Nervenarzt最新文献

Aim: From a public health perspective, the provision of information on low-risk consumption is highly relevant for behavior with addictive potential and negative health, psychological or social consequences. This article provides an overview of the effectiveness and benefits of such recommendations for alcohol, cannabis, gambling and gaming.

Methods: An overview based on a narrative review.

Results: The recommendation for alcohol consumption limits can no longer be upheld on the basis of current evidence. Instead, abstinence is recommended. In the case of cannabis, it is currently not possible to determine thresholds for the frequency and quantity of use with regard to consequential harms. Current recommendations, therefore, relate to "safer use". With respect to gambling, initial but not yet reliable empirical data are available. Thresholds of varying consumption dimensions, such as the involvement in different forms of gambling, the regularity or duration of gambling as well as the amount of money spent, must be taken into account. There are no evidence-based consumption recommendations for gaming. Furthermore, a consideration of the media content that goes beyond pure usage time is essential before any recommendations can be derived. Overall, the effectiveness of recommendations depends on the perception and acceptance of the population.

Conclusion: Recommendations for consumption are based on the available evidence and must be continuously reviewed and adapted, as can be seen from the example of alcohol consumption. Behavioral recommendations must be communicated in a suitable form so that they are understood without bias and are accepted by the general population.

Background: Digital technologies open up new opportunities in the treatment of mental health disorders. Internet-based and mobile telephone-based interventions (IMIs), in particular, have proven to be effective, cost-efficient and accessible approaches to improving the care of people with mental disorders. In Germany digital health applications (DiGAs) that are reimbursed by all public health insurances are gaining increasing importance in routine clinical practice.

Objective: This article provides a narrative review of the evidence and challenges related to DiGAs for depression in the German healthcare system. The approved DiGAs are presented and key studies, developments and perspectives for future research and care concepts are discussed.

Material and methods: This study is based on a narrative review of the relevant literature. The focus is on evidence-based DiGAs approved by the Federal Institute for Drugs and Medical Devices (BfArM) for the treatment of depression and their integration into routine care as well as acceptance by patients and clinicians.

Results: Internet-based cognitive behavioral therapy (iCBT) in particular, demonstrate a small to medium effect strength for depression, comparable to face-to-face therapy (Hedge's g = 0.43). Guided and blended care approaches appear to provide advantages with respect to the evidence and care; however, the utilization of DiGAs remains low, considering the large number of affected individuals, which is attributable to factors, such as limited awareness, complex access routes and prescription processes and data privacy concerns.

Conclusion: Despite promising evidence, the integration of DiGAs into existing healthcare systems remains challenging. Future research efforts should focus on the long-term effectiveness, personalization of digital solutions and hybrid care models to enhance acceptance and utilization.

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.