Obstructive sleep apnea (OSA) and clinical depression-prevalence in a sleep center.

BACKGROUND: This study aimed to determine the prevalence of clinical depression as defined by ICD-10 criteria in all patients with obstructive sleep apnea (OSA) referred to a sleep center. METHODS: Prospective general and sleep evaluations were conducted in 447 consecutive patients referred to our sleep center during the first quarter of 2008. Inclusion criteria were Apnea Hypopnea Index (AHI) > 9, completion of the Beck Depression Inventory (BDI-II) with a score ≥14 and World Health Organization WHO-5 Well-Being Index (WHO-5) ≤ 13. The subsequent psychiatric examination according to ICD-10 criteria was performed by in-house clinical sleep specialists. RESULTS: A total of 447 patients were surveyed, of whom 322 had an AHI > 9. Out of these, 85 met the combined screening criterion BDI II ≥ 14 and WHO-5 ≤ 13. Eighty-one patients underwent a psychiatric examination by psychiatric sleep specialists. In 21.5 % of the sample, clinical depression was diagnosed. Other complaints existed in 12 % (n = 10); 7 % (n = 6) of patients had a different psychiatric diagnosis. CONCLUSIONS: The prevalence of clinical depression according to ICD-10 criteria in a selected clinical sample (referred to the sleep center) was 21.5 %. Mood scales tend to overestimate complaints as compared to psychiatric consultation. Interdisciplinary cooperation is recommended for both OSA patients with symptoms of depression and depressed patients with treatment resistance.

[Waiting for Asylum: Psychiatric Diagnosis in Bavarian Admission Center]. / Warten auf Asyl: Psychiatrische Diagnosen in der zentralen Aufnahmeeinrichtung in Bayern.

INTRODUCTION: In 2014, 15% of about 140,000 asylum seekers were distributed to Bavaria. The Bavarian State Ministry of Labour and Social Affairs, Family and Integration promoted a project under which, first, the frequency and nature of psychiatric diagnoses among asylum seekers in the ZAE Zirndorf should be examined and, secondly, recommendations on psychiatric-psychological care of asylum seekers should be carried out. METHODS: A total 283 asylum seekers were examined. The sample was composed of 2 sample groups: self-referrals and a randomized group. A structured diagnostic interview and several self- and external assessment scales were used (MINI, BSI, MADRS, WHO-5, ETI, PSQI). RESULTS: In 180 (63,6%) asylum seekers, one or more psychiatric diagnoses were made. The most common diagnosis was posttraumatic stress disorder (F43,1) followed by depressive, recurrent depressive episodes (F32, F33), adjustment disorder (F43,2) and chronic insomnia (51,0 F). Suicidal thoughts were explored in 26% of self-referrals and only in 6% in the random sample. CONCLUSION: We recommend a low-threshold psychiatric emergency care for asylum seekers in the central refugee reception facility. This should not be done on voluntary basis, but must be regulated by law. For comprehensive care by national healthcare physicians, the social welfare law on asylum seekers (1993) must be revised.

The role of alcohol use disorder and alcohol consumption in suicide attempts--a secondary analysis of 1921 suicide attempts.

BACKGROUND: It is not known how characteristics of suicide attempts vary with different forms of alcohol involvement. The aim of this study is to clarify the role of alcohol use disorder and acute alcohol consumption in suicide attempts. METHODS: Data on 1921 suicide attempts was gathered in a major German city over a 5-year period. Suicide attempts were categorised according to a diagnosis of alcohol use disorder and acute alcohol consumption at the time of the attempt. Group comparisons and multinomial logistic regression were used for statistical analysis. RESULTS: In 331 suicide attempts (17%) an alcohol use disorder was diagnosed. Six hundred and twenty-two suicide attempts (32%) were committed with acute alcohol consumption. Suicide attempts by individuals with alcohol use disorder were more often committed by men, older individuals and as a recurrent attempt, independently of alcohol consumption at the time of the attempt. When alcohol was consumed in suicide attempts by individuals with alcohol use disorder, low-risk methods were used most often. CONCLUSIONS: Individuals with a diagnosis of alcohol use disorder are a high-risk group for multiple suicide attempts and should be a target group for suicide prevention. Screening for suicidality should be a regular part of the clinical assessment in individuals with alcohol use disorder.

[Comparison of patient therapy adherence of two structural different memory clinics]. / Vergleich der Therapietreue von zwei regional benachbarten Gedächtnissprechstunden mit unterschiedlicher Struktur.

There are more than 100 memory clinics established in Germany, Austria and German-speaking Switzerland. We compared the impact of the structure of two German memory clinics (Erlangen and Nuremberg) on therapeutic outcome. 483 patients suffering from dementia with indication for antidementive therapy were included in this study. The data ascertainment included patient-related data, the mini mental score, comorbidity as well as psychiatric drug therapy. After a mean follow-up of 3.7 years, we performed a single cross-sectional survey covering over 90 % of patients to assess clinical course and adherence to therapy. The patients of the Erlangen University Memory Clinic were significantly younger (69.8 +/- 9.49 vs. 74.6 +/- 10.7 years; p = 0.01) and had a better mini mental score at their first presentation (20.9 +/- 9.4 vs. 19.5 +/- 5.9; p = 0.02). They showed a non-significantly faster disease progression (as measured by mini mental decline per year), than the patients from Nuremberg. Concerning the allocation of diagnosis, more late onset-dementias and dementias of a mixed type were treated at the Nuremberg clinic. At the university clinic, more dementias were of unclassified origin. Concomitant drug therapies, death rates and therapy adherence (53 %) were not different between the two clinics. The two memory clinics under investigation differed in patient age, disease severity and diagnostic assessment. Still, parameters of therapeutic outcome showed converging results.

[Changes in the frequency of suicidal behaviour after a 2-year intervention campaign]. / Veränderung der Häufigkeit suizidaler Handlungen nach zwei Jahren "Bündnis gegen Depression".

BACKGROUND: Insufficient treatment of depression is one of the most important causes of suicide. The Nuremberg Alliance against Depression (funded by the German Ministry of Education and Research) tried to improve the quality of care for patients suffering from depression. This multilevel programme focussed on close cooperation with general practitioners, a public relation campaign about depression, involvement of other professional groups, and reinforcement of self-help activities. METHODS: The project was realised in the city of Nuremberg, Germany in 2001-2002. Changes in the frequency of suicidal acts (successful and attempted suicides) compared to a baseline (2000) and a control region (Wuerzburg, Germany) were prospectively defined as the main outcome criterion. RESULTS: The frequency of suicidal acts decreased significantly (-21.7%) compared to the control region. This reduction was mainly due to a lower rate of suicide attempts. CONCLUSIONS: Many other regions in Germany and Europe followed the Nuremberg model project and have initiated regional alliances against depression.

[Psychosomatic diseases of the eye--a review]. / Psychosomatische Erkrankungen des Auges. Eine Ubersicht.

After remarks on the uncritical use of the term "hysteria" in some investigations on psychosomatic phenomena in ophthalmology some recent reviews are presented, followed by the results of psychosomatic research on specific ophthalmological diseases. Dealing with glaucoma controlled studies are emphasized which attempt to determine the structure of neuroses and the importance of environmental situations. Using the MMPI high values on the scales 'depression', 'hypochondria' and 'hysteria' were observed. In previous attempts to influence glaucoma psychotherapeutically mainly autosuggestive and hypnotizing methods have been applied. The number of reported cases of psychogenic blindness has decreased considerably. We discuss, that it may not only be caused by the mechanism of hysterical conversion but also by a tendency to regression in schizoid neurotic structure. Concerning asthenopia and amblyopia the dependence of vision and visual acuity of the level of vegetative innervation is being accentuated; there appear to be correlations between certain errors of refraction and certain personality patterns. Psychiatric diseases may also influence vision: observations in paranoid and affective psychoses of later life and in schizophrenic children confirm it. This leads to the question, if schizoid neurotic structure can also be characterized by a specific disturbance in affective relations to sensations. Examples are given for investigations on other diseases (ablantio retinae, retinopathia centrales serosa), on the problem of self mutilation (auto-enuclation) and on neurophysiological question (psychogenic influences on pupil size).