Fortschritte Der Neurologie Psychiatrie最新文献

{"title":"Post-Epileptic Ischemic Stroke (PEIS): pathophysiological conditions of ischemic stroke events due to epileptic seizures.","authors":"Andreas Posa, Ole Hensel, Walter Alexander Wohlgemuth, Gumash Babayeva, Malte Erich Kornhuber","doi":"10.1055/a-2816-4615","DOIUrl":"10.1055/a-2816-4615","url":null,"abstract":"<p><strong>Abstract: </strong>The most common cause of epileptic seizures in adults over the age of 60 is cerebrovascular disease, such as stroke. Although there are many studies of epilepsy after stroke, there are few data on the reverse causality (Post-Epileptic Ischemic Stroke, PEIS). Interestingly, in this constellation, sometimes no correlating vascular abnormalities can be identified as the hemodynamic cause for the ischemic stroke. We review the pathophysiological mechanisms of PEIS and highlight the diagnostic and therapeutic relevance of PEIS for daily clinical practice to raise clinical awareness of such events.</p>","PeriodicalId":12353,"journal":{"name":"Fortschritte Der Neurologie Psychiatrie","volume":" ","pages":"190-192"},"PeriodicalIF":0.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147347540","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":"[Ketamine and esketamine in treatment-resistant depression - Pharmacological effects and augmented psychotherapy].","authors":"Cornelius Schüle, Anna Sobieraj, Helena Rogg","doi":"10.1055/a-2742-4611","DOIUrl":"10.1055/a-2742-4611","url":null,"abstract":"<p><strong>Abstract: </strong>Esketamine is an NMDA receptor antagonist and was approved as a nasal spray in March 2019, initially in the USA and then in December 2019 in Europe, as an adjunct to antidepressant pharmacotherapy for the treatment of treatment-resistant major depression or for rapid symptom reduction in psychiatric emergency situations in patients with major depression. In addition, esketamine nasal spray was approved in the United States, but not in Europe, as a monotherapy for the treatment of treatment-resistant depression in January 2025. Particularly at the beginning of a series of acute treatments with esketamine nasal spray (usually 8 treatments over 4 weeks), dissociative effects may occur in the treated patient, although a connection between initial dissociative symptoms and the therapeutic response in the further course cannot be sufficiently proven based on the currently available data. One methodological problem with studies on the antidepressant efficacy of ketamine (racemate) or esketamine (levorotatory enantiomer) is functional unblinding, in which the practitioner and the patient being treated can guess whether they belong to the verum or placebo group due to the characteristic side effects of esketamine. Proponents of ketamine-augmented psychotherapy (KAP) postulate that the rapid improvement in synaptic plasticity induced by ketamine, particularly in pathways to the prefrontal cortex, opens a 'therapeutic window' in which psychotherapeutic intervention is particularly effective. Due to the functional unblinding that cannot be ruled out when ketamine itself is administered, but especially due to the considerable general methodological limitations of psychotherapy studies (no possibility of blinding the practitioner and the patient being treated, problems in finding suitable control conditions, difficulties in empirically verifying complex therapy manuals), it is hardly possible with the currently available research methods to scientifically investigate potential causal relationships between ketamine administration and presumed improved psychotherapeutic efficacy.</p>","PeriodicalId":12353,"journal":{"name":"Fortschritte Der Neurologie Psychiatrie","volume":"94 5","pages":"193-207"},"PeriodicalIF":0.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147927608","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":"Ten years of maintenance treatment of severe melancholic depression in an adult woman including discontinuation experiences.","authors":"Udo Bonnet","doi":"10.1055/a-2332-6107","DOIUrl":"10.1055/a-2332-6107","url":null,"abstract":"<p><strong>Abstract: </strong>BACKGROUND: There are only few publications on long-term treatments for major depressive disorder (MDD) lasting 5 years or longer. Most clinical controlled trials lasted no longer than 2 years and some recent studies suggested an advantage of cognitive behavioral therapy (CBT) over antidepressants in relapse prevention of MDD.</p><p><strong>Abstract: </strong>METHODS: Exclusively outpatient \"real world\" treatment of severe melancholia, prospectively documented over 10 years with different serial treatment strategies, discontinuation phenomena and complications.</p><p><strong>Abstract: </strong>METHODS: Compared to CBT, agomelatine, mirtazapine, bupropion and high-dose milnacipran, high-dose venlafaxine (extended-release form, XR) was effective, even sustainably. Asymptomatic premature ventricular contractions (PVCs) were found at the beginning of the treatment of the MDD, which initially led to the discontinuation of high-dose venlafaxine (300 mg daily). Even the various treatment strategies mentioned above were unable to compensate for or prevent the subsequent severe deterioration in MDD (2 rebounds, 1 recurrence). Only the renewed use of high-dose venlafaxine was successful. PVC no longer occurred and the treatment was also well tolerated over the years, with venlafaxine serum levels at times exceeding 5 times the recommended upper therapeutic reference level (known bupropion-venlafaxine interaction, otherwise 2.5 to 3-fold increase with high-dose venlafaxine alone). During dose reduction or after gradual discontinuation of high-dose venlafaxine, rather mild withdrawal symptoms occurred, but as described above, also two severe rebounds and one severe recurrence happened.</p><p><strong>Abstract: </strong>DISCUSSION: This long-term observation supports critical reflections on the discontinuation of successful long-term treatment with antidepressants in severe MDD, even if it should be under \"the protection\" of CBT. The PVC seemed to be more related to the duration of the severe major depressive episode than to the venlafaxine treatment itself. A particular prospective observation of this longitudinal case study is that relapses (in the sense of rebounds) during or after previous venlafaxine tapering seemed to herald the recurrence after complete recovery. Remarkably, neither relapses nor recurrence could be prevented by CBT.</p><p><strong>Abstract: </strong>CONCLUSION: In this case, high-dose venlafaxine has a particular relapse-preventive (and \"recurrence-preventive\") effect with good long-term tolerability.</p>","PeriodicalId":12353,"journal":{"name":"Fortschritte Der Neurologie Psychiatrie","volume":" ","pages":"177-185"},"PeriodicalIF":0.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141431760","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":"[Long-term treatment of severe depression].","authors":"Christoph Mulert","doi":"10.1055/a-2836-5296","DOIUrl":"https://doi.org/10.1055/a-2836-5296","url":null,"abstract":"","PeriodicalId":12353,"journal":{"name":"Fortschritte Der Neurologie Psychiatrie","volume":"94 5","pages":"176"},"PeriodicalIF":0.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147927819","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 the intensive care unit to a new home: Case report on the complex treatment and reintegration of a patient with intellectual disability and autism spectrum disorder].","authors":"Lioba Grünfelder, Christiane Sandbote, Bernd Schönhofer, Tanja Sappok","doi":"10.1055/a-2816-4684","DOIUrl":"10.1055/a-2816-4684","url":null,"abstract":"<p><strong>Abstract: </strong>This case study illustrates the vulnerability of individuals with intellectual developmental disorders and autism spectrum disorders to crisis situations and severe, life-threatening complications that can arise from the loss of primary caregivers and changes in their environment. With time and a tightly knit network of dedicated caregivers and a multidisciplinary professional team, the patient was accompanied through the serious illness, successfully treated, and ultimately discharged to a new home in order to participate in life once again.</p>","PeriodicalId":12353,"journal":{"name":"Fortschritte Der Neurologie Psychiatrie","volume":"94 5","pages":"186-189"},"PeriodicalIF":0.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147927578","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":"[Evaluation of a Peer Support Concept for Coping with Distressing Events].","authors":"Torsten Alexander Piendl, Pamela Lippl, Lena Hirschi, Sabrina Birke, Chaimae ElHammadi, Johannes Hamann","doi":"10.1055/a-2816-4200","DOIUrl":"https://doi.org/10.1055/a-2816-4200","url":null,"abstract":"<p><strong>Abstract: </strong>Emotionally stressful events are part of everyday working life for employees of psychiatric clinics and are risk factors for stress syndromes. At the Mainkofen District Hospital, a specially trained team (SkN - System of Collegial Aftercare) supports employees coping with such incidents. Experiences with the SkN team were evaluated as part of an anonymized online survey. Significant differences were found between individual professional groups and hospital departments in terms of information and previous experience with SkN. Among the respondents, 58% had already experienced stressful events, and more than a quarter reacted with moderate to severe psychological complaints. Around 28% had made use oft the SkN service. Satisfaction with the support experienced was very high. The feedback underlines the importance of prompt and low-threshold support services following emotionally stressful events, even for employees with a great deal of previous professional expertise.</p>","PeriodicalId":12353,"journal":{"name":"Fortschritte Der Neurologie Psychiatrie","volume":" ","pages":""},"PeriodicalIF":0.6,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147812915","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 Closeness and Distance: A New Instrument Proves Its Value in Forensic Psychiatry Practice].","authors":"Susanne Stübner, Christian Güldenpfennig, Martina Weig, Michael Schwarz","doi":"10.1055/a-2846-4342","DOIUrl":"https://doi.org/10.1055/a-2846-4342","url":null,"abstract":"<p><strong>Abstract: </strong>Professional proximity is considered an important component and prerequisite for a working alliance between practitioners and patients in therapeutic contexts. Professional distance is protected by professional and criminal law in therapeutic relationships due to specific vulnerabilities and hierarchical constellations, which is why particular attention must be paid to this. In the forensic context, additional protection requirements of the clienteles and sovereign tasks of the institutions such as ensuring security require even greater attention. It is therefore essential to always focus on maintaining a balance. For this reason, a seminar on the topic of \"Professional closeness and distance in dealing with patients in forensic psychiatry\" was introduced in 2020 at the forensic hospital at the Ansbach District Hospital (Bavaria, Germany) and has been held on an ongoing basis. In the meantime, the offer has also been extended to the Center for Inpatient Forensic Therapy Rheinau, University Hospital of Psychiatry Zurich (Switzerland). All employees from all professional groups are requested to participate at least once. As a quality assurance measure, the seminar serves to impart legal, psychiatric and psychological principles as well as to encourage self-reflection and development of sensitivity for the topic. Clinical experience shows that a de-tabooing has taken place and that a better balance has been achieved among professional groups and at various hierarchical levels. Transparency within the forensic hospital has increased. More attention is paid to the topic when new employees are being trained. Problems are discussed more openly. Various graduated intervention options can be used. A quantitative evaluation cannot yet be referred to in this case; detailed qualitative reports would also only be possible with broader application to ensure reliable anonymity. This report should therefore be understood as a first step toward a new discussion: according to current clinical impression, the instrument has proved its worth in practice.</p>","PeriodicalId":12353,"journal":{"name":"Fortschritte Der Neurologie Psychiatrie","volume":" ","pages":""},"PeriodicalIF":0.6,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147812927","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":"[Self-realization and existential psychotherapy].","authors":"Georg Juckel, Paraskevi Mavrogiorgou","doi":"10.1055/a-2844-5439","DOIUrl":"https://doi.org/10.1055/a-2844-5439","url":null,"abstract":"<p><strong>Abstract: </strong>The hypothesis is explored that today's ideas of self-realization usually remain superficial and do not meet the real expectations of the individual in all their interests if they do not include the concepts of transience and finiteness of life and the possibility of coping with them through e.g., the dialogical power of love. People with mental disorders in particular need reliable concepts and stable relationships with fellow human beings, both of which can be experienced and learned in current forms of existential psychotherapy of May and Yalom in confrontation with basic conflicts such as death, freedom, loneliness, senselessness.</p>","PeriodicalId":12353,"journal":{"name":"Fortschritte Der Neurologie Psychiatrie","volume":" ","pages":""},"PeriodicalIF":0.6,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147766989","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":"[The positive Mozart effect on people with epilepsy: Is there some truth in this claim?]","authors":"Johannes Rösche","doi":"10.1055/a-2366-6948","DOIUrl":"10.1055/a-2366-6948","url":null,"abstract":"<p><p>The positive treatment effect of Mozart's melody on patients with epilepsy, which was propagated in the late 1990s, was investigated in 29 papers. Commonly, the first movement of the sonata for two pianos KV 448 was played with many repetitions. At least a fifth of the patients achieved a reduction of seizure frequency of more than 50%. Patients with epileptic discharges from the occipital lobe responded very rarely. The mechanism of the effect is not clear, but the melodic aspects seem to have a significant role in this context.</p>","PeriodicalId":12353,"journal":{"name":"Fortschritte Der Neurologie Psychiatrie","volume":" ","pages":"141-148"},"PeriodicalIF":0.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142004001","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":"[Developments in Psychiatric Care from 2005 to 2022: A Retrospective, Longitudinal Analysis of Hospital Data on 110,996 Inpatient Cases].","authors":"Nils Diogo Nellessen, Olaf Bick, Evgeny Chula, Aleksandr Rakitin, Adieb Hazzan, Juraj Kukolja, Eugen Davids","doi":"10.1055/a-2600-3518","DOIUrl":"10.1055/a-2600-3518","url":null,"abstract":"<p><p>The prevalence of mental disorders is 27.8% among the adult population in Germany. Although psychiatric clinics play a central role in the care of these patients, the extensive, digitally collected routine data are rarely systematically evaluated. This study characterises the patient population of a large psychiatric clinic and analyses constants as well as developments in inpatient psychiatric care over an 18-year period.The retrospective analysis was based on longitudinal data from the hospital information system of the Evangelische Stiftung Tannenhof, which operates psychiatric clinics in urban regions of the Bergisches Land. Anonymised data from 110,996 fully inpatient cases from the years 2005 to 2022 were included in the analysis. The study examined demographic characteristics, length of stay, psychiatric main discharge diagnoses, somatic comorbidities, and the development of prescribed medications.The gender ratio and age structure of the patients remained largely constant over the entire period. Diagnostically, there was a slight increase in psychotic disorders and organic psychiatric disorders, while substance use disorders slightly decreased. A significant increase was observed in somatic comorbidities and the number of prescribed medications, with somatic medication increasing disproportionately compared to psychiatric medication. The COVID-19 pandemic led to a significant increase in Z-diagnoses, indicating a need for action from a somatic perspective.The retrospective data analysis showed that demographic characteristics and diagnostic patterns remained largely stable. Meanwhile, the complexity of medication and the number of somatic comorbidities increased. These developments emphasise the growing need for expertise in both somatic and psychiatric medication in clinical practice. Significant short-term changes in the data across the entire clinic only occurred during major events, namely the integration of a new larger addiction clinic and the COVID-19 pandemic. The results underscore the value of routine data in optimising care strategies in inpatient psychiatry.</p>","PeriodicalId":12353,"journal":{"name":"Fortschritte Der Neurologie Psychiatrie","volume":" ","pages":"132-139"},"PeriodicalIF":0.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144505313","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}