BackgroundThis study examined whether the COVID-19 pandemic produced diagnosis-specific and cross-nationally reproducible alterations in psychiatric admissions, or whether observed variations primarily reflected organizational responses. We compared psychiatric inpatient services from Austria and Germany—two hospital-centered systems with similar pre-pandemic structures—and used Italy as a contrasting community-based model.MethodsWe conducted a retrospective multicenter observational study including all psychiatric hospitalizations between 2017 and 2020. Temporal admission trends were analyzed bi-weekly for each ICD-10 diagnostic group. Generalized Linear Models (Poisson family) were used to model the effects of Diagnosis, Year (2020 vs. pre-2020), Week, and Country, and their interactions. Diagnostic categories were grouped following ICD-10, with F10 (alcohol-related disorders) analyzed separately from other substance-use disorders to capture differences between planned and emergency admissions.ResultsAcross Austria and Germany, 2020 was associated with a marked temporal distortion in admission patterns compared with previous years (Week × Year interaction, p < 0.05), consistent across diagnoses except for F10. Alcohol-related disorders showed country-specific trajectories, reflecting service reorganization—bed closures in Austria versus stable capacity in Germany. No other diagnosis exhibited reproducible temporal deviations across countries, indicating that the pandemic affected admission organization rather than disorder-specific psychopathology. A supplementary comparison including Italy showed that, while Austria and Germany experienced a decline in total hospitalizations (−16 and −10%, respectively), Italy remained stable (+12%), suggesting greater resilience of its community-based system.ConclusionThe pandemic did not induce diagnosis-specific increases in acute psychiatric admissions but substantially altered their temporal organization. Differences across countries highlight how healthcare structure—particularly the integration of territorial and inpatient services—modulates system resilience under crisis conditions.

Zusammenfassung Der Beitrag analysiert eine Szene aus dem Länderspiel Deutschland–Italien (2025), in der es zu einem kuriosen Gegentor kam, und interpretiert diese mithilfe der Kommunikationstheorie Paul Watzlawicks. Im Zentrum steht die Beobachtung, dass kulturelle Unterschiede in der nonverbalen Kommunikation – etwa in Bezug auf Näheverhalten, Aufmerksamkeitssteuerung und situatives Handlungstiming – zu realen Konsequenzen führen können. Die Szene dient als Beispiel für eine nicht geteilte Wirklichkeitskonstruktion im interkulturellen Kontext und wird auf ihre Relevanz für psychiatrische und psychotherapeutische Interaktionen hin diskutiert.

Dementia is a terminal illness and places significant burden on individuals and their caregivers, especially regarding end-of-life decisions for people with dementia (PwD) who lose their decision-making capacity. Current advance healthcare planning concepts fail to consider the psychological processes of decision making. Supported Advance Care Decision-Making (ACD) is a promising approach aiming to enrich existing advance healthcare planning concepts by integrating empowering support strategies and ensuring the success of empowerment. The study aims at providing a feasible and effective approach to enhance ACD in dementia care practice with the goal to increase PwD’s autonomy in making advance care and end-of-life decisions and to reduce proxy burden. It is embedded within Dementia Care Management (DeCM), a routine care measure specifically designed for PwD who live at home. The efficacy of supported ACD incorporated in DeCM routine care will be investigated with a single-blind randomized controlled trial. The primary endpoints are the prevalence and validity of advance healthcare planning documents (advance directives or other) and proxy burden at pre vs. post measurement. The secondary endpoints are decisional conflict, patient autonomy, and patient-proxy congruence in preferences. Depending on the results, supported ACD shall be added to the curriculum of DeCM to further increase its effectiveness. DRKS00036478, 17.04.2025.

The COVID-19 pandemic has posed significant challenges to healthcare systems worldwide. Psychiatric patients appear to be particularly affected by the pandemic and the lockdown measures in Germany. There is limited knowledge about the impact on psychiatric emergencies in emergency departments (EDs) from the onset of the pandemic until the initial relaxations in 2022. This study investigates the impact on psychiatric emergencies in an interdisciplinary ED during the various phases of the pandemic.A retrospective analysis was conducted of all psychiatric emergency contacts in an interdisciplinary ED of a general hospital in a German metropolitan city. The study period covered from January 1, 2019, to December 31, 2022. Significant changes in case numbers were observed depending on the different phases of the pandemic. Neurotic, stress-related, and somatoform disorders (ICD-10 F4) showed the most substantial and significant decrease in case numbers until 2021 among all primary diagnoses. The admission rate significantly increased in 2021 and declined the following year.The different phases of the pandemic had significant impacts on psychiatric emergency patients in an ED, particularly the altered diagnostic spectrum, leading to changed demands. The increased admission rate can be interpreted as an indicator of worsening psychopathological severity. The results of this study indicate that access to the healthcare system for psychiatric patients must be ensured and considered in health policy decisions, even during a pandemic.

Die COVID-19-Pandemie hat weltweit erhebliche Herausforderungen für Gesundheitssysteme mit sich gebracht. Besonders psychiatrische Patient:innen in Deutschland scheinen von der Pandemie und den Lockdown-Maßnahmen stark betroffen zu sein. Über die Auswirkungen auf psychiatrische Notfälle in Zentralen Notaufnahmen mit Beginn der ersten Lockerungen im Jahr 2022 ist bisher wenig bekannt. Die Studie untersucht die Auswirkungen auf psychiatrische Notfälle in einer interdisziplinären ZNA während der verschiedenen Phasen der Pandemie. Es wurde eine retrospektive Untersuchung aller psychiatrischen Notfallkontakte in einer interdisziplinären ZNA eines Allgemeinkrankenhauses in einer deutschen Großstadt durchgeführt. Der untersuchte Zeitraum umfasste den gesamten Zeitraum vom 1.1.2019 bis zum 31.12.2022. In Abhängigkeit der verschiedenen Phasen der Pandemie zeigten sich deutliche Veränderungen der Fallzahlen. Unter allen Hauptdiagnosen zeigten die Neurotische, Belastungs- und somatoforme Störung (ICD-10 F4) bis 2021 einen signifikanten Rückgang der Fallzahlen. Die Aufnahmerate stieg signifikant im Jahr 2021 und fiel im Folgejahr. Die unterschiedlichen Phasen der Pandemie hatten deutliche Auswirkungen auf psychiatrische Notfallpatient:innen in einer ZNA hinsichtlich Diagnosespektrum und Fallzahlen. Die erhöhte Aufnahmerate wurde als Indikator für eine Zunahme der Krankheitsschwere interpretiert. Die Ergebnisse dieser Studie zeigen, dass der Zugang zum Gesundheitssystem auch während einer Pandemie für psychiatrische Patient:innen sichergestellt und in gesundheitspolitischen Entscheidungen berücksichtigt werden muss.

INTRODUCTION:Theoretically, the procedural risk of electroconvulsive therapy (ECT) could be increased in the presence of undetected aneurysms due to the hemodynamic changes associated with ECT. However, empirical evidence is limited to few individual case reports and case series. METHODS:We performed a systematic review of available evidence on ECT treatment in patients with intracranial aneurysms and untreated aortic aneurysms and we retrospectively analyzed data from 252 consecutive patients referred for ECT at the Department of Psychiatry, Psychotherapy and Psychosomatics of Siegen Hospital, Germany, who received magnetic resonance angiographies and abdominal sonographies as part of their routine pre-ECT workup. RESULTS:Of 252 patients referred for ECT, 5 (2.0%) were found to have an intracerebral aneurysm and 1 (0.4%) was found to have an abdominal aortic aneurysm. These cases are reported in detail together with 2 additional cases of aortic aneurysms from the Central Institute of Mental Health, Mannheim, Germany. Electroconvulsive therapy was performed without complications in all 8 cases. CONCLUSIONS:Aneurysms might occur in ECT patients at a similar rate as in the general population. The number of ECTs performed annually in mostly unscreened patients suggests that there might be a significant number of patients with undetected aneurysms in whom ECT is performed without reported complications.

Zusammenfassung Ziel der Studie Es gibt Hinweise, dass sich der Klimawandel, verbunden mit einer Zunahme der Häufigkeit und Schwere von Hitzeperioden, negativ auf die psychische Gesundheit auswirkt. Das Ziel dieser Studie war es, mögliche Zusammenhänge zwischen hohen Temperaturen und der Inanspruchnahme einer ZNA durch Menschen mit psychischen Erkrankungen zu untersuchen. Methodik Es wurde eine retrospektive Analyse aller psychiatrischen Notfallpatienten im Zeitraum von 2015 bis 2022 (N=15478) durchgeführt und den lokalen Temperaturdaten gegenübergestellt. Ergebnisse Während Hitzeperioden stellten sich mehr psychiatrische Notfallpatienten in der ZNA vor. Schlussfolgerung Bis auf eine erhöhte Vorstellungsrate während Hitzeperioden konnten in unserer Stichprobe keine weiteren signifikanten Auswirkungen von Hitze auf psychiatrische Notfälle gefunden werden. Dies steht im Widerspruch zu Ergebnissen anderer Studien. Andere systemische Einflüsse, wie die Inanspruchnahme der ZNA währen der Covid-19-Pandemie, konnten die Ergebnisse modifizieren.

Introduction Theoretically, the procedural risk of electroconvulsive therapy (ECT) could be increased in the presence of undetected aneurysms due to the hemodynamic changes associated with ECT. However, empirical evidence is limited to few individual case reports and case series. Methods We performed a systematic review of available evidence on ECT treatment in patients with intracranial aneurysms and untreated aortic aneurysms and we retrospectively analyzed data from 252 consecutive patients referred for ECT at the Department of Psychiatry, Psychotherapy and Psychosomatics of Siegen Hospital, Germany, who received magnetic resonance angiographies and abdominal sonographies as part of their routine pre-ECT workup. Results Of 252 patients referred for ECT, 5 (2.0%) were found to have an intracerebral aneurysm and 1 (0.4%) was found to have an abdominal aortic aneurysm. These cases are reported in detail together with 2 additional cases of aortic aneurysms from the Central Institute of Mental Health, Mannheim, Germany. Electroconvulsive therapy was performed without complications in all 8 cases. Conclusions Aneurysms might occur in ECT patients at a similar rate as in the general population. The number of ECTs performed annually in mostly unscreened patients suggests that there might be a significant number of patients with undetected aneurysms in whom ECT is performed without reported complications.

OBJECTIVE:There is evidence suggesting that climate change, coupled with an increase in the frequency and severity of heatwaves, affects mental health. The aim of this study was to investigate potential associations between high temperature and the utilization of an emergency department (ED) by individuals with psychiatric disorders. METHODS:A retrospective analysis of all psychiatric emergency patients from 2015 to 2022 (N=15478) was conducted and compared with local temperature data. RESULTS:Particularly during heatwaves, more psychiatric emergency patients presented to the ED. CONCLUSION:Beyond the results identified during heatwaves, our extensive analysis of the examined ED revealed no additional significant effects of heat on psychiatric emergencies. This contradicts findings from other studies. Other systemic influences, such as the utilization of the ED during the Covid-19 pandemic, could have modified the results.

The UN Convention on the Rights of Persons with Disabilities, and the reformed guardianship law in Germany, require that persons with a disability, including people with dementia in Alzheimer’s disease (PwAD), are supported in making self-determined decisions. This support is achieved through communication. While content-related communication is a deficit of PwAD, relational aspects of communication are a resource. Research in supported decision-making (SDM) has investigated the effectiveness of different content-related support strategies for PwAD but has only succeeded in improving understanding, which, although one criterion of capacity to consent, is not sufficient to ensure overall capacity to consent. The aim of the ‘spatial intervention study’ of the DECIDE project is to examine an innovative resource-oriented SDM approach that focuses on relational aspects. We hypothesise that talking to PwAD in their familiar home setting (as opposed to a clinical setting) will reduce the complexity of the decision-making process and enhance overall capacity to consent. People with a suspected or confirmed diagnosis of dementia in Alzheimer’s disease will be recruited from two memory clinics (N = 80). We will use a randomised crossover design to investigate the intervention effect of the decision-making place on capacity to consent. Besides reasoning capacity, which is part of overall capacity to consent and will be the primary outcome, various secondary outcomes (e.g., other aspects of capacity to consent, subjective task complexity, decisional conflict) and suspected moderating or mediating variables (e.g., meaning of home, demographic characteristics) will be assessed. The results of the study will be used to develop a new SDM strategy that is based on relational resources for PwAD. If a change in location achieves the anticipated improvement in capacity to consent, future research should focus on implementing this SDM strategy in a cost-effective manner in clinical practice. Trial registration: DRKS00030799 .

Background It is estimated that around 21 million patients are treated in emergency rooms (ERs) in German hospitals every year. The psychiatric emergency alone accounts for about 5-10%. At this point in time, there is little knowledge of typical characteristics related to admission status (treated as outpatients or admitted as inpatients). Objectives The aim of this study was to support the decision-making process for further treatment especially for paramedics and ER staff. Materials and methods We undertook a retrospective examination of all psychiatric emergency patients presenting to an emergency room at a general hospital in the year 2015. The patients had to be at least 18 years old. We included only patients who were brought to the emergency room by the rescue and fire department. Results Overall, patients who presented to the ER by paramedics or emergency physicians made up to 29.4% of all psychiatric emergency contacts. Over two thirds of the patients were admitted to the hospital. The most frequent presentation was caused by psychotropic substances (F1), followed by schizophrenia (F2) and organic mental disorders (F0). The most common diagnosis of patients treated only on an outpatient basis was the F4 spectrum (neurotic, stress-related and somatoform disorders), followed by F1 and affective disorders (F3). Patients under the age of 25 were more likely to receive outpatient treatment. Furthermore, 96.5% of the admitted patients met the criteria of being a psychiatric emergency. Conclusion The patient presented by the rescue service is of high relevance within the psychiatric emergency cohort. Patients treated as outpatients or admitted as inpatients show clearly different characteristics. The high proportion of patients who met emergency criteria makes the syndromic severity of the patients presented by emergency services clear.

BACKGROUND:In emergency departments, patients with mental health conditions are a major concern and make up the third or fourth of the most common diagnosis seen during all consultations. Over the past two decades, there has been a noticeable rise in the number of cases, particularly due to an increase in nonurgent visits for somatic medical issues. The significance of nonurgent visits for psychiatric patients is yet to be determined. This study aims to uncover the significance and identify the characteristics of this group.METHODS:A retrospective analysis of psychiatric emergency visits at an interdisciplinary emergency department of a German general hospital in 2015 was conducted. For this purpose, patient records were reviewed and evaluated. An analysis was conducted based on the German definition of psychiatric emergencies according to the German guidelines for emergency psychiatry.RESULTS:A total of 21,124 emergency patients visited the evaluated Emergency Department. Of this number, 1,735 psychiatric patient records were evaluated, representing 8.21% of the total population. Nearly 30% of these patients did not meet any emergency criteria according to German guidelines. Significant differences were observed between previously treated patients and those presenting for the first time.CONCLUSIONS:The high proportion of nonurgent psychiatric patients in the total volume of psychiatric emergency contacts indicates a possible control and information deficit within the emergency system. Just as prior research has emphasized the importance of investigating nonurgent somatic medical visits, it is equally imperative to delve into studies centered around psychiatric nonurgent presentations.

OBJECTIVE:The current coronavirus pandemic (Covid-19 disease) poses major challenges to healthcare systems worldwide. The aim of this work was to identify the impact on psychiatric emergency presentations in an ED during the implemented lockdown.METHODS:A retrospective survey of all psychiatric emergency presentations in the ED during the lockdown was conducted. The same period in 2019 served as the reference year.RESULTS:There was a decrease in psychiatric patients. Changes were observed in the age and diagnoses.CONCLUSION:Some clear effects of the lockdown on psychiatric emergencies in an ED setting can be described. However, the changes were smaller than in other countries with other health care systems.

Everybody has the right to decide whether to receive specific medical treatment or not and to provide their free, prior and informed consent to do so. As dementia progresses, people with Alzheimer’s dementia (PwAD) can lose their capacity to provide informed consent to complex medical treatment. When the capacity to consent is lost, the autonomy of the affected person can only be guaranteed when an interpretable and valid advance directive exists. Advance directives are not yet common in Germany, and their validity is often questionable. Once the dementia diagnosis has been made, it is assumed to be too late to write an advance directive. One approach used to support the completion of advance directives is ‘Respecting Choices’®—an internationally recognised, evidence-based model of Advance Care Planning (ACP), which, until now, has not been evaluated for the target group of PwAD. This study’s aims include (a) to investigate the proportion of valid advance directives in a memory clinic population of persons with suspected AD, (b) to determine the predictors of valid advance directives, and (c) to examine whether the offer of ACP can increase the proportion of valid advance directives in PwAD. We intend to recruit at least N = 250 participants from two memory clinics in 50 consecutive weeks. Of these, the first 25 weeks constitute the baseline phase (no offer of ACP), the following 25 weeks constitute the intervention phase (offer of ACP). The existence and validity of an advance directive will be assessed twice (before and after the memory clinic appointment). Moreover, potential predictors of valid advance directives are assessed. The results of this study will enhance the development of consent procedures for advance directives of PwAD based on the ACP/Respecting Choices (R) approach. Therefore, this project contributes towards increasing the autonomy and inclusion of PwAD and the widespread acceptance of valid advance directives in PwAD. Trial Registration DRKS, DRKS00026691, registered 15th of October 2021, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML TRIAL_ID=DRKS00026691

BACKGROUND:Psychiatric emergency patients have great relevance in the interdisciplinary emergency department. Emergency physicians in this setting often have to make decisions under time pressure based on incomplete information regarding the patient's further treatment. The aim of this study was to identify possible predictors associated with an increased likelihood of inpatient psychiatric admission.METHODS:A retrospective cross-sectional study of all psychiatric emergency contacts in an interdisciplinary emergency department (ED) of a general hospital in a large German city was conducted for 2015. A binary regression analysis was performed to identify possible predictors.RESULTS:In 2015, a total of 21421 patient contacts were reported in the emergency department, of which 1733 were psychiatric emergencies. Psychiatric emergency was the fourth most common cause presenting to the ED. The most common diagnosis given was mental and behavioral disorders due to the use of psychotropic substances (F1). Factors associated with an increased probability of inpatient psychiatric admission were previously known patients, patients under a legal care order (guardianship), and previous outpatient medical contact. No association for gender or age was found. Data demonstrated a negative relationship between a neurotic, stress-related and somatoform disorder diagnosis and admission.CONCLUSIONS:The present study shows some significant characteristics associated with an increased likelihood of emergency admission. Independent of the health care system, the predictors found seem to be relevant with regard to the probability of admission, when compared internationally. To improve the treatment of patients in emergency units, these factors should be taken into account.

Zusammenfassung Ziel der Studie Die aktuelle Coronaviruspandemie (COVID-19-Erkrankung) stellt die Gesundheitssysteme weltweit vor große Herausforderungen. Speziell psychiatrische Patienten sind in besonderer Weise von Lockdown-Maßnahmen betroffen. Die Häufigkeit psychiatrischer Notfälle ist ein sensibler Indikator für die psychische Belastung. Das Ziel dieser Arbeit war die Identifizierung von Auswirkungen während des durchgeführten Lockdowns auf psychiatrische Notfallvorstellungen. Methodik Es erfolgte im Jahr 2021 eine retrospektive Erhebung aller psychiatrischen Notfallkontakte in der ZNA. Das Jahr 2019 diente als Referenzjahr. Ergebnisse Es fand sich ein Rückgang der psychiatrischen Fallzahlen. Des Weiteren konnte eine Veränderung in der Altersstruktur und der Diagnoseverteilung beschrieben werden. Schlussfolgerung Es lassen sich z. T. deutliche Auswirkungen durch den Lockdown auf psychiatrische Notfälle im Setting einer Notaufnahme beschreiben. Entgegen der Hypothese fielen die Fallzahlen.

Zusammenfassung Ziel der Studie Charakterisierung psychiatrischer Notfallkontakte in einer interdisziplinaren Zentralen Notaufnahme. Methodik Retrospektive Untersuchung aller direkt aus der Notaufnahme stationar aufgenommenen Patienten des Behandlungsjahres 2015. Ergebnisse Die drei haufigsten Notfallsyndrome konnten in absteigender Reihenfolge der F1- (32,2 %), den F2- (25,9%) und den F3-Haupdiagnosen (21,2%) zugeordnet werden. Die Aufnahmequote lag bei 58,8%, und mehr als die Halfte der Patienten kam fu ss laufig in die ZNA (55,7%). Es fanden sich diagnosespezifische Unterschiede zwischen Erstvorstellern und bekannten Patienten. Schlussfolgerung Der psychiatrische Notfall hat eine hohe Relevanz in diesem Setting. Ein Gro ss teil der stationar aufgenommenen Patienten erfullen die Notfallkriterien entsprechend der Leitlinie. Abstract Objectives Evaluation of psychiatric emergency contacts in an interdisciplinary emergency room. Methods We conducted a retrospective examination of all psychiatric consultations of 2015. Results The three most common emergency syndromes could be assigned in descending order to the F1 (32.2%), the F2 (25.9%) and the F3 diagnoses (21.2%). The admission rate was 58.9% and more than half of the patients came to the emergency room on foot (55.7%). Diagnosis-specific differences were found between first-time presenters and patients who had presented previously. Conclusion The psychiatric emergency has high relevance in the emergency room. The majority of the patients admitted to hospital meet the emergency criteria according to the guideline.

Zusammenfassung Ziel der Studie Das Wissen zu psychiatrischen Patienten in interdisziplinaren Notaufnahmen ist bundesweit gering. Mit dieser Studie sollte eine Charakterisierung von ambulant verbliebenen psychiatrischen Notfallpatienten in einer interdisziplinaren Zentralen Notaufnahme erfolgen. Methodik Es wurde eine retrospektive Untersuchung aller ambulant verbliebenen psychiatrischen Notfallkontakte im Jahr 2015 durchgefuhrt. Ergebnisse Die F4-Hauptdiagnose machte bei allen ambulant verbliebenen Erstvorstellungen 48,1% der Diagnosen aus. Weibliche Patienten unter 25 Jahre nahmen die Zentrale Notaufnahme doppelt so haufig in Anspruch als ihre mannliche Vergleichsgruppe. Ungefahr 50% der Patienten erfullten keinerlei Notfallkriterien. Schlussfolgerung Das Inanspruchnahmeverhalten der untersuchten Patienten zeigte deutliche geschlechts- und altersspezifische Unterschiede. uberraschend hoch war der Anteil von Patienten ohne jegliches Notfallkriterium. Hier stellte sich die Frage, ob es ein Fehlinanspruchnahmeverhalten gab. Abstract Objective Scientific interest in emergency psychiatric patients has increased significantly over the last two decades. Nevertheless, current knowledge of this group of patients in the setting of an interdisciplinary emergency department is surprisingly low. Methods A retrospective examination of all ambulatory psychiatric emergency contacts in the emergency room of a regional hospital in 2015 took place. Results Solely F4 diagnoses accounted for 48.1% of all first-time patients. Female patients younger than 25 years used the ER twice as often as their male control-group. Almost half of all outpatients fulfilled no emergency criteria. Conclusion There are specific age and gender differences. The proportion of patients without any emergency criteria was surprisingly high. More scientific research is needed in order to scrutinize this possible inappropriate use of an ER by psychiatric patients.

Introduction Non-invasive brain stimulation techniques such as repetitive transcranial magnetic stimulation (rTMS) offer a promising alternative to psychotherapeutic and pharmacological treatments for depression. This paper aims to present a practical guide for its clinical implementation based on evidence from the literature as well as on the experience of a group of leading German experts in the field.Methods The current evidence base for the use of rTMS in depression was examined via review of the literature. From the evidence and from clinical experience, recommendations for the use of rTMS in clinical practice were derived. All members of the of the German Society for Brain Stimulation in Psychiatry and all members of the sections Clinical Brain Stimulation and Experimental Brain Stimulation of the German Society for Psychiatry, Psychotherapy, Psychosomatics and Mental Health were invited to participate in a poll on whether they consent with the recommendations.Findings Among rTMS experts, a high consensus rate could be identified for clinical practice concerning the setting and the technical parameters of rTMS treatment in depression, indications and contra-indications, the relation of rTMS to other antidepressive treatment modalities and the frequency and management of side effects.

Schätzungsweise werden jährlich ca. 21 Millionen Fälle in Notaufnahmen deutscher Krankenhäuser behandelt. Der psychiatrische Notfallkontakt macht hiervon allein ca. 5–10