Search

Population stressors, such as the Covid 19 pandemic, climate change, the Russian-Ukrainian war, or a tense economic situation, are putting a strain on the well-being and mental health of Western populations. To examine the impact of such stressors, our group has recently published a study on the impact of current crises on subclinical stress symptoms in the German population. This short communication utilizes data from the latest second wave of this study. It evaluates, as to whether the results from the first study are still valid for the current and rapid changes in these population stressors. As in the first wave, the Russian-Ukrainian war was still rated as the most worrisome. However, the burden of the Covid 19 pandemic remains the most important predictor for subclinical stress symptoms.

Background Climate change, the Covid-19 pandemic, and the Ukraine crisis are considered unprecedented global stressors, potentially associated with serious health consequences. However, simultaneous effects of these stressors are not yet understood, making it difficult to evaluate their relative contribution to the population burden and potential future manifestations in clinically significant psychiatric disorders. This study aimed at disentangling the relative contribution of the three stressor groups on current sub-clinical stress symptoms. Methods A cross-sectional, representative survey study was conducted two months after the outbreak of the Ukraine war in Germany. Proportional quota sampling was applied for age, gender, income, and regional characteristics. Data were recruited by means of an online survey. 3094 data sets (1560 females) were included. Age ranged from 18–89 (M: 50.4 years; SD: 17.2). The Subclinical Stress Questionnaire (SSQ-25) served as main outcome measure. In collaboration with a professional media agency, 20 items were generated to capture salient population stressors. A three-factor exploratory structural equation model confirmed the appropriateness of this scale. Results (1) Differences in subjective rankings revealed that stressors related to the Ukraine crisis were rated as most worrying, followed by climate change, and the Covid-19 pandemic (Generalized-Linear-Model: Epsilon = .97; F(1.94, 6001.14) = 1026.12, p ηp2 = .25). (2) In a linear regression model (R2 = .39), Covid-19 pandemic stressors were the only meaningful predictors for current ill-health (standardized β = .48). Ukraine crisis did not predict stress symptom profiles in the present sample. (3) Older and male individuals report less and/or less severe stress symptoms, although effect sizes were small (range: η2 .11—.21). An older age also reduced the impact of Covid-19 stressors. Conclusions Researchers from the health sciences must consider overlapping effects from population stressors. Although the Ukraine crisis and climate change mark salient stressors, including economic threats, the Covid-19 pandemic still has a profound effect on ill-health and must be considered as a relevant factor in future manifestations of psychiatric and associated health consequences.

The Covid-19 pandemic highly impacts mental health worldwide. Patients with psychiatric disorders are a vulnerable risk population for worsening of their condition and relapse of symptoms. This study investigates the pandemic-related course of psychosocial burden in patients with pre-existing mental disorders. With the newly developed Goettingen psychosocial Burden and Symptom Inventory (Goe-BSI) psychosocial burden has been traced retrospectively (1) before the pandemic (beginning of 2020), (2) at its beginning under maximum lockdown conditions (March 2020), and (3) for the current state after maximum lockdown conditions (April/May 2020). The Goe-BSI also integrates the Adjustment Disorder New Module (ADNM-20), assesses general psychiatric symptoms, and resilience. A total of 213 patients covering all major psychiatric disorders (ICD-10 F0-F9) were interviewed once in the time range from April, 24th until May 11th, 2020. Across all diagnoses patients exhibited a distinct pattern with an initial rise followed by a decline of psychosocial burden (p 2 = 0.09; Bonferroni-corrected pairwise comparisons between all three time-points: p

Attention deficit hyperactivity disorder (ADHD) symptomatology, comorbid diseases, and pharmacological treatment with antidepressants can have a negative impact on sexual function, which in turn increases the likelihood of sexual dysfunction in people with ADHD. The objective of this pilot study was to differentiate and delineate possible sexual dysfunction in adults with ADHD. Adult ADHD patients (n = 32, cisgender / heterosexual) and healthy controls (n = 32, cisgender / heterosexual) filled out the DÄS-Zuf questionnaire with 59 items (Krieger, 2013). This questionnaire is divided into the scales “general contentment with life,” “anxiety/depression,” “sexual dysfunction” and “sexual satisfaction.” Patients with ADHD had significantly higher scores on single items measuring various aspects of sexual dysfunction as well as higher scores on the “anxiety/depression” scale and lower scores on the “general contentment with life” scale. Following repeated measures analyses of covariance in which the scale “anxiety/depression” was controlled as covariate, none of the previously differences for single items between ADHD patients and controls remained significant. ADHD patients with methylphenidate showed stronger physical sexual arousal compared to those without methylphenidate. The results of this pilot study suggest several explanations for sexual dysfunction among adults with ADHD and offer tentative routes for practical treatment approaches.

Introduction The Comparison of Methylphenidate and Psychotherapy in adult ADHD Study (COMPAS) was a prospective, randomized multicenter clinical trial, comparing methylphenidate (MPH) with placebo (PLAC) in combination with cognitive behavioral group psychotherapy (GPT) or individual clinical management (CM) over the period of 1 year. Here, we report results on treatment safety. Methods MPH and PLAC were flexibly dosed. Among 433 randomized patients, adverse events (AEs) were documented and analyzed on an “as received” basis during week 0–52. Electrocardiogram data were recorded at baseline and week 24. Results Comparing 205 patients who received ≥1 dose of MPH with 209 patients who received PLAC, AEs occurring significantly more frequently in the MPH group were decreased appetite (22 vs. 3.8%), dry mouth (15 vs. 4.8%), palpitations (13 vs. 3.3%), gastrointestinal infection (11 vs. 4.8%), agitation (11 vs. 3.3%), restlessness (10 vs. 2.9%), hyperhidrosis, tachycardia, weight decrease (all 6.3 vs. 1.9%), depressive symptom, influenza (both 4.9 vs. 1.0%), and acute tonsillitis (4.4 vs. 0.5%). Syncope occurred significantly more often in the PLAC group (2.4 vs. 0%). Clinically relevant ECG changes occurred very rarely in both groups. Serious AEs were rare and without a significant group difference. The comparison of 206 patients treated with GPT versus 209 patients who received CM revealed no major differences. Serious AE classified as psychiatric occurred in 5 cases in the CM group and in 1 case in the GPT group. Conclusion In this so far longest-running clinical trial, methylphenidate treatment was safe and well-tolerated.

Current guidelines support the use of nuclear medical imaging (NMI) techniques for differential diagnostics of certain cases of dementia. We aimed at studying the association between using NMI and the accuracy of dementia diagnoses. Additionally, we evaluated the effect of conducting NMI on the duration of hospital treatment. This study was based on data collected according to §21 of the German hospital remuneration law, including relevant diagnostic and procedural codes for NMI in dementia patients. In total, more than 7.2 million cases treated in German psychiatric and somatic hospitals between 2015 and 2017 were included. Associations between the frequency of NMI and the accuracy of dementia diagnoses in terms of specific vs. unspecific diagnostic codes were analyzed using Fischer’s exact test. In total, 351,106 cases with a dementia diagnosis were encoded during the study period. NMI was performed in 1.03% or 0.15% of all patients with dementia in psychiatric or somatic clinics, respectively. In psychiatric clinics, the proportion of unspecific dementia diagnoses decreased from 20.86% in 2015 to 17.73% in 2017. NMI was mainly performed within psychiatric day-care settings. Interestingly, patients receiving NMI stayed shorter within day-care settings (8.1 ± 16.0 days) compared to inpatient settings (38.3 ± 44.7 days). Nuclear medical imaging is often performed in psychiatric day-care settings. Further studies are warranted to understand the predictive diagnostic value of NMI in dementia diagnosis compared with clinical, CSF and structural imaging in different healthcare settings.

While the COVID-19 pandemic continues, patients with pre-existing mental disorders are increasingly recognized as a risk group for adverse outcomes. However, data are conflicting and cover only short time spans so far. Here, we investigate the medium-term and peri-lockdown-related changes of mental health outcomes in such patients in a longitudinal study. A cohort of 159 patients comprising all major mental disorders (ICD-10 F0-F9) were interviewed twice with the Goettingen psychosocial Burden and Symptom Inventory (Goe-BSI) to evaluate psychosocial burden, psychiatric symptoms and resilience at the end of the first (April/May 2020) and the second lockdown in Germany (November/December 2020). For the primary outcome “psychosocial burden” ratings also comprised retrospective pre-pandemic (early 2020) and very early states during the pandemic (March 2020). For all diagnostic groups, psychosocial burden varied significantly over time (p p p = 0.044 and p = 0.037). The longitudinal course of psychosocial burden indicates an initial stress response, followed by a return to pre-pandemic levels even under recurrent lockdown conditions, mimicking symptoms of an adjustment disorder. Strategies for proactive, specific and continuous treatment have to address resilience capacities before their depletion in the pandemic aftermath, especially for patients with additional risk factors.

A correction to this paper has been published: https://doi.org/10.1007/s00406-021-01275-7

BACKGROUND Clinical outcomes of patients with proximal femoral fracture within 1 year after hospitalization are presented. In particular, associations between the patients' clinical status and their pre-fracture residence were evaluated (community-dwelling vs nursing home). METHODS Patients aged ≥60 years with proximal femoral fractures were included in a prospective, single-centre observational study and followed for 12 months. Patients' clinical status at baseline was compared to their health status at follow-up 12 months later. Several standardized questionnaires were used to evaluate the patients' functional and cognitive capacity (e.g. Lawton Instrumental Activities of Daily Living Scale, Barthel Index, and Mini-Mental State Examination), mobility (timed up-and-go test, Tinetti Test, and Harris Hip Score), quality of life (EuroQol-5 Dimensions index and EuroQol Visual Analogue Scale), and psychological status (Geriatric Depression Scale). RESULTS This study included 402 patients (mean age: 81.3 ± 8.2 years, 72% women). Patients stayed in hospital for 13.7 ± 6.1 days on average. The comparison of patients' clinical status at baseline and at 12-month follow-up revealed that the Mini-Mental State Examination and Charlson Comorbidity Index remained unchanged (P = 0.527 and P = 0.705), the level of depression (Geriatric Depression Scale) significantly decreased (P

Background Given the need for disease-modifying therapies for dementia, drug repurposing appears to be a promising approach, at least as a risk reduction treatment. Preclinical studies suggest that antidepressants-in particular selective serotonin reuptake inhibitors-have beneficial effects on dementia-related biomarkers and functional outcomes, although clinical data are inconclusive. The present case-control study aimed to evaluate the effects of antidepressant drug classes and individual compounds with different treatment durations on the risk of developing dementia. Methods Analyses are based on data from the German Disease Analyzer database (owned and maintained by IQVIA) and included 62,317 subjects with an incident dementia diagnosis (ICD-10: F01, F03, G30, F06.7) and controls matched by age, sex, and physician between January 2013 and December 2017. Logistic regression analyses adjusting for health insurance status and comorbid diseases associated with dementia or antidepressant use were performed to investigate the association between dementia incidence and treatment with 4 major antidepressant drug classes and 14 of the most frequently prescribed individual substances. Results In 17 of 18 comparisons, long-term treatment (≥ 2 years) with any antidepressant was associated with a lower incidence of dementia than short-term treatment. Tricyclic and herbal antidepressants were associated with a decrease in dementia incidence, especially with long-term treatment. The lowest risks for dementia on an individual substance basis were identified for long-term treatment with escitalopram (odds ratio [OR] = 0.66; 95% CI, 0.50-0.89) and Hypericum perforatum (OR = 0.6; 95% CI, 0.51-0.70). Conclusions Long-term treatment with tricyclic antidepressants, Hypericum perforatum, or escitalopram may be associated with reduced incidence of dementia. If antidepressant therapy is well tolerated, continuation-even if depressive symptoms have resolved-may be considered even beyond the purpose of relapse prevention. Future combined analyses of multinational registries and long-term clinical trials are needed to substantiate these findings.

Zusammenfassung Hintergrund und Ziel der Studie Bisher gibt es in Deutschland nur wenige Untersuchungen zu den soziodemographischen Einflussgrößen auf die Diagnosestellung einer ADHS-Erkrankung, obwohl die Kenntnis dieser Merkmale bedeutend für das diagnostische Prozedere und die Ausgestaltung von Präventionsprogrammen sein kann. Unser Ziel war es daher, die Evidenz zu den Einflussgrößen einer ADHS-Diagnose zu erweitern und Hinweise dafür zu geben, welchen Einfluss die familiäre Vorbelastung mit psychiatrischen Diagnosen und soziodemographischen Faktoren haben. Material und Methoden Durch ein 3:1 Kontrollgruppendesign mit Daten der Techniker Krankenkasse wurden psychosoziale, regionale und demographische Einflussfaktoren deskriptiv und anhand einer logistischen Regression untersucht. Die unabhängigen Variablen bestanden aus Alter, Geschlecht, Region und Komorbiditäten der Patienten, dem sozioökonomischen Berufsstatus und dem Bildungsniveau der Mitglieder, den psychiatrischen Diagnosen der Eltern sowie dem Alter der Eltern bei der Geburt der Kinder (Variablen des Familienhintergrunds). Ergebnisse Es wurden 9.881 ADHS-Patienten mit einem Durchschnittsalter von 14,9 Jahren [SD: 12,6] identifiziert. Anhand dieser umfassenden Stichprobe konnte bestätigt werden, dass das ADHS-Risiko bei männlichen Patienten höher liegt als bei weiblichen Patientinnen (OR: 2,3 [95%-KI: 2,2–2,5]). Ein mittlerer oder höherer Bildungsabschluss eines Mitglieds war mit niedrigerem Risiko einer ADHS-Diagnose im Vergleich zur Referenzkategorie niedriger Bildungsstatus verbunden (OR: 0,78 [95%-KI: 0,70–0,89] bzw. OR: 0,55 [95%-KI: 0,47–0,63]). Zudem erhöhte sich das ADHS-Risiko mit höherem Alter der Eltern sowie bei Vorliegen von psychiatrischen Diagnosen dieser (OR: 1,02 [95%-KI: 1,01–1,03] bzw. OR: 2,09 [95%-KI: 1,95–2,25]). Für den sozioökonomischen Beschäftigungsstatus konnte kein eindeutiger Zusammenhang nachgewiesen werden. Diskussion Das Wissen um soziodemographische Einflussfaktoren kann die Diagnosestellung unterstützen und Hinweise zur Entwicklung individueller Präventions- und Therapiekonzepte geben.

BACKGROUND Multimorbidity in dementia is associated with an increased risk of complications and a higher need for care. Having knowledge of cardiovascular and metabolic comorbidities is crucial when making decisions about diagnostic procedures and therapies. We compared the prevalence of comorbidities in hospitalized patients with Alzheimer's disease (AD), vascular dementia, and psychiatric diseases other than dementia. Additionally, we compared clinically relevant health-care indicators (length of hospital stay, rate of re-hospitalization) between these groups. METHODS We used information from a database of treatment-relevant indicators from psychiatric and psychosomatic hospitals throughout Germany. This database contains routinely recorded data collected from 85 German hospitals from 2011 to 2015. In total, 14 411 AD cases, 7156 vascular dementia cases, and 34 534 cases involving non-demented psychiatric patients (used as controls) were included. To analyze comorbidities and health-care indicators, χ2 tests and t-tests were used. RESULTS Diabetes mellitus, lipoprotein disorders, coronary artery diseases, cardiac arrhythmia and insufficiency, and atherosclerosis were significantly more prevalent in patients with vascular dementia than in those with AD and psychiatric controls. Hypertension and coronary artery diseases were less frequently associated with AD than with non-demented psychiatric controls (P

Introduction Benzodiazepines and related drugs (BZDR) should be avoided in patients with cognitive impairment. We evaluated the relationship between a BZDR treatment and the health status of patients with Alzheimer’s disease (AD). Methods Cross-sectional study in 395 AD patients using bivariate and multiple logistic analyses to assess correlations between the prescription of BZDR and patients’ characteristics (cognitive and functional capacity, health-related quality of life (HrQoL), neuropsychiatric symptoms). Results BZDR were used in 12.4% (n=49) of all participants. In bivariate analyses, the prescription was associated with a lower HrQoL, a higher need of care, and the presence of anxiety. Multivariate models revealed a higher risk of BZDR treatment in patients with depression (OR 3.85, 95% CI: 1.45 – 10.27). Community-dwelling participants and those treated by neurologists/psychiatrists had a lower risk of receiving BZDR (OR 0.33, 95% CI: 0.12 – 0.89 and OR 0.16, 95% CI: 0.07 – 0.36). Discussion The inappropriate use of BZDR conflicts with national and international guidelines. We suggest evaluating indications and treatment duration and improving the knowledge of alternative therapies in healthcare institutions.

A restrictive use of antipsychotic drugs in patients with Alzheimer's disease (AD) is recommended due to an increased risk of cerebrovascular events and mortality. We hypothesise that the prescription of antipsychotics is associated with the patients' socio-demographic and clinical status (e.g., dementia severity).The prescription of antipsychotics was cross-sectionally evaluated in 272 community-dwelling and 123 institutionalised patients with AD across all severity stages of dementia. The patients' clinical characteristics covered the cognitive status, neuropsychiatric symptoms, daily activities, and quality of life (HrQoL). To determine associations with the use of antipsychotics bivariate and logistic regression analyses were conducted.Totally, 25% of the patients were treated with antipsychotics. significantly less frequently than nursing home inhabitants (15.1% vs. 45.5%). Severely demented patients (MMSE 0-9) received antipsychotics most often (51.5%). Additionally, multiple regression analyses revealed a higher chance of prescription for participants with depressive symptoms (OR 2.3, 95% CI: 1.019-5.160) and those treated by neuropsychiatric specialists (OR 3.4, 95% CI: 1.408-8.328).Further longitudinal studies are required to assess the appropriateness of indications for antipsychotics and the reasons for a higher use in nursing home inhabitants and patients with severe dementia and depression.

Zusammenfassung Ziel Patienten mit einer Alzheimer-Demenz (AD) und leichten kognitiven Beeinträchtigungen (LKB) beurteilen ihre gesundheitsbezogene Lebensqualität (LQ) häufig besser als ihre Angehörigen. Einflussfaktoren dieses Beurteilungsunterschieds werden evaluiert. Methodik Die LQ von 241 zu Hause lebenden Patienten wurde anhand des krankheitsspezifischen Quality of Life-Alzheimer’s Disease-Fragebogens (QoL-AD) erhoben. Ergebnisse Das Verwandtschaftsverhältnis, depressive Symptome und die Alltagsfunktionalität stellen relevante Einflussfaktoren bei Beurteilungsunterschieden der LQ dar. Schlussfolgerung Soziodemografische und klinische Variablen können Bewertungsunterschiede der LQ von Patienten mit AD und LKB teilweise erklären.

Background Proximal femoral fractures are frequent injuries of elderly people and are often associated with declines in physical function and high rates of morbidity and mortality. A severe and frequent complication after hip surgery is postoperative delirium (POD), potentially associated with poorer clinical outcomes. We hypothesized that elderly patients with POD after hip fracture showed significantly worse clinical outcomes within one year after the fracture, compared to patients not suffering from POD. Additionally, relevant predictors of POD were evaluated. Methods Patients with proximal femoral fractures aged ≥ 60 years were included in a prospective, single-center observational study in Germany and followed up for 12 months. POD was evaluated by daily application of the Confusion Assessment Method (CAM) during the acute hospital stay. A variety of standardized instruments were used to evaluate patients’ functional and cognitive capacity, mobility, quality of life (HrQoL), depression, pain, etc., at baseline, discharge, and follow-up. A multiple logistic regression analysis was conducted to determine socio-demographic and clinical predictors of POD. Results Among 402 included patients (mean age: 81.3 ± 8.2 years), 184 (45.8%) developed POD (mean duration: 6.5 ± 4.4 days). At baseline, POD patients were significantly older, more often institutionalized, cognitively and physically more impaired, reported lower HrQoL, and had significantly more complications during the hospital stay. Multiple logistic regression analyses explained 22% of the variance, while prolonged intensive care unit stays, level of pain after surgery, and diminished pre-operative physical and cognitive state were significant predictors of POD. In-hospital mortality and overall mortality after 12 months were significantly higher in POD patients. Twelve months after the fracture, POD was significantly associated with diminished mobility, HrQoL, cognitive and functional capacity, and higher risk of falls. Conclusions Pain management is an important and controllable variable during hospital stay and should be a specific focus of the postoperative period, especially in functionally and cognitively impaired patients. Since patients with POD showed significantly worse clinical outcomes at discharge and 12 months post-fracture, prevention and effective treatment of POD should be of high priority in elderly patients with hip fractures.

Objective The cognitive capacity to change perspective is referred to as theory of mind (ToM). ToM deficits are detectable in a variety of psychiatric and neurological disorders. Since executive abilities are closely associated with ToM skills, we suspected that due to a common neuropsychological basis, ToM deficits exist in treatment‐naïve adults with attention‐deficit/hyperactivity disorder (ADHD). Methods Performance of treatment‐naïve adults with ADHD (N = 30) in tasks assessing executive functions (Trail Making Test, Stroop color–word test, and Test Battery for Attentional Performance), empathy skills (Cambridge Behaviour Scale), and ToM (Movie for Assessment of Social Cognition) was compared with that of a healthy control group (N = 30) matched according to basic demographic variables. Results Compared to healthy controls, treatment‐naïve adults with ADHD showed deficits in various executive functions and the ability to empathize (all p, This study explored the extent to which social interaction problems of treatment‐naïve adults with ADHD can be attributed to deficits in theory of mind using established neuropsychological tests. The results revealed that adults with ADHD showed impairment in various executive functions and the ability to empathize but no theory of mind deficits. Our findings imply that ToM impairments, even when present in adult ADHD, appear to be independent of executive deficits and might be explained by comorbid disorders.

Objective: A restrictive use of tricyclic antidepressants (TCA) in patients with dementia (PwD) is recommended due to the hazard of anticholinergic side effects. We evaluated the frequency of TCA dispensing in PwD over a period of 1 year and the use of TCA before and after the incident diagnosis of dementia. Methods: This analysis was based on administrative data from a German statutory health insurance for a period of 2 years. Totally, 20,357 patients with an incident diagnosis of dementia in 2014 were included. We evaluated the dispensing of TCA in 2015. Subgroup analyses were conducted to evaluate associations between the incident diagnosis of dementia and modifications in TCA dispensing. Results: In 2015, 1,125 dementia patients (5.5%) were treated with TCA and 31% were medicated with TCA in all four quarters of 2015. Most dispensings were conducted by general practitioners (67.9%). On average, patients received 3.7 ± 2.6 dispensings per year. Amitriptyline (56.3%), doxepin (26.8%), and trimipramine (16.8%) were dispensed most often. Subgroup analyses revealed that the dispensing of TCA remained mainly unchanged following the incident diagnosis. Conclusion: A relevant number of PwD were treated with TCA. To maintain the patients' safety, an improved implementation of guidelines for the pharmaceutical treatment of PwD in healthcare institutions might be required. Since 68% of the patients suffered from depression, future studies should further evaluate the indications for TCA. Copyright © 2019 Hessmann, Zeidler, Stahmeyer, Eberhard, Vogelgsang, Abdel-Hamid, Wolff-Menzler, Wiltfang and Kis. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

Comorbid disorders are common in psychiatric diseases and understanding the risk of secondary diseases can aid successful clinical treatment. The objective of this study was to compare the frequency of comorbid dementia, affective disorders, and inflammatory polyarthropathies. Healthcare data obtained via the German Hospital Fees Act from two independent databases with more than 7.4 million cases were analyzed to compare the prevalence of comorbid disorders. Comorbid inflammatory polyarthropathy was observed in 2.27% of patients diagnosed with affective disorders and 1.35% of patients with dementia (p

Background Hearing-impairment can lead to a reduced quality of life and thus represents a vulnerability factor for mental disorders. Objective This study represents the first psychiatric analysis of subjective quality of life and depression in people with hearing-impairment in Germany. Materials and methods The patient group included 30 hearing-impaired participants (27 women, 3 men) with a current or previous mental disorder and/or psychiatric/psychotherapeutic treatment (age: mean, M = 49.67 years; standard deviation, SD = 13.54 years). The control group consisted of 22 hearing-impaired participants (16 women, 6 men) without mental disorders or treatment (age: M = 52.41 years, SD = 17.30 years). Besides sociodemographic variables, we registered onset/extent of the various hearing-impairments and hearing aid provision. Both groups underwent extensive diagnostic assessment comprising subjective functional impairment (Sheehan Disability Scale, SDS), health-related quality of life (SF-36 Health Survey), and depressive symptoms (Beck Depression Inventory, BDI-II). Results Groups did not differ significantly in terms of sociodemographic variables such as age, gender, or intelligence. Participants of the patient group had a significantly greater subjective impairment, a lower quality of life, and more pronounced symptoms of depression. The invasiveness of the hearing aid (i. e., cochlear implant) as well as the timepoint of hearing-impairment onset (postlingually) appear to serve as vulnerability factors for mental health problems in this group. Conclusion Our results indicate that besides delivering high-quality acoustic care, practitioners should continuously check patients' requirements for psychosocial treatment due to a loss of quality of life. The development of a specific psychotherapeutic treatment for hearing-impaired clients requires additional research focused on protective and vulnerability factors which may influence the emergence of mental disorders in these patients.

Long-term treatment with benzodiazepines (BZD) should be avoided in dementia patients because of an increased risk of adverse events. We evaluated how continuously dementia patients were prescribed BZD over 12 months. For this observational study, we used claims data from a large German public sickness fund for 2014 and 2015, including patients with an incident diagnosis of dementia in 2014. The aim was to evaluate the continuity of treatment, the frequency of BZD prescriptions and defined daily doses were evaluated. In total, 1298 (5.6%) patients received 4.7±5.2 BZD prescriptions in 2015 on average. Thereof, lorazepam (47.5%), oxazepam (18.6%), diazepam (14.5%), and bromazepam (12.2%) were most often prescribed. 30.7% of the patients received at least one BZD prescription in each quarter of 2015. Although the total number of patients receiving BZD decreased in 2015, defined daily doses for single substances remained mainly unchanged. The incident diagnosis of dementia was not associated with modifications of prescription behavior. The treatment with BZD was not discontinued in a large proportion of dementia patients, increasing the risk of adverse events. Physicians' awareness of avoiding BZD should be improved and further evidence for the appropriate treatment of psychiatric symptoms in dementia (e.g. sleep disturbances, anxiety) is required.

Objective The use of antidepressant drugs in dementia patients is associated with the risk of adverse events, and the evidence for relevant effects is scarce. We aimed to determine the associations between the prescription of antidepressants and patients' sociodemographic (e.g., age, gender, living situation) and clinical characteristics (e.g., disease severity, neuropsychiatric symptoms). Materials and methods We included 395 institutionalized and community-dwelling patients with Alzheimer's disease (AD) across all severity stages of dementia in a cross-sectional study design. The patients' clinical characteristics comprised of cognitive status, daily activities, depressive symptoms, further neuropsychiatric symptoms, and health-related quality of life (HrQoL). We conducted multiple logistic regression analyses for the association between the use of antidepressant drugs and the covariates. Results Approximately 31% of the participants were treated with antidepressant drugs, with a higher chance of being medicated for institutionalized patients (χ2-test: p = 0.010). In the bivariate analyses, the use of antidepressants was significantly associated with higher levels of care, lower cognitive and daily life capacity, higher extent of neuropsychiatric symptoms, and a lower proxy-reported HrQoL. Finally, multiple logistic regression models showed a significantly higher use of antidepressants in patients treated by psychiatrists and neurologists (OR 2.852, 95% CI: 1.223 - 6.652). Conclusion The use of antidepressant drugs in the study population was high, and the suitability of the treatment with antidepressants remains unclear. Participants with diminished cognitive and functional capacity, higher extent of neuropsychiatric symptoms, and those treated by neuropsychiatric specialists were more likely to be treated with antidepressants. The pharmaceutical treatment of patients with these clinical characteristics should be particularly considered in the daily care for dementia patients. Further longitudinal studies should evaluate the appropriateness of indications for antidepressants and the causative direction of correlations with the patients' clinical characteristics. .

Einleitung Die Kosten und die Qualitat der Diagnostik und Therapie von Patienten mit Verdacht auf Schlafbezogene Atmungsstorungen (SBAS) wurden in 18 von 24 hessischen Schlaflaboren (SL) im 2. Abrechnungsquartal 2009 erhoben.

The objective of this study was to evaluate the use of antidementia drugs (ADDs) in patients with Alzheimer's disease (AD) regarding German guideline recommendations and to assess correlations between the use of ADDs and the patients' characteristics. A total of 395 community-dwelling and institutionalized patients with AD across all severity stages of dementia were recruited in this cross-sectional study. Associations between the prescription of ADDs and patients' sociodemographic and clinical parameters (neuropsychiatric symptoms, cognitive capacity, daily activities, and health-related quality of life) were analyzed in multiple logistic regression analyses. ADDs were prescribed in 46.6% of all participants and less often in institutionalized patients (38.2 vs. 50.4%, P=0.025). Patients with mild-to-moderate dementia had a higher chance of receiving ADDs [odds ratio (OR)=3.752, 95% confidence interval (CI): 1.166-12.080 and OR=3.526, 95% CI: 1.431-8.688] as well as those treated by neurologists/psychiatrists (OR=2.467, 95% CI: 1.288-4.726). Overall, 39% of the patients with mild cognitive deficits (Mini-Mental Status Examination 27-30) received ADDs and 21% of the mildly demented patients (Mini-Mental Status Examination 20-26) received memantine. The treatment with ADDs was in part not in line with German guideline recommendations. Particularly, the lower use of ADDs in patients not attending neuropsychiatric specialists should be further evaluated.

The self-assessment of health-related quality of life (HrQoL) in patients with Alzheimer's disease (AD) and mild cognitive impairment is commonly higher than the proxy-assessment by caregivers. This study aims at evaluating sociodemographic and clinical factors to explain this difference.HrQoL of 241 community-dwelling patients was analysed using the dementia-specific Quality of Life-Alzheimer's Disease questionnaire (QoL-AD). Behavioural and psychological symptoms and functional capacity were evaluated using the Geriatric Depression Scale (GDS), the Neuropsychiatric Inventory (NPI) and the Alzheimer's Disease Cooperative Study-Activities of Daily Living scale (ADCS-ADL).The self-assessment of patients' HrQoL was significantly higher than the caregiver-ratings (mean difference: 7.4 ± 5.6, p 0.001). Considerable influencing factors were the extent of depressive symptoms (GDS), the degree of impairment in functional performance (ADCS-ADL) and the relationship between patients and caregivers.Independent variables explained 23 % of the variance in the difference between self- and proxy-assessment of HrQoL. Future studies should include further influencing factors such as caregivers' mental health.ZIEL: Patienten mit einer Alzheimer-Demenz (AD) und leichten kognitiven Beeinträchtigungen (LKB) beurteilen ihre gesundheitsbezogene Lebensqualität (LQ) häufig besser als ihre Angehörigen. Einflussfaktoren dieses Beurteilungsunterschieds werden evaluiert.Die LQ von 241 zu Hause lebenden Patienten wurde anhand des krankheitsspezifischen Quality of Life-Alzheimer’s Disease-Fragebogens (QoL-AD) erhoben.Das Verwandtschaftsverhältnis, depressive Symptome und die Alltagsfunktionalität stellen relevante Einflussfaktoren bei Beurteilungsunterschieden der LQ dar.Soziodemografische und klinische Variablen können Bewertungsunterschiede der LQ von Patienten mit AD und LKB teilweise erklären.

Background: The aim of this study was to evaluate health-related quality of life (HrQoL) in patients with obstructive sleep apnea (OSA) and to investigate the impact of socio demographic and clinical parameters on HrQoL. Methods: A total of 627 patients were consecutively recruited in 18 sleep laboratories in the state of Hessen, Germany. Standardized questionnaires were used to assess co-morbid disorders, depressive symptoms (Beck Depression Inventory) and daytime sleepiness (Epworth Sleepiness Scale). HrQoL was evaluated with the generic EuroQol-Instrument (EQ-5D-3L index and EQ VAS). Influencing factors were analyzed using bivariate and multiple linear regression analyses. Results: The mean EQ-5D-3L index was 0.86 ± 0.19, and the mean EQ VAS score was 66.8 ± 19.3. Patients primarily reported problems in the domains of pain/discomfort (55.5%), anxiety/depression (33.5%), and usual activities (29.5%). Multivariate analyses explained 34.9% and 35.9% of the variance in the EQ VAS and the EQ-5D-3L index, respectively. Relevant predictors of HrQoL were patient age, daytime sleepiness, the presence of medical comorbidities and depression. Conclusions: The results of our study suggest that depressive disorders and excessive daytime sleepiness have considerable effects on patient HrQoL and should be considered in the treatment of OSA patients to improve HrQoL.

The purpose of this study is to evaluate the health-related quality of life (HrQoL) of patients with Alzheimer's disease (AD) in different care settings (institutionalized versus community-dwelling) across all severity stages of dementia. Patients were consecutively recruited with their primary caregivers (123 inpatients and 272 outpatients), and the impact of patient-related parameters such as behavioral and psychological symptoms of dementia (BPSD) (Geriatric Depression Scale [GDS] and Neuropsychiatric Inventory [NPI]) and functional capacity (Alzheimer's Disease Cooperative Study-Activities of Daily Living [ADCS-ADL]) on HrQoL was analyzed. Patients' HrQoL was assessed using self-reported and caregiver-rated generic (EuroQoL Instrument) and dementia-specific (Quality of Life-Alzheimer's Disease [Qol-AD]) scales. Patients reported a considerably higher HrQoL than their caregivers on the QoL-AD, EQ-5D, and EQ VAS (p < 0.001). Different dementia severity groups showed significantly worse results in HrQoL for patients with lower MMSE scores. The mean self-reported QoL-AD decreased from 32.3±5.7 in the group with the highest MMSE scores to 27.1±5.5 in patients with the lowest MMSE scores (p < 0.001). A considerably lower HrQoL was shown for institutionalized patients versus participants in outpatient settings (proxy-rated QoL-AD 19.7±4.6 versus 26.0±7.1, p < 0.001). Depressive symptoms (GDS), BPSD (NPI), and reduced functional capacity (ADCS-ADL) were evaluated for their impact on patients' HrQoL. Multivariate models explained between 22% and 54% of the variance in patients' HrQoL. To analyze the causative direction of the reported associations, further longitudinal studies should be conducted.

The study aims to report service use and costs for patients with Alzheimer's disease (AD) and to explore the incremental influence of sociodemographic and illness-related determinants in ambulatory and inpatient settings within the German health care system. 395 patients with dementia were recruited at the following sites: 1) University hospital, 2) general practitioners' offices, 3) office-based neurologists, 4) a regional psychiatric hospital, and 5) nursing homes. Sociodemographic, economic, and clinical parameters were assessed using a standardized questionnaire. Informal care was not evaluated. Disease severity was measured using the Mini-Mental Status Examination and the Alzheimer's Disease Assessment Scale - Cognitive Subscale. Neuropsychiatric status was assessed using the Geriatric Depression Scale, the Neuropsychiatric Inventory, and the Alzheimer's Disease Cooperative-Study-Activities of Daily Living. Annual total costs were estimated to be €13,080 per patient. The most important cost component was (long-term) care, constituting about 43% of total costs. Indirect costs comprised about 18% of total costs and were mainly due to reductions in working time of caregivers. Poorer functional status was associated with higher total and caregiving costs. In multivariate analyses, we identified younger age, female gender, and impaired activities of daily living as independent predictors of higher costs. Given that care for patients with AD is complex and expensive, our models were only able to explain about 17-43% of the variability in total costs. This suggests that further social and individual factors considerably influence the costs associated with AD. Direct medical care costs and long-term care costs related differently to the patient's clinical characteristics. Longitudinal and population-based studies are necessary for thoroughly evaluating the burden of disease.