Screening for Generalized Anxiety Disorder in inpatient psychosomatic rehabilitation: pathological worry and the impact of depressive symptoms

Objective: Pathological worry is considered to be a defining feature for Generalized Anxiety Disorder (GAD). The Penn State Worry Questionnaire (PSWQ) is an instrument for assessing pathological worry. Two earlier studies demonstrated the suitability of the PSWQ as screening instrument for GAD in outpatient and non-clinical samples. This study examined the suitability of the PSWQ as a screening instrument for GAD in a German inpatient sample (N=237). Furthermore, a comparison of patients with GAD and patients with depression and other anxiety disorders regarding pathological worry and depression was carried out in a sub-sample of N=118 patients

Astro2020 APC White Paper. 2020 Vision: Towards a Sustainable OIR System

Open-access telescopes of all apertures are needed to operate a competitive and efficient national science program. While larger facilities contribute light-gathering power and angular resolution, smaller ones dominate for field of view, time-resolution, and especially, total available observing time, thereby enabling our entire, diversely-expert community. Smaller aperture telescopes therefore play a critical and indispensable role in advancing science. Thus, the divestment of NSF support for modest-aperture (1 – 4 m) public telescopes poses a serious threat to U.S. scientific leadership, which is compounded by the unknown consequences of the shift from observations driven by individual investigators to survey-driven science. Given the much higher cost efficiency and dramatic science returns for investments in modest aperture telescopes, it is hard to justify funding only the most expensive facilities. We therefore urge the Astro2020 panel to explicitly make the case for modest aperture facilities, and to recommend enhancing this funding stream to support and grow this critical component of the OIR System. Further study is urgently needed to prioritize the numerous exciting potential capabilities of smaller facilities,and to establish sustainable, long-term planning for the System

Scaling relations of metallicity, stellar mass, and star formation rate in metal-poor starbursts: I. A fundamental plane

Most galaxies follow well-defined scaling relations of metallicity (O/H), star formation rate (SFR), and stellar mass. However, low-metallicity starbursts, rare in the Local Universe but more common at high redshift, deviate significantly from these scaling relations. On the "main sequence" of star formation, these galaxies have high SFR for a given M*; and on the mass-metallicity relation, they have excess M* for their low metallicity. In this paper, we characterize O/H, M*, and SFR for these deviant "low-metallicity starbursts", selected from a sample of ~1100 galaxies, spanning almost two orders of magnitude in metal abundance, a factor of ~10^6 in SFR, and of ~10^5 in stellar mass. Our sample includes quiescent star-forming galaxies and blue compact dwarfs at redshift 0, luminous compact galaxies at redshift 0.3, and Lyman Break galaxies at redshifts 1-3.4. Applying a Principal Component Analysis (PCA) to the galaxies in our sample with M*<10^{10} Msun gives a Fundamental Plane (FP) of scaling relations; SFR and stellar mass define the plane itself, and O/H its thickness. The dispersion for our sample in the edge-on view of the plane is 0.17 dex, independently of redshift and including the metal-poor starbursts. The same FP is followed by 55100 galaxies selected from the Sloan Digital Sky Survey, with a dispersion of 0.06dex. In a companion paper, we develop multi-phase chemical evolution models that successfully predict the observed scaling relations and the FP; the deviations from the main scaling relations are caused by a different (starburst or "active") mode of star formation. These scaling relations do not truly evolve, but rather are defined by the different galaxy populations dominant at different cosmological epochs.Comment: 14 pages, 7 figures, accepted for publication by MNRA

Scaling relations of metallicity, stellar mass, and star formation rate in metal-poor starbursts: II. Theoretical models

Scaling relations of metallicity (O/H), star formation rate (SFR), and stellar mass give important insight on galaxy evolution. They are obeyed by most galaxies in the Local Universe and also at high redshift. In a companion paper, we compiled a sample of ~1100 galaxies from redshift 0 to ~3, spanning almost two orders of magnitude in metal abundance, a factor of $\sim10^6$ in SFR, and of ~10^5 in stellar mass. We have characterized empirically the star-formation "main sequence" (SFMS) and the mass-metallicity relation (MZR) for this sample, and also identified a class of low-metallicity starbursts, rare locally but more common in the distant universe. These galaxies deviate significantly from the main scaling relations, with high SFR and low metal content for a given M*. In this paper, we model the scaling relations and explain these deviations from them with a set of multi-phase chemical evolution models based on the idea that, independently of redshift, initial physical conditions in a galaxy's evolutionary history can dictate its location in the scaling relations. Our models are able to successfully reproduce the O/H, M*, and SFR scaling relations up to z~3, and also successfully predict the molecular cloud fraction as a function of stellar mass. These results suggest that the scaling relations are defined by different modes of star formation: an "active" starburst mode, more common at high redshift, and a quiescent "passive" mode that is predominant locally and governs the main trends.Comment: 17 pages, 7 figures, accepted for publication by MNRA

Impact, evaluation and modification of interpersonal problem patterns in psychotherapy research : a study with the Inventory of Interpersonal Problems

Diese Arbeit beschäftigt sich mit der Erfassung interpersonaler Probleme und deren Veränderung in unterschiedlichen Kontexten der ambulanten und stationären Psychotherapie. Interpersonale Probleme wurden mit dem Inventar zur Erfassung interpersonaler Probleme (IIP-D; Horowitz et al., 2000) untersucht. Anhand vier empirischer Studien konnte gezeigt werden, dass sich mittels Auswertungsstrategien für Circumplex-Daten (vgl. Gurtman, 1994; Wright et al., 2009) und clusteranalytischer Verfahren Subtypen interpersonaler Problemmuster ermitteln lassen. In einer ersten Studie konnten interpersonale Subtypen in einer diagnostisch homogenen Stichprobe von N=78 Patienten mit der Primärdiagnose der Generalisierten Angststörung nachgewiesen werden. In einer zweiten Studie wurde darüber hinaus gezeigt, dass sich interpersonale Subtypen in einer diagnostisch homogenen Stichprobe von N=52 Patienten mit Generalisierter Angststörung hinsichtlich der Veränderung ihrer globalen interpersonalen Problembelastung nach ambulanter Kurzzeitbehandlung unterschieden. In einer dritten Studie konnte demonstriert werden, dass die Auswertung interpersonaler Probleme basierend auf interpersonalen Subtypen auch in einer diagnostisch heterogenen Stichprobe von N=2809 stationär behandelten Patienten klinisch relevante Informationen liefert. Die Veränderungen interpersonaler Probleme unterschieden sich erneut zwischen den Subtypen, also in Abhängigkeit vom vorherrschenden interpersonalen Schwerpunktthema. Auch zeigte sich, dass die interpersonalen Subtypen hinsichtlich des allgemeinen Therapie-Outcomes unterschiedlich profitierten. In einer vierten Studie schließlich wurden interpersonale Subtypen bei N=121 Patienten untersucht, die mit Psychoanalytischer Psychotherapie behandelt wurden. Bei den Analytischen Langzeitbehandlungen fanden sich in dieser naturalistischen Therapiestudie große Effekte im Bereich interpersonaler Probleme durchgängig für alle Problemmuster. Die verschiedenen, mittels des IIP erfassbaren interpersonalen Problemmuster sind in klinischen Stichproben unterschiedlich häufig vertreten. Diese Subtypen unterscheiden sich in Qualität und Ausmaß interpersonaler Probleme und der interpersonalen Flexibilität sowie hinsichtlich der Veränderung ihrer interpersonalen Probleme. Die Ergebnisse unterstützen die Befunde früherer Arbeiten, in denen interpersonale Subtypen in diagnostisch homogenen Stichproben bei Patienten mit Generalisierter Angststörung (Kasoff & Pincus, 2002) und mit Sozialer Phobie (Kachin et al., 2001) bereits nachgewiesen wurden. Der Nachweis interpersonaler Subtypen demonstriert auch die Grenzen klassifikatorischer Diagnostik nach ICD (Dilling et al., 2008) oder DSM (Sass et al., 2000), da hier der interpersonalen Stil eines Patienten nicht berücksichtigt wird. Mit der vorgestellten Auswertungsstrategie kann das volle Potential des IIP für Gruppendaten erst nutzbar gemacht werden. Wie die berichteten Ergebnisse zeigen, stellt die Auswertung auf der Ebene von interpersonalen Subtypen einen Schlüssel zum besseren Verständnis von interindividuellen Unterschieden im Outcome sowohl hinsichtlich der Verbesserung von interpersonalem Distress als auch der psychischen Gesamtbelastung dar. Werden zwischenmenschliche Schwierigkeiten und der interpersonale Stil von Patienten in der Psychotherapieforschung adäquat berücksichtigt, können aussagekräftigere Daten mit mehr klinischer Relevanz generiert werden

Interindividual Differences in Treatment Effects Based on Structural Equation Models with Latent Variables: An EffectLiteR Tutorial

Mayer A, Zimmermann J, Hoyer J, et al. Interindividual Differences in Treatment Effects Based on Structural Equation Models with Latent Variables: An EffectLiteR Tutorial. Structural Equation Modeling: A Multidisciplinary Journal. 2020;27(5):798-816.The investigation of interindividual differences in the effects of a treatment is challenging, because many constructs-of-interest in psychological research such as depression or anxiety are latent variables and modeling heterogeneity in treatment effects requires interactions and potentially non-linear relationships. In this paper, we present a tutorial of the EffectLiteR approach that allows for estimating individual treatment effects based on latent variable models. We describe step by step how to apply the approach using the EffectLiteR software package with data from the multicenter randomized controlled trial of the Social Phobia Psychotherapy Network (SOPHO-NET) and provide guidelines and recommendations for researchers. The focus of the paper is on explaining the results of a comprehensive effect analysis in an accessible language and on highlighting the opportunities the EffectLiteR approach offers for analyzing interindividual differences in treatment effects

Reduced amygdalar and hippocampal size in adults with generalized social phobia

BACKGROUND: Structural and functional brain imaging studies suggest abnormalities of the amygdala and hippocampus in posttraumatic stress disorder and major depressive disorder. However, structural brain imaging studies in social phobia are lacking. METHODS: In total, 24 patients with generalized social phobia (GSP) and 24 healthy controls underwent 3-dimensional structural magnetic resonance imaging of the amygdala and hippocampus and a clinical investigation. RESULTS: Compared with controls, GSP patients had significantly reduced amygdalar (13%) and hippocampal (8%) size. The reduction in the size of the amygdala was statistically significant for men but not women. Smaller right-sided hippocampal volumes of GSP patients were significantly related to stronger disorder severity. LIMITATIONS: Our sample included only patients with the generalized subtype of social phobia. Because we excluded patients with comorbid depression, our sample may not be representative. CONCLUSION: We report for the first time volumetric results in patients with GSP. Future assessment of these patients will clarify whether these changes are reversed after successful treatment and whether they predict treatment response

Borderline personality disorder – a comprehensive review of diagnosis and clinical presentation, etiology, management, and current controversies

Borderline personality disorder (BPD) was introduced in the DSM-III in 1980. From the DSM-III to the DSM-5, no major changes have occurred in its defining criteria. The disorder is characterized by instability of self-image, interpersonal relationships and affects. Further symptoms include impulsivity, intense anger, feelings of emptiness, strong abandonment fears, suicidal or self-mutilation behavior, and transient stress-related paranoid ideation or severe dissociative symptoms. There is evidence that BPD can be reliably diagnosed and differentiated from other mental disorders by semi-structured interviews. The disorder is associated with considerable functional impairment, intensive treatment utilization, and high societal costs. The risk of self-mutilation and suicide is high. In the general adult population, the lifetime prevalence of BPD has been reported to be from 0.7 to 2.7%, while its prevalence is about 10% in outpatient and 20% in inpatient psychiatric services. BPD is significantly associated with other mental disorders, including depressive disorders, substance use disorders, post-traumatic stress disorder, attention-deficit/hyperactivity disorder, bipolar disorder, bulimia nervosa, and other personality disorders. There is convincing evidence to suggest that the interaction between genetic factors and adverse childhood experiences plays a central role in the etiology of BPD. In spite of considerable research, the neurobiological underpinnings of the disorder remain to be clarified. Psychotherapy is the treatment of choice for BPD. Various techniques have been validated in randomized controlled trials (RCTs), including dialectical behavior therapy, mentalization-based therapy, transference-focused therapy, and schema therapy. No technique has proved to be superior to others. Compared to treatment as usual, psychotherapy has proved to be more efficacious, with effect sizes between 0.50 and 0.65 with regard to core BPD symptom severity. However, almost half of the patients do not respond sufficiently to psychotherapy, and further research in this area is warranted. It is not clear whether some patients may benefit more from one psychotherapeutic technique than from others. No evidence is available consistently showing that any psychoactive medication is efficacious for the core features of BPD. For discrete and severe comorbid anxiety or depressive symptoms or psychotic-like features, pharmacotherapy may be useful. Early diagnosis and treatment of BPD can reduce individual suffering and societal costs. However, more high-quality studies are required, in both adolescents and adults. This review provides a comprehensive update of the BPD diagnosis and clinical characterization, risk factors, neurobiology, cognition, and management. It also discusses the current controversies concerning the disorder, and highlights the areas in which further research is needed

WIFA-k: Ein neues Messinstrument zur zeitökonomischen Erfassung allgemeiner Wirkfaktoren nach Grawe

Research on common and differential factors in the therapeutic process is impeded by the lack of instruments suitable for assessing common change mechanisms. This study presents the psychometric properties of a newly developed time-economic instrument (WIFA-k), which was designed to assess common factors of psychotherapy as designed by Grawe. Within a multi-center study comparing the efficacy of cognitive therapy and psychodynamic therapy in the treatment of social phobia, 6 raters assessed 25 randomly selected, videotaped therapy sessions of each treatment approach, and evaluated common factors using the Wifa-k. Interrater-reliability was found to be high for the items "resource activation", "motivational clarification" and "mastery" and low for the items "therapeutic relationship" and "problem activation". Ways to increase reliability and validity of the scale are discussed