Lateralisierte ?Out-of-body experience��

The authors report 2 patients with an out-of-body experience (OBE) as an epileptic phenomenon. The autoscopic illusion was constantly lateralized. One patient had a contralateral lesion, while in the other patient a contralateral lesion was suspected. Patients with autoscopic phenomena should be asked for a lateralization as this might be an indication of a contralateral brain pathology. Generally, patients should explicitly be asked for autoscopic perceptions, as these are probably only rarely mentioned spontaneously. Limitations of the hypothesis of a cerebral lesion which is located contralaterally to the autoscopic illusion are the retrospective nature of data collection and the small number of published reports in the literature on lateralization of autoscopic phenomena.     

?Basiscurriculum in psychotherapeutischer Medizin��: Psychotherapeutische Ausbildung in der Psychiatrie �C ein Beginn

Die Ausbildung zum/zur Fach?rztIn für Psychiatrie und Psychotherapeutische Medizin sieht eine Einführung in Theorie und praktische Umsetzung der 4 wichtigsten psychotherapeutischen Traditionen (psychoanalytische, verhaltenstherapeutische, systemische und humanistische Tradition) vor. Die Experten-Arbeitsgruppe Psychotherapeutische Ausbildung in der Psychiatrie erarbeitete im Auftrag der ?GPP das Basiscurriculum Psychotherapeutische Medizin im Rahmen der Facharztausbildung, deren Inhalte hier im überblick vorgestellt werden. Der Unterricht wurde in Wien im M?rz 2010 gestartet. Eine besondere St?rke der Ausbildung ist die Vernetzung und Einbettung des Basiscurriculums in die laufende Ausbildung, sodass neu erworbene Inhalte direkt in den Arbeitsalltag der AusbildungskandidatInnen einflie?en k?nnen, somit weiter gefestigt und erweitert werden k?nnen. Der Unterricht legt überlegungen zur Didaktik nahe, die eine moderne interaktive, affektiv involvierende Gestaltung erm?glichen und eine hochqualitative Vermittlung der Lernziele gew?hrleisten.     

Beitrag der Neurobiologie zum Verst?ndnis der Borderline-Pers?nlichkeitsst?rung

Affect dysregulation and impulsivity are the main topics of neurobiological research in borderline personality disorder. Affect dysregulation subsumes enhanced resting arousal, increased emotional responsiveness as well as deficient emotional regulation and is associated with structural and functional abnormalities in a prefrontal-limbic network, above all orbitofrontal hypoactivity and amygdalar as well as insular hyperactivity. Impulsivity describes a lack of future-oriented problem solving style as well as a decreased threshold for motoric responses and is associated with decreased serotonergic activity in the ventral prefrontal cortex. Future research has to clarify how specific the findings of borderline personality disorder are and how far temperament dimensions, such as neuroticism can explain the neurobiological deviations from the norm.     

Clowns in der Psychiatrie?

Zusammenfassung Hintergrund Dieses Pilotprojekt untersucht, ob der Einsatz von ausgebildeten Klinikclowns in einem station?ren psychiatrischen Setting bei erwachsenen Patienten sinnvoll ist. Material und Methoden Ablauf und Beurteilung (Einstellung gegenüber den Clowns bei Patienten und Behandlungsteam) einer 6-w?chigen Phase mit einem Auftritt pro Woche auf einer geriatrischen Akutstation wurden beobachtet. Ergebnisse Es fand sich ein Einstellungswandel der Patienten mit einer deutlich positiveren Beurteilung der Clowns nach diesem Zeitraum. Schlussfolgerung Dies ist ein Hinweis auf positive Effekte der Clowns und Anlass, weitere Projekte dieser Art zu initiieren.      

Evidenz der Evidenz-basierten Medizin?

Ohne Zusammenfassung     

Interferontherapie der Multiplen Sklerose Eine Frage der richtigen Dosis?

Ohne Zusammenfassung     

Botulinum-Neurotoxin in der Behandlung der Spastizit?t im Erwachsenenalter

Spasticity is one of the major causes of functional impairment in adults with lesions of the central nervous system. For instance, approximately 30% of post-stroke patients suffer from different degrees of spasticity with possible consecutive impairments. Numerous studies or meta-analyses showed that local injections of botulinum toxin in spastic muscles lead to dose-dependent reduction in muscle tone and improvement of passive movements (e. g. facilitated care), especially following repeated injections.However, country-specific regulations and patient-remote administration in German health care often do not allow adequate provision of this therapy. Thus, the present consensus statement based on the EBM analyses of the published international literature tries to highlight recent advances and the standard in the field of local spasticity treatment, aiming to facilitate communication between the decision makers and German reimbursement institutions in health care. Prior to initiation of BoNT-A injections, patient-oriented goals should be identified in a multiprofessional context to assure realistic goals for this specific treatment and patient expectations. In Germany for the treatment of focal spasticity following stroke three products have been approved: Botox? (Pharm Allergan, Ettlingen), Dysport? (Ipsen Pharma, Ettlingen) and Xeomin? (Merz Pharma, Frankfurt/Main). For all preparations safety has been repeatedly shown. Functional improvements have also been illustrated for selected patients concerning hand/arm function and gait. The dose per muscle and the selection of muscles to be injected have to be individualized according to the patient's symptoms and should be accompanied by modern neurorehabilitative therapies such as redression or repetitive activation of the injected and antagonistic muscles.     

Neuromuskul?re Signal��bertragung im Erwachsenenalter

The availability of early diagnosis and modern effective therapies has reduced mortality and disability linked to late-onset acquired or hereditary neuromuscular transmission disorders. Nevertheless, identification of the pathogenesis of these diseases remains a challenge. In addition to non-specific and fluctuating presenting symptoms current diagnostic work-up strategies include electrophysiology, antibody measurements and less frequently molecular genetics. For differential diagnostic purposes there is an increasing demand for improving awareness concerning late-onset congenital myasthenic syndromes (CMS) which are rare but nevertheless symptomatically treatable diseases. Especially in seronegative myasthenic syndromes, molecular genetic analyses of CMS genes should be integrated into the differential diagnostic work-up. Therefore, some facets of neuromuscular synaptogenesis in the context of seronegative acquired myasthenic syndromes and recently uncovered congenital myasthenic syndromes are reviewed.     

Temporallappenepilepsien Einfluss der Fokusseite auf die autonome Regulation der Herzfrequenz?

Epileptic activity can modulate reactions of the autonomic nervous system. Although there is some evidence of a differential left/right hemispheric influence on the cardiovascular system, diverse investigations have shown controversial results. In our study, complex partial seizures of patients with temporal lobe epilepsy were recorded using subdural electrodes, thus providing reliable information on the focus side. We analyzed the preictal and ictal heart rates of 27 patients, 16 revealing right and 11 revealing left temporal foci. During the seizures, both groups showed a significant increase in heart rate. Preictal tachycardia was only significant in the right focus group, whereas no significant change in heart rates could be detected in the left focus group. Our results confirm a right hemispheric lateralization of sympathetic cardiac control.     

Medikament?se Therapie der Epilepsie

Modern medical treatment of epilepsy renders two out of three newly diagnosed epilepsy patients seizure-free. More than 20 drugs are currently available and even for epilepsy specialists it may not be easy to select the drug which is best suited for the individual patient. Current guidelines recommend drugs with proven efficacy and optimal tolerability that address the individual needs of the patient. Non-enzyme-inducing agents are preferred if possible, to protect the patient from loss of efficacy when taking other medications for life-threatening disorders. In one out of three patients, seizure freedom is currently not possible due to drug-resistance, which requires a prompt diagnostic and therapeutic reevaluation of the epilepsy.     

St?rungen der visuellen Wahrnehmung

Disorders of visual perception are frequent and disabling functional consequences of acquired brain injury (20-40%). They also have adverse effects on the assessment, diagnosis and treatment of other functional disorders. Most frequent are visual field disorders followed by disorders of visual acuity and contrast sensitivity, visual adaptation, color and visual space perception as well as of visual recognition. Multiple visual and/or additional cognitive disorders are most common. The differential diagnosis of cerebral visual disorders and an individually tailored and specific approach in the rehabilitation are therefore of great importance. Compensatory treatment methods are to be preferred because of their efficacy, ecological validity as well as a good cost-benefit ratio.     

Psychopathologie und Psychotherapie der Borderline-Pers?nlichkeitsst?rung

With a lifetime prevalence of about 3%, borderline personality disorder is a frequent and often debilitating psychiatric disorder, especially during adolescence. Most features of typical borderline pathology can be classified into three dimensions: disturbed affect regulation, identity disturbance and problems in social interaction. Within the last decade several treatment programs have been tailored to the specific needs of borderline therapy and three of them have meanwhile shown empirically proven evidence: dialectical behavior therapy (DBT), mentalization-based therapy (MBT) and schema therapy. Although the studies showed clear superiority of specifically designed treatment programs compared to non-structured standard care, implementation of these programs in the German health care system is far from sufficient. Only one out of every thousand patients suffering from borderline personality disorder receives evidence-based outpatient psychotherapy. This is mirrored by the annual costs for inpatient treatment extending to 4 billion Euros, which is approximately 20% of the total costs for psychiatric care in Germany.     

Emotionale Teilleistungsst?rungen und ?first impression formation�� bei Pers?nlichkeitsst?rungen

"Minimal cerebral dysfunctions" are isolated impairments of basic mental functions, which are elements of complex functions like speech. The best described are cognitive dysfunctions such as reading and writing problems, dyscalculia, attention deficits, but also motor dysfunctions such as problems with articulation, hyperactivity or impulsivity. Personality disorders can be characterized by isolated emotional dysfunctions in relation to emotional adequacy, intensity and responsivity. For example, paranoid personality disorders can be characterized by continuous and inadequate distrust, as a disorder of emotional adequacy. Schizoid personality disorders can be characterized by low expressive emotionality, as a disorder of effect intensity, or dissocial personality disorders can be characterized by emotional non-responsivity. Minimal emotional dysfunctions cause interactional misunderstandings because of the psychology of "first impression formation". Studies have shown that in 100?ms persons build up complex and lasting emotional judgements about other persons. Therefore, minimal emotional dysfunctions result in interactional problems and adjustment disorders and in corresponding cognitive schemata.From the concept of minimal emotional dysfunctions specific psychotherapeutic interventions in respect to the patient-therapist relationship, the diagnostic process, the clarification of emotions and reality testing, and especially an understanding of personality disorders as impairment and "selection, optimization, and compensation" as a way of coping can be derived.     

Ist der Hypothalamus der Rezeptor für Schilddrüsenhormon?

Ohne ZusammenfassungMit 1 Textabbildung     

Begutachtung von Beschleunigungsverletzungen der Halswirbels?ule

Formulating an expert opinion on whiplash injuries requires that consideration be given to biomechanical, orthopedic, neurological, psychiatric and medicolegal aspects. The greatest difficulties are encountered in cases of mild whiplash where patients complain of constant pain without any physical correlative. Diverse assessments and principles for approving a claim are reflected in the fact that the prevalence of chronic spine pain after whiplash injuries (late whiplash syndrome) varies between 16% and 71% in different countries, and the proportion of whiplash injuries involved in petitions for compensation differs greatly across Europe (UK 75%, Germany 47%, Finland 8.5% and France 3% of all personal injuries).Important biomechanical, orthopedic, neurological, psychiatric and medicolegal aspects of expert testimony on whiplash associated disorders (WAD) are delineated.     

Psychobiologische Aspekte der Posttraumatischen Belastungsst?ung

Die Posttraumatische Belastungsst?rung (PTBS) wird durch das Auftreten eines schwerwiegenden Ereignisses (Psychotrauma) ausgel?st und geht mit einer Vielzahl psychischer Beschwerden einher, die sich den drei Hauptsymptomen Intrusion, Vermeidung und Hyperarousal zuordnen lassen. Da die PTBS als eine Reaktion auf einen gravierenden Stressor aufgefa?t werden kann, finden sich verschiedene Studien zu den biologischen Ver?nderungen, die mit der physiologischen Stre?antwort assoziiert sind. Dazu geh?ren auf endokriner Ebene die Hypothalamus-Hypophysen-Nebennierenrinden-Achse (HHNA), auf der Neurotransmitterebene das noradrenerge System und die endogenen Opiate, als Indikatoren der zentralnerv?sen Innervation verschiedene psychophysiologische Parameter und als m?gliche Korrelate der peripheren biologischen Abweichungen hirnanatomische Ver?nderungen. Wenngleich die beobachteten biologischen Dysregulationen, insbesondere ein relativer Hypocortisolismus mit einer erh?hten Feedbacksensitivit?t der HHNA, eine erh?hte noradrenerge Aktivit?t sowie die Hinweise auf neuroanatomische Ver?nderungen das Vorliegen spezifischer St?rungssymptome erkl?ren, stellt sich die Frage nach der Spezifit?t der beobachteten biologischen Ver?nderungen für das St?rungsbild der PTBS. Die jeweiligen Befunde werden mit den Ergebnissen aus Studien zur Major Depression und zu somatoformen St?rungen in Beziehung gesetzt und diskutiert.