Differential diagnostics of acute and acute transient psychotic disorders. Diagnostic criteria and epidemiology: After an overview of the historical development of the diagnostic categories for acute (transient) psychotic disorders (ATPS), validity and stability of the current diagnostic criteria and their effects on epidemiology and upcoming development of ICD 11 are discussed. Differential diagnostic considerations for ATPS are dealt with in the following sections: Pharmacological causes: For the substanceinduced psychotic disorders that are frequently encountered in medical consultations, the most common medications are listed in a table. Common physical causes: From this list, some typical causes are explained in more detail, including endocrine disorders, organic brain changes after trauma and in neurodegenerative processes such as dementias and demyelinating processes. Metabolic causes: Hereditary neurometabolic disorders are listed and the most important ones are discussed as an example of rare but important causes of psychotic symptoms due to their potential treatability: urea cycle disorders, porphyria, Mb. Wilson, Mb. Niemann-Pick type C. Clinical key symptoms, special examinations and treatment are discussed. Inflammatory processes: In inflammatory diseases, the focus is on autoimmune encephalopathies, which have become increasingly important in recent years, in particular because up to 80% of these patients are primarily admitted to a psychiatric facility. Because only a limit ed number of antibodies are currently known and MRI and CSF examinations can sometimes remain without findings a detailed medical history and exact clinical observation are of particular importance in these cases. Finally, diagnostic work up and procedures for clarifying these sometimes unclear clinical conditions are discussed, followed by recommendations for CSF examination and treatment. J Neurol Neurochir Psychiatrie 2021; 22 (1): 18–29.
Case Report: Erdheim-Chester disease. Erdheim-Chester disease (ECD) is a rare non-Langerhans histiocytosis with possible manifestation in multiple organ systems. Only few cases are described in literature. The following case report presents a 54-year-old female patient with CNS dominant form of ECD, in whom the disease manifested itself as an intracranial tumor with neurological symptoms like gait disturbance, ataxia, dysarthria and dizziness. The suspected diagnosis was a meningioma with compression of the cerebellum. After tumor resection of the intracranial tissue, the histopathological diagnosis was Erdheim-Chester disease. As it is frequently for this disease, the patient also presented a perinephritic infiltration and a central diabetes insipidus. Postoperative the neurological symptoms did not decrease, further manifestations of the disease could not be detected in the following examinations. The patient was referred to a specialized unit for further treatment with vemurafenib if the BRAF mutation was positive. J Neurol Neurochir Psychiatrie 2020; 21 (2): 72–3.
Neuroimaging in the forensic context – possibilities and limitations. In recent years, an increasing number of neuroimaging studies has resulted in a wide range of methodolo gies probably allowing to decode the human brain and to translate imaging results into legal contexts. Suggested applications include diagnostic procedures and evaluation of therapy for psychiatric disorders, gain of scientific knowledge or detection of deception. Among numerous neuroimaging methods, magnetic resonance imaging (MRI) seems to be the most promising technique, given its insignificant side effects. Using MRI, both structural as well as functional measurements can be conducted. In particular, functional MRI techniques for lie detection have been investigated and developed within the last years. Despite substantial neuroscientific advances, neuroimaging methods have not been established during legal proceedings. Most notably, imaging results are not reflective of human behavior in real life situations or determining offending behaviour. Furthermore, internationally accepted medical or legal guidelines for implementation of current methods or standards of quality have not been defined yet. In this article neurobiological basics as well as recent studies are presented and possible applications and limitations within the legal context are discussed. In general, validation and replication of existing results as well as an adequate translation between neurobiological results and the legal system is crucial for the application of neuroimaging in the forensic field. J Neurol Neurochir Psychiatr 2019; 20 (1): 25–33.
Auricular Vagus nerve stimulation (Auristim) and alcohol craving, measured by pupillometry – a pilot study. Aims: Aim was to investigate the reaction of the pupil to tropicamide in alcohol withdrawal, before and after percutaneous auricular vagus nerve stimulation with AuriStim. Method: In a prospective study, 30 patients were investigated for alcohol withdrawal. All patients were in inpatient care. The TEMPS-M short version captured the emotional attitude of the patients. With the OCD-scale and a visual 10cm scale, the alcohol demand of the patients was raised. The patients were treated with the standardized medication for alcohol withdrawal and additionally received a three-day percutaneous auricular stimulation of the vagus nerve. On the first and last day, the patients were measured pupilometrically with a receptor test. The averages were compared with the t-test for paired samples. Results: The difference between the mean differences on both days of the test is high significant. The Temps-M expression of the temperaments shows no effects on the measured values of pupillometry. No correlation could be found between indicated alcohol cravings in the scales and pupil diameter. Limitations: The patients were compared with themselves in the form of repeated measure ments, there is no control group of patients without stimulation. Conclusion: The parasympathetic activation by AuriStim in alcohol withdrawal may be useful to accelerate the balance of the autonomic nervous system. J Neurol Neurochir 2019; 20 (3): 106–10.
