Diagnostic criteria to differentiate pathological procrastinators from common delayers: a re-analysis.

Detection and treatment of clinically relevant forms of procrastination would be greatly facilitated by diagnostic criteria as formulated for psychological disorders in the Diagnostic and Statistical Manual (DSM-5). In the present article, the steps for deriving and validating diagnostic criteria for pathological procrastination are described. In an online survey of a random sample of N = 10,000 German university students, 990 answered 13 items derived from the attempts in the literature to define procrastination, the Aitken Procrastination Inventory (API) and the Patient Health Questionnaire (PHQ-9). A subset of six items related to the first factor onset delay of the API was selected by Best Subset Multiple Regression (BSMR). A latent class analysis (LCA) of these six items sorted the students into six clusters. A cluster of pathological procrastinators (10%) was separated from the clusters of less impaired habitual, average, and occasional delayers. In addition, a cluster of unconcerned delayers (10%), with strong procrastination tendencies but little personal disadvantages, and a small cluster of fast performers (2%) emerged. The pathological procrastinators differed from all other clusters significantly on nine of the 13 items. They were older, had studied longer but had fulfilled less of their study obligations and were more depressed. The answer options of the six questions were collapsed into two categories (procrastination feature present for at least half a year or absent). These criteria were used for the clinical diagnosis of pathological procrastination. For a diagnosis, two fixed criteria (delaying important tasks needlessly and strong interference with personal goals) plus at least two of four additional criteria (time spent procrastinating, time pressure, physical and psychological complaints, below performance potential) must be met. This diagnostic rule captured 92% from the cluster of pathological procrastinators and 10% of the habitual delayers, but no one from the remaining clusters. Using these diagnostic criteria for clinical diagnosis and intervention decisions will facilitate the comparison and integration of the results from future studies of procrastination.

Joint versus separate inpatient rehabilitation treatment for patients with alcohol use disorder or drug use disorder: an observational study.

BACKGROUND: In many national treatment systems, patients with alcohol use disorders (AUD) and those with drug use disorders (DUD) are treated separately, while other systems provide joint treatment for both kinds of substance use disorders (SUDs). Regarding long-term rehabilitation treatment of DUD and AUD patients, there is however a lack of empirical studies on the comparison between a separate versus joint treatment modality. METHODS: Data were gathered from 2 rehabilitation units located in small towns from the same German region. One unit provided treatment to a mixed group of AUD and DUD patients, while the other unit treated the 2 groups separately. Staffing, funding, and treatment programs were otherwise similar between facilities. Data were gathered from standardized routine documentation and standardized interviews. In order to understand correlates of premature treatment termination, a logistic regression analysis was performed, with treatment modality and type of SUD as main predictors, and a range of patient characteristics as covariates. RESULTS: Patients (N=319) were diagnosed with AUD (48%), DUD (34%), or AUD plus DUD (18%). Patients in joint treatment showed a higher prevalence of lapses during treatment than those in separate treatment (26% versus 12%; p=0.009), but there was no significant difference in the prevalence of premature terminations (38% versus 44%, p=0.26). Treatment modality and interaction between modality and type of SUD was not significantly associated with premature termination. Joint treatment completers showed higher satisfaction with treatment than separate treatment completers (p<0.001). CONCLUSION: We found no evidence here for a difference between treatment modalities in terms of premature termination rate. Satisfaction level was higher in those who completed joint treatment compared to separate treatment.

Propofol sedation during gastrointestinal endoscopy arouses euphoria in a large subset of patients.

BACKGROUND: Propofol is recommended for sedation in gastrointestinal endoscopy (GE), but preliminary data suggest addictive potentials. OBJECTIVE: The objective of this article is to evaluate the frequency of predominantly euphoric reaction after GE and patients' subsequent reminiscences. METHODS: Eighty-two patients undergoing elective GE under propofol sedation were enrolled in a prospective observational study. The grade of anxiety, expectation or relief about the examination's result and affective state in terms of cheerfulness, relaxation, activation, sedation and anxiety were surveyed using a numeric rating scale (1 to 10) immediately before (t1), after GE (t2) and seven days (t3) later. Statistics: hierarchical cluster analysis, heat map, χ2 test and paired t test. RESULTS: Mean propofol dosage was 264 ± 120 mg. Two clusters of mood changes emerged (t1 vs. t2). One (n = 46, 56.1%) was characterized by an unease reaction pattern with equal values regarding cheerfulness, relaxation and anxiety, while relaxation decreased; the other cluster showed a euphoric reaction pattern (n = 36, 43.9%) with markedly increased cheerfulness, relaxation and decreased anxiety. These effects intensified at recall (t3). Despite similar endoscopy results, euphoric cluster patients rated these more positively. CONCLUSION: Propofol induces euphoria in nearly half of the patients undergoing elective GE with persisting, even enhanced reminiscence (germanctr.de, trial number DRKS00011202).

"This Treatment Can Really Help Me"-A Longitudinal Analysis of Treatment Readiness and Its Predictors in Patients Undergoing Alcohol and Drug Rehabilitation Treatment.

BACKGROUND: There is evidence that patients entering alcohol or drug treatment have different levels of treatment readiness and change their motivation differently over time. Nonetheless, existing studies mainly use single measures of motivation and do not consider individual differences. This study addresses 2 questions: (i) How does treatment readiness change in patients with alcohol and drug use dependence over the course of an inpatient rehabilitation treatment?; and (ii) Can changes in treatment readiness be explained by sociodemographic and substance use-related characteristics? METHODS: Data from 177 alcohol-dependent patients and 152 drug-dependent patients were collected in 2 inpatient rehabilitation centers in Germany. Three single-item indicators of treatment readiness were assessed weekly over the course of the treatment. Sociodemographic and substance use-related characteristics were assessed at baseline. To model developments of treatment readiness that may be different for each patient, multilevel analyses for longitudinal data were used. RESULTS: The overall effect of time on treatment readiness was not significant, indicating that average motivation across all patients did not change over the course of the treatment. However, individuals showed different initial states and different rates of change. School education, employment status, earlier substance use treatments, and craving predicted treatment readiness. Interactions with time were found for craving and marital status. CONCLUSIONS: The results suggest that it is necessary to consider individual differences when evaluating treatment motivation in alcohol- and drug-dependent patients. The identification of variables predicting motivation may help to improve substance abuse treatment contents and outcomes.

Neural correlates of an attentional bias to health-threatening stimuli in individuals with pathological health anxiety.

BACKGROUND: An attentional bias to health-threat stimuli is assumed to represent the primary pathogenetic factor for the development and maintenance of pathological health anxiety (PHA; formerly termed "hypochondriasis"). However, little is known about the neural basis of this attentional bias in individuals with PHA. METHODS: A group of patients with PHA, a group of depressed patients and a healthy control group completed an emotional Stroop task with health-threat (body symptom and illness) words and neutral control words while undergoing functional MRI. RESULTS: We included 33 patients with PHA, 28 depressed patients and 31 controls in our analyses. As reflected in reaction times, patients with PHA showed a significantly stronger attentional bias to health-threat words than both control groups. In addition, patients with PHA showed increased amygdala and rostral anterior cingulate cortex activation for body symptom, but not for illness words. Moreover, only in patients with PHA amygdala activation in response to symptom words was positively associated with higher arousal and more negative valence ratings of the body symptom word material. LIMITATIONS: A control group of patients with an anxiety disorder but without PHA would have helped to define the specificity of the results for PHA. CONCLUSION: The attentional bias observed in patients with PHA is associated with hyperactivation in response to body symptom words in brain regions that are crucial for an arousal-related fear response (e.g., the amygdala) and for resolving emotional interference (e.g., the rostral anterior cingulate cortex). The findings have important implications for the nosological classification of PHA and suggest the application of innovative exposure-based interventions for the treatment of PHA.

Cough Is Dangerous: Neural Correlates of Implicit Body Symptoms Associations.

The negative interpretation of body sensations (e.g., as sign of a severe illness) is a crucial cognitive process in pathological health anxiety (HA). However, little is known about the nature and the degree of automaticity of this interpretation bias. We applied an implicit association test (IAT) in 20 subjects during functional magnetic resonance imaging (fMRI) to investigate behavioral and neural correlates of implicit attitudes toward symptom words. On the behavioral level, body symptom words elicited strong negative implicit association effects, as indexed by slowed reaction times, when symptom words were paired with the attribute "harmless" (incongruent condition). fMRI revealed increased activation in the dorsolateral prefrontal cortex (DLPFC) and posterior parietal cortex for the comparison of incongruent words with control words, as well as with a lower significance threshold also in comparison to congruent words. Moreover, activation in the DLPFC, posterior parietal cortex, nucleus accumbens, and cerebellum varied with individual levels of HA (again, in comparison to control words, as well as with a lower significance threshold also in comparison to congruent words). Slowed reaction times as well as increased activation in dorsolateral prefrontal and posterior parietal cortex point to increased inhibitory demands during the incongruent IAT condition. The positive association between HA severity and neural activity in nucleus accumbens, dorsolateral prefrontal, and posterior parietal cortex suggests that HA is characterized by both intensified negative implicit attitudes and hampered cognitive control mechanisms when confronted with body symptoms.

Health anxiety and hypochondriasis in the light of DSM-5.

BACKGROUND: In the DSM-5, the diagnosis of hypochondriasis was replaced by two new diagnositic entities: somatic symptom disorder (SSD) and illness anxiety disorder (IAD). Both diagnoses share high health anxiety as a common criterion, but additonal somatic symptoms are only required for SSD but not IAD. DESIGN: Our aim was to provide empirical evidence for the validity of these new diagnoses using data from a case-control study of highly health-anxious (n = 96), depressed (n = 52), and healthy (n = 52) individuals. RESULTS: The individuals originally diagnosed as DSM-IV hypochondriasis predominantly met criteria for SSD (74%) and rarely for IAD (26%). Individuals with SSD were more impaired, had more often comorbid panic and generalized anxiety disorders, and had more medical consultations as those with IAD. Yet, no significant differences were found between SSD and IAD with regard to levels of health anxiety, other hypochondriacial characteristics, illness behavior, somatic symptom attributions, and physical concerns, whereas both groups differed significantly from clinical and healthy controls in all of these variables. CONCLUSION: These results do not support the proposed splitting of health anxiety/hypochondriasis into two diagnoses. Further validation studies with larger samples and additional control groups are warranted to prove the validity of the new diagnoses.

Clarifying the latent structure and correlates of somatic symptom distress: A bifactor model approach.

Distressing somatic symptoms are ubiquitous both in mental disorders and medical diseases. From a psychometric perspective, the structure of somatic symptom distress is unclear, and little is known about the strengths of associations to related constructs, such as health anxiety and somatosensory amplification. To clarify the structure of somatic symptom distress and to explore associations to health anxiety, somatosensory amplification, and functional somatic syndromes, data sets of 2 samples of college students from Germany (N = 1,520) and Switzerland (N = 3,053) were investigated with confirmatory factor analysis with robust estimation. A bifactor model (with 1 general and 4 orthogonal specific symptom factors-gastrointestinal, fatigue, cardio-pulmonary, and pain symptoms) revealed the best model fit. Medium-sized associations were found among latent factors of general somatic symptom distress, health anxiety, and depression. First evidence for the construct validity of the latent variables within the proposed bifactor structure was gained by observing (a) strong associations between the general somatic symptom distress factor and somatosensory amplification and (b) significant associations between both the general somatic symptom factor as well as the symptom-specific factors with functional somatic syndromes. The results offer a theoretically and psychometrically plausible model for the structure of somatic symptom distress and suggest a distinction between cognitive-affective and sensory aspects of symptom perception. The findings are compatible with current cognitive psychological and neuropsychological approaches to symptom perception and imply that somatic symptom distress is a multidimensional phenomenon that is both strongly linked to but also clearly separable from related constructs.

Metacognitions, worry and sleep in everyday life: Studying bidirectional pathways using Ecological Momentary Assessment in GAD patients.

BACKGROUND: The metacognitive model of generalized anxiety disorder proposes that negative metacognitive beliefs are crucial in the maintenance of excessive worry. Furthermore, according to the cognitive model of insomnia, worry leads to problems falling or staying asleep and poor sleep quality. In order to test the assumed causal relationships, the present study examined the time-dependent course of negative metacognition and worry as well as worry and sleep quality, using Ecological Momentary Assessment (EMA). METHOD: Negative metacognitions, worry and sleep were assessed by self-report questionnaires as well as EMA in 56 GAD patients who carried a portable device for 1 week and logged sleep quality, negative metacognition and worry processes four times a day. RESULTS: Metacognitions, worry and sleep were significantly correlated. Structural equation modeling using multilevel analyses showed a unidirectional relationship of negative metacognitions leading to prolonged worry processes and a bidirectional relationship of worry and sleep quality. CONCLUSIONS: These findings support the theoretically derived assumptions on the relationship between negative metacognitions, worry and sleep. Implications for further research as well as clinical implications are discussed.

A diary-based modification of symptom attributions in pathological health anxiety: effects on symptom report and cognitive biases.

OBJECTIVE: To examine whether a 2-week attribution modification training (AMT) changes symptom severity, emotional evaluation of health-threatening stimuli, and cognitive biases in pathological health anxiety. METHOD: We randomized 85 patients with pathological health anxiety into an electronic diary-based AMT group (AMTG; n = 42) and a control group without AMT (CG; n = 43). Self-report symptom measures, emotional evaluation, attentional bias, and memory bias toward symptom and illness words were assessed with an emotional Stroop task, a recognition task, and an emotional rating task for valence and arousal. RESULTS: After the 2-week period, the AMTG compared with the CG reported lower symptoms of pathological health anxiety, F(1, 82) = 10.94, p < .01, η2p = .12, rated symptom, F(1, 82) = 5.56, p = .02, η2p = .06, and illness words, F(1, 82) = 4.13, p = .045, η2p = .05, as less arousing, and revealed a smaller memory response bias toward symptom words in the recognition task F(1, 82) = 12.32, p < .01, η2p = .13. However, no specific AMT effect was observed for the attentional bias. CONCLUSION: The results support the efficacy of a comparatively short cognitive intervention in pathological health anxiety as a possible add-on intervention to existing treatment approaches to reduce symptom severity, as well as abnormalities in health-related emotional evaluation and memory processes.

Placement matching of alcohol-dependent patients based on a standardized intake assessment: rationale and design of a randomized controlled trial.

BACKGROUND: Despite considerable research on substance-abuse placement matching, evidence is still inconclusive. The aims of this exploratory trial are to evaluate (a) the effects of following matching guidelines on health-care costs and heavy drinking, and (b) factors affecting the implementation of matching guidelines in the treatment of alcohol-dependent patients. METHODS: A total of 286 alcohol-dependent patients entering one of four participating detoxification units and having no arrangements for further treatment will be recruited. During the first week of treatment, all patients will be administered Measurements in the Addictions for Triage and Evaluation (MATE), European Quality of Life-Five Dimensions health status questionnaire (EQ-5D), and the Client Socio--Demographic and Service Receipt Inventory-European Version (CSSRI-EU). Patients who are randomly allocated to the intervention group will receive feedback regarding their assessment results, including clear recommendations for subsequent treatment. Patients of the control group will receive treatment as usual and, if requested, global feedback regarding their assessment results, but no recommendations for subsequent treatment. At discharge, treatment outcome and referral decisions will be recorded. Six months after discharge, patients will be administered MATE-Outcome, EQ-5D, and CSSRI-EU during a telephone interview. DISCUSSION: This trial will provide evidence on the effects and costs of using placement-matching guidelines based on a standardized assessment with structured feedback in the treatment of alcohol-dependent patients. A process evaluation will be conducted to facilitate better understanding of the relationship between the use of guidelines, outcomes, and potential mediating variables. TRIAL REGISTRATION: German Clinical Trials Register DRKS00005035. Registered 03 June 2013.

Childhood maltreatment is associated with depression but not with hypochondriasis in later life.

OBJECTIVE: Previous studies demonstrated that a history of childhood trauma is linked to mental disorders in adulthood, particularly to depression. Adverse childhood experiences are also considered to contribute to the risk of hypochondriasis, but the results of previous studies have not been conclusive with respect to the strength and specificity of this association. Therefore, we compared the association of adverse childhood experiences with both hypochondriasis and depression. METHODS: Fifty-eight patients with hypochondriasis, 52 patients with depression, and 52 healthy control participants completed the Childhood Trauma Questionnaire (CTQ) which assesses 5 varieties of abuse and neglect. A clinical interview (SCID-I) was used to establish DSM-IV diagnoses. Associations between childhood maltreatment, hypochondriasis and depression were estimated by means of analyses of variance and multiple linear regression analyses. RESULTS: In comparison to hypochondriacal and healthy participants, patients with a current depressive disorder reported more emotional abuse as well as more emotional and physical neglect during childhood. Patients with hypochondriasis reported more emotional neglect than healthy individuals. However, when predicting the CTQ trauma types by diagnostic category adjusting for sex and comorbid DSM-IV diagnoses, emotional abuse, emotional neglect, physical abuse, physical neglect, as well as the CTQ total score were significantly associated with depression, but none of the CTQ scores was significantly related to hypochondriasis. CONCLUSIONS: The findings suggest a robust association of childhood maltreatment with depression but not with hypochondriasis. This result does not support etiological models of hypochondriasis which rely on childhood maltreatment as a risk factor for the development of this disorder.

Neuronal and behavioral correlates of health anxiety: results of an illness-related emotional Stroop task.

BACKGROUND: Health anxiety (HA) is defined as the objectively unfounded fear or conviction of suffering from a severe illness. Predominant attention allocation to illness-related information is regarded as a central process in the development and maintenance of HA, yet little is known about the neuronal correlates of this attentional bias. METHODS: An emotional Stroop task with body symptom, illness, and neutral words was employed to elicit emotional interference in healthy participants with high (HA+, n = 12) and low (HA-, n = 12) HA during functional magnetic resonance imaging. RESULTS: Prolonged reaction times for indicating the color of symptom words and a decrease in rostral anterior cingulate cortex (rACC) activation were seen in HA+ participants. Emotional interference effects on the behavioral level were negatively related to rACC activity over the whole group. Groups did not differ during the processing of threatening illness words. CONCLUSION: The results indicate stronger attention allocation toward body symptom words already in subclinical HA. This attentional bias appears to be linked to hypoactivity of the rACC which impedes effective emotional interference reduction, leading instead to a ruminative processing of the stimulus content.

Conceptual structure of the symptoms of adult ADHD according to the DSM-IV and retrospective Wender-Utah criteria.

OBJECTIVE: Adult Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) and retrospective childhood Wender-Utah ADHD criteria are implemented in self-report measures to assess adult ADHD and its required onset in childhood. Yet their dimensional structure and relationship to adult ADHD depressivity is still at debate. Therefore, both aspects were investigated, applying two respective German instruments (ADHD-Self-Report [ADHD-SR] and Wender Utah Rating Scale-German [WURS-G]) to two student samples. METHOD: ADHD-SR and WURS-G dimensions were identified by nonlinear confirmatory factor analyses, and their interrelations and relationship with adult depressivity were identified by structural equation modeling. RESULTS: Adult ADHD-SR symptoms were organized into inattention, hyperactivity, and impulsivity, and WURS-G symptoms were organized into inattention/hyperactivity, affect lability, depressivity, and conduct problems. Yet only the first two WURS factors directly affected adult ADHD facets, though childhood depressivity influenced them indirectly via adult depressivity. CONCLUSION: Only criteria of the first two WURS factors can be considered valid childhood ADHD indicators. Thus, only they should be used as an aid in the retrospective assessment of ADHD symptoms.

Somatic symptom reporting has a dimensional latent structure: results from taxometric analyses.

Medically unexplained symptoms (MUS) are one of the key features of somatoform disorders. Although MUS are currently treated as both categorical (in terms of the diagnosis of somatoform disorders) and dimensional (in terms of quantitative measures of somatization/somatic symptom reporting), little is known about the empirical latent structure of MUS. Using taxometric analyses, the latent structure of somatic symptom reporting was analyzed with the Patient Health Questionnaire (PHQ)-15 in two student samples (N=782 and N=2,577) and a primary care sample (N=519). We applied three popular taxometric methods: Maximum Eigenvalue (MAXEIG), Mean Above Minus Below a Cut (MAMBAC) and Latent-Mode (L-Mode). Simulation data were created to evaluate the appropriateness of the data for our analyses and to create the comparison curve fit index (CCFI) as an objective outcome measure. The results of all taxometric methods in any of the three data sets were in favor of a dimensional solution (CCFI<.50). Simulated taxonic and dimensional datasets differed substantially and the samples were appropriate for taxometric analysis. Accordingly, the latent structure of somatization/somatic symptom reporting as assessed by the PHQ-15 is dimensional in both primary care and student samples. Implications regarding the practical application as well as models of etiology and pathogenesis of somatic symptom reporting are discussed.

Prediction of the outcome of inpatient opiate detoxification treatment: results from a multicenter study.

BACKGROUND: Monocentric studies of inpatient opiate detoxification treatment show considerable variability regarding treatment success rates. This multicentric study investigates whether patient characteristics explain the different rates of regular discharge between treatment units. METHODS: 1,017 opiate-dependent patients from 12 detoxification units with similar treatment programs, funding, staffing and equipment were analyzed. Patient data and outcomes were documented by treatment staff using a standard form. RESULTS: Controlling for center, regular discharge (range: 14-49% between centers) was significantly associated with pre-existing plans for follow-up treatment, previous completed long-term residential and detoxification treatments, fewer unsuccessful detoxification treatments, higher age, later onset of opiate use, and longer duration of use. Controlling for patient characteristics, the center variable was significantly associated with outcome in a multiple logistic regression analysis. CONCLUSIONS: Regular discharge could best be predicted by patients' plans for follow-up treatment and previous treatment outcomes. Although treatment units had equivalent resources and regulations, and although patient effects were statistically controlled for, there were still considerable center effects. Setting factors as well as actual drop-out processes should be investigated more closely in the future.

Eye movement assessment in individuals with social phobia: differential usefulness for varying presentation times?

Visual dot probe tasks are used to examine attentional biases towards threat faces in social phobia. Based on eye movement assessments, short presentation times of stimuli have been proposed to investigate initial attentional processes. However, it remains unclear if eye movements contribute to anxiety related biases as measured in dot probe tasks when presentation times below 200 ms are used. In this study the electrooculogram (EOG) was recorded in a sample of 17 participants with social phobia and 13 controls performing a visual dot probe task in two presentation time conditions. In the 175 ms condition, half of the participants moved their eyes in only 10% of the trials. Significantly more participants moved their eyes in the 600 ms condition and individuals with social phobia directed their gaze more often to the threat faces than to the neutral faces. Eye movement measures were not related to reaction time measures but the number of initial eye movements towards threatening faces correlated with measures of social anxiety. For dot probe paradigms, the additional use of eye movement measures seems to be particularly appropriate for longer presentation times. The dissociation between attentional bias scores as measured with reaction time versus eye movement measures and their relation to different presentation times underlines the need for both measures when conducting visual probe studies.

Heart rate stress response dampening: the impact of alcohol, family history, and gender on at risk children and siblings.

OBJECTIVE: In the following study we tested the stress response dampening (SRD) model which postulates that stress responses are more likely to be attenuated by alcohol in individuals at risk for alcohol dependence than in persons without that risk. In a laboratory experiment we examined a) if SRD effects exist for both sons and healthy daughters of alcohol dependent fathers, and b) if SRD effects exist for siblings of alcohol dependent males. METHODS: We recruited 104 subjects at risk and 51 matched control subjects. In a laboratory experiment, study subjects received alcohol in one of two laboratory sessions and a stress paradigm served to elicit heart rate stress responses. RESULTS: Heart rate stress responses were attenuated by alcohol in female family history positive (FHP) and female family history negative (FHN) subjects, however not in males. A multiple regression analysis revealed "Heart Rate Stress Response in the Non-Alcohol Condition" and "Blood Alcohol Level" as significant predictors of SRD. CONCLUSIONS: According to our findings, females carry a distinct risk for developing alcohol dependence, regardless of their family history and regardless of their degree of familial relationship. This is an important issue for devising models concerning the development and maintenance of alcohol dependence in females. The study extends the current research literature, which mainly focuses on male subjects at risk, by including female subjects at risk, as well as siblings at risk of both genders.

Implicit and explicit procedural learning in patients recently remitted from severe major depression.

In acute depression a high prevalence of deficits in learning and memory performance has been reported. Still, it is unclear whether these cognitive deficits are present after remission of clinical symptoms of depression. The present study compared 20 inpatients recently remitted from severe major depressive disorder (MDD) with 20 healthy matched control participants on two sequence learning tasks: a modified serial reaction-time task (SRT) for implicit learning, which is sensitive to subcortical and frontal impairments, and a serial generation task (SGT) for explicit learning. As compared with performance in healthy controls, implicit and explicit learning were not impaired in recently remitted inpatients with depression. Intentional acquisition of new information was related to the severity of depressive symptoms as patients with higher scores on Beck's Depression Inventory (BDI) showed poorer explicit learning. In contrast to findings in acute depression, our results suggest a normal degree of learning in remitted depression; these findings are consistent with unimpaired fronto-striatal functioning. However, although not statistically significant, patients remitted from melancholic MDD revealed poorer implicit learning performance compared with patients remitted from non--melancholic MDD. Longitudinal studies in patients with melancholic vs. non-melancholic MDD are needed to investigate the course of cognitive functioning during the recovery from MDD.

[Increased prevalence of problematic alcohol consumption in university students]. / Zur erhöhten Prävalenz des problematischen Alkoholkonsums bei Studierenden.

OBJECTIVE: To compare the prevalence rates of problematic alcohol consumption in students and in the general population. METHODS: A sample of students (n=1 115) and a population sample (n=631) were assessed with the Patient Health Questionnaire (PHQ). The PHQ probes for problematic alcohol consumption with five questions. An "alcohol syndrome" is suspected if at least one of these indicators is present. RESULTS: The alcohol syndrome was present more frequently among students than in the population sample (30,1% versus 8,1%). The odds ratio, adjusted for age, gender and education, was OR=3,7. However, when the five indicators were analysed separately, only two of them were significantly more frequent in students than in the comparison sample. Both indicate a neglect of duties as a consequence of alcohol consumption. CONCLUSIONS: Intervention strategies aimed at students' alcohol consumption should focus on binge drinking and the risks associated with this problematic form of alcohol consumption.