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Recently, unexpectedly high virus-specific IgG4 levels were reported after more than two mRNA vaccinations. Class switch towards IgG4 occurs after long-term antigen exposure, downregulates immune responses and is associated with several autoimmune diseases.Here, we examined differences in antigen-specific IgG subtypes in serum samples from 64 Post-COVID patients and an equally sized cohort of convalescent controls.In both cohorts, the relative amounts of spike protein-specific IgG subtypes were comparable. IgG1 was the most frequent, followed by IgG3, IgG2, and IgG4. A difference between cohorts was observed only for IgG2, which was significantly lower in the Post-COVID cohort. Further analysis of the reactive IgG4 revealed a small but significant difference for the spike protein receptor-binding domain but not for the spike ectodomain.Since the total IgG4 levels are very low, we do not expect a biologically relevant role in Post-COVID syndrome. However, reduced virus-specific IgG2 levels could contribute to the persistence of SARS-CoV-2, causing chronic inflammation in the setting of Post-COVID syndrome.

Background For a better understanding of the factors underlying the Post-Acute COVID Syndrome, we studied the relationship between symptoms and functional alterations in COVID-19 patients 10 months after hospitalization. Methods One-hundred-one patients hospitalized between March 1st and June 30th 2020 participated in a follow-up visit for an assessment of clinical history, comorbidities, lung function, physical capacity and symptoms, including the SGRQ for health-related quality of life, PHQ-9-D for depression, and SOMS-2 J for somatoform disorders. Data were analyzed by univariate comparisons and multiple logistic regression analyses. Results Median age was 60 years, 42% were female, 76% had at least one comorbidity, the median length of the hospital stay was 8 days, 19% had been on the ICU. The most prevalent symptoms included shortness of breath (49%), fatigue (49%) and cognitive impairment (39%). Signs of major depression (PHQ-9-D ≥ 10) occurred in 28%/2% (p

Zusammenfassung Hintergrund In Psychiatrie, Psychosomatik und Psychotherapie werden Basisdokumentationen (BaDo) als Instrument zur Qualitätssicherung eingesetzt. Für den Bereich der Kinder-, Jugend- und Familienpsychosomatik gibt es bisher keine einheitliche einrichtungs- und sektorenübergreifende Basisdokumentation. Das Ziel der Studie war es, auf Basis eines synoptischen Vergleichs etablierter BaDo’s einen Merkmalskatalog für den Kontext kinder- und jugendpsychosomatischer Behandlungen vorzuschlagen. Methodik Im Rahmen einer qualitativen Dokumentenanalyse wurden BaDo-Items aus dem Kinder-/Jugend- und Erwachsenenbereich entlang eines Kategoriensystems inhaltsanalytisch ausgewertet. Die herausgearbeiteten Aspekte wurden anschließend nach alters- und fachübergreifenden Inhalten klassifiziert und nach ihrer Kinder-/Jugendspezifität eingeschätzt. Die Ergebnisse wurden deskriptiv statistisch ausgewertet. Ergebnisse Aspekte der Kategorien Familienanamnese und Biografische Anamnese spezifizierten eine BaDo für Kinder und Jugendliche. Eine Erfassung von Vorbehandlungen wurde altersübergreifend in BaDo’s aus dem psychosomatischen Bereich akzentuiert. Die Erhebung soziodemografischer Daten musste konzeptuell an die altersabhängigen Anforderungen des Kinder- und Jugendbereichs angepasst werden. Schlussfolgerung Auf Grundlage eines empirischen Zugangs konnte eine modular aufgebaute BaDo für die Kinder-, Jugend- und Familienpsychosomatik formuliert werden, die einrichtungs-, sektoren- und berufsgruppenübergreifende Auswertungen ermöglicht. Das Instrument sollte in einem nächsten Schritt in einer Anwendungsstudie evaluiert und im Anschluss auf breiter Ebene konsentiert werden.

Nach einer kurzen Hinfuhrung und einer Definition des Korperbildes wird die Zugangsmoglichkeit uber das Malen in der sogenannten »Korperbildarbeit« erlautert. Sie ist eine Auseinandersetzung mit unbewussten symptomatischen und biografischen Aspekten, bei der in der Regel lebensgros angelegt und in Frontalansicht ein Korperbild gemalt wird, und die sich uber mehrere Einzelstunden erstreckt. Das Ziel dieser Korperbildarbeit ist die Bewusstmachung psychodynamischer Prozesse, ausgehend von dem hier und jetzt Spurbaren. Durch den eingeflochtenen Dialog mit der Therapeut*in wird die Versprachlichung zur Verankerung des reflektiven Prozesses in der Beziehung und die Fragen, die weiterfuhren konnen, vorgestellt.

Die aktuelle Coronavirus-Pandemie stellt psychosomatische Kliniken vor neue Herausforderungen. Damit auch niedergelassene Psychotherapeuten sich für ihre Patientinnen und Patienten ein Bild machen können, wurden im Folgenden zentrale hygienische Aspekte aufbereitet. Drei grundsätzliche Versorgungsmuster und Angebote der Einrichtungen können unterschieden werden: Umwidmung, schrittweise Räumung und Stand-by für die Umwidmung sowie Fortsetzung des Betriebs unter seuchenmedizinischen Rahmenbedingungen. Inhaltlich werden folgende Themen relevant: Beratungsbedarf in Sachen Angst vor dem Coronavirus sowie zwischenmenschliche psychische und psychosomatische Probleme im Zuge der notwendigen sozialen Distanz, Versorgung insbesondere bei prekären Wohnsituationen, veränderte Kommunikationsstrukturen (Telefon, Videosprechstunde) und Betreuung der mit dem Thema „coronavirus disease 2019“ (COVID-19) Beschäftigten. Alle Patientinnen und Patienten durchlaufen vor der Aufnahme einen klinischen und virologischen Diagnoseprozess und werden, evtl. unter Quarantänebedingungen beginnend, psychosomatisch-psychotherapeutisch stationär versorgt. Abschließend wird dargestellt, was den Patientinnen und Patienten mithilfe eines einfachen Merkschemas mitgeteilt wird: Abstand (mindestens 2 m), Abreibung (oft und wenigstens 20 s lang Händewaschen mit Seife), Ausweichen (freundliches Aneinander-vorbei-Gehen), alternative Kommunikation, Aussetzen (es geht auch ohne Shopping), Abwischen (regelmäßig alle Flächen, durch das Reinigungspersonal, aber auch Tablet und Handy durch die Patientin oder den Patienten) und möglichst außen bewegen, allein oder zusammensitzen (mit Sicherheitsabstand). Das psychosomatische Angebot wurden entsprechend umgewandelt.

Within the Routine Outcome Monitoring system “OQ‐Analyst,” the questionnaire “Assessment for Signal Cases” (ASC) supports therapists in detecting potential reasons for not‐on‐track trajectories. Factor analysis and a machine learning algorithm (LASSO with 10‐fold cross‐validation) were applied, and potential predictors of not‐on‐track classifications were tested using logistic multilevel modeling methods. The factor analysis revealed a shortened (30 items) version of the ASC with good internal consistency (α = 0.72–0.89) and excellent predictive value (area under the curve = 0.98; positive predictive value = 0.95; negative predictive value = 0.94). Item‐level analyses showed that interpersonal problems captured by specific ASC items (not feeling able to speak about problems with family members; feeling rejected or betrayed) are the most important predictors of not‐on‐track trajectories. It should be considered that our results are based on analyses of ASC items only. Our findings need to be replicated in future studies including other potential predictors of not‐on‐track trajectories (e.g., changes in medication, specific therapeutic techniques, or treatment adherence), which were not measured this study.

Zusammenfassung Hintergrund Die COVID-19-Pandemie („coronavirus disease 2019“) hat immense Auswirkungen auf die psychische Gesundheit. Kinder und Jugendliche gelten hierbei als besonders vulnerabel. Deshalb sind gerade für sie Angebote zur Gesundheitsförderung und Prävention wichtig. Gesundheitsförderung sollte motivierend gestaltet werden, um für diese Altersgruppe attraktiv zu sein. Ziel dieser Arbeit war zu untersuchen, ob Jugendliche mithilfe von innovativen digitalen Formaten erreicht werden können. Methodik Es wurde ein App-basiertes Training zur Förderung der Selbstregulation für die Sekundarstufe I konzipiert und Jugendlichen der Sekundarstufe I im Herbst 2020 angeboten. Hier wurde u. a. die Art der Motivation zur Teilnahme am Training abgefragt. Zudem konnten die Schüler*innen die Attraktivität des Trainings abschließend bewerten. Ergebnis Von den registrierten Schüler*innen (n = 91) absolvierten 39,56 % das komplette Training. 40,91 % der Schüler*innen, die das Training vollständig absolviert haben, gaben an, dass das Training „sehr“ hilfreich war, 36,36 % bewerteten es als „ziemlich“ hilfreich. 50 % der Befragten fand das App-basierte Training „modern und motivierend“, die andere Hälfte hätte sich jedoch mehr persönliche Betreuung gewünscht. Schlussfolgerung Die Ergebnisse decken sich mit den Ergebnissen bereits veröffentlichter Studien: Heranwachsende sind zwar prinzipiell offen für digitale Formate, jene werden aber kaum verbindlich und kontinuierlich genutzt.

Theoretical background: More than two-thirds of adolescents were moderately to severely burdened during the COVID-19 pandemic and reported lower quality of life as well as increased stress. Inadaequately regulated emotion and negative stress are risk factors for the development of internalization and externalization problems. Students can use an internet-based app for stress regulation training based on slow-paced breathing. This technique is simple and inexpensive and can be used anywhere. Slow-paced breathing stabilizes, calms, and improves physical and mental well-being. This technique can be used in both primary and secondary prevention. Objective: This study is a pilot project intended to investigate the accessibility, acceptance, and effectiveness of an app with the technology of slow-paced breathing. Method: A multimodule app has been designed and developed that explains the technique of slow-paced breathing and guides the use and practice of this technique before or during stressful situations. An additional breathing app provides support. As part of a pilot project during the second wave of the COVID-19 pandemic, students in grades 6 – 8 tested the 4-week training. 31 students evaluated the entire app, and training with the technique of “slow-paced breathing” was evaluated by 7 students. Results: First results indicate that most users were satisfied with the app technology and other aspects, such as design and processing time. The contents of the different modules were rated well by the training group “slow-paced breathing.” On the other hand, the accessibility was considered low, and half of the students (n = 30) would prefer face-to-face stress regulation training in school. All results are presented descriptively. Discussion and conclusion: The revised app plus face-to-face modules for compliance and motivational incentives should be evaluated in a larger sample of teenage students. Theoretischer Hintergrund: Belastungen und Stress nahmen bei den Jugendlichen während der COVID-19-Pandemie zu. Das Entschleunigte Atmen (EA) wirkt kurz- wie langfristig stressreduzierend und stabilisierend. Mithilfe einer App, die diese Technik vermittelt, haben Schüler_innen auch während des pandemiebedingten Distanz-Lernens die Möglichkeit, an einem schulbasierten Training teilzunehmen. Fragestellung: Wie hoch ist die Erreichbarkeit und wie werden inhaltliche und nicht-inhaltliche Aspekte der App bewertet? Methode: Eine mehrmodulige App, die das EA erklärt, zum Anwenden und Üben dieser Technik anleitet, wurde konzipiert und entwickelt. Während eines Pilotprojekts in der zweiten Welle der COVID-19-Pandemie wurde das vierwöchige Training von 6. bis 8. Klässler_innen erprobt. Das gesamte Training bewerteten 31 Schüler_innen, das EA sieben. Ergebnisse: Erste Ergebnisse deuten auf eine zufriedenstellende nicht-inhaltliche und eine gute inhaltliche Akzeptanz hin. Die Erreichbarkeit hingegen war gering. Alle Ergebnisse werden deskriptiv vorgestellt. Diskussion und Schlussfolgerung: Die App-Revision soll Präsenzmodule beinhalten, die motivationalen Anreize erhöhen und an einer größeren Stichprobe durchgeführt werden.

This study compared the effectiveness of a 12-day stress-prevention program (SGS) supplemented by individualized, structured, four-session telephone-coaching to that of an SGS without telephone-coaching in entrepreneurs from the green professions presenting with increased stress levels. All participants went through the SGS before being randomized either to the telephone-coaching group (TC) or to the control group without telephone-coaching (noTC). SGS included four key therapeutic elements: stress-management intervention, relaxation, physical exercise, and balneotherapy. The primary outcome was the current degree of subjectively experienced stress assessed with the Perceived Stress Questionnaire (PSQ) at a 9-month follow-up. Secondary outcomes included burnout symptoms, well-being, health status, sleep disorders, expectation of self-efficacy, depression, anxiety, ability to work, pain, and days of sick leave. Assessments were conducted at baseline, 12 days (end of program), and 1 (start telephone-coaching), 3, 6 (end of telephone-coaching), and 9 months. Data from 103 adults (TC = 51, noTC = 52), mostly fulltime farmers, were available for analysis (mean age: 55.3, 49.1% female). Participants experienced significant immediate improvement in all outcome measurements, which declined somewhat during the first three months after the end of SGS and then remained stable for at least another six months. While within-group changes from baseline to 9 months showed significant improvements at medium to large effect sizes for all target variables (PSQ-total, TC: &minus, 13.38 (&plusmn, 14.98), 95%-CI: (&minus, 17.68, &minus, 9.07), noTC: &minus, 11.09 (&plusmn, 14.15), 15.11, 7.07)), no statistically significant differences were found between the groups at any time and for any target variable (between-group ANCOVA for PSQ-total at 9 months, parameter estimator for the group: &minus, 1.58, 7.29, 4.13)). The stress-prevention program SGS is a feasible, effective, and practical way to reduce perceived stress and improve participants&rsquo, resources. Four subsequent telephone-coaching sessions do not seem to contribute to a further improvement in the results.

Introduction Endothelial dysfunction is a very common finding in obesity and metabolic syndrome. The aim of our study was to investigate if longterm weight reduction (WR) success may reverse endothelial activation in individuals with severe obesity participating in a multimodal WR program. Methods Participants with obesity (oBMI 40.3 ±7.5 kg/m2) underwent a standardized non-surgical 1-year WR program. Carotid artery studies and determination of endothelial function biomarkers were performed at baseline and after 1 year. Individuals were dichotomized in “successful WR” (% WR≥10% of initial body weight) and “failed WR” (% WR Results From 191 people with obesity, 115 achieved successful WR. Compared to controls without obesity (n=44) participants with obesity had higher carotid intima media thickness as well as higher sICAM-1, sE-selectin, MMP-9, hsCRP and IL-6 levels. After 12 months follow up delta values of inflammation and endothelial adhesion markers were significantly different between participants with obesity and successful WR and participants with obesity and failed WR, in favour of the successful WR group (mean ± standard deviation): ΔhsCRP (−5.2 mg/L ±7.8 vs. 1.1 mg/L ±5.1, P Conclusion Our data corroborate the finding that obesity leads to endothelial dysfunction. Furthermore, successful non-surgical WR may at least partially reverse endothelial activation implicating cardiovascular health benefits of WR in people with severe obesity.

Zusammenfassung Einleitung Das 500-jährige Reformationsjubiläum bildet den Anlass, die Historie der Pathographie Martin Luthers (1483–1546) zu skizzieren und mögliche Schlussfolgerungen für die psychiatrische Praxis abzuleiten. Methode Relevantes Schrifttum wurde ausgewertet. Ergebnisse Luther wurde als manisch-depressiv diagnostiziert, er wurde pathologisiert zum Syphilitiker und Alkoholkranken. Es existieren sogar Suizid-Spekulationen. Diskussion Die Verhaltenskomplexität einer historischen Persönlichkeit lässt sich weder aus Quellen noch aus Schrifttum objektiv bewerten. Dem gedanklichen Durchdringen und emotionalen Durchleben der eigenen Theologie mag neben Gesellschaftszwängen, reformatorentypischen Charaktereigenschaften und schwerwiegenden somatischen Erkrankungen eine essentielle Rolle bei der Ausgestaltung von Luthers Psychogramm zukommen. Schlussfolgerung Luthers Resilienz trotz somatischer und psychischer Krisen kann die heilsame Wirkung von Religiosität auf die Psyche unterstreichen.

Background Diet induced weight loss represents an intervention for obesity to prevent associated diseases. However there is considerable inter-individual variation. Single nucleotide polymorphisms (SNPs) and plasma miRNA might be contributing factors. We therefore hypothesized that changes in the miRNA pattern during weight loss depend on the SNP genotype. Methods Plasma miRNA profiles from 12 patients were determined before and after a three month weight loss intervention by Illumina sequencing. 46 further patients were analyzed by qPCR. SNP genotypes were determined on the Sequenom iPLEX platform. Results Samples before and after weight loss were analyzed by miRNA-seq and delta miRNA levels ranked according to p-value. Levels of miRNAs 25, 93 and 106 that are expressed from a common genomic cluster were reduced after weight loss. Those results were substantiated in a qPCR analysis of 46 additional patients. This is in accordance with mouse data showing a functional involvement of this cluster in obesity. Correlation of the changes in miRNA abundance with SNP genotypes revealed a statistical association of all three miRNAs with known obesity susceptibility SNPs. Conclusion Diet induced weight loss leads to SNP dependent modulation of miRNAs from the miR 25/93/106 gene cluster in humans.

Numerous methods for enhancing consciousness and well-being emphasize the role of breathing. For the first time, we have investigated the link between body rhythms and slow cortical brain dynamics during paced breathing. We present physiological data from 37 participants who performed paced breathing sessions with respiration rates (RRs) from 6 to 14 s/cycle (with 7 min for each task). Measures of respiration, heart rate variability (HRV) and 64-channel electroencephalogram (EEG) as well as subjective ratings were recorded and compared with each other. Both the respiratory sinus arrhythmia of the HRV and the slow cortical potentials (SCPs) of the EEG correlated with the respiration cycle. The highest correlations were observed at a RR of 10 s/cycle for the SCPs. A strong positive voltage deflection during inhalation is followed by a negative variation during exhalation. This decelerated breathing rhythm matches the frequency of baroreceptor sensitivity, leading to synchronization between breathing, HRV, baroreceptors and the brain. Subjectively, participants rated this RR as the most relaxing one. This study demonstrates the importance of the effect of speed of breathing on brain dynamics, which might help in understanding the role of breathing in mental health.

The ICD-10 Symptom Rating (ISR) 1 measures the severity of psychiatric disorders with 29 items on 5 subscales as comprehensively as possible. The following syndromes are measured: Depressive syndrome, anxiety syndrome, obsessive-compulsive syndrome, Somatoform syndrome, eating disorder syndrome as well as additional items that cover various mental syndromes, and an overall score. The study reports findings on the validity and sensitivity to change of the depression subscale (ISR-D). In a clinical sample of N=949 inpatients with depression spectrum disorders the convergent validity was determined by correlation with the Beck Depression Inventory (BDI) 3 and the subscale "depression" of the Symptom-Checklist-90-R (SCL-90-R) 4. The high correlation between the different instruments confirms the validity of the ISR-Depression Scale. The sensitivity to change of the ISR seems higher than that of the BDI and the SCL-90. Because of its economy and the good psychometric properties the ISR is recommended for use in clinical samples.

Ziel der Studie: Da Therapieabbruche als Misserfolge gewertet werden, wurden im naturalistischen Design Haufigkeit, Risikofaktoren und Outcome von Therapieabbruchen untersucht. Methodik: Auf der Basis einer storungsheterogenen Stichprobe (n = 584) wurden Risikofaktoren regressionsanalytisch ermittelt sowie Pra- und Post-Mittelwerte des Patient Health Questionnaire verglichen. Ergebnisse: Der Anteil problematischer Abbruche betrug 24,5 %. Risikofaktoren waren: Patient weiblich, Patient arbeitslos, geringe Erfolgszufriedenheit bei Patient und/oder Therapeut sowie uberdurchschnittlich hohe Beziehungszufriedenheit des Therapeuten. Abbrecher hatten signifikante Symptomreduktionen (ES = 0,30, …, 0,44), waren am Therapieende aber starker belastet als Patienten mit regularem/unproblematischem Therapieende (ES = 0,17, …, 0,37). Schlussfolgerung: Nicht alle Abbruche sind per se therapeutische Misserfolge. Ein Warnsignal fur sich anbahnende Abbruche ist die schlechte Bewertung der Erfolgsaussichten wahrend der laufenden Therapie.

Aims This study aimed to examine the incremental value of growth-differentiation factor-15 (GDF-15) to N-terminal pro brain natriuretic hormone (NT-proBNP) levels for the diagnosis of left ventricular diastolic dysfunction (LVDD) and possible heart failure (HF) in morbidly obese patients. Method and results We analysed data from 207 obese subjects [body mass index (BMI) 41 ± 8 kg/m2] with normal ejection fraction, LVDD, and symptoms and/or signs of HF (referred to as ‘LVDD with possible HF’, n = 88) and with normal left ventricular function (n = 119) before participating in a medical weight loss programme, in addition to the study of healthy lean subjects (n = 51). Median NT-proBNP (interquartile range) for obese subjects with ‘LVDD and possibe HF’ and with normal LV function was 52 (29–96) and 42 (25–66) pg/mL, respectively (P = 0.12). There was no correlation of NT-proBNP with parameters of left ventricular filling pressure, i.e. E/E' (r2 = 0.002, P = 0.63) or E' velocity (r2 = 0.02, P = 0.24). In contrast, GDF-15 was 665 (496–926) with ‘LVDD and possible HF’ and 451 (392– 679) pg/mL without (P < 0.0001). GDF-15 was significantly correlated to E/E', E' velocity, E/A ratio, isovolumetric relaxation time, duration of reversed pulmonary vein atrial systolic flow, and left atrial size. The area under the receiver operating characteristic curve that defines LVDD with possible HF was 0.56 for NT-proBNP and 0.74 for GDF-15 (P < 0.0001). The addition of GDF-15 to a multivariate predicition model increased the net reclassification improvement (NRI) by 9% (P= 0.022). Conclusion In morbidly obese individuals, GDF-15 levels seem to better correlate with diastolic dysfunction than NT-proBNP levels. GDF-15 significantly improves reclassification for the diagnosis of ‘LVDD with possible HF’ and, thus, adds incremental value to NT-proBNP.

Although psychosomatic in-patient treatment is effective, 5-10% of the patients deteriorate. Providing patient progress feedback and clinical support tools to therapists improves the outcome for patients at risk of deterioration in counseling, outpatient psychotherapy, and substance abuse treatment. This study investigated the effects of feedback on psychosomatically treated in-patients at risk of treatment failure.At intake, all patients of two psychosomatic clinics were randomized either into the experimental group or the treatment-as-usual control group. Both groups were tracked weekly with the "Outcome Questionnaire" (OQ-45) measuring patient progress and with the clinical support tool "Assessment of Signal Cases" (ASC). Therapists received feedback from both instruments for all their experimental group patients. "Patients at risk" were defined as patients who deviated from expected recovery curves by at least one standard deviation. Of 252 patients, 43 patients were at risk: 23 belonged to the experimental group, 20 to the control group. The feedback effect was analyzed using a level-2-model for discontinuous change, effect size (d), reliable change index (RCI), and odds ratio for reliable deterioration.For patients at risk, the experimental group showed an improved outcome on the OQ-45 total scale compared to the control group (p0.05, d=0.54). By providing feedback, the rate of reliably deteriorated patients at risk was reduced from 25.0% (control group) to 8.7% (experimental group) - odds ratio=0.29. All reliably improved patients at risk belonged to the experimental group.Feedback improves the outcome of patients at risk undergoing psychosomatic in-patient treatment.