Spracherhaltende Resektion einer fokalen kortikalen Dys­plasie neben dem Broca‑Areal

We report the case of a 14-year-old male with a history of focal seizures since the age of six due to a focal cortical dysplasia located within the left frontal lobe. The patient’s seizures proved to be refractory to treatments with Oxcarbazepine, Lamotrigine, Valproate, and Clobazame. Because fMRI for language mapping suggested a close spatial relationship of the lesion and Broca’s area, invasive language mapping was performed using a subdural grid for direct cortical stimulation. This suggested a clear topographic distinction between the lesion and Broca’s area, finally enabling language retaining lesionectomy. This case illustrates some pitfalls of fMRI language mapping in preoperative workup for epilepsy surgery.     

Der DGPPN-Teilhabekompass II

For most people living with mental illnesses, participating in society is of existential importance; however, psychosocial care often fails to recognize its significance and therefore rarely includes the patient’s interaction with society in the course of treatment. The reasons for this are both substantial and organizational in nature. The endless opportunities for participating in society, current areas as well as ways of taking part in social life even beyond the terms of the social legislative definition are, in addition to institutional variety and regional differences, all too often barriers to providing the very urgently needed support. Further aspects are insufficient knowledge of therapists about established options of rehabilitative treatment and about responsibilities related to participation in specialized training and further education for professional caregivers. The presented compass of participation for social integration of persons with mental illnesses starts at this point: it provides guidelines for psychiatric and psychotherapeutic practitioners, general practitioners as well as for physicians working in residential or day care institutions with a psychiatric and psychotherapeutic background. Both this article and planned online versions should help professionals to timely and successfully assist people, particularly those with severe mental illnesses, to navigate the broad spectrum of services for social and vocational integration in Germany     

Morbus Niemann-Pick Typ C

Niemann-Pick disease type C (NPC) is a rare, neurovisceral lipid storage disorder caused by genetic defects in lipid transporting proteins. It is distinct from Niemann-Pick types A and B (sphingomyelin lipidoses) and displays genetic (mutations in the NPC1 or NPC2[=HE1] gene), biochemical, and clinical heterogeneity. Late infantile to juvenile forms of NPC predominate and are characterised by atypical behaviour, ataxia, dysarthria, dysphagia, dystonia, cataplexy, vertical gaze palsy, splenomegaly, and dementia. In adult variants, psychosis and dementia are common, and dysarthria, ataxia, splenomegaly, and vertical gaze palsy are further facultative signs. Routine laboratory results including serum cholesterol are normal. In bone marrow smears, sea-blue histiocytes are often demonstrated and foam cells sometimes seen. The diagnosis is confirmed by detecting free cholesterol accumulation in perinuclear granules (lysosomes) and reduced cholesterol esterification after challenge with exogenous low-density lipoprotein in fibroblasts. Alternatively or additionally, mutational analysis can be performed. Treatment is restricted to symptomatic measures, since there is no specific therapy.     

Single case studies in human sexuality – important or idiosyncratic?

Abstract

The single case study has been an important feature in the history of medicine. The advent of evidence-based medicine, however, now places them as the lowest and weakest of evidences and downgrades their importance. This article reviews selected aspects of human sexuality to examine whether single case studies have contributed significantly to the field or whether they are just interesting but idiosyncratic reports.     

Brief Report: Altered Social Behavior in Isolation-Reared Fmr1 Knockout Mice

Social behavior abnormalities in Fragile X syndrome (FXS) are characterized by social withdrawal, anxiety, and deficits in social cognition. To assess these deficits, a model of FXS, the Fmr1 knockout mouse (Fmr1 KO), has been utilized. This mouse model has a null mutation in the fragile X mental retardation 1 gene (Fmr1) and displays physical and behavioral characteristics similar to humans with FXS. Several studies have investigated the social behavior of this model, but the results on the behavioral phenotype have not been consistent. In order to further characterize the social behavior in the knockout, isolation-reared Fmr1 KO were evaluated to determine if they differ in their social behavior compared to wild-type littermate controls. Differences by genotype were not observed in social approach behavior; however, the knockout mice showed a significantly reduced preference for social novelty and decreased sniff time in the sociability phase. These findings add to the growing body of knowledge on the subtle differences in social behavior shown by the Fmr1 knockout mice, and that differences occur when the subjects are isolation-reared. Validity of the model and possible changes to methodology are discussed.     

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.

     

Interferon β bei Multipler Sklerose

Interferon?β-1b (IFNB-1b, Betaferon?) was the first therapy for multiple sclerosis (MS) showing efficacy in a randomized controlled clinical trial. Early studies suggested a dose-dependency of the clinical efficacy of IFNB-1b. However, until recently no reliable clinical data were available to assess the potential of higher dosing to increase therapeutic efficacy. In addition, no clinical trials have been conducted to directly compare the efficacy of IFNB-1b with that of glatiramer acetate, an alternative first line treatment option for relapsing-remitting MS. Just recently, the prospective, randomized, multicenter study BEYOND was published which addressed both issues. In this review the BEYOND trial is reviewed and placed in the context of advantages and disadvantages of currently available first line therapies for MS.     

Neurofibromatose Typ I und Megadolichobasilaris

Intracranial vascular malformations are rare but tend to appear more frequently than usual in patients with type I neurofibromatosis (NFI). Aneurysms of the basilar artery have been described four times so far. We report two cases of 51- and 62-year-old patients with type I neurofibromatosis who showed long fusiform dilation of the basilar artery. Clinically both patients presented with locked-in syndrome and died 15 and 11 days after admission. The diagnosis was confirmed by autopsy. These are the first published cases of locked-in syndrome following thrombosis of a megadolichobasilar artery in association with neurofibromatosis I. Our results show that cerebral vascular malformations are found more frequently than random chance would predict in patients with NF I.     

Botulinumtoxin A in der Kopfschmerztherapie

In recent years botulinum toxin type A has been used increasingly more in the treatment of specific headache disorders. Especially regarding chronic migraine with and without combined medication overuse, convincing randomized studies have proven the efficacy of this treatment option and have led to approval for this indication. Regarding other headache entities, such as episodic migraine, tension-type headache, trigeminal autonomic cephalalgia (TAC), neuralgic, neuropathic and myofascial pain, currently available scientific data on the efficacy of botulinum toxin type A are scarce and often ambiguous. The exact underlying mechanisms of the influence of botulinum toxin type A on the pathophysiology of headache are not completely clear but an influence on the release of calcitonin gene-related peptide (CGRP) seems to play a crucial role. This article summarizes the most important studies as well as experiences of treatment with botulinum toxin type A regarding different headache entities.     

Language development at ten months

Aims Language development was followed from infancy to primary school age in order to examine the predictive significance for later language and scholastic outcome. Methods Participants were from a prospective longitudinal study of a birth cohort of initially 362 children. A subsample of 90 children (54 boys, 36 girls) was administered with the Receptive–Expressive Emergent Language Scale (REEL) in order to obtain age-appropriate measures of expressive and receptive language at the age of 10 months. At 11 years, children completed a comprehensive test battery assessing various intellectual skills and language performance. Scholastic measures included a school performance score and a recommendation for type of secondary school. Results Both expressive and receptive language performance at 10 months were significantly associated with cognitive and educational outcome 10 years later. Infant language performance not only predicted later verbal and nonverbal skills but also school achievement at the end of primary school. Prediction was higher in girls than in boys and slightly better for verbal and academic than for nonverbal performance. Conclusions The results demonstrate the importance of early language abilities in predicting cognitive and academic outcome at school age.     

Investigation of TNFA 308G > A and TNFB 252G > A polymorphisms in genetic susceptibility to migraine

We aimed to look for the association of tumor necrosis factor (TNF) gene polymorphisms (TNFA 308G > A, and TNFB 252G > A) in genetic susceptibility to migraine. The pathogenesis of migraine involves many immune-mediated mechanisms in the vascular endothelium. TNF, being a potent immunomodulator and pro-inflammatory cytokine, is suggested to be involved in inflammatory reactions leading to migraine attacks. A total of 216 normotensive migraine patients, 160 tension type headache (TTH) patients and 216 healthy controls (HC) were recruited in the study. The genetic polymorphisms were investigated through SNP association analysis using a matched case control migraine population. Genotyping of TNFA 308G > A polymorphism and TNFB 252G > A was done using ARMS PCR and PCR–RFLP, respectively. A borderline association was observed in TNFA 308GA genotype in migraine patients versus HC (p = 0.043; OR = 1.763; 95% CI = 1.019–3.051). After sub-grouping migraine into migraine with aura (MA) or without aura, significant difference at genotypic (p = 0.015; OR = 2.293; 95% CI = 1.172–4.487) as well as allelic (p = 0.035; OR = 1.955; 95% CI = 1.047–3.651) level was evident. The difference was even more significant in female MA at genotypic (p = 0.006; OR = 2.901; 95% CI = 1.361–6.181) and allelic level (p = 0.017; OR = 2.318; 95% CI = 1.159–4.635) as well as for A allele carriers in MA [p value = 0.020; OR = 2.205 (1.132–4.295)] and female MA (p value = 0.008; OR = 2.741; CI = 1.297–5.792). No association of TNFB252G > A was observed in migraine patients or any subgroups. We did not find any association of TNFA or TNFB gene polymorphisms with TTH. In conclusion, the TNFA 308G > A polymorphism was found to be associated with MA, particularly in females, whereas we could not find any association of TNFB 252G > A polymorphism in genetic susceptibility to migraine on comparing the migraine patients with HC or TTH patients.     

Cyber.rules – What you really need to know about the Internet

Over the next three issues three linked articles will take you through guidance about how to write for publication. In 2009 and 2010 Taylor &; Francis funded two workshops on this topic for members of the British Association for Sexual and Relationship Therapy. Using some of the exercises and feedback from these workshops the article will consider: common anxieties that therapists have about writing and how to address these; some of the main forms of writing that counsellors and therapists can consider; key aspects of structure and content; and how to go through the process of submission, review and revision. It is hoped that the articles will go some way towards demystifying the process and increasing your confidence in writing and submitting publications.     

150 Years of Freud-Kraepelin Dualism

The year 2006 marked the 150th Birthday of Emil Kraepelin and Sigmund Freud. Kraepelin and Freud were two very different yet very similar men. The comparison between their biographies shows many parallels in their lives and personalities. They were, in their time, the two most influential individuals in psychiatry. They wrote and thought about similar topics in the field yet came to quite different conclusions. Both did not show public respect for each other but wrote about the importance of integrating their respective approaches into the study of the mind/brain problem. Psychiatry today continues to struggle with the integration of the biological and psychodynamic approach.