TY - RPRT A1 - Zauter, Sigrid A1 - Reindl, Richard A1 - Richter, Kneginja A1 - Peter, Lukas T1 - Onlineberatung Müdigkeitsmilderung (OMM) BT - Vorstudie zur Entwicklung eines internetgestützten Programms zur Prävention von Schlafstörungen insb. bei Mitarbeiter/innen im Schichtdienst ; Projektzeitraum Oktober 2016 - März 2018, Abschlussbericht N2 - Ziel des Vorhabens war es, ein internetgestütztes Programm zu entwickeln, das zur Prävention von Schlafstörungen eingesetzt werden kann und verhaltensorientierte Bausteine zum besseren Umgang mit Schlafproblemen enthält. Neben einem Selbsttest zur ersten Einschätzung von Schlafstörungen, einem Schlaftagebuch zur Kontrolle der Schlafeffizienz, setzt das Programm wesentlich auf eine individualisierte Onlineberatung, die Hilfe und Unterstützung bei der Verbesserung der Schlafeffizienz leisten und zur Verminderung der Symptome des SWD beitragen kann. Die geplanten Projektziele im Sinne der Verbesserung von Schlafstörungen und Müdigkeit durch Onlineschlaf-beratung wurden bei der Stichprobe, die das Beratungsprogramm vollständig durchlaufen haben, erreicht. T3 - E-Beratung - 2018,1 KW - Computerunterstützte Kommunikation KW - Schichtarbeit KW - Schlafrestriktionstherapie KW - Schlafstörung KW - digitale Beratung KW - Schlafberatung KW - Onlineberatung KW - Onlinekommunikation KW - Onlineschlafberatung Y1 - 2018 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:92-opus4-5517 VL - 2018 IS - 1 ER - TY - JOUR A1 - Frase, Lukas A1 - Acker, Jens A1 - Cohrs, Stefan A1 - Danker-Hopfe, Heidi A1 - Frohn, Corinna A1 - Göder, Robert A1 - Mauche, Nicole A1 - Norra, Christine A1 - Pollmächer, Thomas A1 - Richter, Kneginja A1 - Riemann, Dieter A1 - Schilling, Claudia A1 - Weeß, Hans-Günter A1 - Wetter, Thomas C. A1 - Nissen, Christoph T1 - Empfehlungen zur Durchführung einer Polygraphie oder Polysomnographie im Bereich Psychiatrie und Psychotherapie BT - Positionspapier des DGPPN-Referats Schlafmedizin JF - Der Nervenarzt N2 - Ein- und Durchschlafstörungen, nichterholsamer Schlaf oder erhöhte Tagesmüdigkeit sind unspezifische Symptome von heute ca. 100 unterscheidbaren Störungsbildern, die in der kommenden 11. Revision der Internationalen statistischen Klassifikation der Krankheiten (ICD-11) erstmals als eigenes Kapitel 7 „Schlaf-Wach-Störungen“ zusammengefasst werden. Mit Blick auf den Fachbereich Psychiatrie und Psychotherapie besteht ein bidirektionaler Zusammenhang zwischen Schlaf-Wach-Störungen und psychischen Erkrankungen. Schlaf-Wach-Störungen können einen unabhängigen Risikofaktor für das Entstehen einer psychischen Erkrankung darstellen und den Erkrankungsverlauf ungünstig beeinflussen. Zudem können Schlaf-Wach-Störungen einer psychischen Erkrankung auch als Frühsymptom vorausgehen und damit ein wichtiger Hinweis bei der Früherkennung sein. Zahlreiche Schlaf-Wach-Störungen können anhand der Anamnese und üblicher klinischer Untersuchungen diagnostiziert werden. Bei spezielleren Fragestellungen können die Untersuchung in einem speziali-sierten Schlaflabor und die Behandlung in einem schlafmedizinischen Zentrum im Sinne einer gestuften Versorgung notwendig sein. Hier ist die Polysomnographie die wichtigste Untersuchungsmethode für die Differenzialdiagnostik, für deren Abrechnung über die Kostenträger heute in Deutschland jedoch keine gesetzliche Grundlage im Bereich neuro-psychiatrischer Störungen besteht. Die vorliegende Arbeit fasst die aktuellen Leitlinien hinsichtlich der Kriterien für eine Untersuchung im Schlaflabor aus Sicht des Fachgebiets Psychiatrie und Psychotherapie zusammen und stellt daraus abgeleitet Forderungen für eine leitliniengerechte Diagnostik und Behandlung. N2 - Difficulties in falling asleep and maintaining sleep, nonrestorative sleep and decreased daytime wakefulness represent very common but relatively unspecific health complaints. Around 100 specific sleep-related disorders will be classified in their own major chap. 7 (sleep wake disorders) for the first time in the upcoming 11th version of the International Classification of Diseases (ICD 11). With respect to the disciplines of psychiatry and psychotherapy there is a bidirectional relationship between mental health and sleep wake disorders. Sleep wake disorders can be an independent risk factor for the onset of a mental disorder and have a negative influence on the course of the disease. In addition, sleep wake disorders can also precede a mental disease as an early symptom and therefore be an important indication for early recognition. Many sleep wake disorders can be diagnosed based on the anamnesis and routine clinical investigations. In special cases, examination in a specialized sleep laboratory and treatment in a sleep medicine center following a staged care approach can be mandatory. Polysomnography represents the gold standard for the differential diagnostics; however, there is no legal foundation in the field of neuro-psychiatric disorders for remuneration in the German healthcare system. This review summarizes the current guidelines with respect to the criteria for an investigation in a sleep laboratory from the perspective of the disciplines of psychiatry and psychotherapy. From this the requirements for guideline-conform diagnostics and treatment are derived. T2 - Recommendations on performing polygraphy or polysomnography in the fields of psychiatry and psychotherapy Y1 - 2019 U6 - https://doi.org/10.1007/s00115-019-00855-2 SN - 0028-2804 VL - 91 IS - 9 SP - 843 EP - 853 PB - Springer Science and Business Media LLC ER - TY - JOUR A1 - Richter, Kneginja A1 - Baumgärtner, Lisa A1 - Niklewski, Günter A1 - Peter, Lukas A1 - Köck, Melanie A1 - Kellner, Stefanie A1 - Hillemacher, Thomas A1 - Büttner-Teleaga, Antje T1 - Sleep disorders in migrants and refugees BT - a systematic review with implications for personalized medical approach JF - EPMA Journal Y1 - 2020 U6 - https://doi.org/10.1007/s13167-020-00205-2 SN - 1878-5077 VL - 11 IS - 2 SP - 251 EP - 260 PB - Springer Science and Business Media LLC ER - TY - JOUR A1 - Spiegelhalder, Kai A1 - Baumeister, Harald A1 - Al-Kamaly, Abdulwahab A1 - Bader, Martina A1 - Bauereiss, Natalie A1 - Benz, Fee A1 - Braun, Lina A1 - Buntrock, Claudia A1 - Burkhardt, Maike A1 - Cuijpers, Pim A1 - Domschke, Katharina A1 - Dülsen, Patrick A1 - Franke, Marvin A1 - Frase, Lukas A1 - Heber, Elena A1 - Helm, Kathrin A1 - Jentsch, Terry A1 - Johann, Anna A1 - Küchler, Ann-Marie A1 - Kuhn, Michael A1 - Lehr, Dirk A1 - Maun, Andy A1 - Morin, Charles M A1 - Moshagen, Morten A1 - Richter, Kneginja A1 - Schiel, Julian A1 - Simon, Laura A1 - Spille, Lukas A1 - Weeß, Hans-Günter A1 - Riemann, Dieter A1 - Ebert, David Daniel T1 - Comparative effectiveness of three versions of a stepped care model for insomnia differing in the amount of therapist support in internet-delivered treatment: study protocol for a pragmatic cluster randomised controlled trial (GET Sleep) JF - BMJ Open N2 - IntroductionIt is unclear how internet-delivered cognitive-behavioural therapy for insomnia (CBT-I) can be integrated into healthcare systems, and little is known about the optimal level of therapist guidance. The aim of this study is to investigate three different versions of a stepped care model for insomnia (IG1, IG2, IG3) versus treatment as usual (TAU). IG1, IG2 and IG3 rely on treatment by general practitioners (GPs) in the entry level and differ in the amount of guidance by e-coaches in internet-delivered CBT-I.Methods and analysisIn this randomised controlled trial, 4268 patients meeting International Classification of Diseases, Tenth Revision (ICD-10) criteria for insomnia will be recruited. The study will use cluster randomisation of GPs with an allocation ratio of 3:3:3:1 (IG1, IG2, IG3, TAU). In step 1 of the stepped care model, GPs will deliver psychoeducational treatment; in step 2, an internet-delivered CBT-I programme will be used; in step 3, GPs will refer patients to specialised treatment. Outcomes will be collected at baseline, and 4 weeks, 12 weeks and 6 months after baseline assessment. The primary outcome is insomnia severity at 6 months. An economic evaluation will be conducted and qualitative interviews will be used to explore barriers and facilitators of the stepped care model.Ethics and disseminationThe study protocol was approved by the Ethics Committee of the Medical Centre—University of Freiburg. The results of the study will be published irrespective of the outcome.Trial registration numberDRKS00021503. Y1 - 2022 U6 - https://doi.org/10.1136/bmjopen-2021-058212 SN - 2044-6055 VL - 12 IS - 8 PB - BMJ ER - TY - JOUR A1 - Acker, Jens G. A1 - Becker-Carus, C. A1 - Büttner-Teleaga, Antje A1 - Cassel, Werner A1 - Danker-Hopfe, Heidi A1 - Dück, Alexander A1 - Frohn, Corinna A1 - Hein, Holger A1 - Penzel, Thomas A1 - Rodenbeck, Andrea A1 - Roenneberg, Till A1 - Sauter, Cornelia A1 - Weeß, Hans-Günter A1 - Zeitlhofer, Josef A1 - Richter, Kneginja T1 - The role of actigraphy in sleep medicine JF - Somnologie N2 - AbstractActigraphy has been used for more than 60 years to objectively measure sleep–wake rhythms. Improved modern devices are increasingly employed to diagnose sleep medicine disorders in the clinical setting. Although less accurate than polysomnography, the chief advantage of actigraphs lies in the cost-effective collection of objective data over prolonged periods of time under everyday conditions. Since the cost of wrist actigraphy is not currently reimbursed, this method has not enjoyed wide acceptance to date. The present article provides an overview of the main clinical applications of actigraphy, including the recommendations of specialist societies. Y1 - 2021 U6 - https://doi.org/10.1007/s11818-021-00306-8 SN - 1432-9123 VL - 25 IS - 2 SP - 89 EP - 98 PB - Springer Science and Business Media LLC ER - TY - JOUR A1 - Spiegelhalder, Kai A1 - Acker, Jens A1 - Baumeister, Harald A1 - Büttner-Teleaga, Antje A1 - Danker-Hopfe, Heidi A1 - Ebert, David D. A1 - Fietze, Ingo A1 - Frase, Lukas A1 - Klein, Sarah A1 - Lehr, Dirk A1 - Maun, Andy A1 - Mertel, Isabella A1 - Richter, Kneginja A1 - Riemann, Dieter A1 - Sauter, Cornelia A1 - Schilling, Claudia A1 - Schlarb, Angelika A. A1 - Specht, Markus A1 - Steinmetz, Lisa A1 - Weeß, Hans G. A1 - Crönlein, Tatjana T1 - Digitale Behandlungsangebote für Insomnie – eine Übersichtsarbeit JF - Somnologie N2 - ZusammenfassungDigital angebotene psychologische Interventionen gegen Schlafstörungen sind aktuell ein sehr intensiv bearbeitetes Forschungsthema. In dieser Übersichtsarbeit werden Originalarbeiten und Metaanalysen zu diesem Thema zusammengefasst. Hierbei zeigt sich, dass die internetbasierte kognitive Verhaltenstherapie für Insomnie (KVT-I) bei Erwachsenen durchweg sehr effektiv ist mit allenfalls leicht geringeren Effektstärken als die gleiche Behandlung mit physischer Präsenz von Therapeuten und Patienten. Behandlungseffekte zeigen sich dabei auch für sekundäre Outcome-Parameter wie Depressivität, Angst, Fatigue und Lebensqualität. Hingegen lassen die Forschung zur Wirksamkeit der internetbasierten KVT‑I bei Erwachsenen mit komorbiden psychischen Störungen oder körperlichen Erkrankungen sowie die Forschung zur Frage, wieviel Therapeutenkontakt in die Behandlung integriert werden sollte, anscheinend noch keine abschließenden Antworten zu. In diesen Bereichen scheint weitere Forschung notwendig zu sein scheint. Y1 - 2020 U6 - https://doi.org/10.1007/s11818-020-00238-9 SN - 1432-9123 VL - 24 IS - 2 SP - 106 EP - 114 PB - Springer Science and Business Media LLC ER - TY - JOUR A1 - Pourhassan, Jasmin A1 - Sarginson, Jane A1 - Hitzl, Wolfgang A1 - Richter, Kneginja T1 - Cognitive function in soccer athletes determined by sleep disruption and self-reported health, yet not by decision-reinvestment JF - Frontiers in Neurology N2 - BackgroundSleep disruption (SD) increases sympathetic activity and cortisol secretion, and delays cognitive functions such as reaction-time (RT). Sympathetic activity of disturbed sleepers, is similar to those of so-called decision-reinvesters. Decision-reinvestment refers to traits in individuals with greater tendency to ruminate and reinvest in their decisions, with significant decrease in both motor-control and cognitive performance. Decision-making quality is a crucial attribute to athletic performance which relies on RT. Consequently, SD affects pitch-performance negatively, particularly in decision-reinvesters. This observational pilot-study examined the relationship between SD and cognitive function, perceived health, as well as reinvestment strategies. The hypothesis was that athletes with lower SD perceive their health better, report lower stress levels, perform better in cognitive tasks, and show lower tendency for decision-reinvestment.MethodsTwenty-one football player recorded their sleep with fit-trackers for 7 nights. Participants self-reported their mental and physical health, decision-reinvestment strategy, sleep behaviour, and perceived stress levels. Athletes then performed a set of cognitive tests to examine memory function (Backwards Corsi), selective attention (STROOP), and cognitive flexibility (Wisconsin Card Sorting Test, WCST). Normality was tested with a Shapiro-Wilk test, and analysed with a Pearson's or Spearman's correlation test.ResultsSignificant correlation appeared between extended sleep-interruptions and Backwards Corsi RT, r = 0.66, p = 0.010, as further in total sleep time and wellbeing r = 0.50, p = 0.029. A negative correlation exist in regard of pain scores and Backwards Corsi scores r = −0.57, p = 0.110. Physical health correlated with error-rates in the WCST, r = 0.69, p ≤ 0.001. Also, reinvestment negatively correlated with physical health, r = −0.80, p ≤ 0.001.ConclusionWellbeing relies on total sleep-time. Athletes with extended sleep-interruptions are slower in recalling memory, and those with greater reported pain have lower memory scores. Participants who rate physical health greater, have more error-rates in the WCST; indicating that cognitive flexibility is enhanced in individuals with inferior perceived health. However, individuals with lower physical health scores also have greater tendency to ruminate and reinvest in decisions, suggesting interrelation between reinvestment and physical health. Y1 - 2023 U6 - https://doi.org/10.3389/fneur.2022.872761 SN - 1664-2295 VL - 13 SP - 1 EP - 13 PB - Frontiers Media SA ER - TY - JOUR A1 - Kellner, Stefanie A1 - Richter, Kneginja T1 - Insomnie in der Schwangerschaft – eine systematische Übersichtsarbeit JF - Somnologie N2 - Insomnie und ein reduzierter Schlaf gehören zu den häufigsten Beschwerden, die im Verlauf einer Schwangerschaft auftreten können, vor allem im dritten Trimester. Rund 66–94 % aller Schwangeren geben Schlafprobleme an, die mit negativen physischen und psychischen Konsequenzen für das schwangere Individuum wie auch für das ungeborene Kind verbunden sind. Y1 - 2022 U6 - https://doi.org/10.1007/s11818-022-00342-y SN - 1432-9123 VL - 26 IS - 1 SP - 40 EP - 48 PB - Springer Science and Business Media LLC ER - TY - JOUR A1 - Richter, Kneginja A1 - Acker, Jens A1 - Kamcev, Nikola A1 - Bajraktarov, Stojan A1 - Piehl, Anja A1 - Niklewski, Günter T1 - Recommendations for the prevention of breast cancer in shift workers JF - EPMA Journal N2 - Abstract 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. KW - Schichtarbeit KW - Brustkrebs KW - Voprbeugung KW - Prävention KW - Schlaf KW - Shiftwork KW - Prevention KW - Breast Cancer KW - Sleep Y1 - 2011 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:92-opus-923 VL - 2011 IS - 2 SP - 351 EP - 356 ER - TY - JOUR A1 - Retzer, Lukas A1 - Feil, Monika A1 - Reindl, Richard A1 - Richter, Kneginja A1 - Lehmann, Robert A1 - Stemmler, Mark A1 - Graessel, Elmar T1 - Anonymous online cognitive behavioral therapy for sleep disorders in shift workers BT - a study protocol for a randomized controlled trial JF - Trials N2 - AbstractBackgroundMany shift workers suffer from sleep issues, which negatively affect quality of life and performance. Scientifically evaluated, structured programs for prevention and treatment are scarce. We developed an anonymous online cognitive behavioral therapy for insomnia (CBT-I) program. After successful completion of a feasibility study, we now start this prospective, randomized, controlled superiority trial to compare outcomes of two parallel groups, namely an intervention group and a waiting-list control-group. Additionally, we will compare these outcomes to those of a face-to-face CBT-I outpatient sample.MethodsCollaborating companies will offer our anonymous online intervention to their shift-working employees. Company physicians and counseling services will screen those interested for inclusion and exclusion criteria. Participants will receive access to our online service, where they will complete psychometric assessment and receive random assignment to either the intervention group or the waiting-list control group. Participants and providers will be aware of the group assignment. We aim to allocate at leastN= 60 participants to the trial. The intervention consists of psychoeducation, sleep restriction, stimulus control, relaxation techniques, and individual feedback delivered via four e-mail contacts. During the intervention, as well as during the waiting period, participants will fill out weekly sleep diaries. Immediately after completion of the program, the post-intervention assessment takes place. Participants in the control group will be able to participate in the program after all study assessments. To recruit an additional sample, collaborating outpatient sleep clinics will provide six sessions of standard face-to-face CBT-I to an ad hoc sample of shift working patients. We expect both the online and the face-to-face CBT-I interventions to have beneficial effects compared to the control group on the following primary outcomes: self-reported symptoms of depression and insomnia, sleep quality, and daytime sleepiness.ConclusionsThe online intervention allows shift workers to follow a CBT-I program independently of their working schedule and location. Forthcoming results might contribute to further improvement of prevention and therapy of sleep issues in shift workers.Trial registrationGerman Clinical Trials Register DRKSDRKS00017777. Registered on 14 January 2020—retrospectively registered. KW - Cognitive behavioral therapy, E-Health, Shift work, Intervention studies, Circadian rhythm sleep disorder, Insomnia, Study protocol Y1 - 2021 U6 - https://doi.org/10.1186/s13063-021-05437-9 SN - 1745-6215 VL - 22 IS - 1 PB - Springer Science and Business Media LLC ER - TY - JOUR A1 - Richter, Kneginja A1 - Zimni, Melanie A1 - Tomova, Iva A1 - Retzer, Lukas A1 - Höfig, Joachim A1 - Kellner, Stefanie A1 - Fries, Carla A1 - Bernstein, Karina A1 - Hitzl, Wolfgang A1 - Hillemacher, Thomas A1 - Miloseva, Lence A1 - Acker, Jens T1 - Insomnia Associated with Tinnitus and Gender Differences JF - International Journal of Environmental Research and Public Health N2 - Chronic tinnitus causes a decrease in well-being and can negatively affect sleep quality. It has further been indicated that there are clinically relevant gender differences, which may also have an impact on sleep quality. By conducting a retrospective and explorative data analysis for differences in patients with tinnitus and patients diagnosed with tinnitus and insomnia, hypothesized differences were explored in the summed test scores and on item-level of the validated psychometric instruments. A cross-sectional study was conducted collecting data from a sample of tinnitus patients (n = 76). Insomnia was diagnosed in 49 patients. Gender differences were found on aggregated test scores of the MADRS and BDI with men scoring higher than women, indicating higher depressive symptoms in men. Women stated to suffer more from headaches (p < 0.003), neck pain (p < 0.006) and nervousness as well as restlessness (p < 0.02). Women also reported an increase in tinnitus loudness in response to stress compared to men (p < 0.03). Male individuals with tinnitus and insomnia have higher depression scores and more clinically relevant depressive symptoms than women, who suffer more from psychosomatic symptoms. The results indicate a need for a targeted therapy of depressive symptoms in male patients and targeted treatment of psychosomatic symptoms, stress-related worsening of insomnia and tinnitus in women. KW - tinnitus; insomnia; sleep; sleep disturbance; depression; gender difference Y1 - 2021 U6 - https://doi.org/10.3390/ijerph18063209 SN - 1660-4601 VL - 18 IS - 6 PB - MDPI AG ER - TY - JOUR A1 - Weber, Franziska C. A1 - Danker-Hopfe, Heidi A1 - Dogan-Sander, Ezgi A1 - Frase, Lukas A1 - Hansel, Anna A1 - Mauche, Nicole A1 - Mikutta, Christian A1 - Nemeth, Diana A1 - Richter, Kneginja A1 - Schilling, Claudia A1 - Sebestova, Martina A1 - Spath, Marian M. A1 - Nissen, Christoph A1 - Wetter, Thomas C. T1 - Restless Legs Syndrome Prevalence and Clinical Correlates Among Psychiatric Inpatients BT - a multicenter study JF - Frontiers in Psychiatry N2 - BackgroundThere are only limited reports on the prevalence of restless legs syndrome (RLS) in patients with psychiatric disorders. The present study aimed to evaluate the prevalence and clinical correlates in psychiatric inpatients in Germany and Switzerland.MethodsThis is a multicenter cross-sectional study of psychiatric inpatients with an age above 18 years that were diagnosed and evaluated face-to-face using the International RLS Study Group criteria (IRLSSG) and the International RLS severity scale (IRLS). In addition to sociodemographic and biometric data, sleep quality and mood were assessed using the Pittsburgh Sleep Quality Index (PSQI), the Insomnia Severity Index (ISI), the Epworth Sleepiness Scale (ESS), and the Patient Health Questionnaire (PHQ-9). In addition to univariate statistics used to describe and statistically analyze differences in variables of interest between patients with and without RLS, a logistic model was employed to identify predictors for the occurrence of RLS.ResultsThe prevalence of RLS in a sample of 317 psychiatric inpatients was 16.4%, and 76.9% of these were diagnosed with RLS for the first time. RLS severity was moderate to severe (IRLS ± SD: 20.3 ± 8.4). The prevalences in women (p = 0.0036) and in first-degree relatives with RLS (p = 0.0108) as well as the body mass index (BMI, p = 0.0161) were significantly higher among patients with RLS, while alcohol consumption was significantly lower in the RLS group. With the exception of atypical antipsychotics, treatment with psychotropic drugs was not associated with RLS symptoms. Regarding subjective sleep quality and mood, scores of the PSQI (p = 0.0007), ISI (p = 0.0003), and ESS (p = 0.0005) were higher in patients with RLS, while PHQ-9 scores were not different. A logistic regression analysis identified gender (OR 2.67; 95% CI [1.25; 5.72]), first-degree relatives with RLS (OR 3.29; 95% CI [1.11; 9.73], ESS score (OR 1.09; 95% CI [1.01; 1.17]), and rare alcohol consumption (OR 0.45; 95% CI [0.22; 0.94] as predictors for RLS.ConclusionsClinically significant RLS had a high prevalence in psychiatric patients. RLS was associated with higher BMI, impaired sleep quality, and lower alcohol consumption. A systematic assessment of restless legs symptoms might contribute to improve the treatment of psychiatric patients. Y1 - 2022 U6 - https://doi.org/10.3389/fpsyt.2022.846165 SN - 1664-0640 VL - 13 PB - Frontiers Media SA ER -