NEUROPSYCHIATRIE最新文献

Climate change is the predominant global crisis of the 21st century and yet it appears as if not enough attention is being paid to its impact on health including mental health and wellbeing of populations globally. There is an increasing acknowledgement that eco-anxiety, solastalgia and other related conditions are emerging. However, more importantly the international impact of climate change with increasing internal and external migration places increasing strain on healthcare systems and healthcare professionals. The sheer speed of change related to climate factors started over 200 years ago but has accelerated in the past few decades and impacts human beings at multiple levels. Extreme weather events, rising temperatures, and environmental degradation contribute very strongly to both existing and newer psychiatric disorders. Recommendations are made for policymakers, researchers and clinicians about what is needed and how to deliver it.

The World Psychiatric Association (WPA) advocates for a practical approach to implementing alternatives to coercion in mental health care. It adopted a Position Statement and Call to Action in 2020 that give special attention to provisions of the United Nations Convention on the Rights of Persons with Disabilities (CRPD). The WPA aims to continue promoting rights-based policies and practices through mutual support across its member societies in more than 120 countries. Collaborating with people with lived experience of mental health conditions and their families, and other government, research, and civil society groups is a prerequisite for this process. The call to action is relevant for people at all life stages and in all countries irrespective of resources available. The work aims to demonstrate how shared experiences and outcomes assessments can promote the spread of good practices and improved quality of mental health care. Culturally sensitive changes to treatment and care including priority for early intervention and personalised care are needed in most places. Changes are needed to policy, laws, attitudes, human and financial resources, training and research, open access to data about coercive practices, and above all readiness and capacity to work with people with lived experience and their families.

In the wake of current events, the question arises as to the possible psychological and biological consequences of playing violent video games. This area of research has grown enormously in recent decades, with several hundred publications examining a total of over 100,000 study participants. Various meta-analyses in recent years have repeatedly demonstrated a statistically significant aggression-promoting effect of playing violent video games. Nevertheless, controversies continue to arise in this field. Studies on possible biologically measurable changes in the brain have produced mixed results. The following review article provides a brief overview of the current state of this research area. The discussion addresses methodological difficulties, further open questions, hypotheses regarding the nature of the aggression-promoting effect, sociopolitical aspects, and possible conclusions.

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.

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.