Zeitschrift Fur Die Gesamte Neurologie Und Psychiatrie最新文献

{"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":"30 1","pages":"118 - 120"},"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":"36 1","pages":"162 - 163"},"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":"11 1","pages":"136 - 144"},"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}

{"title":"Schizophrenie","authors":"W. Gaebel","doi":"10.1055/s-0038-1669680","DOIUrl":"https://doi.org/10.1055/s-0038-1669680","url":null,"abstract":"","PeriodicalId":49348,"journal":{"name":"Zeitschrift Fur Die Gesamte Neurologie Und Psychiatrie","volume":"40 1","pages":"115 - 116"},"PeriodicalIF":0.0,"publicationDate":"2016-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80542744","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":"Brain stimulation methods for patients with schizophrenia – new therapies on the horizon?","authors":"A. Hasan, U. Palm, F. Padberg, T. Wobrock","doi":"10.1055/s-0038-1672285","DOIUrl":"https://doi.org/10.1055/s-0038-1672285","url":null,"abstract":"Summary Background: Non-invasive brain stimulation (NIBS) techniques offer new promising treatment options in schizophrenia. However, the evidence from meta-analyses and randomized clinical studies is limited. Results: For repetitive transcranial magnetic stimulation (rTMS) the clinical efficacy is highest for the 1-Hz rTMS over the left temporal cortex to improve auditory hallucinations, nevertheless there are studies showing no benefit. For negative symptoms rTMS could be offered keeping in mind the good tolerability. Transcranial direct current stimulation (tDCS) has a good risk-benefit ratio, but the evidence for schizophrenia symptoms is still derived from small sample studies. Electroconvulsive therapy (ECT) is the treatment option with the highest clinical efficacy for treatment-resistant schizophrenia, catatonia or other defined treatment circumstances, but has more adverse side effects. More research is needed to understand which stimulation technique could be recommended for a certain patient.","PeriodicalId":49348,"journal":{"name":"Zeitschrift Fur Die Gesamte Neurologie Und Psychiatrie","volume":"38 1","pages":"145 - 151"},"PeriodicalIF":0.0,"publicationDate":"2016-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90046238","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":"Improving outcomes: Factors influencing help-seeking behaviors in immigrants and ethnic minorities with first-episode psychosis","authors":"I. Melle, A. Berg, K. Leopold, S. Zarafonitis-Müller, M. Nerhus, L. Stouten, A. Bechdolf","doi":"10.1055/s-0038-1672286","DOIUrl":"https://doi.org/10.1055/s-0038-1672286","url":null,"abstract":"Summary Background: Immigrants have increased risk of a poor recovery from first episode psychosis (FEP). Early treatment can improve prognosis, but having an immigrant background may influence pathways to care. Method: We present research of service use and factors influencing treatment outcome in immigrants with FEP. Service use was assessed in in-patients at an early intervention center in Berlin, Germany. Duration of untreated psychosis and beliefs about illness was assessed in a FEP study in Oslo, Norway and cognitive functioning in patients with FEP schizophrenia from the regular mental health services in The Hague, the Netherlands. The proportion of immigrants in Berlin and Oslo was at level with the local populations, while the proportion in The Hague appeared to be higher. Result: There were clear indications that mental health literacy, probably based in different cultural expectations, were lower in first generation immigrants (FGI). Findings regarding clinical insight were ambiguous. There were also indications that FGI had more cognitive problems, based in higher stress levels or in cognitive styles. Early psychosis services must take issues of immigration and ethnicity into consideration.","PeriodicalId":49348,"journal":{"name":"Zeitschrift Fur Die Gesamte Neurologie Und Psychiatrie","volume":"55 1","pages":"152 - 157"},"PeriodicalIF":0.0,"publicationDate":"2016-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90692484","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":"The ROAMER project – future directions and their implementation","authors":"Stefano R Belli, T. Wykes, J. Haro","doi":"10.1055/s-0038-1672288","DOIUrl":"https://doi.org/10.1055/s-0038-1672288","url":null,"abstract":"4. It will be important to perform studies that help to identify the scope of eMental health interventions in the delivery of psychosocial interventions. A recent EPA guidance paper on eMental health interventions has presented a number of recommendations (2). It will be important to establish the scope of eMental health in fields such as, e.g., psychoeducation, self-help, peer support and illness management. 5. There are good reasons to monitor the effects of guideline recommendations on psychosocial interventions on both process (clinician/ team behavior) and patient outcomes. Current evidence suggests that the desired (process and patient) outcome effects of guideline implementation cannot be taken for granted, and thus, researchers in the field should strive for rigorous testing of individual measures and programmes implementing guidelines in routine care.","PeriodicalId":49348,"journal":{"name":"Zeitschrift Fur Die Gesamte Neurologie Und Psychiatrie","volume":"57 1","pages":"159 - 161"},"PeriodicalIF":0.0,"publicationDate":"2016-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81281313","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-0038-1672294","DOIUrl":"https://doi.org/10.1055/s-0038-1672294","url":null,"abstract":"","PeriodicalId":49348,"journal":{"name":"Zeitschrift Fur Die Gesamte Neurologie Und Psychiatrie","volume":"11 1","pages":"176 - 176"},"PeriodicalIF":0.0,"publicationDate":"2016-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87518863","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":"Predictors and mechanisms of conversion to psychosis","authors":"Tyrone D. Cannon","doi":"10.1055/s-0038-1672283","DOIUrl":"https://doi.org/10.1055/s-0038-1672283","url":null,"abstract":"Summary Background: Identifying predictors and elucidating mechanisms underlying onset of psychosis are critical for the development of preventive interventions. Methods: This paper reviews findings on risk prediction algorithms and potential mechanisms of onset in youth at clinical high-risk for psychosis. Results: An independently validated individualized risk calculator is available that incorporates risk factors from clinical, demographic, neurocognitive, and psychosocial assessments to predict likelihood of conversion to psychosis among individuals who meet criteria for a prodromal risk syndrome. At risk individuals who convert to psychosis show a steeper rate of gray matter reduction, most prominent in prefrontal cortex, compared with those who do not. Higher levels of pro-inflammatory cytokines at baseline predicted the accelerated reduction in prefrontal gray matter. These same markers are associated with microglial-mediated synaptic pruning and dendritic retraction in animal models. Conclusions: Processes that modulate microglial activation, such as dysregulated immune function and deficient synaptic plasticity, may represent convergent mechanisms that influence brain dysconnectivity and risk for onset of psychosis.","PeriodicalId":49348,"journal":{"name":"Zeitschrift Fur Die Gesamte Neurologie Und Psychiatrie","volume":"38 1","pages":"130 - 135"},"PeriodicalIF":0.0,"publicationDate":"2016-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81935928","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":"Where should we put the focus of schizophrenia research in the next five years?","authors":"T. Becker, U. Gühne, K. Stengler, S. Riedel-Heller","doi":"10.1055/S-0038-1672287","DOIUrl":"https://doi.org/10.1055/S-0038-1672287","url":null,"abstract":"Die Psychiatrie 2016; 13: 158–159 P et al. (6) have argued in a recent editorial, that there is a false belief that psychotherapy is a psychosocial treatment whereas pharmacotherapy is a biological treatment. The authors argued that this assertion is not held out by cognitive neuroscience which suggests that both work on neurocognitive processes corresponding to complex functional disturbance and mental illness symptoms. In that perspective, future research to clarify treatment effects would have to combine biological, neurocognitive, imaging and social parameters with the ultimate aim of building effective systems of care. In a recent debate, Kendall et al. (3) have taken issue with an editorial that commented on the 2014 NICE guideline on psychosis and schizophrenia, compared it with its equivalent 2013 Scottish guideline and retained that the NICE guideline was biased towards psychosocial treatments and against drug treatments. In response to that critique, Kendall et al. (3) argued that, in fact, the NICE guideline had more rigorous methodology than the Scottish guideline, and that the authors of the editorial appeared to have succumbed to bias themselves. This suggests that the issue of weighing the evidence on pharmacological and psychosocial interventions is complex and may be contentious. Therefore, valid methods of weighing the evidence and of translating guideline recommendations into mental health care practice should be prioritized. In this comment, the following five specific topics are considered of importance in moving the field forward: 1. The case of supported employment (SE) in getting people with schizophrenia into competitive employment has been eloquently put in recent years by authors from the United States, and there is accruing evidence from other countries in support of this intervention that aims at direct labor market integration for people with psychosis who seek work and are offered ongoing support by both SE workers and community mental health teams. There have been recent efforts at weighing the evidence (Kinoshita et al. 2013). The focus, in research, should continue to be on rigorous testing in non-US settings and on identifying barriers to implementation in European labor market and mental health settings. 2. There is a shortage of high-quality research on how best to provide adequate housing to people with schizophrenia. The case of supported housing (SH) is eloquently put by studies such as the At Home/ Chez Soi project in Canada (http://www.mentalhealthcommis sion.ca/English/system/files/private/document/ mhcc_at_home_report_national_cross-site_eng_2.pdf), and there is substantial implementation and research interest of SH-type models outside North America. Supported housing, a model combining a normal tenant role, focus on client control, social inclusion and in vivo learning with flexible community services and support should be tested in European settings. This would help move ahead in an area of research t","PeriodicalId":49348,"journal":{"name":"Zeitschrift Fur Die Gesamte Neurologie Und Psychiatrie","volume":"137 1","pages":"158 - 159"},"PeriodicalIF":0.0,"publicationDate":"2016-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80391891","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}