Predictors and outcomes in primary depression care (POKAL) – a research training group develops an innovative approach to collaborative care

BACKGROUND: The interdisciplinary research training group (POKAL) aims to improve care for patients with depression and multimorbidity in primary care. POKAL includes nine projects within the framework of the Chronic Care Model (CCM). In addition, POKAL will train young (mental) health professionals in research competences within primary care settings. POKAL will address specific challenges in diagnosis (reliability of diagnosis, ignoring suicidal risks), in treatment (insufficient patient involvement, highly fragmented care and inappropriate long-time anti-depressive medication) and in implementation of innovations (insufficient guideline adherence, use of irrelevant patient outcomes, ignoring relevant context factors) in primary depression care. METHODS: In 2021 POKAL started with a first group of 16 trainees in general practice (GPs), pharmacy, psychology, public health, informatics, etc. The program is scheduled for at least 6 years, so a second group of trainees starting in 2024 will also have three years of research-time. Experienced principal investigators (PIs) supervise all trainees in their specific projects. All projects refer to the CCM and focus on the diagnostic, therapeutic, and implementation challenges. RESULTS: The first cohort of the POKAL research training group will develop and test new depression-specific diagnostics (hermeneutical strategies, predicting models, screening for suicidal ideation), treatment (primary-care based psycho-education, modulating factors in depression monitoring, strategies of de-prescribing) and implementation in primary care (guideline implementation, use of patient-assessed data, identification of relevant context factors). Based on those results the second cohort of trainees and their PIs will run two major trials to proof innovations in primary care-based a) diagnostics and b) treatment for depression. CONCLUSION: The research and training programme POKAL aims to provide appropriate approaches for depression diagnosis and treatment in primary care

Evaluation of the viscoelastic properties of a nematic dimer by cone-and-plate rheo-nuclear magnetic resonance spectroscopy and comparison with Leslie-Ericksen theory

The viscoelastic behavior of a nematic dimer is studied by deuteron (2H) nuclear magnetic resonance (NMR) spectroscopy using a cone-and-plate rheometer. From the 2H NMR spectra, monitored as a function of the shear rate, the orientation of the director relative to the magnetic field is obtained. Analysis of this experiment, using an analytical and a numerical solution of the Leslie\u2013Ericksen equations, gives detailed information on the viscoelastic properties of the dimer. In particular, the two Leslie viscosities \u3b12 and \u3b13 and the three-dimensional director distribution are determined. The analysis reveals that \u3b12 and \u3b13 are both positive, that is, the dimer is of the flow-aligning type, and the director is tilted by an angle of about 33\ub0 from the magnetic field toward the velocity axis

Association of adult attachment and suicidal ideation in primary care patients with multiple chronic conditions.

Background: Suicidal ideation is a common health concern in primary care. Attachment theory indicates that subjects with higher anxiety and/or avoidance may be more susceptible to suicidal ideation. Therefore, the aim of our study was to examine the association of attachment anxiety, avoidance, and suicidal ideation in middle-aged to elderly, chronically ill primary care patients.Methods: The APRICARE Study comprised 207 patients aged 50-85 years with a minimum of three chronic diseases. Adult attachment, depressive symptoms and suicidal ideation were measured via the self-report questionnaires Experiences in Close Relationships-Revised (ECR-RD12) and Patient Health Questionnaire -9 (PHQ-9). Univariable and adjusted associations of suicidal ideation with ECR-RD12-attachment anxiety, ECR-RD-12-attachment avoidance, and ECR-RD12-insecure adult attachment were examined via logistic regression analyses.Results: Suicidal ideation was present in 13% of all patients. ECR-RD12-anxiety was significantly associated with suicidal ideation (OR=1.88, CI 1.44-2.44), while ECR-RD12-avoidance was not associated. In patients with suicidal ideation, 85% were insecurely attached compared to 63% in those without suicidal ideation - thus the OR for suicidal ideation in insecurely attached patients was 3.33 (CI=1.10-10.04) with securely attached patients as reference. Further variables associated with suicidal ideation were depressive symptomatology, living alone (especially in men) and obesity (especially in women).Limitations: The study was cross-sectional in design, and suicidal ideation was assessed using a single item selfreport measure.Conclusion: General practitioners should be aware of attachment styles in order to have a better chance to identify patients at risk for suicide

Determinants of completed railway suicides by psychiatric in-patients: Case-control study.

Background Suicide prediction during psychiatric in-patient treatment remains an unresolved challenge. Aims To identify determinants of railway suicides in individuals receiving in-patient psychiatric treatment. Method The study population was drawn from patients admitted to six psychiatric hospitals in Germany during a 10-year period (1997-2006). Data from 101 railway suicide cases were compared with a control group of 101 discharged patients matched for age, gender and diagnosis. Results Predictors of suicide were change of therapist (OR = 22.86, P = 0.004), suicidal ideation (OR = 7.92, P<0.001), negative or unchanged therapeutic course (OR = 7.73, P<0.001), need of polypharmaceutical treatment (OR = 2.81, P = 0.04) and unemployment (OR = 2.72, P = 0.04). Neither restlessness nor impulsivity predicted in-patient suicide. Conclusions Suicidal ideation, unfavourable clinical course and the use of multiple psychotropic substances (reflecting the severity of illness) were strong determinants of railway suicides. The most salient finding was the vital impact of a change of therapist. These findings deserve integration into the clinical management of patients with serious mental disease