Swiss Archives of Neurology, Psychiatry and Psychotherapy

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Open AccessArticle

Home, sweet home?

by Caroline Christiansen

Swiss Arch. Neurol. Psychiatry Psychother. 2015, 166(5), 176-182; https://doi.org/10.4414/sanp.2015.00347 - 1 Jan 2015

Cited by 1 | Viewed by 31

Abstract

Home, sweet home? Housing constitutes a necessary shelter from adverse weather and hazards. However, a shelter is not always enough. The danger lurks at times “within” the shelter. Drawing upon his personal experience in the areas of housing and asylum, the author expounds [...] Read more.

Home, sweet home? Housing constitutes a necessary shelter from adverse weather and hazards. However, a shelter is not always enough. The danger lurks at times “within” the shelter. Drawing upon his personal experience in the areas of housing and asylum, the author expounds thoughts on the function and significance of one’s home. Full article

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Open AccessReview

Oral therapies for relapsing- remitting multiple sclerosis

by Martin Diebold and Tobias Derfuss

Swiss Arch. Neurol. Psychiatry Psychother. 2015, 166(5), 170-175; https://doi.org/10.4414/sanp.2015.00349 - 1 Jan 2015

Cited by 1 | Viewed by 35

Abstract

During the past 4 years the first oral treatments for relapsing-remitting multiple sclerosis have become available. These agents differ from previous therapies for multiple sclerosis in their mechanisms and safety profiles. Fingolimod (Gilenya®), a sphingosine-analogue, was found to reduce the relative relapse rate [...] Read more.

During the past 4 years the first oral treatments for relapsing-remitting multiple sclerosis have become available. These agents differ from previous therapies for multiple sclerosis in their mechanisms and safety profiles. Fingolimod (Gilenya®), a sphingosine-analogue, was found to reduce the relative relapse rate by 54% compared with placebo. Supposedly its main effect is the inhibition of lymphocyte egress from the thymus and secondary lymphoid organs. In addition to this immunomodulatory action neuroprotective effects of fingolimod have been discussed. Alongside benign side effects, rare cases of serious herpetic infections, bradyarrhythmia and macular oedema were observed. Teriflunomide (Aubagio®) was proven to relatively reduce the relapse rate by 31% to 36%. It inhibits the proliferation of activated lymphocytes by blocking the biosynthesis of pyrimidines. Slight gastrointestinal problems can occur under teriflunomide treatment. Liver enzymes and blood counts need to be monitored during treatment. Dimethylfumarate (Tecfidera®) is associated with a relative reduction of the relapse rate by 44 to 53%. Several immunomodulatory and neuroprotective mechanisms may account for this effect: dimethylfumarate induces an antioxidant response and interacts with candidate pathways for lymphocyte proliferation in in-vitro experiments. The most frequent side effects – flushing and gastrointestinal discomfort – predominantly occur in the initial treatment phase. Scarce cases of serious infections seem to correlate with lymphopenia. Full article

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Open AccessReview

Neurobehavioural evaluation of disorders of consciousness

by Jane Jöhr, Jean-Michel Pignat and Karin Diserens

Swiss Arch. Neurol. Psychiatry Psychother. 2015, 166(5), 163-169; https://doi.org/10.4414/sanp.2015.00345 - 1 Jan 2015

Cited by 6 | Viewed by 42

Abstract

Although diagnostic guidelines for disorders of consciousness (DOC) have been consensually defined and are broadly used worldwide, a very high rate of diagnostic error remains among patients with DOC. Such failure to discern accurately between the different states of altered consciousness may influence [...] Read more.

Although diagnostic guidelines for disorders of consciousness (DOC) have been consensually defined and are broadly used worldwide, a very high rate of diagnostic error remains among patients with DOC. Such failure to discern accurately between the different states of altered consciousness may influence tremendously the accuracy of prognosis, the decision-making process and medical care management or withdrawal. As there is no direct way to detect consciousness, one needs to infer its presence from behavioural observations and clinical examination at the bedside. Guidelines informing how one should approach clinical assessment of DOC have not yet reached the gold standard of diagnostic methodology. In the context of increasing demand for acute neurorehabilitation in Switzerland, there is a crucial need to improve the accuracy of initial diagnosis and prognosis, which profoundly impact treatment decisions in the short and long term. Validated neurobehavioural scales commonly used in our acute care setting are reviewed and their limitations considered. We assume that underlying deficits such as a severely damaged motor system compromise the detection of consciousness in the acute stage. Bearing out this claim, the results from our longitudinal pilot study demonstrate that the additional use of a new set of clinical items specifically oriented towards the observation of subtle aspects of motor behaviour in the acute phase helps to identify better the signs of consciousness with a strong predictive rate. According to our findings, many patients are potentially misdiagnosed with severe impairment of consciousness when rated with existing scales, whereas their condition prevents them from succeeding in the production of an adequate motor or verbal response. Such complex and alarming situations call for future profound modifications in DOC assessment. We posit that the development of a coordinated multimodal approach combining information from different sources will help in reaching an objective appreciation of DOC, overcome the current behavioural-based misdiagnosis issue and, most importantly, improve the care of DOC patients in the acute phase. Full article

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Open AccessReview

Prise en charge dans la phase précoce des troubles psychotiques

by Philippe Conus

Swiss Arch. Neurol. Psychiatry Psychother. 2015, 166(5), 158-162; https://doi.org/10.4414/sanp.2015.00343 (registering DOI) - 1 Jan 2015

Cited by 1 | Viewed by 38

Abstract

Promoting recovery in the early phase of psychotic disorders: a question of partnerships. The development of the concept of early intervention in psychotic disor¬ders has led to the elaboration of specialised programmes in many parts of the world. The treatment of patients involved [...] Read more.

Promoting recovery in the early phase of psychotic disorders: a question of partnerships. The development of the concept of early intervention in psychotic disor¬ders has led to the elaboration of specialised programmes in many parts of the world. The treatment of patients involved in such programmes implies the development of various partnerships: with patients, and their relatives, and between mental health professionals, as well as with general practitioners and private psychiatrists. These partnerships are crucial to facilitating patients’ engagement in complex treatment, which most of the time needs the coordinated work of multidisciplinary teams from the public mental health sector. Full article

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Open AccessReview

Patientenaufklärung–therapeutisch interpretiert

by Julius Kurmann

Swiss Arch. Neurol. Psychiatry Psychother. 2015, 166(5), 151-157; https://doi.org/10.4414/sanp.2015.00338 - 1 Jan 2015

Cited by 2 | Viewed by 28

Abstract

Comprehensive patient information – interpreted from a therapeutic standpoint. Comprehensive patient information was not “invented” by legal experts, but it is an integral part of our professional obligation as medical practitioners. The author goes even further. Besides the legal aspects of risk management, [...] Read more.

Comprehensive patient information – interpreted from a therapeutic standpoint. Comprehensive patient information was not “invented” by legal experts, but it is an integral part of our professional obligation as medical practitioners. The author goes even further. Besides the legal aspects of risk management, he emphasises the role of proper patient information as fundamental to relationship-building and thus as an element of treatment quality. The author holds the view that power relationships are reflected too little in psychotherapy. Aiming to create a space free of the exertion of power in psychotherapy is futile. It is only when power is exercised with little or no mediation that it is branded with negative connotations and perceived by the patient as violence or compulsion. If, however, the aim is open communication and mediation in which the patient can actively contribute, this power assumes a productive feature. Careful patient information is thus crucial at the start of any therapeutic relationship. This article outlines methods for the patient to be perceived in a position of self-determination and autonomy and for fostering such a position. Full article

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Open AccessEditorial

Two review articles on current knowledge

by Jean-Marie Annoni and Claudio Bassetti

Swiss Arch. Neurol. Psychiatry Psychother. 2015, 166(5), 150; https://doi.org/10.4414/sanp.2015.00353 - 1 Jan 2015

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Abstract

Dear Readers, The SANP has decided this year, as you have seen, to publish a certain number of reviews articles that summarise current knowledge on certain topics, with the help of expert and specialised clinicians [...] Full article

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Open AccessEditorial

À propos de partenariat

by Jacques Besson

Swiss Arch. Neurol. Psychiatry Psychother. 2015, 166(5), 149; https://doi.org/10.4414/sanp.2015.00351 - 1 Jan 2015

Viewed by 21

Abstract

La partie psychiatrique du présent numéro présente en fil rouge la question du partenariat avec nos patients. Celui-ci à beaucoup évolué ces dernières années, du paternalisme à «l’empowerment» [...] Full article

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Swiss Arch. Neurol. Psychiatry Psychother., Volume 166, Issue 5 (01 2015) – 7 articles , Pages 149-182

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