Nervenarzt最新文献

Background: Safety or emergency plan interventions, i.e., the creation of a list of hierarchically organized strategies and persons/institutions that patients can use or contact in case of a suicidal escalation, are increasingly used in clinical practice.

Method: This narrative review describes the approach for establishing an emergency plan and discusses studies on the effectiveness of such interventions. In addition, ideas on the mode of action of corresponding interventions and application variants are discussed.

Results: Despite increasing dissemination of safety plans, empirical evidence of their effectiveness is currently inadequate.

Discussion: High-quality studies are urgently needed, particularly with respect to different clinical populations. At this point in time, it should be cautioned against understanding the creation of an emergency plan as a sufficient intervention in dealing with suicidal patients.

Background: Amyotrophic lateral sclerosis (ALS) is a disease that still has to be primarily treated symptomatically or palliatively. It is therefore all the more important, in addition to initiating treatment, such as percutaneous endoscopic gastrostomy (PEG), noninvasive ventilation therapy (NIVT) and invasive ventilation therapy via tracheotomy (IVT), to discuss the possible termination of these measures early on.

Question: What is the importance of advance directives for those affected and where are possible deficits in therapy planning for the end of life?

Material and method: Between March 2017 and January 2019 patients with a clinically confirmed diagnosis of ALS at six treatment centers were asked to fill out a questionnaire. A total of 328 people returned the completed forms.

Results: Of the participants 72% had already made an advance directive (AD), 25% planned to fill one out and only 3% refused to do so. In composing the AD most patients (90%) had support, although 56% lacked medical counselling and only 18% had drawn up the will together with the doctor and relatives, with the majority of the rest also wanting support from a doctor. A total of 37% of all patients wanted a contact person to talk about their illness but only 40% of them had such a contact person. Of the patients 22% stated that they had considered suicide and of these only 55% stated that they had no contact person for the psychological stress caused by the illness but 31% wished to have such a person.

Discussion and conclusion: A coordinated care of ALS patients, which also takes the psychosocial aspects into account is urgently needed.

Background: Anxiety disorders are among the most frequent psychiatric disorders. Although the vast majority of patients in Germany are treated on an outpatient basis, anxiety disorders also play an important role in day care and inpatient care. Among other aspects, this is against the background of comorbidities, treatment-resistant courses or complications such as suicidal ideation.

Material and methods: As part of an evaluation of the basic psychiatric documentation (BADO) data from 894 patients with anxiety disorders treated in a day care or inpatient setting in a German psychiatric community hospital were evaluated over a period of 7 years.

Results: It was found that 89% of the patients had already been treated before admission and that 70% had been under medication prior to admission: patients with panic disorder made up the largest group of patients with 48%. On the date of admission 48% of patients had been treated with a selective serotonin reuptake inhibitor (SSRI) and 37% had received a benzodiazepine. Furthermore, 75% of the patients had psychiatric comorbidities. Somatic illnesses played an important role in 40% of the patients.

Discussion: The present results underline that a significant proportion of patients with anxiety disorders also require inpatient or day care treatment. Most patients had been previously treated and had not responded to therapy in an outpatient setting. Possible consequences with respect to the optimization of outpatient treatment options and the need to maintain day care and inpatient resources for this patient group, are discussed.

Background: Visual snow is a disorder of visual perception that is manifested as a constant flickering or "TV-like" noise in the entire visual field. Visual snow syndrome (VSS) describes a combination with other additional visual symptoms, such as sensitivity to light, afterimages, night blindness and entoptic phenomena. Cases of VS have been described in the literature using a wide variety of terms, often misunderstood as persistent migraine aura. Established diagnostic criteria have existed for more than 10 years now; however, the pathophysiology is still incompletely understood. The exact prevalence also remains unknown and high numbers of unreported cases are suspected. This is the first detailed description of a cohort of VSS patients from Germany.

Methods: Patients with VSS from several studies conducted at our center were pooled and retrospectively evaluated with respect to demographic, epidemiological and clinical data.

Results: In this study 66 patients with VSS were included (age 31.3 ± 8.3 years, 30 women). The most commonly associated visual symptoms were photophobia (67%) and afterimages (65%). Of the patients 36 (54%) had comorbid migraine of whom 25 (70%) had migraine with aura, 26 (39%) reported depressive symptoms and 32 (48%) symptoms of an anxiety disorder. Tinnitus was reported by 32 (48%) patients.

Conclusion: The characteristics of the German cohort described here are similar to other international descriptions. Due to the frequent psychological comorbidity there is still a risk of psychosomatic stigmatization.

Background: Numerous studies have shown a high incidence and increase in stress-related symptoms and depression-like complaints among students. During teaching on mental disorders at our medical faculty, students repeatedly reported emotionally stressful situations and expressed a desire for support services. The aim of the present study was to objectify the level of stress and the need for such support services.

Material and methods: A total of 118 students in the 9th semester (winter semester 2022/2023) were surveyed using a questionnaire on their emotional stress. The online questionnaire was conducted via LimeSurvey (LimeSurvey GmbH, Hamburg, Germany) and contained a total of 18 items formulated as statements as well as other items. The students rated the individual items on 11-point numerical scales with external anchor ratings.

Results: The respondents rated their own stress as increased compared to other modules, particularly for the subject of psychiatry (> 5 out of 10). Bedside teaching was estimated as being the most stressful, followed by seminars and lectures (all pairwise comparisons p < 0.001). The contents on depression predominantly caused the most stress. Approximately half of the students would like to be offered support services and most frequently a consultation session (78.0%) and defined contact persons (70.7%).

Conclusion: The emotional stress of students in the context of teaching on mental disorders is particularly high in psychiatry and higher with increasing patient contact; offers of support services are needed. Teachers should be sensitized to this and create offers such as open consultation sessions and the provision of defined contact persons.