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Behandlungsmanual und Behandlungsmaterialien für die psychologische Kurzintervention zur Erwartungsoptimierung von Patienten vor herzchirurgischen Eingriffen im Rahmen der randomisiert-kontrollierten mulitzentrischen PSY-HEART-II-Studie.

This study examined whether baseline (3–14 days pre-surgery) levels of (i) depressive or (ii) anxiety symptoms and (iii) illness beliefs moderate the effects of additional preoperative interventions before coronary artery bypass graft surgery on (i) depressive or (ii) anxiety symptoms and (iii) illness beliefs 1 day before surgery, 1 week and 6 months after surgery. In the PSY-HEART trial, 115 patients were assessed. They were randomized into one of three groups: 1. receiving standard medical care only (SMC), additional psychological interventions: 2. aiming to optimize patients’ expectations (EXPECT), or 3. focusing on emotional support. Patients with a higher baseline level of depressive symptoms receiving a preoperative psychological intervention indicated lower depressive symptoms 6 months after surgery compared to SMC. EXPECT increased personal control and concern levels in patients with low baseline personal control/concern 1 day before surgery. Brief preoperative psychological interventions can improve psychological outcomes in heart surgery patients. Baseline status may moderate these effects. The study has been approved by the medical ethics committee of the Philipps University of Marburg and has been pre-registered at www.clinicaltrials.gov (NCT01407055) on August 1, 2011.

This study examined whether i) brief videos aiming to optimise outcome expectations would augment the efficacy of progressive muscle relaxation (PMR) and ii) whether participants' characteristics would moderate these effects. Sixty-eight healthy subjects randomized to one of three experimental manipulations before undergoing a single PMR session either watched i) a video displaying a neutral expert, ii) a video with a warm expert, or iii) were part of an active control condition. Constrained linear mixed models indicated increased relaxation and decreased stress levels for all participants after the PMR session. The primary outcome was the change of perceived relaxation/stress from pre to post. Participants with high neuroticism and trait anxiety indicated an augmented PMR's efficacy and increased outcome expectations when watching the warm expert video compared to the control group or the less warm expert. Brief videos displaying an expert aiming to optimise outcome expectations regarding a brief stress-reducing psychological intervention may boost or decrease an intervention's efficacy. Effects may depend on the viewer's personality and the (video) expert's communication style. Trial Registration: The study protocol was approved by the local Ethics Committee of the University of Marburg, Germany. This study was registered at www.clinicaltrials.gov (NCT03330431).

Background Depression is associated with an increased risk for cardiovascular disease (CVD). Biological cardiac risk factors are already elevated in depressed patients without existing CVD. The purpose of this exploratory trial was to examine whether treating Major Depression (MD) with cognitive behavioral therapy (CBT) is associated with improvements in cardiac risk biomarkers and whether depressive symptom severity at baseline moderates treatment effects. Methods Eighty antidepressant-free patients with MD were randomly assigned to CBT or waiting list (WL). Biological outcomes included long-term recordings (24-h, daytime, nighttime) of heart rate, heart rate variability (HRV), and blood pressure, as well as inflammatory markers such as C-reactive protein (CRP), interleukin (IL)-6, and tumor necrosis factor (TNF)-α. A sample of 40 age- and sex-matched non-clinical controls was also involved to verify biological alterations in MD at study entry. Results Compared to WL, CBT was associated with a significant increase in overall HRV, as indexed by the 24-h and daytime HRV triangular index, as well as trend improvements in 24-h low-frequency HRV and daytime systolic blood pressure. Self-rated depressive symptom severity moderated (or tended to moderate) improvements in CBT for 24-h and daytime heart rate and several indices of HRV (especially daytime measures). Inflammatory treatment effects were not observed. Conclusions CBT increased overall HRV in patients with MD. Initially more depressed patients showed the most pronounced cardiovascular improvements through CBT. These exploratory findings may provide new insights into the biological effects of psychological treatment against depression and must be confirmed through future research.

Chronischer Pruritus (CP) ist ein hoch pravalentes und sehr belastendes Symptom, das schwer zu behandeln ist. Heutzutage stehen mehrere topische und systemische Therapiekonzepte zur Behandlung von CP zur Verfugung. Aktuelle Leitlinien empfehlen neben der topischen Therapie die Anwendung einer Vielzahl von systemischen Praparaten (zumeist im Off-label-Bereich) mit unterschiedlichen Wirkungsweisen. Beispiele sind Antihistaminika, Gabapentinoide, Antidepressiva, Immunsuppressiva und μ‑Opioidrezeptor-Antagonisten. Die Wahl des richtigen Medikaments hangt von der Indikation, dem Sicherheitsprofil des Arzneimittels und von patientenspezifischen Faktoren wie Komorbiditaten und Komedikation ab. Aufgrund eines tieferen Verstandnisses der Pathophysiologie von CP konnten innovative Medikamente entwickelt werden, die bereits eine antipruritische Wirkung in klinischen Studien und Fallberichten gezeigt haben. Besonders vielversprechend sind Phosphodiesterase-4-Hemmer als topische Substanzen und monoklonale Antikorper, Neurokinin-1-Rezeptor-Antagonisten, Januskinaseinhibitoren und Opioidrezeptormodulatoren als systemische Therapeutika. Zusatzlich konnten weitere Zielstrukturen des peripheren und zentralen Nervensystems identifiziert werden, die mogliche therapeutische Ansatzpunkte darstellen. Der vorliegende Beitrag bietet einen Uberblick der derzeit verfugbaren topischen und systemischen Therapien fur CP und diskutiert innovative Wirkstoffe sowie vielversprechende Zielstrukturen fur die Therapie des CP.

Hintergrund Rezepturarzneimittel sind in Deutschland besonders im Bereich der topischen Therapie als wichtige Erganzung zu zugelassenen Fertigarzneimitteln unverzichtbar. Bundesweit werden im ambulanten kassenarztlichen Bereich pro Quartal etwa 2 Mio. Rezepturen verordnet, 50 % davon durch Dermatologen. Methodik Die Verordnungspraxis wurde evaluiert mittels eines Fragebogens, der an 186 niedergelassene Dermatologen sowie 1491 Apotheken in Rheinland-Pfalz und dem Saarland versendet wurde. Ziel war Erfassung und Einordnung von Verordnungsgewohnheiten und Problemen in der interdisziplinaren Zusammenarbeit zur Optimierung der Patientenversorgung. Ergebnisse In 351 Fallen (23,5 %) wurde ein beantworteter Fragebogen von Apothekern und in 53 Fallen (28,4 %) von Dermatologen zuruckgesendet. Als haufigster Beweggrund (83 %) fur die Verordnung eines Rezepturarzneimittels wurde von Dermatologen die Verordnung groser Mengen angegeben, haufigste Krankheitsbilder fur die Verwendung von Rezepturen waren die Schuppenflechte und Ekzeme. Die am haufigsten verordneten Wirkstoffe waren Triamcinolonacetonid (80 %), Erythromycin (78,3 %) sowie Clotrimazol (72,5 %). Apotheker gaben an, dass die Kommunikation mit Arzten „mit Arger verbunden“ (58 %) sei und in einem viel zu geringen Umfang stattfinde (34 %). Schlussfolgerungen Rezepturarzneimittel sind wichtige Instrumente zur optimalen Patientenversorgung. Die interdisziplinare Zusammenarbeit stellt Apotheker und Arzte vor Probleme. Expertisen mussen besser vereint werden, beispielsweise durch intensivere Aus- und Fortbildung. Studien zum Rezepturen-Management sollten Probleme und Chancen in diesem Feld weiter untersuchen.

Background Compounded preparations (CPs) are an indispensable addition to approved, commercially available drugs (CADs), especially for topical therapy. In Germany, about eight million CPs are prescribed within the statutory health insurance system each year, 50 % thereof by dermatologists. Methods We analyzed prescribing habits based on a questionnaire sent out to 186 office-based dermatologists and 1,491 pharmacies in the federal states of Rhineland-Palatinate and Saarland. The goal was to improve patient care by collecting and categorizing data in terms of prescription practice and associated challenges in interdisciplinary cooperation. Results Overall, 351 pharmacists (23.5 %) and 53 dermatologists (28.4 %) participated in this survey. The most common reason (83 %) stated for prescribing a CP was the possibility to prescribe large quantities of a given topical medication; CPs were most commonly prescribed for psoriasis and various types of dermatitis. The most frequently prescribed active pharmaceutical ingredients were triamcinolone (80 %), erythromycin (78.3 %) and clotrimazole (72.5 %). Fifty-eight percent of pharmacists reported that the collaboration with dermatologists was "associated with problems"; 34 % complained about insufficient communication. Conclusions CPs are essential for optimizing patient care. Interdisciplinary cooperation poses a challenge to both physicians and pharmacists. In this context, it is important to increase collaborative efforts in terms of training and continuing medical education. Further studies on CPs are required to better elucidate the challenges and opportunities associated with their prescription.

The PSY-HEART-I trial indicated that a brief expectation-focused intervention prior to heart surgery improves disability and quality of life 6 months after coronary artery bypass graft surgery (CABG). However, to investigate the clinical utility of such an intervention, a large multi-center trial is needed to generalize the results and their implications for the health care system. The PSY-HEART-II study aims to examine whether a preoperative psychological intervention targeting patients' expectations (EXPECT) can improve outcomes 6 months after CABG (with or without heart valve replacement). EXPECT will be compared to Standard of Care (SOC) and an intervention providing emotional support without targeting expectations (SUPPORT). In a 3-arm multi-center randomized, controlled, prospective trial (RCT), N = 567 patients scheduled for CABG surgery will be randomized to either SOC alone or SOC and EXPECT or SOC and SUPPORT. Patients will be randomized with a fixed unbalanced ratio of 3:3:1 (EXPECT: SUPPORT: SOC) to compare EXPECT to SOC and EXPECT to SUPPORT. Both psychological interventions consist of 2 in-person sessions (à 50 minute), 2 phone consultations (à 20 minute) during the week prior to surgery, and 1 booster phone consultation post-surgery 6 weeks later. Assessment will occur at baseline approx. 3-10 days before surgery, preoperatively the day before surgery, 4-6 days later, and 6 months after surgery. The study's primary end point will be patients' illness-related disability 6 months after surgery. Secondary outcomes will be patients' expectations, subjective illness beliefs, quality of life, length of hospital stay and blood sample parameters (eg, inflammatory parameters such as IL-6, IL-8, CRP). This large multi-center trial has the potential to corroborate and generalize the promising results of the PSY-HEART-I trial for routine care of cardiac surgery patients, and to stimulate revisions of treatment guidelines in heart surgery.

Depressive Störungen sind mit einem erhöhten Risiko für kardiovaskuläre Erkrankungen verbunden. Metaanalysen zeigen, dass auch bei Personen mit einer Major Depression ohne kardiovaskuläre Erkrankungen biologische Risikofaktoren kardiovaskulärer Erkrankungen vorliegen. Hierzu zählen insbesondere (i) autonome Dysregulationen, indiziert durch eine herabgesetzte Herzratenvariabilität (HRV) und (ii) erhöhte Blutkonzentrationen von an Entzündungsreaktionen beteiligten Immunmarkern (d.h. C-reaktives Protein, Interleukin (IL)-6 und Tumornekrosefaktor (TNF)-α). Obwohl diese biologischen Faktoren partiell durch behaviorale und kognitiv-affektive Prozesse beeinflussbar sind, werden sie in der Psychotherapieforschung wenig berücksichtigt. Im Rahmen dieser systematischen Übersichtsarbeit gehen wir der Frage nach, ob durch kognitive Verhaltenstherapie (KVT) Parameter des Immunsystems und die HRV bei Personen mit einer Major Depression positiv beeinflusst werden können. In Bezug auf die HRV wurden 2 randomisierte kontrollierte Studien (RCTs) und eine quasi-randomisierte Studie extrahiert. Bezüglich der proinflammatorischen Immunmarker lagen 3 RCTs, eine nichtrandomisierte Studie und 2 Prä-Post-Studien vor. Zusammenfassend kann aufgrund der geringen Anzahl publizierter Studien und methodischer Einschränkungen nicht eindeutig geschlussfolgert werden, ob und unter welchen Umständen bei einer Major Depression im Rahmen der KVT mit einer Verbesserung der HRV oder des immunologischen Status zu rechnen ist. Bei unmedizierten Patientengruppen ergaben sich Hinweise auf positive immunologische Interventionseffekte in Form einer Reduktion von IL-6 und TNF-α. Empfehlungen für zukünftige Forschungsarbeiten werden abgeleitet.

BackgroundMajor depression (MD) is a risk factor for cardiovascular disease. Reduced heart rate variability (HRV) has been observed in MD. Given the predictive value of HRV for cardiovascular health, reduced HRV might be one physiological factor that mediates this association.MethodsThe purpose of this study was to provide up-to-date random-effects meta-analyses of studies which compare resting-state measures of HRV between unmedicated adults with MD and controls. Database search considered English and German literature to July 2018.ResultsA total of 21 studies including 2250 patients and 1982 controls were extracted. Significant differences between patients and controls were found for (i) frequency domains such as HF-HRV [Hedges' g = −0.318; 95% CI (−0.388 to −0.247)], LF-HRV (Hedges' g = −0.195; 95% CI (−0.332 to −0.059)], LF/HF-HRV (Hedges' g = 0.195; 95% CI (0.086–0.303)] and VLF-HRV (Hedges' g = −0.096; 95% CI (−0.179 to −0.013)), and for (ii) time-domains such as IBI (Hedges' g = −0.163; 95% CI (−0.304 to −0.022)], RMSSD (Hedges' g = −0.462; 95% CI (−0.612 to −0.312)] and SDNN (Hedges' g = −0.266; 95% CI (−0.431 to −0.100)].ConclusionsOur findings demonstrate that all HRV-measures were lower in MD than in healthy controls and thus strengthens evidence for lower HRV as a potential cardiovascular risk factor in these patients.

Background Most patients experiencing preoperative anxiety would welcome support in coping with their anxiety. Anxiolytic medication is a common way to address preoperative anxiety. However, the proportion of patients who welcome anxiolytic medication preoperatively and the preferred time of taking it have not been studied thoroughly. Methods Adult patients (n = 1000) scheduled to undergo elective surgery under general anesthesia were eligible to participate in this single-center observational study. Primary outcomes were the ratio of patients desiring anxiolytic medication (no/yes/on request) and the preferred time of taking it (evening before surgery/morning of day of surgery/on call to the operating room). Secondary outcomes included associations between different measures of anxiety (i.e., anxiety level according to the Amsterdam Preoperative Anxiety and Information Scale (APAIS) and anxiety status (no/yes)) and desire for anxiolytic medication (no/yes/on request). Primary outcomes were analyzed descriptively, and secondary outcomes were analyzed using multinomial logistic regressions. Results Three hundred fifty-six (35.6%) out of 1000 patients desired anxiolytic medication and 239 (23.9%) patients would welcome anxiolytic medication on request. In patients reporting anxiety (no/yes; n = 493), 228 (46.2%) stated a clear desire for anxiolytic medication (yes) and 142 (28.8%) considered anxiolytic medication (on request). Patients’ preferences concerning the timing of premedication vary widely. In patients reporting a clear desire for anxiolytic medication (n = 356), the “morning of the day of surgery” was most frequently (n = 111, 31.2%) stated as the preferred time to get anxiolytic medication, followed by “on call to the operating room” (n = 51, 14.3%). All anxiety measures were significantly associated with desire for anxiolytic medication (p < 0.05). Conclusions Given the importance of preoperative anxiety to patients, patients’ desire for anxiolytic medication should be considered when discussing the pros and cons of premedication. Individualized instead of standardized prescription and timing of premedication is recommended. Trial registration German Clinical Trials Register (DRKS 00013319, approved 23/11/2017).

The coronavirus disease 2019 (COVID‐19) is associated with a wide clinical spectrum of skin manifestations, including chilblain‐like, urticarial, vesicular and vasculitic lesions. Recently, delayed skin reactions following mRNA vaccination against SARS-CoV-2 have been reported. The exact pathomechanisms underlying these skin lesions remain unknown. Here, we describe eleven cases of delayed skin reactions after SARS-CoV-2 vaccination with the mRNA-1273 vaccine, discuss their transient and benign clinical courses and consider their potential pathomechanisms based on histopathological analyses. We conclude that further investigations to characterize the precise molecular and cellular mechanisms underlying this rare phenomenon are warranted.

Purpose of Review To review the current state of preoperative psychological preparation to improve outcomes after cardiac surgery. Recent Findings Preoperative psychosocial factors are associated with short- and long-term outcomes after cardiac surgery. There are several approaches to optimize patients’ preoperative psychological status with promising effects on postoperative outcomes (e.g., less complications, improved quality of life). Preoperative psychological preparation often aims to improve patients’ knowledge or social support and to modify and optimize expectations and illness beliefs. Summary Preoperative psychological preparation is gaining importance for cardiac surgery. However, patients’ psychological status still does not get as much attention as it deserves. Preoperative psychological preparation seems to have positive effects on postoperative outcomes. Since overall evidence is still weak, further studies are warranted to understand which intervention works best for whom and why.

Chronic pruritus (CP) is a highly prevalent, difficult-to-treat, and burdensome condition. Today, multiple topical and systemic therapy concepts are available for the treatment of CP. Current guidelines recommend, besides topical treatments, the use of a vast array of mostly off-label systemic drugs with different mechanisms, including antihistamines, gabapentinoids, antidepressants, immunosuppressive drugs, and μ‑opioid receptor antagonists. The choice of the right agent depends on the indication, the safety profile of the drug, and patient-specific features, such as comorbidities and comedication. Thanks to a deeper understanding of the pathophysiology of CP, novel drugs have been developed and have already shown antipruritic efficacy in clinical studies and case reports. Of note, phosphodiesterase‑4 inhibitors as topical agents and monoclonal antibodies, neurokinin‑1 receptor antagonists, Janus kinase inhibitors, and opioid receptor modulators as systemic agents are in the frontline of innovative CP treatment. Other promising targets include structures of the peripheral and central nervous system which are involved in itch signaling. This article provides an overview of currently available topical and systemic therapies for CP and their indications and discusses novel innovative agents and promising new targets in CP.

Introduction Inflammation has been related to several somatic and psychological disorders and may moderate effects of psychological interventions. In the PSY-HEART trial patients benefitted from preoperative psychological interventions before undergoing coronary artery bypass graft surgery (CABG) and, if necessary, concomitant valvular surgery, compared to standard medical care. In this study we examined whether patients’ baseline inflammatory status moderated the intervention effects. Material and methods In a prospective three-arm randomized clinical trial with 6-months follow-up, 124 patients scheduled for CABG surgery alone or concomitant with valvular surgery were randomized to (i) standard medical care only (SMC) or two preoperative psychological interventions: (ii) CBT-based optimizing expectations (EXPECT) and an (iii) an active control group focusing on emotional support (SUPPORT). Available baseline CRP- (n = 79), IL-6- (n = 78), IL-8- (n = 78) and TNF-alpha-(n = 80) parameters were considered as potential moderators (CRP as a categorical and continuous moderator). Linear mixed model analyses were calculated to test whether baseline inflammatory levels moderated intervention effects on disability, mental and physical quality of life at 6 months after surgery. Results IL-8 moderated intervention effects on patients’ disability and categorical CRP moderated intervention effects on mental quality of life. Follow-up tests indicated that EXPECT (and in part SUPPORT) led to lower postoperative disability and higher mental quality of life compared to SMC in patients with low baseline inflammatory markers. EXPECT indicated higher mental quality of life compared to SUPPORT in the high CRP subgroup. Patients in the SMC group had higher mental quality of life in the high CRP subgroup compared to the low CRP subgroup. Conclusion Especially for patients with a lower inflammatory baseline status preoperative psychological interventions might be helpful to optimize long-term CABG surgery outcomes.

Background Extemporaneous formulations broaden the spectrum of therapeutic options for topical treatment in particular and thus improve patient care. The latest amendment to the Regulation on the Operation of Pharmacies issued in 2012 brought about changes in prescribing and manufacturing practices. The aim of the present study was to assess the relevance of extemporaneous formulations in everyday clinical practice. Methods We used data from the German Institute for Drug Use Evaluation (DAPI) to analyze the prescribing practice for compounded preparations in Germany between the fourth quarter of 2011 and the third quarter of 2014. In doing so, we determined the total cost associated with extemporaneous formulations covered by statutory health insurance funds in the outpatient setting. Results Approximately three out of ten prescriptions (30.54 %) by German dermatologists during the observation period were extemporaneous formulations. While dermatologists make up only 2.7 % of physicians working in the statutory health care system in Germany, they prescribe more than half of all compounded preparations (53.6 %). Each dermatologist prescribed an average of 270.4 formulations per quarter; that number was 13.5 (1.3 %) for all other medical specialties. On average, 1,983,687 extemporaneous formulations overall (1.3 % of all prescriptions) were prescribed per quarter, corresponding to a total cost of € 40,944,982 (0.55 %). Conclusions Apart from finished medicinal products, extemporaneous formulations play a key role in outpatient care. Based on the principles of evidence-based and patient-oriented medicine, the quality of compounded preparations and the prescribing practice of physicians (standardized vs. individual formulations) should be further investigated to optimize the quality of these preparations.

The aim of the study was to examine whether preoperative psychological interventions targeting patients' expectations are capable of influencing the biological stress response after coronary artery bypass graft (CABG) surgery and could thus improve recovery after heart surgery.Randomized controlled trial with assessments 10 days before surgery, after psychological intervention (day of hospital admission, but before surgery), postoperative (6-8 days later), and at follow-up (6 months after surgery). Eligible patients (N = 124) scheduled for elective on-pump CABG or CABG with valve replacement surgery were approached before hospital admission. Standard medical care (SMC) was compared with two additional preoperative psychological interventions: (a) an expectation manipulation intervention to optimize patients' expectations about course and outcomes or (b) supportive therapy, containing the same amount of therapeutic attention, but without specifically focusing on expectations. Postoperative plasma adrenaline, noradrenaline, and cortisol levels were a secondary outcome of our study (primary outcome patients' disability 6 months after surgery and other secondary patient-reported or clinical outcomes were reported elsewhere).Expectation manipulation intervention (3.68 ln pg/mL, 95% confidence interval = 3.38-3.98, p = .015) and supportive therapy (3.70 ln pg/mL, 95% confidence interval = 3.38-4.01, p = .026) led to significantly lower postoperative adrenaline levels compared with SMC (4.26 ln pg/mL, 95% confidence interval = 3.99-4.53) only. There were no treatment effects of the preoperative intervention for noradrenaline (p = .90) or cortisol (p = .30). Higher postoperative adrenaline levels predicted disability 6 months after surgery (r = .258, p = .018).In addition to SMC, preoperative psychological interventions seem to buffer psychobiological stress responses and could thus facilitate recovery from CABG surgery. Patients' postoperative stress responses could be an important factor for explaining trajectories of long-term outcomes.www.clinicaltrials.gov(NCT01407055).

Zusammenfassung. Theoretischer Hintergrund: Depressivität und Ängstlichkeit beeinträchtigen den Behandlungserfolg von herzchirurgischen Patienten. Fragestellung: Untersucht wurde, ob und wie präoperative Patientenerwartungen mit postoperativer Depressivität und Ängstlichkeit zusammenhängen und welche präoperativen Erwartungen hierbei den höchsten prädiktiven Wert haben. Methoden: 124 aortocoronare Bypass-Patienten bearbeiteten eine Woche vor der Operation einen Fragebogen, der verschiedene Aspekte von Erwartungen mischt (Positive Health Expectation Questionnaire; PHES) und einen Fragebogen, der einzelne Erwartungsaspekte getrennt erfasst (Expected Illness Perception Questionnaire, IPQ-E) und eine Woche vor sowie eine Woche nach der Operation Fragen zu ihrer Depressivität und Ängstlichkeit (Hospital Anxiety and Depression Scale (HADS)). Ergebnisse: Postoperative Depressivität wird durch präoperative Erwartungen vorhergesagt (R2 = 0.32, F = 3.13, p = .02). Der einzig signifikante Prädiktor hierbei sind positive Gesundheitserwartungen gemessen mit dem PHES. Auch postoperative Ängstlichkeit wird durch präoperative Erwartungen vorhergesagt (R2 = 0.27, F = 2.55, p

Hintergrund: Patientenerwartungen gelten als wichtige Wirkmechanismen bei psychotherapeutischen und medizinischen Behandlungen und spielen für die Genesung eine große Rolle. Vor diesem Hintergrund wurde eine psychologische präoperative Kurzintervention zur Erwartungsoptimierung entwickelt, um den Genesungsprozess nach Herzoperationen positiv zu beeinflussen. Dieser Artikel beschreibt die psychologische Kurzintervention (EXPECT) und stellt Evaluationsergebnisse der Intervention aus Patientensicht dar. Patienten und Methoden: 124 herzchirurgische Patienten wurden randomisiert und einer von drei Interventionen zugeteilt: a) Erwartungsoptimierung, b) supportive Therapie oder c) ausschließlich medizinische Standardbehandlung. In der Erwartungsintervention, die 2 Sitzungen und 2 Telefonate vor der Operation umfasst, wurden systematisch verhaltens- und behandlungsbezogene Ergebniserwartungen optimiert. Die Patienten wurden mithilfe von Fragebögen zu ihrer Zufriedenheit mit der Intervention befragt. Mittelwerte wurden berechnet. Ergebnisse: Die Zufriedenheit der Patienten mit beiden psychologischen Interventionen war im Mittel hoch bis sehr hoch. In der Erwartungsinterventionsgruppe fühlten sich die Patienten noch besser informiert und erwarteten einen positiveren Heilungsverlauf als die Patienten, die eine supportive Therapie erhielten. Ein Großteil der Patienten erlebte die Interventionen als hilfreich und erwartete durch diese positivere Ergebnisse, was sich auch im längsschnittlichen Verlauf bestätigte. Somit können präoperative Interventionen bei herzchirurgischen Eingriffen das bestehende Behandlungsangebot sinnvoll erweitern. Schlussfolgerungen: Die Optimierung von verhaltens- und ergebnisbezogenen Patientenerwartungen vor der eigentlichen Intervention kann zu einer Verbesserung von Behandlungsergebnissen beitragen. Eine solche psychologische Intervention wird gut angenommen und ist im Rahmen eines herzchirurgischen Settings durchführbar. Die Förderung positiver Erwartungen und die Veränderung ungünstiger Ausgangserwartungen von Patienten sollten sowohl bei psychotherapeutischen als auch bei herzchirurgischen Behandlungen stärker berücksichtigt werden.

A new approach of psychological interventions prior to stress aiming to optimize expectations may have beneficial effects on a person's health status by reducing physiological stress. The purpose of this experiment was to determine whether a brief psychological intervention designed to optimize personal control expectations prior to acute stress would affect perceived and biological stress responsiveness in comparison to two more established interventions (fostering gratitude or distraction) in a healthy sample.74 healthy participants were randomized to one of three psychological interventions prior to stress: (i) writing about ways to influence stress to optimize personal control expectations (EXPECTATION), (ii) writing a gratitude-letter (GRATITUDE) (iii) or a distraction writing task (DISTRACTION). After completing the intervention, the Maastricht acute stress test was administered to induce (psychosocial and physiological) stress. Assessments took place at baseline, post-intervention (15 min writing task) and after stress induction (additional salivary assessments: 15 and 30 min after stress). Main outcomes were expectations, emotions, perceived stress, salivary cortisol and alpha-amylase. Personality traits (eg, optimism) were assessed at baseline.EXPECTATION specifically increased personal control expectations (p = .016, d = .72) and GRATITUDE specifically increased gratitude (p = .026, d = .68). EXPECTATION and DISTRACTION led to lower cortisol concentrations after stress induction than GRATITUDE (time x group interaction: p .001, d = .88). We detected no intervention effects on alpha-amylase or perceived stress. Optimism moderated intervention effects on cortisol (p = .023, d = .74).Brief psychological interventions aiming to optimize expectations or distraction prior to stress reduce the cortisol response in healthy participants after an acute stressor.

Objective To examine the effect of a preoperative expectation-optimizing psychological intervention on length of stay in the hospital and time spent in the Intensive Care Unit (ICU) in patients undergoing elective cardiac surgery. Methods In a randomized controlled trial, 124 patients prior to undergoing coronary artery bypass grafting (CABG) or CABG combined with heart valve surgery were randomized to either a) standard medical care alone (SMC) or an additional preoperative intervention, b) an additional expectation manipulation intervention (EXPECT) to optimize patients' expectations, or c) an additional supportive therapy (SUPPORT), containing the same amount of therapeutic attention but without a specific focus. Participants were followed-up post-operatively to assess their length of hospital stay and the time spent in the ICU. Results Patients in both psychological intervention groups spent significantly less days in the hospital then patients in the SMC group ( M (EXPECT) = 12.62, M (SUPPORT) = 14.13, M (SMC) = 17.27, p = 0.028). There was a significant linear trend ( F (1112) = 7.68, p = 0.009) showing that the more specific the intervention patients received the shorter they stayed in the hospital. The effect of the intervention on time spent in the ICU was only marginally significant ( M (EXPECT) = 103.76, M (SUPPORT) = 103.10, M (SMC) = 158.45, p = 0.066). Conclusion Changing patients' preoperative expectations via a psychological intervention leads to less days spent in the hospital. The psychological interventions are associated with positive cost-benefit ratios. Specific psychological mechanisms underlying the effect of our intervention remain unclear and need to be investigated further. Trial Registration: www.clinicaltrials.gov ( NCT01407055 ).

As in many other high mountainous regions, local people in the Eastern Pamirs (Tajikistan) use biomass fuels, mainly teresken shrubs, to heat their houses during the winter months. This overuse of already scarce natural resources results in serious land degradation. Since 2006, thermal insulation measures have been disseminated and financed through microloans. This case study analyzes the impacts of thermal insulation in Murgab, the main town in the Eastern Pamirs, where thermal insulation measures have been implemented in 159 households since 2008. Although clients are more interested in increased comfort than in fuel savings, according to quantitative data collected in 2010 and 2011, thermal insulation measures led to a 20 to 30% savings in heating energy on average. However, it is mainly better-off households that are aware of energy efficiency issues and willing to invest in thermal insulation. In contrast, poorer households are the main teresken users, but they rarely have their houses insulated due to a lack of awareness and a low ability to repay loans. Therefore, the approach to introducing thermal insulation has only had a small effect on teresken consumption until now.

‘Jumping to conclusions’ is a cognitive bias relevant to delusional ideation that has been reliably replicated with the Beads Task decision-making paradigm. Due to the artificial nature of this classical task, little is known about the generalization of hasty decision-making to more naturalistic, real-life situations. In this study the construction and psychometrical evaluation of an experimental Social Beads Task paradigm are reported. The task involves eighteen neutral, self-relevant and delusion-relevant scenarios in which participants have to decide between alternative explanations by obtaining complex, naturalistic pieces of information. Besides satisfying psychometric properties in the present non-clinical sample (N = 92), the proposed enhancing impact of self-relevant and delusion-relevant scenarios on hasty decision-making was corroborated, F(2, 160) = 25.26, p, < 0.01, partial η2 = 0.24. The Social Beads Task could therefore be a useful tool in delusion research that allows the investigation of cognitive biases in social scenarios.