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Background: Self-help can play an important supplementary role in the treatment of people with severe mental illness; however, little is known about the utilization of the various approaches., Objective: This study describes the use of various self-help options by patients with severe mental illness and examines potential predictors., Material and Methods: As part of the observational cross-sectional study on patients with severe mental illness (IMPPETUS, N = 397), trained staff collected sociodemographic, illness-associated and treatment-associated data between March 2019 and September 2019. Binary logistic regression was used to analyze a possible association with the use of self-help., Results: The participants most frequently reported using self-help literature (n = 170; 45.5%) followed by self-help groups (n = 130; 33.2%), electronic mental health applications (n = 56; 15.5%) and self-management approaches (n = 54; 14.8%). Trialogue seminars (n = 36; 9.9%) were the least used by the participants. The utilization of the various approaches is influenced by sociodemographic and disease-related characteristics (age, education, marital status, migration background, age at onset of initial mental health problems, psychosocial functioning level) but not by factors associated with treatment., Conclusion: The potential of self-help is not being fully utilized in the sample investigated. The reported use of self-help approaches by the participants ranged between 10% and 46%. The various formats address specific target groups. More targeted information must be provided about the various options and the use of self-help in routine treatment must be actively fostered in order to increase the utilization of self-help., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Background: Although people receiving means-tested benefits are regularly taken care of at the job center, little is known about their mental health situation and mental health care., Objective: The aim of the study was to describe the diagnostic spectrum and the functional status as well as the mental health care utilization of individuals with mental illnesses who are receiving means-tested benefits., Methods: Mentally ill people with means-tested benefits were recruited at the job center as part of the "Leipzig Individual Placement and Support for Mentally Ill People" (LIPSY) project, where they were initially diagnosed according to ICD-10 and included in the project if they had a mental disorder. Mental healthcare utilization was recorded. In the present study, data from n = 583 consecutively included persons were analyzed descriptively and by multivariate statistics., Results: Of the study participants 60.7% (n = 583; 51.5% female; average age 36 years; unemployed for an average of 4.8 years) suffered from affective disorders, followed by neurotic, stress and somatoform disorders (42.5%). With a mean global assessment of functioning (GAF) value of 49.4 (SD 7.7), there was on average a serious impairment. Nearly half of the subjects (48.5%) had never received psychotherapeutic, psychiatric or neurological treatment in the 6 months prior to inclusion in the project., Discussion: It could be shown that there is a broad spectrum of mental disorders with substantial functional impairment. The data suggest that this group is significantly undertreated and difficult to reach., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Hermann Oppenheim (1858-1919) was a German neurologist without an academic career, who in his productive period around 1900 made a name for himself during his lifetime as a major player in the history of German neurology with his many contributions to multiple sclerosis, syphilis and the controversial study of traumatic neurosis; however, it is almost unknown that in 1890 he introduced the term "witzelsucht", which is still used internationally today. Moritz Jastrowitz dealt with behavioral abnormalities due to frontal brain injuries 1 year earlier and used the term "moria" for a form of mental disorder associated with a kind of childish behavior and inappropriate jocularity. Oppenheim was critical of this and differentiated his "witzelsucht" from this. With this term he wanted to describe humoristic feeble-mindedness in a much narrower sense, which stands in striking contrast to the usual symptoms in cases of cerebral tumors. Oppenheim recognized the frontal brain, particularly the right brain, to be an important functional unit for humorous behavior. Modern research has confirmed that the processing of humor requires a complex interaction of multiple brain regions. Damage to the right frontal lobe or to connecting structures can lead to the disorder "witzelsucht". Whether a simultaneous damage to the left hemisphere must be present or if this is dependent on the individual dominant hemisphere, needs further research., (© 2024. The Author(s).)

The adult form of attention deficit hyperactivity disorder (ADHD) has increasingly become a focus of adult psychiatry. Despite long-established diagnostic criteria and specific therapeutic approaches for the disorder, the common misconception that ADHD is a "fad" has persisted. Examining the history of psychiatry can make an educational contribution by showing that the adult form of ADHD is a continuously existing illness phenomenon. The present study examines the discussion of sometimes prominent authors about "chronic mania" in German-speaking psychiatry around 1900. The individual concepts were analyzed for their content and compared with each other and with modern diagnostic manuals for adult ADHD. The aim of this work is to question and discuss whether these "chronic-manic concepts" are part of the conceptual history of adult ADHD and whether a gap in the history of this disorder can be filled with their help. It is concluded that in the early twentieth century neurologists reported and discussed about patients who nowadays would almost certainly receive the diagnosis of ADHD. The psychiatrists had difficulty in classifying this disorder into their nosological schemes but their "chronic-manic concepts" show clear parallels to the current diagnostic criteria for adult ADHD and its symptoms., (© 2024. The Author(s).)

Background: Clinical practice guidelines (CPG), which are crucial for evidence-based healthcare, should be kept up to date, especially on topics where emerging evidence could modify one of the recommendations with implications for the healthcare service; however, an updating process, which is practicable for guideline developers as well as users represents a challenge., Objective: This article provides an overview of the currently discussed methodological approaches for the dynamic updating of guidelines and systematic reviews., Material and Methods: As part of a scoping review, a literature search was conducted in the databases MEDLINE, EMBASE (via Ovid), Scopus, Epistemonikos, medRxiv, as well as in study and guideline registers. Concepts on the dynamic updating of guidelines and systematic reviews or dynamically updated guidelines and systematic reviews or their protocols published in English or German were included., Results: The publications included most frequently described the following main processes that must be adapted in dynamic updating processes 1) the establishment of continuously working guideline groups, 2) networking between guidelines, 3) the formulation and application of prioritization criteria, 4) the adaptation of the systematic literature search and 5) the use of software tools for increased efficiency and digitalization of the guidelines., Conclusion: The transformation to living guidelines requires a change in the needs for temporal, personnel and structural resources. The digitalization of guidelines and the use of software to increase efficiency are necessary instruments, but alone do not guarantee the realization of living guidelines. A process in which dissemination and implementation must also be integrated is necessary. Standardized best practice recommendations on the updating process are still lacking., (© 2023. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Background: Guidelines are central pillars of high-quality care and care planning. The quality requirements for the development of guidelines and the associated effort are very high. Therefore, more efficient approaches are being forced., Objective: The opportunities and challenges in the introduction of a dynamic updating concept within the framework of the digitalization of guidelines were explored from the perspective of guideline developers in the field of psychiatry. This perspective should be included in the implementation., Material and Methods: Between January and May 2022 a cross-sectional survey was conducted among guideline developers (N = 561, response 39%) based on a questionnaire developed and tested in advance. Data were analyzed descriptively., Results: A total of 60% were familiar with the concept of living guidelines. A large proportion endorsed a dynamic updating (83%) and digitalization (88%) of guidelines; however, various challenges are associated with the concept of living guidelines: the risk of inflationary changes (34%), the need for continuity of all actors (53%), involvement of patient and family representatives (37%) and definition of criteria regarding the decision what to change (38%). The vast majority (85%) thought it necessary that guideline development should be followed by implementation projects., Conclusion: German guideline developers are very receptive regarding the implementation of living guidelines; however, they named numerous challenges, which need to be addressed in this approach., (© 2023. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Outdated guidelines can cause inadequate care. To counter this problem a dynamic updating process for guidelines is being internationally discussed (living guidelines). This process has specific challenges. The rhythm of updating has to be determined and a priori criteria have to be defined, which indicate that a substantial change of the medical practice is needed in order to then update individual recommendations. Digital tools have to be identified that can support a dynamic updating. Their (further) development has to be oriented to the specific requirements and needs of the trialogically composed guideline development teams. Recommendations have to be examined from the user perspective. The current guideline development methods that are still divergent, have to be harmonized and specific needs with respect to the cross-linking of guidelines have to be taken into account. The German Association for Psychiatry, Psychotherapy and Psychosomatics (DGPPN) supports and accompanies scientific projects dealing with the challenges of the dynamics of guideline development. From the first results of "Guide2Guide", a project funded by the Innovation Fund, it can be summarized that the development of living guidelines is a complex dynamic process that has only just started internationally and in Germany. It demands a special engagement of the guideline developers including representatives of patients and relatives, to responsibly work long term and flexibly. Digital tools can be useful in various process steps but at present they still have to be meaningfully linked into the process. Central elements of the development of S3 guidelines will continue to require substantial working time of the experts in the trialogue. In order for living guidelines to be actually used dissemination and implementation have to be integrated into the dynamic process., (© 2023. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Background: The scientific state of knowledge on modifiable risk factors for dementia has greatly improved in recent years. The established risk and protective factors include physical and social inactivity, hypertension, diabetes mellitus, excessive alcohol consumption and smoking; however, it is assumed that this knowledge is so far insufficiently disseminated among the general population, indicating untapped potential for primary prevention of dementia., Objective: To assess the state of knowledge on established risk and protective factors for dementia in the general population., Material and Methods: Based on a systematic literature search in the PubMed database, international studies that investigated the knowledge on modifiable risk and/or protective factors for dementia in samples from the general population were identified., Results and Conclusion: A total of 21 publications were included in the review. The majority of publications (n = 17) collated risk and protective factors using closed questions, while n = 4 studies used open questions. Lifestyle factors, e.g. cognitive, social and physical activity, were most frequently named as protective against dementia. Furthermore, many participants recognized depression as a risk factor for dementia. Knowledge of cardiovascular risk constellations for dementia, such as hypertension, hypercholesterolemia or diabetes mellitus were much less known among the participants. The results indicate that there is a need for a targeted clarification of the role of pre-existing cardiovascular diseases as risk factors for dementia. Studies assessing the state of knowledge on social and environmental risk and protective factors for dementia are currently scarce., (© 2023. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Wilson's disease is an autosomal recessive disorder of copper metabolism and is caused by a genetic defect on chromosome 13. Nuclear medicine methods can prove the metabolic defect and contribute to the assessment of central neurological deficits.With high specificity and sensitivity, the intravenous radiocopper test enables the diagnosis to be confirmed as the basis for initiating treatment. The oral radiocopper test is used to monitor zinc treatment.[ 123 I]β-CIT-SPECT and [ 123 I]IBZM-SPECT provide functional information of the nigrostriatal system.[ 123 I]β-CIT-SPECT also allows the determination of SERT availability in the hypothalamus/brain stem as a surrogate parameter of depression.Metabolic parameters of the cortex, basal ganglia and cerebellum can be assessed by [ 18 F]FDG-PET studies.SPECT and [ 18 F]FDG-PET studies show significant differences between neurological and non-neurological Wilson patients. Overall, only noninvasive in vivo nuclear medicine enables a deeper insight into the pathophysiology of neurological processes in Wilson's disease., (© 2022. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Background: In his comprehensive classification of the beginning of the twentieth century, Emil Kraepelin provided a detailed description of an entity he called "impulsive insanity", which had not been elaborated before him. The forms depicted by him largely corresponded to the offences, which were referred to as typically female in their nature in the late nineteenth and early twentieth centuries., Question: How did Kraepelin classify "impulsive insanity" and what forms did he describe? Did Kraepelin also see these disorders predominantly prevailing in women, did he establish a connection with women's criminality and how did this fit into the discourses of the time on femininity, criminal legislation and degeneration?, Material and Methods: This study focused on the clinical picture "impulsive insanity" as described by Emil Kraepelin in his main work, the 8th edition of his Textbook of Psychiatry published between 1909 and 1915. His description was analyzed in detail and embedded in a historical context on the basis of secondary literature., Results: In rudiments Kraepelin's clinical classification is still comprehensible today, although there are major differences to how literature in later years treated this issue. Kraepelin clearly sees "impulsive insanity" as a driving disorder predominantly prevailing in women., Discussion: Elaborating his concept of "impulsive insanity", Kraepelin positioned himself in relation to important scientific discourses of the early twentieth century, such as the debate on criminal legislation and the theory of degeneration. On the basis of the individual forms of "impulsive insanity" described by Kraepelin, various concepts of constructing and pathologizing femininity can be identified. Apparently, it also aims to explain common female crimes within the patriarchal hegemony., (© 2022. The Author(s).)

The notion that the adult form of attention deficit hyperactivity disorder (ADHD) is not a construct of modern psychiatry is increasingly prevailing. Looking into the history of psychiatry can make an enlightening contribution here. Guided by this aim and specifically following literature referred to by Emil Kraepelin (1856-1926), we analyzed the content of one study each by Gustav Specht (1860-1940) and the later Nazi psychiatrist Hermann Paul Nitsche (1876-1948) from 1905 and 1910, respectively, on the topic of chronic mania. Our investigation concluded that in their case studies both authors described people who would today be diagnosed as suffering from adult ADHD as the clinical descriptions reveal core symptoms of this entity as defined by modern classifications. They also mentioned currently discussed research questions. Both authors expressed their dissatisfaction with the classificatory situation of these patients at the time. Specht even postulated a "completely independent mental illness" that he called "chronic mania", under which he classified all the patients suffering from today's adult ADHD. He also pointed out that this diagnosis was not widely recognized at the time by psychiatrists as a full-fledged form of illness but used more as a diagnosis to avoid the embarrassment of not having one. Nitsche saw the "chronic manic states" as he called them as a "clinical peculiarity" but assigned them to the large group of "manic depressive insanity", which could only be more finely differentiated in the future., (© 2021. The Author(s).)

Aim: This article aims to describe and discuss in detail the psychiatric medical history of the writer Elsa Asenijeff (1867-1941) in different mental institutions in the German state of Saxony., Research Questions: What can be discovered in preserved archive documents about the placement of Elsa Asenijeff in different mental institutions between 1923 and 1941? What is the historical context in which this individual medical history took place?, Material and Methods: Through systematic research in different archives a part of Elsa Asenijeffs medical records and relevant administrative files of the institutions could be found., Results: The preserved documents provide an insight into the statements of the physicians and the conditions of Elsa Asenijeffs placement in the institutions of that time., Conclusion: The findings of our research suggest that, at least since 1927, Elsa Asenijeff was kept in mental institutions primarly for being an unmarried, destitute and more or less isolated woman. In other words, her stay was justified with social and not psychiatric-medical arguments., (© 2021. Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Background: Traditional work stress research identified a large number of stressors; however, technology as a source of stress was not the focus of interest for long time., Objective: This article describes the concept of technostress and investigates the impact of digital technologies at work on mental health., Material and Methods: Narrative review. Conceptualization of technostress, potential mechanisms of action and summary of empirical results on the influence on mental health., Results: Several domains of technostress have been defined so far. Although empirical studies are rare and subject to methodological limitations, results suggest that certain types of technostress at work may have an adverse effect on mental health. Notably, digital technologies may also have a positive impact on the psychological well-being of employees if, for example, they enable better work organization., Conclusion: The digitalization of work is related to specific risks for the mental health of employees but also to possible benefits. Implications for further research in this developing field are identified., (© 2021. Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Digitalization trends are having an impact on mental healthcare. Online interventions can promote mental health and complement existing mental healthcare services. Effective online interventions have been developed for a variety of mental health disorders and, overall, patient and practitioner acceptance of such programs is high. The Digital Healthcare Act provides the legal framework for the use of healthcare apps in German routine care. After approval by the Federal Institute for Drugs and Medical Devices, the costs of certain healthcare apps are now covered by statutory health insurers. However, digital technologies have rarely been used in mental healthcare to date. Reasons include a low level of awareness of such programs as well as a large number of untested applications. Specified quality criteria can provide better orientation for patients and healthcare providers. Further implementation efforts are necessary in order to fully use the potential of digital support options in psychiatric and psychotherapeutic care for the benefit of patients., (© 2021. Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

The effects of mental diseases on the employment and working situation can be substantial. They are one of the main reasons for inability to work and reduced earning capacity. Against this background the question arises about suitable occupational reintegration measures for people with severe mental illnesses. In recent years, the principle of supported employment has been internationally shown to be increasingly more successful. In this context mentally ill people are primarily placed at a position of the first employment market and supported on-site by a job coach. This concept is inclusive, individual and evidence based. Despite proven effectiveness, it has so far been insufficiently implemented in German-speaking regions. In the future it will be a matter of considering the individual needs for assistance of mentally ill people more intensively than previously and to respond with functional and in a best-case scenario, multiprofessional and flexible offers., (© 2021. Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Background: Memory clinics (MC) are institutions specialized in the (differential) diagnostics, treatment, education, management and counseling of diseases related to dementia and their risk stages. In Germany, they have a variety of different organizational forms. Due to the growing diagnostic options in neurodegenerative diseases, the increasing demand for early detection and prediction as well as foreseeable new diagnostic procedures and disease-modifying treatment, it is important to standardize the structural prerequisites and areas of responsibility of MC., Objective: The article proposes structural and organizational requirements and procedures and a harmonized mode of operation for MC in Germany., Method: Expert consensus of psychiatrists, neurologists and geriatricians from academic and nonacademic institutions., Results: The MC should provide the specialist standards of psychiatry and/or neurology. They need to implement the recommendations of the national guidelines on dementia (S3LL) with respect to the (differential) diagnostics and treatment of dementia. With respect to the early detection and prediction of neurodegenerative disorders, they extend beyond the current German guideline standards. In MC, mild cognitive impairment (MCI) is understood as an at-risk or prodromal stage of diseases related to dementia and biomarkers are consistently applied for etiological (early and differential) diagnostics. There is a requirement for close interaction with specialized diagnostic disciplines. Furthermore, MC should also offer comprehensive advice on social and legal issues and provide caregiver support. They should integrate current knowledge from research into care and serve as regional expert centers., Conclusion: The MC should implement evidence-based standards in diagnostics and treatment and introduce innovations in the care of patients with cognitive disorders and at-risk and prodromal stages. Their role in the German healthcare system must be strengthened. Sufficient and sustained funding needs to be established, since current reimbursement does not cover costs.

Aim: The impacts of the introduction of antipsychotics on psychiatric care in a clinic were investigated for the first time, specifically in the Neurological and Psychiatric Clinic of the University of Leipzig from 1946 to 1965., Research Questions: When and which antipsychotics were first used, to what extent and how did this affect the use of traditional forms of therapy?, Material and Methods: According to psychopathological criteria, 306 cases were selected from the database of patient records from the hospital archive and systematically reviewed with respect to the research question., Results: The use of antipsychotics began in 1953 and subsequently with increasing frequency and duration. Traditional therapies and antipsychotics were frequently used in combination. In particular, the use of antipsychotics and electroconvulsive therapy represented the new basic therapy. A decrease in the length of hospitalization could not be demonstrated. From 1955, however, fewer transfers to the provincial hospitals were necessary and more patients could be discharged into domestic life as "improved". Beginning in 1961, for the first time a discharge medication was mentioned and evidence of outpatient therapies including electric shock therapies were recorded., Conclusion: Evidence of facilitation of mental rehabilitation through the use of antipsychotics cannot be directly confirmed; however, it appears that the administration beyond a time-limited treatment has contributed to this development and also to the establishment of outpatient facilities. Thus, both a watershed in the psychiatric treatment and a change for the patients themselves could be identified.

Background: Severe mental illnesses are often associated with substantial impairments of psychosocial functioning and a high risk of social exclusion. Along with somatic and psychotherapeutic treatment approaches, psychosocial interventions are an integral component of treatment. Psychosocial therapies aim to improve participation and enable patients to live self-determined lives as far as possible., Objective: This paper provides an overview of the structure and recommendations of the German S3 guidelines "Psychosocial therapies for severe mental illnesses" of the German Association for Psychiatry, Psychotherapy and Psychosomatics (DGPPN)., Material and Methods: In the DGPPN S3 guidelines psychosocial therapies are systematically described for the first time and recommendations are formulated on the basis of a systematic processing of scientific evidence and a formalized consensus process., Results: The evidence-based and consensus-based guidelines formulate a total of 33 recommendations and 12 statements. For many psychosocial interventions there is a broad evidence base. In the field of individual interventions psychoeducation, social skills training and health-promoting interventions have been given the highest recommendation strength (A). In the field of system level interventions, team-based, multiprofessional community psychiatric approaches, supported employment and self-determined housing with mobile support (supported housing) are given A level recommendations. For other interventions, the current evidence base is less robust., Conclusion: The successful implementation of guidelines depends not only on the quality but also on the dissemination. Therefore, in addition to the treatment guidelines a short version, a patient version and a waiting room version were developed.

Difficulties in falling asleep and maintaining sleep, nonrestorative sleep and decreased daytime wakefulness represent very common but relatively unspecific health complaints. Around 100 specific sleep-related disorders will be classified in their own major chap. 7 (sleep wake disorders) for the first time in the upcoming 11th version of the International Classification of Diseases (ICD 11). With respect to the disciplines of psychiatry and psychotherapy there is a bidirectional relationship between mental health and sleep wake disorders. Sleep wake disorders can be an independent risk factor for the onset of a mental disorder and have a negative influence on the course of the disease. In addition, sleep wake disorders can also precede a mental disease as an early symptom and therefore be an important indication for early recognition. Many sleep wake disorders can be diagnosed based on the anamnesis and routine clinical investigations. In special cases, examination in a specialized sleep laboratory and treatment in a sleep medicine center following a staged care approach can be mandatory. Polysomnography represents the gold standard for the differential diagnostics; however, there is no legal foundation in the field of neuropsychiatric disorders for remuneration in the German healthcare system. This review summarizes the current guidelines with respect to the criteria for an investigation in a sleep laboratory from the perspective of the disciplines of psychiatry and psychotherapy. From this the requirements for guideline-conform diagnostics and treatment are derived.

This study presents descriptions of symptoms specific to the adult form of attention-deficit/hyperactivity disorder (ADHD) in the 8th edition of the Textbook on Psychiatry by Emil Kraepelin (1856-1926). To identify whether ADHD is a new, fashionable phenomenon in adults or whether early psychiatrists also saw such patients and how they classified them, this textbook is an essential source. Published between 1905 and 1915, it can be perceived as the culmination and at the same time terminal point of Kraepelin's conceptual and nosological work, which in turn marked the beginning of present-day psychiatric classification. Kraepelin did not perceive ADHD as a psychiatric entity of its own, which is either due to the fact that he saw no necessity to do so or that he did not recognize this. If the latter, Kraepelin may have been misled by the manifold psychiatric comorbidities typical for ADHD, which may have masked ADHD. Kraepelin seems to have grouped patients obviously suffering from the adult form of ADHD into two groups: on the one hand into the so-called basic constitution (Grundzustand) of manic-depressive disorder, which he called manic disposition or constitutional excitement (manische Veranlagung oder konstitutionelle Erregung) and on the other hand into the so-called group of anchorless people (Haltlose), which he perceived as a special form of psychopathic personality. It seems that Kraepelin grouped milder grades of ADHD with predominantly ADHD-associated mood swings into the group of manic disposition while grouping more severe forms, which usually occur together with distinct personality disorders and addictive disorders, into that of anchorless people.

Background: To manage the growing numbers of people with dementia (PwD) preventive strategies are becoming more important. Therefore, the diagnostics of patients with mild cognitive impairment (PwMCI) are gaining in importance. Little is known about the current use of diagnostics tests among PwMCI in routine healthcare. The aim of the study was to examine the prevalence of diagnostic methods in newly diagnosed PwMCI over time in comparison to PwD., Methods: The study was based on the complete nationwide patient claims data of the panel doctor services according to §295 of the German social code book V (SGB V). The incidences of PwMCI and PwD in 2011 and 2016 were identified and the use of neuropsychiatric testing, neuroimaging with computed tomography (CT) and magnetic resonance imaging (MRI), laboratory and cerebrospinal fluid (CSF) examinations was ascertained., Results: In 2016 the prevalence of neuroimaging as well as of laboratory examinations was higher in PwMCI compared to PwD (29% vs. 21% and 92% vs. 88%, respectively). There were only small differences in neuropsychiatric testing (70% vs. 72%). The prevalence of CSF examinations was very low in both groups (less than 1%). Between 2011 and 2016 the prevalence of neuroimaging decreased from 36% to 29% among PwMCI, while it remained constant at around 22% for PwD. The rates of neuropsychiatric testing increased over time in both PwMCI (from 49% to 70%) and PwD (from 36% to 72%). The prevalence of laboratory examinations remained unchanged., Conclusion: The use of specific diagnostic methods was higher in PwMCI than in PwD. Referring to the recommendations of practice guidelines, the increase in neuropsychiatric testing is regarded as a pleasing development, whereas the decrease in neuroimaging rates and the very low prevalence of CSF examinations require improvement.

This article provides an analysis of the content of 15 letters and postcards written by the Leipzig neurologist Paul Julius Möbius to his Zurich-based colleague Auguste-Henri Forel between 1889 and 1902. Moreover, they are set in the context of the works of the two correspondence partners. The 15 documents preserved at the University of Zurich Medico-Historical Institute and Museum comprise one half of the correspondence, whereas the letters Forel sent in response do not seem to have been preserved. So far, biographic research has neglected the letters analyzed here. Hypnotism and medical suggestion as well as their effects and efficiency in treating and maybe healing certain nervous and mental disorders, primarily psychoneuroses but also certain somatic disorders, formed the bond that connected Möbius and Forel. The exchange was less concerned with discussing details or concepts of hypnosis. Möbius seemed to be more interested in studying the practical application with Forel. Moreover, Möbius and Forel shared the view that contemporary, largely brain-biologically oriented conventional psychiatry had largely neglected or at least underestimated the psychological component of both nervous and mental disorders. Both shared the notion that electrotherapy, widely used at the time, had a strong suggestive component. The letters revealed that both correspondents requested reviews or discussion of their own papers from each other. Forel invited Möbius to consider writing for his Zeitschrift für Hypnotismus (Journal for Hypnotism). The correspondence also revealed that their harmony in certain views did not prevent them from refusing requests made by the other. The letters discussed in this article enrich the knowledge on these two prominent neurologists of the late nineteenth and early twentieth centuries.

Paul Ferdinand Schilder was born in Vienna in 1886 and died in New York in 1940. He is nowadays remembered predominantly for his contributions to modern psychiatry and psychotherapy; however, he was also a neurologist and neuroscientist and in particular in his early years, he researched and published on neuropathological topics. This paper focuses on his scientific work during his years in Middle Germany (1909-1914), where he worked with Gabriel Anton in Halle and Paul Flechsig in Leipzig. During those years, he laid the foundations for his definition, clinical classification and differentiation of encephalitis periaxialis diffusa. Today, this inflammatory brain disease is known as Schilder's disease and is of some importance as a rare differential diagnosis of multiple sclerosis (MS), especially in children. Schilder's reflections and findings were based on his scrupulous and detailed analysis of only a few medical histories, which also comprised histological neuropathological examinations, as well as on his extensive and critical review of the relevant literature of the time. His aim was to differentiate encephalitis periaxialis diffusa from brain tumors, MS and Heubner's diffuse sclerosis. Schilder's scientific achievement, made in relatively young years, is still impressive even to the present day due do its thoroughness and accuracy as well as the enormous workload and ambition it required. Even though ambitious, Schilder was always prepared to critically review his own ideas.

The article highlights the important work of the Russian psychiatrist Victor Khrisanfovich Kandinsky. His merits, in particular those in the fields of hallucinations and schizophrenias, have hitherto been neglected despite the fact that several of his articles have been published in German medical journals. He defined the term pseudohallucination in a way which is still common today. For him the criterion which separates it from real hallucinations was that the patient is aware of the fallacy of the phenomena perceived. Furthermore, his concept of ideophrenia can be regarded as a one of the precursors to today's concept of schizophrenias.

For the first time, this study presents publications representative for the work of the neurologist and sports physician Bernhard Schwarz, whose career spans from the 1950s to the 1970s. His work is characterized by exceptional originality. Schwarz acted as the physician of the GDR national boxing team and conducted a systematic long-term study of 800 boxers. He found increased occurrences of depression, Alzheimer's and Parkinson's diseases and suggested that these were linked to recurring craniocerebral injury. He was concerned about avoiding such long-term health effects in boxers and suggested a range of preventive measures that were later reflected in the guidelines of international boxing associations. Schwarz was distinguished by his drive to directly implement social psychiatric approaches in the hospital. As head of the psychiatric clinic at Leipzig University, he initiated a club for geriatric patients to help older patients with the problematic transition from hospitalization to outpatient assistance at home. Influenced by holistic anthropological thinking, he regarded geriatric mental illness as a consequence of social isolation. In addition, Schwarz was involved in a model project that assessed the work resilience of patients in the hospital with the goal of optimizing psychiatric rehabilitation. Both projects were successes, according to his published accounts.

Background: Internet-based self-management interventions are effective in the prevention and treatment of mental disorders; however, for those affected as well as treating clinicians and decision makers in the healthcare sector, it is difficult to identify safe and effective interventions., Aim: Development of quality criteria for self-management interventions., Methods: Based on a non-specific assessment matrix, a task force from two scientific societies formulated specific quality criteria for self-management interventions for mental disorders. Patients and other relevant stakeholders were involved in the process., Results: A total of 8 key criteria with 17 subordinate points were developed. These must be met for the certification of an intervention. The criteria focus on therapeutic quality requirements, patient safety, data protection and security as well as proof of efficacy in at least one randomized study. A further five criteria are only descriptive and are not required for certification., Discussion: These quality criteria serve as a starting point for the establishment of a certification process. This could help to make internet-based self-management interventions for mental disorders part of routine care in the German healthcare system.

For most people living with mental illnesses, participating in society is of existential importance; however, psychosocial care often fails to recognize its significance and therefore rarely includes the patient's interaction with society in the course of treatment. The reasons for this are both substantial and organizational in nature. The endless opportunities for participating in society, current areas as well as ways of taking part in social life even beyond the terms of the social legislative definition are, in addition to institutional variety and regional differences, all too often barriers to providing the very urgently needed support. Further aspects are insufficient knowledge of therapists about established options of rehabilitative treatment and about responsibilities related to participation in specialized training and further education for professional caregivers. The presented compass of participation for social integration of persons with mental illnesses starts at this point: it provides guidelines for psychiatric and psychotherapeutic practitioners, general practitioners as well as for physicians working in residential or day care institutions with a psychiatric and psychotherapeutic background. Both this article and planned online versions should help professionals to timely and successfully assist people, particularly those with severe mental illnesses, to navigate the broad spectrum of services for social and vocational integration in Germany.

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.

Background: This chronology gives an overview about continuities and changes in the perception of suicidality in German-speaking school psychiatry over the past 200+ years., Questions: This study was guided by the following questions: has suicidality been perceived as regularly being connected to certain mental illnesses? Which other possible causes have been discussed by psychiatrists from the nineteenth century to the beginning of the twenty-first century? What approaches have major psychiatrists adopted towards suicidal patients and threatened suicide? What treatment and preventive strategies have been suggested?, Methodology: First, we compiled a list of the, in our view, most influential textbooks on psychiatry of German-speaking school psychiatry from 1803 until the present. These textbooks were then skim-read for relevant passages on suicidality. The material gained was elicited, classified and analyzed in relation to the questions at hand. Futhermore, an attempt was made to arrive at contextual estimations., Results: Several authors named a certain set of psychiatric illnesses that are assumed to involve or increase the risk of suicide. These illnesses include depression, schizophrenia and also physical illnesses. In nineteenth century textbooks heredity, anatomical anomalies and nationality were discussed as potential influencing factors. In contrast, more recent books discuss models of how suicidal behavior emerges and often refer to the Werther effect. With respect to therapy there is a trend towards therapeutic discussions and modern psychopharmacotherapy., Discussion: Over time, there have been continuities and changes in psychiatrists' approach to suicidality not only as far as clinical aspects are concerned but also the general approach to and management of suicidal patients.

Background: Dementia is a major challenge for society and its impact will grow in the future. Informal care is an essential part of dementia care. Previous studies considered informal care as a whole and not by its components., Objective: We aimed to assess the degree of association between specific informal care services and dementia., Material and Methods: This analysis is based on data from the seventh wave of the AgeCoDe/AgeQualiDe study. Dementia was diagnosed based on the DSM-IV criteria. Severity of dementia was assessed and categorized by means of the Clinical Dementia Rating and eight individual informal care services were considered. Logistic regression models were used to assess associations., Results: Of the 864 participants 18% suffered from dementia (very mild: 4%; mild: 6%; moderate: 5%; severe: 3%). All informal care services were significantly associated with dementia, with an emphasis on "supervision", "regulation of financial matters" and "assistance in the intake of medication". Considering different degrees of dementia severity, similar results arose from the analyses. All three aforementioned services showed a pronounced association with all degrees of dementia severity, except for supervision and very mild dementia., Conclusion: The provision of all types of informal care services is associated with dementia. The association is pronounced for services that can be more easily integrated into the daily routines of the informal caregiver. Policy makers who plan to integrate informal care into the general care arrangements for dementia should consider this.

Background: In Germany, informal caregiving becomes an increasingly important issue especially for people with dementia. Spouses often provide nursing care due to the limited daily living skills of people with dementia. This leads to a wide range of caregiver burden and decreased quality of life (QoL). Analyses on the relation between QoL and caregiver burden of older informal caregivers in Germany are rare., Objective: The following research questions were assessed: (1) Does caregivers' QoL differ from that of the older general population?; (2) Which sociodemographic, health- and care-related characteristics affect caregivers' QoL?, Material and Methods: For this study, two samples (aged 60 years and older) were recruited: informal caregivers (n = 119) and a representative sample of older non-caregivers in the general population (n = 1133). Linear regression analyses were applied to examine the effects of sociodemographic, health and care-related variables on the QoL of older informal caregivers of people with dementia., Results: Older informal caregivers reported a significantly lower QoL compared to older non-caregivers in the general population. Especially the domains autonomy, activities in the past, the present and the future as well as intimacy were negatively associated with caregivers' QoL., Conclusion: The results of the study highlighted caregivers' need for assistance. Due to demographic changes, tailored support services should be based on older caregivers' needs.

Dietfried Müller-Hegemann was one of the prominent figures in East German psychiatry and psychotherapy of the 1950s and 1960s. Having been a communist prior to 1933, a resistance fighter during the National Socialist regime and having gone through political training during his exile in Soviet Russia, he proved to be a committed member of the new ruling SED socialist party in Eastern Germany. As such both governmental and party organs regarded him as a promising and reliable party member to be supported and implemented as executive staff within the new, socialist scientific system. Also, due to the fact that he supported the Pavlovian school of thought for modern psychiatry, Müller-Hegemann was installed as the new head of the Department of Neurology and Psychiatry at Leipzig University by the state secretary for higher education, notably against the clear opposition of the university medical faculty. Soon thereafter however Müller-Hegemann fell from favor due to the fact that he supported views that did not follow the strict ideological guidelines, e. g. with regard to the emergence of fascism. Moreover, he strongly opposed the separation of neurology from psychiatry as ruled by the ministry. An attempt in 1963 by junior party members and ministerial staff to remove him from office failed, but still managed to make Müller-Hegemann resign from his Leipzig post and take over that of director of the Griesinger hospital for the mentally ill in East Berlin. In May 1971, after new conflicts with party officials, he did not return from a business trip to Essen in West Germany. This study does not review the scientific and medical merits of Müller-Hegemann, but concentrates on how his career as a leading psychiatrist was manipulated, both supported and sabotaged, and ideologically controlled by the German Democratic Republic (GDR) system. His development is documented proof that party officials did not tolerate opposition, neither in ideological nor in professional questions, even if the opponent was a committed Marxist. The example of his career shows that political and ideological dissent soon melted into personal animosity and drives, as a result of which Müller-Hegemann's promising career as professor in Leipzig was terminated.

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.

Background: To this day the definite diagnosis of Alzheimer's disease still relies on post-mortem histopathological detection of neurofibrillary tangles and beta-amyloid deposits. Amyloid positron emission tomography (PET) is a new diagnostic tool that enables the in vivo quantification of pathological beta-amyloid deposits. The aim of the current study was to evaluate to what extent 18 F-florbetaben-PET (FBB-PET) influences the diagnosis of patients with dementia., Material and Methods: Imaging with FBB-PET was performed on 33 patients from our outpatient department for cognitive neurology. Beforehand all patients underwent a comprehensive clinical, neuropsychiatric and laboratory examination as well as imaging by means of magnetic resonance imaging (MRI) and fluorodeoxyglucose-PET. The working diagnoses before and after FBB-PET imaging were compared., Results: 17 out of 33 patients were scored as FBB-PET positive. In four cases the initial diagnosis had to be changed to Alzheimer's disease (three cases) and cerebral amyloid angiopathy (one case) due to the positive FBB-PET scan. 16 patients showed a negative FBB-PET scan. In three patients the initial diagnosis of Alzheimer's disease could be ruled out due to the negative FBB-PET scan. Overall, in 7 out of 33 examined patients the initial diagnosis had to be changed because of the findings of the FBB-PET scan. In 24 patients the initial diagnosis was confirmed by the results of the FBB-PET scan., Conclusion: Amyloid-PET is currently no standard procedure in the diagnosis of dementia; however, it can be a helpful additional diagnostic tool when used according to the "Appropriate Use Criteria" and the S3 guidelines on dementia in cases of unclear clinical presentation, atypically early age of onset as well as in patients with persistent or progressive unexplained mild cognitive impairment. By facilitating early diagnosis amyloid-PET imaging allows patient selection for therapeutic drug trials.

Background: Current international projections suggest that reducing the prevalence of seven well-established risk factors, midlife hypertension and obesity, diabetes mellitus, depression, physical inactivity, smoking and low educational attainment, may also substantially reduce the prevalence of Alzheimer's dementia (AD)., Objective: Following the procedures of the international projections, in this study we aimed to provide projections of a corresponding potential for prevention specific for Germany., Methods: For each risk factor separately and combined (with adjustment for the association between the risk factors) we calculated (1) the population attributable risk (PAR) for AD, (2) the corresponding total number of attributable AD cases and (3) the potential number of current AD cases that may have been prevented by a 10 %, 25 % and 50 % lower prevalence of the risk factors., Results: According to the population projections 30.5 % of the current AD cases in Germany could be attributable to the risk factors considered (305,000 AD cases in total). The highest estimated impact on AD prevalence was found for physical inactivity (PAR = 21.7 %, 217,000 attributable cases) and smoking (PAR = 14.9 %, 149,000 cases). A 10-50 % reduction in the prevalence of all seven risk factors could have potentially prevented 23,000-130,000 of the current AD cases in Germany., Conclusion: The identified possible substantial potential for reducing AD prevalence should act as a strong additional incentive to reduce the seven risk factors in Germany.

Working and living for persons with mental illnesses are a major concern of rehabilitative psychiatry. In Germany the definition of rehabilitation for persons with mental illnesses is closely linked to different sectors of social welfare and to the strongly organized supply chain of prevention, acute treatment, rehabilitation and care. In successfully supporting people with mental health problems in terms of vocational integration, professionals face various obstacles. Besides finding the correct content, structural and organizational difficulties can also arise. The welfare system with its specific institutions and settings is complicated which often leads to delays in the onset of rehabilitation. Some essential reasons are insufficient knowledge about established options of rehabilitative treatment and about responsibilities related to participation in specialized training and further education for professional caregivers. Also information and (positive) experiences from pilot projects working in an inclusive, cross-sectional way and across different settings are practically unavailable in Germany. The presented compass of participation from the German Association for Psychiatry, Psychotherapy and Psychosomatics (DGPPN) for vocational integration of persons with mental illnesses starts at this point: it provides guidelines for psychiatric and psychotherapeutic practitioners, general practitioners as well as for physicians working in residential or day care institutions with a psychiatric and psychotherapeutic background. Both the paper and planned online versions should help professionals to help people, particularly those with severe mental illnesses to navigate the system of services for vocational integration in Germany.

Background: Mental disorders are frequently not or only insufficiently treated. Internet-based interventions offer the potential of closing the existing gaps in the treatment of mental disorders; however, it is very difficult for patients and providers to choose from the numerous interventions available., Objective: The aim of this study was to develop a set of quality criteria that can help patients and care providers to identify recommendable internet-based interventions., Methods: A selective literature search was carried out and the existing evidence on internet-based interventions in the treatment of mental disorders was collated. A panel of experts then developed quality criteria based on existing models for the systematic assessment of telemedicine applications., Results: Internet-based interventions are effective in the treatment of a broad range of mental disorders. The best evidence is available for depression and anxiety disorders. A set of criteria is proposed for the evaluation of available internet-based interventions using a checklist. These criteria have to be developed further with input from other stakeholders., Discussion: When taking these quality criteria into account, evidence-based interventions available on the internet can make an important contribution to improvement of the care of patients with mental disorders.

Background: Dementia impairs the coping with routine daily tasks and social relationships due to an increasing degeneration of cognitive abilities. An appropriate treatment must adequately consider the effects of declined cognitive abilities on patients and their environment. Therefore, in recent times, integrative procedures for cognitive rehabilitation (CR) have become increasingly important for the therapy of patients with mild cognitive impairment (MCI) and mild dementia (MD). CR approaches provide compensatory possibilities for clearly defined routine challenges and the individual needs of those affected., Material and Methods: This overview article in the form of a selective review elaborates factors for the effectiveness of CR on the basis of the currently available literature: 1) individuality - consideration of personal needs and targets, 2) compensation - mediation of skills and strategies to compensate for cognitive impairments, 3) interaction - inclusion of relatives and environmental conditions and 4) integration - integration of various therapeutic disciplines and methods., Results and Discussion: On the basis of this assessment with regards to the content, a critical analysis of the methods of short and long-term therapeutic effects on MCD and MD was carried out. Although the resulting factors were of high long-term relevance for the improvement of depression and quality of life, effects on cognition were more pronounced for MCI than for MD, which emphasizes the importance of beginning therapy as early as possible. The results show that future studies on effectiveness must employ endpoints relevant for routine daily life, and that the possibility of an implementation of therapeutic concepts in a healthcare system should be considered as an essential criterion.

While Emil Kraepelin's comprehensive psychiatric oeuvre has attracted researchers' attention, his studies on sleep disorders and their treatment as well as on the interconnections between sleep and mental disorders so far seem to have been neglected.This article identifies and analyzes Kraepelin's sporadic contributions on the pathology of sleep, the comorbidities and treatment made between 1883 and 1924 in textbooks and isolated papers as well as in a presentation that was also published and compares them with current opinions in sleep research.Kraepelin never published a dedicated work on sleep, apart from a summary of the different narcotics; however, his occasional statements reveal astonishing insights and in particular his clear etiologically oriented classification of sleep disorders is captivating. Similar to the current classification, Kraepelin conceptualized sleep disorders as symptoms or rather a complex of symptoms and also identified associated diseases which once again are very near to current opinion. Apart from this his recommendations on sleep hygiene and, in a second step, pharmacological treatment of pathological sleep patterns are still clinically relevant. As early as the end of the nineteenth century Kraepelin laid down an algorithm of treatment which is very similar to the current clinical guidelines. At Kraepelin's time it seemed impossible to reach an agreement on classification and treatment issues of sleep disturbances and even though there has been an ongoing discussion until the present day, an agreement at least about guidelines could be reached. Against this background Kraepelin's contributions can still be regarded as a proposal for best practice.

Background: The "Psychiatrie-Enquete" (German Report on the State of Psychiatry) is 40 years old this year. It has always been inspirational; also internationally., Objective: Which innovative elements of community mental health services can be found in an international perspective?, Materials and Methods: Narrative review., Results: Community mental health care is a lively field with much research and innovative practice. With assertive community treatment (ACT) and home treatment (HT), internationally well-evaluated forms of community mental health care are available., Conclusion: Recovery-based and peer-to-peer approaches hold promise for the future. In terms of mid- and long-term perspectives, an increase in patient-centering via individualization of mental health care and a better implementation of community mental health interventions would be desirable in Germany.

In German-speaking countries it was Carl Westphal who in 1877 offered the first precise definition of obsessive ideas and distinguished obsessive compulsive disorder (OCD) as an independent disorder in its own right. The criteria mentioned by him for establishing OCD gave rise to a debate on the character and classification of OCD but were not fully acknowledged by his colleagues at the time. In 1895 Westphal's student Robert Thomsen tried to substantiate all points in his teacher's theory that had raised criticism. Thus the works by Westphal and Thomsen are most relevant for the current conceptualization and definition of OCD, for they laid the basis for the present phenomenology, definition and classification of OCD according to ICD-10 and DSM-5. Apart from phenomenologically differentiating between obsessions (i.e. obsessive thoughts and impulses) and compulsions (i.e. compulsive actions and inhibitions), Westphal and Thomsen also laid the basis for most of the current diagnostic criteria. Thomsen led the way to current classifications by subdifferentiating OCD as an illness on its own on the one hand and obsessions and compulsions as symptoms accompanying other conditions on the other.

Background: There is increasing consideration of a family-focused perspective of the psychosocial consequences of cancer., Objectives: This study examined the psychosocial situation of children and adolescents (11 to 17 years old) of cancer patients assessing their psychological distress and coping over time., Methods: A total of 110 children and adolescents were assessed post-treatment of parents with cancer (t1), 6 (t2) and 12 months (t3) after t1. Participants completed validated questionnaires assessing coping (KidCope) and depressive symptoms (CES). These data were compared with a matched sample from the general population., Results: The children reported using a combination of coping measures. In particular, active coping was perceived as being helpful. In terms of coping, there were only small gender differences and 6 months after completion of treatment of the parents (t2), depressive symptoms of the children were still elevated. Depression diminished over time and was near the level of the comparison group at t3., Conclusion: Children and adolescents are particularly psychologically distressed after cancer treatment of parents. This distress was connected with not helpful coping strategies. The extended adjustment of children/adolescents of cancer patients has to be considered in the clinical and psychosocial care of the families.