: Objective: The situation of patient's relatives is still not broadly studied in psychiatry. Their needs are often overlooked. Method: We developed a digital questionnaire concerning the patient's sociodemographic, disease-related, and family-related data and had the patient's therapist fill it out. The patients included (N = 1766) were persons hospitalized on a selected date. Results: One-third of patients had at least one relative with mental illness, prior treatment, or need for treatment. The main diagnoses in relatives were affective, substance use, and somatoform disorders, often in concordance with their index patient. Teenage patients had the most affected relatives. The therapists of the minors included were better informed about their familial situation, whereas the therapists of the 30-59-year-olds knew the least. Conclusions: The comparably lower rate of affected relatives in adults stems most likely from underassessment and needs further investigation. Zusammenfassung: Fragestellung: Die Situation der Angeh & ouml;rigen von psychiatrischen Patienten wird noch immer nicht umfassend untersucht. Ihr Bedarf und ihre Bed & uuml;rfnisse werden oft nicht gesehen. Methodik: Ein digitaler Fragebogen zu soziodemografischen, krankheits- und familienbezogenen Daten des Patienten wurde entwickelt und vom Therapeuten des Patienten ausgef & uuml;llt. Eingeschlossen wurden alle Patienten (Gesamtstichprobe = 1766), die zu einem bestimmten Datum station & auml;r behandelt wurden. Ergebnisse: Ein Drittel der Patienten hatte mindestens einen Verwandten mit einer psychischen Erkrankung, einer Vorbehandlung oder einem Behandlungsbedarf. Die Hauptdiagnosen bei den Verwandten umfassten affektive, somatoforme und stoffgebundene St & ouml;rungen und waren oft deckungsgleich mit denen des Indexpatienten. Bei Jugendlichen war das Risiko f & uuml;r betroffene Angeh & ouml;rige am h & ouml;chsten. Therapeuten von Minderj & auml;hrigen waren besser & uuml;ber deren famili & auml;re Situation informiert, w & auml;hrend Therapeuten von 30-59-J & auml;hrigen am wenigsten wussten. Schlussfolgerung: Die niedrigere Rate betroffener Angeh & ouml;riger bei Erwachsenen ist h & ouml;chstwahrscheinlich auf eine Unterbewertung zur & uuml;ckzuf & uuml;hren und bedarf weiterer Untersuchungen.

IntroductionThe role of emotional dysregulation (ED) in attention-deficit/hyperactivity disorder (ADHD) has become an important issue. This study, in which we analyzed data from a predictive pharmaco-EEG-trial, aimed to examine whether symptoms of ED in adult ADHD affect ADHD symptom severity, brain arousal regulation as measured by resting EEG, and the response to stimulant medication.MethodsED is defined as having a sex- and age-corrected T-score of >70 on the emotional lability subscale of the German version of Conners’ Adult ADHD Rating Scale. A total of 115 participants were included in the study, 56 of whom had ED. Participants with ED were more impaired in terms of the severity of core ADHD symptoms, especially inattentive symptoms, comorbid depressive symptoms, interpersonal relationships, and quality of life. In addition, participants with ED were more likely to report a total score above 13 on the Beck Depression Inventory-II, which was considered to be the cutoff for mild depression.ResultsNo differences were found between the ED and non-ED groups in response to stimulant medication or in brain arousal regulation. In addition, there was no significant effect of ED with comorbid depressive symptoms on treatment response. There was a trend for subgroups that showed a change in brain arousal regulation associated with symptom improvement.DiscussionOur findings may support the assumption that ED may be an important feature of ADHD. The use of EEG-based brain arousal regulation as a diagnostic and predictive tool in ADHD in the presence of ED and comorbid depressive symptoms should be further investigated.

Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation treatment used as an alternative or complementary treatment for various neuropsychiatric disorders, and could be an alternative or add-on therapy to psychostimulants in attention-deficit hyperactivity disorder (ADHD). Previous studies provided some evidence for improvements in cognition and clinical symptoms in pediatric and adult ADHD patients. However, data from multi-center randomized controlled trials (RCTs) for this condition are lacking. Thus, our aim is to evaluate short- and mid-term effects of tDCS in this multi-center, randomized, double blind, and sham-controlled, parallel group clinical trial with a 1:1 randomization ratio. Primary endpoint is the total score of DSM-IV scale of the internationally established Conners’ Adult ADHD Rating Scales (German self-report screening version, CAARS-S-SR), at day 14 post-intervention (p.i.) to detect short-term lasting effects analyzed via analyses of covariance (ANCOVAs). In case of significant between-groups differences at day 14 p.i., hierarchically ordered hypotheses on mid-term lasting effects will be investigated by linear mixed models with visit (5 time points), treatment, treatment by visit interaction, and covariates as fixed categorical effects plus a patient-specific visit random effect, using an unstructured covariance structure to model the residual within-patient errors. Positive results of this clinical trial will expand the treatment options for adult ADHD patients with tDCS and provide an alternative or add-on therapy to psychostimulants with a low risk for side effects. Trial Registration The trial was registered on July 29, 2022 in the German Clinical Trials Register (DRKS00028148).

Attention deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder, characterized by core symptoms of inattention, hyperactivity and impulsivity. Comorbid depression is commonly observed in ADHD-patients. Psychostimulants are recommended as first-line treatment for ADHD. Aberrant long-range temporal correlations (LRTCs) of neuronal activities in resting-state are known to be associated with disorganized thinking and concentrating difficulties (typical in ADHD) and with maladaptive thinking (typical in depression). It has yet to be examined whether (1) LRTC occur in ADHD-patients, and if so, (2) whether LRTC might be a competent biomarker in ADHD comorbid with current depression and (3) how depression affects psychostimulant therapy of ADHD symptoms. The present study registered and compared LRTCs in different EEG frequency bands in 85 adults with ADHD between groups with ( n = 28) and without ( n = 57) additional depressive symptoms at baseline. Treatment-related changes in ADHD, depressive symptoms and LRTC were investigated in the whole population and within each group. Our results revealed significant LRTCs existed in all investigated frequency bands. There were, however, no significant LRTC-differences between ADHD-patients with and without depressive symptoms at baseline and no LRTC-changes following treatment. However, depressed ADHD patients did seem to benefit more from the therapy with psychostimulant based on self-report.

We report on a special case of suicide, which took place in near timely relationship to the broadcast of Sunday evening crime-tv-episode and copyed directly the therein displayed method of death. The problem of such presentations will be discussed either on behalf of the background of the german presscodex.

Background and Objectives: Involuntary hospital admissions and coercive measures are a long-lasting burden in psychiatry. Many efforts have been undertaken to diminish these wearing circumstances. With the Bochum "track system," which is structured in mental health teams across inpatient and outpatient clinics without any closed admission wards, we would like to present a new way of facing coercion. To examine the effects of establishing the so-called Bochum "`track system"' regarding the presumed reduction of coercive measures within a naturalistic, quantitative pre- and post- comparison. Methods: Routine data on coercive measures (involuntary admissions, mechanical restraints, compulsory medications, one-to-one care) from two years of treatment (2011, 2017) are compared (N = 257 involuntary admissions) before and after the introduction of the track system. Results: By changing the general conditions of the hospital, it was possible to reduce the number of coercive measures in the affected cases. The proportion of cases affected by coercion also tended to decrease, with women in particular appearing to benefit from introduction of the track system. Conclusion: Structural changes in psychiatric hospitals can have a significant impact on one of the important quality parameters of psychiatric treatment, namely coercive measures. (C) 2021 Asociacion Universitaria de Zaragoza para el Progreso de la Psiquiatria y la Salud Mental. Published by Elsevier Espana, S.L.U. All rights reserved.

ZusammenfassungWir berichten hier über einen besonderen Fall eines Suizids, der sich im zeitlich sehr nahen Anschluss an die Ausstrahlung einer Tatortfolge ereignete und die dort gezeigte Tötungsmethode direkt kopierte. Es wird kritisch das Problem von derartigen Darstellungen auch unabhängig von den üblichen Regeln des Pressekodex diskutiert.

OBJECTIVE:This nationwide full census survey investigated the documentation status regarding involuntary admissions and coercive measures in psychiatric hospitals in Germany.METHODS:As part of the ZIPHER study, a questionnaire survey on the documentation, application and reduction of coercion was conducted (N = 147, response rate = 34.4 %).RESULTS:The majority of participating hospitals reported a comprehensive documentation of the use of coercion. However, substantial regional differences could be found in this regard as well as for the use of guidelines. The involuntary admission quote was M = 13.4 % (± 10.9). Of those, 33.9 % (± 22.2) were affected by mechanical restraint, 8.9 % (± 17.2) by seclusion, and 11.8 % (± 18.0) by compulsory medication.CONCLUSION:The regional differences plead for a unification of legal bases and applied practice as well as for a merge of respective data on a nationwide level of the relevant stakeholders.

Zusammenfassung Ziel der Studie Die vorliegende Studie untersuchte mit einer angestrebten Vollerhebung den Dokumentationsstatus bezüglich Unterbringungen und Zwangsmaßnahmen in psychiatrischen Kliniken in Deutschland. Methodik Im Rahmen der ZIPHER-Studie wurde eine Fragebogenerhebung hinsichtlich der Dokumentation, Anwendung und Bemühungen zur Reduktion von Zwang durchgeführt (N = 147, Rücklaufquote = 34,4 %). Ergebnisse Die teilnehmenden Kliniken berichteten überwiegend von einer umfassenden Dokumentation von Zwangsmaßnahmen, jedoch zeigten sich sowohl diesbezüglich als auch für den Einsatz von Leitlinien erhebliche regionale Unterschiede. Die Unterbringungsquote lag bei M = 13,4 % (± 10,9). Von diesen waren 33,9 % (± 22,2) von Fixierung betroffen, 8,9 % (± 17,2) von Isolierung und 11,8 % (± 18,0) von Zwangsmedikation. Schlussfolgerung Die regionalen Unterschiede rufen zu einer Vereinheitlichung der rechtlichen Grundlagen und praktischen Anwendung sowie einer flächendeckenden Zusammenführung der entsprechenden Daten auf.

ZUSAMMENFASSUNGBeim Liebeswahn handelt es sich um ein besonderes Phänomen unter den psychiatrischen Symptombildungen. Historisch zunächst als eigene Entität beschrieben, ist dies heutzutage nicht mehr zu halten. Liebeswahn kann in verschiedensten Kontexten auftreten und – nimmt man die Definition genau – sich sogar im Alltag wie im Verliebtsein manifestieren. In den letzten Jahrzehnten steht in diesem Zusammenhang immer mehr das Phänomen des Stalkings im Mittelpunkt. Es wird ein Überblick über die Entwicklung dieser Begrifflichkeit sowie die Übergänge zum Normalen gegeben.

EEG studies have shown that adult ADHD patients have less stable brain arousal regulation than age and gender matched controls. Psychostimulants have brain arousal stabilising properties evident in EEG patterns. The aim of this study was to investigate whether the stability of brain arousal regulation has prognostic value in predicting response to methylphenidate therapy in adult ADHD patients. In an open-label, single-arm, multi-centre, confirmatory trial, 121 adult ADHD patients were recruited and 112 qualified for the full analysis set. All participants received an initial dose of 20 mg extended release methylphenidate at baseline. After a titration phase of up to 4 weeks, patients remained on a weight-based target dose of extended release methylphenidate for 4 weeks. Using the Vigilance Algorithm Leipzig (VIGALL 2.1), we assessed brain arousal regulation before the treatment with methylphenidate, based on a 15-min EEG at quiet rest recorded at baseline. Using automatic stage-classification of 1 s segments, we computed the mean EEG-vigilance (indexing arousal level) and an arousal stability score (indexing arousal regulation). The primary endpoint was the association between successful therapy, defined by a 30% reduction in CAARS, and stable/unstable brain arousal. 52 patients (46%) showed an unstable brain arousal regulation of which 23% had therapy success. In the stable group, 35% had therapy success, implying an absolute difference of 12 percentage points (95% CI -5 to 29, p = 0.17) in the direction opposite to the hypothesized one. There were no new findings regarding the tolerability and safety of extended release methylphenidate therapy. (c) 2020 Elsevier B.V. and ECNP. All rights reserved.

Zusammenfassung Ziel Erfassung von Erfahrungen und Einschätzungen leitender PsychiaterInnen zu Veränderungen in der psychiatrischen Unterbringungspraxis während der COVID-19-Pandemie. Methodik Onlineumfrage unter den Mitgliedern des Landesverbands leitender ÄrztInnen für Psychiatrie und Psychotherapie in Nordrhein-Westfalen (LLPP) sowie Analyse von LLPP-Vorstandsprotokollen. Ergebnisse Sowohl in Situationen mit als auch ohne unmittelbaren COVID-19-Bezug wurden Veränderungen in der psychiatrischen Unterbringungspraxis wahrgenommen, u. a. bei richterlichen Anhörungen sowie Entscheidungen über Zwangsmaßnahmen. Schlussfolgerung Die prozeduralen Standards in Unterbringungsverfahren müssen aufrechterhalten werden. Zwangsmaßnahmen dürfen nur angewendet werden, wenn sie die geltenden ethischen und rechtlichen Voraussetzungen erfüllen. Bei Einführung und Rücknahme von restriktiven Maßnahmen zur Pandemiebekämpfung muss eine unberechtigte Ungleichbehandlung von Menschen mit einer psychischen Erkrankung vermieden werden.

OBJECTIVE: To collect experiences and opinions of chief psychiatrists in relation to changes in the practice of involuntary hospitalization during the COVID-19 pandemic. METHODS: Online survey among members of the Association of Chief Physicians for Psychiatry and Psychotherapy in North Rhine-Westphalia (LLPP) and analysis of protocols of LLPP board meetings. RESULTS: Changes in the practice of involuntary hospitalization have been perceived in contexts with and without direct reference to COVID-19. These changes have affected, among other things, judicial hearings as well as decisions about the use of coercive measures. CONCLUSION: Procedural standards for involuntary hospitalization must be maintained and coercive measures may only be used if they meet the applicable ethical and legal requirements. It must be ensured that people with mental disorders are not treated unequally both when taking and withdrawing restrictive measures to contain the pandemic.

OBJECTIVE:To collect experiences and opinions of chief psychiatrists in relation to changes in the practice of involuntary hospitalization during the COVID-19 pandemic. METHODS:Online survey among members of the Association of Chief Physicians for Psychiatry and Psychotherapy in North Rhine-Westphalia (LLPP) and analysis of protocols of LLPP board meetings. RESULTS:Changes in the practice of involuntary hospitalization have been perceived in contexts with and without direct reference to COVID-19. These changes have affected, among other things, judicial hearings as well as decisions about the use of coercive measures. CONCLUSION:Procedural standards for involuntary hospitalization must be maintained and coercive measures may only be used if they meet the applicable ethical and legal requirements. It must be ensured that people with mental disorders are not treated unequally both when taking and withdrawing restrictive measures to contain the pandemic.

Abstract Background and Aims People with mental illness have worse physical health and reduced life expectancy compared to the general population. Nevertheless, their medical care is often insufficient. The present study aimed to investigate the somatic status of people with mental illness with a focus on somatic diagnoses, metabolic risk factors, regular somatic care, and routine check‐ups. Methods This study used a 14‐item questionnaire to survey the somatic care situation of psychiatric university hospital patients. Main survey topics were psychiatric and somatic diagnoses, metabolic risk factors, regular somatic care, and routine check‐ups. Results Four‐hundred and thirty‐five people with mental illness (48.3% male, mean age 45.4 years) were included. More than three quarters of the participating people with mental illness had access to a general practitioner. People with affective and anxiety disorders reported significantly more contact with medical specialists for somatic diseases, but schizophrenic patients did not receive enough care. Not all people with mental illness and on psychiatric medication received regular somatic care. Somatic diseases increased with number of diagnoses, and the duration of the psychiatric illness was positively correlated with treatment motivation. Conclusion The observed unmet medical needs in this study might reflect the lack of treatment motivation in people with mental illness, but could also represent their obstacles to access care as well as a suboptimal communication between the treating psychiatrist and the referring general practitioner. Increasing awareness of somatic diseases in psychiatric patients and easier access to somatic care have to be implemented in psychiatric clinical routine. The risk of stigmatization in somatic institutions and the lack of self‐care management in people with mental illness are complicating factors.

Theory/calculation: Movement disorders such as disturbances of coordination, clumsiness, and hand-related stereotypies are a frequent phenomenon in individuals with intellectual disabilities (ID). Obsessive-compulsive symptoms are also common in persons with ID. Our aim was to investigate hand motor dysfunction in persons with ID with and without OCD, using a digitizing tablet and the kinematic analysis of handwriting and drawing movements. Methods: We examinedthe hand motor performance of 23 individuals (12 males, 11 females, 42.6 ± 13.7 years old) with ID of heterogeneous aetiology. All subjects were required to write a sentence and draw circles under various conditions. Kinematic parameters were calculated to quantify hand motion. Results: Individuals with ID exhibit serious hand motor impairments suggestive of bradykinesia, irregularity, and micrographia. More than half of our ID patients (60.9%) displayed obsessive-compulsive symptoms of moderate severity (Y-BOCS total score: 16.6 ± 8.3). Interestingly, the ID patients with OCD displayed smaller amplitudes of hand motor movements than did patients with no obsessive-compulsive symptoms, while differences observed in the writing and drawing concentric circles trials were significant. Conclusions: The results of this pilot study support the use of kinematic analyses of handwriting movements to evaluate motor abnormalities in patients with ID and comorbid mental illnesses.

Background: Patients with severe mental illness (SMI) have worse physical health and reduced life expectancy compared to the general population. Individuals with mental disorders also more often suffer from influenceable risk factors such as obesity, smoking, diabetes, arterial hypertension and dyslipidaemia. Moreover, they have more difficulties to access health services and fewer opportunity for cardiovascular risk screening and prevention than would be expected in a non-psychiatric population. Therefore, we aimed to investigate the somatic care situation of psychiatric patients. Methods: This study used a 14-item-questionnaire to survey the physical status of hospital patients with SMI. Main subjects were psychiatric and somatic diagnoses, metabolic risk factors, regular somatic care (by general practitioners and specialists), and routine check-ups. Data collection underwent pseudonymisation and descriptive analysis. Outcome: 350 patients (49.1% male, mean age 46,31 ±16,02 years) were included. More than three quarters had access to a general practitioner (78.2%), whom most of the patients reported to see quite regularly. Patients with affective and anxiety disorders reported significantly more contact with medical specialists for somatic diseases, compared to other diagnostic subgroups. Nearly all of the patients received psychiatric medication, but some had never before a blood sample taken or received an ecq. Interpretation: Although the access to a general practitioner is quite high, it can be concluded, that the interaction of patient, provider, and system factors has created a situation in which access to and quality of health care is problematic for individuals with especially a SMI. Funding: None. Declaration of Interest: The authors declare that they have no conflict of interest. Ethical Approval: The analysis has been performed in accordance with the Declaration of Helsinki. The Ruhr-University Bochum ethics committee approved the analysis, and written informed consent was obtained from the patient.

Coercive measures are a sensitive, much-discussed ethical and legal issue in the psychiatric context. Hence, the identification of their predictors and ways of prevention are of utmost importance. The present study aimed to determine the impact of the social-psychiatric services (SPS) in North Rhine Westphalia (NRW) on involuntary admissions according to the German Mental Health Act and to identify predictors for the reduction of these involuntary admissions. A dataset including details from 31 districts and 23 towns in NRW over a time period of 10 years (2005-2014) was analysed regarding the number of involuntary admissions, gender and age of admitted patients, and person/institution initiating the compulsory act. All 56 SPS in NRW were contacted for information on the number of clients/contacts, home visits, areas of responsibility and their involvement in involuntary admissions. Thirty SPS participated in the survey. We found a significant increase of involuntary admissions over time with significantly higher proportions of male patients and patients younger than 60 years in every year. Regarding the characteristics of SPS, a negative correlation between the number of clients contacting the SPS on their own initiative and low-income households was observed. Additionally, the number of clients contacting the SPS on their own initiative was significantly higher in districts/towns associated with lower involuntary admission rates. These data suggest that patient-based factors were of great importance in the context of involuntary admissions. Furthermore, the SPS and home treatment should be strengthened and intensified to achieve lower involuntary admission rates.