NEUROPSYCHIATRIE最新文献

The sharp rise in the number of predominantly natal female adolescents experiencing gender dysphoria and seeking treatment in specialized clinics has sparked a contentious and polarized debate among both the scientific community and the public sphere. Few explanations have been offered for these recent developments. One proposal that has generated considerable attention is the notion of "rapid-onset" gender dysphoria, which is assumed to apply to a subset of adolescents and young adults. First introduced by Lisa Littman in a 2018 study of parental reports, it describes a subset of youth, primarily natal females, with no childhood indicators of gender dysphoria but with a sudden emergence of gender dysphoria symptoms during puberty or after its completion. For them, identifying as transgender is assumed to serve as a maladaptive coping mechanism for underlying mental health issues and is linked to social influences from peer groups and through social media. The purpose of this article is to analyze this theory and its associated hypotheses against the existing evidence base and to discuss its potential implications for future research and the advancement of treatment paradigms.

Background: A link between insomniac symptoms and suicidality has long been suspected and deserves specific attention.

Objective: We examine the current evidence for this relationship from epidemiology and neurobiology in order to propose a targeted management.

Material and method: Clinical example and selective Medline-literature research for insomnia symptoms and suicidality.

Results: Epidemiological data and statistical analysis show that symptoms of insomnia are independent risk factors for suicidality. Neurobiological factors associated with combined insomnia symptoms and suicidality are: serotonergic dysfunction and circadian rhythm disorder leading to hypofrontality with reduced problem solving capacity and impaired emotional and impulse-control. Social isolation, recurrent rumination, comorbid psychiatric disorders, access to potentially lethal drugs or weapons need urgent evaluation in patients with a combination of suicidality and symptoms of insomnia.

Conclusion: patients with insomnia and further risk factors for suicide need to be treated resolutely and at an early stage. Modern sleep-promoting antidepressants with low toxicity and antipsychotics must be preferred in the treatment of patients with insomniac sleep disorders and suicidality. Multimodal anti-insomnia and anti-depressive therapy adapted to the circadian rhythm can exert a favorable influence both on depressive-suicidal and insomnia symptoms and their inherent risks.

Objective: 59% of Viennese day care children have a first language other than German. Lower proficiency in the second language German might be typical in multilingual settings, but might also be due to language disorder (ICD-10:F80 or comorbid). Diagnostic practise in Austria focuses on second language evaluation. This study describes a group of multilingual children with suspected language impairment at a specialized counselling hour and reflects the role of the first language in language evaluation.

Method: Linguistic evaluation (typically developed, ICD-10:F80, comorbid language disorder) and sociodemographic parameters of 270 children (time period: 2013-2020) are investigated. Linguistic results are reported according to primary diseases. For children without primary disease the relation between the linguistic evaluation and sociodemographic parameters is assessed.

Results: Overall, the children had 37 different first languages (74% were bilingual, 26% multilingual). The percentage of children with typical development and comorbid language development varied according to primary disease. Children without primary disease had higher chances of typical development the older they were at the examination, the earlier they produced first words, and if there was no heredity for ICD-10:F80.

Conclusions: Results suggest that evaluating the children's first language is useful since it contributes to understanding the individual language development at different linguistic levels, despite the heterogeneity of the children, and, thus, allows practitioners to recommend the best possible support.

Purpose: One cognitive domain impaired in Alzheimer's disease (AD) is visuo-construction. The Vienna Visuo-constructional Test 3.0 Screening (VVT 3.0 Screening) measures this cognitive domain. This study examines how it works in the differentiation of AD from healthy controls (HC) and the prodromal stages subjective cognitive decline (SCD) and mild cognitive impairment (MCI) and also how it performs in prediction of progress compared to the Mini Mental State Examination (MMSE) and the Sunderland Clock Drawing Test (CDT).

Methods: Data from 622 patients (33 HC, 68 SCD, 301 MCI, 220 AD) who completed all three tests were obtained. Furthermore, 117 patients were examined in a follow-up. Data were analyzed in a retrospective analysis comparing the validity of tests in diagnosis and prediction using receiver operator characteristic (ROC) curves and multinominal logistic regression.

Results: The VVT 3.0 Screening shows some ability to discriminate between AD and all other participants (sensitivity: 62.1%, specificity: 83.1%), while of the three examined tests none was able to predict membership to all experimental groups or to predict disease-progress adequately. As the VVT 3.0 Screening is short, easy to apply and largely language independent, it can be considered an alternative to the MMSE in certain situations.

Conclusions: The VVT 3.0 Screening is useful to discriminate between AD and all other participants and can be an alternative to the MMSE in certain situations.

Purpose: To analyze predictors of treatment outcome for anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis in adults.

Methods: We performed a comprehensive literature search of PubMed, PsycInfo, and OVID. We included 424 patients from case reports and case series. Demographics, anti-NMDAR antibodies, prodromal and presenting symptoms, diagnostic workup, and treatment variables were recorded. Inferential analyses were performed in the subset (n = 299) of those with known treatment outcomes. Multivariate multinomial logistic regression analysis for treatment outcome compared full recovery versus partial recovery and full recovery versus death.

Results: Treatment outcomes consisted of 34.67% full recovery (n = 147), 30.90% partial recovery (n = 131), 4.95% death (n = 21), and 29.48% unknown (n = 125). Speech/language abnormality and abnormal electroencephalogram (EEG) were each significantly associated with a higher relative risk for a full recovery. Treatment with intravenous immunoglobulin and plasmapheresis were each significantly associated with a higher relative risk for partial recovery. The analysis comparing death to full recovery found that catatonia was significantly associated with a lower relative risk for death. Increased age, orofacial dyskinesia, and no tumor removal were each significantly associated with a higher relative risk for death.

Conclusion: Increased age, orofacial dyskinesia, and no tumor removal were associated with a higher relative risk for death in anti-NMDAR encephalitis in adults. Clinicians should monitor and appropriately treat anti-NMDAR encephalitis with these findings to minimize the risk of death.

Purpose: The aim of this study is to describe coronavirus disease 2019 (COVID-19)-related dysfunctional anxiety and thinking in patients with stroke and caregivers who are family members and their effects on caregiver burden.

Methods: This cross-sectional study included 79 stroke patients and their primary caregivers who were hospitalised in a tertiary rehabilitation hospital. Coronavirus Anxiety Scale (CAS) and Obsession with COVID-19 Scale (OCS) were used to assess the levels of COVID-19-related dysfunctional anxiety and obsession of the patients and their caregivers. Caregiver burden was assessed via the Zarit Burden Interview (ZBI).

Results: In the patients with stroke, COVID-19-related anxiety and COVID-19-related obsession rates were 13.9% (n = 11) and 7.6% (n = 6), respectively, while 17.7% (n = 14) of caregiver family members had COVID-19-related anxiety and 11.4% (n = 9) had COVID-19-related obsession. The CAS score of caregivers showed a significant positive correlation with the CAS and OCS scores of patients (p = 0.000, r = 0.423; p = 0.007, r = 0.300, respectively). The OCS score of caregivers showed a significant positive correlation with the OCS scores of the patients (p = 0.000, r = 0.476). The mean ZBI score of caregiver family members was 31.9 ± 13.5. A significant positive correlation was observed between the caregiver's OCS and CAS scores and ZBI scores (p = 0.002, r = -0.349; p = 0.004, r = 0.323, respectively).

Conclusion: In this study, a significant relationship between caregiver burden and COVID-19-related anxiety and obsession in the caregivers of stroke patients was identified. Therefore, caregivers of stroke patients should not be forgotten during pandemics and should receive physical and psychological support.