Wolfgang Gaebel’s research while affiliated with Heinrich Heine University Düsseldorf and other places

The aim of this study was to compare the availability and use of digital mental health (DMH) across all World Psychiatric Association (WPA) regions (WR) and to guide future regional-tailored initiatives to upscale DMH contingent on introducing international policies, regulations, guidelines, education, and training, the WPA Working Group on Digital Psychiatry developed and disseminated a web-based survey among all 145 WPA National Psychiatric Association (NPA) members, according to official WR including (1) The Americas (WR1), (2) Europe (WR2), (3) Africa, Middle East, Central/Western Asia (WR3), and (4) Asia/Australasia (WR4). Collected data were analyzed using the Qualtrics analytic dashboard. The availability of digital tools/programs in DMH largely varies among WPA regions. In Europe and Asia/Australasia, mobile apps were the most available digital tools (respectively, 76.9% and 90.9%), followed by telemental health (respectively, 65.4% and 81.8%). Wearables, serious games, virtual/augmented reality, and chatbots represented the least commonly used tools/programs across all WR. National policies were mainly reported by Asia/Australasia (81.8%), followed by Europe (38.5%) and the Americas (27.3%). In all WR, less than 40% of NPAs reported the provision of education and training in the use of digital tools and programs in their countries. WPA regional analysis of digital needs promotes designing a roadmap to develop targeted actions to implement DMH and guide global digital upscaling of psychiatric services. Improving digital literacy and digital capacity building of the psychiatric workforce are key priorities for future digital initiatives led by the WPA across all WR.

Background and Hypothesis Abnormal psychomotor behavior is a core schizophrenia symptom. However, assessment of motor abnormalities with expert rating scales is challenging. The Positive and Negative Syndrome Scale (PANSS) includes 3 items broadly related to hypokinetic motor behavior. Here, we tested whether a sum score of the PANSS items mannerisms and posturing (G5), motor retardation (G7), and disturbance of volition (G13) corresponds to expert ratings, potentially qualifying as a proxy-marker of motor abnormalities. Study Design Combining baseline datasets (n = 196) of 2 clinical trials (OCoPS-P, BrAGG-SoS), we correlated PANSS motor score (PANSSmot) and 5 motor rating scales. In addition, we tested whether the cutoff set at ≥3 on each PANSS motor item, ie, “mild” on G05, G07, and G13 (in total ≥9 on PANSSmot) would differentiate the patients into groups with high vs low scores in motor scales. We further sought for replication in an independent trial (RESIS, n = 102), tested the longitudinal stability using week 3 data of OCoPS-P (n = 75), and evaluated the validity of PANSSmot with instrumental measures of physical activity (n = 113). Study Results PANSSmot correlated with all motor scales (Spearman-Rho-range 0.19–0.52, all P ≤ .007). Furthermore, the cutoff set at ≥3 on each PANSS motor item was able to distinguish patients with high vs low motor scores in all motor scales except using Abnormal Involuntary Movement Scale (Mann-Whitney-U-Tests: all U ≥ 580, P ≤ .017). Conclusions Our findings suggest that PANSSmot could be a proxy measure for hypokinetic motor abnormalities. This might help to combine large datasets from clinical trials to explore whether some interventions may hold promise to alleviate hypokinetic motor abnormalities in psychosis.

Background Clinical practice guidelines are crucial for enhancing healthcare quality and patient outcomes. Yet, their implementation remains inconsistent across various professions and disciplines. Previous findings on the implementation of the German guideline for schizophrenia (2019) revealed low adherence rates among healthcare professionals. Barriers to guideline adherence are multifaceted, influenced by individual, contextual, and guideline-related factors. This study aims to investigate the effectiveness of a digital guideline version compared to print/PDF formats in enhancing guideline adherence. Methods A multicenter, cluster-randomized controlled trial was conducted in South Bavaria, Germany, involving psychologists and physicians. Participants were divided into two groups: implementation of the guideline using a digital online version via the MAGICapp platform and the other using the traditional print/PDF version. The study included a baseline assessment and a post-intervention assessment following a 6-month intervention phase. The primary outcome was guideline knowledge, which was assessed using a guideline knowledge questionnaire. Results The study included 217 participants at baseline and 120 at post-intervention. Both groups showed significant improvements in guideline knowledge; however, no notable difference was found between both study groups regarding guideline knowledge at either time points. At baseline, 43.6% in the control group (CG) and 52.5% of the interventional group (IG) met the criterion. There was no significant difference in the primary outcome between the two groups at either time point (T0: Chi²(1) = 1.65, p = 0.199, T1: Chi²(1) = 0.34, p = 0.561). At post-intervention, both groups improved, with 58.2% in the CG and 63.5% in the IG meeting this criterion. Conclusions While the study did not include a control group without any implementation strategy, the overall improvement in guideline knowledge following an implementation strategy, independent of the format, was confirmed. The digital guideline version, while not superior in enhancing knowledge, showed potential benefits in shared decision-making skills. However, familiarity with traditional formats and various barriers to digital application may have influenced these results. The study highlights the importance of tailored implementation strategies, especially for younger healthcare providers. Trial registration https://drks.de/search/de/trial/DRKS00028895

Although COVID-19 vaccines have demonstrated efficacy, there is variability in health professionals’ attitudes towards these agents. Factors associated with mental health professionals’ attitudes towards COVID-19 vaccination are not well understood. We investigated these factors by administering a newly developed measure, the COVID-19 Vaccine Attitudes Questionnaire (C-VAQ), to members of the World Health Organization’s Global Clinical Practice Network (GCPN) of mental health professionals. 1,931 GCPN members representing all world regions participated between July 28 and September 7, 2021. Mental health professionals’ attitudes towards COVID-19 vaccination were assessed in one of five languages (Chinese, English, French, Japanese, Russian, or Spanish) using the C-VAQ. Internal consistency, factor structure, and predictive validity of the C-VAQ were examined, and a multiple-linear regression model was employed to assess C-VAQ score predictors, including sociodemographic variables (age, gender, WHO region, country income level, profession, and years of professional experience) as well as country mortality rate and the stringency of each country’s response to COVID-19. The C-VAQ demonstrated good internal consistency and external validity. Items loaded on to a single factor. Having received a COVID-19 vaccine, higher country mortality rate, and higher stringency index was significantly associated with more positive vaccine attitudes. Lower age, residing in a low-and-middle income country, and living in Asia were all was significantly associated with less positive vaccine attitudes. The C-VAQ scores were negatively correlated with the number of concerns about the COVID-19 vaccination. The C-VAQ was useful in demonstrating the extent to which additional work is needed to improve mental health professionals’ attitudes towards COVID-19 vaccines globally. Relatively poorer attitudes toward vaccination among some mental health clinicians around the world suggests the need for broad, multi-pronged interventions.

Zusammenfassung Psychosen aus dem schizophrenen Formenkreis gehen mit deutlichen kognitiven Beeinträchtigungen einher, die nach klinischer Symptomremission oft noch in relevantem Ausmaß persistieren und negative Auswirkungen auf die psychosoziale Funktionsfähigkeit haben. Diese Beeinträchtigungen werden von Betroffenen oft als sehr belastend erlebt. Unter dem Oberbegriff der Kognitiven Remediationstherapie (CRT) stehen hierzu zunehmend evidenzbasierte Therapieoptionen zur Verfügung, die sowohl die jeweiligen kognitiven Zielfunktionen als auch das psychosoziale Funktionsniveau verbessern. Nach Expertenempfehlungen sollten dabei mindestens 20 Sitzungen durchgeführt werden, die von qualifiziertem therapeutischem Personal begleitet werden. Die aktuelle Auflage der S3 Behandlungsleitlinie Schizophrenie der Deutschen Gesellschaft für Psychiatrie und Psychotherapie, Psychosomatik und Nervenheilkunde (DGPPN) empfiehlt CRT mit dem höchsten Empfehlungsgrad. Unklar ist in diesem Zusammenhang, wie stark CRT in die stationäre Routineversorgung Einzug genommen hat. Zu dieser Frage wurden 395 psychiatrische Universitäts- und nichtuniversitäre psychiatrische Fachkliniken in Deutschland zwischen Juli 2021 und Mai 2022 angeschrieben und gebeten, einen 14 Items umfassenden Fragebogen zu beantworten. Insgesamt nahmen 26,1% (n=103) der Einrichtungen an der Befragung teil. Hiervon nutzen 56,3% der Kliniken mindestens ein evidenzbasiertes CRT-Verfahren. Bei den eingesetzten CRT-Verfahren wurden Cogpack, Rehacom und das Integrierte Psychologische Therapieprogramm (IPT) am häufigsten genannt. In 87,5% der teilnehmenden Einrichtungen erhalten weniger als die Hälfte der an Schizophrenie erkrankten Menschen eine CRT. Bezogen auf die Kliniken, die ein evidenzbasiertes CRT-Verfahren einsetzen, werden bei 64,3% dabei weniger als 11 Therapieeinheiten durchgeführt, bei 28,6% zwischen 11 und 20 Einheiten und bei 7,2% mehr als 20 Einheiten. Die geringe Rückantwortquote von 26,1% und mögliche Selektionseffekte für die Teilnahme an der Studie sind als Limitationen zu bewerten und wurden kritisch diskutiert. Dennoch legen die Ergebnisse der Befragung nahe, dass CRT zumindest in den teilnehmenden psychiatrischen Kliniken in Deutschland bislang noch nicht flächendeckend, noch nicht bei allen an Schizophrenie erkrankten Menschen und noch nicht in ausreichender Intensität angeboten wird. Zudem zeigt sich seitens der Kliniken der Wunsch nach mehr technischen und personellen Ressourcen und einer umfangreicheren Kompetenzentwicklung zur CRT-Anwendung.

Background: The evidence for repetitive transcranial magnetic stimulation (rTMS) to treat negative symptoms in schizophrenia (SCZ) is increasing, although variable response rates remain a challenge. Subject´s sex critically influences rTMS´ treatment outcomes. Females with major depressive disorder are more likely to respond to rTMS, while SCZ data is scarce. Methods: Using data from the 'rTMS for the Treatment of Negative Symptoms in Schizophrenia' (RESIS) trial we assessed the impact of sex on rTMS´ clinical response rate from screening up to 105 days after intervention among SCZ patients. The impact of resting motor threshold (RMT) on response rates was also assessed. Results: 157 patients received either active or sham rTMS treatment. No significant group differences were observed. Linear mixed model showed no effects on response rates (all p > 0.519). Apart from a significant sex*time interaction for the positive subscale of the positive and negative syndrome scale (PANSS) scores (p = 0.032), no other significant effects of sex on continuous PANSS scores were observed. RMT had no effect on response rate. Conclusion: In the largest rTMS trial on the treatment of SCZ negative symptoms we did not observe any significant effect of sex on treatment outcomes. Better assessments of sex-related differences could improve treatment individualisation.

Schizophrenia is a disabling and complex mental disorder that has a negative impact on the real-life functioning of people suffering from this disease, with a consequent huge burden on patients, on their families, and on the healthcare system. Despite the available interventions, only about 15% of subjects with schizophrenia meet the criteria for recovery. This might be due to the fact that available treatments do not satisfactorily target aspects that greatly influence schizophrenia functional outcome, such as negative symptoms and cognitive impairment. Despite the broad consensus on the definition of different negative symptom and cognitive function domains, these aspects are not always assessed in line with current conceptualization, and they are still poorly recognized and often neglected by physicians, family members/caregivers, and the patient himself/herself as they cause much less concern than other clinical features. In this chapter we focus on negative symptoms and cognitive impairment as the two most neglected schizophrenia dimensions in terms of assessment and treatment; we also provide an update of preclinical and clinical research and its relevance to clinical and research practice, and suggest future directions in the field.

A comprehensive handbook covering current, controversial, and debated topics in psychiatric practice, aligned to the EPA Scientific Sections. All chapters been written by international experts active within their respective fields and they follow a structured template, covering updates relevant to clinical practice and research, current challenges, and future perspectives. This essential book features a wide range of topics in psychiatric research from child and adolescent psychiatry, epidemiology and social psychiatry to forensic psychiatry and neurodevelopmental disorders. It provides a unique global overview on different themes, from the recent dissemination in ordinary clinical practice of the ICD-11 to the innovations in addiction and consultation-liaison psychiatry. In addition, the book offers a multidisciplinary perspective on emerging hot topics including emergency psychiatry, ADHD in adulthood, and innovation in telemental health. An invaluable source of evidence-based information for trainees in psychiatry, psychiatrists, and mental health professionals.

The digitalisation of mental health care is expected to improve the accessibility and quality of specialised treatment services and introduce innovative methods to study, assess, and monitor mental health disorders. In this narrative review and practical recommendation of the European Psychiatric Association (EPA), we aim to help healthcare providers and policymakers to navigate this rapidly evolving field. We provide an overview of the current scientific and implementation status across two major domains of digitalisation: i) digital mental health interventions and ii) digital phenotyping , discuss the potential of each domain to improve the accessibility and outcomes of mental health services, and highlight current challenges faced by researchers, clinicians, and service users. Furthermore, we make several recommendations meant to foster the widespread adoption of evidence-based digital solutions for mental health care in the member states of the EPA. To realise the vision of a digitalised, patient-centred, and data-driven mental health ecosystem, a number of implementation challenges must be considered and addressed, spanning from human, technical, ethical–legal, and economic barriers. The list of priority areas and action points our expert panel has identified could serve as a playbook for this process.