Fortschritte Der Neurologie Psychiatrie最新文献

{"title":"[Pharmacological management of attention-deficit/hyperactivity disorders (ADHD) by generalists and specialists in Germany: a secondary data analysis].","authors":"Thomas Grimmsmann, Wolfgang Himmel","doi":"10.1055/a-2317-0470","DOIUrl":"10.1055/a-2317-0470","url":null,"abstract":"<p><strong>Background: </strong>Attention-deficit/hyperactivity disorder (ADHD) is one of the most common mental health disorders among children, and it is rapidly surging among adults as well. The aim of this study was to investigate the role of community neurologists and psychiatrists as well as general practitioners and paediatricians in prescribing ADHD medications in Germany and whether their role has changed over the 10-year period from 2008 and 2018.</p><p><strong>Methods: </strong>In this secondary analysis of anonymized prescribing data, we calculated the absolute and relative frequencies of ADHD prescriptions by neurologists and psychiatrists, summarized as specialists, and family physicians and paediatricians, summarized as generalists, and how it has changed during the years 2008 to 2018.</p><p><strong>Results: </strong>A total of 620 practices delivered data on 77,504 patients diagnosed with ADHD, 38% (29,396/77,504) of them had received a prescription for ADHD medicine at least once in the study period. Over time, we observed a shift from generalists to specialists. While 59% of patients received their prescription from a generalist and 41% from a specialist in 2008, there was reverse in the ratio in 2018: only 37% received their medication from a generalist and the vast majority (63%) from a specialist. This trend was particularly evident among adults: 58% of them received their ADHD medication from a specialist in 2008, but 80% in 2018. The proportion of children and adolescents who received their prescriptions from a specialist rose from 38% to 51% over the same period.</p><p><strong>Conclusion: </strong>There is a shift in drug prescription away from generalists to specialists, without any discussion of advantages or disadvantages so far. However, this would be desirable, not least because specialists alone may not have sufficient resources to care for all ADHD patients.</p>","PeriodicalId":12353,"journal":{"name":"Fortschritte Der Neurologie Psychiatrie","volume":" ","pages":"395-402"},"PeriodicalIF":0.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12488264/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141310484","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Intrajejunal levodopa in Parkinson's disease: Optimization of PEG application].","authors":"Karl-Ernst Grund, Annette Zipfel, Wolfgang H Jost","doi":"10.1055/a-2337-3433","DOIUrl":"10.1055/a-2337-3433","url":null,"abstract":"<p><p>The various forms of Percutaneous Endoscopic Gastrostomy (PEG) are highly relevant in neurology, as pump-administered intrajejunal levodopa application is one of the indispensable forms of therapy in advanced Parkinson's disease. Optimal PEG placement and follow-up are therefore significant for the success of the therapy. However, the standard intrajejunal administration of levodopa gel via a JET-PEG, i. e. a PEG with an internal catheter inserted into the jejunum, is not without problems for various reasons. In particular, the considerable cumulative complication rates demand a reconsideration of the situation. The very limited absorption area of the drug in the region of the flexura duodenojejunalis must also be taken into account. Causes of complications are predominantly a non-optimal application technique of PEG and internal catheter as well as the frequent lack of an adequate follow-up. In this paper, the details of a modified and optimized application technique compared to the conventional techniques are presented. These new methods have proved their usefulness in clinical applications for years, and additionally a new application form, the Hybrid-PEG, is presented. However, many of the details derived from anatomical/physiological, surgical and endoscopic aspects must be strictly observed during the application in order to reduce or avoid minor and major complications. In particular, problems are caused by local infections in the area of the insertion point of the PEG including peritonitis, leaks and buried bumper syndrome (BBS). The relatively frequent dislocations of the internal catheter also prove to be particularly troublesome. These can ultimately be avoided by clip fixation of the catheter tip down in the jejunum. In particular, the use of the newly developed Hybrid-PEG, a combination of endoscopically controlled gastropexy with three sutures and subsequent central thread-pull-through of the PEG tube, can significantly reduce the complication rate and thus achieve a decisive improvement for patients. The aspects discussed here are highly relevant for all those involved in the therapy of advanced Parkinson's disease. Trustful interdisciplinary collaboration between neurology and endoscopy/surgery/gastroenterology is a prerequisite for good clinical outcomes.</p>","PeriodicalId":12353,"journal":{"name":"Fortschritte Der Neurologie Psychiatrie","volume":" ","pages":"403-415"},"PeriodicalIF":0.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12488263/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141497601","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Mental disorders in epilepsy].","authors":"Norbert Bohnert, Peter Martin","doi":"10.1055/a-2586-7859","DOIUrl":"https://doi.org/10.1055/a-2586-7859","url":null,"abstract":"<p><p>Mental disorders frequently occur in patients with epilepsy. Their description, diagnosis and treatment play a central and increasingly important role in epileptology. Work has also been underway for some time to systematically investigate and classify the mental disorders that can occur in connection with epilepsy.Despite great efforts, much in this field is still vague and in the process of being developed.Translated with DeepL.com (free version).</p>","PeriodicalId":12353,"journal":{"name":"Fortschritte Der Neurologie Psychiatrie","volume":"93 10","pages":"416-431"},"PeriodicalIF":0.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145206009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Between health hazards and therapeutic hope: On the proper handling of psychotropic substances].","authors":"Klosterkötter Joachim, Kuhn Jens","doi":"10.1055/a-2684-7419","DOIUrl":"https://doi.org/10.1055/a-2684-7419","url":null,"abstract":"","PeriodicalId":12353,"journal":{"name":"Fortschritte Der Neurologie Psychiatrie","volume":"93 10","pages":"392-394"},"PeriodicalIF":0.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145205923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Can psychedelics be of therapeutic use?]","authors":"Claudia Sommer","doi":"10.1055/a-2652-4403","DOIUrl":"https://doi.org/10.1055/a-2652-4403","url":null,"abstract":"","PeriodicalId":12353,"journal":{"name":"Fortschritte Der Neurologie Psychiatrie","volume":"93 9","pages":"341-342"},"PeriodicalIF":0.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145033018","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Psychopharmacotherapy with the MAO-inhibitor Tranylcypromine Key Aspects and Trends in Theory and Practice].","authors":"Sven Ulrich, Ute Lewitzka","doi":"10.1055/a-2182-5365","DOIUrl":"10.1055/a-2182-5365","url":null,"abstract":"<p><p>The irreversible monoamine oxidase inhibitor tranylcypromine has been known as an antidepressant drug for more than 60 years. The aim of this review was to make an assessment of the state of the art and therapy of tranylcypromine. The recent medical-scientific literature is analyzed and discussed with respect to key aspects of and general trends in practical psychopharmacotherapy. Meta-analyses of controlled clinical studies have shown that tranylcypromine is an established approach to treatment-resistant depression. Doses (maximum dose, maintenance dose) are increasingly adapted to the requirements of treatment-resistant depression. Monoamine oxidase is not only the primary pharmacological target of tranylcypromine but determines for the first doses also the pharmacokinetics of tranylcypromine because monoamine oxidase is also an enantioselective drug-metabolizing enzyme of the monoamine oxidase inhibitor. An increased diversity of the antidepressant pharmacotherapy suggests the need to rethink the continuing assessment of tranylcypromine as a therapeutic \"ultima ratio\" in depression. In conclusion, tranylcypromine as a drug of second choice remains a valuable option in antidepressant treatment. Criteria of a switch from other antidepressant drugs to tranylcypromine should be better defined.</p>","PeriodicalId":12353,"journal":{"name":"Fortschritte Der Neurologie Psychiatrie","volume":" ","pages":"352-363"},"PeriodicalIF":0.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12422799/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138290713","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Vertigo and dizziness in the emergency department - Update on differential diagnosis and treatment].","authors":"Ken Möhwald, Filipp Filippopulos, Andreas Zwergal","doi":"10.1055/a-2566-2439","DOIUrl":"https://doi.org/10.1055/a-2566-2439","url":null,"abstract":"","PeriodicalId":12353,"journal":{"name":"Fortschritte Der Neurologie Psychiatrie","volume":"93 9","pages":"364-378"},"PeriodicalIF":0.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145032999","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Psychedelics in psychiatry: an open debate].","authors":"Uwe Herwig, Knut Schnell, Jörg Daumann, Andrea Jungaberle, Gabriele Koller, Lea Julia Mertens, Stefan Borgwardt","doi":"10.1055/a-2453-0910","DOIUrl":"10.1055/a-2453-0910","url":null,"abstract":"<p><p>The application of psychedelics in psychiatry and psychotherapy is increasingly the subject of scientific evaluation and discussion in national and international professional and general society, and, internationally, has already been partly applied in the clinical setting. The manuscript provides a basic description of the state of the art regarding evidence and clinical issues; law, ethics and economics are addressed; therapeutic qualification of potential users and a potentially clinical embedding in psychiatry are discussed, taking into consideration current challenges. Thus, the discussion will cover the circumstances under which the application of psychedelics might have a potential to broaden the spectrum of treatments in certain psychiatric conditions, particularly in the context of chronicity and treatment resistance to current methods. However, basic and critical issues have to be clarified before eventual implementation.</p>","PeriodicalId":12353,"journal":{"name":"Fortschritte Der Neurologie Psychiatrie","volume":" ","pages":"343-351"},"PeriodicalIF":0.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142817611","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[From stroke via swollen joints to M. Whipple: case report from neurological rehabilitation and review of literature].","authors":"Hilke Weichert, Ina Kötter, Oliver Pade","doi":"10.1055/a-2662-1621","DOIUrl":"https://doi.org/10.1055/a-2662-1621","url":null,"abstract":"<p><p>Whipple's disease is a rare systemic disease caused by a chronic infection with Tropheryma whipplei, which can often only be diagnosed years after the first symptoms appear. The symptoms are varied and sometimes unspecific. In addition to cachexia, recurrent joint swelling and abdominal complaints, neurological symptoms with dementia, myoclonus and motor neuron disease also occur. In the reported case, symptoms such as joint swelling and spasms of the legs occurred during neurological rehabilitation following a paramedian pons infarction. The close collaboration between the neurological rehabilitation physicians and rheumatology colleagues made it possible to diagnose Whipple's disease. Guideline-compliant treatment with ceftriaxone followed by sulfamethoxazole-trimethoprim was initiated. This improved the joint effusions and, surprisingly, also the spasms of the legs within a few days.</p>","PeriodicalId":12353,"journal":{"name":"Fortschritte Der Neurologie Psychiatrie","volume":" ","pages":""},"PeriodicalIF":0.6,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144948294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Disastrous conditions: Forensic Psychiatry in Eastern Germany - The 'Haus 213' in Berlin-Buch].","authors":"Rainer Erices","doi":"10.1055/a-2643-5711","DOIUrl":"https://doi.org/10.1055/a-2643-5711","url":null,"abstract":"<p><p>This article analyzes the little-examined forensic psychiatry in the GDR after the enactment of the Criminal Code of 1968. Using files from the Berlin State Archive, the Federal Archive and the Stasi Records Archive, it traces the historical development of the forensic psychiatric clinic in Berlin-Buch, \"Haus 213\".Like other closed psychiatric clinics, House 213 suffered from overcrowding, inadequate security measures and increasingly catastrophic structural conditions until the end of the GDR. After the 1968 reform and the abolition of the GDR's \"Maßregelvollzug\", it took years before the prescribed diagnostic criteria for the admission of patients were fundamentally implemented. Leading doctors at the clinic constantly criticized the therapeutic possibilities. The Police (Deutsche Volkspolizei) and State Security ('Stasi') criticized the high number of patient escapes. Extensive plans to renovate the clinic were not implemented. There were no consistent concepts and the patients lived in disastrous conditions. Those responsible were aware that both the state and the SED were failing to provide psychiatric care for offenders. The Stasi used the Berlin-Buch clinic for forensic psychiatric assessments and maintained close working relationships with House 213. Senior doctors worked as Stasi informers.It is clear that the political, economic and institutional framework conditions had a considerable influence on the possibilities of forensic psychiatry in the GDR. The deficiencies in structural equipment and staffing, as well as the interference of the State Security, raise fundamental questions about the role and responsibility of the state in the care of mentally ill offenders. Future research should focus more on the analysis of forensic psychiatric clinics and their specific treatment concepts or options. This would also appear useful in order to provide differentiated answers to questions about the possible misuse of psychiatry or forensic psychiatric assessment in the context of political criminal proceedings.</p>","PeriodicalId":12353,"journal":{"name":"Fortschritte Der Neurologie Psychiatrie","volume":" ","pages":""},"PeriodicalIF":0.6,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144648973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}