GABA immunostaining in the central complex of dicondylian insects.

The central complex is a group of midline-crossing neuropils in the insect brain involved in head direction coding, sky compass navigation, and spatial visual memory. To compare the neuroarchitecture and neurochemistry of the central complex in insects that differ in locomotion, ways of orientation, time of activity (diurnal, nocturnal), and evolutionary history, we studied the distribution of γ-aminobutyric acid (GABA) immunostaining in the central complex of 29 species, ranging from Zygentoma to Diptera. In all species, the lower division of the central body was densely innervated by GABA-immunoreactive tangential neurons. These neurons had additional arborizations in the bulb, a distinct region of synaptic complexes in the lateral complex, and somata in a cell cluster mediodorsally to the antennal lobe. Differences in the appearance of GABA immunostaining in the lower division of the central body corresponded to differences in neuropil architecture, such as transformation of the lower division into a toroid in certain Diptera and Heteroptera. In nearly all species two additional systems of tangential neuron of the upper division of the central body were GABA-immunoreactive. One of these systems diffusely invaded a superior layer, while the second system showed fan-like projections in an inferior layer. Sparse immunostaining in the protocerebral bridge was detected in cockroaches, a cricket, and two hemipteran species. The data show that three systems of GABA-immunoreactive tangential neurons of the central body are highly conserved and suggest that the layered organization of the upper division of the central body is, likewise, largely maintained from basal to advanced species.

[Effectiveness of CBT on Unemployed Compared to Employed Individuals Suffering from Prevalent Mental Disorders - A Naturalistic Study]. / Effektivität von kognitiver Verhaltenstherapie bei arbeitslosen und erwerbstätigen Patienten mit prävalenten psychischen Störungen ­ Eine naturalistische Studie.

Background Unemployed individuals suffer more from mental strain than those who have jobs. Up until now, little information could be found regarding the effectiveness of cognitive behavioral therapy (CBT) for unemployed people with mental disorders. The aim of this study was to compare the impact of CBT on employed versus unemployed individuals in a naturalistic setting. Methods 92 outpatients with prevalent mental disorders (depression and anxiety) were matched post-hoc and assessed pre-treatment, post-treatment, and at follow-up. Results Unemployed individuals were more impaired at all assessment points. The multi-level analysis showed that both groups benefited equally. Moderate-to-large effect sizes were found in both groups. At follow-up-assessment, one third of the unemployed sample and one-fifth of those with jobs were classified as unimpaired. The job integration rate was 26%. Discussion The effect sizes indicate that CBT is beneficial for both groups. However, unemployed participants were as impaired at post-treatment as the employed were at pre-treatment. The job integration rate of 26% was comparable to the general integration rate in Germany (25%), although no work-focused interventions were carried out during the adjustment period. Conclusions CBT is effective for unemployed individuals, but because the unemployed participants were still more impaired at post-treatment, they might have a higher risk of relapse.

Population-based cost-offset analyses for disorder-specific treatment of anorexia nervosa and bulimia nervosa in Germany.

Previous research has shown that anorexia nervosa (AN) and bulimia nervosa (BN) are expensive illnesses to treat. To reduce their economic burden, adequate interventions need to be established. Our objective was to conduct cost-offset analyses for evidence-based treatment of eating disorders using outcome data from a psychotherapy trial involving cognitive behavioral therapy (CBT) and focal psychodynamic therapy (FPT) for AN and a trial involving CBT for BN. Assuming a currently running, ideal healthcare system using a 12-month, prevalence-based approach and varying the willingness to participate in treatment, we investigated whether the potential financial benefits of AN- and BN-related treatment outweigh the therapy costs at the population level. We elaborated on a formula that allows calculating cost-benefit relationships whereby the calculation of the parameters is based on estimates from data of health institutions within the German healthcare system. Additional intangible benefits were calculated with the aid of Quality-Adjusted Life Years. The annual costs of an untreated eating disorder were 2.38 billion EUR for AN and 617.69 million EUR for BN. Independent of the willingness to participate in treatment, the cost-benefit relationships for the treatment remained constant at 2.51 (CBT) and 2.33 (FPT) for AN and 4.05 (CBT) for BN. This consistency implies that for each EUR invested in the treatment, between 2.33 and 4.05 EUR could be saved each year. Our findings suggest that the implementation of evidence-based psychotherapy treatments for AN and BN may achieve substantial cost savings at the population level.

Health care costs of borderline personality disorder and matched controls with major depressive disorder: a comparative study based on anonymized claims data.

BACKGROUND: Borderline personality disorder (BPD) and major depressive disorder (MDD) pose a significant burden to the German health care system in terms of direct and indirect costs. The aim of this study was to determine the incremental costs that arise due to the treatment of patients with BPD, in relation to MDD patients adjusted for gender and age. METHODS: Insured persons who suffered from BPD (F60.3; N = 6599) or MDD (F32, F33; N = 26,396) in the year 2010 were identified from the German Health Risk Institute research database. To estimate the costs resulting from disorder-specific health care service utilization and the mean total costs per patient for the health care system, we analyzed anonymized claims data of individuals with BPD and matched individuals with MDD. RESULTS: The costs resulting from disorder-specific health care service utilization 1 year after index diagnosis amounted to 8508 EUR for BPD and 8281 EUR for MDD per patient utilizing services. With mean total annual costs per patient of 4636 EUR versus 2020 EUR 1 year preceding index diagnosis, 7478 EUR versus 3638 EUR in the year after index diagnosis, and 11,817 EUR versus 6058 EUR 2 years after index diagnosis, BPD patients incurred markedly higher costs. CONCLUSIONS: Since the treatment of BPD causes incremental costs for the German health care system compared to the treatment of MDD, and since both conditions are associated with a high level of suffering, there is a need for establishing adequate and early treatment of these mental disorders.

[Interdisciplinary Care of Employees with Mental Disorders: A Fact Check Using the Salzgitter-Model as an Example]. / Interdisziplinäre Versorgung von Arbeitnehmern mit psychischen Störungen: Ein Faktencheck am Beispiel des Salzgitter-Modells.

OBJECTIVE: Mental disorders are quite common among employees, and cause enormous economic costs. The Salzgitter-Model aims at an early recognition of mental disorders in employees of raw material processing industries by rendering a diagnostic examination (DE), so that appropriate health-care services may be provided promptly. METHODS: Data of a consecutive sample consisting of 133 mentally ill employees (61% men) were analyzed. Mental disorders were diagnosed using the Structured Clinical Interview for DSM-IV. Moreover, routine data of company health insurance funds collected in the 6 months preceding the DE were evaluated. RESULTS: On average, the DE was conducted 14 days after application. Half the diagnoses were of mood disorders, while almost one third consisted of neurotic, stress-related, and somatoform disorders. For 63% of diagnoses from the DE, a correspondence was found with diagnoses made by practitioners during standard care over the previous 6 months. Of these employees, 42% received drug therapy. However more than one fifth did not receive guideline-based psychopharmacological treatment. Psychological symptoms and work-related factors were the main reasons for utilization of the DE. No employee had received psychotherapeutic treatment prior to the DE; more than 90% accepted the recommendation of treatment after the DE. CONCLUSION: Strengthened interdisciplinary cooperation can improve the utilization of an employee group that usually does not seek out specific diagnostic examinations and psychotherapeutic treatment.

Work-related treatment for major depressive disorder and incapacity to work: preliminary findings of a controlled, matched study.

The aim of this study was to compare the effectiveness of work-related cognitive-behavioral treatment (W-CBT) with that of cognitive-behavioral treatment as usual (CBT-AU) for employees on sick leave as a result of a major depressive disorder (MDD). We collected data for 26 matched outpatients at pre- and posttreatment, as well as at 1-year follow-up. Outcome measures were the days of incapacity to work (DIW) as well as self-report measures (Beck Depression Inventory [BDI], Symptom Checklist 90-R [GSI], Life Satisfaction Questionnaire [FLZ]). We analyzed data with hierarchical linear modeling in a 2-level model. Therapy effects were defined in 3 ways: effect size (ES), response (based on the reliable change index), and remission compared with the general population's symptom level. The DIW were reduced significantly after both types of treatment, but employees showed even fewer DIW after W-CBT. At follow-up, significantly more employees were working as a result of W-CBT than with CBT-AU. Significant improvements on scores of self-rating measures corresponded with moderate-to-large effect sizes for both treatment types. Approximately 2 thirds of the treated employees were categorized as unimpaired on BDI scores at posttreatment and at follow-up. At least 1 half of the employees were classified as unimpaired on GSI scores at both assessment points. In future research, a randomized controlled trial should be conducted using a larger sample size to investigate the impact of moderators (e.g., employees at different branches of the company). Findings provided support for using common CBT techniques to enhance return to work without losing expected improvements at the symptom level.