Nervenarzt最新文献

{"title":"[Second-step strategies in antidepressant pharmacotherapy : Results of current meta-analyses].","authors":"Marlene Krabs, Tom Bschor, Jonathan Henssler, Christopher Baethge","doi":"10.1007/s00115-024-01785-4","DOIUrl":"10.1007/s00115-024-01785-4","url":null,"abstract":"<p><strong>Background: </strong>Antidepressant pharmacotherapy often does not result in the desired effect despite adequate duration and dose. Better evidence on second-step strategies is needed.</p><p><strong>Objective: </strong>Overview of the current evidence for various pharmacological second-step strategies after nonresponse to antidepressant monotherapy.</p><p><strong>Material and methods: </strong>Summary of recent systematic reviews with meta-analyses of the group of authors on pharmacological second-step treatment.</p><p><strong>Results: </strong>A meta-analysis showed no advantage of switching to a second antidepressant compared with continuing the previously ineffective monotherapy. Another two meta-analyses showed no benefit of increasing the dose of selective serotonin reuptake inhibitors (SSRI). For serotonin and noradrenaline reuptake inhibitors (SNRI) and tricyclic antidepressants (TCA) in each case a meta-analysis showed no clear advantage of increasing the dose. Another two meta-analyses showed a superiority of a combination therapy consisting of a reuptake inhibitor (SSRI, SNRI, TCA) with a presynaptic alpha‑2 autoreceptor antagonist (e.g., mirtazapine) compared with an antidepressant monotherapy.</p><p><strong>Conclusion: </strong>In accordance with the recommendations of the German national treatment guideline, in the event of nonresponse to antidepressant monotherapy, the combination of two antidepressants is preferable to repeated switching of the antidepressant.</p>","PeriodicalId":49770,"journal":{"name":"Nervenarzt","volume":" ","pages":"138-145"},"PeriodicalIF":0.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11968512/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142819932","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Brain sagging dementia-A rare potentially reversible cause of dementia].","authors":"V Sondermann, J C Gerber, W H Polanski, M Brandt, J Schäfer, E Dinter, R Haußmann","doi":"10.1007/s00115-025-01803-z","DOIUrl":"10.1007/s00115-025-01803-z","url":null,"abstract":"","PeriodicalId":49770,"journal":{"name":"Nervenarzt","volume":" ","pages":"192-196"},"PeriodicalIF":0.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11971195/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143014975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Mechanisms of action of antidepressive pharmacotherapy: brain and mind-body and environment].","authors":"Moritz Spangemacher, Jonathan Reinwald, Hana Adolphi, Laura Kärtner, Lea J Mertens, Christian N Schmitz, Gerhard Gründer","doi":"10.1007/s00115-024-01786-3","DOIUrl":"10.1007/s00115-024-01786-3","url":null,"abstract":"<p><strong>Background: </strong>Novel antidepressive substances are challenging the explanations for the mechanisms of action of traditional psychopharmacology.</p><p><strong>Objective: </strong>What could be the shared effects of various antidepressants and in this context what role do extrapharmacological factors, such as the body and environment, play?</p><p><strong>Material and method: </strong>The available literature on clinical and preclinical data for assumed combined active factors of serotonergic psychedelic drugs, (es)ketamine, monoaminergic antidepressants and zuranolone are presented and the influence of context factors on the individual mechanisms of action is discussed.</p><p><strong>Results: </strong>There are many indications that classical and novel pharmacological approaches could share similar mechanisms of action in the treatment of depression. These mechanisms favor long-term neuroplasticity, which can trigger subsequent molecular cascades and vice versa. Furthermore, an improvement in the negative bias in emotional processing could be detected for most antidepressive substances. The influence of extrapharmacological factors appears to be necessary so that the biopsychological alterations can have an antidepressive effect.</p><p><strong>Conclusion: </strong>Instead of attributing factors such as environment, body and social interaction to placebo effects, they should be tested as essential components of the antidepressive effect and considered in the clinical practice.</p>","PeriodicalId":49770,"journal":{"name":"Nervenarzt","volume":" ","pages":"119-127"},"PeriodicalIF":0.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11876238/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143014982","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Education of psychotherapists in hospitals for psychiatry and psychotherapy : Survey on the implementation of different aspects of the old and new education pathways].","authors":"Andreas Schuld, Thomas Pollmächer, Knut Schnell, Bettina Wilms, Sylvia Claus","doi":"10.1007/s00115-024-01697-3","DOIUrl":"10.1007/s00115-024-01697-3","url":null,"abstract":"","PeriodicalId":49770,"journal":{"name":"Nervenarzt","volume":" ","pages":"185-187"},"PeriodicalIF":0.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141494048","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 efficacy and criticism: antidepressants in discourse].","authors":"Gerhard Gründer, Michael Bauer","doi":"10.1007/s00115-025-01800-2","DOIUrl":"10.1007/s00115-025-01800-2","url":null,"abstract":"","PeriodicalId":49770,"journal":{"name":"Nervenarzt","volume":"96 2","pages":"117-118"},"PeriodicalIF":0.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143544168","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":"[Physical health in people with severe mental illness].","authors":"Walter Hewer, Frank Jacobi, Frank Schneider","doi":"10.1007/s00115-025-01802-0","DOIUrl":"10.1007/s00115-025-01802-0","url":null,"abstract":"<p><p>The interrelationships between physical illnesses and mental disorders are diverse and complex. People with severe mental illness, particularly those with psychotic and affective disorders as well as pronounced personality disorders (serious/severe mental illness, SMI), have an increased risk of mortality compared to the general population as well as a higher prevalence of numerous somatic comorbidities. In addition to disease-related factors, explanation approaches for this also relate to the healthcare system. In routine psychiatric and psychotherapeutic care it is very important to keep an eye on the somatic health of people with SMI as physical impairments can easily be overshadowed by the mental illness. This article summarizes selected aspects of the broadly covered topics taking epidemiological data into account and with a focus on collaborative medical care of frequent diseases.</p>","PeriodicalId":49770,"journal":{"name":"Nervenarzt","volume":" ","pages":"203-213"},"PeriodicalIF":0.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143450733","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":"[Prediction and timely identification of postpartum depression: results of the longitudinal RiPoD study in the context of the literature].","authors":"Susanne Nehls, Juergen Dukart, Christian Enzensberger, Elmar Stickeler, Simon B Eickhoff, Natalia Chechko","doi":"10.1007/s00115-024-01726-1","DOIUrl":"10.1007/s00115-024-01726-1","url":null,"abstract":"<p><p>The first 4-6 weeks after childbirth are defined as the onset time for postpartum depression (PPD). Despite this known time frame there are significant gaps in the identification and treatment of PPD. The risk for postpartum depression (RiPoD) study investigated specific risk factors and predictors of postpartum psychological adjustment processes and the results are presented within the framework of a state of the art review of research. The dynamic neuroplastic changes in the maternal brain during pregnancy and the postpartum period appear to be closely linked to peripartum hormone fluctuations, which jointly influence the development of postpartum mood disorders. Hormonal risk factors such as baby blues and premenstrual syndrome have been found to have a bearing on PPD. The combination of these two factors predicts the risk of PPD with 83% sensitivity within the first week postpartum. Follow-up digital monitoring of symptom development in the first 6 weeks postpartum has enabled an accurate identification of women with PPD. Understanding the interaction between hormone fluctuations, neuroplasticity and psychiatric disorders should be an important target for future research. Early identification and diagnosis of PPD can be easily integrated into the clinical routine and everyday life.</p>","PeriodicalId":49770,"journal":{"name":"Nervenarzt","volume":" ","pages":"176-184"},"PeriodicalIF":0.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11876219/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142057088","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Electroconvulsive therapy in people with intellectual disability].","authors":"M Guhra, S H Kreisel, D Zilles-Wegner, A Sartorius, T Sappok, N Freundlieb","doi":"10.1007/s00115-024-01713-6","DOIUrl":"10.1007/s00115-024-01713-6","url":null,"abstract":"<p><p>Electroconvulsive therapy (ECT) is a highly effective treatment option for severe mental illness. Although people with intellectual disability (ID) have similar prevalence rates of mental disorders in comparison to the general population their access to ECT remains challenging. A systematic literature review was carried out on treatment with ECT in patients with ID and a case report on a patient with ID who underwent ECT is presented, to highlight a typical clinical routine. A total of 100 articles with 208 different case reports were retrieved. In summary, the results underline the effectiveness of ECT in people with ID, with side effects comparable to those in the general population. The ECT is effective in the treatment of severe affective and psychotic disorders and particularly in people with catatonia. The use of ECT can improve the patient's mental health and quality of life and is often a life-saving treatment option. The prophylaxis of relapses should be included as early as possible in the planning process. Providing an easy access to ECT treatment for people with ID is corroborated by its effectiveness and is in line with the right to equal treatment in accordance with article 25 of the United Nations Convention on the Rights of Persons with Disabilities.</p>","PeriodicalId":49770,"journal":{"name":"Nervenarzt","volume":" ","pages":"166-175"},"PeriodicalIF":0.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11876283/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142141614","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Metamizole / dipyrone in psychiatry - What about the pharmacokinetics?]","authors":"Michael Paulzen","doi":"10.1007/s00115-025-01799-6","DOIUrl":"10.1007/s00115-025-01799-6","url":null,"abstract":"","PeriodicalId":49770,"journal":{"name":"Nervenarzt","volume":" ","pages":"197-202"},"PeriodicalIF":0.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143494527","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":"[Observational study on the coincidence of Alzheimer's disease and idiopathic normal pressure hydrocephalus: analysis of coincidence, the influence on response to cerebrospinal fluid drainage and cerebrovascular copathology].","authors":"M Beeke, C Sauer, J Petzold, S Schneider, K Frenzen, M Donix, G Reiß, M Brandt, R Haußmann","doi":"10.1007/s00115-025-01808-8","DOIUrl":"https://doi.org/10.1007/s00115-025-01808-8","url":null,"abstract":"<p><strong>Objective: </strong>Analysis of the frequency of comorbid Alzheimer's disease in patients with suspected idiopathic normal pressure hydrocephalus (iNPH) and its effects on the response to cerebrospinal fluid (CSF) drainage as well as analysis of the frequency of a vascular copathology in patients with suspected iNPH.</p><p><strong>Material and methods: </strong>This was a prospective observational analysis of patients with suspected iNPH who underwent guideline-conform NPH routine diagnostics including CSF drainage during clinical routine diagnostics between 1 July 2022 and 30 June 2023. Patients were recruited via the departments of neurology, neurosurgery and psychiatry of the University Hospital Carl Gustav Carus in Dresden. Typical NPH imaging results were acquired from available magnetic resonance imaging (MRI) and computed tomography (CT) sectional images. Relevant sociodemographic, clinical, cognitive and CSF diagnostic parameters were acquired via patient chart review. The patients were categorized with respect to the CSF results according to the amyloid-tau-neurodegeneration (ATN) classification.</p><p><strong>Results: </strong>During the observational period 33 patients (14 female, 19 male, mean age 74.6 ± 8.1 years) with suspected iNPH were analyzed. Of the patients 19 (57.6%) had a complete and 14 (42.4%) an incomplete Hakim's triad. The difference between the MoCA scores before and after CSF drainage varied between patients with and without a response to CSF drainage (F(1;22) = 5.725; p = 0.026). There was a trend that patients with a pathological corpus callosum angle and conspicuous Evans index (p = 0.052) as well as patients with a pathological corpus callosum angle, Evans index and complete clinical Hakim's triad (p = 0.055) more frequently show a response. The mean Fazekas score was 1.7. There was no correlation between the Fazekas score and response to CSF drainage. In 25 patients (75.8%) biomarkers for dementia and neurodegeneration were detected. According to the ATN classification 20 patients (80%) were categorized as A⁺T^-, 3 (12.0%) as A⁺T⁺ and 2 (8.0%) as A^-T^-. Patients classified as A⁺T⁺ and A⁺T^- did not respond more often to CSF drainage (p = 0.600).</p><p><strong>Conclusion: </strong>The combined determination of the corpus callosum angle and the Evans index as well es their contextualization with clinical characteristics can possibly improve the prognostic evaluation regarding response to CSF draínage. Especially a comorbid amyloid pathology and a cerebral microangiopathy represent frequent copathologies of iNPH but the influence on the response to CSF drainage remains to be elucidated.</p>","PeriodicalId":49770,"journal":{"name":"Nervenarzt","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143525105","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}