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12. The polysemous concepts of psychomotricity and catatonia: A European multi-consensus perspective

Author

Foucher, J.R., Foucher, J.R., Jeanjean, L.C., de Billy, C.C., Pfuhlmann, B., Clauss, J.M.E., Obrecht, A., Mainberger, O., Vernet, R., Arcay, H., Schorr, B., Weibel, S., Walther, S., van Harten, P.N., Waddington, J.L., Cuesta, M.J., Peralta, V., Dupin, L., Sambataro, F., Morrens, M., Kubera, K.M., Pieters, L.E., Stegmayer, K., Strik, W., Wolf, R.C., Jabs, B.E., Ams, M., Garcia, C., Hanke, M., Elowe, J., Bartsch, A., Berna, F., Hirjak, D., Foucher, J.R., Foucher, J.R., Jeanjean, L.C., de Billy, C.C., Pfuhlmann, B., Clauss, J.M.E., Obrecht, A., Mainberger, O., Vernet, R., Arcay, H., Schorr, B., Weibel, S., Walther, S., van Harten, P.N., Waddington, J.L., Cuesta, M.J., Peralta, V., Dupin, L., Sambataro, F., Morrens, M., Kubera, K.M., Pieters, L.E., Stegmayer, K., Strik, W., Wolf, R.C., Jabs, B.E., Ams, M., Garcia, C., Hanke, M., Elowe, J., Bartsch, A., Berna, F., and Hirjak, D.

Abstract

Current classification systems use the terms "catatonia" and "psychomotor phenomena" as mere a-theoretical descriptors, forgetting about their theoretical embedment. This was the source of misunderstandings among clinicians and researchers of the European collaboration on movement and sensorimotor/psychomotor functioning in schizophrenia and other psychoses or ECSP. Here, we review the different perspectives, their historical roots and highlight discrepancies.In 1844, Wilhelm Griesinger coined the term "psychic-motor" to name the physiological process accounting for volition. While deriving from this idea, the term "psychomotor" actually refers to systems that receive miscellaneous intrapsychic inputs, convert them into coherent behavioral outputs send to the motor systems. More recently, the sensorimotor approach has drawn on neuroscience to redefine the motor signs and symptoms observed in psychoses.In 1874, Karl Kahlbaum conceived catatonia as a brain disease emphasizing its somatic - particularly motor - features. In conceptualizing dementia praecox Emil Kraepelin rephrased catatonic phenomena in purely mental terms, putting aside motor signs which could not be explained in this way. Conversely, the Wernicke-Kleist-Leonhard school pursued Kahlbaum's neuropsychiatric approach and described many new psychomotor signs, e.g. parakinesias, Gegenhalten. They distinguished 8 psychomotor phenotypes of which only 7 are catatonias. These barely overlap with consensus classifications, raising the risk of misunderstanding.Although coming from different traditions, the authors agreed that their differences could be a source of mutual enrichment, but that an important effort of conceptual clarification remained to be made. This narrative review is a first step in this direction. (C) 2021 Published by Elsevier B.V.

Published
2022

20. Innovative digitale Versorgungsformen zur Personalisierung der stationsäquivalenten Behandlung in der alltäglichen Lebenswelt bei schweren psychischen Erkrankungen [Innovative digital forms of service delivery for personalized crisis resolution and home treatment for people with severe mental health problems]

Author

Ganslandt T, Meyer-Lindenberg A, Schick A, Reininghaus U, Hirjak D, and Rauschenberg C

Subjects
Nursing, Service delivery framework, Home treatment, Psychology, Mental health
Abstract

Die stationsäquivalente psychiatrische Behandlung (StäB) wurde 2018 als neue Krankenhausleistung für Menschen eingeführt, die die Indikation für eine stationäre Behandlung erfüllen. Die rasanten Fortschritte im Bereich der Informations- und Kommunikationstechnologie bieten völlig neue Chancen für innovative digitale Versorgungsangebote wie telemedizinische, eHealth oder mHealth Verfahren. Ziel dieser Arbeit ist es einen umfassenden Überblick über neue digitale Versorgungsformen zu geben, die zur Personalisierung der StäB in der alltäglichen Lebenswelt bei schweren psychischen Erkrankungen beitragen und somit klinische und soziale Outcomes verbessern sowie direkte und indirekte Kosten reduzieren könnten. Es lassen sich vier primäre digitale Versorgungsformen identifizieren, die in diesem Sinne in der StäB gewinnbringend genutzt werden könnten: (1) Kommunikation, Behandlungskontinuität und -flexibilität durch Online-Chat und Videotelefonie; (2) Monitoring von Symptomen und Verhaltensweisen in Echtzeit durch Anwendung des ambulatorischen Assessments (Engl. Ecological Momentary Assessments (EMA)); (3) Nutzung von multimodalen EMA-Daten für die Generierung und Darbietung von personalisiertem Feedback über subjektives Erleben und Verhaltensmuster sowie (4) auf Person, Moment und Kontext zugeschnittene, adaptive ambulatorische Interventionen (Engl. Ecological Momentary Interventions (EMIs)). Neue digitale Versorgungsformen haben erhebliches Potential die Effektivität und Kosteneffektivität der aufsuchenden fachpsychiatrischen und psychotherapeutischen Behandlung zu steigern. Ein wichtiger nächster Schritt besteht nun darin, die Anwendung dieser Versorgungsformen im Bereich der StäB zu modellieren und deren Qualität aus Patientensicht, Sicherheit, und initiale Prozess- und Ergebnisqualität sowie Implementierungsbedingungen sorgfältig zu untersuchen. Abstract:Ward-equivalent treatment (StäB), a form of crisis resolution and home treatment in Germany, has been introduced in 2018 as a new model of mental health service delivery for people with an indication for inpatient care. The rapid progress in the field of information and communication technology offers entirely new opportunities for innovative digital mental health care such as telemedicine, eHealth, or mHealth interventions. This paper aims to provide a comprehensive overview of novel digital forms of service delivery in the daily lives of help-seeking individuals for personalized delivery of StäB that may contribute to improving clinical and social outcomes as well as reducing direct and indirect costs. Four primary digital forms of service delivery have been identified that can be used for personalized delivery of StäB: (1) communication, continuity of care, and flexibility through online chat and video call; (2) monitoring of symptoms and behaviour in real-time through ecological momentary assessment (EMA); (3) use of multimodal EMA data to generate and offer personalized feedback on subjective experience and behavioural patterns as well as (4) adaptive ecological momentary interventions (EMIs) tailored to the person, moment, and context in daily life. New digital forms of service delivery have considerable potential to increase the effectiveness and cost-effectiveness of crisis resolution, home treatment, and assertive outreach. An important next step is to model and initially evaluate these novel digital forms of service delivery in the context of StäB and carefully investigate their quality from the user perspective, safety, feasibility, initial process and outcome quality as well as barriers and facilitators of implementation.

Published
2020

24. Multimodal prevention of first psychotic episode through N-acetyl-l-cysteine and integrated preventive psychological intervention in individuals clinically at high risk for psychosis: Protocol of a randomized, placebo-controlled, parallel-group trial

Author

Schmidt, Stefanie J., Hurlemann, Rene, Schultz, Johannes, Wasserthal, Sven, Kloss, Christian, Maier, Wolfgang, Meyer-Lindenberg, Andreas, Hellmich, Martin, Muthesius-Digon, Ana, Pantel, Tanja, Wiesner, Pia-Sophie, Klosterkoetter, Joachim, Ruhrmann, Stephan, Bechdolf, A., Brockhaus-Dumke, A., Hirjak, D., Fallgatter, A., Frieling, H., Janssen, B., Jessen, F., Kambeitz, J., Koutsouleris, N., Leopold, K., Schaefer, C., Schultze-Lutter, F., Striepens, N., Vernaleken, I, Walter, H., Wildgruber, D., Schmidt, Stefanie J., Hurlemann, Rene, Schultz, Johannes, Wasserthal, Sven, Kloss, Christian, Maier, Wolfgang, Meyer-Lindenberg, Andreas, Hellmich, Martin, Muthesius-Digon, Ana, Pantel, Tanja, Wiesner, Pia-Sophie, Klosterkoetter, Joachim, Ruhrmann, Stephan, Bechdolf, A., Brockhaus-Dumke, A., Hirjak, D., Fallgatter, A., Frieling, H., Janssen, B., Jessen, F., Kambeitz, J., Koutsouleris, N., Leopold, K., Schaefer, C., Schultze-Lutter, F., Striepens, N., Vernaleken, I, Walter, H., and Wildgruber, D.

Abstract

Aim Meta-analyses indicate positive effects of both antipsychotic and cognitive-behavioural interventions in subjects clinically at high risk (CHR) for psychosis in terms of a delay or prevention of psychotic disorders. However, these effects have been limited regarding social functioning and the relative efficacy of both types of interventions remains unclear. Furthermore, neuroprotective substances seem to be a promising alternative agent in psychosis-prevention as they are associated with few and weak side-effects. Methods In this multi-centre randomized controlled trial (RCT), we investigate the effects of two interventions on transition to psychosis and social functioning: (a) an integrated preventive psychological intervention (IPPI) including stress-/symptom-management and social-cognitive remediation; (b) N-acetyl-l-cysteine (NAC) as a pharmacological intervention with glutamatergic, neuroprotective and anti-inflammatory capabilities. Results This is a double-blind, placebo-controlled RCT with regard to NAC and a single-blind RCT with regard to IPPI using a 2 x 2-factorial design to investigate the individual and combined preventive effects of both interventions. To this aim, a total of 200 CHR subjects will be randomized stratified by site to one of four conditions: (a) IPPI and NAC; (b) IPPI and Placebo; (c) NAC and psychological stress management; (d) Placebo and psychological stress management. Interventions are delivered over 26 weeks with a follow-up period of 12 months. Conclusion This paper reports on the rationale and protocol of an indicated prevention trial to detect the most effective and tolerable interventions with regard to transition to psychosis as well as improvements in social functioning, and to evaluate the synergistic effects of these interventions.

Published
2019

25. Multimodal prevention of first psychotic episode through N-acetyl-l-cysteine and integrated preventive psychological intervention in individuals clinically at high risk for psychosis: Protocol of a randomized, placebo-controlled, parallel-group trial

Author

Schmidt, Stefanie J, Hurlemann, René, Wiesner, Pia-Sophie, Klosterkötter, Joachim, Ruhrmann, Stephan, Group, ESPRIT-B1, Bechdolf, A., Brockhaus-Dumke, A., Hirjak, D., Fallgatter, A., Frieling, H., Janssen, B., Schultz, Johannes, Jessen, F., Kambeitz, J., Koutsouleris, N., Leopold, K., Schäfer, C., Schultze-Lutter, F., Striepens, N., Vernaleken, I., Walter, H., Wildgruber, D., Wasserthal, Sven, Kloss, Christian, Maier, Wolfgang, Meyer-Lindenberg, Andreas, Hellmich, Martin, Muthesius-Digón, Ana, and Pantel, Tanja

Subjects
Adult, Male, medicine.medical_specialty, Psychosis, Adolescent, medicine.medical_treatment, psychology [Psychotic Disorders], Psychological intervention, methods [Randomized Controlled Trials as Topic], prevention & control [Psychotic Disorders], Placebo, law.invention, Young Adult, Randomized controlled trial, Double-Blind Method, complications [Stress, Psychological], law, Social cognition, Internal medicine, Intervention (counseling), therapy [Psychotic Disorders], medicine, Humans, Multicenter Studies as Topic, Single-Blind Method, ddc:610, Antipsychotic, Biological Psychiatry, methods [Combined Modality Therapy], Randomized Controlled Trials as Topic, Cognitive Behavioral Therapy, therapeutic use [Acetylcysteine], business.industry, therapy [Stress, Psychological], drug therapy [Stress, Psychological], medicine.disease, Combined Modality Therapy, drug therapy [Psychotic Disorders], Acetylcysteine, Psychiatry and Mental health, Psychotic Disorders, therapeutic use [Antipsychotic Agents], Cognitive remediation therapy, Female, Pshychiatric Mental Health, business, Stress, Psychological, Antipsychotic Agents
Abstract

AIM Meta-analyses indicate positive effects of both antipsychotic and cognitive-behavioural interventions in subjects clinically at high risk (CHR) for psychosis in terms of a delay or prevention of psychotic disorders. However, these effects have been limited regarding social functioning and the relative efficacy of both types of interventions remains unclear. Furthermore, neuroprotective substances seem to be a promising alternative agent in psychosis-prevention as they are associated with few and weak side-effects. METHODS In this multi-centre randomized controlled trial (RCT), we investigate the effects of two interventions on transition to psychosis and social functioning: (a) an integrated preventive psychological intervention (IPPI) including stress-/symptom-management and social-cognitive remediation; (b) N-acetyl-l-cysteine (NAC) as a pharmacological intervention with glutamatergic, neuroprotective and anti-inflammatory capabilities. RESULTS This is a double-blind, placebo-controlled RCT with regard to NAC and a single-blind RCT with regard to IPPI using a 2 × 2-factorial design to investigate the individual and combined preventive effects of both interventions. To this aim, a total of 200 CHR subjects will be randomized stratified by site to one of four conditions: (a) IPPI and NAC; (b) IPPI and Placebo; (c) NAC and psychological stress management; (d) Placebo and psychological stress management. Interventions are delivered over 26 weeks with a follow-up period of 12 months. CONCLUSION This paper reports on the rationale and protocol of an indicated prevention trial to detect the most effective and tolerable interventions with regard to transition to psychosis as well as improvements in social functioning, and to evaluate the synergistic effects of these interventions.

Published
2018

44. Genuine motorische Phänomene bei schizophrenen Psychosen.

Author

Hirjak, D., Northoff, G., Thomann, P. A., Kubera, K. M., and Wolf, R. C.

Abstract

Besides positive and negative symptoms, motor abnormalities have been increasingly recognized as central symptoms of schizophrenia. Recent investigations of antipsychotic-naive first-episode patients with schizophrenia found significantly higher rates of genuine motor abnormalities (GMA) when compared to healthy individuals. The first part of this article introduces the historical and clinical background of GMA in schizophrenia. In the second part the relevance of scientific research and clinical implication of GMA in schizophrenia are discussed. Finally, this article aims at presenting a conceptual framework and a reference system involving both genuine and drug-induced motor abnormalities. The future clinical implications of GMA research are presented and multimodal and transdiagnostic studies are advocated. Future research on GMA will not only essentially enrich the formation of psychiatric theories but also promote progress in clinical neuroscience. [ABSTRACT FROM AUTHOR]

Published
2018
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