Jens Acker

Health promotion and work: prevention of shift work disorders in companies

Workplace health promotion is a strategy to improve the health and well-being of people at work. The measures aim at the personal, organisational and work environment. Shift work is one of many reasons provoking increased job stress. According to worldwide epidemiological data, up to 30% of the working population are employed in shifts. Taking into consideration that shift work causes a large number of somatic and psychiatric diseases which bear considerable negative consequences for the health status and the quality of life, it seems to be important to initiate health promotion strategies for shift workers in the companies. The results of recent studies indicate that well-scheduled und targeted health programmes can change the lifestyle of shift working employees and have an impact on the risk factors involved. One problem, though, is a considerable time lag till effects become apparent; therefore, the long-term economic effects of workplace health promotion have not been evaluated sufficiently to date. These definitely positive effects highlight the demand for trainings and workshops for people in shift work. We urgently suggest a speedy implementation of the recommended strategies by companies with shift work systems. In our view, this poses a challenge to the “infant” interdisciplinary field of sleep medicine that should be solved.

Recommendations for the prevention of breast cancer in shift workers

The functioning of the human body is regulated by the rhythmical change between rest and activity. The SCN (suprachiasmatic nucleus) is responsible for the central control of the biorhythm and the genetic prediction of the individual chronotype, whereas peripheral time cues such as light, social contacts and times of meals modulate the rhythmical activity of the body. Shift workers suffer from a disruption of the sleep-wake rhythm, insomnia and a lack of melatonin. These factors might trigger the development of breast cancer in female shift workers. The growing amount of data which indicate the high risk of breast cancer in female shift workers demonstrates the need for the implementation of prevention strategies against insomnia in shift workers. These strategies include regular sleep education courses on the prevention of sleep disorders in companies. The individual chronotype could be an important predictor for the adaptability to shift work.

Schlafmedizinische Differenzialdiagnostik in Psychiatrie und Psychotherapie

ZusammenfassungKlagen über einen gestörten Schlaf oder erhöhte Tagesmüdigkeit gehören zu den häufigsten Beschwerden, die Patienten gegenüber ihrem Psychiater und Psychotherapeuten beklagen. Solche Beschwerden können Symptom einer psychiatrischen Störung sein, aber auch hinweisend auf andere oder zusätzliche Erkrankungen. Deshalb sind Grundkenntnisse in der schlafmedizinischen Differenzialdiagnostik von erheblicher klinischer Bedeutung für Psychiater und Psychotherapeuten. In der vorliegenden Übersicht wird nach einer Darstellung der diagnostischen Methoden das differenzialdiagnostische Vorgehen orientiert an den klassischen Leitsymptomen, nämlich Ein- und Durchschlafstörungen, gestörte nächtliche Motorik und erhöhte Tagesmüdigkeit, dargestellt.SummaryComplaints about disturbed sleep or increased daytime sleepiness are among the most frequent symptoms reported to psychiatrists by patients. Such complaints can be symptoms of an underlying psychiatric disorder or indicative of a separate or comorbid sleep disorder. Hence, basic knowledge in the differential diagnosis of sleep medicine pathologies is pivotal for psychiatrists and psychotherapists. In the present overview following a description of the diagnostic methods, the diagnostic work-up according to the major symptomatic clusters, namely disturbances in initiating and maintaining sleep, abnormal nocturnal movements and excessive daytime sleepiness will be presented.

Management of Chronic Tinnitus and Insomnia with Repetitive Transcranial Magnetic Stimulation and Cognitive Behavioral Therapy – a Combined Approach

It has been estimated that up to 80% of people will experience symptoms of tinnitus over the courses of their lives, with rates of comorbid sleeping problems ranging from 50 to 77%. Because of a potential connection between tinnitus and sleep disorders as well as high rates of comorbid psychiatric disorders, interdisciplinary approaches to treatment seem to be the most efficient option. In this study, we present the case of a 53-year-old male patient, who started to experience symptoms of tinnitus at the age of 49, most likely caused by work-related stress. Over the course of his illness, the patient developed comorbid insomnia. He consulted us for treatment of both conditions and we developed a treatment plan with ten sessions of repetitive transcranial magnetic stimulation (rTMS) followed by 10 sessions of cognitive behavioral therapy (CBT). We used the Tinnitus Fragebogen (TF) to assess the severity of the tinnitus, the Beck Depression Inventory (BDI-II) for depressive symptoms, and the WHO Well-being Index (WHO-5) for subjective well-being. Improvements could be achieved with regard to both diagnoses and the patient went from severe (48) to clinically negligible (12) TF scores, from minimal (BDI-II score 10) to no (0) depressive symptoms, and from just above critical (WHO-5 percentile 52) to above average (84) well-being. The combination of technological and psychological approaches to treat tinnitus and insomnia thus proved successful in this case. One may therefore conclude that rTMS may be considered an effective first therapeutic step for tinnitus treatment prior to CBT. To our knowledge this is the first published case in which rTMS and CBT were combined for tinnitus therapy. The approach proved successful since it led to a considerable increase in well-being and everyday functioning. To gauge the effect on a more general level, large-scale studies are still needed to cancel out potential placebo effects. Likewise, the importance of the order of the two treatments, and the possibility of using other therapies in combination with CBT to address certain tinnitus subtypes and different etiologies must be studied in greater detail.

Schlafmedizinische Differenzialdiagnostik in Psychiatrie und Psychotherapie@@@Sleep medicine differential diagnostics in psychiatry and psychotherapy

ZusammenfassungKlagen über einen gestörten Schlaf oder erhöhte Tagesmüdigkeit gehören zu den häufigsten Beschwerden, die Patienten gegenüber ihrem Psychiater und Psychotherapeuten beklagen. Solche Beschwerden können Symptom einer psychiatrischen Störung sein, aber auch hinweisend auf andere oder zusätzliche Erkrankungen. Deshalb sind Grundkenntnisse in der schlafmedizinischen Differenzialdiagnostik von erheblicher klinischer Bedeutung für Psychiater und Psychotherapeuten. In der vorliegenden Übersicht wird nach einer Darstellung der diagnostischen Methoden das differenzialdiagnostische Vorgehen orientiert an den klassischen Leitsymptomen, nämlich Ein- und Durchschlafstörungen, gestörte nächtliche Motorik und erhöhte Tagesmüdigkeit, dargestellt.SummaryComplaints about disturbed sleep or increased daytime sleepiness are among the most frequent symptoms reported to psychiatrists by patients. Such complaints can be symptoms of an underlying psychiatric disorder or indicative of a separate or comorbid sleep disorder. Hence, basic knowledge in the differential diagnosis of sleep medicine pathologies is pivotal for psychiatrists and psychotherapists. In the present overview following a description of the diagnostic methods, the diagnostic work-up according to the major symptomatic clusters, namely disturbances in initiating and maintaining sleep, abnormal nocturnal movements and excessive daytime sleepiness will be presented.

Sleep medicine differential diagnostics in psychiatry and psychotherapy

ZusammenfassungKlagen über einen gestörten Schlaf oder erhöhte Tagesmüdigkeit gehören zu den häufigsten Beschwerden, die Patienten gegenüber ihrem Psychiater und Psychotherapeuten beklagen. Solche Beschwerden können Symptom einer psychiatrischen Störung sein, aber auch hinweisend auf andere oder zusätzliche Erkrankungen. Deshalb sind Grundkenntnisse in der schlafmedizinischen Differenzialdiagnostik von erheblicher klinischer Bedeutung für Psychiater und Psychotherapeuten. In der vorliegenden Übersicht wird nach einer Darstellung der diagnostischen Methoden das differenzialdiagnostische Vorgehen orientiert an den klassischen Leitsymptomen, nämlich Ein- und Durchschlafstörungen, gestörte nächtliche Motorik und erhöhte Tagesmüdigkeit, dargestellt.SummaryComplaints about disturbed sleep or increased daytime sleepiness are among the most frequent symptoms reported to psychiatrists by patients. Such complaints can be symptoms of an underlying psychiatric disorder or indicative of a separate or comorbid sleep disorder. Hence, basic knowledge in the differential diagnosis of sleep medicine pathologies is pivotal for psychiatrists and psychotherapists. In the present overview following a description of the diagnostic methods, the diagnostic work-up according to the major symptomatic clusters, namely disturbances in initiating and maintaining sleep, abnormal nocturnal movements and excessive daytime sleepiness will be presented.

Komorbidität der Insomnie mit anderen schlafmedizinischen und psychiatrischen Diagnosen: Ergebnisse aus einem Kollektiv eines schlafmedizinischen Zentrums

Zusammenfassung In dieser Untersuchung wurde die Komorbidität der Insomnie mit anderen schlafmedizinischen und psychiatrischen Diagnosen untersucht. Hierzu wurden die Schlaflaborbriefe von 102 Insomniepatienten eines schlafmedizinischen Zentrums (mittleres Alter: 49 Jahre; 64 Frauen, 38 Männer) nach diesbezüglich relevanten Diagnosen durchsucht. Die höchste Komorbidität zeigte sich mit depressiven Störungen (50%) gefolgt von schlafbezogenen Atmungsstörungen (17,6 – 37,3%) und schlafbezogenen Bewegungsstörungen (12,7 – 21,5%). Dieser Befund spricht bei Vorliegen einer Insomniesymptomatik für die routinemäßige Durchführung einer fundierten Diagnostik mit sowohl Polysomnographie als auch psychiatrischer Exploration.

P03-366 - Effects of a modified RTMS stimulation protocol: contrasting the efficacy of 800 and 2000 daily pulses

Objectives The Clinic of Psychiatry and Psychotherapy of Nuremberg established rTMS as a standard tool in the treatment of patients with depressive disorder since 2001. The stimulation protocol was modified in October 2008 to match the current standard procedure reported in the literature. The pulse number was heightened form 800 to 2000 per proceeding. This study examines the effects of the modified stimulation protocol and contrasts the results with the former stimulation efficacy. Methods The authors compared patients suffering from depression, who were treated by rTMS with 800 pulses/day and with 2000 pulses/day. The results of psychological examinations (MADRS, HAMD, BDI, grading, cognitive screening) prior to and afterwards the three-weeks-rTMS-cycle were submitted. Variance analyses were used for statistical reason. Results The subsamples were comparable by sex, age, premorbid intellectual level as well as by self- and other-rated depression severity at treatment beginning. Statistical analyses showed a significant reduction of the depression symptoms in both stimulation protocol groups. Solely the HAMD score reduction in the 2000 pulse sample exceeded the decrease in the 800 pulse sample. Analogically the grading of human functions partly differed depending on the sample affiliation. Concerning the screening of cognitive functioning neither group was impaired. Conclusions rTMS still seems to be a well-functioning tool in the treatment of depressive disorders in the bounds of daily psychiatric health care. Although the modified stimulation protocol didn’t show many advantages in respect to improving depression symptoms, the results indicate the continual adjustment of the stimulation parameter to meet the current standards.

P01-02 - Depression and obstructive sleep apnea - results from a 12-month survey in routine clinical practice

Objectives Patients with untreated obstructive sleep apnea often report depressive symptoms, such as low mood, loss of interest and reduction of drive. In this study we examined the frequency of significant depressive symptoms amongst patients with untreated obstructive sleep apnea over a one year period. Methods From January to December 2008 we screened 1260 consecutive patients with untreated obstructive sleep apnea (AHI > 9) seen at our Center for Sleep Medicine were screened for depression. Based on self-administered questionnaires, patients with significant depressive symptoms were defined as having either a BDI II score ≥ 14 or WHO-5 ≤ 13. Additionally, severity of depression was rated based on BDI II scores. Results Depressive symptoms were reported frequently. Based on BDI-II, 27.9% of patients report significant depressive symptoms. Of these, 46.2% were mild, 35.9% moderate and 17.9% severe. In addition, 52.6% of patients self-reported feeling unwell based on their WHO-5 scores. Conclusions Significant depressive symptoms measured by standardised self-rating scales were detected in over a quarter of our patients with untreated sleep apnea. It remains unknown whether treatment of OSA alone abolishes depressive symptoms, or whether depressive mood may reduce the compliance with treatment. Patients may need an interdisciplinary approach to initial treatment.

PW01-172 - Treatment effects of repetitive transcranial magnetic stimulation (RTMS) on patients with chronic tinnitus aurium

Objectives In the Federal Republic of Germany about 3 million people suffer from tinnitus/are hit by tinnitus, numerous of them depend on intensive medical care. The repetitive transcranial magnetic stimulation is considered to be an innovative and promising therapy in tinnitus treatment. Low frequency stimulation is meant to reduce the abnormal neural activity in the auditory cortex. This study focuses on the efficacy of rTMS with tinnitus patients in the course of a multi disciplinary / an interdisciplinary therapy concept. Methods From November 2008 to June 2009 29 outpatients with chronic tinnitus were treated by low frequency rTMS (1 Hz frequency, 2000 impulses, intensity 110%) for 10 proceedings, stimulating the sinistral auditory cortex with a figure-of-eight-coil. Prior to and afterwards the proceedings questionnaires and assessments of a psychologist took place, afterwards statistical analyses were conducted, the data was explored and systematically discussed. Results The severity index of the tinnitus as well as the depression symptoms of the subjects improved significantly. The average reduction rate of the tinnitus score is set at 7 points. With a response criterion at the minimum of 5 points, 57% were declared as responder, 29% as non-responder and 4 patients (14%) described an increase of the tinnitus loudness/annoyance. Conclusions The results show that the rTMS works as a helpful treatment tool with tinnitus patients and should be considered as an option in the routine tinnitus treatment.