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1.
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.2.
Background
Nonconvulsive status epilepticus (NCSE) is associated with a poor outcome and is furthermore a diagnostic challenge in routine clinical work.Objective
Several sets of diagnostic criteria exist. What is the difference between them and which ones have been evaluated? Which concept can be recommended in the light of current knowledge?Material and methods
A survey on the current literature is provided and a structured approach for diagnosing NCSE is given.Results
Only one study on evaluation of the diagnostic criteria for NCSE exists, i.?e. the “Salzburg criteria for NCSE”, which were investigated retrospectively in a multicenter study. The diagnosis of NCSE is based on clinical and EEG data. The additional implementation of paraclinical information, such as cerebral imaging, emergency and toxicology laboratories is mandatory.Conclusion
Currently available criteria enable efficient and effective management of the majority of patients suspected of having NCSE; however, in individual cases it has to be taken into consideration that the criteria can be falsely positive or falsely negative.3.
U. Meyding-Lamadé E. M. Craemer E. K. Lamadé B. Bassa K. Enk H. Ilsen C. Jacobi V. Jost M. W. Lorenz C. Mohs C. Schwark B. Zimmerlein T. Gottschalk W. Hacke B. Kress 《Der Nervenarzt》2017,88(2):141-147
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.4.
Laurent M. Willems Lara Kay Felix Rosenow Adam Strzelczyk 《Zeitschrift für Epileptologie》2018,31(4):267-271
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.5.
6.
B. Lindner-Pfleghar H. Neugebauer S. Stösser J. Kassubek A. Ludolph R. Dziewas M. Prosiegel A. Riecker 《Der Nervenarzt》2017,88(2):173-179
Background
The German expert recommendations on the management of dysphagia in patients after acute stroke suggest an algorithm for clinical and technical investigations to identify patients at risk for aspiration and thus reduce the rate of aspiration pneumonia. The effectiveness of this algorithm has, however, not yet been prospectively validated .Methods
In this study 144 consecutive stroke patients were assessed by a full bedside swallowing assessment including the screening procedures of standardized swallowing assessment (SSA) and 2 out of 6. Flexible endoscopic evaluation of swallowing (FEES) was performed in all patients.Results
Aspiration was diagnosed in 25 patients (17.4%) by FEES. The SSA predicted aspiration with a sensitivity of 76% and a specificity of 55.5% and the 2 out of 6 screening with a sensitivity of 68.0% and a specificity of 61.0%. Of the patients 7 with negative screening for 2 out of 6 and 6 patients with negative SSA showed silent aspiration with the penetration aspiration scale (PAS 8) during FEES (28% of all patients with aspiration). Significant predictors for aspiration were dysarthria, dysphonia, abnormal volitional cough and cough after swallowing water; however, in multivariable analysis only dysarthria and cough after swallowing water were identified as independent predictors for aspiration. The rate of aspiration pneumonia was 2.8%.Conclusion
Clinical screening alone is not sufficient to identify patients at risk for aspiration pneumonia. The FEES should be used at a low threshold in cases of severe stroke and minor clinical abnormalities, especially concerning isolated dysarthria and cough after swallowing water; therefore, current recommendations should be correspondingly modified.7.
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.8.
R. Ruscheweyh S. Förderreuther C. Gaul A. Gendolla D. Holle-Lee T. Jürgens L. Neeb A. Straube 《Der Nervenarzt》2018,89(12):1355-1364
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.9.
Background
Status epilepticus (SE) is an epileptic complication of neurological disorders and associated with a poor outcome. The early diagnosis and treatment are of paramount importance. In 2015 the International League Against Epilepsy (ILAE) proposed a new set of diagnostic criteria and a classification of SE.Objective
What will change in daily practical work due to the new ILAE 2015 criteria for SE?Material and methods
A survey on the current literature and a detailed presentation of the criteria for diagnosis and classification regarding ILAE 2015 are provided.Results
Bilateral tonic-clonic seizures in SE (convulsive SE) are diagnosed after 5 min (time T1) in order for treatment to be successful within 30?min (time T2) to prevent permanent neuronal damage. In cases of focal seizures with or without impaired consciousness or absence status, the diagnosis and initiation of treatment should be made within 10?min. Regarding the time period T2 there is only limited evidence available. The most important semiological criteria are the differentiation according to the presence or absence of prominent motor phenomena and the state of consciousness. Further taxonomic axes are the etiology, EEG and age. In a retrospective study the applicability of the criteria was good.Conclusion
The ILAE 2015 definition and classification are transparent, clear, well arranged and easily applicable in routine clinical work. The simultaneous semiological classification of motor phenomena and impairment of consciousness is the most important scientific advantage.10.
Objective
In the present study we reviewed possible strategies and their success rates following primary therapy failure.Material and Methods
From all outpatients, we evaluated those children who had previously been treated unsuccessfully with two or more anticonvulsants, suffering from active epilepsy for at least one year and who had the last therapeutic intervention at least six months ago (n = 103). Regarding etiology, three groups were distinguished. The endpoint was seizure frequency. We distinguished between seizure freedom, seizure reduction by 75?% (responder) and no substantial improvement.Results
Of 103 patients, 45 were seizure-free, 45 were responder and 13 patients did not benefit.Discussion
An important advantage for patients that ultimately contributed significantly to the success of treatment was re-evaluation of the diagnosis and classification of the epilepsy. By correcting diagnosis and consequently changing treatment, some cases were successfully treated. All therapeutic options could be offered, including the full range of available anticonvulsants, surgical treatment and ketogenic diet. The majority of treatment success was achieved by consistent anticonvulsant pharmacotherapy regime. It was found that good therapeutic success was achieved most frequently with valproate and lamotrigine, without a significant difference regarding the epilepsy syndromes.11.
S. Radde S. Gutwinski F. Stuke A. Fuchs M. Schouler-Ocak F. Bermpohl J. Henssler 《Der Nervenarzt》2018,89(11):1254-1261
Background
Suicide is one of the four most common causes of death in adolescence worldwide. Although it is well known that suicidal people often have insufficient communication strategies, the importance of family communication for adolescent suicidality has not yet been sufficiently explored.Objective
The aim of this study was to provide a systematic review of family communication as a risk factor for adolescent suicidal tendencies and to develop treatment recommendations.Methods
In this study a systematic literature search was conducted in PubMed, Embase, CENTRAL and PsychINFO. The methodological quality of the studies was evaluated and a summary prepared.Result
A total of 195 studies were extracted and screened for their suitability. Of these studies, 7 which examined a total of 13,107 adolescents aged 11–22 years were included in this review and critically evaluated. Of the studies evaluated six found a correlative relationship between dysfunctional parent-child communication and adolescent suicidality. Communication with the mother appears to be more essential.Conclusion
The results of this literature search indicate that functional communication with parents seems to be protective for suicidal adolescents. From this, recommendations can be derived for preventive measures in families with adolescents who are otherwise at increased risk of suicide. Longitudinal study designs are needed to conclusively answer the research question.12.
Background
Ictal electroencephalogram (EEG) source imaging has both advantages and disadvantages compared with source imaging of interictal epileptiform discharges. Ictal source imaging estimates the seizure onset zone directly. However, the rapid propagation of the ictal activity and the low signal-to-noise ratio impose additional challenges on ictal source imaging. Several methods have been developed to circumvent these challenges.Objectives
To summarize and explain in plain terms the methods of ictal EEG source imaging and to review the published evidence on its accuracy.Materials and methods
We systematically searched Medline for studies of ictal EEG source imaging. In addition, we summarize our clinical experience with ictal EEG source imaging and we present illustrative examples for the analysis process.Results
Pooled data from 77 operated patients, from four clinical studies, showed that ictal EEG source imaging had a sensitivity of 83.3% (95% confidence interval: 69.8–92.5%) and specificity of 72.4% (95% confidence interval: 52.8–87.3%).Conclusion
Ictal EEG source imaging is accurate and it should be added to the multimodal presurgical evaluation of patients with drug-resistant focal epilepsy.13.
Background
Electroconvulsive therapy (ECT) is a highly effective, yet still controversial therapy for both the general public and psychiatrists. In this study, we investigated the patients’ view regarding effectiveness and tolerability of electroconvulsive therapy under consideration of individual clinical response.Material and methods
In 31 patients with major depression, subjective effectiveness and tolerability were assessed via a differentiated questionnaire prior to, during, and after ECT. Symptoms were rated using the Montgomery-Åsberg depression rating scale (MADRS) and the Beck depression inventory II (BDI?II)Results
Patients assessed ECT to be generally effective both before and after the treatment. This view was independent of their individual treatment success. In contrast, patients’ rating of individual effectiveness depended on the objective improvement of their symptoms. Side effects were rated to be generally slight to moderate.Conclusion
Against the background of persisting criticism towards ECT, the viewpoint of involved patients provides us with important references for an appropriate judgement of this therapy. The results suggest a good benefit-risk ratio for ECT from the patients’ perspective.14.
R. Kreidenhuber G. Demarchi G. Kalss M. Leitinger P. A. Winkler E. Trinka S. Rampp 《Zeitschrift für Epileptologie》2018,31(3):179-184
Background
About 23 million people worldwide suffer from medically refractory epilepsy. Surgery might be the best treatment option with a reasonable chance of seizure freedom. Surgical success depends on the exact definition of the epileptogenic zone (EZ). Magnetoencephalography (MEG) is one of the newer additions to the noninvasive presurgical work-up.Objectives
This study gives an overview of the impact of MEG on the management of epilepsy patients, focusing on (1) the influence on presurgical evaluation, (2) the identification of patients with the greatest benefit, and (3) possible surgical outcome predictors.Methods
An extensive Medline literature search was conducted for studies published from 1990.Results
MEG is in clinical use in the presurgical evaluation of epilepsies for the identification of the EZ and outcome prediction. In cases of failed surgery, it serves as a means to locate the remaining epileptogenic cortex. The usefulness of MEG has been reported for a wide range of localizations including challenging areas like the insula. In cases of multiple possible culprit lesions, MEG can mark the epileptogenic lesion, whereas in cases of nonlesional magnetic resonance imaging (MRI) findings, MEG can pinpoint a lesional or nonlesional epileptogenic cortex area. The role of MEG in the presurgical evaluation of epilepsy was shown with rates of modified approaches in 20–35% of cases. This holds true especially for cases with extratemporal epilepsy.Discussion
The value of MEG source localization is highest in extratemporal epilepsy, in MRI-negative or multilesional cases, if other modalities yield contradictory or inconclusive results, or in cases of suspected multifocal epilepsy. There is clear evidence that MEG yields nonredundant information and influences the therapeutic course of patients. Various patient groups likely to benefit from MEG were identified. Considering the poor chances of seizure freedom with continued medical treatment, these patients should not be denied source localization, which could result in surgery with favorable outcomes.15.
Background
There are scarce data available on the treatment of refractory status epilepticus (SE) where general anesthetics are recommended. However, these may be related to increased morbidity (and possibly mortality).Question
When and how should therapeutic coma be used in this clinical setting?Methods
Critical review of available international literature in the past 50 years as well as of personal experience.Results
Patients with generalized convulsive or nonconvulsive SE in coma not responding to benzodiazepines and an antiepileptic drug should be treated under electroencephalographic (EEG) monitoring with coma induction and general anesthetics. Initially, midazolam/propofol seem to represent the safest options. A progressive weaning attempt should be made after 24?h without EEG seizures. Patients with absence SE should never be treated with coma, and in those with focal SE with preserved consciousness coma should be deferred after the trial of other nonsedating compounds. In cases of super-refractory SE, ketamine and/or a ketogenic diet may be considered.Conclusion
In view of the limited current evidence, it seems reasonable to avoid indiscriminate use of general anesthetics in SE.16.
Jinhua Zheng Xinglong Yang Yalan Chen Quanzhen Zhao Sijia Tian Hongyan Huang Yanming Xu 《Clinical autonomic research》2017,27(2):103-106
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.17.
H. Soda V. Ziegler L. Shammas B. Griewing U. Kippnich M. Keidel A. Rashid 《Der Nervenarzt》2017,88(2):120-129
Objective
The Stroke Angel initiative investigates the implementation of telemedicine for improvement of preclinical communication between emergency medical services (EMS) and stroke units in cases of acute stroke.Material and methods
Stroke Angel is a technical system for the telemedical prenotification of patients in cases of suspected stroke at a stroke unit by the EMS. Within the framework of an observational study, the team has been investigating the effects of the system on door-to-computed tomography (CT) and door-to-needle times as well as the lysis rate in the neighboring regions of Rhön-Grabfeld and Bad Kissingen since 2005.Results
The system supports the acute treatment of neurological emergencies and functions as a catalyst for the interlinking of medical institutions in the region as well as for communication between emergency physicians/EMS and hospital physicians. The use of a computer-based data collection enables a continuous improvement process leading to an acceleration of internal clinical procedures and an increase of the lysis rate with the mortality rate staying constant.Conclusion
Telemedicine is applicable in the preclinical care of acute stroke and, thanks to the computer-based data collection, leads to an increase in process transparency, which helps to improve the internal clinical processes in and around a stroke unit.18.
Paul N. Pfeiffer Marcia Valenstein Dara Ganoczy Jennifer Henry Steven K. Dobscha John D. Piette 《Social psychiatry and psychiatric epidemiology》2017,52(2):183-191
Background
Following discharge, patients hospitalized for depression are at high risk for poor retention in outpatient care and adverse outcomes.Aims
Pilot tests a post-hospital monitoring and enhanced support program for depression.Method
48 patients at a Veterans Affairs Medical Center discharged following a depression-related inpatient stay received weekly visits or phone calls for 6 months from their choice of either a family member/friend (n = 19) or a certified peer support specialist (n = 29). Participants also completed weekly automated telephone monitoring calls assessing depressive symptoms and antidepressant medication adherence.Results
Over 90% of participants were more satisfied with their care due to the service. The mean change from baseline to 6 months in depression symptoms was ?7.9 (p < 0.05) according to the Patient Health Questionnaire and ?11.2 (p < 0.05) according to the Beck Depression Inventory-II for those supported by a family member/friend, whereas those supported by a peer specialist had mean changes of ?3.5 (p < 0.05) and ?1.7 (p > 0.10), respectively.Conclusions
Increased contact with a chosen support person coupled with automated telephone monitoring after psychiatric hospitalization is an acceptable service for patients with depression. Those who received the service, and particularly those supported by a family member/friend, experienced reductions in symptoms of depression.19.
Background
It is still unclear how well the established attention deficit-hyperactive disorder (ADHD)-specific rating scales can differentiate between ADHD symptoms and symptoms of other mental disorders.Methods
A total of 274 patients with suspected adult ADHD were extensively examined clinically and guideline-conform in an ADHD outpatient clinic. In 190 patients the diagnosis of ADHD could be made with certainty. The patients were also subsequently assessed according to the DSM IV criteria by self-rating scales on current (ADHS-SB, ASRS, CAARS) and retrospective (WURS-K) complaints. A binary logistic regression analysis was performed in order to extract from the questionnaires, which could best distinguish the diagnosis of ADHD from other mental disorders.Results
The results showed that two self-rating scales (WURS-K and ADHS-SB) were sufficient to correctly diagnose ADHD in 83% of the patients examined with a sensitivity of 94% and specificity of 56%.Conclusion
The ADHD-specific self-rating scales are additionally useful for the diagnostic differentiation between ADHD-specific and other psychiatric symptoms in the clinical practice and can improve the safety of the diagnosis.20.
Krysten W. Bold Abdullah S. Rasheed Danielle E. McCarthy Thomas C. Jackson Michael C. Fiore Timothy B. Baker 《Annals of behavioral medicine》2015,49(1):128-140