20 strength depended on cannabis use. In cannabis non-users, a greater decrease of N20 strengths over time was associated with more negative symptoms at baseline. At baseline, converters did not differ from subjects remaining at risk. At follow-up, converters showed increased low- and high-frequency activity than at-risk subjects and did not differ from controls. Conclusion: The results of this study lead to the suggestion that the deficits in early somatosensory processing in individuals at risk to develop psychosis may not represent a marker for a genetic risk for psychosis but rather reflect state-dependent factors such as negative symptoms. On the other hand, the transition to psychosis seems to represent an interstage between reduced sensory registration from the at-risk state and gating deficits in the chronic state.
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Affiliation(s)
- Florence Hagenmuller
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), University of Zurich, Zurich, Switzerland
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland
| | - Karsten Heekeren
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), University of Zurich, Zurich, Switzerland
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland
| | - Patrik Roser
- Department of Psychiatry and Psychotherapy, Psychiatric Services Aargau, Academic Hospital of the University of Zurich, Brugg, Switzerland
| | - Helene Haker
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), University of Zurich, Zurich, Switzerland
- Translational Neuromodeling Unit, Institute for Biomedical Engineering, University of Zurich and ETH Zurich, Zurich, Switzerland
| | - Anastasia Theodoridou
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), University of Zurich, Zurich, Switzerland
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland
| | - Susanne Walitza
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), University of Zurich, Zurich, Switzerland
- Department of Child and Adolescent Psychiatry, University of Zurich, Zurich, Switzerland
| | - Wulf Rössler
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), University of Zurich, Zurich, Switzerland
- Laboratory of Neuroscience (LIM 27), Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
- Department of Psychiatry and Psychotherapy, Charité University Medicine, Berlin, Germany
| | - Wolfram Kawohl
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), University of Zurich, Zurich, Switzerland
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland
- Department of Psychiatry and Psychotherapy, Psychiatric Services Aargau, Academic Hospital of the University of Zurich, Brugg, Switzerland
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Abstract
Objective: This prospective study addresses risk factors of compulsory re-admission focusing on the role of the patient's subjective symptom distress and perceived social support, based on comprehensive patient and external (clinicians, study staff) assessments. Methods: Of the baseline sample, 168 (71%) patients with serious mental disorders, who had been compulsorily admitted to psychiatric inpatient care, were followed over 24 months after discharge within the framework of a RCT. Results: During this time 36% had compulsory re-admissions; risk was highest immediately after discharge. Regression models identified a history of previous compulsory hospitalisations and compulsory admission due to endangerment of others as the predictors most strongly associated with the outcome. Patients diagnosed with a psychotic disorder or an emotionally instable or combined personality disorder were most likely to experience compulsory re-hospitalisation, with poor response to treatment further significantly increasing the risk. The patient ratings of subjective symptom distress or perceived social support had no predictive value for compulsory re-admission, and this study did not provide evidence for a significant prognostic relevance of sociodemographic background factors. Conclusions: The present findings suggest that within individual-level variables disease-related factors are essentially the strongest predictors, but including the patients' subjective perspective does not enhance the prediction of compulsory re-hospitalisation. The psychiatric treatment of patients with recurrent and often challenging behavioural problems, at the more severe end of the spectrum of mental disorders, deserves closer attention if the use of compulsory hospitalisation is to be reduced.
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Affiliation(s)
- Barbara Lay
- Klinik für Psychiatrie und Psychotherapie, Psychiatrische Dienste Aargau AG, Windisch, Switzerland
| | - Wolfram Kawohl
- Klinik für Psychiatrie und Psychotherapie, Psychiatrische Dienste Aargau AG, Windisch, Switzerland.,Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Wulf Rössler
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland.,Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Laboratory of Neuroscience (LIM 27), Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
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29
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Böckmann V, Lay B, Seifritz E, Kawohl W, Roser P, Habermeyer B. Patient-Level Predictors of Psychiatric Readmission in Substance Use Disorders. Front Psychiatry 2019; 10:828. [PMID: 32038313 PMCID: PMC6988786 DOI: 10.3389/fpsyt.2019.00828] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 10/18/2019] [Indexed: 12/17/2022] Open
Abstract
Repeated psychiatric readmissions are a particular challenge in the treatment of substance use disorders and are associated with substantial burden for patients and their associates and for healthcare providers. Factors affecting readmission rates are heterogeneous and need to be identified to better allocate resources. Within the Swiss healthcare system, such data on substance use disorder patients are largely missing. Understanding these factors might bear important implications for future healthcare planning. Thus here, we examine risk factors of inpatient readmission. We retrospectively analyzed all admissions to the hospital's department of addictive disorders in the year 2016. Patients included in the study were followed over a period of 1 year after discharge regarding readmissions to the clinic. Besides the demographic, social, and economic data, we extracted data concerning patient history, admission, and discharge as well as clinical data regarding type and number of substances abused and comorbid diagnoses. In order to describe severity of cases, we furthermore included the scores of the Health of the Nation Outcome Scale (HoNOS) at admission and at discharge as documented in the medical database. Of the 554 patients included in the study, 228 (41.2%) were readmitted within 12 months. Previous admissions, concomitant use of different substances, presence of psychosis or mania, and a higher severity score at discharge increased the likelihood of readmission. The odds for readmission were furthermore higher in patients not being married, living alone, and being unemployed. When all (bivariate) statistically significant factors are included into a logistic regression model, the previous number of admissions and the HoNOS clinical score at discharge significantly contributed to this model. Our findings stress that patients with higher symptom load at discharge are prone to be readmitted within 12 months. The same applies for patients with previous admissions. These findings suggest that the development of specific interventions to prevent premature discharge before satisfactory symptom remission, in particular in those patients with previous admissions in their patient history, might help to prevent readmissions.
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Affiliation(s)
- Volker Böckmann
- Department of Addictive Disorders, Psychiatric Services Aargau, Brugg, Switzerland
| | - Barbara Lay
- Department of Psychiatry and Psychotherapy, Psychiatric Services Aargau, Brugg, Switzerland
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Wolfram Kawohl
- Department of Psychiatry and Psychotherapy, Psychiatric Services Aargau, Brugg, Switzerland.,Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Patrik Roser
- Department of Addictive Disorders, Psychiatric Services Aargau, Brugg, Switzerland
| | - Benedikt Habermeyer
- Department of Addictive Disorders, Psychiatric Services Aargau, Brugg, Switzerland
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30
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Rössler W, Ujeyl M, Kawohl W, Nordt C, Lasalvia A, Haker H, Hengartner MP. Predictors of Employment for People With Mental Illness: Results of a Multicenter Randomized Trial on the Effectiveness of Placement Budgets for Supported Employment. Front Psychiatry 2019; 10:518. [PMID: 31379630 PMCID: PMC6659611 DOI: 10.3389/fpsyt.2019.00518] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 07/01/2019] [Indexed: 12/31/2022] Open
Abstract
Background: Individual placement and support (IPS) has proven to be effective for vocational outcomes in people with mental illness. The original concept of IPS requires temporally unlimited provision of support. Using limited placement budgets and investigating factors that predict their effectiveness may inform decisions about resource allocation. Methods: A range of patient characteristics were tested as predictors of employment outcomes in participants who attended six outpatient psychiatric clinics in Switzerland between June 2010 and May 2011. Overall, 116 patients with the full spectrum of psychiatric conditions were randomly assigned and started an IPS intervention, which was provided by three different placement budgets. Support lasted 2 years for those who found a job, and outcomes were repeatedly assessed over 3 years. The intervention ended for those who failed to find competitive employment by the time their placement budget had run out. Results: Of the 15 variables tested, only Global Assessment of Functioning (GAF) and Clinical Global Impression (CGI) scores were predictors for obtaining work (for ≥1 day) and for maintaining it over a longer period (>3 months). Higher GAF and lower CGI scores increased the odds of obtaining employment and keeping it for at least 3 months. Functional role impairment, quality of life, self-esteem, or education level did not predict employment. Conclusion: Our data suggest that, if time-restricted budgets are offered to a wide range of patients, such as those included in this study, better functioning and lower symptom severity at baseline are predictive of better employment outcomes (finding and maintaining work) on the first (competitive) labor market in Switzerland. It remains to be investigated whether this holds true under different environmental factors. Clinical Trial Registration: ISRCTN, trial number: ISRCTN89670872.
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Affiliation(s)
- Wulf Rössler
- Department of Psychiatry and Psychotherapy, Charité University Medicine Berlin, Berlin, Germany
| | - Mariam Ujeyl
- Department of Psychiatry and Psychotherapy, Charité University Medicine Berlin, Berlin, Germany
| | | | - Carlos Nordt
- Department of Psychiatry, Psychotherapy, and Psychosomatics, University of Zurich, Zurich, Switzerland
| | - Antonio Lasalvia
- Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
| | - Helene Haker
- Translational Neuromodeling Unit, ETH Zürich, Zurich, Switzerland
| | - Michael P Hengartner
- Department of Applied Psychology, Zurich University of Applied Sciences, Zurich, Switzerland
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Ajdacic-Gross V, Bechtiger L, Rodgers S, Müller M, Kawohl W, von Känel R, Mutsch M, Rössler W, Seifritz E, Castelao E, Strippoli MPF, Vandeleur C, Preisig M, Howell P. Subtypes of stuttering determined by latent class analysis in two Swiss epidemiological surveys. PLoS One 2018; 13:e0198450. [PMID: 30086147 PMCID: PMC6080750 DOI: 10.1371/journal.pone.0198450] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 05/18/2018] [Indexed: 02/03/2023] Open
Abstract
Aims Associations between stuttering in childhood and a broad spectrum of risk factors, associated factors and comorbidities were examined in two large epidemiological studies. Subtypes of stuttering were then identified based on latent class analysis (LCA). Methods Data were from two representative Swiss population samples: PsyCoLaus (N = 4,874, age 35–82 years) and the ZInEP Epidemiology Survey (N = 1,500, age 20–41 years). Associations between stuttering and sociodemographic characteristics, familial aggregation, comorbidity and psychosocial risk / associated factors were investigated in both samples. LCAs were conducted on selected items from people in both samples who reported having stuttered in childhood. Results Initial analyses linked early anxiety disorders, such as separation anxiety disorder and overanxious disorder, to stuttering (PsyCoLaus). ADHD was associated with stuttering in both datasets. In the analyses of risk / associated factors, dysfunctional parental relationships, inter-parental violence and further childhood adversities were mutual predictors of stuttering. Moreover, comorbidities were seen with hay fever, asthma, eczema and psoriasis (PsyCoLaus). Subsequent LCA identified an unspecific group of persons who self-reported that they stuttered and a group defined by associations with psychosocial adversities (ZINEP, PsyCoLaus) and atopic diseases (PsyCoLaus). Conclusions The two subtypes of developmental stuttering have different risk / associated factors and comorbidity patterns. Most of the factors are associated with vulnerability mechanisms that occur early in life and that have also been linked with other neurodevelopmental disorders. Both psychosocial and biological factors appear to be involved in the etiopathogenesis of stuttering.
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Affiliation(s)
- Vladeta Ajdacic-Gross
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
- ZInEP, The Zurich Program for Sustainable Development of Mental Health Services, University of Zurich, Zurich, Switzerland
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
- * E-mail: (VA); (PH)
| | - Laura Bechtiger
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Stephanie Rodgers
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
- ZInEP, The Zurich Program for Sustainable Development of Mental Health Services, University of Zurich, Zurich, Switzerland
| | - Mario Müller
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
- ZInEP, The Zurich Program for Sustainable Development of Mental Health Services, University of Zurich, Zurich, Switzerland
| | - Wolfram Kawohl
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
- ZInEP, The Zurich Program for Sustainable Development of Mental Health Services, University of Zurich, Zurich, Switzerland
| | - Roland von Känel
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Margot Mutsch
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Wulf Rössler
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
- ZInEP, The Zurich Program for Sustainable Development of Mental Health Services, University of Zurich, Zurich, Switzerland
- Collegium Helveticum, University of Zurich and Swiss Federal Institute of Technology, Zurich, Switzerland
- Institute of Psychiatry, Laboratory of Neuroscience (LIM27), University of Sao Paulo, Sao Paulo, Brazil
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Enrique Castelao
- Department of Psychiatry, Lausanne University Hospital, Prilly, Switzerland
| | | | - Caroline Vandeleur
- Department of Psychiatry, Lausanne University Hospital, Prilly, Switzerland
| | - Martin Preisig
- Department of Psychiatry, Lausanne University Hospital, Prilly, Switzerland
| | - Peter Howell
- Department of Experimental Psychology, University College, London, United Kingdom
- * E-mail: (VA); (PH)
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Wyss C, Tse DHY, Boers F, Shah NJ, Neuner I, Kawohl W. Association between Cortical GABA and Loudness Dependence of Auditory Evoked Potentials (LDAEP) in Humans. Int J Neuropsychopharmacol 2018; 21:809-813. [PMID: 29917080 PMCID: PMC6119294 DOI: 10.1093/ijnp/pyy056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 06/14/2018] [Indexed: 11/13/2022] Open
Abstract
Loudness dependence of auditory evoked potentials (LDAEP) is a widely used EEG-based biomarker for central serotonergic activity. Serotonin has been shown to be associated with different psychiatric disorders such as depression and schizophrenia. Despite its clinical significance, the underlying neurochemical mechanism of this promising marker is not fully understood, and further research is needed to improve its validity. Other neurotransmitters might have a significant impact on this measure. Thus, we assessed the inhibitory action through individual GABA/H20 concentrations and GABA/glutamate ratios by means of magnetic resonance spectroscopy at 3T in healthy subjects. The measurements were assessed in the primary auditory cortex to investigate the association with the LDAEP, whose generators are mainly in the primary auditory cortex. For the first time, this study examines the link between GABAergic neurotransmission and LDAEP, and the data preliminary show that GABA may not contribute to the generation of EEG-based LDAEP.
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Affiliation(s)
- Christine Wyss
- Department of Psychiatry, Psychotherapy and Psychosomatics, Hospital of Psychiatry, University of Zurich, Zurich, Switzerland,Correspondence: Christine Wyss, PhD, Hospital of Psychiatry, University of Zurich, Department of Psychiatry, Psychotherapy and Psychosomatics, Militärstrasse 8, P.O. Box 2019, 8021 Zurich, Switzerland ()
| | - Desmond H Y Tse
- Institute of Neuroscience and Medicine, INM4, Forschungszentrum Jülich, Jülich, Germany
| | - Frank Boers
- Institute of Neuroscience and Medicine, INM4, Forschungszentrum Jülich, Jülich, Germany
| | - Nadim J Shah
- Institute of Neuroscience and Medicine, INM4, Forschungszentrum Jülich, Jülich, Germany,JARA-Brain, Translational Medicine, Jülich, Germany,Department of Neurology, RWTH Aachen University, Aachen, Germany
| | - Irene Neuner
- Institute of Neuroscience and Medicine, INM4, Forschungszentrum Jülich, Jülich, Germany,Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany,JARA-Brain, Translational Medicine, Jülich, Germany
| | - Wolfram Kawohl
- Department of Psychiatry, Psychotherapy and Psychosomatics, Hospital of Psychiatry, University of Zurich, Zurich, Switzerland
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Del Guerra A, Ahmad S, Avram M, Belcari N, Berneking A, Biagi L, Bisogni MG, Brandl F, Cabello J, Camarlinghi N, Cerello P, Choi CH, Coli S, Colpo S, Fleury J, Gagliardi V, Giraudo G, Heekeren K, Kawohl W, Kostou T, Lefaucheur JL, Lerche C, Loudos G, Morrocchi M, Muller J, Mustafa M, Neuner I, Papadimitroulas P, Pennazio F, Rajkumar R, Brambilla CR, Rivoire J, Kops ER, Scheins J, Schimpf R, Shah NJ, Sorg C, Sportelli G, Tosetti M, Trinchero R, Wyss C, Ziegler S. Corrigendum to "TRIMAGE: A dedicated trimodality (PET/MR/EEG) imaging tool for schizophrenia" [Eur Psychiatry 50 (2018) 7-20]. Eur Psychiatry 2018; 51:104-105. [PMID: 29885749 DOI: 10.1016/j.eurpsy.2018.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Affiliation(s)
- Alberto Del Guerra
- Dipartimento di Fisica "E. Fermi", Università di Pisa, and INFN, Sezione di Pisa, Pisa, Italy.
| | | | - Mihai Avram
- Nuklearmedinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany; Department of Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany; Neuroimaging Center (TUM-NIC), Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Nicola Belcari
- Dipartimento di Fisica "E. Fermi", Università di Pisa, and INFN, Sezione di Pisa, Pisa, Italy
| | - Arne Berneking
- Forschungszentrum Jülich GmbH, Institute of Neuroscience and Medicine, INM4, Jülich, Germany
| | - Laura Biagi
- IRCSS, Stella Maris, Calambrone, Pisa, Italy
| | | | - Felix Brandl
- Department of Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany; Neuroimaging Center (TUM-NIC), Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Jorge Cabello
- Nuklearmedinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Niccolò Camarlinghi
- Dipartimento di Fisica "E. Fermi", Università di Pisa, and INFN, Sezione di Pisa, Pisa, Italy
| | | | - Chang-Hoon Choi
- Forschungszentrum Jülich GmbH, Institute of Neuroscience and Medicine, INM4, Jülich, Germany
| | - Silvia Coli
- Istituto Nazionale di Fisica Nucleare, Sezione di Torino, Torino, Italy
| | | | | | - Vito Gagliardi
- Dipartimento di Fisica "E. Fermi", Università di Pisa, and INFN, Sezione di Pisa, Pisa, Italy
| | - Giuseppe Giraudo
- Istituto Nazionale di Fisica Nucleare, Sezione di Torino, Torino, Italy
| | - Karsten Heekeren
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, University of Zurich, Switzerland
| | - Wolfram Kawohl
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, University of Zurich, Switzerland; Department of Psychiatry and Psychotherapy, Psychiatric Services of Aargovia, Switzerland
| | | | | | - Christoph Lerche
- Forschungszentrum Jülich GmbH, Institute of Neuroscience and Medicine, INM4, Jülich, Germany
| | - George Loudos
- Technological Educational Institute of Athens, Greece
| | - Matteo Morrocchi
- Dipartimento di Fisica "E. Fermi", Università di Pisa, and INFN, Sezione di Pisa, Pisa, Italy
| | | | - Mona Mustafa
- Nuklearmedinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Irene Neuner
- Forschungszentrum Jülich GmbH, Institute of Neuroscience and Medicine, INM4, Jülich, Germany; RS2Ds.a.s., Mundolsheim, France
| | | | | | - Ravichandran Rajkumar
- Forschungszentrum Jülich GmbH, Institute of Neuroscience and Medicine, INM4, Jülich, Germany; Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, RWTH Aachen University, JARA Brain, Aachen, Germany
| | - Cláudia Régio Brambilla
- Forschungszentrum Jülich GmbH, Institute of Neuroscience and Medicine, INM4, Jülich, Germany
| | | | - Elena Rota Kops
- Forschungszentrum Jülich GmbH, Institute of Neuroscience and Medicine, INM4, Jülich, Germany
| | - Jürgen Scheins
- Forschungszentrum Jülich GmbH, Institute of Neuroscience and Medicine, INM4, Jülich, Germany
| | | | - N Jon Shah
- Forschungszentrum Jülich GmbH, Institute of Neuroscience and Medicine, INM4, Jülich, Germany
| | - Christian Sorg
- Department of Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany; Neuroimaging Center (TUM-NIC), Klinikum rechts der Isar, Technische Universität München, Munich, Germany; Department of Psychiatry, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Giancarlo Sportelli
- Dipartimento di Fisica "E. Fermi", Università di Pisa, and INFN, Sezione di Pisa, Pisa, Italy
| | | | | | - Christine Wyss
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, University of Zurich, Switzerland
| | - Sibylle Ziegler
- Nuklearmedinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany; Department of Nuclear Medicine, University Hospital, LMU, Munich, Germany
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Lay B, Kawohl W, Rössler W. Outcomes of a psycho-education and monitoring programme to prevent compulsory admission to psychiatric inpatient care: a randomised controlled trial. Psychol Med 2018; 48:849-860. [PMID: 28805175 DOI: 10.1017/s0033291717002239] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND There is a need for interventions that effectively reduce compulsory admission to psychiatry. We conducted a randomised controlled trial to investigate whether an innovative intervention programme prevents compulsory re-admission in people with serious mental illness. METHODS The programme addresses primarily patients' self-management skills. It consists of individualised psychoeducation focusing on behaviours prior to and during illness-related crises, crisis cards and, after discharge from the psychiatric hospital, a 24-month preventive monitoring. A total of 238 inpatients with compulsory admission(s) in the past were randomised to the intervention group or to treatment as usual (TAU). RESULTS Fewer participants who completed the 24-month programme were compulsorily readmitted to psychiatry (28%), compared with those receiving TAU (43%). Likewise, the number of compulsory readmissions per patient was significantly lower (0.6 v. 1.0) and involuntary episodes were shorter (15 v. 31 days), compared with TAU. A negative binomial regression model showed a significant intervention effect (RR 0.6; 95% confidence interval 0.3-0.9); further factors linked to the risk of compulsory readmission were the number of compulsory admissions in the patient's history (RR 2.8), the diagnosis of a personality disorder (RR 2.8), or a psychotic disorder (RR 1.9). Dropouts (37% intervention group; 22% TAU) were characterised by a high number of compulsory admissions prior to the trial, younger age and foreign nationality. CONCLUSIONS This study suggests that this intervention is a feasible and valuable option to prevent compulsory re-hospitalisation in a high-risk group of people with severe mental health problems, social disabilities, and a history of hospitalisations.
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Affiliation(s)
- B Lay
- Department of Psychiatry,Psychotherapy and Psychosomatics,University Hospital of Psychiatry Zurich,Switzerland
| | - W Kawohl
- Department of Psychiatry,Psychotherapy and Psychosomatics,University Hospital of Psychiatry Zurich,Switzerland
| | - W Rössler
- Department of Psychiatry,Psychotherapy and Psychosomatics,University Hospital of Psychiatry Zurich,Switzerland
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35
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Roser P, Pichler EM, Habermeyer B, Kawohl W, Juckel G. Impact of Chronic Cannabis Use on Auditory Mismatch Negativity Generation in Schizophrenia Patients. Pharmacopsychiatry 2018; 52:126-133. [PMID: 29506304 DOI: 10.1055/a-0573-9866] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Cannabis use disorders (CUD) are highly prevalent among patients with schizophrenia (SCZ). Deficient mismatch negativity (MMN) generation is a characteristic finding in SCZ patients and cannabis users. This study therefore examined the effects of CUD on MMN generation in SCZ patients. METHODS Twenty SCZ - CUD patients, 21 SCZ+CUD patients, and 20 healthy controls (HC) were included in this study. MMN to frequency and duration deviants was elicited within an auditory oddball paradigm and recorded by 32 channel EEG. RESULTS As expected, SCZ - CUD patients showed reduced frontocentral MMN amplitudes to duration deviants compared to HC. Interestingly, SCZ+CUD patients demonstrated greater MMN amplitudes to duration deviants compared to SCZ - CUD patients at central electrodes with no differences compared to HC. DISCUSSION These results demonstrate that comorbid cannabis use in SCZ patients might be associated with superior cognitive functioning. It can be assumed that the association between cannabis use and better cognitive performance may be due to a subgroup of cognitively less impaired SCZ patients characterized by lower genetic vulnerability for psychosis.
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Affiliation(s)
- Patrik Roser
- Klinik für Psychiatrie, Psychotherapie und Präventivmedizin, LWL-Universitätsklinikum Bochum, Ruhr-Universität Bochum, Germany.,Zentrum für Abhängigkeitserkrankungen, Psychiatrische Dienste Aargau AG, Akademisches Lehrspital der Universität Zürich, Switzerland
| | - Eva-Maria Pichler
- Bereich Psychiatrie und Psychotherapie, Psychiatrische Dienste Aargau AG, Akademisches Lehrspital der Universität Zürich, Switzerland
| | - Benedikt Habermeyer
- Zentrum für Abhängigkeitserkrankungen, Psychiatrische Dienste Aargau AG, Akademisches Lehrspital der Universität Zürich, Switzerland
| | - Wolfram Kawohl
- Bereich Psychiatrie und Psychotherapie, Psychiatrische Dienste Aargau AG, Akademisches Lehrspital der Universität Zürich, Switzerland
| | - Georg Juckel
- Klinik für Psychiatrie, Psychotherapie und Präventivmedizin, LWL-Universitätsklinikum Bochum, Ruhr-Universität Bochum, Germany
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Uhl I, Kulik A, Roser P, Theodoridou A, Wyss C, Norra C, Brüne M, Kawohl W, Juckel G. Central serotonergic function in patients with predominantly negative symptoms of schizophrenia. Schizophr Res 2018. [PMID: 28641887 DOI: 10.1016/j.schres.2017.05.041] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- I Uhl
- Department of Psychiatry, Ruhr University, LWL University Hospital Bochum, Germany
| | - A Kulik
- Department of Psychiatry, Ruhr University, LWL University Hospital Bochum, Germany
| | - P Roser
- Department of Psychiatry, Ruhr University, LWL University Hospital Bochum, Germany
| | - A Theodoridou
- Psychiatric University Hospital, Zürich, Switzerland
| | - C Wyss
- Psychiatric University Hospital, Zürich, Switzerland
| | - C Norra
- Department of Psychiatry, Ruhr University, LWL University Hospital Bochum, Germany
| | - M Brüne
- Department of Psychiatry, Ruhr University, LWL University Hospital Bochum, Germany
| | - W Kawohl
- Psychiatric University Hospital, Zürich, Switzerland
| | - G Juckel
- Department of Psychiatry, Ruhr University, LWL University Hospital Bochum, Germany.
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Oexle N, Müller M, Kawohl W, Xu Z, Viering S, Wyss C, Vetter S, Rüsch N. Self-stigma as a barrier to recovery: a longitudinal study. Eur Arch Psychiatry Clin Neurosci 2018; 268:209-212. [PMID: 28188369 DOI: 10.1007/s00406-017-0773-2] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [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: 08/23/2016] [Accepted: 01/23/2017] [Indexed: 10/20/2022]
Abstract
Stigma limits life opportunities of persons with mental illness. Self-stigma, the internalization of negative stereotypes, undermines empowerment and could hinder recovery. Here we examined self-stigma's effect on recovery among 222 disability pensioners with mental illness over 2 years, controlling for age, gender, symptoms and recovery at baseline measured by the Recovery Assessment Scale. More self-stigma at baseline was associated with a significant decrease in recovery after 1 year (not significant after 2 years). An increase of self-stigma from baseline to follow-up predicted less recovery 1 and 2 years later. Interventions that reduce self-stigma could therefore improve recovery.
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Affiliation(s)
- Nathalie Oexle
- Department of Psychiatry II, University of Ulm and BKH Günzburg, Parkstrasse 11, 89073, Ulm, Germany.
| | - Mario Müller
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Wolfram Kawohl
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Ziyan Xu
- Department of Psychiatry II, University of Ulm and BKH Günzburg, Parkstrasse 11, 89073, Ulm, Germany
| | - Sandra Viering
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Christine Wyss
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Stefan Vetter
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Nicolas Rüsch
- Department of Psychiatry II, University of Ulm and BKH Günzburg, Parkstrasse 11, 89073, Ulm, Germany
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Stulz N, Pichler EM, Kawohl W, Hepp U. The gravitational force of mental health services: distance decay effects in a rural Swiss service area. BMC Health Serv Res 2018; 18:81. [PMID: 29402266 PMCID: PMC5800291 DOI: 10.1186/s12913-018-2888-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 01/23/2018] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Previous research suggested a distance decay effect in health services systems, with people living closer to service facilities being more likely to use them. METHOD In this ecological cross sectional study, we conducted spatial and statistical analyses in a Swiss mental health services system being legally bound to provide primary mental health care to approximately 620,000 inhabitants. We examined a cohort of all patients who were over 18 years old and who were treated in the mental health services system between January and December 2011. RESULTS There were 5574 treatment cases during the 12-month period, 2161 inpatient cases and 3413 outpatient cases. Travel time by public transportation between patients' residence and the closest mental health service facility negatively predicted the utilization of outpatient services for all mental disorders, even after controlling for variability in ecological (e.g. socioeconomic) characteristics of the communities in the service provision area. For utilization of inpatient wards no geographical distance decay effect was observed, except for organic mental disorders. CONCLUSIONS Based on these findings, outpatient clinics should be most effectively located decentralized and in the largest communities to meet the needs of the population as close as possible to where people live and to avoid remote areas being insufficiently supplied with mental health care. For mental hospitals and inpatient services decentralized location seems to be less important.
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Affiliation(s)
- Niklaus Stulz
- Psychiatric Services Aargau, P.O. Box 432, 5201 Brugg, Switzerland
- Integrated Psychiatric Services Winterthur – Zurcher Unterland, P.O. Box 144, 8408 Winterthur, Switzerland
| | | | - Wolfram Kawohl
- Psychiatric Services Aargau, P.O. Box 432, 5201 Brugg, Switzerland
| | - Urs Hepp
- Integrated Psychiatric Services Winterthur – Zurcher Unterland, P.O. Box 144, 8408 Winterthur, Switzerland
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Del Guerra A, Ahmad S, Avram M, Belcari N, Berneking A, Biagi L, Bisogni MG, Brandl F, Cabello J, Camarlinghi N, Cerello P, Choi CH, Coli S, Colpo S, Fleury J, Gagliardi V, Giraudo G, Heekeren K, Kawohl W, Kostou T, Lefaucheur JL, Lerche C, Loudos G, Morrocchi M, Muller J, Mustafa M, Neuner I, Papadimitroulas P, Pennazio F, Rajkumar R, Brambilla CR, Rivoire J, Kops ER, Scheins J, Schimpf R, Shah NJ, Sorg C, Sportelli G, Tosetti M, Trinchero R, Wyss C, Ziegler S. TRIMAGE: A dedicated trimodality (PET/MR/EEG) imaging tool for schizophrenia. Eur Psychiatry 2018; 50:7-20. [PMID: 29358016 DOI: 10.1016/j.eurpsy.2017.11.007] [Citation(s) in RCA: 26] [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: 09/26/2017] [Revised: 11/15/2017] [Accepted: 11/16/2017] [Indexed: 02/02/2023] Open
Abstract
Simultaneous PET/MR/EEG (Positron Emission Tomography - Magnetic Resonance - Electroencephalography), a new tool for the investigation of neuronal networks in the human brain, is presented here within the framework of the European Union Project TRIMAGE. The trimodal, cost-effective PET/MR/EEG imaging tool makes use of cutting edge technology both in PET and in MR fields. A novel type of magnet (1.5T, non-cryogenic) has been built together with a PET scanner that makes use of the most advanced photodetectors (i.e., SiPM matrices), scintillators matrices (LYSO) and digital electronics. The combined PET/MR/EEG system is dedicated to brain imaging and has an inner diameter of 260 mm and an axial Field-of-View of 160 mm. It enables the acquisition and assessment of molecular metabolic information with high spatial and temporal resolution in a given brain simultaneously. The dopaminergic system and the glutamatergic system in schizophrenic patients are investigated via PET, the same physiological/pathophysiological conditions with regard to functional connectivity, via fMRI, and its electrophysiological signature via EEG. In addition to basic neuroscience questions addressing neurovascular-metabolic coupling, this new methodology lays the foundation for individual physiological and pathological fingerprints for a wide research field addressing healthy aging, gender effects, plasticity and different psychiatric and neurological diseases. The preliminary performances of two components of the imaging tool (PET and MR) are discussed. Initial results of the search of possible candidates for suitable schizophrenia biomarkers are also presented as obtained with PET/MR systems available to the collaboration.
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Affiliation(s)
- Alberto Del Guerra
- Dipartimento di Fisica "E. Fermi", Università di Pisa, Italy; INFN, Sezione di Pisa, Pisa, Italy.
| | | | - Mihai Avram
- Nuklearmedinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany; Department of Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany; Neuroimaging Center (TUM-NIC), Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Nicola Belcari
- Dipartimento di Fisica "E. Fermi", Università di Pisa, Italy; INFN, Sezione di Pisa, Pisa, Italy
| | - Arne Berneking
- Forschungszentrum Jülich GmbH, Institute of Neuroscience and Medicine, INM4, Jülich, Germany
| | - Laura Biagi
- IRCSS, Stella Maris, Calambrone, Pisa, Italy
| | - Maria Giuseppina Bisogni
- Dipartimento di Fisica "E. Fermi", Università di Pisa, Italy; INFN, Sezione di Pisa, Pisa, Italy
| | - Felix Brandl
- Department of Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany; Neuroimaging Center (TUM-NIC), Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Jorge Cabello
- Nuklearmedinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Niccolò Camarlinghi
- Dipartimento di Fisica "E. Fermi", Università di Pisa, Italy; INFN, Sezione di Pisa, Pisa, Italy
| | | | - Chang-Hoon Choi
- Forschungszentrum Jülich GmbH, Institute of Neuroscience and Medicine, INM4, Jülich, Germany
| | - Silvia Coli
- Istituto Nazionale di Fisica Nucleare, Sezione di Torino, Torino, Italy
| | | | | | - Vito Gagliardi
- Dipartimento di Fisica "E. Fermi", Università di Pisa, Italy; INFN, Sezione di Pisa, Pisa, Italy
| | - Giuseppe Giraudo
- Istituto Nazionale di Fisica Nucleare, Sezione di Torino, Torino, Italy
| | - Karsten Heekeren
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, University of Zurich, Switzerland
| | - Wolfram Kawohl
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, University of Zurich, Switzerland; Department of Psychiatry and Psychotherapy, Psychiatric Services of Aargovia, Switzerland
| | | | | | - Christoph Lerche
- Forschungszentrum Jülich GmbH, Institute of Neuroscience and Medicine, INM4, Jülich, Germany
| | - George Loudos
- Technological Educational Institute of Athens, Greece
| | - Matteo Morrocchi
- Dipartimento di Fisica "E. Fermi", Università di Pisa, Italy; INFN, Sezione di Pisa, Pisa, Italy
| | | | - Mona Mustafa
- Nuklearmedinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Irene Neuner
- Forschungszentrum Jülich GmbH, Institute of Neuroscience and Medicine, INM4, Jülich, Germany; Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, RWTH Aachen University, JARA Brain, Aachen, Germany
| | | | | | - Ravichandran Rajkumar
- Forschungszentrum Jülich GmbH, Institute of Neuroscience and Medicine, INM4, Jülich, Germany; Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, RWTH Aachen University, JARA Brain, Aachen, Germany
| | - Cláudia Régio Brambilla
- Forschungszentrum Jülich GmbH, Institute of Neuroscience and Medicine, INM4, Jülich, Germany
| | | | - Elena Rota Kops
- Forschungszentrum Jülich GmbH, Institute of Neuroscience and Medicine, INM4, Jülich, Germany
| | - Jürgen Scheins
- Forschungszentrum Jülich GmbH, Institute of Neuroscience and Medicine, INM4, Jülich, Germany
| | | | - N Jon Shah
- Forschungszentrum Jülich GmbH, Institute of Neuroscience and Medicine, INM4, Jülich, Germany
| | - Christian Sorg
- Department of Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany; Neuroimaging Center (TUM-NIC), Klinikum rechts der Isar, Technische Universität München, Munich, Germany; Department of Psychiatry, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Giancarlo Sportelli
- Dipartimento di Fisica "E. Fermi", Università di Pisa, Italy; INFN, Sezione di Pisa, Pisa, Italy
| | | | | | - Christine Wyss
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, University of Zurich, Switzerland
| | - Sibylle Ziegler
- Nuklearmedinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany; Department of Nuclear Medicine, University Hospital, LMU, Munich, Germany
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Rössler W, Kawohl W, Nordt C, Haker H, Rüsch N, Hengartner MP. "Placement Budgets" for Supported Employment-Impact on Quality of Life in a Multicenter Randomized Controlled Trial. Front Psychiatry 2018; 9:462. [PMID: 30319467 PMCID: PMC6168924 DOI: 10.3389/fpsyt.2018.00462] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 09/06/2018] [Indexed: 11/13/2022] Open
Abstract
Background: Employment is an important aspect of psychiatric rehabilitation. The objective of this analysis was to explore how quality of life (QoL) may affect the outcome of supported employment and vice versa. Methods: A total of 116 participants with severe mental disorders were randomly assigned to either 25, 40, or 55 h placement budgets, which comprises job coaches' time resources to support a client in finding a job. The intervention followed the individual placement and support model and lasted up to 36 months. Primary outcome was employment in the first labor market for at least 3 months. QoL was assessed 7 times over the entire 36-months observation period using the WHO QoL Bref, which comprises the dimensions physical health, psychological, social relationships, and environment. Results: The three placement budgets did not differentially relate to QoL, but QoL environment showed a significant increase over time across all three groups. Baseline QoL environment weakly predicted subsequent obtainment of employment (F = 4.08, df = 1, p = 0.046, Cohen's d = 0.39). Controlling for baseline QoL, those participants who obtained a job, as compared to those who did not, showed persistent increases in QoL physical health (b = 0.39, p = 0.002, Cohen's d = 0.50) and QoL psychological (b = 0.40, p < 0.001, Cohen's d = 0.47). Conclusion: Obtaining employment in the first labor market improves patients' QoL. Supported employment is a valuable intervention that may benefit patients with severe mental disorder.
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Affiliation(s)
- Wulf Rössler
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland.,Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Berlin, Germany.,Laboratory of Neuroscience (LIM 27), Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Wolfram Kawohl
- Department for Psychiatry and Psychotherapy, Psychiatric Services Aargau, Brugg, Switzerland
| | - Carlos Nordt
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland
| | - Helene Haker
- Translational Neuromodeling Unit, Institute for Biomedical Engineering, University of Zurich and ETH Zurich, Zurich, Switzerland
| | - Nicolas Rüsch
- Department of Psychiatry II, University of Ulm and BKH Günzburg, Günzburg, Germany
| | - Michael P Hengartner
- Department of Applied Psychology, Zurich University of Applied Sciences, Zurich, Switzerland
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Stutz C, Kawohl W, Platz C, Warnke I, Jäger M. [Who benefits from the night clinic? - Value of a part-time treatment facility]. Neuropsychiatr 2017; 31:187-195. [PMID: 28667578 DOI: 10.1007/s40211-017-0233-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 04/21/2017] [Accepted: 06/13/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND The night clinic which is part of the psychiatric department of the University of Zurich is a part-time treatment option with psychiatric treatment and support in the evening. This study aimed to characterize the patients and detect different functions of the treatment setting. METHODS Data of 253 patients covering a six-year period from 2008 up to 2013 were retrospectively assessed using descriptive methods. Subgroups according to the situation before admission and after discharge were compared. RESULTS Patients admitted from home differed considerably from those who were transferred from a psychiatric ward concerning sociodemographic and clinical factors. They were more frequently single, unemployed, received disability funds and suffered from a psychotic disorder. They were also more likely to be discharged in a supported housing condition. CONCLUSIONS The night clinic serves as an alternative to full inpatient treatment for individuals who have work as well as a rehabilitative option for homeless patients with severe mental illness. It contributes to a reduction of avoidance of inpatients stays for those groups of patients.
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Affiliation(s)
- Constanze Stutz
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Zentrum für Soziale Psychiatrie, Psychiatrische Universitätsklinik Zürich, Militärstrasse 8, Postfach 1930, 8021, Zürich, Schweiz.
| | - Wolfram Kawohl
- Bereich Psychiatrie und Psychotherapie, Psychiatrische Klinik Königsfelden, Zürcherstrasse 241, 5210, Windisch, Schweiz
| | - Christoph Platz
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Zentrum für Soziale Psychiatrie, Psychiatrische Universitätsklinik Zürich, Militärstrasse 8, Postfach 1930, 8021, Zürich, Schweiz
| | - Ingeborg Warnke
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Zentrum für Soziale Psychiatrie, Psychiatrische Universitätsklinik Zürich, Militärstrasse 8, Postfach 1930, 8021, Zürich, Schweiz
| | - Matthias Jäger
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Zentrum für Akute Psychische Erkrankungen, Psychiatrische Universitätsklinik Zürich, Lenggstrasse 31, 8032, Zürich, Schweiz
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Cosh S, Zenter N, Ay ES, Loos S, Slade M, De Rosa C, Luciano M, Berecz R, Glaub T, Munk-Jørgensen P, Krogsgaard Bording M, Rössler W, Kawohl W, Puschner B. Clinical Decision Making and Mental Health Service Use Among Persons With Severe Mental Illness Across Europe. Psychiatr Serv 2017; 68:970-974. [PMID: 28502242 DOI: 10.1176/appi.ps.201600114] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [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] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The study explored relationships between preferences for and experiences of clinical decision making (CDM) with service use among persons with severe mental illness. METHODS Data from a prospective observational study in six European countries were examined. Associations of baseline staff-rated (N=213) and patient-rated (N=588) preferred and experienced decision making with service use were examined at baseline by using binomial regressions and at 12-month follow-up by using multilevel models. RESULTS A preference by patients and staff for active patient involvement in decision making, rather than shared or passive decision making, was associated with longer hospital admissions and higher costs at baseline and with increases in admissions over 12 months (p=.043). Low patient-rated satisfaction with an experienced clinical decision was also related to increased costs over the study period (p=.005). CONCLUSIONS A preference for shared decision making may reduce health care costs by reducing inpatient admissions. Patient satisfaction with decisions was a predictor of costs, and clinicians should maximize patient satisfaction with CDM.
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Affiliation(s)
- Suzanne Cosh
- Dr. Cosh, Ms. Zenter, Ms. Ay, Dr. Loos, and Dr. Puschner are with the Department of Psychiatry II, University of Ulm, Ulm, Germany. Prof. Slade is with the Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom. Dr. De Rosa and Dr. Luciano are with the Department of Psychiatry, University of Naples SUN, Naples. Dr. Berecz and Dr. Glaub are with the University of Debrecen Medical and Health Science Center, Debrecen, Hungary. Prof. Munk-Jørgensen is with the Department for Organic Psychiatric Disorders, Aarhus University, Risskov, Denmark. Ms. Krogsgaard Bording is with the Unit for Psychiatric Research, Aalborg University Hospital, Aalborg, Denmark. Prof. Rössler and Dr. Kawohl are with the University Hospital of Psychiatry, University of Zurich, Zurich
| | - Nadja Zenter
- Dr. Cosh, Ms. Zenter, Ms. Ay, Dr. Loos, and Dr. Puschner are with the Department of Psychiatry II, University of Ulm, Ulm, Germany. Prof. Slade is with the Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom. Dr. De Rosa and Dr. Luciano are with the Department of Psychiatry, University of Naples SUN, Naples. Dr. Berecz and Dr. Glaub are with the University of Debrecen Medical and Health Science Center, Debrecen, Hungary. Prof. Munk-Jørgensen is with the Department for Organic Psychiatric Disorders, Aarhus University, Risskov, Denmark. Ms. Krogsgaard Bording is with the Unit for Psychiatric Research, Aalborg University Hospital, Aalborg, Denmark. Prof. Rössler and Dr. Kawohl are with the University Hospital of Psychiatry, University of Zurich, Zurich
| | - Esra-Sultan Ay
- Dr. Cosh, Ms. Zenter, Ms. Ay, Dr. Loos, and Dr. Puschner are with the Department of Psychiatry II, University of Ulm, Ulm, Germany. Prof. Slade is with the Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom. Dr. De Rosa and Dr. Luciano are with the Department of Psychiatry, University of Naples SUN, Naples. Dr. Berecz and Dr. Glaub are with the University of Debrecen Medical and Health Science Center, Debrecen, Hungary. Prof. Munk-Jørgensen is with the Department for Organic Psychiatric Disorders, Aarhus University, Risskov, Denmark. Ms. Krogsgaard Bording is with the Unit for Psychiatric Research, Aalborg University Hospital, Aalborg, Denmark. Prof. Rössler and Dr. Kawohl are with the University Hospital of Psychiatry, University of Zurich, Zurich
| | - Sabine Loos
- Dr. Cosh, Ms. Zenter, Ms. Ay, Dr. Loos, and Dr. Puschner are with the Department of Psychiatry II, University of Ulm, Ulm, Germany. Prof. Slade is with the Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom. Dr. De Rosa and Dr. Luciano are with the Department of Psychiatry, University of Naples SUN, Naples. Dr. Berecz and Dr. Glaub are with the University of Debrecen Medical and Health Science Center, Debrecen, Hungary. Prof. Munk-Jørgensen is with the Department for Organic Psychiatric Disorders, Aarhus University, Risskov, Denmark. Ms. Krogsgaard Bording is with the Unit for Psychiatric Research, Aalborg University Hospital, Aalborg, Denmark. Prof. Rössler and Dr. Kawohl are with the University Hospital of Psychiatry, University of Zurich, Zurich
| | - Mike Slade
- Dr. Cosh, Ms. Zenter, Ms. Ay, Dr. Loos, and Dr. Puschner are with the Department of Psychiatry II, University of Ulm, Ulm, Germany. Prof. Slade is with the Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom. Dr. De Rosa and Dr. Luciano are with the Department of Psychiatry, University of Naples SUN, Naples. Dr. Berecz and Dr. Glaub are with the University of Debrecen Medical and Health Science Center, Debrecen, Hungary. Prof. Munk-Jørgensen is with the Department for Organic Psychiatric Disorders, Aarhus University, Risskov, Denmark. Ms. Krogsgaard Bording is with the Unit for Psychiatric Research, Aalborg University Hospital, Aalborg, Denmark. Prof. Rössler and Dr. Kawohl are with the University Hospital of Psychiatry, University of Zurich, Zurich
| | - Corrado De Rosa
- Dr. Cosh, Ms. Zenter, Ms. Ay, Dr. Loos, and Dr. Puschner are with the Department of Psychiatry II, University of Ulm, Ulm, Germany. Prof. Slade is with the Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom. Dr. De Rosa and Dr. Luciano are with the Department of Psychiatry, University of Naples SUN, Naples. Dr. Berecz and Dr. Glaub are with the University of Debrecen Medical and Health Science Center, Debrecen, Hungary. Prof. Munk-Jørgensen is with the Department for Organic Psychiatric Disorders, Aarhus University, Risskov, Denmark. Ms. Krogsgaard Bording is with the Unit for Psychiatric Research, Aalborg University Hospital, Aalborg, Denmark. Prof. Rössler and Dr. Kawohl are with the University Hospital of Psychiatry, University of Zurich, Zurich
| | - Mario Luciano
- Dr. Cosh, Ms. Zenter, Ms. Ay, Dr. Loos, and Dr. Puschner are with the Department of Psychiatry II, University of Ulm, Ulm, Germany. Prof. Slade is with the Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom. Dr. De Rosa and Dr. Luciano are with the Department of Psychiatry, University of Naples SUN, Naples. Dr. Berecz and Dr. Glaub are with the University of Debrecen Medical and Health Science Center, Debrecen, Hungary. Prof. Munk-Jørgensen is with the Department for Organic Psychiatric Disorders, Aarhus University, Risskov, Denmark. Ms. Krogsgaard Bording is with the Unit for Psychiatric Research, Aalborg University Hospital, Aalborg, Denmark. Prof. Rössler and Dr. Kawohl are with the University Hospital of Psychiatry, University of Zurich, Zurich
| | - Roland Berecz
- Dr. Cosh, Ms. Zenter, Ms. Ay, Dr. Loos, and Dr. Puschner are with the Department of Psychiatry II, University of Ulm, Ulm, Germany. Prof. Slade is with the Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom. Dr. De Rosa and Dr. Luciano are with the Department of Psychiatry, University of Naples SUN, Naples. Dr. Berecz and Dr. Glaub are with the University of Debrecen Medical and Health Science Center, Debrecen, Hungary. Prof. Munk-Jørgensen is with the Department for Organic Psychiatric Disorders, Aarhus University, Risskov, Denmark. Ms. Krogsgaard Bording is with the Unit for Psychiatric Research, Aalborg University Hospital, Aalborg, Denmark. Prof. Rössler and Dr. Kawohl are with the University Hospital of Psychiatry, University of Zurich, Zurich
| | - Theodora Glaub
- Dr. Cosh, Ms. Zenter, Ms. Ay, Dr. Loos, and Dr. Puschner are with the Department of Psychiatry II, University of Ulm, Ulm, Germany. Prof. Slade is with the Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom. Dr. De Rosa and Dr. Luciano are with the Department of Psychiatry, University of Naples SUN, Naples. Dr. Berecz and Dr. Glaub are with the University of Debrecen Medical and Health Science Center, Debrecen, Hungary. Prof. Munk-Jørgensen is with the Department for Organic Psychiatric Disorders, Aarhus University, Risskov, Denmark. Ms. Krogsgaard Bording is with the Unit for Psychiatric Research, Aalborg University Hospital, Aalborg, Denmark. Prof. Rössler and Dr. Kawohl are with the University Hospital of Psychiatry, University of Zurich, Zurich
| | - Povl Munk-Jørgensen
- Dr. Cosh, Ms. Zenter, Ms. Ay, Dr. Loos, and Dr. Puschner are with the Department of Psychiatry II, University of Ulm, Ulm, Germany. Prof. Slade is with the Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom. Dr. De Rosa and Dr. Luciano are with the Department of Psychiatry, University of Naples SUN, Naples. Dr. Berecz and Dr. Glaub are with the University of Debrecen Medical and Health Science Center, Debrecen, Hungary. Prof. Munk-Jørgensen is with the Department for Organic Psychiatric Disorders, Aarhus University, Risskov, Denmark. Ms. Krogsgaard Bording is with the Unit for Psychiatric Research, Aalborg University Hospital, Aalborg, Denmark. Prof. Rössler and Dr. Kawohl are with the University Hospital of Psychiatry, University of Zurich, Zurich
| | - Malene Krogsgaard Bording
- Dr. Cosh, Ms. Zenter, Ms. Ay, Dr. Loos, and Dr. Puschner are with the Department of Psychiatry II, University of Ulm, Ulm, Germany. Prof. Slade is with the Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom. Dr. De Rosa and Dr. Luciano are with the Department of Psychiatry, University of Naples SUN, Naples. Dr. Berecz and Dr. Glaub are with the University of Debrecen Medical and Health Science Center, Debrecen, Hungary. Prof. Munk-Jørgensen is with the Department for Organic Psychiatric Disorders, Aarhus University, Risskov, Denmark. Ms. Krogsgaard Bording is with the Unit for Psychiatric Research, Aalborg University Hospital, Aalborg, Denmark. Prof. Rössler and Dr. Kawohl are with the University Hospital of Psychiatry, University of Zurich, Zurich
| | - Wulf Rössler
- Dr. Cosh, Ms. Zenter, Ms. Ay, Dr. Loos, and Dr. Puschner are with the Department of Psychiatry II, University of Ulm, Ulm, Germany. Prof. Slade is with the Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom. Dr. De Rosa and Dr. Luciano are with the Department of Psychiatry, University of Naples SUN, Naples. Dr. Berecz and Dr. Glaub are with the University of Debrecen Medical and Health Science Center, Debrecen, Hungary. Prof. Munk-Jørgensen is with the Department for Organic Psychiatric Disorders, Aarhus University, Risskov, Denmark. Ms. Krogsgaard Bording is with the Unit for Psychiatric Research, Aalborg University Hospital, Aalborg, Denmark. Prof. Rössler and Dr. Kawohl are with the University Hospital of Psychiatry, University of Zurich, Zurich
| | - Wolfram Kawohl
- Dr. Cosh, Ms. Zenter, Ms. Ay, Dr. Loos, and Dr. Puschner are with the Department of Psychiatry II, University of Ulm, Ulm, Germany. Prof. Slade is with the Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom. Dr. De Rosa and Dr. Luciano are with the Department of Psychiatry, University of Naples SUN, Naples. Dr. Berecz and Dr. Glaub are with the University of Debrecen Medical and Health Science Center, Debrecen, Hungary. Prof. Munk-Jørgensen is with the Department for Organic Psychiatric Disorders, Aarhus University, Risskov, Denmark. Ms. Krogsgaard Bording is with the Unit for Psychiatric Research, Aalborg University Hospital, Aalborg, Denmark. Prof. Rössler and Dr. Kawohl are with the University Hospital of Psychiatry, University of Zurich, Zurich
| | - Bernd Puschner
- Dr. Cosh, Ms. Zenter, Ms. Ay, Dr. Loos, and Dr. Puschner are with the Department of Psychiatry II, University of Ulm, Ulm, Germany. Prof. Slade is with the Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom. Dr. De Rosa and Dr. Luciano are with the Department of Psychiatry, University of Naples SUN, Naples. Dr. Berecz and Dr. Glaub are with the University of Debrecen Medical and Health Science Center, Debrecen, Hungary. Prof. Munk-Jørgensen is with the Department for Organic Psychiatric Disorders, Aarhus University, Risskov, Denmark. Ms. Krogsgaard Bording is with the Unit for Psychiatric Research, Aalborg University Hospital, Aalborg, Denmark. Prof. Rössler and Dr. Kawohl are with the University Hospital of Psychiatry, University of Zurich, Zurich
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Pausch K, Nordt C, Pichler EM, Warnke I, Seifritz E, Kawohl W. [Not Available]. Neuropsychiatr 2017; 31:77. [PMID: 28390004 DOI: 10.1007/s40211-017-0224-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Kunigunde Pausch
- Klinik für Psychiatrie, Psychotherapie und, Psychosomatik/Zentrum für Soziale Psychiatrie, Psychiatrische Universitätsklinik Zürich, Militärstrasse 8, 8021, Zürich, Schweiz.
| | - Carlos Nordt
- Klinik für Psychiatrie, Psychotherapie und, Psychosomatik/Zentrum für Soziale Psychiatrie, Psychiatrische Universitätsklinik Zürich, Militärstrasse 8, 8021, Zürich, Schweiz
| | - Eva-Maria Pichler
- Klinik für Psychiatrie, Psychotherapie und, Psychosomatik/Zentrum für Soziale Psychiatrie, Psychiatrische Universitätsklinik Zürich, Militärstrasse 8, 8021, Zürich, Schweiz
| | - Ingeborg Warnke
- Klinik für Psychiatrie, Psychotherapie und, Psychosomatik/Zentrum für Soziale Psychiatrie, Psychiatrische Universitätsklinik Zürich, Militärstrasse 8, 8021, Zürich, Schweiz
| | - Erich Seifritz
- Klinik für Psychiatrie, Psychotherapie und, Psychosomatik/Zentrum für Soziale Psychiatrie, Psychiatrische Universitätsklinik Zürich, Militärstrasse 8, 8021, Zürich, Schweiz
| | - Wolfram Kawohl
- Klinik für Psychiatrie, Psychotherapie und, Psychosomatik/Zentrum für Soziale Psychiatrie, Psychiatrische Universitätsklinik Zürich, Militärstrasse 8, 8021, Zürich, Schweiz
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Oexle N, Rüsch N, Viering S, Wyss C, Seifritz E, Xu Z, Kawohl W. Self-stigma and suicidality: a longitudinal study. Eur Arch Psychiatry Clin Neurosci 2017; 267:359-361. [PMID: 27169427 DOI: 10.1007/s00406-016-0698-1] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [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: 03/18/2016] [Accepted: 05/04/2016] [Indexed: 11/28/2022]
Abstract
Mental illness stigma is a source of distress for persons with mental illness. Self-stigma occurs when negative stereotypes are internalized, leading to low self-esteem, shame and hopelessness. Due to its consequences self-stigma may contribute to suicidality and be a modifiable target for suicide prevention. Based on 222 disability pensioners with mental illness we examined whether self-stigma at baseline is associated with suicidal ideation over a 2-year period, controlling for baseline suicidal ideation, symptoms, age and gender. More self-stigma predicted suicidal ideation at baseline and longitudinally. Interventions on different levels to reduce self-stigma could improve suicide prevention.
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Affiliation(s)
- Nathalie Oexle
- Department of Psychiatry II, University of Ulm and BKH Günzburg, Ulm, Germany.
| | - Nicolas Rüsch
- Department of Psychiatry II, University of Ulm and BKH Günzburg, Ulm, Germany
| | - Sandra Viering
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital for Psychiatry Zurich, Zurich, Switzerland
| | - Christine Wyss
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital for Psychiatry Zurich, Zurich, Switzerland
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital for Psychiatry Zurich, Zurich, Switzerland
| | - Ziyan Xu
- Department of Psychiatry II, University of Ulm and BKH Günzburg, Ulm, Germany
| | - Wolfram Kawohl
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital for Psychiatry Zurich, Zurich, Switzerland
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Wyss C, Tse DHY, Kometer M, Dammers J, Achermann R, Shah NJ, Kawohl W, Neuner I. GABA metabolism and its role in gamma-band oscillatory activity during auditory processing: An MRS and EEG study. Hum Brain Mapp 2017; 38:3975-3987. [PMID: 28480987 DOI: 10.1002/hbm.23642] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 04/25/2017] [Accepted: 04/26/2017] [Indexed: 12/22/2022] Open
Abstract
Gamma-aminobutyric acid (GABA) and glutamate are believed to have inhibitory and exhibitory neuromodulatory effects that regulate the brain's response to sensory perception. Furthermore, frequency-specific synchronization of neuronal excitability within the gamma band (30-80 Hz) is attributable to a homeostatic balance between excitation and inhibition. However, our understanding of the physiological mechanism underlying gamma rhythms is based on animal models. Investigations of the relationship between GABA concentrations, glutamate concentrations, and gamma band activity in humans were mostly restricted to the visual cortex and are conflicting. Here, we performed a multimodal imaging study combining magnetic resonance spectroscopy (MRS) with electroencephalography (EEG) in the auditory cortex. In 14 healthy subjects, we investigated the impact of individual differences in GABA and glutamate concentration on gamma band response (GBR) following auditory stimulus presentation. We explored the effects of bulk GABA on the GBR across frequency (30-200 Hz) and time (-200 to 600 ms) and found no significant relationship. Furthermore, no correlations were found between gamma peak frequency or power measures and metabolite concentrations (GABA, glutamate, and GABA/glutamate ratio). These findings suggest that, according to MRS measurements, and given the auditory stimuli used in this study, GABA and glutamate concentrations are unlikely to play a significant role in the inhibitory and excitatory drive in the generation of gamma band activity in the auditory cortex. Hum Brain Mapp 38:3975-3987, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Christine Wyss
- Department of Psychiatry, Psychotherapie and Psychosomatics, Hospital of Psychiatry, University of Zurich, Switzerland
| | - Desmond H Y Tse
- Institute of Neuroscience and Medicine, INM4, Forschungszentrum Jülich, Germany
| | - Michael Kometer
- Department of Psychiatry, Psychotherapie and Psychosomatics, Hospital of Psychiatry, University of Zurich, Switzerland
| | - Jürgen Dammers
- Institute of Neuroscience and Medicine, INM4, Forschungszentrum Jülich, Germany
| | - Rita Achermann
- Psychological Methods, Evaluation and Statistics, Department of Psychology, University of Zurich, Switzerland
| | - N Jon Shah
- Institute of Neuroscience and Medicine, INM4, Forschungszentrum Jülich, Germany.,Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Germany.,JARA-Brain, Translational Medicine, Jülich, Germany.,Department of Neurology, RWTH Aachen University, Germany
| | - Wolfram Kawohl
- Department of Psychiatry, Psychotherapie and Psychosomatics, Hospital of Psychiatry, University of Zurich, Switzerland
| | - Irene Neuner
- Institute of Neuroscience and Medicine, INM4, Forschungszentrum Jülich, Germany.,Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Germany.,JARA-Brain, Translational Medicine, Jülich, Germany
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Baumgardt J, Moock J, Rössler W, Kawohl W. [Cooperation, Job Satisfaction and Burn Out - Sustainability in Outpatient Mental Health Care among Medical Specialists in Germany]. Psychiatr Prax 2017; 44:154-162. [PMID: 27399587 DOI: 10.1055/s-0042-104095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Objective Cooperation, job satisfaction, and burn out risk are indicators of sustainability in mental health services. Thus they were assessed among registered medical specialists in outpatient mental health care in Germany. Method A postal survey consisting of three questionnaires about cooperation, job satisfaction, and burnout was carried out among all registered medical specialists in outpatient mental health care in Germany (n = 4,430). Results 14.1 % (n = 626) of the specialists responded to the survey. Quality and quantity of cooperation regarding mental health care services were rated diverse, job satisfaction was assessed medium to high, and burnout risk was low to medium. Higher job satisfaction correlated with good quality of cooperation, fewer years of practice, fewer patients' chronically ill, more patients who as well seek psychotherapy, and less time spent on cooperation. Low burn out risk correlated with good quality of cooperation, higher age, single practice setting and a higher amount of patients who as well seek psychotherapy. Conclusion Quality and quantity of cooperation in outpatient mental health care - especially regarding community mental health care institutions - should be fostered. Aspects to be considered to reinforce job satisfaction and minimize burn out risk are age, years of practice, quality and quantity of cooperation, practice setting, and the mixture of patients.
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Affiliation(s)
- Johanna Baumgardt
- Kompetenztandem Vernetzte Versorgung, Innovations-Inkubator, Leuphana Universität Lüneburg (Deutschland)
| | - Jörn Moock
- Kompetenztandem Vernetzte Versorgung, Innovations-Inkubator, Leuphana Universität Lüneburg (Deutschland)
| | - Wulf Rössler
- Kompetenztandem Vernetzte Versorgung, Innovations-Inkubator, Leuphana Universität Lüneburg (Deutschland)
| | - Wolfram Kawohl
- Kompetenztandem Vernetzte Versorgung, Innovations-Inkubator, Leuphana Universität Lüneburg (Deutschland)
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Pausch K, Nordt C, Pichler EM, Warnke I, Seifritz E, Kawohl W. [Acute day hospital as a cost-effective alternative to inpatient therapy]. Neuropsychiatr 2017; 31:63-69. [PMID: 28265867 DOI: 10.1007/s40211-017-0221-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 02/20/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND This is a study of the cost-benefit advantage of the model project acute day hospital (ATK) compared to inpatient care. METHODS The study was performed retrospectively and examined the direct costs and the Global Assessment of Functioning (GAF) in a matched sample. RESULTS The day clinic treatment compared to inpatient therapy showed at a cost benefit of 2.68: 1 at a slightly delayed increase in GAF-value. CONCLUSION The treatment in ATK is more than twice as cheap compared to inpatient treatment, but at a slightly slower improvement in symptoms.
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Affiliation(s)
- Kunigunde Pausch
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik/Zentrum für Soziale Psychiatrie, Psychiatrische Universitätsklinik Zürich, Militärstrasse 8, 8021, Zürich, Schweiz.
| | - Carlos Nordt
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik/Zentrum für Soziale Psychiatrie, Psychiatrische Universitätsklinik Zürich, Militärstrasse 8, 8021, Zürich, Schweiz
| | | | - Ingeborg Warnke
- Forensisch-Psychiatrischer Dienst (FPD), Institut für Rechtsmedizin, Universität Bern, Bern, Schweiz
| | - Erich Seifritz
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik/Zentrum für Soziale Psychiatrie, Psychiatrische Universitätsklinik Zürich, Militärstrasse 8, 8021, Zürich, Schweiz
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Wiemer A, Mölders C, Fischer S, Kawohl W, Rössler W. Effectiveness of Medical Rehabilitation on Return-to-Work Depends on the Interplay of Occupation Characteristics and Disease. J Occup Rehabil 2017; 27:59-69. [PMID: 26936846 DOI: 10.1007/s10926-016-9632-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 06/05/2023]
Abstract
Introduction Work disability causes high costs for economy, organizations, and employees. However, medical rehabilitation does not always enable employees to return to their old jobs. In the present study, we investigated how disease classification and work characteristics interact in predicting the success of medical rehabilitation in terms of one's ability to return to a former job. Methods To this end, we matched 2009 patient data from the German Statutory Pension Insurance agency with job characteristics data from the Occupational Information Network (O*NET) 17.0 database. We used a multilevel approach and a sample of N = 72,029, nested in 194 occupational groups. Results We found that workers are less likely to reenter a former job if mental illnesses coincide with emotionally demanding labor and if musculoskeletal diseases coincide with extreme environmental conditions. We did not find different effects between occupational groups for other types of diseases (circulatory system, neoplasms, injuries, others). Conclusion Thus, the contextual overlap of disease and occupational characteristics notably lowers the chances of a successful return-to-work. These findings should be taken into account by physicians when attempting to set realistic goals for rehabilitation in collaboration with the patient and the funding agency.
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Affiliation(s)
- Anita Wiemer
- Innovation Incubator, Leuphana University Lüneburg, Rotenbleicher Weg 67, 21335, Lüneburg, Germany.
- , Hopfenstrasse 21, 20359, Hamburg, Germany.
| | - Christina Mölders
- Innovation Incubator, Leuphana University Lüneburg, Rotenbleicher Weg 67, 21335, Lüneburg, Germany
- RespectResearchGroup, University of Hamburg, Rothenbaumchaussee 34, 20148, Hamburg, Germany
| | - Sebastian Fischer
- Innovation Incubator, Leuphana University Lüneburg, Rotenbleicher Weg 67, 21335, Lüneburg, Germany
- , Mumsenstrasse 18, 22767, Hamburg, Germany
| | - Wolfram Kawohl
- Innovation Incubator, Leuphana University Lüneburg, Rotenbleicher Weg 67, 21335, Lüneburg, Germany
- Department of Psychiatry, Psychotherapy and Psychosomatics, Center for Social Psychiatry, Psychiatric Hospital, University of Zurich, Militärstrasse 8, P.O. Box 1930, 8021, Zurich, Switzerland
| | - Wulf Rössler
- Innovation Incubator, Leuphana University Lüneburg, Rotenbleicher Weg 67, 21335, Lüneburg, Germany
- University of Zurich, Militärstrasse 8, P.O. Box 1930, 8021, Zurich, Switzerland
- Laboratory of Neuroscience, Institute of Psychiatry, University of São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255, Cerqueira César, São Paulo, 05403-000, Brazil
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Brantschen E, Landolt K, Kawohl W, Rössler W, Bärtsch B, Nordt C. Two types of expectancies concerning competitive employment among people with mental illness in supported employment. JVR 2017. [DOI: 10.3233/jvr-160855] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Loos S, Clarke E, Jordan H, Puschner B, Fiorillo A, Luciano M, Ivánka T, Magyar E, Krogsgaard-Bording M, Østermark-Sørensen H, Rössler W, Kawohl W, Mayer B, Slade M. Recovery and decision-making involvement in people with severe mental illness from six countries: a prospective observational study. BMC Psychiatry 2017; 17:38. [PMID: 28114913 PMCID: PMC5260092 DOI: 10.1186/s12888-017-1207-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 01/16/2017] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Clinical decision-making is the vehicle of health care provision, and level of involvement predicts implementation and satisfaction. The aim of this study was to investigate the impact of decision-making experience on recovery. METHODS Data derived from an observational cohort study "Clinical decision making and outcome in routine care for people with severe mental illness" (CEDAR). Adults (aged 18-60) meeting standardised criteria for severe mental illness were recruited from caseloads of outpatient and community mental health services in six European countries. After consenting, they were assessed using standardised measures of decision-making, clinical outcome and stage of recovery at baseline and 1 year later. Latent class analysis was used to identify course of recovery, and proportional odds models to investigate predictors of recovery stage and change. RESULTS Participants (n = 581) clustered into three stages of recovery at baseline: Moratorium (N = 115; 19.8%), Awareness/Preparation (N = 145; 25.0%) and Rebuilding/Growth (N = 321; 55.2%). Higher stage was cross-sectionally associated with being male, married, living alone or with parents, and having better patient-rated therapeutic alliance and fewer symptoms. The model accounted for 40% of the variance in stage of recovery. An increased chance of worse outcome (change over 1 year to lower stage of recovery) was found for patients with active involvement compared with either shared (OR = 1.84, 95% CI 1.15-2.94) or passive (OR = 1.71, 95% CI = 1.00-2.95) involvement. Overall, both process (therapeutic relationship) and outcome (symptomatology) are cross-sectionally associated with stage of recovery. CONCLUSIONS Patient-rated decision-making involvement and change in stage of recovery are associated. Joint consideration of decision practise within the recovery process between patient and clinician is supposed to be a useful strategy to improve clinical practice (ISRCTN registry: ISRCTN75841675. Retrospectively registered 15 September 2010).
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Affiliation(s)
- Sabine Loos
- Section Process-Outcome Research, Department of Psychiatry II, Ulm University, Ludwig-Heilmeyer-Str. 2, D-89312, Günzburg, Germany.
| | - Eleanor Clarke
- 0000 0001 2322 6764grid.13097.3cKing’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Harriet Jordan
- 0000 0001 2322 6764grid.13097.3cKing’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Bernd Puschner
- 0000 0004 1936 9748grid.6582.9Section Process-Outcome Research, Department of Psychiatry II, Ulm University, Ludwig-Heilmeyer-Str. 2, D-89312 Günzburg, Germany
| | - Andrea Fiorillo
- 0000 0001 0790 385Xgrid.4691.aDepartment of Psychiatry, University of Naples SUN, Naples, Italy
| | - Mario Luciano
- 0000 0001 0790 385Xgrid.4691.aDepartment of Psychiatry, University of Naples SUN, Naples, Italy
| | - Tibor Ivánka
- 0000 0001 1088 8582grid.7122.6Department of Psychiatry, University of Debrecen Medical Centre, Debrecen, Hungary
| | - Erzsébet Magyar
- 0000 0001 1088 8582grid.7122.6Department of Psychiatry, University of Debrecen Medical Centre, Debrecen, Hungary
| | - Malene Krogsgaard-Bording
- 0000 0004 0646 7349grid.27530.33Unit for Psychiatric Research, Aalborg Psychiatric Hospital, Aalborg University Hospital, Aalborg, Denmark
| | - Helle Østermark-Sørensen
- 0000 0004 0646 7349grid.27530.33Unit for Psychiatric Research, Aalborg Psychiatric Hospital, Aalborg University Hospital, Aalborg, Denmark
| | - Wulf Rössler
- 0000 0004 1937 0650grid.7400.3Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Wolfram Kawohl
- 0000 0004 1937 0650grid.7400.3Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Benjamin Mayer
- 0000 0004 1936 9748grid.6582.9Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Mike Slade
- 0000 0001 2322 6764grid.13097.3cKing’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
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