In diesem Panel werden Highlights aus der aktuellen Forschungsaktivität dreier Forschungsgruppen der Klinik für Konsiliarpsychiatrie und Psychosomatik präsentiert. Im ersten Beitrag wird das Studienprotokoll eines RCT zur Untersuchung der Auswirkung von Psychedelika auf den Behandlungserfolg von Patientinnen mit therapieresistenter Anorexie präsentiert. Erwartet wird eine stärkere Symptomminderung bei den mit DMT behandelten Patientinnen im Vergleich zur TAU Gruppe. Im zweiten Beitrag werden die Ergebnisse einer Untersuchung zur Auswirkung von Alter und Geschlecht auf die Lebensqualität nach kardialer Rehabilitation untersucht. Es wird beleuchtet, inwieweit das schlechtere Outcome bei älteren Patient:innen und Frauen zu interpretieren ist. Der dritte Beitrag widmet sich einer Erhebung von möglichem Regret bei Transpersonen, die sich einer geschlechtsangleichenden Transition unterzogen haben. Dieser Aspekt wurde bisher kaum untersucht. Die Validierung eines hierzu entwickelten Fragebogens wird dargestellt und die Ergebnisse der Erhebung kritisch evaluiert. Alle Studien werden von den nachwuchsforschenden Studienleiter:innen selbst vorgestellt und können je nach Auditorium auf deutsch oder englisch dargestellt werden. Presentations can be held in German or English according to the audience.
11:45 Uhr
The efficacy of DMT (N,N-Dimethyltryptamin) for treatment resistent anorexia nervosa in an outpatient group therapy setting
Dr. med. Patrick Pasi | Universitätsspital Zürich
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Autoren:
Dr. med. Patrick Pasi | Universitätsspital Zürich
PD Dr. Sebastian Euler | Universitätsspital Zürich
Dr. Milan Scheidegger | Universität Zürich
Psychedelics are hallucinogenic substances that act primarily on serotonin 2A (5-HT2A) receptors. The various psychedelics differ in their pharmacodynamics and kinetics as well as in their phenomenology, with DMT in particular receiving increased attention in recent years due to its potential for the treatment of psychiatric disorders. Possible impacts of DMT on several neurobiological and behavioral traits of AN include aberrant serotonergic activity, cognitive rigidity and emotional avoidance. Psychedelic experiences have been demonstrated to induce intense emotional states and to improve mindfulness (emotional flexibility) and cognitive flexibility. In this study we want to explore the dose-related safety, tolerability, and efficacy of an innovative DMT-based formulation for anorexia nervosa (AN) in an outpatient group therapy setting compared to treatment as usual. It is assumed that these therapeutic effects will manifest themselves in eating disorder symptomatology. Accordingly, eating disorder score (EDE-Q) is expected to decrease significantly stronger in DMT group therapy compared to treatment as usual group therapy (significant condition*time-interaction) from baseline to post-treatment. This effect is expected to persist until follow-up. According to studies on the use of psychedelics in treatment-resistant depression compared to TAU controls a high effect size of DMT on EDE-Q symptom level can be expected (Cohen’s d = 1.2). Power analysis (α = 0.05, 1-β = 0.8, two-sided) revealed that a sample size of 12 patients per group is needed to provide a significant interaction effect between group and time. Expecting 20% of participants to drop out after informed consent,16 female outpatients (4 groups with 4 patients) with treatment resistant AN will receive three ascending doses of a sublingual DMT-based formulation over a 6-week period delivered in a therapeutic environment and enveloped by psychological preparation and integration (ACT). 16 control female outpatients (4 groups with 4 patients) with treatment resistant AN receive a supportive group therapy as a treatment as usual (Two-arm non-blinded RCT).
12:00 Uhr
Sex and age as predictors of HRQOL change in phase-II cardiac rehabilitation
Dr. med. Lena Jellestad | Universitätsspital Zürich
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Autoren:
Dr. med. Lena Jellestad | Universitätsspital Zürich
Bianca Auschra
Dr Claudia Hackl-Zuccarella
Dr Mary Princip
Prof. Dr. Roland von Känel
PD Dr. Sebastian Euler
Prof. Dr. Matthias Hermann | Universitätsspital Zürich
Background: Cardiovascular diseases (CVD) are the leading cause of mortality and global disease burden in both women and men. Cardiac rehabilitation (CR) is a key component of secondary cardiac prevention and improves not only cardiovascular outcomes, but also health-related quality of life (HRQOL). Poor HRQOL is an independent predictor of worse cardiovascular outcome. Unfortunately, CR is still underutilized, especially among women and elderly patients.
Aim: Aim of this study was to highlight age- and sex-specific effects of inpatient CR on HRQOL. By focusing specifically on the three individual HRQOL domains (social, emotional, physical), we aimed to gain a deeper understanding of relevant changes in each dimension of the patients’ perceived health.
Methods: From 2012 to 2018, 18,459 patients were prospectively assessed in six Swiss CR clinics. A final sample of 8,286 patients was analyzed with a mean (SD) age of 67.8 (11.3) in men and 72.2 (11.3) in women. HRQOL was measured at CR entry and discharge with the disease-specific MacNew Heart HRQOL questionnaire. In multivariable analyses, sex- and age- specific changes in HRQOL throughout CR were estimated, adjusting for baseline HRQOL, exercise capacity and clinical characteristics.
Results: Participants of both sexes improved significantly (p < .001) in all domains of HRQOL during CR. Women reported significantly lower social (p < .001) and emotional (p < .001) HRQOL than men at CR entry. Female sex predicted greater improvement in social (F 19.63, p < .001), emotional (F = 27.814, p < .001) and physical HRQOL (F = 20.473, p < .001). In a subgroup of n= 2’632 elderly patients (>75 years) female sex predicted greater improvements in emotional (F = 15.738, p < .001) and physical (F = 6.295, p = .012), but not in social HRQOL.
Conclusions Our findings provide important new insights into sex- and age-specific changes of HRQoL during CR. Women report poorer emotional and social HRQOL at CR entry compared to men, but in turn particularly benefit from CR. Indeed, female sex predicts greater improvement in all domains of HRQOL throughout CR. Emotional and physical HRQOL proved particularly relevant in the group of elderly female participants. Our results indicate that sex- and age-specific needs of women and elderly patients should be considered for optimal secondary prevention.
12:15 Uhr
Design, Validation and First Swiss Results of a Highly Sensitive Questionnaire to Assess Regret among Transgender Individuals Who Underwent Medical Transition Procedures
Dr. Jan Schulze | Universitätsspital Zürich
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Autoren:
Dr. Jan Schulze | Universitätsspital Zürich
Prof. Dr. Roland von Känel
PD Dr. Sebastian Euler
Background: Regret is a complex and multifaceted experience that can arise in any decision-making process, including those related to medical transition procedures for transgender individuals. It is typically regarded as a negative emotion and actively avoided by individuals. While most trans individuals report high levels of satisfaction with gender-affirming medical interventions, a small subset may experience regret, which can be influenced by various factors. Healthcare providers should ensure that individuals are well-informed about the potential benefits and risks of medical transition, have access to high-quality care, and receive ongoing support and follow-up care to minimize the risk of regret. Regret and detransitioning shouldn't justify more scrutiny of transgender individuals' medical procedures. Critical research can enhance gender-affirming care.
Objective: The objective was to create a scale that could assess (I) the prevalence and (II) degree of regret within a sample of trans individuals, encompassing (III) the threshold beyond which a decision would not be repeated and an (IV) optional open-ended query about the underlying cause of remorse.
Methods:.The University Hospital of Zurich studied 293 German-speaking trans individuals over 18 years old who received medical treatment for gender identity disorders between 2001 and 2021. They were selected using the ICD-10 diagnostic code F64 and completed an online questionnaire after giving informed consent.
Results: In our analysis, we discovered strong values for both the construct and discriminant validity, as well as the test-retest reliability. We found that 15.8% of transgender individuals who underwent gender reassignment surgery reported experiencing regret, indicating the need for continued research and support for the transgender community. Our qualitative analysis shows that the reasons for regret are largely driven by external factors, such as dissatisfaction with the treatment, rather than internal factors.
Discussion: Developing and validating a regret questionnaire is essential to gain a comprehensive understanding of the experiences of transgender individuals who have undergone medical transition procedures. Identifying and addressing regrets is crucial to ensure optimal support and treatment for those affected. Our objective was to enhance medical care for transgender individuals while preserving patient autonomy and access to necessary medical interventions.