[Excited Delirium Syndrome (ExDS): emergence and emergency management]. / Erregungssturm ­ Entstehung und Notfallbehandlung.

The Excited Delirium Syndrome (ExDS) is a state of maximum psychophysiological excitation far beyond mental agitation. Patients themselves are at an acute risk and put others at a high risk. We present data from eleven patients and a short literature review. Results: 9 of 11 patients were acutely intoxicated (alcohol, magic mushrooms, THC, ecstacy, or "flakka"). Eight had a history of substance abuse and 4 of other mental illness. None of the patients responded to attempts at verbal de-escalation. Seven had significant injuries at the time of admission to the hospital. The aggressive "psychiatric" presentation of ExDS can lead to vital risks being overlooked (hyperexcitation, acidosis, rhabdomyolysis, hypoxemia, and cardiovascular decompensation), which may even be increased by severe methods of restraint (hogtie; positional asphyxia). Early recognition of ExDS and its risks, comprehensive management and the prevention of inappropriate treatment will help to reduce fatal outcomes.

[Old and depressed and/or demented? - Pseudodepression vs. pseudodementia]. / Alt und depressiv oder dement? ­ Pseudodepression vs. Pseudodemenz.

Many elderly patients suffer from both, depressive symptoms and cognitive deficits. Clinically, it oftentimes appears unclear whether the affective or the cognitive problems are primary or secondary. Modern molecular and imaging markers contribute to a more efficient distinction between depression and incipient dementia due to neurodegenerative, vascular, and other diseases. A careful history and clinical investigations are necessary to identify the underlying diseases, but they do not always offer sufficient therapeutic guidance. If in doubt, the condition should always be considered as potentially reversible and treated emphatically (but with age-appropriate caution).

[COVID-19 Concerns and Worries in Patients with Mental Illness]. / Psychisch krank in Krisenzeiten: Subjektive Belastungen durch COVID-19.

OBJECTIVE:  This study examines the impact of the COVID-19 pandemic and the lock-down on patients with mental illness. METHODS:  Patients in inpatient or outpatient psychiatric treatment received a questionnaire, examining psychological distress and psychiatric care during the COVID-19 pandemic. RESULTS:  More than half of the patients indicated that the state of emergency had a negative impact on their mental illness. Severely ill patients were more affected. CONCLUSION:  Patients with mental illness are a particularly vulnerable group in the current crisis. Psychiatric and psychotherapeutic care needs to be adapted accordingly; the specific burden and distress needs to be examined actively in patients from all diagnostic groups.

The overnight reduction of amyloid ß 1-42 plasma levels is diminished by the extent of sleep fragmentation, sAPP-ß, and APOE ε4 in psychiatrists on call.

INTRODUCTION: In mice there might be an association between sleep deprivation and amyloid ß plasma levels. Hence, we examined whether amyloid plasma levels are associated with sleep duration or fragmentation in 17 psychiatrists on-call. METHODS: Amyloid ß (Aß)42, Aß40, and soluble amyloid precursor protein ß (sAPP-ß) plasma concentrations were measured at the beginning and end of 90 on-call nights, and analyzed using generalized linear models. RESULTS: In on-call nights, a 10.7% reduction of Aß42 was revealed overnight. Every single short sleep interruption diminished this reduction by 5.4%, as well as every pg/mL of sAPP-ß by 1.2%, each copy of APOE ε4 by 10.6%, and each year of professional experience by 3.0%. DISCUSSION: The extent of sleep fragmentation diminishes the physiological overnight reduction of Aß42 but not Aß40 plasma levels in the same direction as the enzyme for Aß42 production, the genetic risk factor for Alzheimer's disease (AD), and on-call experience. Might on-call duty and sleep fragmentation in general alter the risk for AD?

[COVID-19 Crisis: Early Observations on a Pandemic's Psychiatric Problems]. / Psychische Probleme in der Pandemie ­ Beobachtungen während der COVID-19-Krise.

We have recently observed several clusters of psychiatric symptoms in the context of COVID-19: (1) increased anxiety in psychiatric in- and outpatients with different diagnoses; (2) more cases of domestic violence often associated with increased drug- or alcohol-consumption in offenders and victims; (3) a nihilistic "apocalyptic" syndrome of elderly patients cut-off from their families; (4) visual and acoustic hallucinoses due to pneumonia and sepsis-related confusional states. Cases of chloroquine-related toxicity have been reported elsewhere, but have not been observed in our hospital so far. Mental issues related to COVID-19 reported from China and practical recommendations are briefly summarized. Many patients with serious mental disorders will suffer world-wide due to a reallocation of medical, social and financial ressources.

[Return to Work: A Psychoeducational Module - An Intervention Study]. / Psychoedukationsmodul Rückkehr an den Arbeitsplatz ­ Eine Interventionsstudie.

OBJECTIV: e This study evaluated a psychoeducational intervention that aimed to facilitate return to work. METHODS: The randomized-controlled study trial was established at three psychiatric hospitals. The status of permanent employment in an age group of 18 to 60 served as main inclusion criterion. The intervention consisted of 5 sessions and covered topics such as disclosure of the diagnosis to colleagues and supervisors or legal frameworks in the return-to-work process. Participants of the control group received treatment as usual. RESULTS: The informative value of the comparisons was decreased by strong differences between the groups at baseline due to an allocation bias. However, participants of the intervention group felt more secure and prepared regarding their return to the workplace. In addition, participants developed a higher level of understanding regarding their rights within the legal frameworks when returning to work. More participants of the control group returned to work within 3 months. The decisive factor for a successful return to work was the intention of the participants to return at baseline. CONCLUSION: The psychoeducational program was well accepted among participants and appeared to be a useful addition to individual counseling by social workers. However,the program did not increase the likelihood to return to work within three months.

[Psychiatric Inpatient Treatment and Return to Work]. / Berufstätigkeit und Rückkehr an den Arbeitsplatz bei stationär-psychiatrisch behandelten Patienten.

OBJECTIVE: People with mental diseases have a high risk of unemployment and they have only limited access to the labor market. The return to work is often associated with fears.The present study aims to provide an overview of the number of hospitalized psychiatric patients with permanent employment. Moreover it should give an insight into the process of return to work, the experiences patients gain and the support they receive. METHODS: In the participating clinics we measured the number of patients with permanent employment. The main inclusion criteria for further survey were the status of permanent employment and age between 18 and 65. The participating patients were interviewed on two occasions, at the time of inclusion and 3 months after the patient was discharged. The questions addressed working conditions, job satisfaction and the process of return-to-work. For statistical analysis, descriptive statistics (frequencies, means, standard deviations) were used. RESULTS: Only 21 % of n = 815 inpatients of the participating hospitals were permanently employed. Many patients did not return to work after being discharged. In many cases the interviewed patients saw a connection between their job and their current episode of illness. In this context patients reported unsatisfying workplace conditions such as long working hours, bad work organization and social conflicts. CONCLUSIONS: For mentally ill patients, the employment rate in the primary labor market is devastating low. After psychiatric inpatient treatment patients are at high risk to lose their jobs. In order to prevent this development, work-related stress factors should be discussed with inpatients at an early stage and support should be provided during the return-to-work-process.

Visually guided tracking on a handheld device: can it be used to measure visuomotor skill in shift workers?

OBJECTIVE: We introduced a new visually controlled tracking task that can be assessed on a handheld device in shift workers to evaluate time-of-day dependent modulations in visuomotor performance. BACKGROUND: Tracking tasks have been used to predict performance fluctuations depending on time of day mainly under laboratory conditions. One challenge to an extended use at the actual working site is the complex and fixed test setup consisting of a test unit, a monitor, and a manipulation object, such as a joystick. METHOD: Participants followed an unpredictably moving target on the screen of a handheld device with an attachable stylus. A total of 11 shift workers (age range: 20-59, mean: 33.64, standard deviation: 10.56) were tested in the morning, the evening, and the night shift in 2-hr intervals with the tracking task and indicated their fatigue levels on visual analogue scales. We evaluated tracking precision by calculating the mean spatial deviation from the target for each session. RESULTS: Tracking precision was significantly influenced by the interaction between shift and session, suggesting a clear time-of-day effect of visuomotor performance under real-life conditions. Tracking performance declined during early-morning hours whereas fatigue ratings increased. CONCLUSION: These findings suggest that our setup is suitable to detect time-of-day dependent performance changes in visually guided tracking. APPLICATION: Our task could be used to evaluate fluctuations in visuomotor coordination, a skill that is decisive in various production steps at the actual working place to assess productivity.

The effects of shift work and time of day on fine motor control during handwriting.

Handwriting is an elaborate and highly automatised skill relying on fine motor control. In laboratory conditions handwriting kinematics are modulated by the time of day. This study investigated handwriting kinematics in a rotational shift system and assessed whether similar time of day fluctuations at the work place can be observed. Handwriting performance was measured in two tasks of different levels of complexity in 34 shift workers across morning (6:00-14:00), evening (14:00-22:00) and night shifts (22:00-6:00). Participants were tested during all three shifts in 2-h intervals with mobile testing devices. We calculated average velocity, script size and writing frequency to quantify handwriting kinematics and fluency. Average velocity and script size were significantly affected by the shift work schedule with the worst performance during morning shifts and the best performance during evening shifts. Our data are of high economic relevance as fine motor skills are indispensable for accurate and effective production at the work place. PRACTITIONER SUMMARY: Handwriting is one of the most complex fine motor skills in humans, which is frequently performed in daily life. In this study, we tested handwriting repeatedly at the work place in a rotational shift system. We found slower handwriting velocity and reduced script size during morning shifts.