Psychiatrie mit offenen Türen: Teil 1: Rational für Türöffnungen in der Akutpsychiatrie

Zusammenfassung: Bei allen Reformbemühungen der letzten Jahrzehnte in der modernen Akutpsychiatrie steht diese weiterhin in einem Spannungsfeld, in welchem die psychiatrische Alltagspraxis in verschiedene Widersprüche verwickelt ist. Der Schutz der Patientenautonomie kann in Konflikt mit einem ordnungspolitischen Mandat der Akutpsychiatrie geraten, die Notwendigkeit von Zwangsmaßnahmen als unfreiwillige Hilfestellung kann im mutmaßlichen, aber umstrittenen Interesse des Patienten fraglich werden. Die Widersprüche manifestieren sich insbesondere in Fragen von Unterbringung, Türschließung, Zwangs- und Isolationsmaßnahmen. Die Forschung zur Wirksamkeit solcher Maßnahmen ist gering. Entsprechend ist die Praxis je nach Land, Klinik oder Station heterogen. Epidemiologisch wird eine Zunahme psychiatrischer Erkrankungen prognostiziert, gleichzeitig erhalten medizinethische Ansprüche an die Gewährleistung der Patientenautonomie, an ein "shared decision making" und den "informed consent" in der Psychiatrie zunehmend Bedeutung. Vor diesem Hintergrund werden die strukturellen und klinischen Herausforderungen, wie sie sich in Selbst- und Fremdgefährdungssituationen in der akutpsychiatrischen Behandlung zeigen, dargestellt und ein Rational für mögliche Türöffnungen in der psychiatrischen Akutbehandlung entwickelt

Psychiatrie mit offenen Türen: Teil 2: Therapeutische Herausforderungen

Zusammenfassung: Die Öffnung der Türen akutpsychiatrischer Stationen ist ein "Schlüssel" zu einer patientenbezogenen Psychiatrie. Gemeint ist, dass Patienten in ihrer Persönlichkeit ernst genommen werden wie in ihrer Krankheit. Patienten und ihre Angehörigen sollen ein hohes Maß in der Partizipation an der Behandlung erfahren und sich zugleich Behandlungsteams gegenüber sehen, die in einer empathischen Grundhaltung darum bemüht sind, Vertrauen und Sicherheit in der therapeutische Beziehung zu erarbeiten. Diese vorliegende Arbeit widmet sich therapeutischen Maßnahmen, einzelnen Skills und Veränderungen von Rahmenbedingungen der Akutbehandlung, die hilfreich sein können, die skizzierte Grundüberzeugung einer wesentlichen Beziehungsarbeit in der Psychiatrie und Förderung der Selbst- und Mitbestimmung der Patienten praktisch umzusetzen (z.B. Vermeidung von Patientenkonzentrationen auf Akutabteilungen, Schulungen des Personals, Einschätzung von Gewaltrisiken, Gewaltdeeskalation, Umgang mit Suizidalität etc.). Sie sollen helfen, präventiv, aber auch in entstehenden schwierigen Situationen drohender Selbst- und Fremdgefährdung, der Aggression und Gewalt auf Abteilungen professionell gegenüber zu treten und damit den Prozess einer Türöffnung in der Psychiatrie vorzubereiten

Production of Υ(nS) mesons in Pb+Pb and pp collisions at 5.02 TeV

A measurement of the production of vector bottomonium states, Υ ( 1S ) , Υ ( 2S ) , and Υ ( 3S ) , in Pb + Pb and p p collisions at a center-of-mass energy per nucleon pair of 5.02 TeV is presented. The data correspond to integrated luminosities of 1.38 nb − 1 of Pb + Pb data collected in 2018, 0.44 nb − 1 of Pb + Pb data collected in 2015, and 0.26 fb − 1 of p p data collected in 2017 by the ATLAS detector at the Large Hadron Collider. The measurements are performed in the dimuon decay channel for transverse momentum p μ μ T < 30 GeV , absolute rapidity | y μ μ | < 1.5 , and Pb + Pb event centrality 0–80%. The production rates of the three bottomonium states in Pb + Pb collisions are compared with those in p p collisions to extract the nuclear modification factors as functions of event centrality, p μ μ T , and | y μ μ | . In addition, the suppression of the excited states relative to the ground state is studied. The results are compared with theoretical model calculations

Gender-dependent association of the functional catechol-O-methyltransferase Val158Met genotype with sensation seeking personality trait

The gene encoding cathechol-O-methyltransferase (COMT) contains a common functional missense polymorphism (Val158Met) that regulates dopamine in an allele-dependent manner. A pivotal role of dopamine neurotransmission in the prefrontal cortex has been implicated in drug-seeking behavior and related personality traits, such as sensation seeking, with some evidence for a gender-specific association. Here, we tested the hypothesis that the COMT Val158Met polymorphism modulates the personality dimension, sensation seeking, in a gender-dependent manner. Study sample included 214 male (age 38.1+/-12.6 years) and 218 female (age 36.1+/-13.6 years) healthy volunteers, who were assessed with Zuckerman's sensation-seeking scale and genotyped for the Val158Met polymorphism (dbSNP:rs4680). Univariate analysis of variance showed that the sensation seeking score was significantly affected by a COMT genotype x gender interaction (F=5.330, df=2, p=0.005). The Val158Met polymorphism was associated with the sensation seeking personality trait in women only. The highest scores in the sensation-seeking scale and in three of the four subscales were observed in female subjects with the Val/Val genotype relative to women carrying the Met allele. Our results suggest that high COMT enzyme activity associated with the Val allele predisposes to high sensation seeking scores in female subjects and add to increasing evidence for a gender specific role of COMT in normal and dysfunctional behavior

Association of the met66 allele of brain-derived neurotrophic factor (BDNF) with smoking

Rationale: It has been suggested that a susceptibility locus near the gene encoding the brain-derived neurotrophic factor (BDNF) contributes to individual differences in human addiction vulnerability. BDNF modulates several behaviors that are associated with addictive drugs, and upregulation of BDNF was found to be associated with several drugs of abuse such as amphetamine, cocaine, and nicotine. In this study, we addressed the question if a common BDNF missense variation (Val66Met) influences the risk for smoking behavior in otherwise healthy human volunteers. Materials and methods: In total, 320 healthy unrelated volunteers (155 male, 165 female, mean age: 38.4 ± 14.1 years) consisting of 43.3% never smokers, 20.9% former smokers, and 35.6% current smokers were investigated. Results: The frequency of both Met/Met genotype and Met allele was significantly increased in current and in former smokers when compared to never smokers (χ 2 = 10.856, df = 2, p = 0.004 and χ 2 = 4.350, df = 1, p = 0.045, respectively). Conclusions: Our results suggest that humans who carry the Met allele of the BDNF missense polymorphism might be more vulnerable to initiate and also maintain smoking

Molecular and cellular dissection of NMDA receptor subtypes as antidepressant targets

A growing body of evidence supports the idea that drugs targeting the glutamate system may represent a valuable therapeutic alternative in major depressive disorders (MDD). The rapid and prolonged mood elevating effect of the NMDA receptor (NMDAR) antagonist ketamine has been studied intensely. However, its clinical use is hampered by deleterious side-effects, such as psychosis. Therefore, a better understanding of the mechanisms of the psychotropic effects after NMDAR blockade is necessary to develop glutamatergic antidepressants with improved therapeutic profile. Here we review recent experimental data that addressed molecular/cellular determinants of the antidepressant effect mediated by inactivating NMDAR subtypes. We refer to results obtained both in pharmacological and genetic animal models, ranging from global to conditional NMDAR manipulation. Our main focus is on the contribution of different NMDAR subtypes to the psychoactive effects induced by NMDAR ablation/blockade. We review data analyzing the effect of NMDAR subtype deletions limited to specific neuronal populations/brain areas in the regulation of mood. Altogether, these studies suggest effective and putative specific NMDAR drug targets for MDD treatment

Association of a functional BDNF polymorphism and anxiety-related personality traits

Rationale: Converging lines of evidence point to brain-derived neurotrophic factor (BDNF) as a factor in the pathophysiology of depression. Recently, it was shown that the Val allele of the BDNF Val66Met substitution polymorphism showed a significant association with higher mean neuroticism scores of the NEO-Five Factor Inventory (NEO-FFI) in healthy subjects, and previous studies suggested the Val allele to be increased in bipolar disorder families. The association to anxiety-related traits has not been investigated so far. Methods: We tested a total of 343 unrelated subjects of German descent (171 male, 172 female, age: 39.0±14.6 years) who were carefully screened for psychiatric health. The self-ratable State-Trait Anxiety Inventory (STAI), which allows anxiety to be quantified as a comparatively stable personality trait, and the NEO-Five Factor Inventory (NEO-FFI) was applied. Results: In the trait-related anxiety score, a significant (F=3.2, df=2, p<0.042) effect of the genotype was observed with higher levels of trait anxiety in Val/Val (35.0±7.4) compared to Val/Met (33.4±6.5) and Met/Met (32.0±4.6) genotypes. The NEO neuroticism scores were also higher in Val/Val (29.5±7.0) than in Val/Met (28.4±6.5) or Met/Met (26.8±5.8) genotype, but not at a significant rate. Conclusions: Our findings support the hypothesis that anxiety- and depression-related personality traits are associated with the BDNF polymorphism although the explained variance is low