Sigmund Freud University Vienna

Introduction Whether intravenous thrombolysis (IVT) provides additional benefit in eligible patients with acute vertebrobasilar occlusion who undergo endovascular treatment (EVT) remains an open question. Patients and methods We conducted a pooled analysis using data from two national stroke registries, the ETIS registry in France and GSR-ET registry in Germany. Patients who underwent EVT for vertebral and/or basilar artery occlusions from January 2015 to December 2023 were included. The primary efficacy outcome was a favorable shift toward better functional outcomes on modified Rankin Scale (mRS) scores at 90 days. Safety outcomes included 90-days mortality and symptomatic haemorrhagic transformation (sICH). Comparisons between IVT + EVT and direct EVT groups were made combining inverse propensity score matching, probability of treatment weighting (IPTW) and regression models. Results Among 2028 patients treated during the study period, 797 (39.2%) received IVT before EVT, while 1231 (60.7%) had EVT alone. After IPTW matching, we compared 211 patients treated with IVT + EVT to 260 direct EVT patients. Patients in the IVT + EVT group had a favorable shift across the 90-day mRS distribution (common aOR 1.43 per 1-point mRS improvement, 95% CI 1.01–2.04; p = 0.046), higher odds of 90-day favorable functional outcome (aOR 1.56, 95% CI 1.00–2.44; p = 0.049) and lower odds of 90-day mortality (aOR 0.62, 95% CI 0.39–0.99; p = 0.045). IVT was not associated with increased risk of sICH (aOR 1.65, 95% CI 0.62–4.35; p = 0.313). Discussion This registry-based study suggests a potential benefit of IVT before EVT in eligible patients with vertebrobasilar occlusions. Conclusion: Randomized clinical trials are necessary to confirm these findings and to validate the benefits of IVT in this clinical context.

Background Basal cell carcinoma (BCC) is the most prevalent malignant tumour among Caucasians, characterised by its low metastatic potential but significant morbidity due to local tissue destruction. The COVID‐19 pandemic, declared by the WHO on 11 March 2020, led to various lockdowns and changes in patient behaviour, including reduced consultations with physicians. Objectives This study aims to assess whether surgeries for BCC decreased in Vienna, Austria, during the pandemic and to evaluate the impact of any treatment delays on tumour and surgery complexity notable so far. Methods We conducted a retrospective single‐centre observational study at Klinik Hietzing, Vienna, reviewing patients who underwent BCC surgery from March to May during the years 2017–2022. Patients were divided into pre‐COVID (2017–2019) and during‐COVID (2020–2022) groups. Data from 727 patients were analysed, including metrics such as the number of surgeries, patient demographics, comorbidities, and the distance from home to hospital. Surgery complexity was assessed using a predefined scale based on six parameters, yielding a score from 0 to 6 points. Statistical analyses, including t‐tests and ANOVA, were performed to compare differences between the groups. Results A significant decrease of 32.5% (n = 141) in BCC surgeries was observed since the pandemic (p < 0.001). The mean age of patients increased slightly from 73.9 years (median 76) pre‐COVID to 75.6 years (median 79) during‐COVID (p = 0.341). The number of comorbidities increased significantly (p = 0.042). However, there was no significant change in surgery complexity (p = 0.317), although a slight shift towards higher complexity was noted. Conclusions The COVID‐19 pandemic led to a notable reduction in BCC surgeries at our centre. Despite the delays, there was no significant increase in surgery complexity notable yet, likely due to the slow‐growing nature of BCC. Nonetheless, the increase in comorbidities and the prolonged reduction in surgical procedures highlight the need for ongoing vigilance to prevent future morbidity increases.

As an early neo-Kantian, Johannes Volkelt (1848–1930) attempts to conciliate epistemology and metaphysics. His philosophy determines the transition from intra-subjective givenness to trans-subjective reality while staying loyal to the egological traditions of Kantianism. Based on his philosophical insights, Volkelt tackles the problems of psychology and develops several original ideas. In general, his philosophical psychology is devoted to the subject matter of consciousness. Unlike other neo-Kantians, Volkelt rejected transcendentalism and turned to empirical introspection as the basis for argumentation. He can therefore be compared to Franz Brentano and Wilhelm Wundt, being connected to the latter in friendship while being his critic in science. A lasting contribution can be found in Volkelt’s deliberations about the psychology of aesthetics. In the discourse about empathy, he advocated the assumption that one's relation to other minds depends on trans-subjective projection.

Background : Maladaptive personality traits are transdiagnostic risk factors associated with functional impairment, lower treatment efficacy, and poor mental health outcomes. These traits, encompassing domains such as Negative Affectivity, Detachment, Antagonism, Disinhibition, Psychoticism, and Anankastia, contribute to difficulties in emotional regulation, interpersonal relationships, and occupational functioning. Despite growing evidence that personality traits can change over time, longitudinal research examining within-person fluctuations in maladaptive traits during psychotherapy remains scarce. This study protocol outlines a longitudinal research project aimed at investigating the dynamic interplay between maladaptive personality domains and treatment outcomes in a clinical sample undergoing Cognitive Behavioral Therapy. By examining both within-person fluctuations and between-person differences over multiple time points, this study seeks to clarify how personality change relates to symptom improvement and psychosocial functioning, addressing a critical gap in the literature. Methods : This preregistered longitudinal study will recruit patients from inTHERAPY, an Italian psychotherapy service specializing in Cognitive Behavioral Therapy. A total of 200 participants will be assessed across five time points (baseline, 3, 6, 9, and 12 months). Personality domains and clinical symptoms will be systematically evaluated throughout treatment to track individual trajectories of change. Data will be analyzed using Random Intercept Cross-Lagged Panel Models to investigate reciprocal relationships between personality domains and clinical outcomes, distinguishing between between-person differences and within-person fluctuations and Linear Growth Curve Models to examine mean-level change in maladaptive personality domains over time. An exploratory analysis will also be conducted to assess whether patients tend to show the greatest change in the personality domains most elevated at baseline. Discussion: Understanding the temporal interplay between maladaptive personality domains and clinical outcomes could provide valuable insights for personalized psychotherapy. Identifying which personality domains change most significantly during Cognitive Behavioral Therapy - and whether such changes predict symptom improvement - may inform the development of more targeted interventions. Furthermore, this study’s findings could enhance clinical decision-making by identifying key personality factors influencing therapy trajectories, ultimately improving treatment planning for individuals with impaired maladaptive personality domains.

Objective: The Clinical Outcomes in Routine Evaluation—Outcome Measure (CORE-OM) is a pantheoretical mental health assessment instrument that has been translated into over 50 languages. Despite its widespread international use in clinical practice and research, the psychometric properties of CORE-OM require further investigation. Method: We explored and tested the factorial validity of the German version of CORE-OM in a large adult clinical outpatient sample (N = 4355) using exploratory and confirmatory factor analysis. Internal consistency and correlations of the four CORE-OM domains (Well-being, Problems, Functioning, and Risk) across gender identities are presented. Results: While no model satisfied all fit criteria in confirmatory analyses, the three-factor structure derived from exploratory factor analysis outperformed the theoretically favored four-domain solution. Internal consistency was overall acceptable with Well-being scoring slightly lower than the other scales. Non-binary respondents had statistically significantly higher average Risk scores then men and women. Conclusion: Our findings support the reliability of CORE-OM and lend limited support to its factorial structure in a large German-speaking sample, and emphasize the importance of considering diverse gender identities in mental health assessment. The analyses further indicate a need for refinement in the scoring of CORE-OM in various cultural contexts.

Introduction The present study aimed to evaluate and to compare the influence of anatomical variables such as sinus width (SW), inner maxillary sinus contour length (IMSCL), and residual ridge height (RRH) on new bone formation (%NBF) for deproteinized porcine (DPBM) and bovine bone mineral (DBBM) used for lateral window sinus augmentation (LWSA) grafting. Material and Methods For LWSA groups grafted either with DPBM ( n = 10) or DBBM ( n = 13) a linear‐ as well as a multivariate‐regression analysis was conducted between measured %NBF and radiographically retrospectively assessed anatomical variables (SW/IMSCL/RRH). Correlations as well as regression coefficients ( R ² ) were calculated, evaluating the influence of anatomical variables on %NBF with differentiation between both xenogenic graft materials used. Results With no differences for patient‐epidemiologic data, for anatomical variables as well as for surgical‐ and patient‐related risk factors, comparison between the two LWSA groups was possible. The linear‐regression analysis provided significant correlations between histomorphometrically evaluated %NBF and SW (DPBM: r = −0.660, p = 0.038; DBBM: r = −0.614, p = 0.026) as well as between %NBF and IMSCL (DPBM: r = −0.737; p = 0.015, DBBM: r = −0.573, p = 0.041), but not for RRH. Between SW/IMSCL/RRH and %NBF, regression‐coefficients‐(R ² ) of 0.435/0.543/0.258 using DPBM and R ² of 0.377/0.328/0.053 using DBBM represented evidently higher influences of anatomical structures when porcine graft material was applied. The multivariate‐regression analysis confirmed the different influence between various xenogenic graft materials on % NBF as well with a pronounced effect for porcine material (DPBM: R ² = 0.591 [59.1%] vs. DBBM: R ² = 0.314 [31.4%]). Conclusion In LWSA, anatomical structures such as SW and IMSCL significantly affect new bone formation, though with varying effects for different xenogenic (porcine vs. bovine) bone mineral graft materials used.

Background Long-term color match is one of the most important characteristics of aesthetic restorative materials as discoloration constitutes a primary reason for otherwise unnecessary replacements. The aim of the present in vitro study was to evaluate the color stability of frequent dental materials (ceramic, composite, orthodontic adhesive) induced by common antiseptic mouthrinses taking into account black tea consumption and mechanical cleaning. Methods Twenty-four disc-shaped specimens (8 × 2 mm) were made of the materials Ceram.x Spectra™ ST HV, Ceram.x Spectra™ flow, Ceramill® Zolid HT+ PS and Unitek™ Transbond™ LR. Each of the following solutions was tested on six pieces per material: Chlorhexamed forte (CHX), octenident® (OCTD), octenimed® (OCTM) and artificial saliva (control). Dental samples underwent a total of 30 discoloration cycles in which they were alternatively placed into artificial saliva, black tea and respective mouthrinse or only in artificial saliva. After every 10 cycles, discs were mechanically cleaned with toothbrush and toothpaste. After 30 cycles, dental specimens were submitted to professional polishing. Color shifts were measured at different time-points using the VITA Easyshade® V spectrophotometer and displayed as total color difference ∆E (mean ± standard error). A post-hoc Tukey test (⍺ = 0.05) was applied to the mean ∆E values after 30 cycles to determine discoloration discrepancies between various mouthrinses as well as the control. Moreover, photos of individual discs were taken at all measurement times to visualize potential color changes by eye. Results All mouthrinses showed major color shifts in the clinically visible range compared to the control on all different dental materials tested. However, CHX caused significantly more discoloration than OCTM and OCTD. Established color changes could be almost completely removed by simple brushing and even further by professional polishing to clinically acceptable levels on all tested materials. Conclusions Prolonged application of antiseptic mouthrinses may cause discoloration on different restorative materials. To maintain aesthetically satisfying conditions, patients should be educated about the importance of daily mechanical tooth brushing and regular professional polishing.

Background: Optimal dosing of antibiotics in critically ill patients treated with the novel multi organ replacement therapy ADVOS (ADVanced Organ Support) based on albumin dialysis is unclear. This study aims to provide real life data on meropenem plasma concentrations after prolonged infusion in patients treated with ADVOS and a critically ill control group with and without continuous veno-venous hemodiafiltration (CVVHDF). Methods: We retrospectively analyzed plasma concentrations of meropenem obtained as part of our standard of care therapeutic drug monitoring in the intensive care unit. Meropenem was administered as a prolonged infusion over 3 hours. We measured peak and trough levels, pre-and post-filter levels of meropenem using high performance liquid chromatography. We calculated the meropenem clearance and compared the measured clearance with predicted clearance based on creatinine, calculated by the MeroEasy tool. Results: In total, 171 measurements across 16 patients were analyzed. Meropenem trough concentrations were highest in the CVVHDF group with a median of 23.5 mg/L, followed by the ADVOS (median 9.3 mg/L) and control group (median 7.6 mg/L). No trough levels were below the lower limit of 2 mg/L in the CVVHDF and ADVOS groups. Meropenem machine clearance by CVVHDF was calculated to be 1.8 (± 0.5) L/h and 3.5 (± 1) L/h for ADVOS. Conclusion: Our results suggest that ADVOS treatment in critically ill patients receiving meropenem in standard dosage does not lead to underdosing. Some trough values were even within potentially toxic levels, especially in the CVVHDF group, highlighting the importance of therapeutic drug monitoring.

Purpose To present a pediatric case of acute retinal pigment epitheliitis (ARPE) and propose a classification based on imaging findings and prognosis. Methods A case report with literature review. Results The case demonstrated hallmark ARPE features alongside an atypical disease course, indicating a broader clinical spectrum. Multimodal imaging plays a crucial role in differentiating ARPE from mimicking retinal disorders. Conclusion ARPE may represent a spectrum of subtypes with varying prognostic implications. A classification based on age, laterality and imaging biomarkers could improve diagnostic accuracy and patient management.

This essay employs the Icarus myth as a metaphor to examine the role of transcendence in addiction. Icarus’ disregard for boundaries, driven by his quest for transcendence, mirrors the behavior of individuals with addictive tendencies. Addiction, a chronic disorder marked by compulsive substance use or behaviors, is characterized by loss of control, tolerance, withdrawal, and life disruptions. Furthermore it is linked to traits such as impulsivity and sensation-seeking. Transcendence, the pursuit of experiences beyond ordinary limits, often manifests in addiction as a distorted attempt to address spiritual or existential voids. While practices like meditation can facilitate healthy transcendence (e.g., by influencing the periaqueductal grey activity), addiction provides only fleeting euphoria, perpetuating dependency. Sigmund Freud’s concept of “oceanic feelings” (discussed in correspondence with Romain Rolland) and Abraham Maslow’s notion of “peak experiences” parallel the addict’s pursuit of unity and self-actualization. However, addiction undermines genuine fulfillment and growth. Spirituality emerges as a pivotal factor in both the development and recovery of addiction, offering reconnection to meaning, purpose, and a higher power. Neuroscientific insights suggest ancient brain regions, such as the Periaqueductal Grey, may underlie the human drive for transcendence. Drawing on Jungian psychology, the essay highlights spirituality’s role in addressing existential crises and guiding recovery, echoing Jung’s “Spiritus contra Spiritum” as a principle for overcoming addiction. In conclusion, the essay advocates for a balanced approach in addiction therapy, harmonizing the innate human desire for transcendence with sustainable personal growth, and avoiding the extremes symbolized by Icarus’ fatal pursuit.

With the continuous emergence of novel SARS-CoV-2 variants, long-lasting and broadly reactive cellular and humoral immunity is critical for durable protection from COVID-19. We investigated SARS-CoV-2-specific T cell immunity in relation to antibodies, infection outcome and disease severity and assessed its durability in a longitudinal cohort over a three-year time course. We identified pre-existing T cells reactive to the seasonal coronavirus (CoV) OC43 that cross-react with the conserved SARS-CoV-2 spike S813-829 peptide. These cross-reactive T cells increased in frequency following SARS-CoV-2 infection or vaccination and correlated with enhanced spike-specific T cell responses and significantly reduced viral loads. Furthermore, our data revealed that CoV-cross-reactive T cells were maintained as part of the long-lasting memory response, contributing to increased T cell frequencies against omicron variants. These findings suggest a functional role of CoV-cross-reactive T cells that extends beyond the initial SARS-CoV-2 exposure, contributing to enhanced immunity against highly mutated SARS-CoV-2 variants.

Background The Clinical Outcomes in Routine Evaluation – Outcome Measures (CORE‐OM) is a pantheoretical diagnostic instrument that has been widely used in mental health research. Nevertheless, the exploration of the factor structure of the CORE‐OM yields diverse results. Aims This study aimed to explore the internal structure of the German CORE‐OM using network analysis and compare several competing factorial structures of the CORE‐OM with traditional confirmatory factor analysis (CFA) to gain a more comprehensive understanding of its structural validity. Method A total sample comprised 4496 (63% female) participants from an outpatient population. In a first step, we used network analysis ( n 1 = 2248) to assess relationships between the items, followed by explorative graph analysis (EGA) to analyse community structure. Finally, we specified five competing models, including the one derived from the EGA, and used CFA in a second sample ( n 2 = 2248) to identify the best‐fitting structure of the instrument. Results The estimated cross‐sectional network demonstrated high correlation stability. The average item predictability was R ² = 0.42. The EGA identified four distinct communities in the German CORE‐OM (General Problems; Interpersonal Problems; Positive Resources; Self Harm Risk). Confirmatory factor analysis showed that the EGA‐derived models had the most parsimonious fit. Conclusions These findings suggest a refined structure for the CORE‐OM, highlighting key item relationships and offering potential improvements for scoring and clinical use.

Zusammenfassung Der Kritische Personalismus ist nicht nur ein philosophisches Gesamtsystem sozialer und persönlicher Auslegung, sondern auch ein Wissenschaftszweig mit besonderer Verantwortung für die pädagogische Psychologie und Entwicklungspsychologie. Hierbei hat Clara Stern eine wichtige Rolle inne: Die Grundlegung einer personalistischen Pädagogik. Diese leiten wir aus ihrer unter Pseudonym veröffentlichten Monografie, Aus einer Kinderstube, Tagebuchblätter einer Mutter, ab. Neben der Analyse von pädagogischen Leitlinien – auf Basis von Clara Sterns Erziehung und Beobachtung – leiten wir auch auf wichtige Grundsätze für die zukünftige Forschung im Kritischen Personalismus hin. Folgende theoretische Überlegungen haben sich dabei für die personalistische Pädagogik herausgestellt: Die Einsicht in das eigene, dynamische Zwecksystem und seine gestaltende Kraft, die Konsolidierung des Zusammenspiels von Richtungs- und Rüstungsdispositionen in Alltags- und Entwicklungsaufgaben, den vitalen Unterbau des Kindes/Jugendlichen stärken, das Erlernen von Aushandlungsstrategien für die Versöhnung von Selbst- und Fremdzwecken (Introzeption) und den kognitiven Anteil von Geborgenheit stärken. Letztendlich werden die Implikationen für den Kritischen Personalismus diskutiert, welche in Revisionsmöglichkeiten münden.

Objectives This randomized clinical trial aimed to evaluate the effect of selective caries removal in deep cavities of posterior teeth associated or not by photobiomodulation (PBM) on postoperative sensitivity, pulp vitality, and dentin neoformation. Materials and methods Twenty seven permanent molars with deep Class I cavities were allocated into three groups (n = 9): selective caries removal (Control), selective caries removal followed by infrared (IR; 810 nm) or red (R; 660 nm) laser irradiation. After the cavities were restored with a two-step self-etch adhesive and composite layers, the participants scored their tooth sensitivity perception on a visual analogue scale, as well as after 1, 3, and 6 months. Two teeth per group were randomly selected for cone beam computed tomography (CBCT) scanning upon restoration and after 6 months to evaluate the thickness, mineralization density, and area of neoformed dentin. The sensitivity scores among groups were statistically analyzed by the Friedman test (p < 0.05) while dentin neoformation aspects were descriptively compared. Results All teeth remained vital, and the sensitivity mean scores were not significantly different among groups (p < 0.05). Most of the CBCT sections revealed dentin neoformation in all groups. The mineralization density of affected dentin and the remaining dentin area increased in all groups, albeit higher values were found in IR and R groups. Conclusion Selective removal of infected dentin followed by mild self-etch adhesive application and composite restoration was effective in maintaining pulp vitality, attenuating postoperative sensitivity, and dentin neoformation after 6 months. PBM therapy improved the mineralization density and area of neoformed dentin. Clinical relevance Selective caries removal in deep cavities is a regenerative, effective, safe, and simplified treatment that can be combined with photobiomodulation therapy to optimize dentin neoformation.

Background and objective Despite evidence supporting the effectiveness of Virtual Reality (VR) for mental disorders, VR adoption in therapy remains low. As VR-technology continues to advance, it is crucial to examine individual and contextual barriers preventing implementation of therapeutic VR. Methods An online survey with closed and open-ended questions regarding knowledge of VR, VR-usage and barriers to VR adoption was conducted among clinical psychologists and psychotherapists in Austria (Mage=51.71 years, 76% women). Results Of 694 participants, only 10 reported using therapeutic VR. Chi-square tests revealed significant differences regarding interest in therapeutic VR based on prior experience, employment status, professional training, and therapeutic cluster. Besides a small age effect, no effects of gender or professional experience were found. Participants interested in VR (interest group, IG) frequently cited barriers and other reasons (see thematic analysis) for not having used VR yet. Those not interested in VR (no interest group, NIG) indicated a lack of relevance, no perceived advantage, or disinterest as reasons for not using VR. Thematic analysis identified four themes shared by both IG and NIG, each encompassing group-specific sub-themes: professional barriers (lack of knowledge, training, time, personal reasons), financial barriers (costs, cost-benefit-ratio), therapeutic barriers (clinical applicability, concerns about “real” therapeutic relationship), and technological barriers (immature technology, cybersickness, no equipment). Conclusions Significant barriers to the adoption of therapeutic VR among clinical psychologists and psychotherapists are gaps in knowledge and training, financial constraints, and lack of motivation, all of which highlight the need for training and financial support to enhance VR implementation.

In this article, I aim to restore the original meaning of William Stern’s concept of worldview and compare it to Jerome Bruner’s cultural psychology, particularly his theory of narrative dynamics. Stern’s early research on worldviews has been largely overlooked by contemporary scholars, despite its valuable implications for understanding both human action in the external world and the process of self-construction. Through this comparison, I demonstrate that Bruner’s narrative psychology has yet to adequately address the issue of agency when speaking about narratives. Specifically, Bruner’s framework would benefit from the inclusion of a conceptual system that accounts for purpose and meaningfulness, as well as mechanisms for identifying when a narrative has become overly ideological or narrow-minded. The implications for Sternian psychology focus on how an individual can engage with multiple communities and cultivate a pluralistic attitude, thereby enriching their personal life philosophy. Finally, I propose a potential pathway for integrating narratives and worldviews, suggesting that interconnected narratives can evolve into higher-order structures, which I hypothesize to be worldviews.

Background and objectives: Whether thrombectomy compared with best medical treatment (BMT) improves outcome in patients with stroke and carotid artery dissection (CAD) is unknown. Methods: This was an international observational study based on prospective nationwide Austrian, German, and Swiss stroke registries. Patients with large vessel occlusion (LVO) due to CAD were compared according to treatment modality (thrombectomy vs BMT including intravenous thrombolysis) and to admission stroke severity NIH Stroke Scale (NIHSS) <6 vs NIHSS ≥6. The primary outcome was the favorable functional outcome (modified Rankin Score 0-2) at 3 months. Results: Of 1,023 patients (mean age 54 years, 72% males), 516 received thrombectomy and 507 received BMT. After robust adjustment, thrombectomy was associated with favorable outcome in patients presenting with NIHSS ≥6 (adjusted risk ratio (aRR) = 1.77, 95% CI 1.44-2.17). In those presenting with NIHSS <6, thrombectomy was associated with unfavorable outcome (aRR 1.68, CI 1.1-2.56) as compared with BMT. Discussion: Thrombectomy improved functional outcome in patients with LVO due to CAD and admission NIHSS ≥6, but not NIHSS <6 points. Classification of evidence: This study provides Class III evidence that for patients with LVO due to CAD and admission NIHSS ≥6 points, thrombectomy compared with BMT significantly increases the probability of favorable outcome.