Zeitschrift Fur Die Gesamte Neurologie Und Psychiatrie最新文献

{"title":"Leitliniengerechte Diagnostik und Therapie der ADHS im Erwachsenenalter","authors":"Ann-Kristin Hörsting","doi":"10.1055/s-0038-1672306","DOIUrl":"https://doi.org/10.1055/s-0038-1672306","url":null,"abstract":"Zusammenfassung ADHS ist eine häufige chronische psychiatrische Erkrankung, die sich klinisch sehr heterogen mit hoher Symptompersistenz präsentiert. Unbehandelt entwickelt bis zu 80% der Betroffenen zumindest eine weitere psychiatrische Erkrankung. Wichtig ist eine gute Diagnostik, die eine (Familien-)Anamnese, die Erhebung von Schweregrad, Frequenz und Chronizität der Symptome sowie die Auswirkungen auf die Lebensqualität und die Funktion in verschiedenen Lebensbereichen (Arbeitsplatz, häusliches und soziales Umfeld etc.) einschließt. Eine leitliniengerechte multimodale Therapie umfasst neben der Medikation auch psychosoziale und psychotherapeutische Interventionen. Zur medikamentösen Behandlung bei erwachsenen ADHS Patienten empfehlen die Leitlinien Methylphenidat als Medikament der ersten Wahl. Summary ADHD is a frequently occurring chronic psychiatric disorder whose presentation is very heterogeneous with a high degree of symptom persistence. Without adequate treatment, up to 80% of patients will develop one or more psychiatric comorbidities. An extensive and correct diagnostic process is very important. This should include the patients` and family history, a good documentation of frequency and grade of symptom severity, the impact on quality of life and the functional impairment in different areas of life (workplace, social and family environment). The guideline based therapy is multimodal and requires medical treatment combined with psychotherapy or psychosocial interventions. According to the guidelines, the first-line pharmacotherapy for adults with ADHD is methylphenidat.","PeriodicalId":49348,"journal":{"name":"Zeitschrift Fur Die Gesamte Neurologie Und Psychiatrie","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72851517","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Behandlungsoptionen bei Depression Therapieresistente Depressionen","authors":"P. Grampp","doi":"10.1055/s-0038-1669706","DOIUrl":"https://doi.org/10.1055/s-0038-1669706","url":null,"abstract":"Depressionen gehören nicht nur zu den sogenannten Volkskrankheiten, sondern stehen sogar an erster Stelle der psychiatrischen Erkrankungen (1). Aktuelle Krankenstandsdaten für Deutschland bestätigen: die Anzahl der Fehltage erhöhte sich zwischen 2011 und 2015 um 41% (2). Welche Folgen dieser Entwicklung in der täglichen Praxis zu beobachten sind und welche therapeutischen Möglichkeiten bei therapieresistenten Depressionen bestehen, berichtete Dr. med. Peter Grampp, Wermsdorf.","PeriodicalId":49348,"journal":{"name":"Zeitschrift Fur Die Gesamte Neurologie Und Psychiatrie","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90629193","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Aus Forschung und Industrie","authors":"","doi":"10.1055/s-0038-1669708","DOIUrl":"https://doi.org/10.1055/s-0038-1669708","url":null,"abstract":"In einem von Hexal unterstützten Symposium betonten Suchtmediziner, dass eine optimale Substitutionstherapie neben einem engen therapeutischen Netzwerk auch profunde Kenntnisse über Wechselwirkungen mit anderen Medikamenten und mit illegalen Drogen erfordert. Während die Arzneimittelwechselwirkungen der Substitutionstherapeutika Methadon (Methaddict®, Methaliq®) sowie Buprenorphin (Buprenaddict®) bekannt sind, gibt es hinsichtlich der Interaktionen insbesondere mit neuen psychoaktiven Substanzen noch deutliche Erkenntnislücken. Was die Schadenspotenziale illegaler Drogen und deren Beitrag zu drogenassoziierten Todesfällen angehe, stünden in Deutschland Heroin, Crack und Crystal Meth bzw. Kokain im Vordergrund, betonte der Suchtmediziner Stephan Walcher, Schwerpunktpraxis CONCEPT in München: „Die Substitutionspräparate spielen nur eine untergeordnete Rolle, aber wir müssen der Tatsache, dass das gefährliche Substanzen sind, trotzdem eingedenk sein.“ Welches Substitutionsmedikament im Einzelfall eingesetzt werden sollte, hängt vom individuellen Patienten ab. Viele Patienten benötigen einen Vollagonisten am Opiatrezeptor und sind dann mit Methadon als Tablette, als Lösung oder in Form von Levomethadon am besten bedient. Kombinierte Agonisten/Antagonisten wie Buprenorphin haben, wenn sie eingesetzt werden können, Vorteile durch ein geringeres Missbrauchspotenzial. So werde Buprenorphin von Süchtigen so gut wie gar nicht mit Vollagonisten wie Heroin kombiniert. Der Suchtmediziner Chaim Jellinek von der Ambulanz für integrierte Drogenhilfe (aid) Berlin betonte, dass Buprenorphin im Hinblick auf die Risiken durch Beigebrauch das sicherere Medikament sei: „In der Praxis sehen wir aber meist Patienten, die bereits substitutionserfahren sind, und viele dieser Patienten bestehen auf Vollagonisten.“ Für den Arzt sei die Herausforderung, die individuelle substitutionsgestützte Suchttherapie engmaschig zu begleiten und dabei nicht nur Opioid-Beigebrauch, sondern möglichst auch Beigebrauch von neuen psychoaktiven Substanzen (NPS)","PeriodicalId":49348,"journal":{"name":"Zeitschrift Fur Die Gesamte Neurologie Und Psychiatrie","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87717005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Der Einfluss kurzzeitigen und länger anhaltenden Stresses sowie einer verhaltenstherapeutischen Intervention auf die Ticsymptomatik","authors":"B. Bodmer, J. Buse, V. Rössner","doi":"10.1055/s-0038-1672303","DOIUrl":"https://doi.org/10.1055/s-0038-1672303","url":null,"abstract":"Zusammenfassung Hintergrund: Die Ticsymptomatik unterliegt einem physiologischen, unregelmäßigen und individuellen Schwankungsverlauf. Weiterhin werden Tics durch u.a. psychosozialen Stress moduliert, welcher ein Prädiktor für die zukünftige Entwicklung der Ticsymptomatik zu sein scheint. Interessanterweise zeigen Patienten mit einer Ticstörung (TS) im Vergleich zu gesunden Menschen eine erhöhte Anzahl an belastenden Lebensereignissen mit berichteten erhöhten Stressleveln. Außerdem scheinen Patienten mit TS physiologische Veränderungen in der Stressantwort zu zeigen. Methode: Um den Einfluss einzelner belastender Lebensereignisse mit psychosozialem Stress auf die Ticsymptomatik bei Kindern und Jugendlichen zu untersuchen, wurden in einer experimentellen Studie der Forschungsgruppe um Prof. Veit Rößner physiologische Parameter mit einer standardisierten Methode erhoben und mit einer objektiven Erfassung von Tics kombiniert. Psychosozialer Stress wurde mit dem Trier Social Stress Test (TSST) erzeugt. Ergebnis: Dabei zeigten die Patienten mit TS erhöhte Werte im Speichelcortisol, der Herzrate und der Hautleitfähigkeit während einer Stressbedingung. In der Stressbedingung wurden jedoch entgegen der Erwartung weniger Tics als in einer Entspannungs- und Konzentrationsbedingung beobachtet. Diese Erkenntnisse sind auch für verhaltenstherapeutische Behandlungsmöglichkeiten von Ticstörungen (z.B. CBIT) bedeutsam, da Stress Einfluss auf den Behandlungserfolg haben kann. Summary Background: The fluctuation of tics underlies a natural, irregular and individual process. Thereby it seems that constant psychosocial stress functions as a predictor of the future development of tics. Corresponding, patients with tic disorder compared to healthy people perceived an increased number of short stressful life events with subjectively evaluated increased stress levels and an altered physiological stress response. Method: To examine the influence of a stressful live event on the tic severity, the research group of Prof. Veit Rößner conducted an experimental study in children and adolescents. This included a combination of different physiological parameters, a standardized method and an objective detection of tics. Psychosocial stress was generated with the Trier Social Stress Test (TSST). Result: The minors showed elevated cortisol concentration in the saliva, heart rate and skin conductance during the stress condition but less tics than in a concentration and relaxation condition. These insights of stress depending effects of tic severity are achieved in treatments like CBIT, because the parallel use of psychoeducation and relaxation techniques improves the treatment outcome. This is linked with reduced stress levels.","PeriodicalId":49348,"journal":{"name":"Zeitschrift Fur Die Gesamte Neurologie Und Psychiatrie","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86377785","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Psychopharmaka 2016 – eine kritische Bestandsanalyse","authors":"T. Bschor","doi":"10.1055/s-0038-1672300","DOIUrl":"https://doi.org/10.1055/s-0038-1672300","url":null,"abstract":"Zusammenfassung Hintergrund: Psychopharmaka sind zentraler Bestandteil psychiatrischer Therapie. Zugleich ist ihre Wirkung oft unspezifisch und begrenzt. Antidepressiva haben hohe Non-Responder-Raten und zu lange Wirklatenzen, und nur ein kleiner Teil bipolar erkrankter Patienten kann über mehrere Jahre mit der gleichen Monotherapie behandelt werden. Ernüchternd sind die unter 15% liegenden Raten von Patienten mit Schizophrenie, die neben einer klinischen auch eine sozial-funktionelle Genesung (Recovery) erreichen. Neuroleptika scheinen hierauf keinen positiven Einfluss zu haben. So gibt es großen Bedarf für psychopharmakologische Verbesserungen. Ergebnis: Basis der heutigen Psychopharmaka sind die bahnbrechenden Entdeckungen im Gründerjahrzehnt (1949-1960), nach dem es nur noch geringe Weiterentwicklungen gab. Aus dem Gründerjahrzehnt können Lehren gezogen werden, was Fortschritt befördert: einfache, klinische Fragestellungen; Wagemut und aufmerksame Beobachtung; stärkere Förderung industrieunabhängiger klinischer, und nicht einseitig hoch technisierter biologischer Forschung; exakte Diagnostik anhand von Psychopathologie und Anamnese. Summary Background: Psychotropic medications are a core component of psychiatric therapy. However, often their effects are limited and rather unspecific. Antidepressants have high nonresponse rates and a long latency of onset. Only a small part of bipolar patients can be treated with the same monotherapy over several years. And rates of patients with schizophrenia who achieve a full clinical as well as social-functional recovery are below 15% - a very sobering result. Antipsychotics do not seem to have a positive influence on this rate. Therefore, there is great need for psychopharmacological improvements. Result: The basis of today’s psychotropic drugs are the revolutionary developments of the founders’ decade (1949-1960). Since that decade only small improvements have been made. There are lessons to be learned from the founders’ decade on factors supporting psychopharmacological progress: straightforward, clinical questions; boldness and attentive observation; promotion of industry-independent research, which is clinically oriented rather than being overly technical/biological in nature; exact diagnosis making on the basis of psychopathology and anamnesis.","PeriodicalId":49348,"journal":{"name":"Zeitschrift Fur Die Gesamte Neurologie Und Psychiatrie","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79823800","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Aetiopathological mechanisms of negative symptoms in schizophrenia","authors":"S. Galderisi, F. Caputo, G. Giordano, A. Mucci","doi":"10.1055/s-0038-1669683","DOIUrl":"https://doi.org/10.1055/s-0038-1669683","url":null,"abstract":"Summary Background: Negative symptoms represent core features of schizophrenia and have an unfavorable impact on the disease outcome. Unfortunately, their aetiopathology has not been elucidated yet and the effectiveness of available treatments is not satisfactory. Aims: This review aims to provide a critical overview of research findings concerning negative symptom aetiopathology, highlighting limitations and future perspectives. Results: Enduring and transient negative symptoms, as well as motivation-related and expression-related domains of negative symptoms, have different risk factors and clinical correlates, and are associated to distinct brain abnormalities. Enduring negative symptoms seem to be related to subtle, pervasive deviations in neurodevelopmental trajectories. Expression deficit, as compared with avolition, shows a stronger association with neurological soft signs, cognitive impairment and diffuse disconnectivity. Avolition/apathy is a multifaceted construct probably related to deficits of reward and action valuation and instrumental learning, subtended by cortico-striatal dysfunctions. Conclusions: Research findings support the heterogeneity of negative symptoms and are likely to pave the way for the discovery of more effective treatments.","PeriodicalId":49348,"journal":{"name":"Zeitschrift Fur Die Gesamte Neurologie Und Psychiatrie","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80357399","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unipolare Depression. Neue Erkenntnisse und Therapieansätze verbessern die Prognose","authors":"A. Ameri","doi":"10.1055/s-0038-1672293","DOIUrl":"https://doi.org/10.1055/s-0038-1672293","url":null,"abstract":"","PeriodicalId":49348,"journal":{"name":"Zeitschrift Fur Die Gesamte Neurologie Und Psychiatrie","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85652399","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"“Bridging Gaps – Improving Outcomes”: Problem domains in schizophrenia research, treatment and policy","authors":"V. Toeller, W. Wölwer, W. Gaebel","doi":"10.1055/s-0038-1669682","DOIUrl":"https://doi.org/10.1055/s-0038-1669682","url":null,"abstract":"Summary Background: The provision of mental healthcare for patients with schizophrenia is still characterized both by knowledge gaps and by treatment gaps in everyday clinical practice. Aim: This article discusses the different types of treatment gaps in schizophrenia and describes actions taken to overcome these gaps especially in Europe.","PeriodicalId":49348,"journal":{"name":"Zeitschrift Fur Die Gesamte Neurologie Und Psychiatrie","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88109217","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Which routes should psychopharmacological treatment research take in schizophrenia?","authors":"K. Wiedemann, M. Friede, C. von der Goltz","doi":"10.1055/s-0038-1672290","DOIUrl":"https://doi.org/10.1055/s-0038-1672290","url":null,"abstract":"There is evidence that suggests that families often play an important role in the recovery of people with mental health problems. (3) and that family interventions can have a positive impact on service user outcomes, for example, rehospitalisation rates and adherence with medication (1, 4). Family members and supporters report poor access to general information about mental ill health and limited information regarding the wellbeing and treatment of their loved one (3). They believe that their voice often goes unheard even when the actions of the health services directly impacts on the family and supporter. This is particularly apparent at critical times such as admission and discharge from hospital. In addition, the trauma and challenge of supporting a person who experiences mental ill health can often be detrimental to the wellbeing and mental health of the individual supporter and the wider family for whom there may be limited information or supports. All professionals working in mental health services are bound by law and their professional codes of practice to maintain strict confidentiality between themselves and those who use their service. The rights of the individual to his or her privacy and integrity is both recognised and respected within this document. Families and supporters do not want or need to know personal details. They are often the primary supporter of a loved one, particularly at times of crisis and they want and need to know what they can do to support their family member’s recovery in a constructive way. There is growing recognition of the impact of supporting a person with mental illness on the family and supporters (3), and the need for a response that is inclusive of everyone’s needs. The importance of the support offered by the family/supporter and their need for support to be able to perform this role is also recognised within this document. In summary research on the needs of families should focus on the key themes outlined in this document. Such research should be participative and designed to inform improved service provision from the perspective of family members.","PeriodicalId":49348,"journal":{"name":"Zeitschrift Fur Die Gesamte Neurologie Und Psychiatrie","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82527652","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early medication discontinuation in first episode schizophrenia – beneficial or risky?","authors":"W. Gaebel, L. Wunderink, M. Riesbeck","doi":"10.1055/s-0038-1672284","DOIUrl":"https://doi.org/10.1055/s-0038-1672284","url":null,"abstract":"Summary Background: After acute treatment of a first episode in schizophrenia, continued antipsychotic maintenance treatment (MT) is effective regarding (positive) symptom remission and relapse prevention. Nevertheless, due to unwanted effects patients and clinicians sooner or later are faced with the decision to continue or discontinue antipsychotics. Evidence indicates that risk for relapse or symptom recurrence is 2- to 5-times higher after personalized dose-reduction (PDR) or complete drug discontinuation, even if early intervention in case of early warning signs of relapse is applied. Method: A recent 7-year follow up of an 18 months RCT comparing MT with PDR however, revealed advantages of PDR regarding functional outcome and recovery. Although only one study with its specific characteristics limits generalization, the findings have newly fueled the debate whether early drug discontinuation-strategies have more risks or benefits. Result: The paper discusses the pros and cons of early drug discontinuation-strategies, in particular of PDR, after a first episode in schizophrenia and summarizes the empirical evidence to support patients and clinicians in this essential treatment decision.","PeriodicalId":49348,"journal":{"name":"Zeitschrift Fur Die Gesamte Neurologie Und Psychiatrie","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81802976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}