TY - JOUR A1 - Angermann, Christiane E. A1 - Assmus, Birgit A1 - Anker, Stefan D. A1 - Asselbergs, Folkert W. A1 - Brachmann, Johannes A1 - Brett, Marie‐Elena A1 - Brugts, Jasper J. A1 - Ertl, Georg A1 - Ginn, Greg A1 - Hilker, Lutz A1 - Koehler, Friedrich A1 - Rosenkranz, Stephan A1 - Zhou, Qian A1 - Adamson, Philip B. A1 - Böhm, Michael T1 - Pulmonary artery pressure‐guided therapy in ambulatory patients with symptomatic heart failure: the CardioMEMS European Monitoring Study for Heart Failure (MEMS‐HF) JF - European Journal of Heart Failure N2 - Aims Heart failure (HF) leads to repeat hospitalisations and reduces the duration and quality of life. Pulmonary artery pressure (PAP)‐guided HF management using the CardioMEMS™ HF system was shown to be safe and reduce HF hospitalisation (HFH) rates in New York Heart Association (NYHA) class III patients. However, these findings have not been replicated in health systems outside the United States. Therefore, the CardioMEMS European Monitoring Study for Heart Failure (MEMS‐HF) evaluated the safety, feasibility, and performance of this device in Germany, The Netherlands, and Ireland. Methods and results A total of 234 NYHA class III patients (68 ± 11 years, 22% female, ≥1 HFH in the preceding year) from 31 centres were implanted with a CardioMEMS sensor and underwent PAP‐guided HF management. One‐year rates of freedom from device‐ or system‐related complications and from sensor failure (co‐primary outcomes) were 98.3% [95% confidence interval (CI) 95.8–100.0] and 99.6% (95% CI 97.6–100.0), respectively. Survival rate was 86.2%. For the 12 months post‐ vs. pre‐implant, HFHs decreased by 62% (0.60 vs. 1.55 events/patient‐year; hazard ratio 0.38, 95% CI 0.31–0.48; P < 0.0001). After 12 months, mean PAP decreased by 5.1 ± 7.4 mmHg, Kansas City Cardiomyopathy Questionnaire (KCCQ) overall/clinical summary scores increased from 47.0 ± 24.0/51.2 ± 24.8 to 60.5 ± 24.3/62.4 ± 24.1 (P < 0.0001), and the 9‐item Patient Health Questionnaire sum score improved from 8.7 ± 5.9 to 6.3 ± 5.1 (P < 0.0001). Conclusion Haemodynamic‐guided HF management proved feasible and safe in the health systems of Germany, The Netherlands, and Ireland. Physician‐directed treatment modifications based on remotely obtained PAP values were associated with fewer HFH, sustainable PAP decreases, marked KCCQ improvements, and remission of depressive symptoms. KW - heart failure KW - morbidity KW - haemodynamic monitoring KW - CardioMEMS™ HF system KW - health‐related quality of life KW - depression Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-218061 VL - 22 IS - 10 SP - 1891 EP - 1901 ER - TY - JOUR A1 - Arnold, Michaela Maria A1 - Müller-Oerlinghausen, Bruno A1 - Hemrich, Norbert A1 - Bönsch, Dominikus T1 - Effects of Psychoactive Massage in Outpatients with Depressive Disorders: A Randomized Controlled Mixed-Methods Study JF - Brain Sciences N2 - The clinical picture of depressive disorders is characterized by a plethora of somatic symptoms, psychomotor retardation, and, particularly, anhedonia. The number of patients with residual symptoms or treatment resistance is high. Touch is the basic communication among humans and animals. Its application professionally in the form of, e.g., psychoactive massage therapy, has been shown in the past to reduce the somatic and mental symptoms of depression and anxiety. Here, we investigated the effects of a specially developed affect-regulating massage therapy (ARMT) vs. individual treatment with a standardized relaxation procedure, progressive muscle relaxation (PMR), in 57 outpatients with depression. Patients were given one ARMT or PMR session weekly over 4 weeks. Changes in somatic and cognitive symptoms were assessed by standard psychiatric instruments (Hamilton Depression Scale (HAMD) and the Bech–Rafaelsen–Melancholia–Scale (BRMS)) as well as a visual analogue scale. Furthermore, oral statements from all participants were obtained in semi-structured interviews. The findings show clear and statistically significant superiority of ARMT over PMR. The results might be interpreted within various models. The concept of interoception, as well as the principles of body psychotherapy and phenomenological aspects, offers cues for understanding the mechanisms involved. Within a neurobiological context, the significance of C-tactile afferents activated by special touch techniques and humoral changes such as increased oxytocin levels open additional ways of interpreting our findings. KW - massage therapy KW - psychoactive massage KW - affect-regulating massage therapy KW - affective touch KW - depression KW - pain KW - interoception KW - C-tactile fibers KW - body psychotherapy Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-213385 SN - 2076-3425 VL - 10 IS - 10 ER - TY - JOUR A1 - Biere, Silvia A1 - Kranz, Thorsten M. A1 - Matura, Silke A1 - Petrova, Kristiyana A1 - Streit, Fabian A1 - Chiocchetti, Andreas G. A1 - Grimm, Oliver A1 - Brum, Murielle A1 - Brunkhorst-Kanaan, Natalie A1 - Oertel, Viola A1 - Malyshau, Aliaksandr A1 - Pfennig, Andrea A1 - Bauer, Michael A1 - Schulze, Thomas G. A1 - Kittel-Schneider, Sarah A1 - Reif, Andreas T1 - Risk Stratification for Bipolar Disorder Using Polygenic Risk Scores Among Young High-Risk Adults JF - Frontiers in Psychiatry N2 - Objective: Identifying high-risk groups with an increased genetic liability for bipolar disorder (BD) will provide insights into the etiology of BD and contribute to early detection of BD. We used the BD polygenic risk score (PRS) derived from BD genome-wide association studies (GWAS) to explore how such genetic risk manifests in young, high-risk adults. We postulated that BD-PRS would be associated with risk factors for BD. Methods: A final sample of 185 young, high-risk German adults (aged 18–35 years) were grouped into three risk groups and compared to a healthy control group (n = 1,100). The risk groups comprised 117 cases with attention deficit hyperactivity disorder (ADHD), 45 with major depressive disorder (MDD), and 23 help-seeking adults with early recognition symptoms [ER: positive family history for BD, (sub)threshold affective symptomatology and/or mood swings, sleeping disorder]. BD-PRS was computed for each participant. Logistic regression models (controlling for sex, age, and the first five ancestry principal components) were used to assess associations of BD-PRS and the high-risk phenotypes. Results: We observed an association between BD-PRS and combined risk group status (OR = 1.48, p < 0.001), ADHD diagnosis (OR = 1.32, p = 0.009), MDD diagnosis (OR = 1.96, p < 0.001), and ER group status (OR = 1.7, p = 0.025; not significant after correction for multiple testing) compared to healthy controls. Conclusions: In the present study, increased genetic risk for BD was a significant predictor for MDD and ADHD status, but not for ER. These findings support an underlying shared risk for both MDD and BD as well as ADHD and BD. Improving our understanding of the underlying genetic architecture of these phenotypes may aid in early identification and risk stratification. KW - polygenic risk score KW - bipolar disorder KW - genetic phenotypes KW - depression KW - ADHD KW - early recognition Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-214976 VL - 11 ER - TY - THES A1 - Brüser, Judith T1 - Prüfung der Effektivität eines interdisziplinären psychokardiologischen Behandlungsprogrammes auf die Reduktion von Depressivität, Angst und Panik und die Verbesserung der gesundheitsbezogenen Lebensqualität bei psychisch belasteten kardiologischen Rehabilitanden T1 - Examination of the Effectiveness of an Interdisciplinary Psychocardiological Treatment Programme for the Reduction of Depressivity, Anxiety, and Panic and the Improvement of the Health-Related Quality of Life in Psychologically burdened Cardiological Rehabilitants N2 - In dieser Arbeit wurde geprüft, ob ein leitlinienkonformes psychokardiologisches Behandlungskonzept einer herkömmlichen kardiologischen Behandlung bei psychisch belasteten kardiologischen Rehabilitanden in der Reduktion von Angst, Depression und Panik (primäre Zielkriterien) und einer Verbesserung der gesundheitsbezogenen Lebensqualität (sekundäre Zielparameter) überlegen ist. In der Nebenfragstellung wurden Unterschiede in der Wirksamkeit der Intervention in Abhängigkeit vom Geschlecht explorativ geprüft. Die Fragestellungen wurden mit einem quasiexperimentellen Studiendesign mit sequentiell aufeinanderfolgenden Kohorten untersucht. Die Zielparameter wurden zu Rehabeginn, -ende und 6 Monate nach Entlassung mit validierten Fragebögen (PHQ-9, PHQ-Panik, GAD-7 und MacNew Heart Disease-Fragebogen) erfasst. Die Hauptanalyse ergab einen kleinen signifikanten Intergruppeneffekt für den Zielparameter Depressivität zugunsten der Kontrollgruppe zu Rehaende und in der Katamnese keine signifikanten Unterschiede im Behandlungserfolg beider Studienbedingungen mehr. Die Moderatoranalyse ergab kleine Interaktionseffekte zwischen Intervention und Geschlecht für Angst und die gesundheitsbezogene Lebensqualität zu beiden Folgemess-zeitpunkten. Deskriptiv zeigte sich der Trend, dass Frauen von der Interventionsbedingung schlechter, Männer hingegen besser profitierten. Für die mangelnde Überlegenheit des Interventionsprogrammes kommen vielfältige Aspekte in Frage, die methodisch das sequentiell aufeinanderfolgenden Behandlungsdesign betreffen sowie interventionsbezogen die Ausschöpfung der Therapieressourcen, den Zeitpunkt des Behandlungsbeginns, die Behandlungsdauer, die Berücksichtigung spezifischer Patientenbedürfnisse und auch die Möglichkeit einer ungünstigen Wirkung von Psychotherapie. Ferner war die statistische Power und damit die Aussagekraft der Studie einschränkt. Als Fazit unterliegen noch vielfältige Einflussgrößen gezieltem Forschungsbedarf. N2 - In this study, it was examined whether a guideline-conforming psychocardiological treatment concept is superior to conventional cardiological treatment for psychologically burdened cardiological rehabilitants in the reduction of anxiety, depression, and panic (primary target criteria) and an improvement of the health-related quality of life (secondary target parameters). In the supplementary question, differences in the effectiveness of the intervention depending on gender were exploratively examined. The questions were investigated with a quasiexperimental study design with sequentially consecutive cohorts. Target parameters were assessed at the start and end of rehabilitation and 6 months after discharge using validated questionnaires (PHQ-9, PHQ-Panic, GAD-7, and MacNew Heart Disease Questionnaire). The main analysis showed a small significant intergroup effect for the target parameter depressivity in favour of the control group at the end of rehabilitation and no significant in the treatment success of both study conditions in the catamnesis. The moderator analysis revealed small interaction effects between intervention and gender for anxiety and health-related quality of life at both follow-up measurement points. Descriptively, the trend showed that women benefited less from the intervention condition than men. For the lack of superiority of the intervention programme, various aspects can be considered, which methodically concern the sequentially successive treatment design as well as the exhaustive use of therapy resources, the time of the onset of treatment, the duration of treatment, the consideration of specific patient needs, and also the possibility of an unfavourable effect of psychotherapy. Furthermore, the statistical power and thus the significance of the study was limited. In conclusion, a wide range of influencing variables are still subject to a targeted need for research. KW - Depression KW - Angstsyndrom KW - Lebensqualität KW - Klinische Psychotherapie KW - Herzkrankheit KW - Psychokardiologische Behandlung KW - Angst/Panik KW - gesundheitsbezogene Lebensqualität KW - kardiologische Rehabilitation KW - psychological treatment KW - depression KW - anxiety/panic KW - health-related quality of life KW - cardiac rehabilitation Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-198233 ER - TY - JOUR A1 - Esser, Peter A1 - Mehnert‐Theuerkauf, Anja A1 - Friedrich, Michael A1 - Johansen, Christoffer A1 - Brähler, Elmar A1 - Faller, Hermann A1 - Härter, Martin A1 - Koch, Uwe A1 - Schulz, Holger A1 - Wegscheider, Karl A1 - Weis, Joachim A1 - Kuba, Katharina A1 - Hinz, Andreas A1 - Hartung, Tim T1 - Risk and associated factors of depression and anxiety in men with prostate cancer: Results from a German multicenter study JF - Psycho‐Oncology N2 - Objective In order to optimize psycho‐oncological care, studies that quantify the extent of distress and identify certain risk groups are needed. Among patients with prostate cancer (PCa), findings on depression and anxiety are limited. Methods We analyzed data of PCa patients selected from a German multi‐center study. Depression and anxiety were assessed with the PHQ‐9 and the GAD‐7 (cut‐off ≥7). We provided physical symptom burden, calculated absolute and relative risk (AR and RR) of depression and anxiety across patient subsets and between patients and the general population (GP) and tested age as a moderator within the relationship of disease‐specific symptoms with depression and anxiety. Results Among 636 participants, the majority reported disease‐specific problems (sexuality: 60%; urination: 52%). AR for depression and anxiety was 23% and 22%, respectively. Significant RR were small, with higher risks of distress in patients who are younger (eg, RR\(_{depression}\) = 1.15; 95%‐CI: 1.06‐1.26), treated with chemotherapy (RR\(_{depression}\)n = 1.46; 95%‐CI: 1.09‐1.96) or having metastases (RR\(_{depression}\) = 1.30; 95%‐CI: 1.02‐1.65). Risk of distress was slightly elevated compared to GP (eg, RR\(_{depression}\) = 1.13; 95%‐CI: 1.07‐1.19). Age moderated the relationship between symptoms and anxiety (B\(_{urination}\) = −0.10, P = .02; B\(_{sexuality}\) = −0.11, P = .01). Conclusions Younger patients, those with metastases or treatment with chemotherapy seem to be at elevated risk for distress and should be closely monitored. Many patients suffer from disease‐specific symptom burden, by which younger patients seem to be particularly distressed. Support of coping mechanisms associated with disease‐specific symptom burden seems warranted. KW - anxiety KW - cancer KW - depression KW - oncology KW - prostatic neoplasms Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-218277 VL - 29 IS - 10 SP - 1604 EP - 1612 ER - TY - JOUR A1 - Oorschot, Birgitt van A1 - Ishii, Koji A1 - Kusomoto, Yuko A1 - Zetzl, Theresa A1 - Roch, Carmen A1 - Mettenleiter, Andreas A1 - Ozawa, Hiroko A1 - Flentje, Michael T1 - Anxiety, depression and psychosocial needs are the most frequent concerns reported by patients: preliminary results of a comparative explorative analysis of two hospital-based palliative care teams in Germany and Japan JF - Journal of Neural Transmission N2 - In the partnership between the medical departments of Würzburg University, Germany, and Nagasaki University, Japan, palliative care is a relevant topic. The aim of the study was to perform a comparative analysis of the hospital-based palliative care teams in Würzburg (PCT-W) and Nagasaki (PCT-N). Survey of staff composition and retrospective analysis of PCT patient charts in both PCTs were conducted. Patients self-assessed their symptoms in PCT-W and in Radiation Oncology Würzburg (RO-W). The (negative) quality indicator ‘percentage of deceased hospitalised patients with PCT contact for less than 3 days before death’ (Earle in Int J Qual Health Care 17(6):505–509, 2005) was analysed. Both PCTs follow a multidisciplinary team approach. PCT-N saw 410 cancer patients versus 853 patients for PCT-W (22.8% non-cancer patients). The Eastern Cooperative Oncology Group Performance Status at first contact with PCT-N was 3 or 4 in 39.3% of patients versus 79.0% for PCT-W. PCT-N was engaged in co-management longer than PCT-W (mean 20.7 days, range 1–102 versus mean 4.9 days, range 1–48). The most frequent patient-reported psychological symptom was anxiety (family anxiety: 98.3% PCT-W and 88.7% RO-W, anxiety 97.9% PCT-W and 85.9% RO-W), followed by depression (98.2% PCT-W and 80.3% RO-W). In 14 of the 148 deceased patients, PCT-N contact was initiated less than 3 days before death (9.4%) versus 121 of the 729 deceased PCT-W patients (16.6%). Psychological needs are highly relevant in both Germany and Japan, with more than 85% anxiety and depression in patients in the Japanese IPOS validation study (Sakurai in Jpn J Clin Oncol 49(3):257–262, 2019). This should be taken into account when implementing PCTs. KW - hospital-based palliative care KW - patient-reported outcome KW - quaility indicator KW - anxiety KW - depression Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-235675 SN - 0300-9564 VL - 127 ER - TY - JOUR A1 - Riederer, Peter A1 - ter Meulen, Volker T1 - Coronaviruses: a challenge of today and a call for extended human postmortem brain analyses JF - Journal of Neural Transmission N2 - While there is abounding literature on virus-induced pathology in general and coronavirus in particular, recent evidence accumulates showing distinct and deleterious brain affection. As the respiratory tract connects to the brain without protection of the blood–brain barrier, SARS-CoV-2 might in the early invasive phase attack the cardiorespiratory centres located in the medulla/pons areas, giving rise to disturbances of respiration and cardiac problems. Furthermore, brainstem regions are at risk to lose their functional integrity. Therefore, long-term neurological as well as psychiatric symptomatology and eventual respective disorders cannot be excluded as evidenced from influenza-A triggered post-encephalitic Parkinsonism and HIV-1 triggered AIDS–dementia complex. From the available evidences for coronavirus-induced brain pathology, this review concludes a number of unmet needs for further research strategies like human postmortem brain analyses. SARS-CoV-2 mirroring experimental animal brain studies, characterization of time-dependent and region-dependent spreading behaviours of coronaviruses, enlightening of pathological mechanisms after coronavirus infection using long-term animal models and clinical observations of patients having had COVID-19 infection are calling to develop both protective strategies and drug discoveries to avoid early and late coronavirus-induced functional brain disturbances, symptoms and eventually disorders. To fight SARS-CoV-2, it is an urgent need to enforce clinical, molecular biological, neurochemical and genetic research including brain-related studies on a worldwide harmonized basis. KW - coronavirus KW - COVID-19 KW - SARS-CoV-2 brain disorders KW - cardiorespiratory centre KW - brain pathology KW - neurological symptoms/disorders KW - brain stem KW - Parkinson’s disease KW - Parkinsonism KW - Alzheimer’s disease KW - multiple sclerosis KW - movement disorders KW - neuroinvasion KW - therapy KW - neuroprotection KW - depression KW - cognitive dysfunction KW - brain bank KW - postmortem studies Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-314637 SN - 0300-9564 SN - 1435-1463 VL - 127 IS - 9 ER - TY - THES A1 - Schwarz, Elisa T1 - Psychische Belastung bei Patienten mit Multiplem Myelom vor autologer Stammzelltransplantation. Subanalyse von Zusammenhängen zwischen depressiven Symptomen und klinischen Variablen T1 - Psychological stress in patients with multiple myeloma before autologous stem cell transplantation. Subanalysis between depressive symptoms and clinical variables N2 - Bereits bestehende wissenschaftliche Literatur weist in präklinischen Ergebnissen darauf hin, dass das sympathische Nervensystem eine entscheidende Rolle bei der Mobilisierung von hämatopoetischen Stammzellen spielt. Mehrere Vorarbeiten lieferten Hinweise, dass psychischer Distress bei Stammzelltransplantation mit einem langsameren Anstieg der absoluten Leukozytenzahl während Aplasie einhergehen könnte. Die Dauer der Aplasie ist von klinischer Relevanz. In der vorliegenden Arbeit wurden Zusammenhänge zwischen Distress in Form von depressiven Symptomen und hämatologischer Rekonstitution nach erster autologer Stammzelltransplantation bei Patienten mit Multiplem Myelom (n = 47) untersucht. Mit Hilfe des Fragebogens PHQ-9 wurden die Patienten mit Multiplem Myelom am Tag ihrer ersten autologen Stammzelltransplantation auf depressive Symptome gescreent. Patienten mit Multiplem Myelom wiesen ein hohes Maß an Distress auf. In der Stichprobe aus 47 konsekutiven Patienten lag bei 12 Patienten (26%) Distress in Form von Symptomen einer Depression vor. Es ließ sich kein Zusammenhang zwischen psychischer Belastung und verlängerter hämatologischen Rekonstitution (r = 0.025; n = 37; p = 0.882) feststellen. Erstmalig wurde der Zusammenhang zwischen psychischer Belastung und klinischen Parametern während hämatologischer Rekonstitution untersucht. Dabei ergaben sich klinisch relevante Resultate. Es zeigte sich eine Tendenz mit einem größeren Bedarf an Erythrozytenkonzentraten bei Verdacht auf Depression (V = 0.387; p = 0.071). Nebenbefundlich ergab sich in der multivariaten Analyse der signifikante Zusammenhang, dass ein hohes molekulargenetisches Risiko mit einer größeren Anzahl an verabreichten Erythrozytenkonzentraten einhergeht (p = 0.046). Darüber hinaus ergab sich ein relevanter Zusammenhang zwischen Verdacht auf Depression nach PHQ-9 und Aufenthaltsdauer. Depressive Patienten waren demnach tendenziell kürzer im Krankenhaus (r = -0.25; n = 47; p = 0.09). N2 - Subject: Preclinical results indicate the crucial role of the sympathetic nervous system in the mobilization of haematopoietic stem cells. Several preliminary studies suggest that psychological stress in stem cell transplantation could be associated with a slower increase in absolute leukocyte counts during aplasia. The duration of aplasia is of clinical relevance. In the present work, correlation between distress in the form of depressive symptoms and haematological reconstitution after the first autologous stem cell transplantation in patients with multiple myeloma (n=47) was examined. Methods: Patients with multiple myeloma were screened for depressive symptoms on the day of their first autologous stem cell transplant using the PHQ-9. Results: In patients with multiple myeloma a high degree of distress can be observed. In our sample of 47 patients, 12 patients (26%) experienced distress in the form of depressive symptoms. We could not establish a correlation between psychological stress and prolonged haematological reconstitution (r = 0.025; n = 37; p = 0.882). To the best of our knowledge, the correlation between psychological stress and clinical parameters during haematological reconstitution was examined for the first time. Clinically relevant results were shown. There was a trend with an increased requirement of erythrocyte concentrates when depression was suspected (V = 0.387; p = 0.071). Incidentally, the multivariate analysis showed the significant and clinically relevant connection that a high molecular genetic risk is associated with a larger number of administered erythrocyte concentrates (p = 0.046). There was also a relevant correlation between suspected depression after PHQ-9 and duration of hospitalisation. Hospitalisation of depressed patients tended to be shorter (r = -0.25; n = 47; p = 0.09). KW - Psychoneuroimmunologie KW - Multiples Myelom KW - Stammzelltransplantation KW - Depression KW - psychoneuroimmunology KW - multiple myeloma KW - stem cell transplantation KW - depression Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-205462 ER -