Fortschritte Der Neurologie Psychiatrie最新文献

Major depressive disorder is a common mental health disease with a chronic and treatment-resistant course in about one-third of patients. Invasive vagus nerve stimulation (VNS) as a long-term adjunctive treatment option has increasingly been used in the last years. VNS was CE-certified in the European Union for use in chronic and treatment-resistant depression in 2001. Method In this narrative literature review we provide an overview on VNS as a treatment option in patients with depression. We particularly focus on aspects with high clinical relevance. Results Indication to conduct VNS is determined after comprehensive evaluation of the patients' symptoms and psychiatric history. After education of patients and caregivers and obtaining informed consent, a pacemaker-like pulse generator is implanted in the left chest in a short surgical procedure. In the first weeks after implantation, the stimulation is turned on stepwise in an outpatient setting. The left vagal nerve is stimulated for 30 sec. every 5 minutes. Hoarseness during stimulation is the most frequent side-effect. There is a delay in the onset of antidepressant action of about 6-12 months. In a large registry, the cumulative response rate after 5 years was significantly higher (67.6%) in patients treated with VNS plus treatment-as-usual (TAU) than TAU alone (40.9%). Long-term benefits of VNS on quality of life, cognition, morbidity and mortality have been described previously. Conclusion VNS is a long-term safe treatment option in severely affected patients with depression with positive impact on depression severity, quality of life and cognitive function. Increase of monoaminergic transmission and anti-inflammatory effects of VNS are possible mechanisms of action.

A 56-year-old male patient was presented to the neurology department of the emergency unit by the ambulance service with progressive gait instability, dysarthria and gastrointestinal symptoms. Clinical findings also included bilateral mydriasis, asymmetric bilateral ptosis, proximal paresis of the upper extremity and marked dry mouth. Imaging was unremarkable, but the differential diagnosis revealed evidence of a neurotoxic cause. The history of recent consumption of preserved food and the characteristic symptoms quickly led to a suspected diagnosis of foodborne botulism. After early administration of antitoxin and intensive medical treatment with temporary invasive and non-invasive ventilation, the patient was discharged after 14 days without residual neurological impairment.

A subgroup of psychiatric patients are at increased risk of committing interpersonal violence, which may lead to placements in forensic-psychiatric institutions. The majority of patients treated in forensic hospitals have had contact with the general psychiatric care system years before being forensically committed due to an offence. Nevertheless, attempts to establish models related to violence prevention in general psychiatry have remained sparse. In the Canton of Zurich, the forensic psychiatric consultation liaison service provides the general psychiatric clinics with access to forensic psychiatric expertise. In this paper, we describe the consultation service's diagnostic and advisory offers and aim to characterize the patient population seen by the service. We compared the three most common diagnostic groups (schizophrenic, affective and personality disorders) regarding reason for consultation, history of violence and substance abuse. In addition, we analyzed content and kind of the recommendations made. From 2013 to 2021, 188 patients in general psychiatric clinics in Zurich have been examined after informed consent. Most patients had a positive history of violence (72.7%) and substance use (66.1%). Almost half of the patients (48.4%) had been diagnosed with schizophrenia or a related disorder.

Opioid use disorder (OUD) is a chronic, relapsing condition associated with high morbidity and mortality, primarily due to respiratory depression and overdose. In Germany, approximately 160,000 people are affected by opioid dependence, with significant variation across regions. Opioid Agonist therapy (OAT), also known as opioid agonist treatment (OAT), is the internationally recognized first-line therapy for OUD. It involves the medically supervised administration of long-acting opioid agonists such as methadone, levomethadone, buprenorphine, or - under strict conditions - diacetylmorphine (heroin) and aims to stabilize physical and mental health, reduce illicit opioid use, and support social reintegration.The legal framework for OAT in Germany is defined by the Narcotic Drugs Act (BtMG), the Narcotic Drugs Prescription Ordinance (BtMVV) and guidelines issued by the Federal Medical Association and the Joint Federal Committee (GBA). These regulations stipulate the qualifications required for prescribers, conditions for supervised daily dosing, and criteria for take-home prescriptions. Psychosocial support is strongly recommended. OAT has proven effective in reducing mortality, improving quality of life, and lowering the prevalence of infectious diseases among people with OUD. Special regulations apply to substitution with diacetylmorphine, which is reserved for patients with severe treatment-resistant opioid dependence. Despite clear benefits and legal clarity, access to OAT is unevenly distributed in Germany, with rural areas facing significant gaps in care. Expanding provider capacity and increasing the flexibility of treatment delivery remain key priorities to ensure comprehensive and equitable care for individuals affected by OUD.

Cyclic vomiting attacks associated with chronic cannabis use were virtually unknown until 25 years ago. Following legalization of cannabis for recreational use in North America and the resulting increase in high-potency cannabis use, the prevalence of cannabis-related cyclic vomiting in emergency departments was increasing at an alarming rate. In the ROME-IV criteria, cannabis-induced cyclic vomiting is now defined as cannabinoid hyperemesis syndrome (CHS). This review is intended to provide information on the current state of knowledge on CHS, as an increase in CHS cases is also to be expected in Germany following the partial legalization of cannabis for recreational use.Scoping review on the diagnosis, complications, treatment options and prognosis of CHSCannabis-related cyclic vomiting attacks are better known in emergency medicine than in general medicine and addiction medicine. Young adults are often affected. A reliable differentiation between CHS and the nosologically related cyclic vomiting syndrome (CVS) - in which 30% of those affected also use cannabis chronically - is only possible by establishing remission during at least 6 months of abstinence. For this reason, mixed forms of CVS and CHS are usually seen in emergency departments (suspicious CHS), sometimes with masked life-threatening comorbidities. Severe vomiting can also lead to serious complications. Common antiemetics are often ineffective. Hot showers and baths (diagnostic secondary criterion in ROM-IV) and haloperidol (up to 5 mg i.m.) can acutely alleviate the severe vomiting. Rubbing the abdomen with 0.075-0.1% capsaicin cream also helps, but less quickly. After several cyclical CHS clusters, the individual threshold for their occurrence decreases continuously (chronification): Cannabis relapses, even at low doses, lead to stronger and longer cyclic CHS clusters than experienced before (sensitization).CHS is nosologically classified in ROME-IV as a specific variant of CVS, but it is also a specific and mostly a severe cannabis-related disorder. As full remission and cure (full remission for at least 5 years) can only be achieved through sustained abstinence from cannabis, suspected CHS presents an interdisciplinary challenge for various medical disciplines, consultation/liaison psychiatry and addiction support systems.

Alzheimer's disease (AD) is one of the most common neurodegenerative disorders in older age. Individuals with Down syndrome (DS) are at significantly increased risk due to trisomy 21 and the resulting overexpression of the amyloid precursor protein. Prevalence rates of AD-related dementia in DS (DSAD) reach up to 88% beyond the age of 65. Despite this, structured diagnostic and therapeutic guidelines for DSAD are lacking.A narrative review of current literature on etiology, diagnosis, treatment, and care pathways for DSAD was conducted. Currently employed dementia diagnostic standards were evaluated in regard to the specific needs of individuals with DS.Established diagnostic methods are applicable to individuals with DS but require adaptations regarding symptom recognition, test administration, and interpretation. Early awareness among caregivers and healthcare providers, as well as timely referral to specialized centers, is essential for accurate diagnosis and treatment planning.Improving care for individuals with DSAD requires close coordination between general healthcare services and specialized centers. This review highlights the medical, diagnostic, and structural challenges in suspected DSAD and provides practical recommendations for patient care. The proposed guideline aims to reduce uncertainties in clinical practice and support sustainable, needs-based care.

Since its introduction in 1999, the clinical syndrome Mild Cognitive Impairment (MCI) has been established in scientific and clinical practice. Technical and scientific advances made it necessary to regularly update research criteria, resulting in a shift to a more biological definition and biomarker-based criteria, while clinical core criteria remained essentially unchanged. The cognitive core criterion (objective evidence of cognitive impairment) allows concrete operationalization and has, in turn, led to the development of various neuropsychological criteria. Approaches more sensitive to early cognitive changes or taking greater account of cognitive decline may also be further elaborated for their future use. In general, certain conditions must be met for the use of neuropsychological criteria, such as the assessment of relevant cognitive domains with appropriately standardized test procedures to a sufficient extent. Standardized and consistent criteria use could reduce the high rates of variation observed in MCI prevalence rates and could help harmonizing prognostic evaluations and treatment decisions in routine clinical practice. Surveys of the status quo in German memory clinics suggest that there is a basis to possibly reach consensus on a set of criteria across institutions. Despite a potential commitment to specific neuropsychological criteria, clinical judgment appropriately considering individual factors would remain decisive for an MCI diagnosis and thus leaving existing MCI clinical core criteria untouched. The present work provides an overview on clinical and neuropsychological MCI criteria, discusses their challenges and future perspectives to timely and adequately detect first meaningful cognitive changes.