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Recent research findings have contributed to an improved understanding and treatment of borderline personality disorder. This disorder is characterised by severe functional impairments, a high risk of suicide, a negative effect on the course of depressive disorders, extensive use of treatment, and high costs to society. The course of this disorder is less stable than expected for personality disorders. The causes are not yet clear, but genetic factors and adverse life events seem to interact to lead to the disorder. Neurobiological research suggests that abnormalities in the frontolimbic networks are associated with many of the symptoms. Data for the effectiveness of pharmacotherapy vary and evidence is not yet robust. Specific forms of psychotherapy seem to be beneficial for at least some of the problems frequently reported in patients with borderline personality disorder. At present, there is no evidence to suggest that one specific form of psychotherapy is more effective than another. Further research is needed on the diagnosis, neurobiology, and treatment of borderline personality disorder.

In the context of the COVID-19 pandemic, many individuals have been found to endorse conspiracy beliefs. Socio-demographic variables, personality functioning, anxiety, and loneliness could be risk factors for this endorsement. In a representative sample of the German population (N = 2,503) measures of conspiracy mentality, conspiracy-related beliefs toward COVID-19, personality functioning (OPD-SQS), anxiety (HADS), and loneliness (UCLA) were assessed. Pearson product-moment correlations and multiple linear regression analyses were conducted. Conspiracy mentality and conspiracy-related beliefs toward COVID-19 were strongly correlated. Regression analyses found younger age, male gender, lower education, and lower income to be associated with conspiracy mentality. The subscales relationship model and self-perception of the OPD-SQS were positively related to conspiracy mentality whereas interpersonal contact was negatively associated. Higher levels of anxiety were statistically predictive for conspiracy mentality. Our findings indicate a contribution of personality functioning to the understanding of conspiracy mentality and thus to the advancement of interventions during the pandemic.

To quantify the impact of depression measured by self-reports and depression measured by clinical interview on all-cause mortality in individuals with diabetes and to analyze the strength of both associations, the influence of covariates, and possible differences between studies assessing self-rated depressive symptoms and those using a clinical interview to measure depression as predictors of mortality. PUBMED and PsycINFO were searched up to July 2013 for prospective studies assessing depression, diabetes and mortality. The pooled hazard ratios were calculated using random-effects models. Sixteen studies met the inclusion criteria. After adjustment for demographic variables depression measured by self-reports was associated with an increased all-cause mortality risk (pooled HR = 2.56, 95% CI 1.89-3.47), and the mortality risk remained high after additional adjustment for diabetes complications (HR = 1.76, 95% CI 1.45-2.14,). Six studies reporting adjusted HRs for depression measured by clinical interviews supported the results of the other models (HR = 1.49, 95% CI 1.15-1.93). Both depression measured by self-report and depression measured by clinical interview have an unfavorable impact on mortality in individuals with diabetes. The results, however, are limited by the heterogeneity of the primary studies. It remains unclear whether self-reports or clinical interviews for depression are the more precise predictor.

The electrical energy system has attracted much attention from an increasingly diverse research community. Many theoretical predictions have been made, from scaling laws of fluctuations to propagation velocities of disturbances. However, to validate any theory, empirical data from large-scale power systems are necessary but are rarely shared openly. Here, we analyse an open database of measurements of electric power grid frequencies across 17 locations in 12 synchronous areas on three continents. The power grid frequency is of particular interest, as it indicates the balance of supply and demand and carries information on deterministic, stochastic, and control influences. We perform a broad analysis of the recorded data, compare different synchronous areas and validate a previously conjectured scaling law. Furthermore, we show how fluctuations change from local independent oscillations to a homogeneous bulk behaviour. Overall, the presented open database and analyses constitute a step towards more shared, collaborative energy research. Power grid frequencies mirror the state of the grid. Here, Rydin Gorjão et al. analyse measurements of power grid frequencies across areas and continents and uncover scaling laws of their fluctuations and spatio-temporal dynamics, which could aid the design, operation and control of power systems.

NF2 -related schwannomatosis ( NF2 -SWN) is a rare genetic disorder and is associated with progressive morbidities. This study aimed to investigate the relationship between NF2 -SWN disease severity, health-related Quality of Life (QoL), and mental health aspects of patients. Standardised questionnaires assessing mental health problems (symptoms of depression, anxiety, and somatic burden), psychological factors (resilience, loneliness, and personality functioning), and health-related QoL were administered to 97 patients with NF2 -SWN. The results of these questionnaires were compared with physician-rated disease severity. Questionnaires were completed by 77 patients. Physician-rated disease severity scores were available for 55 patients. NF2 -SWN patients showed a high prevalence of clinically relevant symptoms of depression (30%), anxiety (16%), and somatic burden (32%). Almost all variables showed moderate to high correlations with NF2 -SWN-related QoL. NF2 -SWN-related QoL was associated with physician-reported disease severity ( r  = 0.614). In the stepwise hierarchical linear regression analysis, a significant model with four predictors (disease severity type, depression symptoms, personality functioning, and gender) explained 64% of the variance in NF2 -SWN-related QoL. Our results showed a strong association between NF2 -SWN-related QoL and depression symptoms. Moreover, personality functioning is an important influencing factor, representing a modifiable construct that can be targeted by prevention programs or psychotherapy.

Diabetes is a chronic disease requiring daily self-management to regulate physiological parameters like glycemic control. Despite extensive training being available, most patients with diabetes do not meet their target blood sugar levels. Moreover, diabetes-related emotional distress and psychological burden in the form of depressive and anxiety symptoms are very common. Patients with these challenges represent a high-risk group in terms of increased morbidity, mortality, and health care costs as well as decreased quality of life. Hence, in addition to somatically focused standard care, this patient group requires specific treatment options that also address psychosocial aspects. However, these treatments are often not available in routine care. Psychosomatic outpatient clinics (PsIAs) could address this gap by offering multimodal and integrative treatment. However, the indication for treatment in PsIAs and the referral pathways for patients with diabetes from practices or diabetes clinics to PsIAs remain complicated. Moreover, specific treatment options must be adapted. This study aims to assess the needs for referral pathways to PsIAs from the patient and service provider perspectives and to adapt the already effective psychosomatic intervention psy-PAD for a group setting (psy-PAD ), fitting the multimodal PsIA structures. This pilot study comprises an explorative qualitative design based on a multilevel approach, using 2 work packages: work package 1 assesses the patient perspective (n=40) using focus groups, as well as the service provider perspective with interviews (n=30). Work package 2 comprises an expert workshop with clinicians and patient representatives (n=10) to adapt the psy-PAD manual for the modalities of PsIAs. We will audio-record the patient focus groups and service provider interviews. The audio recordings will be transcribed and analyzed using content analysis within the framework of interpretative text evaluations with MAXQDA. Outcomes will be (1) the needs regarding referral pathways, (2) short questionnaires to economically assess the acceptance and feasibility of the referral pathways in preparation for the minDBe main study, and (3) the adapted psy-PAD intervention for an interdisciplinary multimodal treatment option to be implemented in the structures of PsIAs. The minDBe pilot study will lay the foundation for the minDBe main study, which aims to evaluate the psy-PAD as part of an interdisciplinary multimodal psychotherapeutic treatment program in a randomized controlled trial. DERR1-10.2196/73199.

Background Access to outpatient mental healthcare can be challenging for patients. In Germany, a national structural reform was implemented in 2017 to accelerate and enhance access to outpatient psychotherapy and reduce waiting times. During the first phase of the study ‘Evaluation of a structural reform of the outpatient psychotherapy guideline (ES-RiP)’ and embedded into a process evaluation, the implementation was to be evaluated through assessing general practitioners’ (GPs) and psychotherapists’ (PTs) perspectives regarding utilization of provided new measures, and perceived potential for optimization. Particular focus was on patients with a comorbidity of mental disorders and chronic physical conditions (cMPs). Methods This exploratory cross-sectional qualitative study used on-site and online focus group discussions and semi-structured telephone interviews with GPs and outpatient PTs. Generated data were analyzed using thematic framework analysis. Descriptive statistics were used to analyze participant characteristics collected via a socio-demographic questionnaire. Results Perspectives on the structural reform were heterogenous. GPs and PTs considered the component of timely initial psychotherapeutic assessment consultations beneficial. GPs disapproved of their deficits in detailed information about the structural reform and exchange with outpatient PTs. Improvement suggestions included structured short information exchange and joint quality circles. The overall number of available outpatient PTs in rural areas was perceived as insufficient. For patients with cMPs, GPs saw patient barriers for therapy access and continuity in low intrinsic motivation, physical impediments and older age. PTs also saw patient challenges regarding low intrinsic motivation and keeping scheduled appointments. They considered post-reform administrative efforts to be high and reported that the regulations (conformity) lead to planning difficulties and financial losses. Reform elements were tailored to fit in with PTs key therapy areas. Stronger networking and joint lectures were suggested as remedy for the currently still limited exchange with GPs. Unlike the GPs, PTs emphasized that accepting patients into psychotherapeutic treatment was independent of a possibly present chronic physical disease. Conclusions The findings contribute to understanding the integration of the delivered structural reform into daily care processes and provide an indication about reached targets and potential improvements. Further phases of the ES-RiP study can build on the findings and broaden insights. Trial registration Registration-ID DRKS00020344 (DRKS German Register of Clinical Trials.

Persons with diabetes mellitus have complex healthcare needs. Existing disease management programmes (DMPs) are based on a one-size-fits-all approach. However, individuals might require more individualised care. This study aims to identify groups with different patterns of healthcare utilization among people with diabetes in Germany and factors associated with these different patterns. A cross-sectional survey was conducted among a random sample from a statutory health insurance (SHI) with diabetes (n = 1332) and linked to longitudinal SHI data. Latent class analysis was used to identify subgroups with similar patterns of healthcare utilization and factors associated with different patterns. Four patterns of healthcare utilization were identified among people with diabetes: ‘low users’ (20.8% of the total sample); ‘low users with ophthalmologist visit’ (45.2%); ‘high users’ (26.5%); and ‘high users with mental health care’ (7.5%). The classes differed significantly in age, sex, type, duration and severity of diabetes, DMP membership, diabetes training, health-related quality of life, and prevalence of depression. The ‘high users with mental health care’ class was for example younger, more female, had a lower quality of life and the highest prevalence of depression. This study may provide a first basis for thinking about targeted care in Germany beyond DMPs.

The irritation scale is a widely used and reliable self-report scale for measuring cognitive and emotional strain related to the work environment. It extends existing measures by providing a sensitive assessment for pre-clinical stress at work. Existing normative data are based on convenience samples and are therefore not representative. This study provides new normative data for the irritation scale based on a representative German sample ( N  = 1480). The new normative data indicate that the overall level of irritation in the German workforce is significantly lower compared to previously published data. Convergent and discriminant validity is confirmed by correlations with depression and anxiety (Patient Health Questionnaire-4 for Depression and Anxiety), somatic symptom scales (Bodily Distress Syndrome 25 checklist, Somatic Symptom Scale-8, Giessen Subjective Complaints List-8, comorbidity), psychological functioning (Mini-ICF rating for activity and participation disorders in mental illness), work-related stressors (overcommitment and bullying) and individual resources (self-efficacy). The results confirm the utility of the irritation scale and provide new benchmarks that avoid an underestimation of the levels of irritation in future studies.

Background Neurofibromatosis type 2 (NF2) is a rare genetic disease that causes a wide range of disabilities leading to compromised quality of life (QOL). There is clear need for a validated disease-specific tool to assess quality of life among German-speaking patients with neurofibromatosis type 2 (NF2). The NFTI-QOL questionnaire has produced useful results in English-speaking cohorts. The aim of this study was to produce and validate a German version of the NFTI-QOL (NFTI-QOL-D) and to correlate QOL scores with a depression score (PHQ-9) and clinical disease severity. Methods The original English-language NFTI-QOL was translated into German and then back-translated in order to preserve the questionnaire’s original concepts and intentions. A link to an online survey encompassing the NFTI-QOL-D and the PHQ-9 depression questionnaire was then sent to 97 patients with NF2 by email. The respondents’ scores were compared to clinician-reported disease severity scores. Results 77 patients completed the online survey in full. Internal reliability among NFTI-QOL-D responses was strong (Cronbach’s alpha: 0.74). Both PHQ-9 and clinician disease severity scores correlated with NFTI-QOL-D scores (Pearson’s rho 0.63 and 0.62, respectively). Conclusions The NFTI-QOL-D is a reliable and useful tool to assess patient-reported QOL in German-speaking patients with NF2. The correlation of QOL with both psychological and physical disease parameters underlines the importance of individualized interdisciplinary patient care for NF2 patients, with attention paid to mental well-being as well as to somatic disease manifestations.