Evidence and expert consensus based German guidelines for the use of repetitive transcranial magnetic stimulation in depression.

INTRODUCTION: Non-invasive brain stimulation techniques such as repetitive transcranial magnetic stimulation (rTMS) offer a promising alternative to psychotherapeutic and pharmacological treatments for depression. This paper aims to present a practical guide for its clinical implementation based on evidence from the literature as well as on the experience of a group of leading German experts in the field. METHODS: The current evidence base for the use of rTMS in depression was examined via review of the literature. From the evidence and from clinical experience, recommendations for the use of rTMS in clinical practice were derived. All members of the of the German Society for Brain Stimulation in Psychiatry and all members of the sections Clinical Brain Stimulation and Experimental Brain Stimulation of the German Society for Psychiatry, Psychotherapy, Psychosomatics and Mental Health were invited to participate in a poll on whether they consent with the recommendations. FINDINGS: Among rTMS experts, a high consensus rate could be identified for clinical practice concerning the setting and the technical parameters of rTMS treatment in depression, indications and contra-indications, the relation of rTMS to other antidepressive treatment modalities and the frequency and management of side effects.

[Hashimoto's encephalopathy-An underdiagnosed disease in psychiatry?] / Hashimoto Enzephalopathie ­ Eine unterdiagnostizierte Erkrankung in der Psychiatrie?

In recent years, research has increasingly focused on inflammatory processes as a trigger for psychiatric illnesses. Contrary to previous suggestions, clinical pictures with psychiatric features only also can occur, leading to erroneous diagnoses and treatments. We describe the case of a patient who was initially diagnosed paranoid schizophrenia on the basis of the clinical presentation. Antipsychotic treatment was frequently discontinued by the patient also due to inadequate response. After intensifying the diagnostic procedures autoimmune thyroiditis oft he Hashimoto type was detected in the patient. Excluding the other causes, Hashimoto's encephalopathy was considered as a differential diagnosis. The patient agreed to a therapeutic attempt with cortison leading to complete remission of psychotic symptoms thus confirming the diagnosis of steroid-responsive encephalopathy associated with autoimmune thyroiditis.

[Rhabdomyolysis induced by paliperidone palmitate]. / Paliperidonpalmitat-induzierte Rhabdomyolyse.

Rhabdomyolysis is defined by disintegration of skeletal muscle fibres. Clinical presentation varies and is mostly associated with myalgias as well as elevation of creatine kinase in the serum. Mechanical damage, toxic medicinal factors, and predisposing factors such as myopathies may trigger the condition. This report describes a case of rhabdomyolysis uncovered by chance after administration of paliperidonepalmitate as depot medication in a 45 years old schizophrenic male patient after having tolerated oral risperidone without any problems. Routine screening for clinical manifestations and serum-creatin kinase maybe essential in unravelling antipsychotic-induced rhabdomyolysis.

[Consequences of hospitalisations on smoking behaviour in psychiatric and somatic inpatients]. / Auswirkungen stationärer Aufnahmen auf das Rauchverhalten psychiatrischer und somatischer Patienten.

BACKGROUND: To examine the differences and potential changes that occur in smoking habits among psychiatric and somatic patients due to and during their hospital stay in a general hospital. METHODS: Inpatients of three departments (psychiatry,cardiology, pulmology) were given a questionnaire that asked for epidemiologic data and their smoking habits,including the Fagerstrom-Test. In order to achieve sufficient data, the questionnaire was administered twice on two different dates. Primary goal of this examination was to determine a potential change in smoking behaviour whereas the secondary goal was to check for differences between psychiatric and somatic inpatients and within the psychiatric diagnostic groups according to their smoking habits respectively. According to a lack of normal distribution of the data non parametric tests undvisual classifying were used for statistical analysis. RESULTS: A substantial proportion (26.4 %) of psychiatric inpatients reported an increase in cigarette consumption or have restarted or newly started smoking cigarettes are due to their admission. On the other hand, none of the somatic patients did so, actually they showed higher proportion of being non-smokers. There were statistically significant differences between psychiatric and somatic patients in two age-groups due to their change in smoking habits and severity of nicotine dependence as measured by the Fagerstrom-test. Among the psychiatric patients sampled, those with schizophrenia and affective disorders showed high prevalence of being highly addicted smokers in 85.7 and 44.4 % respectively. CONCLUSIONS: As a result of this small sample and hindered comparability of somatic and psychiatric groups of inpatients further investigations are needed to evaluate the influence of hospitalisations on smoking behaviour and to tailor suitable actions

Changing aspects of psychiatric inpatient treatment. A census investigation in five European countries.

This paper presents data obtained in a one-day census investigation in five European countries (Austria, Hungary, Romania, Slovakia, Slovenia). The census forms were filled in for 4191 psychiatric inpatients. Concerning legal status, 11.2% were hospitalised against their will (committed) and 21.4% were treated in a ward with locked doors. There was only a small correlation between commitment and treatment in a locked ward. More frequent than treatment of committed patients in locked wards was treatment of committed patients in open wards (Austria, Hungary) and treatment of voluntary patients in closed wards (Slovakia, Slovenia). Concerning employment, 27.7% of patients aged 18-60 held a job before admission. The vast majority of patients (84.8%) had a length of stay of less than 3 months. A comparison of these data with the results of a study performed in 1996 and using the same method shows a decrease of rates of long-stay patients. In 1996 the rates of employment were significantly higher in Romania (39.3%) and Slovakia (42.5%) compared to Austria (30.7%). These differences disappeared in 1999 due to decreasing rates of employment in Romania and Slovakia. The numbers of mental health personnel varies between types of institution (university or non-university) and countries, being highest in Austria and lowest in Romania. A considerable increase in the numbers of staff was found in Slovakia.

[Consequences of decentralization on the basis of a psychiatric department in the upper austrian salzkammergut]. / Konsequenzen der Regionalisierung anhand einer psychiatrischen Abteilung im oberösterreichischen Salzkammergut - Veränderungen im Diagnosespektrum, Kooperation im Allgemeinspital.

OBJECTIVE: To describe the changes of utilization of a psychiatric department following its decentralization into an Upper Austrian region, the Salzkammergut. METHODS: 9 months before and after decentralization all kinds of contacts to psychiatric patients (inpatients, outpatients, day clinic patients, patients of consulting psychiatric service) regarding frequency of contacts, case numbers and diagnosis have been evaluated. For the inpatients their legal status was recorded. RESULTS: Since the establishment of the decentralized psychiatric department an increase in the frequency of admissions of inpatients up to 157 % could be revealed. Depressive disorders showed the largest increase of admissions (204 %), remarkable increase was also seen in substance use disorders, neurotic and organic disorders (between 171 % and 183 %). Changes also emerged concerning the legal status of the patients with a decrease of the percentage of involuntary admissions from 26.5 % prior to decentralization to 20.7 % thereafter. Among the patients seen by the consulting service length of stay was higher than usually seen on somatic wards as there was a very high proportion of patients with depressive syndromes. CONCLUSION: Within the context of decentralization provision of psychiatric care seems to be improved. Treating more patients with depressive and neurotic disorders the staff of the psychiatric ward was confronted to apply more psychotherapeutic interventions to meet the patient's neurotic and suicidal behaviour.