Vitos

Psychological interventions for delusions may be enhanced by targeting their presumed causal factors. An emotion-oriented variant of cognitive behavioral therapy for delusions (CBTd-E), designed to target affect regulation and maladaptive schemata, was evaluated for its effect on delusions. A single-blind, multicenter, randomized, waitlist-controlled trial was conducted in three German outpatient clinics. Ninety-four patients with psychotic disorders and persistent delusions were randomized to 25 individual sessions of CBTd-E over 6 months (n = 47) or waitlist (n = 47). CBTd-E included two modules designed to improve affect regulation and maladaptive schemata. Assessments were performed at baseline (T1), three months (T2), and six months (T3). Regression-based analysis of covariance at T3 in the intent-to-treat sample indicated no significant benefit for the CBT-E group in the primary outcome (Psychotic Symptom Rating Scale delusions subscale, d = -0.45 [CI: 0.36; -1.26]). Regarding secondary outcomes, a significant effect favoring CBTd-E was observed in general psychopathology (d = -0.56), but no effects on positive and negative symptoms, depression, general and social functioning, or antipsychotic dosage. Regarding the proposed target mechanisms, we found improved cognitive reappraisal (d = 0.59), worrying (d = -0.52), quality of sleep (d = -0.49), and self-esteem (d = 0.36). Despite its effect on the suggested target mechanisms, affect regulation and maladaptive schemata, and on general psychopathology, this emotion-focused variant of CBT did not show an effect on delusions. A possible avenue to achieve stronger effects on delusions is to personalize the modularized interventions.Trial registration: Clinicaltrials.gov Identifier: NCT02787135

ObjectiveStatus epilepticus (SE) represents one of the most common neurological emergencies. The International League Against Epilepsy (ILAE) redefined SE duration thresholds from 30 to 5 min for convulsive SE in 2015. We conducted a prospective population‐based study to determine SE incidence and outcomes under the revised criteria and compared findings with historical data using the 30‐min definition.MethodsA prospective, population‐based cohort study was conducted over a period of 18 months to determine the incidence of SE in Germany, replicating the methodology of a first study conducted in this region in 1999. The study included all adults residing within the 35‐postcode area, with participation from all regional hospitals and emergency departments. SE cases were prospectively identified and reported. To ensure comparability with the historical data, the analysis focused on the Primary Service Area (PS‐Area)—the direct catchment region of the University Hospital Marburg.ResultsA total of 180 adults with SE (96 men, mean age 66.47 years, SD ± 18.5 years, range: 20–94 years). The crude annual incidence in the PS‐Area increased from 15.8/100 000 (95% confidence interval [CI] 11.2–21.6) in 1999 to 29.4/100 000 adults (95% CI 20.5–40.0). It was higher in men than in women (30.9 vs 28.1/100 000, p = .11) and in patients ≥60 years (68.5 vs 13.5/100 000; p < .0001). The calculated age‐ and gender‐adjusted incidence was 32.5/100 000 in the PS‐Area. The case–fatality rate was 5.77% (95% CI 1.2%–12.7%) and the crude annual cause‐specific mortality rate per 100 000 is 1.70 (95% CI 0.21–4.73). In 53% SE was the first seizure episode; only 47% had a history of epilepsy. When extrapolating these findings to the entire German population, there were at least 20 000 cases of SE with 1000 associated deaths annually.SignificanceThese findings provide new epidemiologic evidence that the incidence of SE has increased by ~12% with the adoption of the ILAE 2015 definition, underscoring the impact of updated diagnostic criteria on epidemiological estimates.

Men convicted of sexual offenses (MCSO) can be treated with testosterone-lowering medications (TLM) in order to support the control of paraphilic sexual fantasies and to decrease the risk of sexual recidivism. However, due to partly severe side effects, TLM should not be a lifelong treatment. The Change or Stop Testosterone-Lowering Medication (COSTLow)-R Scale was developed to assist forensic professionals in deciding on whether to change or stop TLM treatment in MCSO. The current study aimed to evaluate the scale in forensic outpatient aftercare practice. The COSTLow-R Scale was applied retrospectively in a forensic-psychiatric outpatient institution in Hesse, Germany, on 72 MCSO. TLM was stopped in 30 patients (41.7%). Moreover, 10 forensic professionals of the institution (23.3%) as well as an experienced working group within the institution focusing on the treatment of MCSO, qualitatively evaluated the COSTLow-R Scale by participating in an open designed survey. The COSTLow-R Scale ratings as assessed by forensic professionals were collected. In addition, a survey was performed among these professionals about the usefulness of the scale and their practical experiences with it. TLM stopping decisions were significantly associated with three COSTLow-R Scale items: the compliance for monitoring effects and side effects, the possibility of psychotherapy before TLM treatment, and the therapeutic alliance before starting TLM treatment. In sum, the decision towards stopping TLM was more likely for patients whose compliance was considered higher, and for those who had demonstrated a greater treatment readiness as well as therapeutic alliance before starting TLM. The forensic professionals described the scale as a good and structured tool that displays which aspects are important to consider during TLM treatment decisions. The COSTLow-R Scale provides structure to the decision whether to change or stop TLM and should thus be implemented in the forensic treatment process of patients with TLM more frequently. Although the small sample size limits generalizability of the findings, the present study was conducted directly in a forensic center and, therefore, has high external validity and a strong impact on the life and health of patients treated with TLM. The results indicate that the COSTLow-R Scale can be a useful instrument facilitating the TLM decision-making process by providing a structured compendium of criteria. Further research is still needed to evaluate the scale and to provide additional evidence for the results of the current study.

ZusammenfassungVitiligo ist eine häufige Erkrankung, die mit einem meist sichtbaren Pigmentverlust der Haut einhergeht. Der wichtigste Vertreter ist die nicht‐segmentale Vitiligo (NSV). Ihr liegt pathogenetisch eine autoimmunvermittelte Zerstörung der Melanozyten zugrunde. Die Erkrankung führt zu Stigmatisierung und signifikanter Einschränkung der Lebensqualität. Unter Missachtung der psychosozialen Belastung wird die Vitiligo manchmal nur als kosmetisches Problem betrachtet und laut eines globalen Surveys im Durschnitt erst nach 2,4 Jahren diagnostiziert. Es kommt zu erheblicher Krankheitslast bis hin zur Suizidalität. Stigmatisierung begünstigt die Entwicklung psychischer Komorbidität wie Angst‐ und depressive Störungen. Deren Prävalenz variiert je nach Land und Studie (0,1%–67,9%). Die Daten für Deutschland sind heterogen und basieren weitgehend auf Schätzwerten. Aufgrund der psychosozialen Einflussfaktoren, der entzündlichen Komponente und einer höheren Inzidenz somatischer Begleiterkrankungen ergibt sich die Frage, ob die NSV zu den entzündlichen Systemerkrankungen zu zählen ist. Wir empfehlen zur Optimierung der Versorgung neben der Krankheitsaktivität auch die Erhebung der Lebensqualität als Standard in die Routineversorgung einzuführen und frühzeitig auf psychische Komorbidität zu screenen, um eine fachgerechte Behandlung einzuleiten bevor Krankheitsverläufe chronifizieren und kumulative (zum Teil irreversible) Beeinträchtigungen entstehen. Ziel ist eine personalisierte und patientenorientierte integrierte Versorgung, die den Gesundheitszustand der Betroffenen nachhaltig verbessert.

BackgroundDysmorphic concern is an overconcern with an imagined or slight defect in physical appearance that can be a symptom of body dysmorphic disorder (BDD). Appearance‐related concerns are frequently reported by people with dermatological conditions. However, relatively little remains known about the relationship between dysmorphic concern and other variables within persons with different skin conditions.ObjectivesThe aim of this multicentre, cross‐sectional study was to investigate gender differences regarding dysmorphic concern and the prevalence of BDD in a large sample of patients with skin conditions, in relation to sociodemographic, clinical and psychological variables.MethodsParticipants aged ≥18 years with skin conditions were consecutively enrolled in dermatological clinics of 22 European centres. Dysmorphic concern and the possible presence of BDD were measured using the Dysmorphic Concern Questionnaire (DCQ) and compared between men and women in relation to sociodemographic, clinical and psychological variables, and separately for each skin condition.ResultsThe DCQ questionnaire was completed by 5290 dermatological patients. In all categories, mean scores were significantly higher in women than in men. Mean DCQ scores were also higher in women for most skin conditions, with the highest effect size in vitiligo. The percentage of patients who screened positive for BDD on the DCQ was 10.5%, 7.7% of men and 12.7% of women. The prevalence of BDD positive was 6.9% in patients with mild clinical severity, 11.1% for moderate and 19.1% for severe condition. In the multivariate model in patients with mild skin condition, the presence of BDD was positively associated with stress and stigma both in men and in women.ConclusionsDysmorphic concern and BDD were more frequent in women than in men with skin conditions. Both received and actual stigmatization might have an impact on body‐related concerns, in particular in women, who may be more at risk for sociocultural reasons.

ZusammenfassungDer multiple Schlaflatenztest (MSLT) ist ein diagnostisches Instrument zur objektiven Bestimmung der Einschlafneigung am Tage. Er dient der Differentialdiagnostik der Narkolepsie, Hypersomnie und anderen Erkrankungen mit gesteigerter Tagesschläfrigkeit. Mittels Elektroenzephalographie, Elektromyographie des Kinns und Elektrookulographie werden in diesem Einschlaftest die durchschnittliche Einschlaflatenz sowie das Auftreten von REM-Schlaf, unter idealen Schlafbedingungen in einem abgedunkelten Raum mit der Aufforderung einzuschlafen, gemessen. Er wird tagsüber nach einer Polysomnographie in der vorausgehenden Nacht durchgeführt und besteht aus fünf standardisierten Testdurchgängen im Abstand von jeweils zwei Stunden. Medikamente, Schlafentzug sowie stimulierende Substanzen oder Aktivitäten können die Ergebnisse des Tests beeinflussen. Im Jahr 2021 wurde die MSLT-Leitlinie seitens der American Academy of Sleep Medicine (AASM) aktualisiert. Der vorliegende Artikel stellt die aktualisierte Richtlinie vor und kommentiert diese.

Abstract Background The COVID-19 pandemic has strong effects on most health care systems. Forecasting of admissions can help for the efficient organisation of hospital care. We aimed to forecast the number of admissions to psychiatric hospitals before and during the COVID-19 pandemic and we compared the performance of machine learning models and time series models. This would eventually allow to support timely resource allocation for optimal treatment of patients. Methods We used admission data from 9 psychiatric hospitals in Germany between 2017 and 2020. We compared machine learning models with time series models in weekly, monthly and yearly forecasting before and during the COVID-19 pandemic. Results A total of 90,686 admissions were analysed. The models explained up to 90% of variance in hospital admissions in 2019 and 75% in 2020 with the effects of the COVID-19 pandemic. The best models substantially outperformed a one-step seasonal naïve forecast (seasonal mean absolute scaled error (sMASE) 2019: 0.59, 2020: 0.76). The best model in 2019 was a machine learning model (elastic net, mean absolute error (MAE): 7.25). The best model in 2020 was a time series model (exponential smoothing state space model with Box-Cox transformation, ARMA errors and trend and seasonal components, MAE: 10.44). Models forecasting admissions one week in advance did not perform better than monthly and yearly models in 2019 but they did in 2020. The most important features for the machine learning models were calendrical variables. Conclusion Model performance did not vary much between different modelling approaches before the COVID-19 pandemic and established forecasts were substantially better than one-step seasonal naïve forecasts. However, weekly time series models adjusted quicker to the COVID-19 related shock effects. In practice, different forecast horizons could be used simultaneously to allow both early planning and quick adjustments to external effects.

Knöchel, Christian MD, PhD; Hefner, Gudrun PhD; Stiehl, Thomas MD, PhD; Schmidbauer, Walter MD Author Information

Stopping antidepressants can cause withdrawal (discontinuation) symptoms, the return of the original illness, and rebound. The latter means that the disease will return stronger, faster, or with greater likelihood than if it had not been treated with medication. The Psychiatry Working Group of the Drug Commission of the German Medical Association (AkdÄ) presents the scientific findings and provides practical recommendations for action. Withdrawal symptoms are multiform; unspecific physical symptoms are predominant. Distinguishing them from the recurrence of depressive symptoms can be difficult. Most of them are mild and self-limiting. There is insufficient evidence on the extent and frequency of rebound depression. The rebound risk implies that when establishing the medication, the short-term benefit must be weighed against the possible long-term risk of chronic depression or the possible need for long-term medication. Patients should be informed about the risk of withdrawal both as early as the joint decision-making process about treatment initiation and regularly during the course of treatment. Withdrawal should take place gradually, except in emergency situations, whereby small steps should be taken, especially in the low-dose range.