Die Verhandlungsfähigkeit des alten (multimorbiden) Patienten

Zusammenfassung: Die Anforderungen an die Verhandlungsfähigkeit entsprechen im Wesentlichen dem "Kompetenzmodell" in der neuropsychiatrischen Literatur: Eine Person muss einen Sachverhalt verstehen, in einen Zusammenhang einordnen, die Konsequenzen bedenken sowie eine Entscheidung fällen und ausdrücken können. Gesundheitliche Störungen, die die Verhandlungsfähigkeit beeinflussen, sind im Alter vorwiegend bei Demenzen, Depressionen und/oder Delirien zu erwarten. Relevante Fakten zu diesen Syndromen werden dargestellt. Um die Interraterreliabilität und die Validität von Kompetenzbeurteilungen zu optimieren, erscheint es sinnvoll, strukturierte "assessments" unter Einbeziehung auch psychometrischer Tests heranzuziehen, statt sich allein auf ein klinisches Global- oder Gesamturteil zu verlassen. Bestuntersucht ist bis heute der "Mini-Mental Status Test" (MMSE). Bei Werten von weniger als 16Punkten ist danach sicher von einer Kompetenzstörung auszugehen, bei solchen über 26 allenfalls fraglich. Skalen und Instrumente, die Depressivität oder andere psychopathologische Funktionen quantifizieren, wurden hierzu bisher nicht untersucht. Mit diesem Thema befasste Juristen sollten eine Basiskompetenz im Umgang mit diesen orientierenden Instrumenten erwerbe

Die Rolle der Psychoedukation in der stationären Behandlung psychisch Kranker: Eine kritische Übersicht

Zusammenfassung: Psychoedukation ist ein nachweislich hocheffektives Verfahren zur Reduzierung von Rückfällen und Klinikeinweisungen bei schizophrenen Patienten. Ein günstiger Einfluss findet sich u.a. auch hinsichtlich Wissensstand und insbesondere Compliance, die wiederum eng mit dem klinischen Verlauf korreliert ist. Trotz der Wirksamkeitsnachweise und entsprechenden Empfehlungen in evidenzbasierten Leitlinien sind die therapeutischen Programme aber v.a. im stationären Behandlungssetting unterrepräsentiert. Wir fassen auf der Basis eines Literaturüberblicks den derzeitigen Kenntnis- und Entwicklungsstand zusammen und formulieren offene Fragen, Erklärungshypothesen und Lösungsmodelle im Hinblick auf eine breitere Anwendung von Psychoedukation v.a. in der stationären Versorgung. Wesentliche Aspekte der Erörterung hinsichtlich zeitgemäßer und zielgruppengerechter Formen sind die bislang übliche Diagnosenspezifität des traditionell in der Schizophreniebehandlung eingesetzten Verfahrens sowie eine methodenintegrative Struktur der informationszentrierten Schulungsprogramm

Erregungszustände und γ-Hydroxybutyrat

Zusammenfassung: Erregungszustände können Ausdruck unterschiedlicher Krankheitsbilder sein. Gamma-Hydroxybutyrat (GHB) wird wegen euphorisierender Effekte missbraucht und kann zu Agitation, Bewusstseinsstörungen und Koma führen. Wir stellen einen 50-jährigen Patienten mit wiederholten GHB-Intoxikationen bei abstinenter Alkoholabhängigkeit und einen videodokumentierten Erregungszustand vor. Die Differenzialdiagnose wird vor dem Hintergrund der aktuellen Literatur diskutiert. GHB-Intoxikation und -Abhängigkeit stellen auch im nervenärztlichen Kontext wichtige Krankheitsbilder da

Efficacy of bifocal diagnosis-independent group psychoeducation in severe psychiatric disorders: results from a randomized controlled trial

Despite evidence for its efficacy, diagnosis-specific psychoeducation is not routinely applied. This exploratory randomized controlled trial analyses the efficacy of an easily implementable bifocal diagnosis-mixed group psychoeducation in the treatment of severe psychiatric disorders regarding readmission, compliance and clinical variables, for example global functioning. Inpatients of the Psychiatric Hospital of the University of Basel (N=82) were randomly assigned to a diagnosis-mixed psychoeducational (PE) or a non-specific intervention control group. Relatives were invited to join corresponding family groups. Results at baseline, 3- and 12-month follow-ups are presented. Better compliance after 3months and a lower suicide rate were significant in favour of PE. For most other outcome variables, no significant differences, however advantages, in PE were found. In summary, it can be concluded that diagnosis-mixed group psychoeducation is effective in the treatment of severe psychiatric disorders. The effects can be classified as induced by distinctive psychoeducational elements. Findings similar to those on psychosis-specific programmes justify clinical application and further investigatio

Dynamics of tidal synchronization and orbit circularization of celestial bodies

PACS number s : 05.45.Xt, 05.45.Gg, 95.10.Ce, 96.15.DeWe take a dynamical-systems approach to study the qualitative dynamical aspects of the tidal locking of the rotation of secondary celestial bodies with their orbital motion around the primary. We introduce a minimal model including the essential features of gravitationally induced elastic deformation and tidal dissipation that demonstrates the details of the energy transfer between the orbital and rotovibrational degrees of freedom. Despite its simplicity, our model can account for both synchronization into the 1:1 spin-orbit resonance and the circularization of the orbit as the only true asymptotic attractors, together with the existence of relatively long-lived metastable orbits with the secondary in p:q synchronous rotationWe acknowledge projects OTKA T72037 Hungary , Hielocris Spain , the Human Frontier Science Program I.T. , MCI project CGL-2008-06245-C02-02 Spain , and the Spanish-Hungarian Binational project TeT ESP-34/2006.Peer reviewe

Understanding Barriers to the Realization of Human Rights Among Older Women With Mental Health Conditions

There is increasing emphasis in research and at the level of international human rights bodies such as the United Nations on the gendered contours of age-based disadvantage and discrimination, and the cumulative effects of gender inequalities over the life-course on outcomes in later life. However, to date, the role of mental health in shaping the age/gender nexus in the realization of human rights has received little attention. In response, this paper aims to 1) elucidate the economic, social and cultural disadvantages and discrimination faced by older women living with mental health conditions; and 2) identify opportunities to protect their human rights. It concludes that older women face inequalities and disadvantages at the intersections of age, gender, and mental health and wellbeing that compromise their capacity to age well, illuminating the urgent need for a UN Convention on the Human Rights of Older Persons that considers the role of mental health in shaping the realization of human rights among older people. (Am J Geriatr Psychiatry 2021; 29:1009-1014

Limb remote ischemic conditioning of the recipient protects the liver in a rat model of arterialized orthotopic liver transplantation

Background Ischemic-reperfusion (IR) injury still represents a major concern in clinical transplantation, especially in the era of extreme organ shortage and extended criteria donor organs. In the present study we aimed to investigate the hepatoprotective effects of remote ischemic conditioning (RIC) in a rat model of arterialized orthotopic liver transplantation (OLT). Methods Male Lewis rats were used (n = 144 / 72 OLT cases; 240-340g) as donors and recipients. Livers were flushed and stored in 4 degrees C HTK-solution for 8h before implantation. Recipients were randomly allocated into three experimental groups: RIC 1, RIC 2, Control. In RIC 1, RIC 2 groups, RIC was applied in the recipient before hepatectomy or after reperfusion (4x5-5min IR via clamping the infrarenal aorta), respectively. Animals were sacrificed at 1, 3,24,168h post-reperfusion (n = 6 recipient/group/time point). Hepatocellular injury, graft circulation, serum cytokines, tissue redox-stress and adenosine-triphosphate (ATP) levels have been assessed. Additional markers were analyzed, using Western blotting and reverse-transcription polymerase chain reaction. Results RIC 1 group showed significantly (p<0.05) improved portal venous and microcirculation flow as well as velocity. RIC has significantly reduced tissue injury according to the serum levels of transaminases and results of histopathological evaluation. Reduced TUNEL-staining (p<0.01 RIC 1-2 vs. Control) and elevated pBAD/BAD ratio was detected in the RIC groups (p<0.01 RIC 1 vs. Control). Supporting findings were obtained from measurements of serum IL-10 as well as tissue malondialdehyde and ATP levels. Hemoxygenase-1 (HO-1) mRNA-expression was significantly higher in RIC 1 compared to Control (p<0.05 RIC 1 vs. Control). Conclusion These results suggest that RIC might confer potent protection against the detrimental effects of IR injury including tissue damage, apoptosis, graft circulation, inflammation, tissue energetic status in OLT. HO-1 overexpression might play an orchestrating role in RIC mediated organ protection. An earlier intervention (RIC 1 protocol) was more effective than remote conditioning after graft reperfusion

Spatially-explicit and spectral soil carbon modeling in Florida.

Profound shifts have occurred over the last three centuries in which human actions have become the main driver to global environmental change. In this new epoch, the Anthropocene, human-driven changes such as population growth, climate and land use change, are pushing the Earth system well outside its normal operating range causing severe and abrupt environmental change. In this context, we present research highlights from Florida (150,000 km2) showing how anthropogenic-induced changes have had major impacts on carbon dynamics in soils, including (i) modeling of carbon and nutrient dynamics and soil carbon sequestration impacted by climate and land use change; (ii) geospatial assessment of soil carbon stocks and pools, and (iii) spectral-based soil carbon modeling. Our research is embedded in the STEP-AWBH modeling concept which explicitly incorporates Human forcings and time-dependent evolution of Atmospheric, Water, and Biotic factors into the modeling process. Spatially-explicit soil carbon observations were fused with ancillary environmental data and various statistical and geostatistical methods were used to upscale soil carbon across the region. Our results suggest that soil hydrologic and taxonomic, biotic (vegetation and land use), and climatic properties show complex interactions explaining the variation of soil carbon within this heterogeneous subtropical landscape