Co-Planar Stereotaxic Atlas of the Human Brain—3-Dimensional Proportional System: An Approach to Cerebral Imaging, J. Talairach, P. Tournoux. Georg Thieme Verlag, New York (1988), 122 pp., 130 figs. DM 268

中枢神経系疾患の治療は正常細胞（ニューロン）の機能維持を目的とするが，脳血管障害のように機能障害の原因が細胞の死滅に基づくことは多い．一方，脳腫瘍の治療においては薬物療法や放射線療法といった腫瘍細胞の死滅を目標とするものが大きな位置を占める．いずれの場合にも，細胞死の機序を理解することは各種病態や治療法の理解のうえで重要である．現在のところ最も研究の進んでいる細胞死の型はアポトーシスである．そのなかで重要な位置を占めるミトコンドリアにおける反応および抗アポトーシス因子について概要を紹介する．

Neuroscience 細胞死：最近の知見

The dopamine hypothesis of schizophrenia has been one of the most enduring ideas in psychiatry. Initially, the emphasis was on a role of hyperdopaminergia in the etiology of schizophrenia (version I), but it was subsequently reconceptualized to specify subcortical hyperdopaminergia with prefrontal hypodopaminergia (version II). However, these hypotheses focused too narrowly on dopamine itself, conflated psychosis and schizophrenia, and predated advances in the genetics, molecular biology, and imaging research in schizophrenia. Since version II, there have been over 6700 articles about dopamine and schizophrenia. We selectively review these data to provide an overview of the 5 critical streams of new evidence: neurochemical imaging studies, genetic evidence, findings on environmental risk factors, research into the extended phenotype, and animal studies. We synthesize this evidence into a new dopamine hypothesis of schizophrenia-version III: the final common pathway. This hypothesis seeks to be comprehensive in providing a framework that links risk factors, including pregnancy and obstetric complications, stress and trauma, drug use, and genes, to increased presynaptic striatal dopaminergic function. It explains how a complex array of pathological, positron emission tomography, magnetic resonance imaging, and other findings, such as frontotemporal structural and functional abnormalities and cognitive impairments, may converge neurochemically to cause psychosis through aberrant salience and lead to a diagnosis of schizophrenia. The hypothesis has one major implication for treatment approaches. Current treatments are acting downstream of the critical neurotransmitter abnormality. Future drug development and research into etiopathogenesis should focus on identifying and manipulating the upstream factors that converge on the dopaminergic funnel point.

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The Dopamine Hypothesis of Schizophrenia: Version III—The Final Common Pathway

Purpose of reviewThe aim of this article is to review recent epidemiological research on age-of-onset of mental disorders, focusing on the WHO World Mental Health surveys.Recent findingsMedian and inter-quartile range (IQR; 25th–75th percentiles) of age-of-onset is much earlier for phobias (7–14, IQ

/pdf/age-of-onset-of-mental-disorders-a-review-of-recent-3d9br06478.pdf

Age of onset of mental disorders: a review of recent literature

A rating scale for drug-induced akathisia has been derived that incorporates diagnostic criteria for pseudoakathisia, and mild, moderate, and severe akathisia. It comprises items for rating the observable, restless movements which characterise the condition, the subjective awareness of restlessness, and any distress associated with the akathisia. In addition, there is an item for rating global severity. A standard examination procedure is recommended. The inter-rater reliability for the scale items (Cohen's kappa) ranged from 0.738 to 0.955. Akathisia was found in eight of 42 schizophrenic in-patients, and nine had pseudoakathisia, where the typical sense of inner restlessness was not reported.

A rating scale for drug-induced akathisia

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.

[Documentation, Application and Efforts to Reduce Involuntary Admissions and Coercive Measures - Results from a Nationwide Study on Acute Psychiatric Hospitals in Germany].

Gegenstand und Ziel: Aufgrund der Schnittstellenproblematik in unserem sektorisierten Versorgungssystem gelangen viele Patienten mit einer ernsthaften psychiatrischen Erkrankung wie einer Depression zu spat zu einem adaquaten Behandler, sodass oft nur die stationare Notfallaufnahme ubrig bleibt. Integrierte Versorgungsvertrage sollen das verhindern durch besser verzahnte ambulante-teilstationare Angebote, aber auch post-stationar die Patienten sicher in das ambulante Setting ubernehmen. Ziel dieser naturalistischen Studie war es, klinische und okonomische Effekte einer Integrierten Versorgung (IV) von depressiven Patienten zu erfassen und zu bewerten. Material und Methoden: Es wurde ein Pra-post-Vergleich von 125 Patienten hinsichtlich Depressivitat und anderer klinischer Parameter, Krankenhaus-, AU-Zeiten sowie geschatzten Therapiekosten im Zeitraum von 2009 bis 2011 im Rahmen eines IV-Vertrages mit der Techniker Krankenkasse NRW durchgefuhrt. Ergebnisse: Es wurde eine Abnahme der Depressivitat und weiterer klinischer Parameter sowie eine tendenzielle Reduktion stationarer Kosten, aber eine Steigerung von AU-Zeiten, insbesondere bei mannlichen Patienten unter IV gefunden. Schlussfolgerungen: Da eine Kontrollgruppe fehlte, konnen die Veranderungen nicht eindeutig auf das Behandlungsregime in der IV zuruckgefuhrt werden. Weitere Studien sollten Patienten mit leichten Depressionen nicht mit einschliesen. Die antidepressive Behandlung berufstatiger, insbesondere mannlicher Patienten, sollte noch weitere fruhrehabilitative Aspekte integrieren. Klinische Relevanz: Diese ersten vorlaufigen Daten unterstutzen die Einschatzung, dass IV-Vertrage die Versorgung psychiatrischer, hier depressiver, Patienten verbessern.

Integrierte Versorgung von Patienten mit Depression

Kreativität und psychische Störung: Creativity and mental disorder

Oxytocin bei Schizophrenie: Evidenz für eine ätiologische und therapeutische Relevanz des sozialen Neuromodulators

Paranormal experiences such as superstition, perception of the supernatural and magical thinking have accompanied human history into the so-called modern world and play a major role in developmental psychology. Yet this area has remained unclear in its terminology, in its phenomenal scope, but also in its relation to reality in literature and everyday practice. The attempt is here undertaken clarify the significance of paranormal experience on a theoretical level in the sense of a "unsure experience of reality", but also to present its importance for diagnostics and therapy of psychiatric conditions in the context of e. g., psychotic, dissociative or OCD-related symptomatology.

Georg Juckel

Papers

[Documentation, Application and Efforts to Reduce Involuntary Admissions and Coercive Measures - Results from a Nationwide Study on Acute Psychiatric Hospitals in Germany].

Integrierte Versorgung von Patienten mit Depression

Kreativität und psychische Störung: Creativity and mental disorder

Oxytocin bei Schizophrenie: Evidenz für eine ätiologische und therapeutische Relevanz des sozialen Neuromodulators

[Paranormal Experience and Mental Disorders].