Attachment--and loss.

Summary Background Since December, 2019, Wuhan, China, has experienced an outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological and clinical characteristics of patients with COVID-19 have been reported but risk factors for mortality and a detailed clinical course of illness, including viral shedding, have not been well described. Methods In this retrospective, multicentre cohort study, we included all adult inpatients (≥18 years old) with laboratory-confirmed COVID-19 from Jinyintan Hospital and Wuhan Pulmonary Hospital (Wuhan, China) who had been discharged or had died by Jan 31, 2020. Demographic, clinical, treatment, and laboratory data, including serial samples for viral RNA detection, were extracted from electronic medical records and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death. Findings 191 patients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital) were included in this study, of whom 137 were discharged and 54 died in hospital. 91 (48%) patients had a comorbidity, with hypertension being the most common (58 [30%] patients), followed by diabetes (36 [19%] patients) and coronary heart disease (15 [8%] patients). Multivariable regression showed increasing odds of in-hospital death associated with older age (odds ratio 1·10, 95% CI 1·03–1·17, per year increase; p=0·0043), higher Sequential Organ Failure Assessment (SOFA) score (5·65, 2·61–12·23; p Interpretation The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 μg/mL could help clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding provides the rationale for a strategy of isolation of infected patients and optimal antiviral interventions in the future. Funding Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences; National Science Grant for Distinguished Young Scholars; National Key Research and Development Program of China; The Beijing Science and Technology Project; and Major Projects of National Science and Technology on New Drug Creation and Development.

Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

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Introduction To Robust Estimation And Hypothesis Testing

Unraveling the Mystery of Health

Context The place of long-term psychodynamic psychotherapy (LTPP) within psychiatry is controversial. Convincing outcome research for LTPP has been lacking. Objective To examine the effects of LTPP, especially in complex mental disorders, ie, patients with personality disorders, chronic mental disorders, multiple mental disorders, and complex depressive and anxiety disorders (ie, associated with chronic course and/or multiple mental disorders), by performing a meta-analysis. Data Sources Studies of LTPP published between January 1, 1960, and May 31, 2008, were identified by a computerized search using MEDLINE, PsyclNFO, and Current Contents, supplemented by contact with experts in the field. Study Selection Only studies that used individual psychodynamic psychotherapy lasting for at least a year, or 50 sessions; had a prospective design; and reported reliable outcome measures were included. Randomized controlled trials (RCTs) and observational studies were considered. Twenty-three studies involving a total of 1053 patients were included (11 RCTs and 12 observational studies). Data Extraction Information on study characteristics and treatment outcome was extracted by 2 independent raters. Effect sizes were calculated for overall effectiveness, target problems, general psychiatric symptoms, personality functioning, and social functioning. To examine the stability of outcome, effect sizes were calculated separately for end-of-therapy and follow-up assessment. Results According to comparative analyses of controlled trials, LTPP showed significantly higher outcomes in overall effectiveness, target problems, and personality functioning than shorter forms of psychotherapy. With regard to overall effectiveness, a between-group effect size of1.8 (95% confidence interval [Cl], 0.7-3.4) indicated that after treatment with LTPP patients with complex mental disorders on average were better off than 96% of the patients in the comparison groups (P= .002). According to subgroup analyses, LTPP yielded significant, large, and stable within-group effect sizes across various and particularly complex mental disorders (range, 0.78-1.98). Conclusions There is evidence that LTPP is an effective treatment for complex mental disorders. Further research should address the outcome of LTPP in specific mental disorders and should include cost-effectiveness analyses.

Effectiveness of Long-term Psychodynamic Psychotherapy : A Meta-analysis. Commentary

Since introducing the first non-pharmaceutical interventions (NPIs) to decelerate the spread of the virus, European governments have highlighted the role of “solidarity”. However, the role and levels of solidarity, especially during the past lockdowns, is uncertain. The present study thus explores the levels, the role, and the distribution of received and demonstrated interpersonal solidarity during the COVID-19 pandemic. This pooled cross-sectional study was conducted from March 2020 to March 2021 in Germany, including 19,977 participants. Levels of solidarity between the first and the second lockdowns in Germany were compared, possible predictors were examined, and three clusters were defined to unveil distributional patterns of solidarity reception and/or demonstration. To compare solidarity levels between the first and the second lockdowns in Germany, a dummy-coded lockdown variable was introduced and regressed on the two solidarity items. To identify predictors of received and demonstrated solidarity, two multiple linear regression models were computed, testing several demographic and psychological factors. For further exploratory analyses, clusters of “helpers”, “non-helpers”, and “help-receivers and helpers” were computed based on a k-means cluster analysis. Results revealed a lower level of solidarity during the second lockdown compared with the first one. Demonstrated solidarity was positively predicted by adherent safety behavior to avoid COVID-19 infection and by middle age, and negatively by depression symptoms, male gender, and high age. Received solidarity was positively predicted by higher age, by both adherent and dysfunctional safety behavior in avoidance of COVID-19 infection, and by lower educational level. “Helpers” reported little received solidarity but demonstrated high solidarity, “non-helpers” showed both little demonstrated and received solidarity, and “help-receivers and helpers” showed middle–high received and demonstrated solidarity. The three clusters differed the most regarding the variables of age, adherent and dysfunctional safety behavior, fear of COVID-19, subjective risk perceptions regarding contraction of COVID-19 and the respective consequences, and trust in governmental interventions in response to COVID-19. The decrease in interpersonal solidarity over the course of the COVID-19 pandemic, as well as its predictors, should be considered regarding prospective impositions. Furthermore, as depressive symptoms were identified to negatively predict interpersonal solidarity, the adequate provision of mental health services, especially during the COVID-19 pandemic, becomes even more important.

https://www.mdpi.com/1660-4601/19/4/2041/pdf?version=1644997168

Levels, Predictors, and Distribution of Interpersonal Solidarity during the COVID-19 Pandemic

Der zunachst auff alligste Befund der Anorexia nervosa (AN) ist der reduzierte Ernahrungszustand bei einem oft drastischen Gewichtsverlust. Patientinnen mit schwerer Anorexie zeigen einen kachektischen Ernahrungszustand. Die auserliche Erscheinung ist fahl, subkutanes Fettgewebe kann fehlen, sodass einzelne Knochen sowie Muskeln und Muskelsehnen wahrgenommen werden. Es besteht der Wunsch nach einer Gewichtsabnahme, eine Gewichtsgrenze nach unten scheint es nicht zu geben. Der Gewichtsverlust wird erreicht durch Einschrankung der Nahrungszufuhr, Erbrechen, exzessive korperliche Aktivitat oder Einnahme von Abfuhrmitteln oder Diuretika. Auffallig ist, dass Patientinnen den Gewichtsverlust selbst nicht adaquat wahrnehmen konnen und verleugnen. In Extremfallen fuhlen sich Patientinnen auch im Zust and der Kachexienoch zu dick-vorwiegend betroffen sind Bauch, Huften und Oberschenkel.

Anorexia nervosa und Bulimia nervosa im Erwachsenenalter

INTRODUCTION Multidisciplinary obesity services at university hospitals usually treat patients with more complex and severe obesity. In addition, patients with Class 3 obesity, in particular, have different attitudes regarding the choices of therapy. METHODS This explorative study investigated the effect of patient attitudes towards bariatric surgery on body weight change (primary outcome) and psychological improvement (secondary outcomes: quality of life, depression, anxiety, and eating behaviour) in a 6-month moderate behavioural weight loss (BWL) programme in a university outpatient setting. RESULTS 297 patients with mostly Class 3 obesity participated in the programme. The patients did not yet have any indications for bariatric surgery. Of the participants, 37% had a positive attitude towards bariatric surgery (POS), whereas 38% had a negative attitude (NEG). The drop-out rate was 8%. NEG participants lost significantly more body weight than the POS participants (intention-to-treat population: 4.5 [SD: 6.3] kg versus 0.4 [SD: 5.8] kg; p < 0.001). In both subgroups, anxiety, depression, the mental score for quality of life, and eating behaviour improved. CONCLUSION A BWL treatment in a clinical setting identified 2 distinct groups with different attitudes towards bariatric surgery that were associated with different body weight change outcomes. These groups may require differently targeted programmes to achieve the best body weight loss results.

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Attitude Matters! How Attitude towards Bariatric Surgery Influences the Effects of Behavioural Weight Loss Treatment.

Background:In Germany, some units of specialized palliative care (SPC) offer a 6- to 12-month rotation for resident physicians (RPs) and fellows from different specialties.Objective:This pilot stud...

/pdf/knowledge-and-self-efficacy-assessment-of-residents-and-4gzh85bfhp.pdf

Knowledge and Self-Efficacy Assessment of Residents and Fellows Following Palliative Care Unit Rotation: A Pilot Study

Zusammenfassung Fragestellung: Therapieabbruche ziehen Konsequenzen nach sich, unter anderem fur die Patienten selbst, ihre Mitpatienten, den Therapeuten und die Klinik. In dieser Studie wurde untersucht, ob und in wie weit sich betroffene Patienten fruhzeitig identifizieren lassen. Methode: Patienten der Abteilung fur Psychosomatische Medizin und Psychotherapie der Medizinischen Universitatsklinik Tubingen wurden retrospektiv in einer Fall-Kontroll-Studie mittels Matched-Pairs-Technik untersucht. In der konsekutiven Fallgruppe waren 59 Abbrecher, 50 Frauen und neun Manner. Diese wurden in 28 Fruhabbrecher und 31 Spatabbrecher unterteilt. Die Daten wurden zwischen Fruhabbrechern, Spatabbrechern und der Kontrollgruppe im Hinblick auf Unterschiede in den Bereichen allgemeine Psychopathologie (SCL- 90-R, IIP-D, SF-36), den Grunden fur den Abbruch und den soziodemographischen Daten verglichen. Ergebnisse: Fruhabbrecher waren signifikant junger als Spatabbrecher, lebten haufiger bei Eltern oder allein und hatt...

Martin Teufel

Papers

Levels, Predictors, and Distribution of Interpersonal Solidarity during the COVID-19 Pandemic

Anorexia nervosa und Bulimia nervosa im Erwachsenenalter

Attitude Matters! How Attitude towards Bariatric Surgery Influences the Effects of Behavioural Weight Loss Treatment.

Knowledge and Self-Efficacy Assessment of Residents and Fellows Following Palliative Care Unit Rotation: A Pilot Study

Behandlungsabbrüche während einer stationären Psychotherapie