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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: 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.

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: 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.