Alzheimer's disease: history, ethics and medical humanities in the context of assisted suicide.

INTRODUCTION: Dementia diseases, especially Alzheimer's disease (AD), are of considerable importance in terms of social policy and health economics. Moreover, against the background of the current Karlsruhe judgement on the legalisation of assisted suicide, there are also questions to be asked about medical humanities in AD. METHODOLOGY: Relevant literature on complementary forms of therapy and prognosis was included and discussed. RESULTS: Creative sociotherapeutic approaches (art, music, dance) and validating psychotherapeutic approaches show promise for suitability and efficiency in the treatment of dementia, but in some cases still need to be scientifically tested. Biomarker-based early diagnosis of dementia diseases is increasingly becoming a subject of debate against the background of the Karlsruhe ruling. DISCUSSION: Needs-oriented and resource-enhancing approaches can make a significant contribution to improving the quality of life of people with dementia. The discussion on the issue of "assisted suicide" should include questions of the dignity and value of a life with dementia. OUTLOOK: The integrative dementia therapy model can be complemented by a religion- and spirituality-based approach. Appropriate forms of psychotherapy should be scientifically evaluated.

[The "popular saint" Therese of Konnersreuth and her stigmata : An historical example for the interaction of psyche and religiosity]. / Die "Volksheilige" Therese Neumann von Konnersreuth und ihre Stigmata : Ein historisches Beispiel zur Wechselwirkung von Psyche und Religiosität.

BACKGROUND: In present times, we see ourselves confronted by the challenge of engaging increasingly diverse views of the world, god and healing in a constructive dialogue. Consequently, it is important to research into the contrary effects of religiosity on the human psyche. METHODS: Original- and literary medical historian research RESULTS: Gottfried Ewald (1888-1963), a psychiatric expert at the Friedrich-Alexander University of Erlangen, was appointed 90 years ago with the task of examining Therese Neumann (1898-1962), colloquially known as Resl of Konnersreuth. In 1927, Ewald retrospectively confirmed the diagnosis of "most severe hysteria with blindness and partial paralysis". Within the context of regular pastoral care, Resl's "hysterical blindness" disappeared on 24.06.1923. This remission might be ascribed to a positive effect of religiosity on mental health. Besides the beneficial effects of religiosity on healing, pathogenic phenomena of religion can also be seen in the case of Resl. During Lent in 1926, Resl experienced ecstatic states as well as blood-stained tears. On Good Friday in 1926, bleeding of the scalp occurred; since Holy Saturday 1927, she experienced stigmata on her hands and the soles of her feet. Ewald assessed the latter as probably being genuine, although he spoke in favor of a clinical observation in hospital to obtain scientifically substantiated findings. DISCUSSION: The story of Resl of Konnersreuth shows the contrary influences of religiosity on mental health in one and the same individual. CONCLUSION: Detailed psychiatric historical and ethical research on the interaction of the psyche and religiosity can provide information about mechanisms that channel the psychic power of religiosity to promote remission. It is further important to take a religious and spiritual history of the patients.

[Psychotherapy and Religion: A Representative Survey Among Psychotherapists in Southern Germany]. / Psychotherapie und Religion: Eine repräsentative Umfrage unter Psychotherapeuten in Süddeutschland.

Objective: Religion and spirituality play an appreciable role as a problem area or as a resource for patients with mental disorders. It is therefore of interest what attitudes psychotherapists assume towards this complex range of issues in their work, but also in their personal lives. The majority of empirical studies on this subject originate from the USA, with little data being available from Europe and Germany. Our own survey among practising psychotherapists was designed to elucidate these questions. Method and Study Population: A cross-sectional study was conducted in the form of a written survey of all accessible practising psychotherapists in the area of Northern Bavaria (Franconian administrative districts; n=1 081, return rate 65%). Results: Around two-thirds of the therapists consider religion to be an important subject in psychotherapy, but only one-fifth of them routinely take a history of the patients' religious beliefs. The therapists' own closeness to religion correlates positively with the tendency to incorporate religion in their therapy. In around one-third of the therapists, religion holds an important place within their own world view, although significantly fewer psychotherapists than the general population of Franconia are bound to a specific confession. Around one-quarter had at least once consulted a pastor due to a patient, while each seventh therapist had at least once actively mediated contact to a pastor. Conclusions: Religion is a subject that is relevant for therapeutic practice, but a history of religious beliefs is rarely taken on a routine basis. The incorporation of religion into psychotherapy correlates with religious characteristics of the therapists ("personal bias"). There appears to be a "religiosity gap" between psychotherapists and the general population. Advanced training on the subject of "religion/spirituality" and increased consideration in supervision may counteract the danger of religious needs and religion-related resources of patients being neglected.

Changes of cytokine profiles during electroconvulsive therapy in patients with major depression.

OBJECTIVES: Electroconvulsive therapy (ECT) is an effective treatment of depression, but its mechanism of action still remains unknown. Some studies emphasize that epileptic seizures result in cerebral production of cytokines, including the cytokine network in association with the pathophysiology of depression. We hypothesized that depressed patients would show a dysregulated profile of peripheral cytokines before and after ECT treatment. METHODS: Fifteen hospitalized subjects with major depressive disorder were recruited. Human cytokine array IV was used to determine the profile of cytokines in the serum during the course of ECT. Positive results of the cytokine assay were verified by reverse transcriptase-polymerase chain reaction. Depressive symptoms were evaluated before and after ECT series. RESULTS: The signal intensity of eotaxin-3 and interleukin (IL)-5 changed statistically significantly between the first ECT and 24 hours after the last ECT. Furthermore, there were significant correlations between the signal intensities of eotaxin-3, bone morphogenetic protein 6, IL-5, and transforming growth factor-ß and the severity of depression. The results of Cytoray assays were confirmed partly by reverse transcriptase-polymerase chain reaction. The changes of tumor necrosis factor ß in pre-post comparison of ECT and the correlation of the Montgomery-Asberg Depression Scale score with tumor necrosis factor ß, IL-5, and bone morphogenetic protein 6 expression could be verified. Only the relative signal intensity of IL-16 correlated significantly with the clinically as well as electroencephalographically measurable seizure duration. CONCLUSION: Electroconvulsive therapy treatment seems to change the expression of various cytokines in relation to changes of affective states such as mood. Therefore, cytokines might play a specific role within the treatment and pathogenesis of affective disorders.

To sweat or not to sweat? A hypothesis on the effects of venlafaxine and SSRIs.

The hypothesis put forward here attempts to explain how the efficacy of venlafaxine against climacteric symptoms, including sweating, can be reconciled with the fact that this medication is known to cause sweating as an adverse side-effect. Peripherally, the sweating function is regulated noradrenergically by the sympathetic nervous system, central noradrenergic signal transmission being subject partly to inhibitory, partly to excitatory influences by serotonin (5-HT). Theoretically, sweating can be both initiated and inhibited by the activity of selective 5-HT reuptake inhibitors (SSRIs), so that the noradrenergic "tone" resulting from the interaction of noradrenergic and serotonergic neurons in the various regions of the brain probably determines the degree of sweating. Venlafaxine can counteract sweating at low doses as a result of its serotonergic effect, while it can increase sweating at higher doses with an increasing noradrenergic active component. At daily doses of up to 75 mg venlafaxine, sweating is largely avoided as a concomitant effect.

Effects of night shifts in bipolar disorders and extreme morningness.

BACKGROUND: Night work and shift work scenarios are increasing in modern society. Instability in the sleep-wake rhythm is an important risk factor for triggering episodes of bipolar disorder. Extreme chronotype has negative effects on shift work ("shift-worker syndrome"). Effects of night or shift work on patients with bipolar disorder and extreme chronotype are not well understood. CASE REPORT: A patient with bipolar II disorder and extreme morning type followed a stable work schedule for a significant period of time, maintaining a stable mood. After changing to a night-shift schedule, depressive symptoms developed. When the night-shift schedule was stopped, her mental state normalised. CONCLUSIONS: This case highlights the possibility of a sensitizing role of chronotype in triggering episodes of bipolar disorder after the sleep-wake rhythm has been disrupted by night work or shift work. The evaluation of a person's capability to perform night work or shift work should take into account psychiatric disorders and chronotype as well as physical conditions.