Swiss Archives of Neurology, Psychiatry and Psychotherapy

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Open AccessArticle

by EMH Swiss Medical Publishers Ltd.

Swiss Arch. Neurol. Psychiatry Psychother. 2010, 161(2), 79-80; https://doi.org/10.4414/sanp.2010.02144 - 1 Jan 2010

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Abstract

Der Normaldruckhydrozephalus oder «normal pressure hydrocephalus» (NPH) ist sicher ein heiss diskutiertes Thema zwischen Neurologen und Neurochirurgen – die Kontroverse dreht sich in erster Linie um die Indikation für eine Shunt-Operation [1] [...] Full article

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Aktualitäten

by Karl Studer

Swiss Arch. Neurol. Psychiatry Psychother. 2010, 161(2), 78; https://doi.org/10.4414/sanp.2010.02138 - 1 Jan 2010

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Abstract

Eine neue Studie des psychiatrisch psychologischen Dienstes Zürich bestätigt die Wirkung der deliktorientierten Therapie [...] Full article

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Open AccessArticle

Burnout – eine Standortbestimmung

by Rico Nil, Nicola Jacobshagen, Hartmut Schächinger, Pierre Baumann, Paul Höck, Josef Hättenschwiler, Fritz Ramseier, Erich Seifritz and Edith Holsboer-Trachsler

Swiss Arch. Neurol. Psychiatry Psychother. 2010, 161(2), 72-77; https://doi.org/10.4414/sanp.2010.02140 - 1 Jan 2010

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Abstract

The concept of burnout was first introduced in the mid-seventies as a negative affective state in response to a prolonged exposure to interpersonal work-related stress. The phenomenon has become highly debated in various research areas and in the public. The present review attempts [...] Read more.

The concept of burnout was first introduced in the mid-seventies as a negative affective state in response to a prolonged exposure to interpersonal work-related stress. The phenomenon has become highly debated in various research areas and in the public. The present review attempts to bring clarity by discussing burnout from various perspectives including (biological) psychiatry, psychosomatics and occupational health psychology. Burnout has been described as both a multidimensional syndrome and as a stress-related adaptive process. The syndrome encompasses the three main dimensions emotional exhaustion, depersonalization (exhibiting features of cynicism and detachment), and reduced personal accomplishment with a sense of a diminished performance level. The process was described as going through several phases, from increased working efforts to cope with external demands, which can lead to mental and physical exhaustion and demotivational affective states, and on to psychosomatic complaints and finally depressive states. Although burnout may lead to full-blown depression in its late and most severe stages, it is not regarded as a medical/psychiatric diagnosis as defined by the DSM-IV or ICD-10 manuals and has, therefore, not been the subject of psychiatric epidemiological studies. The Maslach Burnout Inventory has established itself as the main assessment tool of burnout in a rapidly growing research field, mainly in occupational and health psychology. Most investigations on the prevalence rates of burnout have been performed in service-related professionals such as medical doctors, nurses or teachers. The prevalence levels of severe burnout differ substantially between researched groups, ranging from 3.5%–12% among primary care doctors up to levels as high as 50% in emergency care unit professionals. Although the rates of clinical depression clearly increase with the severity of burnout, the common variance remains relatively low and has led many authors to conclude that burnout and depression represent different concepts. It is agreed that sleep problems are a common feature of depression and burnout as established by subjective and objective assessments. This leads to impaired recovery during sleep with manifestations of mental impairment and daytime sleepiness. Moreover, sleep problems were shown to have predictive value for the later development of burnout. Although burnout is regarded as a stress-related state, the biological markers relating to functional and pathophysiological changes of the HPA axis remain inconsistent. Both increased and decreased cortisol levels and reactivity have been described in burnout individuals. This was recently confirmed in a study which also included BDNF (brain-derived neurotropic factor) analyses and presented preliminary evidence of altered BDNF levels in severe burnout patients. There is increasing evidence that burnout as a stress response represents a risk factor not only for depression, but also for cardiovascular and other somatic diseases. Mediators of such developments are being discussed and include increased vegetative arousal, immunological and inflammatory processes and maladaptive behaviours such as alcohol and nicotine use. A series of occupational and health psychology stress models focusing on controllability of the working environment and relation between resources, demands and reward may serve both as an explanation of burnout development as well as an approach to preventive and behavioural treatment. From a medical/psychiatric perspective, the treatment of severe burnout should follow common psychiatric rules and guidelines, namely careful diagnostics and pharmacological and psychological treatments including coaching and stresscoping training. From the present review it can be concluded that burnout is a multidimensional occupational health concept and not a medical diagnosis. Individuals with severe burnout are at substantial risk of developing depressive episodes and it is assumed that only these burnout patients are seen in psychiatric practises. The overlap between severe burnout and depression may give rise to confusion between the concept of burnout and clinical depression. Full article

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Open AccessCase Report

Induktion paraphiler Handlungen als unerwünschte Wirkung der Neueinstellung auf Aripiprazol?

by Andreas Frei

Swiss Arch. Neurol. Psychiatry Psychother. 2010, 161(2), 69-71; https://doi.org/10.4414/sanp.2010.02139 - 1 Jan 2010

Cited by 3 | Viewed by 32

Abstract

Many antipsychotic drugs inhibit the dopamine receptor in the brain which causes an increase of prolactine and hence an impaired sexual function. We report the case of a 32yearold hebephrenic male patient, who confessed during his 12th hospitalisation to an intern that he [...] Read more.

Many antipsychotic drugs inhibit the dopamine receptor in the brain which causes an increase of prolactine and hence an impaired sexual function. We report the case of a 32yearold hebephrenic male patient, who confessed during his 12th hospitalisation to an intern that he felt some homopaedophilic urges. Even though it was registered in the file it was never addressed by the medical staff. Months later, because of his negative symptomatology, the patient’s antipsychotic medication was changed by his GP from the atypical neuroleptic drug Olanzapine to the novel antipsychotic drug Aripiprazole. The patient started long walks and started to molest boys on schoolyards. After he had been blackmailed by some of these, he reported to the police and confessed what he had done. He was send to a psychiatric hospital for treatment. Aripiprazole is in fact recommended for schizophrenic patients suffering from sexual dysfunction. A careful evaluation of the sexual needs and history not only of such patients, but of schizophrenic patients in general is recommended. Full article

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Open AccessArticle

Gibtes Posttraumatische Belastungsstörungen bei älteren Schweizerinnen und Schweizern?

by Andreas Maercker and Laura Pielmaier

Swiss Arch. Neurol. Psychiatry Psychother. 2010, 161(2), 64-68; https://doi.org/10.4414/sanp.2010.02141 - 1 Jan 2010

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Abstract

To date, there is only one representative study providing epidemiological data on posttraumatic stress disorder (PTSD) in Switzerland, showing zero or fairly low prevalences for PTSD in Switzerland [1]. However in a representative study with elderly people (65–96 years) living in Zurich, we [...] Read more.

To date, there is only one representative study providing epidemiological data on posttraumatic stress disorder (PTSD) in Switzerland, showing zero or fairly low prevalences for PTSD in Switzerland [1]. However in a representative study with elderly people (65–96 years) living in Zurich, we recently reported prevalences of 0.7% for full PTSD according to DSM-IV criteria and 4.2% for partial PTSD using clinical interviews as well as questionnaires [2]. In this paper we present trauma constellations of this sample in a case-related and detailed way. 36% of the sample indicated having experienced at least one potentially traumatizing event; primarily severe accidents, physical violence and war-related events. Three of four participants suffered from PTSD due to war-related events or political persecution – they were all naturalized persons and had immigrated to Switzerland from different European countries. For participants with partial PTSD, traumas such as severe accidents, violence, and war-related events occurred almost equally frequent. In the discussion we point out that for the clinical routine both full and partial PTSD should be assessed as full PTSD diagnosis according to the more liberal criteria defined by ICD-10. Furthermore we draw attention to the great number of Swiss with war-related experiences stemming from different immigration waves and their specific therapeutic needs. Full article

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Open AccessReview

Alien hand syndrome: a neurological disorder of will

by Leonardo Sacco and Pasquale Calabrese

Swiss Arch. Neurol. Psychiatry Psychother. 2010, 161(2), 60-63; https://doi.org/10.4414/sanp.2010.02142 - 1 Jan 2010

Cited by 1 | Viewed by 32

Abstract

Alien hand syndrome (AHS) is a neurological disorder in which movements are performed without awareness or conscious will. Phenomena like awareness or consciousness are still poorly studied in physiology and have only become a crucial topic in neuroscience in the last few years. [...] Read more.

Alien hand syndrome (AHS) is a neurological disorder in which movements are performed without awareness or conscious will. Phenomena like awareness or consciousness are still poorly studied in physiology and have only become a crucial topic in neuroscience in the last few years. Pertinent experiments in which the volitional control of a movement was studied unanimously, demonstrate that movements are initiated before consciousness occurs. By doing so, the brain adopts internal anticipatory models of voluntary action. Several studies suggest that the parietal cortex is important in activating and maintaining such internal models of action. AHS is characterized by a loss of the sense of agency associated with the purposeful movement of the limb while retaining a sense of ownership. The hand seems to perform acts without intentional guidance by the patient. Thus, the patient has no control over the movements; instead, the hand has the capability of acting autonomously, independent of patient’s voluntary control. This complex phenomenon may present in different variants which are caused by different lesions and can be categorized by several dimensions: – type of aberrant behavior performed by the affected hand; – coordinative disturbances in a bimanual behavior, caused by conflicts arising while using both hands; – subjective reactions of the affected individual toward this limb. The syndrome and its variants is caused by lesions to the medial frontal lobe, the corpus callosum and the parietal areas, but can also appear within neurodegenerative diseases, such as corticobasal degeneration, and may even precede them (e.g. Creutzfeldt-Jakob disease). In a functional MRI study of AHS, major activation was reported for the frontal inferior gyrus of the dominant hemisphere in voluntary movement of the affected hand, suggesting an important role of this area in organizing willed actions. Neuropsychological investigations indicate an involvement of a supramodal attentional system in the organization of movements. AHS serves as a paradigm to study the conscious experience of movement and can be considered as a neurological disorder of will. This review discusses some physiological as well as functional-neuroanatomical aspects, by reporting some actual studies relating AHS to consciousness and will. Full article

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Open AccessReview

Die Glykogenose Typ II (Morbus Pompe)

by Thomas Hundsberger, Ursula Hohl, Barbara Erdèlyi and Kai M. Rösler

Swiss Arch. Neurol. Psychiatry Psychother. 2010, 161(2), 55-59; https://doi.org/10.4414/sanp.2010.02143 - 1 Jan 2010

Cited by 2 | Viewed by 43

Abstract

Hundsberger T, Hohl U, Erdèlyi B, Rösler M. Glycogen storage disease type II (Pompe’s disease). Schweiz Arch Neurol Psychiatr. 2010;161(2):55–9. Glycogen storage disease type II (Pompe disease) is a rare autosomal recessive disorder due to mutations in the acid alpha-glucosidase (GAA) gene. [...] Read more.

Hundsberger T, Hohl U, Erdèlyi B, Rösler M. Glycogen storage disease type II (Pompe’s disease). Schweiz Arch Neurol Psychiatr. 2010;161(2):55–9. Glycogen storage disease type II (Pompe disease) is a rare autosomal recessive disorder due to mutations in the acid alpha-glucosidase (GAA) gene. The disease defining genetic alteration can be found at several nucleotides as more than 200 different mutations has been reported so far. Some of these mutations lead to a complete loss of function of the GAA whereas others only reduce enzyme activity to various degrees. Deficient GAA activity leads to harmful lysosomal glycogen storage and disruption of various cell types. Depending on the degree of residual enzyme activity symptoms of the disease evolve in infancy, childhood or adulthood. As a rule loss of enzyme function or low residual activity is associated with a severe phenotype and early onset disease. Glycogenosis type II is a multisystem disorder with a broad clinical spectrum. Muscle weakness and respiratory failure are the most important clinical symptoms in adults. In infants symptoms due to cardiomyopathy, arrhythmia and heart failure are most prominent and life threatening. Glycogen accumulation has also been detected in the brain, brainstem and anterior horn cells. Soon after birth first symptoms occur with a fast disease progression leading to death after 6–12 months in untreated patients (“classic form”). Infants with signs of generalized myopathy (floppy infant) and cardiomyopathy should be screened for Pompe’s disease as early enzyme replacement therapy (ERT) with recombinant human GAA (rhGAA) can prevent a lethal outcome. If the enzyme activity is more than 1% of the normal GAA activity children and adults have a more benign phenotype consisting of muscle weakness and ventilatory problems. In children developmental motor milestones are usually delayed or not reached (i.e., walking). Adults are affected by proximal myopathy and diaphragmal insufficiency (“late-onset form”). Diagnosis is based on the clinical suspicion of a proximal myopathy, a muscle biopsy showing intracellular glycogen accumulation and the biochemical measurement of GAA activity in lymphocytes, dried blood spots assays, skin fibroblast or muscle. The diagnosis should be confirmed by genetic testing at least for the most common IVS1 splice site mutation. ERT with rhGAA (Myozyme®) for this disease is worldwide available since 2006. For infants and children this therapy is well established despite high costs and the need for frequent intravenous infusions every other week in a dosage of 20 mg/kg body weight. Reconstitution of cardiomyopathy clearly improves survival and enhances quality of life compared with untreated children with a life expectancy of less than one year. The timing, duration and benefit of ERT in adults is still an open question. Due to the few published studies, reflecting the rarity of the disease, muscle strength and ventilator function improves under ERT. Early therapy seems to prevent disease progression. Unfortunately, there is no predictive marker for the beneficial effect of ERT therapy in Pompe patients. Nevertheless, a randomized, placebo-controlled trial of 90 “late-onset” patients ERT significantly improved walking and pulmonary outcomes. Keeping the high costs of therapy in mind and knowing the wide spectrum of clinical presentation the indication for ERT in “late-onset” patients must be considered on an individual basis. This decision depends on the degree of muscle weakness, impairment of daily life activities and especially the presence of diaphragmal insufficiency. If respiratory insufficiency occurs it has to be treated by lifetime invasive or non-invasive ventilation. Of note, diaphragmal weakness can rapidly deteriorate triggered by respiratory infection or elective intubation with prolonged weaning. This review is meant to raise more attention and to describe the latest insights in glycogen storage disease type II. Full article

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Open AccessEditorial

Psychiatrie

by M. Axel Wollmer

Swiss Arch. Neurol. Psychiatry Psychother. 2010, 161(2), 54; https://doi.org/10.4414/sanp.2010.02136 - 1 Jan 2010

Cited by 2 | Viewed by 24

Abstract

Der psychiatrische Teil dieser Ausgabe umfasst diesmal drei Beiträge [...] Full article

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Open AccessEditorial

Neurology

by Andreas Steck

Swiss Arch. Neurol. Psychiatry Psychother. 2010, 161(2), 53; https://doi.org/10.4414/sanp.2010.02137 - 1 Jan 2010

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Abstract

Pompe disease (glycogen storage disease type II, acid maltase deficiency) is a rare progressive metabolic myopathy caused by deficiency of the lysosomal enzyme acid, alpha-glucosidase [...] Full article

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Swiss Arch. Neurol. Psychiatry Psychother., Volume 161, Issue 2 (01 2010) – 9 articles , Pages 53-80

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