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Kolar DR, Kaurin A, Meule A, Schlegl S, Dittmer N, Voderholzer U. Interpersonal, affective and compulsive features of driven exercise in anorexia nervosa. J Affect Disord 2022; 307:53-61. [PMID: 35337926 DOI: 10.1016/j.jad.2022.03.044] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 03/15/2022] [Accepted: 03/17/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND This preregistered (https://osf.io/g9ajb) analysis sought to integrate the current literature on trait compulsivity into maintenance models of driven exercise in anorexia nervosa (AN). We tested whether compulsivity increases the likelihood of driven exercise via interpersonal and affect-regulatory pathways. METHODS We used multilevel structural equation modeling to test the hypothesis that trait compulsivity predicts a stronger within-person link between affect-regulatory difficulties or interpersonal sensitivity and driven exercise in female adolescents and adults with AN. We used data from five assessments across inpatient treatment and 6-months follow-up of 207 adult and adolescent patients with AN (1035 datapoints). RESULTS In line with our hypotheses, patients who generally experienced more affect-regulatory difficulties or stronger interpersonal sensitivity tended to engage in driven exercise more strongly. Moreover, high levels of trait compulsivity amplified the effect of interpersonal sensitivity on driven exercise across time. Contrary to our hypotheses, the link between affect regulation and driven exercise was not moderated by compulsivity. Similar effects on general eating disorder psychopathology were found, but no cross-level moderation effect of compulsivity. LIMITATIONS Due to sample size, potential AN subtype-dependent effects were not analyzed. CONCLUSION Our results suggest that driven exercise coincides with self-reported experiences of interpersonal sensitivity and that this link varies as a function of compulsivity such that the within-person coupling is stronger among those scoring high on compulsivity. To derive clinically useful functional models of driven exercise, future studies might use intensive longitudinal data to investigate its momentary associations with affect and interpersonal sensitivity in the context of compulsive traits.
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Philipsen A, Voderholzer U. [Update on attention deficit hyperactivity disorder]. DER NERVENARZT 2020; 91:573-574. [PMID: 32632901 DOI: 10.1007/s00115-020-00926-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
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Voderholzer U. [Not Available]. MMW Fortschr Med 2019; 161:34. [PMID: 31828639 DOI: 10.1007/s15006-019-1228-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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Voderholzer U, Wündrich M, Zielasek J. Bedeutung der studentischen Lehre für die Attraktivität des Faches Psychiatrie und Psychotherapie: Was müssen wir ändern, damit wir mehr Nachwuchs bekommen? ACTA ACUST UNITED AC 2018. [DOI: 10.1055/s-0038-1671757] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
ZusammenfassungDas Fach Psychiatrie und Psychotherapie wird wie viele andere medizinische Fächer in den kommenden Jahren von einem Nachwuchsmangel bedroht werden. Es müssen daher besondere Anstrengungen unternommen werden, um Studenten frühzeitig für dieses Fach zu begeistern. Hierzu sollte in der Lehre stärker das Thema Entstigmatisierung aufgegriffen werden, und es sollten die neurowissenschaftlichen Erkenntnisse sowie die Fortschritte in der evidenzbasierten Therapie psychischer Erkrankungen stärker herausgestellt werden. Angesichts der zunehmenden soziökonomischen Bedeutung psychischer Erkrankungen sollte die Lehre im Fach Psychiatrie insgesamt ausgeweitet werden, wobei sich am besten drei- bis vierwöchige ganztägige Praktika empfehlen, am besten mit Integration neuer Lehrmethoden wie Simulationspatienten und auch OSCE-Prüfungen. Auch die praktischen Vorteile einer Tätigkeit im Bereich der Psychiatrie und Psychotherapie im Vergleich mit anderen Fächern sollten bereits in der Ausbildung stärker vermittelt werden. Eine Qualitätssicherung durch systematische Lehr-Evaluation ist unerlässlich.
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Kästner D, Löwe B, Weigel A, Osen B, Voderholzer U, Gumz A. Factors influencing the length of hospital stay of patients with anorexia nervosa - results of a prospective multi-center study. BMC Health Serv Res 2018; 18:22. [PMID: 29334934 PMCID: PMC5769422 DOI: 10.1186/s12913-017-2800-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 12/14/2017] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The length of stay (LOS) strongly influences anorexia nervosa (AN) inpatient weight outcomes. Hence, understanding the predictors of LOS is highly relevant. However, the existing evidence is inconsistent and to draw conclusions, additional evidence is required. METHODS We conducted a prospective, multi-center study including adult female inpatients with AN. Using stepwise linear regression, the following demographic and clinical variables were examined as potential predictors for LOS: admission BMI, AN-subtype, age, age of onset, living situation, partnership status, education, previous hospitalization, self-rated depression, anxiety and somatic symptoms (PHQ-9, PHQ-15, GAD-7), self-rated therapy motivation (FEVER) and eating disorder psychopathology (EDI-2 subscale scores). RESULTS The average LOS of the sample (n = 176) was 11.8 weeks (SD = 5.2). Longer LOS was associated with lower admission BMI (ß = -1.66; p < .001), purging AN-subtype (ß = 1.91; p = .013) and higher EDI-2 asceticism (ß = 0.12; p = .030). Furthermore, differences between treatment sites were evident. CONCLUSIONS BMI at admission and AN-subtype are routinely assessed variables, which are robust and clinically meaningful predictors of LOS. Health care policies might consider these variables. In light of the differences between treatment sites future research on geographical variations in mental health care seems recommended.
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Wündrich M, Schwartz C, Feige B, Lemper D, Nissen C, Voderholzer U. Empathy training in medical students - a randomized controlled trial. MEDICAL TEACHER 2017; 39:1096-1098. [PMID: 28749198 DOI: 10.1080/0142159x.2017.1355451] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
AIM Empathy is a core element in the doctor-patient relationship. This study examined whether empathy in medical students can be improved by specific training. METHODS 158 medical students were randomized into two groups. The intervention group participated in an empathy skills training with simulated patients (SPs). The control group participated in a history course. After the intervention, empathy was assessed by blinded SPs and experts in an Objective Structured Clinical Examination (OSCE). Students also filled out a self-assessment concerning their attitude on empathy (Jefferson Scale of Physician Empathy Student Version, JSPE-S-S). RESULTS AND CONCLUSIONS Participants of the intervention group showed significantly higher levels of empathy when rated by SPs and experts than the control group. In contrast to that, no significant group differences were observed in self-rated empathy. The results underpin the value of empathy skills trainings in medical school study programs.
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Maier JG, Piosczyk H, Holz J, Landmann N, Deschler C, Frase L, Kuhn M, Kloeppel S, Spiegelhalder K, Sterr A, Riemann D, Feige B, Voderholzer U, Nissen C. 0213 BRIEF PERIODS OF NREM SLEEP DO NOT PROMOTE EARLY OFFLINE GAINS BUT SUBSEQUENT ON-TASK PERFORMANCE IN MOTOR SKILL LEARNING. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Schwartz C, Hilbert S, Schubert C, Schlegl S, Freyer T, Löwe B, Osen B, Voderholzer U. Change Factors in the Process of Cognitive-Behavioural Therapy for Obsessive-Compulsive Disorder. Clin Psychol Psychother 2016; 24:785-792. [DOI: 10.1002/cpp.2045] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 09/12/2016] [Accepted: 09/12/2016] [Indexed: 11/08/2022]
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Naab S, Hauer M, Voderholzer U, Hautzinger M. [Depressive disorders in juveniles: diagnosis and therapy]. FORTSCHRITTE DER NEUROLOGIE-PSYCHIATRIE 2015; 83:49-61; quiz 62. [PMID: 25602192 DOI: 10.1055/s-0034-1385776] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Voderholzer U. EPA-0659 – Multimodal inpatient treatment for depression: effectiveness and predictors. Eur Psychiatry 2014. [DOI: 10.1016/s0924-9338(14)78027-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Bermejo I, Hölzel L, Voderholzer U, Tebartz van Elst L, Berger M. 1411 – Integrated care of depression in germany - the freiburger modell. Eur Psychiatry 2013. [DOI: 10.1016/s0924-9338(13)76449-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Voderholzer U, Cuntz U, Schlegl S. [Eating disorders: state of the art research and future challenges]. DER NERVENARZT 2012; 83:1458-67. [PMID: 23104604 DOI: 10.1007/s00115-012-3686-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Eating disorders are a common mental disorder during adolescence and young adulthood. While prevalence rates of eating disorders dramatically increased during the second half of the last century, these rates have remained relatively stable over the last 20 years. According to ICD-10 eating disorders are diagnostically categorized as anorexia nervosa, bulimia nervosa and atypical eating disorders or eating disorders not otherwise specified. Concerning the etiology, genetic factors are involved, especially in anorexia nervosa, as well as psychological and sociocultural factors. Evidence-based recommendations are available for the treatment of bulimia nervosa and binge eating disorder and in this context cognitive behavioral therapy is seen as the first choice. In contrast, the state of knowledge concerning the treatment of anorexia nervosa is still limited, especially concerning effective treatments for adults. Recent data only provide evidence for the effectiveness of family therapy for adolescents. Due to the lack of high quality studies, research on therapy for anorexia nervosa is a future challenge.
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Durand D, Landmann N, Piosczyk H, Holz J, Riemann D, Voderholzer U, Nissen C. Auswirkungen von Medienkonsum auf Schlaf bei Kindern und Jugendlichen. SOMNOLOGIE 2012. [DOI: 10.1007/s11818-012-0559-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Greetfeld M, Cuntz U, Voderholzer U. Pharmakotherapie von Anorexia nervosa und Bulimia nervosa: State of the Art. FORTSCHRITTE DER NEUROLOGIE-PSYCHIATRIE 2011; 80:9-16. [DOI: 10.1055/s-0031-1281845] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Dersch R, Zwernemann S, Voderholzer U. Partial Status Epilepticus after Electroconvulsive Therapy and Medical Treatment with Bupropion. PHARMACOPSYCHIATRY 2011; 44:344-6. [DOI: 10.1055/s-0031-1284425] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Voderholzer U, Schlegl S, Külz AK. [Epidemiology and health care situation of obsessive-compulsive disorders]. DER NERVENARZT 2011; 82:273-4, 276, 278, passim. [PMID: 21340638 DOI: 10.1007/s00115-010-2960-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Obsessive-compulsive disorders are with a 12-month prevalence of up to 1% and a lifetime prevalence of 1-2% among the more common mental disorders. This is, however, neither reflected in the health care utilization of patients nor in the daily practice of psychotherapists, where obsessive-compulsive disorders still do not seem to play a major role. Due to feelings of shame, patients often tend to conceal their obsessive-compulsive symptoms. Furthermore, besides deficits in the health care situation for this disorder, treatment practice is not satisfying as well. Current guidelines recommend exposure and response prevention as the psychotherapeutic intervention of choice. Although this treatment has proved to be effective, it is still underutilized in psychotherapeutic routine care.Lack of experience or training on the part of therapists as well as insufficient information about the disorder and treatment possibilities on the part of patients contribute to the existing insufficient and inappropriate health care situation. Further education for therapists as well as more information for patients may help to sensitize them to this disorder and therefore increase the prognosis considerably.
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Külz AK, Voderholzer U. [Psychotherapy for obsessive-compulsive disorder: what is evidence based?]. DER NERVENARZT 2011; 82:308-10, 312, 314-6, passim. [PMID: 21347694 DOI: 10.1007/s00115-010-2962-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Obsessive-compulsive disorder is a severe, very disabling condition that usually takes a chronic course if no adequate treatment is applied. Up to now, cognitive behavioural therapy with exposure and response prevention (CBT) is the most thoroughly investigated and most effective intervention, leading to a clinically significant symptom reduction in 60-70% of the patients. Correctly applied, this treatment can be equally effective as its combination with pharmacological management. For a correct implementation, however, several points have to be considered which are described in the following review. Considering the fact that some of the patients are unable to benefit sufficiently from this approach, potential alternatives and extensions of CBT are discussed. To date, however, no other treatment approach has proven to be effective based on randomised controlled trials.
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Voderholzer U. [Obsessive-compulsive disorder: still the secret disease?]. DER NERVENARZT 2011; 82:271-272. [PMID: 21424417 DOI: 10.1007/s00115-010-2965-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Wahl K, Kordon A, Kuelz KA, Voderholzer U, Hohagen F, Zurowski B. Obsessive-Compulsive Disorder (OCD) is still an unrecognised disorder: a study on the recognition of OCD in psychiatric outpatients. Eur Psychiatry 2011; 25:374-7. [PMID: 20627468 DOI: 10.1016/j.eurpsy.2009.12.003] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2009] [Revised: 12/09/2009] [Accepted: 12/12/2009] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE The study aims to investigate the recognition of patients with Obsessive-Compulsive Disorder (OCD) in psychiatric outpatients. SUBJECTS AND METHODS A total of 2282 outpatients seen at 14 different psychiatric clinics in South Germany were asked to participate in the study. Five hundred and eighty-nine (30%) of the original 2282 patients met screening criteria for OCD, and of those, 237 (42%) participated in the final interview including DSM-IV diagnosis, and comorbidity. RESULTS Sixty-nine of 589 participating patients who screened positively for obsessive symptoms actually had an Obsessive-Compulsive Disorder. Only 19 (28%) of the outpatients diagnosed with OCD according to DSM-IV criteria were also given this diagnosis by their consultant. The psychopathology scores indicated that the OCD patients had clinically relevant OCD with a mean Yale-Brown Obsessive Compulsive Score (Y-BOCS) of 17.5 (± 5.4), and a mean Clinical Global Impression Score (CGI) of 5.2 (± 1.2). CONCLUSIONS In outpatient clinics over 70% of OCD patients remain unrecognised and thus untreated by consultants. Screening questions provide a rapid way of identifying those who may have OCD and should be incorporated into every mental state examination by consultants.
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Voderholzer U, Dersch R, Dickhut HH, Herter A, Freyer T, Berger M. Physical fitness in depressive patients and impact of illness course and disability. J Affect Disord 2011; 128:160-4. [PMID: 20638135 DOI: 10.1016/j.jad.2010.06.028] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2010] [Revised: 06/18/2010] [Accepted: 06/19/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND There is a large and increasing body of evidence that physical exercise, such as endurance training, exerts antidepressant effects in psychiatric disorders. However, compliance rates are rather low due to reduced energy and lack of motivation. Another important reason may be low baseline fitness leading to overstrain when participating in a training program. The aim of the study was to evaluate the physical fitness of depressive patients compared to healthy controls by a standardized assessment. METHODS 51 hospitalized depressive patients were investigated by a standardized physical fitness assessment on a bicycle ergometer including measurement of maximum workload (pmax), heart rate, lactate concentration, workload at first lactate elevation (pLT), individual anaerobic threshold (IAT) and workload at IAT (pIAT). They were compared to 51 healthy controls matched for age, sex and body mass index. RESULTS p(max), p(LT) and p(IAT) were markedly reduced in depressive patients compared to healthy controls (p<0.001). Lactate increase was faster and steeper in depressed patients, albeit differences never reached significant levels. There was a significant negative correlation between the length of disability and poor performance parameters but no significant correlation with other illness variables. LIMITATIONS The study was not prospective and no study protocol was applied. CONCLUSION This study demonstrates a marked reduction of physical fitness in depressive patients which cannot be explained by differences of body mass index or age. When designing therapeutic exercise programs for depressive patients evaluation of baseline training level is recommendable because many patients might overstrain themselves because of strongly reduced baseline fitness.
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Freyer T, Klöppel S, Tüscher O, Kordon A, Zurowski B, Kuelz AK, Speck O, Glauche V, Voderholzer U. Frontostriatal activation in patients with obsessive-compulsive disorder before and after cognitive behavioral therapy. Psychol Med 2011; 41:207-216. [PMID: 20236568 DOI: 10.1017/s0033291710000309] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Cognitive behavioral therapy (CBT) with exposure and response prevention (ERP) is the psychotherapeutic treatment of choice for obsessive-compulsive disorder (OCD). However, little is known about the impact of CBT on frontostriatal dysfunctioning, known to be the neuronal correlate of OCD. METHOD A probabilistic reversal learning (RL) task probing adaptive strategy switching capabilities was used in 10 unmedicated patients with OCD and 10 healthy controls during an event-related functional magnetic resonance imaging (fMRI) experiment. Patients were scanned before and after intensive CBT, controls twice at comparable intervals. RESULTS Strategy change within the RL task involved activity in a broad frontal network in patients and controls. No significant differences between the groups or in group by time interactions were detected in a whole-brain analysis corrected for multiple comparisons. However, a reanalysis with a more lenient threshold revealed decreased responsiveness of the orbitofrontal cortex and right putamen during strategy change before treatment in patients compared with healthy subjects. A group by time effect was found in the caudate nucleus, demonstrating increased activity for patients over the course of time. Patients with greater clinical improvement, reflected by greater reductions in Yale-Brown Obsessive Compulsive Scale (YBOCS) scores, showed more stable activation in the pallidum. CONCLUSIONS Although these findings are preliminary and need to be replicated in larger samples, they indicate a possible influence of psychotherapy on brain activity in core regions that have been shown to be directly involved both in acquisition of behavioral rules and stereotypes and in the pathophysiology of OCD, the caudate nucleus and the pallidum.
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Doerr JP, Spiegelhalder K, Petzold F, Feige B, Hirscher V, Kaufmann R, Riemann D, Voderholzer U. Impact of Escitalopram on Nocturnal Sleep, Day-Time Sleepiness and Performance Compared to Amitriptyline: A Randomized, Double-Blind, Placebo-Controlled Study in Healthy Male Subjects. PHARMACOPSYCHIATRY 2010; 43:166-73. [DOI: 10.1055/s-0030-1249049] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Doerr JP, Hirscher V, Riemann D, Voderholzer U. [Disturbances of slow-wave sleep and psychiatric disorders]. DER NERVENARZT 2010; 81:347-54. [PMID: 20012932 DOI: 10.1007/s00115-009-2897-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Slow-wave sleep is defined as sleep stages 3 and 4 that characteristically show slow delta EEG activity during polysomnography. The percentage of slow-wave sleep normally declines with age. Sleep disorders are a common symptom of many psychiatric disorders. In polysomnographic recordings they mostly manifest as disturbances of sleep continuity. In some disorders changes in REM sleep are also found. A reduction of slow-wave sleep has most often been described in patients with depression and addictive disorders. More recent research implicates slow-wave sleep as an important factor in memory consolidation, especially the contents of declarative memory. Psychotropic drugs influence sleep in different ways. Hypnotic substances can reduce the deep sleep stages (e.g. benzodiazepines), whereas 5-HT2C antagonists increase the percentage of slow-wave sleep. Whether a selective impairment/alteration of slow-wave sleep is clinically relevant has not yet been proved.
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Bermejo I, Voderholzer U, Hölzel L, Berger M. S11-04 - Integrated care of depressive disorders - the freiburg model. Eur Psychiatry 2010. [DOI: 10.1016/s0924-9338(10)70042-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Lee E, Baumann K, Voderholzer U, Zahn A. P02-273 - Religion in psychiatry? The pilot study in Freiburg, Germany: the meaning of religion / spirituality in psychiatry from staff's perspective. Eur Psychiatry 2010. [DOI: 10.1016/s0924-9338(10)70899-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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