Zugl.: Kassel, Universiẗat, Diss., 2006.

Epidemiological data on a wide range of mental disorders from community studies conducted in European countries are presented to determine the availability and consistency of prevalence, disability and treatment findings for the EU. Using a stepwise multimethod approach, 27 eligible studies with quite variable designs and methods including over 150,000 subjects from 16 European countries were identified. Prevalence: On the basis of meta-analytic techniques as well as on reanalyses of selected data sets, it is estimated that about 27% (equals 82.7 million; 95% CI: 78.5–87.1) of the adult EU population, 18–65 of age, is or has been affected by at least one mental disorder in the past 12 months. Taking into account the considerable degree of comorbidity (about one third had more than one disorder), the most frequent disorders are anxiety disorders, depressive, somatoform and substance dependence disorders. When taking into account design, sampling and other methodological differences between studies, little evidence seems to exist for considerable cultural or country variation. Disability and treatment: despite very divergent and fairly crude assessment strategies, the available data consistently demonstrate (a) an association of all mental disorders with a considerable disability burden in terms of number of work days lost (WLD) and (b) generally low utilization and treatment rates. Only 26% of all cases had any consultation with professional health care services, a finding suggesting a considerable degree of unmet need. The paper highlights considerable future research needs for coordinated EU studies across all disorders and age groups. As prevalence estimates could not simply be equated with defined treatment needs, such studies should determine the degree of met and unmet needs for services by taking into account severity, disability and comorbidity. These needs are most pronounced for the new EU member states as well as more generally for adolescent and older populations.

Universiẗat, Diss.--Freiburg (i. Br.), 2004.

Univ., Diss.--Bremen, 2005. / Literaturverz. S. 256 - 268.

Diplomarbeit Hochschule für Angewandte Psychologie Zürich, 2005.

Der Konsum psychoaktiver Substanzen stellt einen der wichtigsten vermeidbaren Risikofaktoren für Krankheit und frühzeitige Sterblichkeit dar. Die Weltgesundheitsorganisation (WHO, 2009) berichtet im Rahmen ihrer Schätzungen zur weltweiten Morbiditäts-und Mortalitätsbelastung, dass die legalen Substanzen Tabak und Alkohol zwei der fünf wichtigsten gesundheitlichen Risikofaktoren darstellen. ...

Background: Substance use disorders (SUDs) are a great burden on adolescent patients and treatment of these patients is often not successful. One reason for this difficulty is the high rate of co-occurring disorders. One disorder that frequently accompanies SUDs in adolescence is a Post-Traumatic Stress Disorder (PTSD). In studies it has often been reported that a large number of patients fulfill diagnostic criteria for both disorders at the same time. Several explanations for this co-occurrence exist: i) A common etiological factor (genetic predisposition, similar neurobiological pathways) might underlie the development of both disorders. ii) Various lifestyle factors that go hand-in-hand with an adolescent SUD (risky sexual behavior, violent dark markets) might expose patients to circumstances that increase the rate of encountered traumatic experiences (TEs) and therefore PTSD. iii) The self-medication hypothesis, where it is posited that adolescents use drugs to medicate their PTSD symptoms, often in a very specific manner, such that particular substances are used to reduce explicit symptoms. One aim explored in this thesis is the relationship between SUD, TEs, and PTSD with regard to differences in SUD severity, patterns of substance use, the role of self-medication and the effects of SUD-specific treatment on PTSD symptomatology. Methods: Five studies are presented in chapters 2 to 6 of this thesis. Chapter 2 contains a study in which the Drug Use Disorder Identification Test (DUDIT) was evaluated for use in a psychiatric adolescent patient population. This was the first study in which the DUDIT in relation to DSM-5 criteria was evaluated, in order to try to establish cut-off scores for the presence of a SUD in adolescents. In chapter 3 an evaluation is presented of the differences in SUD severity between adolescents with a SUD (‘noTE’ group), adolescents with a SUD and a history of TE but not PTSD (‘TE’ group) and adolescents with SUD and co-occurring PTSD (‘PTSD’ group). In the study presented in chapter 4 an investigation of the differences in substance use patterns between the three groups was undertaken, along with an evaluation of the associations between PTSD symptoms and use of specific substances. In chapter 5, the role coping motives play in the relationship between substance and PTSD symptoms was established. Finally, in chapter 6 the results of a pragmatic clinical trial are presented, in which the effects of a group-based treatment manual (the DELTA program) on SUD symptoms, substance use frequency and PTSD symptoms are assessed. Results: Across all included studies in this dissertation, an instrument for the assessment of SUD in adolescents was evaluated. This was used with other instruments, to establish a link between adolescent SUD and increased rates of PTSD and substance use. Furthermore, the connection between SUD and PTSD in adolescence seems to be related to a self-medication motive. Additionally we established a treatment program that reduced SUD symptoms but failed to influence the PTSD symptoms, which indicates treatment specific to one disorder is unlikely to support reductions in the co-occurring disorder. More specifically, the results presented in chapter 2 showed that the DUDIT has excellent discriminant validity and is a valid tool for the assessment of SUD severity in a clinical adolescent population. In chapter 3, it was shown that the prevalence of TEs and PTSD in adolescents with SUD is higher than in the general adolescent population. Furthermore, the PTSD group showed a significantly higher level of SUD severity than the other two groups. In contrast to our expectations, the TE group did not differ significantly with regard to SUD severity from the noTE group. In addition, SUD severity correlated positively with the number of PTSD symptoms in each symptom cluster. The study presented in chapter 4 showed that past-month substance use frequency was nearly the same across groups and across substances, with only the use of methylenedioxymethamphetamine (MDMA) being significantly more frequent and more prominent in the PTSD group compared to the other two. Participants in the PTSD group also reported a significantly earlier age of first substance use compared to participants in the other two groups. Moreover, in this study it was shown that the presence of the avoidance symptom cluster of PTSD was related to a more frequent past-month MDMA use. The findings presented in chapter 5, confirmed the pattern detected for past-month substance use in chapter 4. The PTSD group showed a more frequent MDMA use over the past-year compared to the other two groups. Additionally, the PTSD group reported using substances more frequently for coping reasons, and the frequency of coping use motives was positively correlated with the frequency of past-year MDMA use. In this study, evidence was provided that the relationship between group membership (noTE, TE, PTSD) and MDMA use frequency is in part mediated by the relationship both variables have with coping use motives. In chapter 6 medium-sized but non-significant reductions were shown in SUD symptoms and substance use frequency as a result of the DELTA intervention. Additionally, there was no indication that the treatment program resulted in changes in PTSD symptomatology. Discussion: Several important conclusion can be derived from the studies presented in this thesis. First, a co-occurring PTSD is more prevalent in SUD patients than in the general adolescent population and is associated with higher SUD severity. Second, patients with co-occurring PTSD and SUD are distinguished from SUD patients without PTSD through their increased use of MDMA. Third, the relationship between PTSD and MDMA use is partially mediated by a coping motive, supporting the self-medication hypothesis. Finally, the treatment of co-occurring PTSD and SUD seems to require therapeutic interventions specific for each disorder. The result that PTSD symptoms are not reduced after SUD-specific treatment can be interpreted as support for the self-medication hypothesis as well, in the sense that the treatment of the consequence (SUD) does not affect the preceding factor (PTSD). However, while the above interpretation is consistent with the data presented in this thesis on substance use itself, the associated data on the occurrence of SUDs indicates, that more factors than just self-medication are relevant for the development of a SUD. Furthermore, the results of this thesis do not imply that substance use motivated by self-medication motives is harmless or even beneficial, since there was no way of assessing if self-reported, coping-motivated substance use is successful in reducing symptoms or acute psychopathology. Consequently, in future projects focus should be on developing longitudinal research designs, in order to assess if and how PTSD symptoms develop over time with regard to substance use and how substance use trajectories develop in relation to PTSD symptomatology.

Alkoholabhängigkeit (AA) zeichnet sich durch einen starken Drang nach Alkoholkonsum trotz schwerwiegender negativer Folgen aus. Eine gängige Theorie aus der Suchtforschung besagt, dass AA mit einer Verlagerung von zielgerichteter zu habitueller Kontrolle einhergeht, durch welche Handlungen automatisiert ausgeführt werden und weitgehend unabhängig von ihren Folgen sind. Evidenzen hierfür stammen weitgehend aus experimentellen Untersuchungen an Tieren. Das Fachgebiet des maschinellen Lernens hat zudem neue Experimente hervorgebracht, welche die Anwendung von Algorithmen erlauben, um die Verlagerung von zielgerichtetem zu habituellen Verhalten zu untersuchen. Diese Paradigmen fanden bisher keine Anwendung in der Untersuchung von alkoholabhängigen Patienten. Daher widmet sich diese Dissertation der Untersuchung von habituellem und zielgerichtetem Verhalten bei AA aus unterschiedlichen Perspektiven. Hierfür adaptierten wir zunächst ein Paradigma aus der Tierliteratur, durch welches habituelles Verhalten als reizgesteuerte Kontrolle quantifiziert wird. Anschließend nutzten wir eine Aufgabe, die aus dem maschinellen Lernen stammt und die Untersuchung von habitueller und zielgerichteter Kontrolle ermöglicht. Drittens untersuchten wir den Zusammenhang des Verhaltens über beiden Paradigmen hinweg. Zuletzt untersuchten wir, ob habitueller und zielgerichteter Kontrolle mit dem Alkoholkonsum in jungen sozialen Trinkern assoziiert ist. Die Ergebnisse liefern weitere Hinweise auf eine Verlagerung von zielgerichteter zu habitueller Kontrolle bei AA. Das Verhalten in beiden Paradigmen war miteinander assoziiert, was darauf rückschließen lässt, dass ähnliche kognitive Mechanismen involviert sind. Soziale Trinker zeigten keine Verlagerung von zielgerichteter zu habituellem Verhalten, was darauf hin weist, dass jenes Ungleichgewicht erst im Verlauf der AA entsteht und kein Korrelat von Alkoholkonsum per se darstellt. / Alcohol dependence (AD) manifests as a strong drive to consume alcohol despite serious adverse consequences. A popular theory in addiction research thus suggests that AD is characterized by a shift from goal-directed to habitual control, where actions are automatic and disentangled from outcomes. Evidence for this has mainly been drawn from experimental investigations in animals. The field of machine learning has additionally advanced new experiments that allow the application of reinforcement learning algorithms to investigate a shift towards habits. Again, these tasks have yet not been applied to human AD. To fill this gap, this thesis investigates habitual at the expense of goal-directed control from distinct theoretical fields in AD patients. We adapted a paradigm from the animal literature, which quantifies habits as cue-induced control over behavior. Then, we applied an experimental procedure inspired from machine learning that allows to investigate the balance between habitual and goal-directed control. Third, we examined the relationship between behavior across these paradigms. Last, we investigated whether the imbalance between habitual and goal-directed control was associated with alcohol consumption in young social drinkers. Our results add further evidence that AD is associated with a shift from goal-directed to habitual control, e.g. increased cue-induced control / reductions in goal-directed decision-making. Behavior across both paradigms were associated with each other, suggesting the involvement of similar mechanisms. As non-pathological alcohol intake was not associated with an imbalance between goal-directed and habitual control, this imbalance might arise over the course of AD rather than being a trait marker of alcohol intake.

The purpose of this study is to approach the understanding of viewing of reality television with the intention to explore emotional responses in the reception since emotions are crucial part in the emotionalized television genre of reality television. The German adaption of the format The Farmer Wants a Wife was chosen for this case study to examine tendencies of portraying contestants in unpleasant situations. Humiliation, embarrassment or discrediting the contestants creates a balancing act between fun and ridicule. The protagonists are located between the status of (temporary) cult figures and/or figures of fun. The thesis’ main aim is to find out which emotions are perceived and addressed in the watching experience of the format being named in the context of ‘fremdschämen’. The winged German word for vicarious or empathic embarrassment was thereby addressed beyond its descriptive metaphor for current programs. Emotional responses in connection with shame and embarrassment were previously predominantly neglected in research on reality television. Its relevance and occurrence in media is insofar important, as the concept of ‘fremdschämen’ found the way into German mainstream language use. The thesis delivers qualitative approaches to capture the mediation of emotions in reality TV: In a narrative analysis, the question on how emotions actually are staged was approached. Subsequently, four focus group discussions with overall 18 German-speaking discussants were conducted to understand individual and social watching preferences, emotional involvement, attachment styles and positioning in the reception. The study’s findings suggest that the contestants’ ordinariness is challenged by mainly focusing on extraordinarity in the docusoap. Thereby, new opportunities of audience positioning, identification and anti-identification and constructions of appealing figures are encouraged. Gentle mockery in the style of presentation contains furthermore self-criticism of the genre and expresses a critical stance of viewing. Emotions are performed on different levels to increase entertaining values in the program. Especially embarrassment can be connected to its function of ridicule and the maintenance of social order.

Thesis (doctoral)--Universität Erfurt, 2009. / Includes bibliographical references.