THERAPEUTISCHE UMSCHAU最新文献

Introduction: Depression is one of the most common mental disorders. The effectiveness of pharmacological and psychotherapeutic treatments is well documented. Remission rates are around 67 % for pharmacological antidepressant initial and secondary treatment of a depressive episode in unipolar disorders. However, patients with a depressive episode who do not respond to at least two successive attempts at pharmacological antidepressant treatment have significantly lower remission rates. Particularly in this subgroup with difficult-to-treat depression, brain stimulation procedures and treatment with novel substances represent innovative and effective treatment options that complement pharmacotherapy and psychotherapy. The aim of this paper is to provide an overview and outlook on the following treatment procedures: repetitive transcranial magnetic stimulation (rTMS), electroconvulsive therapy (ECT), ketamine/esketamine, transcranial direct current stimulation (tDCS), deep brain stimulation (DBS), and psychedelic-assisted psychotherapy (PAT). An outlook on selected current developments with the aim of a procedure-specific, individualized indication will be given.

Introduction: Background: ASSIP flex is a structured, low-threshold brief therapy for individuals with suicidal behavior. As a flexible treatment approach, it can be delivered in inpatient, outpatient, and home settings. This study examines its feasibility, acceptability, and clinical application in routine practice. Method: In an observational pre-post study, 105 patients (53.8 % women; M = 38.8 years, SD = 15.2) were interviewed before (t0) and after (t1) the ASSIP flex brief intervention. Sociodemographic characteristics, feasibility aspects, and clinical variables were assessed. In addition, nine therapists evaluated implementation and acceptability. Results: ASSIP flex was mainly recommended by professionals (57.3 %) and showed high acceptability, with its adaptability across different treatment settings cited as a key advantage. Patients demonstrated a significant reduction in suicidal ideation (t104 = 4.5, p 0.001) and depressive symptoms (t104 = 6.0, p 0.001), as well as an increase in self-efficacy (t104 = -2.3, p 0.05). Higher perceived effectiveness of ASSIP flex correlated with lower suicidal ideation (r = -0.28, p 0.01) and depressive symptoms (r = -0.29, p 0.01), as well as increased self-efficacy (r = 0.22, p 0.05). Conclusion: ASSIP flex is a versatile treatment option for individuals with suicidal behavior. The results confirm its potential as a promising addition to existing care structures and its ability to address a critical gap in post-attempt care.

Introduction: The diagnosis of "depression" encompasses very heterogeneous clinical pictures. There are different treatment methods for depression, with psychopharmacological and psychotherapeutic treatment strategies being particularly relevant. There is increasing evidence that a personalised therapeutic approach, which takes into account individual biological, psychological and social vulnerability factors and resources, is useful. The article describes the specific impact factors that are important for treatment planning. In the presence of stressful childhood experiences, which are particularly relevant for the development of chronic depression, these should be specifically considered in therapy. As the inadequate satisfaction of basic psychological needs is a central factor in the development and maintenance of depression, the individual case concept helps to analyse psychological conflicts and motivational goals in greater depth. Two checklists are presented as instruments for this purpose, which - taking into account the biological and psychosocial dimensions, both in regard of deficits and resources - identify the factors relevant for treatment planning.

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Introduction: As a result of the burden of a somatic illness, mental illnesses can newly occur or existing ones can worsen. Psychiatric comorbidity in turn significantly worsens the prognosis of somatic illnesses. Adjustment disorders play an important role here: they significantly impair the active management of the underlying disease. The prevalence of adjustment disorders in somatic illnesses varies greatly depending on the context. Somatic physicians are the primary points of contact for those affected and play a crucial role. However, due to a lack of therapeutic guidelines, specialists in somatic disciplines often feel uncertain about how to approach the diagnosis. The aim of this article is to provide an understanding of the diagnosis of adjustment disorder according to ICD-11 and to describe the clinical approach to adjustment disorders in somatic illnesses.

Introduction: Glucocorticoid (GC) therapy has been shown to be associated with a dose-dependent significantly elevated risk of osteoporosis and fractures. It is estimated that about 3 % of the population are prescribed systemic GC on a daily basis, and approximately 30-50 % of patients treated with GC experience an osteoporotic fracture. Evidence has been mounting that inhaled, topical, and locally infiltrated GC also adversely affect bone mineral density. At the cellular level, GC have been shown to activate osteoclasts and inhibit the activity of osteoblasts and osteocytes, resulting in a loss of bone mass and a deterioration in bone quality, thereby increasing fracture risk. Patients prescribed a daily dosage of ≥ 5 mg of prednisone equivalents for a period of at least three months should undergo a bone density assessment and a fracture risk evaluation. Lifestyle modifications, including physical activity as well as calcium and vitamin D supplementation are recommended for all patients with GC therapy. In cases of a very high risk for fracture, the administration of osteoanabolic therapy followed by antiresorptive therapy is imperative. In patients with high fracture risk, antiresorptive therapy is recommended, whereas for those at moderate/low risk for fracture selective estrogen receptor modulators or oral bisphosphonates can be considered.

Introduction: Osteoporosis is a chronic disease that requires lifelong therapy management that includes both non-drug and drug-based approaches. The availability of various drugs for osteoporosis therapy, characterized by different mechanisms of action, has significantly changed treatment strategies in recent years. Due to the potential treatment risks associated with long-term monotherapy and the fact that the osteoanabolic therapies used in patients with a high fracture risk are time-limited, sequential treatment strategies are increasingly being used today. The aim of this review article is to present the significance of different treatment sequences in osteoporosis drug therapy.

Introduction: Amino-bisphosphonates (BP), such as zoledronate, alendronate, ibandronate or risedronate, and the antibody therapies with denosumab (DMAb) or romosozumab (ROMO) are highly effective therapies for reducing the risk of vertebral fractures and non-vertebral fractures in patients with osteoporosis. Generally very well tolerated, these antiresorptive therapies have an association with bone-specific adverse events such as osteonecrosis of the jaw (ONJ) and atypical femoral fractures (AFF). This association leads to uncertainty among patients and treating physicians as to how the benefit-risk should be assessed in individual cases. By providing concrete answers to specific questions in connection with these rare events, patients can be informed in a targeted manner.

Introduction: Bone is continuously remodelled. Bone turnover markers reflect the activity of osteoblasts and osteoclasts during remodelling. Collagen synthesis by osteoblasts is reflected by the formation of bone-specific alkaline phosphatase (BALP), osteocalcin (OC) and procollagen N-propeptides (P1NP). During bone resorption, fragments of collagen (N- and C-terminal telopeptides, pyridinolines) and tartrate-resistant acid phosphatase (TRACP) are released. These markers enable a dynamic assessment of bone remodelling. P1NP is recommended as a reference marker for bone formation and ßCTX for bone resorption. Using and, above all, interpreting the results of bone turnover markers, it is impor-tant to take into account the various sources of variability of these markers, such as diurnal rhythm, day-to-day fluctuations, food intake and also the stability of the marker after blood sampling. The most important area for the clinical use of bone turnover markers is the monitoring of antiresorptive or anabolic treatments of osteoporosis. A short-term decrease in bone turnover during antiresorptive therapy correlates with an increase in bone density after 1-2 years and a decrease in fracture risk. The bone formation markers, especially P1NP, correlate with the increase in bone mineral density on anabolic treatment.

Introduction: Premenopausal osteoporosis is often overlooked because fragility fractures and low bone mass are uncommon in premenopausal women. The definition and diagnostic criteria for premenopausal osteoporosis are less well defined than for postmenopausal women. Diagnostic procedures should be initiated in premenopausal women with existing fragility fractures or diseases and drug therapies that cause bone loss. Recent studies have shown that lifestyle and dietary habits influence bone mass in the premenopausal phase. Bone mass can be improved by an adequate intake of calcium and vitamin D in combination with increased physical activity in premenopausal women with idiopathic osteoporosis. Secondary causes of osteoporosis should be corrected or treated if possible. In women with recurrent fractures or secondary causes that cannot be reversed, e.g. glucocorticoids or oncological treatments, pharmacological intervention with bisphosphonates or teriparatide (the latter not in patients with carcinomas) may be considered. Antiresorptive and osteoanabolic agents have been shown to effectively increase bone mass; however, no studies have been conducted to date with fractures as the primary endpoint.