Effects of inpatient, residential, and day-patient treatment on obsessive-compulsive symptoms in persons with obsessive-compulsive disorder: A systematic review and meta-analysis.

INTRODUCTION: Patients with severe or treatment-refractory obsessive-compulsive disorder (OCD) often need an extensive treatment which cannot be provided by outpatient care. Therefore, we aimed to estimate the effects and their moderators of inpatient, residential, or day-patient treatment on obsessive-compulsive symptoms in patients with OCD. METHODS: PubMed, PsycINFO, and Web of Science were systematically screened according to the PRISMA guidelines. Studies were selected if they were conducted in an inpatient, residential, or day-patient treatment setting, were using a number of pre-defined instruments for assessing OCD symptom severity, and had a sample size of at least 20 patients. RESULTS: We identified 43 eligible studies in which inpatient, residential, or day-patient treatment was administered. The means and standard deviations at admission, discharge, and-if available-at follow-up were extracted. All treatment programs included cognitive-behavioral treatment with exposure and response prevention. Only one study reported to not have used psychopharmacological medication. Obsessive-compulsive symptoms decreased from admission to discharge with large effect sizes (g = -1.59, 95%CI [-1.76; -1.41]) and did not change from discharge to follow-up (g = 0.06, 95%CI [-0.09; 0.21]). Length of stay, age, sex, and region did not explain heterogeneity across the studies but instrument used did: effects were larger for clinician-rated interviews than for self-report measures. CONCLUSIONS: Persons with OCD can achieve considerable symptom reductions when undertaking inpatient, residential, or day-patient treatment and effects are-on average-maintained after discharge.

Too much of a good thing? Hand hygiene and the long-term course of contamination-related obsessive-compulsive symptoms.

Increased hygiene behavior may be a factor in the development of contamination-related obsessive-compulsive symptoms (C-OCS). We aimed at investigating (1) the course of C-OCS over 1 year after the start of the COVID-19 pandemic and (2) the effects of changes in hand hygiene (i.e., duration and frequency of handwashing) and related distress regulation on the long-term course of C-OCS. In a longitudinal study, we assessed 1,220 individuals from the German general population at the start of the COVID-19 pandemic (t1), 3 months later (t2), and 12 months later (t3). Pre-pandemic data were available in a subsample from 2014 (n = 430). A decrease in C-OCS over the first year of the pandemic emerged with a small effect size. Thirty-six percent of the participants scored above the clinical cut-off score at t1, 31% at t2, and 27% at t3. In 2014, only 11% scored above the clinical cut-off score. Hierarchical regression showed that C-OCS at t1 was the strongest predictor of a long-term increase in C-OCS. With small effect sizes, change in the duration (not frequency) of handwashing from t1 to t2, as well as the distress-reducing effect of handwashing served as additional predictors. Implications for information on hand hygiene guidelines are discussed.

[Treatment-resistant obsessive-compulsive disorders]. / Therapieresistente Zwangsstörungen.

BACKGROUND: Obsessive-compulsive disorders (OCD) are mainly treated with disorder-specific cognitive behavioral therapy using exposure and response management and/or selective serotonin reuptake inhibitors; however, a significant subgroup of patients does not sufficiently benefit from this approach. OBJECTIVE: This article provides an overview of treatment-resistant OCD. MATERIAL AND METHODS: In this narrative review the definition, causes, diagnostic and therapeutic approaches to treatment-resistant OCD are addressed. RESULTS: Treatment resistance can be assumed in the absence of clinically relevant improvement under therapy, in the sense of a reduction of < 25% on the Yale-Brown obsessive-compulsive scale and a score of 4 (no change) on the clinical global impression-improvement scale. The number of unsuccessful treatment attempts required to establish treatment resistance is defined differently. Causative factors include misdiagnosis, a high severity, comorbid disorders, substance use, specific symptom constellations, organic causes, environmental factors, and aggravating factors in psychotherapy and pharmacotherapy. Suggestions for diagnostic and therapeutic approaches based on the German S3 guideline on OCD are presented. CONCLUSION: For patients with treatment resistance to first-line therapy, useful diagnostic and therapeutic recommendations are available (psychotherapeutic, psychopharmacological and neurostimulation procedures).

Exploring mechanisms of change in the metacognitive training for depression.

The Metacognitive Training for Depression (D-MCT) is a highly structured group therapy that has been shown to be effective in reducing depressive symptoms. First evidence suggests that need for control represents a mechanism of change. However, more research is needed to evaluate the mode of action of each module and identify predictors of treatment response. Two sequential studies (one naturalistic pilot study [study I, N = 45] and one randomized controlled trial [study II, N = 32]) were conducted to evaluate the session-specific effects and predictors of D-MCT in patients with depression. The D-MCT was conducted over eight weeks, and patients answered a questionnaire on dysfunctional beliefs (e.g., negative filter) and depressive symptoms (e.g., lack of energy, self-esteem) before and after each session. Linear mixed-effects models showed that several dysfunctional beliefs and symptoms improved over the course of the treatment; three modules were able to evoke within-session effects, but no between-session effects were found. The improvement in lack of energy in one module was identified as a relevant predictor in study I via lasso regression but was not replicated in study II. Exploratory analyses revealed further predictors that warrant replication in future studies. The identified predictors were inconclusive when the two studies were compared, which may be explained by the different instruments administered. Even so, the results may be used to revise questionnaires and improve the intervention.

Implicit aggressive self-concept in patients with obsessive-compulsive disorder: Results from an approach-avoidance task.

BACKGROUND AND OBJECTIVES: Patients with obsessive-compulsive disorder (OCD) have reported higher anger and aggression than healthy individuals in previous studies using explicit measures. However, studies using implicit measures have demonstrated mixed results. The aim of the present study was to investigate implicit aggressiveness in OCD using an approach-avoidance task (AAT). METHODS: Seventy-eight patients with OCD and 37 healthy controls underwent structured clinical interviews and measures of anger, OCD, and depressive symptoms as well as a computerized AAT that included aggressive, peaceful, negative, and positive stimuli. RESULTS: In line with previous studies, patients with OCD reported higher scores on explicit anger. With respect to the implicit measure, repeated measures ANOVAs did not show any differences in mean reaction times for pushing compared to pulling aggressive versus peaceful and negative versus positive words. However, analyses of specific OCD symptom dimensions demonstrated significantly faster reaction times for pulling compared to pushing aggressive words for patients with high scores in the OCD symptom dimensions obsessing and hoarding. LIMITATIONS: Eighty percent of patients with OCD showed psychiatric comorbidities and all were seeking treatment. CONCLUSION: The present study supports previous studies reporting the absence of higher aggressiveness in patients with OCD compared to healthy controls using implicit measures. However, in contrast to previous studies, we found an implicit approach bias towards aggressive self-statements for OCD patients scoring high in the symptom dimensions obsessing and hoarding compared to healthy controls. Future studies should further elucidate putative functional relationships between different OCD symptom dimensions and implicit aggressiveness.

Prevalence of body-focused repetitive behaviors in a diverse population sample - rates across age, gender, race and education.

BACKGROUND: Prevalence estimates for body-focused repetitive behaviors (BFRBs) such as trichotillomania differ greatly across studies owing to several confounding factors (e.g. different criteria). For the present study, we recruited a diverse online sample to provide estimates for nine subtypes of BFRBs and body-focused repetitive disorders (BFRDs). METHODS: The final sample comprised 1481 individuals from the general population. Several precautions were taken to recruit a diverse sample and to exclude participants with low reliability. We matched participants on gender, race, education and age range to allow unbiased interpretation. RESULTS: While almost all participants acknowledged at least one BFRB in their lifetime (97.1%), the rate for BFRDs was 24%. Nail biting (11.4%), dermatophagia (8.7%), skin picking (8.2%), and lip-cheek biting (7.9%) were the most frequent BFRDs. Whereas men showed more lifetime BFRBs, the rate of BFRDs was higher in women than in men. Rates of BFRDs were low in older participants, especially after the age of 40. Overall, BFRBs and BFRDs were more prevalent in White than in non-White individuals. Education did not show a strong association with BFRB/BFRDs. DISCUSSION: BFRBs are ubiquitous. More severe forms, BFRDs, manifest in approximately one out of four people. In view of the often-irreversible somatic sequelae (e.g. scars) BFRBs/BFRDs deserve greater diagnostic and therapeutic attention by clinicians working in both psychology/psychiatry and somatic medicine (especially dermatology and dentistry).

A randomized controlled trial to evaluate the efficacy of metacognitive training for older adults with depression (MCT-Silver) in Portugal: study protocol.

Introduction: Depression is one of the most common psychological disorders in later life. Although psychological interventions are recommended by treatment guidelines, most older adults with depression remain untreated. The aim of this study is to evaluate the efficacy of the Portuguese version of Metacognitive Training for Depression in later life (MCT-Silver). Methods: This is a study protocol of an observer-blind, parallel-group, randomized controlled trial to compare the efficacy of MCT-Silver with a treatment as usual (TAU) control group among older adults (age 65 years and older) with depressive symptoms according to the Montgomery-Asberg Depression Scale. Participants will be tested at three assessment time points (baseline, immediately following the intervention [8 weeks], and 3 months after the intervention). The primary outcome is change in self-rated depression symptoms assessed by the Beck Depression Inventory (BDI-II). Secondary outcomes include clinician-rated depression, self-esteem, dysfunctional beliefs, metacognitive beliefs, ruminations, attitudes toward aging and quality of life. A self-designed subjective appraisal rating scale consisting of 21-items will be used to assess participant acceptance of MCT-Silver. Discussion: MCT-Silver is an innovative intervention, which aims to reduce dysfunctional thoughts as well as depression-related behaviors and coping strategies through the metacognitive perspective. Until now, the training has only been tested in Germany. It is expected that after 8 weeks of treatment and 3 months later, the experimental group will demonstrate significant reductions in depressive symptoms, metacognitive beliefs, dysfunctional attitudes and ruminative responses compared to the TAU group. Moreover, quality of life, self-esteem, and attitudes towards aging will be significantly improved in MCT-Silver compared to the TAU group. Clinical trial registration: ClinicalTrials.gov, NCT05640492.

Efficacy of an Internet-based intervention with self-applied exposure therapy in virtual reality for people with panic disorder: study protocol for a randomized controlled trial.

BACKGROUND: Due to several treatment barriers, many individuals with panic disorder do not receive evidence-based treatment. One promising option to narrow this treatment gap is Internet-based psychotherapy, which has been shown particularly effective in guided formats. Still, there remains room for improvement to make these digital therapies more accessible, cost-efficient, and aligned with best practices for in-person interventions (e.g., exposure). The smartphone app "Invirto - Treatment for Anxiety" offers digitally guided, evidence-based treatment of panic disorders including virtual reality (VR) for exposure therapy. The aim present study is to investigate the efficacy, safety, and acceptance of Invirto in comparison to a care-as-usual (CAU) control group. METHODS: We plan to conduct a randomized controlled trial with two conditions (intervention vs. CAU), three assessment times via online surveys (t0: baseline; t1: 3 months after baseline; t2: follow-up assessment 6 months after baseline), and a total of 128 participants with a clinical diagnosis of panic disorder (symptoms must be experienced ≥ 1 year). Recruitment will take place via email, phone, and the study website. The primary outcome will be the change in anxiety symptoms as measured by Beck's Anxiety Inventory from t0 to t1. Secondary outcomes will be the change in anxiety symptoms (measured by the Panic and Agoraphobia Scale, PAS; Questionnaire on panic-related Anxieties, Cognitions and Avoidance, ACA), depressive symptoms (measured by the Beck-Depression-Inventory, BDI-II), treatment satisfaction (measured by the Client Satisfaction Questionnaire, CSQ-8; Treatment Adherence Perception Questionnaire, TAPQ-adapt; Positive and Negative Effects of Psychotherapy Scale, PANEPS-I), psychological flexibility (measured by the Acceptance and Action Questionnaire-II, AAQ-II), and dissociation during VR exposure (measured by an adapted version of the Peritraumatic Dissociative Experiences Questionnaire, PDEQ-adapt). Participants in the intervention group will receive access to the intervention (Invirto) right after t0, while the CAU group will receive access to Invirto after t1. We expect a larger change in both the primary and secondary outcomes from t0 to t1 in the intervention group in comparison to the CAU group. DISCUSSION: This study is one of the first to evaluate an Internet-based intervention for people with panic disorder that includes self-application of VR exposure therapy. The findings are expected to extend the body of knowledge about effective Internet-based treatment options for people with panic disorder. The empirical and clinical implications and the limitations of the study are discussed. TRIAL REGISTRATION: DRKS00027585 ( www.drks.de/drks_web/ ), date of registration: 13 January 2022.

Obsessive-Compulsive Symptom Dimensions and Their Relationships with Obsessive Beliefs: A Structural Equation Modeling Analysis.

Dysfunctional beliefs are central in the development and maintenance of obsessive-compulsive disorder (OCD) as well as its treatment. Yet, research suggests that not all dysfunctional beliefs are equally important for each of the symptom dimensions of OCD. However, results are inconsistent in that studies contradict each other regarding the associations between specific symptom dimensions and belief domains. The aim of the present study was to clarify which belief domain is specifically associated with which OCD symptom dimension. Results could help to tailor treatments more specifically to the patient's OCD symptom dimension. In- and outpatients with OCD (N = 328; 43.6% male and 56.4% female) filled out questionnaires on symptom dimensions of OCD (Obsessive-Compulsive Inventory Revised) and dysfunctional beliefs (Obsessive Beliefs Questionnaire). A structural equation model analysis was conducted to identify the associations between dysfunctional beliefs and symptom dimensions. Our results showed that perfectionism/intolerance of uncertainty was associated with hoarding and symmetry/ordering, (2) overestimation of threat/inflated responsibility was associated with checking compulsions, and (3) importance of thoughts/control of thoughts was associated with obsessing. These results were largely supported by a backward selection. Our results demonstrated associations of specific dysfunctional beliefs and specific OCD symptom dimensions. However, future studies are necessary to replicate these findings with other measures (e.g., clinician ratings).

Expected increase in health competence improves over modules of an unguided internet-based cognitive-behavioural therapy for obsessive-compulsive disorder.

Internet-based cognitive-behavioural interventions (iCBT) are a valuable alternative to face-to-face psychotherapy. An unguided iCBT program has shown to be efficacious for patients with obsessive-compulsive disorder (OCD). However, the modules' mode of action is not well understood, which is the objective of the present study. Twenty-five patients with OCD who participated at the iCBT program for 8 weeks answered a questionnaire on their self-efficacy, motivation, expected increase in health competence and experiential avoidance before and after each module and were included in the present analyses. Linear mixed-effects models demonstrated that patients' expected increase in health competence improved over the course of the treatment. No within-module-specific effect was found. The iCBT program was able to improve patients' expected health competence. However, all other variables did not change. The iCBT program should be revised by focusing more strongly on the integration of the content to reduce experiential avoidance and to improve motivation.

How to assess and analyse session-specific effects and predictors: An example with the Metacognitive Training for Obsessive-Compulsive Disorder intervention.

It is essential to understand the effects of specific therapy elements (i.e., mechanisms of change) to optimize the efficacy of available treatments. There are, however, existing challenges in the assessment and analysis of constructs of interest. The present study aims to improve research on the effects of specific therapy elements using the example of the Metacognitive Training for Obsessive-Compulsive Disorder (MCT-OCD) intervention. Specifically, we introduce an innovative analytical method to identify predictors of treatment outcome and expand the assessment of common factors (e.g., coping expectations). A sample of 50 day- and inpatients with OCD was assessed before and after participation in an 8-week MCT-OCD programme. We investigated within-session change in scores on revised questionnaires administered before and after each session. Linear mixed models (for session-effects) and lasso regression (for prediction analyses) were used to analyse data. The revised assessments and data analyses showed greater improvement in dysfunctional (meta-)cognitive beliefs over the time of the intervention and within sessions compared to previous MCT-OCD studies. Some predictors, for example, improvement in coping expectation after the module on overestimation of threat for treatment outcome, were identified. The present study contributed to a better understanding of how to assess and analyse data of a modular intervention and demonstrated the strengths and weaknesses of different analytic approaches. Moreover, the analyses provided a deeper understanding of the specific effects and mechanisms of change of MCT-OCD modules, which can be refined and examined in future studies.

Mixed results for exposure and response prevention therapy in mixed reality for patients with contamination-related obsessive-compulsive disorder: A randomized controlled pilot study.

INTRODUCTION: Technology-supported exposure and response prevention (ERP) for patients with obsessive-compulsive disorder (OCD) as tested in clinical research, holds promise but also has limitations. The present study aims to overcome these limitations by using mixed reality for ERP (MERP). The objectives of this pilot study were to evaluate the safety, feasibility, and acceptance of MERP and to identify possible obstacles. METHODS: Twenty inpatients with contamination-related OCD were recruited and randomized to two conditions: MERP (six sessions in 3 weeks) and care as usual treatment. Patients were assessed before treatment (baseline), after the 3-week intervention period (post), as well as 3 months after post assessment (follow-up) regarding symptomatology (Y-BOCS). RESULTS: Results showed a similar reduction in symptomatology in both groups from baseline to post. Regarding safety, no clinically significant deterioration was detected in the MERP group. Patients' evaluation of the MERP was heterogeneous. The qualitative feedback provided helpful indications for further development of the software. Sense of presence was below the midpoint of the scales. CONCLUSION: This is the first study evaluating a MERP for patients with OCD that shows cautious evidence for the acceptance and safety of MERP. The results of the subjective evaluation suggest revisions of the software.

Improving adherence to unguided Internet-based therapy for obsessive-compulsive disorder: A randomized controlled trial.

BACKGROUND: Adherence to internet-based cognitive-behavioral therapy (iCBT) is often low, possibly reducing its potential. The current study set out to test whether adherence and effects of unguided iCBT for obsessive-compulsive disorder (OCD) could be improved by varying the degree of autonomy in which modules are completed (free choice vs. fixed order). METHODS: We randomized 151 individuals with OCD to either an unguided iCBT with a fixed (iCBTfixed) or a free-choice (iCBTfree+) order of the modules. We assessed participants at baseline (t0), eight weeks (t1), and 16 weeks (t2). Primary outcomes were adherence (utilization time, modules completed) and change in OCD severity (Y-BOCS). Secondary outcomes included depression, self-esteem, and treatment satisfaction. We calculated intent-to-treat (ITT) and complete case (CC) analyses. RESULTS: Analyses showed that both iCBT programs significantly reduced OCD severity. While groups did not differ on the ITT analyses, for the CC analyses, a greater improvement was found in the iCBTfixed in comparison to the iCBTfree+ group regarding OCD severity and quality of life, with medium effect sizes from t0 to t1 (ηp2 = 0.067-0.077). Time of utilization and number of modules completed did not differ between groups. LIMITATIONS: No placebo control group, short follow-up period, self-report assessment. CONCLUSIONS: iCBT is effective in improving OCD. Despite similar adherence in the fixed versus the free-choice module order, the study offers tentative evidence that a fixed order of content is associated with better effects. More research on the effects of adherence on outcome is necessary.

Negative cognitive beliefs, positive metacognitive beliefs, and rumination as mediators of metacognitive training for depression in older adults (MCT-Silver).

Background: Metacognitive Training for Depression in older adults (MCT-Silver; www.uke.de/mct-silver) is a cognitive-behavioral based group intervention that aims at reducing depression by targeting (meta)cognitive beliefs and rumination. In the present study, it was examined whether negative cognitive beliefs, positive metacognitive beliefs and/or rumination may be implicated as mediators of MCT-Silver's effects on depression. Materials and methods: We conducted a secondary analysis of a randomized controlled trial comparing MCT-Silver to an active control intervention (cognitive remediation) including 66 older adults (60 years and older) with complete baseline data. Clinician-rated (Hamilton Depression Rating Scale) and self-reported (Beck Depression Inventory-II) depression, negative cognitive beliefs (Dysfunctional Attitudes Scale-18B), positive metacognitive beliefs (positive beliefs subscale; Metacognition Questionnaire-30) and rumination (10-item Ruminative Response Scale) were assessed before (pre) and after 8 weeks of treatment (post), as well as 3 months later (follow-up). It was examined whether change in depression (pre- to follow-up) was mediated by change in negative cognitive beliefs, positive metacognitive beliefs and/or rumination (pre- to post-assessment). Results: Mediation results differed for self-reported vs. clinician-rated depression. The effect of MCT-Silver on reduction in clinician-rated depression was mediated by a reduction in self-reported rumination, whereas reduction in self-reported depression was mediated by a reduction in negative cognitive beliefs. Positive metacognitive beliefs were not a significant mediator for either outcome. Conclusion: The current study provides initial evidence for the roles of negative cognitive beliefs and rumination in the treatment of depression in later life with MCT-Silver. Given the divergence of findings and lack of causal precedence, mechanisms of change for MCT-Silver cannot yet be equivocally identified.

Depression in older adults during the COVID-19 pandemic: A systematic review.

BACKGROUND: Depression affected 5.7% of people aged 60 years and over prior to the pandemic and has increased by approximately 28%. The aim of this study is to identify and describe factors associated with depressive symptoms, the diagnostic assessment instruments and interventions used to evaluate and treat depression in adults aged 60 years and older since the onset of the COVID-19 pandemic. METHODS: Four electronic databases were systematically searched to identify eligible studies published since the beginning of the COVID-19 pandemic. A total of 832 articles were screened, of which 53 met the inclusion criteria. RESULTS: Factors contributing to depressive symptoms in older adults prior to the pandemic were grouped into the following categories: sociodemographic characteristics (i.e., being female); loneliness and weak social support; limitations in daily functioning, physical activity and neurocognitive impairment; and clinical factors. The following groups of factors directly related to the pandemic were found: stress-related factors and feelings or worries related to the pandemic; information access (e.g., receiving news about COVID-19 through the media); factors directly related to COVID-19 (e.g., having infected acquaintances); and factors related to the measures that were taken to reduce the spread of COVID-19 (e.g., confinement measures). The most frequently used instrument to assess depressive symptoms was the Geriatric Depression Scale Short Form (GDS-SF). Four studies implemented interventions during the pandemic that led to significant reductions in depressive symptoms and feelings of loneliness. CONCLUSIONS: Improved understanding of pandemic-associated risk factors for depression can inform person-cantered care. It is important continued mental healthcare for depression for older adults throughout crises, such as the COVID-19 pandemic. Remote delivery of mental healthcare represents an important alternative during such times. It is crucial to address depression in older adults (which often causes disability), since the pandemic situation has increased depressive symptoms in this population.

Efficacy of exposure and response prevention therapy in mixed reality for patients with obsessive-compulsive disorder: study protocol for a randomized controlled trial.

Many patients with obsessive-compulsive disorder (OCD) do not receive cognitive behavioral therapy with exposure and response prevention (first line treatment for OCD), for example, due to patients' fear of the exposure and reservations of the therapists. Technology-supported exposure (e.g., exposure therapy with response prevention in mixed reality [MERP]) for patients with OCD may help to overcome this obstacle. Building upon findings of our pilot study objectives of this study are to evaluate the efficacy, expectations of treatment success, feasibility, and acceptance of MERP as well as to identify possible limitations. In total, 64 outpatients with contamination-related OCD will be recruited and randomized to one of two conditions: MERP (six sessions in six weeks) and self-guided exposure therapy (six exercises in six weeks). Participants will be assessed before (baseline), after the six-week intervention period (post), as well as three months after post assessment (follow-up) regarding symptomatology (Yale-Brown Obsessive Compulsive Scale; Y-BOCS), their subjective evaluation of MERP (acceptance) and sense of presence. The planned study is the first to investigate MERP in patients with OCD.

[Psychological Burden in Relatives of People with Mental Illness During the COVID-19 Pandemic]. / Psychische Belastungen bei Angehörigen von Menschen mit psychischen Erkrankungen während der COVID-19 Pandemie.

CONCERN: The COVID-19 pandemic is a burden for most people - particular for those with mental illness and their families. The aim of the present study was to investigate specific burdens as well as coping strategies among relatives of people with mental illness. METHODS: A questionnaire to assess Corona pandemic-related influences on burdens of relatives of people with mental illness was developed. A total of 228 relatives participated in the survey between March and June 2021. RESULTS: More than 87% of the relatives surveyed reported that they were burdened by the mental illness of their ill relatives. Many of the respondents subjectively described helpful coping strategies such as appreciation of healthy parts. CONCLUSION: In times of crisis, such as the COVID-19 pandemic, care structures and support services should also be sensitively aligned and continuously provided for relatives of people with mental illness.

Behavioral and location-related antecedents of train suicides.

BACKGROUND: In the European Union, over 2000 suicides on railway premises were reported in 2020. Identifying individuals' behavioral and location patterns just before they die or attempt to die by train suicide (ITS) is critical for effective prevention of suicides by train. We conducted a naturalistic study using a newly developed instrument for the assessment of fatalities in rail traffic that used information from on-site video cameras. METHODS: A total of 56 case files and surveillance recordings of ITS prior to their suicide or suicide attempt were compared to 46 surveillance recordings of matched regular train passengers (RTP) before they boarded their trains. Groups were compared on individuals' behavior as well as location and contextual parameters. RESULTS: ITS performed unusual movement patterns more frequently, carried luggage less often, stayed on the platform longer, and let more trains pass relative to RTP. CONCLUSIONS: If this study is replicated with a larger sample, artificial intelligence could be used to detect suspicious/unusual (movement) patterns in order to prevent train suicide. Social awareness campaigns that foster the identification of people in distress at train stations in combination with lower thresholds for the use of emergency devices on platforms may help to detect potential train suicides and reduce their incidence.

Implicit cognitions on self-injurious and suicidal behavior in borderline personality disorder.

BACKGROUND AND OBJECTIVES: Performance on implicit measures of suicidality has been associated with suicidal and nonsuicidal self-injury. Despite the high prevalence of self-harm in patients with borderline personality disorder (BPD), no previous study has assessed implicit measures in this patient group. METHODS: Forty patients with BPD and 25 healthy controls completed three implicit association tests (IATs) (Death words - Me/Others words, Self-Harm pictures - Me/Others, and Self-Harm pictures - Good/Bad words) and a subliminal priming task (effect of the primes "dying"/"growing" on the categorization speed of positive/negative adjectives) as well as measures of psychopathology (suicidal ideation, previous nonsuicidal self-injury, borderline symptomatology, depression, and hopelessness). RESULTS: Patients with BPD had higher scores on all three IATs than healthy controls. The subliminal priming procedure did not reveal group differences. Correlations between implicit measures and psychopathology among patients with BPD were mostly weak and nonsignificant with a few exceptions: Positive correlations were observed between IAT Self-Harm - Good/Bad and lifetime frequency of nonsuicidal self-injury, between IAT Self-Harm - Me/Others and depression, and between IAT Death - Me/Others and depression. Correlations between implicit measures were weak to moderate. LIMITATIONS: The study was cross-sectional only, and the study had reduced power as the sample size was limited. CONCLUSIONS: As expected, patients with BPD had higher scores than healthy controls on the IATs, which indicates higher implicit self-identification with self-harm and death as well as stronger implicit positive attitudes towards self-harm. The mostly weak correlations between implicit and explicit measures speak against the discriminative value of IATs in patients with BPD.

Can you trust this source? Advice taking in borderline personality disorder.

Research suggests that patients with borderline personality disorder (BPD) share a range of cognitive biases with patients with psychosis. As the disorder often manifests in dysfunctional social interactions, we assumed associated reasoning styles would be exaggerated in a social setting. For the present study, we applied the Judge-Advisor System by asking participants to provide initial estimates of a person's age and presumed hostility based on a portrait photo. Afterwards, we presented additional cues/advice in the form of responses by anonymous previous respondents. Participants could revise their estimate, seek additional advice, or make a decision. Contrary to our preregistered hypothesis, patients with BPD (n = 38) performed similarly to healthy controls (n = 30). Patients sought the same number of pieces of advice, were equally confident, and used advice in similar ways to revise their estimates. Thus, patients with BPD did trust advice. However, patients gave higher hostility ratings to the portrayed persons. In conclusion, patients with BPD showed no cognitive biases in seeking, evaluating, and integrating socially provided information. While the study implies emotional rather than cognitive biases in the disorder, cognitive biases may still prove to be useful treatment targets in order to encourage delaying and reflecting on extreme emotional responses in social interactions.