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[Introduction to the topic: is work good for your health?] [主题介绍:工作有益健康吗?]
IF 0.9 4区 医学 Q4 CLINICAL NEUROLOGY Pub Date : 2024-09-01 Epub Date: 2024-09-04 DOI: 10.1007/s00115-024-01717-2
Steffi G Riedel-Heller
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引用次数: 0
Mitteilungen der DGPPN 09/2024. DGPPN 09/2024 号来函。
IF 0.9 4区 医学 Q4 CLINICAL NEUROLOGY Pub Date : 2024-09-01 DOI: 10.1007/s00115-024-01741-2
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引用次数: 0
[Advance directives and mental disorders: a practice recommendation of the Commission for Ethics and Law of the German Association for Psychiatry, Psychotherapy and Psychosomatics]. [预嘱与精神障碍:德国精神病学、心理治疗和心身医学协会伦理与法律委员会的实践建议]。
IF 0.9 4区 医学 Q4 CLINICAL NEUROLOGY Pub Date : 2024-09-01 Epub Date: 2024-05-03 DOI: 10.1007/s00115-024-01662-0
Sabine Müller, Jakov Gather, Euphrosyne Gouzoulis-Mayfrank, Tanja Henking, Matthias Koller, Henning Saß, Tilman Steinert, Thomas Pollmächer

Background: Since the creation of legal requirements for advance directives by the legislator in 2009, special aspects of their application in the treatment of people with mental illnesses have been discussed.

Goal of the paper: Important questions on dealing with advance directives in everyday life will be answered in a practice-oriented manner.

Results: Among other things, this document answers the question of the conditions under which a patient can refuse or consent to hospitalization and treatment in advance, and in particular how to deal with advance directives whose implementation would also affect the rights of third parties. The German Association for Psychiatry, Psychotherapy and Psychosomatics (DGPPN) has addressed these and other questions in the present document and added practical advice on how to formulate advance directives for people with mental illnesses and how to deal with psychiatric advance directives.

Discussion: The DGPPN has developed an advance directive for the area of mental health and published it on its website together with detailed explanations. With the help of this advance directive, people can decide on their treatment in phases of incapacity to consent in the context of a mental crisis or illness.

背景:自 2009 年立法者对预先医疗指示提出法律要求以来,人们一直在讨论在治疗精神疾病患者时应用预先医疗指示的特殊方面:本文将以实践为导向,回答日常生活中处理预先医疗指示的重要问题:结果:除其他事项外,本文件还回答了病人在何种情况下可以拒绝或同意提前住院和治疗的问题,特别是如何处理其执行也会影响第三方权利的预先指令。德国精神病学、心理治疗和心身医学协会(DGPPN)在本文件中讨论了这些问题和其他问题,并就如何为精神病患者制定预先医疗指示以及如何处理精神病患者的预先医疗指示补充了实用建议:DGPPN 制定了精神健康领域的预先指示,并在其网站上公布了该预先指示及详细说明。在这一预先指示的帮助下,人们可以在精神危机或精神疾病的情况下,在无能力作出同意的阶段决定自己的治疗。
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引用次数: 0
[Cannabis use and cannabis use disorders]. [大麻使用和大麻使用障碍]。
IF 0.9 4区 医学 Q4 CLINICAL NEUROLOGY Pub Date : 2024-09-01 Epub Date: 2024-08-12 DOI: 10.1007/s00115-024-01722-5
E Hoch, U W Preuss

Cannabis use and cannabis use disorders have taken on a new social significance as a result of partial legalization. In 2021 a total of 4.5 million adults (8.8%) in Germany used the drug. The number of users as well as problematic use have risen in the last decade. Cannabis products with a high delta-9-tetrahydrocannabinol (THC) content and their regular use lead to changes in cannabinoid receptor distribution in the brain and to modifications in the structure and functionality of relevant neuronal networks. The consequences of cannabinoid use are particularly in the psychological functioning and can include intoxication, harmful use, dependence with withdrawal symptoms and cannabis-induced mental disorders. Changes in the diagnostics between ICD-10 and ICD-11 are presented. Interdisciplinary S3 guidelines on cannabis-related disorders are currently being developed and will be finalized shortly.

由于部分大麻合法化,大麻使用和大麻使用障碍具有了新的社会意义。2021 年,德国共有 450 万成年人(8.8%)吸食大麻。在过去十年中,吸毒人数和吸毒问题都有所上升。大麻产品中的δ-9-四氢大麻酚(THC)含量很高,经常使用会导致大脑中大麻素受体分布发生变化,并改变相关神经元网络的结构和功能。使用大麻素的后果尤其体现在心理功能方面,可能包括中毒、有害使用、出现戒断症状的依赖性和大麻诱发的精神障碍。介绍了 ICD-10 和 ICD-11 诊断方法的变化。目前正在制定关于大麻相关疾病的 S3 跨学科指南,不久将最终定稿。
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引用次数: 0
[The challenges for psychiatric care posed by synthetic drugs]. [合成药物给精神病治疗带来的挑战]。
IF 0.9 4区 医学 Q4 CLINICAL NEUROLOGY Pub Date : 2024-09-01 Epub Date: 2024-08-26 DOI: 10.1007/s00115-024-01705-6
Norbert Scherbaum, Udo Bonnet

Background: In addition to the drugs that have been known for decades, several hundred mainly synthetic substances have been identified as drugs for the first time in the last 20 years.

Aim of the work: Presentation of the various groups of substances and their psychotropic effects, the epidemiology of their use and the legal and social background of this development.

Material: Narrative literature review.

Results: The most important new psychoactive substances (NPS) are synthetic cannabinoids, synthetic stimulants (cathinones), halluginogens and new synthetic opioids (NSO), in particular fentanyl and related substances. The new substances do not have any qualitatively new psychotropic effects. They were brought onto the market in particular as substitutes for substances subject to the Narcotics Act but are often associated with dangerous side effects and even mortality. The increasing availability of these substances has gone hand in hand with the establishment of the Internet as a source of knowledge (e.g. for synthesis routes) and as a marketplace. Substance group-related regulations have also been established in Germany (New Psychoactive Substances Act). In Germany the prevalence of NPS use is significantly lower than that of cannabis; however, there are indications that the production and distribution of synthetic drugs is more profitable for drug dealers than with conventional plant-based drugs, such as heroin. In the USA, for example, NSOs are the primarily drugs used for opioid addiction.

Discussion: It remains to be seen whether NPS and NSOs will replace conventional drugs. The availability of synthetic drugs is more difficult to reduce than that of plant-based drugs. Harm reduction measures should be expanded, e.g., early warning systems for new drugs, drug checking and naloxone programs.

背景:除了几十年来一直为人所知的毒品外,在过去 20 年里,有几百种主要是合成的物质首次被确认为毒品:介绍各类物质及其精神作用、其使用的流行病学以及这一发展的法律和社会背景:材料:叙述性文献综述:最重要的新型精神活性物质(NPS)是合成大麻素、合成兴奋剂(卡西酮类)、致幻剂和新型合成阿片类物质(NSO),特别是芬太尼和相关物质。这些新物质没有任何新的精神作用。它们主要是作为受《麻醉品法》管制的物质的替代品进入市场的,但往往具有危险的副作用,甚至会导致死亡。随着互联网作为知识来源(如合成路线)和市场的建立,这些物质的供应量也在不断增加。德国也制定了与物质类别相关的法规(《新精神活性物质法》)。在德国,非精神活性物质的使用率明显低于大麻;然而,有迹象表明,与海洛因等传统植物类毒品相比,合成毒品的生产和分销对毒贩来说更有利可图。例如,在美国,非处方药是治疗阿片类药物成瘾的主要药物:讨论:NPS 和 NSO 是否会取代传统毒品还有待观察。合成毒品的供应比植物毒品更难减少。应扩大减少危害的措施,如新型毒品预警系统、毒品检查和纳洛酮计划。
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引用次数: 0
[Psychedelic and dissociative agents in psychiatry: challenges in the treatment]. [精神病学中的迷幻剂和解离剂:治疗中的挑战]。
IF 0.9 4区 医学 Q4 CLINICAL NEUROLOGY Pub Date : 2024-09-01 Epub Date: 2024-08-28 DOI: 10.1007/s00115-024-01727-0
Johannes Jungwirth, Francesco Bavato, Boris B Quednow

With the discovery of the antidepressive effects of ketamine and the increasing withdrawal of the pharmaceutical industry from the development of new psychotropic drugs, the psychiatric research into the clinical application of hallucinogens in psychiatry has literally blossomed in the last two decades. Promising results for various treatment approaches with psychedelic agents, such lysergic acid diethylamide (LSD) and psilocybin, and dissociative agents, such as ketamine and esketamine, have raised great hopes among researchers, clinicians and patients in recent years, so that there was already talk of a new era in psychiatry. As one of the first of these substances, in December 2019 intranasal esketamine was approved in the USA and the EU for the treatment of treatment-resistant depression and Switzerland followed in 2020. Recently, psilocybin was approved in Australia, Canada and Switzerland for compassionate use in exceptional cases for the treatment of depression, while large approval studies with various psychedelic agents are currently ongoing worldwide. The medical application of psychedelic agents and ketamine/esketamine is considered to be safe; however, as with all new forms of treatment it is of crucial importance that, in addition to the hopes, the specific challenges of these new treatment approaches must also be carefully considered and assessed. Excessive expectations and an insufficient risk-benefit estimation are detrimental to the patients and the reputation of the treating physician. Although a possible paradigm shift in the care of mental health is already being discussed, this review article consciously concentrates on the possible risks of treatment and the methodological weaknesses of the studies carried out so far.

随着氯胺酮抗抑郁作用的发现,以及制药业越来越多地退出新精神药物的开发,过去二十年来,精神科对致幻剂在精神科临床应用的研究可谓百花齐放。近年来,迷幻剂(如麦角酰二乙胺(LSD)和西洛赛宾等)和解离剂(如氯胺酮和氯胺酮等)的各种治疗方法都取得了可喜的成果,给研究人员、临床医生和患者带来了巨大的希望,以至于人们已经开始谈论精神病学的新时代。作为这类物质中的首批药物之一,2019 年 12 月,美国和欧盟批准鼻内注射埃斯氯胺酮用于治疗耐药性抑郁症,瑞士也将于 2020 年批准。最近,澳大利亚、加拿大和瑞士批准在特殊情况下同情性使用迷幻剂治疗抑郁症,目前全世界正在进行各种迷幻剂的大规模批准研究。迷幻剂和氯胺酮/开塞露在医学上的应用被认为是安全的;然而,与所有新的治疗形式一样,至关重要的是,除了希望之外,还必须仔细考虑和评估这些新治疗方法的具体挑战。过高的期望值和不充分的风险效益评估会损害患者和治疗医生的声誉。尽管人们已经在讨论精神健康护理模式可能发生的转变,但这篇综述文章有意识地将重点放在治疗可能存在的风险以及迄今为止所开展研究在方法上的不足之处上。
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引用次数: 0
[Psychiatric symptoms of Huntington's disease]. [亨廷顿氏病的精神症状]。
IF 0.9 4区 医学 Q4 CLINICAL NEUROLOGY Pub Date : 2024-09-01 Epub Date: 2024-08-30 DOI: 10.1007/s00115-024-01728-z
Alzbeta Mühlbäck, Rainer Hoffmann, Nicolo Gabriele Pozzi, Martin Marziniak, Peter Brieger, Matthias Dose, Josef Priller

Huntington's disease (HD) is an autosomal dominant inherited disease, which leads to motor, cognitive and psychiatric symptoms. The diagnosis can be confirmed by genetic testing for extended CAG repeats in the Huntingtin gene. Mental and behavioral symptoms are common in HD and can appear several years before the onset of motor symptoms. The psychiatric symptoms include apathy, depression, anxiety, obsessive-compulsive symptoms and, in some cases, psychoses and aggression. These are currently restricted to symptomatic treatment as disease-modifying treatment approaches are still under investigation. The current clinical practice is based on expert opinions as well as experience with the treatment of similar symptoms in other neurological and mental health diseases. This article provides an overview of the complex psychiatric manifestations of HD, the diagnostic options and the established pharmacological and nonpharmacological treatment approaches.

亨廷顿氏病(Huntington's disease,HD)是一种常染色体显性遗传疾病,会导致运动、认知和精神症状。通过基因检测亨廷廷基因中的延长CAG重复序列可确诊该病。精神和行为症状是 HD 的常见症状,可在运动症状出现前数年出现。精神症状包括冷漠、抑郁、焦虑、强迫症状,在某些情况下还会出现精神病和攻击行为。这些症状目前仅限于对症治疗,因为改变疾病的治疗方法仍在研究之中。目前的临床实践是基于专家意见以及治疗其他神经和精神疾病类似症状的经验。本文概述了 HD 的复杂精神表现、诊断选择以及既有的药物和非药物治疗方法。
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引用次数: 0
[The challenge of drugs: a dynamic situation requires evidence-based interventions]. [毒品的挑战:动态局势需要循证干预]。
IF 0.9 4区 医学 Q4 CLINICAL NEUROLOGY Pub Date : 2024-09-01 Epub Date: 2024-09-04 DOI: 10.1007/s00115-024-01724-3
Falk Kiefer
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引用次数: 0
[Sexual abuse in the area of responsibility of the Protestant Church: some results from a subproject of the ForuM study]. [新教教会责任区内的性虐待:ForuM 研究子项目的一些结果]。
IF 0.9 4区 医学 Q4 CLINICAL NEUROLOGY Pub Date : 2024-09-01 Epub Date: 2024-04-29 DOI: 10.1007/s00115-024-01670-0
Harald Dreßing, Dieter Dölling, Elke Voss, Leonie Scharmann, Andreas Hoell
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引用次数: 0
[Individual placement and support in mental health services: evaluation of routine clinical data using a retrospective chart review]. [心理健康服务中的个人安置和支持:利用回顾性病历审查对常规临床数据进行评估]。
IF 0.9 4区 医学 Q4 CLINICAL NEUROLOGY Pub Date : 2024-09-01 Epub Date: 2024-07-18 DOI: 10.1007/s00115-024-01706-5
Dorothea Jäckel, Karolina Leopold, Andreas Bechdolf

Background: People with severe mental illnesses are often excluded from working life and would like support to (re)enter the general labor market as part of the psychiatric treatment. Individual placement and support (IPS) is an effective method of finding and retaining work in the general labor market. The aim of the study was to determine the integration rates of IPS into the general labor market in acute and postacute psychiatric settings, identifying patient, setting and program characteristics associated with (re)entering work.

Method: A retrospective chart review (RCR) of routine clinical data between 2016 and 2021 was carried out. The IPS program adherence was rated using the IPS fidelity scale.

Results: A total of 375 patients participated in the IPS with at least 4 appointments. The (re)integration rate into the general labor market was 51.7%. A shorter time period to the last working day, diagnosis of F1, F2, F3 (vs. F4), change of treatment setting and IPS in the psychiatric institute outpatient department (PIA), IPS fidelity and the number of IPS coaching sessions were positively correlated with (re)integration into work.

Conclusion: The implementation of IPS in clinical mental healthcare is possible and leads to high integration rates in the open labor market. An early start of IPS during the clinical treatment can promote social inclusion.

背景:患有严重精神疾病的人往往被排除在职业生活之外,他们希望得到支持,以便(重新)进入普通劳动力市场,这也是精神治疗的一部分。个人安置和支持(IPS)是在普通劳动力市场寻找和保留工作的有效方法。本研究旨在确定急性期和急性期后精神病治疗机构中 IPS 与普通劳动力市场的融合率,识别与(重新)进入工作相关的患者、环境和项目特征:方法:对2016年至2021年间的常规临床数据进行回顾性病历审查(RCR)。结果:共有375名患者参加了IPS项目:结果:共有 375 名患者参与了 IPS 计划,至少预约了 4 次。重新)融入普通劳动力市场的比例为 51.7%。较短的最后工作日时间、F1、F2、F3 诊断(与 F4 诊断相比)、治疗环境的改变以及在精神病院门诊部(PIA)实施 IPS、IPS 的忠实度和 IPS 指导次数与(重新)融入工作呈正相关:结论:在临床精神卫生保健中实施 IPS 是可行的,并能在开放的劳动力市场中获得较高的融入率。在临床治疗期间尽早开始 IPS 可以促进社会融入。
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