Nervenarzt最新文献

Background: Digitalization in the German healthcare system is advancing. Digital services are increasingly being incorporated into mental healthcare.

Research question: This questionnaire study examined the assessment of professionals working in mental healthcare regarding the opportunities and challenges of digital health services. It takes digital health applications (DiGA) and non-DiGA (apps and web services without reimbursement and governmental regulation) into account.

Method: The online questionnaire included e.g. Likert scales for assessing the success of therapy, the quality of care, the doctor-patient relationship and the willingness to undergo further training. The quantitative questions were supplemented by free text comment fields.

Results: Based on 200 participants the analysis shows that a slight majority do not incorporate digital services into their therapy. The majority of respondents stated that digital services can support prevention and psychoeducation; however, whether they could meet the requirements in other areas of psychotherapy was mostly considered questionable. Challenges were largely seen in the high costs and insufficient information available to practitioners. In addition, the risk of exacerbating health inequalities (e.g., due to insufficient digital literacy) was discussed.

Discussion: It can be concluded that digital services can certainly add value to mental healthcare; however, the sustainable integration into care is linked to improvements in structural conditions (such as the cost-benefit ratio and better information for those providing treatment) as well as consideration and compensation for socially unequal access conditions.

Background: Climate change is considered one of the central public health challenges of the twenty-first century. While the somatic consequences of heat exposure are well documented, the evidence on mental health effects, particularly suicidal mortality, is so far limited in Germany.

Objective: The aim of this study was to examine the association between temperature, sunshine duration and the number of suicides in Germany during the period 2015-2023.

Methods: Data from the official cause of death statistics (International Classification of Diseases (ICD-10): X60-X84 intentional self-harm and suicide) were linked with monthly meteorological data from the German Weather Service (DWD). Correlations between meteorological variables and monthly suicide cases were analyzed complemented by a comparison of pandemic and nonpandemic years.

Results: On a monthly level both mean temperature (r = 0.34; p < 0.001) and sunshine duration (r = 0.36; p < 0.001) were significantly correlated with the number of monthly suicides. The correlation was particularly strong in 2020-2021 (r = 0.53).

Conclusion: Continuous monthly meteorological variables, such as temperature and sunshine duration are associated with suicidal mortality in Germany. These are exploratory findings describing concurrent associations and do not establish causality. The findings highlight the need to incorporate mental health vulnerability into heat action plans.

Background: Affective disorders are associated with an enormous disease burden, necessitating research on the mechanisms of effective treatments.

Objectives: This article introduces the intervention projects of the transregional Collaborative Research Center 393 (CRC/TRR 393). By employing targeted interventions, we aim to induce modifiability in the key mechanisms underlying the trajectories of affective disorders studied in CRC/TRR 393: emotion regulation, expectation, social cognition, and (circadian) cognitive-behavioral rhythms.

Materials and methods: The longitudinal design of the CRC/TRR 393 study will examine four interventions targeting specific mechanisms in subgroups of the German Mental Health Cohort (GEMCO). GEMCO includes patients with a current or lifetime diagnosis of major depressive disorder (MDD), bipolar disorder (BD), and healthy control (HC) participants. Multilevel measurements of these targeted mechanisms will allow us to investigate their fine-grained modifiability and their effects on disease trajectories.

Results: The results will provide insights into how these mechanisms can be modified. Together with the CRC/TRR 393 mechanisms projects, we will examine the effects of key cognitive-emotional mechanisms on disease trajectories.

Conclusion: For the first time, the modifiability of four key mechanisms underlying the trajectories of affective disorders will be investigated both cross-sectionally and longitudinally.

Background: Memory clinics in Germany are facing major challenges due to increasing numbers of patients and the first available disease-modifying treatments for Alzheimer's disease. Capacities for counselling, biomarker-based diagnostics, drug administration and follow-up examinations must be achieved, which creates the need for modified workflows. Value-based healthcare (VBHC) aims at optimizing the value for patients (outcome in relation to costs) and can serve as a framework for a patient-oriented increase in efficacy.

Objective: This project applied approaches of VBHC to analyze and improve the diagnostic processes in our memory clinic in order to achieve a better value for patients and care partners with a more efficient use of existing resources.

Methods: In a first survey among memory clinic patients and relatives the essential aspects in relation to VBHC were collated and based on the results the existing workflow processes were modified. These modifications were evaluated by a second survey and analysis particularly of process-oriented aspects.

Results: The first survey revealed a general satisfaction with the presentation in the memory clinic. The main point of criticism was the duration of the diagnostic process. After the modification the duration and extent of the diagnostics could be reduced. The second evaluation showed improved patient and care partner satisfaction. The respondents considered the modified trajectories to be better and resources were conserved.

Conclusion: In our memory clinic an improvement in the sense of VBHC could be achieved through an increased satisfaction with the treatment (outcome) and reduced personnel binding times (costs). This approach can serve as a model for other memory clinics for the development of a more efficient and patient-centered care.

Major depressive disorder (MDD) and bipolar disorder (BD) are prevalent and disabling psychiatric disorders, often following a chronic and relapsing course. The Collaborative Research Centre 393 (SFB/TRR 393), funded by the German Research Foundation (DFG), aims to identify trajectories and symptom changes in MDD and BD, with a focus on cognitive-emotional mechanisms and their neurobiological underpinnings.Our research initiative seeks to (1) identify individual trajectories of recurrences and remissions in affective disorder (AD), (2) determine cognitive-emotional mechanisms and neurobiological correlates of acute symptom changes, and (3) probe mechanism-based interventions.These goals will be pursued through a threefold approach: (1) Continuous mobile assessment in a prospective cohort: We will combine in-depth clinical characterization with multilevel neuroimaging, biobanking, and -omics analyses in 1500 AD patients and healthy participants over a 2-year follow-up (German Mental Health Cohort, GEMCO) at three time points. Participants will be drawn from existing DFG FOR 2107 and BMBF Early-BipoLife cohorts (Domain A). (2) Identification of key cognitive-emotional mechanisms: We will study emotion regulation, expectation, social cognition, and cognitive-behavioural rhythms, and their neurobiological correlates mediating symptom changes, using parallel human studies and animal experiments (Domain B). (3) Targeted interventions: We will probe key cognitive-emotional mechanisms in relation to recurrences and remissions (Domain C).Over a 12-year period, we will elucidate environmental, psychosocial, and (neuro)biological predictors of illness course; cognitive-emotional and neurobehavioural mechanisms underlying real-life recurrences and remissions; and targeted, mechanism-based interventions.

Background: Value-based healthcare (VBHC) is a concept in health economics that aims to improve patient care through needs-oriented treatment approaches while considering the costs incurred. "Value" describes the ratio of patient-centered outcome and experience data to the costs incurred.

Objective: To analyze and optimize the workflows of the Outpatient Memory Clinic of the ZI Mannheim according to VBHC criteria. The aim of the study was to improve the quality of care from the patient's perspective, to measure the changes in benefits for all involved parties and simultaneously to evaluate the costs and revenues of the diagnostic process.

Methods: The initial diagnostic process was analyzed in 25 dyads (patient + caregiver) using standardized (State-Trait Anxiety Inventory (STAI), Patient Assessment of Chronic Illness Care (PACIC), Euroquol visual analogue scale (EQ-VAS)) and process-oriented questionnaires. After staff training, a modified diagnostic process (VBHC-M) was implemented in a pilot study. This process was then evaluated in a second survey of 17 dyads and 8 additional patients using the same questionnaires. The results from both surveys were compared using t‑tests or Mann-Whitney U tests. A cost and revenue analysis (CRA) was conducted using annual data.

Results: The quality of care (PACIC) for patients (p < 0.001) and caregivers (p = 0.004) improved following VBHC‑M, as did patient satisfaction and expectations (process-oriented questionnaires). The CRA showed that VBHC‑M resulted in a financial disadvantage for the care provider.

Conclusion: The workflows of the outpatient memory clinic could be successfully optimized in the sense of patient-centered care, leading to an increased number of patients treated, higher patient and caregiver satisfaction and cost savings. This shows that VBHC can be implemented in outpatient memory clinics; however, the accelerated diagnostic process is reimbursed at a lower rate under the current flat-rate quarterly payment system, highlighting the need for adjustments to reimbursement models.