NEUROPSYCHIATRIE最新文献

Among mentally ill young people, the rate of nicotine consumptionremains high despite an overall decline in numbers. Within the group ofyoung people with mental illness the proportion is 38% and in a population receiving child and adolescent psychiatric care the proportion of consumers is as high as 63%. Thelegal ban on tobacco products for young people therefore presents staff in child andadolescent psychiatric institutions with the ongoing challenge ofenforcing rules and prohibitions, while at the same time perceivingperceive consumption as an addiction. In this paper we will discussthe specifics of the substance nicotine, current forms of consumption and epidemiology, but above all we will consider how to deal withnicotine consumption by underage patients in the often highly complex situations ofpsychiatric and acute psychiatric settings.

Background: Treating delirium in adolescents with congenital long QT syndrome (LQTS) demands agents that do not aggravate ventricular repolarisation. A 15-year-old girl with genetically confirmed LQT1 and newly diagnosed acute lymphoblastic leukaemia developed hyperactive delirium in the paediatric intensive care unit after sepsis, abdominal surgery and prolonged sedation. Baseline manually calculated QTc in lead II was 533 ms (Bazett), 500 ms (Framingham), and 489 ms (Fridericia). Standard antipsychotics were avoided owing to torsadogenic risk. Low-dose aripiprazole (2 mg p.o. initially, up to 2 mg every 2 h as needed) was introduced, with twice-daily 12-lead ECGs. Agitation resolved within 48 h; QTc fluctuated between 460 and 490 ms (all three formulas) without ventricular arrhythmia. Serial serum aripiprazole levels were monitored for toxicity during intermittent dosing (cumulative dose 42 mg over 6 days). No extrapyramidal or haemodynamic adverse effects occurred, and aripiprazole was discontinued after a further 8 days.

Conclusion: This case illustrates a structured approach to delirium in adolescent LQTS and supports aripiprazole as a pragmatic option when QT-prolonging antipsychotics are contraindicated.

Background: The care and support of people with dementia (PwD) is predominantly provided by informal carers and support workers (iPuB). A high degree of preparedness for caregiving improves the care of PwD and reduces the burden of care. The development of support and information services to increase preparedness is one of the goals of the FFG-funded TeleCareHub project.

Methods: In this multicentre cross-sectional study, iPuB were examined using the following questionnaires: General Self-Efficacy Short Scale (ASKU-3), Affinity for Technology Interaction Scale (ATI-8), Zarit Burden Interview (ZBI-7), Loneliness Scale (UCLA-3), Patient Health Questionnaire (PHQ-9), Scale for the Quality of the Current Relationship in Caregiving (SQCRC-14) and the Preparedness for Caregiving Scale (PCS-8). Data analysis was performed using correlation, variance and linear regression analyses (including mediation and moderation models).

Results: This study analysed data from 308 iPuBs (76% female, PCS-8: 20.8 ± 6.4). Self-efficacy (ASKU-3) and relationship quality (SQCRC-14) correlated significantly positively with preparedness (PCS-8), whereas caregiver burden (ZBI-7), loneliness (UCLA-3) and depression (PHQ-9) correlated negatively with PCS‑8. In non-burdened iPuB (ZBI-7 < 11), but not in burdened iPuB, a low ZBI‑7 score and a short duration of care were predictive of high preparedness (β = -0.318; SE = 0.077; p < 0.001). Results from SQCRC-14, ASKU‑3 and PHQ‑9 showed significant modulating effects on the PCS‑8.

Conclusion: The results highlight the influence of multiple personal factors of iPuB on the feeling of preparedness for caregiving. Interventions to strengthen self-efficacy and reduce depression in iPuB, who are not yet under significant stress, could improve preparedness.

Armed conflicts can engender substantial detrimental effects for mental health, both within immediate settings and for faraway populations. Guided by frameworks from geopsychiatry, this narrative review underlines the local- and macro-level psychiatric consequences of conflicts, informed by illustrative findings from academic sources and gray literature focusing on contemporary global disputes. Specifically, the review demonstrates that exposure to conflict is consistently associated with elevated rates of mental illnesses, which are worsened by devastated healthcare systems and related phenomena. Subsequently, it highlights how vulnerable populations often experience disproportionate mental health burdens in conflict, before exploring how secondary, distal psychiatric effects can arise from vicarious media exposure, forced displacement, and associated environmental degradation. With the most armed hostilities occurring since the end of World War Two, the paper concludes by considering how the psychiatric discipline can adapt to confront the modern challenges of diversifying patient populations in an increasingly turbulent geopolitical landscape.

Korsakoff syndrome (KS) presents an interdisciplinary challenge in diagnosis and care. The frequent lack of distinct clinical symptoms represents a diagnostic challenge and can complicate early diagnosis. This case report describes a 59-year-old patient who initially presented to internal medicine due to symptoms that appeared to be associated with pre-known cardiovascular and metabolic comorbidities. The initial suspected diagnosis of osmotic demyelination syndrome (formerly known as pontine myelinolysis), which can induce a clinical state very similar to KS, could only be ruled out by MRI evidence of atrophy of the mammillary bodies, confirming the diagnosis of KS. High-dose thiamine supplementation, neurorehabilitative measures, and support by a stable social environment, led to an improvement in cognitive performance. This case highlights the need for differential diagnostic efforts regarding KS and interdisciplinary awareness beyond neurological and psychiatric disciplines.

In recent years, major psychiatric disorders have been intensively researched. Studies have investigated the pathophysiology of these disorders in detail and at various molecular levels with several omics techniques, including genomics, epigenomics, transcriptomics, proteomics, and metabolomics. However, although the results of a single omics study can help shed light on some of the unclear aspects of the biological circuits involved in the pathophysiology of major psychiatric disorders, the complexity of the biological mechanisms underlying these conditions makes it necessary to consider multiple types of omics data and multiple levels of analysis, including various conceptional, methodological, and quality control criteria. Currently, dealing with high-dimensional data and sparse heterogeneous data structures remains one of the biggest challenges to integrating data from multi-omics approaches. The hope is that eventually the development and application of methods to integrate biological and phenotypic data through multi-omics and machine learning-based algorithms may allow early diagnosis of major psychiatric disorders, perhaps even before disease onset, and enable accurate, personalized treatment. In this mini-review, we summarized the main findings of the field by reviewing systematic reviews, meta-analyses, and narrative reviews on the major psychiatric disorders schizophrenia, bipolar disorder, and major depressive disorder.

Background: Adolescents with mental health conditions need stable care structures during their transition to adulthood. The traditionally mandated transfer from child and adolescent psychiatry to adult psychiatric care at the age of 18 does not satisfy this need. A new amendment to the medical training regulations (Ärztinnen/Ärzte-Ausbildungsordnung), effective May 15, 2024, now officially allows child and adolescent psychiatrists (CAPs) in Austria to continue treatment after their patients reach legal adulthood. This study is the first to analyze CAPs' assessments of the amendment and aims to document initial effects on care provision.

Methodology: Semi-structured interviews were conducted with 16 child and adolescent psychiatrists (CAPs) working in various settings. Data analysis was performed using Reflexive Thematic Analysis.

Results: The study shows that the amendment was introduced unexpectedly for many CAPs, with some private practitioners expressing frustration over the lack of preparation time. Despite this, the reform was largely welcomed and even considered overdue by some. However, given the high patient load, many CAPs still allocate their limited resources to minors, leaving the amendment's impact minimal. In the inpatient sector, persistent shortages of beds have also hindered any substantial changes.

Conclusions: While the amendment receives substantive approval from the interviewed CAPs, existing resource constraints in both inpatient and outpatient sectors prevent the realization of its potential. The improvements in psychiatric care for transition-age patients intended by the amendment will likely not materialize without capacity expansion.

Apathy is a frequently overlooked yet disabling neuropsychiatric symptom in dementia syndromes, often misdiagnosed as depression. We describe a diagnostically challenging presentation of subcortical ischaemic vascular dementia in a 48-year-old Middle Eastern man, whose primary symptom was progressive apathy rather than overt cognitive decline or focal neurological deficits. Despite repeated emergency visits and antidepressant trials, his condition deteriorated until detailed neuropsychiatric evaluation and neuroimaging revealed right temporal gliosis/encephalomalacia, left frontal periventricular change, and multiple chronic lacunar infarcts in the left thalamus and bilateral centrum semiovale, on a background of small-vessel disease. Autoimmune workup confirmed previously undiagnosed systemic lupus erythematosus (SLE) with antiphospholipid markers, providing a unifying explanation for his vascular pathology. The clinical course was stepwise over ~ 18 months, with intermittent falls. Management included psychosocial interventions, behavioural support planning, and cautious pharmacological strategies; anticoagulation and rheumatological therapy were considered in light of his autoimmune risk. The patient showed modest improvements in affective responsiveness and engagement. This case highlights how apathy can be an early and dominant manifestation of vascular dementia when frontal-subcortical circuits are compromised. It underscores the need to differentiate apathy from depression using behavioural observations, collateral history, and cognitive testing, and to consider autoimmune vasculopathies in younger patients with unexplained vascular lesions. Timely neuroimaging and autoimmune screening could enable earlier diagnosis and intervention, improving outcomes in autoimmune-associated cognitive disorders.