Muscle sympathetic nerve activity in frontotemporal lobar degeneration is similar to amyotrophic lateral sclerosis

Purpose

To determine whether frontotemporal lobar degeneration (FTLD) is associated with similar cardiovascular autonomic dysfunction to that seen in amyotrophic lateral sclerosis (ALS), we compared cardiovascular parameters between ALS patients and patients with FTLD.

Methods

In ten patients with FTLD (mean age ± SD: 71.6 ± 4.6 years) and 12 patients with ALS (mean age ± SD: 71.4 ± 4.6 years), MSNA (using microneurography), heart rate (HR), and blood pressure (BP) were recorded simultaneously.

Results

MSNA was significantly higher in both groups of patients compared with the controls (p < 0.01), while there were no significant differences in MSNA between the patients with FTLD and those with ALS. During head-up tilt, changes in HR, BP, and the frequency of MSNA bursts were smaller in the patients than in controls (p < 0.05 or p < 0.01).

Conclusions

Patients with FTLD and ALS showed similar dysfunction of HR, BP, and sympathetic outflow to muscles.

     

Therapieabbruch als Prädiktor erneuter Straftaten

Background

Recidivism rates in substance-addicted patients placed in institutions according to §64 of the German legal code are approximately 50%, 3 years after discharge from inpatient treatment. The recidivism rates of patients with premature termination of inpatient treatment who had then been referred back to prison and were finally discharged into the community are unknown.

Research question

Is premature termination of treatment a risk factor for recidivism?

Methods

Patients released from forensic treatment according to § 64 of the German legal code were followed up for violent and non-violent recidivism. Full data were acquired for Baden-Württemberg patients released in 2010 and 2011 with regular vs. premature termination of treatment.

Results

All measures revealed highly significant group differences: 48% of the patients discharged after subsequent prison sentences recidivated within the first year and 73% within 3 years after discharge. Among recidivists, the severity of offences was much higher (odds ratio > 3.8 each). Regularly discharged patients also re-offended to a remarkable extent (50%).

Discussion

Patients serving prison sentences after unsuccessful forensic treatment are a high-risk group for recidivism. Alternative concepts of clinical and legal treatment of this group should be developed.

     

Stalking von Psychiatern und Psychotherapeuten

Background

Currently, there are clear indications that due to their exposed occupational position psychiatrists and psychotherapists are at a higher risk than the general public to become the victim of stalking by patients.

Objectives

This study investigated the frequency of stalking and its psychosocial impact among psychiatrists and psychotherapists in the Federal Republic of Germany.

Methods

Analysis of an online survey among members of the German Association for Psychiatry, Psychotherapy and Psychosomatics (DGPPN) from 23 September 2015 until 22 October 2015.

Results

Of the respondents 26.5% reported having been the victim of stalking. In more than a third of the reported cases the stalking was described as severely or very severely debilitating. The majority of the perpetrators suffered from psychotic or personality disorders. Male victims were significantly more frequently stalked by a female perpetrator. Approximately 1 in 10 stalking victims continued the treatment of the perpetrator. The majority of the stalking victims did not obtain substantial support from their employer.

Conslusion

The phenomenon of stalking within therapeutic relationships needs to be incorporated into the medical and psychotherapeutic professional training, e.?g. by implementing specialized training courses and the systematic integration of this topic into clinical supervision. The institutional dealing with stalking by patients needs to optimized, e.?g. by promptly transferring treatment of patients who stalk to other professionals and, where required, providing assistance in reporting stalking incidents to the police.

     

Onset of bladder and motor symptoms in multiple system atrophy: differences according to phenotype

Purpose

To compare the order of presentation of bladder and motor symptoms between multiple system atrophy phenotypes.

Methods

Medical records were retrospectively reviewed in 144 patients.

Results

Bladder symptoms occurred either before or within 12 months after onset of motor symptoms in significantly more patients with the cerebellar phenotype than the parkinsonian phenotype (80 vs. 53%, p = 0.003); similar results were observed for urinary incontinence (79 vs. 45%, p = 0.001).

Conclusions

Urinary dysfunction is more likely to appear either before or shortly after motor symptoms in the cerebellar phenotype than in the parkinsonian phenotype.

     

A Self-Regulatory Intervention for Patients with Head and Neck Cancer: Pilot Randomized Trial

Background

Research is yet to investigate whether psychological interventions delivered early after diagnosis can benefit patients with head and neck cancer (HNC).

Purpose

The aim of this study was to investigate the effectiveness of a brief self-regulatory intervention (targeting illness perceptions and coping) at improving HNC patient health-related quality of life (HRQL).

Methods

A pilot randomized controlled trial was conducted, in which 64 patients were assigned to receive three sessions with a health psychologist in addition to standard care or standard care alone. Participants completed questionnaires assessing HRQL, general distress, and illness perceptions at baseline and again 3 and 6 months later.

Results

Compared to the control group, patients who received the intervention had increased treatment control perceptions at 3 months (p = .01), and increased social quality of life at 6 months (p = .01). The intervention was particularly helpful for patients exhibiting distress at baseline.

Conclusion

A brief psychological intervention following HNC diagnosis can improve patient perceptions of treatment and social quality of life over time. Such interventions could be targeted to patients who are distressed in order to confer the greatest benefit.

Trial Registration Number

12614000813684.

     

Daten zum aktuellen Praxiseinsatz von Eslicarbazepinacetat in Deutschland

Background

The anticonvulsant eslicarbazepine acetate (ESL) is licensed as adjunctive therapy for adults with partial-onset seizures (POS).

Objectives

To gather information on the use of ESL in current clinical practice in Germany and to assess its efficacy and tolerability.

Methods

Clinical data from consecutive patients with POS who started adjunctive treatment with ESL after 1 January 2012 was retrospectively collected from 18 neurological centres in Germany. Data on utilisation, efficacy, and tolerability of ESL were documented on a standardised electronic documentation sheet.

Results

Included in the analysis were 125 patients (median age: 48 years (range 20–83 years), 59.2?% male). The most common primary treatment goals were improvement of seizure control (70.4?% of patients) and improvement of tolerability (20.8?%). A median dose of 800 mg (range 400–2,400 mg) was both the initial target and last treatment dose. The responder rate, defined as proportion of patients achieving a reduction in seizure frequency by ≥50?% versus baseline, was 46.7?%, 53.3?%, and 55.3?% after 3, 6, and 12 months, respectively. At the last documented visit, 38.8?% of patients were seizure-free for ≥3 months. The last documented visit occurred after a mean treatment period of 397 ± 246 days. The physician’s rating of ESL efficacy was very good or good in 61.6?% of treated patients, while tolerability was rated very good or good in 70.4?% of patients. Due to adverse events (AEs), 12.0?% of patients discontinued treatment with ESL. More frequently (≥5?%) reported AEs were fatigue, dizziness, and hyponatremia. Overall, 77?% of patients continued ESL therapy for at least 12 months.

Conclusions

In this retrospective collection of current real-life data in Germany, adjunctive anticonvulsant treatment with ESL was effective and well-tolerated.

     

Longitudinal predictors of caregiver burden in amyotrophic lateral sclerosis: a population-based cohort of patient–caregiver dyads

Objective

Caregiver burden is a recognised consequence of caring for a patient with neurodegeneration. Amyotrophic lateral sclerosis (ALS) differs from other neurodegenerations by its rapid progression and impairment of motor, cognitive, and behavioural function, which contribute to caregiver burden. However, longitudinal factors that determine the extent of caregiver burden, and in particular the impact of psychological distress among caregivers, have not been fully established.

Methods

Patients with ALS (n = 85) and their primary caregivers (n = 85) completed three serial evaluations. Caregiver burden was measured using the Zarit Burden Interview (ZBI). Anxiety and depression were evaluated using the Hospital Anxiety and Depression Scale (HADS). The Edinburgh Cognitive-Behavioural ALS Screen (ECAS) was used to determine cognitive function in patients. The ALS Functional Rating Scale (ALSFRS-R) measured disease progression.

Results

Using the ZBI, caregivers were categorised as high or low burden. In the low burden group, anxiety scores from the HADS predicted caregiver burden (r = 0.410, F = 3.73, p = 0.033), whereas the depression sub-score from the HADS was predictive of caregiver burden in the high burden group (r = 0.501, F = 5.87, p = 0.006) for cross-sectional analyses. Longitudinally, an elevated score on the HADS at Time 1 was the largest predictor of caregiver burden across serial assessments.

Conclusion

In a patient cohort with relatively preserved cognitive function (65%), anxiety and depression at Time 1, as measured by the HADS, were the best predictors of caregiver burden at Time 3. This observation provides a mechanism by which caregiver burden can be identified by health-care professionals and a stepped care programme of intervention initiated.

     

„Mission (im)possible“

Background

Specialized neurological treatment decreases the mortality and morbidity of stroke patients. In many regions of the world an extensive coverage is not available. The cooperation between the Krankenhaus Nordwest (KHNW, Frankfurt, Germany) and the Government of Brunei Darussalam describes the set-up process of a specialized neurological center, including stroke unit, science and rehabilitation center.

Aim

The aim of this project called to teach to treat – to treat to teach was to set up a center of excellence in neurology in Brunei Darussalam over a distance of 12,000?km. Treatment options were elucidated by teaching and taught by case examples.

Material and methods

The construction of the Brunei Neuroscience Stroke and Rehabilitation Center (BNSRC) began in July 2010. To overcome the large distance between the department of neurology and neuroradiology at the KHNW and the BNSRC, a telemedical network was established. We provided daily teleteaching for all professions involved in patient care as well as 24/7 availability of teleneurological services from Germany to support the local team on site.

Results

In the BNSRC unit over 1000 patients with ischemic and hemorrhagic stroke and all the various acute neurological conditions were treated from July 2010 until July 2016 as inpatients and over 5000 were treated as outpatients. Since 2010, a total of 52 patients with stroke were treated by thrombolysis within the thrombolytic window and 81 hemicraniectomies were performed.

Conclusion

The project has shown that it is possible to convey specialized neurological knowledge over large distances to provide significant benefits for patients and caregivers.

     

Therapie der chronischen Migräne mit Botulinumneurotoxin A

Background

Injection of botulinum neurotoxin A (BoNT-A) according to the PREEMPT (Phase 3 REsearch Evaluating Migraine Prophylaxis Therapy) paradigm has been approved for the treatment of refractory chronic migraine in Germany in 2011.

Objective

The practical application raises some questions, such as the choice of dose and injection intervals during the course of the treatment, and the appropriate time point for discontinuation of BoNT-A treatment.

Material and methods

Taking into account the existing literature, the German Migraine and Headache Society (Deutsche Migräne- und Kopfschmerzgesellschaft, DMKG) gives recommendations for the treatment of chronic migraine with BoNT-A.

Results

Treatment is usually started with a dose of 155 U BoNT-A. During the first year of treatment, 3?month injection intervals are recommended. Goal of the treatment is an improvement of migraine by ≥30%. If needed, dose escalation up to 195 U can be used to reach this goal. If improvement by ≥30% is not reached after the third injection cycle, the treatment is usually considered to be insufficiently efficient and discontinuation is recommended. If a stable success is reached during the first year of treatment, prolongation of injection intervals to 4 months can be considered. If success continues to be stable for at least two 4?month intervals, discontinuation of BoNT-A treatment can be tried.

Conclusion

The literature on these points is insufficient for recommendations at the guideline level. The present recommendations are based on an expert consensus of the DMKG for the structured approach to the treatment of chronic migraine with BoNT-A.

     

Trends in non-help-seeking for mental disorders in Germany between 1997–1999 and 2009–2012: a repeated cross-sectional study

Purpose

This study sought to examine trends in non-help-seeking for mental disorders among persons with a prevalent mental disorder (12-month prevalence) in Germany between 1997–1999 and 2009–2012.

Methods

We examined data from 1909 persons aged 18–65 years who participated in two independent, repeated cross-sectional surveys (German National Interview and Examination Study 1997–1999, German Health Interview and Examination Survey for Adults 2009–2012) conducted 12 years apart. Prevalent mental disorders (12-month prevalence) were determined using the Composite International Diagnostic Interview, which included information on lifetime help-seeking for mental health problems. Correlates of self-reported help-seeking were analyzed according to Andersen’s Behavioral Model. Multivariable Poisson regression models were used to assess time trends in the directly standardized and model-adjusted prevalence of non-help-seeking across strata of socio-economic and clinical variables.

Results

The proportion of people with a prevalent mental disorder who have never sought help in their lifetime decreased significantly from 62% (95% CI 58.7–64.7) to 57% (95% CI 52.2–60.9) between 1997–1999 and 2009–2012 in adults aged 18–65 years in Germany. Downward trends in non-help-seeking occurred in all investigated strata and reached statistical significance in women, in people who were living alone, people with medium educational level, people living in middle-sized communities, people with non-statutory health insurance, smokers, and people with co-existing somatic conditions.

Conclusion

Despite a downward trend over the course of 12 years, a large proportion of people suffering from mental disorders are still not seeking treatment in Germany. Further efforts to increase uptake of help-seeking for mental disorders in hard-to-reach groups are warranted to continue this trend.

     

Einstellungen gegenüber Psychotherapie in Südkorea und Deutschland

Background

Due to the relatively recent introduction of psychotherapy in South Korea and against the background of collectivist and Confucian values, it has been suggested that South Koreans harbor more negative attitudes towards psychotherapy compared to Germans and that the social acceptance of psychotherapy is lower.

Methods

We compared the attitudes of 99 women from South Korea with 98 German women using the questionnaire on attitudes towards psychotherapeutic treatment (FEP). For the study of the South Korean women we translated the questionnaire into the Korean language.

Results

The results of the psychometric analysis suggest that the Korean version of the FEP is of acceptable quality. South Korean women reported a significantly more negative attitude towards psychotherapy compared to German women. Furthermore, South Korean women anticipated a more skeptical social attitude towards psychotherapy compared to Germans.

Conclusion

The presented results suggest the relevance of cultural imprinting in psychotherapy. They are discussed with respect to culture-specific self-concepts, concepts of disease and healing expectations and the increase of individualistic values in the Korean society.

     

Rates and Predictors of Renewed Quitting After Relapse During a One-Year Follow-Up Among Primary Care Patients

Background

Most people who quit smoking relapse within a year of quitting. Little is known about what prompts renewed quitting after relapse or how often this results in abstinence.

Purpose

This study seeks to identify rates, efficacy, and predictors of renewed quit attempts after relapse during a 1-year follow-up.

Methods

Primary care patients in a comparative effectiveness trial of smoking cessation pharmacotherapies reported daily smoking every 6–12 weeks for 12 months to determine relapse, renewed quitting, and 12-month abstinence rates.

Results

Of 894 known relapsers, 291 (33 %) renewed quitting for at least 24 h, and 99 (34 %) of these were abstinent at follow-up. The average latency to renewed quitting was 106 days and longer latencies predicted greater success. Renewed quitting was more likely for older, male, less dependent smokers, and later abstinence was predicted by fewer depressive symptoms and longer past abstinence.

Conclusions

Renewed quitting is common and produces meaningful levels of cessation.

     

Reduced retinal nerve fiber layer (RNFL) thickness in ALS patients: a window to disease progression

Objectives

To assess RNFL thickness in ALS patients and compare it to healthy controls, and to detect possible correlations between RNFL thickness in ALS patients and disease severity and duration.

Methods

Study population consisted of ALS patients and age- and sex-matched controls. We used the revised ALS functional rating scale (ALSFRS-R) as a measure of disease severity. RNFL thickness in the four quadrants were measured with a spectral domain OCT (Topcon 3D, 2015).

Results

We evaluated 20 ALS patients (40 eyes) and 25 healthy matched controls. Average RNFL thickness in ALS patients was significantly reduced compared to controls (102.57?±?13.46 compared to 97.11?±?10.76, p 0.04). There was a significant positive correlation between the functional abilities of the patients based on the ALSFRS-R and average RNFL thickness and also RNFL thickness in most quadrants. A linear regression analysis proved that this correlation was independent of age. In ALS patients, RNFL thickness in the nasal quadrant of the left eyes was significantly reduced compared to the corresponding quadrant in the right eyes even after adjustment for multiplicity (85.80?±?23.20 compared to 96.80?±?16.96, p?=?0.008).

Conclusion

RNFL thickness in ALS patients is reduced compared to healthy controls. OCT probably could serve as a marker of neurodegeneration and progression of the disease in ALS patients. RNFL thickness is different among the right and left eyes of ALS patients pointing to the fact that asymmetric CNS involvement in ALS is not confined to the motor system.

     

Wahn: aktuelle psychodynamische und neurokognitive Ansätze

Background

The symptom “delusions” is a central psychopathological symptom in psychiatric diseases. Since the beginning of psychiatry various disciplines have attempted to explain and understand delusions but even now no generally accepted definition of this phenomenon exists.

Aim

A comprehensive review of current psychopathological and neurobiological theories of delusions is given.

Material and methods

PubMed and Google scholar searches were performed using the keywords “delusion”, “psychodynamic” and “neurobiology”, both in English and German. Relevant German textbooks of psychiatry were also included.

Discussion

A differentiated perspective of the phenomenon of delusions appears to be necessary to approach this complex and fascinating symptom. A one-dimensional approach does not do justice to the complexity of delusions. The various explanatory approaches can increasingly be linked to each other and are no longer considered to be mutually exclusive.

     

Autonomic symptoms following Zika virus infection

Purpose

To determine if autonomic symptoms are associated with previous Zika virus infection.

Methods

Case–control study including 35 patients with Zika virus infection without evidence of neurological disease and 105 controls. Symptoms of autonomic dysfunction were assessed with the composite autonomic symptom scale 31 (COMPASS-31).

Results

Patients with previous Zika virus infection had significantly higher COMPASS-31 score than controls regardless of age and sex (p = 0.007). The main drivers for the higher scores where orthostatic intolerance (p = 0.003), secretomotor (p = 0.04) and bladder symptoms (p < 0.001).

Conclusion

Zika virus infection is associated with autonomic dysfunction. The mechanisms remain to be elucidated.

     

Krankheitskosten und Outcome: Versorgungsrealität des Status epilepticus

Background

In times of an increasing economic impact on healthcare systems the collection, processing and analysis of disease-specific costs becomes more and more relevant. This is particularly true for chronic diseases, such as epilepsy where the focus of interest is due to the high direct and indirect costs of the disease. The additional economic impact of status epilepticus (SE) is under-represented in the few available cost of illness studies (COI).

Objective

The systematic analysis and comparison of disease-specific costs and mortality of SE in Germany and other countries.

Methods

A systematic combined literature search was performed via the PubMed gateway in June 2018.

Results

A total number of three COI studies was available on SE in Germany. The median direct costs amounted to ca. 4000–15,000?€ per stay with a mean length of stay (LOS) of 1–2 weeks. The inhospital mortality was 10–15%. For patients with non-refractory SE (NSE) average costs were calculated as 4500–5500?€ (mortality 10%, LOS 8 days), whereas refractory SE (RSE) accounted for 4500–13,500?€ (mortality 15%, LOS 14 days) and super-RSE (SRSE) 33,000–50,500?€ (mortality 40%, LOS 37 days). These results are comparable to other COI studies on SE from Australia, India and the USA.

Conclusion

From both health-economic and healthcare perspectives SE represents a relevant disease manifestation. Further studies to collate the incidence, mortality and costs are urgently needed in view of the increasing number of treatment options.

     

Deutschlandweite Evaluation der ärztlichen Weiterbildung in der klinischen Neurologie

Background

Currently, no data are available, which reflect the situation of medical doctors specializing in neurology in German hospitals. In order to secure the high standard of neurological patient care it is essential to evaluate the working conditions and the specialty training in neurology.

Objective

This nationwide survey was conducted throughout Germany with the aim to address problems and to give suggestions for improvements in neurological training curricula.

Material and methods

The survey was online from February to May 2017 and 953 neurologists undergoing further training participated.

Results

More than half of the young neurologists were satisfied with their medical training. One of the main problems that complicates clinical training is the workload. In addition, organizational obstacles within the clinic, such as poor structure of education or a lack of mentors, lead to dissatisfaction among participants. The size or type of the department, as well as the prevailing service system, exert only a minor influence on the quality of specialist training, although there were differences especially in the self-assessment of the participants in connection with the type of department (university hospital versus public or private hospital).

Conclusion

Specialist training in neurology can be improved by simple arrangements, e.?g., the introduction of a binding rotation scheme, internal mentoring and structured feedback. In addition, it will be necessary to relieve medical staff of administrative duties in order to create time for training and the learning of competencies.

     

The yield of non-elective inpatient video-EEG monitoring in adults

Background

Inpatient video-EEG monitoring (VEM) can contribute to the diagnosis and treatment in many of the monitored patients. Most admissions to VEM are elective and are scheduled ahead before the monitoring session.

Purpose

To retrospectively evaluate the yield of non-elective VEM sessions.

Methods

We retrospectively reviewed the VEM recordings and medical records of all the patients admitted to our one-bed VEM unit from June 2007 to June 2015. A VEM session was diagnostic when a seizure, an event or previously unreported interictal epileptiform discharges were recorded.

Results

The study group included 304 adults aged 18–92 years (mean 40.4 ± 17.4 years), 181 (59%) women. The diagnostic yield of non-elective and elective VEM session was similar (66 and 69%, respectively). In non-elective VEM, fewer patients had known epilepsy (p = 0.0001), session duration was shorter (p = 0.0001), and seizures and interictal epileptiform discharges were recorded less frequently compared to elective VEM (p = 0.005 and p = 0.0001, respectively).

Conclusion

Non-elective VEM can provide useful information in patients admitted to the neurology department with recent neurological or behavioral events. A timely and correct diagnosis in these patients can potentially reduce unnecessary use of antiepileptic drugs in patients with psychogenic nonepileptic seizures and the morbidity and mortality associated with undiagnosed seizures.

     

Factors that influence access to mental health services in South-Eastern Europe

Introduction

Access to mental health (MH) services is unequal worldwide and changes are required in this respect.

Objectives

Our aim was to identify the delay to the first psychiatry consult and to understand patients’ characteristics and perspectives on the factors that may influence the delay, among a sample of participants from three Southeastern European Countries.

Materials and methods

The WHO Pathway Encounter Form questionnaire was applied in 400 patients “new cases” and a questionnaire on the factors influencing the access was administered to the same patients, as well as to their caretakers and MH providers.

Result and discussions

The average profile of the patient “new case” was: married female older than 40 years, with an average economic status and no MH history. The mean delay was up to 3 months and the most important factors that were influencing the delay were stigma and lack of knowledge regarding MH problems and available current treatments.

Conclusions

Future policies trying to improve the access to psychiatric care should focus on increasing awareness about MH problems in the general population.