Nervenarzt最新文献

{"title":"[Genetic Variation in the CYP2D6 and CYP2C19 Genes: Relevance for the Treatment of Depression].","authors":"Maike Scherf-Clavel, Heike Weber, Chantal Hampf, Stefan Unterecker, Daniel Müller, Sebastian Walther, Jürgen Deckert","doi":"10.1007/s00115-026-02027-5","DOIUrl":"https://doi.org/10.1007/s00115-026-02027-5","url":null,"abstract":"","PeriodicalId":49770,"journal":{"name":"Nervenarzt","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149197471","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":"[Anti-amyloid antibodies against Alzheimer's disease : Lecanemab and donanemab in practice-Clinical importance, patient selection and safety management].","authors":"Timo Jan Oberstein","doi":"10.1007/s00115-026-02024-8","DOIUrl":"https://doi.org/10.1007/s00115-026-02024-8","url":null,"abstract":"<p><p>Lecanemab and donanemab are the first disease-modifying therapies for early Alzheimer's disease. These humanized IgG1 antibodies promote the clearance of aggregated amyloid-beta peptides and, in the pivotal CLARITY AD and TRAILBLAZER-ALZ 2 trials, significantly delayed cognitive and functional decline, with an approximately 30% relative risk reduction for the clinical stage progression; however, the clinical meaningfulness remains contested: critics point to the small between-group difference in relation to the total score. This is weighed against the first disease-modifying effect and the first pharmacotherapy for mild cognitive impairment due to Alzheimer's disease. A prerequisite is the biological diagnosis: the reference standard is cerebrospinal fluid (CSF) and amyloid positron emission tomography (PET), potentially complemented in the future by blood biomarkers such as plasma p‑Tau217. Amyloid-related imaging abnormalities (ARIA) are the key adverse event, manageable through patient selection, ApoE-ε4 genotyping and magnetic resonance imaging (MRI) monitoring. The indications and follow-up belong in specialized centers.</p>","PeriodicalId":49770,"journal":{"name":"Nervenarzt","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149148587","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":"[Home(s) inside and out-Artistic self-representations by psychiatric inpatients around 1900].","authors":"T Röske, L Kluge, S Stewner, M Rotzoll","doi":"10.1007/s00115-026-02016-8","DOIUrl":"https://doi.org/10.1007/s00115-026-02016-8","url":null,"abstract":"<p><p>Around 1900, what did \"home\" mean to people who, marginalized from the rest of civil society, were permanently confined within psychiatric institutions? Where did they feel they belonged (emotionally); did memories of family, landscape and politically defined territories dominate or was it the appropriation of the institutional space? An exploration of the Heidelberg Prinzhorn Collection, a collection unique in the world, provides a multifaceted answer to these questions. The historical collection contains paintings, drawings, texts, sculptures and musical compositions by psychiatric patients from institutions in German-speaking countries dating from around 1840 to the Nazi era.An interdisciplinary research project at the intersection of art history and the history of psychiatry, based at the Heidelberg Special Research Field (SFB) 1671 \"Home(s). Phenomena-Practices-Representations\", aims to re-examine the phenomenon of institutional psychiatry from its subjective, emotional perspective by focusing on \"Home(s)\" or \"Heimat(en)\". Based on the works and other sources it explores the motives of patient artists in the context of (the search for) affiliation, taking as its starting point the situation of exclusion from conventional \"homely\" connections. The examination of their artistic strategies is also conducted on the assumption that it will enable statements to be made about notions of home and affiliation within the \"matrix\" of mainstream society from which the patient-artists originated. This essay presents the initial findings based on three examples of different historical approaches to the subject.</p>","PeriodicalId":49770,"journal":{"name":"Nervenarzt","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149117409","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":"Relevance of the negative valence system, the cognitive system, and their interactions for understanding aggression in mental disorders.","authors":"Katja Bertsch, Lisa Wagels, Corinne Neukel, Natalya Chechko, Gabriele Ende, Tomas Frodl, Michael Hanke, Christian Schmahl, Christoph W Korn","doi":"10.1007/s00115-026-02019-5","DOIUrl":"https://doi.org/10.1007/s00115-026-02019-5","url":null,"abstract":"<p><strong>Background: </strong>The Research Domain Criteria (RDoC) domains of the negative valence system (NVS) and the cognitive system (CS) offer a framework for current research on aggression. In particular, the projects of the Transregio \"Neuropsychobiology of Aggression\" (Transregional Collaborative Research Center 379, TRR 379) are grouped according to these domains.</p><p><strong>Objective of the study: </strong>The present review article describes how these domains are conceptualized and what role they play in the investigation and understanding of aggressive behavior in mental disorders and its biological correlates within the framework of TRR 379.</p><p><strong>Materials and methods: </strong>This is a qualitative review that summarizes empirical findings based on exemplary studies and selected reviews and discusses recent developments. The focus is on work that explicitly links aggression to the NVS and/or CS and on work within TRR 379.</p><p><strong>Results and discussion: </strong>Using the NVS and the CS, the projects within TRR 379 are developing a wide range of innovative, experimental setups to investigate the various aspects of aggression in a transdiagnostic manner across large samples of individuals with mental disorders, in conjunction with established paradigms and questionnaires as well as a rich repertoire of neurophysiological measures. Based on the initial results, the interdisciplinary community of TRR 379 researchers engages in intensive and critical discussions on how the various aspects of the RDoC approach, as well as other transdiagnostic approaches such as \"HiTOP\" and \"Computational Psychiatry,\" can be utilized both conceptually and methodologically for current and future projects. Early-career researchers are particularly active in this area.</p>","PeriodicalId":49770,"journal":{"name":"Nervenarzt","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149117462","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":"[Opportunities and limitations of the synergy of psychotherapeutic interventions and neuromodulation within the framework of an enhanced psychotherapy approach].","authors":"Katrin E Giel, Kathrin Schag, Beatrix Barth, Andreas J Fallgatter, Stephan Zipfel, Christian Plewnia","doi":"10.1007/s00115-026-02022-w","DOIUrl":"https://doi.org/10.1007/s00115-026-02022-w","url":null,"abstract":"<p><strong>Background: </strong>Psychotherapy is a guideline-conform treatment approach for most mental disorders. Recently, neuromodulation techniques have also become established as independent approaches in the treatment of mental disorders. The concept of \"enhanced psychotherapy\" aims to expand proven evidence-based psychotherapeutic approaches through the mechanism-oriented integration of new treatment modules; however, the combination of neuromodulation and psychotherapeutic interventions is often understood as a general enhancement. Given the heterogeneous mechanisms of action, this perspective falls short and is only limitedly supported by the evidence.</p><p><strong>Research question: </strong>This article aims to provide a conceptual clarification of mechanism-based combination approaches. Enhanced psychotherapy is defined here as a targeted, synergistic combination of psychotherapeutic interventions with neuromodulation that promotes adaptive plasticity in specific neural networks.</p><p><strong>Conclusion: </strong>Particularly promising are the combination of transcranial direct current stimulation (tDCS) with cognitive training paradigms and the principle of target engagement in repetitive transcranial magnetic stimulation (rTMS), although the evidence remains heterogeneous. The targeted use of complementary mechanisms of action rather than nonspecific combinations is crucial. This combination model should be further developed on a disorder-specific basis to improve the clinical application.</p>","PeriodicalId":49770,"journal":{"name":"Nervenarzt","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149117395","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":"[CYP2D6 inhibition by bupropion during tamoxifen treatment-Successful switch to desvenlafaxine].","authors":"Andreas Philipp Eckert","doi":"10.1007/s00115-026-02020-y","DOIUrl":"https://doi.org/10.1007/s00115-026-02020-y","url":null,"abstract":"","PeriodicalId":49770,"journal":{"name":"Nervenarzt","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149076303","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":"[Modular acute psychotherapy-Background, concept and implications for psychiatric and psychotherapeutic training : A consensus paper of the German Society for Psychiatry and Psychotherapy, Psychosomatics and Neurology (DGPPN)].","authors":"Andreas Bechdolf, Anja Lehmann, Hendrik Müller, Katharina Kubera, Sabine C Herpertz","doi":"10.1007/s00115-026-02025-7","DOIUrl":"https://doi.org/10.1007/s00115-026-02025-7","url":null,"abstract":"<p><strong>Background: </strong>The application of disorder-specific psychotherapy often requires a minimum level of joint treatment, clarification of goals and a therapeutic alliance. In acute psychiatric treatment these prerequisites are not always initially present: admissions can be unplanned or involuntary, diagnostic classification can be uncertain and shared goals and a viable therapeutic alliance first need to be established.</p><p><strong>Objective: </strong>The modular acute psychotherapy (MAPT) is presented as an integrative psychotherapeutic concept for the specific requirements of acute psychiatric treatment and its implications for psychiatric and psychotherapeutic training are discussed.</p><p><strong>Material and methods: </strong>The MAPT integrates concepts from different psychotherapeutic approaches and psychiatric care models into a transdiagnostic interprofessional and modular framework for therapeutic decision-making and interventions.</p><p><strong>Results: </strong>The MAPT distinguishes three dynamic treatment foci: risk of self-harm, risk of harm to others and threats to the therapeutic process. The selection of defined interventions is supported by four modules: risk reduction, access to subjective experience, motivation enhancement and the development of a shared understanding of the problem. Therapeutic relationship building provides the overarching foundation. Clinicians continuously evaluate and adapt the treatment focus and interventions.</p><p><strong>Conclusion: </strong>The MAPT provides a framework for decision and treatment concepts for psychotherapy in acute psychiatric treatment. In this respect psychotherapy is not understood as a downstream component but as a therapeutic perspective on admission. As a shared framework for therapeutic thinking and action it can also support psychotherapeutic learning, interprofessional collaboration and clinical supervision.</p>","PeriodicalId":49770,"journal":{"name":"Nervenarzt","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149041458","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":"[Inpatient treatment of substance use disorders : Structures and treatment strategies: results of a nationwide survey of treatment facilities].","authors":"Mandy Roy, Aljosha Deen, Jason Porsch, Daniel Bader, Stefan Schöneberger, Peter Strate","doi":"10.1007/s00115-026-02014-w","DOIUrl":"https://doi.org/10.1007/s00115-026-02014-w","url":null,"abstract":"<p><strong>Background: </strong>Systematic data on the implementation of key elements of inpatient treatment for substance use disorders in Germany are still limited.</p><p><strong>Objective: </strong>To systematically assess inpatient care practices with a focus on pharmacological strategies, relapse management, temporal aspects of (qualified) withdrawal treatment, and the management of psychiatric comorbidities, as well as differences between acute care and rehabilitation settings and regional variations.</p><p><strong>Materials and methods: </strong>Nationwide, anonymized online survey of 500 inpatient facilities (acute care and rehabilitation clinics). Structural characteristics, treatment strategies, and organizational aspects were assessed. Data were analyzed descriptively and inferentially (χ² test/Fisher's exact test).</p><p><strong>Results: </strong>A total of 112 facilities participated (68 acute care and 44 rehabilitation clinics). Treatment services covered a broad range of substances. Evidence-based pharmacotherapy for alcohol-related disorders was often not initiated or continued, particularly in rehabilitation settings. Access for patients receiving opioid substitution treatment was limited in these settings. Relapses were frequently managed on an individualized and motivation-based basis; however, in cases of repeated unreported relapse, treatment was often terminated. Temporal aspects of qualified withdrawal treatment varied considerably, with regional differences. Psychiatric comorbidities were widely addressed.</p><p><strong>Conclusion: </strong>Care practices are heterogeneous, with relevant deviations from evidence-based recommendations, particularly regarding pharmacological strategies and access for specific patient groups. There is a need for more consistently evidence-based and patient-centered inpatient treatment approaches.</p>","PeriodicalId":49770,"journal":{"name":"Nervenarzt","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149018626","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":"[Psychopharmacological treatment of mentally ill offenders : A sample survey of forensic psychiatric patients admitted to two forensic psychiatric facilities in Hesse].","authors":"N Erlacher, B Eusterschulte, S Krimmer, C Culmsee, M Hahn","doi":"10.1007/s00115-026-02015-9","DOIUrl":"https://doi.org/10.1007/s00115-026-02015-9","url":null,"abstract":"<p><strong>Background: </strong>Many studies on psychopharmacological treatments in general psychiatric care exist, but only few are addressing the psychopharmacological treatment of mentally ill offenders.</p><p><strong>Study design: </strong>A sample survey was conducted at the Vitos Forensic Psychiatric Hospitals Gießen and Haina. Demographic, forensic, and pharmacological data were collected (nondigital patient files). All current inpatients were included. The primary objective of the study was a description of the pharmacological care of forensic patients.</p><p><strong>Results: </strong>Data from 416 forensic psychiatric patients were analyzed. More than half of the patients (55.05%) obtained psychopharmacological polypharmacy (use of ≥ 2 psychotropic drugs), the majority of which resulted from antipsychotic polypharmacy (37.7%). The most commonly combined agents were two second generation antipsychotics. Among the antipsychotics, olanzapine was prescribed most frequently (17.8%) and used in most cases (19/34) at off-label dosages. Clozapine was combined most often (11.5%) with other psychotropic drugs.</p><p><strong>Conclusion: </strong>The therapeutic advantage of combinations of psychotropic drugs compared to monotherapy is not sufficiently supported by clinical evidence. The therapeutic advantage of combination therapies compared with monotherapy is not sufficiently established for psychopharmacotherapy in general, and for antipsychotic treatment in particular. However, the high prevalence of psychopharmacological polypharmacy in this study reflects routine clinical practice in forensic psychiatry. Further analyses are meaningful to evaluate specific substance combinations in terms of drug safety and off-label use.</p>","PeriodicalId":49770,"journal":{"name":"Nervenarzt","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149018557","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":"[Nonpatient-related tasks in psychiatric hospitals : Results of a multicentre survey with real-time validation].","authors":"Johannes Gabriel, Georg Juckel","doi":"10.1007/s00115-026-02017-7","DOIUrl":"https://doi.org/10.1007/s00115-026-02017-7","url":null,"abstract":"<p><strong>Background: </strong>Hospital staff have complained for years that documentation and administrative duties consume a large share of working time. Profession-wide data on clinical psychiatry are scarce.</p><p><strong>Objective: </strong>To quantify time spent on patient-distant tasks in psychiatric hospitals by category and profession, and to cross-check self-reports against a prospective real-time measurement.</p><p><strong>Materials and methods: </strong>Multicentre cross-sectional study at four psychiatric hospitals of the LWL Psychiatry Network Westphalia (three adult psychiatry, one child and adolescent psychiatry). An anonymous questionnaire assessed 27 patient-distant tasks in six categories (n = 287 from five professional groups). An additional prospective day-by-day observation tracked n = 34 employees over 76 working days.</p><p><strong>Results: </strong>Both methods concurred at the aggregate level at about 61% of working time (~24 h/week, part-time-adjusted) spent on patient-distant tasks. Part-time employees were disproportionately burdened. Largest categories: internal exchange and coordination (27%), internal documentation (24%) and organization of treatment (20%); the most time-consuming single activity was patient-related team meetings (4.2 h/week). Real-time measurement yielded only 10.5% for documentation; informal short conversations emerged as an underestimated time factor.</p><p><strong>Conclusion: </strong>Patient-distant tasks account for the majority of working time in psychiatric staff. Contrary to public debate, documentation is not the dominant burden; meetings and coordination weigh more heavily. Alongside political deregulation, hospitals should use internal organisational levers.</p>","PeriodicalId":49770,"journal":{"name":"Nervenarzt","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149018607","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}