Burdens and resources of Austrian clinical psychologists: results of a qualitative study two years into the COVID-19 pandemic.

BACKGROUND: The COVID-19 pandemic increased the mental health burden in the general population, enhancing the demands placed on mental healthcare professionals. METHODS: This study aimed to assess the burdens and resources of clinical psychologists that emerged since the beginning of the pandemic. N = 172 Austrian clinical psychologists participated in a cross-sectional online survey between April and May 2022. The burdens and the sources of support that emerged during the pandemic were analyzed using qualitative content analysis. RESULTS: Mental health-related issues were identified as the greatest burden, followed by work-related themes and restrictions imposed by the government to combat the spreading of the virus. The most important resources mentioned by the clinical psychologists were social contacts and recreational activities. Practising mindfulness and focusing on inner processes and work-related aspects were further important resources mentioned. CONCLUSION: Overall, it seems that clinical psychologists have a high awareness of mental health-related problems related to the pandemic and use adaptive coping strategies to deal with them.

Efficacy of mentalization-based therapy in treating self-harm: A systematic review and meta-analysis.

INTRODUCTION: Mentalization-based therapy (MBT) and its adapted version for adolescents (MBT-A) are repeatedly highlighted as promising treatments for reducing self-harm, particularly in borderline personality disorder (BPD). Despite the availability of publications providing evidence of their efficacy in reducing self-harm, recent meta-analyses have yielded mixed results. To inform best-practice clinical decision-making, we conducted a systematic review and meta-analysis. We aimed to disentangle findings for both adolescents and adults on the efficacy of MBT(-A) in reducing self-harm (primary outcome) and symptoms of BPD and depression (secondary outcomes). METHODS: Web of Science, Scopus, Embase, PubMed/Medline, and Cochrane Review Database were searched for eligible studies published until September 2022. In total, 14 studies were identified, comprising 612 participants from nine MBT studies (six pre-post, three RCTs) and five MBT-A studies (two pre-post, three RCTs). Aggregated effect sizes were estimated using random-effects models. Meta-regressions were conducted to assess the effect of moderator variables (treatment duration, drop-out rates, and age) on effect sizes. RESULTS: Overall, both MBT and MBT-A demonstrated promising effects in reducing self-harm (g = -0.82, 95% CI -1.15 to -0.50), borderline personality disorder (g = -1.08, 95% CI -1.38 to -0.77), and depression (g = -1.1, 95% CI -1.52 to -0.68) symptoms. However, when compared to control interventions (TAU, SCM), MBT(-A) did not prove to be more efficacious, with the exception of MBT showing superior effects on BPD symptoms in adults (g = -0.56, 95% CI -0.88 to -0.24). CONCLUSION: Although the pre-post evaluations seem promising, this analysis, including RCTs, showed no superiority of MBT(-A) to control conditions, so that prioritizing the application of MBT (-A) for the treatment of self-harm is not supported. Possible explanations and further implications are discussed.

[VR-supported therapy for anxiety and posttraumatic stress disorder: current possibilities and limitations]. / VR-gestützte Therapie bei Angst und posttraumatischer Belastungsstörung: aktuelle Möglichkeiten und Grenzen.

BACKGROUND: Virtual reality (VR) is increasingly used in psychotherapy, and the speed of development of therapeutic VR tools is continuously increasing. OBJECTIVE: This narrative review provides an overview of the state of the art regarding VR applications for psychotherapy. MATERIAL AND METHODS: The current state of VR therapy research for anxiety disorders and posttraumatic stress disorder (PTSD) is summarized. The focus lies on VR exposure therapy. Current developments in the field are outlined. RESULTS: For anxiety disorders, especially phobic disorders, there are already positive recommendations in the current German S3 guidelines. For PTSD, the development of VR therapy tools is still in a relatively early stage. CONCLUSION: The development of mobile cost-effective VR solutions in recent years has enabled entirely new applications for VR. The empirical challenges of these new developments are considerable. Nevertheless, the chances for an improvement of psychotherapeutic routine care are good.

Human cytomegalovirus seropositivity is associated with reduced patient survival during sepsis.

BACKGROUND: Sepsis is one of the leading causes of death. Treatment attempts targeting the immune response regularly fail in clinical trials. As HCMV latency can modulate the immune response and changes the immune cell composition, we hypothesized that HCMV serostatus affects mortality in sepsis patients. METHODS: We determined the HCMV serostatus (i.e., latency) of 410 prospectively enrolled patients of the multicenter SepsisDataNet.NRW study. Patients were recruited according to the SEPSIS-3 criteria and clinical data were recorded in an observational approach. We quantified 13 cytokines at Days 1, 4, and 8 after enrollment. Proteomics data were analyzed from the plasma samples of 171 patients. RESULTS: The 30-day mortality was higher in HCMV-seropositive patients than in seronegative sepsis patients (38% vs. 25%, respectively; p = 0.008; HR, 1.656; 95% CI 1.135-2.417). This effect was observed independent of age (p = 0.010; HR, 1.673; 95% CI 1.131-2.477). The predictive value on the outcome of the increased concentrations of IL-6 was present only in the seropositive cohort (30-day mortality, 63% vs. 24%; HR 3.250; 95% CI 2.075-5.090; p < 0.001) with no significant differences in serum concentrations of IL-6 between the two groups. Procalcitonin and IL-10 exhibited the same behavior and were predictive of the outcome only in HCMV-seropositive patients. CONCLUSION: We suggest that the predictive value of inflammation-associated biomarkers should be re-evaluated with regard to the HCMV serostatus. Targeting HCMV latency might open a new approach to selecting suitable patients for individualized treatment in sepsis.

Physiological stress reactivity and self-harm: A meta-analysis.

OBJECTIVE: Self-harm is associated with alterations in the psychobiological stress response. Specifically, the reactivity of the autonomic nervous system (ANS) and the endocrine hypothalamic-pituitary-adrenal (HPA) axis may differ in individuals who engage in self-harm. However, evidence in this regard is inconsistent. BACKGROUND: We conducted a preregistered random-effects meta-analysis of sympathetic ANS, parasympathetic ANS, sympathetic-parasympathetic, i.e., mixed-influence ANS, and HPA axis reactivity following laboratory stress exposure in individuals who engage in self-harm and controls. Stress exposure consisted of paradigms using either social-evaluative (e.g., TSST), emotional (e.g., negatively valenced visual stimuli), or physical (e.g., cold pressor test) challenges. A total of 29 studies (self-harm: n = 954, controls: n = 1122, 74% females) were included in the analysis. RESULTS: Regarding ANS reactivity to stress, no differences emerged between the two groups. However, parasympathetic ANS activity was lower before stress (g = -0.30, CI -0.51 to -0.09) and after stressor cessation (g = 0.54, CI -1.07 to -0.01) in the self-harm group compared to controls. Regarding HPA axis reactivity, individuals who engage in self-harm showed significantly lower cortisol responses to stress than did controls (g = -0.26, CI -0.45 to -0.08). After stressor cessation (i.e., during stress recovery), cortisol was also lower in individuals who engage in self-harm compared to controls (g = -0.26, CI -0.43 to -0.08). CONCLUSIONS: Lower basal parasympathetic ANS activity and flattened cortisol responses indicate dysregulation of psychobiological stress systems in individuals who engage in self-harm. A better understanding of the psychobiological underpinnings of self-harm may allow for the establishment of biomarkers of risk stratification and treatment monitoring in affected individuals.

Water temperature during the cold pressor test: A scoping review.

The cold pressor test (CPT) is a commonly used method to induce pain and stress in experimental settings. Previous research has found that the temperature of the water used in the test significantly affects outcome measures such as pain tolerance. Variations in CPT protocols, specifically regarding temperature, have been criticized. Hence, our objective is to investigate water temperature and associated methodological factors through a scoping review of the CPT in adults. Among 331 included trials, the most commonly reported temperature was 1°C (33.8°F). Reporting of the water temperature was adequate (93% of all trials), but a precise range within which the temperature was maintained was reported only in 27% of all trials. Pain measurement was the primary focus for most studies (90%), predominantly utilizing pain tolerance as the main outcome (78%). Water circulation was reported in 44% of studies, and 10% reported manually agitating the water. The most common maximum immersion time (i.e., ceiling time) was 180 s; notably, 64% of trials lacked information on participant awareness of this limit specification. The limb most immersed was the hand (76%). Overall, multiple methodological factors significantly impacting outcome measures were inconsistently implemented or reported. For future studies, we advocate for precise standardization of the water temperature used during the CPT. We suggest using 1°C (33.8°F), especially when assessing pain tolerance. A cooling apparatus allowing precise temperature control and continuous water circulation is advised. At the bare minimum, the temperature should be monitored continuously. While other decisions regarding the implementation of the CPT may differ depending on the specific aims of the respective study, it remains essential to standardize the water temperature and to provide a comprehensive report of the experimental protocol.

Mental Health of Transgender Youth: A Comparison of Assigned Female at Birth and Assigned Male at Birth Individuals.

Gender dysphoric adolescents report a gender identity which is incongruent with their assigned sex at birth, whereby the experienced incongruence is accompanied by clinically relevant distress. The aim of the study was to assess and compare the mental health of transgender youth by assigned sex at birth. A total of n = 49 adolescents (n = 29 assigned females at birth, n = 20 assigned male at birth) aged 12 to 18 years with the diagnosis of gender dysphoria according to DSM-5 were included in the study. The adolescents underwent a psychological assessment in a child and adolescent psychiatry outpatient department prior to starting gender-affirming medical treatment, completing relevant mental health questionnaires. Although no differences were found in psychiatric disorders, more externalizing problems above the clinical threshold were reported by parents in assigned female at birth (AFAB) adolescents. On the other hand, internalizing problems, both in general and within the clinical range, were found to be more prevalent in assigned male at birth (AMAB) adolescents, as indicated by self-report. Our results suggest that a comprehensive assessment of mental health in gender dysphoric adolescents is crucial for understanding the diverse range of challenges they may face and tailoring appropriate interventions to address their specific needs.

Virtual Reality Interventions for Mental Health.

Virtual Reality (VR) is a growing field in psychological research and therapy. While there is strong evidence for the efficacy of exposure therapy in VR (VRET) to treat anxiety disorders, new opportunities for using VR to treat mental health disorders are emerging. In this chapter, we first describe the value of VRET for the treatment of several anxiety disorders. Next, we introduce some recent developments in research using VR investigating schizophrenia, neurodevelopmental disorders, and eating disorders. This includes therapeutic strategies beyond VRET, including avatar-based therapies or those combining VR with biofeedback approaches. Although VR offers many convincing advantages, contraindications in treatment must be considered when implementing VR-supported therapy in clinical practice. Finally, we provide an outlook for future research, highlighting the integration of augmented reality and automation processes in VR environments to create more efficient and tailored therapeutic tools. Further, future treatments will benefit from the gamification approach, which integrates elements of computer games and narratives that promote patients' motivation and enables methods to reduce drop-outs during psychological therapy.

Does Being Ignored on WhatsApp Hurt? A Pilot Study on the Effect of a Newly Developed Ostracism Task for Adolescents.

(1) Background: Many studies have used a well-known social exclusion task, namely Cyberball, to assess the psychophysiological reactions to ostracism in laboratory settings. However, this task has been recently criticized for its lack of realism. Instant messaging communication platforms are currently central communication channels where adolescents conduct their social life. These should be considered when recreating the emotional experiences that fuel the development of negative emotions. To overcome this limitation, a new ostracism task, namely SOLO (Simulated On-Line Ostracism), recreating hostile interactions (i.e., exclusion and rejection) over WhatsApp was developed. The aim of this manuscript is to compare adolescents' self-reported negative and positive affect, as well as physiological reactivity (i.e., heat rate, HR; heart rate variability, HRV) exhibited during SOLO to Cyberball. (2) Method: A total of 35 participants (Mage = 15.16; SD = 1.48; 24 females) took part in the study. The first group (n = 23; transdiagnostic group), recruited at an inpatient and outpatient unit of a clinic for children and adolescent psychiatry, psychotherapy, and psychosomatic therapy in Baden-Württemberg (Germany), reported clinical diagnoses linked with emotional dysregulation (e.g., self-injury and depression). The second group (n = 12; control group), recruited in the district of Bavaria and Baden-Württemberg, had no pre-existing clinical diagnoses. (3) Results: The transdiagnostic group showed higher HR (b = 4.62, p < 0.05) and lower HRV (b = 10.20, p < 0.01) in SOLO than in Cyberball. They also reported increased negative affect (interaction b = -0.5, p < 0.01) after SOLO but not after Cyberball. In the control group, no differences in either HR (p = 0.34) or HRV (p = 0.08) between tasks were found. In addition, no difference in negative affect after either task (p = 0.83) was found. (4) Conclusion: SOLO could be an ecologically valid alternative to Cyberball when assessing reactions to ostracism in adolescents with emotional dysregulation.

Comparison of mental health indicators in clinical psychologists with the general population during the COVID-19 pandemic.

Mental healthcare professionals face diverse challenges during the COVID-19 pandemic, which may augment their risk of experiencing adverse mental health outcomes themselves. We aimed to compare depressive, anxiety, insomnia, and stress symptoms in Austrian clinical psychologists during the COVID-19 pandemic with the Austrian general population. A total of N = 172 Austrian clinical psychologists (91.9% women; mean age: 44.90 ± 7.97 years) participated in an online survey in spring 2022. A representative sample (N = 1011) of the Austrian general population was surveyed simultaneously. Symptoms of depression (PHQ-2), anxiety (GAD-2), insomnia (ISI-2), and stress (PSS-10) were assessed. Differences in the prevalence of clinically relevant symptoms were analyzed using univariate (Chi-squared tests) and multivariable (binary logistic regression including covariates age and gender) analyses. Clinical psychologists showed lower adjusted odds for exceeding the cut-offs for clinically relevant depression (aOR 0.37), anxiety (aOR 0.50), and moderate to high stress levels (aOR 0.31) compared to the general population (p < 0.01). No difference was observed for insomnia (aOR 0.92; p = 0.79). In conclusion, clinical psychologists experience better mental health than the general population during the COVID-19 pandemic. Future studies are needed to analyze the underlying reasons.

Did the mental health and well-being of young people increase after the COVID-19 vaccination campaign period? A cross-sectional multicentre study in Austria and Turkey.

In 2019, the global Coronavirus (COVID-19) pandemic and associated prevention measures affected the mental health and psychological well-being of young people with and without a migratory background. The present study aimed to compare the mental health and psychological well-being of migrant and non-migrant young people before and after the COVID-19 vaccination campaign period in two countries which had different policies to deal with the pandemic. The "Psychological General Well-being" of young people and their experiences during the pandemic were investigated using an anonymous online survey during two pandemic waves before the vaccination campaign and 6 months after its start. A majority of the 6154 participants (aged between 15 and 25 years in all study groups) reported a decrease of mental health from the time period before the vaccination (BV) to after the vaccination (AV) campaign (b = 0.27, p < .001). This association was higher in females (b = 0.04, p = 0.008) and in youth with financial problems (b = 0.13, p < .001). Furthermore, this decrease was more pronounced in people ≤17 years old (40% to 62%) than in those >17 years (59% to 67%). Contrary to expectation, vulnerable groups such as the economically disadvantaged, younger, and female participants did not experience a significant easing of the pandemic's psychological burden AV. Vaccination campaigns should continue emphasizing the beneficial effects of COVID-19 vaccination on general well-being, but with an acknowledgement that the road to recovery is still a long one. Concurrently, free access to psychological treatment and financial support should be offered, especially for vulnerable groups. Supplementary Information: The online version contains supplementary material available at 10.1007/s12144-023-04366-x.

Conspiracy beliefs and COVID-19 guideline adherence in adolescent psychiatric outpatients: the predictive role of adverse childhood experiences.

BACKGROUND: Conspiracy beliefs have become widespread throughout the COVID-19 pandemic. Previous studies have shown that endorsing conspiracy beliefs leads to lower protective guideline adherence (i.e., wearing face masks), posing a threat to public health measures. The current study expands this research across the lifespan, i.e., in a sample of adolescents with mental health problems. Here, we investigated the association between conspiracy beliefs and guideline adherence while also exploring the predictors of conspiracy beliefs. METHODS: N = 93 adolescent psychiatric outpatients (57% female, mean age: 15.8) were assessed using anonymous paper-pencil questionnaires. Endorsement of generic and COVID-19 conspiracy beliefs was assessed, in addition to items measuring adherence to protective guidelines and mental health (stress, depressive symptoms, emotional/behavioral problems, and adverse childhood experiences). Multiple regressions and supervised machine learning (conditional random forests) were used for analyses. RESULTS: Fourteen percent of our sample fully endorsed at least one COVID-19 conspiracy theory, while protective guidelines adherence was relatively high (M = 4.92, on a scale from 1 to 7). The endorsement of COVID-19 conspiracy beliefs-but not of generic conspiracy beliefs-was associated with lower guideline adherence (ß = - 0.32, 95% CI - 0.53 to - 0.11, p < .001). Conditional random forests suggested that adverse childhood experiences and peer and conduct problems were relevant predictors of both conspiracy belief categories. CONCLUSION: While a significant proportion of our sample of adolescents in psychiatric treatment endorsed conspiracy beliefs, the majority did not. Furthermore, and to some degree, contrary to public perception, we found that adolescents show relatively good adherence to public health measures-even while experiencing a high degree of mental distress. The predictive value of adverse childhood experiences and peer/conduct problems for conspiracy beliefs might be explained by compensatory mechanisms to ensure the safety, structure, and inclusion that conspiracies provide.

Coping styles mediating the relationship between perceived chronic stress and conspiracy beliefs about COVID-19.

As a global health crisis, COVID-19 has led to a rise in overall stress levels. Concurrently, conspiracy beliefs regarding the origin and spread of the disease have become widespread. Engaging in such beliefs can be explained as a form of coping in order to deal with elevated levels of stress. The present study investigated the indirect effects of coping strategies in the association between perceived chronic stress and COVID-related conspiracy beliefs. We report data from an online survey (N = 1,354 individuals: 807 female; 508 male; 8 diverse; 6 not specified; mean age 39.14 years) in German-speaking countries collected between January and March 2021. Our results indicate that people who felt more stressed were more prone to conspiracy beliefs. Coping via acceptance and self-blame was associated with decreased tendencies towards COVID-related conspiracy beliefs, while people who used denial as a strategy were more prone to these beliefs. These findings emphasize the need for stress management interventions and effective coping strategies during times of crisis in order to reduce chronic perceived stress, promote adaptive coping, and ultimately reduce conspiracy beliefs.

Radical Acceptance of Reality: Putting DBT®-A Skill Groups Online During the COVID-19 Pandemic: A Qualitative Study.

Introduction: Emotion dysregulation is a common challenge pertaining to numerous psychiatric disorders in adolescence and is associated with increased morbidity and mortality. Dialectical Behavior Therapy for Adolescents (DBT®-A) has been shown to be an effective treatment, especially in the reduction of self-harm and suicidality. Measures in relation to the COVID-19 pandemic set strict limits on physical contacts with patients. In order to continuously provide evidence-based specialized care to patients suffering from emotion dysregulation, we offered two online DBT®-A skill groups in a video-group-call format. Objective: We aimed at assessing our online DBT®-A skills groups, collect according up- and downsides, and form a basis for advancement of this form of treatment provision. Also, the impact of the COVID-19 pandemic on patients was assessed. Methods: A physical DBT®-A skill group was switched to a video-group-call format and a second group was initiated de novo online. After five sessions, patients engaged in structured group discussions to reflect experiences. Discussion content was analyzed via Inductive Category Formation within the Framework of Qualitative Content Analysis. Results: Patients unanimously found the COVID-19 pandemic challenging, but also reported differentially on its impact. Downsides were balanced by subjective "gains" in time and a perceived reduction in stress. Technical problems of the online format were discussed, but did not limit the positive experience of still receiving treatment. Patients of both online DBT®-A skill groups valued the offer, felt connected, and reported benefits from the treatment. The transition group additionally discussed changes in structure and content of the group sessions after the switch to online meetings and reflected differential functions of the group. Discussion: Although the sample size is small, and conclusions are drawn from Inductive Qualitative Content Analysis, the presented results are of interest. In our investigation, video-group-calls were both safe and beneficial for patients. This alternative to physical meetings is not only interesting for further waves of the current pandemic but also for service provision in remote areas with limited access to specialized care. Further research is needed to challenge and refine our results and to explore extensions to "basic" video-group-calls, such as "break-out sessions," blended therapy, or real-time supervision within an online session.

Determinants of satisfaction with the detection process of autism in Europe: Results from the ASDEU study.

LAY ABSTRACT: Professional guidance and support in response to first concerns appears to be an important predictor of the level of satisfaction with the detection process of autism in young children. In this study, we analyzed the views of 1342 family members, including 1278 parents, who completed an online survey form collecting information about their experience and satisfaction with the early detection of autism in their child. Specifically, we were interested in how specific experiences with the detection process relate to the satisfaction with it and whether we could identify important predictors of satisfaction. The detection process is an emotionally charged period for parents, often described as painful, chaotic, and lengthy. A better understanding of their experiences is important to take appropriate action to improve the detection process. In our sample, the level of satisfaction with the detection process varied greatly from one respondent to another. Among the different experiences we considered, whether or not respondents received professional guidance and support in response to first concerns explained most of this variation. We also found that difficulty finding information about detection services, lack of professional guidance and support in response to first concerns, having to find a diagnostic service on one's own, and longer delays between confirmation of concerns and first appointment with a specialist were experiences associated with a greater likelihood of being unsatisfied. The findings of this study highlight the importance of the parent-professional relationship in the detection process and have important practical implications for health administrations to improve the detection process.

[Safety and efficacy of en bloc vs. conventional transurethral resection of bladder tumors: a meta-analysis and systematic review]. / Sicherheit und Effizienz der en bloc vs. konventionellen transurethralen Resektion von Blasentumoren: eine Metaanalyse und systematic Review.

BACKGROUND: En bloc tumor resection of bladder tumors (ERBT) is a novel alternative procedure to conventional resection of bladder tumor (cTURBT), which might help to address common problems of the standard method, such as inadequate detrusor muscle in specimens, high re-resection rates and high recurrence rates. OBJECTIVE: To analyze current data on ERBT in efficacy and safety compared to cTURBT. DATA SOURCES: PubMed. STUDY SELECTION: Two independent authors identified trials based on keywords and inclusion criteria. A third author was consulted in case of discrepancies. Screening keywords: ERBT, en bloc transurethral resection of bladder tumor, TURBT en bloc. A meta-analysis of 13 studies was performed. The effect size was estimated based on odds ratios and mean differences including their corresponding two-sided 95% confidence intervals. DATA SYNTHESIS: The analyzed studies comprised a homogenous collective in terms of tumor size, tumor multiplicity and tumor stage. Operation time did not significantly differ between the methods. Differences were observed in hospitalization and catheterization time in favor of ERBT. Reported complications did not show clear differences. There was significantly more detrusor muscle in the specimens in the ERBT group. No significant differences were found in recurrence up to 2 years of follow-up. CONCLUSION: ERBT is a safe alternative to conventional TURBT with promising features regarding effective resection of detrusor muscle. More standardized data on recurrence rates, different resection modalities and resection margin results are needed.

Virtual reality biofeedback interventions for treating anxiety : A systematic review, meta-analysis and future perspective.

BACKGROUND: Virtual reality (VR)-based biofeedback is a relatively new intervention and is increasingly being used for the treatment of anxiety disorders. This is the first research synthesis regarding effects and efficacy of this novel mode of treatment. METHOD: We conducted a systematic review and meta-analysis of the VR biofeedback literature on treating anxiety symptoms. The MEDLINE/PubMed, Scopus and Web of Science databases were searched for eligible pre-post comparisons and randomized controlled trials (RCTs). We used self-reported anxiety, heart rate (HR), and heart rate variability (HRV) as primary outcome measures. RESULTS: A total of 7 studies with 191 participants reported VR biofeedback interventions. Of these studies 5 were RCTs, with 103 participants receiving VR biofeedback and 99 control participants (either 2D biofeedback or waiting list controls). We found that VR biofeedback significantly lowers self-reported anxiety (g = -0.28) and HR (g = -0.45), but not HRV. Furthermore, there were no significant differences in outcomes between VR biofeedback and 2D biofeedback but a significant reduction in HR in the VR biofeedback group compared with the waiting list (g = -0.52). CONCLUSION: While the first findings are optimistic, more controlled studies with a wider variety of samples are needed to bring this field forward. Particularly, children and adolescents may profit from the combination of gamification elements, VR, and biofeedback.

[Transurethral resection of bladder tumors (TURBT)]. / Transurethrale Resektion von Blasentumoren (TUR-B).

Transurethral resection of bladder tumors (TURBT) is the standard of care for the diagnostics and primary treatment of bladder tumors. These are removed by fragmentation using loop diathermy. The resection area is coagulated for hemostasis. An important aspect is always a complete resection with an adequate amount of detrusor muscle in the specimen. Postoperative intravesical instillation of single-shot chemotherapy has been proven to reduce recurrence rates. Methods for improved tumor visualization (particularly photodynamic diagnostics) are used to enhance tumor detection rates particularly in multifocal tumors or carcinoma in situ (CIS). Thus, recurrence and progression rates can be reduced. Depending on the histological examination of the TURBT specimen, follow-up treatment for non-muscle invasive bladder tumors are adjuvant instillation treatment using chemotherapy or Bacillus Calmette-Guérin (BCG), second look TURBT and early cystectomy or for muscle invasive bladder tumors, radical cystectomy or (oncologically subordinate) trimodal treatment with renewed TURBT, radiotherapy and chemotherapy are indicated. Possible complications of TURBT include bleeding with bladder tamponade, extraperitoneal or intraperitoneal bladder perforation and infections of the urogenital tract.

'The world somehow stopped moving': impact of the COVID-19 pandemic on adolescent psychiatric outpatients and the implementation of teletherapy.

BACKGROUND: The COVID-19 pandemic results in disproportional consequences for psychiatric patients. Due to restraints in physical contacts, providers switched from face-to-face contacts to teletherapy, but prior experiences were mostly limited. The study aimed at assessing symptom dynamics, potentially increased adversities and factors influencing a successful transition into teletherapy in adolescent psychiatric outpatients during the COVID-19 pandemic. METHOD: Thirty adolescent psychiatric outpatients participated in an interview-based study. The differential impact of the COVID-19 pandemic was measured by integrating patients' and psychiatrists' judgements. RESULTS: Patients who reported deteriorated symptoms and patients who showed (partial) improvement of symptomatology could be separated by feelings of isolation (specific to deterioration) and perceived reduction in school-associated stress (unique to improvement). Patients with worsening symptomatology showed a significantly higher degree of psychosocial disability before lockdown and at the first interview. Patients who deteriorated in their level of psychosocial functioning also reported negatively on teletherapy. These patients were verbally less differentiated concerning emotions and affect, reported introspection and rumination, and stated distinctly lower levels of perceived social support. Concerning adversities, no clear trend could be identified, but some patients reported increased domestic violence and neglect. CONCLUSIONS: Patients with a higher degree of psychosocial disability suffer disproportionally from the crisis, so that an assessment of functioning should serve as a triage tool. Also, a screening of the perceived level of social support should be established before offering teletherapy. Additionally, the provision of strategies to enhance verbalisation and differentiation of emotions and affect might be beneficial.

Does the Progression of the COVID-19 Pandemic Have an Influence on the Mental Health and Well-Being of Young People? A Cross-Sectional Multicenter Study.

The COVID-19 pandemic has been shown to have impaired the mental health and well-being of young people. This study, for the first time, explores these aspects in young people with and without a migratory background during the extended course of the pandemic and restrictive measures, comparing two countries with a high COVID-19 prevalence: Austria and Turkey. METHODS: The authors used the "Psychological General Well-being" index as part of an anonymous online survey with 3665 participants (ages 15-25), recruited from both countries during the first and the second waves of the pandemic, collecting data on individual experiences and problems encountered during the pandemic. RESULTS: Mental health (b = 0.06, p < 0.023) and general psychological well-being worsened with the progression of the pandemic. Participants with financial problems had the most severe negative effect on mental health (b = 0.12, p < 0.001). Furthermore, females living in Turkey, both natives (b = -0.21, p < 0.001) and migrants (b = 0.25, p < 0.001), reported a more deteriorated mental health status over time. CONCLUSIONS: The extended pandemic duration and resultant "lockdown" restrictions have negatively affected the mental health of young people to varying degrees, depending on country of residence and migration background. A strong "recovery plan" that considers group-specific needs and vulnerabilities is urgently needed.