Issue 80, November 2016
bullet The Future of Mental Health Care
bullet Urbanization and Mental Health
bullet MyTherapy - The App that Improves Medication Adherence
bullet Interview with Prof. Dr. Jürgen Margraf, Alexander von Humboldt-Professor of Clinical Psychology and Psychotherapy, Ruhr-Universität Bochum
bullet Center for Intercultural Psychiatry and Psychotherapy (ZIPP) - Research Group Transcultural Psychiatry
The Future of Mental Health Care
Approximately 450 million people worldwide suffer from some form of mental illness, enduring conditions such as depression, schizophrenia, dementia, autism, and anxiety disorders, all of which can have significant social and economic consequences. Urban environments in particular are associated with an increased prevalence of mental health problems, especially schizophrenia.

The majority of individuals with mental illness do not seek treatment from health care professionals and those who are being treated often do not adhere to their medication regimens. An innovation coming out of Germany, MyTherapy, has been particularly successful in addressing medication nonadherence.  The app, which was developed by smartpatient gmbh, is a software platform that improves medication adherence by reminding and motivating patients to take their medication correctly.

In Germany, the number of mental health cases has increased significantly with the influx of refugees. In an interview with Scientific American, the clinical psychologist Thomas Elbert from the University of Konstanz said that "more than half of those who arrived in Germany in the last few years show signs of mental disorder, and a quarter of them have PTSD, anxiety or depression that won't get better without help." The multidisciplinary and multicultural team at the Charité - Universitätsmedizin Berlin's Center for Intercultural Psychiatry and Psychotherapy (ZIPP), aims to facilitate migrants' access to the German health care system and to improve the care they receive.

It is estimated that 67% of the global population will have settled in urban areas by the year 2050. Rapid urban migration and the explosive growth in megacities put metropolitan areas under increasing social and economic strain, with implications for mental health.

Urban life is associated with an increased prevalence of mental health disorders, in particular schizophrenia, a brain disorder that affects roughly 0.5% to 1% of the population worldwide and leads to major suffering and disability in many patients. Living in cities doubles the risk of developing schizophrenia in males and increases the risk by 30% among females. Moreover, exposure to urban environments during childhood and adolescence, when the brain is still developing, seems to be particularly relevant for schizophrenia risk.

While many factors have been discussed as possible mediators of this association with schizophrenia, most researchers favor the hypothesis that modern urban living stands as a proxy for increased exposure to social stress. Plausible sources of social stress in urban environments include the increased competition for employment and affordable living space as well as the transformation of urban social networks, with an increase in anonymity in neighborhoods and more virtual and fragmented social bonds.

In the past five years, neuroscience researchers from the Central Institute of Mental Health in Mannheim have started to unravel the neural circuits that mediate the observed association between urban life, social stress, and mental health issues. The first studies on this topic point to the involvement of the so-called, "perigenual anterior cingulate cortex," a key structure of the human brain involved in the regulation of negative emotions and stress.

Another innovative study, currently under way in Mannheim, aims to identify which factors in the complex city landscape have an impact on human well-being in everyday life. For this study, the researchers are using a combination of state-of-the-art methods to measure brain function (neuroimaging), emotional well-being, and stress responses in daily life (ambulatory assessment) as well as geoinfomatic mapping.

Source: Central Institute of Mental Health in Mannheim

Image: Central Institute of Mental Health in Mannheim, reprinted with permission from Tost H, Champagne FA, Meyer-Lindenberg A, Nat Neurosci 2015, 18(10):1421-31

Each year approximately 125,000 Americans die prematurely as a result of skipping or not properly taking their medication. This is a widespread problem known as medication nonadherence. Forty-five percent of the US population has at least one chronic disease and only half of all prescribed medication is taken correctly.

The MyTherapy app, developed by Munich-based smartpatient gmbh, is a software platform that improves medication adherence by reminding and motivating patients to take their medication correctly. In addition, MyTherapy displays measurements, such as weight, blood pressure and blood glucose. It has a patient-centric design and contains a built-in health journal to keep track of medication intake, measurements, activities, and well-being.

Patients can use the app for all medical conditions. Healthcare professionals can connect with their patients using the web service, MyTherapy Professional, which allows them to see at a glance whether patients are adhering to their medical treatment and if their use of multiple drugs is having adverse effects. Patients can also share their progress with family members and caregivers.

MyTherapy's unique features have been assessed in several studies, including one by the Charité - Universitätsmedizin Berlin. The results confirmed that MyTherapy increases medication adherence and patients' well-being. MyTherapy recently won the German Federal Ministry for Economic Affairs and Energy's Smart Service World contest.

The MyTherapy app is available in English, German, Spanish, and other languages and can be used on iOS and Android devices. The app is free for patients. For this reason, MyTherapy's business model relies on partnerships with healthcare providers and life science organizations. MyTherapy's partners benefit from the additional support for their patients and close ties with their existing patient care initiatives and processes.
Source & Image: smartpatient gmbh


In 2010 Prof. Dr. Jürgen Margraf was the first psychologist to be awarded an Alexander von Humboldt Professorship, a prestigious international award for German academics. The professorship has enabled him to carry out several long-term research projects at the Ruhr-Universität Bochum. He founded the Mental Health Research and Treatment Center (MHRTC) at Ruhr-Universität Bochum´s Faculty of Psychology, which treats over 2000 children, adolescents and adults annually using evidence-based methods.

Prof. Dr. Margraf's work on mental health focuses on the interplay between psychological, biological, and social factors, using a combination of etiological, epidemiological and intervention research strategies. He is the author of approximately 400 publications. Prof. Dr. Margraf is a member of Leopoldina - German National Academy of Science and a fellow of the American Psychological Society.

In this interview with the GCRI, Prof. Dr. Margraf discusses some of his current research projects, including an international mental health study and a research program based on anxiety disorders. He compares the current state of depression and anxiety in North America and Germany, and predicts that the role of outpatient psychotherapy will increase in the future. Prof. Dr. Margraf also describes his research plans after his Alexander von Humboldt Professorship ends. To read the full interview, click here.

Source & Image: Ruhr-Universität Bochum

Innovation Resilience Research as an Alternative to Traditional Disease-oriented Research
Each year, more than half a billion people suffer from stress-related disorders such as anxiety, PTSD, depression, or addiction. Stress-related disorders cause enormous personal suffering and have economic and societal repercussions. Despite the efforts to investigate the pathophysiology of these disorders and develop better treatments, the number of people affected by stress-related disorders has not decreased in the past decades.

The German Research Foundation's new Collaborative Research Center (CRC), Neurobiology of Resilience, pursues an alternative approach. It investigates protective mechanisms that help people stay mentally healthy in spite of their exposure to significant stressors, including trauma, chronic adversity, major life transitions, and physical illness. Furthermore, the CRC uses this knowledge to prevent stress-related disorders before individuals suffer from significant societal and economic repercussions.

This focus on resilience rather than pathophysiology represents an effective paradigm shift in mental health research. The Collaborative Research Center, Neurobiology of Resilience, is located in the Rhine-Main Neuroscience Network in Mainz and Frankfurt. The Collaborative Research Center is closely linked with the German Resilience Center (DRZ) at Johannes Gutenberg University Mainz, which is the first center in Europe that is assembling researchers from molecular neurobiology, genetics, systems, and cognitive neuroscience as well as clinical and social sciences to focus on resilience.

The German Resilience Center currently carries out the Mainz Resilience Project (MARP), which investigates key resilience mechanisms of young adults during the challenging transition from adolescence to adulthood by closely following them over several years. The Mainz Resilience Project uses a dedicated testing battery permitting in-depth sociodemographic, psychological, (epi)genetic, microbiomic, immunological, neurobiological, and behavioral subject characterization that is repeated every 1.5 years and complemented by high-frequency sampling of stressor exposure and mental health changes.  The Collaborative Research Center, Neurobiology of Resilience, will soon launch a similar project by examining resilience in the wider population.
Source & Image: Johannes Gutenberg-Universität Mainz

BionaticCenter for Intercultural Psychiatry and Psychotherapy (ZIPP) - Research Group Transcultural Psychiatry
Escape, expulsion, and migration have occupied all spheres of German society - especially since the summer of 2015. Mental health, within the context of flight and migration, is the main focus at the Center for Intercultural Psychiatry and Psychotherapy (ZIPP) at Charité - Universitätsmedizin Berlin.

The three pillars of ZIPP are care, research, and education. The Ethnopsychiatric Outpatient Clinic is responsible for care. The multidisciplinary team consists of psychiatrists, psychologists, ethnologists, social workers, nurses, as well as linguistic and cultural interpreters. The multicultural team employs ethnopsychiatric and ethnopsychoanalytic approaches to integrate patients from various sociocultural backgrounds into regular care based on concepts of the "intercultural opening." The German concept "intercultural opening" is an approach to facilitate migrants' access to the health care system and to improve the care they receive.

Since 2015, in addition to ZIPP's regular single and group therapy, the Ethnopsychiatric Outpatient Clinic has created an acute ward for refugees with mental health problems who need to communicate in Arabic, Farsi, or English. Furthermore, ZIPP implemented two new group therapeutical offers for Arabic-speaking refugees - one for women and one for men.

ZIPP's research is closely interlinked with the Berlin Institute for Empirical Integration and Migration Research (BIM) at the Humboldt University of Berlin, through its Migration, Mental Health and Health Promotion Unit. The combination of natural scientific and humanities-oriented approaches as well as quantitative and qualitative methods provides the basis for critical reflection and adequate research in this field. A main goal is the transfer of research insights into the provision of appropriate care models. 

Since 2016, ZIPP established three new projects, focusing on network intensification, education, supervision, and the evaluation of psychosocial care approaches for refugees. 
Source: Center for Intercultural Psychiatry and Psychotherapy (ZIPP)

Image: Claudia Neuhaus