Search Results (553)

Introduction: Sex-specific differences in psychopharmacological treatment have gained increasing attention in adults, with studies showing that women often have higher serum concentrations of psychotropic drugs due to biological differences. However, despite recognition of these differences in adults, reference ranges for therapeutic drug monitoring (TDM) in general, but even more sex-specific therapeutic windows for psychotropic drugs, are lacking in children and adolescents, who may metabolize and respond to medications differently. Aim: The study aimed to investigate sex-specific differences in antidepressant (AD) and antipsychotic (AP) -treatment outcomes, and pharmacokinetics in childhood/adolescence. In particular, we examined differences in AD and AP serum levels and clinical effects, including adverse drug effects (ADEs) and therapeutic effectiveness. Methods: This study is part of the multicenter “TDM-VIGIL” pharmacovigilance project, which prospectively followed patients aged 6–18 years treated with AD and AP across 18 child psychiatric centers in German-speaking countries from 2014 to 2018. Clinical data, including drug concentrations (AD: fluoxetine, mirtazapine, (es)citalopram, sertraline; AP: aripiprazole, quetiapine, olanzapine, risperidone), were collected using an internet-based registry, and treatment outcomes and ADEs were assessed during routine visits. Statistical analyses were performed to examine sex differences in pharmacokinetics and clinical responses, adjusting for age, weight, and other confounders. Results: A total of 705 patients (66.5% girls, 24.7% <14 years, mean age of 14.6 years) were included. Female patients were slightly older, had lower body weight, and were more often diagnosed with depression and anorexia nervosa, while boys were more frequently diagnosed with hyperkinetic disorders and atypical autism. We found no sex differences in the serum concentrations of investigated drugs when adjusted for age and weight. In fluoxetine treatment in patients diagnosed with mood (affective) disorders, female sex was associated with the probability for very good therapy response (p = 0.04), as well as with moderate treatment response (p = 0.02) compared to no treatment response. Discussion: Our findings suggest that sex may not affect serum levels of investigated AD and AP in children/adolescents. However, treatment outcome of fluoxetine was associated with sex, with higher probability for a better outcome in female patients diagnosed with mood (affective) disorders. Full article

Attentional biases seem to play an important role in anorexia nervosa (AN). The objective of this study was to measure visual attention patterns toward female bodies in adolescents and adults with and without AN in order to explore developmental and disease-specific aspects. Female adult and adolescent patients with AN (n = 38) and control participants (n = 39) viewed standardized photographic stimuli showing women’s bodies from five BMI categories. The fixation times on the bodies and specific body parts were analyzed. Differences between participants with and without AN did not emerge: All participants showed increased attention toward the body, while adolescents displayed shorter fixation times on specific areas of the body than adults. Increased visual attention toward areas indicative of weight (e.g., hips, thighs, abdomen, buttocks) and a shorter fixation time on unclothed body parts were observed in all participants. There is evidence for the developmental effect of differential viewing patterns when looking at women’s bodies. The attention behavior of patients with AN seems to be similar to that of the control groups, which is partly consistent with, and partly contradictory to, previous studies. Full article

Background/Objectives: Pathological vertebral fragility (path-VF) increases the risk of osteoporotic fractures and pedicle screw loosening (PSL) after posterior instrumented spinal fusion (PISF). While WHO body mass index (BMI) categories broadly identify risks related to underweight and obesity, fixed thresholds may inadequately reflect vertebral fragility risks among elderly patients, especially within the normal-weight range. This study investigates whether current BMI classifications sufficiently capture the risk of path-VF in older adults. Methods: This retrospective study included 225 patients who underwent kyphoplasty or PISF (2022–2023). Path-VF was defined by non-tumorous fractures, screw reinforcement, or PSL within six months without prior reinforcement. Patients were grouped into the path-VF (n = 94) and control (n = 131) groups. HU and BMI values, BMI-related ORs, and age trends were analysed, and a logistic regression was performed. Results: Mean HU values were significantly lower in the path-VF group (71.37 ± 30.50) than in controls (130.35 ± 52.53, p < 0.001). Path-VF females (26.26 ± 5.38) had a lower BMI than the control females (29.33 ± 5.98, p = 0.002); no difference was found in males. Normal-weight females showed a borderline risk for path-VF (OR 2.03, p = 0.0495). Obesity (OR_male 0.31/OR_female 0.37) and being male and overweight (OR 0.21) were protective (all p < 0.05). BMI declined with age in path-VF males (p = 0.001) but increased in the controls (p = 0.023). A logistic regression identified a BMI < 22.5 kg/m² and age > 67.5 years as significant risk thresholds. Notably, 20.2% of path-VF patients over 67.5 had a normal weight, suggesting a potentially overlooked subgroup. Conclusions: The current WHO lower limit for normal BMI (18.5 kg/m²) may underestimate the risk of path-VF in patients older than 67.5 years, potentially overlooking 24.7% of cases. The results offer a new approach for clinicians to interpret BMI values at the lower end of the normal range (<22.5 kg/m²) with caution in elderly patients undergoing spinal surgery. Full article

Our four-year interdisciplinary behavioral weight loss program is fully covered by public health insurance for patients with a body mass index of ≥35 kg/m². We evaluated the real-world outcomes of anthropometric, metabolic and psychologic parameters collected prior to the start (t₀, n = 381, 71% women) and after each segment of the program (t_1–4, n = 243, 126, 94, and 77). It is a prospective evaluation of clinical real-world data including all patients who started the first segment of behavioral treatment until they quit/finished the program. The mean dropout rates per treatment segment were 23%. Body weight after one year decreased from 127.3 kg to 122.2 (p < 0.001). Average hemoglobin A1c value decreased from 5.8% to 5.6% in all patients (p < 0.001) and from 6.6% to 6.2% in patients with type 2 diabetes (p < 0.001). Further metabolic and psychological parameters improved significantly as well. The average weight nadir was reached after two segments, co-occurring with the most beneficial changes in laboratory parameters. Afterwards, mean weight slightly increased accompanied by a discrete loss of benefits in laboratory parameters. Our real-world data with significant health improvements adds important value to discussions about the funding of obesity therapy and thus has the chance to improve therapy availability for obesity patients worldwide. Full article

Biomonitoring often yields normal results in patients who report environmental sensitivities, such as in multiple chemical sensitivity. This study examined whether biomonitoring results influence disease attribution and perception. Patients over 18 presenting for the first time to the University Environmental Medicine Outpatient Clinic in Freiburg with suspected complaints linked to heavy metals, wood preservatives, pesticides, solvents, or mold spores were included. Illness perceptions were assessed before and after biomonitoring using the Illness Perception Questionnaire (IPQ-R). Of 358 patients, 51 met inclusion criteria; 3 showed relevant findings, and 15 did not attribute their symptoms to environmental causes at baseline. The remaining 33 patients were analyzed. After receiving a normal biomonitoring result, only seven patients (21%) altered their illness attribution. These individuals also reported milder perceived consequences, less personal control over the illness, and showed lower levels of somatization and compulsiveness than those who maintained their original attribution. Most patients remained convinced of an environmental cause despite unremarkable findings. This suggests that a substantial subset of patients is strongly attached to an environmental explanation for their symptoms, with stable attribution linked to higher psychological symptom burden and a belief in personal control over the illness. Full article

Pre-eclampsia (PE) is a hypertensive pregnancy complication. Oxidative stress is hypothesized to contribute to the pathophysiology of PE. Both the hydrogen sulfide (H₂S) and oxytocin (OT) systems might play a role in the pathophysiology of PE, like their antioxidant and hypotensive effects. Thus, the role of the interaction of the OT and H₂S systems in the context of PE was further elucidated in the present clinical case–control study “NU-HOPE” (Nürnberg-Ulm: The role of H₂S and Oxytocin Receptor in Pre-Eclampsia; ethical approval by the Landesärztekammer Bayern, file number 19033, 29 August 2019), comparing uncomplicated pregnancies, early onset PE (ePE, onset < 34 weeks gestational age) and late onset PE (lPE, onset > 34 weeks gestational age). Routine clinical data, serum H₂S and homocysteine levels, and tissue protein expression, as well as nitrotyrosine formation, were determined. The main findings were (i) unchanged plasma sulfide levels, (ii) significantly elevated homocysteine levels in ePE, but not lPE, (iii) significantly elevated expression of H₂S enzymes and OT receptor in the placenta in lPE, and (iv) significantly elevated nitrotyrosine formation in the lPE myometrium. Taken together, these findings suggest a role for the interaction of the endogenous H₂S- and OT/OTR systems in the pathophysiology of pre-eclampsia, possibly linked to impaired antioxidant protection. Full article

Introduction: The usefulness of neuroimaging in patients with first-episode psychosis (FEP) remains controversial. The aim of this study was to assess the prevalence and types of structural abnormalities on neuroimaging in patients with FEP and identify the most frequently used imaging modalities in a real-world setting. Methodology: A retrospective observational study based on a consecutive series of patients admitted to our institution with FEP was conducted. We analyzed the imaging tests performed, the presence of specific lesions, the degree of cortical atrophy (Global Cortical Atrophy, GCA scale), medial temporal atrophy (Medial Temporal lobe Atrophy, MTA scale) and non-specific white matter lesions (Fazekas scale). Descriptive and bivariate analyses were performed according to previously established age cut-offs. Results: A total of 105 patients were included (median age: 36 years; 52.4% men). The most frequently used neuroimaging test was computed tomography (CT) (92.4%). GCA scores that were out of the age range were found in 32.4% of patients, being more frequent in those older than 65 years (p < 0.001). Out-of-range MTA scores were found in 36.2% of patients, especially in patients older than 75 years (p < 0.001). Out-of-range Fazekas scores were found in 4.3% of patients, especially in patients older than 70 years (p = 0.157). Finally, only one specific structural lesion (right frontal cavernoma) was identified in one patient (1%). Overall, at least one non-age-matched abnormality was found in 46.7% of patients. Conclusions: Although non-specific alterations not in accordance with age exist in a significant percentage of patients with FEP, the prevalence of specific lesions is very low. This suggests that neuroimaging tests could be restricted in patients with FEP, especially CT, due to the risks associated with ionizing radiation. However, further prospective and controlled studies are needed to validate our results. Full article

Bidirectionality between insomnia and depression is well documented in general and clinical populations but remains under-researched in family caregivers of people with dementia. This study aimed to explore this relationship using a longitudinal design with 155 family caregivers assessed annually over three years. Data collected included sociodemographic information, health behaviors, medical data, caregiving stressors, and depressive and insomnia symptoms. Two linear mixed models were tested: Model 1 considered insomnia symptoms as the independent variable and depressive symptoms as the outcome; Model 2 considered depressive symptoms as the independent variable and insomnia symptoms as the outcome. The results showed that caregivers with more insomnia symptoms over time had significantly higher depressive symptoms, even after adjusting for covariates. Insomnia accounted for an additional 7.47% of the variance, with a total explained variance of 57.93%. Conversely, higher depressive symptoms over time were associated with increased insomnia. Depressive symptoms explained an additional 7.28% of the variance, with a total explained variance of 25.74%. These results were consistent with previous studies on non-caregiving populations, adding empirical evidence to the notion that both insomnia and depression may operate as a risk factor for the other disorder. Caregiver support interventions could improve their psychological well-being if they incorporate sleep-focused strategies. Full article

Background: Stress, anxiety and depression are phenomena that often accompany the onset of chronic illness. The development of psychosomatic medicine has led to the study of the influence of other emotional factors, including the presence of anxiety and depression, on a patient’s health status, in addition to quality of life. The aim of this study is to evaluate the relationship between vascular access function and the occurrence of stress, anxiety and depression in haemodialysis patients. Methods: A total of 202 haemodialysis patients were included in the analysis, and the severity of vascular access problems and levels of negative emotions (feelings of stress, anxiety, depression) were assessed using standardised questionnaires (VAQ, HADS-M, PSS-10). Results: The results show that an increase in vascular access function problems correlated with increased levels of stress (r = 0.262; p < 0.001), anxiety (r = 0.456; p < 0.001) and depression (r = 0.391; p < 0.001). Conclusions: The study confirms the significant impact of vascular access quality on patients’ emotional state, highlighting the need to monitor and optimise its functioning to improve the psychological well-being of dialysis patients. Full article

Background: Psychological impacts of the coronavirus disease 2019 (COVID-19) pandemic on individuals with chronic medical conditions remain understudied. Chronic kidney disease (CKD) is one of the chronic conditions associated with an increased risk of severe COVID-19 outcomes. The aim of this study was to define the psychological burden of individuals with CKD during the COVID-19 pandemic. Methods: In this cross-sectional study, 219 individuals with CKD were recruited from the Nephrology Outpatient Unit at the University Hospital Essen, Germany, and completed anonymous surveys incorporating validated psychological assessment tools for generalized anxiety (GAD-7) and depressive symptoms (PHQ-2), along with self-generated items addressing COVID-19-specific concerns and behavioral changes. These participants were propensity score matched with controls from the general German population. Results: Individuals with CKD exhibited lower levels of generalized anxiety and depressive symptoms compared to the general population. However, they reported significantly greater risk perceptions regarding the likelihood of experiencing symptoms, a severe disease course, and death from COVID-19. COVID-19-related fear and associated behavioral changes were more frequently reported among CKD patients. Adherent and dysfunctional safety behaviors predominated among the CKD cohort. Conclusions: This study underscores psychological challenges faced by individuals with CKD during the COVID-19 pandemic. The increased risk perceptions and fears of severe disease and mortality from COVID-19 emphasize the need for mental health interventions aimed at improving coping strategies alongside physical health management in this vulnerable population. Full article

The bilateral interaction between the brain and the gut has recently been on the spectrum of researchers’ interests, including complex neural, endocrinological, and immunological signaling pathways. The first case reports and clinical studies have already reported that delivering microbes through fecal microbial transplantation (FMT) may alleviate symptoms of psychiatric disorders. Therefore, modifying the gut microbiota through FMT holds promise as a potential treatment for psychiatric diseases. This scoping review assessed studies from PubMed related to FMT in autism spectrum disorder and attention deficit hyperactivity disorder. The evaluation included nine clinical studies and case reports. The beneficial and persistent effect on the autism spectrum disorder (ASD) symptoms has been reported. Also, an increased microflora diversity and altered levels of neurometabolites in serum were identified, albeit with a tendency to return to baseline over time. The microbiome–gut–brain axis could provide new targets for preventing and treating psychiatric disorders. However, a recent large randomized clinical trial has shed light on the previously collected data and suggested a possible contribution of the placebo effect. This highlights the necessity of large randomized double-blind studies to reliably assess the effect of FMT in ASD. Full article

Background/Objectives: Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a debilitating condition with not fully understood causes, though evidence points to immune system involvement and possible autoimmunity. ME/CFS could be triggered by various infectious pathogens, like SARS-CoV-2; furthermore, a subset of the post-COVID-19 condition (PCC) patients fulfill the diagnostic criteria of ME/CFS. According to the Canadian Consensus Criteria (CCC), the presence of specific symptoms such as fatigue, post-exertional malaise, sleep dysfunction, pain, neurological/cognitive manifestations, and symptoms from at least two of the following categories lead to the diagnosis of ME/CFS: autonomic, neuroendocrine, and immune manifestation. In this study, the patient selection was based on the identification of ME/CFS patients with elevated autoantibodies, regardless of the triggering factor of their condition. Methods: The aim of this study was to identify ME/CFS patients among long COVID patients with elevated autoantibodies. In seven cases, plasmapheresis (PE) and intravenous immunoglobulins (IVIGs) with repetitive autoantibody measurements were applied: four PE sessions on days 1, 5, 30, and 60, and a low-dose IVIG therapy after each treatment. Antibodies were measured before the first PE and two weeks after the last PE session. To monitor clinical outcomes, the following somatic and psychometric follow-up assessments were conducted before the first PE, 2 weeks after the second, and 2 weeks after the last PE: the Schellong test, ISI (insomnia), FSS (fatigue), HADS (depression and anxiety), and EQ-5D-5L (quality of life) questionnaires. Results: There was a negative association between both the β2-adrenergic and M3-muscarinic receptor autoantibody concentration and the quality of life measurements assessed with the EQ-5D-5L questionnaire. Per 1 U/mL increase in the concentration levels of β2-adrenergic receptor antibodies or M3-muscarinic acetylcholine receptor antibodies, the EQ-5D-5L index score [−0.59 to 1] decreased by 0.01 (0.63%) or 0.02 (1.26%), respectively. There were no significant associations between the ISI, HADS, and FSS questionnaires and the β1-adrenergic and M4-muscarinic receptor antibodies titers. Conclusions: After a thorough selection of patients with present autoantibodies, this pilot study found negative associations concerning autoantibody concentration and somatic, as well as psychological wellbeing. To validate these promising feasibility study results—indicating the potential therapeutic potential of antibody-lowering methods—further investigation with larger sample sizes is needed. Full article

Background: Biofeedback (BFB) has long been a successful treatment for various mental health disorders. The purpose of this scoping review is to investigate the implementation of BFB in inpatient treatment concepts for the therapy of mental health disorders. Methods: Through a systematic search via Medline, PubMed, and the Web of Science, as well as a manual search in Google Scholar and reference lists, relevant articles published up to 30 December 2024 were identified. Studies were included if they focused on BFB interventions to treat mental health disorders in inpatient settings and were published in English or German. Studies were assessed by two independent raters, and key information was summarized in a shared document. Results: This scoping review analyzed 20 articles published between 1979 and 2022, examining BFB in inpatient settings for various mental health disorders, i.e., obsessive–compulsive disorder, depression, anxiety, substance use disorders, schizophrenia, and eating disorders. Positive outcomes were observed in symptoms, stress reduction, and improvements in cardiac autonomic and motor functions. The duration and frequency of the sessions varied widely, and different methodologies were used across studies, including controlled sessions and self-administered exercises. Conclusions: Most BFB inpatient studies showed positive effects on clinical symptoms. There was a broad heterogeneity of the studies. Comparisons are limited, making it challenging to give general recommendations for BFB implementation. The issue remains whether a methodologically consistent approach is necessary for clinical success. Full article

Background: Cancer-related neuropathic pain (CR-NP) is challenging to manage, and the effectiveness of corticosteroids remains underexplored. Objectives: This study investigated the analgesic and functional benefits of corticosteroids in CR-NP. Methods: This multicenter, prospective observational study enrolled patients with CR-NP who initiated or escalated corticosteroid therapy. Pain intensity and daily activities were assessed at baseline (T0), 72 (T1), and 168 h (T2). A paired-sample t-test compared pain intensity changes. Linear regression analysis examined the association between changes in opioid daily dose and pain intensity, while Pearson’s correlation coefficient assessed the relationship between changes in daily activities and pain intensity. Results: In total, 107 patients were consecutively enrolled. The mean worst pain intensity decreased from 8.2 ± 1.9 at T0 to 5.2 ± 2.9 at T1 and further to 4.4 ± 3.0 at T2. No significant correlation was found between changes in opioid daily dose and pain intensity. However, daily activities improved significantly in correlation with pain reduction (r = −0.36, p < 0.01). Over 75% of patients reported satisfaction with CR-NP management. Adverse events occurred in 21 cases and were generally mild. Conclusions: Corticosteroids provided rapid and considerable analgesic and functional benefits for patients with CR-NP in this observational setting; further validation through comparative controlled studies is required. Full article

Background/Objectives: Burnout is a highly prevalent issue among physicians. Recent research has indicated that personality traits, such as narcissism, may influence the development of burnout. This study investigates the relationship between the threatened self (TS) narcissism subscale and burnout in male physicians. Methods: We analyzed data from 60 male physicians in Switzerland, divided into burnout (n = 30) and control (n = 30) groups. Male physicians in Switzerland were recruited via hospitals, clinics, medical associations, professional journals, and direct email outreach. We assessed participants using the Maslach burnout inventory (MBI-HSS) and the Narcissism Inventory (NI-20). A generalized linear model (GLM) was used for the statistical analysis. Results: The results showed that lower TS scores were significantly associated with a reduced likelihood of burnout, suggesting that self-esteem instability and emotional vulnerability, characteristic of TS, may act as risk factors for burnout. Furthermore, we found that Effort–Reward Imbalance (ERI) was significantly associated with burnout. Conclusions: These findings highlight the importance of considering personality traits such as TS in burnout research and could be explored in further studies. In clinical practice, increasing therapists’ awareness of TS may support more targeted interventions and help prevent the onset of burnout. Full article