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Digital health applications (DiGA) for borderline personality disorder (BPD) are still a relatively new and underresearched topic but hold great potential, especially considering that there is no single approved medication for BPD. So far, one DiGA (priovi) has been permanently approved for BPD by the Federal Institute for Drugs and Medical Devices (BfArM). Concerns related to this topic mainly relate to patient safety and the lack of a therapeutic relationship; however, studies on priovi have actually shown positive findings regarding the therapeutic relationship and its use seems to increase safety rather than compromise it. That said, there is still a significant need for further research in this field. In the practical application each clinician must consider the individual situation of their patient and integrate a DiGA into the treatment plan in a way that seems to best suit the specific patient's needs.

Background: Despite the high prevalence of posttraumatic stress disorder (PTSD), no digital health application (digitale Gesundheitsanwendung, DiGA) prescribable within the German statutory health insurance system is currently available to treat the disorder.

Objective: Overview of digital intervention options for the treatment of PTSD and potential challenges in developing an effective DiGA.

Material and method: Narrative review of the current literature.

Results: Internet- and mobile-based interventions for PTSD have the potential to serve as an effective treatment option, as demonstrated by a series of meta-analyses comparing them to waiting list control groups, conditions involving no or minimal usual care, and active control groups (e.g., psychoeducation); however, specific challenges exist within the target population that go beyond commonly known barriers, such as pronounced concerns of developers and medical professionals regarding safety and potentially even lower adherence of patients.

Conclusion: The development of DiGAs for the treatment of PTSD might be perspectively promising but the aforementioned challenges must be considered in the design and implementation to ensure an effective application.

Background: Bipolar disorders require long-term monitoring. Digital applications, such as smartphone apps, offer potential for self-management and early detection but there are uncertainties regarding availability, guideline conformity and evidence. In Germany, specific digital health applications (DiGAs) for bipolar disorders are lacking, highlighting regulatory and healthcare delivery challenges.

Aim: This review examines apps for bipolar disorder available in Germany with respect to their functions, availability and evidence base.

Material and methods: Between January and March 2025 a systematic search was conducted in the databases MindApps.org and MindTools.io for apps. Functions, research evidence, languages, cost models, and app-store availability were recorded. Additionally, scientific studies on the identified apps were reviewed.

Results: A total of 18 apps were identified 11 of which are specifically for bipolar disorders. The functions range from mood and symptom tracking to psychoeducational contents. Of the apps six had published studies but none showed significant improvements in symptoms.

Discussion: Although digital interventions show promise for improving the treatment of bipolar disorder, large-scale, methodologically rigorous randomized controlled trials with standardized endpoints are still lacking. In Germany no DiGAs specifically designed for this patient group are currently available. Moreover, for sustainable integration into routine care of a chronic condition such as bipolar disorder, dependable reimbursement models and comprehensive long-term studies are also required.

Since 2020 digital health applications, or DiGA for short, can be prescribed and reimbursed by health insurance companies, making them one of the pioneers in the integration of digital therapeutics in patient care. The prerequisite for these "apps on prescription" is a listing in the DiGA directory after successfully passing an evaluation process at the Federal Institute for Drugs and Medical Devices (BfArM). The DiGA directory of the BfArM contains information on the individual DiGAs and their properties that are transparent and tailored to the target group. In addition to a positive effect on care a DiGA must meet extensive quality, data protection and security parameters. Of the 59 DiGAs currently available on prescription 28 deal with psychiatric indications. The proof of positive effects on care were overwhelmingly demonstrated in randomized controlled trials. A DiGA should be used after proper diagnostics, determination of indications and education, both as a preparation for therapy and as a supplement to therapy. They can be prescribed by medical or psychotherapeutic practices but also by inpatient treatment providers as part of discharge management. Patients who use DiGAs appreciate their availability in their individual everyday lives, the opportunities for information and exchange within the therapy setting and the increased sense of self-management.

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.

Methamphetamine (MA) is one of the most relevant illegal drugs of our time worldwide. In German hospitals the management of a variety of MA-associated problems are also part of the daily routine, especially in the central area of Germany. A rapid infiltration of the central nervous system, pronounced dopaminergic stimulation and a long-term effect together with easy availability are the reasons for the enormous potential for dependency. This review article shows the dimensions and complexity of MA-related disorders (MRD). Proven diagnostic and therapeutic knowledge is reported and approaches for a possible sustainable solution to the problems are named.

Background: Suicide during inpatient treatment represents distressing events for clinics and medical staff while raising questions about liability consequences. They require a differentiated approach balancing patient protection and therapeutic necessities.

Objective: To analyze long-standing case law to identify practice-relevant principles for clinical risk management regarding suicidal ideation.

Material and methods: Systematic evaluation of 22 decisions from German high and supreme courts (1985-2025) concerning suicides during inpatient treatment.

Results: Case law acknowledges the impossibility of absolute suicide prevention and grants psychiatric treatment teams considerable discretionary latitude. The legal assessment is based on the treating physician's ex-ante perspective. Specific duties of care arise in cases of acute suicidal ideation, risk situations such as therapeutic relaxations and necessary structural and organizational measures. The balance between security interests and therapeutic requirements remains central.

Conclusion: The jurisprudence demonstrates a nuanced understanding of the clinical challenges in suicide prevention. The identified assessment standards provide orientation for the clinical practice and emphasize the necessity of individual risk assessments and documentation of all relevant decisions.

Background: Longitudinal outcome studies confirm that the majority of patients with schizophrenic psychoses develop cognitive impairments associated with schizophrenia (CIAS).

Objective: To provide an overview of the epidemiology, diagnostics and evidence for various treatment options for CIAS.

Material and methods: Literature review of the current level of evidence regarding the efficacy of different treatment strategies for CIAS.

Results: Up to 85% of patients with schizophrenic psychoses exhibit CIAS, in some cases even before the development of positive or negative symptoms. The CIAS are associated with extensive individual burden due to impairments in many areas of cognitive and psychosocial functioning relevant to daily life. Various test instruments are available for clinical assessment with the Mental Health's Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) consensus cognitive battery (MCCB) as an established standard for clinical trials and special clinical issues. The treatment of CIAS warrants a multimodal approach with non-drug strategies (e.g., cognitive remediation, exercise) currently providing the best level of evidence. Noninvasive neurostimulation procedures and dopaminergic antipsychotic drugs of the first and second generations have demonstrated low effectiveness on cognitive function disorders in schizophrenic psychoses.

Conclusion: The CIAS is a frequent disease-immanent symptom in schizophrenic psychoses that should be considered in the clinical routine as it substantially impairs those affected in the functional level and quality of life. Current treatment options are limited but innovative psychosocial interventions show low to moderate effects. In addition, new medications developed based on current neurobiological findings and combinations with psychosocial and neurostimulation procedures could open up new perspectives.