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Introduction: Current scientific developments seem to allow for an “olfactory implant” in analogy to cochlear implants. However, the position and surgical approaches for electrical stimulation of the olfactory system are unclear. Methods: In a human anatomic cadaver study, we investigated different endoscopic approaches to electrically stimulate the olfactory bulb (OB) based on the following considerations: (1) the stimulating electrode should be close to the OB. (2) The surgical procedure should be as non-invasive and safe as possible and (3) as easy as possible for an experienced ENT surgeon. Results: In summary, the endoscopic intracranial positioning of the electrode via a widened ostium of the fila olfactoria or a frontal sinus surgery like a Draf IIb procedure is a good option in terms of patients’ risk, degree of difficulty for ENT surgeons, and position to the OB. Endoscopic intranasal positioning appeared to be the best option in terms of patient risk and the degree of difficulty for ENT surgeons. Although a bigger approach to the OB using a drill and the combined intranasal endoscopic and external approach enabled a close placement of the electrode to the OB, they do not seem relevant in practice due to their higher invasiveness. Conclusion: The study suggested that an intranasal positioning of a stimulating electrode is possible, with placements beneath the cribriform plate, extra- or intracranially, applying elegant surgical techniques with low or medium risk to the patient and a close placement to OB.

Purpose This study aimed to evaluate the course of olfactory dysfunction [OD] due to upper respiratory tract infections [URTI] especially for COVID-19 [C19] in a multicentric design and to investigate possible predictors for the outcome. Methods In a multicentric study, patients (n = 147, of which 96 were women) with OD due to URTI, including C19 and non-C19 were evaluated at two visits with a standardized medical history and “Sniffin’ Sticks” extended psychophysical testing to examine the course and possible predictors for improvement of olfactory function. Results C19 patients showed better overall olfactory function (p p p = 0.20) except for a more pronounced improvement of odour threshold (p = 0.03) in C19. C19 patients with parosmia exhibited a higher probability of clinically relevant improvement of odour threshold, a better threshold in the second visit, and tended to have a better TDI-score at the second visit. Further possible predictors for an improving olfactory function were younger age, female gender, and had lower scores in olfactory tests at the first visit. Conclusions Patients with C19 and non-C19 URTI exhibit a similar improvement over 3–4 months except for the odour threshold, with a better TDI in both visits for C19. For C19 a better prognosis in terms of olfactory recovery was found for younger patients with parosmia and lower olfactory scores at the first visit. Still, for many patients with olfactory loss, an improvement that is experienced as complete may only occur over months and possibly years.

ZUSAMMENFASSUNGNachdem im Jahr 2015 das Gesetz zur Strafbarkeit der Geschäftsmäßigen Förderung der Selbsttötung vom Bundestag verabschiedet und im Jahr 2020 vom Bundesverfassungsgericht als verfassungswidrig und nichtig erklärt wurde, ist die Debatte zur Neuregelung der Beihilfe zum Suizid in Deutschland weiterhin offen. Der Artikel präsentiert aus der interdisziplinären Position einer Juristin, einer Psychotherapeutin und eines Psychiaters, und mit Fokus auf die Situation von Menschen mit psychischen Erkrankungen und in Krisen, Überlegungen zu den Hintergründen dieser Debatte. Wir plädieren statt eines „Regelungseifers“ für einen breiten, kontroversen, dabei achtungs- und respektvollen Diskurs über die vielen komplexen existenziellen Fragen zu dieser Thematik, die sowohl fachliche wie auch persönliche Aspekte berühren.

ZUSAMMENFASSUNGDer Psychotherapie suizidaler Patienten kommt unter den individuumszentrierten Ansätzen zur Suizidprävention besondere Bedeutung bei. Als effektiv erwiesen haben sich vor allem die kognitive Verhaltenstherapie (KVT) und die dialektisch-behaviorale Therapie (DBT). Vor diesem Hintergrund werden in diesem CME-Beitrag zentrale Interventionen zur Risikoabschätzung und Krisenintervention, zur Aufarbeitung suizidfördernder Faktoren und zur Rückfallprävention praxisnah dargestellt.

In the scientific literature, it is often said that 90% of all suicides are the consequences of a mental illness. Nevertheless, recent reports and comments cast doubt on this view and point out that such a limitation might hamper effective suicide prevention. In this overview we will outline and discuss important results on how often suicides are the consequence of mental illnesses and whether the association between mental illnesses and suicide might be overestimated.Mental illnesses and especially affective disorders increase the risk of suicide by 30 to 50 times. Nevertheless, they explain only a certain percentage of all suicides. Observational and treatment studies indicate that mental illness is only one factor of several that lead to suicide. Among other factors are relationship problems, drug abuse, severe somatic illnesses, job problems, financial worries or juridical threats.Suicidal behaviour is an indicator of deep unhappiness but not necessarily caused by a mental illness. Many persons with mental illnesses do not show suicidal behaviour. On the other hand, not all people who take their own lives have a mental illness. This has significant consequences for universal and indicated prevention of suicide.Die Aussage, dass Suizide zu 90 % Folge psychischer Erkrankungen sind, wird häufig in der wissenschaftlichen Literatur zitiert. Neuere Analysen und Kommentare ziehen das aber in Zweifel und betonen die Notwendigkeit, vielfältigere Ursachen für Suizidereignisse zu beachten, auch um die Prävention von Suiziden nicht auf das Erkennen und Behandeln psychischer Erkrankungen zu reduzieren. Das Ziel dieser Übersichtsarbeit ist die Darstellung und Bewertung wichtiger empirischer Befunde zu der Frage, ob die Rolle psychischer Störungen beim Suizid überbewertet wird.Psychische Störungen erhöhen das Risiko eines Suizides um das bis zu 30- bis 50-Fache gegenüber der Allgemeinbevölkerung, dennoch wird dadurch nur ein Teil aller Suizide erklärt. Aus Beobachtungs- und Therapiestudien ergeben sich deutliche Hinweise, dass psychische Störungen nur ein Faktor unter mehreren sind, die zu Suizid führen. Eine Rolle spielen beispielsweise auch Beziehungsprobleme, Substanzmissbrauch, Belastungen durch schwere körperliche Erkrankungen, akute Krisen im Beruf, Probleme mit Finanzen und juristische Belastungen.Suizidales Verhalten weist auf eine tiefe Unzufriedenheit hin, aber nicht notwendigerweise auf eine psychische Erkrankung. Viele Menschen mit einer psychischen Erkrankung zeigen kein suizidales Verhalten und nicht alle Menschen, die sich ihr Leben nehmen, haben eine psychische Erkrankung. Diese Erkenntnisse haben erhebliche Konsequenzen für die universale und indizierte Prävention von Suiziden.

Introduction Suicide notes are not only the last personal message from the suicide victim to the bereaved, but are also a valuable source for research in preventing suicides. However, not all suicide victims leave a suicide note and it is unclear whether note leavers are representative of the general population of suicide victims. Methods The aim of our study was to compare suicide victims who leave a suicide note compared to those who do not. Therefore, data from the Allgau Suicide Study, which comprised detailed information on N = 626 suicides, were analysed using multiple regression analyses. Results Of N = 612 cases with complete data, n = 255(42%) left a suicide note and n = 357 (58%) did not. Persons who wrote suicide notes before they killed themselves were more often female, less often married, found themselves more often in a financial or partnership crisis, and were more likely to suffer from a medical illness. They tended to poison themselves more often and were less likely to have a history of alcohol abuse disorder. Conclusion Suicide notes are one source to better understand the motives, which lie behind suicides and therefore may help to further develop and improve suicide prevention programs. Keeping in mind that suicide has heterogeneous reasons, the group of “note writers” might be one, which might especially have benefitted from psychosocial and psychotherapeutic interventions, as interpersonal relationships obviously played an important role even shortly before suicide.

To examine if the short formed Sniffin Sticks Parosmia Test (SSParoT), a test for parosmia can distinguish cases with parosmia from cases without parosmia.In this study, 63 patients with postviral olfactory dysfunction were investigated including both COVID and non-COVID cases. The age, symptom duration, degree of parosmia/phantosmia was collected. For olfactory function, the Sniffin Sticks olfactory score was obtained including scores for odor threshold, discrimination and identification. For assessment of parosmic changes, the short SSParoT was adopted and both hedonic range (HedRang) and direction (HedDir) was calculated.The mean HedRang of patients with parosmia (2.35, standard deviation, SD = 1.40) and without parosmia (2.78, SD = 1.09) was smaller than that in controls (4.5, SD = 2.15). However, the mean HedDir of both parosmia (- 0.32, SD = 0.98) and non-parosmia patients (0.04, SD = 1.07) was similar to controls (- 0.1, SD = 1.55). When considering that the 10The present study showed that the short SSParoT score could not distinguish patients with parosmia from patients without parosmia. Although the SSParoT represents an innovative approach to assess parosmia, and could be useful in the tracking of parosmic changes, the development of measures to diagnose parosmia in an objective way remains a challenge.

Inpatient equivalent home-treatment (IEHT) was implemented in Germany in 2018. Persons with a mental disorder can be admitted to acute multiprofessional IEHT to avoid or shorten inpatient hospital treatment. Exclusion criteria are amongst others lack of consent of cohabitants or endangerment of self and others. Advantages of IEHT include normalization and reduction of stigma. Nevertheless, administrative requirements are high. While there is international evidence for home treatment and crisis resolution teams, there is still a lack of evidence for the concept of IEHT, although specific studies are currently being carried out (e.g. AktiV study financed by the Innovation Fund). Overall, IEHT is important for mental health services and should be further developed.Stationsäquivalente Behandlung (StäB) wird seit 2018 in Deutschland vergütet und bietet demnach prinzipiell allen Personen mit akut behandlungsbedürftigen psychiatrischen Erkrankungen eine intensive multiprofessionelle Behandlung zuhause an. Dadurch können stationäre Klinikbehandlungen ersetzt oder verkürzt werden. Ausschlusskriterien für eine StäB sind z. B. fehlendes Einverständnis von Mitbewohner*innen oder akute Eigen- oder Fremdgefährdung. StäB bietet Vorteile wie die Nähe zum Alltag und den Einbezug des Umfelds in die Behandlung, wobei durch die regulatorischen Vorgaben ein komplexer organisatorischer Aufwand für die Behandlungsform zu benennen ist. Evidenz zur Wirksamkeit aufsuchender Hilfen liegt vor und zeigt bezüglich einer stationären Behandlung vergleichbare Effekte. Spezifische Evidenz ist für StäB bislang kaum vorhanden. Laufende Studien (z. B. AKtiV-Studie des Innovationsfonds) werden aber hier bald Ergebnisse liefern. Insgesamt ist StäB ein wichtiges Angebot der psychiatrischen Versorgung, das weiterentwickelt werden sollte.

ZUSAMMENFASSUNGDer Beitrag beleuchtet die gesundheitspolitischen Aspekte stationsäquivalenter Behandlung (StäB). StäB ist eine Chance, neue Behandlungskonzepte zu entwickeln und zum Nutzen der behandelten Menschen und ihrer Angehörigen eine Krankenhausbehandlung zu vermeiden. Sie dient der Entstigmatisierung und der Normalisierung. StäB ist ein Paradigma neuer Versorgungsformen. Deswegen sollte aus unserer Sicht die StäB-Behandlung unbedingt weiter ausgebaut werden, auch wenn es in der momentanen Umsetzung offenkundige Hindernisse und Schwierigkeiten gibt.

This cross-sectional, retrospective study aimed to investigate the differences in well-being among patients with olfactory disorder (OD) with quantitative and/or qualitative olfactory dysfunctions, and to identify factors associated with well-being (WB). We included 470 OD patients. WB (WHO-5 questionnaire), quantitative olfactory function (Sniffin' Sticks) and qualitative dysfunction were assessed. Overall, 35% of the OD patients reported a poor WB, higher than 22% of the normative data in general population. For quantitative function, anosmia patients showed lower WB scores than hyposmia and normosmia patients (all p's 0.03). For qualitative dysfunction, patients with severe parosmia showed lower WB scores than patients without and with less severe parosmia (p's 0.01). Regarding OD causes in hyposmic patients, post-infectious patients showed poorer WB than idiopathic patients (p = 0.01); sinonasal patients had lower WB than post-traumatic and idiopathic patients (all p's 0.04). There was a weak but significant positive correlation between WB score and Threshold test score (r = 0.11, p = 0.02). Hierarchical regression analyses showed that women gender, Threshold and overall Sniffin' Sticks scores (TDI) significantly predicted WB score in OD patients. Our results implied that quantitative and qualitative dysfunction is associated with WB. However, only patients with severe dysfunction showed significantly lower WB. While this needs to be better understood, in order to improve well-being, in these patients it appears to be highly important to improve olfactory function, and here especially olfactory sensitivity.

Using an optical transmission electroabsorption modulator (T-EAM) in combination with a common image sensor and a high-power illumination source allows to build a three-dimensional (3D) imaging system based on the indirect time-of-ight (iTOF) principle. In contrast to most available iTOF systems that use specialized image sensors, in this case the EAM is doing the required demodulation at the receiver in the optical domain. A first 3D imaging setup was built and investigations on the performance of the system are reported. A high-power laser source was characterized in order to design and fabricate matched large-area T-EAMs. The fabricated modulators show extinction ratios of about 6 dB and bandwidths of up to 37MHz at 1mm2 size. 3D images taken with the prototype camera consisting of the T-EAM, the laser source, and a Raspberry Pi camera show promising results with a depth inaccuracy below 5 cm at a distance of 1 m.

ZUSAMMENFASSUNGArbeit hat auch bei psychisch erkrankten Menschen eine überwiegend salutogenetische Bedeutung – sie macht nicht krank, sondern gesund. Der Artikel stellt Veränderungen der Arbeitswelt durch den gesellschaftlichen Wandel dar, er diskutiert, welche Auswirkungen dies auf psychisch kranke Menschen haben kann und welche Ansatzpunkte es für eine diesbezüglich bessere Versorgung gibt.

The application of socio-scientific issues (SSI) in classrooms intends to better prepare learners for future challenges, for example in the domains of environmental and health education. But while the real-world connections of these issues have been found to be beneficial for learning and motivation, peoples’ closeness to SSIs is only scarcely understood. This especially concerns (pre-service) teachers, who have high obligations in teaching, for example in guiding discussions and decision-making about the respective issues. As prior studies found less distance to a SSI as positive predictor of teaching motivation, the presented study applied the idea of psychological distance and investigated (1) the differences in psychological distance towards the SSI topics of climate change, returning wolves, and pre-implantation genetic diagnosis (PGD). Furthermore, we identified (2) antecedents of the psychological distance. Overall, the 189 surveyed pre-service teachers (73.5% female, Mage = 23.45 years, SDage = 3.71) reported the smallest psychological distance towards the topic of climate change and the largest psychological distance towards the topic of PGD, with significant differences between all issues. The factors influencing psychological distance showed a large variation between the issues, as urbanity (returning wolves), self-reported knowledge (climate change), and the implementation of the topic in the own school time (PGD) only affected the psychological distance within specific issues. Only information from the social environment affected the psychological distance for two issues (wolves and PGD). While further conceptual elaboration around the construct of psychological distance is needed, the results illustrate possible causes for pre-service teachers’ psychological distance towards SSIs. This may be useful for professional development and further research about teaching behavior in SSIs.

Ein Suizid in der Klinik – am Ort des maximalen Schutzes für den Betroffenen und der Entlastung von Angehörigen – ist besonders belastend für alle Beteiligten. Diese Arbeitshilfe stellt das aktuelle Wissen über Suizid im Krankenhaus oder anderen psychosozialen Einrichtungen dar und macht praxiserprobte Vorschläge, wie Begleitung und Unterstützung aussehen können. Suizidnachbesprechungen etablieren Wenn ein Suizid an dem Ort geschieht, der als Ort des Schutzes für den Betroffenen und als Entlastung von Verantwortung für die Angehörigen gedacht war, dann bleibt von einem solchen Ereignis niemand unberührt. Die Autoren haben deshalb die Suizidnachbesprechung als festen Bestandteil der Nachbearbeitung von Suizidereignissen in ihrer Klinik etabliert. Dabei geht es nicht um Kontrolle oder Schuldzuweisung, sondern um ein unmittelbares Lernen aus der Situation, um eine angemessene Würdigung des Geschehenen und um die Fürsorge für die Mitarbeiterinnen und Mitarbeiter, die Angehörigen oder andere Beteiligte. Neben einer knappen Zusammenfassung zum Wissen über den Suizid allgemein und im psychiatrischen Krankenhaus im Besonderen wird ein Konzept zum Umgang mit dem Krankenhaussuizid vorgestellt. Mit seinen transparenten Informationsregeln, festen Routinen und klaren Abläufen kann es auf viele psychosoziale Einrichtungen übertragen werden.

The indirect time-of-flight principle is one possibility to build a three-dimensional (3D) camera system. Available products based on this principle mostly use special CMOS sensors for demodulation of the optical signal at the receiver. This special CMOS chip can be replaced by a standard image sensor in combination with a quantum well electroabsorption modulator. In this case, the modulator heavily influences the 3D camera performance. Especially the characteristics of large-area devices are of major interest. Transmission electroaborption modulators with sizes in the square millimeter range have been fabricated for operating wavelengths of 850 and 940 nm. While the 850nm devices were realized as non-resonant structures, for 940nm devices a resonant design was developed to overcome the limitation in the number of quantum wells. Investigations of the static and dynamic behavior show extinction ratios up to 2.5 dB and corner frequencies up to 30 MHz. A single-point distance measurement setup demonstrates the high potential of the devices for the 3D application.

Biodiversity issues can fruitfully be adopted as contexts of Education for Sustainable Development, as they involve ecological, economic and social dimensions. But as these contexts are demanding t...