[Psyche in Climate Crisis?An Update on Ecological Psychiatry and Psychotherapy]
The human-caused climate crisis is advancing relentlessly and poses a global threat. But to what extent is our psyche also in crisis due to climate change? This article explores the profound impacts of the climate crisis and environmental destruction on mental health, advocating for a comprehensive, ecologically-oriented approach to psychiatry and psychotherapy.
[Neurological evaluation of "post-COVID-19 syndrome" (PCS)]
The so-called "post-COVID-19 syndrome" (PCS) includes a variety of subjective complaints and represents a challenge to medical evaluation. The review focuses on symptom validation of the most common neurological, neuropsychiatric and neuropsychological PCS symptoms like fatigue, loss of smell and taste, problems speaking or communicating, cognitive disorders, dysaesthesia and persistent muscle pain.
[Correction: The pioneers Schwerin and Brandenburg-Görden in the development of alcohol use disorder therapy in the GDR]
[Diagnostic utility of the MTA-Score depending on age and cerebral microangiopathy in times of automated volumetry]
To investigate the diagnostic value of the MTA score according to age, cerebral small vessel disease and in times of automated volumetry. Retrospective analysis of patients with subjective cognitive decline (SCD), amnestic mild cognitive impairment (aMCI), Alzheimer's disease (AD) and mixed dementia (MD) who presented to our outpatient dementia clinic between February 2018 and October 2020. Patients underwent cranial magnetic resonance imaging (MRI) including specific MRI sequences needed for automated volumetry. MRI data sets were analyzed regarding MTA score, Fazekas score, hippocampal und temporal lobe percentile and total white matter lesion volume. Within the study period, 242 patients (100 male, 142 female, mean age 74.7±9.9 years) with SCD (n=20), aMCI (n=110), AD (n=62) and MD (n=50) were analyzed. MTA score strongly correlated with age (ρ=0.545; p<0.001), especially regarding the aMCI and AD group. MTA score differentiated only between prodromal and dementia stages (aMCI vs. AD: p=0.005), whereas hippocampal percentile also showed a trend in differentiating between SCD and aMCI. There was a correlation between MTA score and hippocampal percentile (ρ=-0.385; p<0.001), which, on a single group level, could only be shown for the aMCI and AD group. There was significant correlation between MTA score with hippocampal and temporal lobe percentile. MTA score also correlated with Fazekas score (ρ=0.451; p<0.001) which again could only be detected within the aMCI and AD group. But there was no correlation between hippocampal percentile and total white matter lesion volume. When interpreting the MTA score, patient's age needs to be taken into consideration. Especially, in early dementia diagnostics, automated volumetric procedures might be advantageous, but due to the strong correlation of MTA score with hippocampal percentile, the MTA score still is a valid diagnostic marker. Whether hippocampal atrophy is modulated by cerebral small vessel disease still needs to be elucidated.
[Obsessive-compulsive Disorder: Exposure Treatment and special Features of concentrated Treatment]
Obsessive-compulsive disorder (OCD) is often associated with great suffering for both the affected individual as well as their relatives. The treatment of choice for OCD is cognitive behavioural therapy (CBT) with exposure and response prevention. Exposurebased treatment is offered in a concentrated, high-frequency format over four consecutive days in the Bergen 4-Day Treatment (B4DT). This article presents the procedure and effectiveness of this concentrated exposure treatment.
[Psychedelics in psychiatry: an open debate]
The application of psychedelics in psychiatry and psychotherapy is increasingly the subject of scientific evaluation and discussion in national and international professional and general society, and, internationally, has already been partly applied in the clinical setting. The manuscript provides a basic description of the state of the art regarding evidence and clinical issues; law, ethics and economics are addressed; therapeutic qualification of potential users and a potentially clinical embedding in psychiatry are discussed, taking into consideration current challenges. Thus, the discussion will cover the circumstances under which the application of psychedelics might have a potential to broaden the spectrum of treatments in certain psychiatric conditions, particularly in the context of chronicity and treatment resistance to current methods. However, basic and critical issues have to be clarified before eventual implementation.
[The pioneers Schwerin and Brandenburg-Görden in the development of alcohol use disorder therapy in the GDR]
The aim of this study was to provide insights into the addiction therapy concepts applied at the clinics of Hugo von Keyserlingk in Schwerin and Hubertus Windischmann in Brandenburg and to enable an understanding of the specific problems in this subsector of psychiatric care in the GDR.
[Telemedicine for mental disorders: Presentation and initial results of a telephone-based care approach]
A telephone-based health program for people with depressive and anxiety disorders as well as stress, already implemented in the standard care of a private health insurance company, as well as the initial evaluation results will be presented.
[Ethical challenges of telepsychiatry]
Telepsychiatry is shifting the focus of psychiatry and psychotherapy from personal interaction and relationship building to communication with technological mediators in the form of telecommunication, virtual reality (VR), social robots or artificial intelligence (AI). This article discusses the opportunities and risks of new technologies in psychiatric treatment, taking into account the principles of medical ethics. Telepsychiatric treatments can promote self-determination in the home environment as opposed to institutionalisation but carry the risk of uncontrolled data sharing. They harbour risks of potential harm such as social isolation, negative effects on the doctor-patient relationship and long-term changes in patient behaviour through, for example, VR. In terms of justice, demographic and psychopathological factors could result in unequal access to telepsychiatry, with questionable sustainability effects. The anonymity of telepsychiatry threatens alienation, while moral considerations cannot be replaced by AI for the time being. It is obligatory to carefully weigh up the benefits and risks of telepsychiatry, but especially in rural areas they could optimise care.Precisely because of ethical concerns, further intensive research is necessary to weigh up the risks and benefits. The development of telepsychiatric systems requires transdisciplinary co-operation. At a societal level, the significance of technologies as a supplement or replacement for the doctor-patient relationship needs to be discussed.
[Benefits and challenges: antidepressants and bleeding risk, health information for patients and use of biomarkers]
[Gamma-hydroxybutyric acid (GHB): Rehab- treatment in an inpatient setting]
[Pharmacogenetic testing to optimize psychopharmacotherapy: Case study of a patient with severe depression and lack of treatment success due to genetic polymorphisms for CYP2D6 and CYP2C19]
[Physician-led healthcare structures for patients in out-of-hospital intensive care nursing: a cross-sectional survey by the German Society for Out-of-Hospital Ventilation]
Patients in out-of-hospital intensive care are usually provided with a tracheal cannula and often additionally receive mechanical ventilation. Less frequently, they receive non-invasive ventilation. Their potential to be weaned from the ventilator and to have their tracheostomy tubes removed must be evaluated twice per year from January 1, 2025 on. If there is a potential for weaning from mechanical ventilation or removal of the tracheostomy tube, referral to a specialized facility is required.
[Correction: Pharmacogenetic testing to optimize psychopharmacotherapy: Case study of a patient with severe depression and lack of treatment success due to genetic polymorphisms for CYP2D6 and CYP2C19]
[Neurological long-term consequences of COVID-19]
The COVID-19 pandemic faced the public health sector with unprecedented challenges. While the immediate impact on society seems to diminish, reports of long-term health consequences persist. Among the most frequently reported symptoms are neurological complaints such as persistent fatigue and cognitive impairments. Scientific understanding is evolving rapidly, and first therapeutic approaches are emerging. However, many questions still remain unanswered.
[The Impact of Antidepressants on COVID-19 and Post-Acute COVID-19 Syndrome: A Scoping-Review Update]
Introduction Preclinically, fluvoxamine and other antidepressants (AD) exerted antiviral and anti-inflammatory properties also against SARS-COV-2. Therfore, It makes sense to test the clinical effect of AD against COVID-19 and Long COVID.
[Metabolic adverse drug reactions related to psychotropic drugs]
Metabolic adverse drug reactions (mADR) related to psychotropic drugs have significant health-related effects including weight gain, impaired glucose tolerance, diabetes mellitus and dyslipidemia as well as economic relevance. Nearly all antipsychotics (AP) and many antidepressants (AD) and mood stabilisers may induce weight gain. Weight development in the first weeks or months after the beginning of the therapy is the strongest predictor for weight gain related to AP and AD. The most important risk factors for mADR are antagonistic effects at H-, 5-HT- und M-receptors and antidopaminergic effects. However, several other systems are also relevant. Systematic monitoring of metabolic parameters is recommended in all patients treated with substances that are associated with an increased risk of mADR. Lifestyle modification, dietary measures, exercise therapy, dose reduction, change and discontinuation of the substance, and additional treatment with metformin and topiramate are evidence-based treatment options for AP-associated weight gain. GLP-1 receptor agonists such as liraglutide are also promising.