Christian Imboden

Purpose: Trazodone is metabolized by CYP3A4 to the active metabolite meta-chlorophenylpiperazine (mCPP), which is associated with various adverse drug reactions (ADRs). mCPP is further inactivated by CYP2D6. Despite the knowledge of trazodone metabolism, the evidence regarding the impact of pharmacogenetics remains limited. This study aimed to examine the association between pharmacogenetic variants in genes involved in the metabolism of trazodone and the occurrence of ADRs during trazodone treatment. Methods: We performed an explorative observational study using available data and serum samples from 2 ongoing pharmacogenetic studies. For patients treated with trazodone, we analyzed information on trazodone tolerability, genetic variants in CYP2D6, CYP3A5, and ABCB1 , as well as co-medications to assess potential drug-drug-gene interactions (phenoconversion). Serum levels of mCPP and trazodone were measured in a subset of patients. Results: Data from 98 patients were analyzed. Reduced CYP2D6 activity was associated with an increased risk of ADRs during trazodone therapy. After accounting for phenoconversion and adjusting for sex, trazodone dose, and CYP3A5 phenotype, CYP2D6 poor metabolizers were found to be more likely to develop ADRs compared with normal metabolizers (OR: 8.96; 95% CI=1.67-48.08). No association with ADRs was found for genetic variants in CYP3A5 and ABCB1 . Subgroup analysis revealed that reduced CYP2D6 activity was associated with a higher mCPP-to-trazodone ratio and a greater tendency for ADRs. Conclusions: Our findings suggest that mCPP could contribute to trazodone-related ADRs, especially in individuals with reduced CYP2D6 metabolism. Larger clinical studies are needed to confirm that CYP2D6 genotyping could contribute to preventing ADRs in clinical practice.

This qualitative study investigated non-doping-related substance use among Swiss elite para-athletes, an area with limited existing research. Through in-depth semi-structured interviews conducted at the beginning of 2023 with 15 elite para-athletes (N=15) from diverse sports and language regions, the study explores athletes' perceptions and experiences of substance use, including both legal (alcohol, nicotine, supplements, medications) and illegal non-doping-related substances (illicit drugs). Overall, interviewed para-athletes reported low levels of non-doping-related substance use, but with differences related to on/off-season, sports, or time of the entrance in professional sports. The findings indicate a complex relationship between non-doping-related substance use and para-sports, highlighting both negative impacts on athletic performance and health, and the role of non-doping-related substances in coping with physical pain and stress. Professionalization and doping controls are seen to reduce non-doping-related substance use, promoting healthier lifestyles and heightened awareness of performance and health. The study underscored the need for comprehensive mental and physical health support systems and enhanced educational resources to address substance use within this vulnerable population. The insights gained aim to inform targeted interventions to support the health and well-being of para-athletes, contributing positively to their sporting careers and overall quality of life.

Introduction: Physical activity (PA) shows beneficial effects for various mental illnesses, but exercise-prescription has not yet become routine practice in psychiatry. Therefore, this survey addresses attitudes and barriers towards exercise-prescription in health professionals. Methods: We conducted an anonymous online survey among health professionals on the importance of PA in prevention and treatment of mental illness and perceived barriers as part of a larger survey on sports psychiatry. The survey was promoted by societies for sports psychiatry. Results: N = 310 health professionals from Switzerland (86.5%) and other countries responded to the online survey. Sixty percent were physicians (51.1% psychiatrists). Most respondents strongly agreed that PA plays an important role in prevention and treatment of mental (80.2%, 69.8%) and physical (84.5%, 72.0%) illness. Forty-six percent use PA in prevention and 59.4% in treatment of mental illness with lower proportions for physical illness (39.5%, 36.2%). Most mentioned barriers to the use of PA were “insufficient possibilities” in psychiatric institutions (34.8%) and “no reimbursement” (41.9%) in private practice. Participants working in private practice rated barriers in practice significantly higher than those from other workplaces. “No motivation” was found to be the most common barrier for patients (56.5%). PA was used most often for depression (39.5%) followed by substance use disorders (32.1%) and anxiety disorders (30.9%). Conclusions: Health professionals in Switzerland and some extent other European countries show a positive attitude towards the use of PA in mental illness. Current barriers, especially reimbursement in private practice should be addressed to improve prescription-rates of PA.

Introduction: The aim of this study is to provide an overview of Paralympic athletes’ views on mental health in a competitive sport context. Although research in the field of Paralympic sport has increased exponentially over the last two decades, mental health and its promotion have hardly been the subject of research so far. Previous research shows that the practice of competitive sports influences the mental health of Paralympic athletes both positively and negatively. Mental disorders are no exception, even in elite sports. Well-coordinated health care for the prevention and treatment of mental health challenges and mental disorders in elite sports is crucial for this purpose. Methods: The methodological approach of the present study is based on a qualitative research design. The data was collected through semi-structured interviews and their evaluation with the help of applied thematic analysis. For the interviews, 15 active, adult, Swiss elite Para athletes were recruited. Results: The results suggest that athletic success, the athletic activity itself and an improvement in physical health can lead to an increase in mental well-being. On the other hand, athletic failure, pressure to perform, and physical problems can cause psychological stress and facilitate mental disorders. Conclusion: In particular, the coordinated handling of mental health challenges and mental disorders among Paralympic athletes seems to need improvement, especially regarding the use of sports psychiatry and psychotherapy services.

Major depressive disorder (MDD) is an increasingly common psychiatric illness associated with a high risk of insufficient physical activity, which in turn is associated with negative mental and physical health outcomes. Theory-based, individually tailored, in-person and remote physical activity counseling has the potential to increase physical activity levels in various populations. Given this, the present study investigated the effect of such a physical activity intervention on the physical activity behavior of in-patients with MDD. This was a multi-center, two-arm randomized controlled trial including initially insufficiently physically active adult in-patients with MDD from four study sites in Switzerland. The sample consisted of 220 participants (M_age = 41 ± 12.6 years, 52% women), 113 of whom were randomized to the intervention group and 107 to the control group. The main outcome, moderate-to-vigorous physical activity (MVPA), was assessed at three time points via hip-worn accelerometer. According to accelerometer measures, there was no significant difference in minutes spent in MVPA over a 12-month intervention period when comparing the intervention with the control group (β = −1.02, 95% CI = −10.68 to 8.64). Higher baseline physical activity significantly predicted physical activity at post and follow-up. This study showed that it is feasible to deliver an individually tailored, theory-based physical activity counseling intervention to in-patients with MDD, however yielding no significant effects on accelerometer-based MVPA levels. Further efforts are warranted to identify efficacious approaches.Trial registration: ISRCTN, ISRCTN10469580, registered on 3rd September 2018, https://www.isrctn.com/ISRCTN10469580.

Introduction The aim of this study is to provide an overview of Paralympic athletes’ views on mental health in a competitive sport context. Although research in the field of Paralympic sport has increased exponentially over the last two decades, mental health and its promotion have hardly been the subject of research so far (Claussen et al., 2022). Previous research shows that the practice of competitive sports influences the mental health of Paralympic athletes both positively and negatively (Swartz et al., 2019). Mental disorders are no exception, even in elite sports. Well-coordinated health care for the prevention and treatment of mental health challenges and mental disorders in elite sports is crucial for this purpose. Methods The methodological approach of the present study is based on a qualitative research design. The data was collected through semi-structured interviews and their evaluation with the help of applied thematic analysis (Guest et al., 2012). For the interviews, 15 active, adult, Swiss elite Para athletes were recruited. Results The results suggest that athletic success, the athletic activity itself and an improvement in physical health can lead to an increase in mental well-being. On the other hand, athletic failure, pressure to perform, and physical problems can cause psychological stress and facilitate mental disorders. (Lüdi et al., 2023). Conclusion In particular, the coordinated handling of mental health challenges and mental disorders among Paralympic athletes seems to need improvement, especially regarding the use of sports psychiatry and psychotherapy services. References Claussen, M. C., Imboden, C., Raas, M. I., Hemmeter, U., Seifritz, E., & Hofmann, C. G. (2022). Sportpsychiatrie und -psychotherapie im Leistungssport – Interdisziplinäre und interprofessionelle Versorgung und Zusammenarbeit [Sports psychiatry in competitive sports – Interdisciplinary and interprofessional care and collaboration]. Praxis, 111(4), 213-219. https://doi.org/10.1024/1661-8157/a003849 Guest, G., MacQueen, K., & Namey, E. (2012). Applied Thematic Analysis. SAGE. https://doi.org/10.4135/9781483384436 Lüdi, L., Pfarrwaller, G., Imboden, C., Stoffel, O., Schlüssel, M., Heiniger, A., Kleim, B., & Kiselev, N. (2023). Perspectives on mental health and well-being: Voices of Swiss paralympic athletes. Sports Psychiatry: Journal of Sports and Exercise Psychiatry. Advance online publication. https://doi.org/10.1024/2674-0052/a000057 Swartz, L., Hunt, X., Bantjes, J., Hainline, B., & Reardon, C. L. (2019). Mental health symptoms and disorders in Paralympic athletes: A narrative review. British Journal of Sports Medicine, 53(12), 737-740. https://doi.org/10.1136/bjsports-2019-100731

Objective The scientific studies on the mental health and substance use among elite para-athletes are rare (Lardi et al., in preparation; Lüdi et al., 2023). However, the shows similarities as well as differences to the regular elite athletes’ populations (Rice et al., 2016; Swartz et al., 2019). The aim of this study was to investigate the mental health and substance use of para-athletes (PAs) from their perspective, in order to gain an overview of the situation in elite para-sport and to potentially create a basis for prevention campaigns and, if necessary, interventions. Methodology An online survey (SoSciSurvey) was used to create a questionnaire, which was translated into eight languages to reach PAs internationally. In addition to socio-demographic and sports-specific (Para-Sport, PS) variables, psychological and physical factors, as well as substance use, were assessed using standardized instruments. Results (CAVE: at the time at submission preliminary since the survey ends by the end of November/The final results will be presented at the congress): The PAs (N = 82) showed different prevalences regarding mental disorders compared to data from the general population and regular elite athletes, with disorder-specific deviations. There were significant gender differences in psychological distress (K-10, p < .001), depression severity (PHQ-9, p < .001), and anxiety severity (GAD-7, p < .001). The majority of PAs reported good or very good mental (69.51%) and physical (64.63%) health, and these results significantly correlated (p < .001) with a strong effect size. PAs were more likely to disclose and seek support in professional than in private settings. 51.22% of the PAs felt disadvantaged in everyday life, and in PS, it was 29.27%. The BA and K-10 did not correlate significantly (p > .05), but there was a significant correlation (p < .001) between discrimination in PS and the K-10. The results of discrimination in everyday life and in PS both significantly correlated with the WHODAS-12 (p < .01, and p < .001), with a weak and moderate effect size, respectively. Regarding substance use, 41.46% of PAs reported alcohol, 7.32% nicotine, and 8.54% cannabis use. The AUDIT-C did not significantly correlate with the K-10 or the WHODAS-12 (p > .05), and there was no significant gender difference (AUDIT-C, p > .05). Conclusions Based on the results, prevention should occur in the disorder-specific area and refer to the professional services, social support, focusing more on discrimination, and include substance use (alcohol and cannabis). It is important to consider that PAs are a vulnerable population and research gaps still exist. References Lardi, M., Kiselev, N., Imboden, C., Stoffel, O., Heiniger, A., & Schaub, M. (in preparation). Unveiling the shadows - Substance use among para-athletes: A qualitative study with Swiss elite para-athletes. Lüdi, L., Pfarrwaller, G., Imboden, C., Stoffel, O., Schlüssel, M., Heiniger, A., Kleim, B., & Kiselev, N. (2023). Perspectives on mental health and well-being: Voices of Swiss paralympic athletes. Sports Psychiatry: Journal of Sports and Exercise Psychiatry. Advance online publication. https://doi.org/10.1024/2674-0052/a000057 Rice, S. M., Purcell, R., De Silva, S., Mawren, D., McGorry, P. D., & Parker, A. G. (2016). The mental health of elite athletes: A narrative systematic review. Sports Medicine, 46, 1333-1353. https://doi.org/10.1007/s40279-016-0492-2 Swartz, L., Hunt, X., Bantjes, J., Hainline, B., & Reardon, C. L. (2019). Mental health symptoms and disorders in Paralympic athletes: A narrative review. British Journal of Sports Medicine, 53(12), 737-740. https://doi.org/10.1136/bjsports-2019-100731

Background Despite the growth of para-sport, little research has been conducted on psychotropic substance use among Swiss elite para-athletes (McDuff et al., 2019; Rice et al., 2016; Weber et al., 2022). This study is among the first to explore this under-researched area, focusing on athletes’ perceptions and mental health concerns related to substance use. Methodology Adopting a qualitative research design, this study conducted semi-structured interviews with fifteen (N = 15) active Swiss adult elite para-athletes from nine different summer and winter sports. Thematic analysis was employed to interpret the interview data, focusing on athletes' perceptions and experiences related to substance use (Guest et al., 2012). Findings On the one hand, an increase in athletic level and professionalisation seem to leave little room for the use of substances that could be detrimental to athletic performance. On the other hand, the results suggest that stress, negative emotions, physical pain, and a background of substance use may be positively associated with substance use in elite para-athletes (Lardi et al., in preparation). Conclusion The findings suggest a need for targeted interventions and support systems within athletic federations. Proposed measures include the development of comprehensive prevention strategies, regulatory frameworks, and treatment programs tailored to the unique needs of para-athletes. This study contributes valuable insights into substance use among Swiss elite para-athletes, advocating for specialized interventions to support athlete well-being. References Guest, G., MacQueen, K., & Namey, E. (2012). Applied Thematic Analysis. SAGE. https://doi.org/10.4135/9781483384436 Lardi, M., Kiselev, N., Imboden, C., Stoffel, O., Heiniger, A., & Schaub, M. (in preparation). Unveiling the shadows - Substance use among para-athletes: A qualitative study with Swiss elite para-athletes. McDuff, D., Stull, T., Castaldelli-Maia, J. M., Hitchcock, M. E., Hainline, B., & Reardon, C. L. (2019). Recreational and ergogenic substance use and substance use disorders in elite athletes: A narrative review. British Journal of Sports Medicine, 53(12), 754-760. https://doi.org/10.1136/bjsports-2019-100669 Rice, S. M., Purcell, R., De Silva, S., Mawren, D., McGorry, P. D., & Parker, A. G. (2016). The mental health of elite athletes: A narrative systematic review. Sports Medicine, 46, 1333-1353. https://doi.org/10.1007/s40279-016-0492-2 Weber, K., Patterson, L. B., & Blank, C. (2022). Doping in disabled elite sport: Perceptions, knowledge and opinions from the perspective of German and UK coaches. Psychology of Sport and Exercise, 62, Article 102233. https://doi.org/10.1016/j.psychsport.2022.102233