Publications by authors named "Andreas Hillert"

12 Publications

  • Page 1 of 1

Psychological consequences and differential impact of the COVID-19 pandemic in patients with mental disorders.

Psychiatry Res 2021 08 6;302:114045. Epub 2021 Jun 6.

Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany; Schoen Clinic Roseneck, Prien am Chiemsee, Germany; Department of Psychiatry and Psychotherapy, University Hospital of Freiburg, Freiburg, Germany.

Objective: People with mental disorders might be differentially affected by the COVID-19 pandemic. The aim of the current study was to evaluate the impact of the pandemic on patients with various psychiatric disorders who were admitted to inpatient treatment.

Methods: Five-hundred thirty-eight inpatients with mental disorders participated in a survey about psychological consequences of the pandemic between March-December 2020. We examined the perceived burden by restrictions and worries, changes in health care utilization, and helpfulness of coping strategies.

Results: More than 50% reported any worsening of symptoms, 40% stated increased need of therapeutic support. High rates of symptom deterioration were observed for depressive symptoms (>55%), anxiety (>40%), and sleeping behavior (>40%). Treatment impairment was stated by 27.9%. Patients with anxiety disorders were less affected by contact restrictions compared with eating disorders and depression. Patients with anorexia nervosa and post-traumatic stress disorder experienced higher helpfulness by daily structuring than patients with depression.

Discussion: About half of our sample of psychiatric patients experienced symptom deterioration due to the pandemic and about one quarter reported impairment of treatment modalities. Especially patients with eating disorders and depressive disorders were more frequently affected. The results indicate a needed improvement of treatment options during a pandemic.
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http://dx.doi.org/10.1016/j.psychres.2021.114045DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8180351PMC
August 2021

The Burnout Phenomenon: A Résumé After More Than 15,000 Scientific Publications.

Front Psychiatry 2020 9;11:519237. Epub 2020 Dec 9.

Schön Klinik Roseneck, Prien am Chiemsee, Germany.

The "burnout" phenomenon, supposedly caused by work related stress, is a challenge for academic psychiatry both conceptually and professionally. Since the first description of burnout in 1974 until today, more than 140 definitions have been suggested. Burnout-symptomatology's main characteristic, the experience of exhaustion, is unspecific. Different development-models of burnout were proposed, assumed to depict a quasi-natural process. These could not be confirmed empirically. An expert consensus on the diagnostic criteria and the conceptual location, whether as an independent disorder or as a risk, could not be agreed on. Nevertheless, the phenomenon of burnout in the ICD-11 is considered to be categorized as a work-related disorder. Psychiatric research on the burnout-phenomenon ignores problems of definition resulting from different perspectives: It may meet societal expectations, but does not fulfill scientific criteria, and therefore is not suitable to establish an objective diagnosis and treatment. Parallel detection of ICD/DSM diagnoses from an expert perspective and subjective perturbation models are considered appropriate.
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http://dx.doi.org/10.3389/fpsyt.2020.519237DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7793987PMC
December 2020

Fear of negative and positive evaluation and reactivity to social-evaluative videos in social anxiety disorder.

Behav Res Ther 2019 05 14;116:140-148. Epub 2019 Mar 14.

Paris-Lodron-University of Salzburg, Department of Psychology, Centre for Cognitive Neuroscience, Salzburg, Austria. Electronic address:

Social anxiety disorder (SAD) is marked by persistent fear of being scrutinized by others. This and most diagnostic symptoms relate to some form of fear of negative evaluation (FNE). More recent accounts of SAD, such as the Bivalent Fear of Evaluation Model, however, complement FNE with fear of positive evaluation (FPE), described as distress and avoidance of positive feedback. An explicit test of the incremental validity of FPE in discriminating SAD patients from controls - over and on top of the explanatory power of FPE - is currently missing and generally, well controlled laboratory experiments with positive and negative social stimuli in this patient group are rare. To fill this gap, we exposed 35 patients with SAD and healthy controls (HCs) to short social-evaluative video clips with actors expressing negative and positive as well as neutral statements while recording reactivity on experiential measures (valence, arousal, and approval ratings) as well as on facial electromyography and electrocardiography. In addition, participants completed questionnaire measures of FNE and FPE. Results revealed that FPE questionnaire scores as well as experiential (valence and appreciation) and electromyographical reactivity measures to positive videos improved prediction of group membership beyond the predictive power of FNE questionnaires scores and reactivity to negative videos. Results document the importance of FPE to more fully characterize and understand social anxiety and SAD. Implications include amendments to future diagnostic criteria, theoretical models, and treatment approaches for SAD.
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http://dx.doi.org/10.1016/j.brat.2019.03.009DOI Listing
May 2019

[Burnout in Intensive Care].

Dtsch Med Wochenschr 2018 01 9;143(1):21-26. Epub 2018 Jan 9.

Both acute crises and chronically incriminating circumstances in people's lives may lead to their being afflicted by psychological and somatic ailments. "Burnout" has been coined and established as the term for chronic occupational strain. Many professions claim to be extraordinarily affected by burnout, amongst others physicians and nurses, especially those working in anaesthesiology and critical care. Usually assessed with the Maslach Burnout Inventary, the prevalence of moderate or severe burnout in these areas is estimated at about 30 % amongst nurses and about 40 % to 50 % amongst physicians. Both individual characteristics of those afflicted and occupational factors - as well as their interactions - are made responsible for causing burnout. The complexity of potentially stressful impingements, though, particularly within anaesthesiology and critical care, cannot be covered by the traditional burnout-paradigm. The plethora of recommendations found in popular science may be helpful in individual cases. However, there are no evidence-based preventive or therapeutic measures yet, that would endurably mitigate the sequelae of chronic occupational strain. On the one hand, occupationally burdensome factors needed to be registered more elaborately, for instance using the "Stress-Monitor" instrument. On the other hand, an in-hospital "peer-support system" has been developed and implemented in a Munich hospital recently. Anaesthetists and intensive care physicians have formed a network that supports health care workers surmounting acute occupational strain and thus helps to prevent its chronification. Ultimately, the goal of health care workers needed to consist of establishing individual work-related strategies to adequately cope with the manifold occupational stressors in a lifelong learning process.
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http://dx.doi.org/10.1055/s-0043-109258DOI Listing
January 2018

Don't Praise Me, Don't Chase Me: Emotional Reactivity to Positive and Negative Social-Evaluative Videos in Patients With Borderline Personality Disorder.

J Pers Disord 2017 02 4;31(1):75-89. Epub 2016 Feb 4.

Centre for Cognitive Neuroscience, University of Salzburg, and Department of Psychology, University of Salzburg.

Diagnostic criteria for borderline personality disorder (BPD) include interpersonal problems and high reactivity to negative social interactions. However, experimental studies on these symptoms are scarce, and it remains unclear whether reactivity is also altered in response to positive social interactions. To simulate such situations, the present study used videographic stimuli (E.Vids; Blechert, Schwitalla, & Wilhelm, 2013) in which actors express rejecting, neutral, or appreciating sentences. Twenty BPD patients and 20 healthy controls rated their emotional responses to these on pleasantness, arousal, and 11 specific emotions. In addition to elevated reactivity to negative E.Vids, patients with BPD showed marked reduction in pleasantness responses to positive E.Vids. Furthermore, they exhibited less pride, happiness, feelings of approval, and attraction/love in response to positive videos and more anger, anxiety, embarrassment, contempt, guilt, feelings of disapproval/rejection, and sadness to negative videos. Interestingly, BPD patients also reported negative emotions in response to positive videos. Implications for psychotherapy and research are discussed.
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http://dx.doi.org/10.1521/pedi_2016_30_238DOI Listing
February 2017

[Burnout as a disease category].

Psychiatr Prax 2011 Oct 27;38(7):320-2. Epub 2011 Sep 27.

Guiollettstraße 27 60325 Frankfurt am Main.

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http://dx.doi.org/10.1055/s-0031-1276895DOI Listing
October 2011

What can balance the effort? Associations between effort-reward imbalance, overcommitment, and affective disorders in German teachers.

Int J Occup Environ Health 2009 Oct-Dec;15(4):374-84

Department of Medical Psychology, Faculty of Human Medicine at Philipps University Marburg, Karl von Frisch Strasse 4, 35032 Marburg/Lahn, Germany.

Affective disorders in schoolteachers are a frequent reason for absenteeism and early retirement. The objective of this study was to clarify the relationship between effort-reward imbalance at work, overcommitment, and affective disorders. In addition, we examined the differential impact of different types of reward (salary, job security/promotion, and esteem). In a matched case-control study of 244 teachers, 122 teachers in inpatient treatment for affective disorders were compared to 122 healthy controls. Logistic regression analyses revealed strong associations between effort-reward imbalance and affective disorders. Overcommitment was not an independent risk factor for depression. The lack of esteem by supervisors or colleagues was a more important risk factor for depression than low salary or job security. Results suggest that perceived esteem is essential in understanding the nature of stress. Interventions for preventing depression in the workplace should address supervisors' and colleagues' skills in adequately appreciating their supervisees and co-workers.
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http://dx.doi.org/10.1179/oeh.2009.15.4.374DOI Listing
December 2009

Subjective complaints in persons under chronic low-dose exposure to lower polychlorinated biphenyls (PCBs).

Int J Hyg Environ Health 2008 Oct 18;211(5-6):648-57. Epub 2008 Apr 18.

Institute and Outpatient Clinic of Occupational, Social and Environmental Medicine, Friedrich-Alexander-Universität Erlangen-Nuremberg, Schillerstrasse 25 & 29, 91054 Erlangen, Germany.

Polychlorinated biphenyls (PCBs) have been in widespread industrial use in the 1960s and 1970s. Despite a worldwide reduction, environmental exposure remains an issue especially in contaminated buildings. Due to the ubiquitous presence and poor degradation of PCBs, public health concerns continue to exist; however, evidence on the actual health effects of chronic low-dose exposure is scanty. The objective of the present study is an assessment of subjective complaints of exposed subjects in comparison to a non-exposed control group and their inter-relation to plasma levels of PCB congeners. The plasma concentrations of PCB congeners were measured in 583 subjects who had worked for an average of 14.7+/-9.6 years in a contaminated building in Germany, and 205 control subjects working in a non-contaminated building. Subjective complaints were assessed with the 24-item 'Giessen Subjective Complaints List' (GSCL-24). The subjects under chronic low-dose exposure scored significantly higher values on all the GSCL subscales except 'stomach complaints' in comparison to the non-exposed subjects and a 'normal' sample derived from the literature. However, thorough statistical analysis revealed no correlation of symptoms and PCB congener plasma concentration; the scores on the subscale 'exhaustion were even higher in subjects with low PCB concentration. Subjects working in a PCB-contaminated building report more subjective complaints in comparison to non-exposed subjects, but the complaints are not related to current PCB plasma concentrations.
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http://dx.doi.org/10.1016/j.ijheh.2008.02.001DOI Listing
October 2008

Psychopharmacological treatment of dermatological patients--when simply talking does not help.

J Dtsch Dermatol Ges 2007 Dec 17;5(12):1101-6. Epub 2007 Sep 17.

Clinic for Dermatology and Phlebology, Vivantes Clinic, Berlin Friedrichshain, Academic Teaching Hospital Charité - Universitätsmedizin Berlin, Berlin, Germany.

In dermatology, primary emotional disorders with cutaneous manifestations, secondary emotional disorders caused by dermatoses and multifactorial diseases are possible indications for the use of psychopharmaceuticals. Neuroleptics (anti-psychotics) are usually used in psychiatric illnesses, while antidepressants are foremost in treating depression as well as obsessive-compulsive, anxiety and panic disorders. Minor tranquilizers may be used symptomatically. To define the indications for mid- and long-term treatment with psychopharmaceuticals, the unequivocal diagnosis of the main and secondary psychiatric symptoms as well as the primary target symptoms must be designated. At the start of therapy planning, any possible desired and undesired side effects must be taken into account, such as stimulation, sedation, anticholinergic side effects or weight gain. The main antidepressants are the well-tolerated selective serotonin reuptake inhibitors (SSRI) such as sertraline, fluoxetine or citalopram. A clear long-term plan and how to monitor it must be discussed with patient carefully because of the need for individual dose titration and the late onset of action of many of these medications. Good results can be achieved in dermatologic patients requiring psychopharmaceuticals if the indications are carefully assessed and the therapy logically structured.
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http://dx.doi.org/10.1111/j.1610-0387.2007.06398.xDOI Listing
December 2007

Identifying the concepts contained in outcome measures of clinical trials on depressive disorders using the International Classification of Functioning, Disability and Health as a reference.

J Rehabil Med 2004 Jul(44 Suppl):49-55

Spa Medicine Research Institute, Bad Elster, Germany.

Objectives: First, to systematically identify the concepts contained in outcome measures of trials on depressive disorders using the International Classification of Functioning, Disability and Health (ICF) as a reference. Secondly, to explore differences in the use of ICF categories across different intervention types. Thirdly, to examine which and how often health status measures have been applied in trials on depressive disorders.

Methods: Randomized controlled trials between 1991 and 2000 were located in MEDLINE and selected according to predefined criteria. The outcome measures were extracted and the concepts contained in the outcome measures were linked to the ICF.

Results: A random sample of 203 (50%) of 406 eligible studies were included. The 5 most used ICF categories (range 88-94%) were sleep functions (b134), emotional functions (b152), energy and drive functions (b130), thought functions (b160) and higher-level cognitive functions (b164), all belonging to the body functions component. The use of ICF categories did not vary across different intervention types. A total of 126 different health status measures were extracted. The Hamilton Rating Scale for Depression was the most used health status measure applied in 80% of the studies.

Conclusion: Concepts about execution of tasks/actions, participation in life situations, and the influence of the environment were under-represented in the outcome assessment of trials on depressive disorders. These observations indicate that most trials were limited in their ability to assess more global individual outcomes.
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http://dx.doi.org/10.1080/16501960410015380DOI Listing
July 2004
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