[Treatment of obsessive-compulsive disorders: recommendations of the revised S3 guidelines on obsessive-compulsive disorders]. / Therapie der Zwangsstörungen: Empfehlungen der revidierten S3-Leitlinie Zwangsstörungen.

In 2022, the first revised version of the S3 guidelines on obsessive-compulsive disorder will be published under the auspices of the German Society for Psychiatry, Psychotherapy and Psychosomatics (DGPPN). This article contains a summary of the most important recommendations for therapy in a condensed form. There were no major changes in the central basic therapy recommendations compared with the first version of the guidelines, as the evidence base has not fundamentally changed since then. Cognitive behavioral therapy (CBT) with exposure and response management is the most effective form of therapy for this clinical picture and therefore the therapy of first choice. Regarding pharmacotherapy, selective serotonin reuptake inhibitors are the first-line medications. They are indicated when CBT with exposure is not available or has not been effective, when CBT is rejected by the patient and in the patient's personal preference for medication, or to increase the readiness for CBT with exposure. New recommendations include, e.g., the use of Internet therapy, and recommendations for the use of CBT and exposure, e.g., also in group format, including video conferencing if appropriate as well as in intensive format.

Psychological flexibility as a potential change factor in cognitive behavioural therapy of OCD.

BACKGROUND: To gain a better understanding about which aspects of the treatment work for obsessive-compulsive disorders (OCD), the investigation of possible change factors is essential. Psychological flexibility (PsyF) has been of interest in research on successful OCD therapy for some time. Exposure interventions and cognitive strategies in cognitive behavioural therapy (CBT) for OCD may enhance PsyF. To date, however, no process studies have been published that clarify the role of PsyF as a possible change factor for the reduction of OCD symptoms. AIMS: This study investigates whether PsyF works as a mediator in successful CBT treatment of OCD. METHOD: The study recruited 112 adults diagnosed with OCD in a multi-modal in-patient treatment with specific CBT including exposure and response prevention (ERP). The Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) was used to measure OCD symptoms and three self-constructed items to assess PsyF. PsyF was conceptualised as the capability of patients to accept stressful feelings and thoughts. Data were collected weekly. For statistical analysis at the process level, longitudinal multi-level models (MLMs) with random intercepts and linear growth curves were estimated to test for mediation of PsyF on Y-BOCS. RESULTS: OCD symptoms decreased significantly and PsyF increased in patients throughout the course of therapy. MLM revealed that higher average values in PsyF were associated with lower Y-BOCS sum values, but only values between subjects significantly predicted the degree of obsessions and compulsions. CONCLUSIONS: Although research shows that PsyF is enhanced by CBT and also shows a connection with Y-BOCS values, its role as a mediator could not be confirmed.

Psychological consequences and differential impact of the COVID-19 pandemic in patients with mental disorders.

OBJECTIVE: People with mental disorders might be differentially affected by the COVID-19 pandemic. The aim of the current study was to evaluate the impact of the pandemic on patients with various psychiatric disorders who were admitted to inpatient treatment. METHODS: Five-hundred thirty-eight inpatients with mental disorders participated in a survey about psychological consequences of the pandemic between March-December 2020. We examined the perceived burden by restrictions and worries, changes in health care utilization, and helpfulness of coping strategies. RESULTS: More than 50% reported any worsening of symptoms, 40% stated increased need of therapeutic support. High rates of symptom deterioration were observed for depressive symptoms (>55%), anxiety (>40%), and sleeping behavior (>40%). Treatment impairment was stated by 27.9%. Patients with anxiety disorders were less affected by contact restrictions compared with eating disorders and depression. Patients with anorexia nervosa and post-traumatic stress disorder experienced higher helpfulness by daily structuring than patients with depression. DISCUSSION: About half of our sample of psychiatric patients experienced symptom deterioration due to the pandemic and about one quarter reported impairment of treatment modalities. Especially patients with eating disorders and depressive disorders were more frequently affected. The results indicate a needed improvement of treatment options during a pandemic.

Impact of comorbid borderline personality disorder on the outcome of inpatient treatment for anorexia nervosa: a retrospective chart review.

BACKGROUND: Data on patients with anorexia nervosa (AN) and comorbid Borderline personality disorder (AN+BPD) are scarce. Therefore, we investigated (1) whether patients with AN and AN+BPD differ in characteristics related to admission to, discharge from, and course of specialized inpatient eating disorder treatment and (2) how comorbid BPD affects treatment outcome. METHOD: One-thousand one-hundred and sixty inpatients with AN (97.2% female, 5.9% with comorbid BPD; mean age = 26.15, SD = 9.41) were administered the Brief Symptom Inventory (BSI), the Eating Disorder Inventory 2 (EDI-2), and the Global Assessment of Functioning (GAF) at admission and discharge. Data were extracted by a retrospective chart review of naturalistic treatment data. Age, sex, weekly weight gain, length of stay, and discharge characteristics were compared with independent t-tests and χ2-tests. Changes in outcome variables, including body mass index (BMI), were analyzed with longitudinal multilevel mixed-effects models. RESULTS: No differences in age or sex were found between patients with AN and AN+BPD, but groups differed in previous inpatient treatments, BMI at admission, and frequency of at least one additional comorbidity with higher values for AN+BPD. Higher levels of disorder-specific and general psychopathology at admission were found for AN+BPD. Patients with AN showed statistically significant improvement in all examined variables, patients with AN+BPD improved in all variables except EDI-2 body dissatisfaction. Strongest improvements in patients with AN+BPD occurred in BMI (Cohen's d = 1.08), EDI-2 total score (Cohen's d = 0.99), EDI-2 interpersonal distrust (d = 0.84). Significant Group x Time Interactions were observed for BSI GSI, GAF, and EDI-2 body dissatisfaction, indicating a reduced benefit from inpatient treatment in AN+BPD. At discharge, no differences were found in weekly weight gain, BMI, length of stay, or discharge characteristics (e.g., ability to work, reason for discharge), however, patients with AN+BPD were more frequently treated with medication. CONCLUSIONS: Patients with AN+BPD differ from patients with AN in that they show higher general and specific eating disorder psychopathology and only partially improve under specialized inpatient treatment. In particular, aspects of emotion regulation and core AN symptoms like body dissatisfaction and perfectionism need to be even more targeted in comorbid patients.

Bulimia nervosa in times of the COVID-19 pandemic-Results from an online survey of former inpatients.

OBJECTIVE: The COVID-19 pandemic might pose special challenges to patients with eating disorders (EDs) by interfering with daily routines. The aim of this study was to investigate the impact of the current pandemic on patients with bulimia nervosa (BN). METHODS: Fifty-five former inpatients with BN completed an online survey on psychological consequences of the COVID-19 pandemic as well as on changes in health care utilisation and on the use and helpfulness of different coping strategies. RESULTS: Almost half of patients (49%) reported a deterioration of their ED symptomatology and 62% reported a reduced quality of life. The frequency of binge eating increased in 47% of patients and self-induced vomiting in 36%. Forty-six percent of patients stated a noticeable impairment of psychotherapy. Face-to-face psychotherapy decreased by 56% but videoconferencing therapy was only used by 22% of patients. Enjoyable activities, virtual social contacts with friends and mild physical activities were rated as the most helpful coping strategies among those most used. DISCUSSION: Approximately one half to two-thirds of former inpatients with BN experienced a negative impact of the crisis on their ED symptomatology and quality of life. In challenging times when face-to-face therapy options are restricted, e-health treatments such as videoconferencing therapy should be considered to ensure continuity of care.