Nervenarzt最新文献

{"title":"[Liability in cases of suicide during inpatient treatment].","authors":"Johannes Kornhuber, Antonia Stummvoll","doi":"10.1007/s00115-025-01889-5","DOIUrl":"https://doi.org/10.1007/s00115-025-01889-5","url":null,"abstract":"<p><strong>Background: </strong>Suicide during inpatient treatment represents distressing events for clinics and medical staff while raising questions about liability consequences. They require a differentiated approach balancing patient protection and therapeutic necessities.</p><p><strong>Objective: </strong>To analyze long-standing case law to identify practice-relevant principles for clinical risk management regarding suicidal ideation.</p><p><strong>Material and methods: </strong>Systematic evaluation of 22 decisions from German high and supreme courts (1985-2025) concerning suicides during inpatient treatment.</p><p><strong>Results: </strong>Case law acknowledges the impossibility of absolute suicide prevention and grants psychiatric treatment teams considerable discretionary latitude. The legal assessment is based on the treating physician's ex-ante perspective. Specific duties of care arise in cases of acute suicidal ideation, risk situations such as therapeutic relaxations and necessary structural and organizational measures. The balance between security interests and therapeutic requirements remains central.</p><p><strong>Conclusion: </strong>The jurisprudence demonstrates a nuanced understanding of the clinical challenges in suicide prevention. The identified assessment standards provide orientation for the clinical practice and emphasize the necessity of individual risk assessments and documentation of all relevant decisions.</p>","PeriodicalId":49770,"journal":{"name":"Nervenarzt","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144976595","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":"[Digital health applications (DiGAs) in mental illnesses-Expectations, evidence and practical utility].","authors":"Alexandra Philipsen","doi":"10.1007/s00115-025-01872-0","DOIUrl":"https://doi.org/10.1007/s00115-025-01872-0","url":null,"abstract":"","PeriodicalId":49770,"journal":{"name":"Nervenarzt","volume":"96 5","pages":"421-422"},"PeriodicalIF":1.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144994057","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 reclassification of neurodevelopmental disorders in ICD-11. German Version].","authors":"Ludger Tebartz van Elst, Andreas Riedel, Monica Biscaldi-Schäfer","doi":"10.1007/s00115-025-01873-z","DOIUrl":"https://doi.org/10.1007/s00115-025-01873-z","url":null,"abstract":"<p><p>In the ICD-10 the developmental disorders are categorized under three different chapters: F7 for mental retardation, F8 for developmental disorders and F9 for disorders with onset in childhood and adolescence. In ICD-11 neurodevelopmental disorders represent the first new main classification group. The disorders grouped in these categories are all characterized by essentially genetically related atypical patterns of perception, emotional processing, cognition (general and social), language and motor skills. These patterns of mental functioning usually manifest in the first decade of development. They represent persisting characteristics of mental functioning, which can be understood as structural diagnoses. As such, they do not always have pathological significance but must be understood as variants of the norm, at least in less severe cases. In such constellations, they often form the psychodynamic basis for characteristic patterns of interpersonal relationship and communication problems in a subsyndromic expression and hinder the development of valid and constructive identities. These psychodynamics are often associated with interpersonal problems and conflicts as well as classical psychiatric comorbidities, such as stress reactions, adjustment disorders, anxiety disorders, obsessive-compulsive disorders, depression, personality disorders or impulsive and psychotic states. Developmental disorders have a high degree of overlap and comorbidity. This article summarizes the conceptual changes in ICD-11 compared to ICD-10, particularly with respect to the four main subgroups: intellectual disability, autism spectrum disorders, ADHD and tic disorders.</p>","PeriodicalId":49770,"journal":{"name":"Nervenarzt","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144976699","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":"[Cognitive impairments associated with schizophrenic psychoses : Diagnostics, course and therapy].","authors":"Lana Kambeitz-Ilankovic, Wolfgang Strube, Bernhard T Baune, Peter Falkai, Lukas Röll, Stefan Leucht","doi":"10.1007/s00115-024-01773-8","DOIUrl":"10.1007/s00115-024-01773-8","url":null,"abstract":"<p><strong>Background: </strong>Longitudinal outcome studies confirm that the majority of patients with schizophrenic psychoses develop cognitive impairments associated with schizophrenia (CIAS).</p><p><strong>Objective: </strong>To provide an overview of the epidemiology, diagnostics and evidence for various treatment options for CIAS.</p><p><strong>Material and methods: </strong>Literature review of the current level of evidence regarding the efficacy of different treatment strategies for CIAS.</p><p><strong>Results: </strong>Up to 85% of patients with schizophrenic psychoses exhibit CIAS, in some cases even before the development of positive or negative symptoms. The CIAS are associated with extensive individual burden due to impairments in many areas of cognitive and psychosocial functioning relevant to daily life. Various test instruments are available for clinical assessment with the Mental Health's Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) consensus cognitive battery (MCCB) as an established standard for clinical trials and special clinical issues. The treatment of CIAS warrants a multimodal approach with non-drug strategies (e.g., cognitive remediation, exercise) currently providing the best level of evidence. Noninvasive neurostimulation procedures and dopaminergic antipsychotic drugs of the first and second generations have demonstrated low effectiveness on cognitive function disorders in schizophrenic psychoses.</p><p><strong>Conclusion: </strong>The CIAS is a frequent disease-immanent symptom in schizophrenic psychoses that should be considered in the clinical routine as it substantially impairs those affected in the functional level and quality of life. Current treatment options are limited but innovative psychosocial interventions show low to moderate effects. In addition, new medications developed based on current neurobiological findings and combinations with psychosocial and neurostimulation procedures could open up new perspectives.</p>","PeriodicalId":49770,"journal":{"name":"Nervenarzt","volume":" ","pages":"482-489"},"PeriodicalIF":1.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12411580/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142717432","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":"[The current legal practice of judicial review of restraints].","authors":"Maximilian Gahr, Bernhard J Connemann, Dominikus Bönsch, Markus Jäger","doi":"10.1007/s00115-024-01779-2","DOIUrl":"10.1007/s00115-024-01779-2","url":null,"abstract":"","PeriodicalId":49770,"journal":{"name":"Nervenarzt","volume":" ","pages":"496-499"},"PeriodicalIF":1.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142639989","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":"[Therapy and healthcare applications in the treatment of adult attention deficit hyperactivity disorder: a review].","authors":"Marie-Christin Atzor, Luisa Jung, Benjamin Selaskowski, Max Pensel, Silke Lux, Alexandra Philipsen, Niclas Braun, Matthias Guth","doi":"10.1007/s00115-025-01855-1","DOIUrl":"10.1007/s00115-025-01855-1","url":null,"abstract":"<p><strong>Background: </strong>Digital interventions for day-to-day use in adult attention deficit hyperactivity disorder (ADHD) can be a useful further treatment option in addition to established ADHD treatments.</p><p><strong>Objective: </strong>This review of the literature presents the digital interventions for adults with ADHD in Germany that are currently available or in advanced development.</p><p><strong>Material and methods: </strong>The aim is the identification and characterization of the digital interventions available for adult ADHD with a special focus on key features, modes of use, evidence achieved so far and maturity levels.</p><p><strong>Results: </strong>In total, six applications for adults with ADHD (attexis, AwareMe App, AwareMe Chatbot, hiFoon, NeuroNation MED, ORIKO) were identified. Clinical studies with initial proof of efficacy have already been carried out for some of the interventions, for the remainder clinical studies are planned or are currently being carried out.</p><p><strong>Conclusion: </strong>One of the digital interventions is already available on prescription in Germany as so-called digital healthcare apps (digitale Gesundheitsanwendungen, DiGA). Other developers plan to seek regulatory approval in the near future. Innovation potential is seen particularly in the translation of existing applications into new languages and in the future integration of mobile sensing functions.</p>","PeriodicalId":49770,"journal":{"name":"Nervenarzt","volume":" ","pages":"451-457"},"PeriodicalIF":1.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12411583/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144785825","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":"[Digital interventions for psychoses: current opportunities and challenges].","authors":"Melina Luker, Mar Rus-Calafell","doi":"10.1007/s00115-025-01883-x","DOIUrl":"10.1007/s00115-025-01883-x","url":null,"abstract":"<p><p>Digital interventions (DI) are emerging as promising tools to support individuals with psychoses and complement traditional therapeutic approaches. This overview examines the usability and efficacy of recently developed DI (including virtual reality, smartphone and online interventions) designed to enhance treatment outcomes in psychoses. While emerging evidence suggests their efficacy in reducing positive, cognitive and affective symptoms in comparison to treatment as usual and other active therapies, evidence from large, controlled trials is still scarce. Further research is needed to refine intervention strategies, enhance long-term outcomes and develop implementation frameworks that ensure accessibility within routine care. Their full integration into mental health services requires sustained efforts in research, policy and clinical practice. Key remaining challenges include the design of autonomic interventions, discovery of new treatment targets relevant to patients and creating solutions for sustainable funding of these applications beyond clinical research studies.</p>","PeriodicalId":49770,"journal":{"name":"Nervenarzt","volume":" ","pages":"439-444"},"PeriodicalIF":1.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12411582/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144818076","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":"[Lithium treatment and reduction of suicide risk: evidence and clinical significance].","authors":"Michael Bauer","doi":"10.1007/s00115-025-01880-0","DOIUrl":"10.1007/s00115-025-01880-0","url":null,"abstract":"","PeriodicalId":49770,"journal":{"name":"Nervenarzt","volume":" ","pages":"504-510"},"PeriodicalIF":1.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12411315/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144856906","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":"Mitteilungen der DGPPN 05/2025.","authors":"","doi":"10.1007/s00115-025-01894-8","DOIUrl":"https://doi.org/10.1007/s00115-025-01894-8","url":null,"abstract":"","PeriodicalId":49770,"journal":{"name":"Nervenarzt","volume":"96 5","pages":"519-523"},"PeriodicalIF":1.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144994074","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":"[Relapse prevention of bipolar disorders: a cluster analytical approach in a randomized controlled psychotherapy study].","authors":"Thomas J Stamm, J Fiebig, G O Malley, L M Sondergeld, P Treu, F Bermpohl, E Friedel, G Hindi-Attar, E Quinlivian, S Schreiter, A Wietzke, T Ethofer, A Fallgatter, I Lang, E Beck, K Krisch, I Kunze, R Niebler, J Zwick, V Kraft, M Lambert, Rohenkohl, F Rühl, M Bauer, J Conell, L Jurjanz, D Ritter, P Ritter, M Spreer, S Biere, N Goldbach, S Kittel-Schneider, S Matura, V Oertel, A Reif, I Falkenberg, T Kircher, I Kluge, S Mehl, E Poll, K Adorjan, M Heilbronner, J Kálmán, F Klöhn-Saghatolislam, T G Schulze, F Senner, O Gruber, L Heß, S Trost, C Werner, S Wolter, M Hautzinger","doi":"10.1007/s00115-024-01720-7","DOIUrl":"10.1007/s00115-024-01720-7","url":null,"abstract":"<p><p>The aim of this study was to differentiate between types of bipolar disorders and the associated features using explorative analysis. The focus was particularly on the role of bipolar 1 and bipolar 2 disorders as well as the influence of prophylactic interventions for relapse in a randomized, controlled treatment study. A total of 274 of the 305 originally included persons could be investigated in the study. Patients participated in either cognitive behavioral group therapy (SEKT) or supportive, patient-centered group therapy (FEST). Treatment took place over 4 days separated by a 1-month interval (equivalent to 16 double hours). Depressive and manic symptoms were assessed using the longitudinal interval follow-up evaluation (LIFE). The symptoms were retrospectively assessed for the previous 6 months, with respect to each week before and after the intervention phase and for 6‑month and 12-month follow-ups. The results show that the effects of both group therapies were comparable; however, there were statistically significant differences in a multivariate proportional hazards model for the factors bipolar 1 and 2 as well as the interaction of therapy with bipolar 1 and 2. In particular, bipolar 2 patients benefited significantly less from the SEKT intervention than from the FEST intervention. There were three clusters identified that separated bipolar 1 (SEKT, no comorbidity, predominantly no recurrences, younger patients), from bipolar 2 (FEST, no comorbidity, at least 1 often 2 recurrences, older patients) and from a heterogeneous group (SEKT and FEST, comorbidity). The distinction between bipolar 1 and bipolar 2 disorder is important and has so far not received sufficient attention. Bipolar 2 disorders generally have a worse course and respond particularly poorly to cognitive behavioral therapy (SEKT). An open, unstructured, supportive, patient-centered psychotherapy (FEST) is generally effective.</p>","PeriodicalId":49770,"journal":{"name":"Nervenarzt","volume":" ","pages":"471-479"},"PeriodicalIF":1.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12411313/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142019336","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}