A Telephone- and Text Message-Based Telemedicine Concept for Patients with Mental Health Disorders: Results of a Randomized Controlled Trial

Background: A telemedicine care concept based on telephone contacts and individualized text messages was developed for patients with mental disorders to continue treatment after therapy in a psychiatric day hospital. The primary objective of this study was to evaluate the effectiveness of the telemedicine interventions. Methods: The study had a 3-armed, randomized design with 2 intervention arms (intervention 1: telephone contacts; intervention 2: telephone contacts and short text messages; both took place over a period of 6 months and in addition to usual care), and a control group with usual care. Primary outcomes were 18-item Brief Symptom Inventory (BSI-18) scores for anxiety, depression and somatization. All participants were recruited from psychiatric day hospitals. The study was registered in the German Clinical Trials Register (DRKS00000662). Results: 113 participants were analyzed 6 months after starting the intervention. The average BSI-18 anxiety score after 6 months was -2.04 points lower in intervention group 2 than in the control group (p value: 0.042). The difference in BSI depression score between these two groups was marginally significant (p value: 0.1), with an average treatment effect of -1.73. In an exploratory sensitivity analysis restricted to the 75% of patients with the highest symptom scores at baseline, intervention group 1 yielded a significant effect for anxiety and depression compared to the control group (p = 0.036 and 0.046, respectively). Conclusions: Telemedicine provides a novel option in psychiatric ambulatory care with statistically significant effects on anxiety. A positive tendency was observed for depression, especially in cases with higher symptom load at baseline

Structural Alterations in the Corpus Callosum Are Associated with Suicidal Behavior in Women with Borderline Personality Disorder

Structural alterations in the corpus callosum (CC), the major white matter tract connecting functionally related brain regions in the two hemispheres, have been shown to be associated with emotional instability, impulsivity and suicidality in various mental disorders. To explore whether structural alterations of the CC would be similarly associated with emotional instability, impulsivity and suicidality in borderline personality disorder (BPD), we used diffusion tensor imaging (DTI) to assess the structural integrity of the CC in 21 BPD and 20 healthy control (HC) participants. Our hypothesis-driven analyses revealed a positive correlation between BPD participants’ suicidal behavior and fractional anisotropy (FA) in the splenium and genu of the CC and a negative correlation between BPD participants’ suicidal behavior and mean diffusivity (MD) in the splenium of CC. Our exploratory analyses suggested that suicidal BPD participants showed less FA and more MD in these regions than HC participants but that non-suicidal BPD participants showed similar FA and MD in these regions as HC participants. Taken together, our findings suggest an association between BPD participants’ suicidal behavior and structural alterations in regions of the CC that are connected with brain regions implicated in emotion regulation and impulse control. Structural alterations of the CC may, thus, account for deficits in emotion regulation and impulse control that lead to suicidal behavior in BPD. However, these findings should be considered as preliminary until replicated and extended in future studies that comprise larger samples of suicidal and non-suicidal BPD participants

Traumatization and mental distress in long-term prisoners in Europe

This article investigates the prevalence of traumatization and mental distress in a sample of 1055 male European long-term prisoners as part of a wider study of the living conditions of prisoners serving sentences of at least five years in Belgium, Croatia, Denmark, England, Finland, France, Germany, Lithuania, Poland, Spain and Sweden. Data were collected in a written survey using the Posttraumatic Diagnostic Scale (PDS), the Brief Symptom Inventory (BSI) as well as questions on attempted suicide and auto-aggressive behaviour. Participants experienced a mean of three traumatic events, with 14 per cent developing a Posttraumatic Stress Disorder (PTSD) subsequently. In each national sample, more than 50 per cent of the participants were in need of treatment because of psychological symptoms and nearly one-third had attempted suicide

From Childhood Trauma to Adult Dissociation: The Role of PTSD and Alexithymia

Background: The mechanism of how childhood trauma leads to increased risk for adult dissociation is not sufficiently understood. We sought to investigate the predicting effects and the putatively mediating roles of PTSD and alexithymia on the path from childhood trauma to adult dissociation. Methods: A total of 666 day-clinic outpatients were administered the Childhood Trauma Questionnaire (CTQ), the Toronto Alexithymia Scale (TAS-20), the Posttraumatic Diagnostic Scale (PDS), and the Dissociative Experiences Scale (DES) and controlled for sex, age, and the Global Symptom Index (GSI). Linear regression analyses and mediation analyses were applied. Results: Independent predictive effects on dissociation were found for childhood trauma, alexithymia and PDS, even after adjusting for GSI. Effects of childhood neglect on dissociation were slightly stronger than of abuse. Alexithymia did not mediate the path from childhood trauma to dissociation. Mediation by PDS was specific for childhood abuse, with all PTSD symptom clusters being significantly involved. Conclusions: Childhood abuse and neglect are important predictors of dissociation. While the effects of abuse are mediated by PTSD, the mechanism of how neglect leads to dissociation remains unclear. The results further support the predictive value of alexithymia for adult dissociation above and beyond the effects of childhood trauma, PTSD, and GSI scores

Impact of War Trauma and Posttraumatic Stress Disorder on Psychopathology in Croatian and German Patients with Severe Mental Illness

Aim To explore posttraumatic stress symptoms and current psychopathology in a binational sample of Croatian and German participants with severe mental illness. Methods We studied 178 inpatients from the Greifswald University (German patients, n = 89) and University Hospital Zagreb and Ivan Barbot Neuropsychiatric Hospital (Croatian patients, n = 89) with either major depression (n = 150), schizophrenia (n = 26), or bipolar disorder (n = 2). Measurements included Posttraumatic Diagnostic Scale and the Symptom Check List-90-R. Participants were matched according to age, sex, and diagnosis. Results Croatians reported significantly more war traumatic events (64/82 vs 5/74, χ2 1 = 77.142, P < 0.001) and significantly more Croatians met the criteria for posttraumatic stress disorder (55/89 vs 27/89, χ2 1 = 17.73, P < 0.001). They also suffered from a higher level of psychopathological distress as they scored significantly higher at all Symptom Check List-90-R revised version subscales (P < 0.001). The regression models demonstrated that predictors of general psychopathological distress were war trauma (P < 0.001), posttraumatic stress disorder (P < 0.001), and diagnosis (P = 0.01). Conclusion This is the first study comparing the impact of war trauma on psychopathology of participants with severe mental illness between two nations. Our results clearly indicate the importance of trauma assessment in subjects with severe mental illness, particularly in postconflict setting

Norwegische 'Wehrmachtskinder': Psychosoziale Aspekte, Identitätsentwicklung und Stigmatisierung

Am 09. April 1940 überfielen deutsche Truppen Norwegen. Neun Monate später kamen die ersten 'Wehrmachtskinder' zur Welt. Im Laufe des Krieges wurden 72 Heime des 'Lebensborn' (ein von der SS getragener Verein zur Erhöhung der Geburtenrate 'arischer' Kinder) in Norwegen gegründet, so viele wie in keinem anderen durch das NS-Regime besetzten Land; darunter befand sich das erste außerhalb des damaligen Deutschen Reiches gelegene. In den Archiven des Lebensborn wurden knapp 8000 Kinder registriert. Schätzungen gehen davon aus, dass während der deutschen Okkupationszeit in Norwegen 10000 bis 12 000 Kinder geboren wurden, deren Väter den deutschen Truppen angehörten und deren Mütter norwegische Staatsbürgerinnen waren. Die 'Wehrmachtskinder' trugen ein doppeltes Stigma: Sie waren häufig unehelich geboren und waren durch die Beziehung mit dem Feind entstanden. Aus Zeitzeugnissen geht hervor, dass ihr soziales Umfeld sie diskriminierte und ausgrenzte; sie wurden verhöhnt und zum Teil körperlich und seelisch misshandelt. Auch von staatlicher Seite widerfuhren Ihnen unterschiedliche Repressalien. Die geistes- und sozialwissenschaftlichen Fächer haben die Umstände und Bedingungen der norwegischen 'Wehrmachtskinder' bereits Ende des letzten Jahrhunderts als Forschungsgegenstand aufgegriffen. Die psychosozialen Fächer haben dieses Thema jedoch erst kürzlich begonnen zu bearbeiten. Im Rahmen des hier vorgestellten Forschungsvorhabens werden erstmalig mittels eines umfangreichen Fragebogens die psychosozialen Konsequenzen des Aufwachsens als 'Wehrmachtskind' im Nachkriegsnorwegen erfasst. Das Projekt ist in eine bereits etablierte internationale und interdisziplinäre Forschungsstruktur zu den 'Kinder[n] des Krieges' eingebunden (www.childrenbornofwar.org), wobei an den Universitäten Leipzig und Greifswald die psychosoziale Belastung von Besatzungskindern in Deutschland parallel untersucht wird. Eine Besonderheit der norwegischen Situation sind die umfangreichen Aktivitäten des 'Lebensborn', der während des Krieges für viele Wehrmachtskinder und deren Mütter eine wichtige Rolle spielte.On 9 April 1940, German troops invaded Norway. Nine months later the first 'Wehrmacht children' were born. In the course of the war, 13 'Lebensborn' homes were established in Norway, more than in any other country occupied by the Nazis and including the first ever of these homes to be set up outside the former German Reich. (The Lebensborn was an SS-initiated association dedicated to raising the number of 'Aryan' births via extramarital relations between people living up to Nazi standards of health and racial purity). In the archives of the Lebensborn almost 8,000 children were registered. It is estimated that 10,000 to 12,000 children were born during the German occupation of Norway whose fathers belonged to the German troops and whose mothers were Norwegian nationals. 'Wehrmacht children' labored under a dual stigma. They were (often) born out of wedlock and they were the fruit of relations with the enemy. Socially they were discriminated and marginalized. They were ridiculed and, in many cases, physically and mentally abused. These children also suffered a variety of reprisals from the state. Initial investigations of the biographies and careers of the 'Wehrmacht children' in Norway date back to the end of the last century, most of them undertaken by scholars working in the humanities and the social sciences. Recently, the psychosocial sciences have also taken up this issue. The research project discussed here is the first to investigate the psychosocial consequences of growing up as a 'Wehrmacht child' in post-war Norway. The project is part of an established international and interdisciplinary research network named 'Children Born of War' (www.childrenbornofwar.org). The Universities of Leipzig and Greifswald have conducted a parallel study on occupation-born German children after WWII. A special feature of the Norwegian situation is the extensive activity of the 'Lebensborn', which played an important role for many 'Wehrmacht children' and their mothers during the war

A telephone- and text-message based telemedical care concept for patients with mental health disorders - study protocol for a randomized, controlled study design

<p>Abstract</p> <p>Background</p> <p>As in other countries worldwide, the prevalence of mental disorders in Germany is high. Although numerically a dense network of in- and outpatient psychiatric health services exists, the availability in rural and remote regions is insufficient.</p> <p>In rural regions, telemedical concepts can be a chance to unburden and complement the existing healthcare system. Telemedical concepts consisting of video or telephone consulting show first positive results, but there are only a few studies with a randomized controlled design.</p> <p>To improve the treatment of patients with mental disorders in rural regions, we developed a telemedical care concept based on telephone contacts and text-messages. The primary objective of this study is to evaluate the effects of the telemedical interventions on psychopathological outcomes, e. g. anxiety, depressive symptoms, and somatisation. Secondary objective of the study is the analysis of intervention effects on the frequency of medical contacts with healthcare services. Furthermore, the frequency of patients' crises and the frequency and kind of interventions, initiated by the project nurses will be evaluated. We will also evaluate the acceptance of the telemedical care concept by the patients.</p> <p>Methods/Design</p> <p>In this paper we describe a three-armed, randomized, controlled study. All participants are recruited from psychiatric day hospitals. The inclusion criteria are a specialist-diagnosed depression, anxiety disorder, adjustment disorder or a somatoform disorder and eligibility to participate in the study. Exclusion criteria are ongoing outpatient psychotherapy, planned interval treatment at the day clinic and expected recurrent suicidality and self-injuring behaviour.</p> <p>The interventions consist of regular patient-individual telephone consultations or telephone consultations with complementing text-messages on the patients' mobile phone. The interventions will be conducted during a time period of 6 months.</p> <p>Trial registration</p> <p>This study is registered in the German Clinical Trials Register (DRKS00000662).</p

Dark sectors 2016 Workshop: community report

This report, based on the Dark Sectors workshop at SLAC in April 2016, summarizes the scientific importance of searches for dark sector dark matter and forces at masses beneath the weak-scale, the status of this broad international field, the important milestones motivating future exploration, and promising experimental opportunities to reach these milestones over the next 5-10 years

Needs-oriented discharge planning and monitoring for high utilisers of psychiatric services (NODPAM): Design and methods

<p>Abstract</p> <p>Background</p> <p>Attempts to reduce high utilisation of psychiatric inpatient care by targeting the critical time of hospital discharge have been rare.</p> <p>Methods</p> <p>This paper presents design and methods of the study "Effectiveness and Cost-Effectiveness of Needs-Oriented Discharge Planning and Monitoring for High Utilisers of Psychiatric Services" (NODPAM), a multicentre RCT conducted in five psychiatric hospitals in Germany. Inclusion criteria are receipt of inpatient psychiatric care, adult age, diagnosis of schizophrenia or affective disorder, defined high utilisation of psychiatric care during two years prior to the current admission, and given informed consent. Consecutive recruitment started in April 2006. Since then, during a period of 18 months, comprehensive outcome data of 490 participants is being collected at baseline and during three follow-up measurement points.</p> <p>The manualised intervention applies principles of needs-led care and focuses on the inpatient-outpatient transition. A trained intervention worker provides two intervention sessions: (a) Discharge planning: Just before discharge with the patient and responsible clinician at the inpatient service; (b) Monitoring: Three months after discharge with the patient and outpatient clinician. A written treatment plan is signed by all participants after each session.</p> <p>Primary endpoints are whether participants in the intervention group will show fewer hospital days and readmissions to hospital. Secondary endpoints are better compliance with aftercare, better clinical outcome and quality of life, as well as cost-effectiveness and cost-utility.</p> <p>Discussion</p> <p>If a needs-oriented discharge planning and monitoring proves to be successful in this RCT, a tool will be at hand to improve patient outcome and reduce costs via harmonising fragmented mental health service provision.</p> <p>Trial Registration</p> <p>ISRCTN59603527</p