Auswirkungen der frühen Nutzenbewertung auf Patienten mit Epilepsie in Deutschland

Epilepsy is one of the most common chronic neurological diseases and represents a significant burden for patients, their families and society. In more than 75 % of patients anticonvulsant therapy consists of valproate, carbamazepine, lamotrigine or levetiracetam. There is a need for polytherapy in drug-refractory patients and they suffer from negative effects on quality of life and employment that is associated with high indirect costs. To allow a comprehensive treatment in this patient group, access to new anticonvulsants with novel modes of action is needed; however, all applications for new antiepileptic drugs failed to prove added benefits during the Pharmaceutical Market Restructuring Act (AMNOG) in Germany. One of the main reasons is the mandatory definition of a standard comparative therapy. It remains unclear whether there will be studies in the future which will fulfill the requirements of the current version of AMNOG. Observational studies after approval and marketing of new antiepileptic drugs could be better alternatives to prove added benefits for individual patients in the current German healthcare system.     

Vergleich deutscher und türkischer Patienten mit ischämischem Schlaganfall

BACKGROUND: Until now no data has been available on possible specific features of the Turkish minority in Germany with respect to stroke. PATIENTS AND METHODS: We compared 20 Turkish stroke patients with matched German controls analyzing risk factors, findings at admission, rehabilitative treatments, and psychosocial aspects. RESULTS: In the Turkish group the interval between onset of symptoms and admission was longer (532 min vs 255 min, P < 0.01). All other findings during acute treatment and rehabilitation were comparable. At follow-up after 22 months, the Barthel index was 90 for the Turks and 100 for the Germans. The Turkish patients reported more consultations with physicians than their German counterparts (68 vs 12 per year, P < 0.01). Scores for quality of life and outcome did not differ. The Turkish patients more frequently required care and had a higher degree of disability. CONCLUSIONS: Turkish stroke patients have a longer time to admission. Risk factors, findings at admission, and treatment in the acute phase and rehabilitation are comparable. Several findings point towards a different health behavior. These results highlight the need for specific education of the Turkish population in Germany.     

Patienten, Ärzte und Pflegepersonal auf Intensivstationen

During intensive care treatment patients suffer from various forms of stress. Certain psychological and psychotherapeutic interventions (e.?g. cognitive behavior therapy, hypnotherapy and psychoeducation) can provide relief. Even patients with a severely reduced ability to communicate can benefit from an early psychological intervention as supportive treatment. The aim of these interventions is to reduce psychological impairments and burdens, provide strategies for coping with physical handicaps or necessary treatment and avoid long-term negative psychological impacts. Organizational and institutional constraints as well as emotional stress are a specific challenge for intensive care personnel. In order to guarantee an efficient collaboration within an interdisciplinary team it is vital to follow clearly defined methods of communication exchange, such as daily ward rounds, regular multidisciplinary meetings and team or case-focused supervision. Properly functioning teamwork increases job satisfaction and is the key to an optimal therapy for the patients.     

Psychiatrische und somatische Morbidität bei Patienten mit vermuteter Multiple Chemical Sensitivity (MCS)

Multiple chemical sensitivity (MCS) or idiopathic environmental intolerance (IEI) is understood as an acquired disorder with multiple recurrent symptoms that cannot be traced to any well-known medical or psychiatric condition and is associated with diverse environmental influences that are well tolerated by the majority of people. In a prospective study, we investigated 120 consecutive patients admitted a university-based outpatient department for environmental medicine during 1 year. Apart from routine medical examination and special toxicological diagnostic procedures, a structured clinical interview for DSM-IV psychiatric disorders was performed with every patient. At least one psychiatric diagnosis was found in 100 patients. The diagnostic criteria for somatoform disorders were filled by 53 patients. We found lifetime or current affective disorders in 39 patients, anxiety disorders in 29, and substance dependency or abuse in 25. In 16 patients, personality disorders were diagnosed. Nine suffered from psychotic disorders. This is the largest prospective study with standardized psychiatric diagnostic methods concerning psychiatric morbidity and MCS. The data show that many patients with environmental health problems obviously suffer from somatoform disorders but also from other, well-known psychiatric conditions.     

Debilität,Kriminalität und Revolution

Ohne ZusammenfassungAls Vortrag gehalten vor der forensisch-psychologischen Gesellschaft in Hamburg am 28. Februar 1920.     

Pseudospontanbewegungen bei Patienten mit Petit-mal-Anfällen

Zusammenfassung Die Videoanalyse zeigt bei 26 Patienten (42% des untersuchten Kollektives) iktuale motorische Entäußerungen, die bei routinemäßiger klinischer Untersuchung leicht als spontane Willkürbewegungen oder als nervöser Tic verkannt werden. Solche Pseudospontanbewegungen werden je nach Zusammensetzung des zugrundeliegenden Bewegungsprogrammes inelementare, komplexe undszenische Anfallsphänomene unterteilt. Die Videoanalyse zeigt außerdem, daß identische iktuale motorische Entäußerungen bei ein und demselben Patienten mit Petit-mal-Anfällen nicht nur während eines elektroencephalographisch gekennzeichneten Anfalls, sondern auch oftohne sichtbare Veränderungen im EEG auftreten. Es ist daher anzunehmen, daß in Wirklichkeit viel häufiger maskierte kleine Anfälle ablaufen, als die konventionelle EEG-Diagnostik vermuten läßt. Minimalformen von Pseudospontanbewegungen können als motorische Schablone so gut in den Gesamtverlauf der Willkürmotorik integriert werden, daß sie oft nur bei subtiler Untersuchungstechnik (SDA) als Ausdruck einer organischcerebralen Funktionsstörung erkannt werden. Einige Pseudospontanbewegungen bei Petit-mal-Anfällen werden auf eine paroxysmale Beteiligung extrapyramidaler Funktionssysteme zurückgeführt.Für die Hilfe bei der Dokumentation bin ich Frau K. Schmidt zu Dank verpflichtet.     

Psychosoziale Situation von Patienten mit Borderline- Persönlichkeitsstörung: Betreuungssituation,Lebensqualität und Symptombelastung nach einem stationären Aufenthalt

Patienten mit einer Borderline-St?rung (BPS) zeigen ein tiefgreifendes Muster von Instabilit?t in der Affektregulation, Impulskontrolle, Selbstwertregulation sowie im interpersonellen Bereich.     

Chronisch subdurales Hämatom bei einem Patienten mit Verdacht auf Prodromalstadium einer Schizophrenie

A patient showing "prodromal symptoms" of suspected psychosis was referred to our clinic specialized in early recognition of schizophrenia where an MRI brain scan showed a chronic subdural hemorrhage. Based on this case, it will be shown that organic brain disease, in addition to incipient schizophrenia, needs to be considered in patients with marked personality changes, social withdrawal, aggressiveness, and suspiciousness. Diagnosis of the first episode and prodromal stage of schizophrenia should include-apart from the case history as well as the psychopathological and physiological findings-certain obligatory medical examinations (EEG, cCT, or MRI) in order to identify possible organic causes and avoid misdiagnoses.