Aim of the Study The aim of this paper was to describe and trace the development of the "hysterical character" and the etiology of the concept of hysteria on the basis of the individual editions of Emil Kraepelin's psychiatry textbooks and to discuss the social, methodological and scientific factors influencing it. Methodology The 8 chapters about hysteria in the 1st to the 8 th edition of Kraepelin's psychiatry textbook (published from 1883 to 1915) were analyzed, compared and examined for changes and their motivations for change. Results In all 8 editions, hysteria was attributed to a predisposition- related genesis, which had to be activated by external stimuli (e.g., from the sexual organs), with the degree of severity of the necessary stimuli depending on the degree of predispositionn. In the 6 th edition, the immediate causes of the symptoms were described as "strongly emotional ideas", following Paul Julius M & ouml;bius' views. In the 8 th edition, Kraepelin added that this emotive process could be traced back to "phylogenetically ancient protective mechanisms" that could manifest themselves due to developmental inhibitions. The "hysterical character" essentially contained the criteria of the "histrionic personality disorder" conceptualized much later in psychiatry, but was expanded, especially in the 5 th and 8 th editions, to include numerous contradictory, socially stigmatizing behaviours. Conclusion The research principle of empirical-clinical psychiatry, the theory of degeneration and the nosological and etiological convictions of M & ouml;bius, a colleague who stood close to Kraepelin and demonstrably influenced his entire work, can now also be shown to have had an influence on his concept of hysteria. In addition, the social upheavals resulting from the women's movement, stereotypical ideas of femininity and Ernst Haeckel's "Biogenetic Principle" appear to have had a particular influence on his concept of hysteria.
Background The treatment of substance use disorders (SUD) remains a persistent challenge. Dialectical behavior therapy (DBT) is a multimodal cognitive-behavioral treatment approach that integrates acceptance- and change-oriented strategies and was originally developed to address severe emotion dysregulation. In the context of SUD, DBT-based adaptations and skills-oriented formats are particularly used to target emotion regulation, distress tolerance, mindfulness and relapse prevention. Aim: The aim of this review was to synthesize the current state of research in order to explore and evaluate the use and effectiveness of DBT-based interventions for SUD. Methods A systematic literature search in databases, Google Scholar and Semantic Scholar identified 13 relevant studies from the period 2010 to 2024, which were narratively synthesized. Results Despite methodological limitations, the findings suggested that the DBT-based formats used, in particular DBT skills training (DBT-ST), might improve emotion regulation, distress tolerance and adaptive coping strategies. Additionally, there was evidence for beneficial effects on substance use, abstinence and craving. Furthermore, several findings suggested promising treatment acceptance and adherence, although these results depended on the context and study design. Conclusions Overall, it can be concluded that DBT-ST, in particular, may be a suitable intervention option for individuals with SUD. However, further robust studies with standardized diagnostic procedures, longer follow-up periods and active control groups are needed to more precisely determine its specific efficacy and indications.
Deprescribing is the process of pharmacotherapy optimization by dose reduction or discontinuation of medications. Deprescribing is of high clinical relevance in geriatric psychiatry. The reduction of psychotropic medications is possible in the majority of cases and can improve quality of life. Guidance in deprescibing is provided by lists of potentially inappropriate medications (PIM), guidelines and specific deprescribing tools, although the necessary risk-benefit analysis and individualized case assessment cannot be replaced. An essential prerequisite for a successful deprescribing process is transparent communication with patients and relatives about benefits and risks and the individualized case management. This review summarizes available deprescribing recommendations in the field of geriatric psychiatry from relevant guidelines, PIM lists and specific deprescribing tools.
Diagnostics of polyneuropathies Polyneuropathies are a heterogeneous group of peripheral nerve disorders with diverse causes and phenotypes. Structured, phenotype-oriented diagnostics are important for reliably identifying common and treatable triggers such as diabetes, alcohol, vitamin deficiency, or medication, and for distinguishing them from immune-mediated, paraneoplastic, or genetic neuropathies. Medical history, clinical examination, and electrophysiology usually provide the decisive clues. In addition, basic laboratory diagnostics, targeted immunological tests, and modern genetics are used for selected indications-such as for the question of sorbitol dehydrogenase (SORD) mutations and repeat expansion of replication factor C 1 (RFC1). Nerve ultrasound and biopsy have selected indications. Entities such as immune checkpoint inhibitor (ICI)-associated neuropathies and nitrous oxide induced myeloneuropathy are gaining in importance. Age-related physiological changes must always be taken into account.
ZUSAMMENFASSUNG Für die Behandlung der frühen symptomatischen Alzheimer-Krankheit (AD) steht seit 2025 mit Donanemab eine neue Antikörpertherapie zur Verfügung. In der Zulassungsstudie TRAILBLAZER-ALZ 2 verlangsamte Donanemab gegenüber Placebo bei z.T. vorbestehender oraler Antidementiva-Therapie den kognitiven und funktionellen Abbau bei Patienten mit leichter kognitiver Störung infolge der Alzheimer-Krankheit (MCI-AD) und leichter AD-Demenz. Entsprechend dem Verständnis der Alzheimer-Krankheit als klinisches Kontinuum erfolgte die europäische Zulassung für beide Krankheitsstadien gemeinsam. Die nationale Zusatznutzenbewertung durch den Gemeinsamen Bundesausschuss (GBA) und das Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen (IQWiG), Grundlage für die Preisfindung, erforderte hingegen eine nach Krankheitsstadium getrennte Bewertung von Donanemab gegenüber dem deutschen Versorgungsstandard: Placebo (Best-Supportive-Care) bei MCI-AD und Acetylcholinesterase-Inhibitoren (AChE-I) bei leichter AD-Demenz; einen Zusatznutzen erkannte der GBA jeweils nicht an. Die Divergenz zwischen Zulassungsentscheidung und Zusatznutzenbewertung auf Basis derselben Evidenz wird seitdem kontrovers diskutiert und führt zu Unsicherheit hinsichtlich der klinischen Relevanz der Therapie. Ziel der Arbeit ist es, die Ursachen der unterschiedlichen Bewertungen aufzuarbeiten und die Evidenzbasis klinisch einzuordnen. Hierzu werden die methodischen Anforderungen und vergleichenden klinischen Daten der Zusatznutzenbewertung der Zulassungsbewertung gegenübergestellt. Die Analyse zeigte, dass die klinischen Effekte – getrennt nach MCI-AD und leichter AD-Demenz, und erfasst anhand der post-hoc an die IQWiG-Methodik angepassten Endpunkte – trotz Powerverlusts inhaltlich konsistent sind mit den Ergebnissen der prädefinierten Endpunkte aus der Zulassungsbewertung der Gesamtpopulation. Die Nichtanerkennung eines Zusatznutzens durch den GBA beruhte maßgeblich auf Unsicherheiten hinsichtlich der Repräsentativität der MCI-AD-Population sowie der Robustheit der Effektschätzer bei leichter AD-Demenz. Eine nachträgliche Sensitivitätsanalyse des Herstellers auf Basis einer enger gefassten MCI-AD-Definition bestätigte die positiven Effekte von Donanemab gegenüber Placebo. Zusammenfassend ist ein nicht belegter Zusatznutzen nicht mit einem fehlenden Wirksamkeitsnachweis gleichzusetzen, sondern Ausdruck einer von der Zulassung abweichenden Fragestellung, Methodik und Bewertungslogik. Aus klinischer Sicht sprechen die konsistenten Effekte dafür, dass Patienten in der Indikation unabhängig vom frühen symptomatischen Stadium und einer bestehenden AChE-I-Behandlung von Donanemab profitieren können.
