Effektivität und Kosteneffizienz von Individual Placement and Support (IPS) in Deutschland : eine Vergleichsstudie bei Menschen mit Psychosen
2023, Nischk, Daniel, Herwig, Uwe, Senner, Simon, Rockstroh, Brigitte
Ziel der Studie
Um die Wirksamkeit von Individual Placement & Support (IPS) zur Integration von Menschen mit psychischen Erkrankungen auf den allgemeinen Arbeitsmarkt in Deutschland zu überprüfen, bedarf es Vergleiche mit der üblichen rehabilitativen Praxis in Bezug auf Beschäftigungsquoten und Kosteneffizienz.
20 IPS-Teilnehmende mit psychotischen, insbesondere Schizophrenie-Spektrumsstörungen wurden mit 20 Kontrollpersonen, denen in angrenzenden Landkreisen übliche Rehabilitationsverfahren angeboten wurden (Rehabilitation as usual, RAU), über 18 Monate verglichen.
IPS war RAU signifikant auf allen tätigkeitsbezogenen Kriterien mit mittleren bis hohen Effektstärken überlegen, ohne dass sich Unterschiede bei Fehlzeiten, Krankenhaustagen und Abbruchquoten zeigten. IPS war RAU hinsichtlich der Kosteneffizienz deutlich überlegen.
Die Studie bietet Hinweise darauf, dass IPS auch in Deutschland eine effektive und kosteneffiziente Ergänzung zu den bestehenden berufsrehabilitativen Angeboten für Menschen mit Psychosen darstellt.
Therapeutic success in relapse prevention in alcohol use disorder : the role of treatment motivation and drinking-related treatment goals
2021, Senn, Smeralda, Odenwald, Michael, Sehrig, Sarah, Haffke, Peter, Rockstroh, Brigitte, Pereyra-Kröll, Devi, Menning, Hans, Wieber, Frank, Volken, Thomas, Rösner, Susanne
Changing addictive behavior is a complex process with high demands on motivation. The Transtheoretical Model of Behavior Change provides a theoretical framework for explaining and predicting behavioral change, although its predictive value for addiction is somewhat inconsistent.
The aim of the present study is to extend the Transtheoretical Model of Behavior Change by investigating not only treatment motivation but also the predictive value of the type of drinking-related treatment goal. Additional predictors, such as substance-related and sociodemographic variables, are also included in analyses seeking to predict return to drinking during relapse prevention treatment for alcohol use disorder.
In this observational study, 99 inpatients from a treatment center for alcohol use disorder were recruited. Treatment motivation was assessed in accordance with the Transtheoretical Model of Behavior Change, drinking-related treatment goal through a self-report questionnaire, and substance-related and sociodemographic variables via the clinic information system. Associations between the potential predictors and covariates were explored using stepwise logistic regression.
During treatment, 42.6% of participants had at least one relapse. Scoring higher on the action dimension at admission (OR = 0.81, p = .04) and being employed (OR = 0.37, p = .02) were significant predictors of abstinence during treatment.
This study confirms that treatment motivation contributes to the prediction of treatment outcome, even when controlling for other variables. In future research, the underlying mechanisms of treatment motivation should be further explored.
Early neglect is a key determinant of adult hair cortisol concentration and is associated with increased vulnerability to trauma in a transdiagnostic sample
2019-06-13, Schalinski, Inga, Teicher, Martin H., Rockstroh, Brigitte
Childhood adversities and traumatic events have each been associated with hypothalamus-pituitary-adrenal (HPA) axis dysregulation and trauma-related symptoms in adulthood. Hair cortisol concentration (HCC) reflects cumulative cortisol levels over the course of months and is discussed as a potential marker between trauma-induced neuroendocrine dysfunction and trauma-related symptoms. The present study examines this hypothetical link by delineating the impact of exposure to categories of abuse and neglect during development and lifetime traumatic experiences on HCC and trauma-related symptoms.
The Maltreatment and Abuse Chronology Exposure (MACE) scale, Life Events Checklist, and predictive analytics were used to evaluate the importance of type and timing of maltreatment and trauma load on HCC in inpatients (n = 183) with different psychiatric diagnoses. Additionally, a comparison group of n = 75 controls were recruited from the community. The extent to which the relationship between trauma load and trauma-related symptoms was influenced by childhood adversities and HCC was determined by analysis of variance.
Early neglect, in particular neglect at 3 years, emerged as the most important predictor of adult HCC. Post-hoc explanatory analysis showed that patients with high neglect at age 3 had lower HCC compared to patients with low neglect at age 3 and controls. Patients with high neglect at age 3 and low cortisol reported increased trauma-related symptoms upon trauma exposure.
Results strengthen evidence that inadequate care and neglect during critical periods alter HPA axis biology towards enduring reduction in cortisol, the latter being associated with augmented trauma-related symptoms upon trauma exposure. If validated by longitudinal assessments these cross-sectional findings suggest biological mechanisms of childhood adversities into psychopathology in adulthood.
Oscillatory brain dynamics supporting impaired Stroop task performance in schizophrenia-spectrum disorder
2019-02, Popov, Tzvetan G., Kustermann, Thomas, Popova, Petia, Miller, Gregory A., Rockstroh, Brigitte
The Stroop color-word interference task, prompting slower response to color-incongruent than to congruent items, is often used to study neural mechanisms of inhibitory control and dysfunction in schizophrenia-spectrum disorders. Inconsistent findings of an augmented Stroop effect limit identification of relevant dysfunctional mechanism(s) in schizophrenia. The present study sought to advance understanding of normal and impaired neural oscillatory dynamics by distinguishing interference detection and response preparation during the Stroop task in schizophrenia-spectrum disorders via analysis of behavioral performance and 4-7 Hz (theta) and 10-30 Hz (alpha/beta) EEG oscillations in 40 patients (SZ) and 27 healthy comparison participants (HC). SZ responded more slowly and showed less dorsal anterior cingulate (dACC) theta enhancement during INC trials, less enhancement of dACC-sensorimotor cortex connectivity (theta phase synchrony) during INC trials, more alpha/beta suppression though less enhancement of that suppression during INC trials, and slower post-response alpha/beta rebound than did HC. Reaction time distributions showed larger group and Stroop effects during the 25% of trials with the slowest responses. Poorer theta phase coherence in patients indicates impaired communication between regions associated with interference processing (dACC) and response preparation (sensorimotor cortex). Results suggest a failure cascade in which compromised behavioral Stroop effects are driven at least in part by dysfunctional interference processing (less theta power increase) prompting dysfunctional motor response preparation (less alpha/beta power suppression). Inconsistent Stroop effects in past studies of schizophrenia may result from differing task parameters sampling different degrees of Stroop task difficulty.
Oscillatory connectivity as a mechanism of auditory sensory gating and its disruption in schizophrenia
2022, Popov, Tzvetan G., Rockstroh, Brigitte, Miller, Gregory A.
Although innumerable studies using an auditory sensory gating paradigm have confirmed that individuals with schizophrenia (SZ) show less reduction in brain response to the second in a pair of clicks, this large literature has not yielded consensus on the circuit(s) responsible for gating nor for the gating difference in SZ. Clinically stable adult inpatients (N = 157) and matched community participants (N = 90) participated in a standard auditory sensory gating protocol. Responses to paired clicks were quantified as peak-to-peak amplitude from a response at approximately 50 ms to a response at approximately 100 ms in MEG-derived source waveforms. For bilateral sources in each of four regions near Heschl's gyrus, the gating ratio was computed as the response to the second stimulus divided by the response to the first stimulus. Spectrally resolved Granger causality quantified effective connectivity among regions manifested in alpha-band oscillatory coupling before and during stimulation. Poorer sensory gating localized to A1 in SZ than in controls confirmed previous results, here found in adjacent brain regions as well. Spontaneous, stimulus-independent effective connectivity within the hemisphere from angular gyrus to portions of the superior temporal gyrus was lower in SZ and correlated with gating ratio. Significant involvement of frontal and subcortical brain regions previously proposed as contributing to the auditory gating abnormality was not found. Findings point to endogenous connectivity evident in a sequence of activity from angular gyrus to portions of superior temporal gyrus as a mechanism contributing to normal and abnormal gating in SZ and potentially to sensory and cognitive symptoms.
Decoding the impact of adverse childhood experiences on the progression of schizophrenia
2019-03, Hirt, Vanessa, Schalinski, Inga, Rockstroh, Brigitte
Adverse childhood experiences are frequently present in patients with mental disorders, including those with schizophrenia. Whereas an impact of childhood adversities on psychopathology and potential neuroendocrine/biological mediators has been reported for posttraumatic stress disorder, depression, and anxiety disorders, the relationships in schizophrenia remain to be clarified. The present study compared amount and types of adverse childhood experiences (screened by interview) between individuals at risk for psychosis (n = 29), early schizophrenia patients with 1-2 admissions (n = 34), chronic schizophrenia patients with multiple admissions (n = 24), and healthy comparison participants (n = 38). It was expected that at-risk individuals and early-stage as well as chronic patients report more childhood adversities than controls, and that adversity load predicts psychotic symptom severity and altered neuroendocrine regulation based on hair cortisol concentration. Results confirmed more childhood adversities in clinical groups than in controls, and relationships between total childhood adversities and increased positive symptom severity. Hair cortisol concentration did not differ between groups, but early abuse experiences predicted lower hair cortisol concentration, and the latter predicted severity of specific psychotic symptoms in the clinical sample. In conclusion, individuals at risk and with manifest schizophrenia experienced substantial childhood maltreatment, as reported for other diagnoses. The present findings suggest childhood adversities as sensitizing (environmental) factor in vulnerable individuals. Lower hair cortisol concentration may indicate lasting effects of past stress experiences on stress axis function in schizophrenia, which might modulate unfolding psychopathology.
Feedback-Related Brain Potentials Indicate the Influence of Craving on Decision-Making in Patients with Alcohol Use Disorder : An Experimental Study
2021, Sehrig, Sarah, Odenwald, Michael, Rockstroh, Brigitte
Introduction: Alcohol craving is a key symptom of alcohol use disorder (AUD) and a significant cause of poor treatment outcome and frequent relapse. Craving is supposed to impair executive functions by modulating reward salience and decision-making.
Objective: The present study sought to clarify this modulation by scrutinizing reward feedback processing in an experimental decision-making task, which was accomplished by AUD patients in 2 conditions, in the context of induced alcohol craving and in neutral context.
Methods: AUD inpatients (N = 40) accomplished the Balloon Analog Risk Task, while their EEG was monitored; counterbalanced across conditions, the tasks were preceded either by craving induction by means of imagery and olfactory alcohol cues, or by neutral cues. Decision choice and variability, and event-related potentials (ERPs) prior to (stimulus-preceding negativity [SPN]) and following (P2a) reward feedback upon decisions, and the outcome-related feedback-related negativity (FRN) were compared between conditions and between patients, who experienced high craving upon alcohol cues (N = 18) and those who did not (N = 22).
Results: Upon craving induction (vs. neutral condition), high-craving AUD patients showed less adjustment of decision choice to preceding reward experience and more variable decisions than low-craving AUD patients, together with accentuated reward-associated ERP (SPN and P2a), while outcome-related FRN was not modified by craving. Conclusions: Results support orientation to reward in AUD patients, particularly amplified upon experienced craving, which may interfere with (feedback-guided) decision-making even in alcohol-unrelated context. Craving-accentuated ERP indices suggest neuroadaptive changes of cognitive-motivational states upon chronic alcohol abuse. Together with altered reward-related expectancies, this has to be considered in intervention and relapse prevention.
Mismatch negativity and cognitive performance in the course of schizophrenia
2019-11, Hirt, Vanessa, Schubring, David, Schalinski, Inga, Rockstroh, Brigitte
Cognitive deficits and abnormal event-related brain potentials (ERP) have been proposed as risk markers for the development of schizophrenia. Evidence is inconclusive whether these markers indicate a risk for the development of psychosis or illness progression.
The present study aimed at further clarification by comparing symptom expression (Brief Psychiatric Rating Scale, BRPS), the ERP Mismatch Negativity (MMN), and neuropsychological performance on the MATRICS Consensus Cognitive Battery between healthy controls (HC, n = 38) and individuals at different stages of illness: individuals at risk for psychosis (ARP, n = 33), patients at first admission, thus, early stage (ES, n = 35), chronic schizophrenia patients (CS, n = 25). Moreover, symptom expression was reassessed for ARP and ES at a 6 months follow-up.
MMN was smaller in individuals with manifest psychosis (ES, CS) than in HC, but did not differ between ARP and HC. In contrast, ARP showed similar cognitive deficits as ES and CS, all three groups differing from HC. Lower cognitive performance predicted higher symptom severity at index assessments and 6 months follow-up in ARP and ES, while MMN did not explain additional variance.
MMN seems to mark manifest psychosis, independent of early or chronic stage, while cognitive deficits mark early present psychopathology in individuals at risk for and with diagnosed psychosis rather than illness progression.
Environmental adversities and psychotic symptoms : The impact of timing of trauma, abuse, and neglect
2019-03, Schalinski, Inga, Breinlinger, Susanne, Hirt, Vanessa, Teicher, Martin H., Odenwald, Michael, Rockstroh, Brigitte
Trauma and adverse childhood experiences (ACE) occur more often in mental illness, including psychosis, than in the general population. Individuals with psychosis (cases) report a higher number and severity (dose) of adversities than healthy controls. While a dose-dependent increase of adversities has been related to more severe psychopathology, the role of type and timing is still insufficiently understood on the exacerbation of positive and negative psychotic symptoms. Moreover, dissociative symptoms were examined as potential mediator between adversities and severity of psychotic symptoms.