Nervenarzt最新文献

{"title":"[Traumatic childhood experiences and cardiovascular health using the example of adults with congenital heart disease].","authors":"Britta Stapel, Friederieke Löffler, Mechthild Westhoff-Bleck, Ivo Heitland, Kai G Kahl","doi":"10.1007/s00115-025-01898-4","DOIUrl":"https://doi.org/10.1007/s00115-025-01898-4","url":null,"abstract":"<p><strong>Background: </strong>Adverse childhood experiences (ACE) are a risk factor for an unfavorable lifestyle, mental disorders and cardiometabolic diseases. However, the mechanisms through which these risks are mediated have not been conclusively investigated.</p><p><strong>Research question: </strong>Is there a connection between ACE and cardiovascular health in adults with congenital heart disease (ACHD)?</p><p><strong>Methods: </strong>A total of 609 ACHD were included. Sociodemographic parameters, ACE (Childhood Trauma Questionnaire, CTQ), depressive symptoms (Hospital Anxiety and Depression Scale, HADS) and physical activity were assessed. Patients underwent a full cardiological examination including the measurement of epicardial adipose tissue (EAT) using echocardiography. Bootstrapped mediation analyses were performed with ACE as the predictor, depressive symptoms and physical activity as mediators and EAT as the dependent variable.</p><p><strong>Results: </strong>The CTQ sum score showed a significant indirect effect on EAT, which was serially mediated by depressive symptoms and physical activity (CTQ → HADS-D → Exercise → EAT; a*d*b2 = 0.0171, 95% confidence interval, CI 0.0080, 0.0285). Comparable significant effects were found for the individual CTQ domains (emotional/physical neglect, emotional/physical abuse, sexual trauma).</p><p><strong>Discussion: </strong>We show that ACE are associated with increased depressive symptoms, which in turn lead to reduced physical activity and increased EAT, a risk marker for cardiac events. Our findings point to a key mechanism through which ACE impair cardiovascular health and highlight several targets for primary and secondary preventive interventions within a multimodal treatment approach for ACHD.</p>","PeriodicalId":49770,"journal":{"name":"Nervenarzt","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145132306","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 importance of integration support in the care of severely mentally ill people].","authors":"Raoul Borbé, Iris Graef-Calliess, Gerhard Längle","doi":"10.1007/s00115-025-01897-5","DOIUrl":"https://doi.org/10.1007/s00115-025-01897-5","url":null,"abstract":"<p><strong>Background: </strong>People with severe mental disorders often need multiprofessional treatment and support, even between acute phases of illness. During the integration support they repeatedly switch between inpatient acute care and outpatient community psychiatric care.</p><p><strong>Objective: </strong>What is integration support? What tasks in the care of severely mentally ill people are fulfilled by integration assistance? How can cooperation between acute psychiatry and integration support be successful?</p><p><strong>Material and method: </strong>Selective literature search.</p><p><strong>Results: </strong>The integration support according to the Social Security Code IX (SGB IX) serves to support social participation. This need is often present in the group of severely mentally ill people. Integration support services can be used flexibly and needs oriented. The cross-sectoral, person-centered treatment of this patient group requires close coordination between clinics, outpatient therapists and integration support, for example by case conferences and case management.</p><p><strong>Conclusion: </strong>Clinics, outpatient practitioners and providers of integration support should closely cooperate with each other to provide social inclusion for severe mentally ill patients.</p>","PeriodicalId":49770,"journal":{"name":"Nervenarzt","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145087907","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":"Flexible, integrated, and person-centered psychiatric care through global treatment budgets: results of the multiperspective study PsychCare.","authors":"Andrea Pfennig, Bettina Soltmann, Anne Neumann, Martin Heinze, Roman Kliemt, Dennis Häckl, Enno Swart, Fabian Baum, Yuri Ignatyev, Julian Schwarz, Denise Kubat, Ines Weinhold, Tarcyane Barata Garcia, Sebastian von Peter, Jochen Schmitt","doi":"10.1007/s00115-025-01896-6","DOIUrl":"https://doi.org/10.1007/s00115-025-01896-6","url":null,"abstract":"<p><strong>Background: </strong>To overcome fragmented care provision in Germany, flexible, integrated psychiatric care (FIT) model projects according to § 64b of the German Social Code Book (SGB) V were implemented.</p><p><strong>Objectives: </strong>The results of the prospective cross-model, controlled, multiperspective/multimethod study PsychCare are presented and discussed along with data from statutory health insurance (SHI)-based research.</p><p><strong>Materials and methods: </strong>PsychCare applied a multi- and mixed-method design. Primary data were acquired in 18 psychiatric hospitals (n = 10 FIT; n = 8 matched treatment as usual-TAU) at study start (M-I) and 15 months later (M-II). Main outcomes were treatment satisfaction and health-related quality of life. Secondary outcomes included recovery, clinical decision-making, symptom severity, healthcare utilization and costs, needs and experiences with care, and caregiver burden. Participatory process evaluation assessed process-, structure-, and experience-related components.</p><p><strong>Results: </strong>Patients in FIT (n = 595) had significantly higher treatment satisfaction (ZUF-8: 26.3 ± 4.36 vs. 24.9 ± 4.70; p < 0.001) and recovery (RAS‑R total: 134 ± 35.8 vs. 119 ± 54.3; p < 0.001) at M‑I compared to TAU patients (n = 555), despite comparable symptom severity. About 50% of patients reported high satisfaction with clinical decision-making (p > 0.05); FIT caregivers were numerically more satisfied. Direct medical costs were significantly lower in FIT both at M‑I and M‑II. Type of care was associated with the degree of implementation of FIT components. Linking primary and SHI data was feasible.</p><p><strong>Conclusion: </strong>PsychCare showed that FIT was superior in cross-sectional treatment satisfaction, recovery, and caregiver satisfaction with suggested cost-effectiveness. Long-term FIT success compared to standard care needs further assessment.</p>","PeriodicalId":49770,"journal":{"name":"Nervenarzt","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145081828","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":"Sleep disorders: comparison of ICD-11 and ICD-10.","authors":"Kai Spiegelhalder, Dieter Riemann","doi":"10.1007/s00115-025-01859-x","DOIUrl":"https://doi.org/10.1007/s00115-025-01859-x","url":null,"abstract":"<p><p>The current article reviews adjustments that were made to the classification of sleep disorders in the 11th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-11) in comparison to the 10th revision of the coding system (ICD-10). A new chapter on sleep-wake disorders was introduced as chapter 7 in ICD-11, removing the distinction in nonorganic and organic sleep disorders that was used in ICD-10. The rationale for this was the commonsense notion that clinicians and researchers have difficulties to identify the etiology of insomnia and to establish causality between insomnia and coexisting conditions. With respect to sleep disorders that were previously included in chapter V \"Mental and behavioural disorders\" of the ICD-10, the following important changes were made: the diagnosis of insomnia disorder can now be made as comorbid with other mental disorders or physical illnesses if the insomnia symptoms are a focus of independent clinical attention, non-restorative sleep alone without difficulties initiating or maintaining sleep is not sufficient anymore to diagnose insomnia disorder and new diagnostic categories have been created, including insufficient sleep syndrome and sleep-related eating disorder. Future research will show whether the adjustments in ICD-11 will help clinicians to make reliable and clinically useful diagnoses and whether this improves routine clinical care for sleep disorders.</p>","PeriodicalId":49770,"journal":{"name":"Nervenarzt","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145081765","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 SFB/TRR 393 Collaborative Research Centre: trajectories of affective disorders : Cognitive-emotional mechanisms of symptom change.","authors":"Tilo Kircher, Nina Alexander, Michael Bauer, Udo Dannlowski, Ulrich W Ebner-Priemer, Philipp Kanske, Markus Wöhr, Andrea Pfennig","doi":"10.1007/s00115-025-01886-8","DOIUrl":"https://doi.org/10.1007/s00115-025-01886-8","url":null,"abstract":"<p><p>Major depressive disorder (MDD) and bipolar disorder (BD) are prevalent and disabling psychiatric disorders, often following a chronic and relapsing course. The Collaborative Research Centre 393 (SFB/TRR 393), funded by the German Research Foundation (DFG), aims to identify trajectories and symptom changes in MDD and BD, with a focus on cognitive-emotional mechanisms and their neurobiological underpinnings.Our research initiative seeks to (1) identify individual trajectories of recurrences and remissions in affective disorder (AD), (2) determine cognitive-emotional mechanisms and neurobiological correlates of acute symptom changes, and (3) probe mechanism-based interventions.These goals will be pursued through a threefold approach: (1) Continuous mobile assessment in a prospective cohort: We will combine in-depth clinical characterization with multilevel neuroimaging, biobanking, and -omics analyses in 1500 AD patients and healthy participants over a 2-year follow-up (German Mental Health Cohort, GEMCO) at three time points. Participants will be drawn from existing DFG FOR 2107 and BMBF Early-BipoLife cohorts (Domain A). (2) Identification of key cognitive-emotional mechanisms: We will study emotion regulation, expectation, social cognition, and cognitive-behavioural rhythms, and their neurobiological correlates mediating symptom changes, using parallel human studies and animal experiments (Domain B). (3) Targeted interventions: We will probe key cognitive-emotional mechanisms in relation to recurrences and remissions (Domain C).Over a 12-year period, we will elucidate environmental, psychosocial, and (neuro)biological predictors of illness course; cognitive-emotional and neurobehavioural mechanisms underlying real-life recurrences and remissions; and targeted, mechanism-based interventions.</p>","PeriodicalId":49770,"journal":{"name":"Nervenarzt","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145056180","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 diamorphine treatment of opioid addicts-On the amendment of the indication criteria according to the narcotics prescription regulation].","authors":"N Scherbaum, M Specka, N Wodarz, U Bonnet, P Roser","doi":"10.1007/s00115-025-01888-6","DOIUrl":"https://doi.org/10.1007/s00115-025-01888-6","url":null,"abstract":"","PeriodicalId":49770,"journal":{"name":"Nervenarzt","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145041807","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":"Affective disorders-developments of ICD-11 in comparison with ICD-10.","authors":"Martin Härter, Frank Schneider","doi":"10.1007/s00115-025-01877-9","DOIUrl":"https://doi.org/10.1007/s00115-025-01877-9","url":null,"abstract":"<p><p>With the introduction of the 11th revision of the World Health Organization (WHO) \"International Statistical Classification of Diseases and Related Health Problems\" (ICD-11), structural and content-related adjustments were made to the diagnostic guidelines for affective disorders, which are presented in this review article. The update has resulted in some changes to the diagnostic classification of affective disorders, based on the American Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5). The ICD-11 assigns depressive symptoms to so-called clusters, the main symptoms of depressed mood and joylessness can be accompanied by cognitive, behavioral or neurovegetative symptoms. In the case of remission of depressive episodes, the ICD-11 distinguishes between partial and complete remission. A persistent depressive disorder is present if the depressive episode lasts continuously for more than 2 years. In future, bipolar disorder will be divided into type I and type II. Manic episodes can still only be coded in the context of bipolar disorders and cannot be diagnosed as an independent, separate disorder. The concept of persistent affective disorders in the ICD-10 is abandoned, dysthymia is categorized as a depressive disorder and cyclothymia as a bipolar disorder.</p>","PeriodicalId":49770,"journal":{"name":"Nervenarzt","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145034619","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":"Schizophrenia and catatonia: from ICD-10 to ICD-11.","authors":"T Nickl-Jockschat, J Steiner, D Hirjak, A Hasan","doi":"10.1007/s00115-025-01861-3","DOIUrl":"https://doi.org/10.1007/s00115-025-01861-3","url":null,"abstract":"<p><p>The classification of psychotic disorders has undergone a variety of changes. Since Karl Ludwig Kahlbaum's (Kahlbaum 1874) first descriptions of catatonic states and Emil Kraepelin's (Kraepelin 1883) nosological classification of psychotic syndromes in the second half of the nineteenth century, the diagnostic criteria for these disorders have been repeatedly modified, significantly impacting clinical practice. Eugen Bleuler (Bleuler 1911) coined the term \"schizophrenia\", emphasizing the disturbances in thinking, feeling and acting that he had observed. With the introduction of the 11th version of the International Classification of Diseases (ICD-11), several significant changes to the diagnostic criteria were introduced. First-line symptoms according to Schneider lost importance. The subtypes (e.g., paranoid, hebephrenic and catatonic schizophrenia) were also omitted and symptom and progression classifiers have been introduced instead. Finally, catatonia is now defined as an independent diagnostic entity, while in ICD-10 it was still assigned to schizophrenia under the code F20.2. This recognizes catatonia's independent, cross-diagnostic nature. Due to these symptom and progression classifiers, the ICD-11 now takes a more a hybrid categorical and dimensional approach to the diagnosis than the previous version.</p>","PeriodicalId":49770,"journal":{"name":"Nervenarzt","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144994015","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":"[Integrated youth mental health services - Low-threshold, integrated programs for young people in mental health crises : International experiences and the current situation in Germany].","authors":"Andreas Bechdolf, Christoph U Correll, Tobias Hellenschmidt, Laura Holzner, Laura von Hardenberg, Dorothea Jäckel, Joseph Kambeitz, Nikolaus Koutsouleris, Norma Kusserow, Karolina Leopold, Eva Meisenzahl, Andrea Pfennig, Andreas Reif, Ullrich Reininghaus, Mario Schellong, Olga Shmuilovich, Peter J Uhlhaas, Olga Maria Domanska","doi":"10.1007/s00115-025-01895-7","DOIUrl":"https://doi.org/10.1007/s00115-025-01895-7","url":null,"abstract":"<p><strong>Background: </strong>Young people in mental health crises have severely limited access to clinical care and show the lowest adherence to conventional clinical services. Low-threshold and integrated services (integrated youth mental health services, IYMHS) are recommended to overcome these barriers and provide early detection, early intervention and psychosocial care appropriate for young people.</p><p><strong>Objective: </strong>The aim is to provide an overview of low-threshold IYMHS globally and in Germany and to report on international experiences with these services and evidence of their effectiveness.</p><p><strong>Methods: </strong>The narrative review is based on research conducted in PubMed, including the use of published reviews.</p><p><strong>Results: </strong>International developments show that IYMHS have become established as innovative models of care for young people in mental health crises. Australia is seen as a pioneer with its nationwide network of headspace centers. In Germany, soulspace is the first model project and another, ancora, is in the pipeline. Evaluations to date show that many young people who would not otherwise have sought help use these integrated services and predominantly experience symptomatic and functional improvements.</p><p><strong>Conclusion: </strong>International experiences to date and pilot projects in Germany have demonstrated the potential of IYMHS to provide low-threshold support at an early disease stage to young people with first symptoms of mental health. For Germany, expanding an integrated, cross-sectoral care structure is recommended through pooling resources from statutory health insurances and public funding.</p>","PeriodicalId":49770,"journal":{"name":"Nervenarzt","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144994010","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":"[Assessment of recommendations for low-risk use of alcohol, cannabis, gambling and gaming: state of knowledge].","authors":"Hans-Jürgen Rumpf, Ulrich John, Helmut Seitz, Florian Rehbein, Norbert Scherbaum, Ursula Havemann-Reinecke, Tobias Hayer","doi":"10.1007/s00115-025-01893-9","DOIUrl":"10.1007/s00115-025-01893-9","url":null,"abstract":"<p><strong>Aim: </strong>From a public health perspective, the provision of information on low-risk consumption is highly relevant for behavior with addictive potential and negative health, psychological or social consequences. This article provides an overview of the effectiveness and benefits of such recommendations for alcohol, cannabis, gambling and gaming.</p><p><strong>Methods: </strong>An overview based on a narrative review.</p><p><strong>Results: </strong>The recommendation for alcohol consumption limits can no longer be upheld on the basis of current evidence. Instead, abstinence is recommended. In the case of cannabis, it is currently not possible to determine thresholds for the frequency and quantity of use with regard to consequential harms. Current recommendations, therefore, relate to \"safer use\". With respect to gambling, initial but not yet reliable empirical data are available. Thresholds of varying consumption dimensions, such as the involvement in different forms of gambling, the regularity or duration of gambling as well as the amount of money spent, must be taken into account. There are no evidence-based consumption recommendations for gaming. Furthermore, a consideration of the media content that goes beyond pure usage time is essential before any recommendations can be derived. Overall, the effectiveness of recommendations depends on the perception and acceptance of the population.</p><p><strong>Conclusion: </strong>Recommendations for consumption are based on the available evidence and must be continuously reviewed and adapted, as can be seen from the example of alcohol consumption. Behavioral recommendations must be communicated in a suitable form so that they are understood without bias and are accepted by the general population.</p>","PeriodicalId":49770,"journal":{"name":"Nervenarzt","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144976597","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}