[Does education focusing on depression change the attitudes towards schizophrenia? A target-group oriented anti-stigma-intervention]. / Verändert der Unterricht über Depression die Einstellungen gegenüber Schizophrenie? Eine zielgruppenorientierte Anti-Stigma-Intervention.

OBJECTIVE: It should be evaluated, whether two units of education about depression in a secondary school alter the student;s attitude towards patients suffering from depression and whether this intervention could also change the attitude towards patients with schizophrenia. METHODS: A patient with depression - at the moment without symptoms - was involved in the educational program. At three specific times (T0 = some days before the intervention; T1 = some days after the intervention; T2 = 3-4 month follow-up), students have been presented with the same case vignette, one with the description of a fictitious depressive classmate as well as with one fictitious classmate with schizophrenia. The affective, the behavior-related and the cognitive dimensions of attitudes towards the described person were assessed by questionnaires. RESULTS: At T0, the attitudes towards the case vignette "depression" have been significantly more positive than the attitudes to the case vignette "schizophrenia" in all dimensions of attitude. At T1, in the case vignette "depression" the factor "fear" showed a decrease, as well as the opinion this person could be dangerous. At T2, these factors reached the level of T0 again. The opinion, that these fictitious depressive classmates suffer from a treatable illness, was approved significantly more often at T1 and T2 compared to T0. The change of attitude towards the case vignette "schizophrenia" was even more distinctive. Compared to T0 feelings of fear, social distance and stereotypes, that such a person would be dangerous and unpredictable, decreased significantly at T1 as well as T2. CONCLUSIONS: Target group oriented interventions including the contact with patients, may improve the attitude towards patients with mental illnesses. Seeing that some improvements decreased again after three month one may wonder whether a single shortterm educational program would be sufficient in order to provoke a sustainable change in attitudes. Although the intervention focused on a less stigmatized illness (like depression), the attitudes towards a more stigmatized illness (like schizophrenia) could markedly be improved.

Randomized clinical trial of telepsychiatry through videoconference versus face-to-face conventional psychiatric treatment.

Although telepsychiatry in the form of videoconferencing has been well received in terms of increasing access to care and user satisfaction, few data on treatment outcomes and efficacy from telepsychiatry applications are available at the present time. This paper evaluates the efficacy of telepsychiatry through videoconference in the treatment of mental disorders by comparing to face-to-face conventional (F2FC) treatment. We carried out a randomized clinical trial where 140 psychiatric outpatients were randomized to either F2FC treatment or videoconference telepsychiatry (VCTP) treatment. Patients were diagnosed according to International Classification of Diseases, 10th edition (ICD-10) criteria using the Composite International Diagnostic Interview. Treatment involves eight consultations lasting 30 minutes over the 24-week study period. Patients received pertinent psychotropic medication plus cognitive- behavioral therapy during sessions. The same psychiatrist diagnosed and treated all the patients that were recruited from the Community Mental Health Centre of San Sebastian de la Gomera, in the Canary Islands. Change in psychiatric test scores served as the primary efficacy criterion. Efficacy was determined by comparing baseline (visit 1) Clinical Global Impressions-Severity of Illness (CGI-S) and -Improvement (CGI-I) scales as well as Global Indexes (GSI, PSDI, and PST) from SCL-90R with scores obtained at the end of the study period (week 24). Response was defined as a CGI-I score of 1 or 2. Reliable Change Indexes were computed in SCL-90R Global Indexes scores. Of 140 patients randomized, 130 completed 24 weeks of treatment. Only 4 patients dropped out prematurely from the study in VCTP and 6 in F2FC. The study involves 534 teleconsultations, 522 F2FC consultations, and more than 500 hours of clinical practice. Significant improvements were found on the CGI and SCL-90- R Global Indexes scores of both treatment groups, showing clear clinical state improvement. No statistically significant differences were observed when the efficacy of VCTP treatment was compared to F2FC psychiatric treatment efficacy. This study demonstrated that telepsychiatry treatment through videoconference has equivalent efficacy to F2FC psychiatric treatment. Telepsychiatry showed to be an effective mean of delivering mental health services to psychiatric outpatients living in remote areas with limited resources.

Stimulation of cortisol during mental task performance in a provocative virtual environment.

Fully immersive and stereoscopic Virtual Environments (VE) represent a powerful multimedia tool for laboratory-based simulations of distinct scenarios including scenarios for evaluating stressful situations resembling reality. Thus far, cortisol secretion as a neuroendocrine parameter of stress has not been evaluated within a Virtual Reality (VR)-based paradigm. In this study 94 healthy volunteers were subjected to a provocative VR-paradigm and a cognitive stress task. Provocative in this context means the VE was designed to provoke physiological reactions (cortisol secretion) within the respective users by purpose. It was tested (a) if a fully dynamic VE as opposed to a static VE can be regarded as a stressor and (b) if such a fully dynamic VE can modify an additional response to a cognitive stressor presented within the VE additionally. Furthermore, possible gender-related impacts on cortisol responses were assessed. A significant cortisol increase was observed only after the combined application of the fully dynamic VE and the cognitive stressor, but not after application of the dynamic VE or the cognitive stressor alone. Cortisol reactivity was greater for men than for women. We conclude that a fully dynamic VE does not affect cortisol secretion per se, but increases cortisol responses to a dual task paradigm that includes performance of a stressful mental task. This provides the basis for the application of VR-based technologies in neuroscientific research, including the assessment of the human Hypothalamus-Pituitary-Adrenal (HPA) axis regulation.

Neurophysiological age differences during task-performance in a stereoscopic virtual environment.

In today's society, there is an increasing number of workplaces in virtual environments (VE). But, there are only a few reports dealing with occupational health issues or age effects. The question arises how VR generally interferes with cognitive processes. This interference might have relevant implications for workability and work-efficiency in virtual environments. Event-related potentials are known to reflect different stages of stimulus reception, evaluation, and response. We have established an electroencephalographic (EEG) monitoring, focussing on event-related potentials (N100; mismatch negativity, i.e., MMN) to obtain access to attention dependent and pre-attentive processing of sensory stimuli applied in VE. The MMN is known to be correlated with the ability of subjects to react to an unexpected event. The aim of the present study was to investigate cognitive responses to distracting auditory stimuli in two different age groups in a virtual environment (VE) and in a real environment ("real reality"), and to compare characteristic neurophysiological response patterns. Data show that stimulus detection as given by the N100 amplitude and latency does not differ in both age groups and task conditions. In contrast, the pre-attentive processing as given by the MMN is altered in the VR such as the non-VR condition in an age-related manner. A relevant finding of the present study was that the age related differences seen in the non-VR condition were not strengthened in VR.

Cognitive ergonomics in virtual environments: development of an intuitive and appropriate input device for navigating in a virtual maze.

For patients suffering from mild cognitive impairments, the navigation through a virtual maze should be as intuitive and efficient as possible in order to minimize cognitive and physical strain. This paper discusses the appropriateness of interaction devices for being used for easy navigation tasks. Information gained from human centered evaluation was used to develop an intuitive and ergonomic interaction device. Two experiments examined the usability of tracked interaction devices. Usability problems with the devices are discussed. The findings from the experiments were translated into general design guidance, in addition to specific recommendations. A new device was designed on the basis of these recommendations and its usability was evaluated in a second experiment. The results were used to develop a lightweight interaction device for navigation in the virtual maze.