E-Health intervention for subthreshold depression: Reach and two-year effects of a randomized controlled trial.

BACKGROUND: There is evidence for e-Health interventions for full-blown depression. Little is known regarding commonly untreated subthreshold depression in primary care. This randomized controlled multi-centre trial assessed reach and two-year-effects of a proactive e-Health intervention (ActiLife) for patients with subthreshold depression. METHODS: Primary care and hospital patients were screened for subthreshold depression. Over 6 months, ActiLife participants received three individualized feedback letters and weekly messages promoting self-help strategies against depression, e.g., dealing with unhelpful thoughts or behavioural activation. The primary outcome depressive symptom severity (Patient Health Questionnaire;PHQ-8) and secondary outcomes were assessed 6, 12 and 24 months. RESULTS: Of those invited, n = 618(49.2 %) agreed to participate. Of them, 456 completed the baseline interview and were randomized to ActiLife (n = 227) or assessment only (n = 226). Generalised estimation equation analyses adjusting for site, setting and baseline depression revealed that depressive symptom severity declined over time, with no significant group differences at 6 (mean difference = 0.47 points; d = 0.12) and 24 months (mean difference = -0.05 points; d = -0.01). Potential adverse effects were observed at 12 months, with higher depressive symptom severity for ActiLife than control participants (mean difference = 1.33 points; d = 0.35). No significant differences in rates of reliable deterioration or reliable improvement of depressive symptoms were observed. ActiLife increased applied self-help strategies at 6 (mean difference = 0.32; d = 0.27) and 24 months (mean difference = 0.22; d = 0.19), but not at 12 months (mean difference = 0.18; d = 0.15). LIMITATIONS: Self-report measures and lack of information on patients' mental health treatment. DISCUSSION: ActiLife yielded satisfactory reach and increased the use of self-help strategies. Data were inconclusive in terms of depressive symptom changes.

The association of cognitive distortions and the type of gambling in problematic and disordered gambling.

BACKGROUND: Previous studies have shown that particular types of gambling are related to the development of gambling-related problems. Further, gambling-related cognitive distortions contribute to the development of disordered gambling. The aim of the present study is to compare different gambling types with respect to cognitive distortions and the development of disordered gambling. METHODS: Based on a proactively screened sample of vocational school students (N = 6718), 309 students were selected to undergo an in-depth interview. We assessed the Gamblers-Belief-Questionnaire (GBQ) to measure gambling-related cognitive distortions and the Stinchfield questionnaire for assessing gambling-related problems. Associations between cognitive distortions, gambling-related symptoms, and types of gambling were analysed using logistic regression analyses. RESULTS: Higher scores on the GBQ subscale "belief in luck/perseverance" led to a significantly higher chance to be classified as a person with Gambling Disorder (Conditional Odds Ratio (COR) = 1.05, Confidence Interval (CI) = 1.02-1.08) as well as problematic gambling (COR = 1.04, CI = 1.01-1.06). Higher scores on the subscale "illusion of control" were also associated with problematic gambling (COR = 1.04, CI = 1.00-1.08). The multivariate analyses of the gambling types identified only sports betting as a predictor for problematic gambling (COR = 1.91, CI = 1.05-3.49). When controlling for cognitive distortions, sports betting was not significant anymore. With respect to disordered gambling, gambling on electronic gambling machines (EGMs) turned out to be a risk factor besides cognitive distortions (COR = 2.59, CI = 1.04-6.49). DISCUSSION: The present study confirmed the high relevance of cognitive distortions for problematic and disordered gambling especially for sports betting and gambling on EGMs. Preventive measures and psychotherapy should take these relationships into account.

Manifesto for a European research network into Problematic Usage of the Internet.

The Internet is now all-pervasive across much of the globe. While it has positive uses (e.g. prompt access to information, rapid news dissemination), many individuals develop Problematic Use of the Internet (PUI), an umbrella term incorporating a range of repetitive impairing behaviours. The Internet can act as a conduit for, and may contribute to, functionally impairing behaviours including excessive and compulsive video gaming, compulsive sexual behaviour, buying, gambling, streaming or social networks use. There is growing public and National health authority concern about the health and societal costs of PUI across the lifespan. Gaming Disorder is being considered for inclusion as a mental disorder in diagnostic classification systems, and was listed in the ICD-11 version released for consideration by Member States (http://www.who.int/classifications/icd/revision/timeline/en/). More research is needed into disorder definitions, validation of clinical tools, prevalence, clinical parameters, brain-based biology, socio-health-economic impact, and empirically validated intervention and policy approaches. Potential cultural differences in the magnitudes and natures of types and patterns of PUI need to be better understood, to inform optimal health policy and service development. To this end, the EU under Horizon 2020 has launched a new four-year European Cooperation in Science and Technology (COST) Action Programme (CA 16207), bringing together scientists and clinicians from across the fields of impulsive, compulsive, and addictive disorders, to advance networked interdisciplinary research into PUI across Europe and beyond, ultimately seeking to inform regulatory policies and clinical practice. This paper describes nine critical and achievable research priorities identified by the Network, needed in order to advance understanding of PUI, with a view towards identifying vulnerable individuals for early intervention. The network shall enable collaborative research networks, shared multinational databases, multicentre studies and joint publications.

[Migration Background and Pathological Gambling: Results of a Nationwide Epidemiological Study on the Impact of Region of Origin in Germany]. / Migrationshintergrund und pathologisches Glücksspielen: Befunde einer deutschlandweiten epidemiologischen Untersuchung zur Bedeutung der Herkunftsregion.

OBJECTIVE: To investigate the extent to which the presence and number of symptoms of pathological gambling (PG), distinguished by region of origin (RO), differ. METHODS: Data was obtained from a nationwide telephone survey of 15 023 individuals living in Germany and aged 14-64 years. They were categorized according to their RO and the number of symptoms of PG (0-10 DSM-IV-criteria). RESULTS: The lifetime prevalence of PG symptoms is 18.1% for people of the RO Turkey, 9.0% for those of the RO Yugoslavia and 6.8% for those without a migration background. Compared to the latter, the two-part count data regression method showed a higher chance of PG symptoms for the RO Turkey as well as a 70.3 and 87.2% increase in the number of symptoms for the RO Turkey and Yugoslavia, respectively. CONCLUSION: The RO could independently contribute to the presence and amount of symptoms of PG.

Genome-wide association study of pathological gambling.

BACKGROUND: Pathological gambling is a behavioural addiction with negative economic, social, and psychological consequences. Identification of contributing genes and pathways may improve understanding of aetiology and facilitate therapy and prevention. Here, we report the first genome-wide association study of pathological gambling. Our aims were to identify pathways involved in pathological gambling, and examine whether there is a genetic overlap between pathological gambling and alcohol dependence. METHODS: Four hundred and forty-five individuals with a diagnosis of pathological gambling according to the Diagnostic and Statistical Manual of Mental Disorders were recruited in Germany, and 986 controls were drawn from a German general population sample. A genome-wide association study of pathological gambling comprising single marker, gene-based, and pathway analyses, was performed. Polygenic risk scores were generated using data from a German genome-wide association study of alcohol dependence. RESULTS: No genome-wide significant association with pathological gambling was found for single markers or genes. Pathways for Huntington's disease (P-value=6.63×10(-3)); 5'-adenosine monophosphate-activated protein kinase signalling (P-value=9.57×10(-3)); and apoptosis (P-value=1.75×10(-2)) were significant. Polygenic risk score analysis of the alcohol dependence dataset yielded a one-sided nominal significant P-value in subjects with pathological gambling, irrespective of comorbid alcohol dependence status. CONCLUSIONS: The present results accord with previous quantitative formal genetic studies which showed genetic overlap between non-substance- and substance-related addictions. Furthermore, pathway analysis suggests shared pathology between Huntington's disease and pathological gambling. This finding is consistent with previous imaging studies.

[Evaluation of Psychiatric Disorders on the Basis of a SCID Screening]. / Evaluation psychiatrischer Störungen anhand eines erweiterten SKID-Screenings.

BACKGROUND: Psychiatric symptoms/syndromes such as depression, apathy, anxiety or psychotic episodes are present in a range of neurological disorders including Parkinson's disease. The Structured Clinical Interview for DSM-IV (SCID) represents the gold standard for the assessment of psychiatric disorders but is often too time-consuming for application in clinical practice. METHODS: 66 participants were examined using the screening items and the first two questions of section A of the SCID as well as the complete version of the SCID, part I. The accuracy of the screening and the complete SCID was evaluated, and logistic regression was conducted to analyze factors associated with measure disagreement between the two procedures. RESULTS: Overall, psychiatric disorders were identified by screening in 40/66 (60.6%), as against 31/66 (47.0%) using the complete SCID. Compared to the complete SCID, the sensitivity and specificity of the screening items were 88% and 59%, respectively. CONCLUSION: Based on its good sensitivity, the SCID screening may be used in clinical practice to yield an overview of psychiatric disorders that may require treatment. Due to its moderate specificity, however, the complete version of the SCID should be subsequently used in cases whenever the SCID screening is positive. In any case, the SCID screening must be regarded as inadequate for the detection of psychotic symptoms.

Prevalence of suicide attempts in pathological gamblers in a nationwide Austrian treatment sample.

BACKGROUND: For pathological gambling (PG), a 12-month prevalence rate of up to 0.66% has been reported. Multiple financial, occupational and relationship problems and losses, humiliation of the person and the environment are possible side effects and may lead to hopelessness, suicidal ideation and suicidal behavior. Suicide attempt rates among pathological gamblers of between 4% and 40% and suicidal ideation of between 12% and 92% have been reported. AIM: This study aims at assessing the prevalence of suicide attempts in PG and at elucidating differences between the patients with and without suicide attempt history (SAH) in a large nationwide Austrian sample. METHODS: Between 2002 and 2011, the Austrian Society for the Research of Non-Substance Related Addiction collected 862 questionnaires of pathological gamblers undergoing outpatient and inpatient treatment for PG in Austria. RESULTS: (a) Of all pathological gamblers, 9.7% had an SAH. (b) The SAH group suffered significantly more from a comorbid disorder and was more often in previous inpatient treatments. (c) The SAH patients had a longer time of an abstinence period in their PG career. DISCUSSION: One in 10 pathological gamblers has an SAH, demonstrating the relevance of suicidality in this population. Significant differences for several parameters were found for PG with and without SAH. However, a regression analysis only explained 15% of the variance. This suggests that suicidality must be considered in pathological gamblers in general.

Acute psychosis in a verified Huntington disease gene carrier with subtle motor signs: psychiatric criteria should be considered for the diagnosis.

Huntington disease (HD) is an inherited, progressive, autosomal dominant disorder. Some patients develop severe chorea or cognitive symptoms. The genetic defect causes progressive atrophy of the striatum, the cortex and extrastriatal structures (Sheperd GM. Corticostriatal connectivity and its role in disease. Nat Rev Neurosci 2013;14:278-91). The precise timing of clinical diagnosis of HD is poorly characterized and is mainly based on motor symptoms (Huntington, Study and Group. Unified Huntington's Disease Rating Scale: reliability and consistency. Huntington Study Group. Mov Discord 1996:136-42). Patients suffering from HD frequently show cognitive or affective symptoms even before manifesting motor signs. Psychiatric symptoms like depression, apathy, aggression, and disinhibition are common, and suicide rates are over four times higher than in the general population (Di Maio L, Squitieri F, Napolitano G, Campanella G, Trofatter JA, Conneally PM. Suicide risk in Huntington's disease. J Med Genet 1993;30:293-5). This case report of a female patient with genetically proven HD is of special interest because motor or cognitive impairment were absent whereas she suffered from symptoms of an acute and severe psychosis likely to be symptomatic signs of HD.

[The quality of life in relatives giving care to patients with psychotic disorders is mainly determined by their internal locus of control]. / Die Lebensqualität von Angehörigen psychotisch erkrankter Patienten wird entscheidend von ihren Kontrollüberzeugungen bestimmt.

INTRODUCTION: The presented study examines to which extent the quality of life and experiences of relatives giving care to patients with psychotic disorders are being influenced by patient- or relative-dependent factors. MATERIAL AND METHODS: The quality of life and experiences of care-giving of 33 relatives of patients with a schizophrenic spectrum disorder were assessed. Applying a multiple regression model, they were correlated to the relatives' internal locus of control as well as to data referring to the patients' disease. RESULTS: 47 % of the variance of the relatives' quality of life could be explained by their locus of control, their social support, and their level of psychosocial functioning. In contrast, data determined by the patients' disease only accounted for 9 % of the variance. DISCUSSION: In order to specifically encourage strengths on the part of the relatives and therefore improve their quality of life and their experiences of caregiving, their locus of control, social support and psychosocial functioning should be taken into consideration in concepts for the treatment of patients with psychosis.

[Video game and internet addiction. The current state of research]. / Computerspiel- und Internetsucht. Der aktuelle Forschungsstand.

The use of interactive screen media is widespread and for some users leads to pathological symptoms that are phenomenologically similar to signs of addictive disorders. Addictive use of computer games and other Internet applications, such as social media can be distinguished. In the past standard criteria to classify this new disorder were lacking. In DSM-5, nine criteria are proposed for diagnosing Internet gaming disorder. The focus is currently on video games as most studies have been done in this field. Prevalence estimations are difficult to interpret due to the lack of standard diagnostic measures and result in a range of the frequency of Internet addiction between 1 % and 4.2 % in the general German population. Rates are higher in younger individuals. For computer game addiction prevalence rates between 0.9 % and 1.7  % can be found in adolescents. Despite substantial comorbidity among those affected current research points to addictive media use as a stand-alone disorder.

Changes in drinking behavior among control group participants in early intervention studies targeting unhealthy alcohol use recruited in general hospitals and general practices.

BACKGROUND: This study aims to analyze the influence of setting variables on drinking behavior in patients with unhealthy alcohol consumption recruited proactively in general medical practices (GP) and internal and surgical wards of two general hospitals (GH) assigned to control groups. METHOD: This analysis compared two control groups of RCTs targeting unhealthy alcohol consumption: one outpatient sample (GP; n=99) with one inpatient sample (GH; n=173). Both groups were recruited via systematic screening of all patients aged between 18 and 64 years and were included in the studies if drank above the at-risk criteria of the British Medical Association (20/30 g alcohol/daily) and/or fulfilled criteria of alcohol abuse or - dependence according to DSM-IV. Both samples received a non-alcohol specific brochure on healthy living after study inclusion and were re-assessed 12 months later. RESULTS: GH patients were significantly older, included of more males, had received less schooling and had a higher readiness to change at baseline than GP patients. Groups did not differ concerning alcohol-related diagnoses or smoking status. At the 12-month follow-up, significantly more GH patients revealed abstinence or drinking below the inclusion criteria (50.0% vs. 26.1%, p<.001). In a multivariate analysis, medical setting (GH vs. GP) remained a significant predictor for non-problematic drinking or abstinence even after controlling for baseline differences between groups. CONCLUSIONS: Findings suggest that untreated change from problematic alcohol use may be more intense after non-alcohol-related inpatient treatment than after having been a GP patient. Implications for brief interventions in inpatients are discussed.

Attitudes towards brief interventions to reduce smoking and problem drinking behaviour in gynaecological practice.

OBJECTIVE: To assess attitudes towards brief interventions, obstacles and assessment rates for smoking and problem drinking in gynaecological practice, and to evaluate the differences between smoking and problem drinking. STUDY DESIGN: Cross-sectional survey. METHOD: An anonymous mail survey was conducted with all 358 primary care gynaecologists in the state of Schleswig-Holstein, Germany. RESULTS: Most gynaecologists considered brief interventions for problem drinking to be less important in gynaecological practice than in general (74% vs 64%). Brief interventions were believed to be ineffective, particularly for problem drinking (64% vs 53% for smoking). Gynaecologists felt better prepared to counsel their patients than to assess substance use. Only 35% stated that they assess the smoking status of every patient, and less than 12% stated that they assess the alcohol consumption of every patient. The counselling rate for smoking was high (79%), but problem drinkers were often referred to specialists (counselling rate 36%). The most important obstacles for the implementation of brief interventions were lack of time and poor patient compliance. In addition, for problem drinking, insufficient specialization was a further obstacle. CONCLUSION: Although a link was found between primary gynaecological care and tobacco and alcohol use, brief interventions are not yet integrated into gynaecological practice. There are, however, some promising starting points for patients who smoke, as motivation among gynaecologists to conduct brief interventions and counselling is high. The findings underscore the need for increased medical education and information about brief interventions, as well as assessment programmes for gynaecologists.

[The readiness of staff in general medical practices to participate in a smoking cessation programme]. / Die Bereitschaft nichtärztlicher Mitarbeiterinnen in Hausarztpraxen, an der Umsetzung eines Nichtraucherangebots mitzuwirken.

AIM: So far, the chances for tobacco prevention are not currently implemented sufficiently in general practices. The involvement of practice nurses (PN) could contribute to reach more patients. This study investigated the characteristics of PN which could be relevant for the implementation of counselling offers. METHODS: A total of 216 general practices was randomly selected from all general practitioners registered for primary care in a defined region in West Pomerania. The participation rate was 69% (n=151). A total of 209 PN participated in a training and 94.3% filled in the questionnaire. RESULTS: The data indicated a smoking prevalence rate of 30.3% among PN. Their motivation, to offer counselling measures in general practices was higher on average than the confidence to realise such interventions. There was no association between characteristics of PN such as age, number of work years in the practice, hours worked per week or smoking status and motivation or confidence measures. CONCLUSION: There is a need for proactive interventions to decrease the smoking prevalence among PN. Furthermore, it should be examined which skills and knowledge are essential for PN nurses to manage new tasks with a high level of confidence.

[Readiness to provide smoking cessation counselling--results of a survey among general practitioners in Brandenburg]. / Bereitschaft zur Beratung von rauchenden Patienten--Ergebnisse einer Arztebefragung in Brandenburg.

BACKGROUND: The effectiveness of brief interventions on smoking cessation together with regular visits to the general practitioners (GP) has been proven. Nevertheless, the guidelines for smoking cessation are not currently implemented sufficiently. A lack of financial resources, time, and consulting abilities prevent GPs from offering systematic advice on smoking cessation. This study examine 1) to what extent GPs ask their patients to provide information about their smoking habits and to what extent they document this, 2) how willing, and 3) how confident GPs are to offer all smoking patient counselling, and 4) which factors influence their level of confidence. METHODS: From August 2005 until May 2006, a questionnaire was sent to all 1 247 GPs in Brandenburg. In all 68 practices was excluded for several reasons (closed practice, death, not providing primary care) a total of 54.0% (n=637) of the GPs took part. RESULTS: 30.0% of the GPs documented the smoking status of their patients during the first consultation. 12.9% had already offered advice to all their smoking patients, while 27.6% were not willing to offer advice to all smoking patients. The average confidence of GPs to offer all smoking patients advice on smoking cessation was 4.1 (SD=2.6) on scale of 1 to 10 (1=not at all confident and 10=very confident). The confidence of non-smoking GPs to offer an advice was higher in comparison with smoking GPs. CONSEQUENCES: To motivate GPs to offer advice on smoking cessation, it seems necessary to change some conditions. This includes programms, initiated by professional medical associations, to help colleagues stop smoking. Further studies should indicate whether the inclusion of practice colleagues in screening and regular updates of the patient's smoking status increase the number of regular counselling.

[Assessment of problematic alcohol use]. / Erfassung problematischen Alkoholkonsums.

An overview with respect to the identification of patients with risky drinking, alcohol abuse or alcohol dependence is given. As a first step, a simple screening questionnaire should be used. Self-statements in standardized questionnaires are more valid than standard laboratory markers. A useful instrument is for example BASIC. In screening positive patients, an in-depth diagnosis is necessary and helps to distinguish between different forms of problematic alcohol use. Depending on the severity of the alcohol problem, brochures, internet-programs, counselling or referral to treatment services is helpful.

Primary focal dystonia: evidence for distinct neuropsychiatric and personality profiles.

BACKGROUND: Primary focal dystonia (PFD) is characterised by motor symptoms. Frequent co-occurrence of abnormal mental conditions has been mentioned for decades but is less well defined. In this study, prevalence rates of psychiatric disorders, personality disorders and traits in a large cohort of patients with PFD were evaluated. METHODS: Prevalence rates of clinical psychiatric diagnoses in 86 PFD patients were compared with a population based sample (n = 3943) using a multiple regression approach. Furthermore, participants were evaluated for personality traits with the 5 Factor Personality Inventory. RESULTS: Lifetime prevalence for any psychiatric or personality disorder was 70.9%. More specifically, axis I disorders occurred at a 4.5-fold increased chance. Highest odds ratios were found for social phobia (OR 21.6), agoraphobia (OR 16.7) and panic disorder (OR 11.5). Furthermore, an increased prevalence rate of 32.6% for anxious personality disorders comprising obsessive-compulsive (22.1%) and avoidant personality disorders (16.3%) were found. Except for social phobia, psychiatric disorders manifested prior to the occurrence of dystonia symptoms. In the self-rating of personality traits, PFD patients demonstrated pronounced agreeableness, conscientiousness and reduced openness. CONCLUSIONS: Patients with PFD show distinct neuropsychiatric and personality profiles of the anxiety spectrum. PFD should therefore be viewed as a neuropsychiatric disorder rather than a pure movement disorder.

Naturalistic changes in the readiness of postpartum women to quit smoking.

BACKGROUND: This study involves a long-term examination of the natural behavioral changes in postpartum women undergoing smoking cessation. The analysis was based on the readiness to quit smoking as assessed using the Transtheoretical Model of intentional behavioral change. This is a secondary data analysis of a randomized controlled trial. METHODS: Between May 2002 and March 2003, all women in the maternity wards of six hospitals in the German state of Mecklenburg-West Pomerania were screened for smoking before or during pregnancy. Of the women who answered in the affirmative, 871 (77%) participated in the study.We utilized a questionnaire to classify 345 women into stages of progress regarding their motivation to change their smoking behavior 4­6 weeks postpartum (T0). Participants were followed-up after 6 (T1), 12 (T2), and 18 months(T3). In addition to the descriptive analysis, latent transition analysis was applied as a statistical method to test models of patterns of change and to evaluate transitions in the stages of change over time. RESULTS: During the time interval between consecutive follow-up surveys, 59.1% (T0/T1), 72.3% (T1/T2), and 67.9% (T2/T3) of women remained at the same stage of motivation to change. Most relapses into earlier stages occurred 6 months postpartum (T1) (31.5% of the stage transition). The patterns of change across the first three time points were best described by a model that includes stability, one-stage progressions,and one-to-four-stage regressions. CONCLUSIONS: Readiness to quit smoking in study participants did not substantially change over the span of 18 months postpartum.

Intention to quit smoking: is the partner's smoking status associated with the smoker's intention to quit?

BACKGROUND: Smoking behavior among couples is often similar. PURPOSE: The aim of the study was to examine the relationship between the partner's smoking status and the intention to stop smoking of the index person. METHOD: Cross-sectional data of 1,044 patients in a random sample of 34 general medical practices in northeastern Germany were analyzed. RESULTS: Among smokers with a non-smoking partner (SNP), more intended to quit smoking in the next six months (37.0% vs. 31.4%), compared to smokers with a smoking partner (SSP). Also, more SNP intended to quit in the next four weeks (4.7% vs. 2.7%) compared to SSP. SNP were more active in the use of self-change strategies than SSP. CONCLUSION: The data confirm that the partner's smoking status is related to the intention to quit smoking. Interventions should address the different needs of both smokers with a smoking partner and those with a non-smoking partner.