Nervenarzt最新文献

Background: The prescription of antidepressants has been steadily increasing in Germany and worldwide for decades; however, there are no indications that this leads to an improvement in public mental health.

Objective: The question is investigated whether antidepressant pharmacotherapy, when administered over a long period of time, can adversely affect the course of depressive disorders.

Material and method: A selective literature search was carried out in the PubMed and ScienceDirect (since 1969) databases. In addition to the keyword "antidepressants", the search included the terms "tolerance", "withdrawal", "relapse", "loss of effectiveness" and "treatment resistance".

Results: If antidepressant treatment is stopped, the interval until the next episode of illness decreases compared to the inter-episode interval before initiation of drug treatment and the faster the antidepressant is stopped, the shorter the interval becomes. The relatively high frequency of relapses during ongoing treatment suggests that tolerance to the effects of the drugs has developed. In some cases, treatment resistance must also be considered to be a biological (counter)reaction of the brain to the intervention.

Conclusion: The literature summarized in this narrative review indicates that long-term antidepressant drug treatment can have an adverse effect on the course of the disease in some patients. The undisputed benefits of acute antidepressant drug treatment are offset by potential risks when taken chronically or when discontinued, which are probably due to adaptive brain changes. This must be taken into account when initiating any antidepressant pharmacotherapy.

Background: Anorexia nervosa, bulimia nervosa and binge-eating disorder are severe mental illnesses and are often associated with mental comorbidities, such as depression, anxiety and obsessive-compulsive disorders. Psychotherapy is considered the primary method of treatment; however, in the clinical practice it is not uncommon to also use psychopharmacotherapy.

Material and methods: The article considers international and national guidelines as well as the updated World Federation of Societies of Biological Psychiatry (WFSBP) guidelines to summarize the current evidence on psychopharmacotherapy of eating disorders.

Results: Anorexia nervosa: psychopharmacotherapy for anorexia nervosa should especially support weight gain. To date, there is no evidence for the efficacy of antidepressants for weight gain in anorexia nervosa. For antipsychotics, such as olanzapine in particular, the studies are heterogeneous, which is why off-label use in clinical practice is limited exclusively to individual cases. Bulimia nervosa: fluoxetine has been shown to be effective in reducing binge eating and compensatory behaviors. Fluoxetine is also the only medication approved in Germany for the treatment of an eating disorder. Binge-eating disorder: by far the greatest evidence exists for lisdexamfetamine. But this is not approved in Germany for the treatment of binge-eating disorder.

Discussion: In recent years the number of randomized controlled trials on psychopharmacotherapy for eating disorders has greatly increased. In Germany, fluoxetine is still the only approved drug for the treatment of bulimia nervosa; however, psychopharmacotherapy for eating disorders should always be embedded in a treatment plan with psychotherapy and nutritional management as well as appropriate medical monitoring. Overall, there is a need for further research.

The interrelationships between physical illnesses and mental disorders are diverse and complex. People with severe mental illness, particularly those with psychotic and affective disorders as well as pronounced personality disorders (serious/severe mental illness, SMI), have an increased risk of mortality compared to the general population as well as a higher prevalence of numerous somatic comorbidities. In addition to disease-related factors, explanation approaches for this also relate to the healthcare system. In routine psychiatric and psychotherapeutic care it is very important to keep an eye on the somatic health of people with SMI as physical impairments can easily be overshadowed by the mental illness. This article summarizes selected aspects of the broadly covered topics taking epidemiological data into account and with a focus on collaborative medical care of frequent diseases.

Background: Clinical studies with psilocybin in combination with psychotherapy show promising results for the treatment of various mental disorders; however, there still exists a lack of knowledge, rejection and prejudice towards this new form of therapy among doctors, psychotherapists and patients. The aim of this study was to gain a representative impression, as far as possible, of the level of information and attitudes towards the implementation of psilocybin-assisted therapy (PAT) among mental health experts, patients and the general population.

Methods: An online survey was used to collect information on the attitudes and knowledge of 1456 participants and to test the effect of a brief intervention. Results were determined using analyses of variance and regression models.

Results: Regression analyses showed that a higher knowledge score and self-assessed level of knowledge, own treatment experience and also own experience with psychedelics predicted more positive attitudes towards the introduction of PAT, F(8, 1447) = 154.646, p < 0.001, R² = 0.39. Providing information about the potential of PAT only led to higher acceptance when combined with information about its risks.

Conclusion: The results indicate that participants are optimistic about the implementation of PAT. The relationship between knowledge and acceptance was confirmed. The fact that receiving balanced information leads to higher acceptance should be taken into account when educating and reporting on PAT.

Background: Disorders of sexual function are a frequent comorbidity of depression and have complex interactions on psychological, sexual and relationship qualities.

Objective: To determine the prevalence of sexual functional disorders in depressed patients, the effects of antidepressant drugs and development of treatment recommendations.

Material and method: Evaluation of the current literature and discussion of fundamental studies.

Results: Depression and sexual dysfunction frequently affect each other in complex ways which makes it important to address interpersonal relationship dynamics and to include these in the therapy. The use of serotonergic antidepressants can greatly increase the risk for sexual dysfunction by up to 27 times. In addition to (couples) therapeutic interventions, reducing the dose or switching medications to, e.g., bupropion or using additive medications can also be treatment options.

Conclusion: Despite the shame associated with the topic, it is crucial for therapists to address sexual topics early and openly. Relationship dynamics should be considered during therapy. If antidepressant medications are used it is recommended to provide a more detailed clarification for patients about their potential sexual side effects and their limited treatment options before starting the medication.

Background: To date there has been no evaluation of further training and working conditions in medical specialist training in psychiatry and psychotherapy in Germany. In order to counteract the lack of young talent and ensure long-term care for patients, quality assurance is essential.

Aim of the work: The evaluation aims to identify strengths and weaknesses of the further training and to derive measures for improvement. For a better classification, a comparison is also made with other disciplines with medical specialist further training.

Material and methods: The online-based survey took place from 15 May 2023 to 30 June 2023. The results refer to 315 questionnaires from 202 physicians in further training and 113 medical specialists (specialist title for less than 3 years).

Results: Of those surveyed 64% were satisfied with the quality and implementation of the general psychiatry part, only 11% were considering changing their specialty and 18% were considering moving their job abroad due to the training conditions. There is a need for improvement in induction and in the organization of the training. In addition, significant time and financial burdens for mandatory external training events as well as the lack of compatibility between training and research, teaching and care work responsibilities were criticized.

Discussion: Overall, it appears that the working conditions are better than in other disciplines. With respect to the potential for improvement, the creation of financing for further training is essential; certificates for high quality training and the publication of positive examples can also contribute to quality assurance and improvement.